Cécile de Monyé

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (14)46.07 Total impact

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    ABSTRACT: In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations. The study group consisted of 123 consecutive patients diagnosed with either breast cancer or ductal carcinoma in situ eligible for breast-conserving surgery between April 2007 and July 2010. For these patients, a first plan for breast-conserving surgery was made on the basis of clinical examination and conventional imaging. The final surgical plan was made with knowledge of the preoperative breast MRI. The rates of tumor-positive resection margins and reoperations were compared with those of a historical control group consisting of 119 patients who underwent 123 breast-conserving procedures between January 2005 and December 2006. The percentage of change in the surgical plan was recorded. Preoperative breast MRI changed the surgical plan to more extensive surgery in 42 patients (34.1%), mainly to mastectomy (29 patients, 23.6%). Ninety-four patients underwent 95 breast-conserving procedures. Significantly fewer patients had tumor-positive resection margins than in the control group (15.8%, 15/95 versus 29.3%, 36/123; p < 0.01). Patients in the study group underwent significantly fewer reoperations compared with the historical control group (18.9%, 18/95 vs 37.4%, 46/123; p < 0.01). Preoperative breast MRI can substantially decrease the rate of tumor-positive resection margins and reoperations in breast cancer patients eligible for breast-conserving surgery.
    American Journal of Roentgenology 02/2013; 200(2):304-10. · 2.90 Impact Factor
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    ABSTRACT: To assess the effectiveness and cost-effectiveness of state-of-the-art noninvasive diagnostic imaging strategies in patients with a transient ischemic attack (TIA) or minor stroke who are suspected of having carotid artery stenosis (CAS). All prospectively evaluated patients provided informed consent, and the local ethics committee approved this study. Diagnostic performance, treatment, long-term events, quality of life, and costs resulting from strategies employing duplex ultrasonography (US), computed tomographic (CT) angiography, contrast material-enhanced magnetic resonance (MR) angiography, and combinations of these modalities were modeled in a decision tree and Markov model. Data sources included a prospective diagnostic cohort study, a meta-analysis, and a review of the literature. Outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and net health benefits (QALY-equivalents), with a willingness-to-pay threshold of euro 50,000 per QALY and a societal perspective. The strategy with the highest net health benefit was considered the most cost effective. Extensive one-way, two-way, and probabilistic sensitivity analyses to explore the effect of varying parameter values were performed. The reference case analysis assumed that patients underwent surgery 2-4 weeks after the first symptoms, and the effect of earlier intervention was explored. The reference case analysis showed that duplex US combined with CT angiography and surgery for 70%-99% stenoses was the most cost-effective strategy, with a net health benefit of 13.587 and 15.542 QALY-equivalents in men and women, respectively. In men, the CT angiography strategy with a 70%-99% cutoff yielded slightly more QALYs, at an incremental cost of euro 71,419 per QALY, compared with duplex US combined with CT angiography. In patients with a high-risk profile, in patients with a high prior probability of disease, and when patients could be treated within 2 weeks after the first symptoms, the CT angiography strategy with surgery for 50%-99% stenoses was the most cost-effective strategy. In diagnosing CAS, duplex US should be the initial test, and, if its results are positive, CT angiography should be performed; patients with 70%-99% stenoses should then undergo carotid endarterectomy. In patients with a high-risk profile, a high probability of CAS, or who can undergo surgery without delay, immediate CT angiography and surgery for 50%-99% stenoses is indicated.
    Radiology 08/2010; 256(2):585-97. · 6.34 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the volume and the composition of atherosclerotic plaque in symptomatic carotid arteries and to investigate the relationship between these plaque features and the severity of stenosis and the presence of cardiovascular risk factors. One hundred patients with cerebrovascular symptoms underwent CT angiography. We measured plaque volume (PV) and the relative contribution of plaque components (calcifications, fibrous tissue, and lipid) in the symptomatic artery. The contribution of different components was measured as the number of voxels within defined ranges of HU values (calcification >130 HU, fibrous tissue 60-130 HU, lipid core <60 HU). Fifty-seven patients had atherosclerotic plaque in the symptomatic carotid artery. The severity of stenosis and PV were moderately correlated. Age and smoking were independently related to PV. Patients with hypercholesterolemia had significantly less lipid and more calcium in their plaques than patients without hypercholesterolemia. Other cardiovascular risk factors were not significantly related to PV or plaque composition. Luminal stenosis of the carotid artery partly reflects the amount of atherosclerotic carotid disease. Plaque volume and plaque composition are associated with cardiovascular risk factors.
