Publications by authors named "Rodrigo Salgado"

33 Publications

Gadolinium-based Contrast Agents for Cardiac MRI: Use of Linear and Macrocyclic Agents with Associated Safety Profile from 154 779 European Patients.

Radiol Cardiothorac Imaging 2020 Oct 29;2(5):e200102. Epub 2020 Oct 29.

Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, Germany (J.U., O.A.B., J.L.); Section of Interventional Radiology, Yale School of Medicine, New Haven, Conn (J.U.); Department of Radiology, Antwerp University Hospital, Antwerp, Belgium (R.S.); Department of Radiology, Holy Heart Hospital, Lier, Belgium (R.S.); Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy (M.F.); Department of Radiology, Center for Medical Imaging, University Medical Center Groningen, Groningen, the Netherlands (R.V.); Radiology Department, University Hospital Basel, Basel, Switzerland (J.B.); German Cardiovascular Research Center (DZHK), Partner site Goettingen, Germany (J.L.); and Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Centre, Leipzig, Germany (M.G.).

Purpose: To assess current use and acute safety profiles of gadolinium-based contrast agents (GBCAs) in cardiac MRI given recent suspensions of GBCA approval.

Materials And Methods: Patients were retrospectively included from the multinational multicenter European Society of Cardiovascular Radiology (ESCR) MR/CT Registry collected between January 2013 and October 2019. GBCA-associated acute adverse events (AAEs) were classified as mild (self-limiting), moderate (pronounced AAE requiring medical management), and severe (life threatening). Multivariable generalized linear mixed-effect models were used to assess AAE likelihood.

Results: A total of 154 779 patients (average age, 53 years ± 19 [standard deviation]; 99 106 men) who underwent cardiac MRI were included, the majority of whom underwent administration of GBCAs (94.2% [ = 145 855]). While linear GBCAs were used in 15.2% of examinations through 2011, their use decreased to less than 1% in 2018 and 2019. Overall, 0.36% ( = 556) of AAEs were documented (mild, 0.12% [ = 178]; moderate, 0.21% [ = 331]; severe, 0.03% [ = 47]). For nonenhanced cardiac MRI, examination-related events were reported in 2.59% (231 of 8924) of cases, the majority of which were anxiety (0.98% [ = 87]) and dyspnea (0.93% [ = 83]). AAE rates varied significantly by pharmacologic stressor, GBCA molecular structure (macrocyclic vs linear GBCA: multivariable odds ratio, 0.634; 95% confidence interval: 0.452, 0.888; = .008), GBCA subtype, and imaging indication.

Conclusion: Gadolinium-based contrast agent administration changed according to recent regulatory decisions, with use of macrocyclic agents almost exclusively in 2018 and 2019; these agents also demonstrated a favorable acute safety profile.© RSNA, 2020.
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http://dx.doi.org/10.1148/ryct.2020200102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977928PMC
October 2020

Intestinal Helminths in Wild Rodents from Native Forest and Exotic Pine Plantations () in Central Chile.

Animals (Basel) 2021 Feb 3;11(2). Epub 2021 Feb 3.

Departamento de Ciencias Biológicas Animales, Facultad de Ciencias Veterinarias y Pecuarias, Universidad de Chile, Santa Rosa 11735, La Pintana, Santiago 8820808, Chile.

Native forests have been replaced by forestry plantations worldwide, impacting biodiversity. However, the effect of this anthropogenic land-use change on parasitism is poorly understood. One of the most important land-use change in Chile is the replacement of native forests by Monterey pine () plantations. In this study, we analyzed the parasitism (presence and prevalence) of intestinal helminths from fecal samples of wild rodents in three habitat types: native forests and adult and young pine plantations in central Chile. Small mammals were sampled seasonally for two years, and a total of 1091 fecal samples from seven small mammal species were analyzed using coprological analysis. We found several helminth families and genera, some of them potentially zoonotic. In addition, new rodent-parasite associations were reported for the first time. The overall helminth prevalence was 16.95%, and an effect of habitat type on prevalence was not observed. Other factors were more relevant for prevalence such rodent species for sp. and season for sp. Our findings indicate that pine plantations do not increase helminth prevalence in rodents compared to native forests.
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http://dx.doi.org/10.3390/ani11020384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913297PMC
February 2021

Machine learning in cardiovascular radiology: ESCR position statement on design requirements, quality assessment, current applications, opportunities, and challenges.

Eur Radiol 2021 Jun 19;31(6):3909-3922. Epub 2020 Nov 19.

Department of Radiology, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.

