Ragna Vanslembrouck - Academia.edu (original) (raw)

Papers by Ragna Vanslembrouck

Journal of Crohn's and Colitis, 2019

Radiology: Imaging Cancer

Clinical and Translational Gastroenterology

Poster: "ECR 2012 / C-2233 / Pneumatosis intestinalis, not always a surgical emergency"... more Poster: "ECR 2012 / C-2233 / Pneumatosis intestinalis, not always a surgical emergency" by: "E. Vanhoutte1, M. Lefere2, R. Vanslembrouck1, D. Bielen1, G. De Hertogh1, A. Wolthuis1, D. Vanbeckevoort1; 1Leuven/BE, 2Louvain/BE"

Cross-Sectional Imaging in Crohn’s Disease, 2019

In patients with inflammatory bowel disease, CT and MR have become the radiological methods of ch... more In patients with inflammatory bowel disease, CT and MR have become the radiological methods of choice in the assessment of disease activity, severity and extension, complementary to endoscopy and biopsy. These radiological tools have the ability to evaluate bowel wall changes, location, extent and can detect extramural complications such as fistulae and abscesses. These radiological findings are important to determine the therapeutic strategy and also have prognostic implications.

Oncology Research and Treatment, 2020

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of t... more Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and the most frequent sarcomas in some geographic regions. In patients with metastatic GIST, the tyrosine kinase inhibitor imatinib is the first-line standard of care. Mutations in KIT or specific platelet-derived growth factor receptor alpha (PDGFRA) gene aberrations in the tumor cells predict a favorable response to this agent, while tumors without KIT or PDGFRA mutations (“wild-type” GISTs) are usually resistant to such treatment. Next-generation sequencing (NGS) is commonly used for mutational analysis of GISTs. Case Presentation: We present a case of an unexpected response to imatinib treatment in a GIST that was initially called “wild-type” based on routine NGS. A spectacular response to empirical imatinib treatment triggered further genetic analysis and led to the identification of a 45-bp duplication in KIT exon 11 undetectable by routine NGS. Conclusion...

Clinical Gastroenterology and Hepatology, 2020

BACKGROUND & AIMS: Higher infliximab trough levels are associated with clinical and endoscopic re... more BACKGROUND & AIMS: Higher infliximab trough levels are associated with clinical and endoscopic remission in patients with Crohn's disease (CD). We investigated pharmacodynamic features of infliximab and radiological healing. METHODS: We performed a substudy of the TAILORIX trial (patients with active luminal CD in Europe, treated with infliximab), analyzing baseline and week 54 magnetic resonance enterography (MRE) data. MREs were scored using the MaRIA score by blinded central readers. Radiologic response and remission were defined, based on MaRIA criteria in all segments, as scores below 11 and 7, respectively. We collected data on infliximab trough levels, biomarkers, and endoscopic endoscopy findings. Our primary aim was to evaluate pharmacodynamic features associated with radiologic response and remission, based on MRE assessments at baseline and at 54 weeks after initiation of infliximab therapy. RESULTS: We analyzed data from 36 patients (50% female; median age 35.7 years; interquartile age range, 25.6-48.6 years; median disease duration, 1.5 months; interquartile duration range, 0.6-22.4 months). At week 54 of treatment, 36.4% of patients had a radiologic response, 30.3% of patients were in remission, and 71% had endoscopic features of remission. At baseline, there was a correlation between the CD endoscopic index of severity and MaRIA scores (k [ 0.46; P [ .008), but we found no correlation at week 54 (k [ 0.06; P [. 75). Radiologic remission correlated with infliximab trough level at week 14 (P [ .049) when the infliximab trough level cutoff value was set at 7.8 mg/ml (area under the curve, 0.74; 75% sensitivity; 86% specificity; 90% negative predictive value; 57% positive predictive value). Radiologic response correlated with infliximab trough levels at week 14 (P [ .048) when the infliximab trough level cutoff value was set at 7.8 mg/ml (area under the curve, 0.73; 70% sensitivity; 90% specificity; 86% negative

