Publications by authors named "Paul M Parizel"

171 Publications

Artificial intelligence, chest radiographs, and radiology trainees: a powerful combination to enhance the future of radiologists?

Quant Imaging Med Surg 2021 May;11(5):2204-2207

Department of Radiology, Royal Perth Hospital and University of Western Australia Medical School, Perth, WA, Australia.

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http://dx.doi.org/10.21037/qims-20-1306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047344PMC
May 2021

Cerebellar ataxia in progressive supranuclear palsy: a clinico-pathological case report.

Acta Neurol Belg 2021 Apr 5;121(2):599-602. Epub 2021 Mar 5.

Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, B-2650, Edegem, Belgium.

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http://dx.doi.org/10.1007/s13760-021-01629-xDOI Listing
April 2021

Anterior pituitary gland T1 signal intensity is influenced by time delay after injection of gadodiamide.

Sci Rep 2020 09 11;10(1):14967. Epub 2020 Sep 11.

Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.

To test the hypothesis of washout from the anterior pituitary (AP) gland after serial injections of gadodiamide. We included 59 patients with history of at least 5 injections of gadodiamide. Values of mean signal intensity of the AP and of the central pons were measured on unenhanced sagittal T1-weighted images. AP-to-pons signal intensity ratios were calculated dividing the values of the AP by those of the pons. The measurements were performed using MR images acquired at four different time points including baseline (prior to any gadodiamide injection), minimum post-injection time delay, maximum post-injection time delay, and last available MR scans. Normalized ratios (i.e. ratios divided total volume of injected gadodiamide) were also calculated. To assess the difference between ratios, non-parametric Wilcoxon signed-rank test was applied. The correlations were tested with non-parametric Spearman correlation coefficient. A p-value < 0.05 was considered as statistically significant. A statistically significant increase of AP signal intensity was found by comparing the baseline scans with both the minimum time delay (p = 0.003) and maximum time delay scans (p = 0.005). We found significant higher normalized ratios for minimum post-injection time delay with respect to maximum post-injection time delay (p < 0.001). The normalized ratios demonstrated a statistically significant negative correlation with the post-injection time delay (r = - 0.31; p = 0.006). The findings of this study suggest that washout phenomena of retained/deposited gadolinium from the AP are influenced by the total injected volume and post-injection time delay.
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http://dx.doi.org/10.1038/s41598-020-71981-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486291PMC
September 2020

Macro- and microstructural changes in cosmonauts' brains after long-duration spaceflight.

Sci Adv 2020 Sep 4;6(36). Epub 2020 Sep 4.

imec-Vision Lab, Department of Physics, University of Antwerp, Antwerp, Belgium.

Long-duration spaceflight causes widespread physiological changes, although its effect on brain structure remains poorly understood. In this work, we acquired diffusion magnetic resonance imaging to investigate alterations of white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF) compositions in each voxel, before, shortly after, and 7 months after long-duration spaceflight. We found increased WM in the cerebellum after spaceflight, providing the first clear evidence of sensorimotor neuroplasticity. At the region of interest level, this increase persisted 7 months after return to Earth. We also observe a widespread redistribution of CSF, with concomitant changes in the voxel fractions of adjacent GM. We show that these GM changes are the result of morphological changes rather than net tissue loss, which remained unclear from previous studies. Our study provides evidence of spaceflight-induced neuroplasticity to adapt motor strategies in space and evidence of fluid shift-induced mechanical changes in the brain.
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http://dx.doi.org/10.1126/sciadv.aaz9488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473746PMC
September 2020

Effect of Exposure to Gadodiamide and Brain Irradiation on T -Weighted Images and ADC Maps of the Dentate Nucleus.

J Magn Reson Imaging 2020 11 1;52(5):1525-1530. Epub 2020 Jun 1.

Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.

Background: Brain irradiation is considered a cofactor influencing the dentate nucleus (DN) signal intensity (SI) on unenhanced T -weighted images in patients exposed to gadolinium-based contrast agents (GBCAs).

Purpose: To assess the effect of gadodiamide and whole-brain radiation therapy (WBRT) on T -weighted images and on apparent diffusion coefficient (ADC) maps of DN.

Study Type: Single-center retrospective.

Population: In all, 125 patients who underwent brain MRIs were classified into four groups: 1) patients who did neither receive intravenous GBCAs injections nor irradiation (controls); 2) patients having ≥3 GBCAs-enhanced scans and no WBRT; 3) patients having WBRT and < 3 GBCAs-enhanced scans; and 4) patients having WBRT and ≥ 3 GBCAs-enhanced scans.

Field Strength/sequence: 1.5T magnet, echo-planar diffusion weighted imaging (DWI) and unenhanced T -weighted sequences.

