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Vereecke E, Diekhoff T, Eshed I, Herregods N, Morbée L, Jaremko JL, Jans L. ESR Essentials: Imaging of sacroiliitis-practice recommendations by ESSR. Eur Radiol 2024:10.1007/s00330-024-10653-3. [PMID: 38459347 DOI: 10.1007/s00330-024-10653-3] [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: 12/06/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage. Imaging has a prominent place in the diagnostic process and several new imaging techniques have been examined for this purpose. We present a summary of updated evidence-based practice recommendations for imaging of sacroiliitis. MRI remains the imaging modality of choice for patients with suspected sacroiliitis, using at least four sequences: coronal oblique T1-weighted and fluid-sensitive sequences, a perpendicular axial oblique sequence, and a sequence for optimal evaluation of the bone-cartilage interface. Both active inflammatory and structural lesions should be described in the report, indicating location and extent. Radiography and CT, especially low-dose CT, are reasonable alternatives when MRI is unavailable, as patients are often young. This is particularly true to evaluate structural lesions, at which CT excels. Dual-energy CT with virtual non-calcium images can be used to depict bone marrow edema. Knowledge of normal imaging features in children (e.g., flaring, blurring, or irregular appearance of the articular surface) is essential for interpreting sacroiliac joint MRI in children because these normal processes can simulate disease. CLINICAL RELEVANCE STATEMENT: Sacroiliitis is a potentially debilitating disease if not diagnosed and treated promptly, before structural damage to the sacroiliac joints occurs. Imaging has a prominent place in the diagnostic process. We present a summary of practice recommendations for imaging of sacroiliitis, including several new imaging techniques. KEY POINTS: • MRI is the modality of choice for suspected inflammatory sacroiliitis, including a joint-line-specific sequence for optimal evaluation of the bone-cartilage interface to improve detection of erosions. • Radiography and CT (especially low-dose CT) are reasonable alternatives when MRI is unavailable. • Knowledge of normal imaging features in children is mandatory for interpretation of MRI of pediatric sacroiliac joints.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Vereecke E, Jans L, Herregods N, Chen M, Jaremko JL, Laloo F, Carron P, Varkas G, de Hooge M, Van den Bosch F, Elewaut D, Morbée L. Association of anatomical variants of the sacroiliac joint with bone marrow edema in patients with axial spondyloarthritis. Skeletal Radiol 2024; 53:507-514. [PMID: 37682337 DOI: 10.1007/s00256-023-04435-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To determine the prevalence of sacroiliac joint variants in patients with axial spondyloarthritis (axSpA) using MRI-based synthetic CT images and to evaluate their relationships with the presence of bone marrow edema, as this may potentially complicate diagnosing active sacroiliitis on MRI in patients with suspected axSpA. METHODS 172 patients were retrospectively included. All patients underwent MRI because of clinical suspicion of sacroiliitis. The diagnosis of axSpA was made by a tertiary hospital rheumatologist. Two readers independently determined the presence of bone marrow edema and the presence of one or more of the nine known sacroiliac joint (SIJ) variants. RESULTS SIJ variants were common in axSpA patients (82.9%) and the non-SpA group (85.4%); there were no significant differences in prevalence. Bone marrow edema was frequently found in axSpA (86.8%) and non-SpA patients (34%). AxSpA patients with SIJ variants (except for accessory joint) demonstrated 4 to 10 times higher odds for bone marrow edema, however not statistically significant. The more variants were present in this group, the higher the chance of bone marrow edema. However, some multicollinearity cannot be excluded, since bone marrow edema is very frequent in the axSpA group by definition. CONCLUSION SIJ variants are common in axSpA and non-SpA patients. SIJ variants were associated with higher prevalence of bone marrow edema in axSpA patients, potentially due to altered biomechanics, except for accessory joint which may act as a stabilizer.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, Canada
