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Hoving AM, Mikhal J, Kuipers H, de Borst GJ, Slump CH. Development of an in vitro setup for flow studies in a stented carotid artery bifurcation. Med Biol Eng Comput 2024; 62:1165-1176. [PMID: 38155315 DOI: 10.1007/s11517-023-02977-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
To investigate flow conditions in a double-layered carotid artery stent, a bench-top in vitro flow setup including a bifurcation phantom was designed and fabricated. The geometry of the tissue-mimicking phantom was based on healthy individuals. Two identical phantoms were created using 3D-printing techniques and molding with PVA-gel. In one of them, a clinically available CGuard double-layer stent was inserted. Measurements were performed using both continuous and pulsatile flow conditions. Blood flow studies were performed using echoPIV: a novel ultrasound-based technique combined with particle image velocimetry. A maximum deviation of 3% was visible between desired and measured flow patterns. The echoPIV measurements showed promising results on visualization and quantification of blood flow in and downstream the stent. Further research could demonstrate the effects of a double-layered stent on blood flow patterns in a carotid bifurcation in detail.
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Affiliation(s)
- Astrid M Hoving
- Robotics and Mechatronics Group, TechMed Centre, University of Twente, 7500 AE, Enschede, The Netherlands.
| | - Julia Mikhal
- Health Technology and Services Research Group, TechMed Centre, University of Twente, 7500 AE, Enschede, The Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics Group, TechMed Centre, University of Twente, 7500 AE, Enschede, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, TechMed Centre, University of Twente, 7500 AE, Enschede, The Netherlands
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Voets MM, Hassink NS, Veltman J, Slump CH, Koffijberg H, Siesling S. Opportunities for personalised follow-up in breast cancer: the gap between daily practice and recurrence risk. Breast Cancer Res Treat 2024:10.1007/s10549-024-07246-5. [PMID: 38409613 DOI: 10.1007/s10549-024-07246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Follow-up guidelines barely diverge from a one-size-fits-all approach, even though the risk of recurrence differs per patient. However, the personalization of breast cancer care improves outcomes for patients. This study explores the variation in follow-up pathways in the Netherlands using real-world data to determine guideline adherence and the gap between daily practice and risk-based surveillance, to demonstrate the benefits of personalized risk-based surveillance compared with usual care. METHODS Patients with stage I-III invasive breast cancer who received surgical treatment in a general hospital between 2005 and 2020 were selected from the Netherlands Cancer Registry and included all imaging activities during follow-up from hospital-based electronic health records. Process analysis techniques were used to map patients and activities to investigate the real-world utilisation of resources and identify the opportunities for improvement. The INFLUENCE 2.0 nomogram was used for risk prediction of recurrence. RESULTS In the period between 2005 and 2020, 3478 patients were included with a mean follow-up of 4.9 years. In the first 12 months following treatment, patients visited the hospital between 1 and 5 times (mean 1.3, IQR 1-1) and received between 1 and 9 imaging activities (mean 1.7, IQR 1-2). Mammogram was the prevailing imaging modality, accounting for 70% of imaging activities. Patients with a low predicted risk of recurrence visited the hospital more often. CONCLUSIONS Deviations from the guideline were not in line with the risk of recurrence and revealed a large gap, indicating that it is hard for clinicians to accurately estimate this risk and therefore objective risk predictions could bridge this gap.
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Affiliation(s)
- Madelon M Voets
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Noa S Hassink
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Jeroen Veltman
- Multi-Modality Medical Imaging, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
- Department of Radiology, Ziekenhuisgroep Twente, Zilvermeeuw 1, 9609 PP, Almelo, The Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
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Stam LB, Linden SML, Oostveen LJ, Hansen HHG, Aquarius R, Slump CH, de Korte CL, Bartels RHMA, Prokop M, Boogaarts HD, Meijer FJA. Dynamic Computed Tomography Angiography for capturing vessel wall motion: A phantom study for optimal image reconstruction. PLoS One 2023; 18:e0293353. [PMID: 38134125 PMCID: PMC10745207 DOI: 10.1371/journal.pone.0293353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 10/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Reliably capturing sub-millimeter vessel wall motion over time, using dynamic Computed Tomography Angiography (4D CTA), might provide insight in biomechanical properties of these vessels. This may improve diagnosis, prognosis, and treatment decision making in vascular pathologies. PURPOSE The aim of this study is to determine the most suitable image reconstruction method for 4D CTA to accurately assess harmonic diameter changes of vessels. METHODS An elastic tube (inner diameter 6 mm, wall thickness 2 mm) was exposed to sinusoidal pressure waves with a frequency of 70 beats-per-minute. Five flow amplitudes were set, resulting in increasing sinusoidal diameter changes of the elastic tube, measured during three simulated pulsation cycles, using ECG-gated 4D CTA on a 320-detector row CT system. Tomographic images were reconstructed using one of the following three reconstruction methods: hybrid iterative (Hybrid-IR), model-based iterative (MBIR) and deep-learning based (DLR) reconstruction. The three reconstruction methods where based on 180 degrees (half reconstruction mode) and 360 degrees (full reconstruction mode) raw data. The diameter change, captured by 4D CTA, was computed based on image registration. As a reference metric for diameter change measurement, a 9 MHz linear ultrasound transducer was used. The sum of relative absolute differences (SRAD) between the ultrasound and 4D CTA measurements was calculated for each reconstruction method. The standard deviation was computed across the three pulsation cycles. RESULTS MBIR and DLR resulted in a decreased SRAD and standard deviation compared to Hybrid-IR. Full reconstruction mode resulted in a decreased SRAD and standard deviations, compared to half reconstruction mode. CONCLUSIONS 4D CTA can capture a diameter change pattern comparable to the pattern captured by US. DLR and MBIR algorithms show more accurate results than Hybrid-IR. Reconstruction with DLR is >3 times faster, compared to reconstruction with MBIR. Full reconstruction mode is more accurate than half reconstruction mode.
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Affiliation(s)
- Lotte B. Stam
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
| | - Sabine M. L. Linden
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Luuk J. Oostveen
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | | | - René Aquarius
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
| | - Cornelis H. Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Chris L. de Korte
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | | | - Mathias Prokop
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
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Simmering JA, de Vries M, Haalboom M, Reijnen MMPJ, Slump CH, Geelkerken RH. Geometrical Changes of the Aorta as Predictors for Thromboembolic Events After EVAR With the Anaconda Stent-Graft. J Endovasc Ther 2023; 30:904-919. [PMID: 35786215 PMCID: PMC10637097 DOI: 10.1177/15266028221105839] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Thromboembolic events (TE), including limb graft occlusion (LGO) and distal limb embolization (DLE), are common complications after endovascular aneurysm repair (EVAR). The aim of this study was to find predictors for TE in patients treated with the Anaconda stent-graft for infrarenal aneurysms. MATERIALS AND METHODS Geometrical and anatomical variables were retrospectively analyzed in a consecutive Anaconda cohort. Pre- and postoperative CT scans were used to derive geometrical parameters length, curvature, torsion, and tortuosity index (TI) from the center lumen lines (CLLs). Limb characteristics, pre-to-post EVAR and mid-term-follow-up changes in the parameters were evaluated for their predictive value for TE. RESULTS Eighty-four patients (mean age 74±8.3 years, 74 men) were enrolled. The risk of TE was lowered with pre-to-post implant decreasing TI (steps of 0.05: OR: 1.30, 95% CI: 1.01-1.66, p=0.04), pre-to-post implant decreasing mean curvature (OR: 1.08, 95% CI: 1.01-1.16, p=0.03), and a larger degree of circumferential common iliac artery (CIA) calcification (OR: 0.98, 95% CI: 0.97-1.00, p=0.03). The only LGO predictor was the caudal relocation of maximal curvature after EVAR (OR: 1.01, 95% CI: 1.00-1.01, p=0.04). Preventors of DLE were CIA diameter (OR: 0.87, 95% CI: 0.76-0.99, p=0.04), circumferential CIA calcification (OR: 0.97, 95% CI: 0.95-1.00, p=0.03), mean and maximal curvature of the preoperative aortoiliac trajectory (OR: 0.86, 95% CI: 0.79-0.94, p<0.01 and OR: 0.97, 95% CI: 0.95-1.00, p=0.03, respectively) and pre-to-postoperative decrease in mean curvature (OR: 1.11, 95% CI: 1.02-1.21, p=0.02). Midterm TE predictors were length (OR: 0.95, 95% CI: 0.89-1.01, p=0.08) and torsion maximum location (OR: 1.01, 95% CI: 0.99-1.01, p=0.10). CONCLUSION The present study confirms that treatment of infrarenal AAA with an Anaconda stent-graft is related to a relatively high TE rate which decreases with a pre-to-postoperative reduction in curvature and TI, and a larger degree of circumferential CIA calcification. In other words, more aortoiliac straightening and more circumferential CIA calcification may prevent TE development after EVAR with this stent-graft.
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Affiliation(s)
- Jaimy A. Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mattijs de Vries
- Division of Vascular Surgery, Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Marieke Haalboom
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Michel M. P. J. Reijnen
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Division of Vascular Surgery, Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Cornelis H. Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Robert H. Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Simmering JA, Koenrades MA, Slump CH, Groot Jebbink E, Zeebregts CJ, Reijnen MMPJ, Geelkerken RH. Renal and Visceral Artery Configuration During the First Year of Follow-Up After Fenestrated Aortic Aneurysm Repair Using the Anaconda Stent-graft: A Prospective Longitudinal Multicenter Study With ECG-Gated CTA Scans. J Endovasc Ther 2023:15266028231209929. [PMID: 37933525 DOI: 10.1177/15266028231209929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The performance of fenestrated endovascular aortic aneurysm repair (FEVAR) may be compromised by complications related to the dynamic vascular environment. The aim of this study was to analyze the behavior of FEVAR bridging stent configurations during the cardiac cycle and during follow-up to improve our understanding on treatment durability. DESIGN Twenty-one patients presenting with complex abdominal aortic aneurysms (AAAs; 9 juxtarenal/6 pararenal/3 paravisceral/1 thoracoabdominal aortic aneurysm type IV), treated with a fenestrated Anaconda (Terumo Aortic, Inchinnan, Scotland, UK) with Advanta V12 bridging stents (Getinge, Merrimack, NH, USA), were prospectively enrolled in a multicenter observational cohort study and underwent electrocardiogram (ECG)-gated computed tomographic angiography (CTA) preoperatively, at discharge, 7-week, and 12-month follow-ups. METHODS Fenestrated endovascular aortic aneurysm repair stability was assessed considering the following variables: branch angle as the angle between the aorta and the target artery, end-stent angle as the angle between the end of the bridging stent and the native artery downstream from it, curvature and tortuosity index (TI) to describe the bending of the target artery. Body-bridging stent stability was assessed considering bridging stent flare lengths, the distances between the proximal sealing stent-ring and fenestrations and the distance between the fenestration and first apposition in the target artery. RESULTS Renal branch angles significantly increased after FEVAR toward a perpendicular position (right renal artery from median 60.9°, inter quartile range [IQR]=44.2-84.9° preoperatively to 94.4°, IQR=72.6-99.8°, p=0.001 at 12-month follow-up; left renal artery [LRA], from 63.7°, IQR=55.0-73.0° to 94.3°, IQR=68.2-105.6°, p<0.001), while visceral branch angles did not. The mean dynamic curvature only decreased for the LRA from preoperative (3.0, IQR=2.2-3.8 m-1) to 12-month follow-up (1.9, IQR=1.4-2.6 m-1, p=0.027). The remaining investigated variables did not seem to show any changes over time in this cohort. CONCLUSIONS Fenestrated endovascular aortic aneurysm repair for complex AAAs using the Anaconda fenestrated stent-graft and balloon-expandable Advanta V12 bridging stents demonstrated stable configurations up to 12-month follow-up, except for increasing renal branch angles toward perpendicular orientation to the aorta, yet without apparent clinical consequences in this cohort. CLINICAL IMPACT This study provides detailed information on the cardiac-pulsatility-induced (dynamic) and longitudinal geometry deformations of the target arteries and bridging stents after fenestrated endovascular aortic aneurysm repair (FEVAR) up to 12-month follow-up. The configuration demonstrated limited dynamic and longitudinal deformations in terms of branch angle, end-stent angle, curvature, and tortuosity index (TI), except for the increasing renal branch angles that go toward a perpendicular orientation to the aorta. Overall, the results suggest that the investigated FEVAR configurations are stable and durable, though careful consideration of increasing renal branch angles and significant geometry alterations is advised.
