1
|
Hoeijmakers EJI, Martens B, Hendriks BMF, Mihl C, Miclea RL, Backes WH, Wildberger JE, Zijta FM, Gietema HA, Nelemans PJ, Jeukens CRLPN. How subjective CT image quality assessment becomes surprisingly reliable: pairwise comparisons instead of Likert scale. Eur Radiol 2024:10.1007/s00330-023-10493-7. [PMID: 38165429 DOI: 10.1007/s00330-023-10493-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/22/2023] [Accepted: 10/29/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The aim of this study is to improve the reliability of subjective IQ assessment using a pairwise comparison (PC) method instead of a Likert scale method in abdominal CT scans. METHODS Abdominal CT scans (single-center) were retrospectively selected between September 2019 and February 2020 in a prior study. Sample variance in IQ was obtained by adding artificial noise using dedicated reconstruction software, including reconstructions with filtered backprojection and varying iterative reconstruction strengths. Two datasets (each n = 50) were composed with either higher or lower IQ variation with the 25 original scans being part of both datasets. Using in-house developed software, six observers (five radiologists, one resident) rated both datasets via both the PC method (forcing observers to choose preferred scans out of pairs of scans resulting in a ranking) and a 5-point Likert scale. The PC method was optimized using a sorting algorithm to minimize necessary comparisons. The inter- and intraobserver agreements were assessed for both methods with the intraclass correlation coefficient (ICC). RESULTS Twenty-five patients (mean age 61 years ± 15.5; 56% men) were evaluated. The ICC for interobserver agreement for the high-variation dataset increased from 0.665 (95%CI 0.396-0.814) to 0.785 (95%CI 0.676-0.867) when the PC method was used instead of a Likert scale. For the low-variation dataset, the ICC increased from 0.276 (95%CI 0.034-0.500) to 0.562 (95%CI 0.337-0.729). Intraobserver agreement increased for four out of six observers. CONCLUSION The PC method is more reliable for subjective IQ assessment indicated by improved inter- and intraobserver agreement. CLINICAL RELEVANCE STATEMENT This study shows that the pairwise comparison method is a more reliable method for subjective image quality assessment. Improved reliability is of key importance for optimization studies, validation of automatic image quality assessment algorithms, and training of AI algorithms. KEY POINTS • Subjective assessment of diagnostic image quality via Likert scale has limited reliability. • A pairwise comparison method improves the inter- and intraobserver agreement. • The pairwise comparison method is more reliable for CT optimization studies.
Collapse
Affiliation(s)
- Eva J I Hoeijmakers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands.
| | - Bibi Martens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, The Netherlands
| | - Babs M F Hendriks
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, The Netherlands
| | - Razvan L Miclea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- Department of Neurology and School for Mental health and Neuroscience (MheNs), Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, The Netherlands
| | - Frank M Zijta
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, The Netherlands
| | - Patricia J Nelemans
- Department of Epidemiology, Maastricht University, Universiteitssingel 50, Maastricht, 6229 ER, The Netherlands
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| |
Collapse
|
2
|
Hereijgers MJ, van der Velden RM, el Moussaoui N, Verhaert DV, Habibi Z, Luermans J, den Uijl D, Chaldoupi SM, Vernooy K, Schotten U, Baumert M, Gietema HA, Mihl C, Koltowski L, Franssen FM, Simons SO, Linz D. Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation. Int J Cardiol Heart Vasc 2023; 49:101305. [PMID: 38053981 PMCID: PMC10694302 DOI: 10.1016/j.ijcha.2023.101305] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
Background In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments from the pre-ablation work-up to identify and understand the characteristics of affected patients. Methods We screened 110 consecutive AF patients scheduled for catheter ablation with handheld spirometry. Routine pre-ablation work-up included cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. CCTA was analyzed qualitatively for emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of expiratory airflow limitation. Results We found that 25 % of patients had expiratory airflow limitation, which was undiagnosed in 86 % of these patients. These patients were more likely to have pulmonary abnormalities on CCTA, including emphysema (odds ratio [OR] 4.2, 95 % confidence interval [CI] 1.12-15.1, p < 0.05) and bronchial wall thickening (OR 2.6, 95 % CI 1.0-6.5, p < 0.05). The absence of pulmonary abnormalities on CCTA accurately distinguished patients with normal lung function from those with airflow limitation (negative predictive value: 85 %). Echocardiography and polygraphy did not contribute significantly to identifying airflow limitation. Conclusions In conclusion, routine pre-ablation CCTA can detect pulmonary abnormalities in AF patients with airflow limitation, guiding further pulmonary assessment. Future studies should investigate its impact on ablation procedure success.
Collapse
Affiliation(s)
- Maartje J.M. Hereijgers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Nora el Moussaoui
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dominique V.M. Verhaert
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zarina Habibi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Dennis den Uijl
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Mathias Baumert
- Discipline of Biomedical Engineering, The University of Adelaide, Adelaide, Australia
| | - Hester A. Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Casper Mihl
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lukasz Koltowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sami O. Simons
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Koster TD, Charbonnier JP, Pruim J, Gietema HA, Posthuma R, Vanfleteren LEGW, van Dijk M, Klooster K, Slebos DJ. High-Resolution Computed Tomography-approximated Perfusion Is Comparable to Nuclear Perfusion Imaging in Severe Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2023; 208:495-498. [PMID: 37192444 DOI: 10.1164/rccm.202303-0463le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
| | | | - Jan Pruim
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine and
- GROW School for Oncology and Reproduction, Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Lowie E G W Vanfleteren
- Department of Respiratory Medicine and Allergology, COPD Center, Sahlgrenska University Hospital, Gothenburg, Sweden; and
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | |
Collapse
|
4
|
van Bakel SIJ, Gietema HA, Stassen PM, Gosker HR, Gach D, van den Bergh JP, van Osch FHM, Schols AMWJ, Beijers RJHCG. CT Scan-Derived Muscle, But Not Fat, Area Independently Predicts Mortality in COVID-19. Chest 2023; 164:314-322. [PMID: 36894133 PMCID: PMC9990885 DOI: 10.1016/j.chest.2023.02.048] [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] [Received: 11/28/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND COVID-19 has demonstrated a highly variable disease course, from asymptomatic to severe illness and eventually death. Clinical parameters, as included in the 4C Mortality Score, can predict mortality accurately in COVID-19. Additionally, CT scan-derived low muscle and high adipose tissue cross-sectional areas (CSAs) have been associated with adverse outcomes in COVID-19. RESEARCH QUESTION Are CT scan-derived muscle and adipose tissue CSAs associated with 30-day in-hospital mortality in COVID-19, independent of 4C Mortality Score? STUDY DESIGN AND METHODS This was a retrospective cohort analysis of patients with COVID-19 seeking treatment at the ED of two participating hospitals during the first wave of the pandemic. Skeletal muscle and adipose tissue CSAs were collected from routine chest CT-scans at admission. Pectoralis muscle CSA was demarcated manually at the fourth thoracic vertebra, and skeletal muscle and adipose tissue CSA was demarcated at the first lumbar vertebra level. Outcome measures and 4C Mortality Score items were retrieved from medical records. RESULTS Data from 578 patients were analyzed (64.6% men; mean age, 67.7 ± 13.5 years; 18.2% 30-day in-hospital mortality). Patients who died within 30 days demonstrated lower pectoralis CSA (median, 32.6 [interquartile range (IQR), 24.3-38.8] vs 35.4 [IQR, 27.2-44.2]; P = .002) than survivors, whereas visceral adipose tissue CSA was higher (median, 151.1 [IQR, 93.6-219.7] vs 112.9 [IQR, 63.7-174.1]; P = .013). In multivariate analyses, low pectoralis muscle CSA remained associated with 30-day in-hospital mortality when adjusted for 4C Mortality Score (hazard ratio, 0.98; 95% CI, 0.96-1.00; P = .038). INTERPRETATION CT scan-derived low pectoralis muscle CSA is associated significantly with higher 30-day in-hospital mortality in patients with COVID-19 independently of the 4C Mortality Score.
Collapse
Affiliation(s)
- Sophie I J van Bakel
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Grow School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patricia M Stassen
- Section Acute Medicine, Division of General Internal Medicine, Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Harry R Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Debbie Gach
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
| | - Frits H M van Osch
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
| |
Collapse
|
5
|
Rogers W, Keek SA, Beuque M, Lavrova E, Primakov S, Wu G, Yan C, Sanduleanu S, Gietema HA, Casale R, Occhipinti M, Woodruff HC, Jochems A, Lambin P. Towards texture accurate slice interpolation of medical images using PixelMiner. Comput Biol Med 2023; 161:106701. [PMID: 37244145 DOI: 10.1016/j.compbiomed.2023.106701] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 08/06/2022] [Accepted: 11/23/2022] [Indexed: 05/29/2023]
Abstract
Quantitative image analysis models are used for medical imaging tasks such as registration, classification, object detection, and segmentation. For these models to be capable of making accurate predictions, they need valid and precise information. We propose PixelMiner, a convolution-based deep-learning model for interpolating computed tomography (CT) imaging slices. PixelMiner was designed to produce texture-accurate slice interpolations by trading off pixel accuracy for texture accuracy. PixelMiner was trained on a dataset of 7829 CT scans and validated using an external dataset. We demonstrated the model's effectiveness by using the structural similarity index (SSIM), peak signal to noise ratio (PSNR), and the root mean squared error (RMSE) of extracted texture features. Additionally, we developed and used a new metric, the mean squared mapped feature error (MSMFE). The performance of PixelMiner was compared to four other interpolation methods: (tri-)linear, (tri-)cubic, windowed sinc (WS), and nearest neighbor (NN). PixelMiner produced texture with a significantly lowest average texture error compared to all other methods with a normalized root mean squared error (NRMSE) of 0.11 (p < .01), and the significantly highest reproducibility with a concordance correlation coefficient (CCC) ≥ 0.85 (p < .01). PixelMiner was not only shown to better preserve features but was also validated using an ablation study by removing auto-regression from the model and was shown to improve segmentations on interpolated slices.
Collapse
Affiliation(s)
- W Rogers
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - S A Keek
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - M Beuque
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - E Lavrova
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; GIGA Cyclotron Research Centre in Vivo Imaging, University of Liège, Liège, Belgium
| | - S Primakov
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - G Wu
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - C Yan
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - S Sanduleanu
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - H A Gietema
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - R Casale
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Occhipinti
- Radiomics, Clos Chanmurly 13, 4000, Liege, Belgium
| | - H C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - A Jochems
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - P Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| |
Collapse
|
6
|
Sidorenkov G, Stadhouders R, Jacobs C, Mohamed Hoesein FAA, Gietema HA, Nackaerts K, Saghir Z, Heuvelmans MA, Donker HC, Aerts JG, Vermeulen R, Uitterlinden A, Lenters V, van Rooij J, Schaefer-Prokop C, Groen HJM, de Jong PA, Cornelissen R, Prokop M, de Bock GH, Vliegenthart R. Multi-source data approach for personalized outcome prediction in lung cancer screening: update from the NELSON trial. Eur J Epidemiol 2023; 38:445-454. [PMID: 36943671 PMCID: PMC10082103 DOI: 10.1007/s10654-023-00975-9] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/31/2023] [Indexed: 03/23/2023]
Abstract
Trials show that low-dose computed tomography (CT) lung cancer screening in long-term (ex-)smokers reduces lung cancer mortality. However, many individuals were exposed to unnecessary diagnostic procedures. This project aims to improve the efficiency of lung cancer screening by identifying high-risk participants, and improving risk discrimination for nodules. This study is an extension of the Dutch-Belgian Randomized Lung Cancer Screening Trial, with a focus on personalized outcome prediction (NELSON-POP). New data will be added on genetics, air pollution, malignancy risk for lung nodules, and CT biomarkers beyond lung nodules (emphysema, coronary calcification, bone density, vertebral height and body composition). The roles of polygenic risk scores and air pollution in screen-detected lung cancer diagnosis and survival will be established. The association between the AI-based nodule malignancy score and lung cancer will be evaluated at baseline and incident screening rounds. The association of chest CT imaging biomarkers with outcomes will be established. Based on these results, multisource prediction models for pre-screening and post-baseline-screening participant selection and nodule management will be developed. The new models will be externally validated. We hypothesize that we can identify 15-20% participants with low-risk of lung cancer or short life expectancy and thus prevent ~140,000 Dutch individuals from being screened unnecessarily. We hypothesize that our models will improve the specificity of nodule management by 10% without loss of sensitivity as compared to assessment of nodule size/growth alone, and reduce unnecessary work-up by 40-50%.
