Leuven, Belgium


Leuven, Belgium
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Horch R.A.,Radiology | Gochberg D.F.,Radiology | Nyman J.S.,Orthopedic Surgery and Rehabilitation | Nyman J.S.,Vanderbilt University
Radiology | Year: 2015

Purpose: To translate and evaluate an in vivo magnetic resonance (MR) imaging protocol for quantitative mapping of collagen-bound and pore water concentrations in cortical bone that involves relaxation-selective ultrashort echo time (UTE) methods. Materials and Methods: All HIPAA-compliant studies were performed with institutional review board approval and written informed consent. UTE imaging sequences were implemented on a clinical 3.0-T MR imaging unit and were used for in vivo imaging of bound and pore water in cortical bone. Images of the lower leg and wrist were acquired in five volunteers each (lower leg: two men and three women aged 24, 24, 49, 30, and 26 years; wrist: two men and three women aged 31, 23, 25, 24, and 26 years) to generate bound and pore water concentration maps of the tibia and radius. Each volunteer was imaged three times, and the standard error of the measurements at the region-of-interest (ROI) level was computed as the standard deviation across studies, pooled across volunteers and ROIs. Results: Quantitative bound and pore water maps in the tibia and radius, acquired in 8-14 minutes, had per-voxel signal-tonoise ratios of 18 (bound water) and 14 (pore water) and inter-study standard errors of approximately 2 mol 1H per liter of bone at the ROI level. Conclusion: The results of this study demonstrate the feasibility of quantitatively mapping bound and pore water in vivo in human cortical bone with practical human MR imaging constraints. © RSNA, 2015.

Bishawi M.,Cardiothoracic Surgery | Moore W.,Radiology | Bilfinger T.,Cardiothoracic Surgery
Journal of Surgical Research | Year: 2013

Background: Nonesmall cell lung cancer (NSCLC) has a predilection to occur in emphysematous lungs. The relation between the regional severity of emphysema and the location of NSCLC as well as long-term survival has been poorly studied. Methods: Computed tomography (CT) scans of 153 patients with biopsy-proven stage I NSCLC diagnosed between 2001 and 2006 were assigned an emphysema severity score in four regions of the lung. The location of the cancer was compared with the severity of emphysema in that region. Survival was also analyzed. Results: Thirty-nine patients had no emphysema documented on CT scan and 114 did. The most common location of cancer was the right upper quadrant with 37% of cancers, followed by the left upper quadrant with 23% of cancers. Twenty-two percent of the cancers occurred in the right lower quadrant, and only 12% were in the left lower quadrant. There is a strong association for cancer being located in the area with the highest degree of emphysema (P < 0.001). Emphysema severity score was also associated with long-term survival (log-rank P = 0.03). Conclusions: The regional severity of emphysema assessed via a visual scale using CT appears to be associated with the location of lung cancer and is an independent predictor of long-term survival. © 2013 Elsevier Inc. All rights reserved.

Chintamaneni S.,State University of New York at Stony Brook | Finzel K.,Radiology | Gruber B.L.,York College
Osteoporosis International | Year: 2010

Fractures have a significant impact on the quality of life for the patient in addition to an enormous indirect cost in lost productivity for our economy. While majority of fractures heal uneventfully, some fail to heal even after many months resulting in nonunion. Introduction: Sternal nonunions, although rare, are particularly onerous for the patient given the magnitude of impact on quality of life. Methods: Current treatment for fracture nonunions emphasizes various approaches to surgical fixation in addition to bone grafting. These treatments are aggressive and have a variety of drawbacks, rendering them suboptimal as a therapeutic approach. Conclusion: Based on the success of teriparatide in animal studies to accelerate fracture healing, there is growing interest in using this drug in humans for the same purpose. We report a case of what we believe to be the first successful use of teriparatide in the healing of a sternal nonunion fracture. © International Osteoporosis Foundation and National Osteoporosis Foundation 2009.

Machado P.,University of Coimbra | Machado P.,Leiden University | Landewe R.,Maastricht University | Braun J.,Rheumatology | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2010