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Philippe Carron
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Gaëlle Varkas
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Rheumatology, Jan Palfijn Hospital, Ghent, Belgium
| | - Manouk de Hooge
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Molecular Immunology and Inflammation Unit, VIB-UGent Center for Inflammation Research, Zwijnaarde, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Janssens E, Huygens S, Moors I, Delie A, Kerre T, Vande Weygaerde Y, Van Braeckel E, Boelens J, Morbée L, Schauwvlieghe A. Baseline chest computed tomography for diagnosis of invasive aspergillosis in patients with acute myeloid leukaemia treated with intensive chemotherapy: A retrospective single-centre cohort study. Mycoses 2024; 67:e13715. [PMID: 38477367 DOI: 10.1111/myc.13715] [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: 08/01/2023] [Revised: 12/11/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Invasive pulmonary aspergillosis (IPA) is a relatively common infection in patients with acute myeloid leukaemia (AML), and is associated with high mortality rates. Optimising early detection is key to reduce the burden of IPA in this population. In this retrospective cohort study, we evaluated the added value of baseline chest CT before start of classical induction chemotherapy. METHODS Adult patients receiving first-line intensive chemotherapy for AML were included if a baseline chest CT scan was available (±7 days). Data were collected from the electronic health record. IPA was classified using the EORTC/MSGERC 2020 consensus definitions. RESULTS Between 2015 and 2019, 99 patients were included. During first-line treatment, 29/99 (30%) patients developed a probable IPA. Baseline chest CT was abnormal in 61/99 (62%) and 14/61 (23%) patients had typical radiological signs for IPA. An abnormal scan showed a trend towards higher risk for IPA (hazard ratio (HR): 2.12; 95% CI 0.95-4.84). Ground glass opacities were a strong predictor for developing IPA (HR 3.35: 95% CI 1.61-7.00). No probable/proven IPA was diagnosed at baseline; however, a bronchoalveolar lavage (BAL) at baseline was only performed in seven patients. Twelve-week mortality was higher in patients with IPA (7/26, 27% vs. 5/59, 8%; p = .024). CONCLUSION Baseline chest CT scan could be an asset in the early diagnosis of IPA and contribute to risk estimation for IPA. In patients with an abnormal baseline CT, performing a BAL should be considered more frequently, and not only in patients with radiological findings typical for IPA.
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Affiliation(s)
- Emilie Janssens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Sammy Huygens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ine Moors
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Anke Delie
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Tessa Kerre
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | | | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Respiratory Infection and Defense lab (RIDL), Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Jerina Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Schauwvlieghe
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
- Department of Hematology, AZ Sint-Jan, Bruges, Belgium
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Schiettecatte E, Vereecke E, Jaremko JL, Morbée L, Vande Walle C, Jans L, Herregods N. MRI-based synthetic CT for assessment of the bony elements of the sacroiliac joints in children. Insights Imaging 2024; 15:53. [PMID: 38369564 PMCID: PMC10874918 DOI: 10.1186/s13244-023-01603-6] [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: 05/22/2023] [Accepted: 12/06/2023] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVES The purpose of this study is to assess the equivalency of MRI-based synthetic CT (sCT) to conventional CT for sacroiliac joint bony morphology assessment in children. METHODS A prospective study was performed. Children who had (PET-)CT-scan underwent additional MRI. sCT-CT image quality was analyzed by two readers subjectively overall, semi-quantitatively in terms of cortical delineation, joint facet defects, growth plate fusion, ossified nuclei, lumbosacral transitional anomaly, and bony bridges, and quantitatively for disc space height, spinal