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van der Steen W, van der Ende NAM, van Kranendonk KR, Chalos V, Brouwer J, van Oostenbrugge RJ, van Zwam WH, van Doormaal PJ, van Es ACGM, Majoie CBLM, van der Lugt A, Dippel DWJ, Roozenbeek B. Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment. Eur Stroke J 2022; 7:393-401. [PMID: 36478761 PMCID: PMC9720857 DOI: 10.1177/23969873221112279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/20/2022] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Little is known about the timing of occurrence of symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) for acute ischemic stroke. A better understanding could optimize in-hospital surveillance time points and duration. The aim of this study was to delineate the probability of sICH over time and to identify factors associated with its timing. PATIENTS AND METHODS We retrospectively analyzed data from the Dutch MR CLEAN trial and MR CLEAN Registry. We included adult patients who underwent EVT for an anterior circulation large vessel occlusion within 6.5 h of stroke onset. In patients with sICH (defined as ICH causing an increase of ⩾4 points on the National Institutes of Health Stroke Scale [NIHSS]), univariable and multivariable linear regression analysis was used to identify factors associated with the timing of sICH. This was defined as the time between end of EVT and the time of first CT-scan on which ICH was seen as a proxy. RESULTS SICH occurred in 205 (6%) of 3391 included patients. Median time from end of EVT procedure to sICH detection on NCCT was 9.0 [IQR 2.9-22.5] hours, with a rapidly decreasing incidence after 24 h. None of the analyzed factors, including baseline NIHSS, intravenous alteplase treatment, and poor reperfusion at the end of the procedure were associated with the timing of sICH. CONCLUSION SICHs primarily occur in the first hours after EVT, and less frequently beyond 24 h. Guidelines that recommend to perform frequent neurological assessments for at least 24 h after intravenous alteplase treatment can be applied to ischemic stroke patients treated with EVT.
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Affiliation(s)
- Wouter van der Steen
- Department of Neurology, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear
Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nadinda AM van der Ende
- Department of Neurology, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear
Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Katinka R van Kranendonk
- Department of Radiology and Nuclear
Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, The
Netherlands
| | - Vicky Chalos
- Department of Neurology, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear
Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
| | - Josje Brouwer
- Department of Neurology, Amsterdam
University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht
University Medical Center, Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, The Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear
Medicine, Maastricht University Medical Center, Cardiovascular Research Institute
Maastricht (CARIM), Maastricht, The Netherlands
| | - Pieter J van Doormaal
- Department of Neurology, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
| | - Adriaan CGM van Es
- Department of Radiology, Leiden
University Medical Center, Leiden, The Netherlands
| | - Charles BLM Majoie
- Department of Radiology and Nuclear
Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam, The
Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear
Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik WJ Dippel
- Department of Neurology, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
| | - Bob Roozenbeek
- Department of Neurology, Erasmus MC
University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear
Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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van der Steen W, van der Ende NA, van Kranendonk KR, Chalos V, van Oostenbrugge RJ, van Zwam WH, Roos YB, van Doormaal PJ, van Es AC, Lingsma HF, Majoie CB, van der Lugt A, Dippel DW, Roozenbeek B, Boiten J, Albert Vos J, Jansen IG, Mulder MJ, Goldhoorn RJB, Compagne KC, Kappelhof M, Brouwer J, den Hartog SJ, Emmer BJ, Coutinho JM, Schonewille WJ, Albert Vos J, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, Martens JM, Lycklama à Nijeholt GJ, Boiten J, de Bruijn SF, van Dijk LC, van der Worp HB, Lo RH, van Dijk EJ, Boogaarts HD, de Vries J, de Kort PL, van Tuijl J, Peluso JP, Fransen P, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RP, Schreuder TH, Heijboer RJ, Keizer K, Yo LS, den Hertog HM, Bulut T, Brouwers PJ, Lycklama GJ, van Walderveen MA, Sprengers ME, Jenniskens SF, van den Berg R, Yoo AJ, Beenen LF, Postma AA, Roosendaal SD, van der Kallen BF, van den Wijngaard IR, Emmer BJ, Martens JM, Yo LS, Vos JA, Bot J, Meijer A, Ghariq E, Bokkers RP, van Proosdij MP, Krietemeijer GM, Peluso JP, Boogaarts HD, Lo R, Dinkelaar