Thomas C Lauenstein

University Hospital Essen, Essen, North Rhine-Westphalia, Germany

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Publications (307)716.78 Total impact

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    ABSTRACT: Background: Tumor biopsy is not essential for the diagnosis of hepatocellular carcinoma (HCC); however, grading remains important for the prognosis. Purpose: To investigate whether combined Gd-EOB-DTPA and gadobutrol liver magnetic resonance imaging (MRI) can predict HCC grading. Material and methods: Thirty patients (66.6 ± 7.3 years) with histologically confirmed HCC (grade 1, n = 5; grade 1-2, n = 6; grade 2, n = 13; grade 2-3, n = 2; grade 3, n = 4) underwent two liver MRIs, one with gadobutrol and one with Gd-EOB-DTPA, on consecutive days. Blinded to grading, two radiologists reviewed the gadobutrol and Gd-EOB-DTPA images in consensus with respect to: (i) HCC hyper-/iso-/hypointensity in the arterial, portal-venous/delayed, and Gd-EOB-DTPA hepatocellular phase; and (ii) morphologic tumor features (encapsulated growth, vessel invasion, heterogeneity, liver capsule infiltration, satellite metastases). Results: A significant correlation with grading was not found for either the combined dynamic information of all gadobutrol phases (r = -0.187, P = 0.331) or all the Gd-EOB-DTPA phases (r = 0.052, P = 0.802). No correlation with grading was found for a combination of arterial and hepatocellular phase in Gd-EOB-DTPA MRI (r = 0.209, P = 0.305), a combination of both arterial phases (gadobutrol and Gd-EOB-DTPA) with the Gd-EOB-DTPA hepatocellular phase (r = 0.240, P = 0.248), or a combination of all available gadobutrol and Gd-EOB-DTPA phases (r = 0.086, P = 0.691). For all gadobutrol information (dynamic phases and morphology; r = 0.049, P = 0.801) and for all Gd-EOB-DTPA information (r = 0.040, P = 0.845), no correlation with grading was found. Hepatocellular Gd-EOB-DTPA phase iso-/hyperintensity never occurred in grade 3 HCCs. Conclusion: Histological HCC grading cannot be predicted by combined Gd-EOB-DTPA/gadobutrol MRI. However, Gd-EOB-DTPA hepatocellular phase iso-/hyperintensity was never detected in grade 3 HCCs.
    Acta Radiologica 11/2015; DOI:10.1177/0284185115616293 · 1.60 Impact Factor
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    ABSTRACT: The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract as well as the parenchymal abdominal organs. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. The working group experts cover the most recent relevant studies concerning liver-specific contrast media with an emphasis on a new classification system for liver adenomas. Additionally studies regarding selective internal radiotherapy (SIRT) are reviewed. For the pancreas the most important tumors are described followed by an introduction to the most recently introduced functional imaging techniques. The manuscript concludes with some remarks on recent studies and concerning chronic pancreatitis as well as autoimmune pancreatitis. Key Points: • Different subtypes of liver adenomas with different therapeutic consequences can be differentiated by MRI• Most recently published studies focus on liver imaging with extracelluar liver specific contrast media as well as diffusion weighted imaging. They consider this new method having a high diagnostic potential.• For pancreatic neoplasm diagnosis diffusion - as well as perfusion - imaging is considered as a highly promising method. Citation Format: • Grenacher L, Juchems MS, Holzapfel K et al. A Review of Scientific Topics and Literature in Abdominal Radiology in Germany - Part 2: Abdominal Parenchymal Organs. Fortschr Röntgenstr 2015; DOI: 10.1055/s-0041-105411.