Collapse
Affiliation(s)
- Grigory Sidorenkov
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Ralph Stadhouders
- Department of Pulmonary Medicine, University Medical Center Rotterdam, Erasmus, Rotterdam, MC, The Netherlands
| | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Hester A Gietema
- Maastricht University Medical Centre, Maastricht University, Maastricht, the Netherlands
| | - Kristiaan Nackaerts
- Department of Respiratory Oncology, KU Leuven-University Hospital Leuven, Leuven, Belgium
| | - Zaigham Saghir
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marjolein A Heuvelmans
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Hylke C Donker
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Joachim G Aerts
- Department of Pulmonary Medicine, University Medical Center Rotterdam, Erasmus, Rotterdam, MC, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andre Uitterlinden
- Department of Internal Medicine, University Medical Center Rotterdam, Erasmus, Rotterdam, MC, The Netherlands
| | - Virissa Lenters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen van Rooij
- Department of Pulmonary Medicine, University Medical Center Rotterdam, Erasmus, Rotterdam, MC, The Netherlands
| | | | - Harry J M Groen
- Department of Pulmonary diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, University Medical Center Rotterdam, Erasmus, Rotterdam, MC, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| |
Collapse
|
7
|
Bels JLM, van Gassel RJJ, Timmerman L, Hemmen B, van de Poll MCG, Peters NHGM, Spruit MA, van Santen S, Gietema HA, Posthuma R. One-Year Outcomes of Mechanically Ventilated COVID-19 ICU Survivors: A Prospective Cohort Study. Am J Respir Crit Care Med 2022; 206:777-780. [PMID: 35608501 PMCID: PMC9799109 DOI: 10.1164/rccm.202112-2789le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Julia L. M. Bels
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands,Corresponding author (e-mail: )
| | - Rob J. J. van Gassel
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands
| | | | - Bena Hemmen
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands,Adelante ZorggroepHoensbroek, the Netherlands
| | - Marcel C. G. van de Poll
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands
| | | | - Martijn A. Spruit
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands,Ciro+Horn, the Netherlands
| | | | - Hester A. Gietema
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands
| | - Rein Posthuma
- Maastricht University Medical CentreMaastricht, the Netherlands,Maastricht UniversityMaastricht, the Netherlands,Ciro+Horn, the Netherlands
| |
Collapse
|
8
|
Hagens LA, Van der Ven FLIM, Heijnen NFL, Smit MR, Gietema HA, Gerretsen SC, Schultz MJ, Bergmans DCJJ, Schnabel RM, Bos LDJ. Improvement of an interobserver agreement of ARDS diagnosis by adding additional imaging and a confidence scale. Front Med (Lausanne) 2022; 9:950827. [PMID: 36117964 PMCID: PMC9473335 DOI: 10.3389/fmed.2022.950827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) often is not recognized in clinical practice, largely due to variation in the interpretation of chest x-ray (CXR) leading to poor interobserver reliability. We hypothesized that the agreement in the interpretation of chest imaging for the diagnosis of ARDS in invasively ventilated intensive care unit patients between experts improves when using an 8-grade confidence scale compared to using a dichotomous assessment and that the agreement increases after adding chest computed tomography (CT) or lung ultrasound (LUS) to CXR. Three experts scored ARDS according to the Berlin definition based on case records from an observational cohort study using a dichotomous assessment and an 8-grade confidence scale. The intraclass correlation (ICC), imaging modality, and the scoring method were calculated per day and compared using bootstrapping. A consensus judgement on the presence of ARDS was based on the combined confidence grades of the experts, followed by a consensus meeting for conflicting scores. In total, 401 patients were included in the analysis. The best ICC was found using an 8-grade confidence scale for LUS (ICC: 0.49; 95%-CI: 0.29–0.63) and CT evaluation (ICC: 0.49; 95%-CI: 0.34–0.61). The ICC of CXR increased by 0.022 and of CT by 0.065 when 8-grade scoring was used instead of the dichotomous assessment. Adding information from LUS or chest CT increased the ICC by 0.25 when using the 8-grade confidence assessment. An agreement on the diagnosis of ARDS can increase substantially by adapting the scoring system from a dichotomous assessment to an 8-grade confidence scale and by adding additional imaging modalities such as LUS or chest CT. This suggests that a simple assessment of the diagnosis of ARDS with a chart review by one assessor is insufficient to define ARDS in future studies.
Collapse
Affiliation(s)
- Laura A. Hagens
- Department of Intensive Care, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Laura A. Hagens
| | - Fleur L. I. M. Van der Ven
- Department of Intensive Care, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Intensive Care, Rode Kruis Ziekenhuis, Brandwondencentrum, Beverwijk, Netherlands
| | - Nanon F. L. Heijnen
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marry R. Smit
- Department of Intensive Care, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hester A. Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Suzanne C. Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Medical Affairs, Hamilton Medical AG, Bonaduz, Switzerland
| | - Dennis C. J. J. Bergmans
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Ronny M. Schnabel
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Lieuwe D. J. Bos
- Department of Intensive Care, Amsterdam University Medical Center, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Respiratory Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
9
|
Keek SA, Kayan E, Chatterjee A, Belderbos JSA, Bootsma G, van den Borne B, Dingemans AMC, Gietema HA, Groen HJM, Herder J, Pitz C, Praag J, De Ruysscher D, Schoenmaekers J, Smit HJM, Stigt J, Westenend M, Zeng H, Woodruff HC, Lambin P, Hendriks L. Investigation of the added value of CT-based radiomics in predicting the development of brain metastases in patients with radically treated stage III NSCLC. Ther Adv Med Oncol 2022; 14:17588359221116605. [PMID: 36032350 PMCID: PMC9403451 DOI: 10.1177/17588359221116605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/05/2022] [Accepted: 07/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Despite radical intent therapy for patients with stage III non-small-cell
lung cancer (NSCLC), cumulative incidence of brain metastases (BM) reaches
30%. Current risk stratification methods fail to accurately identify these
patients. As radiomics features have been shown to have predictive value,
this study aims to develop a model combining clinical risk factors with
radiomics features for BM development in patients with radically treated
stage III NSCLC. Methods: Retrospective analysis of two prospective multicentre studies. Inclusion
criteria: adequately staged [18F-fluorodeoxyglucose positron
emission tomography-computed tomography (18-FDG-PET-CT), contrast-enhanced
chest CT, contrast-enhanced brain magnetic resonance imaging/CT] and
radically treated stage III NSCLC, exclusion criteria: second primary within
2 years of NSCLC diagnosis and prior prophylactic cranial irradiation.
Primary endpoint was BM development any time during follow-up (FU). CT-based
radiomics features (N = 530) were extracted from the
primary lung tumour on 18-FDG-PET-CT images, and a list of clinical features
(N = 8) was collected. Univariate feature selection
based on the area under the curve (AUC) of the receiver operating
characteristic was performed to identify relevant features. Generalized
linear models were trained using the selected features, and multivariate
predictive performance was assessed through the AUC. Results: In total, 219 patients were eligible for analysis. Median FU was 59.4 months
for the training cohort and 67.3 months for the validation cohort; 21 (15%)
and 17 (22%) patients developed BM in the training and validation cohort,
respectively. Two relevant clinical features (age and adenocarcinoma
histology) and four relevant radiomics features were identified as
predictive. The clinical model yielded the highest AUC value of 0.71 (95%
CI: 0.58–0.84), better than radiomics or a combination of clinical
parameters and radiomics (both an AUC of 0.62, 95% CIs of 0.47–076 and
0.48–0.76, respectively). Conclusion: CT-based radiomics features of primary NSCLC in the current setup could not
improve on a model based on clinical predictors (age and adenocarcinoma
histology) of BM development in radically treated stage III NSCLC
patients.
Collapse
Affiliation(s)
- Simon A Keek
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Esma Kayan
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - José S A Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland Hospital, Heerlen, The Netherlands
| | - Ben van den Borne
- Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Judith Herder
- Department of Pulmonary Diseases, Meander Medical Center, Amersfoort, The Netherlands
| | - Cordula Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, Roermond, The Netherlands
| | - John Praag
- Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Janna Schoenmaekers
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hans J M Smit
- Department of Pulmonary Diseases, Rijnstate, Arnhem, The Netherlands
| | - Jos Stigt
- Department of Pulmonary Diseases, Isala Hospital, Zwolle, The Netherlands
| | - Marcel Westenend
- Department of Pulmonary Diseases, VieCuri, Venlo, The Netherlands
| | - Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Lizza Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| |
Collapse
|
10
|
Martens B, Driessen RG, Brandts L, Hoitinga P, van Veen F, Driessen M, Weberndörfer V, Kietselaer B, Ghossein-Doha C, Gietema HA, Vernooy K, van der Horst IC, Wildberger JE, van Bussel BC, Mihl C. Coronary Artery Calcifications Are Associated With More Severe Multiorgan Failure in Patients With Severe Coronavirus Disease 2019 Infection: Longitudinal Results of the Maastricht Intensive Care COVID Cohort. J Thorac Imaging 2022; 37:217-224. [PMID: 35412497 PMCID: PMC9223512 DOI: 10.1097/rti.0000000000000648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is regarded as a multisystemic disease. Patients with preexisting cardiovascular disease have an increased risk for a more severe disease course. This study aimed to investigate if a higher degree of coronary artery calcifications (CAC) on a standard chest computed tomography (CT) scan in mechanically ventilated patients was associated with a more severe multiorgan failure over time. MATERIALS AND METHODS All mechanically ventilated intensive care unit patients with SARS-CoV-2 infection who underwent a chest CT were prospectively included. CT was used to establish the extent of CAC using a semiquantitative grading system. We categorized patients into 3 sex-specific tertiles of CAC: lowest, intermediate, and highest CAC score. Daily, the Sequential Organ Failure Assessment (SOFA) scores were collected to evaluate organ failure over time. Linear mixed-effects regression was used to investigate differences in SOFA scores between tertiles. The models were adjusted for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, cardiovascular risk factors, and chronic liver, lung, and renal disease. RESULTS In all, 71 patients were included. Patients in the highest CAC tertile had, on average, over time, 1.8 (0.5-3.1) points higher SOFA score, compared with the lowest CAC tertile ( P =0.005). This association remained significant after adjustment for age, sex, and APACHE II score (1.4 [0.1-2.7], P =0.042) and clinically relevant after adjustment for cardiovascular risk factors (1.3 [0.0-2.7], P =0.06) and chronic diseases (1.3 [-0.2 to 2.7], P =0.085). CONCLUSION A greater extent of CAC is associated with a more severe multiorgan failure in mechanically ventilated coronavirus disease 2019 patients.
Collapse
Affiliation(s)
- Bibi Martens
- Departments of Radiology and Nuclear Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
| | - Rob G.H. Driessen
- Intensive Care Medicine
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM)
| | - Lloyd Brandts
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+
| | | | | | | | | | - Bas Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Chahinda Ghossein-Doha
- Intensive Care Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
- School for Oncology & Developmental Biology (GROW)
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Hester A. Gietema
- Departments of Radiology and Nuclear Medicine
- School for Oncology & Developmental Biology (GROW)
| | | | | | - Joachim E. Wildberger
- Departments of Radiology and Nuclear Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
| | - Bas C.T. van Bussel
- Intensive Care Medicine
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Casper Mihl
- Departments of Radiology and Nuclear Medicine
- Cardiovascular Research Institute Maastricht (CARIM)
| |
Collapse
|
11
|
Primakov SP, Ibrahim A, van Timmeren JE, Wu G, Keek SA, Beuque M, Granzier RWY, Lavrova E, Scrivener M, Sanduleanu S, Kayan E, Halilaj I, Lenaers A, Wu J, Monshouwer R, Geets X, Gietema HA, Hendriks LEL, Morin O, Jochems A, Woodruff HC, Lambin P. Automated detection and segmentation of non-small cell lung cancer computed tomography images. Nat Commun 2022; 13:3423. [PMID: 35701415 PMCID: PMC9198097 DOI: 10.1038/s41467-022-30841-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/09/2022] [Indexed: 12/25/2022] Open
Abstract
Detection and segmentation of abnormalities on medical images is highly important for patient management including diagnosis, radiotherapy, response evaluation, as well as for quantitative image research. We present a fully automated pipeline for the detection and volumetric segmentation of non-small cell lung cancer (NSCLC) developed and validated on 1328 thoracic CT scans from 8 institutions. Along with quantitative performance detailed by image slice thickness, tumor size, image interpretation difficulty, and tumor location, we report an in-silico prospective clinical trial, where we show that the proposed method is faster and more reproducible compared to the experts. Moreover, we demonstrate that on average, radiologists & radiation oncologists preferred automatic segmentations in 56% of the cases. Additionally, we evaluate the prognostic power of the automatic contours by applying RECIST criteria and measuring the tumor volumes. Segmentations by our method stratified patients into low and high survival groups with higher significance compared to those methods based on manual contours. Correct interpretation of computer tomography (CT) scans is important for the correct assessment of a patient’s disease but can be subjective and timely. Here, the authors develop a system that can automatically segment the non-small cell lung cancer on CT images of patients and show in an in silico trial that the method was faster and more reproducible than clinicians.