Cancer Imaging, 2019

Background: Correct staging of patients with colorectal cancer is of utmost importance for the pr... more Background: Correct staging of patients with colorectal cancer is of utmost importance for the prediction of operability. Although computed tomography (CT) has a good overall performance, estimation of peritoneal cancer spread is a known weakness, a problem that cannot always be overcome by Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT); especially in infiltrative and miliary disease spread. Due to its high spatial and contrast resolution magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) might have a better performance. Our aim was to evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for prediction of peritoneal cancer spread and operability assessment in colorectal cancer patients with clinically suspected peritoneal carcinomatosis (PC). Methods: This institutional review board approved retrospective study included sixty colorectal cancer patients who underwent WB-DWI/MRI in addition to CT for clinically suspected peritoneal metastases. WB-DWI/MRI and CT were assessed for detecting PC following the peritoneal cancer index (PCI), determination of PCI-score categorized as PC < 12, PCI = 12-15 and PCI > 15, detection of nodal and distant metastases and estimation of overall operability. Histopathology after surgery and biopsy and/or 6 months follow-up were used as reference standard. Results: For detection of PC, CT had 43.2% sensitivity, 95.6% specificity, 84.5% positive predictive value (PPV) and 75.2% negative predictive value (NPV). WB-DWI/MRI had 97.8% sensitivity, 93.2% specificity, 88.9% PPV and 98.7% NPV. WB-DWI/MRI enabled better detection of inoperable distant metastases (all 12 patients) than CT (2/12 patients) and significantly improved prediction of PCI category [WB-DWI/MRI PCI < 12: 37/39 patients (94.9%); PCI = 12-15: 4/4 patients (100%); PCI > 15: 16/17 patients (94.1%) versus CT PCI < 12: 38/39 patients (97.4%); PCI = 12-15: 0/4 patients (0%); PCI > 15: 2/17 patients (11.8%); p < 0.0001)]. WB-DWI/MRI improved prediction of inoperability over CT with 90.6% sensitivity compared to 25% (p < 0.0001). Conclusions: WB-DWI/MRI significantly outperformed CT for estimation of spread of PC, overall staging and prediction of operability. Pending validation in larger prospective trials, WB-DWI/MRI could be used to guide surgical planning and minimize unnecessary exploratory laparotomies.

Gastroenterology, 2017

Other gut homing mechanisms of lymphocytes might thus prevail in some IBD patients and limit the ... more Other gut homing mechanisms of lymphocytes might thus prevail in some IBD patients and limit the anti-inflammatory effect of vedolizumab.

Alimentary Pharmacology & Therapeutics, 2015

Background Reliable tools for patient selection are critical for clinical drug trials. Aim To eva... more Background Reliable tools for patient selection are critical for clinical drug trials. Aim To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. Methods This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). Results 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. Conclusions Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi-centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.

Journal of Vascular and Interventional Radiology, 2013

Coil embolization should be considered when antegrade arterial flow is diminished, such as in pat... more Coil embolization should be considered when antegrade arterial flow is diminished, such as in patients receiving bevacizumab. Our results have three important limitations. First, our data were gathered from procedures performed at a tertiary care center with extensive radioembolization experience and as such may make our observations less generalizable. Second, our analysis focused on glass microspheres and cannot be extrapolated to the more moderately embolic resin spheres. Further studies are needed before any further recommendations for resin spheres can be made. Third, this is a letter to the editor and not a formal scientific article. More studies, including one with a larger series powered to achieve statistical significance, are needed before these observations can be generalized.

Journal of Crohn's and Colitis, 2014

The majority of strictures in CD patients treated by surgery are consistent with a mixed type inf... more The majority of strictures in CD patients treated by surgery are consistent with a mixed type inflammation (acute inflammation plus fibrosis). The presence of stratified BS pattern shows a significantly higher degree of fibrosis while the evidence of high mural signal intensity on T2-weighted fatsaturated images on MRI reflects histological features of acute inflammation. Even if the ideal definition of the type of the strictures in CD still remains significantly far to be obtained, the combined use of BS and MRI can offer useful information in a subgroup of patients needing surgery for complicating CD.

