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Tsai HH, Ali M, Mohindra A, Parmar S, Breik O. Outcomes of incidental pulmonary nodules detected in oral and oropharyngeal cancer patients. Br J Oral Maxillofac Surg 2024; 62:956-961. [PMID: 39414403 DOI: 10.1016/j.bjoms.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/05/2024] [Accepted: 09/24/2024] [Indexed: 10/18/2024]
Abstract
Computed tomography (CT) of the chest is routinely performed as part of head and neck cancer (HNC) staging. Pulmonary nodules incidentally encountered present a clinical dilemma, as they may indicate early malignancy. Clinically indeterminant nodules are those that cannot be classed as definitively malignant or benign. This study aimed to assess the outcomes of pulmonary nodules detected on initial staging chest CT in a consecutive cohort of patients with oral and oropharyngeal squamous cell carcinoma (SCC). A retrospective cohort study of newly diagnosed oral or oropharyngeal SCC patients with pulmonary nodules identified on staging chest CT at a single institution was conducted. Pulmonary nodules were categorised as benign, indeterminant, or malignant. Indeterminant nodules underwent further investigations with either repeat imaging or needle biopsy to exclude malignancy. Descriptive and bivariate statistics were used to evaluate the association between pulmonary metastasis and patient demographics, disease characteristics, and nodular features. P values of ≤ 0.05 were considered statistically significant. Of 579 patients diagnosed with HNC who had undergone staging chest CT between 2010 and 2015, 154 had pulmonary nodules. Indeterminant pulmonary nodules at staging in 26 patients (16.9%) were later confirmed to be lung metastases. Pulmonary nodules of subsolid type found in patients with N2/N3 disease were significantly more likely to be metastatic. Isolated pulmonary nodules in the right lung were more likely to be benign. A HNC-specific protocol for the management of incidental pulmonary nodules should now be developed to guide the interval and duration of required clinical and radiological surveillance, taking into account the disease characteristics and nodular features.
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Affiliation(s)
- Hao-Hsuan Tsai
- Department of Oral and Maxillofacial Surgery, John Hunter Hospital, Newcastle, Australia.
| | - Mahim Ali
- Department of Oral and Maxillofacial Surgery, Birmingham University Hospital, Birmingham, United Kingdom
| | - Aneesh Mohindra
- Department of Oral and Maxillofacial Surgery, Bedfordshire Hospital, Bedford, United Kingdom
| | - Sat Parmar
- Department of Oral and Maxillofacial Surgery, Birmingham University Hospital, Birmingham, United Kingdom
| | - Omar Breik
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Mahajan A, Shukla S, Nandi D, Sable N, Ankathi SK, Vaish R, Patil V, Sahu A, Bhattacharya K, Agarwal U, Pai P, Laskar SG, Chaukar D, Prabhash K, Cruz AD, Patil A, Pantvaidya G, Noronha V, Patil V, Menon N, Thiagarajan S, Chaturvedi P. CT-Based Screening for Pulmonary Metastases in Head and Neck Squamous Cell Cancers: Diagnostic Accuracy and Cost Comparison with PET-CECT. Indian J Surg Oncol 2023; 14:881-889. [PMID: 38187855 PMCID: PMC10766925 DOI: 10.1007/s13193-023-01783-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/10/2023] [Indexed: 01/09/2024] Open
Abstract
This study's objective was to compare detection rates of radiograph, computed tomography (CT), and positron emission tomography-contrast-enhanced computed tomography (PET-CECT) for pulmonary metastasis/synchronous primary lung tumors in head and neck squamous cell cancer (HNSCC) and its association with clinico-radio-pathological factors. Our retrospective study included 837 HNSCC patients from January 2012 to December 2017. Lung nodules were characterized on CT as benign, indeterminate, and metastatic. The true detection rate and statistical significance of associated risk factors were calculated. Risk factors for metastasis were determined using univariate and multivariate logistic regression models. Seventy-five (8.9%) patients had pulmonary metastasis and 3 (0.3%) had second lung primary. Detection rate of pulmonary metastasis by CT was higher (sensitivity-97.3%, specificity-97.2%) as compared to radiograph (sensitivity 49% and specificity 89%). Correlation was found between pulmonary and extra-pulmonary metastasis and N classification (P = 0.01, P = 0.02) and positive low jugular node (P = 0.001, P = 0.001). Using PET-CECT in place of CT costed an extra outlay of 7,033,805 INR (95,551.85 USD) while detecting distant metastasis in only 4 (0.47%) extra cases. Chest CT is a useful pulmonary metastases screening tool in advanced HNSCC patients with reasonable imaging cost as compared to PET-CT.