Collapse
Affiliation(s)
- Sergey P Primakov
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Abdalla Ibrahim
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, Hospital Center Universitaire De Liege, Liege, Belgium.,Department of Nuclear Medicine and Comprehensive diagnostic center Aachen (CDCA), University Hospital RWTH Aachen University, Aachen, Germany.,Department of Radiology, Columbia University Irving Medical Center, New York, USA
| | - Janita E van Timmeren
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.,Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Guangyao Wu
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.,Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Simon A Keek
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Manon Beuque
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Renée W Y Granzier
- Department of Surgery, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Elizaveta Lavrova
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.,GIGA Cyclotron Research Centre In Vivo Imaging, University of Liège, Liège, Belgium
| | - Madeleine Scrivener
- Department of Radiation Oncology, Cliniques universitaires St-Luc, Brussels, Belgium
| | - Sebastian Sanduleanu
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Esma Kayan
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Iva Halilaj
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Anouk Lenaers
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.,Department of Surgery, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - René Monshouwer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires St-Luc, Brussels, Belgium
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Olivier Morin
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, CA, USA
| | - Arthur Jochems
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW- School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands. .,Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| |
Collapse
|
12
|
Posthuma R, Vaes AW, Walraven KHM, Sardari Nia P, Schreiber JU, Gietema HA, Wesseling G, Wouters EFM, Vanfleteren LEGW. Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study. Respiration 2021; 101:476-484. [PMID: 34937034 DOI: 10.1159/000520885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. OBJECTIVES In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. METHOD A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention. RESULTS Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (n = 2) or lack of benefit (n = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT -4 ± 6 points, FEV1 +190 ± 140 mL, RV -770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. CONCLUSION Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.
Collapse
Affiliation(s)
- Rein Posthuma
- Department of Research and Development, Ciro, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Anouk W Vaes
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Kim H M Walraven
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan U Schreiber
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hester A Gietema
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Geertjan Wesseling
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research and Development, Ciro, Horn, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Lowie E G W Vanfleteren
- Department of Respiratory Medicine and Allergology, COPD Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
13
|
van Gassel RJJ, Bels J, Remij L, van Bussel BCT, Posthuma R, Gietema HA, Verbunt J, van der Horst ICC, Olde Damink SWM, van Santen S, van de Poll MCG. Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study. Crit Care Med 2021; 49:1726-1738. [PMID: 33967204 PMCID: PMC8439632 DOI: 10.1097/ccm.0000000000005089] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We performed a comprehensive health assessment in mechanically ventilated coronavirus disease 2019 survivors to assess the impact of respiratory and skeletal muscle injury sustained during ICU stay on physical performance at 3 months following hospital discharge. DESIGN Preregistered prospective observational cohort study. SETTING University hospital ICU. PATIENTS All mechanically ventilated coronavirus disease 2019 patients admitted to our ICU during the first European pandemic wave. MEASUREMENTS AND MAIN RESULTS At 3 months after hospital discharge, 46 survivors underwent a comprehensive physical assessment (6-min walking distance, Medical Research Council sum score and handgrip strength), a full pulmonary function test, and a chest CT scan which was used to analyze skeletal muscle architecture. In addition, patient-reported outcomes measures were collected. Physical performance assessed by 6-minute walking distance was below 80% of predicted in 48% of patients. Patients with impaired physical performance had more muscle weakness (Medical Research Council sum score 53 [51-56] vs 59 [56-60]; p < 0.001), lower lung diffusing capacity (54% [44-66%] vs 68% of predicted [61-72% of predicted]; p = 0.002), and higher intermuscular adipose tissue area (p = 0.037). Reduced lung diffusing capacity and increased intermuscular adipose tissue were independently associated with physical performance. CONCLUSIONS Physical disability is common at 3 months in severe coronavirus disease 2019 survivors. Lung diffusing capacity and intermuscular adipose tissue assessed on CT were independently associated with walking distance, suggesting a key role for pulmonary function and muscle quality in functional disability.
Collapse
Affiliation(s)
- Rob J J van Gassel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Julia Bels
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Loes Remij
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jeanine Verbunt
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Susanne van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| |
Collapse
|
14
|
Gietema HA, Walraven KHM, Posthuma R, Mitea C, Slebos DJ, Vanfleteren LEGW. Dual-Energy Computed Tomography Compared to Lung Perfusion Scintigraphy to Assess Pulmonary Perfusion in Patients Screened for Endoscopic Lung Volume Reduction. Respiration 2021; 100:1186-1195. [PMID: 34375973 DOI: 10.1159/000517598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic lung volume reduction (ELVR) using one-way endobronchial valves is a technique to reduce hyperinflation in patients with severe emphysema by inducing collapse of a severely destroyed pulmonary lobe. Patient selection is mainly based on evaluation of emphysema severity on high-resolution computed tomography and evaluation of lung perfusion with perfusion scintigraphy. Dual-energy contrast-enhanced CT scans may be useful for perfusion assessment in emphysema but has not been compared against perfusion scintigraphy. AIMS The aim of the study was to compare perfusion distribution assessed with dual-energy contrast-enhanced computed tomography and perfusion scintigraphy. MATERIAL AND METHODS Forty consecutive patients with severe emphysema, who were screened for ELVR, were included. Perfusion was assessed with 99mTc perfusion scintigraphy and using the iodine map calculated from the dual-energy contrast-enhanced CT scans. Perfusion distribution was calculated as usually for the upper, middle, and lower thirds of both lungs with the planar technique and the iodine overlay. RESULTS Perfusion distribution between the right and left lung showed good correlation (r = 0.8). The limits of agreement of the mean absolute difference in percentage perfusion per region of interest were 0.75-5.6%. The upper lobes showed more severe perfusion reduction than the lower lobes. Mean difference in measured pulmonary perfusion ranged from -2.8% to 2.3%. Lower limit of agreement ranged from -8.9% to 4.6% and upper limit was 3.3-10.0%. CONCLUSION Quantification of perfusion distribution using planar 99mTc perfusion scintigraphy and iodine overlays calculated from dual-energy contrast-enhanced CTs correlates well with acceptable variability.
Collapse
Affiliation(s)
- Hester A Gietema
- Department of Radiology and Nuclear Medicine, GROWSchool for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Kim H M Walraven
- Department of Pulmonology, NUTRIMSchool of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Pulmonology, NUTRIMSchool of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands.,CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Cristina Mitea
- Department of Radiology and Nuclear Medicine, GROWSchool for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lowie E G W Vanfleteren
- COPD Center, Sahlgrenska University Hospital and Institute of Medicine, University of Gothenburg, Göteborg, Sweden
| |
Collapse
|
15
|
Affiliation(s)
- Rob J J van Gassel
- Maastricht University Medical Centre Maastricht, the Netherlands.,Maastricht University Maastricht, the Netherlands
| | - Julia L M Bels
- Maastricht University Medical Centre Maastricht, the Netherlands
| | - Hester A Gietema
- Maastricht University Medical Centre Maastricht, the Netherlands.,Maastricht University Maastricht, the Netherlands
| | - Rein Posthuma
- Maastricht University Medical Centre Maastricht, the Netherlands.,Maastricht University Maastricht, the Netherlands
| | | |
Collapse
|
16
|
Marcuse F, Rutten M, Schreurs R, Gietema HA, Theunissen P, Maessen JG. Symptomatic mediastinal mass in a 32-year-old male. Breathe (Sheff) 2021; 17:210029. [PMID: 34295427 PMCID: PMC8291925 DOI: 10.1183/20734735.0029-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022] Open
Abstract
A 32-year-old male, known to have atopic eczema, presented with a 3-day history of acute pleuritic chest pain and shortness of breath. No traumatic event had occurred. The pain was described as sharp and posture dependent, and was worse when leaning backwards. The patient had no palpitations, oedema or radiated pain. Dyspnoea was present both at rest and during exercise, without the presence of wheezing, haemoptysis or purulent sputum. He had no history of fever, cold shivers, weight loss or perspiration. His nutritional state was normal and he had no symptoms of nausea, vomiting or diarrhoea. For 3 days he had experienced dysphagia during meals. The patient was working full-time as a national courier and did not visit foreign countries for his work and did not travel outside Europe. The patient owned a dog but he had no specific contact with (farm) animals. He never smoked and never consumed alcohol. His physical condition, before the start of the present symptoms, was excellent due to daily exercises. On clinical examination our patient was conscious and orientated. He had a normal temperature of 36.9 °C, a respiratory rate of 16 breaths·min−1, blood pressure of 115/75 mmHg, heart rate of 68 beats·min−1 and an oxygen saturation of 95% on room air. Both percussion and respiratory sounds were reduced over the right hemithorax, without crackles or rhonchi. He had no pitting oedema around the ankles. A chest radiograph was performed (figure 1). Most bronchogenic cysts are found incidentally and clinicians should be aware of an atypical case presentation. Total surgical resection is the treatment of choice of a bronchogenic cyst, especially in symptomatic patients.https://bit.ly/3uQrFXo
Collapse
Affiliation(s)
- Florit Marcuse
- Dept of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marijke Rutten
- Dept of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rick Schreurs
- Dept of Cardiothoracic surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hester A Gietema
- Dept of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Prisca Theunissen
- Dept of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Dept of Cardiothoracic surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
17
|
Degens JHRJ, Dingemans AMC, Willemsen ACH, Gietema HA, Hurkmans DP, Aerts JG, Hendriks LEL, Schols AMWJ. The prognostic value of weight and body composition changes in patients with non-small-cell lung cancer treated with nivolumab. J Cachexia Sarcopenia Muscle 2021; 12:657-664. [PMID: 33951326 PMCID: PMC8200425 DOI: 10.1002/jcsm.12698] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is not well known to what extent effectiveness of treatment with immune checkpoint inhibitors in stage IV non-small-cell lung cancer (NSCLC) is influenced by weight loss and changes in body composition. Therefore, the goal of this study was to evaluate body composition changes in relation to early weight change and overall survival (OS) in stage IV NSCLC patients treated with second-line nivolumab. METHODS All patients with stage IV NSCLC, who were treated with second-line nivolumab between June 2015 and December 2018 at Maastricht University Medical Center, were evaluated. Skeletal muscle mass (SMM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were assessed at the first lumbar level on computed tomography images obtained before initiation of nivolumab and at week 6 of treatment. The contribution of changes in body weight (defined as >2% loss), SMM, VAT, and SAT to OS was analysed by Kaplan-Meier method and adjusted for clinical confounders in a Cox regression analysis. The results from the study cohort were validated in another Dutch cohort from Erasmus Medical Center, Rotterdam. RESULTS One hundred and six patients were included in the study cohort. Loss of body weight of >2% at week 6 was an independent predictor for poor OS (hazard ratio 2.39, 95% confidence interval 1.51-3.79, P < 0.001) when adjusted for gender, >1 organ with metastasis, pretreatment hypoalbumenaemia, and pretreatment elevated C-reactive protein. The result was confirmed in the validation cohort (N = 62). Loss of SMM as a feature of cancer cachexia did not significantly predict OS in both cohorts. Significant (>2%) weight loss during treatment was reflected by a significant loss of VAT and SAT, while loss of SMM was comparable between weight-stable and weight-losing patients. CONCLUSIONS Weight loss, characterized by loss of subcutaneous and visceral adipose tissues, at week 6 of treatment with nivolumab, is a significant poor prognostic factor for survival in patients with Stage IV NSCLC.
Collapse
Affiliation(s)
- Juliette H R J Degens
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Respiratory Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, The Netherlands.,Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anna C H Willemsen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center +, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Daan P Hurkmans
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joachim G Aerts
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lizza E L Hendriks
- Department of Respiratory Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center +, Maastricht, The Netherlands
| |
Collapse
|
18
|
Mulder MMG, Brandts LI, Brüggemann RAG, Koelmann M, Streng AS, Olie RH, Gietema HA, Spronk HMH, van der Horst ICC, Sels JWEM, Wildberger JE, van Kuijk SMJ, Schnabel RM, Ten Cate H, Henskens YMC, van Bussel BCT. Serial markers of coagulation and inflammation and the occurrence of clinical pulmonary thromboembolism in mechanically ventilated patients with SARS-CoV-2 infection; the prospective Maastricht intensive care COVID cohort. Thromb J 2021; 19:35. [PMID: 34059058 PMCID: PMC8165953 DOI: 10.1186/s12959-021-00286-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Background The incidence of pulmonary thromboembolism is high in SARS-CoV-2 patients admitted to the Intensive Care. Elevated biomarkers of coagulation (fibrinogen and D-dimer) and inflammation (c-reactive protein (CRP) and ferritin) are associated with poor outcome in SARS-CoV-2. Whether the time-course of fibrinogen, D-dimer, CRP and ferritin is associated with the occurrence of pulmonary thromboembolism in SARS-CoV-2 patients is unknown. We hypothesise that patients on mechanical ventilation with SARS-CoV-2 infection and clinical pulmonary thromboembolism have lower concentrations of fibrinogen and higher D-dimer, CRP, and ferritin concentrations over time compared to patients without a clinical pulmonary thromboembolism. Methods In a prospective study, fibrinogen, D-dimer, CRP and ferritin were measured daily. Clinical suspected pulmonary thromboembolism was either confirmed or excluded based on computed tomography pulmonary angiography (CTPA) or by transthoracic ultrasound (TTU) (i.e., right-sided cardiac thrombus). In addition, patients who received therapy with recombinant tissue plasminogen activator were included when clinical instability in suspected pulmonary thromboembolism did not allow CTPA. Serial data were analysed using a mixed-effects linear regression model, and models were adjusted for known risk factors (age, sex, APACHE-II score, body mass index), biomarkers of coagulation and inflammation, and anticoagulants. Results Thirty-one patients were considered to suffer from pulmonary thromboembolism ((positive CTPA (n = 27), TTU positive (n = 1), therapy with recombinant tissue plasminogen activator (n = 3)), and eight patients with negative CTPA were included. After adjustment for known risk factors and anticoagulants, patients with, compared to those without, clinical pulmonary thromboembolism had lower average fibrinogen concentration of − 0.9 g/L (95% CI: − 1.6 – − 0.1) and lower average ferritin concentration of − 1045 μg/L (95% CI: − 1983 – − 106) over time. D-dimer and CRP average concentration did not significantly differ, 561 μg/L (− 6212–7334) and 27 mg/L (− 32–86) respectively. Ferritin lost statistical significance, both in sensitivity analysis and after adjustment for fibrinogen and D-dimer. Conclusion Lower average concentrations of fibrinogen over time were associated with the presence of clinical pulmonary thromboembolism in patients at the Intensive Care, whereas D-dimer, CRP and ferritin were not. Lower concentrations over time may indicate the consumption of fibrinogen related to thrombus formation in the pulmonary vessels. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00286-7.