    European Radiology 05/2009; 19(9):2294-301. · 4.34 Impact Factor
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    ABSTRACT: The amount of atherosclerotic plaque and its components (calcifications, fibrous tissue, and lipid core) could be better predictors of acute events than the now currently used degree of stenosis. Therefore, we evaluated a dedicated software tool for volume measurements of atherosclerotic carotid plaque and its components in multidetector computed tomography angiography (MDCTA) images. Data acquisition was approved by the Institutional Review Board and all patients gave written informed consent. MDCTA images of 56 carotid arteries were analyzed by three observers. Plaque volumes were assessed by manual drawing of the outer vessel contour. The luminal boundary was determined based on a Hounsfield-Unit (HU) threshold. The contribution of different components was measured by the number of voxels within defined ranges of HU-values (calcification >130 HU, fibrous tissue 60-130 HU, lipid core <60 HU). Interobserver variability (IOV) was assessed. Plaque volume was 1,259 +/- 621 mm3. The calcified, fibrous and lipid volumes were 238 +/- 252 mm3, 647 +/- 277 mm3 and 376 +/- 283 mm3, respectively. IOV was moderate with interclass correlation coefficients (ICC) ranging from 0.76 to 0.99 and coefficients of variation (COV) ranging from 3% to 47%. Atherosclerotic carotid plaque volume and plaque component volumes can be assessed with MDCTA with a reasonable observer variability.
    The International Journal of Cardiovascular Imaging 03/2008; 24(7):751-9. · 2.65 Impact Factor
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    ABSTRACT: Fetal origin of the posterior cerebral artery (PCA) is not uncommon. Whether patients with this anomaly have a higher risk of ischemic stroke in the territory of the PCA is not known. The clinical benefit of screening for a fetal origin in patients with TIA or stroke in the territory of the PCA and an ipsilateral atherosclerotic carotid stenosis is not clear. This study assessed the frequency of a fetal origin of the PCA in patients with a TIA or infarct in the territory of the PCA with 16-multidetector-row CT angiography (CTA). 82 patients (52 male; mean age = 64; range 19 to 90 years) with isolated homonymous hemianopia and/or a PCA infarct underwent CTA of the carotid artery and circle of Willis. A fetal origin of the PCA at the symptomatic side was present in 14 patients (17 %) and at the asymptomatic side in 18 patients (22%) (OR: 0.7; 95 % CI: 0.3 to 1.7). Severity of stenosis (NASCET criteria) of the ICA at the symptomatic side was < 30%, 30-49% and > or = 50% in 72, 2 and 8 patients, respectively. Number and frequency of a fetal origin in these groups were 12 (17 %), 0 (0%) and 2 (25 %), respectively. There was no association between a severe carotid stenosis and a fetal origin of the PCA at the symptomatic side. This study does not provide arguments for an increased risk of ischemic stroke in the territory of the PCA in patients with a fetal origin of the PCA. A few patients with a TIA or infarct in the territory of the PCA have a fetal origin of the PCA in combination with a high-grade stenosis of the ipsilateral ICA, but not more often than one would expect from chance. Nevertheless, these patients may benefit from carotid endarterectomy.
