Koen L Vincken

• University Medical Center Utrecht

Aims To meet the flexible learning needs of pathology residents preparing for national board examinations, a joint distance learning approach was developed using both asynchronous and synchronous activities with whole slide images, drawing on empirical educational research on online distance learning. Methods In a case study of an implementation o...

Microscopy is an essential basis for exploring and understanding pathological disease mechanisms. As a discipline, pathology is highly dependent on visual imaging technologies. Currently, digital pathology is a standard method with special advantages in both clinical histopathological diagnostics as well as the education of (undergraduate and postg...

BACKGROUND AND PURPOSE: The clinical relevance of cortical microinfarcts has recently been established; however, studies on microinfarcts in the deep gray matter are lacking. We examined the risk factors and MR imaging correlates of microinfarcts in the deep gray matter on 7T MR imaging and their relation to cognitive functioning. MATERIALS AND MET...

Background and purpose: The clinical relevance of cortical microinfarcts has recently been established; however, studies on microinfarcts in the deep gray matter are lacking. We examined the risk factors and MR imaging correlates of microinfarcts in the deep gray matter on 7T MR imaging and their relation to cognitive functioning. Materials and m...

Objective Knee Image Digital Analysis (KIDA) is standardized radiographic analysis software for measuring osteoarthritis (OA) characteristics. It was validated in mild OA, but used for severe OA as well. The current goal was to evaluate the performance of KIDA in severe OA. Design Of 103 patients, standardized radiographs were performed before and...

The current study used theories on expertise development (the holistic model of image perception and the information reduction hypothesis) as a starting point to identify and explore potentially relevant process measures to monitor and evaluate expertise development in radiology residency training. It is the first to examine expertise development i...

Objective: High tibial osteotomy (HTO) and knee joint distraction (KJD) are treatments to unload the osteoarthritic (OA) joint with proven success in postponing a total knee arthroplasty (TKA). While both treatments demonstrate joint repair, there is limited information about the quality of the regenerated tissue. Therefore, the change in quality...

Purpose To define the longitudinal rotation axis around which individual vertebrae rotate, and to establish the various extra- and intravertebral rotation patterns in thoracic adolescent idiopathic scoliosis (AIS) patients, for better understanding of the 3D development of the rotational deformity. Methods Seventy high-resolution CT scans from an...

The interpretation of medical images is a primary task for radiologists. Besides two-dimensional (2D) images, current imaging technologies allow for volumetric display of medical images. Whereas current radiology practice increasingly uses volumetric images, the majority of studies on medical image interpretation is conducted on 2D images. The curr...

Background Patients with adolescent idiopathic scoliosis (AIS) are usually investigated by serial imaging studies during the course of treatment, some imaging involves ionizing radiation, and the radiation doses are cumulative. Few studies have addressed the correlation of spinal deformity captured by these different imaging modalities, for which p...

Introduction: Clinical reasoning in diagnostic imaging professions is a complex skill that requires processing of visual information and image manipulation skills. We developed a digital simulation-based test method to increase authenticity of image interpretation skill assessment. Methods: A digital application, allowing volumetric image viewin...

Background Misinterpretation of medical images is an important source of diagnostic error. Errors can occur in different phases of the diagnostic process. Insight in the error types made by learners is crucial for training and giving effective feedback. Most diagnostic skill tests however penalize diagnostic mistakes without an eye for the diagnost...

Background Since abnormal loading can cause onset and progression of OA, unloading the affected compartment of an osteoarthritic knee, should slow down OA progression, or even enable joint repair. High tibial osteotomy (HTO) is a well-known unloading approach for treating unilateral compartment osteoarthritis (OA) with mechanical axis deviation. Tr...

Study design: Cross-sectional study. Objective: To establish the relevance of the conventional two-dimensional (2D) RVAD and the relationship with the complex three-dimensional (3D) apical morphology in scoliosis. Summary of background data: The rib vertebra angle difference (RVAD, also known as Mehta's angle) describes apical rib asymmetry on...

Rationale and objectives: Radiology expertise is dependent on the use of efficient search strategies. The aim of this study is to investigate the effect of teaching search strategies on trainee's accuracy in detecting lung nodules at computed tomography. Materials and methods: Two search strategies, "scanning" and "drilling," were tested with a...