Collapse
Affiliation(s)
- Mark M G Mulder
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - LIoyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Renée A G Brüggemann
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marcel Koelmann
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Alexander S Streng
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Renske H Olie
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Henri M H Spronk
- Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jan-Willem E M Sels
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Yvonne M C Henskens
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
19
|
Scheijmans JCG, Borgstein ABJ, Puylaert CAJ, Bom WJ, Bachiri S, van Bodegraven EA, Brandsma ATA, Ter Brugge FM, de Castro SMM, Couvreur R, Franken LC, Gaspersz MP, de Graaff MR, Groenen H, Kleipool SC, Kuypers TJL, Martens MH, Mens DM, Orsini RG, Reneerkens NJMM, Schok T, Sedee WJA, Tavakoli Rad S, Volders JH, Weeder PD, Prins JM, Gietema HA, Stoker J, Gisbertz SS, Besselink MGH, Boermeester MA. Impact of the COVID-19 pandemic on incidence and severity of acute appendicitis: a comparison between 2019 and 2020. BMC Emerg Med 2021; 21:61. [PMID: 33980150 PMCID: PMC8114672 DOI: 10.1186/s12873-021-00454-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/15/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023] Open
Abstract
Background During the COVID-19 pandemic, a decrease in the number of patients presenting with acute appendicitis was observed. It is unclear whether this caused a shift towards more complicated cases of acute appendicitis. We compared a cohort of patients diagnosed with acute appendicitis during the 2020 COVID-19 pandemic with a 2019 control cohort. Methods We retrospectively included consecutive adult patients in 21 hospitals presenting with acute appendicitis in a COVID-19 pandemic cohort (March 15 – April 30, 2020) and a control cohort (March 15 – April 30, 2019). Primary outcome was the proportion of complicated appendicitis. Secondary outcomes included prehospital delay, appendicitis severity, and postoperative complication rates. Results The COVID-19 pandemic cohort comprised 607 patients vs. 642 patients in the control cohort. During the COVID-19 pandemic, a higher proportion of complicated appendicitis was seen (46.9% vs. 38.5%; p = 0.003). More patients had symptoms exceeding 24 h (61.1% vs. 56.2%, respectively, p = 0.048). After correction for prehospital delay, presentation during the first wave of the COVID-19 pandemic was still associated with a higher rate of complicated appendicitis. Patients presenting > 24 h after onset of symptoms during the COVID-19 pandemic were older (median 45 vs. 37 years; p = 0.001) and had more postoperative complications (15.3% vs. 6.7%; p = 0.002). Conclusions Although the incidence of acute appendicitis was slightly lower during the first wave of the 2020 COVID-19 pandemic, more patients presented with a delay and with complicated appendicitis than in a corresponding period in 2019. Spontaneous resolution of mild appendicitis may have contributed to the increased proportion of patients with complicated appendicitis. Late presenting patients were older and experienced more postoperative complications compared to the control cohort. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00454-y.
Collapse
Affiliation(s)
- Jochem C G Scheijmans
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Alexander B J Borgstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter J Bom
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Said Bachiri
- Department of Surgery, Noordwest Hospital Group, Alkmaar, the Netherlands
| | | | | | | | | | - Roy Couvreur
- Department of Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lotte C Franken
- Departement of Surgery, Flevo Hospital, Almere, the Netherlands
| | - Marcia P Gaspersz
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Hannah Groenen
- Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands
| | | | - Toon J L Kuypers
- Department of Surgery, Elisabeth - Tweesteden Hospital, Tilburg, the Netherlands
| | - Milou H Martens
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - David M Mens
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | - Ricardo G Orsini
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | | | - Thomas Schok
- Department of Surgery, VieCuri Medisch Centrum for Noord-Limburg, Venlo, the Netherlands
| | - Wouter J A Sedee
- Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | | | - José H Volders
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Pepijn D Weeder
- Department of Surgery, Spaarne Gasthuis, Haarlem, and Hoofddorp, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G H Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam UMC, location AMC, Amstserdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | | |
Collapse
|
20
|
van Gassel RJJ, Bels JLM, Raafs A, van Bussel BCT, van de Poll MCG, Simons SO, van der Meer LWL, Gietema HA, Posthuma R, van Santen S. High Prevalence of Pulmonary Sequelae at 3 Months after Hospital Discharge in Mechanically Ventilated Survivors of COVID-19. Am J Respir Crit Care Med 2021; 203:371-374. [PMID: 33326353 PMCID: PMC7874313 DOI: 10.1164/rccm.202010-3823le] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Julia L. M. Bels
- Maastricht University Medical CentreMaastricht, the Netherlandsand
| | - Anne Raafs
- Maastricht University Medical CentreMaastricht, the Netherlandsand
| | | | | | - Sami O. Simons
- Maastricht University Medical CentreMaastricht, the Netherlandsand
| | | | | | - Rein Posthuma
- Maastricht University Medical CentreMaastricht, the Netherlandsand
- Centre of Expertise for Chronic Organ Failure (CIRO)Horn, the Netherlands
| | | |
Collapse
|
21
|
Lessmann N, Sánchez CI, Beenen L, Boulogne LH, Brink M, Calli E, Charbonnier JP, Dofferhoff T, van Everdingen WM, Gerke PK, Geurts B, Gietema HA, Groeneveld M, van Harten L, Hendrix N, Hendrix W, Huisman HJ, Išgum I, Jacobs C, Kluge R, Kok M, Krdzalic J, Lassen-Schmidt B, van Leeuwen K, Meakin J, Overkamp M, van Rees Vellinga T, van Rikxoort EM, Samperna R, Schaefer-Prokop C, Schalekamp S, Scholten ET, Sital C, Stöger L, Teuwen J, Vaidhya Venkadesh K, de Vente C, Vermaat M, Xie W, de Wilde B, Prokop M, van Ginneken B. Automated Assessment of COVID-19 Reporting and Data System and Chest CT Severity Scores in Patients Suspected of Having COVID-19 Using Artificial Intelligence. Radiology 2021; 298:E18-E28. [PMID: 32729810 PMCID: PMC7393955 DOI: 10.1148/radiol.2020202439] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has spread across the globe with alarming speed, morbidity, and mortality. Immediate triage of patients with chest infections suspected to be caused by COVID-19 using chest CT may be of assistance when results from definitive viral testing are delayed. Purpose To develop and validate an artificial intelligence (AI) system to score the likelihood and extent of pulmonary COVID-19 on chest CT scans using the COVID-19 Reporting and Data System (CO-RADS) and CT severity scoring systems. Materials and Methods The CO-RADS AI system consists of three deep-learning algorithms that automatically segment the five pulmonary lobes, assign a CO-RADS score for the suspicion of COVID-19, and assign a CT severity score for the degree of parenchymal involvement per lobe. This study retrospectively included patients who underwent a nonenhanced chest CT examination because of clinical suspicion of COVID-19 at two medical centers. The system was trained, validated, and tested with data from one of the centers. Data from the second center served as an external test set. Diagnostic performance and agreement with scores assigned by eight independent observers were measured using receiver operating characteristic analysis, linearly weighted κ values, and classification accuracy. Results A total of 105 patients (mean age, 62 years ± 16 [standard deviation]; 61 men) and 262 patients (mean age, 64 years ± 16; 154 men) were evaluated in the internal and external test sets, respectively. The system discriminated between patients with COVID-19 and those without COVID-19, with areas under the receiver operating characteristic curve of 0.95 (95% CI: 0.91, 0.98) and 0.88 (95% CI: 0.84, 0.93), for the internal and external test sets, respectively. Agreement with the eight human observers was moderate to substantial, with mean linearly weighted κ values of 0.60 ± 0.01 for CO-RADS scores and 0.54 ± 0.01 for CT severity scores. Conclusion With high diagnostic performance, the CO-RADS AI system correctly identified patients with COVID-19 using chest CT scans and assigned standardized CO-RADS and CT severity scores that demonstrated good agreement with findings from eight independent observers and generalized well to external data. © RSNA, 2020 Supplemental material is available for this article.
Collapse
Affiliation(s)
| | | | - Ludo Beenen
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Luuk H. Boulogne
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Monique Brink
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Erdi Calli
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Jean-Paul Charbonnier
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Ton Dofferhoff
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Wouter M. van Everdingen
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Paul K. Gerke
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Bram Geurts
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Hester A. Gietema
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Miriam Groeneveld
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Louis van Harten
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Nils Hendrix
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Ward Hendrix
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Henkjan J. Huisman
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Ivana Išgum
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Colin Jacobs
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Ruben Kluge
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Michel Kok
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Jasenko Krdzalic
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Bianca Lassen-Schmidt
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Kicky van Leeuwen
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - James Meakin
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Mike Overkamp
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Tjalco van Rees Vellinga
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Eva M. van Rikxoort
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Riccardo Samperna
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Cornelia Schaefer-Prokop
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Steven Schalekamp
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Ernst Th. Scholten
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Cheryl Sital
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Lauran Stöger
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Jonas Teuwen
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Kiran Vaidhya Venkadesh
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Coen de Vente
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Marieke Vermaat
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Weiyi Xie
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Bram de Wilde
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Mathias Prokop
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| | - Bram van Ginneken
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands (N.L., C.I.S., L.H.B., M.B., E.C., W.M.V.E., P.K.G., B.G., M.G., N.H., W.H., H.J.H., C.J., R.K., M.K., K.V.L., J.M., M.O., R.S., C.S., S.S., E.T.S., C.S., J.T., K.V.V., C.D.V., W.X., B.D.W., M.P., B.V.G.), Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (L.B.), Thirona, Nijmegen, the Netherlands (J.P., E.M.V.R.), Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, The Netherlands (H.A.G.), GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands (H.A.G.), Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Amsterdam, The Netherlands (L.V.H., I.I.), Department of Radiology, Zuyderland MC, Heerlen, The Netherlands (J.K.), Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany (B.L.), Department of Radiology and Nuclear Medicine, Haaglanden Medical Center, The Hague, The Netherlands (T.V.R.V.), Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands (C.S., S.S.), Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands (L.S.), Department of Internal Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (T.D.), Department of Radiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands (M.V.)
| |
Collapse
|
22
|
Puylaert CAJ, Scheijmans JCG, Borgstein ABJ, Andeweg CS, Bartels-Rutten A, Beets GL, van Berge Henegouwen MI, Braak SJ, Couvreur R, Daams F, van Es HW, Franken LC, Grotenhuis BA, Hendriks ER, de Hingh IHJT, Hoeijmakers F, Ten Holder JT, Huisman PM, Kazemier G, van Kesteren F, van Kesteren J, Keywani K, Kuiper SZ, Lange MDJ, Lobatto ME, du Mée AWF, Poeze M, van Praag EM, van Rossen J, van Santvoort HC, Sedee WJA, Seelen LWF, Sharabiany S, Sosef NL, Quanjel MJR, Veltman J, Verhagen T, van de Vlasakker VCJ, Weeder PD, van Werven JR, Wesdorp NJ, van Dieren S, Han AX, Russell CA, de Jong MD, Bossuyt PMM, Quarles van Ufford JME, Prokop MW, Gisbertz SS, Prins JM, Besselink MG, Boermeester MA, Gietema HA, Stoker J. Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT): Multicenter Study. Ann Surg 2020; 272:919-924. [PMID: 33021367 PMCID: PMC7668335 DOI: 10.1097/sla.0000000000004218] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms. SUMMARY OF BACKGROUND DATA Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown. METHODS This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia. RESULTS A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8-2.1]. Individual yields were 0.7% (95% CI: 0.2-1.1) for chest CT and 1.1% (95% CI: 0.6-1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence. CONCLUSIONS One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.