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Affiliation(s)
- Jaimy A Simmering
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maaike A Koenrades
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Medical 3D Lab, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Erik Groot Jebbink
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michel M P J Reijnen
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Robert H Geelkerken
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Simmering JA, Zagers DA, Geelkerken RH, Kuipers H, te Riet o.g. Scholten GA, Reijnen MM, Slump CH. The influence of electrocardiogram-gated computed tomography reconstruction into 8 or 10 cardiac phases on cardiac-pulsatility-induced motion quantification of stent grafts in the aorta. JVS Vasc Sci 2023; 4:100131. [PMID: 38033397 PMCID: PMC10682660 DOI: 10.1016/j.jvssci.2023.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objective The goal of this study was to determine to what extent aortic stent graft motion quantification is comparable between electrocardiogram (ECG)-gated computed tomography (CT) scans with reconstructions into 8 and 10 cardiac phases on CT scanners from two different vendors. Methods An experimental setup that induces motion of an aortic stent graft, according to a predefined aortic blood pressure wave, was placed in two CT scanners of different vendors. The stent graft motion was captured using an ECG-gated CT technique and quantified using dedicated analysis algorithms. The calculated motion amplitudes and total traveled path lengths of stent segmentations were compared between scans reconstructed into 8 and 10 phases and between the scanners, after validation with sensor measurements and repeated measurements. Results No difference in motion amplitudes in z-direction (craniocaudal direction) was observed between the reconstructions into 8 and 10 phases (0.02 mm; 95% confidence interval [CI], -0.01 to 0.05 mm; P = .358). The z-amplitudes differed by 0.04 mm (95% CI, 0.01-0.07 mm; P = .003) between the different CT scanners. Path lengths differed 0.07 mm (95% CI, 0.01-to 0.13 mm; P = .013) between the reconstructions into 8 and 10 phases and 0.13 mm (95% CI, 0.06-0.17 mm; P < .001) between the different scanners. Conclusions The motion amplitudes can accurately be compared between 8 and 10 phases and between the two scanners, without differences larger than the voxel size of 0.3 × 0.3 × 0.5 mm. Clinical motion analysis results of different ECG-gated CT scans and CT scanners can be compared up to the accuracy of the CT scan.
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Affiliation(s)
- Jaimy A. Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Deborah A. Zagers
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Robert H. Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Gerben A. te Riet o.g. Scholten
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Michel M.P.J. Reijnen
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Cornelis H. Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Hogenes AM, Slump CH, te Riet o. g. Scholten GA, Stommel MWJ, Fütterer JJ, Verdaasdonk RM. The Effect of Partial Electrical Insulation of the Tip and Active Needle Length of Monopolar Irreversible Electroporation Electrodes on the Electric Field Line Pattern and Temperature Gradient to Improve Treatment Control. Cancers (Basel) 2023; 15:4280. [PMID: 37686556 PMCID: PMC10486353 DOI: 10.3390/cancers15174280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Unintentional local temperature effects can occur during irreversible electroporation (IRE) treatment, especially near the electrodes, and most frequently near the tip. Partial electrical insulation of the IRE electrodes could possibly control these temperature effects. This study investigated and visualized the effect of partial electrical insulation applied to the IRE electrodes on the electric field line pattern and temperature gradient. Six designs of (partial) electrical insulation of the electrode tip and/or active needle length (ANL) of the original monopolar 19G IRE electrodes were investigated. A semolina in castor oil model was used to visualize the electric field line pattern in a high-voltage static electric field. An optical method to visualize a change in temperature gradient (color Schlieren) was used to image the temperature development in a polyacrylamide gel. Computational models were used to support the experimental findings. Around the electrode tip, the highest electric field line density and temperature gradient were present. The more insulation was applied to the electrodes, the higher the resistance. Tip and ANL insulation together reduced the active area of and around the electrodes, resulting in a visually enlarged area that showed a change in temperature gradient. Electrically insulating the electrode tip together with an adjustment in IRE parameter settings could potentially reduce the uncontrollable influence of the tip and may improve the predictability of the current pathway development.
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Affiliation(s)
- Annemiek M. Hogenes
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101 (766), 6500 HB Nijmegen, The Netherlands
| | - Cornelis H. Slump
- Department of Robotics and Mechatronics, University of Twente, 7522 NB Enschede, The Netherlands
| | | | - Martijn W. J. Stommel
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101 (766), 6500 HB Nijmegen, The Netherlands
- Department of Robotics and Mechatronics, University of Twente, 7522 NB Enschede, The Netherlands
| | - Rudolf M. Verdaasdonk
- Department of Health Technology Implementation, TechMed Center, University of Twente, 7522 NB Enschede, The Netherlands
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van Dalen JA, Koenders SS, Metselaar RJ, Vendel BN, Slotman DJ, Mouden M, Slump CH, van Dijk JD. Machine learning based model to diagnose obstructive coronary artery disease using calcium scoring, PET imaging, and clinical data. J Nucl Cardiol 2023; 30:1504-1513. [PMID: 36622542 DOI: 10.1007/s12350-022-03166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Accurate risk stratification in patients with suspected stable coronary artery disease is essential for choosing an appropriate treatment strategy. Our aim was to develop and validate a machine learning (ML) based model to diagnose obstructive CAD (oCAD). METHOD We retrospectively have included 1007 patients without a prior history of CAD who underwent CT-based calcium scoring (CACS) and a Rubidium-82 PET scan. The entire dataset was split 4:1 into a training and test dataset. An ML model was developed on the training set using fivefold stratified cross-validation. The test dataset was used to compare the performance of expert readers to the model. The primary endpoint was oCAD on invasive coronary angiography (ICA). RESULTS ROC curve analysis showed an AUC of 0.92 (95% CI 0.90-0.94) for the training dataset and 0.89 (95% CI 0.84-0.93) for the test dataset. The ML model showed no significant differences as compared to the expert readers (p ≥ 0.03) in accuracy (89% vs. 88%), sensitivity (68% vs. 69%), and specificity (92% vs. 90%). CONCLUSION The ML model resulted in a similar diagnostic performance as compared to expert readers, and may be deployed as a risk stratification tool for obstructive CAD. This study showed that utilization of ML is promising in the diagnosis of obstructive CAD.
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Affiliation(s)
- J A van Dalen
- Department of Medical Physics, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
| | - S S Koenders
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - R J Metselaar
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - B N Vendel
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - D J Slotman
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - M Mouden
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - C H Slump
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
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Krol JP, Veerbeek T, Deden LN, Joosten FB, Slump CH, Oyen WJ. Preoperative imaging in primary hyperparathyroidism patients using 4DCT subtraction maps, a report of three cases. Radiol Case Rep 2023; 18:2814-2822. [PMID: 37388258 PMCID: PMC10300484 DOI: 10.1016/j.radcr.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023] Open
Abstract
Four-dimensional computed tomography (4DCT) is one of the preoperative imaging modalities that can be used to localize a parathyroid adenoma in primary hyperparathyroidism patients however, sensitivity differs in literature and could be improved especially for multiglandular hyperplasia or double adenomas. The most robust feature on the 4DCT for the differentiation between parathyroid adenoma and thyroid gland tissue is arterial enhancement. To make this better visible, we have developed a subtraction map that shows arterial enhancement as a color scale to increase sensitivity for 4DCT. In this report of 3 cases, we present the usefulness of this subtraction map in a 54-year-old male, a 57-year-old female and a 51-year-old male. Subtraction maps may increase sensitivity for 4DCT, especially for multiglandular hyperplasia or double adenomas.
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Affiliation(s)
- Jorian P. Krol
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, University of Twente, Enschede, The Netherlands
| | - Tessa Veerbeek
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, University of Twente, Enschede, The Netherlands
| | - Laura N. Deden
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frank B.M. Joosten
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Cornelis H. Slump
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, University of Twente, Enschede, The Netherlands
| | - Wim J.G. Oyen
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
- Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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10
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Noortman WA, Aide N, Vriens D, Arkes LS, Slump CH, Boellaard R, Goeman JJ, Deroose CM, Machiels JP, Licitra LF, Lhommel R, Alessi A, Woff E, Goffin K, Le Tourneau C, Gal J, Temam S, Delord JP, van Velden FHP, de Geus-Oei LF. Development and External Validation of a PET Radiomic Model for Prognostication of Head and Neck Cancer. Cancers (Basel) 2023; 15:2681. [PMID: 37345017 DOI: 10.3390/cancers15102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/23/2023] Open
Abstract
AIM To build and externally validate an [18F]FDG PET radiomic model to predict overall survival in patients with head and neck squamous cell carcinoma (HNSCC). METHODS Two multicentre datasets of patients with operable HNSCC treated with preoperative afatinib who underwent a baseline and evaluation [18F]FDG PET/CT scan were included (EORTC: n = 20, Unicancer: n = 34). Tumours were delineated, and radiomic features were extracted. Each cohort served once as a training and once as an external validation set for the prediction of overall survival. Supervised feature selection was performed using variable hunting with variable importance, selecting the top two features. A Cox proportional hazards regression model using selected radiomic features and clinical characteristics was fitted on the training dataset and validated in the external validation set. Model performances are expressed by the concordance index (C-index). RESULTS In both models, the radiomic model surpassed the clinical model with validation C-indices of 0.69 and 0.79 vs. 0.60 and 0.67, respectively. The model that combined the radiomic features and clinical variables performed best, with validation C-indices of 0.71 and 0.82. CONCLUSION Although assessed in two small but independent cohorts, an [18F]FDG-PET radiomic signature based on the evaluation scan seems promising for the prediction of overall survival for HNSSC treated with preoperative afatinib. The robustness and clinical applicability of this radiomic signature should be assessed in a larger cohort.
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Affiliation(s)
- Wyanne A Noortman
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Nicolas Aide
- Nuclear Medicine Department, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Dennis Vriens
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa S Arkes
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Technical Medicine, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Cornelis H Slump
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Ronald Boellaard
- Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Christophe M Deroose
- Nuclear Medicine and Molecular Imaging, Department of Imaging & Pathology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
- Institute for Experimental and Clinical Research (IREC, pôle MIRO), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium
| | - Lisa F Licitra
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, 20133 Milan, Italy
| | - Renaud Lhommel
- Division of Nuclear Medicine, Institut de Recherche Clinique, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium
| | - Alessandra Alessi
- Department of Nuclear Medicine-PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B.), 1070 Bruxelles, Belgium
| | - Karolien Goffin
- Nuclear Medicine and Molecular Imaging, Department of Imaging & Pathology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris-Saclay University, 75005 Paris, France
| | - Jocelyn Gal
- Epidemiology and Biostatistics Department, Centre Antoine Lacassagne, University Côte d'Azur, 06100 Nice, France
| | - Stéphane Temam
- Department of Head and Neck Surgery Gustave Roussy, 94805 Villejuif, France
| | | | - Floris H P van Velden
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, 2628 CD Delft, The Netherlands
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11
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Hogenes AM, Overduin CG, Slump CH, van Laarhoven CJHM, Fütterer JJ, ten Broek RPG, Stommel MWJ. The Influence of Irreversible Electroporation Parameters on the Size of the Ablation Zone and Thermal Effects: A Systematic Review. Technol Cancer Res Treat 2023; 22:15330338221125003. [PMID: 36598035 PMCID: PMC9830580 DOI: 10.1177/15330338221125003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: The aim of this study was to review the effect of irreversible electroporation parameter settings on the size of the ablation zone and the occurrence of thermal effects. This insight would help to optimize treatment protocols and effectively ablate a tumor while controlling the occurrence of thermal effects. Methods: Various individual studies report the influence of variation in electroporation parameters on the ablation zone size or occurrence of thermal effects. However, no connections have yet been established between these studies. With the aim of closing the gap in the understanding of and personalizing irreversible electroporation parameter settings, a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A quality assessment was performed using an in-house developed grading tool based on components of commonly used grading domains. Data on the electroporation parameters voltage, number of electrodes, inter-electrode distance, active needle length, pulse length/number/protocol/frequency, and pulse interval were extracted. Ablation zone size and temperature data were grouped per parameter. Spearman correlation and linear regression were used to define the correlation with outcome measures. Results: A total of 7661 articles were screened, of which 18 preclinical studies (animal and phantom studies) met the inclusion criteria. These studies were graded as moderate (4/18) and low (14/18) quality. Only the applied voltage appeared to be a significant linear predictor of ablation zone size: length, surface, and volume. The pulse number was moderately but nonlinearly correlated with the ablation zone length. Thermal effects were more likely to occur for higher voltages (≥2000 V), higher number of electrodes, and increased active needle length. Conclusion: Firm conclusions are limited since studies that investigated and precisely reported the influence of electroporation parameters on the ablation zone size and thermal effects were scarce and mostly graded low quality. High-quality studies are needed to improve the predictability of the combined effect of variation in parameter combinations and optimize irreversible electroporation treatment protocols.
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Affiliation(s)
- Annemiek M Hogenes
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Annemiek M Hogenes, MSc, Department of Medical Imaging, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. box 9101 (766), 6500 HB Nijmegen, The Netherlands.
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | | | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | | | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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12
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van den Noort F, Manzini C, Hofsteenge M, Sirmacek B, van der Vaart CH, Slump CH. Unsupervised convolutional autoencoders for 4D transperineal ultrasound classification. J Med Imaging (Bellingham) 2023; 10:014004. [PMID: 36785585 PMCID: PMC9921518 DOI: 10.1117/1.jmi.10.1.014004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/23/2023] [Indexed: 02/13/2023] Open
Abstract
Purpose 4D Transperineal ultrasound (TPUS) is used to examine female pelvic floor disorders. Muscle movement, like performing a muscle contraction or a Valsalva maneuver, can be captured on TPUS. Our work investigates the possibility for unsupervised analysis and classification of the TPUS data. Approach An unsupervised 3D-convolutional autoencoder is trained to compress TPUS volume frames into a latent feature vector (LFV) of 128 elements. The (co)variance of the features are analyzed and statistical tests are performed to analyze how features contribute in storing contraction and Valsalva information. Further dimensionality reduction is applied (principal component analysis or a 2D-convolutional autoencoder) to the LFVs of the frames of the TPUS movie to compress the data and analyze the interframe movement. Clustering algorithms ( K -means clustering and Gaussian mixture models) are applied to this representation of the data to investigate the possibilities of unsupervised classification. Results The majority of the features show a significant difference between contraction and Valsalva. The (co)variance of the features from the LFVs was investigated and features most prominent in capturing muscle movement were identified. Furthermore, the first principal component of the frames from a single TPUS movie can be used to identify movement between the frames. The best classification results were obtained after applying principal component analysis and Gaussian mixture models to the LFVs of the TPUS movies, yielding a 91.2% accuracy. Conclusion Unsupervised analysis and classification of TPUS data yields relevant information about the type and amount of muscle movement present.