Study design: Cross-sectional. Objectives: To quantify the asymmetry of the vertebral bodies and pedicles in the true transverse plane in adolescent idiopathic scoliosis (AIS) and to compare this with normal anatomy. Summary of background data: There is an ongoing debate about the existence and magnitude of the vertebral body and pedicle asymm...

Computerized methods promise quick, objective, and sensitive tools to quantify progression of radiological damage in rheumatoid arthritis (RA). Measurement of joint space width (JSW) in finger and wrist joints with these systems performed comparable to the Sharp–van der Heijde score (SHS). A next step toward clinical use, validation of precision an...

Introduction: Virtual 3D models are powerful tools for teaching anatomy. At the present day, there are a lot of different digital anatomy models, most of these commercial applications are based on a 3D model of a human body reconstructed from images with a 1 millimeter intervals. The use of even smaller intervals may result in more details and mor...

Medical image interpretation is moving from using 2D- to volumetric images, thereby changing the cognitive and perceptual processes involved. This is expected to affect medical students' experienced cognitive load, while learning image interpretation skills. With two studies this explorative research investigated whether measures inherent to image...

Study design: Cross-sectional. Objective: To investigate the presence and magnitude of anterior spinal overgrowth in neuromuscular scoliosis and compare this to the same measurements in idiopathic scoliosis and healthy spines. Summary of background data: Anterior spinal overgrowth has been described as a potential driver for the onset and prog...

Objectives: To compare as proof of concept the sensitivity to change of automated quantification of radiographic wrist and hand joint space width (JSW) with scoring JSW according to the Sharp/van der Heijde scoring method (SHS) in two strategy groups of a treat-to-target and tight-control early rheumatoid arthritis (RA) study. Methods: Digital r...

Introduction: Although much attention has been given to the global three-dimensional aspect of adolescent idiopathic scoliosis (AIS), the accurate three-dimensional morphology of the primary and compensatory curves, as well as the intervening junctional segments, in the scoliotic spine has not been described before. Methods: A unique series of 7...

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Introduction Several studies have reported asymmetry of the vertebral bodies and between the concave and convex pedicles in AIS. There is ongoing debate about its magnitude and whether this caused by a primary growth disturbance, or is secondary to inherent asymmetrical loading within the curvature. The objective of this study is to quantify the as...

Novelty detection is concerned with identifying test data that differs from the training data of a classifier. In the case of brain MR images, pathology or imaging artefacts are examples of untrained data. In this proof-of-principle study, we measure the behaviour of a classifier during the classification of trained labels (i.e. normal brain tissue...

Objectives Deep medullary veins support the venous drainage of the brain and may display abnormalities in the context of different cerebrovascular diseases. We present and evaluate a method to automatically detect and quantify deep medullary veins at 7 T. Methods Five participants were scanned twice, to assess the robustness and reproducibility of...

Medical image interpretation is moving from using 2D-to volumetric images, thereby changing the cognitive and perceptual processes involved. This is expected to affect medical students' experienced cognitive load, while learning image interpretation skills. With two studies this explorative research investigated whether measures inherent to image i...

Medical image interpretation is moving from using 2D-to volumetric images, thereby changing the cognitive and perceptual processes involved. This is expected to affect medical students' experienced cognitive load, while learning image interpretation skills. With two studies this explorative research investigated whether measures inherent to image i...

The assessment of joint space width (JSW) on hand X-ray images of patients suffering from rheumatoid arthritis (RA) is a time-consuming task. Manual assessment is semi-quantitative and is observer-dependent which hinders an accurate evaluation of joint damage, particularly in the early stages. Automated analysis of the JSW is an important step forw...

Many methods have been proposed for tissue segmentation in brain MRI scans. The multitude of methods proposed complicates the choice of one method above others. We have therefore established the MRBrainS online evaluation framework for evaluating (semi)automatic algorithms that segment gray matter (GM), white matter (WM), and cerebrospinal fluid (C...

Objectives: To compare computerised and conventional methodology of radiographic joint destruction assessment in early rheumatoid arthritis (RA). Methods: We investigated the contribution of the 3rd-to-5th carpometacarpal joints (CMC3-5, which are excluded in computerised assessment so far owing to bone overlapping) to total joint space narrowin...

