Publications by authors named "Dirk-André Clevert"

82 Publications

Role of CEUS in Vascular Pathology.

Ultraschall Med 2021 Apr 29. Epub 2021 Apr 29.

Department of Clinical Radiology, University of Munich-Großhadern Campus, Munich, Germany.

In recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.
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http://dx.doi.org/10.1055/a-1403-2400DOI Listing
April 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

Multiparametric MRI Lesion Classified as Prostate Imaging-Reporting and Data System 5 but Histopathologically Described as Benign: A Case Report and Review of Literature.

Urol Int 2021 3;105(5-6):520-524. Epub 2021 Feb 3.

Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany.

Introduction: Prostate cancer (PCa) is the most common malignancy in men. The multiparametric MRI (mpMRI) significantly improved the diagnostic approach of PCa. Although PCa is highly likely to be present in prostate imaging-reporting and data system (PI-RADS) 5 lesions, there are up to 18% of PI-RADS 5 lesions with benign histopathology after targeted biopsy.

Case Description: We present the case of a 66-year-old man who was referred to our hospital for MRI/ultrasound fusion-based targeted biopsy due to an elevated PSA and a PI-RADS 5 lesion described in the mpMRI. After 2 consecutive biopsies, the mpMRI target showed no malignancy. The lesion was described as PI-RADS 2 two years later.

Conclusion: This case demonstrates the risk of false-positive classified PI-RADS 5 lesions in the mpMRI and the challenge in some cases to distinguish between BPH nodules and cancer. Until today, a limited amount of studies exists concerning this issue. However, further studies are required to evaluate further characteristics associated with a higher possibility of histopathologically benign findings in PI-RADS 5 lesions.
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http://dx.doi.org/10.1159/000512378DOI Listing
February 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

Enhancement of the ionoacoustic effect through ultrasound and photoacoustic contrast agents.

Sci Rep 2021 Feb 1;11(1):2725. Epub 2021 Feb 1.

Department for Medical Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching b. München, Germany.

The characteristic depth dose deposition of ion beams, with a maximum at the end of their range (Bragg peak) allows for local treatment delivery, resulting in better sparing of the adjacent healthy tissues compared to other forms of external beam radiotherapy treatments. However, the optimal clinical exploitation of the favorable ion beam ballistic is hampered by uncertainties in the in vivo Bragg peak position. Ionoacoustics is based on the detection of thermoacoustic pressure waves induced by a properly pulsed ion beam (e.g., produced by modern compact accelerators) to image the irradiated volume. Co-registration between ionoacoustics and ultrasound imaging offers a promising opportunity to monitor the ion beam and patient anatomy during the treatment. Nevertheless, the detection of the ionoacoustic waves is challenging due to very low pressure amplitudes and frequencies (mPa/kHz) observed in clinical applications. We investigate contrast agents to enhance the acoustic emission. Ultrasound microbubbles are used to increase the ionoacoustic frequency around the microbubble resonance frequency. Moreover, India ink is investigated as a possible mean to enhance the signal amplitude by taking advantage of additional optical photon absorption along the ion beam and subsequent photoacoustic effect. We report amplitude increase of up to 200% of the ionoacoustic signal emission in the MHz frequency range by combining microbubbles and India ink contrast agents.
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http://dx.doi.org/10.1038/s41598-021-81964-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851171PMC
February 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

Diagnostic Value of CEUS Prompting Liver Biopsy: Histopathological Correlation of Hepatic Lesions with Ambiguous Imaging Characteristics.

Diagnostics (Basel) 2020 Dec 27;11(1). Epub 2020 Dec 27.

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

Background: Contrast-enhanced ultrasound (CEUS) allows for dynamic analysis of vascularization patterns of unclear hepatic lesions. Our study aimed to evaluate the diagnostic performance of CEUS for further characterizing suspicious liver lesions by comparing findings from CEUS examinations with corresponding histopathology.

Methods: Between 2005 and 2016, 160 patients with unclear liver lesions underwent CEUS followed by liver biopsy. All examinations were performed by an experienced consultant radiologist (EFSUMB Level 3) and included native B-mode ultrasound, Color Doppler, and CEUS. A second-generation blood pool contrast agent was applied for CEUS.

Results: CEUS was successfully performed in all patients without occurrence of any adverse side effects. CEUS showed a sensitivity of 94.5%, a specificity of 70.6%, a true positive rate of 87.3%, and a true negative rate of 85.7% compared to histopathological results as the reference standard.