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Affiliation(s)
- Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Pembroke Place, Liverpool, L7 8YA UK
| | - Shreya Shukla
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Debanjan Nandi
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Suman Kumar Ankathi
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Richa Vaish
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Vasundhara Patil
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Arpita Sahu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Kajari Bhattacharya
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Sarbani Ghosh Laskar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Anil D.’ Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400 012 Maharashtra India
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Leto CJ, Sharbel D, Wang CW, Bone TM, Liebman RM, Byrd JK, Groves MW. Workup of Suspected Chest Metastases on 18F-FDG-PET/CT in Head and Neck Cancer: Worth the Wait? EAR, NOSE & THROAT JOURNAL 2019; 98:158-164. [PMID: 30938238 DOI: 10.1177/0145561319828315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of our study is to assess the impact of equivocal or positive positron emission tomography combined with low-dose noncontrast computed tomography (PET/CT) findings in the chest on treatment for head and neck cancer (HNC). We reviewed charts of patients presented at Augusta University's Head and Neck Tumor Board (AUTB) between 2013 and 2016 with the following exclusion criteria: <18 years, Veterans Affairs patients, those with incomplete data, and those without a history of head and neck squamous cell carcinoma. The lung/thorax sections of the radiologists' PET/CT reports were graded as "Positive, Equivocal, or Negative" for chest metastases. Patients who underwent workup for suspected chest metastases were assessed for treatment delays, changes in treatment plans, and complications. In addition, we evaluated the time between AUTB presentation and peri-treatment PET/CT to primary treatment initiation were calculated between groups. There was a total of 363 patients with PET/CT prior to treatment, the read was "Negative" in 71.3% (n = 259), "Equivocal" in 20.9% (n = 76), and "Positive" in 5.8% (n = 21). Of 272 patients with complete treatment data, 22 underwent workup for suspected chest metastases. Mean time from PET/CT to treatment initiation was 27.5 days without workup and 64.9 days with workup ( P < .0001), and from AUTB presentation was 29.1 days without workup and 62.5 days with workup ( P < .0001). Five (19.2%) patients experienced a complication from workup. Twenty (76.9%) patients had no changes in their treatment plan after workup. In conclusion, our results for potential chest metastases on PET/CT in patients with HNC are often not clear-cut. Workup of suspected chest metastasis based on PET/CT findings significantly delays primary treatment initiation and may cause serious complications.
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Affiliation(s)
- Christopher J Leto
- 1 Department of Otolaryngology-Head & Neck Surgery, Augusta University, Augusta, GA, USA
| | - Daniel Sharbel
- 1 Department of Otolaryngology-Head & Neck Surgery, Augusta University, Augusta, GA, USA
| | - Chien Wei Wang
- 2 Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tyler M Bone
- 1 Department of Otolaryngology-Head & Neck Surgery, Augusta University, Augusta, GA, USA
| | - Robert M Liebman
- 3 Department of Otolaryngology-Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Kenneth Byrd
- 1 Department of Otolaryngology-Head & Neck Surgery, Augusta University, Augusta, GA, USA
| | - Michael W Groves
- 1 Department of Otolaryngology-Head & Neck Surgery, Augusta University, Augusta, GA, USA
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Abstract
BACKGROUND Image guided transthoracic needle aspiration (TTNA) is a valuable tool used for the diagnosis of countless thoracic diseases. Computed tomography (CT) is the most common imaging modality used for guidance followed by ultrasound (US) for lesions abutting the pleural surface. Novel approaches using virtual CT guidance have recently been introduced. The objective of this review is to examine the current literature for TTNA biopsy of the lung focusing on diagnostic accuracy and safety. METHODS MEDLINE was searched from inception to October 2015 for all case series examining image guided TTNA. Articles focusing on fluoroscopic guidance as well as influence of rapid on-site evaluation (ROSE) on yield were excluded. The diagnostic accuracy, defined as the number of true positives divided by the number of biopsies done, as well as the complication rate [pneumothorax (PTX), bleeding] was examined for CT guided TTNA, US guided TTNA as well as CT guided electromagnetic navigational-TTNA (E-TTNA). Of the 490 articles recovered 75 were included in our analysis. RESULTS The overall pooled diagnostic accuracy for CT guided TTNA using 48 articles that met the inclusion and exclusion criteria was 92.1% (9,567/10,383). A similar yield was obtained examining ten articles using US guided TTNA of 88.7% (446/503). E-TTNA, being a new modality, only had one pilot study citing a diagnostic accuracy of 83% (19/23). Pooled PTX and hemorrhage rates were 20.5% and 2.8% respectively for CT guided TTNA. The PTX rate was lower in US guided TTNA at a pooled rate of 4.4%. E-TTNA showed a similar rate of PTX at 20% with no incidence of bleeding in a single pilot study available. CONCLUSIONS Image guided TTNA is a safe and accurate modality for the biopsy of lung pathology. This study found similar yield and safety profiles with the three imaging modalities examined.
