TY - GEN A1 - Jung, Ernst Michael A1 - Jung, Friedrich A1 - Verloh, Niklas A1 - Haimerl, Michael A1 - Lürken, Lukas A1 - Jage, Simon A1 - Stroszczynski, Christian A1 - Scharf, Gregor T1 - High resolution flow with glazing flow for optimized flow detection in transjugular intrahepatic portosystemic stent shunt (TIPS): First results T2 - Clinical hemorheology and microcirculation Y1 - 2022 U6 - https://doi.org/10.3233/CH-221427 SN - 1875-8622 SN - 1386-0291 VL - 82 IS - 3 SP - 231 EP - 238 ER - TY - GEN A1 - Jung, Ernst Michael A1 - Stroszczynski, Christian A1 - Jung, Friedrich T1 - Contrast enhanced ultrasonography (CEUS) to detect abdominal microcirculatory disorders in severe cases of COVID-19 infection: First experience T2 - Clinical Hemorheology and Microcirculation N2 - In the hands of experienced examiners, the contrast enhanced sonography (CEUS) offers the possibility to analyze dynamic microcirculatory disturbances in real time dynamically without any risk for kidneys and thyroid gland even in severe progressing disease bedside. Based on severe COVID-19 infections, first experiences with abdominal CEUS examinations are presented. In the stage of an imminent organ failure with significantly reduced kidney and liver function, CEUS can be used to show a narrowing of the organ-supplying arteries, as well as a delayed capillary filling of vessels near the capsule, a regional reduced parenchymal perfusion or an inflammatory hyperemia with capillary hypercirculation. It is possible to quickly rule out organ infarction and to dynamically record the mesenteric arterial and venous blood flow. KW - Corona virus KW - contrast enhanced ultrasound sonography (CEUS) KW - COVID-19 KW - liver KW - kidney Y1 - 2020 UR - https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch209003 U6 - https://doi.org/10.3233/CH-209003 SN - 1875-8622 SN - 1386-0291 VL - 74 IS - 4 SP - 353 EP - 361 ER - TY - GEN A1 - Jung, Ernst Michael A1 - Stroszczynski, Christian A1 - Jung, Friedrich T1 - Contrast enhanced ultrasound (CEUS) to assess pleural pulmonal changes in severe Covid 19 infection: First results T2 - Clinical Hemorheology and Microcirculation N2 - AIM: Use of contrast enhanced ultrasound (CEUS) in severe cases of COVID-19 infection to assess pulmonary changes near the pleura. MATERIAL AND METHODS: Bedside examinations by an experienced intensive care unit examiner using a multi-frequency probe (C1-6 MHz) with B-mode and CEUS to assess pleural-near changes in severe cases of COVID-19 infection with respiratory failure. CEUS with bolus delivery via a central venous catheter of 2.4 ml Sulphur hexafluoride microbubbles from the arterial phase (10–15 s) to the late phase of 5 min. Digital storage of cine sequences of the lung sound with abdomen for independent assessment with the subsequently performed contrast-enhanced dual-source CT. RESULTS: In 11 intubated and ventilated patients (arithmetic mean 62 years, 48 to 78 years, 3 women) with confirmed severe COVID-19 infections, a peripherally accentuated consolidation with irregular hyperemia was found in the CEUS and also in the CT examination. Of the 5 cases with pulmonary arterial embolisms, signs of right ventricular failure were found. In all cases, using CEUS low perfused areas of the pleura with adjacent hyperemia could be detected, while, with CT segmental contrast medium, gaps with subpleural compressions were found. Interstitial changes near the pleura led to B-lines and to ground glass opacities in the CT. Near the diaphragm a delayed arterial contrast of the liver was observed. In addition, in 2 cases partial atelectasis, in 3 cases marginal pleural effusions were found. CONCLUSION: CEUS opens up new possibilities for bedside monitoring of pleural reactive inflammatory or peripheral thrombus embolism in severe cases of COVID-19 infection. KW - COVID-19 infection KW - lung- Contrast-enhanced ultrasound (CEUS) KW - pleural affection KW - peripheral embolic consolidation Y1 - 2020 UR - https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch209005 U6 - https://doi.org/10.3233/CH-209005 SN - 1875-8622 SN - 1386-0291 VL - 75 IS - 1 SP - 19 EP - 26 ER - TY - GEN A1 - Peschel, G. A1 - Jung, Ernst Michael A1 - Fisser, C. A1 - Putz, F. J. A1 - Wertheimer, T. A1 - Sinner, B. A1 - Lunz, D. A1 - Jung, Friedrich A1 - Müller, M. T1 - Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO2 retention T2 - Clinical Hemorheology and Microcirculation