canal width, and sacral vertebrae width and height. Cohen's kappa and equivalence analyses with Bland-Altman plots were calculated for categorical and continuous measures respectively. RESULTS Ten patients were included (6 boys; aged 9-16 years; mean age 14 years). Overall sCT image quality was rated good. Semi-quantitative assessment of cortical delineation of sacroiliac joints, bony bridges, and joint facet defects on the right iliac and sacral sides showed perfect agreement. Correlation was good to excellent (kappa 0.615-1) for the presence of lumbosacral transitional anomaly, fusion of sacral growth plates, joint facet defect, and presence of ossified nuclei. sCT-CT measurements were statistically equivalent and within the equivalence margins (-1-1 mm) for intervertebral disc space height and spinal canal width. Intra- and inter-reader reliability was excellent for quantitative assessment (0.806 < ICC < 0.998). For categorical scoring, kappa ranged from substantial to excellent (0.615-1). CONCLUSION sCT appears to be visually equivalent to CT for the assessment of pediatric sacroiliac joints. sCT may aid in visualizing sacroiliac joints compared to conventional MRI, with the benefit that no ionizing radiation is used, especially important in children. CRITICAL RELEVANCE STATEMENT MRI-based synthetic CT, a new technique that generates CT-like images without ionizing radiation, appears to be visually equivalent to CT for assessment of normal pediatric sacroiliac joints and can potentially assess structural damage as it clearly depicts bony cortex. KEY POINTS • MRI-based sCT is a new image technique that can generate CT-like images. • We found that sCT performs similarly to CT in displaying bony structures of pediatric sacroiliac joints. • sCT has already been clinically validated in the sacroiliac joints in adults. • sCT can potentially assess structural damage from erosions or ankylosis as it clearly depicts bony cortex.
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Affiliation(s)
- Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Caroline Vande Walle
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Cools M, Grijp C, Neirinck J, Tavernier SJ, Schelstraete P, Van De Velde J, Morbée L, De Baere E, Bonroy C, van Bever Y, Bruggenwirth H, Vermont C, Hannema SE, De Rijke Y, Abdulhadi-Atwan M, Zangen D, Verdin H, Haerynck F. Spleen function is reduced in individuals with NR5A1 variants with or without a difference of sex development: a cross-sectional study. Eur J Endocrinol 2024; 190:34-43. [PMID: 38128121 DOI: 10.1093/ejendo/lvad174] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE NR5A1 is a key regulator of sex differentiation and has been implicated in spleen development through transcription activation of TLX1. Concerns exist about hypo- or asplenism in individuals who have a difference of sex development (DSD) due to an NR5A1 disease-causing variant. We aimed to assess spleen anatomy and function in a clinical cohort of such individuals and in their asymptomatic family member carriers. DESIGN Cross-sectional assessment in 22 patients with a DSD or primary ovarian insufficiency and 5 asymptomatic carriers from 18 families, harboring 14 different NR5A1 variants. METHODS Spleen anatomy was assessed by ultrasound, spleen function by peripheral blood cell count, white blood cell differentiation, percentage of nonswitched memory B cells, specific pneumococcal antibody response, % pitted red blood cells, and Howell-Jolly bodies. RESULTS Patients and asymptomatic heterozygous individuals had significantly decreased nonswitched memory B cells compared to healthy controls, but higher than asplenic patients. Thrombocytosis and spleen hypoplasia were present in 50% of heterozygous individuals. Four out of 5 individuals homozygous for the previously described p.(Arg103Gln) variant had asplenia. CONCLUSIONS Individuals harboring a heterozygous NR5A1 variant that may cause DSD have a considerable risk for functional hyposplenism, irrespective of their gonadal phenotype. Splenic function should be assessed in these individuals, and if affected or unknown, prophylaxis is recommended to prevent invasive encapsulated bacterial infections. The splenic phenotype associated with NR5A1 variants is more severe in homozygous individuals and is, at least for the p.(Arg103Gln) variant, associated with asplenism.