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Affiliation(s)
- Frieda van den Noort
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, The Netherlands
| | - Claudia Manzini
- University Medical Centre Utrecht, Department of Obstetrics and Gynecology, Utrecht, The Netherlands
| | - Merijn Hofsteenge
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, The Netherlands
| | - Beril Sirmacek
- Saxion University of Applied Sciences, School of Creative Technology, Smart Cities Group, Enschede, The Netherlands
| | - Carl H. van der Vaart
- University Medical Centre Utrecht, Department of Obstetrics and Gynecology, Utrecht, The Netherlands
| | - Cornelis H. Slump
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, The Netherlands
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13
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van den Noort F, Manzini C, van der Vaart CH, van Limbeek MAJ, Slump CH, Grob ATM. Reply. Ultrasound Obstet Gynecol 2022; 60:589-590. [PMID: 36183346 DOI: 10.1002/uog.26056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- F van den Noort
- Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - C Manzini
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C H van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M A J van Limbeek
- Dynamics of Complex Fluids, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - C H Slump
- Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - A T M Grob
- Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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14
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Noortman WA, Vriens D, de Geus-Oei LF, Slump CH, Aarntzen EH, van Berkel A, Timmers HJLM, van Velden FHP. [ 18F]FDG-PET/CT radiomics for the identification of genetic clusters in pheochromocytomas and paragangliomas. Eur Radiol 2022; 32:7227-7236. [PMID: 36001126 PMCID: PMC9474528 DOI: 10.1007/s00330-022-09034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/15/2022] [Accepted: 07/16/2022] [Indexed: 11/04/2022]
Abstract
Objectives Based on germline and somatic mutation profiles, pheochromocytomas and paragangliomas (PPGLs) can be classified into different clusters. We investigated the use of [18F]FDG-PET/CT radiomics, SUVmax and biochemical profile for the identification of the genetic clusters of PPGLs. Methods In this single-centre cohort, 40 PPGLs (13 cluster 1, 18 cluster 2, 9 sporadic) were delineated using a 41% adaptive threshold of SUVpeak ([18F]FDG-PET) and manually (low-dose CT; ldCT). Using PyRadiomics, 211 radiomic features were extracted. Stratified 5-fold cross-validation for the identification of the genetic cluster was performed using multinomial logistic regression with dimensionality reduction incorporated per fold. Classification performances of biochemistry, SUVmax and PET(/CT) radiomic models were compared and presented as mean (multiclass) test AUCs over the five folds. Results were validated using a sham experiment, randomly shuffling the outcome labels. Results The model with biochemistry only could identify the genetic cluster (multiclass AUC 0.60). The three-factor PET model had the best classification performance (multiclass AUC 0.88). A simplified model with only SUVmax performed almost similarly. Addition of ldCT features and biochemistry decreased the classification performances. All sham AUCs were approximately 0.50. Conclusion PET radiomics achieves a better identification of PPGLs compared to biochemistry, SUVmax, ldCT radiomics and combined approaches, especially for the differentiation of sporadic PPGLs. Nevertheless, a model with SUVmax alone might be preferred clinically, weighing model performances against laborious radiomic analysis. The limited added value of radiomics to the overall classification performance for PPGL should be validated in a larger external cohort. Key Points • Radiomics derived from [18F]FDG-PET/CT has the potential to improve the identification of the genetic clusters of pheochromocytomas and paragangliomas. • A simplified model with SUVmaxonly might be preferred clinically, weighing model performances against the laborious radiomic analysis. • Cluster 1 and 2 PPGLs generally present distinctive characteristics that can be captured using [18F]FDG-PET imaging. Sporadic PPGLs appear more heterogeneous, frequently resembling cluster 2 PPGLs and occasionally resembling cluster 1 PPGLs. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-09034-5.
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Affiliation(s)
- Wyanne A Noortman
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands. .,TechMed Centre, University of Twente, Enschede, the Netherlands.
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.,TechMed Centre, University of Twente, Enschede, the Netherlands.,Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erik H Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anouk van Berkel
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henri J L M Timmers
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Floris H P van Velden
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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15
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Koenders SS, van Dijk JD, Jager PL, Mouden M, Tegelaar AG, Slump CH, van Dalen JA. Effect of temporal sampling protocols on myocardial blood flow measurements using Rubidium-82 PET. J Nucl Cardiol 2022; 29:1729-1741. [PMID: 33655444 PMCID: PMC9345838 DOI: 10.1007/s12350-021-02555-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A variety of temporal sampling protocols is used worldwide to measure myocardial blood flow (MBF). Both the length and number of time frames in these protocols may alter MBF and myocardial flow reserve (MFR) measurements. We aimed to assess the effect of different clinically used temporal sampling protocols on MBF and MFR quantification in Rubidium-82 (Rb-82) PET imaging. METHODS We retrospectively included 20 patients referred for myocardial perfusion imaging using Rb-82 PET. A literature search was performed to identify appropriate sampling protocols. PET data were reconstructed using 14 selected temporal sampling protocols with time frames of 5-10 seconds in the first-pass phase and 30-120 seconds in the tissue phase. Rest and stress MBF and MFR were calculated for all protocols and compared to the reference protocol with 26 time frames. RESULTS MBF measurements differed (P ≤ 0.003) in six (43%) protocols in comparison to the reference protocol, with mean absolute relative differences up to 16% (range 5%-31%). Statistically significant differences were most frequently found for protocols with tissue phase time frames < 90 seconds. MFR did not differ (P ≥ 0.11) for any of the protocols. CONCLUSIONS Various temporal sampling protocols result in different MBF values using Rb-82 PET. MFR measurements were more robust to different temporal sampling protocols.
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Affiliation(s)
- S S Koenders
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- Technical Medical Center, University of Twente, Enschede, The Netherlands.
| | - J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - M Mouden
- Department of Cardiology, Isala hospital, Zwolle, The Netherlands
| | - A G Tegelaar
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - C H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala hospital, Zwolle, The Netherlands
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16
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van Helvert M, Simmering JA, Koenrades MA, Slump CH, Heyligers JM, Geelkerken RH, Reijnen MM. Evaluation of electrocardiogram-gated computed tomography angiography to quantify changes in geometry and dynamic behavior of the iliac artery after placement of the Gore Excluder Iliac Branch Endoprosthesis. J Cardiovasc Surg (Torino) 2022; 63:454-463. [PMID: 35005875 DOI: 10.23736/s0021-9509.22.11980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE) is designed to treat iliac aneurysms with preservation of blood flow through the internal iliac artery (IIA). Little is known about the influence of IBE placement on the IIA geometry. This study aimed to provide detailed insights in the dynamic behavior and geometry of the common iliac artery (CIA) and IIA trajectory and how these are influenced after treatment with an IBE. METHODS Pre- and postoperative electrocardiogram-gated computed tomography angiography (ECG-gated CTA) scans were acquired in a prospective study design and analyzed with in-house written algorithms designed for aorto-iliac and endoprosthesis deformation evaluation. Cardiac pulsatility-induced motion patterns and pathlengths were computed by tracking predefined locations on the aorto-iliac tract. Centerlines through the CIA-IIA trajectory were used to investigate the static and dynamic geometry, including curvature, torsion, length and Tortuosity Index (TI). RESULTS Fourteen CIA-IIA trajectories were analyzed before and after IBE placement. Cardiac pulsatility-induced motion and pathlengths increased after IBE placement, especially at mid IIA and the first IIA bifurcation (P≤0.04). After IBE placement, static and dynamic curvature, length and TI decreased significantly (P<0.05). Furthermore, the average dynamic torsion increased significantly (P=0.030). The remaining geometrical outcomes were not statistically significant. CONCLUSIONS The placement of an IBE device stiffens and straightens the CIA-IIA trajectory. Its relation with clinical outcome is yet to be investigated, which can be done thoroughly with the ECG-gated CTA algorithms used in this study.
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Affiliation(s)
- Majorie van Helvert
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jaimy A Simmering
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands -
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Maaike A Koenrades
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Medical Technology, Medical 3D lab, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Jan M Heyligers
- Department of Vascular Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Robert H Geelkerken
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Michel M Reijnen
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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17
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Coorens NA, Daemen JHT, Slump CH, Janssen N, Jansen Y, Maessen JG, Vissers YLJ, Hulsewé KWE, de Loos ER. Predicting Aesthetic Outcome of the Nuss Procedure in Patients with Pectus Excavatum. Semin Thorac Cardiovasc Surg 2022; 35:627-637. [PMID: 35718221 DOI: 10.1053/j.semtcvs.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/07/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Abstract
Patients suffering from pectus excavatum often experience psychosocial distress due to perceived anomalies in their physical appearance. The ability to visually inform patients about their expected aesthetic outcome after surgical correction is still lacking. This study aims to develop an automatic, patient-specific model to predict aesthetic outcome after the Nuss procedure. Patients prospectively received preoperative and postoperative 3-dimensional optical surface scanning of their chest during the Nuss procedure. A prediction model was composed based on nonlinear least squares data-fitting, regression methods and a 2-dimensional Gaussian function with adjustable amplitude, variance, rotation, skewness, and kurtosis components. Morphological features of pectus excavatum were extracted from preoperative images using a previously developed surface analysis tool to generate a patient-specific model. Prediction accuracy was evaluated through cross-validation, utilizing the mean root squared deviation and maximum positive and negative deviations as performance measures. The prediction model was evaluated on 30 (90% male) prospectively imaged patients. The model achieved an average root mean squared deviation of 6.3 ± 2.0 mm, with average maximum positive and negative deviations of 12.7 ± 6.1 and -10.2 ± 5.7 mm, respectively, between the predicted and actual postoperative aesthetic result. Our developed 2-dimensional Gaussian model based on 3-dimensional optical surface images is a clinically promising tool to predict postsurgical aesthetic outcome in patients with pectus excavatum. Prediction of the aesthetic outcome after the Nuss procedure potentially improves information provision and expectation management among patients. Further research should assess whether increasing the sample size may reduce deviations and improve performance.
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Affiliation(s)
- Nadine A Coorens
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands; Faculty of Science and Technology (S&T), University of Twente, Enschede, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
| | - Cornelis H Slump
- Faculty of Science and Technology (S&T), University of Twente, Enschede, The Netherlands
| | - Nicky Janssen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Yanina Jansen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
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Kamphuis ME, Kuipers H, Verschoor J, van Hespen JCG, Greuter MJW, Slart RHJA, Slump CH. Development of a dynamic myocardial perfusion phantom model for tracer kinetic measurements. EJNMMI Phys 2022; 9:31. [PMID: 35467161 PMCID: PMC9038974 DOI: 10.1186/s40658-022-00458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Absolute myocardial perfusion imaging (MPI) is beneficial in the diagnosis and prognosis of patients with suspected or known coronary artery disease. However, validation and standardization of perfusion estimates across centers is needed to ensure safe and adequate integration into the clinical workflow. Physical myocardial perfusion models can contribute to this clinical need as these can provide ground-truth validation of perfusion estimates in a simplified, though controlled setup. This work presents the design and realization of such a myocardial perfusion phantom and highlights initial performance testing of the overall phantom setup using dynamic single photon emission computed tomography. RESULTS Due to anatomical and (patho-)physiological representation in the 3D printed myocardial perfusion phantom, we were able to acquire 22 dynamic MPI datasets in which 99mTc-labelled tracer kinetics was measured and analyzed using clinical MPI software. After phantom setup optimization, time activity curve analysis was executed for measurements with normal myocardial perfusion settings (1.5 mL/g/min) and with settings containing a regional or global perfusion deficit (0.8 mL/g/min). In these measurements, a specific amount of activated carbon was used to adsorb radiotracer in the simulated myocardial tissue. Such mimicking of myocardial tracer uptake and retention over time satisfactorily matched patient tracer kinetics. For normal perfusion levels, the absolute mean error between computed myocardial blood flow and ground-truth flow settings ranged between 0.1 and 0.4 mL/g/min. CONCLUSION The presented myocardial perfusion phantom is a first step toward ground-truth validation of multimodal, absolute MPI applications in the clinical setting. Its dedicated and 3D printed design enables tracer kinetic measurement, including time activity curve and potentially compartmental myocardial blood flow analysis.
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Affiliation(s)
- Marije E Kamphuis
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands.