    Journal of Neurology 02/2008; 255(2):239-45. · 3.58 Impact Factor
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    ABSTRACT: Vessel image analysis is crucial when considering therapeutical options for (cardio-) vascular diseases. Our method, VAMPIRE (Vascular Analysis using Multiscale Paths Inferred from Ridges and Edges), involves two parts: a user defines a start- and endpoint upon which a lumen path is automatically defined, and which is used for initialization; the automatic segmentation of the vessel lumen on computed tomographic angiography (CTA) images. Both parts are based on the detection of vessel-like structures by analyzing intensity, edge, and ridge information. A multi-observer evaluation study was performed to compare VAMPIRE with a conventional method on the CTA data of 15 patients with carotid artery stenosis. In addition to the start- and endpoint, the two radiologists required on average 2.5 (SD: 1.9) additional points to define a lumen path when using the conventional method, and 0.1 (SD: 0.3) when using VAMPIRE. The segmentation results were quantitatively evaluated using Similarity Indices, which were slightly lower between VAMPIRE and the two radiologists (respectively 0.90 and 0.88) compared with the Similarity Index between the radiologists (0.92). The evaluation shows that the improved definition of a lumen path requires minimal user interaction, and that using this path as initialization leads to good automatic lumen segmentation results.
    European Radiology 08/2007; 17(7):1738-45. · 4.34 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of this article is to describe two cases in which fibromuscular dysplasia of the internal carotid artery was diagnosed with CT angiography. CONCLUSIONS: CT angiography can depict the characteristic findings of fibromuscular dysplasia. If patients with cerebrovascular symptoms undergo screening with CT angiography of the supraaortic vessels, more cases of fibromuscular dysplasia will be recognized as a cause of neurologic symptoms.
    American Journal of Roentgenology 05/2007; 188(4):W367-9. · 2.90 Impact Factor
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    ABSTRACT: The objective of our study was to compare the effect of a caudocranial scan direction versus a craniocaudal scan direction on arterial enhancement and perivenous artifacts in 16-MDCT angiography of the supraaortic arteries. Eighty consecutive patients (51 men; mean age, 62 years; age range, 28-89 years) underwent scanning in the caudocranial direction (group 1; n = 40) or the craniocaudal direction (group 2; n = 40). All patients received 80 mL of contrast material followed by a 40-mL saline chaser bolus, both administered IV at 4 mL/sec. Bolus tracking was used. Attenuation inside the arterial lumen was measured at intervals of 1 sec throughout the data set. Attenuation in the superior vena cava (SVC) was measured. Contrast material-related perivenous artifacts were graded on a scale of 0-3 (none to extensive). Attenuation in the ascending aorta, carotid bifurcation, and intracranial arteries was slightly lower in group 2 versus group 1 (231 +/- 64 H, 348 +/- 52 H, and 258 +/- 48 H vs 282 +/- 43 H, 381 +/- 73 H, and 291 +/- 77 H, respectively; p < 0.05). Maximum and mean arterial attenuations were slightly lower in group 2 versus group 1 (369 +/- 58 H and 303 +/- 48 H vs 401 +/- 71 H and 334 +/- 58 H; p < 0.05). Attenuation in the SVC was much lower in group 2 versus group 1 (169 +/- 39 H vs 783 +/- 330 H; p < 0.001). Mean streak artifact score was much lower in group 2 versus group 1 (1.3 +/- 0.9 vs 2.5 +/- 0.6; p < 0.001). Use of a craniocaudal scan direction results in slightly lower attenuation of the carotid artery and much lower attenuation of the SVC. Streak artifacts are significantly reduced. This technique allows better evaluation of the ascending aorta and supraaortic arteries.
    American Journal of Roentgenology 06/2006; 186(6):1737-45. · 2.90 Impact Factor
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    ABSTRACT: The objective of this study was to compare intracoronary attenuation on 16-row multislice computed tomography (16-MSCT) coronary angiography using 2 contrast materials (CM) with high iodine concentration. Forty consecutive patients (29 male, 11 female; mean age, 61+/-11 years) with suspected coronary artery disease were randomized to 2 groups to receive 100 mL of either iopromide 370 (group 1: Ultravist 370, 370 mg iodine/mL; Schering AG, Berlin, Germany) or iomeprol 400 (group 2: Iomeron 400, 400 mg iodine/mL; Bracco Imaging SpA, Milan, Italy). Both CM were administered at a rate of 4 mL/s. All patients underwent 16-MSCT coronary angiography (Sensation 16; Siemens, Germany) with collimation 16 x 0.75 mm and rotation time 375 ms. The attenuation in Hounsfield units (HU) achieved after each CM was determined at regions of interest (ROIs) placed at the origin of coronary arteries and on the ascending aorta, descending aorta, and pulmonary artery. Differences in mean attenuation in the coronary arteries and on the ascending aorta, descending aorta, and pulmonary artery were evaluated using Student t test. The mean attenuation achieved at each anatomic site was consistently greater after iomeprol 400 than after iopromide 370. At the origin of coronary arteries, the mean attenuation after iomeprol 400 (340+/-53 HU) was greater (P<0.05) than that after iopromide 370 (313+/- 42 HU). Similar findings were noted for the mean attenuation in the ascending aorta, descending aorta, and pulmonary artery. The intravenous administration of iomeprol 400 provides higher attenuation of the coronary arteries and of the great arteries of the thorax as compared with iopromide 370 using the same injection parameters.
