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Khogiani BA, Brix L, Ejlersen J. Hæmatogen spredning af Escherichia coli til sternum. Ugeskr Laeger 2024; 186:V72012. [PMID: 38445331 DOI: 10.61409/v72012] [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] [Indexed: 03/07/2024]
Affiliation(s)
| | - Lau Brix
- Røntgen og Scanning, Regionshospitalet Silkeborg
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Rasmussen LD, Albertsen LEB, Nissen L, Ejlersen JA, Isaksen C, Murphy T, Søndergaard HM, Kirk J, Brix L, Gormsen LC, Petersen SE, Bøttcher M, Winther S. Diagnostic performance of clinical likelihood models of obstructive coronary artery disease to predict myocardial perfusion defects. Eur Heart J Cardiovasc Imaging 2023; 25:39-47. [PMID: 37282714 DOI: 10.1093/ehjci/jead135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/15/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Clinical likelihood (CL) models are designed based on a reference of coronary stenosis in patients with suspected obstructive coronary artery disease. However, a reference standard for myocardial perfusion defects (MPDs) could be more appropriate. We aimed to investigate the ability of the 2019 European Society of Cardiology pre-test probability (ESC-PTP), the risk-factor-weighted (RF-CL) model, and coronary artery calcium score-weighted (CACS-CL) model to diagnose MPDs. METHODS AND RESULTS Symptomatic stable de novo chest pain patients (n = 3374) underwent coronary computed tomography angiography and subsequent myocardial perfusion imaging by single-photon emission computed tomography, positron emission tomography, or cardiac magnetic resonance. For all modalities, MPD was defined as coronary computed tomography angiography with suspected stenosis and stress-perfusion abnormality in ≥2 segments. The ESC-PTP was calculated based on age, sex, and symptom typicality, and the RF-CL and CACS-CL additionally included a number of risk factors and CACS. In total, 219/3374 (6.5%) patients had an MPD. Both the RF-CL and the CACS-CL classified substantially more patients to low CL (<5%) of obstructive coronary artery disease compared with the ESC-PTP (32.5 and 54.1 vs. 12.0%, P < 0.001) with preserved low prevalences of MPD (<2% for all models). Compared with the ESC-PTP [area under the receiver-operating characteristic curve (AUC) 0.74 (0.71-0.78)], the discrimination of having an MPD was higher for the CACS-CL model [AUC 0.88 (0.86-0.91), P < 0.001], while it was similar for the RF-CL model [AUC 0.73 (0.70-0.76), P = 0.32]. CONCLUSION Compared with basic CL models, the RF-CL and CACS-CL models improve down classification of patients to a very low-risk group with a low prevalence of MPD.
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Affiliation(s)
- Laust Dupont Rasmussen
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, Herning DK-7400, Denmark
| | | | - Louise Nissen
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, Herning DK-7400, Denmark
| | | | - Christin Isaksen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Theodore Murphy
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | | | - Jane Kirk
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Lau Brix
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Comparative Medicine Lab, Aarhus University, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London, UK
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, Herning DK-7400, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Hospitalsparken 15, Herning DK-7400, Denmark
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Krogh TP, Isaksen C, Rojo-Manaute JM, Damkier HH, Jensen P, Fredberg U, Brix L. Implementation of ultrasound-guided carpal tunnel release. Dan Med J 2023; 70:A11220689. [PMID: 37622637] [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] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Ultra-minimally invasive ultrasound-guided carpal tunnel release is a surgical procedure for treatment of carpal tunnel syndrome that is associated with less surgery-related morbidity and faster recovery than open surgery. The objectives of this study were to describe how the surgical technique may be acquired and to report the results obtained after implementation in a clinical setting. METHODS The study consisted of two parts: 1) description of the surgical skills needed to perform the procedure, and 2) evaluation of the procedure in the first ten consecutively operated patients after 12-month follow-up using questionnaires and magnetic resonance imaging (MRI). RESULTS The procedure was performed on 29 cadaveric arms and assessed regarding surgical release success and signs of iatrogenic damage. Subsequently, the procedure was performed on ten patients with carpal tunnel syndrome. The results of the six-item Carpal Tunnel Symptoms Scale (1-5) improved from 3.3 ± 0.9 (mean ± standard deviation) preoperatively to 1.2 ± 0.3, p = 0.002, after 12 months. Quick Disabilities of the Arm, Shoulder and Hand (DASH) (0-100) results improved from 33.4 ± 14.8 to 2.3 ± 4.0, p = 0.002. There were no infections or iatrogenic damage to nerves or blood vessels. CONCLUSIONS This study presents a way to safely acquire the skills needed to perform the procedure and implement it in an out-patient setting. The results were comparable to previous findings regarding both effectiveness and safety. MRI documented the surgical gap in the transverse carpal ligament, release length, cross-sectional area changes in the carpal tunnel and median nerve, and reactive changes in the carpal tunnel. FUNDING None. TRIAL REGISTRATION Not relevant.
