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Luderer V, Jung F, Brandenstein M, Stroszczynski C, Jung EM. First assessment of flow phenomena of acute and chronic thrombosis in the jugular veins using new ultrasound vector-flow imaging. Clin Hemorheol Microcirc 2024; 86:133-142. [PMID: 37742633 DOI: 10.3233/ch-238117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
AIM First assessment of flow changes in the jugular veins using high resolution ultrasound vector flow. MATERIAL UND METHODS 15 patients (8 males, 7 females) with an age range of 35 to 82 years (mean age 58.53±12.26 years) were examined by an experienced examiner using high power ultrasound equipment (Resona R9, Mindray) with probe technology (Mindray L9-3U Linear Array transducer, 2.5 to 9.0 MHz). This group was compared with five healthy subjects (mean age 35.4±13.79 years) as a reference. To assess flow changes, the color-coded duplex sonography and the novel vector flow technique were used. The evaluation was performed of vector morphology changes, turbulence, and wall resistance measurements. RESULTS There were changes after acute and chronic thrombosis in 9 cases, and venous compression in 7 cases. Turbulence was measurable from 0.01 % to 64.44 %, the average turbulence was 19.73±22.06 %. Wall resistance measurement showed values from 0.01 Pa to 3.14 Pa, depending on the age of the thrombosis or compression. The reference veins showed turbulence of 0.94±1.5 % and a mean wall resistance of 0.05±0.05 Pa. There are statistically significant differences between normal and thrombotic or compressed veins in terms of maximum wall stress (p = 0.006) and mean degree of turbulence (p = 0.012), while the difference in mean wall stress is not statistically significant (p = 0.058). CONCLUSION Despite still existing technical limitations, the combination of V-flow and wall stress measurements in jugular vein changes suggests a high diagnostic potential.
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Affiliation(s)
- V Luderer
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - M Brandenstein
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - E M Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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2
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Huang YL, Tian XF, Qiu YJ, Lou WH, Jung EM, Dong Y, Wang HZ, Wang WP. Preoperative ultrasound radiomics for predicting clinically relevant postoperative pancreatic fistula after pancreatectomy. Clin Hemorheol Microcirc 2024; 86:313-326. [PMID: 37927251 DOI: 10.3233/ch-231955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To evaluate the efficacy of the radiomics model based on preoperative B-mode ultrasound (BMUS) and shear wave elastography (SWE) for predicting the occurrence of clinically relevant-postoperative pancreatic fistula (CR-POPF). METHODS Patients who were scheduled to undergo pancreatectomy were prospectively enrolled and received ultrasound assessment within one week before surgery. The risk factors of POPF (grades B and grades C) were analyzed. Preoperative BMUS images, SWE values of pancreatic lesions and surrounding parenchyma were used to build preoperative prediction radiomics models. Radiomic signatures were extracted and constructed using a minimal Redundancy Maximal Relevance (mRMR) algorithm and an L1 penalized logistic regression. A combined model was built using multivariate regression which incorporated radiomics signatures and clinical data. RESULTS From January 2020 to November 2021, a total of 147 patients (85 distal pancreatectomies and 62 pancreaticoduodenectomies) were enrolled. During the three-week follow-up after pancreatectomy, the incidence rates of grade B/C POPF were 28.6% (42/147). Radiomic signatures constructed from BMUS of pancreas parenchymal regions (panRS) achieved an area under the receiver operating characteristic curve (AUC) of 0.75, accuracy of 68.7%, sensitivity of 85.7 %, and specificity of 61.9 % in preoperative noninvasive prediction of CR-POPF. The AUC of the radiomics model increased to 0.81 when panRS was used for the prediction of CR-POPF after pancreaticoduodenectomy. CONCLUSIONS Radiomics model based on ultrasound images was potentially useful for predicting CR-POPF. Patients with high-risk factors should be closely monitored when postoperation.
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Affiliation(s)
- Yun-Lin Huang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Fan Tian
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Jie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Hui Lou
- Department of Pancreas Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han-Zhang Wang
- Precision Health Institute, GE Healthcare China, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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3
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Zadeh ES, Schreiber N, Görg C, Huber KP, Möller K, Berzigotti A, Thomsen T, Jenssen C, Jung EM, Lim A, Kitano M, Shimizu R, Dong Y, Cui XW, Srivastava D, Dietrich CF. Comments on and illustrations of the WFUMB CEUS liver guidelines: Rare malignant mesenchymal liver lesions. Med Ultrason 2023. [PMID: 38150699 DOI: 10.11152/mu-4302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The diagnosis or rare mesenchymal malignant lesions of the liver may be a challenge owing to the rarity of the disease and is usually made by histological confirmation. An ultrasound examination with, if required, color Doppler sonography and contrast-enhanced ultrasound, taking into account the clinical background of the patient, may help to focus the differential diagnosis. In this review, we describe the pathological and ultrasound features of several rare mesenchymal malignant liver lesions which include undifferentiated sarcoma of the liver, leiomyosarcoma, angiosarcoma, fibrosarcoma, liposarcoma, and epithelioid hemangioendothelioma.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna
| | - Nicole Schreiber
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg
| | | | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin
| | - Analisa Berzigotti
- Departmen of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern
| | - Thomas Thomsen
- Department of Internal Medicine, Westkuestenkliniken, Brunsbuettel
| | - Christian Jenssen
- 8Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg. Brandenburg Institute of Clinical Medicine at Medical University Brandenburg
| | | | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University
| | - Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - David Srivastava
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern.
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Kehrer A, Ruewe M, Klebuc M, Platz Batista da Silva N, Lonic D, Heidkrueger P, Knoedler S, Jung EM, Prantl L, Knoedler L. Objectifying the Role of the Depressor Anguli Oris Muscle Using High-Resolution Ultrasound: A Prospective Study. Plast Reconstr Surg 2023; 152:866-870. [PMID: 36780356 DOI: 10.1097/prs.0000000000010287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND In the setting of facial palsy, synkinesis of the depressor anguli oris (DAO) muscle is a common pathology, impairing dynamic and resting facial symmetry.In this prospective study, the authors used high-resolution ultrasound (HRUS) to evaluate the morphologic features of DAO and to quantify bilateral differences in DAO cross-sectional diameter (CSD) in individuals with unilateral synkinesis. METHODS From June of 2020 to May of 2021, 30 patients (19 women, 11 men) with clinically diagnosed unilateral synkinesis underwent evaluation with HRUS. DAO CSD was measured bilaterally, 1 cm inferior to the modiolus, in both the resting and smiling positions. RESULTS The Sunnybrook Facial Grading System Synkinesis Score was 6.20 ± 2.48 (range, 0 to 10). DAO CSD at rest measured 2.41 ± 0.67 mm (range, 1.40 to 4.00 mm) on the control side and 2.66 ± 0.98 mm (range, 1.60 to 5.10 mm) on the affected side. On the control side, DAO CSD was reduced by -0.19 ± 0.43 mm (range, -1.10 to 1.12 mm) during smiling. In contrast, the synkinetic DAO CSD increased by 0.64 ± 0.38 mm (range, 0.00 to 1.59 mm) ( P < 0.001) with animation. The pattern of increased CSD in synkinetic DAO muscles and decreased or unchanged CSD on the control side during smiling was identified in 70% of patients. CONCLUSIONS HRUS demonstrates increased CSD in synkinetic DAO muscles during active smiling. The opposite is true for DAO muscles on the control side, which exhibit decreased CSD with animation. HRUS can be performed preoperatively to objectify DAO dysfunction and guide targeted therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Affiliation(s)
- Andreas Kehrer
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Marc Ruewe
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | | | | | - Daniel Lonic
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Paul Heidkrueger
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Samuel Knoedler
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | | | - Lukas Prantl
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Leonard Knoedler
- From the Departments of Plastic, Hand, and Reconstructive Surgery
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Schauer MI, Jung EM, Platz Batista da Silva N, Akers M, Loch E, Markowiak T, Piler T, Larisch C, Neu R, Stroszczynski C, Hofmann HS, Ried M. Intraoperative Contrast-Enhanced Ultrasonography (Io-CEUS) in Minimally Invasive Thoracic Surgery for Characterization of Pulmonary Tumours: A Clinical Feasibility Study. Cancers (Basel) 2023; 15:3854. [PMID: 37568670 PMCID: PMC10417103 DOI: 10.3390/cancers15153854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The intraoperative detection of solitary pulmonary nodules (SPNs) continues to be a major challenge, especially in minimally invasive video-assisted thoracic surgery (VATS). The location, size, and intraoperative frozen section result of SPNs are decisive regarding the extent of lung resection. This feasibility study investigates the technical applicability of intraoperative contrast-enhanced ultrasonography (Io-CEUS) in minimally invasive thoracic surgery. METHODS In this prospective, monocentric clinical feasibility study, n = 30 patients who underwent Io-CEUS during elective minimally invasive lung resection for SPNs between October 2021 and February 2023. The primary endpoint was the technical feasibility of Io-CEUS during VATS. Secondary endpoints were defined as the detection and characterization of SPNs. RESULTS In all patients (female, n = 13; mean age, 63 ± 8.6 years) Io-CEUS could be performed without problems during VATS. All SPNs were detected by Io-CEUS (100%). SPNs had a mean size of 2.2 cm (0.5-4.5 cm) and a mean distance to the lung surface of 2.0 cm (0-6.4 cm). B-mode, colour-coded Doppler sonography, and contrast-enhanced ultrasound were used to characterize all tumours intraoperatively. Significant differences were found, especially in vascularization as well as in contrast agent behaviour, depending on the tumour entity. After successful lung resection, a pathologic examination confirmed the presence of lung carcinomas (n = 17), lung metastases (n = 10), and benign lung tumours (n = 3). CONCLUSIONS The technical feasibility of Io-CEUS was confirmed in VATS before resection regarding the detection of suspicious SPNs. In particular, the use of Doppler sonography and contrast agent kinetics revealed intraoperative specific aspects depending on the tumour entity. Further studies on Io-CEUS and the application of an endoscopic probe for VATS will follow.
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Affiliation(s)
- Martin Ignaz Schauer
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Ernst-Michael Jung
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Natascha Platz Batista da Silva
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Michael Akers
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Tomas Piler
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Christopher Larisch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Christian Stroszczynski
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
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Dong Y, Guggisberg E, Wang WP, Zadeh ES, Christian G, Möller K, Berzigotti A, Chaubal N, Cui XW, De Molo C, Dirks K, Montagut NE, Gilja OH, Hollerweger A, Jenssen C, Jung EM, Klinger C, Lim A, Sansone V, Schuler A, Serra C, Sparchez Z, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part II. Med Ultrason 2023. [PMID: 37632825 DOI: 10.11152/mu-4261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
It is important to be familiar with the typical imaging features of the uncommon or even extremely rare focal liver lesions (FLL). Current guidelines of the World Federation for Ultrasound in Medicine and Biology (WFUMB) is aimed at assessing the usefulness of contrast enhanced ultrasound (CEUS) in the management of various FLL. In this review, we aim to summarize the ultrasound and CEUS characteristics with literature review of some extremely rare benign FLL, which might be helpful for improving diagnostic efficiency clinically.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Elisa Guggisberg
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Görg Christian
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg,
Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nittin Chaubal
- Thane Ultrasound Centre: Jaslok Hospital and Research Centre, Mumbai, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland Strausberg, Germany, and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | | | - Adrian Lim
- 7Imperial College London and Healthcare NHS Trust, London, UK
| | - Vito Sansone
- Unit of Internal Medicine, Dpt of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Geislingen, DOC-da! MVZ GmbH, Goeppingen Germany
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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Dong Y, Wang WP, Zadeh ES, Möller K, Görg C, Berzigotti A, Chaubal N, Cui XW, De Molo C, Dirks K, Montagut NE, Gilja OH, Hollerweger A, Jenssen C, Jung EM, Klinger C, Lim A, Sansone V, Schuler A, Serra C, Sparchez Z, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I. Med Ultrason 2023. [PMID: 37632826 DOI: 10.11152/mu-4260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Improved detection and characterization of common focal liver lesions (FLL) are the main topics of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guidelines on the use of contrast-enhanced ultrasound (CEUS). On stateof-the-art CEUS imaging, to create a library of rare FLL, especially concerning their atypical imaging characteristics, might be helpful for improving clinical diagnostic efficiency. In this review, we aim to summarize the ultrasound and CEUS features of rare benign FLL. Currently there are limited reports and images published.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nittin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Medical Department, Krankenhaus MaerkischOderland, Strausberg, Germany, and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | | | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Vito Sansone
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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Rink M, Jung EM, Künzel J. The Use of Contrast-Enhanced Sonography for Therapy Monitoring of Metastatic Lymph Nodes: A Systematic Review. Curr Oncol 2023; 30:6734-6743. [PMID: 37504354 PMCID: PMC10378161 DOI: 10.3390/curroncol30070494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Metastatic cervical lymph nodes are a frequent finding in head and neck squamous cell carcinoma (HNSCC). If a non-surgical approach is primarily chosen, a therapy response evaluation of the primary tumor and the affected lymph nodes is necessary in the follow-up. Supplementary contrast-enhanced ultrasound (CEUS) can be used to precisely visualize the microcirculation of the target lesion in the neck, whereby malignant and benign findings differ in their uptake behavior. The same applies to many other solid tumors. For various tumor entities, it has already been shown that therapy monitoring is possible through regular contrast-enhanced sonography of the primary tumor or the affected lymph nodes. Thus, in some cases, maybe in the future, a change in therapy strategy can be achieved at an early stage in the case of non-response or, in the case of therapy success, a de-escalation of subsequent (surgical) measures can be achieved. In this paper, a systematic review of the available studies and a discussion of the potential of therapy monitoring by means of CEUS in HNSCC are presented.