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Jacqueline Verschoor
- Department of Nuclear Medicine, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - Johannes C G van Hespen
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Marcel J W Greuter
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands.,Medical Imaging Centre, Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
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19
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Simmering JA, Leeuwerke SJG, Meerwaldt R, Zeebregts CJ, Slump CH, Geelkerken RH. In Vivo Quantification of Cardiac-Pulsatility-Induced Motion Before and After Double-Branched Endovascular Aortic Arch Repair. J Endovasc Ther 2022:15266028221086474. [PMID: 35352980 DOI: 10.1177/15266028221086474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Relay®Branch stent-graft (Terumo Aortic, Sunrise, FL, USA) offers a custom-made endovascular solution for complex aortic arch pathologies. In this technical note, a modified electrocardiography (ECG)-gated computed tomography (CT)-based algorithm was applied to quantify cardiac-pulsatility-induced changes of the aortic arch geometry and motion before and after double-branched endovascular repair (bTEVAR) of an aortic arch aneurysm. This software algorithm has the potential to provide novel and clinically relevant insights in the influence of bTEVAR on aortic anatomy, arterial compliance, and stent-graft dynamics.
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Affiliation(s)
- Jaimy A Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Steven J G Leeuwerke
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Robbert Meerwaldt
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Robert H Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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20
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Verschuur AS, Boswinkel V, Tax CM, Osch JA, Nijholt IM, Slump CH, Vries LS, Wezel‐Meijler G, Leemans A, Boomsma MF. Improved neonatal brain MRI segmentation by interpolation of motion corrupted slices. J Neuroimaging 2022; 32:480-492. [PMID: 35253956 PMCID: PMC9314603 DOI: 10.1111/jon.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anouk S. Verschuur
- Department of Radiology Isala Zwolle The Netherlands
- Image Sciences Institute University Medical Center Utrecht Utrecht The Netherlands
| | - Vivian Boswinkel
- Women and Children's Hospital Isala Zwolle The Netherlands
- UMC Utrecht Brain Center Utrecht University Utrecht The Netherlands
| | - Chantal M.W. Tax
- Image Sciences Institute University Medical Center Utrecht Utrecht The Netherlands
- Cardiff University Brain Research Imaging Centre Cardiff UK
| | | | | | - Cornelis H. Slump
- Department of Robotics and Mechatronics University of Twente Enschede The Netherlands
| | - Linda S. Vries
- Department of Neonatology Wilhelmina Children's Hospital Utrecht The Netherlands
| | | | - Alexander Leemans
- Image Sciences Institute University Medical Center Utrecht Utrecht The Netherlands
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21
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Voets MM, Veltman J, Slump CH, Siesling S, Koffijberg H. Systematic Review of Health Economic Evaluations Focused on Artificial Intelligence in Healthcare: The Tortoise and the Cheetah. Value Health 2022; 25:340-349. [PMID: 35227444 DOI: 10.1016/j.jval.2021.11.1362] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to systematically review recent health economic evaluations (HEEs) of artificial intelligence (AI) applications in healthcare. The aim was to discuss pertinent methods, reporting quality and challenges for future implementation of AI in healthcare, and additionally advise future HEEs. METHODS A systematic literature review was conducted in 2 databases (PubMed and Scopus) for articles published in the last 5 years. Two reviewers performed independent screening, full-text inclusion, data extraction, and appraisal. The Consolidated Health Economic Evaluation Reporting Standards and Philips checklist were used for the quality assessment of included studies. RESULTS A total of 884 unique studies were identified; 20 were included for full-text review, covering a wide range of medical specialties and care pathway phases. The most commonly evaluated type of AI was automated medical image analysis models (n = 9, 45%). The prevailing health economic analysis was cost minimization (n = 8, 40%) with the costs saved per case as preferred outcome measure. A total of 9 studies (45%) reported model-based HEEs, 4 of which applied a time horizon >1 year. The evidence supporting the chosen analytical methods, assessment of uncertainty, and model structures was underreported. The reporting quality of the articles was moderate as on average studies reported on 66% of Consolidated Health Economic Evaluation Reporting Standards items. CONCLUSIONS HEEs of AI in healthcare are limited and often focus on costs rather than health impact. Surprisingly, model-based long-term evaluations are just as uncommon as model-based short-term evaluations. Consequently, insight into the actual benefits offered by AI is lagging behind current technological developments.
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Affiliation(s)
- Madelon M Voets
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Jeroen Veltman
- Multi-Modality Medical Imaging, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Radiology, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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22
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van der Riet C, Schuurmann RCL, Bokkers RPH, van der Zijden FA, Tielliu IFJ, Slump CH, de Vries JPPM. In Vitro Geometry Analysis of Fenestrations in Endovascular Aneurysm Repair. J Endovasc Ther 2022; 30:204-213. [PMID: 35227104 PMCID: PMC10052373 DOI: 10.1177/15266028221079755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Changes in the flared end of balloon-expandable covered stent (BECS) may precede BECS-associated complications but are not regularly assessed with computed tomographic angiography (CTA) after fenestrated endovascular aneurysm repair (FEVAR). Validation of the flare geometric analysis (FGA) and assessment of intraobserver and interobserver variability are investigated in this study. METHODS Two series of 3 BeGraft BECSs (Bentley InnoMed GmbH, Hechingen, Germany) and 1 series of 3 Advanta V12 BECSs (Getinge AB, Göteborg, Sweden) were deployed in 3 side branches (45°, 60°, and 90° aortic branch angles) of an aorta phantom model. A standard post-FEVAR CTA scan was acquired. Computed tomographic angiography-derived measurements consisted of centerline reconstructions and placement of 3-dimensional coordinate markers by 2 observers in a vascular workstation. Flare geometric analysis calculates 3 BECS parameters: the circumferential flare-to-fenestration distance (FFD), which is the distance from the proximal end of the flare to fenestration, and diameters at the proximal end of the flare (Dflare) and at the fenestration (Dfenestration). Computed tomographic angiography-derived measurements were validated against microscopy measurements. Bland-Altman plots were used to determine the intraobserver and interobserver variability of the BECS parameters and intraclass correlation coefficient (ICC). RESULTS For each BECS, the FFD at 4 equidistant quadrants of the circumference, Dflare, and Dfenestration were calculated. The mean difference and repeatability coefficient (RC) of the validation were 0.8 (2.1) mm for FFD, 0.4 (1.0) mm for Dflare, and -0.2 (1.2) mm for Dfenestration. The mean intraobserver and interobserver difference (RC) was 0.5 (1.6) mm and 0.7 (2.6) mm for FFD, 0.1 (0.6) mm and 0.1 (0.7) mm for Dflare, and -0.1 (0.8) mm and -0.8 (1.0) mm for Dfenestration. The mean ICC of intraobserver variability was 0.86 for FFD, 0.94 for Dflare, and 0.78 for Dfenestration. The mean ICC of interobserver variability was 0.77 for FFD, 0.92 for Dflare, and 0.48 for Dfenestration. CONCLUSION This study showed that FGA of the flared ends of BECS can be performed with high accuracy in a phantom model, with good intraobserver and interobserver variability. Flare geometric analysis can be used to determine flare geometry of the BECS on standard post-FEVAR CTA scans.
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Affiliation(s)
- Claire van der Riet
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fenna A van der Zijden
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ignace F J Tielliu
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cornelis H Slump
- Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), Robotics and Mechatronics (RAM), University of Twente, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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23
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Kalisvaart GM, van Velden FHP, Hernández-Girón I, Meijer KM, Ghesquiere-Dierickx LMH, Brink WM, Webb A, de Geus-Oei LF, Slump CH, Kuznetsov DV, Schaart DR, Grootjans W. Design and evaluation of a modular multimodality imaging phantom to simulate heterogeneous uptake and enhancement patterns for radiomic quantification in hybrid imaging; a feasibility study. Med Phys 2022; 49:3093-3106. [PMID: 35178781 PMCID: PMC9314050 DOI: 10.1002/mp.15537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Accuracy and precision assessment in radiomic features is important for the determination of their potential to characterize cancer lesions. In this regard, simulation of different imaging conditions using specialized phantoms is increasingly being investigated. In this study, the design and evaluation of a modular multimodality imaging phantom to simulate heterogeneous uptake and enhancement patterns for radiomics quantification in hybrid imaging is presented. Methods A modular multimodality imaging phantom was constructed that could simulate different patterns of heterogeneous uptake and enhancement patterns in positron emission tomography (PET), single‐photon emission computed tomography (SPECT), computed tomography (CT), and magnetic resonance (MR) imaging. The phantom was designed to be used as an insert in the standard NEMA‐NU2 IEC body phantom casing. The entire phantom insert is composed of three segments, each containing three separately fillable compartments. The fillable compartments between segments had different sizes in order to simulate heterogeneous patterns at different spatial scales. The compartments were separately filled with different ratios of 99mTc‐pertechnetate, 18F‐fluorodeoxyglucose ([18F]FDG), iodine‐ and gadolinium‐based contrast agents for SPECT, PET, CT, and T1‐weighted MR imaging respectively. Image acquisition was performed using standard oncological protocols on all modalities and repeated five times for repeatability assessment. A total of 93 radiomic features were calculated. Variability was assessed by determining the coefficient of quartile variation (CQV) of the features. Comparison of feature repeatability at different modalities and spatial scales was performed using Kruskal‐Wallis‐, Mann‐Whitney U‐, one‐way ANOVA‐ and independent t‐tests. Results Heterogeneous uptake and enhancement could be simulated on all four imaging modalities. Radiomic features in SPECT were significantly less stable than in all other modalities. Features in PET were significantly less stable than in MR and CT. A total of 20 features, particularly in the gray‐level co‐occurrence matrix (GLCM) and gray‐level run‐length matrix (GLRLM) class, were found to be relatively stable in all four modalities for all three spatial scales of heterogeneous patterns (with CQV < 10%). Conclusion The phantom was suitable for simulating heterogeneous uptake and enhancement patterns in [18F]FDG‐PET, 99mTc‐SPECT, CT, and T1‐weighted MR images. The results of this work indicate that the phantom might be useful for the further development and optimization of imaging protocols for radiomic quantification in hybrid imaging modalities.
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Affiliation(s)
| | | | | | - Karin M Meijer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laura M H Ghesquiere-Dierickx
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wyger M Brink
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Dimitri V Kuznetsov
- Electronic and mechanical support division, Delft University of Technology, Delft, The Netherlands
| | - Dennis R Schaart
- Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands.,Holland Proton Therapy Center (HollandPTC), Delft, The Netherlands
| | - Willem Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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24
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Koenders SS, van Dalen JA, Jager PL, Knollema S, Timmer JR, Mouden M, Slump CH, van Dijk JD. Value of SiPM PET in myocardial perfusion imaging using Rubidium-82. J Nucl Cardiol 2022; 29:204-212. [PMID: 32410059 PMCID: PMC8873116 DOI: 10.1007/s12350-020-02141-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND PET scanners using silicon photomultipliers with digital readout (SiPM PET) have an improved temporal and spatial resolution compared to PET scanners using conventional photomultiplier tubes (PMT PET). However, the effect on image quality and visibility of perfusion defects in myocardial perfusion imaging (MPI) is unknown. Our aim was to determine the value of a SiPM PET scanner in MPI. METHODS We prospectively included 30 patients who underwent rest and regadenoson-induced stress Rubidium-82 (Rb-82) MPI on the D690 PMT PET (GE Healthcare) and within three weeks on the Vereos SiPM PET (Philips Healthcare). Two expert readers scored the image quality and assessed the existence of possible defects. In addition, interpreter's confidence, myocardial blood flow (MBF), and myocardial flow reserve (MFR) values were compared. RESULTS Image quality improved (P = 0.03) using the Vereos as compared to the D690. Image quality of the Vereos and the D690 was graded fair in 20% and 10%, good in 60% and 50%, and excellent in 20% and 40%, respectively. Defect interpretation and interpreter's confidence did not differ between the D690 and the Vereos (P > 0.50). There were no significant differences in rest MBF (P ≥ 0.29), stress MBF (P ≥ 0.11), and MFR (P ≥ 0.51). CONCLUSION SiPM PET provides an improved image quality in comparison with PMT PET. Defect interpretation, interpreter's confidence, and absolute blood flow measurements were comparable between both systems. SiPM PET is therefore a reliable technique for MPI using Rb-82. TRIAL REGISTRATION ToetsingOnline NL63853.075.17. Registered 13 November, 2017.
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Affiliation(s)
- S S Koenders
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands.
- Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - J A van Dalen
- Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - S Knollema
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - J R Timmer
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - M Mouden
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - C H Slump
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
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25
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Kamphuis ME, de Vries GJ, Kuipers H, Saaltink M, Verschoor J, Greuter MJW, Slart RHJA, Slump CH. Development of a dedicated 3D printed myocardial perfusion phantom: proof-of-concept in dynamic SPECT. Med Biol Eng Comput 2022; 60:1541-1550. [PMID: 35048275 PMCID: PMC9079041 DOI: 10.1007/s11517-021-02490-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
We aim to facilitate phantom-based (ground truth) evaluation of dynamic, quantitative myocardial perfusion imaging (MPI) applications. Current MPI phantoms are static representations or lack clinical hard- and software evaluation capabilities. This proof-of-concept study demonstrates the design, realisation and testing of a dedicated cardiac flow phantom. The 3D printed phantom mimics flow through a left ventricular cavity (LVC) and three myocardial segments. In the accompanying fluid circuit, tap water is pumped through the LVC and thereafter partially directed to the segments using adjustable resistances. Regulation hereof mimics perfusion deficit, whereby flow sensors serve as reference standard. Seven phantom measurements were performed while varying injected activity of 99mTc-tetrofosmin (330–550 MBq), cardiac output (1.5–3.0 L/min) and myocardial segmental flows (50–150 mL/min). Image data from dynamic single photon emission computed tomography was analysed with clinical software. Derived time activity curves were reproducible, showing logical trends regarding selected input variables. A promising correlation was found between software computed myocardial flows and its reference (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ= − 0.98; p = 0.003). This proof-of-concept paper demonstrates we have successfully measured first-pass LV flow and myocardial perfusion in SPECT-MPI using a novel, dedicated, myocardial perfusion phantom.