Conclusions: CEUS represents a safe imaging modality with a high diagnostic accuracy in assessing both-benign and malignant-liver lesions compared to corresponding histopathological results.
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http://dx.doi.org/10.3390/diagnostics11010035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824701PMC
December 2020

Predictive clinical features for negative histopathology of MRI/Ultrasound-fusion-guided prostate biopsy in patients with high likelihood of cancer at prostate MRI: Analysis from a urologic outpatient clinic1.

Clin Hemorheol Microcirc 2020 ;76(4):503-511

Interdisciplinary Ultrasound-Center, Department of Radiology, LMU Klinikum, Ludwig-Maximilians-University Munich, Munich, Germany.

Objective: The aim of this study was to evaluate clinical features associated with benign histopathology of Prostate Imaging Reporting and Data System (PI-RADS) category 4 and 5 lesions.

Materials And Methods: Between March 2015 and November 2020, 1161 patients underwent mpMRI/Ultrasound-fusion-guided prostate biopsy (FBx) and concurrent 12-core systematic prostate biopsy (SBx) at the Department of Urology of the Ludwig-Maximilians-University of Munich, Germany. 848/ 1161 (73%) patients presented with either PI-RADS 4 or 5 index lesion and were retrospectively evaluated. Multivariate analysis was performed to evaluate clinical parameters associated with a negative outcome of PI-RADS 4 or 5 category lesions after FBx. Area under the receiver operating characteristics (ROC) curve (AUC) was conducted using ROC-analysis.

Results: 676/848 (79.7%) patients with either PI-RADS 4 or 5 index lesion were diagnosed with prostate cancer (PCa) by FBx and 172/848 (20.3%) patients had a negative biopsy (including the concurrent systematic prostate biopsy), respectively. Prostate volume (P-Vol) (OR 0.99, 95% CI = 0.98-1.00, p = 0.038), pre-biopsy-status (OR 0.48, 95% CI = 0.29-0.79, p = 0.004) and localization of the lesion in the transitional zone (OR 0.28, 95% CI = 0.13-0.60, p = 0.001) were independent risk factors for a negative outcome of FBx. Age (OR 1.09, 95% CI = 1.05-1.13, p < 0.001) and PSA density (PSAD) (OR 75.92, 95% CI = 1.03-5584.61, p = 0.048) increased the risk for PCa diagnosis after FBx. The multivariate logistic regression model combining all clinical characteristics achieved an AUC of 0.802 (95% CI = 0.765-0.835; p < 0.001) with a sensitivity and specificity of 66% and 85%.

Conclusion: Lesions with high or highly likelihood of PCa on multiparametric magnetic resonance imaging (mpMRI) but subsequent negative prostate biopsy occur in a small amount of patients. Localization of the lesion in the transitional zone, prostate volume and prebiopsy were shown to be predictors for benign histopathology of category 4 or 5 lesions on mpMRI. Integration of these features into daily clinical routine could be used for risk-stratification of these patients after negative biopsy of PI-RADS 4 or 5 index lesions.
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http://dx.doi.org/10.3233/CH-209225DOI Listing
February 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

EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement.

Ultraschall Med 2021 Apr 11;42(2):154-166. Epub 2020 Dec 11.

Department of Radiology, King's College Hospital London, United Kingdom of Great Britain and Northern Ireland.

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.
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http://dx.doi.org/10.1055/a-1300-1727DOI Listing
April 2021

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

[German recommendations on lung and thoracic ultrasonography in patients with COVID-19].

Med Klin Intensivmed Notfmed 2020 Nov 12;115(8):654-667. Epub 2020 Oct 12.

Fachbereich/Institut f. Gesundheit & Soziales (IfGS), FOM Hochschule für Ökonomie & Management, Franklinstr. 52, 60486, Frankfurt am Main, Deutschland.

Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV‑2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).
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http://dx.doi.org/10.1007/s00063-020-00740-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548535PMC
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

Ultrasound 2020 - Diagnostics & Therapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography.

Rofo 2021 Jan 30;193(1):23-32. Epub 2020 Jul 30.

Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany.

Background:  Ultrasound as a non-ionizing imaging procedure is one of the most important diagnostic procedures in everyday clinical practice. The technology is widely used. Due to constant technical innovations, sonographic procedures, such as contrast-enhanced ultrasound (CEUS), sonoelastography, new microvascular Doppler modalities and, as an example of interventional procedures, sonographically controlled microwave ablation (MWA), are becoming increasingly important in diagnostic imaging and interventional medicine alongside CT and MRI. However, this also requires greater expertise, specialization and qualification on the part of users.

