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Tosco L, Devos G, Schillebeeckx L, Pans S, Goffin K, Everaerts W, Van Poppel H, Joniau S. Radium-223 in patients with prostate specific antigen (PSA) progression and without clinical metastases following maximal local therapy: A pilot study. Urol Oncol 2021; 40:7.e9-7.e17. [PMID: 34099385 DOI: 10.1016/j.urolonc.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the curative intent of radical prostatectomy (RP) (+/- radiotherapy (RT)), 30% of the clinically localized prostate cancer (CaP) patients will develop rising PSA (prostate specific antigen). In absence of clinical recurrence, there is a lack of effective treatment strategies in order to control the disease at its earliest (micro)metastatic stage. The aim of this study was to assess safety, tolerability, and biochemical response of off-label Radium-223 (Xofigo) treatment in CaP patients with PSA relapse following maximal local therapy. METHODS We conducted a prospective, single arm, single center open-label, pilot study with Radium-223 in CaP patients with rising PSA (>0.2 ng/ml) following RP + adjuvant/salvage RT. Negative staging with 68Ga-PSMA-11 PET/CT and whole-body MRI was mandatory at time of inclusion. Patients were eligible if they exhibited adverse clinico-pathological features predictive of significant recurrence. Safety, tolerability, biochemical progression (defined as PSA increase >50% from PSA nadir) and clinical recurrence were assessed. RESULTS In total, 23 patients were screened of whom 8 patients were included is the study. Radium-223 treatment was safe with no serious treatment related adverse events. One patient developed grade 3 lymphopenia. All patients rapidly developed PSA progression (median PSA progression-free survival: 5.5 months). Eventually all patients experienced clinical recurrence (median clinical recurrence-free survival 11.0 months) of whom only 2 patients developed skeletal recurrence. CONCLUSIONS Radium-223 in patients with PSA relapse following maximal local treatment without clinical metastases is safe. However, the clinical benefit of Ra-223 in this setting is doubtful as significant oncological benefit is lacking.
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Affiliation(s)
- Lorenzo Tosco
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Gaëtan Devos
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of development and regenaration, Leuven, Belgium.
| | | | - Steven Pans
- Department of radiology, University Hospitals Leuven, Leuven, Belgium
| | - Karolien Goffin
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of development and regenaration, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of development and regenaration, Leuven, Belgium
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Meyskens T, Vandecaveye V, Pans S, Dresen R, Van Ongeval C, Smeets A, Nevelsteen I, Neven P, Wildiers H, Schoffski P, Denayer E, Van Buggenhout G, Michils G, Brems H, Legius E, Punie K. Cancer surveillance in adults with germline TP53 pathogenic variants: A single-center observational study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10530] [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: 11/20/2022] Open
Abstract
10530 Background: Germline pathogenic variants (PV) in the tumor suppressor gene TP53 are associated with a high risk of developing diverse malignancies, often at young age, and predispose to Li-Fraumeni syndrome (LFS). Surveillance programs for presymptomatic PV carriers have shown survival benefit in a non-randomized trial. Here we describe the surveillance findings and clinical outcomes of adults with TP53 PV undergoing a standardized screening protocol. Methods: We identified adults with germline PV in TP53 who underwent surveillance at the University Hospitals Leuven, Belgium, between 04/2013 and 08/2020. Patients with prior cancer were allowed, while patients with an active malignancy requiring treatment at diagnosis of the TP53 PV were excluded. Surveillance was performed per modified Toronto protocol, including annual whole body diffusion-weighted MRI (WB-DWI/MRI), brain MRI, abdominal ultrasound (US), endoscopic surveillance, laboratory tests, dermatological examination and breast MRI/US in females. The primary aim was to evaluate the number and type of malignancies and premalignant lesions diagnosed during screening and to assess the proportion of malignancies detected by surveillance. Secondary outcomes were the cancer detection rate during the first year of screening, the proportion of carriers with false-positive findings, and overall survival. Results: We included 42 adults from 20 apparently unrelated families. Median age was 38y (range, 17-70y) and 23 had a history of prior cancer. After a median follow-up of 41.5mo, we diagnosed 18 cancers in 12/42 participants (29%). Overall survival was 95% in all participants, including 2 carriers who opted to discontinue surveillance. Surveillance detected 10/18 cancers (56%), the majority of whom through WB-DWI/MRI (6/10; 60%). No malignancies were identified with brain MRI. In 5/42 individuals (12%), surveillance detected a malignancy during the first year of screening. Only 2/10 cancers discovered with surveillance (1 soft tissue and 1 bone sarcoma) belong to the LFS core tumors. Cancers not detected with surveillance (8/18) were 6 non-melanoma skin cancers and 2 interval cancers (sarcoma post radiation, secondary acute leukemia). Additionally, we detected 27 premalignant lesions in 11/42 patients (26%), of whom 78% were diagnosed by colonoscopy. False-positive findings occurred in 7/42 patients (17%) and were mostly seen with WB-DWI/MRI. Conclusions: Adults with germline PV in TP53 that undergo surveillance have high cancer detection rates. The majority of malignancies were asymptomatic at diagnosis and detected with WB-DWI/MRI. Despite the high cancer incidence, few LFS core cancers were diagnosed and survival was encouraging. Increased genetic testing changes the clinical picture of germline TP53 carrier populations, justifying the transition from LFS to a wider concept of heritable TP53-related cancer syndrome.