Machine learning offers great opportunities to streamline and improve clinical care from the perspective of cardiac imagers, patients, and the industry and is a very active scientific research field. In light of these advances, the European Society of Cardiovascular Radiology (ESCR), a non-profit medical society dedicated to advancing cardiovascular radiology, has assembled a position statement regarding the use of machine learning (ML) in cardiovascular imaging. The purpose of this statement is to provide guidance on requirements for successful development and implementation of ML applications in cardiovascular imaging. In particular, recommendations on how to adequately design ML studies and how to report and interpret their results are provided. Finally, we identify opportunities and challenges ahead. While the focus of this position statement is ML development in cardiovascular imaging, most considerations are relevant to ML in radiology in general. KEY POINTS: • Development and clinical implementation of machine learning in cardiovascular imaging is a multidisciplinary pursuit. • Based on existing study quality standard frameworks such as SPIRIT and STARD, we propose a list of quality criteria for ML studies in radiology. • The cardiovascular imaging research community should strive for the compilation of multicenter datasets for the development, evaluation, and benchmarking of ML algorithms.
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http://dx.doi.org/10.1007/s00330-020-07417-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128798PMC
June 2021

Cardiac imaging procedures and the COVID-19 pandemic: recommendations of the European Society of Cardiovascular Radiology (ESCR).

Int J Cardiovasc Imaging 2020 Oct 26;36(10):1801-1810. Epub 2020 May 26.

Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

The severe acute respiratory syndrome coronavirus 2019 (SARS-CoV-2) pandemic currently constitutes a significant burden on worldwide health care systems, with important implications on many levels, including radiology departments. Given the established fundamental role of cardiovascular imaging in modern healthcare, and the specific value of cardiopulmonary radiology in COVID-19 patients, departmental organisation and imaging programs need to be restructured during the pandemic in order to provide access to modern cardiovascular services to both infected and non-infected patients while ensuring safety for healthcare professionals. The uninterrupted availability of cardiovascular radiology services remains, particularly during the current pandemic outbreak, crucial for the initial evaluation and further follow-up of patients with suspected or known cardiovascular diseases in order to avoid unnecessary complications. Suspected or established COVID-19 patients may also have concomitant cardiovascular symptoms and require further imaging investigations. This statement by the European Society of Cardiovascular Radiology (ESCR) provides information on measures for safety of healthcare professionals and recommendations for cardiovascular imaging during the pandemic in both non-infected and COVID-19 patients.
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http://dx.doi.org/10.1007/s10554-020-01892-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247913PMC
October 2020

CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR).

Eur Radiol 2020 May 5;30(5):2627-2650. Epub 2019 Sep 5.

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

Transcatheter aortic valve replacement (TAVR) is a minimally invasive alternative to conventional aortic valve replacement in symptomatic patients with severe aortic stenosis and contraindications to surgery. The procedure has shown to improve patient's quality of life and prolong short- and mid-term survival in high-risk individuals, becoming a widely accepted therapeutic option which has been integrated into current clinical guidelines for the management of valvular heart disease. Nevertheless, not every patient at high-risk for surgery is a good candidate for TAVR. Besides clinical selection, which is usually established by the Heart Team, certain technical and anatomic criteria must be met as, unlike in surgical valve replacement, annular sizing is not performed under direct surgical evaluation but on the basis of non-invasive imaging findings. Present consensus document was outlined by a working group of researchers from the European Society of Cardiovascular Radiology (ESCR) and aims to provide guidance on the utilisation of CT and MR imaging prior to TAVR. Particular relevance is given to the technical requirements and standardisation of the scanning protocols which have to be tailored to the remarkable variability of the scanners currently utilised in clinical practice; recommendations regarding all required pre-procedural measurements and medical reporting standardisation have been also outlined, in order to ensure quality and consistency of reported data and terminology. KEY POINTS: • To provide a reference document for CT and MR acquisition techniques, taking into account the significant technological variation of available scanners. • To review all relevant measurements that are required and define a step-by-step guided approach for the measurements of different structures implicated in the procedure. • To propose a CT/MR reporting template to assist in consistent communication between various sites and specialists involved in the procedural planning.
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http://dx.doi.org/10.1007/s00330-019-06357-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160220PMC
May 2020

Primary midgut volvulus without intestinal malrotation in a young adult: a case report.

Acta Chir Belg 2020 Dec 25;120(6):429-432. Epub 2019 Jun 25.

Department of Abdominal Surgery, H.-Hartziekenhuis, Lier, Belgium.

Background: Midgut volvulus is a rare cause of acute abdomen characterized by a twisting of the entire small intestine around its mesenteric pedicle. It is a well-known complication of intestinal malrotation usually occurring in infants and young children. We report a rare case of a midgut volvulus without any underlying condition occurring in a young adult.

