Raaijmakers, R.H.

Noninvasive evaluation of the celiac trunk and superior mesenteric artery with multislice CT in patients with chronic mesenteric ischaemia (Article)

2008-12-01T00:00:00Z

Purpose. This study sought to assess the role of multislice computed tomography (MSCT) in patients with suspected chronic mesenteric ischaemia (CMI). Materials and methods. Forty-five patients (29 men; mean age 68) underwent MSCT angiography of the abdomen for suspected CMI (main clinical finding: postprandial abdominal pain). The scan protocol was detectors/collimation 16/0.75 mm; feed 36 mm/s; rotation time 500 ms; increment 0.4 mm; 120-150 mAs and 120 kVp. A volume of 80 ml of contrast material was administered through an antecubital vein (rate 4 ml/s), followed by 40 ml of saline (rate 4 ml/s). Images were analysed on the workstation with different algorithms (axial image scrolling, multiplanar reconstructions, maximum intensity projection, volume rendering). Targeted central lumen-line reconstructions (curved reconstructions) were obtained along the celiac trunk (CeT) and superior mesenteric artery (SMA). Vessel occlusions and significant (>50%) stenosis were recorded. Results. Image generation and interpretation required 25 min. Stenosis and/or occlusions were detected in 29 (65%) cases on the CeT and in 32 (71%) on the SMA. Of those lesions (n=61), 44 (49%) were classified as not significant. In 16 (35%) cases, there was a simultaneous stenosis and/or occlusion of the CeT and SMA (confirmed by conventional angiography). In six (13%) cases, there were no lesions affecting the CeT, SMA or their branches (confirmed by clinical follow-up). Conclusions. MSCT angiography can play a major role in the detection of stenosis of the abdominal arteries in patients with suspected CMI.

hK2 and Free PSA, a Prognostic Combination in Predicting Minimal Prostate Cancer in Screen-Detected Men within the PSA Range 4-10 ng/ml (Article)

2007-11-01T00:00:00Z

Objectives: The purpose of screening for prostate cancer is to decrease the disease-specific mortality. However not every screen-detected prostate cancer is a threat to the patient's life. The risk of overdetection and subsequent overtreatment in prostate cancer has been recognised. The purpose of this investigation was to evaluate the role of tumour markers total PSA, free PSA, and hK2, and their combinations in predicting minimal prostate cancer. Methods: Within the European Randomized Study of Screening for Prostate Cancer (ERSPC), section Rotterdam, The Netherlands, prebiopsy serum samples were analysed for 100 selected men who underwent a radical prostatectomy for their screen-detected prostate cancer. All had a PSA value between 4 and 10 ng/ml prior to diagnosis. Minimal prostate cancer is defined as organ confined, Gleason score ≤6 (no Gleason grade 4 or 5), and tumour volume <0.5 ml. Results: Sera and tumour volumes from 91 men were available for analysis. Minimal prostate cancer was diagnosed in 16.5% of the selected cases. Mean tumour volume was 1.2 ml (range: 0.04-13.5); hK2, the algorithms hK2/fPSA, and hK2/%fPSA have significant correlations with tumour volume. Both algorithms also yielded the best test results in predicting minimal disease with an area under the receiver operator characteristics curve of 82%. Conclusions: hK2 and percent free PSA have added prognostic value for the detection of minimal prostate cancer in screen-detected cases within PSA range 4-10 ng/ml. These biomarkers can possibly be used to select less invasive treatment options like active surveillance and to prevent overtreatment.

Overall and Disease-Specific Survival of Patients with Screen-Detected Prostate Cancer in the European Randomized Study of Screening for Prostate Cancer, Section Rotterdam (Article)

2007-02-01T00:00:00Z

Introduction: This report describes survival data of participants of the European Randomized Study of Screening for Prostate Cancer (ERSPC), section Rotterdam, diagnosed with prostate cancer (pCA) during the first round of screening, the prevalence screen. Patients and methods: pCA characteristics from cases diagnosed during the first screening round from December 1993 to March 2000 are shown. During follow-up, data were collected by semiannual patient chart review for the first 5 yr and annually thereafter. The causes of death are scored according to the diagnosis of the treating physician and are not based on the review of the independent causes-of-death committee. Overall and disease-specific survival graphs are shown in Kaplan-Maier projections and compared with expected survival outcomes for males in the same age categories from the Dutch provinces of North Holland and Flevoland. Statistical evaluation was based on Cox regression analysis. Results: During the prevalence screening, 1014 patients were diagnosed with pCA. Median follow up was 55 mo, 126 (12.4%) patients died, 20 (2.0%) of pCA. Overall 5-yr observed and expected disease-specific survival was 97.7% and 82%, respectively. In the multivariate analysis, a Gleason sum of 4+4 or higher (p = 0.025) was predictive of pCA death. Conclusions: The observed survival data are in line with the literature and the expected favorable outcome for a screened population. The proportion of men dying from pCA is still small, and a 10-yr follow-up period for the final evaluation of the ERSPC may be too short.

