Publications (6)23.36 Total impact
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Article: Magnetic resonance imaging- versus computed tomography-based target volume delineation of the glandular breast tissue (clinical target volume breast) in breast-conserving therapy: an exploratory study.
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ABSTRACT: To examine MRI and CT for glandular breast tissue (GBT) volume delineation and to assess interobserver variability. Fifteen breast cancer patients underwent a planning CT and MRI, consecutively, in the treatment position. Four observers (two radiation oncologists and two radiologists) delineated the GBT according to the CT and separately to the MR images. Volumes, centers of mass, maximum extensions with standard deviations (SD), and interobserver variability were quantified. Observers viewed delineation differences between MRI and CT and delineation differences among observers. In cranio-lateral and cranio-medial directions, GBT volumes were delineated larger using MRI when compared with those delineated with CT. Center of mass on MRI shifted a mean (SD) 17% (4%) into the cranial direction and a mean 3% (4%) into the dorsal direction when compared with that on the planning CT. Only small variations between observers were noted. The GBT volumes were approximately 4% larger on MRI (mean [SD] ratio MRI to CT GBT volumes, 1.04 [0.06]). Findings were concordant with viewed MRI and CT images and contours. Conformity indices were only slightly different; mean conformity index was 77% (3%) for MRI and 79% (4%) for CT. Delineation differences arising from personal preferences remained recognizable irrespective of the imaging modality used. Contoured GBT extends substantially further into the cranio-lateral and cranio-medial directions on MRI when compared with CT. Interobserver variability is comparable for both imaging modalities. Observers should be aware of existing personal delineation preferences. Institutions are recommended to review and discuss target volume delineations and to design supplementary guidelines if necessary.International journal of radiation oncology, biology, physics 11/2011; 81(3):804-11. · 4.59 Impact Factor -
Article: MRI- versus CT-based volume delineation of lumpectomy cavity in supine position in breast-conserving therapy: an exploratory study.
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ABSTRACT: To examine magnetic resonance imaging (MRI) and computed tomography (CT) for lumpectomy cavity (LC) volume delineation in supine radiotherapy treatment position and to assess the interobserver variability. A total of 15 breast cancer patients underwent a planning CT and directly afterward MRI in supine radiotherapy treatment position. Then, 4 observers (2 radiation oncologists and 2 radiologists) delineated the LC on the CT and MRI scans and assessed the cavity visualization score (CVS). The CVS, LC volume, conformity index (CI), mean shift of the center of mass (COM), with the standard deviation, were quantified for both CT and MRI. The CVS showed that MRI and CT provide about equal optimal visibility of the LC. If the CVS was high, magnetic resonance imaging provided more detail of the interfaces of the LC seroma with the unaffected GBT. MRI also pictured in more detail the interfaces of axillary seromas (if present) with their surroundings and their relationship to the LC. Three observers delineated smaller, and one observer larger, LC volumes comparing the MRI- and CT-derived delineations. The mean ± standard deviation CI was 32% ± 25% for MRI and 52% ± 21% for CT. The mean ± standard deviation COM shift was 11 ± 10 mm (range 1-36) for MRI and 4 ± 3 mm (range 1-10) for CT. MRI does not add additional information to CT in cases in which the CVS is assessed as low. The conformity (CI) is lower for MRI than for CT, especially at a low CVS owing to greater COM shifts for MRI, probably caused by inadequate visibility of the surgical clips on magnetic resonance (MR) images. The COM shifts seriously dictate a decline in the CI more than the variability of the LC volumes does. In cases in which MRI provides additional information, MRI must be combined with the CT/surgical clip data.International journal of radiation oncology, biology, physics 06/2011; 82(4):1332-40. · 4.59 Impact Factor -
Article: MR imaging: effectiveness and costs at triage of patients with nonacute knee symptoms.
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ABSTRACT: To prospectively evaluate the cost and effectiveness of magnetic resonance (MR) imaging performed to exclude the need for arthroscopy in patients with nonacute knee symptoms who are highly suspected clinically of having intraarticular knee abnormality. The study was approved by the institutional review boards of three hospitals; informed patient consent was obtained. All 584 included patients (406 male, 178 female; mean age, 31.1 years+/-8.0 [standard deviation]) underwent MR imaging. Patients with an MR result positive for the diagnosis of intraarticular knee abnormality underwent arthroscopy (group A). Patients with a negative MR result were randomly assigned to undergo either conservative (group B) or arthroscopic (group C) treatment. Treatment was considered effective if the Noyes function score had increased 10% or more at 6 months. A cost analysis was performed from a societal perspective to compare the treatment strategy involving MR imaging with the strategy not involving MR imaging. Of the 584 patients, 294 (50.3%) were assigned to group A; 149 (25.5%), to group B; and 141 (24.1%), to group C. At 6 months, the number of patients effectively treated in group B (conservative treatment) was a mean of 5.1%+/-10.0 larger than the number of patients effectively treated in group C (arthroscopy). Owing to savings in productivity costs, total societal costs were lower with use of the strategy involving MR imaging by a mean of $153+/-488 (P=.54). MR imaging can be used without additional costs or disadvantageous effects on function to obviate arthroscopy in patients with nonacute knee symptoms who are highly suspected of having intraarticular knee abnormality.Radiology 02/2007; 242(1):85-93. · 5.73 Impact Factor -
Article: The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study.