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Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Frederikshavn
| | - Christin Isaksen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital
| | | | | | - Pia Jensen
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Frederikshavn
- Research Unit of Rheumatology, Department of Clinical Research, Odense University Hospital
- Institute of Sports Medicine Copenhagen, Copenhagen University Hospital - Bispebjerg Hospital
| | - Lau Brix
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital
- Department of Procurement and Biomedical Engineering, Region Midtjylland
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Denmark
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Hyldgaard N, Bolander Malvang L, Brix L. Five-year evaluation of a low-cost quality assurance protocol for clinical ultrasound transducers. Ultrasound 2023; 31:71-78. [PMID: 36794120 PMCID: PMC9923147 DOI: 10.1177/1742271x221091721] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
Objective To implement, execute and evaluate a quality assurance test protocol for clinical ultrasound transducers that is software-based, user-independent, inexpensive, easily repeatable, and does not require tissue phantoms. Methods The test protocol is based on in-air reverberation images. The software test tool generates uniformity- and reverberation profiles to monitor system sensitivities and signal uniformities that provide a sensitive analysis of transducer status. Whenever a transducer was suspected to be damaged validating tests were conducted using the Sonora FirstCall test system. A total of 21 transducers from five ultrasound scanner systems were included in the study. Tests were performed every other month for a total of 5 years. Results Each transducer was tested on average 11.7 times. Testing a transducer required a total of 2.75 hours annually. The ultrasound quality assurance test protocol detected an average annual fail rate of 10.7%. The test protocol provides a reliable approach for monitoring transducer lens status of clinically used ultrasound transducers. Conclusion The ultrasound quality assurance test protocol may potentially find deviations in diagnostic quality before being noticed by the clinicians. Thus, the ultrasound quality assurance test protocol holds the ability to reduce the risk of undiscovered image quality degradation hereby minimizing the danger of diagnostic errors.
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Affiliation(s)
- Niels Hyldgaard
- Department of Radiology, Diagnostic
Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg
Regional Hospital, Silkeborg, Denmark
| | - Lise Bolander Malvang
- Department of Radiology, Diagnostic
Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg
Regional Hospital, Silkeborg, Denmark
| | - Lau Brix
- Department of Procurement and
Biomedical Engineering, Region Midt, Aarhus N, Denmark
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Rasmussen LD, Winther S, Eftekhari A, Karim SR, Westra J, Isaksen C, Brix L, Ejlersen JA, Murphy T, Milidonis X, Nyegaard M, Benovoy M, Johansen JK, Søndergaard HM, Hammid O, Mortensen J, Knudsen LL, Gormsen LC, Christiansen EH, Chiribiri A, Petersen SE, Böttcher M. Second-Line Myocardial Perfusion Imaging to Detect Obstructive Stenosis: Head-to-Head Comparison of CMR and PET. JACC Cardiovasc Imaging 2023; 16:642-655. [PMID: 36881421 DOI: 10.1016/j.jcmg.2022.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 06/30/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Guidelines recommend verification of myocardial ischemia by selective second-line myocardial perfusion imaging (MPI) following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Head-to-head data on the diagnostic performance of different MPI modalities in this setting are sparse. OBJECTIVES The authors sought to compare, head-to-head, the diagnostic performance of selective MPI by 3.0-T cardiac magnetic resonance (CMR) and 82rubidium positron emission tomography (RbPET) in patients with suspected obstructive stenosis at coronary CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference. METHODS Consecutive patients (n = 1,732, mean age: 59.1 ± 9.5, 57.2% men) referred for coronary CTA with symptoms suggestive of obstructive CAD were included. Patients with suspected stenosis were referred for both CMR and RbPET and subsequently ICA. Obstructive CAD was defined as FFR ≤0.80 or >90% diameter stenosis by visual assessment. RESULTS In total, 445 patients had suspected stenosis on coronary CTA. Of these, 372 patients completed both CMR, RbPET and subsequent ICA with FFR. Hemodynamically obstructive CAD was identified in 164 of 372 (44.1%) patients. Sensitivities for CMR and RbPET were 59% (95% CI: 51%-67%) and 64% (95% CI: 56%-71%); P = 0.21, respectively, and specificities 84% (95% CI: 78%-89%) and 89% (95% CI: 84%-93%]); P = 0.08, respectively. Overall accuracy was higher for RbPET compared with CMR (73% vs 78%; P = 0.03). CONCLUSIONS In patients with suspected obstructive stenosis at coronary CTA, CMR, and RbPET show similar and moderate sensitivities but high specificities compared with ICA with FFR. This patient group represents a diagnostic challenge with frequent mismatch between advanced MPI tests and invasive measurements. (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease 2 [Dan-NICAD 2]; NCT03481712).
