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Bunk SA, Ipema J, Sidorenkov G, Bennink E, Vliegenthart R, de Jong PA, Pompe E, Charbonnier JP, Luijk BH, Aerts J, Groen HJ, Mohamed Hoesein FA. The relationship of fat and muscle measurements with emphysema and bronchial wall thickening in smokers. ERJ Open Res 2024; 10:00749-2023. [PMID: 38444665 PMCID: PMC10910310 DOI: 10.1183/23120541.00749-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/17/2023] [Indexed: 03/07/2024] Open
Abstract
Introduction Differences in body composition in patients with COPD may have important prognostic value and may provide opportunities for patient-specific management. We investigated the relation of thoracic fat and muscle with computed tomography (CT)-measured emphysema and bronchial wall thickening. Methods Low-dose baseline chest CT scans from 1031 male lung cancer screening participants from one site were quantified for emphysema, bronchial wall thickening, subcutaneous fat, visceral fat and skeletal muscle. Body composition measurements were performed by segmenting the first slice above the aortic arch using Hounsfield unit thresholds with region growing and manual corrections. COPD presence and severity were evaluated with pre-bronchodilator spirometry testing. Results Participants had a median age of 61.5 years (58.6-65.6, 25th-75th percentile) and median number of 38.0 pack-years (28.0-49.5); 549 (53.2%) were current smokers. Overall, 396 (38.4%) had COPD (256 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1, 140 GOLD 2-3). Participants with COPD had less subcutaneous fat, visceral fat and skeletal muscle (p<0.001 for all). With increasing GOLD stages, subcutaneous (p=0.005) and visceral fat values (p=0.004) were higher, and skeletal muscle was lower (p=0.004). With increasing severity of CT-derived emphysema, subcutaneous fat, visceral fat and skeletal muscle values were lower (p<0.001 for all). With increasing CT-derived bronchial wall thickness, subcutaneous and visceral fat values were higher (p<0.001 for both), without difference in skeletal muscle. All statistical relationships remained when adjusted for age, pack-years and smoking status. Conclusion COPD presence and emphysema severity are associated with smaller amounts of thoracic fat and muscle, whereas bronchial wall thickening is associated with fat accumulation.
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Affiliation(s)
- Stijn A.O. Bunk
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetty Ipema
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther Pompe
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bart H.D. Luijk
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joachim Aerts
- Department of Respiratory Medicine, ErasmusMC, Rotterdam, The Netherlands
| | - Harry J.M. Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Peerlings D, Bennink E, Dankbaar JW, Velthuis BK, Emmer BJ, Hoving JW, Majoie CBLM, Marquering HA, van Voorst H, de Jong HWAM. Standardizing the estimation of ischemic regions can harmonize CT perfusion stroke imaging. Eur Radiol 2024; 34:797-807. [PMID: 37572189 PMCID: PMC10853359 DOI: 10.1007/s00330-023-10035-1] [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: 02/17/2023] [Revised: 04/25/2023] [Accepted: 06/16/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES We aimed to evaluate the real-world variation in CT perfusion (CTP) imaging protocols among stroke centers and to explore the potential for standardizing vendor software to harmonize CTP images. METHODS Stroke centers participating in a nationwide multicenter healthcare evaluation were requested to share their CTP scan and processing protocol. The impact of these protocols on CTP imaging was assessed by analyzing data from an anthropomorphic phantom with center-specific vendor software with default settings from one of three vendors (A-C): IntelliSpace Portal, syngoVIA, and Vitrea. Additionally, standardized infarct maps were obtained using a logistic model. RESULTS Eighteen scan protocols were studied, all varying in acquisition settings. Of these protocols, seven, eight, and three were analyzed with center-specific vendor software A, B, and C respectively. The perfusion maps were visually dissimilar between the vendor software but were relatively unaffected by the acquisition settings. The median error [interquartile range] of the infarct core volumes (mL) estimated by the vendor software was - 2.5 [6.5] (A)/ - 18.2 [1.2] (B)/ - 8.0 [1.4] (C) when compared to the ground truth of the phantom (where a positive error indicates overestimation). Taken together, the median error [interquartile range] of the infarct core volumes (mL) was - 8.2 [14.6] before standardization and - 3.1 [2.5] after standardization. CONCLUSIONS CTP imaging protocols varied substantially across different stroke centers, with the perfusion software being the primary source of differences in CTP images. Standardizing the estimation of ischemic regions harmonized these CTP images to a degree. CLINICAL RELEVANCE STATEMENT The center that a stroke patient is admitted to can influence the patient's diagnosis extensively. Standardizing vendor software for CT perfusion imaging can improve the consistency and accuracy of results, enabling a more reliable diagnosis and treatment decision. KEY POINTS • CT perfusion imaging is widely used for stroke evaluation, but variation in the acquisition and processing protocols between centers could cause varying patient diagnoses. • Variation in CT perfusion imaging mainly arises from differences in vendor software rather than acquisition settings, but these differences can be reconciled by standardizing the estimation of ischemic regions. • Standardizing the estimation of ischemic regions can improve CT perfusion imaging for stroke evaluation by facilitating reliable evaluations independent of the admission center.
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Affiliation(s)
- Daan Peerlings
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands.
| | - Edwin Bennink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, 1105AZ, The Netherlands
| | - Jan W Hoving
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, 1105AZ, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, 1105AZ, The Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, 1105AZ, The Netherlands
- Department of Biomedical Engineering and Physics, Location Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, 1105AZ, The Netherlands
| | - Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, 1105AZ, The Netherlands
- Department of Biomedical Engineering and Physics, Location Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, 1105AZ, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
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Markodimitraki LM, Harkel TCT, Bennink E, Stegeman I, Thomeer HGXM. A monocenter, patient-blinded, randomized, parallel-group, non-inferiority study to compare cochlear implant receiver/stimulator device fixation techniques (COMFIT) with and without drilling in adults eligible for primary cochlear implantation. Trials 2023; 24:605. [PMID: 37743463 PMCID: PMC10518101 DOI: 10.1186/s13063-023-07568-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND During the cochlear implantation procedure, the receiver/stimulator (R/S) part of the implant is fixated to prevent postoperative device migration, which could have an adverse effect on the position of the electrode array in the cochlea. We aim to compare the migration rates of two fixation techniques, the bony recess versus the subperiosteal tight pocket without bony sutures. METHODS AND ANALYSIS This single-blind randomized controlled trial will recruit a total of 112 primary cochlear implantation adult patients, eligible for implantation according to the current standard of practice. Randomization will be performed by an electronic data capture system Castor EDC, with participants block randomized to either bony recess or standard subperiosteal tight pocket in a 1:1 ratio, stratified by age. The primary outcome of this study is the R/S device migration rate; secondary outcomes include patient-experienced burden using the validated COMPASS questionnaire, electrode migration rate, electrode impedance values, speech perception scores, correlation between R/S migration, electrode array migration and patient complaints, assessment of complication rates, and validation of an implant position measurement method. Data will be collected at baseline, 1 week, 4 weeks, 8 weeks, 3 months, and 12 months after surgery. All data analyses will be conducted according to the intention-to-treat principle. DISCUSSION Cochlear implantation by means of creating a tight subperiosteal pocket without drilling a bony seat is a minimally invasive fixation technique with many advantages. However, the safety of this technique has not yet been proven with certainty. This is the first randomized controlled trial that directly compares the minimally invasive technique with the conventional method of drilling a bony seat. TRIAL REGISTRATION Netherlands Trial Register NL9698. Registered on 31 August 2021.
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Affiliation(s)
- Laura M Markodimitraki
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, G.05.1.29, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
- UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Timen C Ten Harkel
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin Bennink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, G.05.1.29, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
- UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, G.05.1.29, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
- UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
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Peerlings D, de Jong HWAM, Bennink E, Dankbaar JW, Velthuis BK, Emmer BJ, Majoie CBLM, Marquering HA. Spatial CT perfusion data helpful in automatically locating vessel occlusions for acute ischemic stroke patients. Front Neurol 2023; 14:1136232. [PMID: 37064186 PMCID: PMC10090274 DOI: 10.3389/fneur.2023.1136232] [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] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionLocating a vessel occlusion is important for clinical decision support in stroke healthcare. The advent of endovascular thrombectomy beyond proximal large vessel occlusions spurs alternative approaches to locate vessel occlusions. We explore whether CT perfusion (CTP) data can help to automatically locate vessel occlusions.MethodsWe composed an atlas with the downstream regions of particular vessel segments. Occlusion of these segments should result in the hypoperfusion of the corresponding downstream region. We differentiated between seven-vessel occlusion locations (ICA, proximal M1, distal M1, M2, M3, ACA, and posterior circulation). We included 596 patients from the DUtch acute STroke (DUST) multicenter study. Each patient CTP data set was processed with perfusion software to determine the hypoperfused region. The downstream region with the highest overlap with the hypoperfused region was considered to indicate the vessel occlusion location. We assessed the indications from CTP against expert annotations from CTA.ResultsOur atlas-based model had a mean accuracy of 86% and could achieve substantial agreement with the annotations from CTA according to Cohen's kappa coefficient (up to 0.68). In particular, anterior large vessel occlusions and occlusions in the posterior circulation could be located with an accuracy of 80 and 92%, respectively.ConclusionThe spatial layout of the hypoperfused region can help to automatically indicate the vessel occlusion location for acute ischemic stroke patients. However, variations in vessel architecture between patients seemed to limit the capacity of CTP data to distinguish between vessel occlusion locations more accurately.