Assessment: The DN-to-pons SI ratio on unenhanced T -weighted images and ADC values of the DN were calculated. Values were compared between groups and relative to the cumulative gadolinium dose and to the time delay after WBRT.

Statistical Tests: Statistical analysis included the Mann-Whitney U-test and Spearman's rank-order correlation.

Results: DN ADC values were not significantly different (P = 0.34) between patients exposed to gadodiamide (0.81 ± 0.06) and controls (0.83 ± 0.07). There were no differences in DN ADC values (P = 0.28) and DN-to-pons SI ratios (P = 0.42) between patients exposed to WBRT (ADC values: 0.85 ± 0.09; SI ratio: 1.11 ± 0.10) and controls (ADC values: 0.83 ± 0.06; SI ratio: 1.09 ± 0.06). There was a significant negative correlation between DN ADC values and the time (days) since the end of WBRT (r = - 0.33; 95% confidence interval [CI]: -0.55, -0.06; P < 0.05).

Data Conclusion: We did not find changes suggestive of gadolinium-related tissue microstructural damage of the DN. The ADC values of the DN are associated with the time from WBRT.

Level Of Evidence: 3 TECHNICAL EFFICACY STAGE: 5.
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http://dx.doi.org/10.1002/jmri.27198DOI Listing
November 2020

Exposure to gadolinium and neurotoxicity: current status of preclinical and clinical studies.

Neuroradiology 2020 Aug 21;62(8):925-934. Epub 2020 Apr 21.

Departmental Faculty of Medicine and Surgery, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy.

Purpose: Gadolinium is a rare-earth lanthanide metal that is known to have a direct neurotoxic effect. The scope of the present review is to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium of the central nervous system and neurotoxicity.

Methods: A literature review was performed by searching for original research papers investigating on gadolinium exposure and neurotoxicity.

Results: Gadolinium is neurotoxic through multiple mechanisms, mainly involving Ca homeostasis and mitochondrial functions, as shown by preclinical in vitro studies. The available evidence related to the four different classes of gadolinium-based contrast agents commonly applied in clinical practice (i.e., linear and macrocyclic based on ligand structure, and ionic and non-ionic based on their net molecular charge) suggests that serial intravenous injections of gadolinium-based contrast agents and gadolinium brain depositions are not associated to histological changes, as confirmed by preclinical animal and human (MR imaging and autopsy) studies.

Conclusion: To date, no cause-effect relationship has been demonstrated in patients between brain gadolinium exposure and clinical consequences specific to neurological toxicity.
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http://dx.doi.org/10.1007/s00234-020-02434-8DOI Listing
August 2020

Within-network brain connectivity in Crohn's disease patients with gadolinium deposition in the cerebellum.

Neuroradiology 2020 Jul 4;62(7):833-841. Epub 2020 Apr 4.

Departmental Faculty of Medicine and Surgery, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.

Purpose: Patients with Crohn's disease (CD) undergo multiple gadolinium-based contrast agent injections across their lifespan to enhance signal intensity of the intestinal wall and differentiate active from quiescent inflammatory disease. Thus, CD patients are prone to gadolinium accumulation in the brain and represent a non-neurological population to explore gadolinium-related brain toxicity. Possible effects are expected to be greater on the cerebellar network due to the high propensity of the dentate nucleus to accumulate gadolinium. Herein, we provide a whole-brain network analysis of resting-state fMRI dynamics in long-term quiescent CD patients with normal renal function and MRI evidence of gadolinium deposition in the brain.

Methods: Fifteen patients with CD and 16 healthy age- and gender-matched controls were enrolled in this study. Relevant resting-state networks (RSNs) were identified using independent component analysis (ICA) from functional magnetic resonance imaging data. An unpaired two-sample t test (with age and sex as nuisance variables) was used to investigate between different RSNs. Clusters were determined by using threshold-free cluster enhancement and a family-wise error corrected cluster significance threshold of p < 0.05.

Results: Patients showed significantly decreased resting-state functional connectivity (p < 0.05, FWE corrected) of several regions of the right frontoparietal (FPR) and the dorsal attention (DAN) RSNs. No differences between the two groups were found in the functional connectivity maps of all the other RSNs, including the cerebellar network.

Conclusion: Our findings suggest a non-significant impact of gadolinium deposition on within-network cerebellar functional connectivity of long-term quiescent CD patients.
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http://dx.doi.org/10.1007/s00234-020-02415-xDOI Listing
July 2020

Functional respiratory imaging of the airways in the acute respiratory distress syndrome.

Anaesth Crit Care Pain Med 2020 Apr 7;39(2):207-213. Epub 2020 Feb 7.

Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.

Background: Alveolar flooding and airway obstruction are present in the acute respiratory distress syndrome. The impact of positive end-expiratory pressure on regional airway aeration has not been described.

Aim: To assess bronchial and lung recruitment and distension during an incremental positive end-expiratory pressure trial in patients with acute respiratory distress syndrome.

Methods: Six patients underwent lung and airway imaging at four positive end-expiratory pressure levels in a cohort trial. Images were post-processed by means of Functional Respiratory Imaging. This technique offers 3-dimensional visualisation and quantification of patients' airway and lung geometry on a regional level.

Results: With increasing positive end-expiratory pressure from 0 to 20 cmHO, the median bronchial recruitment was 151% and the median bronchial distension 43%. Non-aerated lower lobes bronchi had more bronchial volume increase at high positive end-expiratory pressure than partially aerated upper lobes bronchi. Lung recruitment tended to be higher in patients with non-focal acute respiratory distress syndrome. In two patients, bronchial volume increase at high positive end-expiratory pressure largely exceeded bronchial volume increase observed in matched healthy control subjects at total lung capacity, suggesting severe bronchial over-distension.

Conclusions: In early acute respiratory distress syndrome, Functional Respiratory Imaging gives an innovative insight into the relationship between positive end-expiratory pressure-induced bronchial distension and recruitment, positive end-expiratory pressure-induced lung recruitment and hyperinflation and lung morphology.
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http://dx.doi.org/10.1016/j.accpm.2019.10.017DOI Listing
April 2020

Age-related changes to the craniocervical ligaments in asymptomatic subjects: a prospective MR study.

Eur Spine J 2020 05 24;29(5):1029-1035. Epub 2020 Jan 24.

Department of Radiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.

Purpose: The craniocervical junction (CCJ) is a complex of bony and ligamentous structure stabilizing CCJ. Nearly one-third of all traumatic injuries to the cervical spine involve the CCJ. Only little literature is available on this topic, and most of the studies are focused on anatomy, biomechanics or ligamentous injury in whiplash-associated disorders. We conducted a prospective study to investigate age-related changes in the craniocervical ligaments.

Methods: We included asymptomatic volunteers between 16 and 99 years old who had no history of whiplash or other cervical trauma. Volunteers underwent a three-dimensional turbo spin-echo proton density-weighted sequence with variable flip-angle distribution focused on the craniocervical ligaments. The six main ligaments of the craniocervical junction were evaluated for grade of degeneration on a four-point scale by two independent readers, blinded for age and sex.

Results: We included 102 volunteers. The mean age was 50.03 (16-94). Fifty-nine (58%) patients showed degeneration of at least one ligament of the CCJ. High-grade anomalous changes and multiligamentous involvement had a positive correlation with age (p < 0.001). The inter-rater agreement was fair to moderate, and the intra-rater agreement was moderate to substantial.

Conclusion: The craniocervical ligaments show a variable degree of signal intensity and thickness in asymptomatic adults. We postulate that these changes can be due to normal aging or due to repetitive microtrauma. We propose a new grading system to evaluate changes to the craniocervical ligaments in asymptomatic volunteers. These slides can be retrieved under Electronic Supplementary Material.
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http://dx.doi.org/10.1007/s00586-020-06302-0DOI Listing
May 2020

Prognostic Validation of the NINDS Common Data Elements for the Radiologic Reporting of Acute Traumatic Brain Injuries: A CENTER-TBI Study.

J Neurotrauma 2020 06 25;37(11):1269-1282. Epub 2020 Feb 25.

Department of Radiology, University Hospital and University of Antwerp, Antwerp, Belgium.

The aim of this study is to investigate the prognostic value of using the National Institute of Neurological Disorders and Stroke (NINDS) standardized imaging-based pathoanatomic descriptors for the evaluation and reporting of acute traumatic brain injury (TBI) lesions. For a total of 3392 patients (2244 males and 1148 females, median age = 51 years) enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we extracted 96 Common Data Elements (CDEs) from the structured reports, spanning all three levels of pathoanatomic information (i.e., 20 "basic," 60 "descriptive," and 16 "advanced" CDE variables per patient). Six-month clinical outcome scores were dichotomized into favorable (Glasgow Outcome Scale Extended [GOS-E] = 5-8) versus unfavorable (GOS-E = 1-4). Regularized logistic regression models were constructed and compared using the optimism-corrected area under the curve (AUC). An abnormality was reported for the majority of patients (64.51%). In 79.11% of those patients, there was at least one coexisting pathoanatomic lesion or associated finding. An increase in lesion severity, laterality, and volume was associated with more unfavorable outcomes. Compared with the full set of pathoanatomic descriptors (i.e., all three categories of information), reporting "basic" CDE information provides at least equal discrimination between patients with favorable versus unfavorable outcome (AUC = 0.8121 vs. 0.8155, respectively). Addition of a selected subset of "descriptive" detail to the basic CDEs could improve outcome prediction (AUC = 0.8248). Addition of "advanced" or "emerging/exploratory" information had minimal prognostic value. Our results show that the NINDS standardized-imaging based pathoanatomic descriptors can be used in large-scale studies and provide important insights into acute TBI lesion patterns. When used in clinical predictive models, they can provide excellent discrimination between patients with favorable and unfavorable 6-month outcomes. If further validated, our findings could support the development of structured and itemized templates in routine clinical radiology.
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http://dx.doi.org/10.1089/neu.2019.6710DOI Listing
June 2020