    RöFo - Fortschritte auf dem Gebiet der R 10/2015; DOI:10.1055/s-0041-105411 · 1.40 Impact Factor
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    ABSTRACT: The aim of this study was to compare the diagnostic accuracy of [18F]FDG-PET/MRI with PET/CT for the detection of liver metastases. 32 patients with solid malignancies underwent [18F]FDG-PET/CT and subsequent PET/MRI of the liver. Two readers assessed both datasets regarding lesion characterization (benign, indeterminate, malignant), conspicuity and diagnostic confidence. An imaging follow-up (mean interval: 185±92 days) and/-or histopathological specimen served as standards of reference. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both modalities. Accuracy was determined by calculating the area under the receiver operating characteristic (ROC) curve. Values of conspicuity and diagnostic confidence were compared using Wilcoxon-signed-rank test. The standard of reference revealed 113 liver lesions in 26 patients (malignant: n = 45; benign: n = 68). For PET/MRI a higher accuracy (PET/CT: 82.4%; PET/MRI: 96.1%; p<0.001) as well as sensitivity (67.8% vs. 92.2%, p<0.01) and NPV (82.0% vs. 95.1%, p<0.05) were observed. PET/MRI offered higher lesion conspicuity (PET/CT: 2.0±1.1 [median: 2; range 0-3]; PET/MRI: 2.8±0.5 [median: 3; range 0-3]; p<0.001) and diagnostic confidence (PET/CT: 2.0±0.8 [median: 2; range: 1-3]; PET/MRI 2.6±0.6 [median: 3; range: 1-3]; p<0.001). Furthermore, PET/MRI enabled the detection of additional PET-negative metastases (reader 1: 10; reader 2: 12). PET/MRI offers higher diagnostic accuracy compared to PET/CT for the detection of liver metastases.
    PLoS ONE 09/2015; 10(9):e0137285. DOI:10.1371/journal.pone.0137285 · 3.23 Impact Factor
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    ABSTRACT: Selective Internal Radiation Therapy (SIRT) with 90yttrium (Y-90) is an increasingly used therapeutic option for unresectable liver malignancies. Nontarget embolization of extrahepatic tissue secondary to vascular shunting can lead to SIRT associated complications. Our aim was to assess whether extrahepatic shunts can reliably be diagnosed based on hepatic digital subtraction angiography (DSA) or whether subsequent SPECT/CT data can provide additional information. 825 patients with hepatocellular carcinoma (n = 636), hepatic metastases (n = 158) or cholangiocellular carcinoma (n = 31) were retrospectively analyzed. During hepatic DSA 128 arteries causing shunt flow to gastrointestinal tissue were coilembolized (right gastric artery n = 63, gastroduodenal artery n = 29; branches to duodenum / pancreas n = 36). Technectium-99m-labeled human serum albumin (HSA) was injected in all 825 patients. SPECT/CT data was used to identify additional or remaining shunts to extrahepatic tissue. An unexpected uptake of HSA in extrahepatic tissue was found by SPECT/CT in 54/825 (6.5%) patients (located in stomach n = 13, duodenum n = 26, distal bowel segments n = 12, kidney n = 1, diaphragm n = 2). These patients underwent repeated DSA and newly identified shunt vessels were coilembolized in 22/54 patients, while in 12/54 patients a more distal catheter position for repeat injection of HSA was chosen. In 20/54 patients the repeated SPECT/CT data still revealed an extrahepatic HSA uptake. These patients did not receive SIRT. Most extrahepatic shunts can be identified on DSA prior to Y-90 therapy. However, SPECT-CT data helps to identify additional shunts that were initially not seen on DSA.