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Affiliation(s)
- Laust Dupont Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christin Isaksen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways Silkeborg Regional Hospital, Denmark
| | - Lau Brix
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways Silkeborg Regional Hospital, Denmark; Department of Procurement and Biomedical Engineering, Region Midt, Aarhus C, Denmark
| | | | - Theodore Murphy
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom
| | - Xenios Milidonis
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | | | - Osama Hammid
- Department of Cardiology, Regional Hospital East Jutland, Randers, Denmark
| | - Jesper Mortensen
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | | | - Lars Christian Gormsen
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | | | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London, United Kingdom
| | - Morten Böttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Klinge MW, Krogh K, Mark EB, Drewes AM, Brix L, Isaksen C, Dedelaite M, Frøkjær JB, Fynne LV. Colonic volume in patients with functional constipation or irritable bowel syndrome determined by magnetic resonance imaging. Neurogastroenterol Motil 2022; 34:e14374. [PMID: 35383405 PMCID: PMC9539850 DOI: 10.1111/nmo.14374] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional constipation (FC) and irritable bowel syndrome constipation type (IBS-C) share many similarities, and it remains unknown whether they are distinct entities or part of the same spectrum of disease. Magnetic resonance imaging (MRI) allows quantification of intraluminal fecal volume. We hypothesized that colonic volumes of patients with FC would be larger than those of patients with IBS-C, and that both patient groups would have larger colonic volumes than healthy controls (HC). METHODS Based on validated questionnaires, three groups of participants were classified into FC (n = 13), IBS-C (n = 10), and HC (n = 19). The colonic volume of each subject was determined by MRI. Stool consistency was described by the Bristol stool scale and colonic transit times were assessed with radiopaque makers. KEY RESULTS Overall, total colonic volumes were different in the three groups, HC (median 629 ml, interquartile range (IQR)(562-868)), FC (864 ml, IQR(742-940)), and IBS-C (520 ml IQR(489-593)) (p = 0.001). Patients with IBS-C had lower colonic volumes than patients with FC (p = 0.001) and HC (p = 0.019), but there was no difference between FC and HC (p = 0.10). Stool consistency was similar in the two patient groups, but patients with FC had longer colonic transit time than those with IBS-C (117.6 h versus 43.2 h, p = 0.019). CONCLUSION Patients with IBS-C have lower total colonic volumes and shorter colonic transit times than patients with FC. Future studies are needed to confirm that colonic volume allows objective distinction between the two conditions.
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Affiliation(s)
- Mette Winther Klinge
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark,Diagnostic CentreSilkeborg Regional HospitalSilkeborgDenmark
| | - Klaus Krogh
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
| | - Esben Bolvig Mark
- Mech‐SenseDepartment of Gastroenterology and HepatologyAalborg University HospitalAalborgDenmark
| | - Asbjørn Mohr Drewes
- Mech‐SenseDepartment of Gastroenterology and HepatologyAalborg University HospitalAalborgDenmark
| | - Lau Brix
- Department of RadiologyDiagnostic CentreSilkeborg Regional HospitalSilkeborgDenmark
| | - Christin Isaksen
- Department of RadiologyDiagnostic CentreSilkeborg Regional HospitalSilkeborgDenmark
| | - Milda Dedelaite
- Department of RadiologyAalborg University HospitalAalborgDenmark,King´s College Hospital NHS Foundation TrustLondonUK
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Uhrenholt L, Brix L, Wichmann TO, Pedersen M, Ringgaard S, Jensen TS. Advanced magnetic resonance imaging of chronic whiplash patients: a clinical practice-based feasibility study. Chiropr Man Therap 2022; 30:2. [PMID: 34996490 PMCID: PMC8742358 DOI: 10.1186/s12998-022-00410-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury. METHODS Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher's exact test, Mann Whitney U test and analysis of variance between groups. RESULTS The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI. CONCLUSIONS This study did not show that MRI-based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark. .,Nortvig & Uhrenholt Kiropraktisk Klinik, 8200, Aarhus, Denmark.
| | - Lau Brix
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.,Department of Procurement and Biomedical Engineering, Region Midt, Aarhus N, Denmark
| | | | - Michael Pedersen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Ringgaard
- MR Research Centre, Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tue Secher Jensen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Doktor K, Hartvigsen J, Hancock M, Christensen HW, Fredberg U, Boyle E, Kindt M, Brix L, Jensen TS. Reliability of reporting differences in degenerative MRI findings of the lumbar spine from the supine to the upright position. Skeletal Radiol 2022; 51:2141-2154. [PMID: 35536357 PMCID: PMC9463326 DOI: 10.1007/s00256-022-04060-2] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the inter-rater reliability of identifying differences and types of differences in lumbar degenerative findings comparing supine and upright MRI. MATERIALS AND METHODS Fifty-nine participants, low back pain patients (LBP) with or without leg pain and no-LBP individuals were consecutively enrolled to receive supine and upright MRI of the lumbar spine. Three raters independently evaluated the MRIs for degenerative spinal pathologies and compared for differences. Presence/absence of degenerative findings were recorded for all supine and upright images, and then differences from the supine to the upright positions were classified into no-change, appeared, disappeared, worsened, or improved at each individual disc level. Reliability and agreement were calculated using Gwet's agreement coefficients (AC1 or AC2) and absolute agreement. RESULTS Inter-rater reliability of evaluating differences in eight degenerative lumbar findings comparing the supine and upright MRI position, ranged from 0.929 to 0.996 according to Gwet's agreement coefficients (AC2). The total number of positive MRI findings in the supine position ranged from 270 to 453, with an average of 366 per rater. Observed differences from supine to upright MRI ranged from 18 to 80, with an average of 56 per rater. CONCLUSION Inter-rater reliability was found overall acceptable for classification of differences in eight types of degenerative pathology observed with supine and upright MRI of the lumbar spine. Results were primarily driven by high numbers and high reliability of rating negative findings, whereas agreement regarding positive findings and positive positional differences was lower.