Objective: To study the relationship between spinal mobility, radiographic damage of the spine and spinal inflammation as assessed by MRI in patients with ankylosing spondylitis (AS). Methods: In this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI inflammation was assessed by the AS spinal MRI activity (ASspiMRI-a) score, structural damage by the modified Stoke AS Spine Score (mSASSS) and spinal mobility by the linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI). Univariate correlations were calculated on baseline values using Spearman rank correlation. Independent associations between the variables of interest were investigated by multivariate linear regression analysis. Associations with clinical disease activity, C-reactive protein, disease duration, age, gender, body mass index and HLA-B27 status were also investigated. Subanalyses were performed according to disease duration. Results: BASMI correlated moderately well with mSASSS (Spearman's ρ=0.6) and weakly with ASspiMRI-a (ρ=0.3). A best-fit model for BASMI included both mSASSS (regression coefficient (B)=0.865, p<0.001) and ASspiMRI-a (B=0.236, p=0.018). In patients with a disease duration ≤3 years, B was greater for ASspiMRI-a than for mSASSS (0.595 vs 0.380), while in patients with a disease duration >3 years B was greater for mSASSS than for ASspiMRI-a (0.924 vs 0.156). Conclusion: Spinal mobility impairment in AS is independently determined both by irreversible spinal damage and by reversible spinal inflammation. Spinal mobility impairment is more influenced by spinal inflammation in early disease, and by structural damage in later disease.

Cao P.,Vascular Surgery | De Rango P.,Vascular Surgery | Czerny M.,Cardiovascular Surgery | Evangelista A.,Hospital Val dHebron Barcelona | And 4 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2012

Objective: Available data on clinical outcomes of hybrid aortic arch repair are limited, especially for patients with aortic dissection. The objective of this review was to provide pooled analysis of periprocedural mortality and neurologic outcomes in hybrid procedures involving the aortic arch for dissection and other aortic diseases. Methods: Studies involving hybrid aortic arch procedures (2002-2011) were systematically searched and reviewed. End points were periprocedural mortality, stroke, and spinal cord ischemia. Results: A total of 50 studies including 1886 patients were included. Perioperative mortality ranged from 1.6% to 25.0% with a pooled event ratio of 10.8% (95% confidence intervals [CI], 9.3-12.5). Perioperative stroke, regardless of severity, ranged from 0.8% to 25.0% (pooled ratio 6.9%; 95% CI, 5.7%-8.4), and spinal cord ischemia, including permanent and transitory events, ranged from 1.0% to 25.0% (pooled ratio, 6.8%; 95% CI, 5.6-8.2). Neurologic but no mortality risk was affected by timing and center volume with decreased rates in more recent and higher volume studies. In dissected aorta, perioperative mortality rate was 9.8% (95% CI, 7.7-12.4), stroke 4.3% (95% CI, 3.0-6.3), and spinal cord ischemia 5.8% (95% CI, 4.2-7.9). Perioperative mortality was higher in diseases that extended to the ascending aorta (15.1% vs 7.6%; odds ratio, 2.8; 95% CI, 1.17-6.7; P =.021), whereas there were no significant differences in the neurologic risks of stroke or spinal cord ischemia. Conclusions: Hybrid repair of the aortic arch carries not negligible risks of perioperative mortality and neurologic morbidity. Risk of neurologic complications has decreased with timing and center volume and may be limited in dissection repairs. However, contemporary information on aortic hybrid arch procedures is mainly provided by small case series or retrospective studies with wide range of results. Copyright © 2012 by The American Association for Thoracic Surgery.

Kleinerman R.,Mount Sinai School of Medicine | Whang T.B.,Mount Sinai School of Medicine | Bard R.L.,Radiology | Marmur E.S.,Mount Sinai School of Medicine
Journal of the American Academy of Dermatology | Year: 2012

Ultrasonic imaging has been used in the field of dermatology for nearly 30 years. In this review, we seek to explain the basic principles of ultrasound as they relate to the skin. Based on differences in keratin, collagen, and water content, ultrasonic waves are reflected back to a transducer and translated into a gray-scale image for interpretation. The technicalities of the process and its variations (power, continuous wave Doppler ultrasound, ultrasound elastography) are briefly reviewed, and we further highlight many of the applications for ultrasound in the treatment and diagnosis of dermatologic conditions, including melanoma and nonmelanoma skin cancer, benign tumors, inflammatory diseases, and lipoablation. Each of these entities is uniquely characterized using ultrasonic techniques. Based on published sources, we contend that although ultrasound is still being fine-tuned for application in dermatology and largely remains in experimental phases, it has potential for use in many arenas of our specialty. © 2011 by the American Academy of Dermatology, Inc.

Grunert J.H.,Radiology
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren | Year: 2015