Case Presentation: A 24-year-old male was admitted to our surgical department with symptoms and signs of small bowel obstruction. The abdominal computed tomography (CT) scan showed dilatation of the entire small intestine and a rotation of the mesentery. The patient underwent an urgent explorative laparoscopy with conversion to median laparotomy, revealing a midgut volvulus with marked intestinal ischemia. Mesenteric fixation was normal but the mesenteric pedicle was described as relatively narrow. The midgut volvulus was untwisted with subsequent recovery of the intestinal ischemia.

Results: The postoperative period was marked by prolonged ileus requiring nasogastric tube decompression that gradually resolved after 1 week. The patient was discharged on the tenth postoperative day. He had fully resumed his daily activities 1 month after surgery and had experienced no recurrent symptoms 6 months later.

Conclusion: Primary midgut volvulus is an extremely rare condition that must be considered in all young adults presenting with intestinal obstruction without previous abdominal surgery. Early diagnosis and immediate surgical intervention are the key factors to a successful outcome.
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http://dx.doi.org/10.1080/00015458.2019.1631615DOI Listing
December 2020

Abnormal longitudinal peak systolic strain in asymptomatic patients with type I diabetes mellitus.

Echocardiography 2019 03 15;36(3):478-485. Epub 2019 Jan 15.

Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.

Aims: In addition to increased risk of cardiovascular disease, the prevalence of diabetic cardiomyopathy is increasingly recognized in patients with type 1 diabetes mellitus (T1DM). We aimed to identify the occurrence of subclinical markers of cardiovascular risk and cardiac dysfunction and assess their relation to clinical parameters in asymptomatic patients with T1DM.

Methods And Results: A total of 102 patients (mean age 46 years [20-73], 62% male) with a history of T1DM ranging from 5 to 47 years underwent standard 2D and pulse-wave tissue Doppler echocardiography (Philips iE33) and computerized tomography for assessment of coronary calcium score (CACS) and visceral fat. Global peak longitudinal strain (GPLSS, speckle tracking) was calculated by offline analysis (Qlab 9.0). Whereas systolic function was preserved in all patients (LVEF > 50%), subclinical dysfunction (defined as global longitudinal peak systolic strain [GLPSS] of >-20%) was present in 39% and 66% had diastolic dysfunction. Fifty patients had a CACS above the 50th percentile according to age and gender. These patients were older, more obese, had higher levels of visceral fat, higher SBP and increased levels of LDL cholesterol. Higher CACS meant increased risk of diastolic and subclinical systolic dysfunction. However, decreased GLPSS was also detected in 30% of patients with CACS of <50th percentile. Stepwise linear regression analysis indicated visceral fat as a strong predictor of abnormal GPLSS and CACS.

Conclusion: Subclinical left ventricular dysfunction and atherosclerosis were highly prevalent in asymptomatic T1DM. Abnormal GPLSS was noted with or without associated increase in CACS. Visceral fat was a strong predictor of increased CACS as well as abnormal GLPSS.
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http://dx.doi.org/10.1111/echo.14257DOI Listing
March 2019

Non-Invasive Imaging for Cardiovascular Interventions: An Evolving Paradigm.

Authors:
Rodrigo Salgado

J Belg Soc Radiol 2018 Dec 5;102(1):77. Epub 2018 Dec 5.

Heilig Hartziekenhuis Lier, BE.

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http://dx.doi.org/10.5334/jbsr.1667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284139PMC
December 2018

De Novo Myeloid Sarcoma as a Cause of Small Bowel Obstruction: A Case Report.

J Belg Soc Radiol 2017 Aug 14;101(1):28. Epub 2017 Aug 14.

Heilig Hartziekenhuis, BE.

Myeloid sarcoma (MS) is an extremely rare disease, closely correlated to Acute Myeloid Leukamia (AML) and presenting as a tumoral lesion in potentially any anatomic location. It is seen either concomitant with AML, during remission, or more seldom, prior to any detectable haematological abnormality. While MS remains a difficult diagnosis, this rare tumor must be included in the differential diagnosis of atypical, local obstructive abdominal processes, especially when coinciding with a myeloproliferative disorder. We present a case report of an otherwise healthy young patient with small bowel obstruction due to an invasive ileal mass, histologically diagnosed as a myeloid sarcoma.
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http://dx.doi.org/10.5334/jbr-btr.1353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032658PMC
August 2017

Detection of persistent pestivirus infection in pudú (Pudu puda) in a captive population of artiodactyls in Chile.

BMC Vet Res 2018 Feb 1;14(1):37. Epub 2018 Feb 1.

Laboratory of Animal Virology, Department of Animal Preventive Medicine, Faculty of Livestock and Veterinary Sciences, University of Chile, Av. Santa Rosa, 11735, Santiago, Chile.

