Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

MRI has become the preferred noninvasive imaging modality for the heart and great vessels. The substantial technological progress achieved in recent years has provided the user with state of the art MRI systems, but their optimal use can be limited by restricted awareness of the potential patient benefit and the necessity for teaching. This extensively illustrated volume, has been specifically compiled to meet these needs. Essential theoretical background information is provided, and imaging acquisition and potential pitfalls are considered in detail. Most importantly, structured guidelines are provided on the interpretation of clinical data in the wide range of cardiac pathology that can be encountered. Throughout, the emphasis is on the implementation of cardiac MRI in clinical practice.

Physical methods for diagnosis --- Pathology of the circulatory system --- Surgery --- MRI (magnetic resonance imaging) --- diagnostiek (geneeskunde) --- cardiologie --- hartchirurgie --- radiologie --- medische beeldvorming

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

The spleen is considered ‘the forgotten organ’ among radiologists and clinicians, although it is well visualised on abdominal computed tomography and magnetic resonance imaging. Moreover, the spleen is commonly involved in a wide range of pathologic disorders. These include congenital anomalies, infectious and inflammatory diseases, vascular disorders, benign and malignant tumours, and systemic disorders. In this review, we focus on the key imaging findings of the normal spleen, its variants, as well as relevant congenital and acquired abnormalities. It is of utmost importance to recognise and correctly interpret the variable spectrum of abnormalities that may involve the spleen, in order to avoid unnecessary invasive procedures and to guide adequate treatment.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Clinical Cardiac MRI is a comprehensive textbook intended for everyone involved in magnetic resonance imaging of the heart. It is designed both as a useful guide for newcomers to the field and as an aid for those who routinely perform such studies. The first edition, published in 2004-5, was very well received within the cardiac imaging community, and has generally been considered the reference because of its completeness, its clarity, and the number and quality of the illustrations. Moreover, the addition of online material showing 50 real-life cases significantly enhanced the value of the book. In this second edition, the four editors, all experts in the field, have taken great care to maintain a homogeneous high quality throughout the book while incorporating the newest insights and developments in this rapidly evolving domain of medical imaging. Essential theoretical background information is included, and imaging acquisition and potential pitfalls are examined in detail. Most importantly, structured guidelines are provided on the interpretation of clinical data in the wide range of cardiac pathology that can be encountered. Finally, the selection of 100 real-life cases, added as online material, will further enhance the value of this textbook.

Physical methods for diagnosis --- Pathology of the circulatory system --- Pathology --- MRI (magnetic resonance imaging) --- pathologie --- cardiologie --- radiologie --- medische beeldvorming

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Objective: The purpose of this study is to (1) examine ventricular width evolution between preoperative, early and late postoperative findings; (2) correlate the ventricular width and volume measured with a novel artificial intelligence (AI) based tool and (3) analyze the relation between the ventricular width and the ventricle delineation or hindbrain herniation. Methods: Retrospective review of in utero magnetic resonance imaging (MRI) scans performed in a tertiary center of fetuses undergoing surgery for open spinal dysraphism (OSD). Only fetuses with preoperative, early postoperative (<7 days) and late postoperative MRI acquired were included. Grade of hindbrain herniation and width and lining of the lateral ventricles were longitudinally analyzed. 3D superresolution reconstruction (SRR) volumes were created. Semi-automated segmentation of the ventricular system was performed. Results: Seventeen fetuses had all necessary images for this observational study. Four patterns of ventricular lining were noted: normal, undulated, irregular or nodular. The nodular pattern was evenly distributed between the different ventricular widths and was more often found later in pregnancy. A strong correlation between the ventricular volume and atrial width was found. All had hindbrain herniation preoperatively and demonstrated some reversal at the last MRI. Overall there was a significant increase in ventricular width between the preoperative and the late postoperative evaluation. Conclusion: Different patterns of ventricular lining were described. No relation between ventricular width and lining was found. Periventricular nodular heterotopia was most often found on the late-postoperative MRI.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

