E M Jung

University Hospital Regensburg, Ratisbon, Bavaria, Germany

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Publications (246)476.58 Total impact

  • [Show abstract] [Hide abstract]
    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. · 1.67 Impact Factor
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    ABSTRACT: 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.
    Clinical hemorheology and microcirculation 09/2014; · 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.
    European Radiology 06/2014; · 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; · 2.22 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; · 2.76 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; · 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; · 6.21 Impact Factor
  • European Journal of Intensive Care Medicine 11/2013; · 5.17 Impact Factor
  • D-A Clevert, E M Jung
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    ABSTRACT: Optimization of ultrasound guided interventional procedures of the liver and kidneys using new imaging methods. Punctures, biopsies, drainage, intraoperative ultrasound, fusion, embolization in correlation with ultrasound and other imaging methods. Real-time-sonography, contrast-enhanced ultrasound (CEUS) and fusion for planning, monitoring and postinterventional control. The use of CEUS enables better detection, characterization and execution of interventional procedures. Fusion facilitates detection. The CEUS procedure is superior for detection and characterization of smaller lesions in comparison to the B scan. Fusion enables the performance of difficult interventional procedures. The B scan is the standard imaging method but CEUS and fusion could be helpful for smaller lesions.
    Der Radiologe 11/2013; · 0.41 Impact Factor
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    ABSTRACT: Purpose: To evaluate the reliability of ultrasound elastography for delineating thermal ablation defects post-radiofrequency ablation (RFA) by comparing lesion dimensions determined by real-time elastography (RTE) with the findings of contrast-enhanced ultrasound (CEUS).Materials and Methods: A total of 21 malignant liver tumors were percutaneously ablated using RFA. Color-coded elastography and CEUS were performed by one experienced examiner, using a 1 - 5 MHz multi-frequency convex transducer (LOGIQ E9, GE). Lesions were examined using CEUS and real-time elastography (RTE) to assess ablation defects. Measurements of lesions (long axis, short axis, and area) representing the same image plane used for elastography were taken during CEUS examination and compared to the measurements obtained from the elastograms. All measurements were performed by two independent observers.Results: A statistically significant correlation in vivo between RTE and CEUS measurements with respect to the lesion's principal axis and area (r = 0.876 long axis, r = 0.842 short axis and r = 0.889 area) was found. Inter-rater reliability assessed with the concordance correlation coefficient was substantial for all measurements (ρc ≥ 0.96) Overall, elastography slightly underestimated the lesion size, as judged by the CEUS images.Conclusion: These results support that RTE could potentially be used for the routine assessment of thermal ablation therapies.
    Ultraschall in der Medizin 10/2013; · 4.12 Impact Factor
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    ABSTRACT: Purpose: Tissue defects are a common problem in trauma surgery and oncology. Flap transplantation is often the only therapy to cover such defects. Several monitoring systems are currently available but none has made it to the clinical routine. The aim of this study was to assess perfusion disturbances of local and free flaps using contrast-enhanced ultrasound (CEUS).Materials and Methods: 112 patients were examined during the first 72 hours after operation. CEUS was performed by one experienced examiner with a linear transducer (6 - 9 MHz, LOGIQE9/GE) after a bolus injection of 2.4 ml sulfohexa-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 centimeter was analyzed separately. 27 complications were observed. Complete flap loss was only seen in 4 cases, while 23 flaps had to undergo minor revision and survived.Results: Regarding the complete flap size, quantitative analysis showed significantly 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). Analysis of the correlation of the different flap types, age, sex and etiology of the tissue 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 not susceptible to malfunction during measurement.
