Publications by authors named "Constantin Marschner"

19 Publications

  • Page 1 of 1

Differences in Cardiac Magnetic Resonance Imaging Markers Between Patients With COVID-19-associated Myocardial Injury and Patients With Clinically Suspected Myocarditis.

J Thorac Imaging 2021 Jun 9. Epub 2021 Jun 9.

Departments of Radiology Medicine I COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Germany.

Purpose: Coronavirus 2019 disease (COVID-19) has been shown to affect the myocardium, resulting in a worse clinical outcome. In this registry study, we aimed to identify differences in cardiac magnetic resonance imaging (CMRI) between COVID-19 and all-cause myocarditis.

Materials And Methods: We examined CMRI of patients with COVID-19 and elevated high-sensitivity serum troponin levels performed between March 31st and May 5th and compared them to CMRI of patients without SARS-CoV-2 infection with suspected myocarditis in the same time period. For this purpose, we evaluated Lake-Louise Criteria for myocarditis by determining nonischemic myocardial injury via T1-mapping, extracellular volume, late gadolinium enhancement, and myocardial edema (ME) by T2-mapping and fat-saturated T2w imaging (T2Q).

Results: A total of 15 of 18 (89%) patients with COVID-19 had abnormal findings. The control group consisted of 18 individuals. There were significantly fewer individuals with COVID-19 who had increased T2 (5 vs. 10; P=0.038) and all-cause ME (7 vs. 15; P=0.015); thus, significantly fewer patients with COVID-19 fulfilled Lake-Louise Criteria (6 vs. 17; P<0.001). In contrast, nonischemic myocardial injury was not significantly different. In the COVID-19 group, indexed end-diastolic volume of the left ventricle showed a significant correlation to the extent of abnormal T1 (R2=0.571; P=0.017) and extracellular volume (R2=0.605; P=0.013) and absolute T1, T2, and T2Q (R2=0.644; P=0.005, R2=0.513; P=0.035 and R2=0.629; P=0.038, respectively); in the control group, only extracellular volume showed a weak correlation (R2=0.490; P=0.046).

Conclusions: Cardiac involvement in COVID-19 seems to show less ME than all-cause myocarditis. Abnormal CMRI markers correlated to left ventricle dilation only in the COVID-19 group. Larger comparative studies are needed to verify our findings.
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http://dx.doi.org/10.1097/RTI.0000000000000599DOI Listing
June 2021

Structured Reporting in the Characterization of Renal Cysts by Contrast-Enhanced Ultrasound (CEUS) Using the Bosniak Classification System-Improvement of Report Quality and Interdisciplinary Communication.

Diagnostics (Basel) 2021 Feb 15;11(2). Epub 2021 Feb 15.

Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.

Background: This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification.

Methods: Fifty patients with cystic renal lesions who underwent CEUS were included in this single-center study. FTR created in clinical routine were compared to SR retrospectively generated by using a structured reporting template. Two experienced urologists evaluated the reports regarding integrity, effort for information extraction, linguistic quality, and overall quality.

Results: The required information could easily be extracted by the reviewers in 100% of SR vs. 82% of FTR ( < 0.001). The reviewers trusted the information given by SR significantly more with a mean of 5.99 vs. 5.52 for FTR ( < 0.001). SR significantly improved the linguistic quality (6.0 for SR vs. 5.68 for FTR ( < 0.001)) and the overall report quality (5.98 for SR vs. 5.58 for FTR ( < 0.001)).

Conclusions: SR significantly increases the quality of radiologic reports in CEUS examinations of cystic renal lesions compared to conventional FTR and represents a promising approach to facilitate interdisciplinary communication in the future.
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http://dx.doi.org/10.3390/diagnostics11020313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919270PMC
February 2021

Structured Reporting Using CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma (HCC)-Impact and Advantages on Report Integrity, Quality and Interdisciplinary Communication.

Cancers (Basel) 2021 Jan 31;13(3). Epub 2021 Jan 31.

Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.

Background: Our retrospective single-center study aims to evaluate the impact of structured reporting (SR) using a CEUS LI-RADS template on report quality compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC).

