المؤلفون: Appiah, Vartika, Taylor, Stephen, Vaulet, Thibaut, Howarth, Nigel, Gevenois, Pierre Alain, Tack, Denis

المصدر: European Radiology; Sep2021, Vol. 31 Issue 9, p6605-6611, 7p, 1 Diagram, 2 Charts, 3 Graphs

مصطلحات موضوعية: CATEGORIES (Mathematics), CLINICAL indications, DATA distribution, SPINE, RADIATION protection

مستخلص: Objectives: To investigate the proportion of clinical scenarios covered by EURO-2000 Guidelines and ESR iGuide, and assess compliance with both guidelines. Methods: The clinical indication on archived request forms for head, chest, abdomen-pelvis, and spine CT examinations performed in three hospitals in January 2018 was retrospectively matched with EURO-2000 Guidelines and ESR iGuide. For clinical scenarios addressed in the guidelines, the compliance with the guidelines was assessed. Analysis was performed on pooled data from the three centres and further stratified by centre, body region, and prescriber's specialisation. The differences in categorical data distributions between centres, body regions, and prescribers' specialisations were assessed with paired McNemar's χ² tests. Results: A total of 6,812 requests for 7,217 CT examinations were analysed. Sixty-five percent of clinical situations that lead to prescribing CT examinations were addressed in EURO-2000 Guidelines compared with 81% for ESR iGuide. Proportions of clinical scenarios covered by the guidelines were statistically different between centres and body regions (p < 0.001) and varied according to prescribers' specialisations (p ranging from < 0.001 to 0.531). Both EURO-2000 Guidelines and ESR iGuide encompassed more clinical scenarios in certain body regions, favouring, e.g. spine and head over abdomen and chest. The proportion of "unjustified examinations" was greater according to EURO-2000 Guidelines (46%) than ESR iGuide (23%) (p < 0.001). Conclusions: Both EURO-2000 Guidelines and ESR iGuide do not address numerous common clinical scenarios. The proportions of scenarios addressed differ according to the centre, body region, and prescribers' specialisation. Any estimation of compliance with referral guidelines is therefore of relative significance. Key Points: • ESR iGuide performs better than earlier EURO-2000 Guidelines for the coverage of all possible clinical scenarios leading to CT referrals. • Differences in coverage of clinical scenarios by both referral guidelines are observed for different body regions and/or prescribers' subspecialties. • As referral guidelines are incomplete, any estimation of justified or unjustified CT requests is of relative significance. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bondue, Benjamin, Schlossmacher, Pascal, Allou, Nathalie, Gazaille, Virgile, Taton, Olivier, Gevenois, Pierre Alain, Vandergheynst, Frederic, Remmelink, Myriam, Leduc, Dimitri

المصدر: BMC Pulmonary Medicine; 4/26/2021, Vol. 21 Issue 1, p1-8, 8p

مصطلحات موضوعية: INTERSTITIAL lung diseases, LUNGS, BODY mass index, PULMONARY artery, PULMONARY hypertension, PATIENT safety, PNEUMOTHORAX

مستخلص: Background: The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative.Method: This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these risk factors (low-risk group).Results: Ninety-six patients were included between April 2015 and April 2020, respectively 38 and 58 in the high-risk or the low-risk group. No statistically significant difference was observed between both groups in terms of severity and rate of bleeding, pneumothorax, or duration of hospital stay (p value ranging from 0.419 to 0.914).Conclusion: This preliminary study on a limited number of patients suggests that TBLC appears safe in those in whom lung biopsy is at high-risk of complications according to their age, BMI, lung impairment, and cardiac comorbidities. [ABSTRACT FROM AUTHOR]

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المؤلفون: Taccone, Fabio Silvio¹ (AUTHOR) ftaccone@ulb.ac.be, Gevenois, Pierre Alain² (AUTHOR), Peluso, Lorenzo¹ (AUTHOR), Pletchette, Zoe¹ (AUTHOR), Lheureux, Olivier¹ (AUTHOR), Brasseur, Alexandre¹ (AUTHOR), Garufi, Alessandra¹ (AUTHOR), Talamonti, Marta¹ (AUTHOR), Motte, Serge³ (AUTHOR), Nobile, Leda¹ (AUTHOR), Grimaldi, David¹ (AUTHOR), Creteur, Jacques¹ (AUTHOR), Vincent, Jean-Louis¹ (AUTHOR)

المصدر: Critical Care Medicine. Nov2020, Vol. 48 Issue 11, pe1087-e1090. 4p.