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Affiliation(s)
- Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
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9
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Rink M, Krassler J, Symeou L, Fischer R, Jung EM, Künzel J. [Use of Contrast enhanced Ultrasound (CEUS) in the Head and Neck Area: Update]. Laryngorhinootologie 2023; 102:450-463. [PMID: 37267968 DOI: 10.1055/a-1994-5141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the help of contrast enhanced ultrasound, the diagnostic accuracy of conventional sonography can be increased in many areas of otorhinolaryngology. Vascularisation and tissue perfusion can be objectified through the examination. This offers promising approaches for example to monitor the therapy of metastatic cervical lymph nodes or in the treatment of vascular malformations. Contrast Enhanced Ultrasound (CEUS) also offers great potential for differential diagnosis, for example of thyroid nodules. Valid threshold values for the quantitative time intensity curve (TIC) analysis of cervical pathologies are currently still not available. Further studies are necessary. As there is currently no license for the use of contrast enhanced ultrasound in otorhinolaryngology patients must be informed about its off-label use before the examination. This article is intended to provide an overview of the current possibilities and to serve as an introduction to the topic.
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10
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Jung EM, Stroszczynski C, Jung F. Advanced multimodal imaging of solid thyroid lesions with artificial intelligence-optimized B-mode, elastography, and contrast-enhanced ultrasonography parametric and with perfusion imaging: Initial results. Clin Hemorheol Microcirc 2023:CH239102. [PMID: 37092219 PMCID: PMC10357218 DOI: 10.3233/ch-239102] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Goal of the study was the assessment of AI-assisted diagnosis of solid thyroid foci with multimodal modern ultrasound imaging. 50 patients (26-81 years, 54.7±13.1 years) were included in the study. Multimodal ultrasound imaging by means of B-mode with linear probe (4-12 MHz) with option of automated documentation of findings by means of AI, with supplementary Ultra MicroAngiography (UMA) was used. Macrovascularisation was assessed by dynamic contrast ultrasonography (CEUS) with parametric evaluation and perfusion analysis, and microvascularization was assessed by combined strain and shear wave elastography on a novel high-performance ultrasound system (Resono R9/Mindray) by an experienced examiner with independent reading. The evaluation was performed according to TI-RADS III-V.The volume of the thyroid lobes on both sides averaged 39 ml±5 ml (27 to 69 ml). The 13 cases of histologically confirmed thyroid carcinomas (8 papillary, 2 medullary, 2 microfollicular, 1 anaplastic CA) with a mean size of 15 mm±6 mm (9-21 mm) were correctly evaluated by TI-RADS V on the basis of irregular shape, induration > 2.5 m or > 30kPA and striking wash-out kinetics. Tumor lymph nodes could only be correctly detected preoperatively in one case of medullary carcinoma according to the surgical findings, based on irregular vascularization with UMA in roundish shape with cortex > 4 mm, transverse diameter up to 11 mm. In 25 cases of inhomogeneous nodular goiter an evaluation with TI-RADS III was performed in 31 cases, in 4 cases with incomplete marginal contour, partial marginal vascularization with UMA and partial wash out with indurations up to 2.5 m/s 30 kPA an evaluation with TI-RADS IV and surgical excision for nodular goiter. In 12 cases regressive nodular changes without relevant malignancy criteria resulted in nodular goiter, with focal changes up to 1.5 cm in diameter, classified as requiring control with TI-RADS III. There were no relevant changes in findings in the controls after 6 months. From the AI tool, the 20/25 goiter nodes were assessed as TI-RADS III, 7/12 adenomas, 5 goiter nodes, and 5 adenomas as TI-RADS IV, 5/13 carcinomas as TI-RADS IV, and 8/13 carcinomas as TI-RADS V.Multimodal ultrasound diagnostics supported by AI has a high diagnostic potential for the evaluation of solid thyroid lesions and standardizes the reporting with digital representative image documentation. CEUS perfusion and modern elastography techniques allow targeted follow-up of TI-RADS III findings.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - F Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
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Huang Y, Wang Y, Liu L, Zhu L, Qiu Y, Zuo D, Lu X, Dong Y, Jung EM, Wang W. VueBox® perfusion analysis of dynamic contrast enhanced ultrasound provides added value in the diagnosis of small thyroid nodules. Clin Hemorheol Microcirc 2023; 83:409-420. [PMID: 36683500 DOI: 10.3233/ch-221681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To explore the potential added value of dynamic contrast enhanced ultrasound (DCE-US) using VueBox® software for the diagnosis of small solid thyroid nodules (≤1.0 cm). PATIENTS AND METHODS This prospective study was approved by the institutional review board and it was performed at two hospitals from January 2020 to October 2020. B mode ultrasound and contrast enhanced ultrasound (CEUS) images were obtained for 79 small solid thyroid nodules (≤1.0 cm) confirmed by ultrasound-guided fine needle aspiration cytology results in 79 consecutive patients (55 women and 24 men, median age: 41 years). The CEUS time-intensity curves (TICs) of thyroid nodules and surrounding parenchyma were created by VueBox® software (Bracco, Italy). The CEUS quantitative parameters were obtained after curve fitting. The diagnostic efficiency of the diagnostic performance of CEUS and DCE-US was evaluated and compared. The weighted kappa statistic (κ) was performed to assess the interobserver agreement and consistency between the diagnosis of CEUS and DCE-US. RESULTS Among the 79 thyroid nodules, 56 (70.9 %) were malignant and 23 (29.1 %) were benign lesions. Hypoenhancement during the arterial phase of CEUS was associated with malignancy (P < 0.001), with an AUC of 0.705 (sensitivity 71.4 %, specificity 69.6 %). Among all CEUS quantitative parameters, the peak enhancement (PE), wash-in rate (WiR), and wash-out rate (WoR) of DCE-US in malignancies were significantly lower than those in benign nodules (P = 0.049, P = 0.046, and P = 0.020, respectively). The AUCs of PE, WiR, and WoR were 0.642 (sensitivity 65.2 %, specificity 67.9 %), 0.643 (sensitivity 43.5 %, specificity 91.1 %), and 0.667 (sensitivity 69.6 %, specificity 69.6 %) in differentiation between benign and malignant small solid thyroid nodules (≤1.0 cm), respectively. Comparing the quantitative parameters of DCE-US between small solid thyroid nodules and surrounding normal thyroid parenchyma, the PE, WiAUC, WiR, WiPI, WoAUC, WiWoAUC, and WoR of the nodules were significantly lower than those of normal thyroid tissue (P = 0.008, P < 0.001, P = 0.037, P = 0.009, P = 0.003, P = 0.002, P = 0.049, respectively). A total of 16 (20.3 %) nodules showed isoenhancement during the arterial phase of CEUS, while the median PE ratio of surrounding tissue and thyroid nodules was 1.70 (IQR: 1.33-1.89). CONCLUSIONS VueBox® is a helpful tool for the evaluation of dynamic microvascularization of thyroid nodules, and DCE-US using VueBox® perfusion analysis could provide added values for differential diagnosis of small solid thyroid nodules (≤1.0 cm).
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Affiliation(s)
- Yunlin Huang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Zhu
- Department of Ultrasound, Haikou Hospital of The Maternal and Child Health, Haikou, China
| | - Yijie Qiu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dan Zuo
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiuyun Lu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.,Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rink M, Jung EM, Bohr C, Künzel J. Use of contrast-enhanced ultrasound in preoperative planning before resection of a second branchial cleft fistula. Clin Hemorheol Microcirc 2023; 85:83-86. [PMID: 37545228 DOI: 10.3233/ch-231862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
In the head and neck area, a large proportion of clinically relevant fistulas occur in childhood. The present case describes the use of contrast enhanced ultrasound with intraductal administration of the contrast medium for preoperative visualization of the fistula duct in the case of a second brachial cleft fistula. This provided the surgeon with important additional information, such as the detailed course of the fistula and its relation to the large vessels of the neck. The method can help to improve surgical planning, reduce radiation exposure and to avoid imaging under general anesthesia, especially in children.
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Affiliation(s)
- Maximilian Rink
- Department of Otorhinolaryngology, University Hospital Regensburg, Head and Neck Surgery, Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Head and Neck Surgery, Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, University Hospital Regensburg, Head and Neck Surgery, Regensburg, Germany
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Jung EM, Dong Y, Jung F. Current aspects of multimodal ultrasound liver diagnostics using contrast-enhanced ultrasonography (CEUS), fat evaluation, fibrosis assessment, and perfusion analysis - An update. Clin Hemorheol Microcirc 2023; 83:181-193. [PMID: 36776044 PMCID: PMC9986700 DOI: 10.3233/ch-239100] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Current ultrasound multifrequency probes allow both improved detail resolution and depth of penetration when examining the liver. Also, new developments in vascular diagnostics, elastography with fibrosis assessment, evaluation of possible steatosis, and parametric and time intensity curve (TIC) analysis of dynamic microvascularization of the liver with contrast-enhanced ultrasound sonography (CEUS) complement ultrasound-guided diagnostics. State-of-the-art high-resolution technology includes a high frame rate (HiFR) mode for CEUS, fast shear wave measurements with the sound touch quantify (STQ) mode, artifact-free flow detection using HR flow and glazing flow in combination with a special flow-adapted imaging (Ultra Micro Angiography, UMA) and additionally different assessments of possible fatty liver (UltraSound ATtenuation Imaging Technology, USAT). In 50 cases with focal liver lesions, a multimodal liver diagnosis was performed with a still new high-performance ultrasound system as part of the clarification of questions from the university liver consultation and tumor outpatient clinic.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology, Senftenberg, Germany
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Kaiser U, Herr W, Greiner B, Stroszczynski C, Jung EM. Mobile handheld ultrasound with VScan Air for the diagnosis of deep vein thrombosis. Clin Hemorheol Microcirc 2023; 83:149-161. [PMID: 36278343 DOI: 10.3233/ch-221598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate a new W-Lan-supported ultrasound mobile technology for the diagnosis of vascular peripheral thrombosis. MATERIAL AND METHODS Fifty patients were examined by an experienced reference sonographer using high-end technology and a W-Lan supported device (VScan Air) to evaluate its diagnostic capabilities for peripheral thrombosis. RESULTS Fifty patients were examined (age, 25-88 years; male, n = 27, female n = 23). Thromboses were diagnosed in the neck (n = 1), upper leg (n = 7), lower leg (n = 49), and muscle veins (n = 25). VScan Air technique also allows the diagnosis of circumscribed deep vein thrombosis with a sufficient diagnostic certainty. Moreover, for superficial thrombi that can be well-delineated, a maximum image quality is possible compared to high-end technology. CONCLUSION The mobile VScan technology opens up new possibilities for near-patient and location-independent imaging in cases of deep vein thrombosis.
