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Biomedical subjects

Jasper Florie

Publications and source records attributed to Jasper Florie.

11 recordsLinked to original sources

A comparison of primary two- and three-dimensional methods to review CT colonography.

The aim of our study was to compare primary three-dimensional (3D) and primary two-dimensional (2D) review methods for CT colonography with regard to polyp detection and perceptive errors. CT colonography studies of 77 patients were read twice by three reviewers, first with a primary 3D method and then with a primary 2D method. Mean numbers of true and false positives, patient sensitivity and specificity and perceptive errors were calculated with colonoscopy as a reference standard. A perceptive error was made if a polyp was not detected by all reviewers. Mean sensitivity for large (> or = 10 mm) polyps for primary 3D and 2D review was 81% (14.7/18) and 70%(12.7/18), respectively (p-values > or = 0.25). Mean numbers of large false positives for primary 3D and 2D were 8.3 and 5.3, respectively. With primary 3D and 2D review 1 and 6 perceptive errors, respectively, were made in 18 large polyps (p = 0.06). For medium-sized (6-9 mm) polyps these values were for primary 3D and 2D, respectively: mean sensitivity: 67%(11.3/17) and 61%(10.3/17; p-values > or = 0.45), number of false positives: 33.3 and 15.6, and perceptive errors : 4 and 6 (p = 0.53). No significant differences were found in the detection of large and medium-sized polyps between primary 3D and 2D review.

Adult↗

Polyp measurement and size categorisation by CT colonography: effect of observer experience in a multi-centre setting.

The extent measurement error on CT colonography influences polyp categorisation according to established management guidelines is studied using twenty-eight observers of varying experience to classify polyps seen at CT colonography as either 'medium' (maximal diameter 6-9 mm) or 'large' (maximal diameter 10 mm or larger). Comparison was then made with the reference diameter obtained in each patient via colonoscopy. The Bland-Altman method was used to assess agreement between observer measurements and colonoscopy, and differences in measurement and categorisation was assessed using Kruskal-Wallis and Chi-squared test statistics respectively. Observer measurements on average underestimated the diameter of polyps when compared to the reference value, by approximately 2-3 mm, irrespective of observer experience. Ninety-five percent limits of agreement were relatively wide for all observer groups, and had sufficient span to encompass different size categories for polyps. There were 167 polyp observations and 135 (81%) were correctly categorised. Of the 32 observations that were miscategorised, 5 (16%) were overestimations and 27 (84%) were underestimations (i.e. large polyps misclassified as medium). Caution should be exercised for polyps whose colonographic diameter is below but close to the 1-cm boundary threshold in order to avoid potential miscategorisation of advanced adenomas.

Chi-Square Distribution↗

CT colonography interpretation times: effect of reader experience, fatigue, and scan findings in a multi-centre setting.

Our purpose was to assess the effect of reader experience, fatigue, and scan findings on interpretation time for CT colonography. Nine radiologists (experienced in CT colonography); nine radiologists and ten technicians (both groups trained using 50 validated examinations) read 40 cases (50% abnormal) under controlled conditions. Individual interpretation times for each case were recorded, and differences between groups determined. Multi-level linear regression was used to investigate effect of scan category (normal or abnormal) and observer fatigue on interpretation times. Experienced radiologists (mean time 10.9 min, SD 5.2) reported significantly faster than less experienced radiologists and technicians; odds ratios of reporting times 1.4 (CI 1.1, 1.8) and 1.6 (1.3, 2.0), respectively (P<or=0.001). Experienced and less-experienced radiologists took longer to report abnormal cases; ratio 1.2 (CI 1.1,1.4, P<0.001) and 1.2 (1.0, 1.3, P=0.03), respectively. All groups took 70% as long to report the final five cases as they did with an initial five; ratio 0.7 (CI 0.6 to 0.8), P<0.001. For technicians only, accuracy increased with longer reporting times (P=0.04). Experienced radiologists report faster than do less-experienced observers and proportionally spend less time interpreting normal cases. Technicians who report more slowly are more accurate. All groups reported faster as the study period progressed.

Clinical Competence↗

Feasibility of evaluating Crohn's disease activity at 3.0 Tesla.

PURPOSE: To determine whether abdominal 3.0T MRI can be used for evaluation of Crohn's disease (CD) compared with ileocolonoscopy (CS), and to determine patient preference for MRI as opposed to CS. MATERIALS AND METHODS: Twenty patients scheduled for CS underwent MRI. At CS, disease severity was graded and the Crohn's Disease Endoscopic Index of Severity (CDEIS) was determined. Radiological grading (by two observers) was compared with endoscopic grading and CDEIS. Patient experience and preference were determined. RESULTS: In respectively 10 (observer 1) and 13 patients (observer 2) exact agreement between radiological and endoscopic grading was found. In respectively 10 and 7 patients radiological and endoscopic grading differed one level. No statistically significant correlation was found between radiological grading and CDEIS. Between bowel wall thickness and CDEIS weak to moderate correlations were found, and between bowel wall enhancement and CDEIS weak correlations were found. All patients preferred MRI over CS. CONCLUSION: It is feasible to perform abdominal 3.0T MRI using orally administered contrast medium for evaluation of CD, and this method can be considered a patient-friendly alternative to CS.