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Affiliation(s)
- Marije E Kamphuis
- Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre 2386, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Gijs J de Vries
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marloes Saaltink
- Department of Nuclear Medicine, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - Jacqueline Verschoor
- Department of Nuclear Medicine, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - Marcel J W Greuter
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Biomedical Photonic Imaging Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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26
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Abstract
Measurement and production of traditional prosthetic sockets are time-consuming, labor-intensive, and highly dependent on the personnel involved. An alternative way to make prostheses is using computer-aided design (CAD) and computer-aided manufacturing (CAM). Fused Filament Fabrication (FFF) may be an alternative to make low-cost prosthetic sockets. This study investigates the tensile properties of potential printing materials suitable for FFF according to ISO527 (Standard Test Method for Tensile Properties of Plastics). To ensure that FFF-printed sockets are safe for patient usage, the structural integrity of the 3D-printed prosthesis will be investigated according to ISO10328 (International Standard Structural Testing of Lower Limb Prostheses). Tough PLA was the most suitable print material according to ISO 527 testing. The Tough PLA printed socket completed 2.27 million cycles and a static test target value of 4025 N. Future research remains necessary to continue testing new potential materials, improve print settings, and improve the socket design for the production of FFF-printed transtibial prosthetic sockets. FFF using Tough PLA can be used to create transtibial prostheses that almost comply with the International Standard for Structural Testing of Lower Limb Prostheses.
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Affiliation(s)
- Merel van der Stelt
- Technical Medicine, University of Twente, Enschede, The Netherlands.,3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc Verhamme
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelis H Slump
- Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Lars Brouwers
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Thomas Jj Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
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27
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Cornelissen BMW, Leemans EL, Slump CH, van den Berg R, Marquering HA, Majoie CBLM. Hemodynamic changes after intracranial aneurysm growth. J Neurosurg 2021:1-7. [PMID: 34715660 DOI: 10.3171/2021.6.jns204155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For accurate risk assessment of unruptured intracranial aneurysms, it is important to understand the underlying mechanisms that lead to rupture. It is known that hemodynamic anomalies contribute to aneurysm growth and rupture, and that growing aneurysms carry higher rupture risks. However, it is unknown how growth affects hemodynamic characteristics. In this study, the authors assessed how hemodynamic characteristics change over the course of aneurysm growth. METHODS The authors included patients with observed aneurysm growth on longitudinal MRA in the period between 2012 and 2016. Patient-specific vascular models were created from baseline and follow-up images. Subsequently, intraaneurysmal hemodynamic characteristics were computed using computational fluid dynamics. The authors computed the normalized wall shear stress, oscillatory shear index, and low shear area to quantify hemodynamic characteristics. Differences between baseline and follow-up measurements were analyzed using paired t-tests. RESULTS Twenty-five patients with a total of 31 aneurysms were included. The aneurysm volume increased by a median (IQR) of 26 (9-39) mm3 after a mean follow-up period of 4 (range 0.4-10.9) years. The median wall shear stress decreased significantly after growth. Other hemodynamic parameters did not change significantly, although large individual changes with large variability were observed. CONCLUSIONS Hemodynamic characteristics change considerably after aneurysm growth. On average, wall shear stress values decrease after growth, but there is a large variability in hemodynamic changes between aneurysms.
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Affiliation(s)
- Bart M W Cornelissen
- 1Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam.,2Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam; and.,3Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Eva L Leemans
- 1Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam.,2Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Cornelis H Slump
- 3Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - René van den Berg
- 1Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam
| | - Henk A Marquering
- 1Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam.,2Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Charles B L M Majoie
- 1Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam
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Jansen MM, van der Stelt M, Smorenburg SPM, Slump CH, van Herwaarden JA, Hazenberg CEVB. Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps. Quant Imaging Med Surg 2021; 11:3945-3955. [PMID: 34476180 DOI: 10.21037/qims-20-1077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
Background This retrospective study quantifies target vessel displacement during fenestrated and branched endovascular aneurysm repair due to the introduction of stiff guidewires and stent graft delivery systems. The effect that intraoperative vessel displacement has on the usability of computed tomography angiography (CTA) roadmaps is also addressed. Methods Patients that underwent fenestrated or branched EVAR were included in this retrospective study. Two imaging datasets were collected from each patient: (I) preoperative CTA and (II) intraoperative contrast-enhanced cone beam computed tomography (ceCBCT) acquired after the insertion of the stiff guidewire and stent graft delivery system. After image registration, the 3D coordinates of the ostium of the celiac artery, superior mesenteric artery, right renal artery and left renal artery were recorded in both the CTA and the ceCBCT dataset by two observers. The three-dimensional displacement of the ostia of the target vessels was calculated by subtracting the coordinates of CTA and ceCBCT from one another. Additionally, the tortuosity index and the maximum angulation of the aorta were calculated. Results In total 20 patients and 77 target vessels were included in this study. The ostium of the celiac, superior mesenteric, right renal and left renal artery underwent non-uniform three-dimensional displacement with mean absolute displacement of 8.2, 7.7, 8.2 and 6.2 mm, respectively. The average displacement of all different target vessels together was 7.8 mm. A moderate correlation between vessel displacement and the maximum angulation of the aortoiliac segment was found (Spearman's ρ=0.45, P<0.05). Conclusions The introduction of stiff endovascular devices during fenestrated or branched EVAR causes significant, non-uniform displacement of the ostium of the visceral and renal target vessels. Consequently, preoperative CTA roadmaps based on bone registration are suboptimal to guide target vessel catheterization during these procedures.
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Affiliation(s)
- Marloes M Jansen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Cornelis H Slump
- Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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van Zandwijk JK, Tuncay V, Vliegenthart R, Pelgrim GJ, Slump CH, Oudkerk M, van Ooijen PMA. Assessment of Dynamic Change of Coronary Artery Geometry and Its Relationship to Coronary Artery Disease, Based on Coronary CT Angiography. J Digit Imaging 2021; 33:480-489. [PMID: 31745678 PMCID: PMC7165136 DOI: 10.1007/s10278-019-00300-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To investigate the relationship between dynamic changes of coronary artery geometry and coronary artery disease (CAD) using computed tomography (CT). Seventy-one patients underwent coronary CT angiography with retrospective electrocardiographic gating. End-systolic (ES) and end-diastolic (ED) phases were automatically determined by dedicated software. Centerlines were extracted for the right and left coronary artery. Differences between ES and ED curvature and tortuosity were determined. Associations of change in geometrical parameters with plaque types and degree of stenosis were investigated using linear mixed models. The differences in number of inflection points were analyzed using Wilcoxon signed-rank tests. Tests were done on artery and segment level. One hundred thirty-seven arteries (64.3%) and 456 (71.4%) segments were included. Curvature was significantly higher in ES than in ED phase for arteries (p = 0.002) and segments (p < 0.001). The difference was significant only at segment level for tortuosity (p = 0.005). Number of inflection points was significantly higher in ES phase on both artery and segment level (p < 0.001). No significant relationships were found between degree of stenosis and plaque types and dynamic change in geometrical parameters. Non-invasive imaging by cardiac CT can quantify change in geometrical parameters of the coronary arteries during the cardiac cycle. Dynamic change of vessel geometry through the cardiac cycle was not found to be related to the presence of CAD.
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Affiliation(s)
- Jordy K van Zandwijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Volkan Tuncay
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Gert Jan Pelgrim
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, PO Box 30001, NL-9700 RB, Groningen, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Matthijs Oudkerk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M A van Ooijen
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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30
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van Dijk JD, Dotinga M, Jager PL, Slump CH, Ottervanger JP, Mouden M, van Dalen JA. Body weight-dependent Rubidium-82 activity results in constant image quality in myocardial perfusion imaging with PET. J Nucl Cardiol 2021; 28:1536-1544. [PMID: 31485963 DOI: 10.1007/s12350-019-01875-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/31/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical practice shows degrading image quality in heavier patients who undergo myocardial perfusion imaging (MPI) with Rubidium-82 (Rb-82) PET when using a fixed tracer activity. Our aim was to derive and validate a patient-specific activity protocol resulting in a constant image quality in PET MPI. METHODS We included 251 patients who underwent rest MPI with Rb-82 PET (Discovery 670, GE Healthcare). 132 patients were included retrospectively and were scanned using a fixed activity of 740 MBq. The total number of measured prompts was normalized to activity and correlated to body weight, mass per body length and body mass index to find the best predicting parameter. Next, a patient-specific activity was derived and subsequently validated in 119 additional patients. Image quality was scored by three experts on a four-point scale. RESULTS Both image quality and prompts decreased in heavier patients when using a fixed activity (p < .005). Body weight was used to derive a new activity formula: Activity = 8.3 MBq/kg. When applying this formula, both measured prompts and scored image quality became independent of body weight (p > .60). CONCLUSION Administrating a Rb-82 activity that linearly depends on body weight resulted in a constant image quality across all patients and is recommended.
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Affiliation(s)
- J D van Dijk
- Department of Nuclear Medicine, Isala, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
| | - M Dotinga
- Department of Nuclear Medicine, Isala, PO Box 10400, 8000 GK, Zwolle, The Netherlands
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - C H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | | | - M Mouden
- Department of Cardiology, Isala, Zwolle, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala, Zwolle, The Netherlands
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Koenders SS, Van Dalen JA, Jager PL, Mouden M, Slump CH, Van Dijk JD. Value of regional myocardial flow measurements using Rubidium-82 PET. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The combination of myocardial blood flow (MBF) measurements using Rubidium-82 (Rb-82) PET and visual assessment of the PET images is increasingly used due to its high diagnostic and prognostic value. Typically, flow measurements are calculated and used for the myocardium as a whole (global). However, small regional flow deficits may go unnoticed when only looking at global flow values.
Purpose
To compare the diagnostic value of regional and global myocardial flow measurements using Rb-82 PET in the detection of obstructive CAD.
Methods
We retrospectively included 1034 patients with no history of coronary artery disease (CAD) referred for rest and regadenoson-induced stress Rb-82 PET/CT. MBFs were calculated using Lortie’s one-tissue compartment model. Myocardial flow reserve (MFR) was calculated as the ratio of MBF during stress and rest. Regional flow was determined per vessel and per segment. Vessel MFR was defined as the lowest flow reserve of LAD, LCX and RCA territories and segmental MFR as the lowest flow reserve in all 17 segments. Follow-up data were obtained from medical records. Patients were classified to have obstructive CAD if follow-up included a positive invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or all cause death. Receiver-operating characteristic (ROC) analyses were constructed to compare the diagnostic value of global and regional flow values.
Results
Follow-up was obtained in all 1034 patients and the median follow-up time was 2.1 years. Myocardial flow reserve values were significantly lower (p < 0.001) in the 128 patients classified with obstructive CAD than in the 906 patients without obstructive CAD: global MFR (median 1.9 [interquartile range 1.6-2.4] vs. 2.5 [2.1-2.9]); vessel MFR (1.6 [1.3-2.1] vs. 2.3 [1.9-2.6]); Segmental MFR (1.3 [0.9-1.7] vs. 1.9 [1.6-2.2]). The area under the curve of vessel MFR (0.79 ± 0.02) and segmental MFR (0.81 ± 0.02) were similar but significantly (p < 0.001) larger than the area of global MFR (0.75 ± 0.03), as shown in the Figure.
Conclusion
The diagnostic value improved with the use of regional MFR instead of global MFR measurements in the detection of obstructive CAD. Therefore, it seems that visual assessment of PET images can best be combined with regional flow measurements either on a per vessel or a per segment basis in Rubidium-82 PET myocardial perfusion imaging.
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Affiliation(s)
- SS Koenders
- Isala Hospital, Nuclear Medicine, Zwolle, Netherlands (The)
| | - JA Van Dalen
- Isala Hospital, Medical Physics, Zwolle, Netherlands (The)
| | - PL Jager
- Isala Hospital, Nuclear Medicine, Zwolle, Netherlands (The)
| | - M Mouden
- Isala Hospital, Cardiology, Zwolle, Netherlands (The)
| | - CH Slump
- University of Twente, Technical Medical Center, Enschede, Netherlands (The)
| | - JD Van Dijk
- Isala Hospital, Nuclear Medicine, Zwolle, Netherlands (The)
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Metselaar RJ, Van Dalen JA, Vendel BN, Mouden M, Slump CH, Van Dijk JD. Prediction of obstructive coronary artery disease after Rb-82 PET myocardial perfusion imaging and coronary artery calcium scoring using machine learning. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Accurate risk stratification in patients with suspected stable coronary artery disease (CAD) is essential for choosing an appropriate treatment strategy but remains challenging in clinical practice.