W, Auke P, Hammer B, Pegge S, van der Hoorn A, Vinke S, Lycklama à Nijeholt GJ, Boiten J, Vos JA, Hofmeijer J, Martens JM, van der Worp HB, Hofmeijer J, Flach HZ, el Ghannouti N, Sterrenberg M, Pellikaan W, Sprengers R, Elfrink M, Simons M, Vossers M, de Meris J, Vermeulen T, Geerlings A, van Vemde G, Simons T, Messchendorp G, Nicolaij N, Bongenaar H, Bodde K, Kleijn S, Lodico J, Droste H, Wollaert M, Verheesen S, Jeurrissen D, Bos E, Drabbe Y, Sandiman M, Aaldering N, Zweedijk B, Vervoort J, Ponjee E, Romviel S, Kanselaar K, Barning D, Venema E, Geuskens RR, van Straaten T, Ergezen S, Harmsma RR, Muijres D, de Jong A, Berkhemer OA, Boers AM, Huguet J, Groot P, Mens MA, Treurniet KM, Tolhuisen ML, Alves H, Weterings AJ, Kirkels EL, Voogd EJ, Schupp LM, Collette SL, Groot AE, LeCouffe NE, Konduri PR, Prasetya H, Arrarte- Terreros N, Ramos LA, Brown MM, Liebig T, van der Heijden E, Ghannouti N, Fleitour N, Hooijenga I, Puppels C, Pellikaan W, Geerling A, Lindl-Velema A, van Vemde G, de Ridder A, Greebe P, de Bont- Stikkelbroeck J, de Meris J, Haaglanden MC, Janssen K, Licher S, Boodt N, Ros A, Venema E, Slokkers I, Ganpat RJ, Mulder M, Saiedie N, Heshmatollah A, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens RR, Sales Barros R. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study. Stroke 2022; 53:2818-2827. [PMID: 35674042 PMCID: PMC9389940 DOI: 10.1161/strokeaha.121.036195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location.
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Affiliation(s)
- Wouter van der Steen
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nadinda A.M. van der Ende
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Katinka R. van Kranendonk
- Department of Radiology and Nuclear Medicine (K.R.v.K., C.B.L.M.M.), Maastricht University Medical Center, the Netherlands
| | - Vicky Chalos
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert J. van Oostenbrugge
- Amsterdam University Medical Center, University of Amsterdam, the Netherlands. Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands
| | - Wim H. van Zwam
- Department of Radiology and Nuclear Medicine (W.H.v.Z.), Maastricht University Medical Center, the Netherlands
| | - Yvo B.W.E.M. Roos
- Department of Neurology (Y.B.W.E.M.R.), Maastricht University Medical Center, the Netherlands
| | - Pieter J. van Doormaal
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan C.G.M. van Es
- Department of Radiology, Leiden University Medical Center, the Netherlands (A.C.G.M.v.E.)
| | - Hester F. Lingsma
- Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Charles B.L.M. Majoie
- Department of Radiology and Nuclear Medicine (K.R.v.K., C.B.L.M.M.), Maastricht University Medical Center, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Diederik W.J. Dippel
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Delhaas EM, Harhangi BS, van Doormaal PJ, Dinkelaar W, van Es AC, van Assema DM, Frankema SP, van der Lugt A, Huygen FJ. Restoration of rostral cerebrospinal fluid flow to solve treatment failure caused by obstruction in long-term intrathecal baclofen administration. J Spinal Cord Med 2021; 44:312-321. [PMID: 31418647 PMCID: PMC7952057 DOI: 10.1080/10790268.2019.1646476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objects: We describe five traumatic spinal cord injury (SCI) patients with an intrathecal baclofen administration (ITB) failure caused by a rostral CSF flow obstruction referred to our expert center between January 2014 and January 2019. We discuss the diagnostic workup, rostral CSF flow obstruction as the cause of the ITB failure and treatment.Methods: When we could not determine the cause of the ITB failure through the patient's history, physical spasticity examination, pump readout, absence of fluid in the pump reservoir during aspiration, or plain radiography, we performed pump catheter access port (computed tomography [CT]) myelography. When CT myelography did not reveal the diagnosis, we used scintigraphy. In an obstruction, we aimed for CSF flow restoration. In three cases, we conducted a laminectomy with microsurgical adhesiolysis. In two of these patients, we could not achieve CSF flow restoration; thus, we placed an intradural catheter bypass. Recently, in three patients, we applied a less invasive technique of percutaneous fenestration of the obstruction.Results: In one case, we performed a successful catheter replacement. In another case using surgical adhesiolysis, spasticity control was complete. In two cases, we could obtain improvement with an additional intradural bypass, followed by a percutaneous fenestration of the obstruction, resulting in further improved CSF flow restoration. In one case, percutaneous fenestration was the first line of treatment. In all cases with percutaneous fenestration, we experienced spasticity control.Conclusion: Preliminary results showed that the restoration of rostral CSF flow might result in an effective ITB treatment in patients with an intrathecal obstruction.
