E M Jung

University Hospital Regensburg, Ratisbon, Bavaria, Germany

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Publications (268)529.23 Total impact

  • Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology 06/2015; 31(2). DOI:10.1016/j.orthtr.2015.03.016
  • V Teusch · W Wohlgemuth · E Jung
    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551010 · 1.96 Impact Factor
  • E Jung · P Wiggermann
    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551402 · 1.96 Impact Factor
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    ABSTRACT: To evaluate the risk factors associated with short-term local recurrence of malignant liver lesions after irreversible electroporation (IRE). Thirty-nine consecutive patients (79 malignant liver lesions) were treated with IRE, of whom 14 were excluded from the analysis (including 12 without 6 mo of follow-up and two with incomplete ablation). The remaining 25 patients (aged 59.4 y ± 11.2) had 48 malignant liver lesions, including 22 hepatocellular carcinomas (HCCs), six cholangiocellular carcinomas, and 20 metastatic liver cancers. Multivariate analyses were used to evaluate the associations of risk factors with early recurrence. The characteristics of patients, lesions, and IRE procedures were assessed by logistic regression. Fourteen of the 48 treated lesions (29.2%) showed early local recurrence after 6 months. Tumor volume (< 5 cm(3) vs ≥ 5 cm(3); P = .022) and underlying disease type (HCC, cholangiocellular carcinoma, or metastatic disease; P = .023) were independently associated with early local recurrence. However, distances to the surrounding portal veins (< 0.5 cm vs ≥ 0.5 cm; P = .810), hepatic veins (P = .170), hepatic arteries (P = .761), and bile ducts (P = .226) were not significantly associated with local recurrence. Because short distances to the surrounding vessels were not associated with early local recurrence, percutaneous IRE might provide an alternative treatment option for perivascular tumors. However, patients with larger tumor volumes appeared to be poor candidates for percutaneous IRE. Regarding the different types of treated lesions, patients with HCC had significantly better outcomes. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.
    Journal of vascular and interventional radiology: JVIR 03/2015; 26(5). DOI:10.1016/j.jvir.2015.02.001 · 2.15 Impact Factor
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    ABSTRACT: Purpose: A. fumigatus infections represent a major threat for patients with a suppressed immune system. Early diagnosis is of importance for a favorable outcome but appears to be difficult due to limited diagnostic procedures. Here we investigated the sensitivity of high-resolution ultrasound (HRU) for the detection of A. fumigatus infection in the liver. Materials and Methods: BALB/c mice were intravenously infected with A. fumigatus and monitored by HRU, Doppler sonography (CCDS), contrast-enhanced ultrasound (CEUS), and real-time strain color-coded elastography (CCE) using a multi-frequency probe (6 - 15 MHz). Contrast media bolus injection of sulfur-hexafluoride micro-bubbles was applied and digital cine-loops from the arterial phase, as well as the portal venous phase up to the late phase of the whole liver were analyzed. All data were correlated to the histopathological findings. Results: Using HRU and CEUS, a sonic shadow was detected in all infected animals. All Aspergillus-infected nodes from 3 - 6 mm in the liver showed a shadow with rim enhancement and no intranodal enhancement when using CEUS. A. fumigatus infection was confirmed by CFU assessment and histopathological analysis. Granulomas were not associated with shadowing on B-mode. In contrast, granulomas with a diameter above 5 mm and a higher stiffness in CCE generated particularly an arterial rim enhancement and portal venous washout without contrast media uptake in the late phase. In addition, CEUS was able to define dynamic capillary microvascularization of infected liver areas. Conclusion: Liver lesions associated with A. fumigatus infection can be detected in mice when combined with CEUS and CCE in vivo. © Georg Thieme Verlag KG Stuttgart · New York.
