Publications by authors named "Vincent Schwarze"

33 Publications

Reduction of missed thoracic findings in emergency whole-body computed tomography using artificial intelligence assistance.

Quant Imaging Med Surg 2021 Jun;11(6):2486-2498

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

Background: Radiology reporting of emergency whole-body computed tomography (CT) scans is time-critical and therefore involves a significant risk of pathology under-detection. We hypothesize a relevant number of initially missed secondary thoracic findings that would have been detected by an artificial intelligence (AI) software platform including several pathology-specific AI algorithms.

Methods: This retrospective proof-of-concept-study consecutively included 105 shock-room whole-body CT scans. Image data was analyzed by platform-bundled AI-algorithms, findings were reviewed by radiology experts and compared with the original radiologist's reports. We focused on secondary thoracic findings, such as cardiomegaly, coronary artery plaques, lung lesions, aortic aneurysms and vertebral fractures.

Results: We identified a relevant number of initially missed findings, with their quantification based on 105 analyzed CT scans as follows: up to 25 patients (23.8%) with cardiomegaly or borderline heart size, 17 patients (16.2%) with coronary plaques, 34 patients (32.4%) with aortic ectasia, 2 patients (1.9%) with lung lesions classified as "recommended to control" and 13 initially missed vertebral fractures (two with an acute traumatic origin). A high number of false positive or non-relevant AI-based findings remain problematic especially regarding lung lesions and vertebral fractures.

Conclusions: We consider AI to be a promising approach to reduce the number of missed findings in clinical settings with a necessary time-critical radiological reporting. Nevertheless, algorithm improvement is necessary focusing on a reduction of "false positive" findings and on algorithm features assessing the finding relevance, e.g., fracture age or lung lesion malignancy.
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http://dx.doi.org/10.21037/qims-20-1037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107306PMC
June 2021

F FDG PET/MRI with hepatocyte-specific contrast agent for M staging of rectal cancer: a primary economic evaluation.

Eur J Nucl Med Mol Imaging 2021 Mar 9. Epub 2021 Mar 9.

Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.

Purpose: Rectal cancer is one of the most frequent causes of cancer-related morbidity and mortality in the world. Correct identification of the TNM state in primary staging of rectal cancer has critical implications on patient management. Initial evaluations revealed a high sensitivity and specificity for whole-body PET/MRI in the detection of metastases allowing for metastasis-directed therapy regimens. Nevertheless, its cost-effectiveness compared with that of standard-of-care imaging (SCI) using pelvic MRI + chest and abdominopelvic CT is yet to be investigated. Therefore, the aim of this study was to analyze the cost-effectiveness of whole-body F FDG PET/MRI as an alternative imaging method to standard diagnostic workup for initial staging of rectal cancer.

Methods: For estimation of quality-adjusted life years (QALYs) and lifetime costs of diagnostic modalities, a decision model including whole-body F FDG PET/MRI with a hepatocyte-specific contrast agent and pelvic MRI + chest and abdominopelvic CT was created based on Markov simulations. For obtaining model input parameters, review of recent literature was performed. Willingness to pay (WTP) was set to $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was applied, and probabilistic sensitivity was determined using Monte Carlo modeling.

Results: In the base-case scenario, the strategy whole-body F FDG PET/MRI resulted in total costs of $52,186 whereas total costs of SCI were at $51,672. Whole-body F FDG PET/MRI resulted in an expected effectiveness of 3.542 QALYs versus 3.535 QALYs for SCI. This resulted in an incremental cost-effectiveness ratio of $70,291 per QALY for PET/MRI. Thus, from an economic point of view, whole-body F FDG PET/MRI was identified as an adequate diagnostic alternative to SCI with high robustness of results to variation of input parameters.

Conclusion: Based on the results of the analysis, use of whole-body F FDG PET/MRI was identified as a feasible diagnostic strategy for initial staging of rectal cancer from a cost-effectiveness perspective.
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http://dx.doi.org/10.1007/s00259-021-05193-7DOI Listing
March 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

Cost-Effectiveness Analysis of Ga DOTA-TATE PET/CT, In-Pentetreotide SPECT/CT and CT for Diagnostic Workup of Neuroendocrine Tumors.

