Juergen F Schaefer

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (90)197.18 Total impact

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    ABSTRACT: The aims of this study were to investigate subjective perceptions and sensory side effects during whole-body positron emission tomography (PET)/magnetic resonance (MR) examinations and to evaluate differences between PET/MR and standard PET/computed tomography (CT) examinations. During prospective clinical trials using a PET/MR hybrid system after a standard PET/CT examination, 266 patients (including 19 juveniles) were asked to complete questionnaires on causes of discomfort and side effects after both examinations (self-assessment). In case of complaints regarding causes of discomfort, physicians were also asked to complete the questionnaires to provide an external assessment. Visual analog scales were used for the ratings. Seventy-four percent (183/247) of all adult patients and 68% (13/19) of all teenage patients completed the questionnaires. In most of the cases, patient compliance was good and allowed for the acquisition of diagnostic images. Most patients did not report side effects or discomfort at all. Only 11 of 247 PET/MR scans of adult patients (4.4%) and 4 of 19 scans of juvenile patients (21%) were aborted prematurely by the patients' requests; however, this did not influence the final PET/MR diagnoses in most cases (12/15). In terms of noise levels and examination times, patients rated the PET/MR significantly lower than the PET/CT. With the exception of male patients not tolerating the examination time as well as female patients, no significant influences of sex, age, body mass index, and real scan times were observed. The attending physicians tended to underestimate their patient's discomfort, particularly when the discomfort was because of time (in the case of children) or noise exposure (all patients). Patient comfort should drive the design and development of optimized scanner types, workflow processes, and scan protocols. For PET/MR, the most important aim should be to shorten the scan time. However, patient-centered management may be the best instrument to improve patient compliance.
    Investigative radiology 06/2015; DOI:10.1097/RLI.0000000000000177 · 4.45 Impact Factor
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    ABSTRACT: Pediatric imaging is regarded as a key application for combined PET/MRI systems. As existing MR-based attenuation correction (MRAC) methods were not designed specifically for pediatric patients, we assessed the impact of 2 potentially influential factors: inter- and intra-patient variability of attenuation coefficients and anatomical variability. Furthermore, we evaluated the quantification accuracy of 3 methods for MRAC without (SEGbase) and with bone prediction using an adult/pediatric atlas (SEGwBONEad/pe) on PET data of pediatric patients. Variability of attenuation coefficients between and within pediatric (5-17y, n = 17) and adult (27-66y, n = 16) patient collectives was assessed on volumes of interest (VOIs) in CT datasets for different tissue types. Anatomical variability was assessed on SEGwBONEad/pe attenuation maps by computing mean differences to CT-based attenuation maps for regions of bone tissue, lungs and soft tissue. PET quantification was evaluated on VOIs with physiological uptake and on 80%-isocontour VOIs with elevated uptake in thorax and abdomen/pelvis. Inter- and intra-patient variability of the bias was assessed for each VOI group and method. Statistically significant differences in mean VOI Hounsfield unit values between adult and pediatric collectives were found in lungs and femur. Prediction of attenuation maps using the pediatric atlas showed a reduced error in bone tissue and better delineation of bone structure. Evaluation of PET quantification accuracy showed statistically significant mean errors in mean standardized uptake values of -14%±5%/-23%±6% in bone marrow/femur-adjacent VOIs with physiological uptake for SEGbase, which could be reduced to 0%±4%/-1%±5% using SEGwBONEpe attenuation maps. Bias in soft tissue VOIs was <5% for all methods. Lung VOIs showed high standard deviation in the range of 15% for all methods. For VOIs with elevated uptake, mean and SD were <5% except in thorax. Use of a dedicated atlas for the pediatric patient collective resulted in improved attenuation map prediction in osseous regions and reduced inter-patient bias variation in femur-adjacent VOIs. For the lungs, where intra-patient variation was higher for the pediatric collective, a patient- or group-specific attenuation coefficient could improve attenuation map accuracy. Mean errors of -14%/-23% in bone marrow/femur-adjacent VOIs can affect PET quantification in these regions when bone tissue is ignored. Copyright © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