    Ultraschall in der Medizin 10/2013; · 4.12 Impact Factor
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    ABSTRACT: To evaluate the impact of high-resolution contrast-enhanced ultrasound (CEUS), Color Coded and Power Doppler Sonography (CCDS/PD), in the preoperative recognition of thyroid adenomas. A total of 64 patients (36 female, median age 54 years) underwent surgery for thyroid adenoma. CEUS with linear multifrequency probes (6-9 or 6-15 MHz) and CCDS/PD was performed in all patients preoperatively by an experienced examiner and images were stored in PACS. Reading of the ultrasound images was performed in consensus by two experienced radiologists. Histopathology was achieved as standard of reference in all patients. Median diameter of the tumor lesions was 27 mm. 31 nodules were found on the left side. In B-Scan mode 13 (20%) adenomas showed complex cystic echo pattern and 44 (69%) had a complete and sharp hypoechoic edge. 43 (67%) thyroid adenomas had strong hypervascularization in CCDS/PD. In 61 (95%) adenomas early contrast enhancement was present in CEUS and 50 (78%) adenomas proved no wash-out or central wash-out with persisting edge enhancement. In 47 (73%) cases early contrast enhancement was combined with no washout or with central wash-out with persisting edge enhancement. 45 (70%) thyroid lesions had preoperatively been classified as benign lesions correctly. Dynamic evaluation of microcirculation by CEUS and CCDS/PD enables a more reliable preoperative characterization of thyroid adenomas.
    Clinical hemorheology and microcirculation 10/2013; · 2.22 Impact Factor
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    ABSTRACT: To evaluate tumor perfusion by means of dynamic contrast-enhanced ultrasonography (DCEUS) and aggregated time intensity curves (TICs) after transarterial chemoembolization with degradable starch microspheres (DSM-TACE). 18 patients underwent 36 DCEUS examinations conducted via contrast agent application before and after DSM-TACE. Based on time intensity curves (TICs), we analyzed the microcirculation of the embolized HCC lesions with a dedicated perfusion software. Signal intensity was significantly reduced (p ≤ 0.001) after DSM-TACE at all time points measured. The mean signal intensity after 5, 10, 15, 20 and 25 s was 375.18 ± 16.41, 455.66 ± 17.92, 294.47 ± 19.91, 246.51 ± 20.99 and 173.45 ± 25.80 before TACE and 49.47 ± 2.43, 49.51 ± 2.40, 37.40 ± 2.45, 27.48 ± 2.65 and 27.96 ± 3.01 after TACE. In this study, tumor perfusion could be accurately evaluated by means of DCEUS and aggregated TICs after DSM-TACE.
    Clinical hemorheology and microcirculation 10/2013; · 2.22 Impact Factor
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    ABSTRACT: Primary aldosteronism (PA, also Conn syndrome) is a benign disease in majority of cases. However, malignant transformation has been described. Present study reports on three cases of aldosterone producing adrenocortical carcinoma (APAC) in comparison to patients with benign PA. Data of patients undergoing adrenalectomy for benign PA were compared to patients with APAC. Retrospective chart analysis was performed. All patients received spironolactone for 6-8 weeks preoperatively. Seventy-four patients underwent adrenalectomy for PA between 1994 and 2011. Three of them revealed an APAC. Patients with APAC presented with a significantly lower serum potassium level (1.7 mmol/l vs. 3.4 mmol/l, p = 0.001) and significant larger tumors (5.2 vs. 1.8 cm, p = 0.002). In addition, aldosterone/renin (A/R) ratio 675 in patients with APAC as compared to 74 in patients with benign PA (p = 0.0001). Sixty-eight of 71 patients with benign PA underwent minimal invasive surgery, whereas all three patients with APAC were operated conventionally. All patients with APAC developed disease recurrence 6-18 months postoperatively. Tumor size >4 cm and a very high A/R ratio seems to predictors of malignancy in patients with PA. If these criteria are present, open adrenalectomy should be performed instead of endoscopic procedure.