Purpose
Our aim was to develop and validate a risk model to predict the presence of obstructive CAD after Rubidium-82 PET and a coronary artery calcium score (CACS) scan using a machine learning (ML) algorithm.
Methods
We retrospectively included 1007 patients without prior cardiovascular history and a low-intermediate pre-test likelihood, referred for rest and regadenoson-induced stress Rubidium-82 PET combined with a CACS scan. Multiple features were included in the ML model; PET derived features such as summed difference score and flow values, CACS, cardiovascular risk factors (cigarette smoking, hypertension, hypercholesterolemia, diabetes, positive family history of CAD), medication; age; gender; body mass index; creatinine serum values; and visual PET interpretation. An XGBoost ML algorithm was developed using a subset of 805 patients to predict obstructive CAD by using 5-fold cross validation in combination with a grid search. Obstructive CAD during follow-up was defined as a significant stenosis during invasive coronary angiography, a percutaneous coronary intervention or a coronary artery bypass graft procedure. The ML algorithm was validated with unseen data of the remaining 202 patients.
Results
Application of the XGBoost algorithm resulted in an area under the curve (AUC) of 0.93 using the training data (n = 805) and an AUC of 0.89 using the unseen data (n = 202) in predicting obstructive CAD. The strongest predictors were the CAC-scores and quantitative PET derived features. The classical risk factors and medication hardly provided an added value in the prediction of obstructive CAD.
Conclusion
The developed ML algorithm is able to provide individualized risk stratification by predicting the probability of obstructive CAD. Although validation with a larger dataset could result in a more well defined performance range, this model already shows potential to be implemented in the diagnostic workflow.
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Affiliation(s)
- RJ Metselaar
- Isala Clinics, Nuclear Medicine, Zwolle, Netherlands (The)
| | - JA Van Dalen
- Isala Clinics, Medical Physics, Zwolle, Netherlands (The)
| | - BN Vendel
- Isala Clinics, Nuclear Medicine, Zwolle, Netherlands (The)
| | - M Mouden
- Isala Clinics, Cardiology, Zwolle, Netherlands (The)
| | - CH Slump
- University of Twente, MIRA: Institute for Biomedical Technology and Technical Medicine, Enschede, Netherlands (The)
| | - JD Van Dijk
- Isala Clinics, Nuclear Medicine, Zwolle, Netherlands (The)
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Noortman WA, Vriens D, Mooij CDY, Slump CH, Aarntzen EH, van Berkel A, Timmers HJLM, Bussink J, Meijer TWH, de Geus-Oei LF, van Velden FHP. The Influence of the Exclusion of Central Necrosis on [ 18F]FDG PET Radiomic Analysis. Diagnostics (Basel) 2021. [PMID: 34359379 DOI: 10.3390/diagnostics] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Central necrosis can be detected on [18F]FDG PET/CT as a region with little to no tracer uptake. Currently, there is no consensus regarding the inclusion of regions of central necrosis during volume of interest (VOI) delineation for radiomic analysis. The aim of this study was to assess how central necrosis affects radiomic analysis in PET. METHODS Forty-three patients, either with non-small cell lung carcinomas (NSCLC, n = 12) or with pheochromocytomas or paragangliomas (PPGL, n = 31), were included retrospectively. VOIs were delineated with and without central necrosis. From all VOIs, 105 radiomic features were extracted. Differences in radiomic features between delineation methods were assessed using a paired t-test with Benjamini-Hochberg multiple testing correction. In the PPGL cohort, performances of the radiomic models to predict the noradrenergic biochemical profile were assessed by comparing the areas under the receiver operating characteristic curve (AUC) for both delineation methods. RESULTS At least 65% of the features showed significant differences between VOIvital-tumour and VOIgross-tumour (65%, 79% and 82% for the NSCLC, PPGL and combined cohort, respectively). The AUCs of the radiomic models were not significantly different between delineation methods. CONCLUSION In both tumour types, almost two-third of the features were affected, demonstrating that the impact of whether or not to include central necrosis in the VOI on the radiomic feature values is significant. Nevertheless, predictive performances of both delineation methods were comparable. We recommend that radiomic studies should report whether or not central necrosis was included during delineation.
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Affiliation(s)
- Wyanne A Noortman
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Dennis Vriens
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Charlotte D Y Mooij
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Technical Medicine, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Cornelis H Slump
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Erik H Aarntzen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Anouk van Berkel
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Henri J L M Timmers
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Johan Bussink
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Tineke W H Meijer
- Department of Radiation Oncology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Floris H P van Velden
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Manzini C, van den Noort F, Grob ATM, Withagen MIJ, Slump CH, van der Vaart CH. Appearance of the levator ani muscle subdivisions on 3D transperineal ultrasound. Insights Imaging 2021; 12:91. [PMID: 34213688 PMCID: PMC8253870 DOI: 10.1186/s13244-021-01037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The levator ani muscle (LAM) consists of different subdivisions, which play a specific role in the pelvic floor mechanics. The aim of this study is to identify and describe the appearance of these subdivisions on 3-Dimensional (3D) transperineal ultrasound (TPUS). To do so, a study designed in three phases was performed in which twenty 3D TPUS scans of vaginally nulliparous women were assessed. The first phase was aimed at getting acquainted with the anatomy of the LAM subdivisions and its appearance on TPUS: relevant literature was consulted, and the TPUS scan of one patient was analyzed to identify the puborectal, iliococcygeal, puboperineal, pubovaginal, and puboanal muscle. In the second phase, the five LAM subdivisions and the pubic bone and external sphincter, used as reference structures, were manually segmented in volume data obtained from five nulliparous women at rest. In the third phase, intra- and inter-observer reproducibility were assessed on twenty TPUS scans by measuring the Dice Similarity Index (DSI). RESULTS The mean inter-observer and median intra-observer DSI values (with interquartile range) were: puborectal 0.83 (0.13)/0.83 (0.10), puboanal 0.70 (0.16)/0.79 (0.09), iliococcygeal 0.73 (0.14)/0.79 (0.10), puboperineal 0.63 (0.25)/0.75 (0.22), pubovaginal muscle 0.62 (0.22)/0.71 (0.16), and the external sphincter 0.81 (0.12)/0.89 (0.03). CONCLUSION Our results show that the LAM subdivisions of nulliparous women can be reproducibly identified on 3D TPUS data.
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Affiliation(s)
- Claudia Manzini
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frieda van den Noort
- Robotics and Mechatronics, University of Twente, Enschede, Carre 3.526, Drienerlolaan 5, 7522NB, Enschede, The Netherlands.
| | - Anique T M Grob
- Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mariëlla I J Withagen
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics, University of Twente, Enschede, Carre 3.526, Drienerlolaan 5, 7522NB, Enschede, The Netherlands
| | - C Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
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35
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olde Heuvel J, de Wit-van der Veen BJ, Huizing DM, van der Poel HG, van Leeuwen PJ, Bhairosing PA, Stokkel MP, Slump CH. State-of-the-art Intraoperative Imaging Technologies for Prostate Margin Assessment: A Systematic Review. Eur Urol Focus 2021; 7:733-741. [DOI: 10.1016/j.euf.2020.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/06/2020] [Accepted: 02/05/2020] [Indexed: 12/29/2022]
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van de Burgt A, Dibbets-Schneider P, Slump CH, Scholte AJHA, Atsma DE, de Geus-Oei LF, van Velden FHP. Experimental validation of absolute SPECT/CT quantification for response monitoring in patients with coronary artery disease. EJNMMI Phys 2021; 8:48. [PMID: 34132918 PMCID: PMC8208344 DOI: 10.1186/s40658-021-00393-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantitative SPECT enables absolute quantification of uptake in perfusion defects. The aim of this experimental study is to assess quantitative accuracy and precision of a novel iterative reconstruction technique (Evolution; GE Healthcare) for the potential application of response monitoring using 99mTc-tetrofosmin SPECT/CT in patients with coronary artery disease (CAD). METHODS Acquisitions of an anthropomorphic torso phantom with cardiac insert containing defects (with varying sizes), filled with 99mTc-pertechnetate, were performed on a SPECT/CT (Discovery 670 Pro, GE Healthcare). Subsequently, volumes of interest of the defects were manually drawn on CT to assess the recovery coefficient (RC). Bull's eye plots were composed to evaluate the uptake per segment. Finally, 99mTc-tetrofosmin SPECT/CT scans of 10 CAD patients were used to illustrate clinical application. RESULTS The phantom study indicated that Evolution showed convergence after 7 iterations and 10 subsets. The average repeatability deviation of all configurations was 2.91% and 3.15% (%SD mean) for filtered (Butterworth) and unfiltered data, respectively. The accuracy after post-filtering was lower compared to the unfiltered data with a mean (SD) RC of 0.63 (0.05) and 0.70 (0.07), respectively (p < 0.05). More artificial defects were found on Bull's eye plots created with the unfiltered data compared to filtered data. Eight out of ten patients showed significant changes in uptake before and after treatment (p < 0.05). CONCLUSION Quantification of 99mTc-tetrofosmin SPECT/CT seems feasible for CAD patients when 7 iterations (10 subsets), Butterworth post-filtering (cut off frequency 0.52 in cycles/cm, order of 5) and manual CT-delineation are applied. However, future prospective patient studies are required for clinical application.
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Affiliation(s)
- Alina van de Burgt
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Petra Dibbets-Schneider
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Cornelis H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Floris H P van Velden
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Coorens NA, Daemen JHT, Slump CH, Loonen TGJ, Vissers YLJ, Hulsewé KWE, de Loos ER. The Automatic Quantification of Morphological Features of Pectus Excavatum Based on Three-Dimensional Images. Semin Thorac Cardiovasc Surg 2021; 34:772-781. [PMID: 34102293 DOI: 10.1053/j.semtcvs.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Visual examination and quantification of severity are essential for clinical decision making in patients with pectus excavatum. Yet, visual assessment is prone to inter- and intra-observer variability and current quantitative methods are inadequate. This study aims to develop and evaluate a novel, automatic and non-invasive method to objectively quantify pectus excavatum morphology based on three-dimensional images. Key steps of the automatic analysis are normalization of image orientation, slicing, and computation of the morphological features encompassing pectus depth, width, length, volume, position, steepness, flaring, asymmetry and mean cross-sectional area. A digital phantom mimicking a patient with pectus excavatum was used to verify the analysis method. Prospective three-dimensional imaging and subsequent surface analysis in patients with pectus excavatum was performed to assess clinical feasibility. Verification of the developed analysis tool demonstrated 100% reproducibility of all morphological feature values. Calculated parameters compared to the predetermined phantom dimensions were accurate for all but four features. The pectus width, length, volume and steepness showed an error of 4 mm (4%), 2 mm (2%), 12 mL (5%) and 1 degree (3%), respectively. Prospective imaging of 52 patients (88% males) demonstrated the feasibility of the developed tool to quantify morphological features of pectus excavatum in the clinical setting. Mean duration to calculate all features in one patient was 7.6 seconds. We have developed and presented a non-invasive pectus excavatum surface analysis tool, that is feasible to automatically quantify morphological features based on three-dimensional images with promising accuracy and reproducibility.
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Affiliation(s)
- Nadine A Coorens
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands; Faculty of Science and Technology (S&T), University of Twente, Enschede, The Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Jean H T Daemen
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Cornelis H Slump
- Faculty of Science and Technology (S&T), University of Twente, Enschede, The Netherlands
| | - Tom G J Loonen
- 3D Lab Radboudumc, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Division of General Thoracic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.
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Heuvel JO, de Wit-van der Veen BJ, van der Poel HG, van Leeuwen PJ, Bekers EM, Grootendorst MR, Vyas KN, Slump CH, Stokkel MPM. Cerenkov Luminescence Imaging in Prostate Cancer: Not the Only Light That Shines. J Nucl Med 2021; 63:29-35. [PMID: 33931467 DOI: 10.2967/jnumed.120.260034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intraoperatively during prostatectomy using 68Ga-prostate-specific membrane antigen (68Ga-PSMA-11). This study evaluated the accuracy of CLI compared with histopathology and, as an exploratory objective, investigated the characteristics of the identified chemiluminescence signal. Methods: After intravenous injection of a mean 68Ga-PSMA-11 activity of 69 MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathologic comparison and scored for the likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in 3 radioactive and 3 nonradioactive specimens using CLI. Results: In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤1 mm). In 6 hot spots, CLI correctly identified PSMs on histopathology, located at the apex and mid prostate. In all 15 patients, an increased signal at the prostate base was observed, without the presence of the primary tumor in this area in 8 patients. This chemiluminescence signal was also observed in nonradioactive prostate specimens, with a half-life of 48 ± 11 min. The chemiluminescence hampered the visual interpretation of 4 PSMs at the base. Conclusion: CLI was able to correctly identify margin status, including close margins, in 83% of the cases. The presence of a diathermy-induced chemiluminescent signal hampered image interpretation, especially at the base of the prostate. In the current form, CLI is most applicable to detect PSMs and close margins in the apex and mid prostate.
