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4. PET/MRI in practice: a clinical centre survey endorsed by the European Association of Nuclear Medicine (EANM) and the EANM Forschungs GmbH (EARL)

Author

Prakken, N.H.J., Besson, F.L., Borra, R.J.H., Buther, F., Buechel, R.R., Catana, C., Chiti, A., Dierckx, R., Dweck, M.R., Erba, P.A., Glaudemans, A., Gormsen, L.C., Hristova, I., Koole, M., Kwee, T.C., Mottaghy, F.M., Polycarpou, I., Prokop, M., Stegger, L., Tsoumpas, C., Slart, R., Prakken, N.H.J., Besson, F.L., Borra, R.J.H., Buther, F., Buechel, R.R., Catana, C., Chiti, A., Dierckx, R., Dweck, M.R., Erba, P.A., Glaudemans, A., Gormsen, L.C., Hristova, I., Koole, M., Kwee, T.C., Mottaghy, F.M., Polycarpou, I., Prokop, M., Stegger, L., Tsoumpas, C., and Slart, R.

Abstract

Contains fulltext : 297141.pdf (Publisher’s version ) (Closed access)

Published
2023

7. A deep learning masked segmentation alternative to manual segmentation in biparametric MRI prostate cancer radiomics

Author

Bleker, J., Kwee, T.C., Rouw, D., Roest, C., Borstlap, J., Jong, I.J. de, Dierckx, R., Huisman, H.J., Yakar, D., Bleker, J., Kwee, T.C., Rouw, D., Roest, C., Borstlap, J., Jong, I.J. de, Dierckx, R., Huisman, H.J., and Yakar, D.

Abstract

Contains fulltext : 283301.pdf (Publisher’s version ) (Open Access), OBJECTIVES: To determine the value of a deep learning masked (DLM) auto-fixed volume of interest (VOI) segmentation method as an alternative to manual segmentation for radiomics-based diagnosis of clinically significant (CS) prostate cancer (PCa) on biparametric magnetic resonance imaging (bpMRI). MATERIALS AND METHODS: This study included a retrospective multi-center dataset of 524 PCa lesions (of which 204 are CS PCa) on bpMRI. All lesions were both semi-automatically segmented with a DLM auto-fixed VOI method (averaging < 10 s per lesion) and manually segmented by an expert uroradiologist (averaging 5 min per lesion). The DLM auto-fixed VOI method uses a spherical VOI (with its center at the location of the lowest apparent diffusion coefficient of the prostate lesion as indicated with a single mouse click) from which non-prostate voxels are removed using a deep learning-based prostate segmentation algorithm. Thirteen different DLM auto-fixed VOI diameters (ranging from 6 to 30 mm) were explored. Extracted radiomics data were split into training and test sets (4:1 ratio). Performance was assessed with receiver operating characteristic (ROC) analysis. RESULTS: In the test set, the area under the ROC curve (AUCs) of the DLM auto-fixed VOI method with a VOI diameter of 18 mm (0.76 [95% CI: 0.66-0.85]) was significantly higher (p = 0.0198) than that of the manual segmentation method (0.62 [95% CI: 0.52-0.73]). CONCLUSIONS: A DLM auto-fixed VOI segmentation can provide a potentially more accurate radiomics diagnosis of CS PCa than expert manual segmentation while also reducing expert time investment by more than 97%. KEY POINTS: * Compared to traditional expert-based segmentation, a deep learning mask (DLM) auto-fixed VOI placement is more accurate at detecting CS PCa. * Compared to traditional expert-based segmentation, a DLM auto-fixed VOI placement is faster and can result in a 97% time reduction. * Applying deep learning to an auto-fixed VOI radiomics approach can

Published
2022

10. Should the ultrasound probe replace your stethoscope?

Author

Cox, E.G.M., Koster, G., Baron, A., Kaufmann, T., Eck, R.J., Veenstra, T.C., Hiemstra, B., Wong, A., Kwee, T.C., Tulleken, J.E., Keus, F., Wiersema, R., van Der Horst, W.C.C., Dieperink, W., Bleijendaal, R., Cawale, Y.F., Clement, R.P., Dijkhuizen, D., Haker, A., Hilbink, C.D.H., Klasen, M., Klaver, M., Schokking, L.J., Sikkens, V.W., Vos, M., Woerlee, J., Guided Treatment in Optimal Selected Cancer Patients (GUTS), ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Lifelong Learning, Education & Assessment Research Network (LEARN), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), RS: Carim - V04 Surgical intervention, Intensive Care, MUMC+: MA Medische Staf IC (9), MUMC+: MA Intensive Care (3), and Critical Care