Journal of Crohn's and Colitis, 2014

The majority of strictures in CD patients treated by surgery are consistent with a mixed type inf... more The majority of strictures in CD patients treated by surgery are consistent with a mixed type inflammation (acute inflammation plus fibrosis). The presence of stratified BS pattern shows a significantly higher degree of fibrosis while the evidence of high mural signal intensity on T2-weighted fatsaturated images on MRI reflects histological features of acute inflammation. Even if the ideal definition of the type of the strictures in CD still remains significantly far to be obtained, the combined use of BS and MRI can offer useful information in a subgroup of patients needing surgery for complicating CD.

Cancer Imaging, 2013

Objective: To evaluate 3 Tesla (T) whole-body diffusion-weighted magnetic resonance imaging (WB D... more Objective: To evaluate 3 Tesla (T) whole-body diffusion-weighted magnetic resonance imaging (WB DWI) for early treatment assessment in aggressive non-Hodgkin lymphoma (NHL). Methods: Fourteen patients with NHL treated with standard chemotherapy underwent 3-T WB DWI before and 2 and 4 weeks during treatment, using b-values of 01000 s/mm 2 from which the apparent diffusion coefficient (ADC) was calculated. Patient follow-up (average 20.3 months, range 1523 months) was the reference standard. Volume and ADC changes between baseline and 2 weeks (Vratio 2w , ADCratio 2w) and 4 weeks (Vratio 4w , ADCratio 4w) of responding and non-responding lesions (lymph node and organ lesions) were compared using MannWhitney U tests. The per patient values of Vratio N and ADCratio N to predict progression-free survival were determined with a log-rank test. Results: Eight patients showed complete remission and 6 showed tumour progression. The ADCratio 2w and ADCratio 4w differed significantly in lesions showing tumour progression versus complete remission (ADCratio 2w ¼ 4 AE 21% versus 119 AE 68%; ADCratio 4w ¼ 18 AE 61% versus 155 AE 78%; both P50.0001); the Vratio 2w and Vratio 4w did not (P40.05). Per body region, the ADCratio 2w showed a negative predictive value of 100% and positive predictive value of 86%. Per patient, the ADCratio 2w and ADCratio 4w correlated significantly with progression-free survival (P50.05). Conclusion: 3-T WB DWI with ADC quantification may enable early treatment assessment of aggressive NHL.

Journal of Hepatology, 2015

Open access under CC BY-NC-ND license.

Alimentary Pharmacology & Therapeutics, 2012

Polycystic liver disease (PLD) is a phenotypical expression of autosomal dominant polycystic kidn... more Polycystic liver disease (PLD) is a phenotypical expression of autosomal dominant polycystic kidney disease and isolated polycystic liver disease. Somatostatin analogues, such as lanreotide, reduce polycystic liver volume.