Cerebral small-vessel disease and cerebral blood flow (CBF) are interrelated. However, the direction of the relationship is unknown, and longitudinal studies are scarce. We investigated the longitudinal relationship between CBF and white matter hyperintensities (WMHs) and lacunes, as representatives of cerebral small-vessel disease, in patients wit...

Cerebral small vessel disease is common in elderly persons and a leading cause of cognitive decline, dementia, and acute stroke. With the introduction of ultra-high field strength 7.0T MRI, it is possible to visualize small vessels in the brain. In this work, a proof-of-principle study is conducted to assess the feasibility of automatically detecti...

In current practice, radiologists interpret digital images, including a substantial amount of volumetric images. We hypothesized that interpretation of a stack of a volumetric data set demands different skills than interpretation of two-dimensional (2D) cross-sectional images. This study aimed to investigate and compare knowledge and skills used fo...

Radiology practice has become increasingly based on volumetric images (VIs), but tests in medical education still mainly involve two-dimensional (2D) images. We created a novel, digital, VI test and hypothesized that scores on this test would better reflect radiological anatomy skills than scores on a traditional 2D image test. To evaluate external...

Objectives: To investigate both cross-sectional and time-related changes of striatal and whole-brain microstructural properties in different stages of Huntington's disease (HD) using diffusion tensor imaging. Experimental design: From the TRACK-HD study, premanifest gene carriers (preHD), early manifest HD and controls were scanned at baseline a...

Rationale and objectives: Current radiology practice increasingly involves interpretation of volumetric data sets. In contrast, most radiology tests still contain only 2D images. We introduced a new testing tool that allows for stack viewing of volumetric images in our undergraduate radiology program. We hypothesized that tests with volumetric CT-...

was smaller (P=0.023), the posteriorly inclined segment was longer (P<0.001) and T1 and T3-T11 were more posteriorly inclined (P<0.05) compared to boys. At the peak of the growth spurt, girls still had a relatively lower thoracic kyphosis with more posterior inclination whereas boys already developed a greater thoracic kyphosis with less posterior...

To examine the cross-sectional and prospective associations between arterial stiffness and structural brain changes within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study, a prospective cohort study among patients with manifest arterial disease. Distension measurements of the common carotid arteries and a brain MRI...

Hemoglobin and hematocrit are important determinants of blood viscosity and arterial oxygen content and may therefore influence cerebral blood flow (CBF). We examined cross-sectional and prospective associations of hemoglobin and hematocrit with CBF in 569 patients with manifest arterial disease (mean age 57 ± 10 years) with available data on magne...

Automatedwhite matter hyperintensity (WMH) segmentation techniques for brain MRI often employ voxel-wise classifiers, trained on traditional features such as: multi-spectral MR image intensities, spatial location, texture, or shape. Recent studies show that diffusion tensor imaging (DTI) provides a measure for WMH, independent from the commonly use...

To assess reliability and construct validity of the Kellgren-Lawrence (K&L) scale in posttraumatic ankle osteoarthritis (OA); additionally evaluate the validity of including tibiotalar tilting in the scale. 150 ankle radiographs (75 patients, unilateral malleolar fractures) evaluated at average of 18 years after surgery. American Orthopaedic Foot &...

Objectives: To assess the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-value combinations for treatment evaluation after magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) of uterine fibroids. Methods: Fifty-six patients with 67 uterine fibroids...

Background Diffusion Tensor Imaging provides indirect information about the quality of the microstructural organisation of tissues. In this longitudinal study, cross-sectional as well as time-related changes of diffusion measures were assessed in (premanifest) Huntington’s disease using automated histogram analysis. Methods Twenty-two premanifest (...

Purpose: Adolescent idiopathic scoliosis occurs far more often in girls than in boys, and its initiation and progression normally takes place around the adolescent growth spurt. Despite extensive research into the topic, no solid explanation for both well-known phenomena has been offered. The sagittal profile of the growing spine has been demonstr...