    PLoS ONE 09/2015; 10(9):e0137587. DOI:10.1371/journal.pone.0137587 · 3.23 Impact Factor
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    ABSTRACT: The working group for abdominal and gastrointestinal diagnosis is a group of the German Radiological Society (DRG) focusing clinically and scientifically on the diagnosis and treatment of the gastrointestinal tract with all parenchymatous abdominal organs. In addition to the clinical and scientific further development of abdominal radiology, the education of radiologists within this core discipline of radiology is one of the major aims. In this article we give an up-to-date literature review of scientific radiological topics especially covered by German radiologists. This manuscript focuses on the most recent literature on the diagnosis of the stomach, small bowel, colon and rectum. The review with a focus on the most recent studies published by German radiologists concludes with a synopsis of mesenterial bleeding and ischemia followed by a critical appraisal of the current literature on conventional abdominal radiography. Key Points: • Based on recent literature and guidelines there is a change of paradigms regarding the diagnosis of esophagus and gastric cancer towards CT, which is considered equally to endosonography.• For small bowel imaging in Crohn's disease ultrasound as well as MRI with a new focus on DWI are the most important imaging modalities scientifically.• For colonic diagnosis virtual colonoscopy has replaced the conventional radiological methods. For staging of rectal carcinoma as well as for therapeutic stratification a high resolution MRI of the pelvis is of paramount interest.• Multislice CT is considered the most important modality to assess mesenteric ischemia or bleeding. Citation Format: • Schreyer AG, Wessling J, Kinner S et al. A Review of Scientific Topics and Literature in Abdominal Radiology in Germany - Part 1: Gastrointestinal Tract. Fortschr Röntgenstr 2015; DOI: 10.1055/s-0041-104892. © Georg Thieme Verlag KG Stuttgart · New York.
    RöFo - Fortschritte auf dem Gebiet der R 09/2015; DOI:10.1055/s-0041-104892 · 1.40 Impact Factor
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    ABSTRACT: To compare the diagnostic competence of FAST-PET/MRI and PET/CT for whole-body staging of female patients suspect for a recurrence of a pelvic malignancy. 24 female patients with a suspected tumor recurrence underwent a PET/CT and subsequent PET/MRI examination. For PET/MRI readings a whole-body FAST-protocol was implemented. Two readers separately evaluated the PET/CT and FAST PET/MRI datasets regarding identification of all tumor lesions and qualitative assessment of visual lesion-to-background contrast (4-point ordinal scale). Tumor relapse was present in 21 of the 24 patients. Both, PET/CT and PET/MRI allowed for correct identification of tumor recurrence in 20 of 21 cases. Lesion-based sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for the detection of malignant lesions were 82%, 91%, 97%, 58% and 84% for PET/CT and 85%, 87%, 96%, 63% and 86% for PET/MRI, lacking significant differences. Furthermore, no significant difference for lesion-to-background contrast of malignant and benign lesions was found. FAST-PET/MRI provides a comparably high diagnostic performance for restaging gynecological cancer patients compared to PET/CT with slightly prolonged scan duration, yet enabling a markedly reduced radiation exposure. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    European journal of radiology 08/2015; 84(11). DOI:10.1016/j.ejrad.2015.08.010 · 2.37 Impact Factor
  • A El Fouly · J Best · T Lauenstein · A Bockisch · S Müller · G Gerken · A Dechêne ·

    Zeitschrift für Gastroenterologie 08/2015; 53(08). DOI:10.1055/s-0035-1559263 · 1.05 Impact Factor
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    ABSTRACT: To assess the diagnostic value of integrated PET/MRI for whole-body staging of cervical cancer patients, as well as to investigate a potential association between PET/MRI derived functional parameters and prognostic factors of cervical cancer. The present study was approved by the local institutional review board. Twenty-seven patients with histopathologically confirmed cervical cancer were prospectively enrolled in our study. All patients underwent a whole-body PET/MRI examination after written informed consent was obtained. Two radiologists separately evaluated the PET/MRI data sets regarding the determination of local tumor extent of primary cervical cancer lesions, as well as detection of nodal and distant metastases. Furthermore, SUV and ADC values of primary tumor lesions were analyzed and correlated with dedicated prognostic factors of cervical cancer. Results based on histopathology and cross-sectional imaging follow-up served as the reference standard. PET/MRI enabled the detection of all 27 primary tumor lesions of the uterine cervix and allowed for the correct determination of the T-stage in 23 (85 %) out of the 27 patients. Furthermore, the calculated sensitivity, specificity and diagnostic accuracy for the detection of nodal positive patients (n = 11) were 91 %, 94 % and 93 %, respectively. PET/MRI correctly identified regional metastatic disease (N1-stage) in 8/10 (80 %) patients and non-regional lymph node metastases in 5/5 (100 %) patients. In addition, quantitative analysis of PET and MRI derived functional parameters (SUV; ADC values) revealed a significant correlation with pathological grade and tumor size (p < 0.05). The present study demonstrates the high potential of integrated PET/MRI for the assessment of primary tumor and the detection of lymph node metastases in patients with cervical cancer. Providing additional prognostic information, PET/MRI may serve as a valuable diagnostic tool for cervical cancer patients in a pretreatment setting.
