Background: Drug-free remission is a desirable goal in rheumatoid arthritis (RA) for both patients and clinicians. The aim of this post hoc analysis was to investigate whether clinical and magnetic... Show moreBackground: Drug-free remission is a desirable goal in rheumatoid arthritis (RA) for both patients and clinicians. The aim of this post hoc analysis was to investigate whether clinical and magnetic resonance imaging (MRI) variables in patients with early RA who achieved remission with methotrexate and/or abatacept at 12 months could predict disease flare following treatment withdrawal.Methods: In the AVERT study of abatacept in early RA, patients with low disease activity at month 12 entered a 12-month period with all treatment discontinued (withdrawal, WD). This post hoc analysis assessed predictors of disease flare at WD+6months (mo) and WD+12mo of patients with Disease Activity Score in 28 joints (DAS28)-defined remission (DAS28[C-reactive protein (CRP)] <2.6) at withdrawal using univariate and multivariable regression models. Predictors investigated included the Health Assessment Questionnaire-Disability Index (HAQ-DI), pain, Patient Global Assessment; MRI synovitis, erosion, bone edema, and combined (synovitis + bone edema) inflammation scores.Results: Remission was achieved by 172 patients; 100 (58%) and 113 (66%) patients had experienced a flare at WD+6mo and WD+12mo, respectively. In univariate analyses, higher HAQ-DI and MRI synovitis, erosion, bone edema, and combined inflammation scores at WD were identified as potential predictors of flare (P < 0.01). In multivariable analysis, high scores at WD for HAQ-DI and MRI erosion were confirmed as independent predictors of flare at WD+6mo and WD+12mo (P < 0.01).Conclusion: In patients with early RA achieving clinical remission, patient function (HAQ-DI), and MRI measures of bone damage (erosion) predicted disease flare 6 and 12 months after treatment withdrawal. These variables may help identify patients with early RA in clinical remission as candidates for successful treatment withdrawal. Show less
Gorris, M.; Janssen, Q.P.; Besselink, M.G.; Broek, B.L.J. van den; Eijck, C.H.J. van; Gils, M.J. van; ... ; Hooft, J.E. van 2022
Background and objectives: Left-sided pancreatic lesions are often treated surgically. Accurate diagnostic work-up is therefore essential to prevent futile major abdominal surgery. Large series... Show moreBackground and objectives: Left-sided pancreatic lesions are often treated surgically. Accurate diagnostic work-up is therefore essential to prevent futile major abdominal surgery. Large series focusing specifically on the preoperative work-up of left-sided pancreatic lesions are lacking. This surgical cohort analysis describes the sensitivity of CT, MRI, and EUS-FNA/B in the diagnostic work-up of left-sided pancreatic lesions.Methods: We performed a post-hoc analysis of patients who underwent surgery for a left-sided pancreatic lesion between April 2010 and August 2017 and participated in the randomized CPR trial. Primary outcome was the sensitivity of CT, MRI, and EUS-FNA/B. Sensitivity was determined as the most likely diagnosis of each modality compared with the postoperative histopathological diagnosis. Additionally, the change in sensitivity of EUS versus EUS-FNA/B (i.e., cyst fluid analysis, and/or tissue acquisition) was measured.Results: Overall, 181 patients were included (benign: 23%, premalignant: 27%, malignant: 50%). Most patients had solid lesions (65%). Preoperative imaging included CT (86%), MRI (41%), EUS (68%). Overall, CT and EUS-FNA/B reached a sensitivity of both 71%, compared with 66% for MRI. When EUS was combined with FNA/B, sensitivity rose from 64% to 71%. For solid lesions, CT reached the highest sensitivity (75%) when compared with MRI (70%) and EUS-FNA/B (69%). For cystic lesions, EUS-FNA/B reached the highest sensitivity (75%) when compared with CT and MRI (both 62%).Conclusions: CT is the most sensitive diagnostic modality for solid and EUS-FNA/B for cystic left-sided pancreatic lesions. EUS-FNA/B was associated with an increased sensitivity when compared to EUS alone. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC. Show less
Kato, Y.; Kizer, J.R.; Ostovaneh, M.R.; Lazar, J.; Peng, Q.; Geest, R.J. van der; ... ; Ambale-Venkatesh, B. 2021
Background Quantification of non-ischemic myocardial scar remains a challenge due to the patchy diffuse nature of fibrosis. Extracellular volume (ECV) to guide late gadolinium enhancement (LGE)... Show moreBackground Quantification of non-ischemic myocardial scar remains a challenge due to the patchy diffuse nature of fibrosis. Extracellular volume (ECV) to guide late gadolinium enhancement (LGE) analysis may achieve a robust scar assessment. Methods Three cohorts of 80 non-ischemic-training, 20 non-ischemic-validation, and 10 ischemic-validation were prospectively enrolled and underwent 3.0 Tesla cardiac MRI. An ECV cutoff to differentiate LGE scar from non-scar was identified in the training cohort from the receiver-operating characteristic curve analysis, by comparing the ECV value against the visually-determined presence/absence of the LGE scar at the highest signal intensity (SI) area of the