Brain atrophy is a strong predictor for cognitive decline and dementia, and these are, in turn, associated with increased mortality in the general population. Patients with cardiovascular disease have more brain atrophy and a higher morbidity and mortality. We investigated if brain volumes on magnetic resonance imaging were associated with the risk...

The testing of image interpretation skills within the profession of Radiology (often paper- pencil) lags behind practice. To increase the authenticity of assessment of image interpretation skills, the Dutch national progress test for medical specialists in training to become radiologists, is digitized using the program VQuest. This programme makes...

Objective: Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors leading to atherosclerosis and diabetes. Diabetes is associated with both structural and functional abnormalities of the brain. MetS, even before diabetes is diagnosed, may also predispose to cerebral changes, probably through shared mechanisms. We examined the associ...

Study design: Cross-sectional study. Objective: To compare the relative contribution of the vertebral bodies and intervertebral discs with the 3-dimensional spinal deformity in adolescent idiopathic scoliosis. Summary of background data: There is an ongoing discussion about the causal role of skeletal growth processes in the etiopathogenesis o...

Purpose Human fully upright ambulation, with fully extended hips and knees, and the body’s center of gravity directly above the hips, is unique in nature, and distinguishes humans from all other mammalians. This bipedalism is made possible by the development of a lordosis between the ischium and ilium; it allows to ambulate in this unique bipedal m...

Objective To compare metal-induced artifacts from coiled intracranial aneurysms on 3.0-Tesla and 1.5-Tesla magnetic resonance angiography (MRA), since concerns persist on artifact enlargement at 3.0 Tesla. Materials and methods We scanned 19 patients (mean age 53; 16 women) with 20 saccular aneurysms treated with coils only, at 1.5 and 3.0 Tesla a...

We examined the association between brain atrophy and vascular brain lesions (i.e., white matter lesions [WMLs] or brain infarcts), alone or in combination, with decline in memory and executive functioning over 4 years of follow-up in 448 patients (57 ± 9.5 years) with symptomatic atherosclerotic disease from the Second Manifestations of ARTerial d...

The midsagittal surface separates the two hemispheres of the cerebrum. This surface is often typified as a geometrical plane: the midsagittal plane. However, in subjects with a considerable amount of naturally occurring brain torque, the midsagittal surface deviates to a large extent from a plane. In the present study, an automated method to extrac...

We estimated progression of brain atrophy and cerebrovascular lesions on MRI in a prospective cohort of patients with various manifestations of arterial disease. Within the SMART-MR study, using brain MRI data from baseline and after on average 3.9 years of follow-up, intracranial volume (ICV), total brain, cortical gray matter, ventricular, white...

PURPOSE Current radiology practice has become increasingly based on the digital interpretation of volumetric multi-planar-reconstruction images (MPR-images). Nevertheless, assessment of radiological image interpretation skills in medical education and postgraduate radiology training is still mainly based on two-dimensional (2D) images (only one or...

Background context: It has previously been shown that rotational stability of spinal segments is reduced by posteriorly directed shear loads that are the result of gravity and muscle tone. Posterior shear loads act on those segments of the spine that are posteriorly inclined, as determined by each individual's inherited sagittal spinal profile. Ac...

Using the simulator, two (virtual) human raters were simulated. Microbleed detection by these raters was simulated in two groups of subjects with different microbleed prevalence. The prevalence of microbleeds in the first group of subjects (L) was low, with on average 0.2 microbleeds/subject and a prevalence of 19%. The second group of subjects (H)...

Lesion-symptom mapping is a valuable tool for exploring the relation between brain structure and function. In order to perform lesion-symptom mapping, lesion delineations made on different brain CT images need to be transformed to a standardized coordinate system. The preferred choice for this is the MNI152 template image that is based on T1-weight...

Diabetes mellitus (DM) is associated with brain atrophy and vascular brain lesions. Cardiovascular disease is a key determinant in this association. We assessed whether DM increased the rate of progression of brain atrophy, vascular brain lesions, and cognitive decline in patients with symptomatic atherosclerotic disease. In 663 patients (58±10year...

Background context: The normal spine is not a symmetrical structure. In recent studies, we demonstrated the presence of an axial rotational pattern that is similar to what is seen in the most prevalent curve patterns in idiopathic scoliosis at different ages. This suggests that if the spine starts to decompensate into scoliosis, it follows this pr...