    Langenbeck s Archives of Surgery 09/2013; · 1.89 Impact Factor
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    ABSTRACT: We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.
    Korean journal of radiology: official journal of the Korean Radiological Society 09/2013; 14(5):797-800. · 1.32 Impact Factor
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    ABSTRACT: Background: Extensive wound defects frequently have to be covered by free flap transplantation. A monitoring device for measuring capillary level perfusion of bone is currently not available.Objective: The aim of the study was to detect complications after osteocutaneous flap transplantation using contrast-enhanced ultrasound (CEUS). Additionally quantitative analysis was performed by special perfusion software (QONTRAST®; Bracco, Italy).Methods: 22 patients were examined after osteocutaneous flap transplantation during the first 72 h after operation. CEUS was performed with a linear transducer (6 - 9 MHz, LOGIQ E9/GE) after bolus injections of 2.4 ml ultrasound contrast agent (SonoVue®; Bracco, Italy). The osseous perfusion and soft tissue perfusion were analyzed separately and quantitative perfusion analysis was performed. Five patients had to undergo reoperation due to compromised flap microvascularization.Results: In all 5 complications reduced osseous and soft tissue perfusion was seen using CEUS. Additionally using the perfusion parameters TTP (time to PEAK), RBV (regional blood volume), RBF (regional blood flow) und MTT (mean transit time), significantly lower soft tissue and osseous perfusion was detected.Conclusion: CEUS seems to be capable of detecting vascular disturbances and of assessing microvascularization of the osseous component after osteocutaneous flap transplantation.
    Ultraschall in der Medizin 06/2013; 34(3):272-279. · 4.12 Impact Factor
  • RöFo - Fortschritte auf dem Gebiet der R 04/2013; 185(S 01). · 1.96 Impact Factor
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    ABSTRACT: Introduction:Preoperative detection of parathyroid gland adenoma (PA) in the presence of primary hyperparathyroidism (pHPT) represents a diagnostic challenge. We present the first prospective study with contrast-enhanced ultrasonography (CEUS) as the central diagnostic tool for the preoperative localization of PA in pHPT in comparison to conventional ultrasonography.Methods:Between 7/2010 and 12/2011 75 consecutive patients underwent surgery for pHPT. In all patients conventional ultrasonography and contrast-enhanced ultrasonography were performed prospectively for localization of pathological parathyroid glands. 25 patients suffered from a concomitant goiter (CG) and 12 patients had undergone previous neck surgery (PNS) due to thyroid pathologies. The sensitivity of both diagnostic tools was analyzed in comparison to intraoperative and histological findings.Results:CEUS had a sensitivity of 97% for the detection of the correct quadrant of the pathological parathyroid gland(s) and of 99% for the correct side in comparison to 70% for conventional ultrasonography. In multivariate regression analysis CG, gland size and BMI had a relevant impact on incorrect findings by conventional ultrasonography as compared to CEUS. Follow-up with a minimum of 6 months after surgery showed normal serum levels of calcium and parathormone in all 75 patients.Conclusions:CEUS represents a highly reliable, non-invasive and non-radioactive diagnostic tool for localization of pathological parathyroid gland(s) in patients with pHPT. Even in the presence of CG, PNS or double adenomas CEUS has a high sensitivity.
    The Journal of Clinical Endocrinology and Metabolism 03/2013; · 6.31 Impact Factor

Publication Stats

1k Citations
476.58 Total Impact Points

Institutions

  • 2007–2014
    • University Hospital Regensburg
      • • Klinik für Chirurgie
      • • Institut für Röntgendiagnostik
      Ratisbon, Bavaria, Germany
  • 2004–2013
    • University Hospital München
      München, Bavaria, Germany
  • 2008–2012
    • Universität Regensburg
      • Lehrstuhl für Innere Medizin I
      Ratisbon, Bavaria, Germany
  • 2007–2012
    • Ludwig-Maximilian-University of Munich
      • Department of Clinical Radiology
      München, Bavaria, Germany
  • 2002–2004
    • Universität Passau
      Passau, Bavaria, Germany