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Affiliation(s)
- Thomas Meyskens
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Steven Pans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Raphaëla Dresen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Ann Smeets
- Department of Surgical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - Ines Nevelsteen
- Department of Surgical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Gynaecology & Obstetrics and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Schoffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ellen Denayer
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | - Geneviève Michils
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Brems
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Eric Legius
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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Beyls C, Haustermans K, Deroose CM, Pans S, Vanbeckevoort D, Verslype C, Dekervel J. Could Autoimmune Disease Contribute to the Abscopal Effect in Metastatic Hepatocellular Carcinoma? Hepatology 2020; 72:1152-1154. [PMID: 32348580 DOI: 10.1002/hep.31186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/10/2020] [Indexed: 12/07/2022]
Affiliation(s)
- Carolien Beyls
- Department of Gastroenterology, AZ Oudenaarde, Oudenaarde, Belgium
| | - Karin Haustermans
- Department of Oncology - Laboratory Experimental Radiotherapy, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe M Deroose
- Department of Imaging and Pathology - Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium.,Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Steven Pans
- Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Chris Verslype
- Department of Oncology - Laboratory of Clinical Digestive Oncology, KU Leuven, Leuven, Belgium.,Department of Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Dekervel
- Department of Oncology - Laboratory of Clinical Digestive Oncology, KU Leuven, Leuven, Belgium.,Department of Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
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Beuselinck B, Pans S, Bielen J, De Wever L, Noppe N, Vanderschueren G, De Keyzer F, Baldewijns M, Lerut E, Laenen A, Verbiest A, Roussel E, Albersen M, Vandecaveye V. Whole-body diffusion-weighted magnetic resonance imaging for the detection of bone metastases and their prognostic impact in metastatic renal cell carcinoma patients treated with angiogenesis inhibitors. Acta Oncol 2020; 59:818-824. [PMID: 32297532 DOI: 10.1080/0284186x.2020.1750696] [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: 10/24/2022]
Abstract
Background: Metastatic renal cell carcinoma (mRCC) patients with bone metastases (BM) are at high risk for skeletal related events and have a poorer outcome when treated with vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs). Computed tomography (CT) lacks sensitivity to detect BM in mRCC. We aimed to determine the added value of whole body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) to CT for the detection of BM in mRCC and to estimate the prognostic impact of the number of BM in mRCC patients treated with VEGFR-TKIs.Material and methods: We conducted a prospective study including consecutive mRCC patients treated with a first-line VEGFR-TKI in the metastatic setting. All patients underwent a pretreatment thoracic-abdominal-pelvic CT and WB-DWI/MRI. CT and WB-DWI/MRI were compared for the detection of BM. The number of detected BM was correlated with response rate (RR), progression-free survival (PFS) and overall survival (OS) after start of the VEGFR-TKI.Results: Ninety-two patients were included. BM were found in 55% of the patients by WB-DWI/MRI and in 43% of the patients by CT (p = .003). Mean number of BM discovered per patient was 6.8 by WB-DWI/MRI versus 1.9 by CT (p = .006). The cutoff of ≤5 versus >5 BM on WB-DWI/MRI had the highest discriminative power for all outcome measures. Patients with >5 BM had a lower RR (10% versus 42%), more frequently early progressive disease (43% versus 13%, p = .003), shorter PFS (4 versus 10 months, p = .006) and shorter OS (10 versus 35 months, p < .0001) compared to patients with ≤5 BM.Conclusion: WB-DWI/MRI detects significantly more BM in mRCC patients than CT, allowing better estimation of the prognostic impact of BM in mRCC patients treated with VEGFR-TKIs. The prognostic impact should now be validated in patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Pans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jurgen Bielen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Noppe
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Evelyne Lerut
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | - Annelies Verbiest
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Haaker L, De Meue E, Wildiers H, Verbiest A, Dumez H, Lerut E, Pans S, Albersen M, Beuselinck B. Bone metastases and age are associated with earlier dose reductions in metastatic clear-cell renal cell carcinoma patients treated with angiogenesis inhibitors. Acta Clin Belg 2019; 74:414-423. [PMID: 30497350 DOI: 10.1080/17843286.2018.1551744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Metastatic clear-cell renal cell carcinoma (m-ccRCC) patients with bone metastases (BM) treated with vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKI) have a poorer outcome compared to patients without BM. We aimed to investigate whether an increased incidence of VEGFR-TKI treatment interruptions and/or dose reductions in patients with BM could explain this difference in outcome. Patients and methods: Retrospective study on m-ccRCC patients treated in first-line with VEGFR-TKI. Analysis of the incidence of treatment interruptions and dose reductions and time-to-event analysis. Study of the correlation with the presence of BM at start of first-line VEGFR-TKIs. Results: Two-hundred-and-five patients were included. In patients with BM, median time-to-dose-reduction was significantly shorter (3 versus 5 cycles; p = 0.005) than in patients without BM. 63% of the total number of cycles was administered at reduced dose, compared to 41% in patients without BM. Age at start of VEGFR-TKI (≤ versus >70 years) was significantly associated with median time-to-dose-reduction (5 versus 3 cycles; p = 0.007). On multivariate analysis, the presence of BM (p = 0.004; HR 1.82, 95%CI 1.21-2.73) and age at start of VEGFR-TKIs (p = 0.017; HR 1.65, 95%CI 1.10-2.50) were independently associated with time-to-dose-reduction. Conclusion: In m-ccRCC patients treated with VEGFR-TKIs, dose reductions occurred earlier in patients with BM compared to patients without BM and in elderly patients.
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Affiliation(s)
- Lorenz Haaker
- Department of General Medical Oncology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Elisabeth De Meue
- Department of General Medical Oncology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Annelies Verbiest
- Department of General Medical Oncology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Herlinde Dumez
- Department of General Medical Oncology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Evelyne Lerut
- Department of Pathology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Steven Pans
- Department of Radiology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | - Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, KULeuven, Leuven, Belgium
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6
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Higham CS, Dombi E, Rogiers A, Bhaumik S, Pans S, Connor SEJ, Miettinen M, Sciot R, Tirabosco R, Brems H, Baldwin A, Legius E, Widemann BC, Ferner RE. The characteristics of 76 atypical neurofibromas as precursors to neurofibromatosis 1 associated malignant peripheral nerve sheath tumors. Neuro Oncol 2019; 20:818-825. [PMID: 29409029 DOI: 10.1093/neuonc/noy013] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Neurofibromatosis 1 (NF1) leads to the development of benign and malignant peripheral nerve sheath tumors (MPNST). MPNST have been described to develop in preexisting benign plexiform neurofibromas (PN) and have a poor prognosis. Atypical neurofibromas (ANF) were recently described as precursor lesions for MPNST, making early detection and management of ANF a possible strategy to prevent MPNST. We aimed to clinically characterize ANF and identify management approaches. Methods We analyzed clinical, imaging, and pathology findings of all patients with NF1 and ANF at 3 institutions. Results Sixty-three patients had 76 ANF (32M/31F; median age 27.1 y). On MRI, most ANF appeared as distinct nodular lesions and were 18F-fluorodeoxyglucose (FDG) avid. Forty-six ANF were associated with pain, 19 with motor weakness, 45 were palpable or visible, and 13 had no clinical signs. Completely resected ANF (N = 57) have not recurred (median follow-up, 4.1 y; range, 0-14 y). Four ANF transformed into MPNST and 17 patients had a history of MPNST in a different location than was their ANF. Conclusions Growth of distinct nodular lesions, pain, and FDG-PET avidity should raise concern for ANF in NF1. Patients with ANF are at greater risk for development of MPNST. Complete resection of ANF may prevent development of MPNST.