Adult↗

Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn's disease.

OBJECTIVE: The purpose of this study was to evaluate the role of contrast-enhanced dynamic MRI in predicting the disease activity of Crohn's disease. MATERIALS AND METHODS: Forty-eight patients in two hospitals who had clinically suspected exacerbation of Crohn's disease were included in this study. In three levels of thickened small-bowel wall, axial dynamic T1-weighted sequences were performed every 4-6 sec for a total duration of 2-3 min after contrast administration; static T1-weighted turbo spin-echo sequences were acquired both before and after contrast administration. The slope of enhancement, enhancement ratio, time to enhancement, enhancement time, and thickness of the small-bowel wall were determined. These MRI results were compared with overall clinical grade, Crohn's disease activity index (CDAI), and Van Hees activity index. Clinical grade was based on clinical information, physical findings, laboratory studies, endoscopy, surgery, and other imaging studies. Spearman's correlation coefficient and p values were determined per hospital. Fisher's z-transformation was applied before pooling the correlation coefficients from both hospitals. RESULTS: The enhancement ratio based on the static series showed significant correlation with the clinical grade (r = 0.29, p = 0.045), CDAI (r =0.31, p = 0.033), and Van Hees activity index (r = 0.36, p = 0.016). The enhancement ratio based on the dynamic series correlated significantly with the CDAI (r = 0.38, p = 0.016). Wall thickness correlated significantly with clinical grade (r = 0.47, p = 0.003) and Van Hees activity index (r = 0.41, p = 0.007). CONCLUSION: These data suggest that the enhancement ratio of bowel wall after IV administration of gadodiamide and bowel wall thickness are weak to moderate indicators of the severity of Crohn's disease.

Adolescent↗

Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn's disease.

BACKGROUND & AIMS: Abdominal magnetic resonance imaging (MRI) has shown promising results in the detection of Crohn's disease (CD)-related lesions. The purpose of this study was to assess the value of MRI in measuring disease activity in CD patients in comparison with ileocolonoscopy. METHODS: Thirty-one patients undergoing ileocolonoscopy because of suspicion of relapsing CD underwent MRI with water as intraluminal contrast medium. At endoscopy, disease severity was graded (4-point scale), and Crohn's Disease Endoscopic Index of Severity (CDEIS) was determined. Two radiologists independently interpreted the MRI scans. Radiologic grading (4-point scale) was compared with endoscopic grading of disease severity and CDEIS (overall, for all segments). Wall thickness and enhancement were compared with CDEIS. Patient experience and preference were determined. RESULTS: In, respectively, 14 and 14 patients (radiologist 1) and 16 and 11 patients (radiologist 2) an exact match or 1 level of difference in grading was scored with the endoscopist. Correlation between severity rated at MRI and CDEIS was moderate to strong with r = 0.61 (P < .001) for observer 1 and r = 0.63 (P < .001) for observer 2. Per segment, best correlation was seen in the terminal ileum (r = 0.63; P < .001, for both observers). Wall thickness correlated moderately to strongly with CDEIS (r = 0.57, P < .001 and r = 0.50, P < .001 for observers 1 and 2), whereas enhancement correlated weakly to moderately (r = 0.45, P < .001 and r = 0.42, P < .001). Patients experienced more pain during endoscopy, and all patients except 2 preferred MRI to endoscopy. CONCLUSION: MRI can correctly identify disease severity in patients with CD and is a patient-friendly alternative to ileocolonoscopy.

Adolescent↗

Colonography by computed tomography.

Computed tomographic colonography ('virtual colonoscopy') has shown promising results in the detection of large (> or = 10 mm) polyps in populations with a high prevalence of polyps. Recent studies in low prevalence populations, however, show variable results in sensitivity, ranging from 55% to 94% for the detection of patients with polyps measuring 10 mm or longer. Therefore questions have been raised about computed tomographic colonography as a screening method, probably the most valuable use of this technique. This article describes possible causes of these remarkable differences as well as advances in computed tomographic colonography.

Attitude to Health↗

CT colonography and colonoscopy: assessment of patient preference in a 5-week follow-up study.