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Affiliation(s)
- Elmar M. Delhaas
- Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Correspondence to: Elmar M. Delhaas, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, P.O. Box 2040, Rotterdam, CA3000, The Netherlands.
| | - Biswadjiet S. Harhangi
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pieter J. van Doormaal
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wouter Dinkelaar
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ad C.G.M. van Es
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Danielle M.E. van Assema
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sander P.G. Frankema
- Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank J.P.M. Huygen
- Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Raats JW, van Dam L, van Doormaal PJ, van Hengel-Jacobs M, Langeveld-Benders H. Neonatal Rupture of the Spleen: Successful Treatment with Splenic Artery Embolization. AJP Rep 2021; 11:e58-e60. [PMID: 34055461 PMCID: PMC8159580 DOI: 10.1055/s-0041-1727257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/28/2021] [Indexed: 11/03/2022] Open
Abstract
Neonatal intra-abdominal hemorrhage has been rarely reported in the literature. We report a case of splenic injury in a neonate, highlighting the importance of a high-index suspicion in early recognition of this rare and potentially fatal injury. We report the first case of a neonate who had a splenic rupture and underwent successful endovascular treatment.
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Affiliation(s)
- Jelle W Raats
- Department of Pediatric Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Lievay van Dam
- Department of Interventional Radiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pieter J van Doormaal
- Department of Interventional Radiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marjoleine van Hengel-Jacobs
- Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Hester Langeveld-Benders
- Department of Pediatric Surgery, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
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Compagne KCJ, Goldhoorn RB, Uyttenboogaart M, van Oostenbrugge RJ, van Zwam WH, van Doormaal PJ, Dippel DWJ, van der Lugt A, Emmer BJ, van Es ACGM. Acute Endovascular Treatment of Patients With Ischemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection. Front Neurol 2019; 10:102. [PMID: 30837934 PMCID: PMC6390807 DOI: 10.3389/fneur.2019.00102] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/11/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.
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Affiliation(s)
- Kars C J Compagne
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands.,Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - R B Goldhoorn
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Wim H van Zwam
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Pieter J van Doormaal
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Bart J Emmer
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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den Harder AM, Willemink MJ, van Doormaal PJ, Wessels FJ, Lock MTWT, Schilham AMR, Budde RPJ, Leiner T, de Jong PA. Radiation dose reduction for CT assessment of urolithiasis using iterative reconstruction: A prospective intra-individual study. Eur Radiol 2017; 28:143-150. [PMID: 28695359 PMCID: PMC5717126 DOI: 10.1007/s00330-017-4929-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/06/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
Objective To assess the performance of hybrid (HIR) and model-based iterative reconstruction (MIR) in patients with urolithiasis at reduced-dose computed tomography (CT). Methods Twenty patients scheduled for unenhanced abdominal CT for follow-up of urolithiasis were prospectively included. Routine dose acquisition was followed by three low-dose acquisitions at 40%, 60% and 80% reduced doses. All images were reconstructed with filtered back projection (FBP), HIR and MIR. Urolithiasis detection rates, gall bladder, appendix and rectosigmoid evaluation and overall subjective image quality were evaluated by two observers. Results 74 stones were present in 17 patients. Half the stones were not detected on FBP at the lowest dose level, but this improved with MIR to a sensitivity of 100%. HIR resulted in a slight decrease in sensitivity at the lowest dose to 72%, but outperformed FBP. Evaluation of other structures with HIR at 40% and with MIR at 60% dose reductions was comparable to FBP at routine dose, but 80% dose reduction resulted in non-evaluable images. Conclusions CT radiation dose for urolithiasis detection can be safely reduced by 40 (HIR)–60 (MIR) % without affecting assessment of urolithiasis, possible extra-urinary tract pathology or overall image quality. Key Points • Iterative reconstruction can be used to substantially lower the radiation dose. • This allows for radiation reduction without affecting sensitivity of stone detection. • Possible extra-urinary tract pathology evaluation is feasible at 40–60% reduced dose. Electronic supplementary material The online version of this article (doi:10.1007/s00330-017-4929-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annemarie M den Harder
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508GA, Utrecht, The Netherlands.