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Affiliation(s)
- Christine S Higham
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland, USA.,Children's National Medical Center, Washington, DC, USA
| | - Eva Dombi
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Aljosja Rogiers
- Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Sucharita Bhaumik
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland, USA.,Winthrop University Hospital, Department of Hematology & Oncology, Mineola, New York, USA
| | - Steven Pans
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Steve E J Connor
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, Kings College Hospital London, London, England
| | - Markku Miettinen
- National Cancer Institute, Laboratory of Pathology, Bethesda, Maryland, USA
| | - Raf Sciot
- Department of Imaging and Pathology, Catholic University of Leuven, Leuven, Belgium
| | - Roberto Tirabosco
- Royal National Orthopaedic Hospital NHS Foundation Trust, London, England
| | - Hilde Brems
- Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Andrea Baldwin
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Eric Legius
- Department of Human Genetics, Catholic University of Leuven, Leuven, Belgium
| | - Brigitte C Widemann
- National Cancer Institute, Center for Cancer Research, Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Rosalie E Ferner
- Neurofibromatosis Center, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, London and King's College, London, England
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De Coster L, Sciot R, Everaerts W, Gheysens O, Verscuren R, Deroose CM, Pans S, Van Laere K, Goffin KE. Fibrous dysplasia mimicking bone metastasis on 68GA-PSMA PET/MRI. Eur J Nucl Med Mol Imaging 2017; 44:1607-1608. [PMID: 28488027 DOI: 10.1007/s00259-017-3712-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/20/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | - Raf Sciot
- Pathology, UZ Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, UZ Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Raf Verscuren
- Nuclear Medicine and Molecular Imaging, UZ Leuven, Leuven, Belgium
| | - Christophe M Deroose
- Nuclear Medicine and Molecular Imaging, UZ Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Steven Pans
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- Radiology, UZ Leuven, Leuven, Belgium
| | - Koen Van Laere
- Nuclear Medicine and Molecular Imaging, UZ Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Karolien E Goffin
- Nuclear Medicine and Molecular Imaging, UZ Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
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Strybol D, Hermans K, Degreef I, Sinnaeve F, Pans S, Debiec-Rychter M, Sciot R. Phalangeal chondrosarcoma: A rare presentation with an unusual biological behavior. Hand Surg Rehabil 2017; 36:228-229. [PMID: 28465204 DOI: 10.1016/j.hansur.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/26/2017] [Accepted: 01/28/2017] [Indexed: 11/18/2022]
Affiliation(s)
- D Strybol
- Department of Pathology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - K Hermans
- Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg Campus, Weligerveld 1, 3212 Pellenberg, Belgium
| | - I Degreef
- Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg Campus, Weligerveld 1, 3212 Pellenberg, Belgium
| | - F Sinnaeve
- Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg Campus, Weligerveld 1, 3212 Pellenberg, Belgium
| | - S Pans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - M Debiec-Rychter
- Department of Human Genetics, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - R Sciot
- Department of Pathology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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Van Steenkiste E, Van Laethem A, Biesemans G, Pans S. Role of diffusion-weighted magnetic resonance imaging in the evaluation of scalp dermatofibrosarcoma protuberans. Int J Dermatol 2015; 55:226-31. [DOI: 10.1111/ijd.13050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/18/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Affiliation(s)
| | - An Van Laethem
- Department of Dermatology; University Hospitals Leuven; Leuven Belgium
| | - Geert Biesemans
- Department of Dermatology; University Hospitals Leuven; Leuven Belgium
| | - Steven Pans
- Department of Radiology; University Hospitals Leuven; Leuven Belgium
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10
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T'Seyen S, Pans S, Laenen A, Devos T, Dierickx D, Schoemans H, Delforge M. Bone healing with bortezomib-based regimens in multiple myeloma: a retrospective imaging study. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aim: We conducted a retrospective single center study to measure bone healing by conventional x-ray radiographs (CXR) and computer tomography (CT) in multiple myeloma patients treated with bortezomib. Imaging data were correlated with serum levels of alkaline phosphatases and with disease response. Materials & methods: We identified 26 multiple myeloma patients receiving six or more 3-weekly cycles of bortezomib with radiological assessments. Imaging data before, during and after bortezomib, were analyzed for signs of bone healing. Results: In the group of CXR, 8/21 patients (38%) had evidence of bone healing compared with 7/10 patients (70%) in the CT group. Signs of bone healing were observed after an average of 28 (CXR) or 30 (CT) bortezomib administrations. Alkaline phosphatases did not correlate with bone healing or with disease response. Conclusion: In 13/26 (or 50%) of patients a beneficial bortezomib-related skeletal effect could be detected. This retrospective study provides further evidence for skeletal improvement during treatment with bortezomib.