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Affiliation(s)
- Martine Cools
- Department of Internal Medicine and Pediatrics, Pediatric Endocrinology Service, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
| | - Celien Grijp
- Department of Internal Medicine and Pediatrics, Pediatric Endocrinology Service, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jana Neirinck
- Department of Diagnostic Science, Ghent University, Department of Laboratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Simon J Tavernier
- Department of Internal Medicine and Pediatrics, PID Research Lab, Ghent University, 9000 Ghent, Belgium
- Laboratory of Molecular Signal Transduction in Inflammation, Center for Inflammation Research, VIB, 9000 Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
| | - Petra Schelstraete
- Department of Internal Medicine and Pediatrics, Pediatric Pulmonology and Infectious Diseases, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
| | - Julie Van De Velde
- Department of Internal Medicine and Pediatrics, Pediatric Endocrinology Service, Ghent University, Ghent University Hospital, 9000 Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Carolien Bonroy
- Department of Diagnostic Science, Ghent University, Department of Laboratory Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Yolande van Bever
- Department of Clinical Genetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Hennie Bruggenwirth
- Department of Clinical Genetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Clementien Vermont
- Department of Pediatric Infectious Diseases and Immunology, Erasmus Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Erasmus Medical Center-Sophia Children's Hospital, 3015 GD Rotterdam, The Netherlands
- Department of Paediatric Endocrinology, Gastroenterology Endocrinology Metabolism, Reproduction and Development, Amsterdam UMC location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Yolanda De Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center 3015 GD Rotterdam, The Netherlands
| | - Maha Abdulhadi-Atwan
- Department of Pediatrics, Pediatric Endocrinology Service, Palestine Red Crescent Society Hospital, PO Box 421, Hebron, Palestine
| | - David Zangen
- Division of Pediatric Endocrinology, Faculty of Medicine, Hadassah University Hospital, Hebrew University of Jerusalem, 91120 Jerusalem, Israel
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University Hospital, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Filomeen Haerynck
- Department of Internal Medicine and Pediatrics, PID Research Lab, Ghent University, 9000 Ghent, Belgium
- Department of Pediatric Pulmonology and Immunology, Centre for Primary Immune Deficiency, Jeffrey Modell Diagnostic and Research Centre for PID, Ghent University Hospital, 9000 Ghent, Belgium
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Van Den Berghe T, Babin D, Chen M, Callens M, Brack D, Maes H, Lievens J, Lammens M, Van Sumere M, Morbée L, Hautekeete S, Schatteman S, Jacobs T, Thooft WJ, Herregods N, Huysse W, Jaremko JL, Lambert R, Maksymowych W, Laloo F, Baraliakos X, De Craemer AS, Carron P, Van den Bosch F, Elewaut D, Jans L. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023; 33:8310-8323. [PMID: 37219619 DOI: 10.1007/s00330-023-09704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of a deep learning network for detection of structural lesions of sacroiliitis on multicentre pelvic CT scans. METHODS Pelvic CT scans of 145 patients (81 female, 121 Ghent University/24 Alberta University, 18-87 years old, mean 40 ± 13 years, 2005-2021) with a clinical suspicion of sacroiliitis were retrospectively included. After manual sacroiliac joint (SIJ) segmentation and structural lesion annotation, a U-Net for SIJ segmentation and two separate convolutional neural networks (CNN) for erosion and ankylosis detection were trained. In-training validation and tenfold validation testing (U-Net-n = 10 × 58; CNN-n = 10 × 29) on a test dataset were performed to assess performance on a slice-by-slice and patient level (dice coefficient/accuracy/sensitivity/specificity/positive and negative predictive value/ROC AUC). Patient-level optimisation was applied to increase the performance regarding predefined statistical metrics. Gradient-weighted class activation mapping (Grad-CAM++) heatmap explainability analysis highlighted image parts with statistically important regions for algorithmic decisions. RESULTS Regarding SIJ segmentation, a dice coefficient of 0.75 was obtained in the test dataset. For slice-by-slice structural lesion detection, a sensitivity/specificity/ROC AUC of 95%/89%/0.92 and 93%/91%/0.91 were obtained in the test dataset for erosion and ankylosis detection, respectively. For patient-level lesion detection after pipeline optimisation for predefined statistical metrics, a sensitivity/specificity of 95%/85% and 82%/97% were obtained for erosion and ankylosis detection, respectively. Grad-CAM++ explainability analysis highlighted cortical edges as focus for pipeline decisions. CONCLUSIONS An optimised deep learning pipeline, including an explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical performance on a slice-by-slice and patient level. CLINICAL RELEVANCE STATEMENT An optimised deep learning pipeline, including a robust explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical metrics on a slice-by-slice and patient level. KEY POINTS • Structural lesions of sacroiliitis can be detected automatically in pelvic CT scans. • Both automatic segmentation and disease detection yield excellent statistical outcome metrics. • The algorithm takes decisions based on cortical edges, rendering an explainable solution.