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Affiliation(s)
- Daan Peerlings
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Daan Peerlings
| | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jan W. Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bart J. Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Charles B. L. M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
| | - Henk A. Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, Netherlands
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Kauw F, Velthuis BK, Takx RAP, Guglielmo M, Cramer MJ, van Ommen F, Bos A, Bennink E, Kappelle LJ, de Jong HWAM, Dankbaar JW. Detection of Cardioembolic Sources With Nongated Cardiac Computed Tomography Angiography in Acute Stroke: Results From the ENCLOSE Study. Stroke 2023; 54:821-830. [PMID: 36779342 PMCID: PMC9951793 DOI: 10.1161/strokeaha.122.041018] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Identifying cardioembolic sources in patients with acute ischemic stroke is important for the choice of secondary prevention strategies. We prospectively investigated the yield of admission (spectral) nongated cardiac computed tomography angiography (CTA) to detect cardioembolic sources in stroke. METHODS Participants of the ENCLOSE study (Improved Prediction of Recurrent Stroke and Detection of Small Volume Stroke) with transient ischemic attack or acute ischemic stroke with assessable nongated head-to-heart CTA at the University Medical Center Utrecht were included between June 2017 and March 2022. The presence of cardiac thrombus on cardiac CTA was based on a Likert scale and dichotomized into certainly or probably absent versus possibly, probably, or certainly present. The diagnostic certainty of cardiac thrombus was evaluated again on spectral computed tomography reconstructions. The likelihood of a cardioembolic source was determined post hoc by an expert panel in patients with cardiac thrombus on CTA. Parametric and nonparametric tests were used to compare the outcome groups. RESULTS Forty four (12%) of 370 included patients had a cardiac thrombus on admission CTA: 35 (9%) in the left atrial appendage and 14 (4%) in the left ventricle. Patients with cardiac thrombus had more severe strokes (median National Institutes of Health Stroke Scale score, 10 versus 4; P=0.006), had higher clot burden (median clot burden score, 9 versus 10; P=0.004), and underwent endovascular treatment more often (43% versus 20%; P<0.001) than patients without cardiac thrombus. Left atrial appendage thrombus was present in 28% and 6% of the patients with and without atrial fibrillation, respectively (P<0.001). The diagnostic certainty for left atrial appendage thrombus was higher for spectral iodine maps compared with the conventional CTA (P<0.001). The presence of cardiac thrombus on CTA increased the likelihood of a cardioembolic source according to the expert panel (P<0.001). CONCLUSIONS Extending the stroke CTA to cover the heart increases the chance of detecting cardiac thrombi and helps to identify cardioembolic sources in the acute stage of ischemic stroke with more certainty. Spectral iodine maps provide additional value for detecting left atrial appendage thrombus. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04019483.
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Affiliation(s)
- Frans Kauw
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Brain Center, Department of Neurology and Neurosurgery (F.K., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Richard A P Takx
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marco Guglielmo
- Department of Cardiology (M.G., M.J.C.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology (M.G., M.J.C.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Fasco van Ommen
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Anneloes Bos
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Edwin Bennink
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - L Jaap Kappelle
- Brain Center, Department of Neurology and Neurosurgery (F.K., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology (F.K., B.K.V., R.A.P.T., F.v.O., A.B., E.B., H.W.A.M.d.J., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Kauw F, Bernsen MLE, Dankbaar JW, de Jong HWAM, Kappelle LJ, Velthuis BK, van der Worp HB, van der Lugt A, Roos YBWEM, Yo LSF, van Walderveen MAA, Hofmeijer J, Bennink E. Cerebrospinal fluid volume improves prediction of malignant edema after endovascular treatment of stroke. Int J Stroke 2023; 18:187-192. [PMID: 35373655 PMCID: PMC9896253 DOI: 10.1177/17474930221094693] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a potential predictor of malignant edema formation in patients with acute ischemic stroke. AIMS We aimed to evaluate the added value of the CSF/ICV ratio in a model to predict malignant edema formation in patients who underwent endovascular treatment. METHODS We included patients from the MR CLEAN Registry, a prospective national multicenter registry of patients who were treated with endovascular treatment between 2014 and 2017 because of acute ischemic stroke caused by large vessel occlusion. The CSF/ICV ratio was automatically measured on baseline thin-slice noncontrast CT. The primary outcome was the occurrence of malignant edema based on clinical and imaging features. The basic model included the following predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, occlusion of the internal carotid artery, collateral score, time between symptom onset and groin puncture, and unsuccessful reperfusion. The extended model included the basic model and the CSF/ICV ratio. The performance of the basic and the extended model was compared with the likelihood ratio test. RESULTS Malignant edema occurred in 40 (6%) of 683 patients. In the extended model, a lower CSF/ICV ratio was associated with the occurrence of malignant edema (odds ratio (OR) per percentage point, 1.2; 95% confidence interval (CI) 1.1-1.3, p < 0.001). Age lost predictive value for malignant edema in the extended model (OR 1.1; 95% CI 0.9-1.5, p = 0.372). The performance of the extended model was higher than that of the basic model (p < 0.001). CONCLUSIONS Adding the CSF/ICV ratio improves a multimodal prediction model for the occurrence of malignant edema after endovascular treatment.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Frans Kauw, Department of Radiology, University Medical Center Utrecht, Utrecht University, Room Q.01.4.46, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | | | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hugo WAM de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Yvo BWEM Roos
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lonneke SF Yo
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Gava UA, D'Agata F, Tartaglione E, Renzulli R, Grangetto M, Bertolino F, Santonocito A, Bennink E, Vaudano G, Boghi A, Bergui M. Neural network-derived perfusion maps: A model-free approach to computed tomography perfusion in patients with acute ischemic stroke. Front Neuroinform 2023; 17:852105. [PMID: 36970658 PMCID: PMC10034033 DOI: 10.3389/fninf.2023.852105] [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: 01/10/2022] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
Objective In this study, we investigate whether a Convolutional Neural Network (CNN) can generate informative parametric maps from the pre-processed CT perfusion data in patients with acute ischemic stroke in a clinical setting. Methods The CNN training was performed on a subset of 100 pre-processed perfusion CT dataset, while 15 samples were kept for testing. All the data used for the training/testing of the network and for generating ground truth (GT) maps, using a state-of-the-art deconvolution algorithm, were previously pre-processed using a pipeline for motion correction and filtering. Threefold cross validation had been used to estimate the performance of the model on unseen data, reporting Mean Squared Error (MSE). Maps accuracy had been checked through manual segmentation of infarct core and total hypo-perfused regions on both CNN-derived and GT maps. Concordance among segmented lesions was assessed using the Dice Similarity Coefficient (DSC). Correlation and agreement among different perfusion analysis methods were evaluated using mean absolute volume differences, Pearson correlation coefficients, Bland-Altman analysis, and coefficient of repeatability across lesion volumes. Results The MSE was very low for two out of three maps, and low in the remaining map, showing good generalizability. Mean Dice scores from two different raters and the GT maps ranged from 0.80 to 0.87. Inter-rater concordance was high, and a strong correlation was found between lesion volumes of CNN maps and GT maps (0.99, 0.98, respectively). Conclusion The agreement between our CNN-based perfusion maps and the state-of-the-art deconvolution-algorithm perfusion analysis maps, highlights the potential of machine learning methods applied to perfusion analysis. CNN approaches can reduce the volume of data required by deconvolution algorithms to estimate the ischemic core, and thus might allow the development of novel perfusion protocols with lower radiation dose deployed to the patient.
