@misc{KupkeDropcoGoetzetal., author = {Kupke, Laura S. and Dropco, Ivor and G{\"o}tz, Markus and Kupke, Paul and Jung, Friedrich and Stroszczynski, Christian and Jung, Ernst Michael}, title = {Contrast-enhanced intraoperative ultrasound shows excellent performance in improving intraoperative decision-making}, series = {Life}, volume = {14}, journal = {Life}, number = {9}, editor = {Miraglia, Roberto}, publisher = {MDPI}, issn = {2075-1729}, doi = {10.3390/life14091199}, pages = {10}, abstract = {Background: The aim of this study was to evaluate the performance and the impact of contrast-enhanced intraoperative ultrasound (CE-IOUS) on intraoperative decision-making, as there is still no standardized protocol for its use. Therefore, we retrospectively analyzed multiple CE-IOUS performed in hepato-pancreatic-biliary surgery with respect to pre- and postoperative imaging and histopathological findings. Methods: Data of 50 patients who underwent hepato-pancreatic-biliary surgery between 03/2022 and 03/2024 were retrospectively collected. CE-IOUS was performed with a linear 6-9 MHz multifrequency probe connected to a high-resolution device. The ultrasound contrast agent used was a stabilized aqueous suspension of sulphur hexafluoride microbubbles. Results: In total, all 50 lesions indicated for surgery were correctly identified. In 30 cases, CE-IOUS was used to localize the primary lesion and to define the resection margins. In the remaining 20 cases, CE-IOUS identified an additional lesion. Fifteen of these findings were identified as malignant. In eight of these cases, the additional malignant lesion was subsequently resected. In the remaining seven cases, CE-IOUS again revealed an inoperable situation. In summary, CE-IOUS diagnostics resulted in a high correct classification rate of 95.7\%, with positive and negative predictive values of 95.2\% and 100.0\%, respectively. Conclusions: CE-IOUS shows excellent performance in describing intraoperative findings in hepato-pancreatic-biliary surgery, leading to a substantial impact on intraoperative decision-making.}, language = {en} } @misc{JungDongJung, author = {Jung, Ernst Michael and Dong, Yi and Jung, Friedrich}, title = {Current aspects of multimodal ultrasound liver diagnostics using contrast-enhanced ultrasonography (CEUS), fat evaluation, fibrosis assessment, and perfusion analysis - An update}, series = {Clinical Hemorheology and Microcirculation}, volume = {83}, journal = {Clinical Hemorheology and Microcirculation}, number = {2}, issn = {1386-0291}, doi = {10.3233/CH-239100}, pages = {181 -- 193}, abstract = {Current ultrasound multifrequency probes allow both improved detail resolution and depth of penetration when examining the liver. Also, new developments in vascular diagnostics, elastography with fibrosis assessment, evaluation of possible steatosis, and parametric and time intensity curve (TIC) analysis of dynamic microvascularization of the liver with contrast-enhanced ultrasound sonography (CEUS) complement ultrasound-guided diagnostics. State-of-the-art high-resolution technology includes a high frame rate (HiFR) mode for CEUS, fast shear wave measurements with the sound touch quantify (STQ) mode, artifact-free flow detection using HR flow and glazing flow in combination with a special flow-adapted imaging (Ultra Micro Angiography, UMA) and additionally different assessments of possible fatty liver (UltraSound ATtenuation Imaging Technology, USAT). In 50 cases with focal liver lesions, a multimodal liver diagnosis was performed with a still new high-performance ultrasound system as part of the clarification of questions from the university liver consultation and tumor outpatient clinic.}, language = {en} } @misc{JungStroszczynskiJung, author = {Jung, Ernst Michael and Stroszczynski, Christian and Jung, Friedrich}, title = {Advanced multimodal imaging of solid thyroid lesions with artificial intelligence-optimized B-mode, elastography, and contrast-enhanced ultrasonography parametric and with perfusion imaging: Initial results}, series = {Clinical Hemorheology and Microcirculation}, volume = {84}, journal = {Clinical Hemorheology and Microcirculation}, number = {2}, issn = {1386-0291}, doi = {10.3233/CH-239102}, pages = {227 -- 236}, abstract = {Goal of the study was the assessment of AI-assisted diagnosis of solid thyroid foci with multimodal modern ultrasound imaging. 