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Affiliation(s)
- Judith Olde Heuvel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; and
| | | | - Kunal N Vyas
- Lightpoint Medical Ltd., Chesham, United Kingdom
| | - Cornelis H Slump
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Stam LB, Aquarius R, de Jong GA, Slump CH, Meijer FJA, Boogaarts HD. A review on imaging techniques and quantitative measurements for dynamic imaging of cerebral aneurysm pulsations. Sci Rep 2021; 11:2175. [PMID: 33500470 PMCID: PMC7838168 DOI: 10.1038/s41598-021-81753-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Measurement of intracranial aneurysm wall motion may refine the current rupture risk estimation. A golden standard for measuring aneurysm pulsation is lacking. The aim is to evaluate magnitudes of aneurysm pulsation as published in current literature. Embase and PubMed were searched for publications containing quantitative measures of cardiac-cycle related cerebral aneurysm pulsation (no date or language restrictions). Eleven studies were included, covering 197 unruptured and untreated cerebral aneurysms. Quantitative pulsation measurements were extracted from the studies. Characteristics of the study population and aneurysms were taken into account, as well as the imaging modality, scanning technique and data processing methods used. A meta-analysis was performed of studies with similar methodologies and individual IA measures and locations. The magnitude of the absolute volume pulsations varied between 14 ± 9 mm3 and 106 ± 123 mm3 and the mean relative volume change varied between 5 and 36%. The meta-analysis revealed a positive correlation between size and absolute volume change. The relative volume change in Basilar artery aneurysms seems smaller. No authors were contacted for original study data and articles only describing visual pulsations were excluded. The variation in methodologies impedes an accurate estimation of the magnitude of IA pulsations. Validation of aneurysm pulsation measurement is crucial prior to clinical studies evaluating IA pulsatility in relation to IA rupture risk. Prerequisite is a reliable and robust imaging method with high spatial and temporal resolution and standardization of the image analysis methods.
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Affiliation(s)
- L B Stam
- Technical Medicine, University of Twente, Enschede, The Netherlands. .,Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein-zuid 30, Internal Post Number 633, Nijmegen, The Netherlands.
| | - R Aquarius
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - G A de Jong
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - C H Slump
- Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - F J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - H D Boogaarts
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
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Dotinga M, van Dijk JD, Vendel BN, Slump CH, Portman AT, van Dalen JA. Clinical value of machine learning-based interpretation of I-123 FP-CIT scans to detect Parkinson's disease: a two-center study. Ann Nucl Med 2021; 35:378-385. [PMID: 33471288 DOI: 10.1007/s12149-021-01576-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Our aim was to develop and validate a machine learning (ML)-based approach for interpretation of I-123 FP-CIT SPECT scans to discriminate Parkinson's disease (PD) from non-PD and to determine its generalizability and clinical value in two centers. METHODS We retrospectively included 210 consecutive patients who underwent I-123 FP-CIT SPECT imaging and had a clinically confirmed diagnosis. Linear support vector machine (SVM) was used to build a classification model to discriminate PD from non-PD based on I-123-FP-CIT striatal uptake ratios, age and gender of 90 patients. The model was validated on unseen data from the same center where the model was developed (n = 40) and consecutively on data from a different center (n = 80). Prediction performance was assessed and compared to the scan interpretation by expert physicians. RESULTS Testing the derived SVM model on the unseen dataset (n = 40) from the same center resulted in an accuracy of 95.0%, sensitivity of 96.0% and specificity of 93.3%. This was identical to the classification accuracy of nuclear medicine physicians. The model was generalizable towards the other center as prediction performance did not differ thereby obtaining an accuracy of 82.5%, sensitivity of 88.5% and specificity of 71.4% (p = NS). This was comparable to that of nuclear medicine physicians (p = NS). CONCLUSION ML-based interpretation of I-123-FP-CIT scans results in accurate discrimination of PD from non-PD similar to visual assessment in both centers. The derived SVM model is therefore generalizable towards centers using comparable acquisition and image processing methods and implementation as diagnostic aid in clinical practice is encouraged.
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Affiliation(s)
- M Dotinga
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.,MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
| | - B N Vendel
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.,Department of Nuclear Medicine, Treant Zorggroep, Emmen, The Netherlands
| | - C H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - A T Portman
- Department of Neurology, Treant Zorggroep, Emmen, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands
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Hoving AM, Voorneveld J, Mikhal J, Bosch JG, Groot Jebbink E, Slump CH. In vitro performance of echoPIV for assessment of laminar flow profiles in a carotid artery stent. J Med Imaging (Bellingham) 2021; 8:017001. [PMID: 33457445 PMCID: PMC7804295 DOI: 10.1117/1.jmi.8.1.017001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: Detailed blood flow studies may contribute to improvements in carotid artery stenting. High-frame-rate contrast-enhanced ultrasound followed by particle image velocimetry (PIV), also called echoPIV, is a technique to study blood flow patterns in detail. The performance of echoPIV in presence of a stent has not yet been studied extensively. We compared the performance of echoPIV in stented and nonstented regions in an in vitro flow setup. Approach: A carotid artery stent was deployed in a vessel-mimicking phantom. High-frame-rate contrast-enhanced ultrasound images were acquired with various settings. Signal intensities of the contrast agent, velocity values, and flow profiles were calculated. Results: The results showed decreased signal intensities and correlation coefficients inside the stent, however, PIV analysis in the stent still resulted in plausible flow vectors. Conclusions: Velocity values and laminar flow profiles can be measured in vitro in stented arteries using echoPIV.
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Affiliation(s)
- Astrid M Hoving
- University of Twente, TechMed Centre, Robotics and Mechatronics Group, Enschede, The Netherlands
| | - Jason Voorneveld
- Erasmus MC, Thorax Center, Department of Biomedical Engineering, Rotterdam, The Netherlands
| | - Julia Mikhal
- University of Twente, TechMed Centre, BIOS Lab-on-a-Chip Group, Enschede, The Netherlands
| | - Johan G Bosch
- Erasmus MC, Thorax Center, Department of Biomedical Engineering, Rotterdam, The Netherlands
| | - Erik Groot Jebbink
- University of Twente, TechMed Centre, Multi-Modality Medical Imaging Group, Enschede, The Netherlands
| | - Cornelis H Slump
- University of Twente, TechMed Centre, Robotics and Mechatronics Group, Enschede, The Netherlands
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Olde Heuvel J, de Wit-van der Veen BJ, Donswijk ML, Slump CH, Stokkel MPM. Day-to-day variability of [ 68Ga]Ga-PSMA-11 accumulation in primary prostate cancer: effects on tracer uptake and visual interpretation. EJNMMI Res 2020; 10:132. [PMID: 33123814 PMCID: PMC7596127 DOI: 10.1186/s13550-020-00708-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Prostate-specific membrane antigen (PSMA) agents, such as [68Ga]Ga-PSMA-11, have an unprecedented accuracy in staging prostate cancer (PCa) and detecting disease recurrence. PSMA PET/CT may also be used for response monitoring by displaying molecular changes, instead of morphological changes alone. However, there are still limited data available on the variability in biodistribution and intra-prostatic uptake of PSMA targeting radiotracers. Therefore, the aim of this study was to assess the repeatability of [68Ga]Ga-PSMA-11 uptake in primary PCa patients in a 4-week interval. METHODS Twenty-four primary PCa patients were prospectively included, who already were scheduled for [68Ga]Ga-PSMA-11 PET/CT scan on clinical indication (≥ cT3, Gleason score ≥ 7 or PSA ≥ 20 ng/mL). These patients received two [68Ga]Ga-PSMA-11 PET/CT scans with a 4-week interval. No treatment was started in between the scans. Semiquantitative measurements (SULmax, SULmean, and SULpeak) were determined in the prostate tumor, normal tissues, and blood pool. The repeatability coefficient of every region was determined. All scans were visually analyzed by two nuclear medicine physicians. RESULTS Within-subject coefficient of variation of [68Ga]Ga-PSMA-11 uptake between the two scans was on average 10% in the prostate tumor, normal tissues (liver, kidney, parotid), and blood pool. The repeatability coefficient of the prostate tumor was 18% for SULpeak and 22% for SULmax. Lesion uptake was visually different in 5 patients, though not clinically relevant. CONCLUSION Results of test-retest [68Ga]Ga-PSMA-11 PET/CT scans in a 4-week interval show that [68Ga]Ga-PSMA-11 uptake is repeatable, with a clinical irrelevant variation in tumor and physiological distribution. Based on the presented repeatable uptake, [68Ga]Ga-PSMA-11 PET/CT scans can potentially be used for disease surveillance and therapy response monitoring. Changes in uptake larger than the RC are therefore likely to reflect actual biological changes in PSMA expression. Trial registration NL8263 at Trialregister.nl retrospectively registered on 03-01-2020. https://www.trialregister.nl/trial/8263.
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Affiliation(s)
- Judith Olde Heuvel
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Berlinda J de Wit-van der Veen
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Cornelis H Slump
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Noortman WA, Vriens D, Slump CH, Bussink J, Meijer TWH, de Geus-Oei LF, van Velden FHP. Adding the temporal domain to PET radiomic features. PLoS One 2020; 15:e0239438. [PMID: 32966313 PMCID: PMC7510999 DOI: 10.1371/journal.pone.0239438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/05/2020] [Indexed: 01/18/2023] Open
Abstract
Background Radiomic features, extracted from positron emission tomography, aim to characterize tumour biology based on tracer intensity, tumour geometry and/or tracer uptake heterogeneity. Currently, radiomic features are derived from static images. However, temporal changes in tracer uptake might reveal new aspects of tumour biology. This study aims to explore additional information of these novel dynamic radiomic features compared to those derived from static or metabolic rate images. Methods Thirty-five patients with non-small cell lung carcinoma underwent dynamic [18F]FDG PET/CT scans. Spatial intensity, shape and texture radiomic features were derived from volumes of interest delineated on static PET and parametric metabolic rate PET. Dynamic grey level cooccurrence matrix (GLCM) and grey level run length matrix (GLRLM) features, assessing the temporal domain unidirectionally, were calculated on eight and sixteen time frames of equal length. Spearman’s rank correlations of parametric and dynamic features with static features were calculated to identify features with potential additional information. Survival analysis was performed for the non-redundant temporal features and a selection of static features using Kaplan-Meier analysis. Results Three out of 90 parametric features showed moderate correlations with corresponding static features (ρ≥0.61), all other features showed high correlations (ρ>0.7). Dynamic features are robust independent of frame duration. Five out of 22 dynamic GLCM features showed a negligible to moderate correlation with any static feature, suggesting additional information. All sixteen dynamic GLRLM features showed high correlations with static features, implying redundancy. Log-rank analyses of Kaplan-Meier survival curves for all features dichotomised at the median were insignificant. Conclusion This study suggests that, compared to static features, some dynamic GLCM radiomic features show different information, whereas parametric features provide minimal additional information. Future studies should be conducted in larger populations to assess whether there is a clinical benefit of radiomics using the temporal domain over traditional radiomics.
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Affiliation(s)
- Wyanne A. Noortman
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - Dennis Vriens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelis H. Slump
- Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tineke W. H. Meijer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
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Leemans EL, Cornelissen BMW, Said M, van den Berg R, Slump CH, Marquering HA, Majoie CBLM. Intracranial aneurysm growth: consistency of morphological changes. Neurosurg Focus 2020; 47:E5. [PMID: 31261128 DOI: 10.3171/2019.4.focus1987] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have shown a relation between growth and rupture of intracranial aneurysms. Additionally, several morphological characteristics are frequently measured to estimate rupture risk. Little is known about how the rupture risk is associated with morphological characteristic changes during growth. The aim of this study was to provide insights into how morphological characteristics, associated with rupture, change during an aneurysm's growth. METHODS The authors retrospectively identified patients with longitudinal MRA images of unruptured growing aneurysms. The MRA images had an in-plane resolution of 0.2-0.5 mm and a slice thickness of 0.2-0.75 mm. Therefore, growth was defined as an increase of at least 0.5 mm in two directions or 1 mm in one direction. Using the MRA images, the authors semiautomatically segmented the aneurysm and the perianeurysmal vasculature. Twelve morphological characteristics were automatically measured. These characteristics were related to size (diameter, height, width, neck diameter, volume, surface area, aspect ratio, height-width ratio, and bottleneck factor) and shape (ellipticity index, nonsphericity index, and undulation index) of the aneurysm. Morphological characteristics before and after growth were compared using the Wilcoxon signed-rank test. RESULTS The authors included 31 patients with 38 growing aneurysms. The aneurysms' growth was detected after a mean of 218 weeks (range 23-567 weeks). A significant increase was seen in all size-related characteristics, and the bottleneck factor also significantly increased (from a median of 1.00 [IQR 0.85-1.04] to 1.03 [IQR 0.93-1.18]), while the ellipticity index decreased (from a median of 0.26 [IQR 0.25-0.28] to 0.25 [IQR 0.24-0.26]). The changes in size ratios and shape indices varied largely among patients. Larger aneurysms more often showed an increase in shape ratios. CONCLUSIONS Although aneurysm growth, size-related characteristics, bottleneck factor, and ellipticity index changed significantly during growth, most size ratios and shape indices showed inconsistent changes among aneurysms. This suggests that, for an accurate rupture prediction, morphological parameters need to be reassessed after growth.