    Ultraschall in der Medizin 03/2015; DOI:10.1055/s-0034-1398873 · 4.65 Impact Factor
  • C M Wendl · E M Jung · J Eiglsperger · G Schuierer
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    ABSTRACT: Purpose: The main goal of cerebral endovascular aneurysm therapy is the complete occlusion of the aneurysm. Along with the development of new aneurysm treatment devices, repeated controls are necessary. We examined whether contrast-enhanced ultrasound can help to monitor aneurysms after endovascular treatment. Materials and Methods: We prospectively examined 12 patients after coiling (7 patients) or flow diverter (FD) implantation (5 patients). These patients were examined with transcranial contrast-enhanced ultrasound using a matrix probe (1 - 5 MHz). Doppler sonography, Power Doppler, contrast harmonic imaging (CHI) and Power Doppler sonography (CPD) were included in the examination. Digital subtraction angiography with 3 D reconstructions served as the gold standard. Two radiologists decided in consensus about the degree of aneurysm occlusion separately in CEUS and digital subtraction angiography using a 4-point grading scheme. Results: The degree of occlusion of the 12 aneurysms comparing the two imaging modalities was identical in 10 cases. In two cases CHI and CPD showed a small aneurysm remnant after coiling in the center of the coil pack while in digital subtraction angiography the aneurysms seemed completely occluded. Conclusion: The investigation indicates that contrast-enhanced ultrasound is a supportive, noninvasive method for post-interventional controls of intracranial aneurysms due to its ability to display not only macro- but also microvascularization. © Georg Thieme Verlag KG Stuttgart · New York.
    Ultraschall in der Medizin 01/2015; 36(02):168-173. DOI:10.1055/s-0034-1398835 · 4.65 Impact Factor
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    ABSTRACT: Abscesses and circumscribed collections of fluid are frequently found as complications of infectious diseases or surgery. Drainage is often indicated. We have established a new, economic, easy-to-make model to learn and improve competence in installing ultrasound-guided drainage. Up to fifteen water balloons (size 30 - 50 mm) were placed in a plastic box which then was filled with instant custard powder mixed with water. Spiral computed tomography (CT) of this box was performed. Experienced (n = 8) and inexperienced examiners (n = 8) drained the balloons via a direct puncture technique using either ultrasound-guidance alone or volume navigation with image fusion (ultrasound and CT) with needle tracking. Trainees filled out a questionnaire (before and after training) asking for information on their experience in ultrasound, in installing drainages and evaluating the new model. The time needed for installing the drainage was measured. None of the participants had ever attended a course on drainage installation. Only a few of the experienced examiners (n = 3) would autonomously install a drainage into a fluid collection with a size exceeding 4 cm before training. After training all participants felt more confident in ultrasound and in installing drainages into abscesses or other fluid collections. Most of the participants rated additional volume navigation with image fusion as a helpful tool. Ultrasound-guided drainage of abscesses can be trained easily with this new and economic model. Students and physicians can improve their skills and gain confidence in performing ultrasound-guided interventions.
    Zeitschrift für Gastroenterologie 11/2014; 52(11):1257-1262. DOI:10.1055/s-0034-1385134 · 1.67 Impact Factor
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    ABSTRACT: AIM: Aim of our pilot study was the application of a contrast-enhanced color-coded ultrasound perfusion analysis in patients with vascular malformations to quantify microcirculatory alterations. MATERIAL AND METHODS: 28 patients (16 female, 12 male, mean age 24.9 years) with high flow (n = 6) or slowflow (n = 22) malformations were analyzed before intervention. An experienced examiner performed a color-coded Doppler sonography (CCDS) and a Power Doppler as well as a contrast-enhanced ultrasound after intravenous bolus injection of 1 - 2.4 ml of a second-generation ultrasound contrast medium (SonoVue (R), Bracco, Milan). The contrast-enhanced examination was documented as a cine sequence over 60 s. The quantitative analysis based on color-coded contrast-enhanced ultrasound (CEUS) images included percentage peak enhancement (%peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT). RESULTS: No side effects occurred after intravenous contrast injection. The mean % peak in arteriovenous malformations was almost twice as high as in slow-flow-malformations. The area under the curve was 4 times higher in arteriovenous malformations compared to the mean value of other malformations. The mean transit time was 1.4 times higher in high-flow-malformations compared to slow-flow-malformations. There was no difference regarding the time to peak between the different malformation types. The comparison between all vascular malformation and surrounding tissue showed statistically significant differences for all analyzed data (% peak, TTP, AUC, MTT; p < 0.01). High-flow and slow-flow vascular malformations had statistically significant differences in % peak (p < 0.01), AUC analysis (p < 0.01), and MTT (p < 0.05). CONCLUSION: Color-coded perfusion analysis of CEUS seems to be a promising technique for the dynamic assessment of microvasculature in vascular malformations.