50 patients (26-81 years, 54.7±13.1 years) were included in the study. Multimodal ultrasound imaging by means of B-mode with linear probe (4-12 MHz) with option of automated documentation of findings by means of AI, with supplementary Ultra MicroAngiography (UMA) was used. Macrovascularisation was assessed by dynamic contrast ultrasonography (CEUS) with parametric evaluation and perfusion analysis, and microvascularization was assessed by combined strain and shear wave elastography on a novel high-performance ultrasound system (Resona R9/Mindray) by an experienced examiner with independent reading. The evaluation was performed according to TI-RADS III-V. The volume of the thyroid lobes on both sides averaged 39 ml±5 ml (27 to 69 ml). The 13 cases of histologically confirmed thyroid carcinomas (8 papillary, 2 medullary, 2 microfollicular, 1 anaplastic CA) with a mean size of 15 mm±6 mm (9-21 mm) were correctly evaluated by TI-RADS V on the basis of irregular shape, induration > 2.5 m/s or > 30kPA and striking wash-out kinetics. Tumor lymph nodes could only be correctly detected preoperatively in one case of medullary carcinoma according to the surgical findings, based on irregular vascularization with UMA in roundish shape with cortex > 4 mm, transverse diameter up to 11 mm. In 25 cases of inhomogeneous nodular goiter an evaluation with TI-RADS III was performed in 31 cases, in 4 cases with incomplete marginal contour, partial marginal vascularization with UMA and partial wash out with indurations up to 2.5 m/s 30 kPA an evaluation with TI-RADS IV and surgical excision for nodular goiter. In 12 cases regressive nodular changes without relevant malignancy criteria resulted in nodular goiter, with focal changes up to 1.5 cm in diameter, classified as requiring control with TI-RADS III. There were no relevant changes in findings in the controls after 6 months. From the AI tool, the 20/25 goiter nodes were assessed as TI-RADS III, 7/12 adenomas, 5 goiter nodes, and 5 adenomas as TI-RADS IV, 5/13 carcinomas as TI-RADS IV, and 8/13 carcinomas as TI-RADS V. Multimodal ultrasound diagnostics supported by AI has a high diagnostic potential for the evaluation of solid thyroid lesions and standardizes the reporting with digital representative image documentation. CEUS perfusion and modern elastography techniques allow targeted follow-up of TI-RADS III findings.}, language = {en} } @misc{JungJungDongetal., author = {Jung, Ernst Michael and Jung, Friedrich and Dong, Yi and Kaiser, Ulrich}, title = {Initial description of the novel handheld wireless ultrasound device TE Air with Doppler and Color Duplex imaging}, series = {Clinical Hemorheology and Microcirculation}, volume = {86}, journal = {Clinical Hemorheology and Microcirculation}, number = {1-2}, issn = {1386-0291}, doi = {10.3233/CH-238100}, pages = {89 -- 97}, abstract = {OBJECTIVE: To test and initially describe a new handheld wireless ultrasound technique (TE Air) for clinical use. METHODS: In this pilot study, the new ultrasound device TE Air from Mindray was used to examine the hepatic and renal vessels of healthy volunteers for first impressions. The probe has a sector transducer with a frequency range of 1.8-4.5 MHz. The B-mode and color-coded doppler sonography (CCDS) scanning methods were used. A high-end device from the same company (Resona 9, Mindray) was used as a reference. The results were evaluated using an image rating scale ranging from 0 to 5, with 0 indicating not assessable and 5 indicating without limitations. RESULTS: Altogether, 61 participants (n = 34 female [55.7\%], n = 27 male [44.3\%]), age range 18-83 years, mean age 37.9±16.5 years) could be adequately studied using TE AIR and the high-end device. With one exception, the image quality score for TE Air never fell below 3 and had a mean/median scored of 4.97/5.00 for the B-mode, 4.92/5.00 for the color flow (CF) mode, and 4.89/5.00 for the pulse wave (PW) mode of the hepatic vein, 4.90/5.00 for the portal vein, 4.11/4.00 for the hepatic artery, and 4.57/5.00 for the renal segmental artery. A significant difference in the assessment of flow measurement of the hepatic artery and renal segmental arteries was found between TE AIR and the high-end device. CONCLUSIONS: TE Air represents a new dimension in point-of-care ultrasound via wireless handheld devices. Especially, its flow measurement ability offers a relevant advantage over other available handheld models. TE Air provides a formally sufficient image quality in terms of diagnostic significance.