    Journal of Nuclear Medicine 05/2015; DOI:10.2967/jnumed.114.149476 · 5.56 Impact Factor
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    ABSTRACT: Newborns and small infants have shallow breathing. To suggest criteria for when respiratory gating is necessary during cardiac MRI in newborns and infants. One-hundred ten data sets of newborns and infants with (n = 92, mean age: 1.9 ± 1.7 [SD] years) and without (n = 18, mean age: 1.6 ± 1.8 [SD] years) navigator gating were analysed retrospectively. The respiratory motion of the right hemidiaphragm was recorded and correlated to age, weight, body surface area and qualitative image quality on a 4-point score. Quantitative image quality assessment was performed (sharpness of the delineation of the ventricular septal wall) as well as a matched-pair comparison between navigator-gated and non-gated data sets. No significant differences were found in overall image quality or in the sharpness of the ventricular septal wall between gated and non-gated scans. A navigator acceptance of >80% was frequently found in patients ages <12 months, body surface area <0.40 m(2), body weight <10 kg and a size of <80 cm. Sequences without respiratory gating may be used in newborns and small infants, in particular if age <12 months, body surface area <0.40 m(2), body weight <10 kg and height <80 cm.
    Pediatric Radiology 04/2015; DOI:10.1007/s00247-015-3346-4 · 1.65 Impact Factor
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    ABSTRACT: Objectives: The aim of this study was to evaluate combined 2D and 3D dynamic MR urography with respiratory compensation in children with anomalies of the genitourinary tract, allowing for computation of split renal function and assessment of urinary tract obstruction. Methods: Dynamic MR urography was performed in 53 children (3mo to 16y) with anomalies of the urinary tract. A protocol for dynamic MR urography and nephrography was implemented at 1.5T using a navigator triggered 2D TurboFLASH sequence. Split renal function and contrast-medium excretion were assessed after bolus injection of 0.05 mmol/kg body weight gadolinium dimeglumine. In the excretory phase, a 3D gradient-echo data set with high spatial resolution was acquired. In all patients, MAG3 scintigraphy was obtained as a reference standard. Results: In all children, dynamic MR nephrography and urography could be performed with excellent compensation of breathing artifacts providing region-of-interest analysis in nearly identical kidney position. The assessment of contrast-medium excretion into the ureter allowed for discrimination of functional from non-functional stenosis. Split renal function assessed by MRI showed an excellent agreement with the MAG3 reference standard with a correlation coefficient r=0.95. Additionally recorded 3D data sets offered good depiction of anatomical anomalies in all patients. Conclusions: The proposed protocol provides a robust technique for assessment of ureteral obstruction and split renal function with compensation of breathing artifacts, short post-processing time, and excellent 3D spatial resolution. Advances in Knowledge: The combined protocol of 2D and 3D MR urography is an efficient technique for assessment of renal morphology and function.
    British Journal of Radiology 10/2014; 87(1044):20140426. DOI:10.1259/bjr.20140426 · 2.02 Impact Factor
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    ABSTRACT: During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. This also holds true for surgery in children with solid tumors. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of reports describe a potential role of MIS in the different entities of pediatric surgical oncology. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. The aim of this article is to give an overview and to describe the current state of the art of MIS in pediatric solid tumors.