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Affiliation(s)
- Stef T'Seyen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Pans
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Anouchka Laenen
- Department of Biostatistics & Statistical Bioinformatics, KU Leuven – University of Leuven, Leuven, Belgium
| | - Timothy Devos
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Daan Dierickx
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Michel Delforge
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
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Rose CD, Pans S, Casteels I, Anton J, Bader-Meunier B, Brissaud P, Cimaz R, Espada G, Fernandez-Martin J, Hachulla E, Harjacek M, Khubchandani R, Mackensen F, Merino R, Naranjo A, Oliveira-Knupp S, Pajot C, Russo R, Thomee C, Vastert S, Wulffraat N, Arostegui JI, Foley KP, Bertin J, Wouters CH. Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes. Rheumatology (Oxford) 2014; 54:1008-16. [DOI: 10.1093/rheumatology/keu437] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/12/2022] Open
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12
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De Somer L, Wouters C, Pans S. Total body MRI, a guide to diagnosis in patients with osteo-articular pain and inflammation. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191126 DOI: 10.1186/1546-0096-12-s1-p164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leijnen D, Van Wambeke P, Bruyninckx F, Pans S, Depreitere B, Peers K. Unusual cause of lower leg pain. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Somer LD, Pans S, Wouters C. A86: Total Body MRI, A Guide to Diagnosis in Patients With Osteo-Articular Pain and Inflammation. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38502] [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: 11/09/2022]
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Devoogdt N, Pans S, De Groef A, Geraerts I, Christiaens MR, Neven P, Vergote I, Van Kampen M. Postoperative Evolution of Thickness and Echogenicity of Cutis and Subcutis of Patients With and Without Breast Cancer-Related Lymphedema. Lymphat Res Biol 2014; 12:23-31. [DOI: 10.1089/lrb.2013.0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Steven Pans
- Department of Radiology, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Rose Christiaens
- Department of Oncology, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Surgical Oncology, Multidisciplinary Breast Clinic, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Oncology, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ignace Vergote
- Department of Oncology, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, KU Leuven–University of Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation, Leuven Lymphedema Center, Gynaecologic Oncology and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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de Jong L, Verfaillie M, Pans S, Lauweryns P, Goffin J, Depreitere B. Atlantoaxial instability in monozygotic twin sisters: degenerative or congenital disease? J Neurosurg Spine 2014; 20:459-63. [PMID: 24484305 DOI: 10.3171/2013.12.spine13227] [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: 11/06/2022]
Abstract
The authors report on two 70-year-old monozygotic twin sisters who both suffered severe nontraumatic atlantoaxial instability. If either had been a solitary case, degenerative atlantoaxial instability would have been the most straightforward diagnosis. In this case report the authors attempt to answer the question of whether an underlying congenital predisposition might be involved.
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Affiliation(s)
- Lars de Jong
- Department of Neurosurgery, Hospital Network Antwerp (ZNA), AZ Middelheim, Antwerp
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Van Campenhout A, Verhaegen A, Pans S, Molenaers G. Botulinum toxin type A injections in the psoas muscle of children with cerebral palsy: muscle atrophy after motor end plate-targeted injections. Res Dev Disabil 2013; 34:1052-1058. [PMID: 23295965 DOI: 10.1016/j.ridd.2012.11.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 05/27/2023]
Abstract
UNLABELLED MEP targeting during BoNT-A injections has been demonstrated to improve outcome. Two injection techniques of the psoas muscle - proximal MEP targeting versus a widely used more distal injection technique - are compared using muscle volume assessment by digital MRI segmentation as outcome measure. METHOD 7 spastic diplegic children received injections in both psoas muscles: two different injection techniques randomly in 5 patients, in 2 patients bilateral MEP targeting. MRI images of the psoas were taken before, after 2 months and in 3 patients after 6 months. RESULTS Average post injection volume (in relation to pre-injection volume) for the MEP targeted muscles (9) is 79.5% versus 107.8% in the 5 distal injected psoas muscles (p=0.0033). In all 5 asymmetric injected patients the MEP targeted psoas had a larger volume reduction than the more distal injected psoas muscle. This atrophy remains even 6 months after the injection. This is the first study were a longitudinal follow-up by MRI demonstrates muscle atrophy after BoNT-A in children with CP. Injections in the MEP zone of the muscle, which is the more proximal part of the psoas muscle, cause atrophy in contrary to more distal injections were this atrophy is not observed.
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Lintermans A, Laenen A, Van Calster B, Van Hoydonck M, Pans S, Verhaeghe J, Westhovens R, Henry NL, Wildiers H, Paridaens R, Dieudonné AS, Leunen K, Morales L, Verschueren K, Timmerman D, De Smet L, Vergote I, Christiaens MR, Neven P. Prospective study to assess fluid accumulation and tenosynovial changes in the aromatase inhibitor-induced musculoskeletal syndrome: 2-year follow-up data. Ann Oncol 2013; 24:350-355. [PMID: 23038762 DOI: 10.1093/annonc/mds290] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aromatase inhibitors (AIs) frequently lead to the AI-induced musculoskeletal syndrome (AIMSS). Looking into its pathophysiology, 6 months of AI therapy thickens the tendon sheath with intra-articular fluid (IAF) retention and loss of grip strength. We here report 24-month follow-up data. PATIENTS AND METHODS A prospective cohort study of 33 postmenopausal breast cancer patients received adjuvant endocrine therapy; 27 received an AI and 6 received tamoxifen. At baseline, 6 and 24 months patients had a rheumatologic examination, including a grip strength test, and magnetic resonance imaging of both hands and wrists. The primary end point was tenosynovial changes; secondary end points were changes in morning stiffness, grip strength and IAF. RESULTS Twenty-three AI and 5 tamoxifen patients completed all investigations. Between month 6 and 24, IAF further increased in AI users (P = 0.04) but not in tamoxifen users, and grip strength further decreased in both groups. The worsened tenosynovial changes were strongly correlated with a decrease in grip strength. At 24 months, morning stiffness continued to be present in over a third of AI users. CONCLUSION AIMSS represents a substantial problem in breast cancer patients. It is associated with tenosynovial changes, IAF retention, joint stiffness and loss of grip strength that do not improve with prolonged use.