}, language = {en} } @misc{LudererJungBrandensteinetal., author = {Luderer, V. and Jung, Friedrich and Brandenstein, M. and Stroszczynski, Christian and Jung, Ernst Michael}, title = {First assessment of flow phenomena of acute and chronic thrombosis in the jugular veins using new ultrasound vector-flow imaging}, series = {Clinical Hemorheology and Microcirculation}, volume = {86}, journal = {Clinical Hemorheology and Microcirculation}, number = {1-2}, issn = {1386-0291}, doi = {10.3233/CH-238117}, pages = {133 -- 142}, abstract = {AIM: First assessment of flow changes in the jugular veins using high resolution ultrasound vector flow. MATERIAL UND METHODS: 15 patients (8 males, 7 females) with an age range of 35 to 82 years (mean age 58.53±12.26 years) were examined by an experienced examiner using high power ultrasound equipment (Resona R9, Mindray) with probe technology (Mindray L9-3U Linear Array transducer, 2.5 to 9.0 MHz). This group was compared with five healthy subjects (mean age 35.4±13.79 years) as a reference. To assess flow changes, the color-coded duplex sonography and the novel vector flow technique were used. The evaluation was performed of vector morphology changes, turbulence, and wall resistance measurements. RESULTS: There were changes after acute and chronic thrombosis in 9 cases, and venous compression in 7 cases. Turbulence was measurable from 0.01 \% to 64.44 \%, the average turbulence was 19.73±22.06 \% . Wall resistance measurement showed values from 0.01 Pa to 3.14 Pa, depending on the age of the thrombosis or compression. The reference veins showed turbulence of 0.94±1.5 \% and a mean wall resistance of 0.05±0.05 Pa. There are statistically significant differences between normal and thrombotic or compressed veins in terms of maximum wall stress (p = 0.006) and mean degree of turbulence (p = 0.012), while the difference in mean wall stress is not statistically significant (p = 0.058). CONCLUSION: Despite still existing technical limitations, the combination of V-flow and wall stress measurements in jugular vein changes suggests a high diagnostic potential.}, language = {en} } @misc{DropcoKaiserWagneretal., author = {Dropco, Ivor and Kaiser, Ulrich and Wagner, Lola and Brunner, Stefan M. and Schlitt, Hans J{\"u}rgen and Stroszczynski, Christian and Jung, Friedrich and Yi, Dong and Herr, Wolfgang and Jung, Ernst Michael}, title = {Color mapping using ultrasound system-integrated perfusion software for evaluation of focal liver lesions: a possible first step for more independent reading}, series = {Journal of Gastrointestinal and Liver Diseases}, volume = {32}, journal = {Journal of Gastrointestinal and Liver Diseases}, number = {4}, issn = {1842-1121}, doi = {10.15403/jgld-4997}, pages = {479 -- 487}, abstract = {Aims To assess the value of using integrated parametric ultrasound software for contrast-enhanced ultrasonography (CEUS) of liver tumors. Methods 107 patients with liver tumors were studied. CEUS were performed to detect focal lesions. Parametric images were based on continuous CINE LOOPs, from the early-arterial phase (15 s) to the portal-venous phase (1 min) generated by perfusion software. The evaluations of the parametric images and their dignity for liver lesions were performed independently by an experienced and a less-experienced investigator. Computed tomography, magnetic resonance imaging scans or histological analysis were used as references. Results High parametric image quality were obtained in all patients. Among the patients, 44\% lesions were benign, 56\% were malignant. The experienced investigator correctly classified 46 of 47 (98\%) as benign, and 60 of 60 (100\%) as malignant tumors based on the parametric images. The less-experienced investigator correctly classified 39 of 47 (83\%) as benign, and 49 of 60 (82\%) malignant tumors, acheaving a high statistical accuracy of 98\% with this type of diagnostic. Conclusion Parametric imaging for grading the malignant degree of tumor may be a good complement to existing ultrasound techniques and was particularly helpful for improving the assessments of the less-experienced examiner.