Diagnostics (Basel) 2021 Feb 18;11(2). Epub 2021 Feb 18.

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

Neuroendocrine tumors (NETs) are relatively rare neoplasms arising from the hormone-producing neuroendocrine system that can occur in various organs such as pancreas, small bowel, stomach and lung. As the majority of these tumors express somatostatin receptors (SSR) on their cell membrane, utilization of SSR analogs in nuclear medicine is a promising, but relatively costly approach for detection and localization. The aim of this study was to analyze the cost-effectiveness of Ga-DOTA-TATE PET/CT (Gallium-68 DOTA-TATE Positron emission tomography/computed tomography) compared to In-pentetreotide SPECT/CT (Indium-111 pentetreotide Single Photon emission computed tomography/computed tomography) and to CT (computed tomography) alone in detection of NETs. A decision model on the basis of Markov simulations evaluated lifetime costs and quality-adjusted life years (QALYs) related to either a CT, SPECT/CT or PET/CT. Model input parameters were obtained from publicized research projects. The analysis is grounded on the US healthcare system. Deterministic sensitivity analysis of diagnostic parameters and probabilistic sensitivity analysis predicated on a Monte Carlo simulation with 30,000 reiterations was executed. The willingness-to-pay (WTP) was determined to be $ 100,000/QALY. In the base-case investigation, PET/CT ended up with total costs of $88,003.07 with an efficacy of 4.179, whereas CT ended up with total costs of $88,894.71 with an efficacy of 4.165. SPECT/CT ended up with total costs of $89,973.34 with an efficacy of 4.158. Therefore, the strategies CT and SPECT/CT were dominated by PET/CT in the base-case scenario. In the sensitivity analyses, PET/CT remained a cost-effective strategy. This result was due to reduced therapy costs of timely detection. The additional costs of Ga-DOTA-TATE PET/CT when compared to CT alone are justified in the light of potential savings in therapy costs and better outcomes.
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http://dx.doi.org/10.3390/diagnostics11020334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922846PMC
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

Evaluation of patients with respiratory infections during the first pandemic wave in Germany: characteristics of COVID-19 versus non-COVID-19 patients.

BMC Infect Dis 2021 Feb 10;21(1):167. Epub 2021 Feb 10.

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

Background: Characteristics of COVID-19 patients have mainly been reported within confirmed COVID-19 cohorts. By analyzing patients with respiratory infections in the emergency department during the first pandemic wave, we aim to assess differences in the characteristics of COVID-19 vs. Non-COVID-19 patients. This is particularly important regarding the second COVID-19 wave and the approaching influenza season.

Methods: We prospectively included 219 patients with suspected COVID-19 who received radiological imaging and RT-PCR for SARS-CoV-2. Demographic, clinical and laboratory parameters as well as RT-PCR results were used for subgroup analysis. Imaging data were reassessed using the following scoring system: 0 - not typical, 1 - possible, 2 - highly suspicious for COVID-19.

Results: COVID-19 was diagnosed in 72 (32,9%) patients. In three of them (4,2%) the initial RT-PCR was negative while initial CT scan revealed pneumonic findings. 111 (50,7%) patients, 61 of them (55,0%) COVID-19 positive, had evidence of pneumonia. Patients with COVID-19 pneumonia showed higher body temperature (37,7 ± 0,1 vs. 37,1 ± 0,1 °C; p = 0.0001) and LDH values (386,3 ± 27,1 vs. 310,4 ± 17,5 U/l; p = 0.012) as well as lower leukocytes (7,6 ± 0,5 vs. 10,1 ± 0,6G/l; p = 0.0003) than patients with other pneumonia. Among abnormal CT findings in COVID-19 patients, 57 (93,4%) were evaluated as highly suspicious or possible for COVID-19. In patients with negative RT-PCR and pneumonia, another third was evaluated as highly suspicious or possible for COVID-19 (14 out of 50; 28,0%). The sensitivity in the detection of patients requiring isolation was higher with initial chest CT than with initial RT-PCR (90,4% vs. 79,5%).