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Affiliation(s)
- A Lintermans
- Department of Obstetrics and Gynecology, KU Leuven, Leuven.
| | - A Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven; Leuven Cancer Institute (LKI), KU Leuven, Leuven
| | - B Van Calster
- Leuven Cancer Institute (LKI), KU Leuven, Leuven; Department of Development and Regeneration, KU Leuven, Leuven
| | | | - S Pans
- Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - J Verhaeghe
- Department of Obstetrics and Gynecology, KU Leuven, Leuven
| | | | - N L Henry
- Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
| | - R Paridaens
- Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
| | - A S Dieudonné
- Department of Obstetrics and Gynecology, KU Leuven, Leuven
| | - K Leunen
- Department of Obstetrics and Gynecology, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
| | - L Morales
- Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
| | | | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven, Leuven
| | - L De Smet
- Orthopedic Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - I Vergote
- Department of Obstetrics and Gynecology, KU Leuven, Leuven; Leuven Cancer Institute (LKI), KU Leuven, Leuven
| | - M R Christiaens
- Department of Obstetrics and Gynecology, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
| | - P Neven
- Department of Obstetrics and Gynecology, KU Leuven, Leuven; Multidisciplinary Breast Center, University Hospitals Leuven, KU Leuven, Leuven
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O'Sullivan K, Verschueren S, Pans S, Smets D, Dekelver K, Dankaerts W. Validation of a novel spinal posture monitor: comparison with digital videofluoroscopy. Eur Spine J 2012; 21:2633-9. [PMID: 22836364 DOI: 10.1007/s00586-012-2440-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/27/2012] [Accepted: 07/06/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE A novel, minimally invasive posture monitor which can monitor lumbar postures outside the laboratory has demonstrated excellent reliability, as well as concurrent validity compared to a surface marker-based motion analysis system. However, it is unclear if this device reflects underlying vertebral motion. METHODS Twelve participants performed full range sagittal plane lumbo-pelvic movements during sitting and standing. Their posture was measured simultaneously using both this device (BodyGuard™) and digital videofluoroscopy. RESULTS Strong correlations were observed between the two methods (all r (s) > 0.88). Similarly, the coefficients of determination were high (all r (2) > 0.78). The maximum mean difference between the measures was located in the mid-range of motion and was approximately 3.4° in sitting and 3.9° in standing. CONCLUSION The BodyGuard™ appears to be a valid method for analysing vertebral motion in the sagittal plane and is a promising tool for long-term monitoring of spinal postures in laboratory and clinical settings in people with low back pain.
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Affiliation(s)
- Kieran O'Sullivan
- Physiotherapy Department, University of Limerick, Limerick, Ireland.
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Waer P, Samson I, Sinnaeve F, Sciot R, Pans S. Perineural spread of endometriosis along the obturator nerve into the adductor thigh compartment. Jpn J Radiol 2012; 30:446-9. [DOI: 10.1007/s11604-012-0060-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 02/03/2012] [Indexed: 11/29/2022]
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Depreitere B, Vander Poorten V, Vranckx J, Pans S, Menten J, Goitein G. Management of Cervical Spine Chordomas. Case Report. World Neurosurg 2012. [DOI: 10.1016/j.wneu.2011.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gheysens O, Lips N, Adriaenssens T, Pans S, Maertens J, Herregods MC, Herijgers P, Peetermans WE, Mortelmans L. Septic pulmonary embolisms and metastatic infections from methicillin-resistant Staphylococcus aureus endocarditis on FDG PET/CT. Eur J Nucl Med Mol Imaging 2011; 39:183. [DOI: 10.1007/s00259-011-1932-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 08/25/2011] [Indexed: 11/30/2022]
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Amant F, Deckers S, Van Calsteren K, Loibl S, Halaska M, Brepoels L, Beijnen J, Cardoso F, Gentilini O, Lagae L, Mir O, Neven P, Ottevanger N, Pans S, Peccatori F, Rouzier R, Senn HJ, Struikmans H, Christiaens MR, Cameron D, Du Bois A. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 2011; 46:3158-68. [PMID: 20932740 DOI: 10.1016/j.ejca.2010.09.010] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 09/03/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE To provide guidance for clinicians about the diagnosis, staging and treatment of breast cancer occurring during an otherwise uncomplicated pregnancy. METHODS An international expert Panel convened to address a series of questions identified by a literature review and personal experience. Issues relating to the diagnosis and management of breast cancer after delivery were outside the scope. RESULTS There is a paucity of large and/or randomized studies. Based on cohort studies, case series and case reports, the recommendations represent the best available evidence, albeit of a lower grade than is optimal. RECOMMENDATIONS In most circumstances, serious consideration should be given to the option of treating breast cancer whilst continuing with the pregnancy. Each woman should ideally be referred to a centre with sufficient expertise, given a clear explanation of treatment options. Most diagnostic and staging examinations can be performed adequately and safely during pregnancy. Treatment should however be adapted to the clinical presentation and the trimester of the pregnancy: surgery can be performed during all trimesters of pregnancy; radiotherapy can be considered during the first and second trimester but should be postponed during the third trimester; and standard chemotherapies can be used during the second and third trimester. Since neonatal morbidity mainly appears to be related to prematurity, delivery should not be induced before 37 weeks, if at all possible. CONCLUSIONS The treatment of breast cancer in pregnancy should be executed by experienced specialists in a multidisciplinary setting and should adhere as closely as possible to standard protocols.
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Affiliation(s)
- Frédéric Amant
- Multidisciplinary Breast Center, Leuven Cancer Institute, UZ Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
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Lintermans A, Van Calster B, Van Hoydonck M, Pans S, Verhaeghe J, Westhovens R, Henry NL, Wildiers H, Paridaens R, Dieudonné AS, Leunen K, Morales L, Verschueren K, Timmerman D, De Smet L, Vergote I, Christiaens MR, Neven P. Aromatase inhibitor-induced loss of grip strength is body mass index dependent: hypothesis-generating findings for its pathogenesis. Ann Oncol 2011; 22:1763-9. [PMID: 21273342 DOI: 10.1093/annonc/mdq699] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our preliminary results showed that tenosynovial changes and decrease in grip strength are associated with the aromatase inhibitor-induced musculoskeletal syndrome (AIMSS). Here, we report the final results and assess the relationship between grip strength and body mass index (BMI). PATIENTS AND METHODS We conducted a prospective study including postmenopausal early breast cancer patients receiving either an aromatase inhibitor (AI) or tamoxifen. Primary end point was change from baseline in tenosynovial abnormalities. Secondary end points were changes from baseline in morning stiffness, intra-articular fluid and grip strength and its association with BMI. RESULTS After 6 months of therapy, 74% [95% confidence interval (CI) 51% to 89%] of AI-treated patients had worsened tenosynovial abnormalities, 56% (95% CI 34% to 75%) had increased intra-articular fluid, and 22% (95% CI 9% to 45%) had increased morning stiffness. Grip strength decreased 8% for the left hand (95% CI 2% to 21%) and 11% for the right (95% CI 4% to 17%). Regression analysis suggested that grip strength decreased more for subjects with high or with low BMI. CONCLUSIONS AIMSS is characterized by tenosynovial changes, intra-articular fluid and morning stiffness. We hypothesize that the quadratic association between BMI and loss of grip strength reflects AI-induced changes on the endocrine control of the growth hormone insulin-like growth factor-I pathway.