    Clinical hemorheology and microcirculation 09/2014; 58(1). DOI:10.3233/CH-141878 · 2.22 Impact Factor
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    ABSTRACT: To assess the diagnostic accuracy of dual-energy computed tomography (DECT) for detection of endoleaks and aneurysm sac calcifications after endovascular aneurysm repair (EVAR) using hard plaque imaging algorithms. One hundred five patients received 108 triple-phase contrast-enhanced CT (non-contrast, arterial and delayed phase) after EVAR. The delayed phase was acquired in dual-energy and post-processed using the standard (HPI-S) and a modified (HPI-M) hard plaque imaging algorithm. The reference standard was determined using the triple-phase CT and contrast-enhanced ultrasound. All images were analysed separately for the presence of endoleaks and calcifications by two independent readers; sensitivity, specificity and interobserver agreement were calculated. Endoleaks and calcifications were present in 25.9 % (28/108) and 20.4 % (22/108) of images. The HPI-S images had a sensitivity/specificity of 54 %/100 % (reader 1) and 57 %/99 % (reader 2), the HPI-M images of 93 %/92 % (reader 1) and 96 %/92 % (reader 2) for detection of endoleaks. For detection of calcifications HPI-S had a sensitivity/specificity of 91 %/99 % (reader 1) and 95 %/97 % (reader 2), the HPI-M images of 91 %/99 % (reader 1) and 91 %/99 % (reader 2), respectively. Using HPI-M, DECT enables an accurate diagnosis of endoleaks after EVAR and allows distinguishing between endoleaks and calcifications with high diagnostic accuracy. aEuro cent Dual-energy computed tomography allows the diagnosis of aortic pathologies after EVAR. aEuro cent Hard plaque imaging algorithms can distinguish between endoleaks and aneurysm sac calcifications. aEuro cent The modified hard plaque imaging algorithm detects endoleaks with high diagnostic accuracy.
    European Radiology 06/2014; 24(10). DOI:10.1007/s00330-014-3266-y · 4.34 Impact Factor
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    ABSTRACT: Background: To evaluate the impact of high-resolution contrast-enhanced ultrasound (CEUS) in combination with Color Coded and Power Doppler Sonography (CCDS/PD) in the preoperative differentiation of thyroid adenomas and thyroid carcinomas. Methods: A total of 101 patients (55 female, median age 54 years) underwent surgery for thyroid adenoma and thyroid carcinoma. CCDS/PD and CEUS were performed in all patients by an experienced examiner using a multifrequency linear transducer (6-9 or 6-15 MHz) and were digitally stored. Reading of the ultrasound images was performed by two experienced radiologists in consensus. A histopathological evaluation was obtained as standard of reference in all patients. Results: Altogether, 75 thyroid adenomas and 26 thyroid carcinomas were detected. Mean diameter of thyroid adenomas and thyroid carcinomas was 27 mm and 32 mm, respectively. The differences in microcirculation of thyroid adenomas and thyroid carcinomas were statistically highly significant (p < 0.01). Representative features for thyroid adenomas were either no wash-out or wash-out with persisting edge in late phase, for thyroid carcinomas a complete wash-out in late phase. Thus, a calculation of sensitivity, specificity, positive and negative predictive value of 81%, 92%, 97% and 63%, respectively, for the differentiation of benignity and malignancy was possible. Conclusions: Dynamic evaluation of microcirculation using CEUS and CCDS/PD enables a more reliable preoperative discrimination between thyroid adenomas and thyroid carcinomas.
    Clinical hemorheology and microcirculation 06/2014; DOI:10.3233/CH-141848 · 2.22 Impact Factor
  • Bsn Platz · J Rennert · M Loss · W Jung · C Stroszczynski · E Michael Jung
    RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1372848 · 1.96 Impact Factor
  • EM Jung · P Wiggermann
    RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1373436 · 1.96 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1372787 · 1.96 Impact Factor
  • S Schleder · C Stroszczynski · EM Jung
    RöFo - Fortschritte auf dem Gebiet der R 04/2014; 186(S 01). DOI:10.1055/s-0034-1373439 · 1.96 Impact Factor
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    ABSTRACT: Purpose: Pneumoperitoneum (PP) is a severe finding in emergency departments. Its quick and correct diagnosis is indispensable for the further treatment of patients. The aim of this study was to analyze the clinical value of abdominal ultrasound performed with a modern hand-carried ultrasound (HCU) device as well as with a high-end ultrasound (HUS) system in the diagnosis of PP in patients with acute abdominal pain. Materials and Methods: 31 patients with acute abdominal pain were enrolled in this study irrespective of their underlying disease, and examination with a latest generation HCU and a newest generation HUS was performed. Diagnosis of PP was based on findings of multidetector computed tomography (MDCT) and abdominal radiography (AR) as the standard of reference. The study was carried out by two independent and experienced examiners unaware of the diagnosis made by MDCT or AR. Results: In five (16 %) patients PP was identified by MDCT and AR. Examination with HCU was calculated with a sensitivity and specificity of 80 % and 81 %, respectively. Examination with HUS yielded a sensitivity and specificity of 80 % and 89 %, respectively. Conclusion: PP can be detected by HCU and HUS with almost equal accuracy in patients with acute abdominal pain but both methods are inferior compared to MDCT and AR. However, HCU and HUS can accelerate the triage of patients and help to make decisions regarding the necessity of further examinations without the need for radiation and while reducing economic and logistic resources. Key Points: Citation Format: • Schleder S, Jung EM, Heiss P et al. Hand-Carried and High-End Ultrasound Systems Are Equally Inferior to Abdominal Radiography and Multidetector Computed Tomography in the Diagnosis of Pneumoperitoneum. Fortschr Röntgenstr 2013; DOI: 10.1055/s-0033-1356222.