Method:  This review article provides information about the range of technical innovations in ultrasound in recent years and describes the underlying technology, the clinical applications, and their diagnostic value. These are presented in the context of the current literature, explaining their advantages and disadvantages and their clinical value.

Results And Conclusion:  Contrast-enhanced ultrasound (CEUS), microvascular Doppler modalities, fusion imaging and elastography complement B-scan ultrasound and conventional Doppler procedures for various problems. Microwave ablation (MWA) has a firm place as an ablative procedure for local tumor therapy in different organ systems and can be performed under ultrasound guidance. Thanks to new developments, the possibilities of ultrasound are now greater than ever. Knowledge of the technology, indications, and possible applications of newer procedures is essential for adequate patient care.

Key Points:   · Contrast-enhanced ultrasound (CEUS) allows an increase in sensitivity and specificity in the assessment of parenchymal lesions.. · CEUS allows the microperfusion to be visualized and quantified. For larger vessels, CEUS is an important instrument in diagnosing endoleak after stenting.. · Microvascular Doppler techniques with clutter suppression algorithms allow a more accurate representation of the smallest vessels than regular color or power Doppler.. · Elastography of the liver in diffuse hepatopathies is a noninvasive diagnostic tool to exclude higher grade fibrosis/cirrhosis.. · Microwave ablation (MWA) also offers sonographically controlled ablation of tumors..

Citation Format: · Kloth C, Kratzer W, Schmidberger J et al. Ultrasound 2020 - Diagnostics & Therapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography . Fortschr Röntgenstr 2021; 193: 23 - 32.
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http://dx.doi.org/10.1055/a-1217-7400DOI Listing
January 2021

Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.

Ultrasound Med Biol 2020 10 24;46(10):2579-2604. Epub 2020 Jul 24.

Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2020.04.030DOI Listing
October 2020

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.

Ultraschall Med 2020 Oct 24;41(5):562-585. Epub 2020 Jul 24.

Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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http://dx.doi.org/10.1055/a-1177-0530DOI Listing
October 2020

Multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging-guided biopsy in the diagnostic pathway of prostate cancer.

Radiologe 2020 Nov;60(Suppl 1):63-69

Interdisziplinäres Ultraschallzentrum, Klinik und Poliklinik Radiologie des Klinikums der Universität München, Ludwig-Maximilians-Universität, Campus Großhadern, Munich, Germany.

Multiparametric magnetic resonance imaging (mpMRI) of the prostate and mpMRI-guided biopsy have proved to be a valuable part of the diagnostic pathway for prostate cancer. This review reports on the current results in terms of clinical performance of these diagnostic tools and their role in clinical decision-making.
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http://dx.doi.org/10.1007/s00117-020-00716-zDOI Listing
November 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

Cost-effectiveness of contrast-enhanced ultrasound for the detection of endovascular aneurysm repair-related endoleaks requiring treatment.

J Vasc Surg 2021 01 20;73(1):232-239.e2. Epub 2020 May 20.

Department of Radiology, Interdisciplinary Ultrasound Center, University Hospital, LMU Munich, Munich, Germany.

Objective: Follow-up after endovascular aneurysm repair is necessary to detect potentially life-threatening complications such as endoleaks. Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is often used as standard of care for follow-up. Contrast-enhanced ultrasound (CEUS) has been shown to be a viable and fast real-time nonionizing imaging modality with equivalent diagnostic accuracy while also being superior to color Doppler ultrasound. The aim of this cost-utility analysis was to evaluate the cost-effectiveness of this imaging method in comparison to others for the evaluation of endoleaks requiring treatment.

Methods: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, MRA, CEUS, and color Doppler ultrasound. Model input parameters were obtained from recent literature. The applied sensitivity and specificity values amounted to 90.5% and 100.0% for CTA, 96.0% and 100.0% for MRA, 94.0% and 95.0% for CEUS, and 82.0% and 93.0% for color Doppler ultrasound. Probabilistic and deterministic sensitivity analysis was performed to estimate uncertainty of model results. To evaluate cost-effectiveness, incremental cost-effectiveness ratios were reported as a measure representing the economic value of a strategy compared with an alternative. The willingness to pay was set to $100,000/QALY.