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ABSTRACT: To assess the accuracy of shoulder infiltrations in the subacromial bursa (SAB) by a posterior or an anteromedial approach. Magnetic resonance imaging (MRI) and clinical outcome were used for evaluation. A prospective randomized study. Thirty-three patients (22 women, 11 men; average age, 46 years; range, 25 to 64 years) with clinical signs of subacromial impingement were infiltrated with a mixture of bupivacaine, methylprednisolone, and gadolinium-DTPA directly followed by MRI to determine the actual site of injection. The SAB was randomly infiltrated posteriorly (n = 17) or anteromedially (n = 16). Injection confidence of the surgeon and body-mass index of the patient were recorded. Follow-up consisted of the Constant Score, Simple Shoulder Test, and visual analog scale score for pain taken within 24 hours and 6 weeks after infiltration. Thirteen injections (76%) were in the SAB with a posterior approach and 10 (69%) with an anteromedial approach. Many surrounding structures were hit as well, especially the rotator cuff. A positive correlation between the injection confidence of the orthopaedic surgeon and the MRI was found in 66%. Only injection of the SAB alone resulted in a significant decrease of the pain (P = .004) and an increase in the functional scores. Injection in the bursa and rotator cuff muscle showed a significant increase in pain (P = .032) but no change in clinical scores. The body mass index had no influence on the scores. Injections in the SAB are inaccurate, despite the confident feeling of the clinician. The finding that many different structures can be infiltrated with 1 injection can create both false-positive and -negative results. Level II.Arthroscopy The Journal of Arthroscopic and Related Surgery 04/2006; 22(3):277-82. · 3.02 Impact Factor -
Article: Clinical consequences of bone bruise around the knee.
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ABSTRACT: The aim of this study is to evaluate the relation between bone bruise and (peri-)articular derangement and to assess the impact of bone bruise on presentation and short term course of knee complaints. We recorded MR abnormalities in 664 consecutive patients with sub-acute knee complaints. Patients were divided in four groups: patients with and without intra-articular knee pathology, subdivided in patients with and without bone bruise. We assessed function and symptoms at the time of MR and 6 months thereafter. Bone bruises were diagnosed in 124 of 664 patients (18.7%). Patients with bone bruise had significantly more complete ACL, lateral meniscal, MCL and LCL tears. Both with and without intra-articular pathology patients with bone bruise had a significantly poorer function at the time of MR (Noyes score of, respectively, 313.21 versus 344.81 and 306.98 versus 341.19). Patients with bone bruise and intra-articular pathology showed significantly more decrease in activity (decrease of Tegner score from 6.28 to 2.12 versus 5.70-2.55). At 6 months there were no significant differences in clinical parameters between the four groups. We concluded that bone bruise in combination with MCL tear is an important cause of initial clinical impairment in patients with sub-acute knee complaints. Clinical improvement within 6 months is more pronounced than in patients without bone bruise.European Radiology 02/2006; 16(1):97-107. · 3.22 Impact Factor -
Article: Radiographic evaluation of the knee joint after meniscal allograft transplantation. An experimental study in rabbits.
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ABSTRACT: Experimental and clinical studies have documented that meniscal allografts show capsular ingrowth in meniscectomized knees. However, it remains to be established whether meniscal allograft transplantation can prevent degenerative changes after total meniscectomy. In this study radiography was used to compare changes in rabbit knees after meniscectomy and after meniscal transplantation. Thirty-two mature female New Zealand rabbits were divided into five groups: group A ( n=6) and group C ( n=6) underwent meniscectomy; group B ( n=7) and group D ( n=6) were subjected to meniscal transplantation immediately after meniscectomy; in group E ( n=7) a delayed meniscus transplantation was performed 6 weeks after meniscectomy. Radiographic changes were evaluated 6 weeks (groups A, B) and 1 year (groups C-E) postoperatively. One year after surgery both meniscectomized and transplanted knees showed significantly more radiographic changes than after 6 weeks. At 1-year follow-up no statistically significant radiographic differences were found between the joints that had undergone meniscectomy and those that were subjected to immediate or delayed meniscal transplantation. Our findings suggest that meniscal allograft transplantation does not prevent degenerative changes in the rabbit knee on a long term.Knee Surgery Sports Traumatology Arthroscopy 08/2002; 10(4):241-6. · 2.21 Impact Factor