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Affiliation(s)
- Klaus Doktor
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark ,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Jan Hartvigsen
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark ,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,The Rheumatology Research Unit, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sport Sciences and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Morten Kindt
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark
| | - Lau Brix
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,Department of Procurement and Clinical Engineering, Region Midt, Aarhus, Denmark
| | - Tue Secher Jensen
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark ,Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus, Denmark ,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Rasmussen LD, Winther S, Westra J, Isaksen C, Ejlersen JA, Brix L, Kirk J, Urbonaviciene G, Søndergaard HM, Hammid O, Schmidt SE, Knudsen LL, Madsen LH, Frost L, Petersen SE, Gormsen LC, Christiansen EH, Eftekhari A, Holm NR, Nyegaard M, Chiribiri A, Bøtker HE, Böttcher M. Danish study of Non-Invasive testing in Coronary Artery Disease 2 (Dan-NICAD 2): Study design for a controlled study of diagnostic accuracy. Am Heart J 2019; 215:114-128. [PMID: 31323454 DOI: 10.1016/j.ahj.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) is the preferred primary diagnostic modality when examining patients with low to intermediate pre-test probability of coronary artery disease (CAD). Only 20-30% of these have potentially obstructive CAD. Because of the relatively poor positive predictive value of coronary CTA, unnecessary invasive coronary angiographies (ICAs) are conducted with the costs and risks associated with the procedure. Hence, an optimized diagnostic CAD algorithm may reduce the numbers of ICAs not followed by revascularization. The Dan-NICAD 2 study has 3 equivalent main aims: (1) To examine the diagnostic precision of a sound-based diagnostic algorithm, The CADScor®System (Acarix A/S, Denmark), in patients with a low to intermediate pre-test risk of CAD referred to a primary examination by coronary CTA. We hypothesize that the CADScor®System provides better stratification prior to coronary CTA than clinical risk stratification scores alone. (2) To compare the diagnostic accuracy of 3T cardiac magnetic resonance imaging (3T CMRI), 82rubidium positron emission tomography (82Rb-PET), and CT-derived fractional flow reserve (FFRCT) in patients where obstructive CAD cannot be ruled out by coronary CTA using ICA fractional flow reserve (FFR) as reference standard. (3) To compare the diagnostic performance of quantitative flow ratio (QFR) and ICA-FFR in patients with low to intermediate pre-test probability of CAD using 82Rb-PET as reference standard. METHODS Dan-NICAD 2 is a prospective, multicenter, cross-sectional study including approximately 2,000 patients with low to intermediate pre-test probability of CAD and without previous history of CAD. Patients are referred to coronary CTA because of symptoms suggestive of CAD, as evaluated by a cardiologist. Patient interviews, sound recordings, and blood samples are obtained in connection with the coronary CTA. If coronary CTA does not rule out obstructive CAD, patients will be examined by 3T CMRI 82Rb-PET, FFRCT, ICA, and FFR. Reference standard is ICA-FFR. Obstructive CAD is defined as an FFR ≤0.80 or as high-grade stenosis (>90% diameter stenosis) by visual assessment. Diagnostic performance will be evaluated as sensitivity, specificity, predictive values, likelihood ratios, calibration, and discrimination. Enrolment started January 2018 and is expected to be completed by June 2020. Patients are followed for 10 years after inclusion. DISCUSSION The results of the Dan-NICAD 2 study are expected to contribute to the improvement of diagnostic strategies for patients suspected of CAD in 3 different steps: risk stratification prior to coronary CTA, diagnostic strategy after coronary CTA, and invasive wireless QFR analysis as an alternative to ICA-FFR.