Background context: It is well known that spinal biomechanics and familial predisposition play an important role in the onset and evolution of idiopathic scoliosis. The relationship between the sagittal profile of the spine and spinal biomechanics has also been established in a number of studies. It has been suggested previously that a certain sag...

Cerebral microbleeds are associated with vascular disease and dementia. They can be detected on MRI and receive increasing attention. Visual rating is the current standard for microbleed detection, but is rater dependent, has limited reproducibility, modest sensitivity, and can be time-consuming. The goal of the current study is to present a tool f...

Importance: Studies have shown that both high and low blood pressure (BP) may play a role in the etiology of brain atrophy. High BP in midlife has been associated with more brain atrophy later in life, whereas studies in older populations have shown a relation between low BP and more brain atrophy. Yet, prospective evidence is limited, and the rel...

Background: Quantitative MRI of articular cartilage has rapidly developed in recent years and provides the clinician with a noninvasive tool to determine the biological consequence of an intervention. Purpose: To evaluate the quality of intra-articular cartilage, using the dGEMRIC scanning technique, 1 year after TruFit implantation. The hypothe...

Objective: Delayed gadolinium enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) facilitates non-invasive evaluation of the glycosaminoglycan content in articular cartilage. The primary aim of this study was to show that the dGEMRIC technique is able to monitor cartilage repair following regenerative cartilage treatment. Design: Th...

Lacunar lesions (LLs) and white matter lesions (WMLs) affect cognition. We assessed whether lesions located in specific white matter tracts were associated with cognitive performance taking into account total lesion burden. Within the Second Manifestations of ARTerial disease Magnetic Resonance (SMART-MR) study, cross-sectional analyses were perfor...

Known as “the invisible lesion”, cerebral microinfarcts have been attracting increased attention because of their key role in cognitive decline and dementia. Recently, cerebral microinfarcts have been visualized for the first time in vivo on high resolution 7.0 T MR images. The detection and scoring of microinfarcts requires extensive manual evalua...

The measurement of joint space width (JSW) in hand x-ray images of patients suffering from Rheumatoid Arthritis (RA) is a time consuming task for radiologists. Manual assessment lacks accuracy and is observer-dependent, which hinders an accurate evaluation of joint degeneration in early diagnosis and follow-up studies. Automatic analysis of the JSW...

Cerebral microbleeds are small bleedings in the human brain, detectable with MRI. Microbleeds are associated with vascular disease and dementia. The number of studies involving microbleed detection is increasing rapidly. Visual rating is the current standard for detection, but is a time-consuming process, especially at high-resolution 7.0 T MR imag...

Automatic detection of the mid-sagittal plane, separating both hemispheres of the brain, is useful in various applications. Several methods have been developed in the past years, applying different techniques to estimate the position of the mid-sagittal plane. These methods can be classified into three distinct classes: feature-based, global symmet...

The most common application of bone grafts is spinal fusion surgery, in which the use of iliac crest autograft is the gold standard. Harvesting of autograft however, requires an extra surgical procedure, which is associated with additional morbidity. Allograft is the well-known alternative, but is generally considered less effective in posterior fu...

Diffusion weighted MR imaging (DWI) plays an important role in the diagnosis of perinatal arterial ischemic stroke (PAIS) during the acute phase. Its derived apparent diffusion coefficient (ADC) can be used to quantify the diffusion restriction. Aim of the current study was to identify the changes in ADC values in the acute phase following PAIS. A...

Mean deep and periventricular white matter lesion (WML) volumes (mL) at baseline for patients with and without any antidepressant medication use, adjusted for age, sex and intracranial volume. Error bars indicate standard errors; statistically significant differences are indicated with an asterix (p value = 0.01)

Objectives: To investigate whether severity and progression of periventricular and deep white matter lesions (WML) and lacunar infarcts were associated with progression of brain atrophy. Methods: Within the SMART-MR study, a prospective cohort on MRI changes in patients with symptomatic atherosclerotic disease, 565 patients (57 ± 9 years) withou...