مصطلحات موضوعية: *COVID-19, *PULMONARY embolism, *CRITICALLY ill, *PATIENTS' rights, *SYMPTOMS, *PULMONARY embolism prevention, *VIRAL pneumonia, *INTENSIVE care units, *ANTICOAGULANTS, *RETROSPECTIVE studies, *CATASTROPHIC illness, *TREATMENT effectiveness, *EPIDEMICS, *DISEASE complications

مصطلحات جغرافية: BELGIUM

مستخلص: Objectives: To assess the role of thromboprophylaxis regimens on the occurrence of pulmonary embolism in coronavirus disease 2019 patients.Design: Retrospective analysis of prospectively collected data on coronavirus disease 2019 patients, included between March 10, and April 30, 2020.Setting: ICU of an University Hospital in Belgium.Patients and Interventions: Critically ill adult mechanically ventilated coronavirus disease 2019 patients were eligible if they underwent a CT pulmonary angiography, as part of the routine management in case of persistent hypoxemia or respiratory deterioration. The primary endpoint of this study was the occurrence of pulmonary embolism according to the use of standard thromboprophylaxis (i.e. subcutaneous enoxaparin 4,000 international units once daily) or high regimen thromboprophylaxis (i.e. subcutaneous enoxaparin 4,000 international units bid or therapeutic unfractioned heparin).Measurements and Main Results: Of 49 mechanically ventilated coronavirus disease 2019, 40 underwent CT pulmonary angiography after a median of 7 days (4-8 d) since ICU admission and 12 days (9-16 d) days since the onset of symptoms. Thirteen patients (33%) were diagnosed of pulmonary embolism, which was bilateral in six patients and localized in the right lung in seven patients. D-dimers on the day of CT pulmonary angiography had a predictive accuracy of 0.90 (95% CIs: 0.78-1.00) for pulmonary embolism. The use of high-regimen thromboprophylaxis was associated with a lower occurrence of pulmonary embolism (2/18; 11%) than standard regimen (11/22, 50%-odds ratio 0.13 [0.02-0.69]; p = 0.02); this difference remained significant even after adjustment for confounders. Six patients with pulmonary embolism (46%) and 14 patients without pulmonary embolism (52%) died at ICU discharge (odds ratio 0.79 [0.24-3.26]; p = 0.99).Conclusions: In this study, one third of coronavirus disease 2019 mechanically ventilated patients have a pulmonary embolism visible on CT pulmonary angiography. High regimen thromboprophylaxis may decrease the occurrence of such complication. [ABSTRACT FROM AUTHOR]

المؤلفون: Colin, Geoffrey C., Verlynde, Guillaume, Pouleur, Anne-Catherine, Gerber, Bernhard L., Beauloye, Christophe, Kefer, Joelle, Coche, Emmanuel, Vachiéry, Jean-Luc, Gevenois, Pierre Alain, Ghaye, Benoit

المصدر: European Radiology; Nov2020, Vol. 30 Issue 11, p6204-6212, 9p, 1 Black and White Photograph, 3 Charts, 2 Graphs

مصطلحات موضوعية: PULMONARY artery, PULMONARY hypertension, HEART diseases, MITRAL valve insufficiency, AORTIC stenosis

مستخلص: Objectives: To evaluate how pulmonary artery (PA) distensibility performs in detecting pulmonary hypertension due to left heart disease (PH-LHD) in comparison with parameters from ungated computed tomography (CT) and echocardiography. Methods: One hundred patients (79 men, mean age = 63 ± 17 years) with either severe heart failure with reduced ejection fraction (HFrEF), aortic stenosis, or primary mitral regurgitation prospectively underwent right heart catheterization, ungated CT, ECG-gated CT, and echocardiography. During the ECG-gated CT, the right PA distensibility was calculated. In ungated CT, dPA, dPA/AA, the ratio of dPA to the diameter of the vertebra, segmental PA diameter, segmental PA-to-bronchus ratio, and the main PA volume were measured; the egg-and-banana sign was recorded. During echocardiography, the tricuspid regurgitation (TR) gradient was measured. The areas under the ROC curves (AUC) of these signs were computed and compared with DeLong test. Correlation between PA distensibility and PA pressure (PAP) was investigated through Pearson's coefficient. Results: PA distensibility was lower in patients with PH than in those without PH (11.4 vs. 21.2%, p < 0.001) and correlated negatively with mean PAP (r = − 0.72, p < 0.001). Age, PA size, and mean PAP were independent predictors of PA distensibility. PA distensibility < 18% detected PH-LHD with 96% sensitivity and 73% specificity; its AUC was 0.92, larger than that of any other sign at ungated CT and TR gradient (AUC ranging from 0.54 to 0.83, DeLong: p ranging from 0.020 to < 0.001). Conclusion: PA distensibility on an ECG-gated CT can detect PH-LHD better than the parameters reflecting PA dilatation in ungated CT or TR gradient in the echocardiography of patients with severe HFrEF, aortic stenosis, or mitral regurgitation. Key Points: • In left heart disease, pulmonary artery distensibility is lower in patients with PH than in those without pulmonary hypertension (11.4 vs. 21.2%, p < 0.001). • In left heart disease, pulmonary artery distensibility detects pulmonary hypertension with an area under the receiver operating curve of 0.92. • In left heart disease, the area under the receiver operating curve of pulmonary artery distensibility for detecting pulmonary hypertension is larger than that of all other signs at ungated CT (p from 0.019 to < 0.001) and tricuspid regurgitation gradient at echocardiography (p = 0.020). [ABSTRACT FROM AUTHOR]