    Frontiers in Pediatrics 06/2014; 2:48. DOI:10.3389/fped.2014.00048
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    ABSTRACT: Purpose To compare positron emission tomography (PET)/magnetic resonance (MR) imaging and PET/computed tomography (CT) for lesion detection and interpretation, quantification of fluorine 18 ((18)F) fluorodeoxyglucose (FDG) uptake, and accuracy of MR-based PET attenuation correction in pediatric patients with solid tumors. Materials and Methods This prospective study had local ethics committee and German Federal Institute for Drugs and Medical Devices approval. Written informed consent was obtained from all patients and legal guardians. Twenty whole-body (18)F-FDG PET/CT and (18)F-FDG PET/MR examinations were performed in 18 pediatric patients (median age, 14 years; range, 11-17 years). (18)F-FDG PET/CT and (18)F-FDG PET/MR data were acquired sequentially on the same day for all patients. PET standardized uptake values (SUVs) were quantified with volume of interest measurements in lesions and healthy tissues. MR-based PET attenuation correction was compared with CT-derived attenuation maps (µ-maps). Lesion detection was assessed with separate reading of PET/CT and PET/MR data. Estimates of radiation dose were derived from the applied doses of (18)F-FDG and CT protocol parameters. Descriptive statistical analyses were performed to report correlation coefficients and relative deviations for comparison of SUVs, rates of lesion detection, and percentage reductions in radiation dose. Results PET SUVs showed strong correlations between PET of PET/CT (PETCT) and PET of PET/MR (PETMR) (r > 0.85 for most tissues). Apart from drawbacks of MR-based PET attenuation correction in osseous structures and lungs, similar SUVs were found on PET images corrected with CT-based µ-maps (13.1% deviation of SUVs for bone marrow and <5% deviation for other tissues). Lesion detection rate with PET/MR imaging was equivalent to that with PET/CT (61 areas of focal uptake on PETMR images vs 62 areas on PETCT images). Advantages of PET/MR were observed especially in soft-tissue regions. Furthermore, PET/MR offered significant dose reduction (73%) compared with PET/CT. Conclusion Pediatric oncologic PET/MR is technically feasible, showing satisfactory performance for PET quantification with SUVs similar to those of PET/CT. Compared with PET/CT, PET/MR demonstrates equivalent lesion detection rates while offering markedly reduced radiation exposure. Thus, PET/MR is a promising modality for the clinical work-up of pediatric malignancies. © RSNA, 2014 Online supplemental material is available for this article.
    Radiology 05/2014; 273(1):131732. DOI:10.1148/radiol.14131732 · 6.21 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1373123 · 1.96 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1373124 · 1.96 Impact Factor
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    I Tsiflikas · C Thomas · D Ketelsen · G Seitz · S Warmann · C D Claussen · J F Schäfer
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    ABSTRACT: Purpose: The aim of this study was to investigate frequencies of typical artifacts in low-dose pediatric lung examinations using high-pitch computed tomography (HPCT) compared to MDCT, and to estimate the effective radiation dose (Eeff). Materials and Methods: Institutional review board approval for this retrospective study was obtained. 35 patients (17 boys, 18 girls; mean age 112 ± 69 months) were included and underwent MDCT and follow-up scan by HPCT or vice versa (mean follow-up time 87 days), using the same tube voltage and current. The total artifact score (0 - 8) was defined as the sum of artifacts arising from movement, breathing or pulsation of the heart or pulmonary vessels (0 - no; 1 - moderate; 2 - severe artifacts). Eeff was estimated according to the European Guidelines on Quality Criteria for Multislice Computed Tomography. The Mann-Whitney U test was used to analyze differences between the patient groups. The Spearman's rank correlation coefficient was used for correlation of ordinal variables. Results: The scan time was significantly lower for HPCT compared to MDCT (0.72 ± 0.13 s vs. 3.65 ± 0.81s; p < 0.0001). In 28 of 35 (80 %) HPCT examinations no artifacts were visible, whereas in MDCT artifacts occurred in all examinations. The frequency of pulsation artifacts and breathing artifacts was higher in MDCT compared to HPCT (100 % vs. 17 % and 31 % vs. 6 %). The total artifact score significantly correlated with the patient's age in MDCT (r = - 0.42; p = 0.01), but not in HPCT (r = - 0.32; p = 0.07). The estimated Eeff was significantly lower in HPCT than in MDCT (1.29 ± 0.31 vs. 1.47 ± 0.37 mSv; p < 0.0001). Conclusion: Our study indicates that the use of HPCT has advantages for pediatric lung imaging with a reduction of breathing and pulsation artifacts. Moreover, the estimated Eeff was lower. In addition, examinations can be performed without sedation or breath-hold without losing image quality. Key points: • Fewer artifacts in pediatric lung imaging with HPCT• Reduced Eeff in HPCT• HPCT without sedation or breath-hold without loss of image quality Citation Format: • Tsiflikas I, Thomas C, Ketelsen D et al. High-Pitch Computed Tomography of the Lung in Pediatric Patients: An Intraindividual Comparison of Image Quality and Radiation Dose to Conventional 64-MDCT. Fortschr Röntgenstr 2014; DOI: 10.1055/s-0034-1366426.
    RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(6). DOI:10.1055/s-0034-1366426 · 1.96 Impact Factor
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    ABSTRACT: This workshop was held a year after the initial positron emission tomography/magnetic resonance (PET/MR) workshop in Tübingen, which was recently reported in this journal. The discussions at the 2013 workshop, however, differed substantially from those of the initial workshop, attesting to the progress of combined PET/MR as an innovative imaging modality. Discussions were focused on the search for truly novel, unique clinical and research applications as well as technical issues such as reliable and accurate approaches for attenuation and scatter correction of PET emission data. The workshop provided hands-on experience with PET and MR imaging. In addition, structured and moderated open discussion sessions, including six dialogue boards and two roundtable discussions, provided input from current and future PET/MR imaging users. This summary provides a snapshot of the current achievements and challenges for PET/MR.
    Molecular imaging and biology: MIB: the official publication of the Academy of Molecular Imaging 03/2014; 16(3). DOI:10.1007/s11307-014-0725-4 · 2.87 Impact Factor
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    ABSTRACT: Surgical approach to children with complicated ureteral duplication is discussed controversially. Our aim was to determine the outcome of children with complicated renal duplication undergoing a single-stage surgical approach with laparoscopic partial nephrectomy and open bladder reconstruction. Data of patients from 2004 to 2008 were investigated retrospectively. Outcome was analyzed in terms of postoperative course, renal function, urinary tract infection and functional voiding. Thirteen patients were treated with laparoscopic partial nephrectomy and reconstruction of the lower urinary tract in a single-stage approach. Median age at operation was 15 months (2-63 m). One girl had a renal triplication. 7/13 patients presented with an ectopic ureterocele, two with an ectopic ureter, severe vesicoureteral reflux occurred in 6 patients. All patients had non-functioning renal moieties. Mean operative time was 239 min (129-309; SD 50). One re-operation was necessary 4 years after primary surgery due to a pole remnant. All patients had uneventful recoveries without evidence of recurrent UTI. Postoperative 99mTc-MAG3 scans showed no significant reduction of partial renal function (p = 0.4), and no signs of obstruction (p = 0.188). During a median follow-up of 60 months (49-86), dysfunctional voiding occurred in one patient. In children with complicated ureteral duplication a definitive single-stage procedure is feasible and shows excellent functional results.
    Pediatric Surgery International 09/2013; DOI:10.1007/s00383-013-3411-8 · 1.06 Impact Factor
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    ABSTRACT: We describe a 99-day old girl with inspissated bile syndrome (IBS) unresponsive to treatment with oral ursodeoxycholic acid. We performed a pure laparoscopic 2-stage procedure, consisting of cholecystostomy and insertion of an indwelling balloon catheter for local ursodeoxycholic acid flushing for 13 consecutive days. Subsequently, the cholecystostomy was removed, preserving the gallbladder using the same laparoscopical approach when bilirubin values returned to normal and bile duct obstruction was no longer detectable radiologically. This is the first report of an exclusively laparoscopic management of IBS.