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Affiliation(s)
- Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Barbara Greiner
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst-Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Jung F, Lamby P, Prantl L, Wiggermann P, Jung EM, Krüger-Genge A, Franke RP. Post-mortem distribution of Iodinated Contrast Media (ICM) (iodixanol versus iopromide) in the porcine kidney after multiple bolus injections in vivo into the supra-renal aorta1. Clin Hemorheol Microcirc 2023; 85:289-295. [PMID: 36502310 DOI: 10.3233/ch-229102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Iodinated contrast media (ICM) are widely used for diagnostic and interventional procedures in radiology and cardiology. Ideally, they should not interact with blood cells or vascular wall cells to avoid deteriorations of the blood circulation. However, it is well known that ICM can affect erythrocytes as well as endothelial cells which consequently might perturb especially the microcirculation. In former studies the influence of two ICM (iodixanol versus iopromide) on the vascular system, the development of blood stasis, on changes in renal resistive index (RRI) and vascular diameters, and on the post-mortem distribution of iodine as marker for ICM in the explanted kidneys was examined. The modus of ICM application into the supra-renal aorta followed the regime in interventional cardiology, so that 10 bolus injections were administered at steady intervals (iopromide 4,32 ml / iodixanol 5 ml) accompanied by infusion of 500 ml isotonic NaCl-solution.In the present study, the post-mortem X-ray analysis revealed that there were no differences in iodine content in the regions of the mid-cortex and the medullo-pelvic transition zone of the kidneys after application of both ICM. Remarkable differences, however, were found in the region of the capsule-near cortex, where the application of iopromide led to a significantly lower iodine content in the microcirculation. This is in good agreement with former studies, in which a maldistribution in this area, presumably due to a decrease in arteriolar inflow as a result of stasis/occlusion was shown.
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Affiliation(s)
- F Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - P Lamby
- Department of Plastic and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - P Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Braunschweig, Germany
| | - E M Jung
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - A Krüger-Genge
- Fraunhofer Institute for Applied Polymer Research (IAP), Potsdam-Golm, Germany
| | - R P Franke
- Department of Biomaterials, Central Institute for Biomedical Engineering, University of Ulm, Ulm, Germany
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Tews HC, Kandulski A, Schmid S, Schlosser S, Schirner S, Putz FJ, Cosma L, Gülow K, Müller M, Jung EM. Multimodal ultrasound imaging with conventional B-mode, elastography, and parametric analysis of contrast-enhanced ultrasound (CEUS): A novel approach to assess small bowel manifestation in severe COVID-19 disease. Clin Hemorheol Microcirc 2022; 82:341-360. [PMID: 35871323 DOI: 10.3233/ch-221540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The aim was to describe the small bowel morphology with conventional B-mode and elastography and additionally to evaluate dynamic effects of COVID-19 associated small bowel microvascularization using CEUS with color coded perfusion parameters.Thirteen patients with severe COVID-19 acute respiratory distress syndrome (ARDS) were investigated. 13 patients required intensive care treatment with mechanical ventilation. Five patients required extracorporeal membrane oxygenation (ECMO). Contrast-enhanced ultrasound (CEUS) was performed by an experienced investigator as a bolus injection of up to 2.4 ml sulfur hexafluoride microbubbles via a central venous catheter. In the parametric analysis of CEUS, the flare of microbubbles over time is visualized with colors. This is the first work using parametric analysis of CEUS to detect perfusion differences in the small bowel.Parametric analysis of CEUS in the intestinal phase was carried out, using DICOM loops for 20 seconds. In 5 patients, parametric analysis revealed intraindividual differences in contrast agent behavior in the small bowel region. Analogous to the computed tomography (CT) images parametric analysis showed regions of simultaneous hyper- and hypoperfusion of the small intestine in a subgroup of patients. In 5 patients, the parametric image of transmural global contrast enhancement was visualized.Our results using CEUS to investigate small bowel affection in COVID-19 suggest that in severe COVID-19 ARDS systemic inflammation and concomitant micro embolisms may lead to disruption of the epithelial barrier of the small intestine.This is the first study using parametric analysis of CEUS to evaluate the extent of small bowel involvement in severe COVID-19 disease and to detect microemboli. In summary, we show that in COVID-19 the small bowel may also be an important interaction site. This is in line with the fact that enterocytes have been shown to a plenitude of angiotensin converting enzyme (ACE)-2 receptors as entry sites of the virus.
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Affiliation(s)
- H C Tews
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - A Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schlosser
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - S Schirner
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - L Cosma
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - K Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - M Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Jung EM, Jung F, Verloh N, Haimerl M, Lürken L, Jage S, Stroszczynski C, Scharf G. High resolution flow with glazing flow for optimized flow detection in transjugular intrahepatic portosystemic stent shunt (TIPS): First results. Clin Hemorheol Microcirc 2022; 82:231-238. [PMID: 35723091 DOI: 10.3233/ch-221427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ultrasound follow-up of transjugular intrahepatic portosystemic shunt (TIPS) is challenging due to the bent course of the stent-graft. OBJECTIVE Aim of this retrospective study was to assess to which extent the combination of HR flow with Glazing Flow improves hemodynamic assessment in the ultrasound follow-up of TIPS. METHODS Comparative studies with CCDS and High Resolution (HR)-Flow with Glazing Flow were evaluated regarding image quality and artifacts on a 5-point scale (0 = cannot be assessed up to 5 = maximum image quality without artifacts). In all cases, an experienced examiner performed the examinations with a 1-6 MHz probe (Resona 7, Mindray). RESULTS 61 ultrasound examinations in 48 patients were performed; the mean patient age was 54±14.2 years. The use of HR-Flow with Glazing Flow resulted in an improved flow display in 55/61 cases (90.2%). Both methods correlated well (r = 0.71), but HR flow with Glazing flow values were in general higher than CCDS values. The reading resulted in an average value of 2.52±0.54 for CCDS and 3.52±0.57 for HR flow with Glazing flow (p = 0.013). CONCLUSION The combination of HR-Flow and Glazing Flow results in improved flow representation and reduction of artifacts in the ultrasound follow-up of TIPS.
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Affiliation(s)
- Ernst-Michael Jung
- Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Friedrich Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - Niklas Verloh
- Department of Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Michael Haimerl
- Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Lürken
- Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Simon Jage
- Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Gregor Scharf
- Department of Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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Brandenstein M, Wiesinger I, Künzel J, Hornung M, Stroszczynski C, Jung EM. Multiparametric Sonographic Imaging of Thyroid Lesions: Chances of B-Mode, Elastography and CEUS in Relation to Preoperative Histopathology. Cancers (Basel) 2022; 14:cancers14194745. [PMID: 36230668 PMCID: PMC9564296 DOI: 10.3390/cancers14194745] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary As the incidence of thyroid lesions in Europe is rising, more and more people affected by thyroid pathologies seek treatment in a clinic. Every suspicious thyroid nodule needs to be confirmed as benign or malignant in order to be treated correctly. Unnecessary invasive diagnostics and thyroid surgery should be avoided. The aim of this retrospective study was to improve the distinction between benign and malignant nodules by using new high-performance multiparametric ultrasound examination techniques. By analyzing 122 thyroid nodules we created a score-based system combining B-mode, shear-wave elastography and contrast-enhanced ultrasound malignancy criteria. This system allows for a quite accurate detection of thyroid carcinomas with a sensitivity of 95% and specificity of 75.49%. Shear-wave elastography and contrast-enhanced ultrasound can detect unique malignancy features, which cannot be found in B-mode. Therefore, these criteria would present a relevant addition to the B-mode TI-RADS classification. Abstract Background: The aim was to improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance multiparametric ultrasound examination techniques. Methods: Multiparametric ultrasound consists of B-mode, shear-wave elastography and contrast enhanced ultrasound (CEUS) including Time-Intensity-Curve (TIC) analysis. A bolus of 1–2.4 mL Sulfur Hexafluorid microbubbles was injected for CEUS. Postoperative histopathology was the diagnostic gold standard. Results: 116 patients were included in this study. 102 benign thyroid nodules were diagnosed as well as 20 carcinomas. Suspicious B-mode findings like microcalcifications, a blurry edge and no homogeneous sonomorphological structure were detected in 60, 75 and 80% of all carcinomas but only in 13.7, 36.3 and 46.1% of all benign lesions. The average shear-wave elastography measurements of malignant lesions (4.6 m/s or 69.8 kPa centrally and 4.2 m/s or 60.1 kPa marginally) exceed the values of benign nodules. Suspicious CEUS findings like a not-homogeneous wash-in and a wash-out were detected almost twice as often in carcinomas. Conclusion: Multiparametric ultrasound offers new possibilities for the preoperative distinction between benign and malignant thyroid nodules. A score based system of B-mode, shear-wave and CEUS malignancy criteria shows promising results in the detection of thyroid carcinomas. It reaches a sensitivity of 95% and specificity of 75.49%.
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Affiliation(s)
- Moritz Brandenstein
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-17-647-793-303
| | - Isabel Wiesinger
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Matthias Hornung
- Department of Surgery, University Hospital, 93053 Regensburg, Germany
| | - Christian Stroszczynski
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
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Jung EM, Jung F, Stroszczynski C, Wiesinger I. Dynamic endoluminal contrast enhanced ultrasound (CEUS) for display of drainages in inflammatory abdominal fluid collections1. Clin Hemorheol Microcirc 2022; 80:49-59. [PMID: 35001884 DOI: 10.3233/ch-211370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the additive clinical value of endoluminal contrast enhanced ultrasound (CEUS) after interventional placement of drainages in abdominal fluid collections. MATERIAL/METHOD Examination of 30 patients using a 1-6 MHz convex probe (Resona 7, Mindray) to locate the fluid collection in B-Mode. Additionally, dynamic endoluminal CEUS with 1 ml sulphur-hexafluoride microbubbles was performed to measure the extent of the percutaneously drained abscesses. Independent assessment of dynamically stored images in PACS in DICOM format. Correlation to reference imaging using computed tomography (CT). RESULTS A total of 30 patients were examined (17 m, 19-78 years, mean 56.1 years). Drainages were positioned in the liver in 15 cases, in the pelvis after kidney transplantation in 4 cases, close to the spleen in 1 case and in the abdomen in 10 cases. In all cases abscesses showed marginal hyperaemia with reactive septations in CEUS. The drainage position was assessed by means of B-mode in all cases first and then by CEUS. In 4 cases CEUS showed a fistula to the pleura, in 5 cases to the peritoneum, in 2 cases to the intestine, in 5 cases to the biliary tract, corresponding to the CT. In 2 cases there was a hint of an anastomotic leakage after intestinal anastomosis, which was reliably detected by CT. The drainage was removed in 11 cases within a period of 2 to 5 days after CEUS control, in 9 cases within a period of 5 to 10 days. Another operation was necessary in 3 cases. A new drainage was placed in 2 cases. The required amount of contrast medium is 1 ml endoluminally diluted to 9 ml sodium chloride. CONCLUSION CEUS facilitates the exact localization and characterization of inflammatory abdominal fluid collections. Furthermore, possible fistulas can be detected that cannot be seen with conventional ultrasound.
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Affiliation(s)
- E M Jung
- Department of Radiology, University Medical Center Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Germany
| | - I Wiesinger
- Department of Radiology, University Medical Center Regensburg, Germany
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Diesch ST, Jung F, Prantl L, Jung EM. Surface imaging of breast implants using modern high-frequency ultrasound technology in comparison to high-end sonography with power analyses for B-scan optimization1. Clin Hemorheol Microcirc 2021; 80:487-495. [PMID: 34897080 DOI: 10.3233/ch-219204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM This study aims to evaluate optimized breast implant surface-structure analysis by comparing high-end ultrasound technology with a new high frequency technique. This comparative study used new breast implants with different surfaces in an in vitro setting. METHODS Nine idle silicon or polyurethane (PU) breast implants were examined by two investigators in an experimental in vitro study using two high-end ultrasound devices with multi-frequency transducers (6-15 MHz, 9-16 MHz, 12.5-33 MHz).The ultrasound B-Mode was optimized using tissue harmonic imaging (THI), speckle reduction imaging (SRI, level 0-5), cross beam (high, medium, low) and photopic.Using a standardized ultrasound protocol, the implants were examined in the middle (point of highest projection) and lateral, by two independent examiners.Image evaluation was performed on anonymized digital images in the PACS. The aim was to achieve an artifact-free recording of the surface structure, the surface coating, the total image structures and, as far as possible, an artifact-free internal representation of the implants.For independent surface evaluation a score was used (0 = undetectability of surface structures, rich in artifacts, 5 = best possible, artifact free image quality). RESULTS The quality of ultrasound imaging of breast implant surfaces after the optimization of B-Scan differed significantly comparing high-end ultrasound technology with modern high-frequency ultrasound technology (p < 0,05).The following setting has been found to be the best setting with the highest image quality:B-Mode, SRI value 3, Crossbeam high level with color coded imaging for B- mode. In the total examined frequency range of 6-33 MHz, the highest image quality was found in the average frequency range of 12.5-33 MHz at both measured points. For both devices, device 1 (high-end) and device 2 (high frequency) ultrasound, the image quality was in the12.5-33 MHz frequency range with an average image quality of 3.236. It was significantly higher, than in the lower frequency ranges and the same frequency range with THI. (p < 0,05). The image quality of the high-end sonography device was superior to the conventional high-frequency ultrasound device in all frequency ranges. CONCLUSION High-end ultrasound imaging technology was superior in the quality of implant surface evaluation in comparison to high-frequency ultrasound sonography. The gained knowledge can serve as a basis for further multicenter clinical application and studies with the aim to develop an objective, precise tool to evaluate the implant and the surrounding tissue with ultrasound.