    Investigative Radiology 04/2006; 41(3):349-53. · 5.46 Impact Factor
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    ABSTRACT: The aim of the study was to evaluate a new method for automated definition of a center lumen line in vessels in cardiovascular image data. This method, called VAMPIRE, is based on improved detection of vessel-like structures. A multiobserver evaluation study was conducted involving 40 tracings in clinical CTA data of carotid arteries to compare VAMPIRE with an established technique. This comparison showed that VAMPIRE yields considerably more successful tracings and improved handling of stenosis, calcifications, multiple vessels, and nearby bone structures. We conclude that VAMPIRE is highly suitable for automated definition of center lumen lines in vessels in cardiovascular image data.
    European Radiology 03/2006; 16(2):391-8. · 4.34 Impact Factor
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    ABSTRACT: To prospectively compare different volumes of intravenously administered contrast material with and without a bolus chaser at 16-detector row computed tomographic (CT) angiography of the carotid arteries. Institutional Review Board approval and informed consent were obtained. Seventy-five consecutive patients (44 men, 31 women; mean age, 63 years; range, 22-85 years) were allocated to one of three protocols: group 1, 80 mL of contrast material; group 2, 80 mL of contrast material followed by 40 mL of saline; and group 3, 60 mL of contrast material followed by 40 mL of saline. Bolus tracking was used to synchronize contrast material injection with CT scanning. The attenuation in Hounsfield units was measured from the ascending aorta to the intracranial arteries at 1-second intervals. Differences were tested with the Student t test. The maximum attenuation was reached in the proximal internal carotid artery in all groups. The addition of a bolus chaser to 80-mL contrast material resulted in a higher mean attenuation (323 HU +/- 39 vs 351 HU +/- 60, P = .06), higher maximum attenuation (393 HU +/- 53 vs 425 HU +/- 76, P = .09), and higher minimum attenuation (240 HU +/- 34 vs 264 HU +/- 48, P < .05). Group 3 had lower mean, maximum, and minimum attenuation than did groups 1 and 2 (P < .001). The addition of a bolus chaser to 80 mL of contrast material results in a slightly higher attenuation. Decreasing the volume of contrast material from 80 to 60 mL results in a significantly lower attenuation.
    Radiology 11/2005; 237(2):555-62. · 6.34 Impact Factor
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    ABSTRACT: LEARNING OBJECTIVES 1. Describe the features of a new generation of multislice CT scanner2. Describe the protocol and issues related to the cardiovascular imaging of the head and neck 3. Provide clinical examples of cardiovascular diseases of head and neck ABSTRACT Sixteen-slice Computed Tomography (CT) has significantly improved the capabilities for non-invasive angiography in all the regions of the body. The improvement was larger in regions where vessels are smaller in diameter and show a more tortuous anatomy. These regions are the heart and the carotido-vertebral circulation.A new generation of multislice CT scanner characterized with higher spatial and temporal resolution has been introduced. This will reduce the scan time for head and neck vascular run-off In this exhibit we describe a new generation of multislice CT scanner able to scan 64 slices per rotation with a voxel size of 0.3x0.3x0.4mm, and a rotation time of 0.33s (effective temporal resolution up to 165ms). Technical issues are described and clinical examples are provided. DISCLOSURE K.S.,T.G.F.: Employees, Siemens AG.