Conclusions: COVID-19 patients show typical clinical, laboratory and imaging parameters which enable a sensitive detection of patients who demand isolation measures due to COVID-19.
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http://dx.doi.org/10.1186/s12879-021-05829-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875010PMC
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

Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison.

Diagnostics (Basel) 2021 Jan 13;11(1). Epub 2021 Jan 13.

Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany.

To evaluate the effect of radiation dose reduction on image quality and diagnostic confidence in contrast-enhanced whole-body computed tomography (WBCT) staging. We randomly selected March 2016 for retrospective inclusion of 18 consecutive patients (14 female, 60 ± 15 years) with clinically indicated WBCT staging on the same 3rd generation dual-source CT. Using low-dose simulations, we created data sets with 100, 80, 60, 40, and 20% of the original radiation dose. Each set was reconstructed using filtered back projection (FBP) and Advanced Modeled Iterative Reconstruction (ADMIRE, Siemens Healthineers, Forchheim, Germany) strength 1-5, resulting in 540 datasets total. ADMIRE 2 was the reference standard for intraindividual comparison. The effective radiation dose was calculated using commercially available software. For comparison of objective image quality, noise assessments of subcutaneous adipose tissue regions were performed automatically using the software. Three radiologists blinded to the study evaluated image quality and diagnostic confidence independently on an equidistant 5-point Likert scale (1 = poor to 5 = excellent). At 100%, the effective radiation dose in our population was 13.3 ± 9.1 mSv. At 20% radiation dose, it was possible to obtain comparably low noise levels when using ADMIRE 5 ( = 1.000, = 0.29). We identified ADMIRE 3 at 40% radiation dose (5.3 ± 3.6 mSv) as the lowest achievable radiation dose with image quality and diagnostic confidence equal to our reference standard ( = 1.000, > 0.4). The inter-rater agreement for this result was almost perfect (ICC ≥ 0.958, 95% CI 0.909-0.983). On a 3rd generation scanner, it is feasible to maintain good subjective image quality, diagnostic confidence, and image noise in single-energy WBCT staging at dose levels as low as 40% of the original dose (5.3 ± 3.6 mSv), when using ADMIRE 3.
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http://dx.doi.org/10.3390/diagnostics11010118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828410PMC
January 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

Tuberculous perihepatic abscess and neurosarcoidosis: report of 2 uncommon manifestations of 2 common granulomatous diseases in 1 patient.

Z Gastroenterol 2021 Jan 11;59(1):50-55. Epub 2021 Jan 11.

Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.

Infections caused by pathogens of the Mycobacterium tuberculosis complex, i. e., tuberculosis (TB), and the non-infectious, autoimmune disease sarcoidosis are among the most common granulomatous diseases worldwide. Typically, the lung is the primary site of infection and manifestation, respectively which makes the two diseases important differential diagnoses. Both diseases can affect virtually all organ systems, albeit with significantly lower incidence. CASE PRESENTATION:  We report the case of a 50-year-old Indian man presenting with a tuberculous perihepatic abscess and a systemic inflammatory response after being diagnosed with neurosarcoidosis presenting as a single granuloma in the frontal lobe with lymphadenopathy in 2014. On day of admission the patient presented with right upper abdominal pain and fever for two weeks. With increased inflammatory parameters in serum and after finding of external CT images, a perihepatic abscess was suspected. This encapsulated cave was drained percutaneously under CT control. A high concentration of acid-fast rods was detected using ZN, PCR was positive for M. tuberculosis. Several samples of sputum and urine were microscopically negative but yielded growth of Mycobacteria after four weeks. DISCUSSION:  This is a case presenting with two different granulomatous diseases, each of which manifested itself in an atypical form. The tuberculous liver abscess might either be explained as a flare-up of latent tuberculosis under azathioprine therapy or as a reinfection acquired during one of several visits in the high-prevalence country India. In addition, it must be discussed whether the cerebral granuloma in 2014 could have been an early stage of tuberculous granuloma. Sensitivity of ZN staining is significantly reduced in cerebral samples, and negative PCR-results might be due to low germ load or methodical issues, e. g., decreased sensitivity in formalin fixated samples.
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http://dx.doi.org/10.1055/a-1330-9046DOI Listing
January 2021

COVID-19 Pandemic and Upcoming Influenza Season-Does an Expert's Computed Tomography Assessment Differentially Identify COVID-19, Influenza and Pneumonias of Other Origin?