Subjects
Male, Stethoscope, Clinical examination, SONOGRAPHY, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Diagnostic accuracy, law.invention, Cohort Studies, 0302 clinical medicine, law, Pulmonary edema, CHEST RADIOGRAPHY, Prospective Studies, 030212 general & internal medicine, Lung, lungs, APACHE, Ultrasonography, Lung ultrasound, medicine.diagnostic_test, ultrasound, lcsh:Medical emergencies. Critical care. Intensive care. First aid, health, Middle Aged, medicine.anatomical_structure, HEART-FAILURE, Female, Radiology, medicine.symptom, medicine.medical_specialty, Critical Illness, Point-of-Care Systems, Physical examination, Rhonchi, Statistics, Nonparametric, 03 medical and health sciences, Intensive care, medicine, Humans, diagnostische nauwkeurigheid, Prospective study, longen, Physical Examination, Aged, Chi-Square Distribution, business.industry, Research, Stethoscopes, klinisch onderzoek, lcsh:RC86-88.9, Auscultation, echografie, medicine.disease, Critical care, kritieke zorg, Heart failure, business
Abstract

Background In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. Methods This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. Results The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. Conclusion The agreement between lung ultrasound and auscultation is poor. Trial registration NCT02912624. Registered on September 23, 2016.

Published
2020

11. Multiparametric MRI and auto-fixed volume of interest-based radiomics signature for clinically significant peripheral zone prostate cancer

Author

Bleker, J., Kwee, T.C., Dierckx, R., Jong, I.J. de, Huisman, H.J., Yakar, D., Bleker, J., Kwee, T.C., Dierckx, R., Jong, I.J. de, Huisman, H.J., and Yakar, D.

Abstract

Contains fulltext : 219672.pdf (Publisher’s version ) (Open Access), OBJECTIVES: To create a radiomics approach based on multiparametric magnetic resonance imaging (mpMRI) features extracted from an auto-fixed volume of interest (VOI) that quantifies the phenotype of clinically significant (CS) peripheral zone (PZ) prostate cancer (PCa). METHODS: This study included 206 patients with 262 prospectively called mpMRI prostate imaging reporting and data system 3-5 PZ lesions. Gleason scores > 6 were defined as CS PCa. Features were extracted with an auto-fixed 12-mm spherical VOI placed around a pin point in each lesion. The value of dynamic contrast-enhanced imaging(DCE), multivariate feature selection and extreme gradient boosting (XGB) vs. univariate feature selection and random forest (RF), expert-based feature pre-selection, and the addition of image filters was investigated using the training (171 lesions) and test (91 lesions) datasets. RESULTS: The best model with features from T2-weighted (T2-w) + diffusion-weighted imaging (DWI) + DCE had an area under the curve (AUC) of 0.870 (95% CI 0.980-0.754). Removal of DCE features decreased AUC to 0.816 (95% CI 0.920-0.710), although not significantly (p = 0.119). Multivariate and XGB outperformed univariate and RF (p = 0.028). Expert-based feature pre-selection and image filters had no significant contribution. CONCLUSIONS: The phenotype of CS PZ PCa lesions can be quantified using a radiomics approach based on features extracted from T2-w + DWI using an auto-fixed VOI. Although DCE features improve diagnostic performance, this is not statistically significant. Multivariate feature selection and XGB should be preferred over univariate feature selection and RF. The developed model may be a valuable addition to traditional visual assessment in diagnosing CS PZ PCa. KEY POINTS: * T2-weighted and diffusion-weighted imaging features are essential components of a radiomics model for clinically significant prostate cancer; addition of dynamic contrast-enhanced imaging does not significantly i

Published
2020

13. Lesion detection by [89Zr]Zr-DFO-girentuximab and [18F]FDG-PET/CT in patients with newly diagnosed metastatic renal cell carcinoma