    RöFo - Fortschritte auf dem Gebiet der R 01/2014; 186(3). DOI:10.1055/s-0033-1356222 · 1.96 Impact Factor
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    ABSTRACT: To estimate the presence and severity of capsular contracture in patients after breast implants an objective measurement tool is necessary. Eleven patients (range of age 37 to 53 years) who underwent cosmetic breast augmentation (seven patients with bilateral implants) or breast reconstruction by mammary asymmetry (four patients unilateral) with smooth silicone gel implants were included in this prospective study. In total seventeen implants were examined clinically and with the colour coded Ultrasound Elastography using a multifrequency probe (5-10 MHz Siemens Antares Premium VFX13-5). The grade of capsular contracture was assessed by two examiners with the palpation method and classified according to the Baker score. The Ultrasound Elastography was performed by two radiologists specialized in breast imaging and was correlated with the Baker score, colour coded ultrasound elastography and a high resolution ultrasound B-scan score (0-5). The clinical examination proved following distribution of the Baker degree: 6 breast implants with Baker grade I and Baker grade II, 3 breast implants with Baker grade III and two breast implants with Baker grade IV. There was a high correlation between the Baker score and the objective scoring measured by Ultrasound Elastography (kappa 0.83-0.89). The new technology of Ultrasound Elastography represents a useful tool to evaluate the compressibility of the peri-implant capsule, the implant and the surrounding tissue.
    Clinical hemorheology and microcirculation 01/2014; 58(4). DOI:10.3233/CH-141812 · 2.22 Impact Factor
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    ABSTRACT: PURPOSE To evaluate if IO-CEUS and CCE allow a differentiation between malignant and benign liver lesions in comparison to histopathology. METHOD AND MATERIALS Retrospective evaluation of digitally stored intraoperative CEUS examinations. IO-CEUS and CCE of 59 liver lesions were compared to histopathology following surgical resection. Examinations were performed by one experienced examiner using a multifrequency linear probe (6-9 MHz, LOGIQ E9/GE). Loops of CEUS were evaluated during the arterial (15-45s), the portal venous (60-90s) and the late-venous phase (2-5 min). Characterization of the CCE quality using digital cine-loops >10 s, based upon a color coding system. Semi-quantitative evaluation of the lesions’ stiffness based upon a specified scaling of 0-6 (0 low up to 6 high) using 6 ROIs (1 in the center, 5 in the marginal zone). RESULTS Lesion diameter from 7 – 56 mm, mean 26 mm. All 54 malignant lesions (20 HCCs, 8 CCCs, 24 metastases) displayed a portal venous washout. 3 lesions that could not be characterized definitely using IO-CEUS and CCE, were found to be a partially thrombosed hemangioma, a granuloma and a dystrophic fibrosis by histopathology. 4 lesions were correctly diagnosed as complicated cysts using IO-CEUS. Overall sensitivity of IO-CEUS was 90%, PPV was 100%, NPV 40% and accuracy was 94%. Using CCE, malignant lesions were found to be inhomogenous, only partially indurated in 12 lesions, with a scaling of 5. In 13/59 lesions, only central indurations were visible (scaling 4-6). Sensitivity of the CCE was 65%, PPV was 94%, NPV 20% and accuracy was 71%. CONCLUSION IO-CEUS offers clear benefits for localization and characterization of liver lesions. CCE only sometimes allows a correct characterization of lesions. CLINICAL RELEVANCE/APPLICATION CEUS in comparison to US elastography (CCE) enables a more exactly intraoperatively localization and characterization of liver tumors before resection
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
  • Ernst Michael Jung · Janine Rennert · Lukas Prantl
