Juergen F Schaefer

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (92)185.16 Total impact

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    ABSTRACT: Objectives: To assess dose area products (DAP) and effective doses (ED) of voiding cystourethrography (VCUG) in children using optimized protocols on a modern flat detector unit. Methods: DAP and ED were evaluated in 651 VCUG (316 girls, median age: 2.25 years) between 2009 and 2012. DAP was analyzed in relation to patient characteristics (gender, age, presence of pathological findings) and experience of performing physician using analysis of variance. ED values were estimated using adapted conversion factors from the literature. Diagnostic image quality was validated by two experienced physicians using a 3-point scale. Results: Median DAP/ED was 0.5 cGycm(2)/4.56 μSv (boys: 0.6 cGycm(2)/6.16 μSv; girls: 0.4 cGycm(2)/3.54 μSv). In 300 studies without pathologic findings DAP was 0.35 cGycm(2), whereas 351 studies with pathologic findings had a median DAP of 0.7 cGycm(2). No significant relationship between DAP and experience of radiologist was observed. Image validation resulted in an overall good to excellent rating. Conclusions: DAP and ED can be markedly reduced in paediatric VCUG performed with optimized protocols on modern equipment without a noticeable decrease in diagnostic image quality. Key points: • Voiding cystourethrography is a comprehensive examination in diagnosing vesicoureteral reflux (VUR). • Radiation reduction is achieved in VCUG through modern equipment and optimized protocols. • Low-dose VCUG is possible without noticeable decrease in diagnostic image quality.
    No preview · Article · Sep 2015 · European Radiology
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    ABSTRACT: The aim of this study was to evaluate the clinical applicability and technical feasibility of fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) compared with FDG PET/computed tomography (CT) in young children focusing on lesion detection, PET quantification, and potential savings in radiation exposure. Twenty examinations (10 PET/CT and 10 PET/MRI examinations) were performed prospectively in 9 patients with solid tumors (3 female, 6 male; mean age, 4.8 [1-6] years). Fluorodeoxyglucose PET/CT and FDG PET/MRI were performed sequentially after a single tracer injection. Lesion detection and analysis were performed independently in PET/CT and PET/MRI. Potential changes in diagnostic or therapeutic patient management were recorded. Positron emission tomography quantification in PET/MRI was evaluated by comparing standardized uptake values resulting from MRI-based and CT-based attenuation correction. Effective radiation doses of PET and CT were estimated. Twenty-one PET-positive lesions were found congruently in PET/CT and PET/MRI. Magnetic resonance imaging enabled significantly better detection of morphologic PET correlates compared with CT. Eight suspicious PET-negative lesions were identified by MRI, of which one was missed in CT. Sensitivity, specificity, and accuracy for correct lesion classification were not significantly different (90%, 47%, and 62% in PET/CT; 100%, 68%, and 79% in PET/MRI, respectively). In 4 patients, the use of PET/MRI resulted in a potential change in diagnostic management compared with PET/CT, as local and whole-body staging could be performed within 1 single examination. In 1 patient, PET/MRI initiated a change in therapeutic management. Positron emission tomography quantification using MRI-based attenuation correction was accurate compared with CT-based attenuation correction. Higher standardized uptake value deviations of about 18% were observed in the lungs due to misclassification in MRI-based attenuation maps. Potential reduction in radiation dose was 48% in PET/MRI compared with PET/CT (P < 0.05). FDG PET/MRI is at least equivalent to FDG PET/CT for oncologic imaging in young children. Specifically, superior soft tissue contrast of MRI results in higher confidence in lesion interpretation. Substantial savings in radiation exposure can be achieved, and the number of necessary imaging examinations can be reduced using PET/MRI compared with PET/CT.
    No preview · Article · Aug 2015 · Investigative radiology
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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.
    No preview · Article · May 2015 · Journal of Nuclear Medicine
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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.
    No preview · Article · Apr 2015 · Pediatric Radiology
  • I. Tsiflikas · A. Seeger · J.F. Schäfer
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    ABSTRACT: Fortunately polytrauma is a rare condition in children. However, accidents are the leading cause of death in children and adolescents. Due to different anatomic proportions as well as smaller vital reserves there are specific characteristics in childhood, requiring knowledge of typical injury patterns. Because of the low incidence immediate management of the injured pediatric patient needs a clear division of responsibilities and fixed processes. Beside of ultrasound also computed tomography has been established in pediatric trauma care. Severe head injuries can be seen more often in children than in adults, so that cranial computed tomography is performed frequently after abdominal ultrasound scan. Indication for whole-body trauma scan has to be discussed interdisciplinary. Although conservative treatment for example of blunt abdominal trauma is getting more important, in our opinion a rapid and complete diagnostic take priority. However, low-dose protocols have to be established, realizing an optimal compromise between a minimum of radiation burden and a maximum of image quality. It is important to use automated dose modulation and to avoid multiphase scans by using biphasic contrast injection.
    No preview · Article · Dec 2014 · Padiatrische Praxis
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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.
    No preview · Article · Oct 2014 · British Journal of Radiology
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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.
    Full-text · Article · Jun 2014 · Frontiers in Pediatrics
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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. Online supplemental material is available for this article.
    No preview · Article · May 2014 · Radiology

  • No preview · Article · Apr 2014 · RöFo - Fortschritte auf dem Gebiet der R

  • No preview · Article · Apr 2014 · RöFo - Fortschritte auf dem Gebiet der R
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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.
    Full-text · Article · Apr 2014 · RöFo - Fortschritte auf dem Gebiet der R
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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.
    No preview · Article · Sep 2013 · Pediatric Surgery International
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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.
    No preview · Article · Dec 2012 · Journal of Pediatric Surgery
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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.
    No preview · Article · Nov 2012 · Respiration
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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.
    No preview · Conference Paper · Nov 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.
    No preview · Conference Paper · Nov 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.
    No preview · Article · Sep 2012 · Journal of Pediatric Surgery

  • No preview · Article · May 2012 · Clinical Research in Cardiology

  • No preview · Article · May 2012 · RöFo - Fortschritte auf dem Gebiet der R
  • I Tsiflikas · M Teufel · S Fleischer · CD Claussen · JF Schäfer

    No preview · Article · May 2012 · RöFo - Fortschritte auf dem Gebiet der R

Publication Stats

843 Citations
185.16 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 Thoracic and Cardiovascular Surgery
      • • Department of Radiology
      Tübingen, Baden-Württemberg, Germany