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Affiliation(s)
- Umberto A Gava
- Division of Neuroradiology, Molinette Hospital, Turin, Italy
- Department of Neurosciences, University of Turin, Turin, Italy
| | | | - Enzo Tartaglione
- Department of Computer Science, University of Turin, Turin, Italy
| | | | - Marco Grangetto
- Department of Computer Science, University of Turin, Turin, Italy
| | - Francesca Bertolino
- Division of Neuroradiology, Molinette Hospital, Turin, Italy
- Department of Neurosciences, University of Turin, Turin, Italy
| | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Giacomo Vaudano
- Division of Neuroradiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Andrea Boghi
- Division of Neuroradiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Mauro Bergui
- Division of Neuroradiology, Molinette Hospital, Turin, Italy
- Department of Neurosciences, University of Turin, Turin, Italy
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Peerlings D, van Ommen F, Bennink E, Dankbaar JW, Velthuis BK, Emmer BJ, Hoving JW, Majoie CBLM, Marquering HA, de Jong HWAM. Probability maps classify ischemic stroke regions more accurately than CT perfusion summary maps. Eur Radiol 2022; 32:6367-6375. [PMID: 35357536 PMCID: PMC9381605 DOI: 10.1007/s00330-022-08700-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: 10/18/2021] [Revised: 02/01/2022] [Accepted: 02/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare single parameter thresholding with multivariable probabilistic classification of ischemic stroke regions in the analysis of computed tomography perfusion (CTP) parameter maps. METHODS Patients were included from two multicenter trials and were divided into two groups based on their modified arterial occlusive lesion grade. CTP parameter maps were generated with three methods-a commercial method (ISP), block-circulant singular value decomposition (bSVD), and non-linear regression (NLR). Follow-up non-contrast CT defined the follow-up infarct region. Conventional thresholds for individual parameter maps were established with a receiver operating characteristic curve analysis. Probabilistic classification was carried out with a logistic regression model combining the available CTP parameters into a single probability. RESULTS A total of 225 CTP data sets were included, divided into a group of 166 patients with successful recanalization and 59 with persistent occlusion. The precision and recall of the CTP parameters were lower individually than when combined into a probability. The median difference [interquartile range] in mL between the estimated and follow-up infarct volume was 29/23/23 [52/50/52] (ISP/bSVD/NLR) for conventional thresholding and was 4/6/11 [31/25/30] (ISP/bSVD/NLR) for the probabilistic classification. CONCLUSIONS Multivariable probability maps outperform thresholded CTP parameter maps in estimating the infarct lesion as observed on follow-up non-contrast CT. A multivariable probabilistic approach may harmonize the classification of ischemic stroke regions. KEY POINTS • Combining CTP parameters with a logistic regression model increases the precision and recall in estimating ischemic stroke regions. • Volumes following from a probabilistic analysis predict follow-up infarct volumes better than volumes following from a threshold-based analysis. • A multivariable probabilistic approach may harmonize the classification of ischemic stroke regions.
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Affiliation(s)
- Daan Peerlings
- grid.7692.a0000000090126352Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Fasco van Ommen
- grid.7692.a0000000090126352Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Edwin Bennink
- grid.7692.a0000000090126352Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands ,grid.7692.a0000000090126352Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Jan W. Dankbaar
- grid.7692.a0000000090126352Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Birgitta K. Velthuis
- grid.7692.a0000000090126352Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
| | - Bart J. Emmer
- grid.509540.d0000 0004 6880 3010Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, 1105AZ The Netherlands
| | - Jan W. Hoving
- grid.509540.d0000 0004 6880 3010Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, 1105AZ The Netherlands
| | - Charles B. L. M. Majoie
- grid.509540.d0000 0004 6880 3010Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, 1105AZ The Netherlands
| | - Henk A. Marquering
- grid.509540.d0000 0004 6880 3010Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, 1105AZ The Netherlands
| | - Hugo W. A. M. de Jong
- grid.7692.a0000000090126352Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX The Netherlands
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9
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van Ommen F, Kauw F, Bennink E, Heit JJ, Wolman DN, Dankbaar JW, de Jong HWAM, Wintermark M. Image Quality of Virtual Monochromatic Reconstructions of Noncontrast CT on a Dual-Source CT Scanner in Adult Patients. Acad Radiol 2021; 28:e323-e330. [PMID: 32616420 DOI: 10.1016/j.acra.2020.05.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the image quality of virtual monochromatic images (VMI) reconstructed from dual-energy dual-source noncontrast head CT with different reconstruction kernels. MATERIALS AND METHODS Twenty-five consecutive adult patients underwent noncontrast dual-energy CT. VMI were retrospectively reconstructed at 5-keV increments from 40 to 140 keV using quantitative and head kernels. CT-number, noise levels (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the gray and white matter and artifacts using the posterior fossa artifact index (PFAI) were evaluated. RESULTS CT-number increased with decreasing VMI energy levels, and SD was lowest at 85 keV. SNR was maximized at 80 keV and 85 keV for the head and quantitative kernels, respectively. CNR was maximum at 40 keV; PFAI was lowest at 90 (head kernel) and 100 (quantitative kernel) keV. Optimal VMI image quality was significantly better than conventional CT. CONCLUSION Optimal image quality of VMI energies can improve brain parenchymal image quality compared to conventional CT but are reconstruction kernel dependent and depend on indication for performing noncontrast CT.
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Affiliation(s)
- Fasco van Ommen
- Department of Neuroradiology, Stanford University, Palo Alto, CA; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Frans Kauw
- Department of Neuroradiology, Stanford University, Palo Alto, CA; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands
| | - Edwin Bennink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeremy J Heit
- Department of Neuroradiology, Stanford University, Palo Alto, CA
| | - Dylan N Wolman
- Department of Neuroradiology, Stanford University, Palo Alto, CA
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max Wintermark
- Department of Neuroradiology, Stanford University, Palo Alto, CA
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10
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Peerlings D, Bennink E, Dankbaar JW, Velthuis BK, de Jong HWAM. Variation in arterial input function in a large multicenter computed tomography perfusion study. Eur Radiol 2021; 31:8317-8325. [PMID: 34050385 PMCID: PMC8523411 DOI: 10.1007/s00330-021-08067-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 01/21/2023]
Abstract
Objectives To report the variation in computed tomography perfusion (CTP) arterial input function (AIF) in a multicenter stroke study and to assess the impact this has on CTP results. Methods CTP datasets from 14 different centers were included from the DUtch acute STroke (DUST) study. The AIF was taken as a direct measure to characterize contrast bolus injection. Statistical analysis was applied to evaluate differences in amplitude, area under the curve (AUC), bolus arrival time (BAT), and time to peak (TTP). To assess the clinical relevance of differences in AIF, CTP acquisitions were simulated with a realistic anthropomorphic digital phantom. Perfusion parameters were extracted by CTP analysis using commercial software (IntelliSpace Portal (ISP), version 10.1) as well as an in-house method based on block-circulant singular value decomposition (bSVD). Results A total of 1422 CTP datasets were included, ranging from 6 to 322 included patients per center. The measured values of the parameters used to characterize the AIF differed significantly with approximate interquartile ranges of 200–750 HU for the amplitude, 2500–10,000 HU·s for the AUC, 0–17 s for the BAT, and 10–26 s for the TTP. Mean infarct volumes of the phantom were significantly different between centers for both methods of perfusion analysis. Conclusions Although guidelines for the acquisition protocol are often provided for centers participating in a multicenter study, contrast medium injection protocols still vary. The resulting volumetric differences in infarct core and penumbra may impact clinical decision making in stroke diagnosis. Key Points • The contrast medium injection protocol may be different between stroke centers participating in a harmonized multicenter study. • The contrast medium injection protocol influences the results of X-ray computed tomography perfusion imaging. • The contrast medium injection protocol can impact stroke diagnosis and patient selection for treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08067-6.
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Affiliation(s)
- Daan Peerlings
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands.
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3584CX, The Netherlands
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11
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Wolman DN, van Ommen F, Tong E, Kauw F, Dankbaar JW, Bennink E, de Jong HWAM, Molvin L, Wintermark M, Heit JJ. Non-contrast dual-energy CT virtual ischemia maps accurately estimate ischemic core size in large-vessel occlusive stroke. Sci Rep 2021; 11:6745. [PMID: 33762589 PMCID: PMC7991428 DOI: 10.1038/s41598-021-85143-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/18/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
Dual-energy CT (DECT) material decomposition techniques may better detect edema within cerebral infarcts than conventional non-contrast CT (NCCT). This study compared if Virtual Ischemia Maps (VIM) derived from non-contrast DECT of patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) are superior to NCCT for ischemic core estimation, compared against reference-standard DWI-MRI. Only patients whose baseline ischemic core was most likely to remain stable on follow-up MRI were included, defined as those with excellent post-thrombectomy revascularization or no perfusion mismatch. Twenty-four consecutive AIS-LVO patients with baseline non-contrast DECT, CT perfusion (CTP), and DWI-MRI were analyzed. The primary outcome measure was agreement between volumetric manually segmented VIM, NCCT, and automatically segmented CTP estimates of the ischemic core relative to manually segmented DWI volumes. Volume agreement was assessed using Bland–Altman plots and comparison of CT to DWI volume ratios. DWI volumes were better approximated by VIM than NCCT (VIM/DWI ratio 0.68 ± 0.35 vs. NCCT/DWI ratio 0.34 ± 0.35; P < 0.001) or CTP (CTP/DWI ratio 0.45 ± 0.67; P < 0.001), and VIM best correlated with DWI (rVIM = 0.90; rNCCT = 0.75; rCTP = 0.77; P < 0.001). Bland–Altman analyses indicated significantly greater agreement between DWI and VIM than NCCT core volumes (mean bias 0.60 [95%AI 0.39–0.82] vs. 0.20 [95%AI 0.11–0.30]). We conclude that DECT VIM estimates the ischemic core in AIS-LVO patients more accurately than NCCT.