Lesion measurement on a combined "all-in-one" window for chest CT: effect on intra- and interobserver variability.

Cancer Imaging 2019 Nov 29;19(1):78. Epub 2019 Nov 29.

Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.

Purpose: A newly developed image processing technique fuses conventional windows into a single 'All-In-One' (AIO) window. This study aims to evaluate variability of CT measurement of lesions in thoracic oncology patients on this novel AIO-window.

Methods: Six radiologists with different levels of expertise measured 368 lesions of various size, origin and sharpness. All lesions were measured twice on the AIO-window and twice on the conventional window settings. Intraclass correlation coefficients and Bland-Altman plots were used to assess intra- and interobserver variability.

Results: Overall intra-observer agreement for lesion diameters on the AIO-window and conventional window settings was 0.986 (95% Confidence interval (CI): 0.983-0.989) and 0.991 (95% CI 0.989-0.993) respectively. For interobserver agreement this was 0.982 (95% CI 0.979-0.985) (AIO) and 0.979 (95% CI 0.957-0.982) (conventional). For both the AIO and conventional windows, intra- and interobserver agreement were dependent on size, sharpness and reader experience. Measurement variability decreased with increasing lesion size. Regarding sharpness, inter- and intra-observer agreement ranged from 0.986-0.989 (AIO) and 0.985-0.992 (conventional) for well-defined lesions and from 0.978-0.983 (AIO) and 0.974-0.991 (conventional) for ill-defined lesions.

Conclusions: Lesion diameters were consistently smaller on the AIO-window compared to conventional window settings. Overall intra- and interobserver variability rates were similar for the AIO-window and conventional window settings. We conclude that the AIO-window offers a reliable and reproducible alternative for measurement of thoracic lesions.
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http://dx.doi.org/10.1186/s40644-019-0262-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884847PMC
November 2019

Molecular profiling in lung cancer associated with cystic airspaces.

Acta Clin Belg 2021 Apr 15;76(2):158-161. Epub 2019 Oct 15.

Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

'Lung cancer associated with cystic airspaces' is a rare radiological entity that is more frequently encountered on imaging studies and is gaining more attention since the widespread use of CT for lung cancer screening. Numerous aspects of this entity remain unraveled, including molecular profiling. The goal of this observational retrospective single-center case series is to investigate the molecular profile of lung cancers presenting with this specific morphology in a Caucasian population. Between January 2014 and May 2017, 13 patients were presented at the Multidisciplinary Thoracic Oncology Tumor Board with imaging findings consistent with 'lung cancer associated with cystic airspaces'. Electronic medical files were reviewed for patient characteristics, stage, histopathological findings and - in particular - molecular profiling. Histopathological diagnosis showed adenocarcinoma in 11 patients in our series. Mutational analysis in 10 showed different molecular alterations: an EGFR exon 18 mutation, ROS1 rearrangement and BRAF mutation in one patient each. Two patients showed KRAS mutations. With 5 out of 10 patients with an adenocarcinoma presenting with cystic airspace morphology showing a molecular alteration, this may indicate that in this subgroup, molecular profiling is mandatory, regardless of smoking history.
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http://dx.doi.org/10.1080/17843286.2019.1680134DOI Listing
April 2021

Increased T1 Signal Intensity of the Anterior Pituitary Gland on Unenhanced Magnetic Resonance Images After Chronic Exposure to Gadodiamide.

Invest Radiol 2020 01;55(1):25-29

From the Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.

Objective: The aim of this study was to assess the signal intensity of the anterior pituitary (AP) gland on unenhanced T1-weighted images in patients with history of serial intravenous injections of gadodiamide and normal renal function.