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Affiliation(s)
- S T Diesch
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - E M Jung
- Center for Plastic, Aesthetic, Hand & Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.,Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany.,Department of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
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Dong Y, Koch JBH, Löwe AL, Christen M, Wang WP, Jung EM, Mohaupt MG, Dietrich CF. VueBox® for quantitative analysis of contrast-enhanced ultrasound in liver tumors. Clin Hemorheol Microcirc 2021; 80:473-486. [PMID: 34897079 DOI: 10.3233/ch-211261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) enables quantification of tumor perfusion. VueBox is a platform independent external software using DICOM cine loops which objectively provides various DCE-US parameters of tumor vascularity. This review summaries its use for diagnosis and treatment monitoring of liver tumors. The existing literature provides evidence on the successful application of Vuebox based DCE-US for characterization and differential diagnosis of focal liver lesions, as well as on its use for monitoring of local ablative therapies and of modern systemic treatment in oncology.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jonas B H Koch
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
| | - Axel L Löwe
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
| | - Michael Christen
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Markus G Mohaupt
- Department of Medicine, Teaching Hospital General Medicine Lindenhofgruppe, Berne, Switzerland
| | - Christoph F Dietrich
- Department General Internal Medicine, Hirslanden Clinics Beau-Site, Salem and Permancence, Bern, Switzerland
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Abstract
In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time-intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.
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Affiliation(s)
- Ernst-Michael Jung
- Institute of Radiology, Interdisciplinary Department for Ultrasound, University Medical Center, Regensburg, Germany. .,Institut für Röntgendiagnostik/Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Isabel Wiesinger
- Institute of Neuroradiology, Bezirksklinikum Regensburg, Regensburg, Germany
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Jung EM, Kammerer S, Brandenstein M, Putz FJ, Stroszczynski C, Jung F. High resolution flow (HR Flow) and glazing flow in cases of hepatic flow changes: Comparison to color-coded Doppler sonography (CCDS). Clin Hemorheol Microcirc 2021; 79:3-17. [PMID: 34397406 PMCID: PMC8609679 DOI: 10.3233/ch-219102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To evaluate the possibilities of flow detection using high resolution flow (HR Flow) and Glazing Flow technique in patients with liver parenchymal changes and flow changes in comparison to colour coded Doppler sonography (CCDS). MATERIAL AND METHODS All examinations were performed using a multi frequency matrix convex probe with high resolution technique (SC6-1U/Resona7, Mindray, Shenzhen, China) by one experienced examiner to evaluate the venous, portal venous and arterial liver flow with digital documentation of the dynamic flow parameters like peak systolic flow, end-diastolic flow and resistance index. For liver parenchymal stiffness changes shear wave elastography was performed with at least 10 measurements. By two independent readers an elevation was performed to evaluate the image quality and the degree of flow artefacts, from 0 = not available to 5 points with excellent image quality without flow artefacts. RESULTS All 40 patients (24 men, 16 women, age 27-83 years, mean 56±5 years) showed morphology changes from B-Mode of the liver parenchyma to inhomogeneous tissue with higher stiffness evaluated by the shear wave elastography (1.45 m/s up to 2.79 m/s±1.79 m/s, considering F1 up to F4 fibrosis) and in 15 cases histopathologically proven liver cirrhosis. In 9 cases after non-acute thrombosis flow reduction of the portal vein was the reason for the diameter less than 5 mm. Flow parameters for the venous flow were between 8 cm/s up to 29 cm/s, mean 14±4 cm/s, for the hepatic portal vein 5 cm/s up to 57 cm/s, mean 17±5 cm/s, for the hepatic artery systolic flow between 50 cm/s up to 127±33 cm/s, end-diastolic flow from 22 cm/s up to 47 cm/s±8 cm/s. Resistance index for the hepatic artery was between 0.41 up to 0.73, mean 0.67±0.25. The image quality for CCDS over all cases was evaluated for CCDS between 1 up to 4. The mean quality was 2.5±0.5, for HR Flow in combination with Glazing flow 3±0.5, with significant differences for the 2 readers (P < 0.01). CONCLUSION Combination of HR Flow with Glazing Flow could be helpful to evaluate morphological und hemodynamic changes of liver arterial flow, portal venous and venous flow. Reduction of flow artefacts in combination with a higher image quality could be helpful for optimizing the digital measurements also for follow up examinations.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - S Kammerer
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - M Brandenstein
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology, Senftenberg, Germany
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Maxeiner A, Fischer T, Stephan C, Treskatsch S, Baur ADJ, Jung EM, Hamm B, Lerchbaumer MH. Use of TDI during MRI/US fusion-guided biopsy for suspected prostate cancer. Clin Hemorheol Microcirc 2021; 78:259-269. [PMID: 33646144 DOI: 10.3233/ch-201035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) uses the Doppler principle to quantify the movement of biological tissues. OBJECTIVE To investigate the contribution of TDI parameters derived during magnetic resonance imaging and ultrasound (MRI/US) fusion-guided biopsy for prostate cancer (PCa) discrimination. METHODS From March 2016 to Dec. 2018, 75 men with suspected PCa prospectively underwent fusion-guided prostate biopsy. TDI overlaid on predefined target lesion were compared to the confirmed contralateral tumor-free area of the prostate gland (using Image J). Diagnostic value of TDI parameters was assessed using histopathology as standard of reference. RESULTS Thirty-seven patients were diagnosed with PCa (49.3%), among them 27 with clinically significant PCa (Gleason score > 3 + 3 = 6 (ISUP 1). The LES/REF ratio was lower in confirmed PCa patients compared to patients without PCa (0.42, IQR, 0.22-0.59 vs. 0.52, IQR, 0.40-0.72, p = 0.017). TDI parameters allowed differentiation of low-risk from high-to-intermediate-risk PCa (ISUP 2 versus ISUP 3) based on lower pixel counts within the target ROI (1340, IQR 596-2430 vs. 2687, IQR 2453-3216, p = 0.004), lower pixel percentage (16.4 IQR 11.4-29.5 vs. 27.3, IQR 22.1-39.5; p = 0.005), and lower LES/REF ratios (0.29, IQR 0.19-0.51 vs. 0.52, IQR 0.47-0.74, p = 0.001). CONCLUSION TDI of prostate lesions prelocated by MRI discriminates between cancerous and noncancerous lesions and further seems to enable characterization of PCa aggressiveness. This widely available US technique may improve confidence in target lesion localization for tissue sampling.
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Affiliation(s)
- Andreas Maxeiner
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology and Berlin Institute for Urologic Research, Berlin, Germany
| | - Thomas Fischer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Carsten Stephan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Urology and Berlin Institute for Urologic Research, Berlin, Germany
| | - Selda Treskatsch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Alexander Daniel Jacques Baur
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Hamm
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Markus Herbert Lerchbaumer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Brandenstein M, Wiesinger I, Jung F, Stroszczynski C, Jung EM. High-performance sonographical multimodal imaging of non cystic thyroid lesions: Chances of the preoperative diagnostics in relation to histopathology. Clin Hemorheol Microcirc 2021; 79:27-38. [PMID: 34334387 PMCID: PMC8609687 DOI: 10.3233/ch-219101] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM: To improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance ultrasound techniques: optimized B-mode morphology, elastography, Color-Coded Doppler-Sonography (CCDS) and contrast enhanced ultrasound (CEUS) MATERIALS AND METHODS: In 33 cases solid, non-cystic thyroid lesions were rated as TIRADS 3 and up from conventional B-mode examinations. Additional high resolution Power Doppler including HR- and Glazing-Flow as optimized macrovascularization techniques, shear wave elastography and CEUS were performed on these patients by one experienced examiner. For CEUS a bolus of 1–2.4 ml Sulfurhexafluorid microbubbles (SonoVue®, Bracco, Milan, Italy) was injected into a cubital vein and then the distribution kinetics of the contrast agent were documented from the early arterial phase (10 to 15 seconds after injection) to the late venous phase (5 minutes after injection). Postoperative histopathology was the diagnostic gold standard as it provides the most reliable proof. RESULTS: 33 patients (13 males, 20 females; age 29 –77 years; mean 55 years; SD 13 years) were included in this study. 28 of them had benign regressive thyroid nodules, 3 had adenomas and 4 were diagnosed with carcinomas (3 were histologically identified as papillary thyroid carcinomas, one as a medullary thyroid carcinoma). The volume of the thyroid gland ranged from 6.6 to 401.3 cm2 (mean 72.6±92.0 cm2). The adenoma diameters ranged from 9 to 40 mm (mean 22±16 mm) and the carcinoma diameters ranged from 19 to 33 mm (mean 26±6 mm). The 3 adenomas had different echogenicities: One was completely echofree, one was hypoechoic and one isoechoic. The 4 carcinomas however were equally characterized as hypoechoic and echofree. Two of three adenomas and all of the carcinomas showed an incomplete or diffuse margin. Micro-calcifications were found in one adenoma and in every carcinoma. However, no micro-calcifications were observed in cases of benign regressive nodules. Performing shear-wave elastography the adenomas showed lower values than the carcinomas: The tissue velocity of the adenomas ranged from 2.86 m/s to 3.85 m/s (mean 3.32±0.5 m/s) and in carcinomas from 3.89 m/s to 5.66 m/s (mean 4.18±0.3 m/s). Marginal hypervascularization was detected in two adenomas after applying CCDS. One adenoma was hypovascularized. The four carcinomas showed an irregular extreme hypervascularization along their margins as well as an irregular central normo- or hypervascularization in CCDS. The additional HR-Flow helped reducing artefacts. In CEUS the dynamic capillary microvascularization of all carcinomas was very irregular with early enhancement and followed by partial or complete wash-out. In CEUS two adenomas had no wash-out and the other one showed a partial wash-out. CONCLUSION: Using modern multimodal imaging offers new possibilities for the differentiation between benign and malignant thyroid lesions. It is a very important diagnostic tool in addition to the B-Mode TIRADS classification and eases the decision between TIRADS 3, 4 and 5. However, additional multicenter studies are required for more detailed evaluations.
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Affiliation(s)
- M Brandenstein
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - I Wiesinger
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - E M Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
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Werner JM, Zidek M, Kammerer S, da Silva NPB, Jung F, Schlitt HJ, Hornung M, Jung EM. Intraoperative contrast-enhanced ultrasound can have a crucial role in surgical decision-making during hepato-pancreatico-biliary surgery - Analysis of impact and input. Clin Hemorheol Microcirc 2021; 78:103-116. [PMID: 33554890 DOI: 10.3233/ch-201031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To assess the impact and procedural input of intraoperative ultrasound (IOUS) with contrast-enhanced ultrasound (CEUS) and ultrasound elastography on surgical decision making during the procedure and consequently the outcome after hepato-pancreatico-biliary (HPB) surgery. MATERIALS AND METHODS Data of 50 consecutive patients, who underwent HPB surgery from 04/2018 to 07/2018 were prospectively collected for this study. During surgery, IOUS with a high-resolution ultrasound device using CEUS after bolus injection of 2.4-5 ml dulphur hexafluoride microbubbles using a 6-9 MHz probe and a share wave and strain elastography was performed by an experienced examiner. Process and time analysis were carried out using mobile phone timer. RESULTS The IOUS with CEUS and elastography correctly identified 42 malignant tumors and 4 benign lesions. In 3 cases, the examination provided false positive result (identifying 3 benign lesions as malignant) and in 1 case a malignant lesion was incorrectly assessed as benign (sensitivity 97,7%, specificity 57,1%, PPV 93,3% and NPV 80%).The specific question by the surgeon could be answered successfully in 98% of the cases. In 76% of the cases, there was a modification (42%) or a fundamental change (34%) of the planned surgical approach due to the information provided by the IOUS. Within the last group, the IOUS had a major impact on therapy outcome. In 7 patients an additional tumor resection was required, in 5 patients the tumor was assessed as inoperable, and in total in 5 patients an intraoperative RFA (4/5) or postoperative RITA (1/5) was required.Regarding procedural input, there was only a slight, but significant difference between the transport and set-up times before the intraoperative use (mean: 14 min 22 s) and the return transport (mean 13 min 6 s), (p = 0,038). The average examination time was 14 minutes, which makes only one third of the overall time demand. CONCLUSION Combination of IOUS with CEUS and elastography in oncological HPB surgery provides valuable information that affects surgical decision-making. The procedural input of about 45 minutes seems to be a good investment considering the improvement of the surgical procedure and a significant modification of the therapy approach in the majority of the cases.