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Affiliation(s)
- Dylan N Wolman
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA.
| | - Fasco van Ommen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elizabeth Tong
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA
| | - Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lior Molvin
- Department of Radiology, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94505, USA
| | - Max Wintermark
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA
| | - Jeremy J Heit
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA.
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12
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Kauw F, van Ommen F, Bennink E, Cramer MJ, Kappelle LJ, Takx RA, Velthuis BK, Viergever MA, Wouter van Es H, Schonewille WJ, Coutinho JM, Majoie CB, Marquering HA, de Jong HW, Dankbaar JW. Early detection of small volume stroke and thromboembolic sources with computed tomography: Rationale and design of the ENCLOSE study. Eur Stroke J 2021; 5:432-440. [PMID: 33598562 PMCID: PMC7856586 DOI: 10.1177/2396987320966420] [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: 06/18/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023] Open
Abstract
Background Computed tomography is the most frequently used imaging modality in acute stroke imaging protocols. Detection of small volume infarcts in the brain and cardioembolic sources of stroke is difficult with current computed tomography protocols. Furthermore, the role of computed tomography findings to predict recurrent ischemic stroke is unclear. With ENCLOSE, we aim to improve (1) the detection of small volume infarcts with thin slice computed tomography perfusion (CTP) images and thromboembolic source with cardiac computed tomography techniques in the acute stage of ischemic stroke and (2) prediction of recurrent ischemic stroke with computed tomography-derived predictors. Methods/design: ENCLOSE is a prospective multicenter observational cohort study, which will be conducted in three Dutch stroke centers (ClinicalTrials.gov Identifier: NCT04019483). Patients (≥18 years) with suspected acute ischemic stroke who undergo computed tomography imaging within 9 h after symptom onset are eligible. Computed tomography imaging includes non-contrast CT, CTP, and computed tomography angiography (CTA) from base of the heart to the top of the brain. Dual-energy CT data will be acquired when possible, and thin-slice CTP reconstructions will be obtained in addition to standard 5 mm CTP data. CTP data will be processed with commercially available software and locally developed model-based methods. The post-processed thin-slice CTP images will be compared to the standard CTP images and to magnetic resonance diffusion-weighted imaging performed within 48 h after admission. Detection of cardioembolic sources of stroke will be evaluated on the CTA images. Recurrence will be evaluated 90 days and two years after the index event. The added value of imaging findings to prognostic models for recurrent ischemic stroke will be evaluated. Conclusion The aim of ENCLOSE is to improve early detection of small volume stroke and thromboembolic sources and to improve prediction of recurrence in patients with acute ischemic stroke.
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Affiliation(s)
- Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fasco van Ommen
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, Utrecht University, The Netherlands
| | - L Jaap Kappelle
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard Ap Takx
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Max A Viergever
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H Wouter van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Henk A Marquering
- Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hugo Wam de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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13
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Leiner T, Bennink E, Mol CP, Kuijf HJ, Veldhuis WB. Bringing AI to the clinic: blueprint for a vendor-neutral AI deployment infrastructure. Insights Imaging 2021; 12:11. [PMID: 33528677 PMCID: PMC7855120 DOI: 10.1186/s13244-020-00931-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 06/03/2020] [Accepted: 10/16/2020] [Indexed: 12/30/2022] Open
Abstract
AI provides tremendous opportunities for improving patient care, but at present there is little evidence of real-world uptake. An important barrier is the lack of well-designed, vendor-neutral and future-proof infrastructures for deployment. Because current AI algorithms are very narrow in scope, it is expected that a typical hospital will deploy many algorithms concurrently. Managing stand-alone point solutions for all of these algorithms will be unmanageable. A solution to this problem is a dedicated platform for deployment of AI. Here we describe a blueprint for such a platform and the high-level design and implementation considerations of such a system that can be used clinically as well as for research and development. Close collaboration between radiologists, data scientists, software developers and experts in hospital IT as well as involvement of patients is crucial in order to successfully bring AI to the clinic.
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Affiliation(s)
- Tim Leiner
- Department of Radiology
- E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Edwin Bennink
- Image Sciences Institute, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Christian P Mol
- Image Sciences Institute, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology
- E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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14
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van Ommen F, Bennink E, Dankbaar JW, Kauw F, de Jong HWAM. Improving the Quality of Cerebral Perfusion Maps With Monoenergetic Dual-Energy Computed Tomography Reconstructions. J Comput Assist Tomogr 2021; 45:103-109. [PMID: 32176156 DOI: 10.1097/rct.0000000000000981] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We compared 40- to 70-keV virtual monoenergetic to conventional computed tomography (CT) perfusion reconstructions with respect to quality of perfusion maps. METHODS Conventional CT perfusion (CTP) images were acquired at 80 kVp in 25 patients, and 40- to 70-keV images were acquired with a dual-layer CT at 120 kVp in 25 patients. First, time-attenuation-curve contrast-to-noise ratio was assessed. Second, the perfusion maps of both groups were qualitatively analyzed by observers. Last, the monoenergetic reconstruction with the highest quality was compared with the clinical standard 80-kVp CTP acquisitions. RESULTS Contrast-to-noise ratio was significantly better for 40 to 60 keV as compared with 70 keV and conventional images (P < 0.001). Visually, the difference between the blood volume maps among reconstructions was minimal. The 50-keV perfusion maps had the highest quality compared with the other monoenergetic and conventional maps (P < 0.002). CONCLUSIONS The quality of 50-keV CTP images is superior to the quality of conventional 80- and 120-kVp images.
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Affiliation(s)
| | | | | | - Frans Kauw
- From the Departments of Radiology and Nuclear Medicine
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15
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Arrarte Terreros N, Tolhuisen ML, Bennink E, de Jong HW, Beenen LF, Majoie CB, van Bavel E, Marquering HA. From perviousness to permeability, modelling and measuring intra-thrombus flow in acute ischemic stroke. J Biomech 2020; 111:110001. [DOI: 10.1016/j.jbiomech.2020.110001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
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16
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van Ommen F, Dankbaar JW, Zhu G, Wolman DN, Heit JJ, Kauw F, Bennink E, de Jong HWAM, Wintermark M. Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke. Neuroradiology 2020; 63:41-49. [PMID: 32728777 PMCID: PMC7803871 DOI: 10.1007/s00234-020-02492-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/05/2020] [Indexed: 12/12/2022]
Abstract
Purpose Early infarcts are hard to diagnose on non-contrast head CT. Dual-energy CT (DECT) may potentially increase infarct differentiation. The optimal DECT settings for differentiation were identified and evaluated. Methods One hundred and twenty-five consecutive patients who presented with suspected acute ischemic stroke (AIS) and underwent non-contrast DECT and subsequent DWI were retrospectively identified. The DWI was used as reference standard. First, virtual monochromatic images (VMI) of 25 patients were reconstructed from 40 to 140 keV and scored by two readers for acute infarct. Sensitivity, specificity, positive, and negative predictive values for infarct detection were compared and a subset of VMI energies were selected. Next, for a separate larger cohort of 100 suspected AIS patients, conventional non-contrast CT (NCT) and selected VMI were scored by two readers for the presence and location of infarct. The same statistics for infarct detection were calculated. Infarct location match was compared per vascular territory. Subgroup analyses were dichotomized by time from last-seen-well to CT imaging. Results A total of 80–90 keV VMI were marginally more sensitive (36.3–37.3%) than NCT (32.4%; p > 0.680), with marginally higher specificity (92.2–94.4 vs 91.1%; p > 0.509) for infarct detection. Location match was superior for VMI compared with NCT (28.7–27.4 vs 19.5%; p < 0.010). Within 4.5 h from last-seen-well, 80 keV VMI more accurately detected infarct (58.0 vs 54.0%) and localized infarcts (27.1 vs 11.9%; p = 0.004) than NCT, whereas after 4.5 h, 90 keV VMI was more accurate (69.3 vs 66.3%). Conclusion Non-contrast 80–90 keV VMI best differentiates normal from infarcted brain parenchyma. Electronic supplementary material The online version of this article (10.1007/s00234-020-02492-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fasco van Ommen
- Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA USA
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - Guangming Zhu
- Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA USA
| | - Dylan N. Wolman
- Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA USA
| | - Jeremy J. Heit
- Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA USA
| | - Frans Kauw
- Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA USA
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - Edwin Bennink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, E01.132, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max Wintermark
- Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA USA
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Risseeuw S, Bennink E, Poirot MG, de Jong PA, Spiering W, Imhof SM, van Leeuwen R, Ossewaarde-van Norel J. A Reflectivity Measure to Quantify Bruch's Membrane Calcification in Patients with Pseudoxanthoma Elasticum Using Optical Coherence Tomography. Transl Vis Sci Technol 2020; 9:34. [PMID: 32855880 PMCID: PMC7422762 DOI: 10.1167/tvst.9.8.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/06/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Progressive calcification of Bruch's membrane (BM) causes considerable visual morbidity in patients with pseudoxanthoma elasticum (PXE). Since calcification is hyperreflective on optical coherence tomography (OCT), our aim was to measure BM calcification with OCT imaging. Methods Case-control study with 45 patients with PXE under 40 years (range, 11-39) and 25 controls (range, 14-39). Spectralis HRA-OCT imaging consisted of seven macular B-scans with 250-µm spacing. Retinal segmentation was performed with the IOWA Reference Algorithms. MATLAB was used to extract and average z-axis reflectivity profiles. Layer reflectivities were normalized to the ganglion cell and inner plexiform layers. Both median and peak layer reflectivities were compared between patients with PXE and controls. The discriminative value of the retinal pigment epithelium (RPE)-BM peak reflectivity was analyzed using receiver operating characteristic analysis. Results The reflectivity profile of patients with PXE differed from controls in the outer retinal layers. The normalized median RPE-BM reflectivity was 41.1 (interquartile range [IQR], 26.3-51.9) in patients with PXE, compared with 22.5 (IQR, 19.3-29.5) in controls (P = 2.09 × 10-3). The normalized RPE-BM peak reflectivity was higher in patients with PXE (67.5; IQR, 42.1-84.2) than in controls (32.7; IQR, 25.7-38.9; P = 2.43 × 10-5) and had a high discriminative value with an area under the curve of 0.85 (95% confidence interval, 0.76-0.95). In patients with PXE under 40 years, increasing age did not have a statistically significant effect on the RPE-BM peak reflectivity (patients under 20 years: 44.2 [IQR, 40.5-74.6]; 20-30 years: 66.0 [IQR, 45.1-83.8]; 30-40 years: 70.8 [IQR, 49.0-88.0], P = 0.47). Conclusions BM calcification can be measured as increased RPE-BM reflectivity in young patients with PXE and has a high discriminative value. Translational Relevance In patients with PXE, the OCT reflectivity of Bruch's membrane may be the first biomarker for Bruch's membrane calcification and a valuable ophthalmologic endpoint in clinical trials.