Background: Bovine Viral Diarrhea Virus (BVDV) is the viral agent causing the most important economic losses in livestock throughout the world. Infection of fetuses before their immunological maturity causes the birth of animals persistently infected with BVDV (PI), which are the main source of infection and maintenance of this pathogen in a herd. There is evidence of susceptibility to infection with BVDV in more than 50 species of the order Artiodactyla, and the ability to establish persistent infection in wild cervid species of South America could represent an important risk in control and eradication programs of BVDV in cattle, and a threat to conservation of these wild species. In this study, a serological and virological study was performed to detect BVDV infection in a captive population of non-bovine artiodactyl species in a Chilean zoo with antecedents of abortions whose pathology suggests an infectious etiology.

Results: Detection of neutralizing antibodies against BVDV was performed in 112 artiodactyl animals from a zoo in Chile. Three alpacas (Vicugna pacos), one guanaco (Lama guanicoe) and seven pudús (Pudu puda) resulted seropositive, and the only seronegative pudú was suspected to be persistently infected with BVDV. Then two blood samples nine months apart were analyzed by a viral neutralization test and RT-PCR. Non-cytopathogenic BVDVs were isolated in both samples. A phylogenetic analysis showed that the virus was highly related to BVDV-1b strains circulating among Chilean cattle.

Conclusions: This is the first report of a South American deer persistently infected with Bovine Viral Diarrhea Virus. Further studies are needed to determine the possible role of BVDV as a pathogen in pudús and as a threat to their conservation.
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http://dx.doi.org/10.1186/s12917-018-1363-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796590PMC
February 2018

Image quality in coronary CT angiography: challenges and technical solutions.

Br J Radiol 2017 Apr 7;90(1072):20160567. Epub 2017 Mar 7.

9 GIGA Cardiovascular Sciences, Liège University (ULg), Domaine Universitaire du Sart Tilman, Rue de l'hôpital, Liège, Belgium.

Multidetector CT angiography (CTA) has become a widely accepted examination for non-invasive evaluation of the heart and coronary arteries. Despite its ongoing success and worldwide clinical implementation, it remains an often-challenging procedure in which image quality, and hence diagnostic value, is determined by both technical and patient-related factors. Thorough knowledge of these factors is important to obtain high-quality examinations. In this review, we discuss several key elements that may adversely affect coronary CTA image quality as well as potential measures that can be taken to mitigate their impact. In addition, several recent vendor-specific advances and future directions to improve image quality are discussed.
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http://dx.doi.org/10.1259/bjr.20160567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605061PMC
April 2017

An evaluation of automatic coronary artery calcium scoring methods with cardiac CT using the orCaScore framework.

Med Phys 2016 May;43(5):2361

Image Sciences Institute, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands.

Purpose: The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular disease (CVD) events. In clinical practice, CAC is manually identified and automatically quantified in cardiac CT using commercially available software. This is a tedious and time-consuming process in large-scale studies. Therefore, a number of automatic methods that require no interaction and semiautomatic methods that require very limited interaction for the identification of CAC in cardiac CT have been proposed. Thus far, a comparison of their performance has been lacking. The objective of this study was to perform an independent evaluation of (semi)automatic methods for CAC scoring in cardiac CT using a publicly available standardized framework.

Methods: Cardiac CT exams of 72 patients distributed over four CVD risk categories were provided for (semi)automatic CAC scoring. Each exam consisted of a noncontrast-enhanced calcium scoring CT (CSCT) and a corresponding coronary CT angiography (CCTA) scan. The exams were acquired in four different hospitals using state-of-the-art equipment from four major CT scanner vendors. The data were divided into 32 training exams and 40 test exams. A reference standard for CAC in CSCT was defined by consensus of two experts following a clinical protocol. The framework organizers evaluated the performance of (semi)automatic methods on test CSCT scans, per lesion, artery, and patient.

Results: Five (semi)automatic methods were evaluated. Four methods used both CSCT and CCTA to identify CAC, and one method used only CSCT. The evaluated methods correctly detected between 52% and 94% of CAC lesions with positive predictive values between 65% and 96%. Lesions in distal coronary arteries were most commonly missed and aortic calcifications close to the coronary ostia were the most common false positive errors. The majority (between 88% and 98%) of correctly identified CAC lesions were assigned to the correct artery. Linearly weighted Cohen's kappa for patient CVD risk categorization by the evaluated methods ranged from 0.80 to 1.00.