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Affiliation(s)
- A Lintermans
- Department of Obstetrics & Gynecology, Division of Gynecological Oncology, University Hospitals Leuven, Belgium.
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Wolter P, Beuselinck B, Pans S, Schöffski P. Flare-up: an often unreported phenomenon nevertheless familiar to oncologists prescribing tyrosine kinase inhibitors. Acta Oncol 2009; 48:621-4. [PMID: 19107622 DOI: 10.1080/02841860802609574] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Morales L, Pans S, Van Hoydonck M, Verschueren K, Van Calster B, Paridaens R, Westhovens R, Timmerman D, De Smet L, Vergote I, Christiaens M, Neven P. The decrease in grip strength in aromatase inhibitor-induced arthralgia is associated with extremes in body mass index and increased tenosynovial abnormalities. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-1141] [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
Abstract
Abstract #1141
Background: We previously demonstrated in 17 patients that aromatase inhibitor (AI)-induced arthralgia is associated with a decrease in grip strength corresponding to an increase in tenosynovial abnormalities on magnetic resonance imaging (MRI). It is important to identify patients at risk of developing arthralgia and its associated functional and tenosynovial changes. Reports on the effect of weight on AI-induced arthralgia are conflicting. Our purpose was to investigate the effect of body mass index (BMI) and tenosynovial abnormalities on grip strength.
 Patients and Methods: This is a prospective single-centre study including consecutive postmenopausal patients with early breast cancer receiving either tamoxifen or an AI. At baseline and after 6 months, patients filled in a rheumatologic history questionnaire and a rheumatologic examination including a grip strength test was done. At the same time points, MRI of both hands and wrists was performed. The primary endpoint was tenosynovial abnormalities from baseline on MRI. Secondary endpoints were changes from baseline for morning stiffness, grip strength and intra-articular fluid on MRI. Wilcoxon signed ranks was used to test changes from baseline and the Spearman correlation coefficient to assess the association between rheumatologic and MRI changes from baseline. Regular and robust regression analysis was employed to investigate the influence of BMI on grip strength.
 Results: Thirty three patients completed all the planned investigations and are included in this report (27 patients on AI and 6 on tamoxifen). Median age was 64 years (range 51-74) and median BMI was 24 kg/m2 (range18-45). At 6 months, patients on AI experienced increased morning stiffness (p<0.05), decrease in grip strength (p>0.005), increase in tenosynovial abnormalities (p<0.001) and increase in intra-articular fluid (p<0.001). Only minor changes were seen in patients on tamoxifen. The decrease in grip strength correlated with the tenosynovial changes on MRI (p=0.05) but was not significantly correlated with intra-articular fluid (p=0.3). The regression analysis suggests that grip strength is predicted to decrease more strongly for extremes in BMI (very high and very low BMI) and least strongly for a BMI around 25. Furthermore, the effect of tenosynovial abnormalities on decrease in grip strength does not diminish when the effect of BMI is accounted for.
 Conclusion: The functional impairment of hands in the AI-induced arthralgia is characterized by tenosynovial changes on MRI correlating with a significant decrease in hand grip strength. Grip strength is predicted to decrease more strongly for extremes in BMI and higher levels of tenosynovial abnormalities.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1141.
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Affiliation(s)
- L Morales
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - S Pans
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - M Van Hoydonck
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - K Verschueren
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - B Van Calster
- 2 Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - R Paridaens
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
- 2 Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - R Westhovens
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - D Timmerman
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - L De Smet
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - I Vergote
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
| | - M Christiaens
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
- 2 Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
| | - P Neven
- 1 University Hospital Gasthuisberg, Multidisciplinary Breast Center, Leuven Kanker Instituut, Leuven, Belgium
- 2 Department of Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
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Morales L, Pans S, Verschueren K, Van Calster B, Paridaens R, Westhovens R, Timmerman D, De Smet L, Vergote I, Christiaens MR, Neven P. Prospective study to assess short-term intra-articular and tenosynovial changes in the aromatase inhibitor-associated arthralgia syndrome. J Clin Oncol 2008; 26:3147-52. [PMID: 18474874 DOI: 10.1200/jco.2007.15.4005] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Arthralgia is an adverse class effect of aromatase inhibitors (AIs). To date, its exact mechanism remains unclear. The purpose of this study was to investigate the changes in clinical rheumatologic features and magnetic resonance imaging (MRI) of hands and wrists in AI and tamoxifen users. PATIENTS AND METHODS This is a prospective single-center study including 17 consecutive postmenopausal patients with early breast cancer receiving either tamoxifen (n = 5) or an AI (n = 12). At baseline and after 6 months, patients filled in a rheumatologic history questionnaire and a rheumatologic examination including a grip strength test was done. At the same time points, MRI of both hands and wrists was performed. The primary end point was tenosynovial changes from baseline on MRI. Secondary end points were changes from baseline for morning stiffness, grip strength, and intra-articular fluid on MRI. Wilcoxon signed ranks was used to test changes from baseline and the Spearman correlation coefficient to assess the association between rheumatologic and MRI changes from baseline. RESULTS At 6 months, patients on AI had a decrease in grip strength (P = .0049) and an increase in tenosynovial changes (P = .0010). The decrease in grip strength correlated well with the tenosynovial changes on MRI (P = .0074). Only minor changes were seen in patients on tamoxifen. AI users reported worsening of morning stiffness and showed an increase in intra-articular fluid on MRI. CONCLUSION The functional impairment of hands in the AI-associated arthralgia syndrome is characterized by tenosynovial changes on MRI correlating with a significant decrease in hand grip strength.