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Affiliation(s)
- Jens Martin Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Zidek
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Sylvia Kammerer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Friedrich Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | | | - Matthias Hornung
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Georgieva M, Rennert J, Brochhausen C, Stroszczynski C, Jung EM. Suspicious breast lesions incidentally detected on chest computer tomography with histopathological correlation. Breast J 2021; 27:715-722. [PMID: 34124813 DOI: 10.1111/tbj.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To evaluate incidental breast lesions on chest computed tomography with histopathological correlation. It is important for general radiologist to characterize a breast lesion as benign, indetermined, or sufficiently suspicious to warrant further work-up. METHODS A total of 35.000 chest CT examinations were performed between January 2016 and December 2020. 27 patients (mean age 70 years, age range 48-87 years) with incidental breast lesions were identified in this retrospective study. Two radiologists scored incidental breast lesions independently regarding their morphology, and the results were compared to histopathology which was obtained by an ultrasound-guided core needle biopsy or a surgical excision. RESULTS Out of 35.000 chest CT examinations, a total of 31 incidental breast lesions in 27 patients were detected. Among the 31 lesions, 23 were malignant and 8 benign. The malignant lesions included 17 carcinomas and 6 metastases (4 lymphomas and 2 melanomas). The benign lesions contained 2 hematomas, 4 fat necrosis, and 2 fibrosis lumps. CONCLUSION Chest computed tomography as a standard imaging technique is helpful for evaluation of suspicious breast lesions. This may ultimately influence patient management and lead to further imaging.
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Affiliation(s)
- Martina Georgieva
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Jung EM, Dinkel J, Verloh N, Brandenstein M, Stroszczynski C, Jung F, Rennert J. Wireless point-of-care ultrasound: First experiences with a new generation handheld device. Clin Hemorheol Microcirc 2021; 79:463-474. [PMID: 34151848 PMCID: PMC8764604 DOI: 10.3233/ch-211197] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 –80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2–5 MHz (convex probe) and 3–12 MHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/LOGIQ E10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality (0–4, from not assessable = 0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions. Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD ± 0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD ± 0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - J Dinkel
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - N Verloh
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - M Brandenstein
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology, Senftenberg, Germany
| | - J Rennert
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
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Peschel G, Grimm J, Buechler C, Gunckel M, Pollinger K, Aschenbrenner E, Kammerer S, Jung EM, Haimerl M, Werner J, Müller M, Weigand K. Liver stiffness assessed by shear-wave elastography declines in parallel with immunoregulatory proteins in patients with chronic HCV infection during DAA therapy. Clin Hemorheol Microcirc 2021; 79:541-555. [PMID: 34120896 DOI: 10.3233/ch-211193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A rapid decline of liver stiffness (LS) was detected by non-invasive methods in patients with chronic hepatitis C (HCV) infection during treatment with direct-acting antivirals (DAA). OBJECTIVE To investigate the influence of inflammation on LS. METHODS We prospectively examined LS by sonographic shear-wave elastography in 217 patients during DAA therapy from treatment initiation (BL) to 12 weeks after end of therapy (SVR12). Demographic data, laboratory findings and serum levels of cytokines were determined. RESULTS Values of LS decreased from 1.86 m/s to 1.68 m/s (p = 0.01) which was most pronounced in patients who had F4 fibrosis at BL (3.27 m/s to 2.37 m/s; p < 0.001). Initially elevated values of aminotransferases, ferritin, IgG (p < 0.001 each) and international normalized ratio (p < 0.003) declined, thrombocyte count (p = 0.007) increased. Correlations of these laboratory parameters with BL levels of LS measurement (LSM) were most apparent in patients with F1-F3 fibrosis. Tumor necrosis factor (TNF)-α (p = 0.031), interleukin (IL)-10 (p = 0.005) and interferon y inducible protein (IP)-10 (p < 0.001) decreased in parallel with LSM under DAA therapy and corelated with BL values. CONCLUSION Decrease of systemic inflammatory parameters correlated with LSM under DAA therapy. We conclude that regression of LSM is attributable to the decline of inflammation rather than reflecting fibrosis.
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Affiliation(s)
- G Peschel
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - J Grimm
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - C Buechler
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - M Gunckel
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - K Pollinger
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - E Aschenbrenner
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - S Kammerer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - J Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Müller
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - K Weigand
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Schiltz D, Lenhard J, Klein S, Anker A, Lonic D, Heidekrueger PI, Prantl L, Jung EM, Platz Batista Da Silva N, Kehrer A. Do-It-Yourself Preoperative High-Resolution Ultrasound-Guided Flap Design of the Superficial Circumflex Iliac Artery Perforator Flap (SCIP). J Clin Med 2021; 10:jcm10112427. [PMID: 34070779 PMCID: PMC8198546 DOI: 10.3390/jcm10112427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 11/21/2022] Open
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe an easy, reliable, systematic, and standardized approach for preoperative SCIP flap design and perforator characterization, using color-coded duplex sonography (CCDS). A list of customized settings and a straightforward algorithm are presented, which are easily applied by an operator with minimal experience. Specific settings for SCIP flap perforator evaluation were investigated and tested on 12 patients. Deep and superficial superficial circumflex iliac artery (SCIA) branches, along with their corresponding perforators and cutaneous veins, were marked individually with a permanent marker and the anatomy was verified intraoperatively. From this, a simplified procedure for preoperative flap design of the SCIP flap was developed. Branches could be localized and evaluated in all patients. A preoperative structured procedure for ultrasonically guided flap design of the SCIP flap is described. A 100% correlation between the number and emergence points of the branches detected by preoperative CCDS mapping and the intraoperative anatomy was found.
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Affiliation(s)
- Daniel Schiltz
- Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany;
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Jasmin Lenhard
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Silvan Klein
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Alexandra Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Daniel Lonic
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Paul I. Heidekrueger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (E.-M.J.); (N.P.B.D.S.)
| | | | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.L.); (S.K.); (A.A.); (D.L.); (P.I.H.); (L.P.)
- Correspondence: ; Tel.: +49-941-9446763
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Peschel G, Jung EM, Fisser C, Putz FJ, Wertheimer T, Sinner B, Lunz D, Jung F, Müller M. Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO2 retention. Clin Hemorheol Microcirc 2021; 77:355-365. [PMID: 33285628 DOI: 10.3233/ch-200925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). OBJECTIVE This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS). METHODS A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-line (1 point), coalescent B-lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1-5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers. RESULTS LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r = 0.467; p = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r = 0.632; p = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz index, CRP, LDH and IL-6 did not. CONCUSIONS The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS.
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Affiliation(s)
- G Peschel
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C Fisser
- Department of Cardiology and Pulmonology, University Hospital Regensburg, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - T Wertheimer
- Department of Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - B Sinner
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - D Lunz
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Department of Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - M Müller
- Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Schellhaas B, Bernatik T, Bohle W, Borowitzka F, Chang J, Dietrich CF, Dirks K, Donoval R, Drube K, Friedrich-Rust M, Gall C, Gittinger F, Gutermann M, Haenle MM, von Herbay A, Ho CH, Hochdoerffer R, Hoffmann T, Hüttig M, Janson C, Jung EM, Jung N, Karlas T, Klinger C, Kornmehl A, Kratzer W, Krug S, Kunze G, Leitlein J, Link A, Lottspeich C, Marano A, Mauch M, Moleda L, Neesse A, Petzold G, Potthoff A, Praktiknjo M, Rösner KD, Schanz S, Schultheiß M, Sivanathan V, Stock J, Thomsen T, Vogelpohl J, Vogt C, Wagner S, Wiegard C, Wiesinger I, Will U, Ziesch M, Zimmermann P, Strobel D. Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma - A Prospective Multicenter DEGUM Study. Ultraschall Med 2021; 42:e20. [PMID: 32717752 DOI: 10.1055/a-1220-8561] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Barbara Schellhaas
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
| | - Thomas Bernatik
- Department of Internal Medicine 1, Kreisklinik Ebersberg gGmbH, Ebersberg, Germany
| | - Wolfram Bohle
- Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, Katharinenhospital, Klinikum Stuttgart, Germany
| | - Fanny Borowitzka
- Department of Internal Medicine 2, Universitätsmedizin Rostock, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | | | - Klaus Dirks
- Gastroenterologie und Innere Medizin, Rems-Murr-Klinikum Winnenden, Germany
| | - Robert Donoval
- Klinik für Gastroenterologie, Diabetologie und Infektiologie, Lausitzer Seenland Klinikum GmbH, Hoyerswerda, Germany
| | - Kristine Drube
- Department of Internal Medicine, Allgemeines Krankenhaus Celle, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Christine Gall
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU IMBE, Erlangen, Germany
| | - Fleur Gittinger
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Martin Gutermann
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | | | - Alexandra von Herbay
- Department of Internal Medicine, Evangelisches Krankenhaus Hamm gGmbH, Hamm, Germany
| | - Chau Hong Ho
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | - Rico Hochdoerffer
- Department of Internal Medicine, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Tatjana Hoffmann
- Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Hüttig
- Department of Internal Medicine, DRK-Kliniken Berlin-Köpenick, Berlin, Germany
| | - Christopher Janson
- Department of Internal Medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | | | - Norbert Jung
- Department of Internal Medicine, Klinikum Heidenheim, Germany
| | - Thomas Karlas
- Department of Internal Medicine, Division of Gastroenterology, Universitätsklinikum Leipzig, Germany
| | | | - Adam Kornmehl
- Department of Internal Medicine, Klinikum Weiden, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine, University Hospital Ulm, Germany
| | - Sebastian Krug
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Georg Kunze
- Internal Medicine, KH Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Jens Leitlein
- Department of Internal Medicine, Klinikum am Steinenberg Reutlingen, Germany
| | - Alexander Link
- Department of Internal Medicine, University Hospital Magdeburg, Germany
| | - Christian Lottspeich
- Medical Clinic and Policlinic IV, Division of Vascular Medicine, Hospital of the Ludwig Maximilians University Hospital, Munich, Germany
| | - Aldo Marano
- Department of Internal Medicine, ViDia Christliche Kliniken Karlsruhe, Germany
| | - Martin Mauch
- Department of Internal Medicine, Innere, Kreisklinik Sigmaringen, Germany
| | - Lukas Moleda
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Golo Petzold
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Andrej Potthoff
- Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Klaus-Dieter Rösner
- Department of Internal Medicine, Barmherzige Brüder Klinikum Sankt Elisabeth Straubing GmbH, Straubing, Germany
| | - Stefan Schanz
- Department of Internal Medicine, Kreisklinikum Siegen gGmbH, Siegen, Germany
| | - Michael Schultheiß
- Department of Internal Medicine, University of Freiburg Hospital, Freiburg, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine, University Hospital Mainz, Department of Internal Medicine 3, Mainz, Germany
| | - Joachim Stock
- Department of Internal Medicine, Klinikum Barnim, Eberswalde, Germany
| | - Thomas Thomsen
- Department of Internal Medicine, Westküstenklinik Brunsbüttel, Brunsbüttel, Germany
| | - Johanna Vogelpohl
- Department of Internal Medicine I, Krankenhaus GmbH Alb-Donau-Kreis Blaubeuren, Germany
| | - Christoph Vogt
- Department of Internal Medicine, St.-Josef-Krankenhaus Moers, Germany
| | - Siegfried Wagner
- Department of Internal Medicine, Donau-Isar-Kliniken Deggendorf, Germany
| | - Christiane Wiegard
- Department of Internal Medicine, University Hospital Hamburg Eppendorf Center of Internal Medicine, Hamburg, Germany
| | - Isabel Wiesinger
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Uwe Will
- Internal Medicine, Klinikum Gera, Gera, Germany
| | - Matthias Ziesch
- Department of Internal Medicine, Diakonissenkrankenhaus Dresden, Germany
| | | | - Deike Strobel
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
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Schellhaas B, Bernatik T, Bohle W, Borowitzka F, Chang J, Dietrich CF, Dirks K, Donoval R, Drube K, Friedrich-Rust M, Gall C, Gittinger F, Gutermann M, Haenle MM, von Herbay A, Ho CH, Hochdoerffer R, Hoffmann T, Hüttig M, Janson C, Jung EM, Jung N, Karlas T, Klinger C, Kornmehl A, Kratzer W, Krug S, Kunze G, Leitlein J, Link A, Lottspeich C, Marano A, Mauch M, Moleda L, Neesse A, Petzold G, Potthoff A, Praktiknjo M, Rösner KD, Schanz S, Schultheiß M, Sivanathan V, Stock J, Thomsen T, Vogelpohl J, Vogt C, Wagner S, Wiegard C, Wiesinger I, Will U, Ziesch M, Zimmermann P, Strobel D. Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma - A Prospective Multicenter DEGUM Study. Ultraschall Med 2021; 42:178-186. [PMID: 32663881 DOI: 10.1055/a-1198-4874] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND This prospective multicenter study funded by the DEGUM assesses the diagnostic accuracy of standardized contrast-enhanced ultrasound (CEUS) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. METHODS Patients at high risk for HCC with a histologically proven focal liver lesion on B-mode ultrasound were recruited prospectively in a multicenter approach. Clinical and imaging data were entered via online entry forms. The diagnostic accuracies for the noninvasive diagnosis of HCC were compared for the conventional interpretation of standardized CEUS at the time of the examination (= CEUS on-site) and the two CEUS algorithms ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) and CEUS LI-RADS (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System). RESULTS 321 patients were recruited in 43 centers; 299 (93.1 %) had liver cirrhosis. The diagnosis according to histology was HCC in 256 cases, and intrahepatic cholangiocarcinoma (iCCA) in 23 cases. In the subgroup of cirrhotic patients (n = 299), the highest sensitivity for the diagnosis of HCC was achieved with the CEUS algorithm ESCULAP (94.2 %) and CEUS on-site (90.9 %). The lowest sensitivity was reached with the CEUS LI-RADS algorithm (64 %; p < 0.001). However, the specificity of CEUS LI-RADS (78.9 %) was superior to that of ESCULAP (50.9 %) and CEUS on-site (64.9 %; p < 0.001). At the same time, the negative predictive value (NPV) of CEUS LI-RADS was significantly inferior to that of ESCULAP (34.1 % vs. 67.4 %; p < 0.001) and CEUS on-site (62.7 %; p < 0.001). The positive predictive values of all modalities were high (around 90 %), with the best results seen for CEUS LI-RADS and CEUS on-site. CONCLUSION This is the first multicenter, prospective comparison of standardized CEUS and the recently developed CEUS-based algorithms in histologically proven liver lesions in cirrhotic patients. Our results reaffirm the excellent diagnostic accuracy of CEUS for the noninvasive diagnosis of HCC in high-risk patients. However, on-site diagnosis by an experienced examiner achieves an almost equal diagnostic accuracy compared to CEUS-based diagnostic algorithms.