Methods: We included 50 patients who underwent CEUS for HCC staging. FTR created after these examinations were compared to SR retrospectively generated by using template-based online software with clickable decision trees. The reports were evaluated regarding report completeness, information extraction, linguistic quality and overall report quality by two readers specialized in internal medicine and visceral surgery.

Results: SR significantly increased report completeness with at least one key feature missing in 31% of FTR vs. 2% of SR ( < 0.001). Information extraction was considered easy in 98% of SR vs. 86% of FTR ( = 0.004). The trust of referring physicians in the report was significantly increased by SR with a mean of 5.68 for SR vs. 4.96 for FTR ( < 0.001). SR received significantly higher ratings regarding linguistic quality (5.79 for SR vs. 4.83 for FTR ( < 0.001)) and overall report quality (5.75 for SR vs. 5.01 for FTR ( < 0.001)).

Conclusions: Using SR instead of conventional FTR increases the overall quality of reports in CEUS examinations of HCC patients and may represent a valuable tool to facilitate clinical decision-making and improve interdisciplinary communication in the future.
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http://dx.doi.org/10.3390/cancers13030534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866827PMC
January 2021

Benefits of contrast-enhanced ultrasonography for interventional procedures.

Ultrasonography 2021 Apr 19;40(2):207-216. Epub 2020 Nov 19.

Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.

For evaluating unclear tumorous lesions, contrast-enhanced ultrasonography (CEUS) is an important imaging modality in addition to contrast-enhanced computed tomography and magnetic resonance imaging, and may provide valuable insights into the microvascularization of tumors in dynamic examinations. In interventional procedures, CEUS can make a valuable contribution in pre-, peri-, and post-interventional settings, reduce radiation exposure and, under certain circumstances, decrease the number of interventions needed for patients.
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http://dx.doi.org/10.14366/usg.20083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994736PMC
April 2021

Evaluation of the Diagnostic Value of Contrast-Enhanced Voiding Urosonography with Regard to the Further Therapy Regime and Patient Outcome-A Single-Center Experience in an Interdisciplinary Uroradiological Setting.

Medicina (Kaunas) 2021 Jan 9;57(1). Epub 2021 Jan 9.

Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.

: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. : Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). : Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. : With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.
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http://dx.doi.org/10.3390/medicina57010056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826578PMC
January 2021

Contrast-Enhanced Ultrasound (CEUS) for the Evaluation of Bosniak III Complex Renal Cystic Lesions-A 10-Year Specialized European Single-Center Experience with Histopathological Validation.

Medicina (Kaunas) 2020 Dec 12;56(12). Epub 2020 Dec 12.

Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany.

: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. : 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010-2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). : CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. : CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future.
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http://dx.doi.org/10.3390/medicina56120692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763943PMC
December 2020

Contrast-Enhanced Ultrasound for Assessing Abdominal Conditions in Pregnancy.

Medicina (Kaunas) 2020 Dec 8;56(12). Epub 2020 Dec 8.

Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany.

: Native ultrasound is the most common imaging modality in obstetrics. The use of contrast-enhanced ultrasound (CEUS) during pregnancy has not been officially approved by leading societies for obstetrics and ultrasound. The present study aims to monitor the safety and diagnostic performance of CEUS for assessing abdominal issues in five pregnant women. : Five pregnant patients who underwent a total of 11 CEUS examinations between June 2020 and October 2020 were included (mean age: 34 years; mean time of pregnancy: 21 weeks). All CEUS scans were interpreted by one experienced consultant radiologist (EFSUMB Level 3). : Upon contrast application, no maternal nor fetal adverse effects were observed. Moreover, no fetal contrast enhancement was observed in any patient. CEUS helped to diagnose renal angiomyolipoma, pyelonephritis, necrotic uterine fibroid, gallbladder polyp, and superior mesenteric vein thrombosis. : In our study, off-label use of CEUS showed an excellent safety profile allowing the avoidance of ionizing radiation exposure as well as contrast agents in case of CT or use of gadolinium-based contrast agents in case of MRI. CEUS is a promising diagnostic instrument for facilitating clinical decision-making and improving the management of pregnant women.
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http://dx.doi.org/10.3390/medicina56120675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762549PMC
December 2020

Diagnostic Performance of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Solid Renal Masses.

Medicina (Kaunas) 2020 Nov 19;56(11). Epub 2020 Nov 19.

Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany.

Background: The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses.

Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent.

Results: Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%).

Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.
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http://dx.doi.org/10.3390/medicina56110624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699268PMC
November 2020

Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI-CEUS) in Oncology.

Cancers (Basel) 2020 Sep 30;12(10). Epub 2020 Sep 30.

Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany.

Fusion imaging depicts an innovative technique that facilitates combining assets and reducing restrictions of advanced ultrasound and cross-sectional imaging. The purpose of the present retrospective study was to evaluate the role of fusion imaging for assessing hepatic and renal lesions. Between 02/2011-08/2020, 92 patients in total were included in the study, of which 32 patients had hepatic lesions, 60 patients had renal lesions. Fusion imaging was technically successful in all patients. No adverse side effects upon intravenous (i.v.) application of (, Milan, Italy) were registered. Fusion imaging could clarify all 11 (100%) initially as indeterminate described hepatic lesions by computed tomography/magnetic resonance imaging (CT/MRI). Moreover, 5/14 (36%) initially suspicious hepatic lesions could be validated by fusion imaging, whereas in 8/14 (57%), malignant morphology was disproved. Moreover, fusion imaging allowed for the clarification of 29/30 (97%) renal lesions initially characterized as suspicious by CT/MRI, of which 19/30 (63%) underwent renal surgery, histopathology revealed malignancy in 16/19 (84%), and benignity in 3/19 (16%). Indeterminate findings could be elucidated by fusion imaging in 20/20 (100%) renal lesions. Its accessibility and repeatability, even during pregnancy and in childhood, its cost-effectiveness, and its excellent safety profile, make fusion imaging a promising instrument for the thorough evaluation of hepatic and renal lesions in the future.
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http://dx.doi.org/10.3390/cancers12102821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600560PMC
September 2020

Single-center study: dynamic contrast-enhanced ultrasound in the diagnostic assessment of carotid body tumors.

Quant Imaging Med Surg 2020 Sep;10(9):1739-1747

Department of Radiology, University Hospital, LMU Munich-Grosshadern Campus, Munich, Germany.

Background: Carotid body tumors (CBTs) depict the most common paraganglioma of the head and neck that can metastasize in up to 15% of cases. They develop either sporadically or hereditarily and may produce catecholamines ("functioning CBTs") resulting in associated symptoms like headache, palpitations or flush. Non-functioning CBTs usually present as slowly and often tender growing mass which may affect adjacent cranial nerves. CBTs can be visualized by ultrasound, CT, MRI or angiography. Pre-surgical interventional embolization, surgical resection and radiation therapy are therapeutical options. The aim of this retrospective single-center study is to assess the safe and real-time evaluation of CBTs by contrast-enhanced ultrasound (CEUS).

Methods: Ten patients with CBT were included in this study on whom CEUS was performed between 2007-2018 (mean age: 62 years). In 6/10 patients, results were confirmed by MRI, 4/12 patients underwent subsequent angiography. CEUS was performed and interpreted by a single consultant radiologist with experience since 2000 (EFSUMB level 3). VueBox software was used for standardized perfusion quantification.

Results: CEUS allowed to detect all CBTs and visualize intratumoral microcirculation. Perfusion quantification was performed in 6/10 cases. CBTs showed significantly reduced peak-enhancement (PE), reduced wash-in perfusion index (WiPI) and significantly elevated time to peak (TTP) compared to common carotid arteries (CCA).

Conclusions: CEUS is a useful and safe tool for identifying CBTs and evaluating intratumoral microperfusion at high spatial and temporal resolutions in real-time. In addition to conventional ultrasound, CT, MRI and digital substraction angiography (DSA), CEUS may be implemented in the future diagnostic work-up and follow-up of CBT patients.
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http://dx.doi.org/10.21037/qims-19-920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417754PMC
September 2020

Safe and pivotal approaches using contrast-enhanced ultrasound for the diagnostic workup of non-obstetric conditions during pregnancy, a single-center experience.

Arch Gynecol Obstet 2021 01 6;303(1):103-112. Epub 2020 Aug 6.

Department of Radiology, University Hospital LMU, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany.