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Nissen L, Winther S, Westra J, Ejlersen JA, Isaksen C, Rossi A, Holm NR, Urbonaviciene G, Gormsen LC, Madsen LH, Christiansen EH, Maeng M, Knudsen LL, Frost L, Brix L, Bøtker HE, Petersen SE, Bøttcher M. Influence of Cardiac CT based disease severity and clinical symptoms on the diagnostic performance of myocardial perfusion. Int J Cardiovasc Imaging 2019; 35:1709-1720. [PMID: 31016502 DOI: 10.1007/s10554-019-01604-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 02/20/2019] [Accepted: 04/15/2019] [Indexed: 12/14/2022]
Abstract
We aimed to identify factors influencing the sensitivity of perfusion imaging after an initial positive coronary computed tomography angiography (CCTA) using invasive coronary angiography (ICA) with conditional fractional flow reserve (FFR) as reference. Secondly we aimed to identify factors associated with revascularisation and to evaluate treatment outcome after ICA. We analysed 292 consecutive patients with suspected significant coronary artery disease (CAD) at CCTA, who underwent perfusion imaging with either cardiac magnetic resonance (CMR) or myocardial perfusion scintigraphy (MPS) followed by ICA with conditional FFR. Stratified analysis and uni- and multiple logistic regression analyses were performed to identify predictors of diagnostic agreement between perfusion scans and ICA and predictors of revascularisation. Myocardial ischemia evaluated with perfusion scans was present in 65/292 (22%) while 117/292 (40%) had obstructive CAD evaluated by ICA. Revascularisation rate was 90/292 (31%). The overall sensitivity for perfusion scans was 39% (30-48), specificity 89% (83-93), PPV 69% (57-80) and NPV 68% (62-74). Stratified analysis showed higher sensitivities in patients with multi-vessel disease at CCTA 49% (37-60) and typical chest pain 50% (37-60). Predictors of revascularisation were multi-vessel disease by CCTA (OR 3.51 [1.91-6.48]) and a positive perfusion scan (OR 4.69 [2.49-8.83]). The sensitivity for perfusion scans after CCTA was highest in patients with typical angina and multiple lesions at CCTA and predicted diagnostic agreement between perfusion scans and ICA. Abnormal perfusion and multi vessel disease at CCTA predicted revascularisation.
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Affiliation(s)
- L Nissen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark.
| | - S Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - J A Ejlersen
- Department of Nuclear Medicine, Hospital Unit West Jutland, Herning, Denmark
| | - C Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - A Rossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Diagnostic Imaging, Humanitas Research Hospital, Milan, Italy
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - L C Gormsen
- Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L H Madsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark
| | - E H Christiansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - L L Knudsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - L Brix
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - H E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - S E Petersen
- William Harvey Research Institute, Queen Mary University of London, London, UK
- St. Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - M Bøttcher
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, Herning, 7400, Denmark
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Nissen L, Winther S, Westra J, Ejlersen JA, Isaksen C, Rossi A, Holm NR, Urbonaviciene G, Gormsen LC, Madsen LH, Christiansen EH, Maeng M, Knudsen LL, Frost L, Brix L, Bøtker HE, Petersen SE, Bøttcher M. Diagnosing coronary artery disease after a positive coronary computed tomography angiography: the Dan-NICAD open label, parallel, head to head, randomized controlled diagnostic accuracy trial of cardiovascular magnetic resonance and myocardial perfusion scintigraphy. Eur Heart J Cardiovasc Imaging 2018; 19:369-377. [PMID: 29447342 DOI: 10.1093/ehjci/jex342] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/17/2017] [Indexed: 01/01/2023] Open
Affiliation(s)
- L Nissen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - S Winther
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - J A Ejlersen
- Department of Nuclear Medicine, Regional Hospital West Jutland, Gl.landevej 61, 7400 Herning, Denmark
| | - C Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - A Rossi
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - L C Gormsen
- Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L H Madsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - E H Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - M Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - L L Knudsen
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - L Brix
- Department of Radiology, Regional Hospital of Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - H E Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - S E Petersen
- William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - M Bøttcher
- Department of Cardiology, Hospital Unit West Jutland, Gl. Landevej 61, 7400 Herning, Denmark
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Poulsen P, Knap M, Brix L, Sørensen T, Schmidt M, Pedersen E. Real-Time Magnetic Resonance Imaging of Simultaneous Lung Tumor Motion and Involved Mediastinal Lymph Node Motion. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nissen L, Winther S, Isaksen C, Ejlersen JA, Brix L, Urbonaviciene G, Frost L, Madsen LH, Knudsen LL, Schmidt SE, Holm NR, Maeng M, Nyegaard M, Bøtker HE, Bøttcher M. Danish study of Non-Invasive testing in Coronary Artery Disease (Dan-NICAD): study protocol for a randomised controlled trial. Trials 2016; 17:262. [PMID: 27225018 PMCID: PMC4880871 DOI: 10.1186/s13063-016-1388-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 10/11/2015] [Accepted: 05/11/2016] [Indexed: 11/29/2022] Open
Abstract
Background Coronary computed tomography angiography (CCTA) is an established method for ruling out coronary artery disease (CAD). Most patients referred for CCTA do not have CAD and only approximately 20–30 % of patients are subsequently referred to further testing by invasive coronary angiography (ICA) or non-invasive perfusion evaluation due to suspected obstructive CAD. In cases with severe calcifications, a discrepancy between CCTA and ICA often occurs, leading to the well-described, low-diagnostic specificity of CCTA. As ICA is cost consuming and involves a risk of complications, an optimized algorithm would be valuable and could decrease the number of ICAs that do not lead to revascularization. The primary objective of the Dan-NICAD study is to determine the diagnostic accuracy of cardiac magnetic resonance imaging (CMRI) and myocardial perfusion scintigraphy (MPS) as secondary tests after a primary CCTA where CAD could not be ruled out. The secondary objective includes an evaluation of the diagnostic precision of an acoustic technology that analyses the sound of coronary blood flow. It may potentially provide better stratification prior to CCTA than clinical risk stratification scores alone. Methods/design Dan-NICAD is a multi-centre, randomised, cross-sectional trial, which will include approximately 2,000 patients without known CAD, who were referred to CCTA due to a history of symptoms suggestive of CAD and a low-risk to intermediate-risk profile, as evaluated by a cardiologist. Patient interview, sound recordings, and blood samples are obtained in connection with the CCTA. All patients with suspected obstructive CAD by CCTA are randomised to either stress CMRI or stress MPS, followed by ICA with fractional flow reserve (FFR) measurements. Obstructive CAD is defined as an FFR below 0.80 or as high-grade stenosis (>90 % diameter stenosis) by visual assessment. Diagnostic performance is evaluated as sensitivity, specificity, predictive values, likelihood ratios, and C statistics. Enrolment commenced in September 2014 and is expected to be complete in May 2016. Discussion Dan-NICAD is designed to assess whether a secondary perfusion examination after CCTA could safely reduce the number of ICAs where revascularization is not required. The results are expected to add knowledge about the optimal algorithm for diagnosing CAD. Trial registration Clinicaltrials.gov identifier, NCT02264717. Registered on 26 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1388-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Nissen
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark.