PURPOSE: To prospectively evaluate short- and midterm patient preference of computed tomographic (CT) colonography relative to colonoscopy in patients at increased risk for colorectal cancer and to elucidate determinants of preference. MATERIALS AND METHODS: Consecutive patients at increased risk for colorectal cancer underwent CT colonography prior to scheduled colonoscopy. Patient experience and preference were assessed both directly after the examinations and 5 weeks after the examinations. Differences in pain, embarrassment, discomfort, and preference were assessed with the Wilcoxon signed rank sum test or a binomial test. Potential determinants of preference were investigated with logistic regression analyses. RESULTS: Data for 249 patients were included. Fewer patients experienced severe or extreme pain during CT colonography (seven [3%] of 245) than during colonoscopy (81 [34%] of 241) (P < .001). Directly after both examinations, 168 (71%) of 236 patients preferred CT colonography; 5 weeks later, 141 (61%) of 233 patients preferred CT colonography (P < .001). Initially, a painful colonoscopy examination (odds ratio, 0.17; 95% confidence interval [CI]: 0.08, 0.38) was a determinant of CT colonography preference. Similarly, a painful (odds ratio, 3.70; 95% CI: 1.54, 8.92) or an embarrassing (odds ratio, 4.46; 95% CI: 1.18, 16.88) CT colonography examination was a determinant of colonoscopy preference. After 5 weeks, the presence of polyps emerged as a determinant of colonoscopy preference (odds ratio, 1.94; 95% CI: 1.02, 3.70), while the role of experiences waned. CONCLUSION: Patients preferred CT colonography to colonoscopy; however, this preference decreased in time, while outcome considerations gradually replaced temporary experiences of inconvenience.

Aged↗

CT colonography: feasibility of substantial dose reduction--comparison of medium to very low doses in identical patients.

In a feasibility study, the authors compared polyp detection and interobserver variability at computed tomographic (CT) colonography in 15 patients with doses ranging from medium to very low (12.00-0.05 mSv). At levels down to 2% of the medium dose, the mean detection of polyps 5 mm or larger remained at least 74%, while the number of false-positive results decreased and the interobserver agreement remained constant. Initial observations indicate that it is feasible to reduce the radiation dose required for CT colonography. Further studies are needed, however, to investigate the clinical value of very low-dose CT colonography.

Adult↗

Computed tomographic colonography compared with colonoscopy in patients at increased risk for colorectal cancer.

BACKGROUND & AIMS: To date, computed tomographic (CT) colonography has been compared with an imperfect test, colonoscopy, and has been mainly assessed in patients with positive screening test results or symptoms. Therefore, the available data may not apply to screening of patients with a personal or family history of colorectal polyps or cancer (increased risk). We prospectively investigated the ability of CT colonography to identify individuals with large (>or=10 mm) colorectal polyps in consecutive patients at increased risk for colorectal cancer. METHODS: A total of 249 consecutive patients at increased risk for colorectal cancer underwent CT colonography before colonoscopy. Two reviewers interpreted CT colonography examinations independently. Sensitivity, specificity, and predictive values were determined after meticulous matching of CT colonography with colonoscopy. Unexplained large false-positive findings were verified with a second-look colonoscopy. RESULTS: In total, 31 patients (12%) had 48 large polyps at colonoscopy. This included 8 patients with 8 large polyps that were overlooked initially and detected at the second-look colonoscopy. In 6 of 8 patients, the missed polyp was the only large lesion. With CT colonography, 84% of patients (26/31) with large polyp(s) were identified, paired for a specificity of 92% (200-201/218). Positive and negative predictive values were 59%-60% (26/43-44) and 98% (200-201/205-206), respectively. CT colonography detected 75%-77% (36-37/48) of large polyps, with 9 of the missed lesions being flat. CONCLUSIONS: CT colonography and colonoscopy have a similar ability to identify individuals with large polyps in patients at increased risk for colorectal cancer. The large proportion of missed flat lesions warrants further study.

Aged↗

Three-dimensional display modes for CT colonography: conventional 3D virtual colonoscopy versus unfolded cube projection.

The authors compared a conventional two-directional three-dimensional (3D) display for computed tomography (CT) colonography with an alternative method they developed on the basis of time efficiency and surface visibility. With the conventional technique, 3D ante- and retrograde cine loops were obtained (hereafter, conventional 3D). With the alternative method, six projections were obtained at 90 degrees viewing angles (unfolded cube display). Mean evaluation time per patient with the conventional 3D display was significantly longer than that with the unfolded cube display. With the conventional 3D method, 93.8% of the colon surface came into view; with the unfolded cube method, 99.5% of the colon surface came into view. Sensitivity and specificity were not significantly different between the two methods. Agreements between observers were kappa = 0.605 for conventional 3D display and kappa = 0.692 for unfolded cube display. Consequently, the latter method enhances the 3D endoluminal display with improved time efficiency and higher surface visibility.

Colonography, Computed Tomographic↗