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Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Danilo Babin
- Department of Telecommunication and Information Processing - Image Processing and Interpretation (TELIN-IPI), Faculty of Engineering and Architecture, Ghent University - IMEC, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Martijn Callens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Denim Brack
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helena Maes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan Lievens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marie Lammens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maxime Van Sumere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Hautekeete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Schatteman
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Jacobs
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Willem-Jan Thooft
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Robert Lambert
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Walter Maksymowych
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstraße 45, 44649, Herne, Germany
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Herregods N, Anisau A, Schiettecatte E, Vereecke E, Morbée L, Laloo F, Jaremko JL, Jans L. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 2023; 53:1576-1586. [PMID: 36856758 DOI: 10.1007/s00247-023-05602-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023]
Abstract
MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.
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Affiliation(s)
- Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Aliaksandr Anisau
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, 8440-112 Street, EdmontonAlberta, T6G 2B7, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Vereecke E, Morbée L, Laloo F, Chen M, Jaremko JL, Herregods N, Jans L. Anatomical variation of the sacroiliac joints: an MRI study with synthetic CT images. Insights Imaging 2023; 14:30. [PMID: 36750489 PMCID: PMC9905396 DOI: 10.1186/s13244-023-01373-1] [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: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Synthetic computed tomography (sCT) images are magnetic resonance imaging (MRI)-based images, generated using artificial intelligence. This study aimed to determine the prevalence of anatomical variants of sacroiliac joints (SIJ) on sCT images and the correlation with age, sex and body weight. METHODS MRI of the SIJ including sCT images of 215 patients clinically suspected for sacroiliitis were retrospectively analyzed. The presence of anatomical variants of the SIJ was assessed. Age, sex and body mass index at the time of the MRI were recorded. RESULTS SIJ variants were found in 82.8% (356/430) of the evaluated joints. The most frequent variants were iliosacral complex (27.7%), bipartite iliac bony plate (27.2%) and crescent iliac bony plate (27%). One new variant was identified, consisting of an accessory facet of the SIJ on the superior side. Overall, SIJ variants were slightly more frequent in women (85.8% vs. 77.8%), but iliosacral complex was significantly more frequent in men. Isolated synostosis was more prevalent with advancing age, in contrast to semicircular defect and unfused ossification center. The occurrence of iliosacral complex was associated with higher BMI, while crescent iliac bony plate occurred more in patients with lower BMI. CONCLUSION Over 80% of patients in this study, who were all suspected of sacroiliitis, had at least one SIJ variant. These variants may actually represent subtypes of the normal SIJ. sCT enables detection of very small or subtle findings including SIJ variants.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lieve Morbée
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- grid.440601.70000 0004 1798 0578Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036 China
| | - Jacob L. Jaremko
- grid.241114.30000 0004 0459 7625Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB T6G 2B7 Canada
| | - Nele Herregods
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart Jans