Collapse
Affiliation(s)
- Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jochem C G Scheijmans
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander B J Borgstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Geerard L Beets
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Roy Couvreur
- Department of Surgery, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Freek Daams
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Hendrik W van Es
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Lotte C Franken
- Department of Surgery, Flevo Hospital, Almere, the Netherlands
| | - Brechtje A Grotenhuis
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eduard R Hendriks
- Department of Surgery, Tergooi Hospitals, Hilversum, the Netherlands
| | | | | | - Joris T Ten Holder
- Department of Pulmonary Medicine, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Peter M Huisman
- Department of Radiology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Floortje van Kesteren
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Kammy Keywani
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sara Z Kuiper
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Maurits D J Lange
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Mark E Lobatto
- Department of Radiology, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | | | - Martijn Poeze
- Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
| | - Elise M van Praag
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorit van Rossen
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, UMC Utrecht Cancer Center, UMC Utrecht, Utrecht, the Netherlands
| | - Wouter J A Sedee
- Department of Emergency Medicine, St Jansdal Hospital, Harderwijk, the Netherlands
| | - Leonard W F Seelen
- Department of Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Sarah Sharabiany
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nico L Sosef
- Department of Surgery, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | - Marian J R Quanjel
- Department of Pulmonary Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jeroen Veltman
- Department of Radiology, Hospital Group Twente, Almelo, the Netherlands
| | - Tim Verhagen
- Department of Surgery, Hospital Group Twente, Almelo, the Netherlands
| | | | - Pepijn D Weeder
- Department of Surgery, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | | | - Nina J Wesdorp
- Department of Surgery, Cancer Center Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alvin X Han
- Laboratory of Applied Evolutionary Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Colin A Russell
- Laboratory of Applied Evolutionary Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Menno D de Jong
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Suzanne S Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity (AI&II), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Hester A Gietema
- Department of Radiology, Maastricht UMC+, Maastricht, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
23
|
Türkkan G, Willems Y, Hendriks LEL, Mostard R, Conemans L, Gietema HA, Mitea C, Peeters S, De Ruysscher D. Idiopathic pulmonary fibrosis: Current knowledge, future perspectives and its importance in radiation oncology. Radiother Oncol 2020; 155:269-277. [PMID: 33245945 DOI: 10.1016/j.radonc.2020.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, fibrotic lung disease with an unknown cause. Uncertainties still remain regarding the pathogenesis of IPF, and the prognosis of this disease is poor despite some recent improvements in treatment. Radiation induced lung injury (RILI) is a common complication and a dose-limiting toxicity of thoracic radiotherapy. Importantly, IPF is a crucial risk factor for pulmonary toxicity after thoracic radiotherapy. Although IPF is not universally accepted as a definite contraindication for thoracic radiotherapy at present, it has been shown that IPF can increase the risk of severe and fatal complications after thoracic radiotherapy. Proton beam therapy has shown promising results in reducing the incidence of thoracic radiotherapy related life-threatening complications in IPF patients, but the current evidence is not sufficient to recommend the standard use of it. Many similarities are noticeable between IPF and RILI in terms of pathogenesis and underlying mechanisms. Better understanding of the mechanisms of IPF and RILI may enable clinicians to provide safer and more effective thoracic radiotherapy treatments in cancer patients with IPF. In this review, we summarize the current knowledge of IPF, present the importance of IPF in radiation oncology practice, and highlight the similarities and relationship between IPF and RILI.
Collapse
Affiliation(s)
- Görkem Türkkan
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Yves Willems
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rémy Mostard
- Department of Respiratory Medicine, Zuyderland Medical Center Heerlen-Sittard, The Netherlands
| | - Lennart Conemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cristina Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Stéphanie Peeters
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
24
|
Schalekamp S, Bleeker-Rovers CP, Beenen LFM, Quarles van Ufford HME, Gietema HA, Stöger JL, Harris V, Reijers MHE, Rahamat-Langendoen J, Korevaar DA, Smits LP, Korteweg C, van Rees Vellinga TFD, Vermaat M, Stassen PM, Scheper H, Wijnakker R, Borm FJ, Dofferhoff ASM, Prokop M. Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience. Radiology 2020; 298:E98-E106. [PMID: 33201791 PMCID: PMC7676748 DOI: 10.1148/radiol.2020203465] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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] [Indexed: 12/17/2022]
Abstract
Background Clinicians need rapid and reliable diagnosis of coronavirus disease 2019 (COVID-19) for proper risk stratification, isolation strategies, and treatment decisions. Purpose To assess the real-life performance of radiologist emergency department chest CT interpretation for diagnosing COVID-19 during the acute phase of the pandemic, using the COVID-19 reporting and data system (CO-RADS). Materials and Methods This retrospective multicenter study included consecutive patients who presented to emergency departments in six medical centers between March and April 2020 with moderate to severe upper respiratory symptoms suspicious for COVID-19. As part of clinical practice, chest CT was obtained for primary workup and scored using the 5-point CO-RADS scheme for suspicion of COVID-19. CT was compared with SARS-CoV-2 RT-PCR, and a clinical reference standard established by a multidisciplinary group of clinicians based on RT-PCR, COVID-19 contact history, oxygen therapy, timing of RT-PCR testing and likely alternative diagnosis. Performance of CT was estimated using area under the receiver operating characteristics curve (AUC) analysis and diagnostic odds ratios (OR) against both reference standards. Subgroup analysis was performed based on symptom duration grouped presentations of < 48 hours, 48 hours through 7 days, and > 7 days. Results A total of 1070 patients (median age 66, IQR 54-75, 626 men) were included, of whom 536/1070 (50%) had a positive RT-PCR, 137/1070 (13%) patients were considered to have a possible or probable COVID- 19 based on the clinical reference standard. Chest CT yielded an AUC of 0.87 (95%CI 0.84-0.89) compared with RT-PCR and 0.87 (95%CI 0.85-0.89) compared with the clinical reference standard. A CO-RADS score ≥4 yielded an OR of 25.9 (95%CI 18.7-35.9) for a COVID-19 diagnosis by RT-PCR, and an OR of 30.6 (95%CI 21.1-44.4) by the clinical reference standard. For symptom duration of less than 48 hours, the AUC fell to 0.71 (95%CI 0.62-0.80; P<.001). Conclusion Chest CT analysis using the COVID-19 reporting and data system (CO-RADS) enables rapid and reliable diagnosis of COVID-19, particularly when symptom duration is greater than 48 hours. See also the editorial by Elicker.
Collapse
Affiliation(s)
- Steven Schalekamp
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Chantal P Bleeker-Rovers
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Ludo F M Beenen
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Henriette M E Quarles van Ufford
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Hester A Gietema
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - J Lauran Stöger
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Vanessa Harris
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Monique H E Reijers
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Janette Rahamat-Langendoen
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Daniel A Korevaar
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Loek P Smits
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Christine Korteweg
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Tjalco F D van Rees Vellinga
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Marieke Vermaat
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Patricia M Stassen
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Henk Scheper
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Roos Wijnakker
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Frank J Borm
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Anthonius S M Dofferhoff
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| | - Mathias Prokop
- From the Department of Radiology, Nuclear Medicine and Anatomy (S.S., M.P.), Department of Internal Medicine, Division of Infectious Diseases, and Radboud Center for Infectious Diseases (C.P.B.R.), Department of Pulmonology (M.H.E.R.), and Department of Medical Microbiology and Radboud Center for Infectious Diseases (J.R.L.), Radboud University Medical Center, Geert Grooteplein zuid 10, 6525GA Nijmegen, the Netherlands; Department of Radiology (L.F.M.B.), Department of Medicine, Division of Infectious Diseases, Department of Internal Medicine (V.H.), Department of Respiratory Medicine (D.A.K.), and Department of Internal Medicine (L.P.S.), Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Departments of Radiology and Nuclear Medicine (H.M.E.Q.v.U., T.v.R.V.) and Pulmonology (C.K.), Haaglanden Medical Center, The Hague, the Netherlands; Department of Radiology and Nuclear Medicine (H.A.G.) and Department of Internal Medicine (P.M.S.), Maastricht University Medical Center+, Maastricht, the Netherlands; Departments of Radiology (J.L.S.), Infectious Diseases (H.S., R.W.), and Pulmonology (F.J.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands (V.H.); Departments of Radiology (M.V.) and Internal Medicine (A.S.M.D.), Canisius-Wilhelmina Ziekenhuis, Nijmegen, the Netherlands; and GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands (H.A.G.)
| |
Collapse
|
25
|
Dumoulin DW, Gietema HA, Paats MS, Hendriks LEL, Cornelissen R. Differentiation of COVID-19 Pneumonitis and ICI Induced Pneumonitis. Front Oncol 2020; 10:577696. [PMID: 33194697 PMCID: PMC7658907 DOI: 10.3389/fonc.2020.577696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/29/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023] Open
Abstract
Immune checkpoint inhibitors (ICI) have become the standard of care treatment for several tumor types. ICI-induced pneumonitis is a serious complication seen with treatment with these agents. Cancer has been reported to be one of the risk factors for severe coronavirus disease 2019 (COVID-19) caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that has engulfed the world in the last couple of months. In patients with cancer treated with ICI who present at the emergency department with respiratory symptoms during the COVID-19 pandemic, correct diagnosis can be challenging. Symptoms and radiological features of ICI pneumonitis can be overlapping with those of COVID-19 related pneumonia. For the latter, dexamethasone and remdesivir have shown encouraging results, while vaccines are currently being evaluated in phase III trials. The mainstay of treatment in ICI pneumonitis is immunosuppressive therapy, as this is a potentially fatal adverse event. It has been speculated that immunosuppression may be associated with increased risk of progression to severe COVID-19, especially during the early stage of infection with SARS-CoV-2. Therefore, distinction between these two entities is warranted. We summarize the clinical, radiological features as well as additional investigations of both entities, and suggest a diagnostic algorithm for distinction between the two. This algorithm may be a supportive tool for clinicians to diagnose the underlying cause of the pneumonitis in patients treated with ICI during this COVID-19 pandemic.
Collapse
Affiliation(s)
- Daphne W. Dumoulin
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Hester A. Gietema
- Department of Radiology, Maastricht University Medical Center, Maastricht, Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Marthe S. Paats
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Lizza E. L. Hendriks
- GROW School for Oncology and Developmental Biology, Maastricht, Netherlands
- Department of Pulmonary Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| |
Collapse
|
26
|
Brüggemann RAG, Spaetgens B, Gietema HA, Brouns SHA, Stassen PM, Magdelijns FJ, Rennenberg RJ, Henry RMA, Mulder MMG, van Bussel BCT, Schnabel RM, van der Horst ICC, Wildberger JE, Stehouwer CDA, Ten Cate H. The prevalence of pulmonary embolism in patients with COVID-19 and respiratory decline: A three-setting comparison. Thromb Res 2020; 196:486-490. [PMID: 33091701 PMCID: PMC7557291 DOI: 10.1016/j.thromres.2020.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The risk of pulmonary embolism (PE) in patients with Coronavirus Disease 2019 (COVID-19) is recognized. The prevalence of PE in patients with respiratory deterioration at the Emergency Department (ED), the regular ward, and the Intensive Care Unit (ICU) are not well-established. OBJECTIVES We aimed to investigate how often PE was present in individuals with COVID-19 and respiratory deterioration in different settings, and whether or not disease severity as measured by CT-severity score (CTSS) was related to the occurrence of PE. PATIENTS/METHODS Between April 6th and May 3rd, we enrolled 60 consecutive adult patients with confirmed COVID-19 from the ED, regular ward and ICU who met the pre-specified criteria for respiratory deterioration. RESULTS A total of 24 (24/60: 40% (95% CI: 28-54%)) patients were diagnosed with PE, of whom 6 were in the ED (6/23: 26% (95% CI: 10-46%)), 8 in the regular ward (8/24: 33% (95% CI: 16-55%)), and 10 in the ICU (10/13: 77% (95% CI: 46-95%)). CTSS (per unit) was not associated with the occurrence of PE (age and sex-adjusted OR 1.06 (95%CI 0.98-1.15)). CONCLUSION The number of PE diagnosis among patients with COVID-19 and respiratory deterioration was high; 26% in the ED, 33% in the regular ward and 77% in the ICU respectively. In our cohort CTSS was not associated with the occurrence of PE. Based on the high number of patients diagnosed with PE among those scanned we recommend a low threshold for performing computed tomography angiography in patients with COVID-19 and respiratory deterioration.
