{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:52:58Z","timestamp":1781866378820,"version":"3.54.5"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to analyze the intraindividual development of lung perfusion in children with congenital diaphragmatic hernia (CDH) at the ages of 2 and 10 years, as well as to investigate prenatal and postnatal influencing factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Fifty-nine children after CDH were examined as part of a monocentric follow-up program using dynamic contrast-enhanced MRI (DCE-MRI) at 2 years (hereafter referred to as Examination 1, E1) and again at 10 years of age (Examination 2, E2). Pulmonary blood flow (PBF) and pulmonary blood volume (PBV) were quantified separately for each lung. Additionally, prenatal parameters (observed-to-expected fetal lung volume, o\/e FLV) and postnatal factors (extracorporeal membrane oxygenation (ECMO); fetoscopic tracheal occlusion (FETO); patch repair; recurrence; and reoperation for recurrence) were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ipsilateral perfusion remained consistently reduced between E1 and E2 (63.4\u2009\u00b1\u200927.8 vs 62.0\u2009\u00b1\u200923.6\u2009mL\/100\u2009mL\/min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.8001), while PBV significantly decreased (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0213). Low prenatal o\/e FLV values correlated with reduced ipsilateral PBF (E1:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.51;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0082; E2:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.03;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0342). Patients who underwent ECMO showed a decrease in contralateral PBF over time (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0435), and those with FETO tended to exhibit poorer perfusion courses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with prenatally more severe lung hypoplasia, particularly those with low o\/e FLV, exhibit persistently reduced lung perfusion even in the long term. These ongoing impairments remain stable over time, indicating permanently compromised lung development. Early identification and detailed risk assessment are therefore essential to initiate targeted therapeutic interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Lung perfusion development in children with CDH between ages 2 and 10, including prenatal and postnatal influencing factors<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Ipsilateral lung perfusion remained reduced, PBV decreased, and low prenatal o\/e FLV correlated with persistently impaired perfusion<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Children with severe prenatal lung hypoplasia show lasting perfusion deficits into adolescence. Early risk assessment enables timely, targeted interventions to mitigate long-term pulmonary impairment<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12443-5","type":"journal-article","created":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T05:32:37Z","timestamp":1773552757000},"page":"5975-5984","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Intraindividual development of MR lung perfusion parameters in children after congenital diaphragmatic hernia at 2 and 10 years"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6377-0473","authenticated-orcid":false,"given":"Greta","family":"Thater","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Enns-Ercan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Elrod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Schanas","family":"Jawhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Boettcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schaible","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christel","family":"Wei\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan O.","family":"Schoenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meike","family":"Weis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,15]]},"reference":[{"key":"12443_CR1","first-page":"357","volume":"112","author":"LM Wessel","year":"2015","unstructured":"Wessel LM, Fuchs J, Rolle U (2015) The surgical correction of congenital deformities: the treatment of diaphragmatic hernia, esophageal atresia and small bowel atresia. Dtsch Arztebl Int 112:357\u2013364","journal-title":"Dtsch Arztebl Int"},{"key":"12443_CR2","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1038\/s41390-018-0063-3","volume":"84","author":"H IJsselstijn","year":"2018","unstructured":"IJsselstijn H, Breatnach C, Hoskote A et al (2018) Defining outcomes following congenital diaphragmatic hernia using standardised clinical assessment and management plan (SCAMP) methodology within the CDH EURO consortium. Pediatr Res 84:181\u2013189","journal-title":"Pediatr Res"},{"key":"12443_CR3","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1002\/pd.2007","volume":"28","author":"P Chiu","year":"2008","unstructured":"Chiu P, Hedrick HL (2008) Postnatal management and long-term outcome for survivors with congenital diaphragmatic hernia. Prenat Diagn 28:592\u2013603","journal-title":"Prenat Diagn"},{"key":"12443_CR4","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2019.07.010","volume":"44","author":"LE Hollinger","year":"2020","unstructured":"Hollinger LE, Buchmiller TL (2020) Long term follow-up in congenital diaphragmatic hernia. Semin Perinatol 44:151171. https:\/\/doi.org\/10.1053\/j.semperi.2019.07.010","journal-title":"Semin Perinatol"},{"key":"12443_CR5","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/s00383-020-04625-z","volume":"36","author":"E Kirby","year":"2020","unstructured":"Kirby E, Keijzer R (2020) Congenital diaphragmatic hernia: current management strategies from antenatal diagnosis to long-term follow-up. Pediatr Surg Int 36:415\u2013429","journal-title":"Pediatr Surg Int"},{"key":"12443_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.101248","volume":"6","author":"V D\u00fctemeyer","year":"2024","unstructured":"D\u00fctemeyer V, Schaible T, Badr DA et al (2024) Fetoscopic endoluminal tracheal occlusion vs expectant management for fetuses with severe left-sided congenital diaphragmatic hernia. Am J Obstet Gynecol MFM 6:101248. https:\/\/doi.org\/10.1016\/j.ajogmf.2023.101248","journal-title":"Am J Obstet Gynecol MFM"},{"key":"12443_CR7","doi-asserted-by":"publisher","first-page":"e000758","DOI":"10.1136\/wjps-2023-000758","volume":"7","author":"N Cimbak","year":"2024","unstructured":"Cimbak N, Buchmiller TL (2024) Long-term follow-up of patients with congenital diaphragmatic hernia. World J Pediatr Surg 7:e000758","journal-title":"World J Pediatr Surg"},{"key":"12443_CR8","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/j.jpedsurg.2016.12.008","volume":"52","author":"T Oluyomi-Obi","year":"2017","unstructured":"Oluyomi-Obi T, Kuret V, Puligandla P et al (2017) Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg 52:881\u2013888","journal-title":"J Pediatr Surg"},{"key":"12443_CR9","doi-asserted-by":"crossref","unstructured":"Skari H, Bjornland K, Haugen G, Egeland T, Emblem R (2000) Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg 35:1187\u20131197","DOI":"10.1053\/jpsu.2000.8725"},{"key":"12443_CR10","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1148\/radiol.12111512","volume":"266","author":"A Debus","year":"2013","unstructured":"Debus A, Hagelstein C, Kilian AK et al (2013) Fetal lung volume in congenital diaphragmatic hernia: association of prenatal MR imaging findings with postnatal chronic lung disease. Radiology 266:887\u2013895","journal-title":"Radiology"},{"key":"12443_CR11","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1148\/radiology.219.1.r01ap18236","volume":"219","author":"F Rypens","year":"2001","unstructured":"Rypens F, Metens, Rocourt N et al (2001) Fetal lung volume: estimation at MR imaging-initial results. Radiology 219:236\u2013241","journal-title":"Radiology"},{"key":"12443_CR12","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.2214\/AJR.15.14860","volume":"206","author":"M Weis","year":"2016","unstructured":"Weis M, Zoellner FG, Hagelstein C et al (2016) Lung perfusion MRI after congenital diaphragmatic hernia repair in 2-year-old children with and without extracorporeal membrane oxygenation therapy. AJR Am J Roentgenol 206:1315\u20131320","journal-title":"AJR Am J Roentgenol"},{"key":"12443_CR13","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1016\/S0022-3476(05)80144-1","volume":"117","author":"KP Van Meurs","year":"1990","unstructured":"Van Meurs KP, Newman KD, Anderson KD, Short BL (1990) Effect of extracorporeal membrane oxygenation on survival of infants with congenital diaphragmatic hernia. J Pediatr 117:954\u2013960","journal-title":"J Pediatr"},{"key":"12443_CR14","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1055\/s-2006-924751","volume":"16","author":"F Morini","year":"2006","unstructured":"Morini F, Goldman A, Pierro A (2006) Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia: a systematic review of the evidence. Eur J Pediatr Surg 16:385\u2013391","journal-title":"Eur J Pediatr