Purpose: Conventional ultrasound is the main imaging modality in obstetrics for assessing the maternal and fetal status. Up to date, contrast-enhanced ultrasound (CEUS) has not found widespread use in gynecology and obstetrics, but recent studies demonstrate promising results. The aim of the present study is to assess safe and valuable application of CEUS during pregnancy to investigate non-obstetric conditions.

Methods: Five pregnant patients on whom CEUS was performed between 2019 and 2020 were included in this retrospective single-center study. A total of six CEUS examinations were performed including one CEUS-guided biopsy (mean age: 31 years, mean weeks of pregnancy: 18 weeks). CEUS examinations were performed by a consultant radiologist (EFSUMB level 3).

Results: All included pregnant women safely underwent CEUS. Neither maternal nor fetal adverse effects were detected. CEUS critically helped in the diagnostic workup of a desmoid tumor of the abdominal wall, hepatic hemangioma, amebic hepatic abscess, uncomplicated renal cyst and post-inflammatory alteration of the renal cortex and for excluding active abdominal bleeding. In addition, CEUS-guided biopsy was performed to prevent intratumoral hemorrhage. Findings from CEUS prompted immediate treatment in two women, whereas in three women regular obstetric monitoring of the women could be conducted.

Conclusion: Our results demonstrate safe and crucial application of off-label CEUS in pregnant women to assess different non-obstetric conditions allowing to prevent additional ionizing CT or application of (gadolinium-based) contrast agent in MRI. Hence, CEUS might add pivotal value for evaluating obstetric and non-obstetric conditions and thereby directing clinical management of pregnant women in the future.
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http://dx.doi.org/10.1007/s00404-020-05735-8DOI Listing
January 2021

Contrast-Enhanced Ultrasound (CEUS) for Follow-Up of Bosniak 2F Complex Renal Cystic Lesions-A 12-Year Retrospective Study in a Specialized European Center.

Cancers (Basel) 2020 Aug 4;12(8). Epub 2020 Aug 4.

Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany.

Bosniak 2F renal cystic lesions feature morphologic characteristics between Bosniak I and III categories, the majority of which remain benign. However, a minor part of Bosniak 2F lesions may progress to malignancy. The purpose of this study was to assess Bosniak 2F cystic lesions during follow-up examinations by CEUS. One-hundred-and-twelve out of 364 patients with Bosniak 2F lesions underwent follow-up CEUS examinations between February 2008 and February 2020. Twelve out of 364 patients underwent renal surgery without follow-up CEUS. The progression rate of Bosniak 2F renal lesions detected by CEUS accounted for 7.1% (8/112 patients) after a mean of 12.9 months. The first follow-up CEUS revealed 75% of progressions (6/8), the remaining 25% (2/8) of progressions were detected during second follow-up CEUS. Underlying clear-cell renal cell carcinoma was histopathologically validated in 5/8 progressive complex cystic renal lesions. Stable sonomorphologic features were observed in 92.1% (104/112 patients). CEUS depicts a promising diagnostic imaging modality in the diagnostic work-up and follow-up of complex renal cystic lesions at higher spatial and temporal resolutions than CT or MRI. Its excellent safety profile, its easy and repeatable accessibility, and low financial costs render CEUS an attractive and powerful alternative imaging tool for monitoring complex renal cystic lesions.
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http://dx.doi.org/10.3390/cancers12082170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465614PMC
August 2020

Diagnostic value of contrast-enhanced ultrasound versus computed tomography for hepatocellular carcinoma: a retrospective, single-center evaluation of 234 patients.

J Int Med Res 2020 Jun;48(6):300060520930151

Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.

Objective: Hepatocellular carcinoma (HCC) is the most common cause of primary liver cancer. A major part of diagnostic HCC work-up is based on imaging findings from sonography, computed tomography (CT), or magnetic resonance imaging (MRI) scans. Contrast-enhanced ultrasound (CEUS) allows for the dynamic assessment of the microperfusion pattern of suspicious liver lesions. This study aimed to evaluate the diagnostic value of CEUS compared with CT scans for assessing HCC.

Methods: We performed a retrospective, single-center study between 2004 and 2018 on 234 patients with suspicious liver lesions who underwent CEUS and CT examinations. All patients underwent native B-mode, color Doppler and CEUS after providing informed consent. Every CEUS examination was performed and interpreted by a single experienced radiologist (European Federation of Societies for Ultrasound in Medicine and Biology level 3).