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Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Edwin Bennink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten G Poirot
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Redmer van Leeuwen
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Kauw F, Bernsen MLE, de Jong HW, Kappelle LJ, Velthuis BK, van der Worp HB, van der Lugt A, Roos YB, Hofmeijer J, Dankbaar JW, Bennink E. Abstract 58: Prediction of Malignant Edema Formation After Endovascular Treatment for Middle Cerebral Artery Infarction: The Added Value of Intracranial Cerebrospinal Fluid Volume. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.58] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Prediction models may guide decisions in the management of patients at risk for malignant middle cerebral artery infarction. The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a predictor of malignant edema in ischemic stroke patients treated with intravenous thrombolysis. The added predictive value in stroke patients who received endovascular treatment is unknown.
Methods:
Patients with available thin-slice non-contrast CT data on admission were selected from the MR CLEAN Registry, which is a prospective national multicenter registry of patients with large vessel occlusion who were treated with endovascular treatment between 2014 and 2017. Baseline characteristics and CT imaging data were collected. The CSF/ICV ratio was automatically measured on baseline thin-slice non-contrast CT. The primary outcome was the formation of malignant edema based on clinical and imaging features on follow-up. A previously built logistic regression model was fitted and included the following baseline predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, poor collateral filling and reperfusion. An extended model with the CSF/ICV ratio was compared to the previous model by using the likelihood ratio test. Odds ratios (OR), areas under the receiver operating characteristic curve (AUROC) and 95% confidence intervals (CI) were reported.
Results:
Of the included 683 patients 40 (6%) developed malignant edema. The CSF/ICV ratio of the group with malignant edema (mean 9±5%) was lower than the group without malignant edema (mean 14±6%, P<0.001). In the extended model, the CSF/ICV ratio was associated with the formation of malignant edema (per one percent decrease OR 1.2, 95% CI 1.1-1.3, P<0.001). In addition, the discriminative performance of the model with the CSF/ICV ratio (AUROC 0.87, 95% CI 0.82-0.91) was higher than that of the model without the CSF/ICV ratio (AUROC 0.84, 0.78-0.89, P<0.001).
Conclusions:
The CSF/ICV ratio improves the prediction of malignant edema formation in ischemic stroke patients who received endovascular treatment.
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Affiliation(s)
- Frans Kauw
- Univ Med Cntr Utrecht, Utrecht, Netherlands
| | | | | | | | | | | | | | - Yvo B Roos
- Amsterdam Univ Med Cntr, Amsterdam, Netherlands
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19
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Risseeuw S, Bennink E, Poirot M, Imhof S, Leeuwen R, Ossewaarde ‐ van Norel J. Quantification of Bruch’s Membrane calcification in Pseudoxanthoma Elasticum: a proof‐of‐concept study using SD‐OCT. Acta Ophthalmol 2019. [DOI: 10.1111/j.1755-3768.2019.5261] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Risseeuw
- Department of Ophthalmology University Medical Center Utrecht The Netherlands
| | - Edwin Bennink
- Image Sciences Institute University Medical Center Utrecht The Netherlands
| | - Maarten Poirot
- Department of Ophthalmology University Medical Center Utrecht The Netherlands
| | - Saskia Imhof
- Department of Ophthalmology University Medical Center Utrecht The Netherlands
| | - Redmer Leeuwen
- Department of Ophthalmology University Medical Center Utrecht The Netherlands
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20
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van Ommen F, Kauw F, Bennink E, Dankbaar JW, Viergever MA, de Jong HWAM. Effect of prolonged acquisition intervals for CT-perfusion analysis methods in patients with ischemic stroke. Med Phys 2019; 46:3156-3164. [PMID: 31049968 PMCID: PMC6851872 DOI: 10.1002/mp.13559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/11/2018] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction The limited axial coverage of many computed tomography (CT) scanners poses a high risk on false negative findings in cerebral CT‐perfusion (CTP) imaging. Axial coverage may be increased by moving the table back and forth during image acquisition. However, this method often increases the acquisition interval between CT frames, which may influence the CTP analysis. In this study, we evaluated the influence of different acquisition intervals on quantitative perfusion maps and infarct volumes by analyzing patient data with three CTP analysis methods. Methods CT‐perfusion data from 25 patients with ischemic stroke were used for this study. The acquisition interval was synthetically reduced from 1 to 5 s before calculating perfusion values, which included cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The color scaling of the perfusion was scaled such that the mean perfusion value had the same color‐coding as the mean perfusion in the 1 s reference. Also, infarct core and penumbra volumes (summary map) were calculated using default thresholds of CBV and relative MTT (rMTT). The original, 1 s acquisition interval scan served as the reference standard. A commercial block‐circulant singular value decomposition (bSVD) based method (ISP; Philips Healthcare), a non‐commercial bSVD method, and a non‐linear regression (NLR) model‐based method were evaluated. Results Cerebral blood volume values generated with bSVD and NLR were not significantly different from the reference standard, while ISP showed significant differences for acquisition intervals of 3 and 4 s. MTT and CBF values generated with bSVD and ISP were significantly different for all acquisition intervals, whereas NLR did not show any significant differences. Calibrated perfusion maps were able to distinguish healthy from infarcted tissue up to an acquisition interval of 5 s for all methods. The infarct core volumes were significantly different for acquisition intervals of 2 (NLR) and 3 s (bSVD and ISP) or greater. For the penumbra volumes, NLR showed no significant differences, while bSVD and ISP showed significant differences for the 5 s interval and for all intervals, respectively. Visual inspection of the summary maps indicated minor differences between the reference standard and acquisition intervals of 4 s or less (ISP) and 5 s or less (bSVD and NLR). Conclusion Altering the acquisition interval may introduce a bias in the perfusion parameters. Calibration of the visualization of the perfusion maps with increasing acquisition intervals allowed distinction between healthy and infarcted tissue. Infarct volumes based on relative MTT can be influenced by the acquisition interval, but visual inspection of the summary maps indicated minor differences between the reference standard and acquisition intervals up to 4 (ISP) and 5 s (bSVD and NLR). Taken together, axial coverage can be increased by prolonging the acquisition interval up to 5 s depending on the perfusion analysis.
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Affiliation(s)
- Fasco van Ommen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans Kauw
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin Bennink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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21
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Kauw F, Bennink E, de Jong HW, Kappelle LJ, Horsch AD, Velthuis BK, Dankbaar JW. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction. Stroke 2019; 50:1437-1443. [PMID: 31092157 PMCID: PMC6553515 DOI: 10.1161/strokeaha.119.024882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/09/2019] [Revised: 03/13/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction. Methods- Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test. Results- Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1-11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6-21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8-23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824; P=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850; P<0.001), and model 3 (areas under the receiver operating characteristic curves, 0.811 versus 0.856; P<0.001) improved significantly after adding CSF/ICV. Conclusions- The CSF/ICV ratio is associated with malignant MCA infarction and has added value to clinical and imaging prediction models in limited numbers of patients.