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المؤلفون: Colin, Geoffrey C, Pouleur, Anne-Catherine, Gerber, Bernhard L, Poncelet, Pierre-Antoine, Meester, Christophe de, D'Hondt, Anne-Marie, Vlassenbroek, Alain, Houard, Laura, Gevenois, Pierre-Alain, Ghaye, Benoit

المصدر: European Heart Journal - Cardiovascular Imaging; Nov2020, Vol. 21 Issue 11, p1291-1298, 8p

مصطلحات موضوعية: AORTIC valve insufficiency, BLOOD pressure, CARDIAC catheterization, COMPUTED tomography, ECHOCARDIOGRAPHY, HEART failure, HEMODYNAMICS, LONGITUDINAL method, MITRAL valve insufficiency, PEPTIDE hormones, PULMONARY artery, PULMONARY circulation, PULMONARY hypertension, PREDICTIVE tests, RECEIVER operating characteristic curves, VENTRICULAR ejection fraction

مستخلص: Aims To evaluate the relationships between pulmonary transit time (PTT), cardiac function, and pulmonary haemodynamics in patients with heart failure with reduced ejection fraction (HFrEF) and to explore how PTT performs in detecting pulmonary hypertension (PH). Methods and results In this prospective study, 57 patients with advanced HFrEF [49 men, 51 years ± 8, mean left ventricular (LV) ejection fraction 26% ± 8] underwent echocardiography, right heart catheterization, and cardiac computed tomography (CT). PTT was measured as the time interval between peaks of attenuation in right ventricle (RV) and LV and was compared between patients with or without PH and 15 controls. PTT was significantly longer in HFrEF patients with PH (21 s) than in those without PH (11 s) and controls (8 s) (P  <   0.001) but not between patients without PH and controls (P  =   0.109). PTT was positively correlated with pulmonary artery wedge pressure (PAWP) (r  =   0.74), mean pulmonary artery pressure (r  =   0.68), N-terminal pro-B-type natriuretic peptide (r  =   0.60), mitral (r  =   0.54), and tricuspid (r  =   0.37) regurgitation grades, as well as with LV, RV, and left atrial volumes (r from 0.39 to 0.64) (P  <   0.01). PTT was negatively correlated with cardiac index (r = −0.63) as well as with LV (r = −0.66) and RV (r = −0.74) ejection fractions. PAWP, cardiac index, mitral regurgitation grade, and RV end-diastolic volume were all independent predictors of PTT. PTT value ≥14 s best-detected PH with 91% sensitivity and 88% specificity (area under the receiver operating characteristic curve: 0.95). Conclusion In patients with HFrEF, PTT correlates with cardiac function and pulmonary haemodynamics, is determined by four independent parameters, and performs well in detecting PH. [ABSTRACT FROM AUTHOR]

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المؤلفون: Vanaudenhove, Thibault, Van Muylem, Alain, Howarth, Nigel, Gevenois, Pierre Alain, Tack, Denis

المصدر: European Radiology; Aug2020, Vol. 30 Issue 8, p4641-4647, 7p, 1 Diagram, 3 Charts, 2 Graphs

مصطلحات موضوعية: X-rays, LUMBAR vertebrae, PELVIC examination, ACQUISITION of data, DATA harmonization