Prostate volume ultrasonography: the influence of transabdominal versus transrectal approach, device type and operator (Article)

2004-08-13T00:00:00Z

OBJECTIVES: We conduct a longitudinal non-invasive study of changes in urinary bladder contractility secondary to benign prostatic enlargement. In that study, the prostate volume is estimated by transabdominal ultrasonography. The accuracy of those measurements was verified by comparison of transabdominal to transrectal stepwise planimetric ultrasonography as the gold standard. Also, two different transabdominal devices used were compared, and the influence of different operators was studied. MATERIALS & METHODS: Two series of measurements in 100 patients each were done. In the first series, transabdominal and transrectal sonography were pairwise compared in each patient. In the second series, transabdominal measurements were done with two devices (a hospital Aloka SSD-1700 and a portable Aloka SSD-900). Transrectal scannings were done by three investigators whilst all transabdominal scannings were done by one. Regression graphs, ratio plots and statistical analyses of the data quantified the reproducibility of different methods, observers and device types. RESULTS: In the transrectal-transabdominal series of prostate volume measurements (in cm3), the Pearson correlation coefficient was 0.84 (p < 0.001), the mean of the means was 51.8 +/- 23.0 (mean +/- S.D.), and the mean of the differences was 1.0 +/- 1.4. In the series with two devices, the Pearson correlation coefficient was 0.73 (p < 0.001), the mean of the means was 31.0 +/- 10.9, and the mean of the differences was 1.0 +/- 1.3. CONCLUSION: No statistically significant differences were found between the transabdominal- transrectal ultrasonography, two different transabdominal devices nor between different observers. However, for those using these measurements in everyday clinical practice, it is worth to point out that in our data a transabdominal scan and a transrectal scan in the same patient, on the same day, differed more than 30% in one fourth of the patients and that two transabdominal scans in the same patient (with two different devices, on two different days) differed more than 30% in every fifth patient

Multi-detector row CT angiography in patients with abdominal angina. (Article)

2004-01-01T00:00:00Z

Abdominal angina (AA) is an infrequently occurring syndrome characterized by postprandial abdominal pain due to reduced blood flow to organs in the territory of the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery. Multi-detector row computed tomographic (CT) angiography with four- or 16-row scanners has become a primary tool for the evaluation of patients with suspected steno-occlusive diseases of the abdominal vessels. In patients with suspected AA, multi-detector row CT angiography can help evaluate the presence and degree of stenosis in the celiac trunk and SMA, demonstrate the collateral circulation, and help exclude other causes of vascular obstruction. It also allows visualization of small vessels and of vessel wall abnormalities in the absence of significant stenosis. Vessels with a complex anatomic configuration can easily be visualized with proper postprocessing techniques. This modality can also be used to follow up patients who have undergone percutaneous interventional treatment. Limitations include the lack of dynamic representation of flow abnormalities and difficulty in evaluating heavily calcified vessels. Nevertheless, multi-detector row CT angiography with appropriate postprocessing techniques is highly effective for the diagnosis, evaluation, and treatment of suspected AA. Additional studies will help further evaluate the performance and applications of this modality.

Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. (Article)

2004-01-01T00:00:00Z

PURPOSE: To compare test bolus and bolus-tracking techniques for intravenous contrast material administration at 16-detector row computed tomographic (CT) coronary angiography. MATERIALS AND METHODS: This study had institutional review board approval, and patients gave informed consent. Thirty-eight patients (mean age, 60 years; three women) were randomized into two groups according to bolus timing technique: group 1 (20-mL test bolus with 100-mL main bolus) and group 2 (bolus tracking with 100-mL main bolus). All patients underwent electrocardiography-gated 16-detector row CT coronary angiography with 12 detectors (collimation, 0.75 mm; rotation time, 420 msec). In group 1, test bolus peak attenuation was used as a delay, while in group 2, a +100-HU threshold in ascending aorta triggered angiographic acquisition, with an additional 4-second delay for patient instruction. Attenuation was measured in the longitudinal direction throughout the examination in three main vessels: ascending aorta (region of interest [ROI] 1), descending aorta (ROI 2), and main pulmonary artery (ROI 3). Mean attenuation and slope of bolus geometry curve were calculated in each patient and ROI. Attenuation at origin of coronary arteries was measured. Student t test was used to compare results. RESULTS: Mean scan delay was 6 seconds longer in group 2 (P < .05). Average attenuation values were 306.6 HU +/- 44.0 (standard deviation) and 328.2 HU +/- 58.6 (P > .05) in ROI 1, 291.6 HU +/- 45.1 and 326.4 HU +/- 62.6 (P > .05) in ROI 2, and 354.7 HU +/- 78.0 and 305.3 HU +/- 71.4 (P < .05) in ROI 3 for groups 1 and 2, respectively. Average slope values were 5.8 and -0.8 (P < .05) in ROI 1, 7.7 and 0.7 (P < .05) in ROI 2, and -1.0 and -13.3 (P < .05) in ROI 3 for groups 1 and 2, respectively. Average attenuation values in left main, left anterior descending, and left circumflex arteries were higher in group 2 (P < .05); there were no differences (P > .05) between groups in right coronary artery. CONCLUSION: Bolus-tracking yields more homogeneous enhancement than does the test bolus technique.