mid-left ventricle (LV) LGE. Based on the ECV cutoff, an LGE semi-automatic threshold of n-times of standard-deviation (n-SD) above the remote-myocardium SI was optimized in the individual cases ensuring correspondence between LGE and ECV images. The inter-method agreement of scar amount in comparison with manual (for non-ischemic) or full-width half-maximum (FWHM, for ischemic) was assessed. Intra- and inter-observer reproducibility were investigated in a randomly chosen subset of 40 non-ischemic and 10 ischemic cases. Results The non-ischemic groups were all female with the HIV positive rate of 73.8% (training) and 80% (validation). The ischemic group was all male with reduced LV function. An ECV cutoff of 31.5% achieved optimum performance (sensitivity: 90%, specificity: 86.7% in training; sensitivity: 100%, specificity: 81.8% in validation dataset). The identified n-SD threshold varied widely (range 3 SD-18 SD), and was independent of scar amount (beta = -0.01, p = 0.92). In the non-ischemic cohorts, results suggested that the manual LGE assessment overestimated scar (%) in comparison to ECV-guided analysis [training: 4.5 (3.2-6.4) vs. 0.92 (0.1-2.1); validation: 2.5 (1.2-3.7) vs. 0.2 (0-1.6); P < 0.01 for both]. Intra- and inter-observer analyses of global scar (%) showed higher reproducibility in ECV-guided than manual analysis with CCC = 0.94 and 0.78 versus CCC = 0.86 and 0.73, respectively (P < 0.01 for all). In ischemic validation, the ECV-guided LGE analysis showed a comparable scar amount and reproducibility with the FWHM. Conclusions ECV-guided LGE analysis is a robust scar quantification method for a non-ischemic cohort. Trial registration ClinicalTrials.gov; NCT00000797, retrospectively-registered 2 November 1999; NCT02501811, registered 15 July 2015. Show less
Improvements in the treatment of rectal cancer patients have led to increased survival. Therefore, long-term outcome has become an increasingly important factor. Both neoadjuvant (chemo... Show moreImprovements in the treatment of rectal cancer patients have led to increased survival. Therefore, long-term outcome has become an increasingly important factor. Both neoadjuvant (chemo)radiotherapy and total mesorectal excision surgery are associated with toxicity. As a result, research for rectal cancer treatment has focused on the reduction of radiation dose to healthy tissue and less extensive surgery or omission of surgery in selected patients. The work described in this thesis can be used to reduce uncertainties related to image-guided external beam radiotherapy (EBRT) and high-dose-rate endorectal brachytherapy (HDREBT) of rectal cancer. By decreasing treatment related uncertainties, dose to surrounding healthy tissue can be reduced and/or a higher dose to the target volume can be delivered with an isotoxic effect. The MRI visibility of four types of fiducial markers as a surrogate for gross tumor volume (GTV) location was evaluated. In addition, it was found that the use of fiducial markers as a surrogate for GTV location in an EBRT GTV boost setting allows smaller treatment margins. For HDREBT, it was found that daily CT imaging should be the minimal standard to verify a correct applicator setup. In addition, we propose the use of an ultrashort echo time MRI sequence to visualize the applicator on MRI. Lastly, we determined the added value of a national study group meeting on the quality and variability of EBRT treatment plans for the introduction of a novel target volume that includes only the mesorectum. Show less
Kuijf, H.J.; Biesbroek, J.M.; Bresser, J. de; Heinen, R.; Andermatt, S.; Bento, M.; ... ; Biessels, G.J. 2019
Infants born very prematurely (gestational age <32 weeks) are at risk of brain injury and neurodevelopmental problems. Imaging the preterm infant__s brain during the neonatal period, using... Show moreInfants born very prematurely (gestational age <32 weeks) are at risk of brain injury and neurodevelopmental problems. Imaging the preterm infant__s brain during the neonatal period, using cranial ultrasonography (cUS) and magnetic resonance imaging (MRI), is important. Our aim was to study and describe brain findings in very preterm infants using modern, high-quality imaging techniques. Part I reviews brain maturation and injury, and imaging thereof, in very preterm infants. Part II discusses our experience on neonatal cUS (Chapters 2-3) and MRI (Chapter 4), and addresses indications, technical aspects, protocols and safety. Part III gives an overview of findings (incidence and evolution) on frequent, sequential neonatal cUS and term-equivalent MRI (Chapter 5), and their relation with perinatal factors (Chapter 6). Part IV focuses on imaging of white matter (Chapters 7-9), describing both normal maturational phenomena and pathological changes and assessing the accuracy of cUS and MRI for these changes. Part V focuses on imaging of deep grey matter (Chapters 10-12), describing both normal maturational phenomena and pathological changes on cUS and assessing their relation with clinical and MRI findings. Part VI reviews the main findings and conclusions of this thesis, and discusses future perspectives and proposals for further research (Chapter 13). Show less