    European Journal of Nuclear Medicine 07/2015; 42(12). DOI:10.1007/s00259-015-3131-5 · 5.38 Impact Factor
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    ABSTRACT: To analyze remodeling processes after advanced core decompression (ACD) in patients with avascular femoral head necrosis by means of 3T MRI and to identify indicators for clinical outcome considering the defect size and characteristics of the bone graft and of the neighboring regeneration tissue. Thirty-four hips, with preexisting preoperative MRIs in 21 cases, were examined 1-34 months (mean 12.7) postoperatively by 3T MRI. The volume of necrosis was measured manually pre- and postoperatively to calculate absolute as well as percentage necrosis reduction. The signal intensity of the bone graft was quantified using a 4-point scale. Border phenomena between the bone graft and bone were described and classified into groups. Wilcoxon sign-rank test was used to identify correlations between the analyzed items and clinical signs of femoral head collapse after a mean follow-up time of 28.6 months (10.4-46.8). Mean percentage reduction of necrosis was significantly higher in asymptomatic patients (59.36 %) compared to patients with signs of femoral head collapse (28.78 %, p = 0.008). Signal intensity of the bone graft increased in T1w and T2w TIRM sequences over time after surgery and was significantly higher in asymptomatic patients. Five border phenomena between the bone graft and healthy bone were identified. Among them, the so-called "rail sign" representing three layers of remodeling tissue correlated with the histological observations. A variety of border phenomena representing remodeling processes have been described using 3T MRI. Beneath the percentage amount of necrosis reduction, we identified the signal intensity of the bone graft as an indicator for clinical outcome.
    Skeletal Radiology 06/2015; 44(10). DOI:10.1007/s00256-015-2192-7 · 1.51 Impact Factor
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    ABSTRACT: T1-weighted (T1w) contrast-enhanced magnetic resonance imaging (MRI) of the small bowel at 1.5 T magnetic field strength has become a standard technique in investigating diseases of the small bowel. High-field MRI potentially offers improved soft tissue contrast and spatial resolution, providing increased image detail. The purpose of this study was to evaluate the feasibility of contrast-enhanced small bowel MRI at 7 T and to compare results with 1.5 T. Twelve healthy volunteers underwent small bowel MRI on a 1.5 T and 7 T MRI system. A coronal fat-saturated T1w spoiled gradient-echo sequence (3-dimensional [3D] FLASH) was applied precontrast and at 20 seconds, 75 seconds, and 120 seconds after intravenous contrast administration. Furthermore, late-phase coronal and axial fat-saturated T1w 2-dimensional (2D) FLASH data sets were acquired. Visual evaluation of tissue contrast and image detail of the small bowel wall and mesentery as well as contrast ratios were compared between 1.5 T and 7 T in an intraindividual comparison. In addition, subjective ratings of image impairment by artifacts were assessed at both field strengths. Magnetic resonance imaging of the small bowel at 7 T revealed equal tissue contrast and image detail compared with 1.5 T. Higher contrast and improved image detail of mesentery structures at 7 T were found in nonenhanced 3D FLASH. Quantitatively measured contrast between the bowel wall and bowel lumen showed significantly lower contrast at 7 T in nonenhanced 3D FLASH and in late-phase 2D FLASH. Image quality was more impaired at 7 T compared with 1.5 T, mainly due to increased susceptibility artifacts and B1 inhomogeneities. T1-weighted contrast-enhanced MRI of the small bowel at 7 T represents a promising MR technique for establishing ultra-high magnetic field strengths in clinical applications. Despite increased artifacts at 7 T, depiction of the small bowel was achieved with comparable quality to the current state-of-the-art field strength of 1.5 T. Assessment of potential diagnostic benefits should be the focus of future high-field MRI studies.