J Clin Med 2020 Dec 28;10(1). Epub 2020 Dec 28.

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

(1) Background: Time-consuming SARS-CoV-2 RT-PCR suffers from limited sensitivity in early infection stages whereas fast available chest CT can already raise COVID-19 suspicion. Nevertheless, radiologists' performance to differentiate COVID-19, especially from influenza pneumonia, is not sufficiently characterized. (2) Methods: A total of 201 pneumonia CTs were identified and divided into subgroups based on RT-PCR: 78 COVID-19 CTs, 65 influenza CTs and 62 Non-COVID-19-Non-influenza (NCNI) CTs. Three radiology experts (blinded from RT-PCR results) raised pathogen-specific suspicion (separately for COVID-19, influenza, bacterial pneumonia and fungal pneumonia) according to the following reading scores: 0-not typical/1-possible/2-highly suspected. Diagnostic performances were calculated with RT-PCR as a reference standard. Dependencies of radiologists' pathogen suspicion scores were characterized by . (3) Results: Depending on whether the intermediate reading score 1 was considered as positive or negative, radiologists correctly classified 83-85% (vs. NCNI)/79-82% (vs. influenza) of COVID-19 cases (sensitivity up to 94%). Contrarily, radiologists correctly classified only 52-56% (vs. NCNI)/50-60% (vs. COVID-19) of influenza cases. The COVID-19 scoring was more specific than the influenza scoring compared with suspected bacterial or fungal infection. (4) Conclusions: High-accuracy COVID-19 detection by CT might expedite patient management even during the upcoming influenza season.
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http://dx.doi.org/10.3390/jcm10010084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795488PMC
December 2020

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

Prognostic Value of Admission Chest CT Findings for Invasive Ventilation Therapy in COVID-19 Pneumonia.

Diagnostics (Basel) 2020 Dec 19;10(12). Epub 2020 Dec 19.

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

(1) Background: To assess the value of chest CT imaging features of COVID-19 disease upon hospital admission for risk stratification of invasive ventilation (IV) versus no or non-invasive ventilation (non-IV) during hospital stay. (2) Methods: A retrospective single-center study was conducted including all patients admitted during the first three months of the pandemic at our hospital with PCR-confirmed COVID-19 disease and admission chest CT scans ( = 69). Using clinical information and CT imaging features, a 10-point ordinal risk score was developed and its diagnostic potential to differentiate a severe (IV-group) from a more moderate course (non-IV-group) of the disease was tested. (3) Results: Frequent imaging findings of COVID-19 pneumonia in both groups were ground glass opacities (91.3%), consolidations (53.6%) and crazy paving patterns (31.9%). Characteristics of later stages such as subpleural bands were observed significantly more often in the IV-group (52.2% versus 26.1%, = 0.032). Using information directly accessible during a radiologist's reporting, a simple risk score proved to reliably differentiate between IV- and non-IV-groups (AUC: 0.89 (95% CI 0.81-0.96), < 0.001). (4) Conclusions: Information accessible from admission CT scans can effectively and reliably be used in a scoring model to support risk stratification of COVID-19 patients to improve resource and allocation management of hospitals.
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http://dx.doi.org/10.3390/diagnostics10121108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766909PMC
December 2020

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

Diagnostic Performance of Different Simulated Low-Dose Levels in Patients with Suspected Cervical Abscess Using a Third-Generation Dual-Source CT Scanner.

Diagnostics (Basel) 2020 Dec 10;10(12). Epub 2020 Dec 10.

Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany.