    Journal of Pediatric Surgery 12/2012; 47(12):e47-e50. DOI:10.1016/j.jpedsurg.2012.09.043 · 1.31 Impact Factor
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    ABSTRACT: Background: It would be beneficial to establish pulmonary MRI as a complementary approach to CT for direct visualization of mosaic perfusion, bullae, and emphysema in patients with cystic fibrosis. Objectives: The purpose of this study was to compare both modalities, CT and MRI, using the Helbich-Bhalla score with a special focus on reliable detection of a mosaic pattern. Methods: Out of 51 patients examined by MRI on a 1.5-Tesla system during a period of 2 years, 19 patients were scheduled for additional low-dose CT in a clinical context. The MRI protocol comprised a gradient echo (GRE) sequence with a very short echo time (TE = 0.8 ms) in inspiration and expiration, a 3-D GRE sequence in breath hold, and a fast spin echo sequence with respiration and ECG triggering. MDCT was carried out in inspiration and adapted to body weight using 100 or 120 kV, 30-60 mA, 1- and 3-mm slice thicknesses, as well as low and high kernels. Additionally incremental slices in 3 positions were recorded in expiration for distinct detection of air trapping. CT and MRI analyses were performed by two radiologic readers in consensus unaware of the clinical parameters. The Helbich-Bhalla score of both examinations was correlated. Mean difference and accordance were assessed in each category. Results: There was a strong correlation between CT and MRI (R = 0.87, p < 0.01). The mean Helbich-Bhalla score for CT was 12.2 (range 1-18) and for MRI it was 11.7 (range 2-19). The mean difference was 0.5 points. Besides this strong correlation for findings (bronchiectasis, mucus plugging, peribronchial thickening, and consolidation) with a prolonged T2 TE in MRI, we could also state a qualitative agreement of 95-100% in the categories with short T2 and low signal intensity in MRI as emphysema, bullae, and mosaic perfusion. Conclusions: These results suggest that in our patient group none of the relevant findings were missed by MR imaging and reading.
    Respiration 11/2012; 86(4). DOI:10.1159/000343085 · 2.92 Impact Factor
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    ABSTRACT: PURPOSE CT has established in evaluation of pathological changes of lung parenchyma, particularly with regard to tumor staging, detection of bronchial anomalies, recurrent infections, cystic fibrosis and trauma. Despite all technological development of CT over the last decade, there is still need for sedation or even controlled ventilation in infants and uncooperative children for imaging. Aim of this study was to evaluate a new high-pitch scanning technique that makes breath-hold and sedation unnecessary. METHOD AND MATERIALS 35 consecutive patients (17 boys; mean age 112 ± 69 months) who underwent conventional MDCT (pitch 1.2) as well as high-pitch DSCT (HPCT) (pitch 3.0) of the lung with an average interval of 101 days between November 2009 and November 2011 were included in our study. None of the children received sedation. Children under the age of 6 years were examined in free breathing. Settings for tube current and voltage were identically for both scanning methods according to a weight-adapted, low-dose protocol (30-40 mAs;100-120 kVp). All images were evaluated by 2 senior radiologists in consensus. Image quality was rated in an intraindividual approach regarding following criteria: motion, breathing and pulsation artifacts as well as resolution of detail. Further effective radiation dose of both examinations was calculated from the DLP. RESULTS All examinations were completed without complications. HPCT results in a superior image quality compared to MDCT, because of reduction of breathing artifacts(HPCT n=1 vs. MDCT n=9) and in particular pulsation artifacts next to heart/mediatinum(HPCT n=7 vs. MDCT n=34), respectively next to pulmonary vessels(HPCT n=2 vs. MDCT n=24). Motion artifacts were not detected in both scanning techniques. Estimated effective radiation dose was on average 15% lower in HPCT(1,47 ± 0,71 mSv) compared to MDCT(1,61 ± 0,82 mSv). CONCLUSION High-pitch DSCT of the lung improves image quality compared to conventional MDCT, due to a significant decrease in breathing and pulsation artifacts. Furthermore examinations can be performed without sedation or breath-hold, even in infants and uncooperative children. In addition estimated radiation exposure is lower compared to conventional MDCT. CLINICAL RELEVANCE/APPLICATION High-pitch DSCT of the lung should be performed in children and infants were applicable, providing high image quality without the need for sedation or breath-hold.