| | - Martin J Willemink
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508GA, Utrecht, The Netherlands
| | - Pieter J van Doormaal
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Frank J Wessels
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508GA, Utrecht, The Netherlands
| | - M T W T Lock
- Department of Urology, University Medical Center, P.O. Box 85500, 3508GA, Utrecht, The Netherlands
| | - Arnold M R Schilham
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508GA, Utrecht, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508GA, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, Utrecht University Medical Center, P.O. Box 85500, E01.132, 3508GA, Utrecht, The Netherlands
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den Harder AM, Suchá D, van Doormaal PJ, Budde RPJ, de Jong PA, Schilham AMR, Breur JMPJ, Leiner T. Radiation dose reduction in pediatric great vessel stent computed tomography using iterative reconstruction: A phantom study. PLoS One 2017; 12:e0175714. [PMID: 28410386 PMCID: PMC5391930 DOI: 10.1371/journal.pone.0175714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/13/2016] [Accepted: 03/30/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To study dose reduction using iterative reconstruction (IR) for pediatric great vessel stent computed tomography (CT). METHODS Five different great vessel stents were separately placed in a gel-containing plastic holder within an anthropomorphic chest phantom. The stent lumen was filled with diluted contrast gel. CT acquisitions were performed at routine dose, 52% and 81% reduced dose and reconstructed with filtered back projection (FBP) and IR. Objective image quality in terms of noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) as well as subjective image quality were evaluated. RESULTS Noise, SNR and CNR were improved with IR at routine and 52% reduced dose, compared to FBP at routine dose. The lowest dose level resulted in decreased objective image quality with both FBP and IR. Subjective image quality was excellent at all dose levels. CONCLUSION IR resulted in improved objective image quality at routine dose and 52% reduced dose, while objective image quality deteriorated at 81% reduced dose. Subjective image quality was not affected by dose reduction.
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Affiliation(s)
- Annemarie M. den Harder
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - Dominika Suchá
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | | | - Pim A. de Jong
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Arnold M. R. Schilham
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Johannes M. P. J. Breur
- Department of Pediatric Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
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van den Hoven AF, Braat MNGJA, Prince JF, van Doormaal PJ, van Leeuwen MS, Lam MGEH, van den Bosch MAAJ. Liver CT for vascular mapping during radioembolisation workup: comparison of an early and late arterial phase protocol. Eur Radiol 2016; 27:61-69. [PMID: 27108297 PMCID: PMC5127855 DOI: 10.1007/s00330-016-4343-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/29/2015] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 11/25/2022]
Abstract
Objectives To compare right gastric (RGA) and segment 4 artery (A4) origin detection rates during radioembolisation workup between early and late arterial phase liver CT protocols. Methods 100 consecutive patients who underwent liver CT between May 2012–January 2015 with early or late arterial phase protocol (n = 50 each, 10- vs. 20-s post-threshold delay) were included. RGA/A4 origin detection rates, assessed by two raters, and contrast-to-noise ratio (CNR) of the hepatic artery relative to the portal vein were compared between the protocols. Results The first–second rater scored the RGA origin as visible in 58–65 % (specific proportion of agreement 82 %, κ = 0.62); A4 origin in 96–89 % (94 %, κ = 0.54). Thirty-six percent of RGA origins not detectable by DSA were identified on CT. Origin detection rates were not significantly different for early/late arterial phases. Mean CNR was higher in the early arterial phase protocol (1.7 vs. 1.2, p < 0.001). Conclusion A 10-s delay arterial phase CT protocol does not significantly improve detection of small intra- and extrahepatic branches. RGA origin detection requires further optimization, whereas A4/MHA origin detection is adequate, with good inter-rater reproducibility. CT remains important for preprocedural planning, because it may reveal arterial anatomy not discernible on DSA. Key Points • An early arterial phase does not significantly improve RGA and A4/MHA origin detection. • RGA origin detection (58–65 %) on CT is still suboptimal. • 36 % of RGA origins undetectable on DSA can be identified on CT. • A4/MHA origin detection (89–96 %) on CT is excellent. • Inter-rater reproducibility is good for RGA and A4/MHA origin detection on CT.
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Affiliation(s)
- Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Manon N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Pieter J van Doormaal
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten S van Leeuwen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Braat MNGJA, van den Hoven AF, van Doormaal PJ, Bruijnen RC, Lam MGEH, van den Bosch MAAJ. The Caudate Lobe: The Blind Spot in Radioembolization or an Overlooked Opportunity? Cardiovasc Intervent Radiol 2016; 39:847-54. [DOI: 10.1007/s00270-016-1321-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/22/2016] [Indexed: 12/14/2022]
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