Author

Verhoeff, S.R. (Sarah R.), van Es, S.C. (Suzanne C.), Boon, E. (Eline), van Helden, E. (Erik), Angus, L. (Lindsay), Elias, S.G. (Sjoerd), Oosting, S.F. (Sjoukje), Aarntzen, E.H.J.G. (Erik), Brouwers, A.H. (A.), Kwee, T.C. (Thomas C.), Heskamp, S. (Sandra), Hoekstra, O.S. (Otto), Verheul, H.M.W. (Henk), van der Veldt, A.A.M. (Astrid A. M.), Vries, E.G.E. (Elisabeth) de, Boerman, O.C. (Otto), Graaf, W.T.A. (Winette) van der, Oyen, W.J. (Wim), Herpen, C.M.L. (Carla), Verhoeff, S.R. (Sarah R.), van Es, S.C. (Suzanne C.), Boon, E. (Eline), van Helden, E. (Erik), Angus, L. (Lindsay), Elias, S.G. (Sjoerd), Oosting, S.F. (Sjoukje), Aarntzen, E.H.J.G. (Erik), Brouwers, A.H. (A.), Kwee, T.C. (Thomas C.), Heskamp, S. (Sandra), Hoekstra, O.S. (Otto), Verheul, H.M.W. (Henk), van der Veldt, A.A.M. (Astrid A. M.), Vries, E.G.E. (Elisabeth) de, Boerman, O.C. (Otto), Graaf, W.T.A. (Winette) van der, Oyen, W.J. (Wim), and Herpen, C.M.L. (Carla)

Abstract

Purpose: The main objective of this preliminary analysis of the IMaging PAtients for Cancer drug selecTion (IMPACT)-renal cell cancer (RCC) study is to evaluate the lesion detection of baseline contrast-enhanced CT, [89Zr]Zr-DFO-girentuximab-PET/CT and [18F]FDG-PET/CT in detecting ccRCC lesions in patients with a good or intermediate prognosis metastatic clear cell renal cell carcinoma (mccRCC) according to the International Metastatic Database Consortium (IMDC) risk model. Methods: Between February 2015 and March 2018, 42 newly diagnosed mccRCC patients with good or intermediate prognosis, eligible for watchful waiting, were included. Patients underwent CT, [89Zr]Zr-DFO-girentuximab-PET/CT and [18F]FDG-PET/CT at baseline. Scans were independently reviewed and lesions of ≥10 mm and lymph nodes of ≥15 mm at CT were analyzed. For lesions with [89Zr]Zr-DFO-girentuximab or [18F]FDG-uptake visually exceeding background uptake, maximum standardized uptake values (SUVmax) were measured. Results: A total of 449 lesions were detected by ≥1 modality (median per patient: 7; ICR 4.25–12.75) of which 42% were in lung, 22% in lymph nodes and 10% in bone. Combined [89Zr]Zr-DFO-girentuximab-PET/CT and CT detected more lesions than CT alone: 91% (95%CI: 87–94) versus 56% (95%CI: 50–62, p = 0.001), respectively, and more than CT and [18F]FDG-PET/CT combined (84% (95%CI:79–88, p < 0.005). Both PET/CTs detected more bone and soft tissue lesions compared to CT alone. Conclusions: The addition of [89Zr]Zr-DFO-girentuximab-PET/CT and [18F]FDG-PET/CT to CT increases lesion detection compared to CT alone in newly diagnosed good and intermediate prognosis mccRCC patients eligible for watchful waiting.

Published
2019
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14. Radiofrequency ablation in the treatment of atypical cartilaginous tumours in the long bones: lessons learned from our experience

Author

Dierselhuis, E.F., Overbosch, J., Kwee, T.C., Suurmeijer, A.J., Ploegmakers, J.J.W., Stevens, M, Jutte, P.C., Dierselhuis, E.F., Overbosch, J., Kwee, T.C., Suurmeijer, A.J., Ploegmakers, J.J.W., Stevens, M, and Jutte, P.C.