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    ABSTRACT: PURPOSE Tissue defects are a common problem in trauma surgery or oncology. Flap transplantation is often the only therapy to cover these extensive wound defects. To date several monitoring systems exist but none has made it to clinical day work. Objective: Aim of this study was to assess perfusion disturbances of local and free flaps using contrast enhanced ultrasound (CEUS). METHOD AND MATERIALS 112 patients were examined after local or free flap transplantation during the first 72 hours after operation. CEUS was performed by one experienced examiner with a linear transducer (6-9 MHz, LOGIQ E9/GE) after a bolus injection of 2.4 ml sufohexa-fluoride microbubbles (SonoVue®, Bracco, Italy). Retrospective vascular perfusion was quantified by evaluating the stored DICOM cine loops using the perfusion software QONTRAST® (Bracco, Italy). Over a total penetration depth of 3 cm every centimetre was analysed separately. 27 complications were observed. Complete flap loss was only seen in 4 cases whereas 23 flaps had to undergo minor revisions and survived. RESULTS Regarding the complete flap size quantitative analysis showed significant higher perfusion values in patients without complications compared to patients with complications: PEAK 16.5 vs. 10.0 (p=0.001), TTP 32.6 vs. 22.2 (p=0.001), RBV: 738.8 vs. 246.2 (p<0.001), RBF 17.5 vs. 10.1 (p<0.001) and MTT 43.1 vs. 29.5 (p=0.001) Correlation analysis of the different flap types, age, sex and aetiology of the wound defect to the complication rate showed no statistical correlation. CONCLUSION CEUS was capable of detecting vascular disturbances after flap transplantation. TTP, RBV and MTT seem to be the most accurately parameters and are very unsusceptible to malfunction during measurement. CLINICAL RELEVANCE/APPLICATION CEUS offers an exacellent imaging method to detect early reduction of the tissue transplants microvasculariazation also if MRI is not avaible or not realiaziable.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Purpose To evaluate the association of inferior mesenteric arterial (IMA) type II endoleaks in patients undergoing endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm with several morphologic parameters. Materials and Methods Approval of the institutional ethical review committee was not required. This was a retrospective review of 322 CT angiographic studies that were performed in patients before they underwent elective EVAR for infrarenal abdominal aortic aneurysm. Morphologic parameters evaluated were IMA patency, origin of the IMA in relation to the aneurysm sac, diameter of the IMA, the cross-sectional area of the contrast material-enhanced aortic lumen at the level of the IMA ostium, and the number of additional patent aortic side branches from the aneurysm sac. The association of IMA type II endoleaks with each variable was analyzed by using univariate and multivariate logistic regression models. Results The diameter of the IMA did not influence the development of IMA type II endoleaks (P = .51). The incidence of these endoleaks was significantly higher in patients with greater cross-sectional area of the aortic lumen at the IMA ostium (P < .001). Patients with an IMA type II endoleak had significantly more patent aortic side branches before EVAR than did patients without an endoleak (3.6 ± 1.7 vs 2.2 ± 1.4; P < .001). According to the final logistic regression model that included cross-sectional area of the aortic lumen at the IMA and the number of aortic side branches as independent predictors, risk for IMA type II endoleaks was determined with a sensitivity of 78% (39 of 50) and a specificity of 79% (92 of 116). Conclusion Cross-sectional area of the contrast-enhanced aortic lumen at the level of the IMA ostium and the number of additional patent aortic side branches are associated with the development of IMA type II endoleaks. © RSNA, 2013.
    Radiology 11/2013; 270(3):130489. DOI:10.1148/radiol.13130489 · 6.21 Impact Factor
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    I Göcze · W A Wohlgemuth · H J Schlitt · E M Jung
    Intensive Care Medicine 11/2013; 40(3). DOI:10.1007/s00134-013-3152-0 · 7.21 Impact Factor

Publication Stats

1k Citations
529.23 Total Impact Points

Institutions

  • 2007–2015
    • University Hospital Regensburg
      • • Abteilung für Unfallchirurgie
      • • Institut für Röntgendiagnostik
      Ratisbon, Bavaria, Germany
  • 2008–2014
    • Universität Regensburg
      Ratisbon, Bavaria, Germany
  • 2007–2011
    • Ludwig-Maximilian-University of Munich
      • Department of Clinical Radiology
      München, Bavaria, Germany
  • 2004
    • University Hospital München
      München, Bavaria, Germany
  • 2002–2003
    • Universität Passau
      Passau, Bavaria, Germany