}, language = {en} } @misc{KaiserVehlingKaiserKuecketal., author = {Kaiser, Ulrich and Vehling-Kaiser, Ursula and K{\"u}ck, Fabian and Gilanschah, Mia and Jung, Friedrich and Jung, Ernst Michael}, title = {Super-resolution contrast-enhanced ultrasound examination down to the microvasculature enables quantitative analysis of liver lesions : first results}, series = {Life}, volume = {15}, journal = {Life}, number = {7}, publisher = {MDPI}, address = {Basel}, issn = {2075-1729}, doi = {10.3390/life15070991}, pages = {1 -- 16}, abstract = {This article investigates the first use of dynamic microvascularization of liver lesions in clinical evaluation using real-time super-resolution contrast-enhanced ultrasound (SR CEUS). A retrospective analysis of SR CEUS examinations of liver lesions was performed. All examinations were conducted using an SC7-1U convex probe after the bolus injection of the ultrasound contrast agent. Digital cine loops were stored for independent evaluation. The evaluation was performed with respect to parallel measuring lines (the diameter corresponded to the capillary density) in the area of the reference lesion, liver tissue, and liver capsule using statistical analysis. In total, 65 patients (female n = 28; male n = 37; average age 57.8 ± 17.2 years) were evaluated. The examined liver lesions were mostly benign masses ( n = 46). Mild liver fibrosis (stage F1) was present in most cases ( n = 35). The lesions examined were located at an average tissue depth of 6.07 ± 2.47 cm. The highest number of lesion measurements was observed in the malignant lesion group. Significant differences in the measurements were found when comparing benign lesions with the capillary region ( p < 0.001) and normal liver tissue ( p < 0.01). The use of SR CEUS opens up new possibilities for the quantification of neovascularization, assessment of microvascular changes, and evaluation of the follow-up of intrahepatic interventions.}, language = {en} } @misc{SieberJungJung, author = {Sieber, Irmgard Maria and Jung, Friedrich and Jung, Ernst Michael}, title = {High-resolution contrast-enhanced ultrasound with SRCEUS for assessing the intrahepatic microvasculature and shunts in patients with hereditary haemorrhagic teleangiectasia (Osler's disease)}, series = {Life}, volume = {15}, journal = {Life}, number = {10}, publisher = {MDPI AG}, address = {Basel}, issn = {2075-1729}, doi = {10.3390/life15101631}, pages = {1 -- 15}, abstract = {The aim of this retrospective clinical pilot study is to evaluate multiparametric ultrasound liver parenchyma assessments in the diagnosis of Osler's disease, and to detect micro-shunts using SRCEUS with quantifications at the capillary level. Material/Method: All examinations were performed by an experienced examiner with a multi-frequency probe on a high-resolution matrix ultrasound device (SC 7-1U), convex probe (Mindray A 20), and were stored digitally in the PACS system. Vascular ultrasound was performed using colour-coded Doppler ultrasound (CCDS) and ultrasound microangiography (UMA). The recent M-Ref tool was utilised for the purpose of liver tissue characterisation, encompassing the domains of shear wave elastography, fat evaluation, and viscosity. Dynamic CEUS, HiFR CEUS, and SR CEUS were performed after the intravenous bolus injection of 1-2.4 mL of ultrasound contrast agent (SonoVue®). Measurements of SR CEUS capillary changes were performed independently by PACS-stored digital cine loops up to 5 s. Results: In the context of angiomas or haemangiomas, the initial contrast enhancement of echogenic or almost echogenic foci within 25 s without late wash-out was observed in 5/10 cases. In the evaluation of microvasculature, the presence of capsule-proximal shunts in Osler's disease was observed, resulting in the identification of increased numbers of dilated capillaries within both peripheral and central shunts. In the control group, general liver tissue changes (20 cases) were observed in instances of inflammation (3/20 cases), peripherally in 4/20 cases with micro-shunts in altered parenchyma. In the context of multiparametric ultrasound, 16 out of 30 cases exhibited elevated fibrosis values, with a maximum recorded as high as 1.7 m/s, and in 13 out of 30 cases, there was an increase in fat values up to 0.65 dB/cm/MHz, indicative of moderate steatosis. Additionally, in seven cases, there was an increase in viscosity values up to 2.7 Pa·s, suggesting reactive changes. Conclusions: Recent advancements in medical imaging technology, specifically SR CEUS contrast ultrasound imaging, have led to the development of novel diagnostic tools that facilitate the evaluation of tissue and haemodynamic changes, in addition to capillary alterations, associated with Osler's disease.