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Morbée L, Vereecke E, Laloo F, Chen M, Herregods N, Jans LBO. Common incidental findings on sacroiliac joint MRI: Added value of MRI-based synthetic CT. Eur J Radiol 2023; 158:110651. [PMID: 36535080 DOI: 10.1016/j.ejrad.2022.110651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/08/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the prevalence of incidental findings on sacroiliac joint MRI and to determine the added value of MRI-based synthetic CT in the detection and evaluation of these incidental findings. METHOD In this retrospective study 210 patients clinically suspected of spondyloarthritis who underwent MRI of the sacroiliac joint with synthetic CT sequence were included. The images were reviewed by two radiologists in consensus for the prevalence of sacroiliitis, incidental findings, and the ability of synthetic CT and the conventional MRI to detect and diagnose these findings. RESULTS In 44.7% of patients sacroiliitis was present. In 89.0% of patients MRI showed at least one incidental finding other than sacroiliitis. Degeneration of the sacroiliac joint was the most prevalent finding (140 patients, 66.6%). The most frequent incidental findings outside the sacroiliac joint were facet joint degeneration (29.0%), disc degeneration (25.2%), enostosis (19.5%) and lumbosacral transitional vertebrae (14.3%). A total of 788 lesions was recorded and synthetic CT was found to be problem solving or necessary for diagnosis in 543 (68.9%) of these lesions. 42.1% of lesions were not visible on conventional MRI (T1 TSE and STIR), most often degenerative osteophytes in the sacroiliac joint or lower lumbar spine. CONCLUSION Incidental findings are seen more frequently on sacroiliac joint MRI than sacroiliitis, which is relevant as some will have clinical significance or require treatment. Nearly half of these incidental lesions were only visible on synthetic CT, which additionally has been shown to be problem solving for diagnosis in many other cases.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
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Morbée L, Jans LBO, Herregods N. Novel imaging techniques for sacroiliac joint assessment. Curr Opin Rheumatol 2022; 34:187-194. [PMID: 35699310 DOI: 10.1097/bor.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls. RECENT FINDINGS Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating 'CT-like' images and better depict osseous structural lesions than routine MRI sequences. SUMMARY New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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De Clercq J, Malfait T, Malfait S, Boelens J, Coorevits L, Padalko E, Vandendriessche S, Verhasselt B, Morbée L, Bauters F, Hertegonne K, Stevens D, Vande Weygaerde Y, Vermaelen K, Van Biesen W, Vanommeslaeghe F, Verbeke F, Piers R, Van Den Noortgate N, Desmet T, Vermassen F, Vandekerckhove L, Van Braeckel E. Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol. Acta Clin Belg 2022; 77:368-376. [PMID: 33586631 PMCID: PMC7885724 DOI: 10.1080/17843286.2021.1883362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 01/08/2023]
Abstract
Introduction: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. Results: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. Conclusion: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.
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Affiliation(s)
- J. De Clercq
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - T. Malfait
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - S. Malfait
- Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - J. Boelens
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - L. Coorevits
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - E. Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - S. Vandendriessche
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - B. Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - L. Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - F. Bauters
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K. Hertegonne
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - D. Stevens
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Y. Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K. Vermaelen
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - W. Van Biesen
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | | | - F. Verbeke
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - R. Piers
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - N. Van Den Noortgate
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - T. Desmet
- Emergency Department, Ghent University Hospital, Ghent, Belgium
| | - F. Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - L. Vandekerckhove
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - E. Van Braeckel
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
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Morbée L, Chen M, Van Den Berghe T, Schiettecatte E, Gosselin R, Herregods N, Jans LBO. MRI-based synthetic CT of the hip: can it be an alternative to conventional CT in the evaluation of osseous morphology? Eur Radiol 2022; 32:3112-3120. [DOI: 10.1007/s00330-021-08442-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