Surg"},{"key":"12443_CR15","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1016\/j.jpedsurg.2011.06.042","volume":"46","author":"KC Bj\u00f6rkman","year":"2011","unstructured":"Bj\u00f6rkman KC, Kjellberg M, Bergstr\u00f6m SE et al (2011) Postoperative regional distribution of pulmonary ventilation and perfusion in infants with congenital diaphragmatic hernia. J Pediatr Surg 46:2047\u20132053","journal-title":"J Pediatr Surg"},{"key":"12443_CR16","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.jpeds.2019.09.053","volume":"219","author":"DT Dao","year":"2020","unstructured":"Dao DT, Kamran A, Wilson JM et al (2020) Longitudinal analysis of ventilation perfusion mismatch in congenital diaphragmatic hernia survivors. J Pediatr 219:160\u2013166.e2","journal-title":"J Pediatr"},{"key":"12443_CR17","doi-asserted-by":"publisher","first-page":"73","DOI":"10.2214\/ajr.182.1.1820073","volume":"182","author":"Y Ohno","year":"2004","unstructured":"Ohno Y, Hatabu H, Higashino T et al (2004) Dynamic perfusion MRI versus perfusion scintigraphy: prediction of postoperative lung function in patients with lung cancer. AJR Am J Roentgenol 182:73\u201378","journal-title":"AJR Am J Roentgenol"},{"key":"12443_CR18","doi-asserted-by":"crossref","unstructured":"Ilicak E, Thater G, Ozdemir S et al (2024) Functional lung imaging of 2-year-old children after congenital diaphragmatic hernia repair using dynamic mode decomposition MRI. Eur Radiol 34:3761\u20133772","DOI":"10.1007\/s00330-023-10335-6"},{"key":"12443_CR19","doi-asserted-by":"publisher","first-page":"2427","DOI":"10.1007\/s00330-014-3304-9","volume":"24","author":"M Weidner","year":"2014","unstructured":"Weidner M, Z\u00f6llner FG, Hagelstein C et al (2014) High temporal versus high spatial resolution in MR quantitative pulmonary perfusion imaging of two-year old children after congenital diaphragmatic hernia repair. Eur Radiol 24:2427\u20132434","journal-title":"Eur Radiol"},{"key":"12443_CR20","doi-asserted-by":"publisher","first-page":"4231","DOI":"10.1007\/s00330-016-4330-6","volume":"26","author":"M Weis","year":"2016","unstructured":"Weis M, Sommer V, Z\u00f6llner FG et al (2016) Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair. Eur Radiol 26:4231\u20134238","journal-title":"Eur Radiol"},{"key":"12443_CR21","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1007\/s00330-021-08315-9","volume":"32","author":"V Gro\u00df","year":"2022","unstructured":"Gro\u00df V, Zahn K, Maurer K et al (2022) MR lung perfusion measurements in adolescents after congenital diaphragmatic hernia: correlation with spirometric lung function tests. Eur Radiol 32:2572\u20132580","journal-title":"Eur Radiol"},{"key":"12443_CR22","doi-asserted-by":"crossref","unstructured":"Okuyama H, Kubota A, Kawahara H, Oue T, Kitayama Y, Yagi M (2006) Correlation between lung scintigraphy and long-term outcome in survivors of congenital diaphragmatic hernia. Pediatr Pulmonol 41:882\u2013886","DOI":"10.1002\/ppul.20466"},{"key":"12443_CR23","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/j.jpedsurg.2014.01.016","volume":"49","author":"T Wright","year":"2014","unstructured":"Wright T, Filbrun A, Bryner B, Mychaliska G (2014) Predictors of early lung function in patients with congenital diaphragmatic hernia. J Pediatr Surg 49:882\u2013885","journal-title":"J Pediatr Surg"},{"key":"12443_CR24","doi-asserted-by":"publisher","first-page":"e133","DOI":"10.1097\/PCC.0b013e3182231872","volume":"13","author":"M Spoel","year":"2012","unstructured":"Spoel M, van den Hout L, Gischler SJ et al (2012) Prospective longitudinal evaluation of lung function during the first year of life after repair of congenital diaphragmatic hernia. Pediatr Crit Care Med 13:e133\u2013e139","journal-title":"Pediatr Crit Care Med"},{"key":"12443_CR25","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1002\/ppul.24375","volume":"54","author":"LCC Toussaint-Duyster","year":"2019","unstructured":"Toussaint-Duyster LCC, van der Cammen-van Zijp MHM, Spoel M et al (2019) Lung function in school-aged congenital diaphragmatic hernia patients; a longitudinal evaluation. Pediatr Pulmonol 54:1257\u20131266","journal-title":"Pediatr Pulmonol"},{"key":"12443_CR26","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1002\/ppul.23082","volume":"50","author":"HB Panitch","year":"2015","unstructured":"Panitch HB, Weiner DJ, Feng R et al (2015) Lung function over the first 3 years of life in children with congenital diaphragmatic hernia. Pediatr Pulmonol 50:896\u2013907","journal-title":"Pediatr Pulmonol"},{"key":"12443_CR27","doi-asserted-by":"publisher","first-page":"620","DOI":"10.3390\/jcm13020620","volume":"13","author":"C