Conclusions: A publicly available standardized framework for the evaluation of (semi)automatic methods for CAC identification in cardiac CT is described. An evaluation of five (semi)automatic methods within this framework shows that automatic per patient CVD risk categorization is feasible. CAC lesions at ambiguous locations such as the coronary ostia remain challenging, but their detection had limited impact on CVD risk determination.
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http://dx.doi.org/10.1118/1.4945696DOI Listing
May 2016

A Curious Case of Acute Myocardial Calcifications.

Circulation 2016 Mar;133(10):e426-7

From Departments of Radiology (M.T., R.S., B.C., P.M.P.), Cardiology (P.V.H.), and Intensive Care (D.R.), Antwerp University Hospital, Belgium.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.115.019178DOI Listing
March 2016

CT imaging features of atrioventricular shunts: what the radiologist must know.

Insights Imaging 2016 Feb 5;7(1):119-29. Epub 2015 Dec 5.

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

Unlabelled: In the last decade, cardiac computed tomography (CT) has gained mainstream acceptance for the noninvasive exclusion of significant coronary disease in a selected population. Improvements in electrocardiogram (ECG)-triggered imaging techniques also allow, by extension, a proper evaluation of the complete heart anatomy. Given the increasing worldwide clinical implementation of cardiac CT for coronary artery evaluation, radiologists can, incidentally, be confronted with unfamiliar and previously unsuspected non-coronary cardiac pathologies, including congenital morphological defects. This presence of congenital heart disease (CHD) should not be overlooked, being the most common form of birth defect, with a total birth prevalence of 9.1 per 1000 live births worldwide [1]. The prevalence of adult patients with CHD is estimated to be 3000 per million adults [2]. Ventricular septal defects (VSDs) are the most frequent subtypes of CHD, accounting together with atrial septal defects (ASDs) for nearly half of all CHD cases [1]. While some small defects are rarely symptomatic and can go undetected for life, others are clinically significant and require adequate and timely medical intervention. In this article, we present the CT imaging features of atrioventricular (AV) shunts, highlighting both their embryological origins and associated relevant clinical features.

Teaching Points: • Congenital heart disease (CHD) is the most common birth defect. • Ventricular and atrial septal defects account for nearly half of CHD cases. • Atrioventricular defects can frequently be detected on a cardiac CT. • Radiologists must be able to identify clinically significant atrioventricular defects.
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http://dx.doi.org/10.1007/s13244-015-0452-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729704PMC
February 2016

Brachiocephalic artery access in transcatheter aortic valve implantation: a valuable alternative: 3-year institutional experience.

Interact Cardiovasc Thorac Surg 2015 Dec 22;21(6):734-40. Epub 2015 Sep 22.

Department of Cardiology, UZA - Antwerp University Hospital, Edegem, Belgium.

Objectives: With the expanding use of transcatheter aortic valve implantation (TAVI), we have encountered increasing numbers of patients without ideal femoral access. Although many alternatives have been described, vascular access and access-related complications remain a point of concern. We report our series of 20 patients undergoing TAVI via brachiocephalic artery access.

Methods: Between September 2011 and May 2014, we performed 107 consecutive CoreValve bioprosthesis implantations, of which 20 were by the brachiocephalic approach due to unfavourable iliac or femoral anatomy.

Results: No vascular or access-related complications were seen. Procedural feasibility, device success and early safety, as defined by the Valve Academic Research Consortium-2 criteria, were good, at 100, 95 and 95%, respectively. No stroke, transient ischaemic attack, acute kidney injury, major vascular or major bleeding complications were observed. At a mean follow-up of 497 days, the 1-year survival rate is 75.0%. Echocardiography at discharge confirmed moderate paravalvular regurgitation in 1 patient and mild paravalvular leakage in 3 patients, and no paravalvular leak more than moderate was seen. Echocardiography at discharge, 6 months and 1 year after TAVI confirmed persistent low mean transvalvular gradients (9, 9 and 10 mmHg, respectively).

Conclusions: TAVI implantation through the brachiocephalic artery is safe and feasible. The distance between the point of access and the aortic valve annulus is short, improving catheter stability and implant site accuracy. We consider it to be a valuable alternative in patients without femoral access.
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http://dx.doi.org/10.1093/icvts/ivv262DOI Listing
December 2015

A case of pneumopericardium as a late complication of gastric bypass surgery.

Circulation 2014 Oct;130(18):1633-5

From the Antwerp University Hospital, Antwerp, Belgium (J.H., E.M., P.P.M.P., R.S.); and AZ St.-Dimpna, Geel, Belgium (J.S.).

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http://dx.doi.org/10.1161/CIRCULATIONAHA.114.007237DOI Listing
October 2014

Transcatheter aortic valve replacement: postoperative CT findings of Sapien and CoreValve transcatheter heart valves.