Materials And Methods: We included 53 patients who had undergone at least 5 injections of gadodiamide and a control group of 15 subjects who underwent at least 5 brain magnetic resonance imaging without gadolinium-based contrast agents. Using unenhanced sagittal T1-weighted images, values of mean signal intensity of the AP and of the central pons were obtained. Anterior pituitary-to-pons signal intensity ratios were calculated dividing the values of the AP by those of the pons. Then, the ratios were compared between the first and the last magnetic resonance imaging scans for all the subjects. To assess the difference between the first and the last ratios, nonparametric Wilcoxon signed-rank test with Monte Carlo resampling was applied. A P value less than 0.05 was considered as statistically significant.

Results: The comparison between the first and the last scan revealed a statistically significant increase of AP-to-pons ratio in the last scan for the gadolinium-exposed group (P < 0.001), whereas nonsignificant results were found for the control group (P = nonsignificant).

Conclusions: We found an increased signal intensity of the AP on unenhanced T1-weighted images in patients with history of serial intravenous injections of gadodiamide and normal renal function, suggesting gadolinium deposition or long-term retention within the AP gland. Our findings need to be confirmed by further histochemical analysis of AP gland tissue samples.
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http://dx.doi.org/10.1097/RLI.0000000000000604DOI Listing
January 2020

Radiologists as co-authors in case reports: does their involvement make a difference?

Acta Radiol 2020 Mar 18;61(3):338-343. Epub 2019 Jul 18.

Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

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http://dx.doi.org/10.1177/0284185119862953DOI Listing
March 2020

Subperiosteal Orbital Hematoma: Imaging Findings of a Rare Complication of Sickle Cell Disease: Subperiosteal orbital hematoma is a rare entity mainly seen in pediatric patients with sickle cell disease and occurs secondary to local vascular disturbances following facial bone infarction.

J Belg Soc Radiol 2019 Jun 28;103(1):40. Epub 2019 Jun 28.

UZA, BE.

Sickle cell disease is the most common hemoglobinopathy. Homozygous patients are prone to vaso-occlusive crises. A 19-year-old male patient with the homozygous sickle cell trait was admitted to the hospital due to a sickle cell crisis. During his admission he developed a left periorbital edema. The diagnosis of a subperiosteal orbital hematoma (SOH) was made by CT and MRI imaging. SOH is a rare complication of a VOC. The clinical course is mostly self-resolving, with some cases reporting the need for surgical decompression when orbital compression syndrome is clinically diagnosed. Differentiation between infection on imaging is necessary for further treatment.
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http://dx.doi.org/10.5334/jbsr.1786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598616PMC
June 2019

Current concepts in imaging and endovascular treatment of acute ischemic stroke: implications for the clinician.

Insights Imaging 2019 Jun 13;10(1):64. Epub 2019 Jun 13.

Department of Radiology, Antwerp University Hospital & University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.

During the last decade, the management of acute ischemic stroke has changed dramatically, from an expectant bedside "wait and see" attitude towards active treatment, thanks to the continuous improvement of new therapeutic options. In addition to the use of intravenous (IV) thrombolysis in emergent large vessel occlusion (ELVO), endovascular therapy (EVT) has proven to be very efficient in selected acute stroke patients. The indications for EVT have progressed from the era of thrombolysis to individual patient profiling. Recently, several indication parameters, e.g., "treatment time window" or "more distal vessel occlusion," are under debate for adjustment. In this article, we review the imaging strategies in acute stroke and discuss several EVT indication dogmas, which are subject to change.
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http://dx.doi.org/10.1186/s13244-019-0744-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565797PMC
June 2019

Aberrant fronto-striatal connectivity and fine motor function in schizophrenia.

Psychiatry Res Neuroimaging 2019 06 30;288:44-50. Epub 2019 Apr 30.

Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium; University Psychiatric Hospital Antwerp, Campus Duffel, Belgium.

Abnormal fine motor function is a frequent finding in schizophrenia and has been linked to structural and functional brain alterations. However, whether fine motor function is related to functional alterations within the motor system remains unclear. The aim of this study was to assess whether abnormalities in resting-state functional connectivity are present in schizophrenia patients and to investigate how these abnormalities may be related to fine motor function. We examined 19 schizophrenia patients and 16 healthy controls using resting-state functional connectivity for 11 bilateral regions of interest. Fine motor function was assessed on a set of copying tasks and the Symbol-Digit-Substitution Test. We found significantly reduced functional connectivity between the left caudate nucleus and bilateral dorsolateral prefrontal cortex (DLPFC) and between the left putamen and bilateral supplementary motor area (SMA) proper in patients compared to controls. Altered connectivity from DLPFC to caudate nucleus was related to fine motor tasks, which are sensitive to psychomotor speed, whereas aberrant connectivity between the SMA proper and putamen was associated to both, fine motor task, which are sensitive to psychomotor speed and to speed of information processing. Our findings emphasize the role of fronto-striatal connections in the pathogenesis of fine motor impairments in schizophrenia.
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http://dx.doi.org/10.1016/j.pscychresns.2019.04.010DOI Listing
June 2019

Brain ventricular volume changes induced by long-duration spaceflight.

