Background: Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation... Show moreBackground: Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI.Methods: In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in >= 10% of patients which is considered the minimal clinically important difference. Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI.Discussion: The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy. This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy. Show less
Nowadays many advanced MR imaging techniques are available for detection of hypoxic-ischemic brain injury in young infants. In tertiary referral centres and large children__s hospitals, these... Show moreNowadays many advanced MR imaging techniques are available for detection of hypoxic-ischemic brain injury in young infants. In tertiary referral centres and large children__s hospitals, these techniques are used on a regular basis. However, a considerable proportion of young infants with hypoxic-ischemic brain injury are imaged in primary and secondary care centres where experience with these advanced techniques is limited. Consequently, cranial ultrasonography and the conventional MR imaging techniques, such as T1- and T2-weighted imaging remain the mainstay of neonatal neuroimaging today. The purpose of this thesis was to study diagnostic and predictive MR imaging features of hypoxic-ischemic brain injury in young infants. We focused on T1-, T2-, and diffusion-weighted imaging, since these are applied on a large scale in primary and secondary centres. It may be anticipated that in the future, the use of these techniques will increase as experience with these techniques increases and access to MR imaging machines becomes more widespread. To identify all cases of neonatal hypoxic-ischemic brain injury and for optimal outcome prediction, a combination of diagnostic modalities is mandatory. For the diagnosis and outcome prediction of hypoxic-ischemic brain injury in young infants, clinical assessment, neuroimaging (cranial ultrasonography and MR imaging), and EEG are complementary. Show less