Radiographics 2014 Oct;34(6):1517-36

From the Departments of Radiology (R.A.S., B.J.O.d.B., P.M.P.), Cardiology (B.S., P.L.V.H., C.V., J.B.), and Cardiothoracic Surgery (I.R.), Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem-Antwerp, Belgium; and Departments of Radiology (R.P.J.B., T.L.), Cardiothoracic Surgery (M.P.B.), and Cardiology (P.R.S.), University Medical Center Utrecht, Utrecht, the Netherlands.

Transcatheter aortic valve replacement represents one of the most exciting medical technical developments in recent years, offering a much-needed therapeutic alternative for patients with severe aortic valve stenosis who, due to comorbidities and advanced age, are considered to be inoperable or at high surgical risk. The efficacy of this procedure compared with standard surgical intervention has been properly validated in multicenter randomized controlled trials (PARTNER A and B trials), leading to widespread clinical implementation, with over 50,000 procedures currently being performed worldwide each year. Although much of the attention has rightly focused on the potential role of computed tomography (CT) in the preprocedural assessment of the aortic root and the establishment of imaging-guided valve-sizing algorithms, less is known regarding the postprocedural CT characteristics of transcatheter heart valves (THVs). However, given the increasing worldwide recognition and clinical implementation of these devices, they will no doubt be encountered with increasing frequency in patients referred for thoracic CT, either for postprocedural evaluation of the aortic root or for unrelated reasons. Familiarity with these devices and their CT characteristics will increase diagnostic confidence and the value of the radiology report. The authors describe the physical and imaging properties of the currently commercially available THVs, their normal postprocedural imaging appearances, and potential complications that can be detected at CT. In addition, they discuss the relative strengths and weaknesses of CT and echocardiography in this setting.
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http://dx.doi.org/10.1148/rg.346130149DOI Listing
October 2014

Preprocedural CT evaluation of transcatheter aortic valve replacement: what the radiologist needs to know.

Radiographics 2014 Oct;34(6):1491-514

From the Departments of Radiology (R.A.S., L.A., B.J.O.d.B., P.M.P.), Cardiology (B.S., P.L.V.H., C.V., J.B.), and Cardiothoracic Surgery (I.R.), Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem-Antwerp, Belgium; and Department of Radiology, Department of Medical Imaging, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada (J.A.L.).

Aortic valve stenosis is the most common valvular heart disease in the Western world. When symptomatic, aortic valve stenosis is a debilitating disease with a dismal short-term prognosis, invariably leading to heart failure and death. Elective surgical valve replacement has traditionally been considered the standard of care for symptomatic aortic valve stenosis. However, several studies have identified various subgroups of patients with a significantly elevated risk for surgery-related complications and death. Thus, not every patient is a suitable candidate for surgery. Recent developments in transcatheter-based therapies have provided an alternative therapeutic strategy for the nonsurgical patient population known as transcatheter aortic valve replacement (TAVR) (also called transcatheter aortic valve implantation or percutaneous aortic valve replacement). In TAVR, the native aortic valve is replaced with a bioprosthetic valve via a nonsurgical endovascular, transaortic, or transapical pathway. Nevertheless, several anatomic and technical criteria must be met to safeguard patient eligibility and procedural success. Therefore, noninvasive imaging plays a crucial role in both patient selection and subsequent matching to a specific transcatheter valve size in an effort to ensure accurate prosthesis deployment and minimize peri- and postprocedural complications. The authors review the relevant anatomy of the aortic root, emphasizing the implications of anatomic pitfalls for correct reporting of imaging-derived measurements and important differences between findings obtained with different imaging modalities. They also discuss the evolving role of computed tomography and the role of the radiologist in patient triage in light of current viewpoints regarding patient selection, device size selection, and the preprocedural evaluation of possible access routes. Online supplemental material is available for this article.
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http://dx.doi.org/10.1148/rg.346125076DOI Listing
October 2014

The effects of extrafine beclometasone/formoterol (BDP/F) on lung function, dyspnea, hyperinflation, and airway geometry in COPD patients: novel insight using functional respiratory imaging.

J Aerosol Med Pulm Drug Deliv 2015 Apr 8;28(2):88-99. Epub 2014 Jul 8.

1 FluidDA NV , 2550 Kontich, Belgium .

Background: The efficacy of inhaled corticosteroids (ICS) in moderately severe COPD patients remains unclear. At the same time, the use of extrafine particles in COPD patients is a topic of ongoing research.

Objectives: This study assessed the effect of ICS in steroid-naïve mild COPD patients and the effect of reducing the ICS dose in more severe COPD patients previously using ICS when switching to an extrafine particle BDP/F formulation (Foster using Modulite technology, Chiesi Pharmaceutici, Parma, Italy).