Many methods exist for the automatic extraction of the midsagittal plane from neuroimages, assuming bilateral symmetry. However, this assumption is incorrect owing to brain torque and the possible presence of pathology. In this paper, a method for extracting the curved midsagittal surface from brain images is presented. First, the method localizes...

Objective The clinical application of quantitative measurement of separate radiographic parameters of knee osteoarthritis (OA) might be hampered by a lack of reproducible semiflexed joint positioning during acquisition of radiographs. The influence of systematic variations in knee positioning on measurement of separate quantitative radiographic par...

MRI can be used to assess structural damage to the brain after aneurysmal subarachnoid hemorrhage. We tuned, validated, and applied k-Nearest Neighbor-based segmentation to quantify cerebral volumes on MRI 6 months after aneurysmal subarachnoid hemorrhage. After tuning, the accuracy of k-Nearest Neighbor-based segmentation was assessed with manual...

Although a relation between depression and white matter lesions (WML) is frequently observed, the direction of causation remains unknown. We investigated whether depressed mood was associated with baseline severity and change in WML volume during 4 years of follow-up, and the relative contribution of mood symptoms and antidepressant use to this rel...

The high tibial osteotomy (HTO) is an effective strategy for treatment of painful medial compartment knee osteoarthritis. Effects on cartilage quality are largely unknown. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) enables non-invasive assessment of cartilage glycosaminoglycan content. This study aimed to evaluate...

Background The clinical application of quantitative measurement of separate radiographic parameters of knee osteoarthritis (OA) might be hampered by a lack of reproducible joint positioning during acquisition of the radiographs. Objectives To evaluate which systematic variations in positioning of the knee towards the X-ray detector have an effect o...

A relationship between depression and mortality has been well established, but underlying mechanisms remain unclear. We investigated the influence of cerebral small vessel disease (CSVD), characterized by white matter lesions (WMLs) and lacunar infarcts, on the relationship between mood mortality during 6 years follow-up. Mood problems were assesse...

Detailed radiographic evaluation might enable the identification of osteoarthritis (OA) earlier in the disease. This study evaluated whether and which separate quantitative features on knee radiographs of individuals with recent onset knee pain are associated with incidence of radiographic OA and persistence and/or progression of clinical OA during...

Cerebral microbleeds (CMBs) are commonly detected on MRI and have recently received an increased interest, because they are associated with vascular disease and dementia. Identification and rating of CMBs on MRI images may be facilitated by semi-automatic detection, particularly on high-resolution images acquired at high field strength. For these i...

For more tailored treatment of osteoarthritis it is worthy to identify different subpopulations early in the disease. Objective of this study is to evaluate whether the sensitivity to detect progression of radiographic features, which may add to this identification, can be improved by quantitative measurement (using Knee Images Digital Analysis; KI...

High levels of angiotensin-converting-enzyme (ACE) may increase the risk of dementia through blood pressure elevation and subsequent development of cerebral small-vessel disease. However, high ACE levels may also decrease this risk through amyloid degradation which prevents brain atrophy. Within the SMART-MR study, a prospective cohort study among...

Introduction & aim: Pelvic morphology in the sagittal plane is usually described by the pelvic incidence (PI), pelvic tilt, and sacral slope. However, the ischium is not included in this assessment. Yet, the position and orientation of the ischium relative to the SI-joint is essential for enabling the typical human fully upright way of ambulation w...

Introduction and aim: It has been suggested that the sagittal spinal profile is partly hereditary. The relationship between the sagittal spinal profile and spinal biomechanics has also been established. In this study we test the hypothesis that the well-known familial trend in AIS may be explained by the inheritance of a sagittal spinal profile, th...

Aim: To evaluate the closure pattern and symmetry of the left and right neurocentral junctions (NCJs) in the normal growing spine, in relation to preexistent spinal rotation and to the convexity of the curve in idiopathic scoliosis. Methods: CT scans of the thorax and abdomen of 199 non-scoliotic children (0-16 years old), with indications other th...

To evaluate to what extent radiographic features of knees and hips that are normally related to osteoarthritis (OA) represent characteristics of an individual in addition to OA severity. We studied a cohort of individuals (n = 1002) with very early signs of hip and knee OA, from the Cohort Hip and Cohort Knee (CHECK) study. Baseline radiographs wer...