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Van Goethem A, De Temmerman G, Van Hoyweghen A, Volders W, Bracke P, Jacobs W. Air bubble artifact: why postmortem brain MRI should always be combined with postmortem CT. Forensic Sci Med Pathol 2024; 20:174-177. [PMID: 36763092 DOI: 10.1007/s12024-023-00585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
Forensic pathology increasingly uses postmortem magnetic resonance imaging (PMMRI), particularly in pediatric cases. It should be noted that each (sudden and unexpected) death of an infant or child should have a forensic approach as well. Current postmortem imaging protocols do not focus adequately on forensic queries. First, it is important to demonstrate or rule out bleeding, especially in the brain. Thus, when incorporating PMMRI, a blood sensitive sequence (T2* and/or susceptibility weighted imaging (SWI)) should always be included. Secondly, as intracranial air might mimic small focal intracerebral hemorrhages, PMMRI should be preceded by postmortem CT (PMCT) since air is easily recognizable on CT. This will be illustrated by a case of a deceased 3-week-old baby. Finally, note that postmortem scans will often be interpreted by clinical radiologists, sometimes with no specific training, which makes this case report relevant for a broader audience.
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Affiliation(s)
- Alexia Van Goethem
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | | | - Astrid Van Hoyweghen
- Department of Radiology, Hospital Geel, Geel, Belgium
- Department of Radiology, AZ Turnhout, Turnhout, Belgium
| | - Wim Volders
- Department of Radiology, AZ KLINA, Brasschaat, Belgium
| | - Peter Bracke
- Department of Radiology, AZ KLINA, Brasschaat, Belgium
| | - Werner Jacobs
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Military Hospital Queen Astrid, Brussels, Belgium
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Franck C, Zanca F, Carpentier K, El Addouli H, Niekel M, Spinhoven M, Van Hoyweghen A, Snoeckx A. LUNG NODULE VOLUMETRY AND MORPHOLOGY IN CHEST CT: EFFECT OF DEEP LEARNING VERSUS ITERATIVE RECONSTRUCTION AT DIFFERENT DOSE LEVELS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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D'Hondt D, Van Hoyweghen A, Broeckx G, Pauwels P. An Incidental Finding of Congenital Pulmonary Airway Malformation Type 3 During a Forensic Autopsy for a Sudden Infant Death: A Case Report With a Brief Literature Review. Am J Forensic Med Pathol 2021; 42:301-306. [PMID: 33833194 DOI: 10.1097/paf.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Congenital pulmonary airway malformation (CPAM), previously known as congenital cystic airway malformation, is a developmental disorder of the lower respiratory tract. It is subdivided into 5 types based on clinical and pathologic features. Type 3, an adenomatoid type of CPAM, is the second rarest form of CPAM, occurring in approximately 5% of all CPAM cases. This article reports an autopsy of a nearly 11-week-old male infant, found unresponsive in bed with his mother. She had fallen asleep after breastfeeding a few hours prior. Although the autopsy and additional technical examinations did not uncover the exact cause of death, CPAM type 3 was eventually identified on histological examination. Taking into account the context of this case, in which accidental asphyxia/neglect could not be ruled out, it is thought that the presence of CPAM might have contributed to the demise of the infant. As CPAM is a rare congenital disorder, the diagnosis could easily be missed. Therefore, this article aims to raise awareness of this diagnosis and points out the clinical and pathologic features of this disorder.
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Snoeckx A, Cant J, Franck C, Luyckx E, Carpentier K, Nicolay S, Van Hoyweghen A, Spinhoven MJ, Vuylsteke P, Parizel PM. Lesion measurement on a combined "all-in-one" window for chest CT: effect on intra- and interobserver variability. Cancer Imaging 2019; 19:78. [PMID: 31783926 PMCID: PMC6884847 DOI: 10.1186/s40644-019-0262-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE A newly developed image processing technique fuses conventional windows into a single 'All-In-One' (AIO) window. This study aims to evaluate variability of CT measurement of lesions in thoracic oncology patients on this novel AIO-window. METHODS Six radiologists with different levels of expertise measured 368 lesions of various size, origin and sharpness. All lesions were measured twice on the AIO-window and twice on the conventional window settings. Intraclass correlation coefficients and Bland-Altman plots were used to assess intra- and interobserver variability. RESULTS Overall intra-observer agreement for lesion diameters on the AIO-window and conventional window settings was 0.986 (95% Confidence interval (CI): 0.983-0.989) and 0.991 (95% CI 0.989-0.993) respectively. For interobserver agreement this was 0.982 (95% CI 0.979-0.985) (AIO) and 0.979 (95% CI 0.957-0.982) (conventional). For both the AIO and conventional windows, intra- and interobserver agreement were dependent on size, sharpness and reader experience. Measurement variability decreased with increasing lesion size. Regarding sharpness, inter- and intra-observer agreement ranged from 0.986-0.989 (AIO) and 0.985-0.992 (conventional) for well-defined lesions and from 0.978-0.983 (AIO) and 0.974-0.991 (conventional) for ill-defined lesions. CONCLUSIONS Lesion diameters were consistently smaller on the AIO-window compared to conventional window settings. Overall intra- and interobserver variability rates were similar for the AIO-window and conventional window settings. We conclude that the AIO-window offers a reliable and reproducible alternative for measurement of thoracic lesions.
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Affiliation(s)
- Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Jeroen Cant
- Agfa Medical Imaging, Septestraat 27, 2640, Mortsel, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Elisa Luyckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Ken Carpentier
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | | | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Snoeckx A, Reyntiens P, Carp L, Spinhoven MJ, El Addouli H, Van Hoyweghen A, Nicolay S, Van Schil PE, Pauwels P, van Meerbeeck JP, Parizel PM. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis 2019; 11:987-1004. [PMID: 31019789 DOI: 10.21037/jtd.2019.02.91] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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Affiliation(s)
- Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Patrick Pauwels
- Department of Pathology Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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