Methods: Novel functional respiratory imaging (FRI) methods, consisting of multi-slice CT scans and Computational Fluid Dynamics, were used in combination with conventional pulmonary function tests and patient reported outcomes.

Results: The study showed that the administration of extrafine BDP/F after 4-6 h led to a significant improvement in lung function parameters and hyperinflation as determined by spirometry, body plethysmography, and functional respiratory imaging. After 6 months of treatment, it was observed that, compared to baseline, the hyperinflation on lobar level at total lung capacity was significantly reduced (-1.19±7.19 %p, p=0.009). In addition, a significant improvement in SGRQ symptom score was noted in the entire patient population. Patients who improved in terms of hyperinflation also improved their MMRC dyspnea score. CFD indicated a difference in regional deposition between extrafine and non-extrafine formulations with -11% extrathoracic deposition and up to +4% lobe deposition for the extrafine formulation.

Conclusions: The study showed that the administration of extrafine BDP/F improved lung function parameters and hyperinflation. Patients previously treated with ICS remained stable despite the lower dose, while ICS naïve patients improved in terms of lobar hyperinflation. FRI seems to be a sensitive biomarker to detect clinically relevant changes that are not detected by spirometry. The next step is to confirm these findings in a controlled trial.
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http://dx.doi.org/10.1089/jamp.2013.1064DOI Listing
April 2015

Images in cardio-thoracic surgery. Identification of a hypertrophied bronchial artery using three-dimensional computed tomography.

Eur J Cardiothorac Surg 2009 Oct 21;36(4):764. Epub 2009 Aug 21.

Antwerp University Hospital, Department of Internal Medicine, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium.

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http://dx.doi.org/10.1016/j.ejcts.2009.05.028DOI Listing
October 2009

Sinus of valsalva aneurysm.

J Am Coll Cardiol 2009 Aug;54(9):876

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

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http://dx.doi.org/10.1016/j.jacc.2009.02.089DOI Listing
August 2009

Multi-slice computed tomography with N1177 identifies ruptured atherosclerotic plaques in rabbits.

Basic Res Cardiol 2010 Jan 20;105(1):51-9. Epub 2009 Aug 20.

Division of Cardiology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.

Rupture-prone and ruptured plaques are characterized by the presence of large numbers of macrophages. N1177 is a contrast agent consisting of iodinated nanoparticles that are selectively phagocytosed by macrophages. The aim of this study was to investigate the effect of N1177 on the CT attenuation of rupture-prone and ruptured plaques in rabbits. In addition, we examined in vitro whether uptake of N1177 occurred without cytotoxic or pro-inflammatory effects on macrophages. In vitro, the viability of J774 macrophages was not affected by treatment with N1177. Moreover, N1177 had no effect on the phagocytic capacity or cytokine production of macrophages. For the in vivo experiments, 6 New Zealand White rabbits were fed a cholesterol-supplemented diet for 12-15 months, resulting in the development of large atherosclerotic plaques that resembled rupture-prone plaques in humans. In three rabbits, mechanical plaque rupture was induced by retrograde pullback of an embolic protection device. N1177 had no effect on the median density of rupture-prone plaques [35 HU (range 3-85) before injection vs. 32 HU (range 1-93) 2 h after injection of N1177; P > 0.05]. However, after induction of mechanical plaque rupture, the median density of the atherosclerotic plaques increased from 40 HU (range 6-86) before injection to 74 HU (range 14-111) 2 h after injection of N1177 (P < 0.001). Using time-of-flight static secondary ion mass spectrometry, the presence of N1177 nanoparticles was demonstrated in macrophage-rich areas of ruptured plaques, but not of non-ruptured plaques. In conclusion, our results show that N1177 is a contrast agent that can identify ruptured atherosclerotic plaques.
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http://dx.doi.org/10.1007/s00395-009-0052-0DOI Listing
January 2010

Development of acute schmorl nodes after discography.

J Comput Assist Tomogr 2009 Jul-Aug;33(4):597-600

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

We report the development of acute Schmorl nodes at the L3-L4 intervertebral disc level after discography in a 36-year-old man. Although a few cases of acute Schmorl nodes have been reported in the literature, they have not been described because of discography. We surmise that the herniation of disc material through the vertebral endplates, with the ensuing formation of Schmorl nodes, should be regarded as a potential, but fortunately rare, complication of discography.
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http://dx.doi.org/10.1097/RCT.0b013e318188598bDOI Listing
August 2009

An unusual case of traumatic pneumatocele in a nine-year-old girl: a bronchial tear with clear bronchial laceration.

Pediatr Pulmonol 2009 Aug;44(8):826-8

Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.