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Affiliation(s)
- Frans Kauw
- From the Department of Radiology (F.K., E.B., H.W.A.M.d.J., A.D.H., B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Edwin Bennink
- From the Department of Radiology (F.K., E.B., H.W.A.M.d.J., A.D.H., B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
- Image Sciences Institute (E.B.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Hugo W.A.M. de Jong
- From the Department of Radiology (F.K., E.B., H.W.A.M.d.J., A.D.H., B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - L. Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Alexander D. Horsch
- From the Department of Radiology (F.K., E.B., H.W.A.M.d.J., A.D.H., B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Birgitta K. Velthuis
- From the Department of Radiology (F.K., E.B., H.W.A.M.d.J., A.D.H., B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jan W. Dankbaar
- From the Department of Radiology (F.K., E.B., H.W.A.M.d.J., A.D.H., B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht University, the Netherlands
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22
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Mulder IA, Holswilder G, van Walderveen MAA, van der Schaaf IC, Bennink E, Horsch AD, Kappelle LJ, Velthuis BK, Dankbaar JW, Terwindt GM, Schonewille WJ, Visser MC, Ferrari MD, Algra A, Wermer MJH. Stroke progression and clinical outcome in ischemic stroke patients with a history of migraine. Int J Stroke 2019; 14:946-955. [DOI: 10.1177/1747493019851288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy. Methods We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses. Results We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77–1.25), infarct core volume (aB: -10.8, 95%CI: -27.04–5.51), penumbra volume (aB: -11.6, 95%CI: -26.52–3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11–2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04–1.73), final infarct volume (aB: -14.8, 95%CI: 29.9–0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21–1.22). Conclusion Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
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Affiliation(s)
- Inge A Mulder
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ghislaine Holswilder
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ale Algra
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Peters JPM, Bennink E, van Zanten GA. Comparison of Place-versus-Pitch Mismatch between a Perimodiolar and Lateral Wall Cochlear Implant Electrode Array in Patients with Single-Sided Deafness and a Cochlear Implant. Audiol Neurootol 2019; 24:38-48. [PMID: 30995658 DOI: 10.1159/000499154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/20/2018] [Accepted: 02/25/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In electric-acoustic pitch matching experiments in patients with single-sided deafness and a cochlear implant, the observed "mismatch" between perceived pitch and predicted pitch, based on the amended Greenwood frequency map, ranges from -1 to -2 octaves. It is unknown if and how this mismatch differs for perimodiolar versus lateral wall electrode arrays. OBJECTIVES We aimed to investigate if the type of electrode array design is of influence on the electric-acoustic pitch match. METHOD Fourteen patients (n = 8 with CI422 + lateral wall electrode array, n = 6 with CI512 + perimodiolar electrode array; Cochlear Ltd.) compared the pitch of acoustic stimuli to the pitch of electric stimuli at two test sessions (average interval 4.3 months). We plotted these "pitch matches" per electrode contact against insertion angle, calculated from high-resolution computed tomography scans. The difference between these pitch matches and two references (the spiral ganglion map and the default frequency allocation by Cochlear Ltd.) was defined as "mismatch." RESULTS We found average mismatches of -2.2 octaves for the CI422 group and -1.3 octaves for the CI512 group. For any given electrode contact, the mismatch was smaller for the CI512 electrode array than for the CI422 electrode array. For all electrode contacts together, there was a significant difference between the mismatches of the two groups (p < 0.05). Results remained stable over time, with no significant difference between the two test sessions considering all electrode contacts. Neither group showed a significant correlation between the mismatch and phoneme recognition scores. CONCLUSION The pitch mismatch was smaller for the perimodiolar electrode array than for the lateral wall electrode array.
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Affiliation(s)
- Jeroen P M Peters
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands, .,UMC Utrecht Brain Center, Utrecht, The Netherlands,
| | - Edwin Bennink
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijsbert A van Zanten
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht, The Netherlands
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24
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van Ommen F, de Jong H, Dankbaar J, Bennink E, Leiner T, Schilham A. Dose of CT protocols acquired in clinical routine using a dual-layer detector CT scanner: A preliminary report. Eur J Radiol 2019; 112:65-71. [DOI: 10.1016/j.ejrad.2019.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/03/2019] [Accepted: 01/12/2019] [Indexed: 11/30/2022]
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25
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van Ommen F, Bennink E, Vlassenbroek A, Dankbaar JW, Schilham AMR, Viergever MA, de Jong HWAM. Image quality of conventional images of dual-layer SPECTRAL CT: A phantom study. Med Phys 2018; 45:3031-3042. [PMID: 29749624 DOI: 10.1002/mp.12959] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/17/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Spectral CT using a dual layer detector offers the possibility of retrospectively introducing spectral information to conventional CT images. In theory, the dual-layer technology should not come with a dose or image quality penalty for conventional images. In this study, we evaluate the influence of a dual-layer detector (IQon Spectral CT, Philips Healthcare) on the image quality of conventional CT images, by comparing these images with those of a conventional but otherwise technically comparable single-layer CT scanner (Brilliance iCT, Philips Healthcare), by means of phantom experiments. METHODS For both CT scanners, conventional CT images were acquired using four adult scanning protocols: (a) body helical, (b) body axial, (c) head helical, and (d) head axial. A CATPHAN 600 phantom was scanned to conduct an assessment of image quality metrics at equivalent (CTDI) dose levels. Noise was characterized by means of noise power spectra (NPS) and standard deviation (SD) of a uniform region, and spatial resolution was evaluated with modulation transfer functions (MTF) of a tungsten wire. In addition, contrast-to-noise ratio (CNR), image uniformity, CT number linearity, slice thickness, slice spacing, and spatial linearity were measured and evaluated. Additional measurements of CNR, resolution and noise were performed in two larger phantoms. RESULTS The resolution levels at 50%, 10%, and 5% MTF of the iCT and IQon showed small, but significant differences up to 0.25 lp/cm for body scans, and up to 0.2 lp/cm for head scans in favor of the IQon. The iCT and IQon showed perfect CT linearity for body scans, but for head scans both scanners showed an underestimation of the CT numbers of materials with a high opacity. Slice thickness was slightly overestimated for both scanners. Slice spacing was comparable and reconstructed correctly. In addition, spatial linearity was excellent for both scanners, with a maximum error of 0.11 mm. CNR was higher on the IQon compared to the iCT for both normal and larger phantoms with differences up to 0.51. Spatial resolution did not change with phantom size, but noise levels increased significantly. For head scans, IQon had a noise level that was significantly lower than the iCT, on the other hand IQon showed noise levels significantly higher than the iCT for body scans. Still, these differences were well within the specified range of performance of iCT scanners. CONCLUSIONS At equivalent dose levels, this study showed similar quality of conventional images acquired on iCT and IQon for medium-sized phantoms and slightly degraded image quality for (very) large phantoms at lower tube voltages on the IQon. Accordingly, it may be concluded that the introduction of a dual-layer detector neither compromises image quality of conventional images nor increases radiation dose for normal-sized patients, and slightly degrades dose efficiency for large patients at 120 kVp and lower tube voltages.
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Affiliation(s)
- Fasco van Ommen
- Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Image Sciences Institute, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Edwin Bennink
- Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Image Sciences Institute, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | | | - Jan Willem Dankbaar
- Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Arnold M R Schilham
- Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Image Sciences Institute, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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26
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Dankbaar JW, Bienfait HP, van den Berg C, Bennink E, Horsch AD, van Seeters T, van der Schaaf IC, Kappelle LJ, Velthuis BK. Wake-Up Stroke versus Stroke with Known Onset Time: Clinical and Multimodality CT Imaging Characteristics. Cerebrovasc Dis 2018; 45:236-244. [PMID: 29772576 DOI: 10.1159/000489566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/03/2017] [Accepted: 04/23/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current guidelines for the treatment of acute ischemic stroke are mainly based on the time between symptom onset and initiation of treatment. This time is unknown in patients with wake-up stroke (WUS). We investigated clinical and multimodality CT imaging characteristics on admission in patients with WUS and in patients with a stroke with a known onset time. METHODS All patients were selected from a large prospective cohort study (Dutch acute stroke study). WUS patients last seen well > 4.5 and ≤4.5 h were separately compared to patients with a known onset time ≤4.5 h. In addition, WUS patients with a proximal occlusion of the anterior circulation last seen well > 6 and ≤6 h were separately compared to patients with a known onset time ≤6 h and a proximal occlusion. National Institute of Health Stroke Score, age, gender, history of atrial fibrillation, non-contrast CT (NCCT) Alberta Stroke Program Early CT Score (ASPECTS), CT-perfusion abnormalities, proximal occlusions, and collateral filling on CT angiography were compared between groups using the Mann-Whitney U test and Fisher's exact test. RESULTS WUS occurred in 149/1,393 (10.7%) patients. Admission clinical and imaging characteristics of WUS patients last seen well > 4.5 h (n = 81) were not different from WUS patients last seen well ≤4.5 h (n = 68). Although WUS patients last seen well > 4.5 h had a significantly lower NCCT ASPECTS than patients with a known time of stroke symptom onset of ≤4.5 h (n = 1,026), 85.2% had an NCCT ASPECTS > 7 and 75% had a combination of favorable ASPECTS > 7 and good collateral filling. There were no statistically significant differences between the admission clinical and imaging characteristics of WUS patients with proximal occlusions last seen well > 6 h (n = 23), last seen well ≤6 h (n = 40), and patients with a known time to stroke symptom onset ≤6 h (n = 399). Of all WUS patients with proximal occlusions last seen well > 6 h, only 4.3% had severe ischemia (ASPECTS < 5), 13 (56.5%) had ASPECTS > 7 and good collateral filling. CONCLUSIONS There are only minor differences between clinical and imaging characteristics of WUS patients and patients who arrive in the hospital within the time criteria for intravenous or endovascular treatment. Therefore, CT imaging may help to identify WUS patients who would benefit from treatment and rule out those patients with severe ischemia and poor collaterals.