Abstract

Contains fulltext : 208199.pdf (publisher's version ) (Open Access), BACKGROUND: Surgery is the cornerstone of treatment of symptomatic cartilaginous neoplasms. We previously studied the application of radiofrequency ablation of atypical cartilaginous tumours in the long bones. The purpose of the present study was to investigate the additional effect of placing multiple needles and a longer procedure duration on the proportion of completely ablated tumours. Post-ablation MRI findings and the occurrence of complications were also assessed. METHODS: We prospectively included 24 patients with atypical cartilaginous tumours in the long bones. Patients underwent CT-guided radiofrequency ablation followed by curettage with adjuvant phenolisation 3 months later, retrieving material assessed for viable tumour. Before curettage, gadolinium-enhanced MRI was performed to check for residual tumour. The occurrence of complications was noted. RESULTS: Complete tumour ablation was achieved in 17 out of 24 patients (71%). Complete ablation was achieved in 5 of the 6 cases (83%) when multiple needles were used in tumours >/=30 mm. There was incomplete ablation in 8% of patients. Post-ablation gadolinium-enhanced MRI findings agreed with the histological results in 17 out of 23 cases and there was a negative predictive value of 83%. One patient suffered a fracture after radiofrequency ablation. CONCLUSION: Radiofrequency ablation could be an alternative to curettage when treating atypical cartilaginous tumours in the long bones. It was shown that multiple needle placement in addition to longer duration of the ablation procedure is an effective measure in achieving complete ablation in tumours >/=30 mm. Gadolinium-enhanced MRI has a negative predictive value of 83% and could guide post-ablation follow-up.

Published
2019

17. Role of Imaging in Lymphoma

Author

Mali, W.P.Th.M., Nievelstein, R.A.J., Kwee, T.C., Adams, H.J.A., Mali, W.P.Th.M., Nievelstein, R.A.J., Kwee, T.C., and Adams, H.J.A.

Published
2015

18. New MRI techniques for staging malignant lymphoma

Author

Kwee, T.C., Mali, WPTM, Nievelstein, Rutger Jan, and University Utrecht

Subjects
Econometric and Statistical Methods: General, Bescherming en bevordering van de menselijke gezondheid, Geneeskunde(GENK), Medical sciences, General [Econometric and Statistical Methods]
Abstract

Malignant lymphomas are a heterogenous group of malignancies, belonging to the ten most frequent types of cancers worldwide. Once a malignant lymphoma has been diagnosed, it is important to assess disease extent (staging), because this has prognostic and therapeutic implications. Computed tomography (CT) and 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET)/CT are commonly used imaging methods for the staging of malignant lymphoma. An important disadvantage of CT and FDG-PET/CT, however, is the use of ionizing radiation, which may lead to the development of cancers in later life. Although this risk is relatively low, it cannot be ignored, especially in children. Magnetic resonance (MR) imaging does not have this disadvantage, and may be an alternative to CT and perhaps FDG-PET/CT for the evaluation of lymphoma. The aim of this thesis was to introduce and assess the value of whole-body magnetic resonance (MR) imaging, including diffusion-weighted imaging (DWI), for the staging of patients with newly diagnosed malignant lymphoma. Of interest, DWI is an advanced MR technique that may improve the detection and functional evaluation of lymphomatous tissue. In this thesis, new concepts were introduced to perform whole-body MR imaging studies, including whole-body DWI. It was shown that noninvasive measurement of diffusivity in lymph nodes by means of DWI is challenging in terms of observer agreement, but it could potentially aid in the discrimination between normal and lymphomatous lymph nodes. Unfortunately, whole-body MR imaging with DWI was found insufficiently reliable to replace bone marrow biopsy (BMB) for the assessment of the bone marrow for lymphomatous involvement. Nevertheless, it may increase the diagnostic yield of BMB alone, although this hypothesis requires further investigation. Head-to-head comparisons of whole-body MR imaging/DWI to CT and whole-body MR imaging/DWI to FDG-PET/CT in patients with newly diagnosed malignant lymphoma showed that these techniques are mostly in agreement with regard to Ann Arbor staging. However, disagreements in staging between the different imaging methods occurred; future studies are required to determine the rates at which whole-body MR imaging/DWI provides correct up- or downstaging in these cases. In addition, although DWI correctly changed Ann Arbor stage in several cases, further research is warranted to determine its additional diagnostic value. Finally, it was shown that future MR imaging studies may be limited to the head/neck and trunk, because in a series of 100 patients, whole-body MR imaging did not detect any clinically relevant lesions (i.e. lesions that change Ann Arbor stage) outside the head/neck and trunk. In conclusion, whole-body MR imaging, including DWI, is a feasible technique for staging newly diagnosed malignant lymphoma, and may be readily applied in those populations in which CT radiation is a major issue and in patients at risk for (severe) adverse reactions to CT contrast agents. However, further technical developments and prospective large-scale studies on staging performance are required before whole-body MR imaging will become a widespread accepted alternative to CT and FDG-PET/CT