Alimentary Pharmacology & Therapeutics, 2013

Long-acting lanreotide (LAN) 120 mg every 4 weeks reduces liver volume (LV) in patients with poly... more Long-acting lanreotide (LAN) 120 mg every 4 weeks reduces liver volume (LV) in patients with polycystic liver diseases (PCLD). Animal studies demonstrated that the inhibition of hepatic and renal cystogenesis is dose dependent. To investigate the safety and efficacy of two different LAN doses in PCLD patients. The 6-month results of the LOCKCYST I trial, its extension study and the LOCKCYST II trial were pooled. LV at baseline and month 6 was measured by CT-scan and blindly re-analysed by two independent radiologists. The study population [132 treatment periods, age 49 years (IQR: 45-55), 114 women] consisted of three groups. Each received treatment every 4 weeks during 6 months: placebo (n = 26); LAN 90 mg (n = 55) or LAN 120 mg (n = 51). The inter-observer variability and agreement in the calculation of LV were excellent. Severe side effects occurred with placebo, LAN 90 mg and LAN 120 mg in respectively 0%, 7% and 16%. Change in LV&amp;amp;amp;amp;#39;s after 6 months in these three groups were respectively: increase of +36 mL [(-45)-(+138)]; decrease of -82 mL [(-285)-(+92)] and decrease of -123 mL [(-312)-(+4)] (Kruskal-Wallis One Way anova on Ranks; P = 0.002). Based on ROC analysis, a reduction of ≥120 mL in LV has a positive predictive value of 64% for improving symptoms (ROC analysis AUC: 0.729; sensitivity 73%, specificity 69%, P &amp;amp;amp;amp;lt; 0.0001). Both LAN 90 mg and LAN 120 mg reduce liver volume. LAN 90 mg has less side effects. This suggests that in case of intolerance to LAN 120 mg, a dose reduction to LAN 90 mg is meaningful.

Journal of Crohn's and Colitis, 2019

Radiology: Imaging Cancer

Clinical and Translational Gastroenterology

Poster: "ECR 2012 / C-2233 / Pneumatosis intestinalis, not always a surgical emergency"... more Poster: "ECR 2012 / C-2233 / Pneumatosis intestinalis, not always a surgical emergency" by: "E. Vanhoutte1, M. Lefere2, R. Vanslembrouck1, D. Bielen1, G. De Hertogh1, A. Wolthuis1, D. Vanbeckevoort1; 1Leuven/BE, 2Louvain/BE"

Cross-Sectional Imaging in Crohn’s Disease, 2019

In patients with inflammatory bowel disease, CT and MR have become the radiological methods of ch... more In patients with inflammatory bowel disease, CT and MR have become the radiological methods of choice in the assessment of disease activity, severity and extension, complementary to endoscopy and biopsy. These radiological tools have the ability to evaluate bowel wall changes, location, extent and can detect extramural complications such as fistulae and abscesses. These radiological findings are important to determine the therapeutic strategy and also have prognostic implications.

Oncology Research and Treatment, 2020

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of t... more Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and the most frequent sarcomas in some geographic regions. In patients with metastatic GIST, the tyrosine kinase inhibitor imatinib is the first-line standard of care. Mutations in KIT or specific platelet-derived growth factor receptor alpha (PDGFRA) gene aberrations in the tumor cells predict a favorable response to this agent, while tumors without KIT or PDGFRA mutations (“wild-type” GISTs) are usually resistant to such treatment. Next-generation sequencing (NGS) is commonly used for mutational analysis of GISTs. Case Presentation: We present a case of an unexpected response to imatinib treatment in a GIST that was initially called “wild-type” based on routine NGS. A spectacular response to empirical imatinib treatment triggered further genetic analysis and led to the identification of a 45-bp duplication in KIT exon 11 undetectable by routine NGS. Conclusion...