N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS). OBJECTIVE: This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS). METHODS: A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-line (1 point), coalescent B-lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1–5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers. RESULTS: LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r = 0.467; p = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r = 0.632; p = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz index, CRP, LDH and IL-6 did not. CONCUSIONS: The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS. Y1 - 2021 UR - https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch200925 U6 - https://doi.org/10.3233/CH-200925 VL - 77 IS - 4 SP - 355 EP - 365 ER - TY - GEN A1 - Wiesinger, Isabel A1 - Jung, Friedrich A1 - Jung, Ernst Michael T1 - Contrast-enhanced ultrasound (CEUS) and perfusion imaging using VueBox® T2 - Clinical Hemorheology and Microcirculation N2 - The external perfusion software (VueBox™) for contrast-enhanced ultrasound (CEUS), enables the quantitative analysis of micro-vascularization within non-cystic lesions in terms of characterization and detection. This review summarizes our work about parathyroid gland, thyroid gland, liver, prostate and other tissues as well as original studies in the use of parametric perfusion imaging. Useful perfusion parameters are introduced. Y1 - 2021 UR - https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch201040 U6 - https://doi.org/10.3233/CH-201040 VL - 78 IS - 1 ER - TY - GEN A1 - Werner, Jens Martin A1 - Zidek, Martin A1 - Kammerer, Sylvia A1 - Platz Batista da Silva, Natascha A1 - Jung, Friedrich A1 - Schlitt, Hans Jürgen A1 - Hornung, Matthias A1 - Jung, Ernst Michael T1 - Intraoperative contrast-enhanced ultrasound can have a crucial role in surgical decision-making during hepato-pancreatico-biliary surgery –Analysis of impact and input T2 - Clinical Hemorheology and Microcirculation N2 - OBJECTIVE: To assess the impact and procedural input of intraoperative ultrasound (IOUS) with contrast-enhanced ultrasound (CEUS) and ultrasound elastography on surgical decision making during the procedure and consequently the out-come after hepato-pancreatico-biliary (HPB) surgery. MATERIALS AND METHODS: Data of 50 consecutive patients, who underwent HPB surgery from 04/2018 to 07/2018 were prospectively collected for this study. During surgery, IOUS with a high-resolution ultrasound device using CEUS after bolus injection of 2.4–5 ml Sulphur hexafluoride microbubbles using a 6–9 MHz probe and a share wave and strain elastography was performed by an experienced examiner. Process and time analysis were carried out using mobile phone timer. RESULTS: The IOUS with CEUS and elastography correctly identified 42 malignant tumors and 4 benign lesions. In 3 cases, the examination provided false positive result (identifying 3 benign lesions as malignant) and in 1 case a malignant lesion was incorrectly assessed as benign (sensitivity 97,7%, specificity 57,1%, PPV 93,3% and NPV 80%). The specific question by the surgeon could be answered successfully in 98% of the cases. In 76% of the cases, there was a modification (42%) or a fundamental change (34%) of the planned surgical approach due to the information provided by the IOUS. Within the last group, the IOUS had a major impact on therapy outcome. In 7 patients an additional tumor resection was required, in 5 patients the tumor was assessed as inoperable, and in total in 5 patients an intraoperative RFA (4/5) or postoperative RITA (1/5) was required. Regarding procedural input, there was only a slight, but significant difference between the transport and set-up times before the intraoperative use (mean: 14 min 22 s) and the return transport (mean 13 min 6 s), (p = 0,038). The average examination time was 14 minutes, which makes only one third of the overall time demand. CONCLUSION: Combination of IOUS with CEUS and elastography in oncological HPB surgery provides valuable information that affects surgical decision-making. The procedural input of about 45 minutes seems to be a good investment considering the improvement of the surgical procedure and a significant modification of the therapy approach in the majority of the cases. KW - Surgical decision-making KW - hepato-pancreatico-biliary surgery KW - CEUS KW - elastography Y1 - 2021 UR - https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch201031 U6 - https://doi.org/10.3233/CH-201031 VL - 78 IS - 1 SP - 1 EP - 14 ER - TY - GEN A1 - Jung, Ernst Michael A1 - Kammerer, Sarah A1 - Brandenstein, M. A1 - Putz, F. J. A1 - Stroszczynski, Christian A1 - Jung, Friedrich T1 - High resolution flow (HR Flow) and Glazing Flow in cases of hepatic flow changes: Comparison to color-coded doppler sonography (CCDS) T2 - Clinical Hemorheology and Microcirculation N2 - AIM: To evaluate the possibilities of flow detection using high resolution flow (HR Flow) and Glazing Flow technique in patients with liver parenchymal changes and flow changes in comparison to color-coded Doppler sonography (CCDS). MATERIAL AND METHODS: All examinations were performed using a multi frequency matrix convex probe with high resolution technique (SC6-1U/Resona7, Mindray, Shenzhen, China) by one experienced examiner to evaluate the venous, portal venous and arterial liver flow with digital documentation of the dynamic flow parameters like peak systolic flow, end-diastolic flow and resistance index. For liver parenchymal stiffness changes shear wave elastography was performed with at least 10 measurements. By two independent readers an elevation was performed to evaluate the image quality and the degree of flow artefacts, from 0 = not available to 5 points with excellent image quality without flow artefacts. RESULTS: All 40 patients (24 men, 16 women, age 27–83 years, mean 56±5 years) showed morphology changes from B-Mode of the liver parenchyma to inhomogeneous tissue with higher stiffness evaluated by the shear wave elastography (1.45 m/s up to 2.79 m/s±1.79 m/s, considering F1 up to F4 fibrosis) and in 15 cases histopathologically proven liver cirrhosis. In 9 cases after non-acute thrombosis flow reduction of the portal vein was the reason for the diameter less than 5 mm. Flow parameters for the venous flow were between 8 cm/s up to 29 cm/s, mean 14±4 cm/s, for the hepatic portal vein 5 cm/s up to 57 cm/s, mean 17±5 cm/s, for the hepatic artery systolic flow between 50 cm/s up to 127±33 cm/s, end-diastolic flow from 22 cm/s up to 47±8 cm/s. Resistance index for the hepatic artery was between 0.41 up to 0.73, mean 0.67±0.25. The image quality for CCDS over all cases was evaluated for CCDS between 1 up to 4. The mean quality was 2.5±0.5, for HR Flow in combination with Glazing Flow 3±0.5, with significant differences for the 2 readers (P < 0.01). CONCLUSION: Combination of HR Flow with Glazing Flow could be helpful to evaluate morphological und hemodynamic changes of liver arterial flow, portal venous and venous flow. Reduction of flow artefacts in combination with a higher image quality could be helpful for optimizing the digital measurements also for follow up examinations. KW - Liver vascular imaging KW - high resolution flow (HR) KW - Glazing Flow KW - imaging quality KW - artefact reduction Y1 - 2021 UR - https://content.iospress.com/articles/clinical-hemorheology-and-microcirculation/ch219102 U6 - https://doi.org/10.3233/CH-219102 SN - 1875-8622 SN - 1386-0291 VL - 79 IS - 1 SP - 3 EP - 17 ER - TY - GEN A1 - Diesch, S. T. A1 - Jung, Friedrich A1 - Prantl, Lukas A1 - Jung, Ernst Michael T1 - Surface imaging of breast implants using modern high-frequency ultrasound technology in comparison to high-end sonography with power analyses for B-scan optimization T2 - Clinical Hemorheology and Microcirculation Y1 - 2022 U6 - https://doi.org/10.3233/CH-219204 SN - 1875-8622 SN - 1386-0291 VL - 80 IS - 4 SP - 487 EP - 495 ER - TY - GEN A1 - Jung, Friedrich A1 - Lamby, Philipp A1 - Prantl, Lukas A1 - Wiggermann, P. A1 - Jung, Ernst Michael A1 - Krüger-Genge, Anne A1 - Franke, Ralf-Peter T1 - Post-mortem distribution of Iodinated Contrast Media (ICM) (iodixanol versus iopromide) in the porcine kidney after multiple bolus injections in vivo into the supra-renal aorta T2 - Clinical Hemorheology and Microcirculation Y1 - 2022 U6 - https://doi.org/10.3233/CH-229102 SN - 1875-8622 VL - 85(2023) IS - 3 SP - 289 EP - 295 ER - TY - GEN A1 - Jung, Ernst Michael A1 - Jung, Friedrich A1 - Stroszczynski, Christian A1 - Wiesinger, Isabel T1 - Dynamic endoluminal contrast enhanced ultrasound (CEUS) for display of drainages in inflammatory abdominal fluid collections T2 - Clinical Hemorheology and Microcirculation Y1 - 2022 U6 - https://doi.org/10.3233/CH-211370 SN - 1875-8622 SN - 1386-0291 VL - 80 IS - 2 SP - 49 EP - 59 ER -