Published
2011

19. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology

Author

Kwee, T.C., Takahara, T., Ochiai, Reiji, Nievelstein, R.A.J., and Luijten, P.R.

Subjects
Geneeskunde, Whole-body imaging, Oncology, Diffusion magnetic resonance imaging, Neoplasm staging, cardiovascular diseases
Abstract

Diffusion-weighted magnetic resonance imaging (DWI) provides functional information and can be used for the detection and characterization of pathologic processes, including malignant tumors. The recently introduced concept of “diffusion-weighted whole-body imaging with background body signal suppression” (DWIBS) now allows acquisition of volumetric diffusionweighted images of the entire body. This new concept has unique features different from conventional DWI and may play an important role in wholebody oncological imaging. This review describes and illustrates the basics of DWI, the features of DWIBS, and its potential applications in oncology.

Published
2008

22. New MRI techniques for staging malignant lymphoma

Author

Brain, Circulatory Health, Cancer, Radiologie, Mali, WPTM, Nievelstein, Rutger Jan, Kwee, T.C., Brain, Circulatory Health, Cancer, Radiologie, Mali, WPTM, Nievelstein, Rutger Jan, and Kwee, T.C.

Published
2011

24. Role of Imaging in Lymphoma

Author

Adams, H.J.A., Mali, W.P.Th.M., Nievelstein, R.A.J., Kwee, T.C., and University Utrecht

Subjects
response evaluation, immune system diseases, hemic and lymphatic diseases, Bone marrow, biopsy, lymphoma, FDG-PET, prognostication, CT, MRI
Abstract

The lymphomas comprise approximately 5.0% of all malignancies and are the sixth most frequently occurring type of cancer in the Western world. The World Health Organization International Classification of Tumors recognizes more than 50 subtypes of lymphoma, based on histopathologic, immunohistochemical, cytogenetic, and molecular analyses. However, the three most common subtypes diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and Hodgkin lymphoma account for more than 60% of all cases. Computed tomography (CT), 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) and whole-body magnetic resonance imaging (MRI) are imaging techniques that may be used for several purposes in lymphoma management. The aim of this thesis was to explore the role of imaging in lymphoma in five different domains: the role of imaging in the evaluation of the bone marrow, the role of imaging in pretreatment risk assessment, the role of imaging in therapy response assessment, the role of imaging in lymphoma grading, and the role of imaging from the patient's perspective. The results show that FDG-PET is reasonably sensitive for the detection of bone marrow involvement in Hodgkin lymphoma. However, the role of FDG-PET in the evaluation of the bone marrow in DLBCL and follicular lymphoma is limited. Initial results show whole-body MRI to be comparable to FDG-PET for bone marrow assessment, but more research is needed to define its exact role. In DLBCL, tumor necrosis at baseline appears to be an independent risk factor of the NCCN-IPI score. Interim FDG-PET has some prognostic value in advanced-stage Hodgkin lymphoma, but it has no role in early-stage Hodgkin lymphoma, DLBCL and follicular lymphoma. End-of-treatment FDG-PET fails to identify a large proportion of patients with Hodgkin lymphoma and DLBCL who will experience treatment failure, which emphasizes that its role in this setting should be reconsidered, if not abandoned. Moreover, there is no evidence-based role for FDG-PET in the end-of-treatment evaluation of follicular lymphoma. FDG-PET performed at baseline is reasonably accurate in differentiating aggressive non-Hodgkin lymphoma from indolent non-Hodgkin lymphoma and Hodgkin lymphoma, but appears to be not reliable in differentiating indolent non-Hodgkin from Hodgkin lymphoma. Finally, patients with newly diagnosed lymphoma regard whole-body MRI as a more patient-friendly technique than CT.

Published
2015

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