von Schrottenberg","year":"2024","unstructured":"von Schrottenberg C, Lindacker M, Weis M et al (2024) Long-term evaluation of the shape of the reconstructed diaphragm in patients with left-sided congenital diaphragmatic hernia using serial chest radiographs and correlation to further complications. J Clin Med 13:620","journal-title":"J Clin Med"},{"key":"12443_CR28","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1159\/000322694","volume":"29","author":"L van den Hout","year":"2011","unstructured":"van den Hout L, Schaible T, Cohen-Overbeek TE et al (2011) Actual outcome in infants with congenital diaphragmatic hernia: the role of a standardized postnatal treatment protocol. Fetal Diagn Ther 29:55\u201363","journal-title":"Fetal Diagn Ther"},{"key":"12443_CR29","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.3390\/jcm12041508","volume":"12","author":"V Cerbelle","year":"2023","unstructured":"Cerbelle V, Le Duc K, Lejeune S et al (2023) Center for rare disease congenital diaphragmatic hernia. fetal lung volume appears to predict respiratory morbidity in congenital diaphragmatic hernia. J Clin Med 12:1508","journal-title":"J Clin Med"},{"key":"12443_CR30","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1080\/14767058.2017.1299126","volume":"30","author":"H Tsuda","year":"2017","unstructured":"Tsuda H, Kotani T, Miura M et al (2017) Observed-to-expected MRI fetal lung volume can predict long-term lung morbidity in infants with congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 30:1509\u20131513","journal-title":"J Matern Fetal Neonatal Med"},{"key":"12443_CR31","doi-asserted-by":"publisher","first-page":"7700","DOI":"10.3390\/jcm12247700","volume":"12","author":"SV Virlan","year":"2023","unstructured":"Virlan SV, Froelich MF, Thater G et al (2023) Radiomics-assisted computed tomography-based analysis to evaluate lung morphology characteristics after congenital diaphragmatic hernia. J Clin Med 12:7700","journal-title":"J Clin Med"},{"key":"12443_CR32","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1007\/s43390-025-01041-y","volume":"13","author":"M Koziara","year":"2025","unstructured":"Koziara M, Irvine S, Wei N et al (2025) The association of congenital diaphragmatic hernia with scoliosis. Spine Deform 13:845\u2013850","journal-title":"Spine Deform"},{"key":"12443_CR33","doi-asserted-by":"crossref","unstructured":"Russell KW, Barnhart DC, Rollins MD, Hedlund G, Scaife ER (2014) Musculoskeletal deformities following repair of large congenital diaphragmatic hernias. J Pediatr Surg 49:886\u2013889","DOI":"10.1016\/j.jpedsurg.2014.01.018"},{"key":"12443_CR34","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1097\/PCC.0b013e3181e8946e","volume":"12","author":"W Hofhuis","year":"2011","unstructured":"Hofhuis W, Hanekamp MN, Ijsselstijn H et al (2011) Prospective longitudinal evaluation of lung function during the first year of life after extracorporeal membrane oxygenation. Pediatr Crit Care Med 12:159\u2013164","journal-title":"Pediatr Crit Care Med"},{"key":"12443_CR35","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jpedsurg.2006.09.011","volume":"42","author":"MJ Hayward","year":"2007","unstructured":"Hayward MJ, Kharasch V, Sheils C et al (2007) Predicting inadequate long-term lung development in children with congenital diaphragmatic hernia: an analysis of longitudinal changes in ventilation and perfusion. J Pediatr Surg 42:112\u2013116","journal-title":"J Pediatr Surg"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12443-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12443-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12443-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T10:18:35Z","timestamp":1781864315000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12443-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,15]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["12443"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12443-5","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,15]]},"assertion":[{"value":"2 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Dr. med. Greta Thater.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Prof. Dr.\u00a0C. Wei\u00df kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained. Approval from the local ethics committee: ethics vote: 2024-415 M-\u00a7 47 [3] MPDG.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Fifty-four of the fifty-nine patients included overlap with the cohort from 2022 [\n                      \n                      ].","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}