Collapse
Affiliation(s)
- Renée A G Brüggemann
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Bart Spaetgens
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands; Grow school of Oncology and Developmental biology, Maastricht, the Netherlands
| | - Steffie H A Brouns
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Patricia M Stassen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Fabienne J Magdelijns
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roger J Rennenberg
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mark M G Mulder
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Ronny M Schnabel
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hugo Ten Cate
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, the Netherlands; Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| |
Collapse
|
27
|
Hermans BCM, Sanduleanu S, Derks JL, Woodruff H, Hillen LM, Casale R, Hoesein FM, de Jong E, Berge DMHJT, Speel EJM, Lambin P, Gietema HA, Dingemans AMC. Exploring imaging features of molecular subtypes of large cell neuroendocrine carcinoma (LCNEC). Lung Cancer 2020; 148:94-99. [PMID: 32858338 DOI: 10.1016/j.lungcan.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Radiological characteristics and radiomics signatures can aid in differentiation between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC). We investigated whether molecular subtypes of large cell neuroendocrine carcinoma (LCNEC), i.e. SCLC-like (with pRb loss) vs. NSCLC-like (with pRb expression), can be distinguished by imaging based on (1) imaging interpretation, (2) semantic features, and/or (3) a radiomics signature, designed to differentiate between SCLC and NSCLC. MATERIALS AND METHODS Pulmonary oncologists and chest radiologists assessed chest CT-scans of 44 LCNEC patients for 'small cell-like' or 'non-small cell-like' appearance. The radiologists also scored semantic features of 50 LCNEC scans. Finally, a radiomics signature was trained on a dataset containing 48 SCLC and 76 NSCLC scans and validated on an external set of 58 SCLC and 40 NSCLC scans. This signature was applied on scans of 28 SCLC-like and 8 NSCLC-like LCNEC patients. RESULTS Pulmonary oncologists and radiologists were unable to differentiate between molecular subtypes of LCNEC and no significant differences in semantic features were found. The area under the receiver operating characteristics curve of the radiomics signature in the validation set (SCLC vs. NSCLC) was 0.84 (95% confidence interval (CI) 0.77-0.92) and 0.58 (95% CI 0.29-0.86) in the LCNEC dataset (SCLC-like vs. NSCLC-like). CONCLUSION LCNEC appears to have radiological characteristics of both SCLC and NSCLC, irrespective of pRb loss, compatible with the SCLC-like subtype. Imaging interpretation, semantic features and our radiomics signature designed to differentiate between SCLC and NSCLC were unable to separate molecular LCNEC subtypes, which underscores that LCNEC is a unique disease.
Collapse
Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - S Sanduleanu
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - H Woodruff
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L M Hillen
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - R Casale
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - F Mohamed Hoesein
- Department of Radiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - E de Jong
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - D M H J Ten Berge
- Department of Radiology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pulmonology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - E J M Speel
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - P Lambin
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - H A Gietema
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pulmonology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| |
Collapse
|
28
|
Gietema HA, Zelis N, Nobel JM, Lambriks LJG, van Alphen LB, Oude Lashof AML, Wildberger JE, Nelissen IC, Stassen PM. CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. PLoS One 2020; 15:e0235844. [PMID: 32645053 PMCID: PMC7347219 DOI: 10.1371/journal.pone.0235844] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/18/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Early differentiation between emergency department (ED) patients with and without corona virus disease (COVID-19) is very important. Chest CT scan may be helpful in early diagnosing of COVID-19. We investigated the diagnostic accuracy of CT using RT-PCR for SARS-CoV-2 as reference standard and investigated reasons for discordant results between the two tests. METHODS In this prospective single centre study in the Netherlands, all adult symptomatic ED patients had both a CT scan and a RT-PCR upon arrival at the ED. CT results were compared with PCR test(s). Diagnostic accuracy was calculated. Discordant results were investigated using discharge diagnoses. RESULTS Between March 13th and March 24th 2020, 193 symptomatic ED patients were included. In total, 43.0% of patients had a positive PCR and 56.5% a positive CT, resulting in a sensitivity of 89.2%, specificity 68.2%, likelihood ratio (LR)+ 2.81 and LR- 0.16. Sensitivity was higher in patients with high risk pneumonia (CURB-65 score ≥3; n = 17, 100%) and with sepsis (SOFA score ≥2; n = 137, 95.5%). Of the 35 patients (31.8%) with a suspicious CT and a negative RT-PCR, 9 had another respiratory viral pathogen, and in 7 patients, COVID-19 was considered likely. One of nine patients with a non-suspicious CT and a positive PCR had developed symptoms within 48 hours before scanning. DISCUSSION The accuracy of chest CT in symptomatic ED patients is high, but used as a single diagnostic test, CT can not safely diagnose or exclude COVID-19. However, CT can be used as a quick tool to categorize patients into "probably positive" and "probably negative" cohorts.
Collapse
Affiliation(s)
- Hester A. Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Noortje Zelis
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - J. Martijn Nobel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Lars J. G. Lambriks
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lieke B. van Alphen
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Astrid M. L. Oude Lashof
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Irene C. Nelissen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia M. Stassen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
29
|
Refaee T, Wu G, Ibrahim A, Halilaj I, Leijenaar RTH, Rogers W, Gietema HA, Hendriks LEL, Lambin P, Woodruff HC. The Emerging Role of Radiomics in COPD and Lung Cancer. Respiration 2020; 99:99-107. [PMID: 31991420 DOI: 10.1159/000505429] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022] Open
Abstract
Medical imaging plays a key role in evaluating and monitoring lung diseases such as chronic obstructive pulmonary disease (COPD) and lung cancer. The application of artificial intelligence in medical imaging has transformed medical images into mineable data, by extracting and correlating quantitative imaging features with patients' outcomes and tumor phenotype - a process termed radiomics. While this process has already been widely researched in lung oncology, the evaluation of COPD in this fashion remains in its infancy. Here we outline the main applications of radiomics in lung cancer and briefly review the workflow from image acquisition to the evaluation of model performance. Finally, we discuss the current assessments of COPD and the potential application of radiomics in COPD.
Collapse
Affiliation(s)
- Turkey Refaee
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands, .,Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia,
| | - Guangyao Wu
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Abdallah Ibrahim
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, Centre Hospitalier Universitaire de Liège, Liège, Belgium.,Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), University Hospital RWTH Aachen University, Aachen, Germany
| | - Iva Halilaj
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Ralph T H Leijenaar
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - William Rogers
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Thoracic Oncology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
30
|
Gietema HA, Zelis N, Nobel JM, Lambriks LJG, van Alphen LB, Oude Lashof AML, Wildberger JE, Nelissen IC, Stassen PM. CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. PLoS One 2020; 15:e0235844. [PMID: 32645053 DOI: 10.1101/2020.04.22.20070441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/18/2020] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Early differentiation between emergency department (ED) patients with and without corona virus disease (COVID-19) is very important. Chest CT scan may be helpful in early diagnosing of COVID-19. We investigated the diagnostic accuracy of CT using RT-PCR for SARS-CoV-2 as reference standard and investigated reasons for discordant results between the two tests. METHODS In this prospective single centre study in the Netherlands, all adult symptomatic ED patients had both a CT scan and a RT-PCR upon arrival at the ED. CT results were compared with PCR test(s). Diagnostic accuracy was calculated. Discordant results were investigated using discharge diagnoses. RESULTS Between March 13th and March 24th 2020, 193 symptomatic ED patients were included. In total, 43.0% of patients had a positive PCR and 56.5% a positive CT, resulting in a sensitivity of 89.2%, specificity 68.2%, likelihood ratio (LR)+ 2.81 and LR- 0.16. Sensitivity was higher in patients with high risk pneumonia (CURB-65 score ≥3; n = 17, 100%) and with sepsis (SOFA score ≥2; n = 137, 95.5%). Of the 35 patients (31.8%) with a suspicious CT and a negative RT-PCR, 9 had another respiratory viral pathogen, and in 7 patients, COVID-19 was considered likely. One of nine patients with a non-suspicious CT and a positive PCR had developed symptoms within 48 hours before scanning. DISCUSSION The accuracy of chest CT in symptomatic ED patients is high, but used as a single diagnostic test, CT can not safely diagnose or exclude COVID-19. However, CT can be used as a quick tool to categorize patients into "probably positive" and "probably negative" cohorts.
Collapse
Affiliation(s)
- Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Noortje Zelis
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - J Martijn Nobel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Lars J G Lambriks
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lieke B van Alphen
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Irene C Nelissen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia M Stassen
- Department of Internal Medicine, Division of General Internal Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
31
|
de Jong EEC, Hendriks LEL, van Elmpt W, Gietema HA, Hofman PAM, De Ruysscher DKM, Dingemans AMC. What you see is (not) what you get: tools for a non-radiologist to evaluate image quality in lung cancer. Lung Cancer 2018; 123:112-115. [PMID: 30089580 DOI: 10.1016/j.lungcan.2018.07.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022]
Abstract
Medical images are an integral part of oncological patient records and they are reviewed by many different specialists. Therefore, it is important that besides imaging experts, other clinicians are also aware that the diagnostic value of a scan is influenced by the applied imaging protocol. Based on two clinical lung cancer trials, we experienced that, even within a study protocol, there is a large variability in imaging parameters, which has direct impact on the interpretation of the image. These two trials were: 1) the NTR3628 in which the added value of gadolinium magnetic resonance imaging (Gd-MRI) to dedicated contrast enhanced computed tomography (CE-CT) for detecting asymptomatic brain metastases in stage III non-small cell lung cancer (NSCLC) was investigated and 2) a sub-study of the NVALT 12 trial (NCT01171170) in which repeated 18 F-fludeoxyglucose positron emission tomography (18F-FDG-PET) imaging for early response assessment was investigated. Based on the problems encountered in the two trials, we provide recommendations for non-radiology clinicians, which can be used in daily interpretation of imaging. Variations in image parameters cannot only influence trial results, but sub-optimal imaging can also influence treatment decisions in daily lung cancer care, when a physician is not aware of the scanning details.
Collapse
Affiliation(s)
- Evelyn E C de Jong
- The D-Lab: Decision Support for Precision Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Doctor Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
| | - Hester A Gietema
- Department of Radiology, Maastricht University Medical Center+, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Paul A M Hofman
- Department of Radiology, Maastricht University Medical Center+, P.Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Dirk K M De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, Doctor Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| |
Collapse
|
32
|
Kockelkorn TTJP, de Jong PA, Schaefer-Prokop CM, Wittenberg R, Tiehuis AM, Gietema HA, Grutters JC, Viergever MA, van Ginneken B. Semi-automatic classification of textures in thoracic CT scans. Phys Med Biol 2016; 61:5906-24. [PMID: 27436568 DOI: 10.1088/0031-9155/61/16/5906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The textural patterns in the lung parenchyma, as visible on computed tomography (CT) scans, are essential to make a correct diagnosis in interstitial lung disease. We developed one automatic and two interactive protocols for classification of normal and seven types of abnormal lung textures. Lungs were segmented and subdivided into volumes of interest (VOIs) with homogeneous texture using a clustering approach. In the automatic protocol, VOIs were classified automatically by an extra-trees classifier that was trained using annotations of VOIs from other CT scans. In the interactive protocols, an observer iteratively trained an extra-trees classifier to distinguish the different textures, by correcting mistakes the classifier makes in a slice-by-slice manner. The difference between the two interactive methods was whether or not training data from previously annotated scans was used in classification of the first slice. The protocols were compared in terms of the percentages of VOIs that observers needed to relabel. Validation experiments were carried out using software that simulated observer behavior. In the automatic classification protocol, observers needed to relabel on average 58% of the VOIs. During interactive annotation without the use of previous training data, the average percentage of relabeled VOIs decreased from 64% for the first slice to 13% for the second half of the scan. Overall, 21% of the VOIs were relabeled. When previous training data was available, the average overall percentage of VOIs requiring relabeling was 20%, decreasing from 56% in the first slice to 13% in the second half of the scan.
Collapse
Affiliation(s)
- Thessa T J P Kockelkorn
- Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Scholten ET, de Jong PA, de Hoop B, van Klaveren R, van Amelsvoort-van de Vorst S, Oudkerk M, Vliegenthart R, de Koning HJ, van der Aalst CM, Vernhout RM, Groen HJM, Lammers JWJ, van Ginneken B, Jacobs C, Mali WPTM, Horeweg N, Weenink C, Thunnissen E, Prokop M, Gietema HA. Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules? Eur Respir J 2014; 45:765-73. [PMID: 25431271 DOI: 10.1183/09031936.00005914] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pulmonary subsolid nodules (SSNs) have a high likelihood of malignancy, but are often indolent. A conservative treatment approach may therefore be suitable. The aim of the current study was to evaluate whether close follow-up of SSNs with computed tomography may be a safe approach. The study population consisted of participants of the Dutch-Belgian lung cancer screening trial (Nederlands Leuvens Longkanker Screenings Onderzoek; NELSON). All SSNs detected during the trial were included in this analysis. Retrospectively, all persistent SSNs and SSNs that were resected after first detection were segmented using dedicated software, and maximum diameter, volume and mass were measured. Mass doubling time (MDT) was calculated. In total 7135 volunteers were included in the current analysis. 264 (3.3%) SSNs in 234 participants were detected during the trial. 147 (63%) of these SSNs in 126 participants disappeared at follow-up, leaving 117 persistent or directly resected SSNs in 108 (1.5%) participants available for analysis. The median follow-up time was 95 months (range 20-110 months). 33 (28%) SSNs were resected and 28 of those were (pre-) invasive. None of the non-resected SSNs progressed into a clinically relevant malignancy. Persistent SSNs rarely developed into clinically manifest malignancies unexpectedly. Close follow-up with computed tomography may be a safe option to monitor changes.