Proc Natl Acad Sci U S A 2019 05 6;116(21):10531-10536. Epub 2019 May 6.

Lab for Equilibrium Investigations and Aerospace, University of Antwerp, 2610 Antwerp, Belgium.

Long-duration spaceflight induces detrimental changes in human physiology. Its residual effects and mechanisms remain unclear. We prospectively investigated the changes in cerebrospinal fluid (CSF) volume of the brain ventricular regions in space crew by means of a region of interest analysis on structural brain scans. Cosmonaut MRI data were investigated preflight ( = 11), postflight ( = 11), and at long-term follow-up 7 mo after landing ( = 7). Post hoc analyses revealed a significant difference between preflight and postflight values for all supratentorial ventricular structures, i.e., lateral ventricle (mean % change ± SE = 13.3 ± 1.9), third ventricle (mean % change ± SE = 10.4 ± 1.1), and the total ventricular volume (mean % change ± SE = 11.6 ± 1.5) (all < 0.0001), with higher volumes at postflight. At follow-up, these structures did not quite reach baseline levels, with still residual increases in volume for the lateral ventricle (mean % change ± SE = 7.7 ± 1.6; = 0.0009), the third ventricle (mean % change ± SE = 4.7 ± 1.3; = 0.0063), and the total ventricular volume (mean % change ± SE = 6.4 ± 1.3; = 0.0008). This spatiotemporal pattern of CSF compartment enlargement and recovery points to a reduced CSF resorption in microgravity as the underlying cause. Our results warrant more detailed and longer longitudinal follow-up. The clinical impact of our findings on the long-term cosmonauts' health and their relation to ocular changes reported in space travelers requires further prospective studies.
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http://dx.doi.org/10.1073/pnas.1820354116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535034PMC
May 2019

Diagnostic and clinical features of lung cancer associated with cystic airspaces.

J Thorac Dis 2019 Mar;11(3):987-1004

Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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http://dx.doi.org/10.21037/jtd.2019.02.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462709PMC
March 2019

Congenital Zika Syndrome: The Main Cause of Death and Correspondence Between Brain CT and Postmortem Histological Section Findings From the Same Individuals.

Top Magn Reson Imaging 2019 Feb;28(1):29-33

Federal University of Pernambuco, Recife, Brazil.

In the present case series, the cause of death of infants diagnosed with congenital Zika syndrome (CZS) was lung disease (pneumonia and sepsis with massive pulmonary aspiration), probably secondary to dysphagia and reflux. The main findings in infants with a confirmed diagnosis of CZS who died were as follows: (1) calcification and hypoplasia of the lentiform nuclei, hypoplasia of the caudate nuclei, and calcification at the cortical-subcortical junction was noted in all cases (100%) and calcification of the caudate nuclei was noted in 66.7% of cases; (2) calcification in the brainstem and along the lateral wall of the lateral ventricles was noted in only the case with arthrogryposis (33.3%); and (3) lesions in the posterior fossa (hypoplasia of the brainstem and cerebellum) were noted in two cases (66.7%), including the case with arthrogryposis. The findings concerning calcifications and brain malformations obtained from non-contrast computed tomography (CT) demonstrated good agreement with findings obtained from the postmortem pathological analysis; however, CT failed to detect discontinuity of the pia mater with heterotopia, invasion of the cerebral tissue into the subarachnoid space, and discontinuity of the ependyma in the lateral ventricles with gliosis; this last feature was only imaged in the most severe case of extreme microcephaly with a simplified gyral pattern. Only histopathology showed grouped calcifications associated with scattered calcifications suggestive of the neuron morphology.
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http://dx.doi.org/10.1097/RMR.0000000000000194DOI Listing
February 2019

Updated Imaging Findings in Congenital Zika Syndrome: A Disease Story That is Still Being Written.

Top Magn Reson Imaging 2019 Feb;28(1):1-14

Royal Perth Hospital (RPH).

In congenital Zika virus syndrome (CZS), the most frequent radiological findings are calcifications in the cortical-white matter junction and malformations of cortical development (pachygyria or polymicrogyria, which occur predominantly in the frontal lobes, or a simplified gyral pattern), ventriculomegaly, enlargement of the cisterna magna and the extra-axial subarachnoid space, corpus callosum abnormalities, and reduced brain volume. This syndrome can also result in a decrease in the brainstem and cerebellum volumes and delayed myelination. Infants with CZS may show venous thrombosis and lenticulostriate vasculopathies. Over a 3-year follow-up period, many infants with CZS showed hydrocephalus, reduction in brain calcifications, and greater reduction in brain thickness.
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http://dx.doi.org/10.1097/RMR.0000000000000193DOI Listing
February 2019

Miliary brain metastases from primary breast carcinoma: a case report.