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Affiliation(s)
- Eva L Leemans
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Bart M W Cornelissen
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and.,3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Miran Said
- Departments of1Biomedical Engineering and Physics, and
| | - René van den Berg
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Cornelis H Slump
- 3Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Henk A Marquering
- Departments of1Biomedical Engineering and Physics, and.,2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
| | - Charles B L M Majoie
- 2Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam; and
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Hogenes AM, Slump CH, Te Riet O G Scholten GA, Meijerink MR, Fütterer JJ, van Laarhoven CJHM, Overduin CG, Stommel MWJ. Effect of irreversible electroporation parameters and the presence of a metal stent on the electric field line pattern. Sci Rep 2020; 10:13517. [PMID: 32782339 PMCID: PMC7421881 DOI: 10.1038/s41598-020-70308-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022] Open
Abstract
The final ablation zone created with irreversible electroporation (IRE) depends on the size, shape and strength of the electric field that is influenced by several parameters. A profound understanding of the effect of IRE parameter alterations on the electric field are a prerequisite for a safe and effective treatment. Here, we demonstrate a semolina in castor oil model that enables visualization of the static electric field developed by a high-voltage generator between two needle-electrodes. We intuitively visualize the variation in electric field line pattern for selected IRE parameters; active needle length, inter-needle distance, applied voltage and presence of a nearby metal stent, by cameras in three dimensions. The observations were compared to and supported by two-dimensional numerical simulations of the electric field. Our semolina model visualizes the disturbance of the electric field by a metal stent, potentially leading to an incomplete tumour ablation between the needles. The reduction in electric field strength and the area at risk for incomplete tumour ablation are confirmed by the numerical simulations. The semolina model provides insight in the fundamental physics of the electric field, the effect of alterations in IRE parameter combinations and presence of a metal stent within the ablation zone.
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Affiliation(s)
- Annemiek M Hogenes
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Centre, P.O. box 9101 (766), 6500 HB, Nijmegen, The Netherlands.
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | | | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Vrije Universiteit-Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Centre, P.O. box 9101 (766), 6500 HB, Nijmegen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | | | - Christiaan G Overduin
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Centre, P.O. box 9101 (766), 6500 HB, Nijmegen, The Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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van der Stelt M, Verhulst AC, Vas Nunes JH, Koroma TAR, Nolet WWE, Slump CH, Grobusch MP, Maal TJJ, Brouwers L. Improving Lives in Three Dimensions: The Feasibility of 3D Printing for Creating Personalized Medical Aids in a Rural Area of Sierra Leone. Am J Trop Med Hyg 2020; 102:905-909. [PMID: 32100676 DOI: 10.4269/ajtmh.19-0359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this feasibility study was to investigate how a 3D printer could be put to its best use in a resource-limited healthcare setting. We have examined whether a 3D printer can contribute to making prostheses, braces, or splints for patients who underwent major limb amputation because of complex wounds, for example, due to burns and subsequent scarring, accidents, conflicts, or congenital abnormalities. During a 3-month period, we investigated the benefits of customized, 3D-printed arm prostheses, splints, and braces in Sierra Leone. Using a handheld 3D scanner and a 3D printer, patient-specific medical aids were designed, manufactured, and tested. Questionnaires regarding patient satisfaction and the functionality of the prostheses were used for a short-term follow-up. Four esthetic prostheses were designed: two prostheses of the hand, one of the forearm, and one of the entire arm. Follow-ups were conducted after 3 to 4 weeks to investigate the quality of the prostheses and to complete a patient questionnaire. Even though the prostheses primarily fulfill esthetic needs, they also exhibit some degree of functionality. In addition, four splints for hands and arms were made to prevent scar contractures after skin transplantation. Finally, a brace for a young boy with kyphoscoliosis was manufactured. The boy has accepted the brace and will be followed up in the months to come. Long-term follow-up is required to prove the sustainability of the 3D-printed brace and prosthetic arms. Further research into how to sustain and refine this project is underway.
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Affiliation(s)
- Merel van der Stelt
- Technical Medicine, University of Twente, Enschede, The Netherlands.,3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arico C Verhulst
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Throy A R Koroma
- Masanga Medical Research Unit (MMRU), Tonkolili District, Sierra Leone
| | - Wouter W E Nolet
- Masanga Medical Research Unit (MMRU), Tonkolili District, Sierra Leone
| | - Cornelis H Slump
- Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas J J Maal
- 3D Lab, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Brouwers
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Simmering JA, Geelkerken RH, Slump CH, Koenrades MA. Geometrical changes in Anaconda endograft limbs after endovascular aneurysm repair: A potential predictor for limb occlusion. Semin Vasc Surg 2020; 32:94-105. [PMID: 32553125 DOI: 10.1053/j.semvascsurg.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The emergence of limb occlusion after endovascular aneurysm repair may be related to the conformational changes between the endograft structure and the patient's anatomy. This study analyzed detailed geometric changes of Anaconda endograft (Terumo Aortic, Inchinnan, Scotland, UK) limbs during the cardiac cycle-based computed tomography on serial imaging after graft implantation. Fifteen patients (mean age 72.8 ± 3.7 years; 14 men) underwent postoperative electrocardiogram-gated computed tomography scans according to a prospective study design between April 2014 and May 2017. Changes in curvature, length of the limbs, and distances between successive stent rings (inter-ring distance) of the endograft limbs during a 2-year follow-up period were quantified using meticulous image processing methods involving image registration, centerline extraction, and model-based stent-ring segmentation. From discharge to 24 months, mean curvature increased significantly by 9.6 m-1 (standard deviation [SD], 11.1 m-1; 95% confidence interval [CI], 3.4 to 15.8 m-1; P = .002) for the right limbs and by 6.1 m-1 (SD 9.4 m-1; 95% CI, 0.8 to 11.5 m-1; P = .21) for the left limbs. The length of the right limbs decreased significantly, by 9.5 mm (SD 7.6 mm; 95% CI, 3.5 to 15.6 mm; P = .002); the length of the left limbs decreased by 10.1 mm (SD 5.1 mm; 95% CI, 5.9 to 14.2 mm; P < .001). The minimal inter-ring distance decreased by 0.36 mm (SD 0.26 mm; 95% CI, 0.17 to 0.55 mm; P < .001) for the right limbs and 0.35 mm (SD 0.19 mm; 95% CI, 0.21 to 0.49 mm; P < .001) for the left limbs. Cardiac pulsatility-induced changes in curvature, limb length, and inter-ring distance were negligible (2%, 0.3% and 0.3%, respectively). Changes in the geometry of the Anaconda endograft limbs after endovascular aortic aneurysm repair were observed during a 2-year follow-up manifest as an increase in curvature, shortening of the stent-graft limbs, and a corresponding decrease in inter-ring distance. These stent-graft conformational changes could result in inward folding of the graft fabric, which may relate to the emergence of limb occlusion. Further investigation of these metrics in a larger cohort involving patients with and without occlusions may allow determination of their predictive value.
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Affiliation(s)
- Jaimy A Simmering
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Multimodality Medical Imaging M3i Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands.
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Multimodality Medical Imaging M3i Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medicine Centre, University of Twente, Enschede, The Netherlands
| | - Maaike A Koenrades
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Multimodality Medical Imaging M3i Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands; Robotics and Mechatronics Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medicine Centre, University of Twente, Enschede, The Netherlands
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de Vries EE, Kök M, Hoving AM, Slump CH, Toorop RJ, de Borst GJ. (In)comparability of Carotid Artery Stent Characteristics: A Systematic Review on Assessment and Comparison with Manufacturer Data. Cardiovasc Intervent Radiol 2020; 43:1430-1437. [PMID: 32409999 PMCID: PMC7524852 DOI: 10.1007/s00270-020-02499-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/17/2020] [Indexed: 12/03/2022]
Abstract
Purpose Carotid stent (CS) characteristics, such as radial force, scaffolding and flexibility, are continuously modified by stent manufacturers aiming to improve stent performance. Since manufacturers’ definitions and assessment methods are not disclosed, it is unknown how characteristics of different CSs relate to each other or to published literature. We examined in vitro methodological techniques used to measure CS characteristics and assessed comparability between published papers and outcomes as provided by the manufacturers. Methods A systematic review was conducted in MEDLINE, Embase, Cochrane, and Scopus databases. Studies reporting on in vitro investigations of predefined characteristics of CS used in current everyday clinical practice were included. The predefined characteristics were radial force, scaffolding, flexibility, foreshortening, side-branch preservation and visibility. Eight manufacturers of 10 currently used CS were contacted and data on the predefined device characteristics was requested. Results 12 published articles were included and six stent manufacturers provided data on six stents (two refused to share data). Used methodologies to measure stent characteristics in published literature and manufacturer data varied greatly for all included characteristics except foreshortening. The number of different units of measurement to express outcomes ranged from two for foreshortening to six for radial force. Conclusion A variety of methodologies and outcome measures is used to quantify CS characteristics, which hampers comparisons between published studies and manufacturer data. Future studies are encouraged to synchronize methodologies and outcome measures. Manufacturers are encouraged up to increase transparency of applied testing methodologies and outcomes. Electronic supplementary material The online version of this article (10.1007/s00270-020-02499-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Evelien E de Vries
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Mert Kök
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Astrid M Hoving
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, The Netherlands.,Department of Robotics and Mechatronics (EEMCS), University of Twente, PO Box 217, Enschede, The Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics (EEMCS), University of Twente, PO Box 217, Enschede, The Netherlands
| | - Raechel J Toorop
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Hoving AM, de Vries EE, Mikhal J, de Borst GJ, Slump CH. A Systematic Review for the Design of In Vitro Flow Studies of the Carotid Artery Bifurcation. Cardiovasc Eng Technol 2020; 11:111-127. [PMID: 31823191 PMCID: PMC7082306 DOI: 10.1007/s13239-019-00448-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE In vitro blood flow studies in carotid artery bifurcation models may contribute to understanding the influence of hemodynamics on carotid artery disease. However, the design of in vitro blood flow studies involves many steps and selection of imaging techniques, model materials, model design, and flow visualization parameters. Therefore, an overview of the possibilities and guidance for the design process is beneficial for researchers with less experience in flow studies. METHODS A systematic search to in vitro flow studies in carotid artery bifurcation models aiming at quantification and detailed flow visualization of blood flow dynamics results in inclusion of 42 articles. RESULTS Four categories of imaging techniques are distinguished: MRI, optical particle image velocimetry (PIV), ultrasound and miscellaneous techniques. Parameters for flow visualization are categorized into velocity, flow, shear-related, turbulent/disordered flow and other parameters. Model materials and design characteristics vary between study type. CONCLUSIONS A simplified three-step design process is proposed for better fitting and adequate match with the pertinent research question at hand and as guidance for less experienced flow study researchers. The three consecutive selection steps are: flow parameters, image modality, and model materials and designs. Model materials depend on the chosen imaging technique, whereas choice of flow parameters is independent from imaging technique and is therefore only determined by the goal of the study.
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Affiliation(s)
- A M Hoving
- University of Twente, 7500 AE, Enschede, The Netherlands.
| | - E E de Vries
- University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - J Mikhal
- University of Twente, 7500 AE, Enschede, The Netherlands
| | - G J de Borst
- University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - C H Slump
- University of Twente, 7500 AE, Enschede, The Netherlands
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Kamphuis ME, Greuter MJW, Slart RHJA, Slump CH. Quantitative imaging: systematic review of perfusion/flow phantoms. Eur Radiol Exp 2020; 4:15. [PMID: 32128653 PMCID: PMC7054493 DOI: 10.1186/s41747-019-0133-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background We aimed at reviewing design and realisation of perfusion/flow phantoms for validating quantitative perfusion imaging (PI) applications to encourage best practices. Methods A systematic search was performed on the Scopus database for “perfusion”, “flow”, and “phantom”, limited to articles written in English published between January 1999 and December 2018. Information on phantom design, used PI and phantom applications was extracted. Results Of 463 retrieved articles, 397 were rejected after abstract screening and 32 after full-text reading. The 37 accepted articles resulted to address PI simulation in brain (n = 11), myocardial (n = 8), liver (n = 2), tumour (n = 1), finger (n = 1), and non-specific tissue (n = 14), with diverse modalities: ultrasound (n = 11), computed tomography (n = 11), magnetic resonance imaging (n = 17), and positron emission tomography (n = 2). Three phantom designs were described: basic (n = 6), aligned capillary (n = 22), and tissue-filled (n = 12). Microvasculature and tissue perfusion were combined in one compartment (n = 23) or in two separated compartments (n = 17). With the only exception of one study, inter-compartmental fluid exchange could not be controlled. Nine studies compared phantom results with human or animal perfusion data. Only one commercially available perfusion phantom was identified. Conclusion We provided insights into contemporary phantom approaches to PI, which can be used for ground truth evaluation of quantitative PI applications. Investigators are recommended to verify and validate whether assumptions underlying PI phantom modelling are justified for their intended phantom application.
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Affiliation(s)
- Marije E Kamphuis
- Multimodality Medical Imaging M3i Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, PO Box 217, Enschede, The Netherlands. .,Robotics and Mechatronics Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Marcel J W Greuter
- Robotics and Mechatronics Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Biomedical Photonic Imaging Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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