Objectives To update the EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV).Methods A systematic literature review update was performed to retrieve new... Show moreObjectives To update the EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV).Methods A systematic literature review update was performed to retrieve new evidence on ultrasound, MRI, CT and [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries. The recommendations were updated based on evidence and expert opinion, iterating until voting indicated consensus. The level of agreement was determined by anonymous votes.Results Three overarching principles and eight recommendations were agreed. Compared to the 2018 version, ultrasound is now recommended as first-line imaging test in all patients with suspected giant cell arteritis, and axillary arteries should be included in the standard examination. As an alternative to ultrasound, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; FDG-PET, CT or ultrasound are alternatives. Although imaging is not routinely recommended for follow-up, ultrasound, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MR-angiography, CT-angiography or ultrasound may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.Conclusions The 2023 EULAR recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with LVV. Show less
Venous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep vein thrombosis (DVT). DVT most commonly occurs in the deep veins of the lower extremity but can also occur in the veins of... Show moreVenous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep vein thrombosis (DVT). DVT most commonly occurs in the deep veins of the lower extremity but can also occur in the veins of upper extremity, abdomen and cerebrum. As symptoms of VTE are nonspecific, the diagnosis of VTE is based on diagnostic tests, including clinical decision rules (CDR), D-dimer tests and imaging. Although the diagnostic management of VTE has greatly advanced in recent years with the introduction of novel CDRs and high-sensitive D-dimer tests, the diagnosis may still be challenging in certain settings. The latter is mainly caused by the indirect way of thrombus visualisation by current imaging tests, such as by showing incompressibility with compression ultrasonography (CUS) or a filling defect on contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI).This thesis focuses on challenging settings for diagnosing VTE, including suspected recurrent ipsilateral DVT, upper extremity DVT, cerebral vein thrombosis and portal vein thrombosis. We studied a novel imaging technique called Magnetic Resonance Non-Contrast Thrombus Imaging (MR-NCTI) and its application in these different VTE settings. Show less
Background: Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in... Show moreBackground: Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients.Methods: Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints.Results: We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging - 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor.Conclusions: Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days. Show less
Objectives Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA.Methods In a cross-sectional multi... Show moreObjectives Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA.Methods In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC).Results Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in the first carpometacarpal joints (AUC = 0.67 and 0.63, respectively). Painful DIP joints were associated with hand OA, but were less able to discriminate between groups (AUC = 0.67). Age and family history of OA were positively associated with hand OA, whereas negative associations were found for pain, stiffness and soft tissue swelling in metacarpophalangeal joints, pain and marginal erosions in wrists, longer morning stiffness, inflammatory biomarkers and autoantibodies.Conclusions Differences in symptoms, clinical findings, radiographic changes and laboratory tests were found in patients with hand OA versus controls. Radiographic OA features, especially in DIP joints, were best suited to discriminate between groups. Show less
Umbilical catheters have been used for decades in neonatal care. There are many advantages to using them, but they also carry risks of complications. The general aim of this thesis is to optimize... Show moreUmbilical catheters have been used for decades in neonatal care. There are many advantages to using them, but they also carry risks of complications. The general aim of this thesis is to optimize positioning of umbilical catheters and to improve their use, thus limiting complications. To predict the correct insertion length of umbilical catheters we recommend the use of a simple method without complex body measurements or combined calculations. However, no method or formula has been proven to reliably predict the correct insertion length. Moreover, umbilical venous catheters (UVCs) tend to migrate even after correct positioning. Regular evaluation of the position of UVCs - preferably by ultrasonography, and starting during or directly after placement - is therefore advised to prevent complications caused by malpositioning. Physicians using UVCs should be aware of the possible complications described in this thesis, such as thrombosis, bloodstream infections and cardiac arrhythmias. However, despite the risk of complications umbilical catheterization is an excellent method for gaining intravenous access in sick infants, especially in cases of extremely premature birth or haemodynamic instability. Show less
Pulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of... Show morePulmonary embolism is traditionally, since autopsy studies by Virchow in the mid 1800s, thought to originate from embolization of a deep-vein thrombosis, resulting in two clinical manifestations of one disease: venous thrombosis. The incidence of deep-vein thrombosis in the population is twice as high as the incidence of pulmonary embolism, i.e. 1 per 1000 and 0.5 per 1000 person-years respectively. The aim of this thesis was to assess whether pulmonary embolism and deep-vein thrombosis are always the same disease or not, and to answer this question with regard to etiology (genetic and acquired risk factors) and anatomical distribution of thrombi in the veins. We studied this question in two populations: the PEDLAR study and the MEGA case-control study. In the PEDLAR study we assessed the origin of pulmonary embolism using a total body Magnetic Resonance Direct Thrombus Imaging technique. We proposed several mecha nisms for the absence of deep-vein thrombi in more than half of the patients with pulmonary embolism. In addition, we investigated the effect of aging on venous valve thickness. This was performed in an ultrasonography study, with participants from 20 to 80 years old (the aging venous valves study). We hypothesized that part of the increasing incidence in venous thrombosis with age can be explained by increasing valve thickness. Show less
Klauser, A.S.; Tagliafico, A.; Allen, G.M.; Boutry, N.; Campbell, R.; Court-Payen, M.; ... ; Martinoli, C. 2012
In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients... Show moreIn this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use of a diagnostic strategy for patients clinically suspected to have appendicitis incorporating non-invasive modalities such as clinical evaluation, routine ultrasound and clinical re-evaluation, and a minimal use of complementary CT or laparoscopy. 3; The possibility to clinically differentiate between children with acute appendicitis and those with acute mesenteric lymphadenitis. 4; The value of secondary signs during the ultrasonographic evaluation of children with suspected appendicitis. 5; The impact of radiological imaging on diagnostic accuracy and clinical decision making for patients with acute colonic diverticulitis. 6; A systematic review on laparoscopic peritoneal lavage for patients with peritonitis due to perforated colonic diverticulitis. Show less
In this thesis the assessment of ultrasonography (US) and Computed Tomography (CT) in the diagnostic strategy of suspected appendicitis is presented. The first study showed that focused single... Show moreIn this thesis the assessment of ultrasonography (US) and Computed Tomography (CT) in the diagnostic strategy of suspected appendicitis is presented. The first study showed that focused single-detector helical CT as well as graded compression US performed in a general community teaching hospital by both body imaging radiologists and general radiology staff members have a similar accuracy for the diagnosis of acute appendicitis. A second study showed that in interpreting CT images the expertise of the attending radiologist should be considered. A third study showed that gender seems to affect the accuracy of US and CT in patients suspected of acute appendicitis. A fourth study showed that US as a sole imaging tool is of limited value both in women with unequivocal and in women with equivocal signs of appendicitis. A fifth study showed that US and CT implemented in a diagnostic pathway yields a high diagnostic accuracy for acute appendicitis without adverse events due to delay in treatment. A sixth study showed that for a majority of the surgeons, the diagnosis of acute appendicitis is based on clinical signs and symptoms. US and CT can be valuable in diagnosing appendicitis but further cooperation between surgeons and radiologists is required. Show less
This thesis describes five ultrasonogaphic studies in children with abdominal pain. The normal appendix can be visualized by ultrasound in 82% of the children without abdominal complaints,... Show moreThis thesis describes five ultrasonogaphic studies in children with abdominal pain. The normal appendix can be visualized by ultrasound in 82% of the children without abdominal complaints, according to the first study. In cases of non-depiction of the appendix in children with a clinical suspicion of appendicitis, the ultrasonographic presence of secondary signs of appendicitis is a strong indicator of this diagnosis. In the absence of these ultrasonographic signs acute appendicitis can be ruled out. The third study shows that increased renal cortex echogenicity in children with acute illness is a transient feature and does not necessarily indicate renal disease. It should alert the radiologist to search the abdomen more thoroughly for a cause of the acute illness, such as appendicitis. The fourth study showed that ultrasonography can differentiate between ileoileal and ileocolic intussusceptions. The diameter and the length of the intussusception are the main criteria. Finally, the last study shows no relation between enlarged mesenteric lymph nodes and parasitic intestinal infections in children with recurrent abdominal pain. In addition, this study shows organic abnormalities in less than 5% of the children with recurrent abdominal pain at ultrasound. Show less