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Affiliation(s)
- Leilani Morales
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
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Morales L, Pans S, Paridaens R, Westhovens R, Timmerman D, Verhaeghe J, Wildiers H, Leunen K, Amant F, Berteloot P, Smeets A, Van Limbergen E, Weltens C, Van den Bogaert W, De Smet L, Vergote I, Christiaens MR, Neven P. Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging. Breast Cancer Res Treat 2006; 104:87-91. [PMID: 17061044 DOI: 10.1007/s10549-006-9394-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [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: 08/22/2006] [Accepted: 08/23/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Arthralgia, skeletal and muscle pain have been reported in postmenopausal women under treatment with third generation aromatase inhibitors (AIs). However, the pathogenesis and anatomic correlate of musculoskeletal pains have not been thoroughly evaluated. Moreover, the impact of AI-induced musculoskeletal symptoms on normal daily functioning needs to be further explored. PATIENTS AND METHODS We examined 12 consecutive non-metastatic breast cancer patients who reported severe musculoskeletal pain under a third generation AI; 11 were on letrozole and 1 on exemestane. Clinical rheumatological examination and serum biochemistry were performed. Radiological evaluation of the hand/wrist joints were performed using ultrasound (US) and/or magnetic resonance imaging (MRI). RESULTS The most common reported symptom was severe early morning stiffness and hand/wrist pain causing impaired ability to completely close/stretch the hand/fingers and to perform daily activities and work-related skills. Six patients had to discontinue treatment due to severe symptoms. Trigger finger and carpal tunnel syndrome were the most frequently reported clinical signs. US showed fluid in the tendon sheath surrounding the digital flexor tendons. On MRI, an enhancement and thickening of the tendon sheath was a constant finding in all 12 patients. CONCLUSIONS Musculoskeletal pains in breast cancer patients under third generation AIs can be severe, debilitating, and can limit compliance. Characteristic tenosynovial, and in some patients joint changes on US and MRI were observed in this series and have not been reported before.
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Affiliation(s)
- Leilani Morales
- Department of General Medical Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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29
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Geusens E, Pans S, Verhulst D, Brys P. The modified axillary view of the shoulder, a painless alternative. Emerg Radiol 2006; 12:227-30. [PMID: 16688433 DOI: 10.1007/s10140-006-0484-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 02/24/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND In our department, axillary views of the shoulder in trauma patients are not performed on a routine base, but sometimes, they are ordered by the trauma surgeon. We usually perform an anteroposterior view of the shoulder, combined with a posterior and an anterior oblique view of the shoulder in trauma patients. Because the classical described axillary view of the shoulder is sometimes very painful for the patient, especially in patients with humeral fractures, we perform a less painful modified axillary view. METHODS We now perform the axillary view with the patient standing upright and bending forward and we give a craniocaudal tube inclination between 30 and 45 degrees. Doing so, we also have an "axillary" view on the shoulder, but without harm for the patient. We performed a retrospective study in 103 patients with a modified axillary view and the additional value was checked. CONCLUSION We conclude that the modified axillary view is useful in 30 patients for detection of Hill-Sachs lesions or evaluation for displacement or angulation in proximal humeral fractures.
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Affiliation(s)
- Eric Geusens
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
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30
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Abstract
Mediastinal widening is a frequent radiological finding in the emergency department patient. The causes of mediastinal widening can be divided into traumatic and nontraumatic mediastinal widening. An important association of moderate to high velocity trauma is the mediastinal haematoma. It may be the result of traumatic transsection of the aorta, or it may be due to bleeding from other mediastinal vessels. Before the era of multidetector spiral CT, angiography was the gold standard for the evaluation of patients with a widened mediastinum. Meanwhile, angiography as a risk-carrying invasive examination has widely been replaced by MDCT. However, conventional radiography remains an important diagnostic tool; so does angiography, especially in the context of interventional radiology. Multidetector spiral CT plays an important role (Alkadhi et al., Radiographics 2004; 24:1239-1255), but usually as a second line procedure. This article discusses the radiological signs of traumatic mediastinal widening. Different traumatic lesions resulting in a widened mediastinum are presented, and some nontraumatic causes of a widened mediastinum are shown, in order to facilitate the differentiation between both entities.
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Affiliation(s)
- Eric Geusens
- Department of Radiology, University Hospitals Leuven, Belgium.
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31
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Lauwers T, Geusens E, Pans S, Nijs S. Epiphysiolysis of the capitellum humeri. JBR-BTR 2005; 88:184-6. [PMID: 16176075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A four-year-old girl presents at the emergency department with left elbow pain after a fall. X-ray demonstrated an epiphysiolysis of the capitellum humeri, without a bony fragment, the so-called Salter Harris Type 1 fracture. The fracture was treated by open reduction and internal fixation. This case is unusual because avulsions of the capitellum are usually associated with a bony fracture.
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Affiliation(s)
- T Lauwers
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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32
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Scheys L, Jonkers I, Schutyser F, Pans S, Spaepen A, Suetens P. Image based methods to generate subject-specific musculoskeletal models for gait analysis. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Geusens E, Van Breuseghem I, Pans S, Brys R. Some tips and tricks in reading cervical spine radiographs in trauma patients. JBR-BTR 2005; 88:87-92. [PMID: 15906582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Despite the fact that we are living in the era of spiral CT and multidetector spiral CT allowing us to scan the whole spine in less than a minute and to make high quality multiplanar reformatted images, plain films remain important in clearing the spine of polytraumatised patients. Particularly hemodynamic unstable patients that must be urgently transferred to the operation room need to be rapidly cleared for (cervical) spine lesions, without being transported to the CT unit which is--in most hospitals--located relatively far away from the emergency room and the operation rooms. In these patients, for the time being, spiral CT cannot replace conventional radiographs for the detection of sometimes subtle lesions. Knowledge of the direct but also the indirect signs of fractures remains important in the evaluation of these plain films. This article demonstrates some of these sometimes subtle signs that can help in making the diagnosis of these lesions.