| | - Simon Winther
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christin Isaksen
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | | | - Lau Brix
- Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | | | - Lars Frost
- Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
| | - Lene Helleskov Madsen
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
| | - Lars Lyhne Knudsen
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
| | - Samuel Emil Schmidt
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Nyegaard
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Bøttcher
- Department of Internal Medicine, Hospital Unit West, Gl.landevej 61, 7400, Herning, Denmark
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Brix L, Ringgaard S, Sandager P, Petersen OB, Sørensen TS, Lundorf E, Stausbøl-Grøn B. Overcoming foetal motion using interactive real-time magnetic resonance imaging. Clin Physiol Funct Imaging 2016; 37:717-722. [PMID: 27005484 DOI: 10.1111/cpf.12364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/21/2013] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Foetal MRI has become an established image modality in the prenatal diagnosis of CNS anomalies, but image quality can be severely affected by foetal movements. The objective was to overcome these inherent motion problems by applying interactive real-time MRI and to evaluate the diagnostic usefulness of the applied real-time MRI sequence in relation to standard protocols. METHODS Ten healthy foetuses (gestation week 21·3 ± 0·5) were scanned using a system, which allowed visual feedback and interactive slice positioning in real time. The data were compared to a control group of 14 healthy foetuses (gestation week 21·0 ± 0·8) who had previously been scanned using standard MRI. Comparisons were carried out by two radiologists with regard to cerebral anthropometric sizes, presence of important brain structures, degree of movement, clinical image value, image quality and ability to obtain correct slice planes. RESULTS Two out of eight anthropometric sizes were statistically different between the two groups. Representation of cerebral structures was found in 70-100% in the real-time group. No statistically differences were found in clinical image value and image quality. The mean ability to obtain optimal slice planes was higher in the real-time group, but it was not significant. CONCLUSION Imaging of the foetal brain using the proposed interactive real-time MRI system is a promising alternative to traditional foetal MRI for anthropometrics or as a supplement for the representation of foetal brain structures in cases in which foetal motion causes challenges in relation to obtaining optimal slice planes using conventional MRI techniques.
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Affiliation(s)
- Lau Brix
- Department of Procurement & Clinical Engineering, Region Midt, Aarhus N, Denmark.,MR Research Centre, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Thomas Sangild Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Computer Science, Aarhus University, Aarhus N, Denmark
| | - Erik Lundorf
- MR Research Centre, Aarhus University Hospital, Aarhus N, Denmark
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Abstract
PURPOSE Combined magnetic resonance imaging (MRI) systems and linear accelerators for radiotherapy (MR-Linacs) are currently under development. MRI is noninvasive and nonionizing and can produce images with high soft tissue contrast. However, new tracking methods are required to obtain fast real-time spatial target localization. This study develops and evaluates a method for tracking three-dimensional (3D) respiratory liver motion in two-dimensional (2D) real-time MRI image series with high temporal and spatial resolution. METHODS The proposed method for 3D tracking in 2D real-time MRI series has three steps: (1) Recording of a 3D MRI scan and selection of a blood vessel (or tumor) structure to be tracked in subsequent 2D MRI series. (2) Generation of a library of 2D image templates oriented parallel to the 2D MRI image series by reslicing and resampling the 3D MRI scan. (3) 3D tracking of the selected structure in each real-time 2D image by finding the template and template position that yield the highest normalized cross correlation coefficient with the image. Since the tracked structure has a known 3D position relative to each template, the selection and 2D localization of a specific template translates into quantification of both the through-plane and in-plane position of the structure. As a proof of principle, 3D tracking of liver blood vessel structures was performed in five healthy volunteers in two 5.4 Hz axial, sagittal, and coronal real-time 2D MRI series of 30 s duration. In each 2D MRI series, the 3D localization was carried out twice, using nonoverlapping template libraries, which resulted in a total of 12 estimated 3D trajectories per volunteer. Validation tests carried out to support the tracking algorithm included quantification of the breathing induced 3D liver motion and liver motion directionality for the volunteers, and comparison of 2D MRI estimated positions of a structure in a watermelon with the actual positions. RESULTS Axial, sagittal, and coronal 2D MRI series yielded 3D respiratory motion curves for all volunteers. The motion directionality and amplitude were very similar when measured directly as in-plane motion or estimated indirectly as through-plane motion. The mean peak-to-peak breathing amplitude was 1.6 mm (left-right), 11.0 mm (craniocaudal), and 2.5 mm (anterior-posterior). The position of the watermelon structure was estimated in 2D MRI images with a root-mean-square error of 0.52 mm (in-plane) and 0.87 mm (through-plane). CONCLUSIONS A method for 3D tracking in 2D MRI series was developed and demonstrated for liver tracking in volunteers. The method would allow real-time 3D localization with integrated MR-Linac systems.