Clinical Gastroenterology and Hepatology, 2020

BACKGROUND & AIMS: Higher infliximab trough levels are associated with clinical and endoscopic re... more BACKGROUND & AIMS: Higher infliximab trough levels are associated with clinical and endoscopic remission in patients with Crohn's disease (CD). We investigated pharmacodynamic features of infliximab and radiological healing. METHODS: We performed a substudy of the TAILORIX trial (patients with active luminal CD in Europe, treated with infliximab), analyzing baseline and week 54 magnetic resonance enterography (MRE) data. MREs were scored using the MaRIA score by blinded central readers. Radiologic response and remission were defined, based on MaRIA criteria in all segments, as scores below 11 and 7, respectively. We collected data on infliximab trough levels, biomarkers, and endoscopic endoscopy findings. Our primary aim was to evaluate pharmacodynamic features associated with radiologic response and remission, based on MRE assessments at baseline and at 54 weeks after initiation of infliximab therapy. RESULTS: We analyzed data from 36 patients (50% female; median age 35.7 years; interquartile age range, 25.6-48.6 years; median disease duration, 1.5 months; interquartile duration range, 0.6-22.4 months). At week 54 of treatment, 36.4% of patients had a radiologic response, 30.3% of patients were in remission, and 71% had endoscopic features of remission. At baseline, there was a correlation between the CD endoscopic index of severity and MaRIA scores (k [ 0.46; P [ .008), but we found no correlation at week 54 (k [ 0.06; P [. 75). Radiologic remission correlated with infliximab trough level at week 14 (P [ .049) when the infliximab trough level cutoff value was set at 7.8 mg/ml (area under the curve, 0.74; 75% sensitivity; 86% specificity; 90% negative predictive value; 57% positive predictive value). Radiologic response correlated with infliximab trough levels at week 14 (P [ .048) when the infliximab trough level cutoff value was set at 7.8 mg/ml (area under the curve, 0.73; 70% sensitivity; 90% specificity; 86% negative

Cancer Imaging, 2019

Background: Correct staging of patients with colorectal cancer is of utmost importance for the pr... more Background: Correct staging of patients with colorectal cancer is of utmost importance for the prediction of operability. Although computed tomography (CT) has a good overall performance, estimation of peritoneal cancer spread is a known weakness, a problem that cannot always be overcome by Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT); especially in infiltrative and miliary disease spread. Due to its high spatial and contrast resolution magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) might have a better performance. Our aim was to evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for prediction of peritoneal cancer spread and operability assessment in colorectal cancer patients with clinically suspected peritoneal carcinomatosis (PC). Methods: This institutional review board approved retrospective study included sixty colorectal cancer patients who underwent WB-DWI/MRI in addition to CT for clinically suspected peritoneal metastases. WB-DWI/MRI and CT were assessed for detecting PC following the peritoneal cancer index (PCI), determination of PCI-score categorized as PC < 12, PCI = 12-15 and PCI > 15, detection of nodal and distant metastases and estimation of overall operability. Histopathology after surgery and biopsy and/or 6 months follow-up were used as reference standard. Results: For detection of PC, CT had 43.2% sensitivity, 95.6% specificity, 84.5% positive predictive value (PPV) and 75.2% negative predictive value (NPV). WB-DWI/MRI had 97.8% sensitivity, 93.2% specificity, 88.9% PPV and 98.7% NPV. WB-DWI/MRI enabled better detection of inoperable distant metastases (all 12 patients) than CT (2/12 patients) and significantly improved prediction of PCI category [WB-DWI/MRI PCI < 12: 37/39 patients (94.9%); PCI = 12-15: 4/4 patients (100%); PCI > 15: 16/17 patients (94.1%) versus CT PCI < 12: 38/39 patients (97.4%); PCI = 12-15: 0/4 patients (0%); PCI > 15: 2/17 patients (11.8%); p < 0.0001)]. WB-DWI/MRI improved prediction of inoperability over CT with 90.6% sensitivity compared to 25% (p < 0.0001). Conclusions: WB-DWI/MRI significantly outperformed CT for estimation of spread of PC, overall staging and prediction of operability. Pending validation in larger prospective trials, WB-DWI/MRI could be used to guide surgical planning and minimize unnecessary exploratory laparotomies.

Gastroenterology, 2017

Other gut homing mechanisms of lymphocytes might thus prevail in some IBD patients and limit the ... more Other gut homing mechanisms of lymphocytes might thus prevail in some IBD patients and limit the anti-inflammatory effect of vedolizumab.

Alimentary Pharmacology & Therapeutics, 2015

Background Reliable tools for patient selection are critical for clinical drug trials. Aim To eva... more Background Reliable tools for patient selection are critical for clinical drug trials. Aim To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. Methods This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). Results 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. Conclusions Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi-centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.