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Affiliation(s)
- E Geusens
- Dpt. of Radiology, UZ Gasthuisberg, Leuven, Belgium
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34
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Pans S, Brys R, Van Breuseghem I, Geusens E. Benign bone tumours of the spine. JBR-BTR 2005; 88:31-7. [PMID: 15792167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A wide variety of primary bone tumours can involve the spine. The imaging features of these lesions are often characteristic. We present an overview of the primary benign bone tumours of the spine. The role of plain film, CT and MRI is discussed.
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Affiliation(s)
- S Pans
- Department of Radiology, UZ Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium
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35
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Geusens E, Van Breuseghem I, Pans S, Brys P. Imaging in trauma of the pelvis and hip region. JBR-BTR 2004; 87:190-202. [PMID: 15487260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Trauma of the pelvis and the hip are frequent and the most common lesions are fractures and dislocations. There are other traumatic lesions around the pelvis, including epiphysiolysis of the femoral head and apophysiolysis of the common muscle insertions around the hip. Cartilaginous lesions and some less frequent fractures are also illustrated in this article. We are not claiming to give a complete overview of traumatic injuries to the pelvis and the hip, but want to illustrate some more and some less frequent lesions.
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Affiliation(s)
- E Geusens
- Department of Radiology, University Hospitals Leuven, Belgium
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Abstract
We present the case of a 70-year-old woman with necrotizing fasciitis of the right leg, sepsis and bacteraemia with Escherichia coli. Chest wall emphysema, detected on standard radiograph and the presence of air in the soft-tissue of the foot was the reason for prompt surgical drainage in addition to standard fluid resuscitation and antibiotic therapy. There was no evidence of underlying diabetes mellitus, but unknown chronic renal failure and corticosteroid therapy for rheumatoid arthritis were considered predisposing factors. We present a short overview of this rare life-threatening condition with emphasis on radiological diagnostic modalities.
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Affiliation(s)
- Eric Geusens
- Department of Radiology, University Hospital Leuven, Leuven, Belgium.
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Van Breuseghem I, Sciot R, Pans S, Geusens E, Brys P, De Wever I. Fibrolipomatous hamartoma in the foot: atypical MR imaging findings. Skeletal Radiol 2003; 32:651-5. [PMID: 12955352 DOI: 10.1007/s00256-003-0684-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2003] [Revised: 07/16/2003] [Accepted: 07/18/2003] [Indexed: 02/02/2023]
Abstract
Lipomatosis of a nerve is a well-known but uncommon entity mostly seen in the median nerve. Magnetic resonance imaging (MRI) has been shown to provide pathognomonic features, obviating the need for diagnostic biopsy. We present a case of lipomatosis of a branch of the medial plantar nerve with an atypical appearance on magnetic resonance imaging.
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Affiliation(s)
- I Van Breuseghem
- Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Affiliation(s)
- Steven Pans
- University Hospitals Gasthuisberg, Leuven B-3000, Belgium
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39
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Van Breuseghem I, Geusens E, Pans S, Brys P. The meniscal ossicle revisited. JBR-BTR 2003; 86:276-7. [PMID: 14651083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The meniscal ossicle is an infrequent radiographic finding in humans. It often is mistaken for an intra-articular loose body. MR imaging is the ideal modality to differentiate between these entities. We report the imaging findings of a meniscal ossicle in a patient with emphasis on the MR imaging appearance. A review of the literature on meniscal ossicles is also presented.
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Geusens E, Pans S, Van Breuseghem I, Brys P. Ultrasound in acute trauma of the ankle and hindfoot. Emerg Radiol 2002; 9:283-8. [PMID: 15290555 DOI: 10.1007/s10140-002-0239-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2002] [Accepted: 07/18/2002] [Indexed: 10/25/2022]
Abstract
Ultrasound is a rapid, widely available and inexpensive imaging modality for the evaluation of the ankle and hindfoot. Ultrasonography can be performed in acute, semiacute and chronic conditions. Ankle injuries can be evaluated with ultrasound combined with X-rays. In the emergency room, acute trauma of ankle and hindfoot is an important indication for ultrasound.
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Affiliation(s)
- E Geusens
- University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium.
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Geusens E, Pans S, Brys P, Desruelles D. The axis ring: a forgotten semiologic sign in the detection of low odontoid fractures. JBR-BTR 2002; 85:241-5. [PMID: 12463500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The axis ring is a very important sign in the detection of low odontoid fractures. It can be the only radiological sign of a type III (low) odontoid fracture in a polytraumatised patient. As these are unstable fractures, their detection is important, even before a spiral CT is performed. Tracheal tube placement in patients with type III odontoid fractures should be performed very carefully to prevent displacement of the fracture. This sign, which has been published more than once in the radiological literature, seems to be not so well known by the physicians nor by a lot of radiologists. We can call it a forgotten semiologic sign. It is not even mentioned in the ATLS (Advanced Trauma Life Support) criteria for evaluation of the cervical spine.
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Affiliation(s)
- E Geusens
- Department of Radiology, UZ Gasthuisberg, Leuven, Belgium
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Geusens E, Pans S, Van Breuseghem I, Sabbe MB. Emergency medicine radiology: a new challenge in radiology. JBR-BTR 2002; 85:237-40. [PMID: 12463499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Emergency medicine is a recent discipline which relies much on emergency radiology. Emergency physicians are developing specific diagnostic work-ups and therapies for emergency conditions and exploring specific management of the department, attesting of a growing interest in emergency medicine radiology. In this article we give a survey of the history of emergency medicine radiology and we discuss this rather young subdiscipline of radiology.
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Affiliation(s)
- E Geusens
- Dept of Radiology, University Hospitals Leuven, Leuven, Belgium
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Affiliation(s)
- S Pans
- Department of Orthopaedic Surgery, University Hospital, Pellenberg, Belgium
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