Results: CEUS was performed on all included patients without occurrence of any adverse effects. CEUS showed a sensitivity of 94%, a specificity of 70%, a positive predictive value of 93% and a negative predictive value of 72% for analyzing HCC compared with CT as the diagnostic gold standard.

Conclusions: CEUS has an excellent safety profile and shows a high diagnostic accuracy in assessing HCC compared with corresponding results from CT scans.
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http://dx.doi.org/10.1177/0300060520930151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294502PMC
June 2020

Multiparametric ultrasonographic analysis of testicular tumors: a single-center experience in a collective of 49 patients.

Scand J Urol 2020 Jun 25;54(3):241-247. Epub 2020 May 25.

Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.

The aim of the present retrospective single-center study is to evaluate the diagnostic performance of multiparametric ultrasonography for characterizing testicular tumors. Forty-nine patients with testicular tumors, 36 of malignant vs 13 of benign entity, were included in this retrospective single-center study on whom multiparametric sonography, encompassing native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) and elastography, was performed between 2011-2018. In 48 of 49 patients, findings from multiparametric analysis were correlated with histopathological results. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Multiparametric ultrasonography was successfully performed in all included patients without any adverse effects. Concomitant testicular microlithiasis, rapid arterial wash-in, elevated values for perfusion quantification - Peak Enhancement (PE), Wash-in Area Under the Curve (WiAUC) and Wash-in Perfusion Index (WiPI) - and higher shear wave velocities were significantly associated with malignancy. Multiparametric ultrasonography depicts a non-ionizing, directly accessible and cost-effective imaging modality that allows for the extensive characterization of testicular tumors, thereby helping to discriminate between malignant and benign entity of testicular tumors.
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http://dx.doi.org/10.1080/21681805.2020.1765863DOI Listing
June 2020

Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions.

Rofo 2020 Nov 15;192(11):1053-1059. Epub 2020 Apr 15.

Department of Radiology, Ludwig-Maximilians-University Munich, Germany.

Purpose:  To compare the sensitivity and specificity of contrast-enhanced ultrasound (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of unclear renal lesions to the histopathological outcome.

Materials And Methods:  A total of 255 patients with a single unclear renal mass with initial imaging studies between 2005 and 2015 were included. Patient ages ranged from 18 to 86 with (mean age 62 years; SD ± 13). CEUS (255 patients), CT (88 out of 255 patients; 34.5 %) and MRI (36 out of 255 patients; 14.1 %) were used for determining malignancy or benignancy and initial findings were correlated with the histopathological outcome.

Results:  CEUS showed a sensitivity of 99.1 % (95 % confidence interval (CI): 96.7 %, 99.9 %), a specificity of 80.5 % (95 % CI: 65.1 %, 91.2 %), a positive predictive value (PPV) of 96.4 % (95 % CI: 93.0 %, 98.4 %) and a negative predictive value (NPV) of 94.3 % (95 % CI: 80.8 %, 99.3 %). CT showed a sensitivity of 97.1 % (95 % CI: 89.9 %, 99.6 %), a specificity of 47.4 % (95 % CI: 24.4 %, 71.1 %), a PPV of 87.0 % (95 % CI: 77.4 %, 93.6 %) and a NPV of 81.8 % (95 % CI: 48.2 %, 97.7 %). MRI showed a sensitivity of 96.4 % (95 % CI: 81.7 %, 99.9 %), a specificity of 75.0 % (95 % CI: 34.9 %, 96.8 %), a PPV of 93.1 % (95 % CI: 77.2 %, 99.2 %) and a NPV of 85.7 % (95 % CI: 42.1 %, 99.6 %). Out of the 212 malignant lesions a total of 130 clear cell renal carcinomas, 59 papillary renal cell carcinomas, 7 chromophobe renal cell carcinomas, 4 combined clear cell and papillary renal cell carcinomas and 12 other malignant lesions, e. g. metastases, were diagnosed. Out of the 43 benign lesions a total 10 angiomyolipomas, 3 oncocytomas, 8 benign renal cysts and 22 other benign lesions, e. g. renal adenomas were diagnosed. Using CEUS, 10 lesions were falsely identified as malignant or benign, whereas 8 lesions were false positive and 2 lesions false negative.