De foetale long is een met vocht gevulde strucuur met een sterk signal op T2 gewogen beelden en dus makkelijk te onderscheiden van de omgevende structuren. Dit blijft het geval zelfs in geval van oligohydramnios en obesitas, condities die een goede echografische evaluatie moeilijk en onnauwkeurig maken. In geval van CDH is een accurate bepaling van de long ontwikkeling een klinische nood alsook het uitsluiten van geassocieerde afwijkingen. Hierdoor kan MRI, vnl in deze populatie, waardevol zijn. Prognostische evaluatie dient bij voorkeur te gebeuren ten laatste op het einde van de tweede trimester, op een moment dat nog alle therapeutische opties mogelijk zijn en dus geen pijnlijke beslissing buiten de theoretische viabiteit nodig is. Gezien het recentelijk beschikbaar zijn van foetale thereapie wordt dit nog belangrijker. In deze thesis konden we in een grote multicenter study aantonen dat o/e TFLV en intrathoracale leverherniatie onafhankelijke predictors zijn van de postnatale overleving, waardoor we deze informatie dan ook kunnen gebruiken in het proces van de klinische diagnose. Bovendien toonde de o/e TFLV een trend voor een bettere overlevings predictie wannneer we de techniek vergelijken met de meest gevalideerde 2D-echografie metingen zijnde o/e LHR. We hebben eveneens een quantitatieve manier van lever herniatie geintroduceerd in foetussen met CDH dmv MRI. We hebben aangetoond dat LiTR op een betrouwbare manier het volume van het intrathoracale gedeelte van de liver bepaald. Voor expectantly behandelde foetussen, toonde LiTR enkel een trend doch was niet significant predictief. De verklaring hiervoor, tenminste gedeeltelijk, is te vinden in een populatie bias, enkel minder aangetaste foetussen waren beschikbaar voor de studie van de expectantly behandelde foetussen. Toekomstige en collaboratieve studies kunnen deze zaak helpen uitklaren. In deze thesis, hebben we normatieve curven opgebouwd voor TFLV tov verschillende ADC warden en voor TFLV tov verschillende T2 signaal intensiteits warden. Onze voorlopige data in foetussen met CDH toont aan dat ADChigh en ADClow waarden zich op de grens van normale waarden bevinden en dat T2 waarden in de ‘geobserveerde’ waarde lager waren dan in de ‘verwachte’ waarden, en dit vnl voor de ipsilaterale long. Zelfs meer interessant is de constatatie dat ADClow metingen niet gerelateerd waren met de afmetingen van de long hetgeen een additieve informate sugereert voor het gebruik van longafmetingen en dus zeker de basis zal zijn voor verder onderzoek. Gezien we een foetaal therapy centrum zijn hebben we veel foetussen bestudeerd die en ernstige geisoleerde vorm hebben van CDH en die behandeld werden met FETO. In deze gevallen konden we aantonen dat de reaktie van het longvolume een onafhankelijke predikter is van postnatale overleving en dit naast andere predikters zoals pre-FETO o/e TFLV. Temeer hebben we aangetoond dat zwangerschapsduur op het moment van FETO en LiTR voor het plaatsen van de ballon op zich een indicator zijn voor de graad van longvolume verandering na FETO. Dit is klinisch zeer belangrijk om het correcte moment van FETO procedure te kunnen plannen. Echografie blijft vanzelfsprekend de meest verspreid, meest beschikbare en meest geaccepteerde beoordelings techniek mede gezien zijn lage kost en ‘real-time’ kenmerken. Omwille van deze reden zal het de voorkeurs screenings techniek blijven in foetale geneeskunde. Evenwel hebben we aangetoond dat in het bepaling van long hypoplasie in foetussen met CDH, MRI betrouwbare en bijkomende informatie kan verschaffen in vergelijking met echografie. Het is dan ook niet te verwonderen dat in de nabije toekomst en in hoog gespecialiseerde centra, zoals foetale therapie centra, MRI gebruikt zal worden in de beoordeling van longen van foetussen met CDH. Op deze manier kan MRI helpen om de patienten die baat hebben bij foetale chirurgie beter te definieren. The fetal lung is a fluid filled structure hence has high signal intensity on T2 WI and is easily discernible from the surrounding structures. This remains so even in case of oligohydramnios and obesity, conditions that make appropriate ultrasound evaluation difficult and inaccurate. In case of CDH, accurate determination of lung development is a clinical need, next to ruling out other associated anomalies. Therefore MRI may be particularly useful in this population. Prognostic evaluation should preferentially be done at the latest at the end of the second trimester, as to leave all options open and avoid painful choices beyond theoretical viability. In view of the current availability of fetal therapy this becomes even more important. In this work we could show in a large multicenter series that o/e TFLV and intrathoracic liver position provide independent prediction of postnatal outcome, which allows using this information in clinical decision making. Furthermore, o/e TFLV showed a trend towards a better prediction of survival as compared to the most validated 2D-ultrasound measurement being o/e LHR. We also introduced a quantitative method for liver herniation in fetuses with CDH using MR imaging. We have shown that LiTR reliably quantifies the volume of the intrathoracic part of liver. For expectantly managed fetuses, LiTR showed a trend, but was not significantly predictive in our series. This may, at least in part, be due to the bias in our population, with typically only less severely affected fetuses available for a study on expectantly managed fetuses. Future and collaborative studies may help out clarifying this matter. In this thesis, we have built normal ranges for TFLV versus different ADC values and for TFLV versus T2 signal intensity values. Our preliminary data in fetuses with CDH have shown that ADChigh and ADClow values were at the limit of the normal range and observed T2 values were lower than expected, in particular for the ipsilateral lung. More interestingly, we have shown that ADClow measurement was unrelated to lung size suggesting potential additive information to the lung size measurement and therefore provides certainly the basis for further research. As a fetal therapy centre, we studied many fetuses with severe isolated CDH who were treated by FETO and where we demonstrated that lung volume responsiveness is an independent predictor of postnatal survival next to pre-FETO o/e TFLV. We have further shown that gestation at FETO and LiTR prior to balloon insertion are both an indicator of lung volume responsiveness to FETO. This is clinically highly relevant in terms of timing the FETO procedure. Ultrasound remains obviously the most widely available and most acceptable assessment tool, with low costs and real-time properties. For that reason it will remain the screening method of choice in fetal medicine. However we have shown in the assessment of lung hypoplasia in fetuses with CDH that MRI proves reliable and additional information can be obtained as compared to ultrasound. It is therefore not surprising that in the near future and in highly specialized centers such as fetal therapy centers, MRI is used to assess lungs of fetuses with CDH, helping to better define cases that are eligible for fetal surgery.