Collapse
Affiliation(s)
- Ernst T Scholten
- Dept of Radiology, University Medical Center, Utrecht, The Netherlands Dept of Radiology, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Pim A de Jong
- Dept of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Bartjan de Hoop
- Dept of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Rob van Klaveren
- Dept of Pulmonology, Lievensberg Hospital, Bergen op Zoom, The Netherlands
| | | | - Matthijs Oudkerk
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Dept of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry J de Koning
- Dept of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carlijn M van der Aalst
- Dept of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands Dept of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - René M Vernhout
- Dept of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Harry J M Groen
- Dept of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bram van Ginneken
- Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Colin Jacobs
- Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands Fraunhofer MEVIS, Bremen, Germany
| | - Willem P T M Mali
- Dept of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Nanda Horeweg
- Dept of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands Dept of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carla Weenink
- Dept of Pulmonology, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Erik Thunnissen
- Dept of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mathias Prokop
- Dept of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Hester A Gietema
- Dept of Radiology, University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
34
|
Scholten ET, de Hoop B, Jacobs C, van Amelsvoort-van de Vorst S, van Klaveren RJ, Oudkerk M, Vliegenthart R, de Koning HJ, van der Aalst CM, Mali WTM, Gietema HA, Prokop M, van Ginneken B, de Jong PA. Semi-automatic quantification of subsolid pulmonary nodules: comparison with manual measurements. PLoS One 2013; 8:e80249. [PMID: 24278264 PMCID: PMC3837004 DOI: 10.1371/journal.pone.0080249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/11/2013] [Indexed: 12/27/2022] Open
Abstract
Rationale Accurate measurement of subsolid pulmonary nodules (SSN) is becoming increasingly important in the management of these nodules. SSNs were previously quantified with time-consuming manual measurements. The aim of the present study is to test the feasibility of semi-automatic SSNs measurements and to compare the results to the manual measurements. Methods In 33 lung cancer screening participants with 33 SSNs, the nodules were previously quantified by two observers manually. In the present study two observers quantified these nodules by using semi-automated nodule volumetry software. Nodules were quantified for effective diameter, volume and mass. The manual and semi-automatic measurements were compared using Bland-Altman plots and paired T tests. Observer agreement was calculated as an intraclass correlation coefficient. Data are presented as mean (SD). Results Semi-automated measurements were feasible in all 33 nodules. Nodule diameter, volume and mass were 11.2 (3.3) mm, 935 (691) ml and 379 (311) milligrams for observer 1 and 11.1 (3.7) mm, 986 (797) ml and 399 (344) milligrams for observer 2, respectively. Agreement between observers and within observer 1 for the semi-automatic measurements was good with an intraclass correlation coefficient >0.89. For observer 1 and observer 2, measured diameter was 8.8% and 10.3% larger (p<0.001), measured volume was 24.3% and 26.5% larger (p<0.001) and measured mass was 10.6% and 12.0% larger (p<0.001) with the semi-automatic program compared to the manual measurements. Conclusion Semi-automated measurement of the diameter, volume and mass of SSNs is feasible with good observer agreement. Semi-automated measurement makes quantification of mass and volume feasible in daily practice.
Collapse
Affiliation(s)
- Ernst Th. Scholten
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Radiology, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Bartjan de Hoop
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Colin Jacobs
- Image Analysis Group, Department of Radiology UMC St Radboud, Nijmegen, The Netherlands
- Fraunhofer MEVIS, Bremen, Germany
| | | | - Rob J. van Klaveren
- Departement of Pulmonology, Lievensberg Hospital, Bergen op Zoom, The Netherlands
| | - Matthijs Oudkerk
- Department of Radiology, University Medical Centre, Groningen, The Netherlands
| | | | - Harry J. de Koning
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Willem Th M. Mali
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hester A. Gietema
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mathias Prokop
- Department of Radiology, UMC St Radboud, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Image Analysis Group, Department of Radiology UMC St Radboud, Nijmegen, The Netherlands
- Fraunhofer MEVIS, Bremen, Germany
| | - Pim A. de Jong
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
| |
Collapse
|
35
|
Mets OM, Smit EJ, Mohamed Hoesein FAA, Gietema HA, Bokkers RPH, Attrach M, van Amelsvoort-van de Vorst S, Scholten ET, Buckens CFM, Oudkerk M, Lammers JWJ, Prokop M, de Jong PA. Visual versus automated evaluation of chest computed tomography for the presence of chronic obstructive pulmonary disease. PLoS One 2012; 7:e42227. [PMID: 22848747 PMCID: PMC3407100 DOI: 10.1371/journal.pone.0042227] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022] Open
Abstract
Background Incidental CT findings may provide an opportunity for early detection of chronic obstructive pulmonary disease (COPD), which may prove important in CT-based lung cancer screening setting. We aimed to determine the diagnostic performance of human observers to visually evaluate COPD presence on CT images, in comparison to automated evaluation using quantitative CT measures. Methods This study was approved by the Dutch Ministry of Health and the institutional review board. All participants provided written informed consent. We studied 266 heavy smokers enrolled in a lung cancer screening trial. All subjects underwent volumetric inspiratory and expiratory chest computed tomography (CT). Pulmonary function testing was used as the reference standard for COPD. We evaluated the diagnostic performance of eight observers and one automated model based on quantitative CT measures. Results The prevalence of COPD in the study population was 44% (118/266), of whom 62% (73/118) had mild disease. The diagnostic accuracy was 74.1% in the automated evaluation, and ranged between 58.3% and 74.3% for the visual evaluation of CT images. The positive predictive value was 74.3% in the automated evaluation, and ranged between 52.9% and 74.7% for the visual evaluation. Interobserver variation was substantial, even within the subgroup of experienced observers. Agreement within observers yielded kappa values between 0.28 and 0.68, regardless of the level of expertise. The agreement between the observers and the automated CT model showed kappa values of 0.12–0.35. Conclusions Visual evaluation of COPD presence on chest CT images provides at best modest accuracy and is associated with substantial interobserver variation. Automated evaluation of COPD subjects using quantitative CT measures appears superior to visual evaluation by human observers.
Collapse
Affiliation(s)
- Onno M Mets
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Mets OM, Isgum I, Mol CP, Gietema HA, Zanen P, Prokop M, de Jong PA. Variation in quantitative CT air trapping in heavy smokers on repeat CT examinations. Eur Radiol 2012; 22:2710-7. [PMID: 22696157 PMCID: PMC3486998 DOI: 10.1007/s00330-012-2526-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/20/2012] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
Abstract
Objectives To determine the variation in quantitative computed tomography (CT) measures of air trapping in low-dose chest CTs of heavy smokers. Methods We analysed 45 subjects from a lung cancer screening trial, examined by CT twice within 3 months. Inspiratory and expiratory low-dose CT was obtained using breath hold instructions. CT air trapping was defined as the percentage of voxels in expiratory CT with an attenuation below −856 HU (EXP−856) and the expiratory to inspiratory ratio of mean lung density (E/I-ratioMLD). Variation was determined using limits of agreement, defined as 1.96 times the standard deviation of the mean difference. The effect of both lung volume correction and breath hold reproducibility was determined. Results The limits of agreement for uncorrected CT air trapping measurements were −15.0 to 11.7 % (EXP−856) and −9.8 to 8.0 % (E/I-ratioMLD). Good breath hold reproducibility significantly narrowed the limits for EXP−856 (−10.7 to 7.5 %, P = 0.002), but not for E/I-ratioMLD (−9.2 to 7.9 %, P = 0.75). Statistical lung volume correction did not improve the limits for EXP−856 (−12.5 to 8.8 %, P = 0.12) and E/I-ratioMLD (−7.5 to 5.8 %, P = 0.17). Conclusions Quantitative air trapping measures on low-dose CT of heavy smokers show considerable variation on repeat CT examinations, regardless of lung volume correction or reproducible breath holds. Key Points • Computed tomography quantitatively measures small airways disease in heavy smokers. • Measurements of air trapping vary considerably on repeat CT examinations. • Variation remains substantial even with reproducible breath holds and lung volume correction.
Collapse
Affiliation(s)
- Onno M Mets
- Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
37
|
Murphy K, Pluim JPW, van Rikxoort EM, de Jong PA, de Hoop B, Gietema HA, Mets O, de Bruijne M, Lo P, Prokop M, Ginneken BV. Toward automatic regional analysis of pulmonary function using inspiration and expiration thoracic CT. Med Phys 2012; 39:1650-62. [DOI: 10.1118/1.3687891] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
38
|
Mets OM, Murphy K, Zanen P, Gietema HA, Lammers JW, van Ginneken B, Prokop M, de Jong PA. The relationship between lung function impairment and quantitative computed tomography in chronic obstructive pulmonary disease. Eur Radiol 2012; 22:120-8. [PMID: 21837396 PMCID: PMC3229695 DOI: 10.1007/s00330-011-2237-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/01/2011] [Accepted: 07/02/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the relationship between lung function impairment and quantitative computed tomography (CT) measurements of air trapping and emphysema in a population of current and former heavy smokers with and without airflow limitation. METHODS In 248 subjects (50 normal smokers; 50 mild obstruction; 50 moderate obstruction; 50 severe obstruction; 48 very severe obstruction) CT emphysema and CT air trapping were quantified on paired inspiratory and end-expiratory CT examinations using several available quantification methods. CT measurements were related to lung function (FEV(1), FEV(1)/FVC, RV/TLC, Kco) by univariate and multivariate linear regression analysis. RESULTS Quantitative CT measurements of emphysema and air trapping were strongly correlated to airflow limitation (univariate r-squared up to 0.72, p < 0.001). In multivariate analysis, the combination of CT emphysema and CT air trapping explained 68-83% of the variability in airflow limitation in subjects covering the total range of airflow limitation (p < 0.001). CONCLUSIONS The combination of quantitative CT air trapping and emphysema measurements is strongly associated with lung function impairment in current and former heavy smokers with a wide range of airflow limitation.
Collapse
Affiliation(s)
- O M Mets
- Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508GA, Postbus 85500, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Mets OM, de Jong PA, van Ginneken B, Gietema HA, Lammers JWJ. Quantitative computed tomography in COPD: possibilities and limitations. Lung 2011; 190:133-45. [PMID: 22179694 PMCID: PMC3310986 DOI: 10.1007/s00408-011-9353-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 11/28/2011] [Indexed: 01/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that is characterized by chronic airflow limitation. Unraveling of this heterogeneity is challenging but important, because it might enable more accurate diagnosis and treatment. Because spirometry cannot distinguish between the different contributing pathways of airflow limitation, and visual scoring is time-consuming and prone to observer variability, other techniques are sought to start this phenotyping process. Quantitative computed tomography (CT) is a promising technique, because current CT technology is able to quantify emphysema, air trapping, and large airway wall dimensions. This review focuses on CT quantification techniques of COPD disease components and their current status and role in phenotyping COPD.
Collapse
Affiliation(s)
- O M Mets
- Department of Radiology, University Medical Center Utrecht, Huispostnummer E01.132, Postbus 85500, 3508 GA Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
40
|
Cristescu SM, Gietema HA, Blanchet L, Kruitwagen CLJJ, Munnik P, van Klaveren RJ, Lammers JWJ, Buydens L, Harren FJM, Zanen P. Screening for emphysema via exhaled volatile organic compounds. J Breath Res 2011; 5:046009. [PMID: 22071870 DOI: 10.1088/1752-7155/5/4/046009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chronic obstructive pulmonary disease (COPD)/emphysema risk groups are well defined and screening allows for early identification of disease. The capability of exhaled volatile organic compounds (VOCs) to detect emphysema, as found by computed tomography (CT) in current and former heavy smokers participating in a lung cancer screening trial, was investigated. CT scans, pulmonary function tests and breath sample collections were obtained from 204 subjects. Breath samples were analyzed with a proton-transfer reaction mass spectrometer (PTR-MS) to obtain VOC profiles listed as ions at various mass-to-charge ratios (m/z). Using bootstrapped stepwise forward logistic regression, we identified specific breath profiles as a potential tool for the diagnosis of emphysema, of airflow limitation or gas-exchange impairment. A marker for emphysema was found at m/z 87 (tentatively attributed to 2-methylbutanal). The area under the receiver operating characteristic curve (ROC) of this marker to diagnose emphysema was 0.588 (95% CI 0.453-0.662). Mass-to-charge ratios m/z 52 (most likely chloramine) and m/z 135 (alkyl benzene) were linked to obstructive disease and m/z 122 (most probably alkyl homologs) to an impaired diffusion capacity. ROC areas were 0.646 (95% CI 0.562-0.730) and 0.671 (95% CI 0.524-0.710), respectively. In the screening setting, exhaled VOCs measured by PTR-MS constitute weak markers for emphysema, pulmonary obstruction and impaired diffusion capacity.