Conclusion:  CEUS is an useful method which can be additionally used to clinically differentiate between malignant and benign renal lesions. CEUS shows a comparable sensitivity, specificity, PPV and NPV to CT and MRI. In daily clinical routine, patients with contraindications for other imaging modalities can particularly benefit using this method.

Key Points:   · Wide availability. · Safe applicability in patients with known renal insufficiency or allergies to iodine or gadolinium. · Comparable sensitivity, specificity, PPV and NPV to CT and MRT. · May lead to a reduction in interventional radiological or surgical interventions.

Citation Format: · Marschner CA, Ruebenthaler J, Schwarze V et al. Comparison of computed tomography (CT), magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear renal lesions. Fortschr Röntgenstr 2020; 192: 1053 - 1058.
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http://dx.doi.org/10.1055/a-1127-3371DOI Listing
November 2020

Single-center study: the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing renal oncocytoma.

Scand J Urol 2020 Apr 12;54(2):135-140. Epub 2020 Mar 12.

Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany.

The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the evaluation of renal oncocytoma. Thirteen patients with histopathologically confirmed renal oncocytoma and 26 patients with histopathologically confirmed renal cell carcinoma were included in this retrospective single-center study on whom CEUS was performed between 2005 and 2015. The applied contrast agent was a second-generation blood pool agent. CEUS examinations were performed and interpreted by a single radiologist with more than 15 years of experience (EFSUMB Level 3). CEUS examinations were successfully performed in all included patients without any adverse effects. Renal oncocytomas showed varying echogenicity (46% hypoechoic, 23% hyperechoic, 8% iso-/hyperechoic, 8% isoechoic). In two cases renal oncocytoma only demarcated upon i.v. application of contrast medium. In bilateral oncocytosis, lesions presented as hyperechoic. Only 23% of renal oncocytomas showed slight vascularization using Color Doppler. No oncocytoma-specific pattern of microperfusion could be elucidated: 85% of the oncocytomas presented hyperenhancing, of whom 50% also showed delayed venous wash-out; 8% of renal oncocytomas showed venous wash-out without early arterial hyperenhancement. Within the frame of the present study and in line with the recent state of knowledge, no specific sonomorphological feature - including CEUS - could be detected allowing for adequate discrimination between oncocytoma and renal cell carcinoma.
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http://dx.doi.org/10.1080/21681805.2020.1736621DOI Listing
April 2020

Overview of ultrasound applications for assessing scrotal disorders.

J Ultrasound Med 2020 Jun 16;39(6):1047-1056. Epub 2019 Dec 16.

Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany.

The scrotum may be affected by a plethora of different disorders such as infections, vasculopathies, trauma, and manifestations of primary and secondary malignant masses. In addition to the patient's medical history and clinical examination, ultrasound represents the imaging modality of choice to assess scrotal disorders. Time-consuming contrast-enhanced ultrasound and elastography can provide further information to distinguish between benign and malignant testicular mass lesions. The following invited Special Communication gives a comprehensive overview of differential diagnoses of the scrotum and their corresponding sonomorphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.
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http://dx.doi.org/10.1002/jum.15197DOI Listing
June 2020

Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions.

Ultraschall Med 2020 Feb 30;41(1):29-35. Epub 2019 Jul 30.

Department of Radiology, Ludwig-Maximilians-University of Munich - Großhadern Campus, Munich, Germany.

Background:  Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively.

Purpose:  The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity.

Methods:  6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single radiologist with experience since 2000 (EFSUMB Level 3).

Results:  CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy.

Conclusion:  Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.
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http://dx.doi.org/10.1055/a-0973-8517DOI Listing
February 2020

SonoVue® Does Not Appear to Cross the Placenta as Observed During an Examination Aimed at Confirming a Diagnosis of Liver Echinococcosis in a Pregnant Woman.

Ultraschall Med 2020 04 7;41(2):146-147. Epub 2019 Feb 7.

Department of Radiology, Interdisciplinary Ultrasound Center, Hospital of the Ludwig-Maximilians-University Munich (LMU), Munich, Germany.

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http://dx.doi.org/10.1055/a-0837-0791DOI Listing
April 2020