}, language = {en} } @misc{DropcoKaiserJungetal., author = {Dropco, Ivor and Kaiser, Ulrich and Jung, Friedrich and Danihel, Ľudiv{\´i}t and Schlitt, Hans J and Stroszczynski, Christian and Herr, Wolfgang and Brunner, Stefan M and Jung, Ernst Michael}, title = {Intraoperative contrast-enhanced ultrasound (CEUS) with time intensity curve (TIC) analysis for better assessment of liver tumor margins}, series = {R{\"o}Fo : Fortschritte auf dem Gebiet der R{\"o}ntgenstrahlen und der bildgebenden Verfahren}, volume = {6}, journal = {R{\"o}Fo : Fortschritte auf dem Gebiet der R{\"o}ntgenstrahlen und der bildgebenden Verfahren}, number = {2}, publisher = {Georg Thieme Verlag KG}, address = {Stuttgart}, issn = {1438-9029}, doi = {10.1055/a-2600-7229}, pages = {430 -- 446}, abstract = {AbstractThe purpose of this study was to conduct an intraoperative evaluation of focal liver lesions using time intensity curve (TIC) analysis of contrast-enhanced ultrasound (CEUS) to better assess liver tumor margins.This study included 28 patients (21 men 75\%, 7 women 25\%) with malignant liver lesions (cholangiocellular carcinoma (CCC), n = 9; hepatocellular carcinoma (HCC), n = 6; hepatic metastases (HepMET), n = 13). A B-mode scan, color-coded Doppler sonography, and CEUS were performed intraoperatively to analyze the focal lesions. The generated parametric images were based on continuous cine loops, acquired with a multifrequency T-probe (6-9 MHz), from the early arterial phase (0-15 seconds) to the portal venous phase (1 minute), generated by integrated perfusion software. Analyses of the CEUS loops were performed using TICs with respect to time-to-peak (TTP) and area under the curve (AUC). Perfusion analysis was performed in the center and periphery of the tumor as well as in healthy liver tissue. All tumor lesions were evaluated histopathologically to verify the diagnosis.Sufficient image quality was achieved in all cases using CEUS for TIC analysis. A comparison of all groups showed a clear difference compared with the center, margin, and healthy liver tissue in the measured parameters of TTP and AUC (p = 0.035 and p = 0.045, respectively). In detail, differences were observed in the CCC group (TTP: p = 0.025) and in the HepMET group (TTP: p = 0.009), particularly in the peripheral areas (strong arterial flooding with a rapid increase in the flooding curve), with equally clear tumor edge representation compared with healthy liver tissue, as shown by the AUC analysis (CCC AUC: p = 0.032 and HepMET AUC: p = 0.029). In patients with HCC, the perfusion pattern (starting from the center) showed the center to be more clearly distinguishable from the edge with significant TTP and AUC (p = 0.035 and p = 0.038).Intraoperative TIC analysis of malignant liver tumors is an important diagnostic tool for better highlighting liver tumor margins during surgery.}, language = {en} } @misc{JungWeberJungetal., author = {Jung, Ernst Michael and Weber, Marc-Andr{\´e} and Jung, Friedrich and Stroszczynski, Christian}, title = {Super-resolution contrast-enhanced ultrasound (SR-CEUS) in solid organs}, series = {R{\"o}Fo : Fortschritte auf dem Gebiet der R{\"o}ntgenstrahlen und der bildgebenden Verfahren}, volume = {90}, journal = {R{\"o}Fo : Fortschritte auf dem Gebiet der R{\"o}ntgenstrahlen und der bildgebenden Verfahren}, number = {2}, publisher = {Georg Thieme Verlag KG}, address = {Stuttgart}, issn = {1438-9029}, doi = {10.1055/a-2754-0219}, pages = {10}, abstract = {It is becoming increasingly common for multimodal radiological imaging to use contrast-enhanced ultrasound (CEUS) because of its high-resolution ultrasound techniques. CEUS has several advantages. It can be used repeatedly without affecting renal function or the thyroid gland. It is also considered to be highly accurate with regard to the diagnosis and detection of small solid liver lesions. In addition, it can be used to characterize solid lesions in other abdominal organs. With additional perfusion imaging and its (semi)quantitative analysis using wash-in and wash-out kinetics, therapies can be monitored. It is also frequently used in the assessment of solid tumors in the near field, such as thyroid tumors and lymph nodes. Super-resolution CEUS (SR-CEUS) is a novel imaging method with dynamic evaluation of microflow changes to the level of capillary structures. SR-CEUS could also open up new possibilities regarding the dynamic assessment of the micro-vascularization of solid abdominal organs and interventional procedures.}, language = {en} }