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Affiliation(s)
- Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henri P Bienfait
- Department of Neurology, Gelre Hospital Apeldoorn, Apeldoorn, the Netherlands
| | - Coen van den Berg
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Horsch AD, Bennink E, van Seeters T, Kappelle LJ, van der Graaf Y, Mali WPTM, de Jong HWAM, Velthuis BK, Dankbaar JW. Computed Tomography Perfusion Derived Blood-Brain Barrier Permeability Does Not Yet Improve Prediction of Hemorrhagic Transformation. Cerebrovasc Dis 2018; 45:26-32. [PMID: 29402765 DOI: 10.1159/000485043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 12/11/2016] [Accepted: 11/03/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hemorrhagic transformation (HT) in acute ischemic stroke can occur as a result of reperfusion treatment. While withholding treatment may be warranted in patients with increased risk of HT, prediction of HT remains difficult. Nonlinear regression analysis can be used to estimate blood-brain barrier permeability (BBBP). The aim of this study was to identify a combination of clinical and imaging variables, including BBBP estimations, that can predict HT. MATERIALS AND METHODS From the Dutch acute stroke study, 545 patients treated with intravenous recombinant tissue plasminogen activator and/or intra-arterial treatment were selected, with available admission extended computed tomography (CT) perfusion and follow-up imaging. Patient admission treatment characteristics and CT imaging parameters regarding occlusion site, stroke severity, and BBBP were recorded. HT was assessed on day 3 follow-up imaging. The association between potential predictors and HT was analyzed using univariate and multivariate logistic regression. To compare the added value of BBBP, areas under the curve (AUCs) were created from 2 models, with and without BBBP. RESULTS HT occurred in 57 patients (10%). In univariate analysis, older age (OR 1.03, 95% CI 1.006-1.05), higher admission National Institutes of Health Stroke Scale (NIHSS; OR 1.13, 95% CI 1.08-1.18), higher clot burden (OR 1.28, 95% CI 1.16-1.41), poor collateral score (OR 3.49, 95% CI 1.85-6.58), larger Alberta Stroke Program Early CT Score cerebral blood volume deficit size (OR 1.26, 95% CI 1.14-1.38), and increased BBBP (OR 2.22, 95% CI 1.46-3.37) were associated with HT. In multivariate analysis with age and admission NIHSS, the addition of BBBP did not improve the AUC compared to both independent predictors alone (AUC 0.77, 95% CI 0.71-0.83). CONCLUSION BBBP predicts HT but does not improve prediction with age and admission NIHSS.
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Affiliation(s)
- Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Peters JP, Bennink E, Grolman W, van Zanten GA. Electro-acoustic pitch matching experiments in patients with single-sided deafness and a cochlear implant. Hear Res 2016; 342:124-133. [DOI: 10.1016/j.heares.2016.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/07/2016] [Accepted: 10/15/2016] [Indexed: 11/25/2022]
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Bennink E, Oosterbroek J, Kudo K, Viergever MA, Velthuis BK, de Jong HWAM. Fast nonlinear regression method for CT brain perfusion analysis. J Med Imaging (Bellingham) 2016; 3:026003. [PMID: 27413770 DOI: 10.1117/1.jmi.3.2.026003] [Citation(s) in RCA: 10] [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: 07/28/2015] [Accepted: 05/26/2016] [Indexed: 11/14/2022] Open
Abstract
Although computed tomography (CT) perfusion (CTP) imaging enables rapid diagnosis and prognosis of ischemic stroke, current CTP analysis methods have several shortcomings. We propose a fast nonlinear regression method with a box-shaped model (boxNLR) that has important advantages over the current state-of-the-art method, block-circulant singular value decomposition (bSVD). These advantages include improved robustness to attenuation curve truncation, extensibility, and unified estimation of perfusion parameters. The method is compared with bSVD and with a commercial SVD-based method. The three methods were quantitatively evaluated by means of a digital perfusion phantom, described by Kudo et al. and qualitatively with the aid of 50 clinical CTP scans. All three methods yielded high Pearson correlation coefficients ([Formula: see text]) with the ground truth in the phantom. The boxNLR perfusion maps of the clinical scans showed higher correlation with bSVD than the perfusion maps from the commercial method. Furthermore, it was shown that boxNLR estimates are robust to noise, truncation, and tracer delay. The proposed method provides a fast and reliable way of estimating perfusion parameters from CTP scans. This suggests it could be a viable alternative to current commercial and academic methods.
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Affiliation(s)
- Edwin Bennink
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands; University Medical Center Utrecht, Image Sciences Institute, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Jaap Oosterbroek
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands; University Medical Center Utrecht, Image Sciences Institute, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Kohsuke Kudo
- Hokkaido University Hospital , Department of Diagnostic and Interventional Radiology, N14 W5, Kita-ku, Sapporo 060-8648, Japan
| | - Max A Viergever
- University Medical Center Utrecht , Image Sciences Institute, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- University Medical Center Utrecht , Department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands; University Medical Center Utrecht, Image Sciences Institute, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
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Bennink E, Horsch AD, Dankbaar JW, Velthuis BK, Viergever MA, de Jong HWAM. CT perfusion analysis by nonlinear regression for predicting hemorrhagic transformation in ischemic stroke. Med Phys 2016; 42:4610-8. [PMID: 26233188 DOI: 10.1118/1.4923751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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
PURPOSE Intravenous thrombolysis can improve clinical outcome in acute ischemic stroke patients but increases the risk of hemorrhagic transformation (HT). Blood-brain barrier damage, which can be quantified by the vascular permeability for contrast agents, is a potential predictor for HT. This study aimed to assess whether this prediction can be improved by measuring vascular permeability using a novel fast nonlinear regression (NLR) method instead of Patlak analysis. METHODS From a prospective ischemic stroke multicenter cohort study, 20 patients with HT on follow-up imaging and 40 patients without HT were selected. The permeability transfer constant K(trans) was measured in three ways; using standard Patlak analysis, Patlak analysis with a fixed offset, and the NLR method. In addition, the permeability-surface (PS) area product and the conventional perfusion parameters (blood volume, flow, and mean transit time) were measured using the NLR method. Relative values were calculated in two ways, i.e., by dividing the average in the infarct core by the average in the contralateral hemisphere, and by dividing the average in the ipsilateral hemisphere by the average in the contralateral hemisphere. Mann-Whitney U tests and receiver operating characteristic (ROC) analyses were performed to assess the discriminative power of each of the relative parameters. RESULTS Both the infarct-core and whole-hemisphere averaged relative K(trans) (rK(trans)) values, measured with the NLR method, were significantly higher in the patients who developed HT as compared with those who did not. The rK(trans) measured with standard Patlak analysis was not significantly different. The relative PS (rPS), measured with NLR, had the highest discriminative power (P = 0.002). ROC analysis of rPS showed an area under the curve (AUC) of 0.75 (95% confidence interval: 0.62-0.89) and a sensitivity of 0.75 at a specificity of 0.75. The AUCs of the Patlak rK(trans), the Patlak rK(trans) with fixed offset, and the NLR rK(trans) were 0.58, 0.66, and 0.67, respectively. CONCLUSIONS CT perfusion analysis may aid in predicting HT, but standard Patlak analysis did not provide estimates for rK(trans) that were significantly higher in the HT group. The rPS, measured in the infarct core with NLR, had superior discriminative power compared with K(trans) measured with either Patlak analysis with a fixed offset or NLR, and conventional perfusion parameters.