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Affiliation(s)
- Barbara Schellhaas
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
| | - Thomas Bernatik
- Department of Internal Medicine 1, Kreisklinik Ebersberg gGmbH, Ebersberg, Germany
| | - Wolfram Bohle
- Klinik für Allgemeine Innere Medizin, Gastroenterologie, Hepatologie und Infektiologie, Katharinenhospital, Klinikum Stuttgart, Germany
| | - Fanny Borowitzka
- Department of Internal Medicine 2, Universitätsmedizin Rostock, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, Germany
| | | | - Klaus Dirks
- Gastroenterologie und Innere Medizin, Rems-Murr-Klinikum Winnenden, Germany
| | - Robert Donoval
- Klinik für Gastroenterologie, Diabetologie und Infektiologie, Lausitzer Seenland Klinikum GmbH, Hoyerswerda, Germany
| | - Kristine Drube
- Department of Internal Medicine, Allgemeines Krankenhaus Celle, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Christine Gall
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU IMBE, Erlangen, Germany
| | - Fleur Gittinger
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Martin Gutermann
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | | | - Alexandra von Herbay
- Department of Internal Medicine, Evangelisches Krankenhaus Hamm gGmbH, Hamm, Germany
| | - Chau Hong Ho
- Department of Internal Medicine, Hufeland-Hospital, Mühlhausen, Germany
| | - Rico Hochdoerffer
- Department of Internal Medicine, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Tatjana Hoffmann
- Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Hüttig
- Department of Internal Medicine, DRK-Kliniken Berlin-Köpenick, Berlin, Germany
| | - Christopher Janson
- Department of Internal Medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | | | - Norbert Jung
- Department of Internal Medicine, Klinikum Heidenheim, Germany
| | - Thomas Karlas
- Department of Internal Medicine, Division of Gastroenterology, Universitätsklinikum Leipzig, Germany
| | | | - Adam Kornmehl
- Department of Internal Medicine, Klinikum Weiden, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine, University Hospital Ulm, Germany
| | - Sebastian Krug
- Department of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Georg Kunze
- Internal Medicine, KH Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Jens Leitlein
- Department of Internal Medicine, Klinikum am Steinenberg Reutlingen, Germany
| | - Alexander Link
- Department of Internal Medicine, University Hospital Magdeburg, Germany
| | - Christian Lottspeich
- Medical Clinic and Policlinic IV, Division of Vascular Medicine, Hospital of the Ludwig Maximilians University Hospital, Munich, Germany
| | - Aldo Marano
- Department of Internal Medicine, ViDia Christliche Kliniken Karlsruhe, Germany
| | - Martin Mauch
- Department of Internal Medicine, Innere, Kreisklinik Sigmaringen, Germany
| | - Lukas Moleda
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Golo Petzold
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Andrej Potthoff
- Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Klaus-Dieter Rösner
- Department of Internal Medicine, Barmherzige Brüder Klinikum Sankt Elisabeth Straubing GmbH, Straubing, Germany
| | - Stefan Schanz
- Department of Internal Medicine, Kreisklinikum Siegen gGmbH, Siegen, Germany
| | - Michael Schultheiß
- Department of Internal Medicine, University of Freiburg Hospital, Freiburg, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine, University Hospital Mainz, Department of Internal Medicine 3, Mainz, Germany
| | - Joachim Stock
- Department of Internal Medicine, Klinikum Barnim, Eberswalde, Germany
| | - Thomas Thomsen
- Department of Internal Medicine, Westküstenklinik Brunsbüttel, Brunsbüttel, Germany
| | - Johanna Vogelpohl
- Department of Internal Medicine I, Krankenhaus GmbH Alb-Donau-Kreis Blaubeuren, Germany
| | - Christoph Vogt
- Department of Internal Medicine, St.-Josef-Krankenhaus Moers, Germany
| | - Siegfried Wagner
- Department of Internal Medicine, Donau-Isar-Kliniken Deggendorf, Germany
| | - Christiane Wiegard
- Department of Internal Medicine, University Hospital Hamburg Eppendorf Center of Internal Medicine, Hamburg, Germany
| | - Isabel Wiesinger
- Department of Internal Medicine, Universitätsklinikum Regensburg, Germany
| | - Uwe Will
- Internal Medicine, Klinikum Gera, Gera, Germany
| | - Matthias Ziesch
- Department of Internal Medicine, Diakonissenkrankenhaus Dresden, Germany
| | | | - Deike Strobel
- Department of Internal Medicine 1, University Hospital Erlangen, Germany
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Bitterer F, Hornung M, Platz Batista da Silva N, Schlitt HJ, Stroszczynski C, Wege AK, Jung EM. In vivo detection of breast cancer liver metastases in humanized tumour mice using tumour specific contrast agent BR55®. Clin Hemorheol Microcirc 2021; 76:559-572. [PMID: 32924994 DOI: 10.3233/ch-200898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of high-resolution ultrasound (HRU) for the detection of hepatic metastases of breast cancer in a humanized tumour mouse (HTM) using clinical standard technology. In addition, the efficiency of standard contrast-enhanced ultrasound (CEUS) [microbubbles of sulphur hexafluoride] and CEUS using a novel VEGFR2-targeted contrast agent [BR55®] was examined. METHODS A total of 14 HTM were sonographically examined twice. In addition to a human immune system, the animals developed hepatic tumour lesions after intrahepatic injection of BT-474 breast cancer cells. Digital cine loops from the arterial phase (15-35 sec), the portal venous phase (35-90 sec) and the late phase (3-15 min) of the entire liver were analysed. Data were correlated to histopathology. RESULTS After 9 months, half of the mice (7/14) revealed the development of hepatic breast cancer metastases. The detection limit was 1 mm tumour diameter. In particular, the use of targeted contrast media reduced the needed tumour diameter and helped to precisely classify tumour tissue. In 93% (13/14), the findings of ultrasound could be approved by histological examination by the pathologist. CONCLUSIONS This study in HTM demonstrated the high feasibility of tumour specific contrast media and standard HRU contrast agents to detect early liver metastases.