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Morbée L, Chen M, Herregods N, Pullens P, Jans LBO. MRI-based synthetic CT of the lumbar spine: Geometric measurements for surgery planning in comparison with CT. Eur J Radiol 2021; 144:109999. [PMID: 34700094 DOI: 10.1016/j.ejrad.2021.109999] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 05/12/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE MRI is the imaging modality of choice for soft tissue-related spine disease. However, CT is superior to MRI in providing clear visualization of bony morphology. The purpose of this study is to test equivalency of MRI-based synthetic CT to conventional CT in quantitatively assessing bony morphology of the lumbar spine. METHOD A prospective study with an equivalency design was performed. Adult patients who had undergone MRI and CT of the lumbar spine were included. Synthetic CT images were generated from MRI using a deep learning-based image synthesis method. Two readers independently measured pedicle width, spinal canal width, neuroforamen length, anterior and posterior vertebral body height, superior and inferior vertebral body length, superior and inferior vertebral body width, maximal disc height, lumbar curvature and spinous process length on synthetic CT and CT. The agreement among CT and synthetic CT was evaluated using equivalency statistical testing. RESULTS Thirty participants were included (14 men and 16 women, range 20-60 years). The measurements performed on synthetic CT of pedicle width, spinal canal width, vertebral body height, vertebral body width, vertebral body length and spinous process length were statistically equivalent to CT measurements at the considered margins. Excellent inter- and intra-reader reliability was found for both synthetic CT and CT. CONCLUSIONS Equivalency of MRI-based synthetic CT to CT was demonstrated on geometrical measurements in the lumbar spine. In combination with the soft tissue information of the conventional MRI, this provides new possibilities in diagnosis and surgical planning without ionizing radiation.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Pim Pullens
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Duprez F, Madani I, Morbée L, Bonte K, Deron P, Domján V, Boterberg T, De Gersem W, De Neve W. IMRT for sinonasal tumors minimizes severe late ocular toxicity and preserves disease control and survival. Int J Radiat Oncol Biol Phys 2011; 83:252-9. [PMID: 22027259 DOI: 10.1016/j.ijrobp.2011.06.1977] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/15/2011] [Accepted: 06/17/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To report late ocular (primary endpoint) and other toxicity, disease control, and survival (secondary endpoints) after intensity-modulated radiotherapy (IMRT) for sinonasal tumors. METHODS AND MATERIALS Between 1998 and 2009, 130 patients with nonmetastatic sinonasal tumors were treated with IMRT at Ghent University Hospital. Prescription doses were 70 Gy (n = 117) and 60-66 Gy (n = 13) at 2 Gy per fraction over 6-7 weeks. Most patients had adenocarcinoma (n = 82) and squamous cell carcinoma (n = 23). One hundred and one (101) patients were treated postoperatively. Of 17 patients with recurrent tumors, 9 were reirradiated. T-stages were T1-2 (n = 39), T3 (n = 21), T4a (n = 38), and T4b (n = 22). Esthesioneuroblastoma was staged as Kadish A, B, and C in 1, 3, and 6 cases, respectively. RESULTS Median follow-up was 52, range 15-121 months. There was no radiation-induced blindness in 86 patients available for late toxicity assessment (≥6 month follow-up). We observed late Grade 3 tearing in 10 patients, which reduced to Grade 1-2 in 5 patients and Grade 3 visual impairment because of radiation-induced ipsilateral retinopathy and neovascular glaucoma in 1 patient. There was no severe dry eye syndrome. The worst grade of late ocular toxicity was Grade 3 (n = 11), Grade 2 (n = 31), Grade 1 (n = 33), and Grade 0 (n = 11). Brain necrosis and osteoradionecrosis occurred in 6 and 1 patients, respectively. Actuarial 5-year local control and overall survival were 59% and 52%, respectively. On multivariate analysis local control was negatively affected by cribriform plate and brain invasion (p = 0.044 and 0.029, respectively) and absence of surgery (p = 0.009); overall survival was negatively affected by cribriform plate and orbit invasion (p = 0.04 and <0.001, respectively) and absence of surgery (p = 0.001). CONCLUSIONS IMRT for sinonasal tumors allowed delivering high doses to targets at minimized ocular toxicity, while maintaining disease control and survival. Avoidance of severe dry eye syndrome and radiation-induced blindness suggests IMRT as a standard treatment for sinonasal tumors.
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Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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