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: PURPOSE Simultaneous MR/PET is a new modality in oncologic imaging demonstrating comparable results to PET/CT in adults. However, the comparison of qualitative and quantitative results between both modalities has to be evaluated especially in children and juveniles. METHOD AND MATERIALS The ongoing study for juveniles was proved by our local ethic committee. Nine patients (mean age 14y, range 11 to 18y) suffering from various solid tumors with indication for PET/CT (Biograph mCT 128, Siemens) were subsequently examined in MR/PET (Biograph mMR, Siemens). As the tracer 18F-FDG injected for routine PET/CT (uptake time approx. 60 min) was also used for the MR/PET examination (uptake time approx. 110 min), no additional radiation dose was applied. A simultaneous acquisition of PET and MRI was carried out using a 3D FLASH sequence with Dixon-based fat-water separation for a segmentation-based PET attenuation correction map. Coronal whole-body STIR sequences and focused transversal T2 weighted images and DWI sequences were obtained additionally. Image quality and artifacts, standardized uptake values (SUV) in tumor and control regions using a VOI analysis were evaluated. RESULTS All MR/PET acquisitions were performed successfully in juveniles. Image quality of the MRI sequences was as good as with a standard 3 Tesla scanner. No artifacts on MRI by the PET detector could be recognized. The visual impressions of the PET images were similar between PET/CT and MR/PET. The median difference of SUVs (average) between MR/PET and PET/CT of the target regions were as follows: tumor -7 %, lung -22% , liver -21% , muscle 4% , bone marrow -5, blood pool – 28 % . In 3 cases (2 soft tissue tumors and 1 neuroblastoma) additional information were provided by higher soft tissue contrast of MRI and the use of DWI. CONCLUSION MR/PET is a robust and promising modality for juveniles with possible additional diagnostic information. Beside biological and kinetic effects of tracer distribution after uptake intervals the modality-specific differences between PET/CT and MR/PET like diverse methods of attenuation correction have to be kept in mind when using SUVs for quantitative analysis. CLINICAL RELEVANCE/APPLICATION MR/PET is a robust and promising modality for juveniles suffering from solid tumors with possible additional diagnostic information.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: Extrahepatic portal vein (PV) obstruction (EHPVO) is a rare disorder in early childhood with unknown incidence and mostly unknown etiology. In children with EHPVO, the hepatopedal flow of the mesenteric venous blood is hindered by an obstruction of the PV resulting in prehepatic portal hypertension. The curative treatment with a meso-Rex shunt connects the superior mesenteric vein to the left PV by a venous autograft. Despite good primary patency, reocclusion of a meso-Rex bypass and its treatment can be challenging. We present 2 patients with EHPVO with subtotal functional occlusion of a meso-Rex shunt treated by percutaneous interventions with short- and mid-term follow-up.
    Journal of Pediatric Surgery 09/2012; 47(9):e23-8. DOI:10.1016/j.jpedsurg.2012.04.011 · 1.31 Impact Factor
  • Clinical Research in Cardiology 05/2012; 101(10):853-5. DOI:10.1007/s00392-012-0464-y · 4.56 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 05/2012; 184(S 01). DOI:10.1055/s-0032-1311022 · 1.96 Impact Factor
  • I Tsiflikas · M Teufel · S Fleischer · CD Claussen · JF Schäfer
    RöFo - Fortschritte auf dem Gebiet der R 05/2012; 184(S 01). DOI:10.1055/s-0032-1311488 · 1.96 Impact Factor
  • JF Schäfer · I Tsiflikas
    RöFo - Fortschritte auf dem Gebiet der R 05/2012; 184(S 01). DOI:10.1055/s-0032-1310960 · 1.96 Impact Factor

Publication Stats

713 Citations
197.18 Total Impact Points

Institutions

  • 2001–2015
    • University of Tuebingen
      • • Institute for Neurobiology
      • • Department of Paediatric Surgery
      • • Department of Internal Medicine
      Tübingen, Baden-Württemberg, Germany
  • 2000–2014
    • Universitätsklinikum Tübingen
      • • Division of Diagnostic and Interventional Radiology
      • • Department of Radiology
      Tübingen, Baden-Württemberg, Germany