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Affiliation(s)
- Lau Brix
- Department of Procurement and Clinical Engineering, Region Midt, Olof Palmes Allé 15, 8200 Aarhus N, Denmark and MR Research Centre, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
| | - Steffen Ringgaard
- MR Research Centre, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
| | - Thomas Sangild Sørensen
- Department of Computer Science, Aarhus University, Aabogade 34, 8200 Aarhus N, Denmark and Department of Clinical Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark
| | - Per Rugaard Poulsen
- Department of Clinical Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark and Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
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Brix L, Ringgaard S, Sangild Sørensen T, Rugaard Poulsen P. PO-0861: Three-dimensional liver motion tracking using 2D real-time MRI. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brix L, Sørensen TS, Berber Y, Ries M, Stausbøl-Grøn B, Ringgaard S. Feasibility of interactive magnetic resonance imaging of moving anatomy for clinical practice. Clin Physiol Funct Imaging 2013; 34:32-8. [DOI: 10.1111/cpf.12061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/22/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Lau Brix
- Department of Procurement & Clinical Engineering; Region Midt; Aarhus N Denmark
- MR Research Centre; Aarhus University Hospital, Skejby; Aarhus N Denmark
| | - Thomas S. Sørensen
- Department of Computer Science; Aarhus University; Aarhus N Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus N Denmark
| | | | - Mario Ries
- Image Sciences Institute; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Steffen Ringgaard
- MR Research Centre; Aarhus University Hospital, Skejby; Aarhus N Denmark
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Helgerud J, Karlsen T, Kim WY, Høydal KL, Støylen A, Pedersen H, Brix L, Ringgaard S, Kværness J, Hoff J. Interval and strength training in CAD patients. Int J Sports Med 2010; 32:54-9. [PMID: 21072747 DOI: 10.1055/s-0030-1267180] [Citation(s) in RCA: 26] [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: 10/18/2022]
Abstract
This study sought to study the effect of high intensity aerobic interval endurance training on peak stroke volume and maximal strength training on mechanical efficiency in coronary artery disease (CAD) patients. 8 CAD patients (age 61.4 ± 3.7 years) trained 30 interval training sessions with 4 × 4 min intervals at 85-95% of peak heart rate while 10 CAD patients (age 66.5 ± 5.5 years) trained 24 sessions of maximal horizontal leg press. In the interval training group peak stroke volume increased significantly by 23% from 94.1 ± 23.0 mL · beat (-1) to 115.8 ± 22.4 mL · beat (-1) (p<0.05). Peak oxygen uptake increased significantly by 17% from 27.2 ± 4.5 mL · kg (-1) · min (-1) to 31.8 ± 5.0 mL · kg (-1) min (-1) (p<0.05) in the same group. In contrast, there was no such exercise training-induced change in peak stroke volume or peak oxygen uptake in the maximal strength training group, despite a 35% improvement in sub maximal walking performance.
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Affiliation(s)
- J Helgerud
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Brix L, Ringgaard S, Rasmusson A, Sørensen TS, Kim WY. Three dimensional three component whole heart cardiovascular magnetic resonance velocity mapping: comparison of flow measurements from 3D and 2D acquisitions. J Cardiovasc Magn Reson 2009; 11:3. [PMID: 19232119 PMCID: PMC2649114 DOI: 10.1186/1532-429x-11-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [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] [Received: 06/30/2008] [Accepted: 02/20/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two-dimensional, unidirectionally encoded, cardiovascular magnetic resonance (CMR) velocity mapping is an established technique for the quantification of blood flow in large vessels. However, it requires an operator to correctly align the planes of acquisition. If all three directional components of velocity are measured for each voxel of a 3D volume through the phases of the cardiac cycle, blood flow through any chosen plane can potentially be calculated retrospectively. The initial acquisition is then more time consuming but relatively operator independent. AIMS To compare the curves and volumes of flow derived from conventional 2D and comprehensive 3D flow acquisitions in a steady state flow model, and in vivo through planes transecting the ascending aorta and pulmonary trunk in 10 healthy volunteers. METHODS Using a 1.5 T Phillips Intera CMR system, 3D acquisitions used an anisotropic 3D segmented k-space phase contrast gradient echo sequence with a short EPI readout, with prospective ECG and diaphragm navigator gating. The 2D acquisitions used segmented k-space phase contrast with prospective ECG and diaphragm navigator gating. Quantitative flow analyses were performed retrospectively with dedicated software for both the in vivo and in vitro acquisitions. RESULTS Analysis of in vitro data found the 3D technique to have overestimated the continuous flow rate by approximately 5% across the entire applied flow range. In vivo, the 2D and the 3D techniques yielded similar volumetric flow curves and measurements. Aortic flow: (mean +/- SD), 2D = 89.5 +/- 13.5 ml & 3D = 92.7 +/- 17.5 ml. Pulmonary flow: 2D = 98.8 +/- 18.4 ml & 3D = 94.9 +/- 19.0 ml). Each in vivo 3D acquisition took about 8 minutes or more. CONCLUSION Flow measurements derived from the 3D and 2D acquisitions were comparable. Although time consuming, comprehensive 3D velocity acquisition could be relatively operator independent, and could potentially yield information on flow through several retrospectively chosen planes, for example in patients with congenital or valvular heart disease.