    Investigative radiology 05/2015; Publish Ahead of Print(8). DOI:10.1097/RLI.0000000000000161 · 4.44 Impact Factor
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    ABSTRACT: Purpose: To compare the utility of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA), a liver-specific magnetic resonance (MR) imaging contrast agent, versus gadobutrol for treatment response evaluation of hepatocellular carcinoma (HCC) after radioembolization. Materials and methods: This prospective study included 50 patients with HCC undergoing radioembolization. All patients underwent contrast-enhanced computed tomography (CT) and MR imaging with gadobutrol and Gd-EOB-DTPA on 2 consecutive days before radioembolization and 30 days, 90 days, 180 days, and 270 days after radioembolization. The standard of reference indicating tumor progression was CT combined with either α-fetoprotein or γ-glutamyltransferase. Gadobutrol-enhanced MR imaging, Gd-EOB-DTPA-enhanced MR imaging without late phase imaging (Gd-EOB-DTPA-), and Gd-EOB-DTPA-enhanced MR imaging with late phase imaging (Gd-EOB-DTPA+) were evaluated by 2 radiologists in consensus using a 4-point scale: 1 = definitely no tumor progression; 2 = probably no tumor progression; 3 = probably tumor progression; 4 = definitely tumor progression. Diagnostic accuracy was assessed with receiver operating characteristic analysis. Results: Tumor progression was detected in 14 of 82 study visits according to the reference standard. Pairwise comparison of the area under the curve showed a tendency toward a larger area under the curve for Gd-EOB-DTPA+ compared with gadobutrol (P = .056). Sensitivity and specificity were higher in Gd-EOB-DTPA+ (0.929 and 0.971) than in Gd-EOB-DTPA- (0.786 and 0.941) or gadobutrol (0.643 and 0.956). In 2 cases, tumor progression was detected by Gd-EOB-DTPA+ and by an increase in α-fetoprotein, but not by CT, gadobutrol, or Gd-EOB-DTPA-. Conclusions: Gd-EOB-DTPA+ MR imaging was not inferior to gadobutrol-enhanced MR imaging in therapy response evaluation after radioembolization and may allow a more accurate detection of early HCC recurrence in single cases.
    Journal of vascular and interventional radiology: JVIR 04/2015; 26(7). DOI:10.1016/j.jvir.2015.03.009 · 2.41 Impact Factor
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    ABSTRACT: The contrast enhancement of pulmonary nodules is a differential diagnostic criterion which can be helpful in staging investigations. To investigate the impact of dual-energy computed tomography (DECT) with regards to the evaluation of pulmonary nodules with emphasis on metastatic lesions. DECT scans of the thorax were performed in 70 consecutive patients. Data of the lung were acquired in the arterial and in delayed venous phase. The virtual native and overlay image data based on arterial and delayed venous phase of these lesions were compared using CT density values (HU) within the nodule tested for statistical significance. A total of 156 pulmonary lesions ≥5 mm were identified on 70 DECT scans. There were no significant differences between the CT-value measurements in the virtual native images based on the arterial and delayed venous phase (27.9+/-3.9 HU vs.28.1+/-4.2 HU, P = 0.89) and between the CT-value measurements in the overlay images based on the arterial und delayed venous phase (35.5+/-6.8 HU vs. 36.6+/-5.0 HU, P = 0.75). Metastases of colorectal carcinoma (51.4+/-9.4 HU vs. 32.5+/-8.9 HU, P = 0.0001), malignant melanoma (56.1+/-6.4 HU vs. 34.2+/-1.6 HU, P = 0.0045), and thyroid cancer (53.5+/-15.5 HU vs. 15.7+/-4.2 HU, P = 0.001) showed a distinct wash-out, whereas metastases of lung cancer (23.1+/-6.3 HU vs. 58.6+/-4.8 HU, P = 0.001), salivary gland cancer (41.4+/-20.3 HU vs. 65.7+/-15.7 HU, P = 0.023), and sarcoma (56.2+/-7.4 HU vs. 90.2+/-3.4 HU, P = 0.001) had an increased enhancement in the delayed venous phase. The contrast enhancement behavior of pulmonary metastases can be evaluated with DECT and depends on the type of the primary malignant tumor. © The Foundation Acta Radiologica 2015 Reprints and permissions:
    Acta Radiologica 04/2015; DOI:10.1177/0284185115582060 · 1.60 Impact Factor
  • J Theysohn · J Schelhorn · S Sipilae · S Müller · J Best · A Dechene · T Lauenstein ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551125 · 1.40 Impact Factor
  • L Umutlu · K Wrede · C Pöttgen · T Pöppel · T Lauenstein · M Forsting · M Schlamann ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551286 · 1.40 Impact Factor
  • K Beiderwellen · S Kinner · B Gomez · P Heusch · L Umutlu · A Bockisch · T Lauenstein ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1550907 · 1.40 Impact Factor
  • K Beiderwellen · O Kraff · A Laader · S Johst · S Maderwald · M Forsting · T Lauenstein · L Umutlu ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1550909 · 1.40 Impact Factor

  • RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551222 · 1.40 Impact Factor
  • J Schelhorn · J Best · M Reinboldt · G Gerken · M Ruhlmann · T Lauenstein · G Antoch · S Kinner ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1550911 · 1.40 Impact Factor
  • A Lazik · S Landgraeber · T Claßen · O Kraff · T Lauenstein · J Theysohn ·

    RöFo - Fortschritte auf dem Gebiet der R 04/2015; 187(S 01). DOI:10.1055/s-0035-1551248 · 1.40 Impact Factor
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    ABSTRACT: To survey the perceived indications for magnetic resonance imaging of the small bowel (MRE) by experts, when MR enteroclysis (MREc) or MR enterography (MREg) may be chosen, and to determine how the approach to MRE is modified when general anaesthesia (GA) is required. Selected opinion leaders in MRE completed a questionnaire that included clinical indications (MREg or MREc), specifics regarding administration of enteral contrast, and how the technique is altered to accommodate GA. Fourteen responded. Only the diagnosis and follow-up of Crohn's disease were considered by over 80 % as a valid MRE indication. The remaining indications ranged between 35.7 % for diagnosis of caeliac disease and unknown sources of gastrointestinal bleeding to 78.6 % for motility disorders. The majority chose MREg over MREc for all indications (from 100 % for follow-up of caeliac disease to 57.7 % for tumour diagnosis). Fifty per cent of responders had needed to consider MRE under GA. The most commonly recommended procedural change was MRI without enteral distention. Three had experience with intubation under GA (MREc modification). Views were variable. Requests for MRE under GA are not uncommon. Presently most opinion leaders suggest standard abdominal MRI when GA is required. • Experts are using MRE for various indications. • Requests for MRE under general anaesthesia are not uncommon. • Some radiologists employ MREc under general anaesthesia; others do not distend the small bowel.
    Insights into Imaging 04/2015; 6(3). DOI:10.1007/s13244-015-0384-2

Publication Stats

4k Citations
716.78 Total Impact Points


  • 2001-2015
    • University Hospital Essen
      • Institute of Diagnostic and Interventional Radiology and Neuroradiology
      Essen, North Rhine-Westphalia, Germany
  • 2003-2014
    • University of Duisburg-Essen
      • • Erwin L. Hahn Institute for Magnetic Resonance Imaging
      • • Faculty of Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2013
    • Heinrich-Heine-Universität Düsseldorf
      • Institute of Diagnostic and interventional radiology
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2006-2008
    • Emory University
      • • Department of Radiology and Imaging Sciences
      • • School of Medicine
      Atlanta, Georgia, United States
    • University of Hamburg
      • Medical Prevention Center Hamburg (MPCH)
      Hamburg, Hamburg, Germany