Acta Neurol Belg 2020 Feb 5;120(1):175-176. Epub 2019 Feb 5.

Department of Radiology, University Hospital Antwerp (UZA), Edegem, Belgium.

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http://dx.doi.org/10.1007/s13760-019-01092-9DOI Listing
February 2020

Absence of dentate nucleus resting-state functional connectivity changes in nonneurological patients with gadolinium-related hyperintensity on T -weighted images.

J Magn Reson Imaging 2019 08 25;50(2):445-455. Epub 2019 Jan 25.

Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.

Background: The dentate nuclei of the cerebellum are the areas where gadolinium predominantly accumulates. It is not yet known whether gadolinium deposition affects brain functions.

Purpose/hypothesis: To assess whether gadolinium-dependent high signal intensity of the cerebellum on T -weighted images of nonneurological adult patients with Crohn's disease is associated with modifications of resting-state functional connectivity (RSFC) of the cerebellum and dentate nucleus.

Study Type: Observational, cross-sectional.

Population: Fifteen patients affected by Crohn's disease were compared with 16 healthy age- and gender-matched control subjects. All participants underwent neurological, neurocognitive-psychological assessment, and blood sampling.

Field Strength/sequence: 1.5-T magnet blood oxygenation level-dependent (BOLD) functional MRI.

Assessment: High signal intensity on T -weighted images, cerebellum functional connectivity, neurocognitive performance, and blood circulating gadolinium levels.

Statistical Tests: An unpaired two-sample t-test (age and sex were nuisance variables) was used to investigate between-group differences in cerebellar and dentate nucleus functional connectivity. Z-statistical images were set using clusters determined by Z > 2.3 and a familywise error (FWE)-corrected cluster significance threshold of P = 0.05.

Results: Dentate nuclei RSFC was not different (P = n.s.) between patients with gadolinium-dependent high signal intensity on T -weighted images and controls. Pre- and postcentral gyrus bilaterally and the right supplementary motor cortex showed a decrease of RSFC with the cerebellum hemispheres (P < 0.05 FWE-corrected) and was related to disease duration but not to gadodiamide cumulative doses (P = n.s.).

Data Conclusion: Crohn's disease patients with gadolinium-dependent hyperintense dentate nuclei on unenhanced T -weighted images do not show dentate nucleus RSFC changes.

Level Of Evidence: 2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:445-455.
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http://dx.doi.org/10.1002/jmri.26669DOI Listing
August 2019

Assessment of Anterolateral Complex Injuries by Magnetic Resonance Imaging in Patients With Acute Rupture of the Anterior Cruciate Ligament.

Arthroscopy 2019 02 3;35(2):521-527. Epub 2019 Jan 3.

Department of Orthopedics, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.

Purpose: To assess anterolateral complex (ALC) injuries in patients with acute anterior cruciate ligament (ACL) rupture on magnetic resonance imaging (MRI).

Methods: Patients with acute ACL rupture who underwent ACL surgery between 2015 and 2017 and underwent MRI within 6 weeks of the initial trauma were included. Two radiologists assessed magnetic resonance images retrospectively for the status of the ALC, including the iliotibial band (ITB), Kaplan fibers, and anterolateral ligament (ALL), as follows: grade 0, normal; grade 1, periligamentous edema; grade 2, partial tear; and grade 3, complete tear. The findings were analyzed using the Friedman test and weighted κ values.

Results: Sixty-nine MRI scans were reviewed. Of the 69 patients, 51% had associated injuries to the ITB (grade 1, n = 31; grade 2, n = 4), 33% had associated injuries to the Kaplan fibers (grade 1, n = 21; grade 2, n = 2), and 57% had associated injuries to the ALL (grade 1, n = 12; grade 2, n = 22; grade 3, n = 5). We found a significant difference in the frequency and grading between ITB, Kaplan fiber, and ALL injuries (P ≤ .032). Inter-reader agreement for assessing the ALC on MRI was almost perfect (κ ≥ 0.922).

Conclusions: On the basis of MRI analysis, ALL injuries were found with varying degrees of severity and intensity with noted injuries to associated surrounding fibers in patients with acute ACL rupture.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1016/j.arthro.2018.08.032DOI Listing
February 2019

Potential of a statistical approach for the standardization of multicenter diffusion tensor data: A phantom study.