    Radiological Society of North America 2004 Scientific Assembly and Annual Meeting; 11/2004
  • Cecile De Monye
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    ABSTRACT: HTML Purpose: To compare different volumes of contrast material with and without a bolus chaser for CT angiography of the carotid artery with a 16-slice multidetector CT scanner. Methods and Materials: 75 consecutive patients (50 male; mean age=62; range 22-85yrs) were enrolled for the study. The first 25 patients (group 1) received 80 cc contrast material, the second 25 patients (group 2) received 80 cc contrast material followed by 40 cc saline and the last 25 patients (group 3) received 60 cc contrast material followed by 40 cc saline. CT angiography was performed with a 16-slice MDCT scanner (Sensation 16, Siemens, Germany). Scan volume ranged from the ascending aorta to the intracranial circulation. Scan parameters: number of detectors/collimation 16/0.75 mm, feed/rotation 12 mm, rotation time 0.5 sec. CTA scan was started when bolus tracking measured an increase in density in the ascending aorta of 75 Hounsfield Units (HU). A region of interest inside the vessel lumen was measured in each scan throughout the data set, with a 1 second interval. Results: The mean HU in the ascending aorta in group 1, 2 and 3 was 281 � 35 HU, 310 � 43 HU and 270 � 48 HU, respectively (group 1 vs 2 and 2 vs 3: p<0.01). The mean HU in the internal carotid artery in group 1, 2 and 3 was 380 � 53 HU, 410 � 86 HU and 293 � 71 HU, respectively (group 2 vs 3: p<0.01). The mean HU in the intracranial vessels in group 1, 2 and 3 was 286 � 67 HU, 286 � 59 HU and 196 � 47 HU, respectively (group 2 vs 3: p<0.01). The maximum enhancement in group 1, 2 and 3 was 385 � 53 HU, 418 � 79 HU and 317 � 68 HU, respectively (group 2 vs 3: p<0.01). The mean enhancement in group 1, 2 and 3 was 321 � 42 HU, 344 � 58 HU and 263 � 53 HU, respectively (group 2 vs 3: p<0.01). Conclusion: The use of a bolus chaser following 80 cc of contrast material provides a slightly higher opacification, but not significant in the internal carotid artery and intracranial vessels. Lowering the amount of contrast material from 80 cc to 60 cc results in a significantly lower opacification of the vessel lumen, especially in the proximal internal carotid artery and intracranial vessels. The optimal strategy is 80 cc contrast material followed by 40 cc saline. Questions about this event email: c.demonye@erasmusmc.nl
    Radiological Society of North America 2003 Scientific Assembly and Annual Meeting; 12/2003
  • Cecile De Monye
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    ABSTRACT: HTML The current modality of choice for the analysis of the carotid artery is ultrasound (duplex) and magnetic resonance imaging. Multidetector CT angiography (MDCTA)has proven to be a powerful tool for vessel visualization. The high spatial and temporal resolution of MDCTA allows an accurate analysis of both carotid and vertebral arteries from the aortic arch to the intracranial circulation. The potential of MDCTA can be effectively appreciated with an optimized protocol for MDCTA, which is described and explained. In addition, three-dimensional post-processing techniques are described. Images of atherosclerotic disease in the aorta, the origin of the supra-aortic arteries, the carotid bifurcation and the intracranial internal carotid arteries are shown. The advantages and pitfalls of semi-automated vessel analysis tools are demonstrated. 1.Describe an optimized multi-detector CT angiography protocol with post-processing techniques for the study of arteries of the neck. 2.Describe the image characteristics and location of atherosclerotic disease from the aorta to the intracranial circulation. 3.Describe the application of semi-automated vessel analysis tools. Questions about this event email: c.demonye@erasmusmc.nl
    Radiological Society of North America 2003 Scientific Assembly and Annual Meeting; 11/2003

Publication Stats

179 Citations
46.07 Total Impact Points

Institutions

  • 2005–2008
    • Erasmus MC
      • Department of Radiology
      Rotterdam, South Holland, Netherlands
  • 2006–2007
    • Erasmus Universiteit Rotterdam
      • Department of Radiology
      Rotterdam, South Holland, Netherlands