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Affiliation(s)
- David M DiBardino
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny B Yarmus
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Roy W Semaan
- 1 Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA ; 2 Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Usefulness of chest CT scan for head and neck cancer. Auris Nasus Larynx 2015; 42:49-52. [DOI: 10.1016/j.anl.2014.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 12/21/2022]
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Lee P, Kupelian P, Czernin J, Ghosh P. Current concepts in F18 FDG PET/CT-based radiation therapy planning for lung cancer. Front Oncol 2012; 2:71. [PMID: 22798989 PMCID: PMC3393879 DOI: 10.3389/fonc.2012.00071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/25/2012] [Indexed: 11/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for early stage as well as locally advanced lung cancer. The use of F18 FDG PET/CT has come to the forefront of lung cancer staging and overall treatment decision-making. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information in lung cancer. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume as well as involved nodal disease. For example, accurate target delineation between tumor and atelectasis is facilitated by utilizing PET and CT imaging. Furthermore, there has been meaningful progress in incorporating metabolic information from FDG PET/CT imaging in radiation treatment planning strategies such as radiation dose escalation based on standard uptake value thresholds as well as using respiratory-gated PET and CT planning for improved target delineation of moving targets. In addition, PET/CT-based follow-up after radiation therapy has provided the possibility of early detection of local as well as distant recurrences after treatment. More research is needed to incorporate other biomarkers such as proliferative and hypoxia biomarkers in PET as well as integrating metabolic information in adaptive, patient-centered, tailored radiation therapy.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Baek SJ, Kim SH, Kwak JM, Cho JS, Shin JW, Amar AHY, Kim J. Indeterminate pulmonary nodules in rectal cancer: a recommendation for follow-up guidelines. J Surg Oncol 2012; 106:481-5. [PMID: 22457192 DOI: 10.1002/jso.23106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/27/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Incidental visualization of indeterminate pulmonary nodules is considered a clinical dilemma. METHODS We identified patients for inclusion in this study by searching for the term "indeterminate nodules" in the radiology database of rectal cancer patients who underwent surgery. Patients with definite metastatic disease were excluded. RESULTS In total, 224 patients underwent chest computerized tomography (CT) and 59 of these patients had indeterminate pulmonary nodules detected more than twice by CT scan. Six patients (10.2%) were confirmed to have metastatic lesions on follow-up evaluation. Pulmonary nodule size (P=0.028), pathologic N status (P=0.049), positive nodal status (P=0.036) and the number of positive lymph nodes (P=0.033) were significant risk factors for pulmonary metastasis. In the pulmonary metastasis group, the patients who had received adjuvant oxaliplatin-based (FOLFOX4) chemotherapy had longer intervals to developing metastasis compared to patients who had not received it. CONCLUSIONS It is not necessary to perform excessive surveillance routinely for all rectal cancer patients who have indeterminate pulmonary lesions. Intensive follow-up chest CT or other invasive diagnostic modalities should be considered only in patients with pulmonary nodules larger than 5.7 mm or positive nodal status. In addition, patients receiving adjuvant FOLFOX4 chemotherapy should be followed-up for longer periods.
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Affiliation(s)
- Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Abstract
We estimate that 30% to 40% of radiation treatment plans for cancer patients are changed when positron emission tomography (PET) scan findings are factored into the plan. The most frequent changes are upstaging of disease and the finding of new distant metastases. When a tumor demonstrates high tracer uptake, the PET scan has high accuracy in staging and in determining recurrent disease. However, the absence of tracer uptake cannot exclude residual dormant disease. Following radiation therapy, a PET scan should be delayed at least 6 weeks and preferably 3 to 4 months so that inflammation within the radiation field can dissipate. PET has resulted in changes in the gross tumor volume; however, the process remains subjective.
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Affiliation(s)
- Steven Bujenovic
- Department of Nuclear Medicine, Our Lady of the Lake, Regional Medical Center, Rouge, LA, USA
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Heerink WJ, de Bock GH, de Jonge GJ, Groen HJM, Vliegenthart R, Oudkerk M. Effect of cerium on drug metabolizing activity in rat liver. Eur Radiol 1972; 27:138-148. [PMID: 27108299 PMCID: PMC5127875 DOI: 10.1007/s00330-016-4357-8] [Citation(s) in RCA: 475] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
Abstract
Objectives To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. Methods Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis. Results For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3–43.5 %) and 24.0 % (95 % CI: 18.2–30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4–7.4 %) and 4.4 % (95 % CI: 2.7–7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified. Conclusions In CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications. Key Points • Minor complications are common in CT-guided lung biopsy • Major complication rate is low in CT-guided lung biopsy • CT-guided lung biopsy complications occur more often in core biopsy than FNA • Major complication rate is similar in core biopsy and FNA • Risk factors for FNA are larger needle diameter, smaller lesion size Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4357-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- W J Heerink
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - G H de Bock
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - G J de Jonge
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - H J M Groen
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - R Vliegenthart
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - M Oudkerk
- Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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