مستخلص: Objectives: To estimate the variability of X-ray diagnostic reference levels (DRLs) depending on the number of X-ray devices and data per device.Methods: Dose-area products (DAP) were collected by the national nuclear control agency from the 590 devices installed in 345 medical centers in the country. From 2015 to 2017, the number of chest (postero-anterior (PA) view alone, and both postero-anterior and lateral views (PA/LAT)), abdomen, pelvis, and lumbar spine examinations collected in these centers ranged from 23,000 to 77,000. The impact of the number of devices and DAP data per device on DRLs' variabilities (95th confidence intervals divided by medians) is estimated using a bootstrapping method as a function of the number of devices and DAP per device.Results: The DRLs' variabilities ranged from 30 to 200% depending on the number of devices and DAP data per device but stabilized at 30% when the number of devices was higher than 200 for chest PA and abdomen examinations, 300 for lumbar spine and pelvis examinations, and 400 for chest PA/LAT examinations, regardless of the number of DAP data per device. Extrapolations of our results suggest that thousands of devices are necessary to reduce DRLs' variabilities to 10%.Conclusion: DAP-related DRL variabilities are high but only moderately influenced by the number of DAP data per device and of devices provided this number is higher than 200 to 400 devices according to the type of examination. Harmonization of methods of data collection between the authorities of the EU states should be recommended.Key Points: • DAP-related DRLs are not fixed values but ranges of values with at least 30% variability. • DAP-related DRLs strongly depend on the number of devices included when lower than 100. • If the number of devices included exceeds 200 to 400, the DRLs' variabilities do not depend on the number of DAP per device and should not exceed 30%. [ABSTRACT FROM AUTHOR]

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المؤلفون: Madani, Afarine, Katz, Raphaël, Muylem, Alain Van, Neugroschl, Carine, Gevenois, Pierre Alain

المصدر: Skeletal Radiology; Jul2020, Vol. 49 Issue 7, p1141-1147, 7p

مصطلحات موضوعية: ZYGAPOPHYSEAL joint, BONE marrow, LUMBAR pain, INTERVERTEBRAL disk hernias, BODY mass index

مستخلص: Objective: To prospectively compare the prevalence and frequency of subchondral bone marrow edema (BME) in the lumbar facet joints of low back pain patients and healthy subjects.Materials and Methods: Lumbar magnetic resonance imaging (MRI) examinations were performed on 55 asymptomatic participants (18 men; age range 21-63; mean 36 ± 12 years; body mass index (BMI) range 16-31; mean 22.6 ± 3.2 kg/m2) and 79 low back pain patients (36 men; age range 18-77; mean 47 ± 14 years; BMI range 18-40; mean 27.8 ± 4.4 kg/m2). In both groups, facet joint subchondral BME signal was evaluated using T2-weighted STIR imaging, and facet joint osteoarthritis was characterized as mild, moderate, and severe.Results: The BME signal was found in seven asymptomatic participants (12.7%) and 28 low back pain patients (35.4%) (P = 0.003). A significant portion of the patients (15.2%) presented more than one BME signal (P = 0.011). By pooling the ten facet joints of all subjects in each group, a significant difference in osteoarthritis grade distribution was observed between the two groups (P < 0.001). When adjusted for low back pain status, age, BMI, Modic type 1, disk herniation, and facet joint osteoarthritis maximal grade, only the latter was significantly associated with the facet joint BME signal (P < 0.001).Conclusion: Despite the higher prevalence and frequency of the BME signal in facet joints of low back pain patients compared to that in healthy subjects, the signal was found to be associated with the severity of the patients' osteoarthritis and not with their low back pain status. [ABSTRACT FROM AUTHOR]

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المؤلفون: Tominaga, Junya, Bankier, Alexander A., Lee, Kyung Soo, Leung, Ann N., Remy-Jardin, Martine, Akira, Masanori, Arakawa, Hiroaki, Boiselle, Phillip M., Franquet, Tomás, Fujimoto, Kiminori, Gevenois, Pierre Alain, Goo, Jin Mo, Grenier, Philippe A., Hatabu, Hiroto, Ichikado, Kazuya, Im, Jung-Gi, Johkoh, Takeshi, Lee, Ki-Nam, Lynch, David A., Noma, Satoshi

المصدر: Japanese Journal of Radiology; Nov2019, Vol. 37 Issue 11, p773-780, 8p

مستخلص: Purpose: To assess inter-observer variability in identifying traction bronchiectasis on computed tomography (CT) using additional criteria for chronic fibrosing interstitial pneumonia.Methods: Seven experts categorized CT image set representing 39 patients into three groups on the basis of the presence of traction bronchiectasis, using a three-point scale: 3-definitely/probably yes; 2-possibly yes; and 1-definitely/probably no. This scale served as a reference standard. The image set included cases of chronic fibrosing interstitial pneumonia, non-interstitial lung disease, and difficult-to-determine cases. Forty-eight observers similarly assessed the same image set, first according to the Fleischner Society definition, and second with additional criteria, in which traction bronchiectasis was observed exclusively in chronic fibrosing interstitial pneumonia. The agreement level between the reference standard and each observer's evaluation in each session was calculated using weighted kappa values which were compared between the two sessions using a paired t test.Results: The mean weighted kappa value for all observers was significantly higher in the second reading session (mean 0.75) than in the first reading session (mean 0.62) (p < 0.001).Conclusion: Inter-observer agreement in identifying traction bronchiectasis improves when using the additional criteria which specify chronic fibrosing interstitial pneumonia as the underlying disease. [ABSTRACT FROM AUTHOR]