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Affiliation(s)
- Florian Bitterer
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Hornung
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Hans J Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Anja K Wege
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Jung EM, Wertheimer T, Putz FJ, Jung F, Kammerer S, Pregler B, Luerken L, Stroszczynski C, Beyer L. Contrast enhanced ultrasound (CEUS) with parametric imaging and time intensity curve analysis (TIC) for evaluation of the success of prostate arterial embolization (PAE) in cases of prostate hyperplasia. Clin Hemorheol Microcirc 2020; 76:143-153. [PMID: 32925006 DOI: 10.3233/ch-209202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To evaluate the use of dynamic contrast enhanced ultrasound (CEUS) with parametric color-coded imaging and time intensity curve analysis (TIC) for planning and follow-up after prostate arterial embolization (PAE). MATERIAL/METHOD Before and after selective iliacal embolization by PAE with a follow up of 6 months 18 male patients (43-78 years, mean 63±3.5 years) with histopathological proven benign prostate hyperplasia were examined by one experienced examiner. A multifrequency high resolution probe (1-6 MHz) was used for transabdominal ultrasound and CEUS with bolus injections of 2.4 ml sulphur-hexafluoride microbubbles. Independent evaluation of color-coded parametric imaging before and after PAE by in PACS stored DICOM loops from arterial phase (10-15 s) up to 1min were performed. Criteria for successful treatment were reduction of early arterial enhancement by changes of time to peak (TTP) and area under the curve (AUC) by measurements in 8 regions of interest (ROI) of 5 mm in diameter at the margin and in the center and changes from hyperenhancement in parametric imaging (perfusion evaluation of arterial enhancement over 15 s) from red and yellow to blue and green by partial infarctions. Reference imaging method was the contrast high resolution 3 tesla magnetic resonance tomography (MRI) using 3D vibe sequences before and after PAE and for the follow up after 3 and 6 months. RESULTS PAE was technically and clinically successful in all 18 patients with less clinical symptoms and reduction of the gland volume. In all cases color-coded CEUS parametric imaging was able to evaluate partial infarction after embolization with changes from red and yellow to green and blue colors in the embolization areas. Relevant changes could be evaluated for TIC-analysis of CEUS with reduced arterial enhancement in the arterial phase and prolonged enhancement of up to 1 min with significant changes (p = 0.0024). The area under the curve (AUC) decreased from 676±255.04 rU (160 rU-1049 rU) before PAE to 370.43±255.19 rU (45 rU-858 rU) after PAE. Time to peak (TTP) did not change significantly (p = 0.6877); TTP before PAE was 25.82±9.04 s (12.3 s-42.5 s) and after PAE 24.43±9.10 s (12-39 s). Prostate volume decreased significantly (p = 0.0045) from 86.93±34.98 ml (30-139 ml) before PAE to 50.57±26.26 ml (19-117 ml) after PAE. There were no major complications and, in most cases (14/18) a volume reduction of the benign prostate hyperplasia occurred. CONCLUSION Performed by an experienced examiner CEUS with parametric imaging and TIC-analysis is highly useful to further establish prostatic artery embolization (PAE) as a successful minimal invasive treatment of benign prostatic hyperplasia.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - T Wertheimer
- Department for Internal Medicine III, Hematology and Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - F J Putz
- Department of Nephrology, University Medical Center Regensburg, Regensburg, Germany
| | - F Jung
- Brandenburgische Technische Universität Cottbus-Senftenberg, Institute of Biotechnology, Cottbus, Germany
| | - S Kammerer
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - B Pregler
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L Luerken
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L Beyer
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
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Lerchbaumer MH, Putz FJ, Rübenthaler J, Rogasch J, Jung EM, Clevert DA, Hamm B, Makowski M, Fischer T. Contrast-enhanced ultrasound (CEUS) of cystic renal lesions in comparison to CT and MRI in a multicenter setting. Clin Hemorheol Microcirc 2020; 75:419-429. [PMID: 32039837 DOI: 10.3233/ch-190764] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Contrast-enhanced-ultrasound (CEUS) has been frequently used in assessment of cystic renal lesions. OBJECTIVE The aim of this study was to investigate the Bosniak classification in CEUS compared to CT and MRI in a multi-center setting. METHODS Bosniak classification in CEUS examinations of cystic renal lesions were compared to imaging findings in computed-tomography (ceCT) and magnetic-resonance-imaging (ceMRI). Imaging results were correlated to histopathological reports. All examinations were performed by experts (EFSUMB level 3) using up-to-date CEUS examination-protocols. RESULTS Overall, 173 cystic renal lesions were compared to subgroups CT (n = 87) and MRI (n = 86). Using Bosniak-classification 64/87 renal cysts (73.6%) were rated equal compared to CT with upgrade of four lesions (4.6%) and downgrade of 19 lesions (21.8%) by CT (Intra-class-correlation [ICC] coefficient of 0.824 [p < 0.001]). CEUS compared to MRI, presenting different scoring especially in classes Bosniak IIF (n = 16/31) and Bosniak III (n = 16/28) with an ICC coefficient of 0.651 (p < 0.001). CONCLUSION CEUS can visualize even finest septal and small nodular wall enhancement, which may result in an upgrade of cystic lesions into a higher Bosniak class compared to CT or MRI. Thus, a modification of the Bosniak classification on CEUS may reduce unnecessary biopsies and surgery.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Charité - Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Franz Josef Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Julian Rogasch
- Charité - Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Nuclear Medicine, Berlin, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Dirk-Andre Clevert
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Marcus Makowski
- Charité - Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Thomas Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of FreieUniversität Berlin, Humbold, Universitätzu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Lerchbaumer MH, Kleemann T, Jung EM, Nagel S, Hamm B, Fischer T. Vascular pattern and diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in spleen alterations. Clin Hemorheol Microcirc 2020; 75:177-188. [PMID: 31929153 DOI: 10.3233/ch-190758] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to clarify rare focal splenic lesions (FSL). CEUS is a safe and cost-effective modality for assessment of perfusion. OBJECTIVE To validate contrast enhancement pattern and evaluate the diagnostic accuracy of CEUS in unclear FSL. METHODS CEUS examinations of the spleen in 50 patients between 2012 and 2018 were included in the study. Examinations were performed using B-mode, colour-coded Doppler ultrasound (CCDS) and CEUS after injection of sulphur hexafluoride microbubbles and interpreted in consensus by two experienced radiologists. Reference standard was defined as histopathological report and clinical course (treatment response, long term follow up). RESULTS All patients were successfully examined by CEUS without an adverse reaction. CEUS presented the correct differentiation of benign and malignant alterations in 49/50 (98%). Lesion washout was found in all malignant but also 16.7% of all benign lesions. Matched to the histopathological report and clinical follow up, CEUS represented a sensitivity of 100% (95% -CI, 57-100), a specificity of 98% (95% -CI, 88-100), a positive predictive value (PPV) of 83% (95% -CI, 44-97) and a negative predictive value (NPV) of 100% (95% -CI, 92-100). CONCLUSION CEUS may provide additional information by visualization of dynamic contrast enhancement pattern to differentiate benign and malignant lesions. Nevertheless, established criteria for malignancy (early enhancement or washout) in FSL should be considered with caution since they are also found in benign lesions.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Tobias Kleemann
- Carl-Thiem-Klinikum, Department of Gastroenterology, Cottbus, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Sebastian Nagel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Bernd Hamm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Thomas Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Huf VI, Wohlgemuth WA, Uller W, Piehler AP, Goessmann H, Stroszczynski C, Jung EM. Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel. Clin Hemorheol Microcirc 2020; 76:161-170. [PMID: 32925019 DOI: 10.3233/ch-209215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - A P Piehler
- OnkoMedeor, MVZ Freising Laboratory, Freising, Germany
| | - H Goessmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Georgieva M, Kammerer S, Prantl L, Jung F, Stroszczynski C, Jung EM. Imaging of breast implant and implant-associated complications: Capsular contracture and intra- or extracapsular rupture. Clin Hemorheol Microcirc 2020; 76:221-231. [PMID: 32925022 DOI: 10.3233/ch-209218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In recent years, follow-up after breast reconstruction with silicone implants and the detection of complications have been relieved by the possibility of improved diagnostic methods. METHODS Between January 2015 and December 2019 a total of 40 patients (29-84 years) with silicone implants were included in this retrospective study. The implants were examined clinically and with modern imaging: general ultrasound imaging (US), magnetic resonance imaging (MRI), high resolution computed tomography (CT) and positron emission tomography -computed tomography (PET-CT). If necessary, a histological/cytological sample was taken. The breast implants were assessed by three radiologists specialized in breast imaging. The grade of capsular contracture was classified according to the Baker classification. RESULTS All 40 women obtained a clinical examination and an US diagnostic to identify early and more common complications such as implant folding and capsular fibrosis. Depending on the clinical examination and ultrasound findings additional MRI (n = 10), CT (n = 9) and/or PET-CT (n = 2) were performed. 16 patients had implants folding proven with US (n = 16), MRI (n = 6) and CT (n = 1). The grade of capsular fibrosis was determined according to the Baker classification. The following results were obtained in our study: 25 breast implants with Baker grade I and eleven breast implants with Baker grade II, both proven with US; one breast implants with Baker grade III and one breast implant with Baker grade IV, proven with US (n = 2), MRI (n = 1) and CT (n = 1). One patient had intracapsular rupture and one patient had extracapsular rupture, both detected on CT and surgically proven. No patient had a silicone accumulation in the lymph nodes. One patient had pathologically enlarged axillary lymph nodes, which were evaluated as inflammatory changes in PET-CT. Long-term complications such as the development of malignant breast tumors could not be observed. CONCLUSION To detect early complications after breast implant surgery, a regular clinical examination is indispensable. Imaging methods complement each other and if they are used multimodal, it is easier to identify early complications. Modern diagnostic modalities like ultrasound and magnetic resonance imaging expand the spectrum and improve diagnostic safety.
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Affiliation(s)
- M Georgieva
- Department of Radiology, University Hospital Regensburg, Germany
| | - S Kammerer
- Department of Radiology, University Hospital Regensburg, Germany
| | - L Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center Regensburg, Germany
| | - F Jung
- Brandenburg University of Technology, Molecular Cell Biology, Senftenberg, Germany
| | - C Stroszczynski
- Department of Radiology, University Hospital Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Germany
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Lamby P, Minkow A, Handt S, Falter J, Schellenberg EL, Graf S, Hiebl B, Haerteis S, Gemeinhardt O, Krüger-Genge A, Klosterhalfen B, Jung EM, Franke RP, Momeni A, Prantl L, Jung F. Histological and SEM Assessment of Blood Stasis in Kidney Blood Vessels after Repeated Intra-Arterial Application of Radiographic Contrast Media. Life (Basel) 2020; 10:life10090167. [PMID: 32867158 PMCID: PMC7554859 DOI: 10.3390/life10090167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND After application of iodinated contrast media (CM), a pronounced deterioration of the microcirculation in skin and myocardium was reported. Clinically, the repeated application of CM, especially, led to an increase of the renal resistance index (RRI). With respect to the transiency of the RRI increase, it is reasonable to assume that the deterioration of blood flow could be due to transient blood stasis caused by reversible morphologic cell alterations due to osmotic discrepancies between CM and human blood. Therefore, the hypothesis was investigated whether CM are able to induce in vivo such blood stasis and cell deformations in the renal vasculature of well-hydrated pigs. METHODS The in vivo study was performed as a prospective randomized examination to compare the effects of two different CM in 16 pigs (German Landrace). Pigs were randomized to receive either Iodixanol (n = 8), or Iopromide (n = 8). Each animal received 10 injections separated by 5-min intervals via the suprarenal aorta at a rate of 10 mL/s according to the usual procedure during a cardiac catheter examination. Finally, the kidneys were explanted and processed for histology (H & E staining and fibrin staining according to Weigert) as well as for scanning electron microscopy (SEM) with regards to morphologic correlates explaining the changes in the microcirculation. RESULTS In each of the predefined four categories of vascular diameters, blood stasis were found, but clearly more often after application of Iopromide than after application of Iodixanol (p < 0.001). In addition, Iopromide induced more blood stasis in all of the examined kidney regions compared to Iodixanol (p = 0.0001). There were no obstructive events in the middle cortex following the application of Iodixanol. Except for the region around a puncture channel of a placed-in catheter probe, no fibrin was detected in Weigert's fibrin-stained samples, neither around the histologically assessed thrombi nor in vessels with blood stasis. Complementary SEM analyses revealed in a few cases only a slight generation of fibrin and thrombi and deformations, such as echinocyte and "box-like" deformations. CONCLUSIONS According to previous in vitro studies, pathological erythrocyte deformations, such as echinocyte and box-like formation of erythrocytes, were observed also in vivo. In addition, blood stasis and/or thrombi could be detected in histological samples from explanted kidneys from young pigs after repeated in vivo administration of CM. In only a few cases, mural platelet aggregates within minimal fibrin meshes occurred only after the application of Iopromide.
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Affiliation(s)
- Philipp Lamby
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.F.); (S.G.); (L.P.)
- Correspondence: or
| | - Alexander Minkow
- Institute of Micro and Nanomaterials, University of Ulm, 89081 Ulm, Germany;
| | - Stefan Handt
- Institute for Pathology, 52146 Bardenberg, Germany;
| | - Johannes Falter
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.F.); (S.G.); (L.P.)
| | | | - Stefanie Graf
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.F.); (S.G.); (L.P.)
| | - Bernhard Hiebl
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, Virtual Center for Replacement–Complementary Methods to Animal Testing, University of Veterinary Medicine Hannover, 30173 Hannover, Germany;
| | - Silke Haerteis
- Institute for Molecular and Cellular Anatomy, University of Regensburg, 93053 Regensburg, Germany;
| | - Ole Gemeinhardt
- Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Department of Radiology, Berlin Institute of Health, 10117 Berlin, Germany;
| | - Anne Krüger-Genge
- Department of Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | | | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Ralf-Peter Franke
- Central Institute for Biomedical Engineering, Department of Biomaterials, University of Ulm, 89069 Ulm, Germany;
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA 94304, USA;
| | - Lukas Prantl
- Department of Plastic and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (J.F.); (S.G.); (L.P.)
| | - Friedrich Jung
- Institute of Biotechnology, Brandenburgische Technische Universität Cottbus-Senftenberg, 01968 Cottbus, Germany;
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Jung EM, Stroszczynski C, Jung F. Contrast enhanced ultrasound (CEUS) to assess pleural pulmonal changes in severe COVID-19 infection: First results. Clin Hemorheol Microcirc 2020; 75:19-26. [PMID: 32538830 PMCID: PMC7458509 DOI: 10.3233/ch-209005] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM: Use of contrast enhanced ultrasound (CEUS) in severe cases of COVID-19 infection to assess pulmonary changes near the pleura. MATERIAL AND METHODS: Bedside examinations by an experienced intensive care unit examiner using a multi-frequency probe (C1-6 MHz) with B-mode and CEUS to assess pleural-near changes in severe cases of COVID-19 infection with respiratory failure. CEUS with bolus delivery via a central venous catheter of 2.4 ml Sulphur hexafluoride microbubbles from the arterial phase (10–15 s) to the late phase of 5 min. Digital storage of cine sequences of the lung sound with abdomen for independent assessment with the subsequently performed contrast-enhanced dual-source CT. RESULTS: In 11 intubated and ventilated patients (arithmetic mean 62 years, 48 to 78 years, 3 women) with confirmed severe COVID-19 infections, a peripherally accentuated consolidation with irregular hyperemia was found in the CEUS and also in the CT examination. Of the 5 cases with pulmonary arterial embolisms, signs of right ventricular failure were found. In all cases, using CEUS low perfused areas of the pleura with adjacent hyperemia could be detected, while, with CT segmental contrast medium, gaps with subpleural compressions were found. Interstitial changes near the pleura led to B-lines and to ground glass opacities in the CT. Near the diaphragm a delayed arterial contrast of the liver was observed. In addition, in 2 cases partial atelectasis, in 3 cases marginal pleural effusions were found. CONCLUSION: CEUS opens up new possibilities for bedside monitoring of pleural reactive inflammatory or peripheral thrombus embolism in severe cases of COVID-19 infection.