Purpose: Mobile radiological image display systems are becoming increasingly common, necessitating a comparison of the features of these systems, specifically the operating system employed, connection to stationary PACS, data security and rang of image display and image analysis functions. Material and methods: In the fall of 2013, a total of 17 PACS suppliers were surveyed regarding the technical features of 18 mobile radiological image display systems using a standardized questionnaire. The study also examined to what extent the technical specifications of the mobile image display systems satisfy the provisions of the Germany Medical Devices Act as well as the provisions of the German X-ray ordinance (RöV). Results: There are clear differences in terms of how the mobile systems connected to the stationary PACS.Web-based solutions allow the mobile image display systems to function independently of their operating systems. The examined systems differed very little in terms of image display and image analysis functions. Conclusion: Mobile image display systems complement stationary PACS and can be used to view images. The impacts of the new quality assurance guidelines (QS-RL) as well as the upcoming new standard DIN6868-157 on the acceptance testing of mobile image display units for the purpose of image evaluation are discussed. Key Points: • The examined mobile image display systems differ very little in terms of image display and analysis functions. • The use of web-based software allows the mobile image display systems to function independently of their operating systems. • Individual PACS suppliers enable the mobile systems to connect to the network via their own internet server. • With zero-footprint technology, no patient data remains on the viewing system once the application is closed. Citation Format: • Grunert JH. Eigenschaften und Einschränkungen mobiler radiologischer Bildwiedergabesysteme. Fortschr Röntgenstr 2015; 187: 173-179 © Georg Thieme Verlag KG Stuttgart New York.

Dicocco J.M.,Radiology | Emmett K.P.,Radiology | Fabian T.C.,Radiology | Zarzaur B.L.,Radiology | And 2 more authors.
Annals of Surgery | Year: 2011

Objective:: We sought to determine the diagnostic accuracy of computed tomographic angiography (CTA) using 32-channel multidetector computed tomography for blunt cerebrovascular injuries (BCVIs). Background:: Unrecognized BCVI is a cause of stroke in young trauma patients. Digital subtraction angiography (DSA), the reference standard, is invasive, expensive, and time-consuming. Computed tomographic angiography has been rapidly adopted by many institutions because of its availability, less resource intensive, and noninvasive nature. However, conflicting results comparing CTA and DSA have been reported. Studies with 16-channel CTA report a wide range of sensitivities for BCVI diagnosis. Methods:: From January 2007 through May 2009, patients with risk factors for BCVI underwent both CTA and DSA. All CTAs were performed using a 32-channel multidetector CT scanner. Using DSA as the reference standard, the diagnostic accuracy of CTA for determination of BCVI was calculated. Results:: There were 684 patients who met the inclusion criteria. Ninety patients (13%) had 109 injuries identified; 52 carotid and 57 vertebral injuries were diagnosed. CTA failed to detect 53 confirmed BCVI, yielding a sensitivity of 51%. Conclusion:: Given the devastation of stroke, and high mortality from missed injuries, this study demonstrates that even with more advanced technology (32 vs 16 channel), CTA is inadequate for BCVI screening. Digital subtraction angiography remains the gold standard for the diagnosis of BCVI. Copyright © 2011 by Lippincott Williams & Wilkins.

Bacchi E.,University of Verona | Negri C.,University of Verona | Targher G.,University of Verona | Faccioli N.,Radiology | And 6 more authors.
Hepatology | Year: 2013

Although lifestyle interventions are considered the first-line therapy for nonalcoholic fatty liver disease (NAFLD), which is extremely common in people with type 2 diabetes, no intervention studies have compared the effects of aerobic (AER) or resistance (RES) training on hepatic fat content in type 2 diabetic subjects with NAFLD. In this randomized controlled trial, we compared the 4-month effects of either AER or RES training on insulin sensitivity (by hyperinsulinemic euglycemic clamp), body composition (by dual-energy X-ray absorptiometry), as well as hepatic fat content and visceral (VAT), superficial (SSAT), and deep (DSAT) subcutaneous abdominal adipose tissue (all quantified by an in-opposed-phase magnetic resonance imaging technique) in 31 sedentary adults with type 2 diabetes and NAFLD. After training, hepatic fat content was markedly reduced (P<0.001), to a similar extent, in both the AER and the RES training groups (mean relative reduction from baseline [95% confidence interval] -32.8% [-58.20 to -7.52] versus -25.9% [-50.92 to -0.94], respectively). Additionally, hepatic steatosis (defined as hepatic fat content >5.56%) disappeared in about one-quarter of the patients in each intervention group (23.1% in the AER group and 23.5% in the RES group). Insulin sensitivity during euglycemic clamp was increased, whereas total body fat mass, VAT, SSAT, and hemoglobin A1c were reduced comparably in both intervention groups. Conclusion: This is the first randomized controlled study to demonstrate that resistance training and aerobic training are equally effective in reducing hepatic fat content among type 2 diabetic patients with NAFLD. © 2013 by the American Association for the Study of Liver Diseases.

Cerebral arteriovenous malformations (AVMs) are uncommon. Treatment options include embolization, radiosurgery and surgery, separately or combined, the final goal being complete occlusion of the malformation. We describe the case of a symptomatic small subependymal AVM with a single deep drainage vein previously treated unsuccessfully by radiosurgery and transarterial embolization. The AVM was successfully embolized transvenously using Onyx, achieving complete occlusion in a single treatment session.

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