J Magn Reson Imaging 2019 04 3;49(4):955-965. Epub 2019 Jan 3.

Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.

Background: Diffusion tensor imaging (DTI) parameters, such as fractional anisotropy (FA), allow examining the structural integrity of the brain. However, the true value of these parameters may be confounded by variability in MR hardware, acquisition parameters, and image quality.

Purpose: To examine the effects of confounding factors on FA and to evaluate the feasibility of statistical methods to model and reduce multicenter variability.

Study Type: Longitudinal multicenter study.

Phantom: DTI single strand phantom (HQ imaging).

Field Strength/sequence: 3T diffusion tensor imaging.

Assessments: Thirteen European imaging centers participated. DTI scans were acquired every 6 months and whenever maintenance or upgrades to the system were performed. A total of 64 scans were acquired in 2 years, obtained by three scanner vendors, using six individual head coils, and 12 software versions.

Statistical Tests: The variability in FA was assessed by the coefficients of variation (CoV). Several linear mixed effects models (LMEM) were developed and compared by means of the Akaike Information Criterion (AIC).

Results: The CoV was 2.22% for mean FA and 18.40% for standard deviation of FA. The variables "site" (P = 9.26 × 10 ), "vendor" (P = 2.18 × 10 ), "head coil" (P = 9.00 × 10 ), "scanner drift," "bandwidth" (P = 0.033), "TE" (P = 8.20 × 10 ), "SNR" (P = 0.029) and "mean residuals" (P = 6.50 × 10 ) had a significant effect on the variability in mean FA. The variables "site" (P = 4.00 × 10 ), "head coil" (P = 2.00 × 10 ), "software" (P = 0.014), and "mean voxel outlier intensity count" (P = 1.10 × 10 ) had a significant effect on the variability in standard deviation of FA. The mean FA was best predicted by an LMEM that included "vendor" and the interaction term of "SNR" and "head coil" as model factors (AIC -347.98). In contrast, the standard deviation of FA was best predicted by an LMEM that included "vendor," "bandwidth," "TE," and the interaction term between "SNR" and "head coil" (AIC -399.81).

Data Conclusion: Our findings suggest that perhaps statistical models seem promising to model the variability in quantitative DTI biomarkers for clinical routine and multicenter studies.

Level Of Evidence: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:955-965.
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http://dx.doi.org/10.1002/jmri.26333DOI Listing
April 2019

Neurocomplications of Recreational Drug Use.

J Belg Soc Radiol 2017 Nov 18;101(Suppl 1):14. Epub 2017 Nov 18.

Antwerp University Hospital, BE.

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http://dx.doi.org/10.5334/jbr-btr.1436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253054PMC
November 2017

Central versus Local Radiological Reading of Acute Computed Tomography Characteristics in Multi-Center Traumatic Brain Injury Research.

J Neurotrauma 2019 04 11;36(7):1080-1092. Epub 2018 Dec 11.

1 Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.

Observer variability in local radiological reading is a major concern in large-scale multi-center traumatic brain injury (TBI) studies. A central review process has been advocated to minimize this variability. The aim of this study is to compare central with local reading of TBI imaging datasets and to investigate the added value of central review. A total of 2050 admission computed tomography (CT) scans from subjects enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were analyzed for seven main CT characteristics. Kappa statistics were used to calculate agreement between central and local evaluations and a center-specific analysis was performed. The McNemar test was used to detect whether discordances were significant. Central interobserver and intra-observer agreement was calculated in a subset of patients. Good agreement was found between central and local assessment for the presence or absence of structural pathology (CT+, CT-, κ = 0.73) and most CT characteristics (κ = 0.62 to 0.71), except for traumatic axonal injury lesions (κ = 0.37). Despite good kappa values, discordances were significant in four of seven CT characteristics (i.e., midline shift, contusion, traumatic subarachnoid hemorrhage, and cisternal compression; p = 0.0005). Central reviewers showed substantial to excellent interobserver and intra-observer agreement (κ = 0.73 to κ = 0.96), contrasted by considerable variability in local radiological reading. Compared with local evaluation, a central review process offers a more consistent radiological reading of acute CT characteristics in TBI. It generates reliable, reproducible data and should be recommended for use in multi-center TBI studies.
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http://dx.doi.org/10.1089/neu.2018.6061DOI Listing
April 2019

Radiologists as Co-Authors in Case Reports Containing Radiological Images: Does Their Presence Influence Quality?

J Am Coll Radiol 2019 04 21;16(4 Pt A):526-527. Epub 2018 Sep 21.

Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

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http://dx.doi.org/10.1016/j.jacr.2018.07.035DOI Listing
April 2019