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Affiliation(s)
- E M Jung
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology, Senftenberg, Germany
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Auer TA, Fischer T, Garcia SRM, Penzkofer T, Jung EM, Hamm B, Lerchbaumer MH. Value of contrast-enhanced ultrasound (CEUS) in Focal Liver Lesions (FLL) with inconclusive findings on cross-sectional imaging. Clin Hemorheol Microcirc 2020; 74:327-339. [PMID: 31658052 DOI: 10.3233/ch-190718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to evaluate focal liver lesions. CEUS is easy and fast to perform, overcomes the limitations of B-mode US. OBJECTIVE To evaluate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in focal liver lesions (FLL) with unclear findings on computed tomography (CT) or magnetic resonance imaging (MRI). METHODS In this single-center retrospective study, 146 patients with at least one FLL underwent additional CEUS of the liver to clarify inconclusive cross-sectional imaging findings. Ultrasonography was performed using B-mode imaging and CEUS after injection of sulphur hexafluoride microbubbles (second-generation contrast agent) within two months after ceMRI or ceCT and interpreted by an experienced radiologist (EFSUMB level 3). Histopathological reports, long-term follow-up or clinical course served as reference standard. RESULTS Thirty-eight of the 146 patients had malignant and 108 benign FLL. Overall, CEUS had 92% sensitivity (95% -CI, 79-97) and 98% specificity (95% -CI, 93-99) with an AUC of 0.95 in correctly characterizing the lesion as malignant or benign. Sensitivity increased to 98% (95% -CI, 96-100) for benign lesions and decreased to 92% (95% -CI, 78-98) for malignant lesions. CEUS showed the highest diagnostical accuracy in lesion <1 cm with an AUC of 1.000, while the lowest accuracy was achieved in lesions >2 cm with an AUC of 0.924 due to a decreasing specificity of 86% (95% -CI, 87-100). CONCLUSION CEUS correctly distinguished malignant from benign FLL in cases with inconclusive cross-sectional imaging findings and achieved high levels of diagnostic accuracy. CEUS has added diagnostic value especially in small lesions ≤1 cm while specificity remains limited in larger lesions.
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Affiliation(s)
| | - Thomas Fischer
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | | | - Tobias Penzkofer
- Department of Radiology, Charité - University Medicine Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ernst-Michael Jung
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - University Medicine Berlin, Germany
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Jung EM, Stroszczynski C, Jung F. Contrast enhanced ultrasonography (CEUS) to detect abdominal microcirculatory disorders in severe cases of COVID-19 infection: First experience. Clin Hemorheol Microcirc 2020; 74:353-361. [PMID: 32333581 PMCID: PMC7369109 DOI: 10.3233/ch-209003] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the hands of experienced examiners, the contrast enhanced sonography (CEUS) offers the possibility to analyze dynamic microcirculatory disturbances in real time dynamically without any risk for kidneys and thyroid gland even in severe progressing disease bedside. Based on severe COVID-19 infections, first experiences with abdominal CEUS examinations are presented. In the stage of an imminent organ failure with significantly reduced kidney and liver function, CEUS can be used to show a narrowing of the organ-supplying arteries, as well as a delayed capillary filling of vessels near the capsule, a regional reduced parenchymal perfusion or an inflammatory hyperemia with capillary hypercirculation. It is possible to quickly rule out organ infarction and to dynamically record the mesenteric arterial and venous blood flow.
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Affiliation(s)
- E M Jung
- Institute of Diagnostic Radiology, University Hospital, Regensburg, Germany.,Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - C Stroszczynski
- Interdisciplinary Ultrasound Department, University Hospital, Regensburg, Germany
| | - F Jung
- Institute of Biotechnology, Brandenburg University of Technology, Senftenberg, Germany
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Fischer C, Krix M, Weber MA, Loizides A, Gruber H, Jung EM, Klauser A, Radzina M, Dietrich CF. Contrast-Enhanced Ultrasound for Musculoskeletal Applications: A World Federation for Ultrasound in Medicine and Biology Position Paper. Ultrasound Med Biol 2020; 46:1279-1295. [PMID: 32139152 DOI: 10.1016/j.ultrasmedbio.2020.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 06/10/2023]
Abstract
This World Federation for Ultrasound in Medicine and Biology position paper reviews the diagnostic potential of ultrasound contrast agents for clinical decision-making and provides general advice for optimal contrast-enhanced ultrasound performance in musculoskeletal issues. In this domain, contrast-enhanced ultrasound performance has increasingly been investigated with promising results, but still lacks everyday clinical application and standardized techniques; therefore, experts summarized current knowledge according to published evidence and best personal experience. The goal was to intensify and standardize the use and administration of ultrasound contrast agents to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
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Affiliation(s)
- Christian Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany.
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Alexander Loizides
- Department of Radiology, Ultrasound Center, Innsbruck Medical University, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Ultrasound Center, Innsbruck Medical University, Innsbruck, Austria
| | | | - Andrea Klauser
- Department of Radiology, Ultrasound Center, Innsbruck Medical University, Innsbruck, Austria
| | - Maija Radzina
- Diagnostic Radiology Institute, Riga Stradins University, Riga, Latvia
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Lerchbaumer MH, Auer TA, Marticorena GS, Stephan C, Hamm B, Jung EM, Fischer T. Diagnostic performance of contrast-enhanced ultrasound (CEUS) in testicular pathologies: Single-center results. Clin Hemorheol Microcirc 2019; 73:347-357. [DOI: 10.3233/ch-190579] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Markus Herbert Lerchbaumer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Timo Alexander Auer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Garcia Stephan Marticorena
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Carsten Stephan
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Urology and Berlin Institute for Urologic Research, Berlin, Germany
| | - Bernd Hamm
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Ernst-Michael Jung
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - Thomas Fischer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Gerk U, Franke RP, Jung EM, Scheller B, Krüger-Genge A, Jung F. Imaging of coronary arteries using ionic versus non-ionic radiographic contrast media: Intraindividual comparison study. Clin Hemorheol Microcirc 2019; 73:35-42. [PMID: 31561345 DOI: 10.3233/ch-199217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- U Gerk
- Krankenhaus Dresden-Friedrichstadt, II. Medizinische Klinik, Dresden, Germany
| | - R P Franke
- Department of Biomaterials, University of Ulm, Ulm, Germany
| | - E M Jung
- Institute for Radiology, University of Regensburg, Regensburg, Germany
| | - B Scheller
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Krüger-Genge
- Fraunhofer Institute Applied Polymer Research (IAP), Division of Life Science and Bioprocesses, Department of Biomaterials and Healthcare, Potsdam-Golm, Germany
| | - F Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
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Maxeiner A, Fischer T, Schwabe J, Baur ADJ, Stephan C, Peters R, Slowinski T, von Laffert M, Marticorena Garcia SR, Hamm B, Jung EM. Contrast-Enhanced Ultrasound (CEUS) and Quantitative Perfusion Analysis in Patients with Suspicion for Prostate Cancer. Ultraschall Med 2019; 40:340-348. [PMID: 29874683 DOI: 10.1055/a-0594-2093] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to investigate contrast-enhanced ultrasound (CEUS) parameters acquired by software during magnetic resonance imaging (MRI) US fusion-guided biopsy for prostate cancer (PCa) detection and discrimination. MATERIALS AND METHODS From 2012 to 2015, 158 out of 165 men with suspicion for PCa and with at least 1 negative biopsy of the prostate were included and underwent a multi-parametric 3 Tesla MRI and an MRI/US fusion-guided biopsy, consecutively. CEUS was conducted during biopsy with intravenous bolus application of 2.4 mL of SonoVue® (Bracco, Milan, Italy). In the latter CEUS clips were investigated using quantitative perfusion analysis software (VueBox, Bracco). The area of strongest enhancement within the MRI pre-located region was investigated and all available parameters from the quantification tool box were collected and analyzed for PCa and its further differentiation was based on the histopathological results. RESULTS The overall detection rate was 74 (47 %) PCa cases in 158 included patients. From these 74 PCa cases, 49 (66 %) were graded Gleason ≥ 3 + 4 = 7 (ISUP ≥ 2) PCa. The best results for cancer detection over all quantitative perfusion parameters were rise time (p = 0.026) and time to peak (p = 0.037). Within the subgroup analysis (> vs ≤ 3 + 4 = 7a (ISUP 2)), peak enhancement (p = 0.012), wash-in rate (p = 0.011), wash-out rate (p = 0.007) and wash-in perfusion index (p = 0.014) also showed statistical significance. CONCLUSION The quantification of CEUS parameters was able to discriminate PCa aggressiveness during MRI/US fusion-guided prostate biopsy.
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Affiliation(s)
| | - Thomas Fischer
- Radiology, Charité - Universitätsmedizin Berlin, Germany
| | - Julia Schwabe
- Radiology, Charité - Universitätsmedizin Berlin, Germany
| | | | | | - Robert Peters
- Urology, Charité - Universitätsmedizin Berlin, Germany
| | | | | | | | - Bernd Hamm
- Radiology, Charité - Universitätsmedizin Berlin, Germany
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Schelker RC, Andorfer K, Putz F, Herr W, Jung EM. Identification of two distinct hereditary hemorrhagic telangiectasia patient subsets with different hepatic perfusion properties by combination of contrast-enhanced ultrasound (CEUS) with perfusion imaging quantification. PLoS One 2019; 14:e0215178. [PMID: 30973932 PMCID: PMC6459476 DOI: 10.1371/journal.pone.0215178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/27/2019] [Indexed: 12/27/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is marked by arteriovenous fusion comprising hepatic vascular malformations (HVaMs) with the chance of bleeding. Aims We investigated HVaMs in HHT patients by combination of contrast-enhanced ultrasound (CEUS) with perfusion imaging quantification to be able to sub-classify a high risk cohort of asymptomatic HHT patients. Methods The imaging characteristics on CEUS in 34 patients (aged 21–84 years; mean 58.9) with HHT were retrospectively evaluated. Real-time contrast harmonic imaging, sulfur hexafluoride-filled microbubbles and motion adjustment were utilized. Cine loops of the liver were digital stored, perfusion was quantified using a software reading DICOM data`s. Results HVaMs were diagnosed in 31 out of 34 patients. Significant uppermost peak enhancement (PE), wash-in area under the curve (WiAUC) and wash-in perfusion index (WiPI) were identified in the shunt region (100%), next in the hilar region (PE 32.6%; WiAUC 33.9%; WiPI 34.1%), and the lowest in the hepatic parenchyma (PE 10.2%; WiAUC 12.0%; WiPI 9.5%). The perfusion parameters in the shunt region compared to the other regions were significantly increased in one subgroup of patients. Consistent with this, the intrahepatic portal vein diameter and Buscarini grading was significantly higher, while portal vein peak velocity was significantly lower in this patient subset. By statistical analysis, we could correlate PE and WiPI to these clinical parameters, while WiAUC showed no clinical association. Conclusions For the first time we combined CEUS findings with motion adjustment software to quantitative determine perfusion parameters of a cohort of HHT patients. Hereby, we could identify a subset of HHT patients with two markedly increased parameter values in the shunt region compared to the hilus/hepatic parenchyma. This could contribute to sub-classify a high-risk group of HHT patients with therapeutic indication.
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Affiliation(s)
- Roland C. Schelker
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
- * E-mail:
| | - Kornelia Andorfer
- Department of Ear-Nose-Throat, University Hospital of Regensburg, Regensburg, Germany
| | - Franz Putz
- Department of Nephrology, University Hospital of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital of Regensburg, Regensburg, Germany
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Probst U, Sieron D, Bruenn K, Fuhrmann I, Verloh N, Stroszczynski C, Jung EM, Wiggermann P, Haimerl M. Efficacy of dynamic enhancement effects on Gd-EOB-DTPA-enhanced MRI for estimation of liver function assessed by 13C- Methacetin breath test. Clin Hemorheol Microcirc 2019; 70:595-604. [DOI: 10.3233/ch-189324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ute Probst
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Dominik Sieron
- Department of Radiology, Inselspital Tiefenau, Bern, Switzerland
| | - Karin Bruenn
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Irene Fuhrmann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Niklas Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Ernst-Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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