Results: In the base-case scenario for a willingness to pay of $100,000 per QALY, CEUS was the most cost-effective of the four diagnostic strategies with estimated costs of $17,383 and effectiveness of 9.770 QALYs. CTA was estimated to result in lifetime costs of $17,679 with an expected effectiveness of 9.768 QALYs, whereas color Doppler ultrasound showed expected costs of $17,287 with 9.763 QALYs. Expected costs and effectiveness of MRA amounted to $17,945 and 9.771 QALYs each. Base-case estimates of the incremental cost-effectiveness ratios for CEUS vs color Doppler ultrasound equaled $14,173.52/QALY.

Conclusions: CEUS is a cost-effective imaging method for the evaluation of therapy-requiring endoleaks in endovascular aneurysm repair surveillance.
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http://dx.doi.org/10.1016/j.jvs.2020.04.512DOI Listing
January 2021

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

Imaging Features of Fibrolamellar Hepatocellular Carcinoma with Contrast-Enhanced Ultrasound.

Ultraschall Med 2021 Jun 26;42(3):306-313. Epub 2020 Feb 26.

Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Switzerland.

Purpose:  Fibrolamellar hepatocellular carcinoma (f-HCC) is a rare primary liver tumor. Imaging plays an important role in diagnosis. The aim of this retrospective study was to analyze contrast-enhanced ultrasound (CEUS) features of histologically proven f-HCC in comparison to benign focal nodular hyperplasia (FNH).

Materials & Methods:  16 patients with histologically proven f-HCC lesions and 30 patients with FNH lesions were retrospectively reviewed regarding CEUS features to determine the malignant or benign nature of the focal liver lesions (FLL). Five radiologists assessed the CEUS enhancement pattern and came to a consensus using the EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) guideline criteria.

Results:  Fibrolamellar hepatocellular carcinoma manifested as a single and huge FLL. On CEUS, f-HCC showed heterogeneous hyperenhancement in the arterial phase and hypoenhancement (16/16, 100 %) in the portal venous and late phases (PVLP) as a sign of malignancy. In contrast to the hypoenhancement of f-HCC in the PVLP, all patients with FNH showed hyperenhancement as the most distinctive feature (P < 0.01). 8 f-HCC lesions showed a central scar as an unenhanced area (8/16, 50.0 %), which could also be detected in 53.3 % (16/30) of FNH lesions (P > 0.05).

Conclusion:  By analyzing the hypoenhancement in the PVLP, CEUS imaging reliably diagnosed f-HCC as a malignant FLL. CEUS also showed differentiation between f-HCC and FNH lesions, showing similar non-enhanced central scars, whereas f-HCC lesions showed peripheral hyperenhancement in the arterial phase and early washout in the PVLP.
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http://dx.doi.org/10.1055/a-1110-7124DOI Listing
June 2021

Comparison of Magnetic Resonance Imaging and Contrast-Enhanced Ultrasound as Diagnostic Options for Unclear Cystic Renal Lesions: A Cost-Effectiveness Analysis.

Ultraschall Med 2020 Feb 12. Epub 2020 Feb 12.

Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany.

Purpose:  Correct differentiation between malignant and benign incidentally found cystic renal lesions has critical implications for patient management. In several studies contrast-enhanced ultrasound (CEUS) showed higher sensitivity with respect to the accurate characterization of these lesions compared to MRI, but the cost-effectiveness of CEUS has yet to be investigated. The aim of this study was to analyze the cost-effectiveness of CEUS as an alternative imaging method to MRI for the characterization of incidentally found cystic renal lesions.

Materials And Methods:  A decision model including the diagnostic modalities MRI and CEUS was created based on Markov simulations estimating lifetime costs and quality-adjusted life years (QALYs). The recent literature was reviewed to obtain model input parameters. The deterministic sensitivity of diagnostic parameters and costs was determined and probabilistic sensitivity analysis using Monte-Carlo Modelling was applied. Willingness-to-pay (WTP) was assumed to be $ 100 000/QALY.

Results:  In the base-case scenario, the total costs for CEUS were $9654.43, whereas the total costs for MRI were $9675.03. CEUS resulted in an expected effectiveness of 8.06 QALYs versus 8.06 QALYs for MRI. Therefore, from an economic point of view, CEUS was identified as an adequate diagnostic alternative to MRI. Sensitivity analysis showed that results may vary if CEUS costs increase or those of MRI decrease.

Conclusion:  Based on the results of the analysis, the use of CEUS was identified as a cost-effective diagnostic strategy for the characterization of incidentally found cystic renal lesions.
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http://dx.doi.org/10.1055/a-1110-7172DOI Listing
February 2020