The aim of this study was to investigate the effects of dose reduction on diagnostic accuracy and image quality of cervical computed tomography (CT) in patients with suspected cervical abscess. Forty-eight patients (mean age 45.5 years) received a CT for suspected cervical abscess. Low-dose CT (LDCT) datasets with 25%, 50%, and 75% of the original dose were generated with a realistic simulation. The image data were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) (strengths 3 and 5). A five-point Likert scale was used to assess subjective image quality and diagnostic confidence. The signal-to-noise ratio (SNR) of the sternocleidomastoid muscle and submandibular gland and the contrast-to-noise ratio (CNR) of the sternocleidomastoid muscle and submandibular glandular fat were calculated to assess the objective image quality. Diagnostic accuracy was calculated for LDCT using the original dose as the reference standard. The prevalence of cervical abscesses was high (72.9%) in the cohort; the mean effective dose for all 48 scans was 1.8 ± 0.8 mSv. Sternocleidomastoid and submandibular SNR and sternocleidomastoid muscle fat and submandibular gland fat CNR increased with higher doses and were significantly higher for ADMIRE compared to FBP, with the best results in ADMIRE 5 (all < 0.001). Subjective image quality was highest for ADMIRE 5 at 75% and lowest for FBP at 25% of the original dose ( < 0.001). Diagnostic confidence was highest for ADMIRE 5 at 75% and lowest for FBP at 25% ( < 0.001). Patient-based diagnostic accuracy was high for all LDCT datasets, down to 25% for ADMIRE 3 and 5 (sensitivity: 100%; specificity: 100%) and lower for FBP at 25% dose reduction (sensitivity: 88.6-94.3%; specificity: 92.3-100%). The use of a modern dual-source CT of the third generation and iterative reconstruction allows a reduction in the radiation dose to 25% (0.5 mSv) of the original dose with the same diagnostic accuracy for the assessment of neck abscesses.
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http://dx.doi.org/10.3390/diagnostics10121072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764070PMC
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

Follow-Up 18F-FDG PET/CT versus Contrast-Enhanced CT after Ablation of Liver Metastases of Colorectal Carcinoma-A Cost-Effectiveness Analysis.

Cancers (Basel) 2020 Aug 27;12(9). Epub 2020 Aug 27.

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

Purpose: After a percutaneous ablation of colorectal liver metastases (CRLM), follow-up investigations to evaluate potential tumor recurrence are necessary. The aim of this study was to analyze whether a combined 18F-Fluordesoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan is cost-effective compared to a contrast-enhanced computed tomography (CE-CT) scan for detecting local tumor progression.

Materials And Methods: A decision model based on Markov simulations that estimated lifetime costs and quality-adjusted life years (QALYs) was developed. Model input parameters were obtained from the recent literature. Deterministic sensitivity analysis of diagnostic parameters based on a Monte-Carlo simulation with 30,000 iterations was performed. The willingness-to-pay (WTP) was set to $100,000/QALY.

Results: In the base-case scenario, CE-CT resulted in total costs of $28,625.08 and an efficacy of 0.755 QALYs, whereas 18F-FDG PET/CT resulted in total costs of $29,239.97 with an efficacy of 0.767. Therefore, the corresponding incremental cost-effectiveness ratio (ICER) of 18F-FDG PET/CT was $50,338.96 per QALY indicating cost-effectiveness based on the WTP threshold set above. The results were stable in deterministic and probabilistic sensitivity analyses.

Conclusion: Based on our model, 18F-FDG PET/CT can be considered as a cost-effective imaging alternative for follow-up investigations after percutaneous ablation of colorectal liver metastases.
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http://dx.doi.org/10.3390/cancers12092432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565889PMC
August 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

Authors' Response to Letter: "Diagnosis of Hepatic Hydatid Cysts by Contrast-Enhanced Ultrasound".

Authors:
Vincent Schwarze

Ultraschall Med 2020 12 24;41(6):700. Epub 2019 Oct 24.

Department of Radiology, Ludwig-Maximilians-University Munich (LMU).

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http://dx.doi.org/10.1055/a-1024-2487DOI Listing
December 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