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Affiliation(s)
- Lau Brix
- Department of Biomedical Engineering, Region Midtjylland, c/o Aarhus University Hospital, Skejby, Denmark
- MR-Centre, Aarhus University Hospital, Skejby, Denmark
| | | | - Allan Rasmusson
- Department of Computer Science, University of Aarhus, Aarhus, Denmark
| | - Thomas Sangild Sørensen
- Department of Computer Science, University of Aarhus, Aarhus, Denmark
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - W Yong Kim
- MR-Centre, Aarhus University Hospital, Skejby, Denmark
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
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Astrup AS, Kim WY, Tarnow L, Botnar RM, Simonsen C, Brix L, Pietraszek L, Hansen PR, Manning WJ, Parving HH. Relation of left ventricular function, mass, and volume to NT-proBNP in type 1 diabetic patients. Diabetes Care 2008; 31:968-70. [PMID: 18252905 DOI: 10.2337/dc07-1536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To measure left ventricular mass (LVM), left ventricular volumes, and left ventricular function (LVF) in a cohort of type 1 diabetic patients and to correlate measures of imaging to NH(2)-terminal pro-brain natriuretic peptide (NT-proBNP). RESEARCH DESIGN AND METHODS In a cross-sectional study, all patients with type 1 diabetes underwent cardiovascular magnetic resonance imaging. We included 63 patients with diabetic nephropathy and 73 patients with normoalbuminuria. RESULTS All patients had normal global LVF. LVM was increased in patients with diabetic nephropathy compared with patients with persistent normoalbuminuria. Patients with nephropathy had smaller left ventricular volumes and increased levels of NT-proBNP. Linear regression analysis in patients with diabetic nephropathy showed that NT-proBNP and creatinine were associated with LVM. CONCLUSIONS Increased LVM is identified in asymptomatic type 1 diabetic patients with nephropathy compared with normoalbuminuric patients. Elevated levels of NT-proBNP were associated with increased LVM, which are both markers of increased cardiovascular risk.
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Hehonah N, Zhu X, Brix L, Bolton-Grob R, Barnett A, Windmill K, McManus M. Molecular cloning, expression, localisation and functional characterisation of a rabbit SULT1C2 sulfotransferase. Int J Biochem Cell Biol 1999; 31:869-82. [PMID: 10481272 DOI: 10.1016/s1357-2725(99)00038-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 11/17/2022]
Abstract
The importance of sulfotransferases in xenobiotic metabolism is gaining recognition. The gastrointestinal (GI) tract is a major portal of entry for many xenobiotics, yet little is known about the contribution of sulfotransferases to detoxication or bioactivation metabolism in these tissues. To this end, isolation and characterisation of sulfotransferases expressed in the stomach of rabbits was undertaken. A unique sulfotransferase cDNA (GenBank Accession No. AF026304) was isolated from a rabbit stomach cDNA library. This cDNA was 1439 base pairs (bp) long and has an open reading frame of 888 bp. On expression of the cDNA in both COS cells and E. coli, a protein molecular weight of 34 kDa was detected on SDS-PAGE. Immunoblotting using an antibody raised in goats against the bacterially expressed protein detected expression of the protein in GI tract tissues. The 34 kDa immunoreactive band was detected in rabbit GI tract tissues (stomach, duodenum, jejunum, ileum, colon, caecum and rectum), liver and kidneys, but not in the lungs (n = 3). The human ortholog (GenBank Accession No AF026303) of the rabbit enzyme was cloned from a human stomach cDNA library. These two enzymes share 84% amino acid sequence identity and have been termed 1C2 sulfotransferases. When functional and kinetic characterisation of the recombinant rabbit and human proteins was carried out using 16 known ST substrates, detectable sulfonation activity was observed only with p-nitrophenol (with Km values of 2.2 mM and 13.3 mM, respectively). In conclusion, we have identified a rabbit GI tract sulfotransferase belonging to a newly defined sulfotransferase subfamily.
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Affiliation(s)
- N Hehonah
- Department of Physiology and Pharmacology, University of Queensland, Brisbane, Australia
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