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Affiliation(s)
- Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands and Image Sciences Institute, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands and Image Sciences Institute, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
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Horsch AD, Dankbaar JW, Stemerdink TA, Bennink E, van Seeters T, Kappelle LJ, Hofmeijer J, de Jong HW, van der Graaf Y, Velthuis BK. Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts. AJNR Am J Neuroradiol 2016; 37:831-7. [PMID: 26797136 DOI: 10.3174/ajnr.a4637] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 07/08/2015] [Accepted: 10/30/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatment strategies. This study aimed to identify variables associated with the development of prominent edema in patients with large MCA infarcts. MATERIALS AND METHODS From the Dutch Acute Stroke Study (DUST), 137 patients were selected with large MCA infarcts on follow-up NCCT (3 ± 2 days after stroke onset), defined as ASPECTS ≤4. Prominent edema was defined as a midline shift of ≥5 mm on follow-up. Admission patient and treatment characteristics were collected. Admission CT parameters used were ASPECTS on NCCT and CBV and MTT maps, and occlusion site, clot burden, and collaterals on CTA. Permeability on admission CTP, and day 3 recanalization and reperfusion statuses were obtained if available. Unadjusted and adjusted (age and NIHSS) odds ratios were calculated for all variables in relation to prominent edema. RESULTS Prominent edema developed in 51 patients (37%). Adjusted odds ratios for prominent edema were higher with lower ASPECTS on NCCT (adjusted odds ratio, 1.32; 95% CI, 1.13-1.55) and CBV (adjusted odds ratio, 1.26; 95% CI, 1.07-1.49), higher permeability (adjusted odds ratio, 2.35; 95% CI, 1.30-4.24), more proximal thrombus location (adjusted odds ratio, 3.40; 95% CI, 1.57-7.37), higher clot burden (adjusted odds ratio, 2.88; 95% CI, 1.11-7.45), and poor collaterals (adjusted odds ratio, 3.93; 95% CI, 1.78-8.69). CONCLUSIONS Extensive proximal occlusion, poor collaterals, and larger ischemic deficits with higher permeability play a role in the development of prominent edema in large MCA infarcts.
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Affiliation(s)
- A D Horsch
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
| | - J W Dankbaar
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
| | - T A Stemerdink
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
| | - E Bennink
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
| | - T van Seeters
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
| | - L J Kappelle
- Neurology (L.J.K.), Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Hofmeijer
- Department of Neurology (J.H.), Rijnstate Hospital, Arnhem, the Netherlands
| | - H W de Jong
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care (Y.v.d.G.), Utrecht, the Netherlands
| | - B K Velthuis
- From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.)
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Bennink E, Oosterbroek J, Horsch AD, Dankbaar JW, Velthuis BK, Viergever MA, de Jong HWAM. Influence of Thin Slice Reconstruction on CT Brain Perfusion Analysis. PLoS One 2015; 10:e0137766. [PMID: 26361391 PMCID: PMC4567308 DOI: 10.1371/journal.pone.0137766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 05/06/2015] [Accepted: 08/21/2015] [Indexed: 12/03/2022] Open
Abstract
Objectives Although CT scanners generally allow dynamic acquisition of thin slices (1 mm), thick slice (≥5 mm) reconstruction is commonly used for stroke imaging to reduce data, processing time, and noise level. Thin slice CT perfusion (CTP) reconstruction may suffer less from partial volume effects, and thus yield more accurate quantitative results with increased resolution. Before thin slice protocols are to be introduced clinically, it needs to be ensured that this does not affect overall CTP constancy. We studied the influence of thin slice reconstruction on average perfusion values by comparing it with standard thick slice reconstruction. Materials and Methods From 50 patient studies, absolute and relative hemisphere averaged estimates of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability-surface area product (PS) were analyzed using 0.8, 2.4, 4.8, and 9.6 mm slice reconstructions. Specifically, the influence of Gaussian and bilateral filtering, the arterial input function (AIF), and motion correction on the perfusion values was investigated. Results Bilateral filtering gave noise levels comparable to isotropic Gaussian filtering, with less partial volume effects. Absolute CBF, CBV and PS were 22%, 14% and 46% lower with 0.8 mm than with 4.8 mm slices. If the AIF and motion correction were based on thin slices prior to reconstruction of thicker slices, these differences reduced to 3%, 4% and 3%. The effect of slice thickness on relative values was very small. Conclusions This study shows that thin slice reconstruction for CTP with unaltered acquisition protocol gives relative perfusion values without clinically relevant bias. It does however affect absolute perfusion values, of which CBF and CBV are most sensitive. Partial volume effects in large arteries and veins lead to overestimation of these values. The effects of reconstruction slice thickness should be taken into account when absolute perfusion values are used for clinical decision making.
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Affiliation(s)
- Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Jaap Oosterbroek
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D. Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max A. Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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Oosterbroek J, Bennink E, Philippens MEP, Raaijmakers CPJ, Viergever MA, de Jong HWAM. Comparison of DCE-CT models for quantitative evaluation ofKtransin larynx tumors. Phys Med Biol 2015; 60:3759-73. [DOI: 10.1088/0031-9155/60/9/3759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Riordan AJ, Bennink E, Dankbaar JW, Viergever MA, Velthuis BK, Smit EJ, de Jong HWAM. Comparison of partial volume effects in arterial and venous contrast curves in CT brain perfusion imaging. PLoS One 2014; 9:e97586. [PMID: 24858308 PMCID: PMC4032231 DOI: 10.1371/journal.pone.0097586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/12/2013] [Accepted: 04/21/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose In brain CT perfusion (CTP), the arterial contrast bolus is scaled to have the same area under the curve (AUC) as the venous outflow to correct for partial volume effects (PVE). This scaling is based on the assumption that large veins are unaffected by PVE. Measurement of the internal carotid artery (ICA), usually unaffected by PVE due to its large diameter, may avoid the need for partial volume correction. The aims of this work are to examine i) the assumptions behind PVE correction and ii) the potential of selecting the ICA obviating correction for PVE. Methods The AUC of the ICA and sagittal sinus were measured in CTP datasets from 52 patients. The AUCs were determined by i) using commercial CTP software based on a Gaussian curve-fitting to the time attenuation curve, and ii) by simple integration of the time attenuation curve over a time interval. In addition, frames acquired up to 3 minutes after first bolus passage were used to examine the ratio of arterial and venous enhancement. The impact of selecting the ICA without PVE correction was illustrated by reporting cerebral blood volume (CBV) measurements. Results In 49 of 52 patients, the AUC of the ICA was significantly larger than that of the sagittal sinus (p = 0.017). Measured after the first pass bolus, contrast enhancement remained 50% higher in the ICA just after the first pass bolus, and 30% higher 3 minutes later. CBV measurements were significantly lowered when the ICA was used without PVE correction. Conclusions Contradicting the assumptions underlying PVE correction, contrast in the ICA was significantly higher than in the sagittal sinus, even 3 minutes after the first pass of the contrast bolus. PVE correction might lead to overestimation of CBV if the CBV is calculated using the AUC of the time attenuation curves.
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Affiliation(s)
- Alan J. Riordan
- Department of Radiology, University Medical Centre, Utrecht, The Netherlands
- * E-mail:
| | - Edwin Bennink
- Department of Radiology, University Medical Centre, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Centre, Utrecht, The Netherlands
| | - Max A. Viergever
- Department of Radiology, University Medical Centre, Utrecht, The Netherlands
| | | | - Ewoud J. Smit
- Department of Radiology, University Medical Centre, Utrecht, The Netherlands
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Oosterbroek J, Philippens M, Bennink E, Raaijmakers C, De Jong H. OC-0166: Automatic tumor delineation using DCE-CT parameter maps in laryngeal and hypopharyngeal carcinoma. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30271-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Riordan AJ, Bennink E, Viergever MA, Velthuis BK, Dankbaar JW, de Jong HWAM. CT brain perfusion protocol to eliminate the need for selecting a venous output function. AJNR Am J Neuroradiol 2013; 34:1353-8. [PMID: 23370476 DOI: 10.3174/ajnr.a3397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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]
Abstract
BACKGROUND AND PURPOSE In CTP, an arterial input function is used for cerebral blood volume measurement. AIFs are often influenced by partial volume effects resulting in overestimated CBV. A venous output function is manually selected to correct for partial volume. This can introduce variability. Our goal was to develop a CTP protocol that enables AIF selection unaffected by partial volume. MATERIALS AND METHODS First, the effects of partial volume on artery sizes/types including the MCA were estimated by using a CTP phantom with 9 protocols (section thicknesses of 1, 1.8, and 5 mm and image resolutions of 0.5, 1, and 1.5 mm). Next, these protocols were applied to clinical CTP studies from 6 patients. The influence of the partial volume effect was measured by comparison of the time-attenuation curves from different artery locations with reference veins. RESULTS AIFs from MCAs were unaffected by partial volume effects when using high image resolution (1 mm) and medium section thickness (1.8 mm). For the clinical data, a total of 104 arteries and 60 veins was selected. The data confirmed that high image resolution and thin section thickness enable selection of MCAs for AIFs free of partial volume influences. In addition, we found that large veins were not insusceptible to partial volume effects relative to large arteries, questioning the use of veins for partial volume correction. CONCLUSIONS A CTP protocol with 1.8-mm section thickness and 1-mm image resolution allows AIF selection unaffected by partial volume effects in MCAs.
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Affiliation(s)
- A J Riordan
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
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