Collapse
Affiliation(s)
- S M Cristescu
- Life Science Trace Gas Facility, Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, the Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Mets OM, Buckens CFM, Zanen P, Isgum I, van Ginneken B, Prokop M, Gietema HA, Lammers JWJ, Vliegenthart R, Oudkerk M, van Klaveren RJ, de Koning HJ, Mali WPTM, de Jong PA. Identification of chronic obstructive pulmonary disease in lung cancer screening computed tomographic scans. JAMA 2011; 306:1775-81. [PMID: 22028353 DOI: 10.1001/jama.2011.1531] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Smoking is a major risk factor for both cancer and chronic obstructive pulmonary disease (COPD). Computed tomography (CT)-based lung cancer screening may provide an opportunity to detect additional individuals with COPD at an early stage. OBJECTIVE To determine whether low-dose lung cancer screening CT scans can be used to identify participants with COPD. DESIGN, SETTING, AND PATIENTS Single-center prospective cross-sectional study within an ongoing lung cancer screening trial. Prebronchodilator pulmonary function testing with inspiratory and expiratory CT on the same day was obtained from 1140 male participants between July 2007 and September 2008. Computed tomographic emphysema was defined as percentage of voxels less than -950 Hounsfield units (HU), and CT air trapping was defined as the expiratory:inspiratory ratio of mean lung density. Chronic obstructive pulmonary disease was defined as the ratio of forced expiratory volume in the first second to forced vital capacity (FEV(1)/FVC) of less than 70%. Logistic regression was used to develop a diagnostic prediction model for airflow limitation. MAIN OUTCOME MEASURES Diagnostic accuracy of COPD diagnosis using pulmonary function tests as the reference standard. RESULTS Four hundred thirty-seven participants (38%) had COPD according to lung function testing. A diagnostic model with CT emphysema, CT air trapping, body mass index, pack-years, and smoking status corrected for overoptimism (internal validation) yielded an area under the receiver operating characteristic curve of 0.83 (95% CI, 0.81-0.86). Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63% (95% CI, 58%-67%), specificity of 88% (95% CI, 85%-90%), positive predictive value of 76% (95% CI, 72%-81%); and negative predictive value of 79% (95% CI, 76%-82%). The diagnostic model showed an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.86-0.88) for participants with symptoms and 0.78 (95% CI, 0.76-0.80) for those without symptoms. CONCLUSION Among men who are current and former heavy smokers, low-dose inspiratory and expiratory CT scans obtained for lung cancer screening can identify participants with COPD, with a sensitivity of 63% and a specificity of 88%.
Collapse
Affiliation(s)
- Onno M Mets
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbus 85500, 3508GA Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
de Hoop B, De Boo DW, Gietema HA, van Hoorn F, Mearadji B, Schijf L, van Ginneken B, Prokop M, Schaefer-Prokop C. Computer-aided Detection of Lung Cancer on Chest Radiographs: Effect on Observer Performance. Radiology 2010; 257:532-40. [PMID: 20807851 DOI: 10.1148/radiol.10092437] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bartjan de Hoop
- Department of Radiology and Image Sciences Institute, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
de Hoop B, Schaefer-Prokop C, Gietema HA, de Jong PA, van Ginneken B, van Klaveren RJ, Prokop M. Screening for Lung Cancer with Digital Chest Radiography: Sensitivity and Number of Secondary Work-up CT Examinations. Radiology 2010; 255:629-37. [PMID: 20413773 DOI: 10.1148/radiol.09091308] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bartjan de Hoop
- Department of Radiology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | | | | | | | | | | | | |
Collapse
|
44
|
Arzhaeva Y, Prokop M, Murphy K, van Rikxoort EM, de Jong PA, Gietema HA, Viergever MA, van Ginneken B. Automated estimation of progression of interstitial lung disease in CT images. Med Phys 2009; 37:63-73. [DOI: 10.1118/1.3264662] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
45
|
van Klaveren RJ, Oudkerk M, Prokop M, Scholten ET, Nackaerts K, Vernhout R, van Iersel CA, van den Bergh KAM, van 't Westeinde S, van der Aalst C, Thunnissen E, Xu DM, Wang Y, Zhao Y, Gietema HA, de Hoop BJ, Groen HJM, de Bock GH, van Ooijen P, Weenink C, Verschakelen J, Lammers JWJ, Timens W, Willebrand D, Vink A, Mali W, de Koning HJ. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009; 361:2221-9. [PMID: 19955524 DOI: 10.1056/nejmoa0906085] [Citation(s) in RCA: 570] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of multidetector computed tomography (CT) in lung-cancer screening trials involving subjects with an increased risk of lung cancer has highlighted the problem for the clinician of deciding on the best course of action when noncalcified pulmonary nodules are detected by CT. METHODS A total of 7557 participants underwent CT screening in years 1, 2, and 4 of a randomized trial of lung-cancer screening. We used software to evaluate a noncalcified nodule according to its volume or volume-doubling time. Growth was defined as an increase in volume of at least 25% between two scans. The first-round screening test was considered to be negative if the volume of a nodule was less than 50 mm(3), if it was 50 to 500 mm(3) but had not grown by the time of the 3-month follow-up CT, or if, in the case of those that had grown, the volume-doubling time was 400 days or more. RESULTS In the first and second rounds of screening, 2.6% and 1.8% of the participants, respectively, had a positive test result. In round one, the sensitivity of the screen was 94.6% (95% confidence interval [CI], 86.5 to 98.0) and the negative predictive value 99.9% (95% CI, 99.9 to 100.0). In the 7361 subjects with a negative screening result in round one, 20 lung cancers were detected after 2 years of follow-up. CONCLUSIONS Among subjects at high risk for lung cancer who were screened in three rounds of CT scanning and in whom noncalcified pulmonary nodules were evaluated according to volume and volume-doubling time, the chances of finding lung cancer 1 and 2 years after a negative first-round test were 1 in 1000 and 3 in 1000, respectively. (Current Controlled Trials number, ISRCTN63545820.)
Collapse
Affiliation(s)
- Rob J van Klaveren
- Department of Pulmonology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Wang Y, van Klaveren RJ, van der Zaag-Loonen HJ, de Bock GH, Gietema HA, Xu DM, Leusveld ALM, de Koning HJ, Scholten ET, Verschakelen J, Prokop M, Oudkerk M. Effect of Nodule Characteristics on Variability of Semiautomated Volume Measurements in Pulmonary Nodules Detected in a Lung Cancer Screening Program. Radiology 2008; 248:625-31. [PMID: 18641255 DOI: 10.1148/radiol.2482070957] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ying Wang
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Stoel BC, Parr DG, Bakker EM, Putter H, Stolk J, Gietema HA, Schilham AM, van Ginneken B, van Klaveren RJ, Lammers JWJ, Prokop M. Can the extent of low-attenuation areas on CT scans really demonstrate changes in the severity of emphysema? Radiology 2008; 247:293-4; author reply 294. [PMID: 18372475 DOI: 10.1148/radiol.2471071608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
48
|
Gietema HA, Schaefer-Prokop CM, Mali WPTM, Groenewegen G, Prokop M. Pulmonary nodules: Interscan variability of semiautomated volume measurements with multisection CT-- influence of inspiration level, nodule size, and segmentation performance. Radiology 2007; 245:888-94. [PMID: 17923508 DOI: 10.1148/radiol.2452061054] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess the precision of semiautomated volume measurements of pulmonary nodules at low-dose multi-detector row computed tomography (CT) and to investigate the influence of nodule size, segmentation algorithm, and inspiration level. MATERIALS AND METHODS This study had institutional review board approval; written informed consent was obtained from all patients. Between June 2004 and March 2005, 20 patients (15 men, five women; age range, 40-84 years; mean age, 57 years) referred for chest CT for known lung metastases underwent two additional low-dose chest CT examinations without contrast material (collimation, 16 x 0.75 mm). Between these examinations, patients got off and on the table to simulate the conditions for a follow-up examination. Noncalcified solid pulmonary nodules between 15 and 500 mm(3) that did not abut vessel or pleura were measured in both studies by using widely applied commercial semiautomated software. Interscan variability was established with the Bland and Altman approach. The impact of nodule shape (spherical or nonspherical) on measurement variability was assessed by using one-way analysis of variance, while the contributions of mean nodule volume and change in lung volume were investigated with univariate linear regression for completely (group A) and incompletely (group B) segmented nodules. RESULTS Two hundred eighteen eligible nodules (volume range, 16.4-472.7 mm(3); 106 spherical, 112 nonspherical) were evaluated. The 95% confidence interval for difference in measured volumes was -21.2%, 23.8% (mean difference, 1.3%). The precision of nodule segmentation was highly dependent on nodule shape (P < .001) and was weakly related to inspiration level for completely segmented nodules (r = -0.20; P < .047), while mean nodule volume did not show any effect (P = .15 and P = .81 for group A and B nodules, respectively). CONCLUSION Variation of semiautomated volume measurements of pulmonary nodules can be substantial. Segmentation represents the most important factor contributing to measurement variability, while change in inspiration level has only a weak effect for completely segmented nodules.
Collapse
Affiliation(s)
- Hester A Gietema
- Department of Radiology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | | | | | | | | |
Collapse
|
49
|
Gietema HA, Schilham AM, van Ginneken B, van Klaveren RJ, Lammers JWJ, Prokop M. Monitoring of Smoking-induced Emphysema with CT in a Lung Cancer Screening Setting: Detection of Real Increase in Extent of Emphysema. Radiology 2007; 244:890-7. [PMID: 17709835 DOI: 10.1148/radiol.2443061330] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [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: 11/11/2022]
Abstract
PURPOSE To retrospectively establish the minimum increase in emphysema score (ES) required for detection of real increased extent of emphysema with 95% confidence by using multi-detector row computed tomography (CT) in a lung cancer screening setting. MATERIALS AND METHODS The study was a substudy of the NELSON project that was approved by the Dutch Ministry of Health and the ethics committee of each participating hospital, with patient informed consent. For this substudy, original approval and informed consent allowed use of data for future research. Among 1684 men screened with low-dose multi-detector row CT (30 mAs, 16 detector rows, 0.75-mm section thickness) between April 2004 and March 2005, only participants who underwent repeat multi-detector row CT with the same scanner after 3 months because of an indeterminate pulmonary nodule were included. Extent of emphysema was considered to remain stable in this short period. Extent of low-attenuation areas representing emphysema was computed for repeat and baseline scans as percentage of lung volume below three attenuation threshold values (-910 HU, -930 HU, -950 HU). Limits of agreement were determined with Bland-Altman approach; upper limits were used to deduce the minimum increase in ES required for detecting increased extent of emphysema with 95% probability. Factors influencing the limits of agreement were determined. RESULTS In total, 157 men (mean age, 60 years) were included in the study. Limits of agreement for differences in total lung volume between repeat and baseline scans were -13.4% to +12.6% at -910 HU, -4.7% to +4.2% at -930 HU, and -1.3% to +1.1% at -950 HU. Differences in ES showed weak to moderate correlation with variation in level of inspiration (r=0.20-0.49, P<.05). Scanner calibration could be excluded as a factor contributing to variation in ES. CONCLUSION Increase in ES required to detect increased extent of smoking-related emphysema with 95% probability varies between 1.1% of total lung volume at -950 HU and 12.6% at -910 HU for low-dose multi-detector row CT. Clinical trial registration no. ISRCTN63545820.
Collapse
Affiliation(s)
- Hester A Gietema
- Department of Radiology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | | | | | | | | | | |
Collapse
|
50
|
Das M, Ley-Zaporozhan J, Gietema HA, Czech A, Mühlenbruch G, Mahnken AH, Katoh M, Bakai A, Salganicoff M, Diederich S, Prokop M, Kauczor HU, Günther RW, Wildberger JE. Accuracy of automated volumetry of pulmonary nodules across different multislice CT scanners. Eur Radiol 2007; 17:1979-84. [PMID: 17206420 DOI: 10.1007/s00330-006-0562-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 12/04/2006] [Accepted: 12/05/2006] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to compare the accuracy of an automated volumetry software for phantom pulmonary nodules across various 16-slice multislice spiral CT (MSCT) scanners from different vendors. A lung phantom containing five different nodule categories (intraparenchymal, around a vessel, vessel attached, pleural, and attached to the pleura), with each category comprised of 7-9 nodules (total, n = 40) of varying sizes (diameter 3-10 mm; volume 6.62 mm(3)-525 mm(3)), was scanned with four different 16-slice MSCT scanners (Siemens, GE, Philips, Toshiba). Routine and low-dose chest protocols with thin and thick collimations were applied. The data from all scanners were used for further analysis using a dedicated prototype volumetry software. Absolute percentage volume errors (APE) were calculated and compared. The mean APE for all nodules was 8.4% (+/-7.7%) for data acquired with the 16-slice Siemens scanner, 14.3% (+/-11.1%) for the GE scanner, 9.7% (+/-9.6%) for the Philips scanner and 7.5% (+/-7.2%) for the Toshiba scanner, respectively. The lowest APEs were found within the diameter size range of 5-10 mm and volumes >66 mm(3). Nodule volumetry is accurate with a reasonable volume error in data from different scanner vendors. This may have an important impact for intraindividual follow-up studies.
Collapse
Affiliation(s)
- Marco Das
- Department of Diagnostic Radiology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|