Post-traumatic pneumatoceles (traumatic pulmonary pseudocysts) after blunt thoracic trauma are not frequently observed. It is widely accepted that pneumatoceles are caused by compression of the lung resulting in bursting parenchyma, followed by decompression of the chest with negative intrathoracic pressure. We present a case of post-traumatic pneumatocele in a nine-year-old girl who was crushed under the tailboard of a horse hamper. A multislice CT of the thorax clearly demonstrated a bronchial laceration pointing to bronchial disruption as an additional causative mechanism.
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http://dx.doi.org/10.1002/ppul.20806DOI Listing
August 2009

Left atrial calcifications: computed tomographic imaging findings of an unusual sign of rheumatic heart disease.

J Comput Assist Tomogr 2008 Sep-Oct;32(5):710-1

Department of Radiology, Universitair Ziekenhuis Antwerpen-University of Antwerp, Edegem, Belgium.

Left atrial wall calcifications are an extremely rare finding of unknown cause usually associated with rheumatic disease. Only a few case reports of this entity are found in the literature, mostly describing the findings on conventional chest radiography, echocardiography, and angiography. To the best of our knowledge, this is the first case documented with multislice computed tomography.
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http://dx.doi.org/10.1097/RCT.0b013e318158b4ebDOI Listing
October 2008

A patient with cardiac fibroma and a subvalvular aortic stenosis caused by a subvalvular membrane.

J Am Soc Echocardiogr 2007 Jul;20(7):906.e1-4

Department of Cardiology, Ziekenhuis Walcheren, Vlissingen, The Netherlands.

In this report, we describe a patient with two uncommon cardiac abnormalities: a subvalvular membrane in the left ventricular outflow tract and a cardiac fibroma (CF) in the left atrium. This 56-year-old patient presented with a known subaortic stenosis caused by a subvalvular membrane, a large mass attached to the interatrial septum in the immediate proximity of mitral valve, and a cardiac history of infective endocarditis. Initially, the mass was thought to be an old vegetation. However, the histology of this lesion diagnosed a CF. Primary cardiac tumors are rare. Myxoma and papillary fibroelastoma are the most frequently encountered primary cardiac tumors. CF is usually diagnosed during childhood. In this case, the presentation of the CF was atypical for 3 reasons: the tumor was diagnosed in an adult, the fibroma was pedunculated, and not located within the myocardium but originated from the interatrial septum.
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http://dx.doi.org/10.1016/j.echo.2006.12.009DOI Listing
July 2007

Multislice cardiac computed tomography in symptomatic middle-aged women.

Ann Med 2007 ;39(4):290-7

Department of Cardiology, University Hospital Antwerp, Belgium.

Objective: To assess the accuracy of multislice cardiac computed tomography (MSCT) for detection of significant coronary artery disease (CAD) in middle-aged symptomatic women.

Methods: We included 70 women (51+/-8 years) with complaints of chest pain or dyspnea, and an abnormal maximum exercise electrocardiogram (ECG) (8.6+/-1.4 metabolic equivalents). All had a MSCT using a 16 detector rows scanner, and coronary arteriography (CA). Blinded results of the two modalities were compared using a segment, vessel, and patient-based analysis.

Results: On MSCT 36% had normal coronaries, 24% had significant CAD requiring revascularization, and the remainder had mild CAD. MSCT had reasonably high diagnostic accuracy at segment level (negative predictive value of 95%, positive predictive value 81%, specificity 99%, and sensitivity 50%), regarding single or multivessel CAD when both nonassessable and assessable segments were included in the analysis. The agreement between the segments comparing MSCT and CA for significant CAD was excellent at 98% (kappa value 0.89).

Conclusions: In this cohort of middle-aged symptomatic women with an abnormal stress test, 24% had significant CAD requiring intervention. MSCT was highly accurate in diagnosing significant CAD with an excellent negative predictive value.
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http://dx.doi.org/10.1080/07853890701233832DOI Listing
August 2007

Malignant pleural mesothelioma with heterologous osteoblastic elements: computed tomography, magnetic resonance, and positron emission tomography imaging characteristics of a rare tumor.

J Comput Assist Tomogr 2005 Sep-Oct;29(5):653-6

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

The imaging findings of a rare mixed type of malignant mesothelioma of the pleura with heterologous bone stroma in a patient without a previous history of asbestos exposure are reported. Imaging findings of this type of bone-forming pleural mesothelioma are scarcely reported in the literature, with only a few case reports describing findings on conventional radiography, computed tomography, and magnetic resonance imaging. To the best of our knowledge, no positron emission tomography imaging characteristics of this type of mesothelioma have been previously reported.
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http://dx.doi.org/10.1097/01.rct.0000174028.06600.53DOI Listing
November 2005