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المؤلفون: Vanaudenhove, Thibault, Van Muylem, Alain, Howarth, Nigel, Gevenois, Pierre Alain, Tack, Denis

المصدر: European Radiology; Oct2019, Vol. 29 Issue 10, p5264-5271, 8p, 2 Charts, 3 Graphs

مصطلحات موضوعية: LUMBAR vertebrae, DESCRIPTIVE statistics, MEDICAL centers

مستخلص: Objectives: To estimate the variability of CT diagnostic reference levels (DRLs) according to the methods used for computing collected data.Methods: Dose-length products (DLP) were collected by our national nuclear control agency from the 250 devices installed in 140 medical centers in the country. In 2015, the number of head, thorax, abdomen, and lumbar spine examinations collected in these centers ranged from approximately 20,000 to 42,000. The impact on DRLs of the number of devices considered, as well as the differences in descriptive statistics (mean vs. median DLP) or methods of pooling DLP data (all devices vs. all patients), was investigated. Variability in DRLs was investigated using a bootstrapping method as a function of the numbers of devices and examinations per device.Results: As expected, DRLs derived from means were higher than those from medians, with substantial differences between device- and patient-related DRLs. Depending on the numbers of devices and DLP data per device, the variability ranged from 10 to 40% but was stabilized at a level of 10-20% if the number of devices was higher than 50 to 60, regardless of the number of DLP data per device.Conclusion: Number of devices and of DLP data per device, descriptive statistics, and pooling data influence DRLs. As differences in methods of computing survey data can artificially influence DRLs, harmonization among national authorities should be recommended.Key Points: • Due to CT dose variability, that of DRLs is at least of 10%. • DRLs derived from medians are lower than from means and differ from those obtained by pooling all patient data. • Fifty to 60 devices should be sufficient for estimating national DRLs, regardless of the number of data collected per device. [ABSTRACT FROM AUTHOR]

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المؤلفون: Taylor, Stephen, Van Muylem, Alain, Howarth, Nigel, Gevenois, Pierre Alain, Tack, Denis

المصدر: European Radiology; Oct2019, Vol. 29 Issue 10, p5307-5313, 7p, 1 Diagram, 2 Charts, 2 Graphs

مصطلحات موضوعية: LUMBAR vertebrae, X-rays, BODY weight, PATIENT selection

مستخلص: Objectives: To determine the variabilities of dose-area-products (DAP) of frequent X-ray examinations collected for comparison with diagnostic reference levels (DRLs).Methods: DAP values of chest, abdomen, and lumbar spine examinations obtained on devices from two manufacturers were collected in three centers over 1 to 2 years. The variability of the average DAP results defined as the 95% confidence interval in percentage of their median value was calculated for increasing sample sizes, each examination and center. We computed the sample sizes yielding variabilities lower or equal to 25% and 10%. The effect of narrowing patient selection based on body weight was also investigated (ranges of 67-73 Kg, or 60-80 Kg).Results: DAP variabilities ranged from 75 to 170% of the median value when collecting small samples (10 to 20 DAP). To reduce this variability, larger samples are needed, collected over up to 2 years, regardless of the examination and center. A variability ≤ 10% could only be reached for chest X-rays, requiring up to 800 data. For the abdomen and lumbar spine, the lowest achievable variability was 25%, regardless of the body weight selection, requiring up to 400 data.Conclusion: Variabilities in DAP collected through small samples of ten data as recommended by authorities are very high, but can be reduced down to 25% (abdomen and lumbar spine) or even 10% (chest) through a substantial increase in sample sizes. Our findings could assist radiologists and regulatory authorities in estimating the reliability of the data obtained when performing X-ray dose surveys.Key Points: • Low but reasonable variabilities cannot be reached with samples sized as recommended by regulatory authorities. Higher numbers of DAP values are required to reduce the variability. • Variabilities of 10% for the chest and 25% for abdomen and lumbar spine examinations are achievable, provided large samples of data are collected over 1 year. • Our results could help radiologists and authorities interpret X-rays dose surveys. [ABSTRACT FROM AUTHOR]

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