Journal of Vascular and Interventional Radiology, 2013

Coil embolization should be considered when antegrade arterial flow is diminished, such as in pat... more Coil embolization should be considered when antegrade arterial flow is diminished, such as in patients receiving bevacizumab. Our results have three important limitations. First, our data were gathered from procedures performed at a tertiary care center with extensive radioembolization experience and as such may make our observations less generalizable. Second, our analysis focused on glass microspheres and cannot be extrapolated to the more moderately embolic resin spheres. Further studies are needed before any further recommendations for resin spheres can be made. Third, this is a letter to the editor and not a formal scientific article. More studies, including one with a larger series powered to achieve statistical significance, are needed before these observations can be generalized.

Journal of Crohn's and Colitis, 2014

The majority of strictures in CD patients treated by surgery are consistent with a mixed type inf... more The majority of strictures in CD patients treated by surgery are consistent with a mixed type inflammation (acute inflammation plus fibrosis). The presence of stratified BS pattern shows a significantly higher degree of fibrosis while the evidence of high mural signal intensity on T2-weighted fatsaturated images on MRI reflects histological features of acute inflammation. Even if the ideal definition of the type of the strictures in CD still remains significantly far to be obtained, the combined use of BS and MRI can offer useful information in a subgroup of patients needing surgery for complicating CD.

Journal of Crohn's and Colitis, 2014

The majority of strictures in CD patients treated by surgery are consistent with a mixed type inf... more The majority of strictures in CD patients treated by surgery are consistent with a mixed type inflammation (acute inflammation plus fibrosis). The presence of stratified BS pattern shows a significantly higher degree of fibrosis while the evidence of high mural signal intensity on T2-weighted fatsaturated images on MRI reflects histological features of acute inflammation. Even if the ideal definition of the type of the strictures in CD still remains significantly far to be obtained, the combined use of BS and MRI can offer useful information in a subgroup of patients needing surgery for complicating CD.

Cancer Imaging, 2013

Objective: To evaluate 3 Tesla (T) whole-body diffusion-weighted magnetic resonance imaging (WB D... more Objective: To evaluate 3 Tesla (T) whole-body diffusion-weighted magnetic resonance imaging (WB DWI) for early treatment assessment in aggressive non-Hodgkin lymphoma (NHL). Methods: Fourteen patients with NHL treated with standard chemotherapy underwent 3-T WB DWI before and 2 and 4 weeks during treatment, using b-values of 01000 s/mm 2 from which the apparent diffusion coefficient (ADC) was calculated. Patient follow-up (average 20.3 months, range 1523 months) was the reference standard. Volume and ADC changes between baseline and 2 weeks (Vratio 2w , ADCratio 2w) and 4 weeks (Vratio 4w , ADCratio 4w) of responding and non-responding lesions (lymph node and organ lesions) were compared using MannWhitney U tests. The per patient values of Vratio N and ADCratio N to predict progression-free survival were determined with a log-rank test. Results: Eight patients showed complete remission and 6 showed tumour progression. The ADCratio 2w and ADCratio 4w differed significantly in lesions showing tumour progression versus complete remission (ADCratio 2w ¼ 4 AE 21% versus 119 AE 68%; ADCratio 4w ¼ 18 AE 61% versus 155 AE 78%; both P50.0001); the Vratio 2w and Vratio 4w did not (P40.05). Per body region, the ADCratio 2w showed a negative predictive value of 100% and positive predictive value of 86%. Per patient, the ADCratio 2w and ADCratio 4w correlated significantly with progression-free survival (P50.05). Conclusion: 3-T WB DWI with ADC quantification may enable early treatment assessment of aggressive NHL.

Journal of Hepatology, 2015

Open access under CC BY-NC-ND license.

Alimentary Pharmacology & Therapeutics, 2012

Polycystic liver disease (PLD) is a phenotypical expression of autosomal dominant polycystic kidn... more Polycystic liver disease (PLD) is a phenotypical expression of autosomal dominant polycystic kidney disease and isolated polycystic liver disease. Somatostatin analogues, such as lanreotide, reduce polycystic liver volume.

Alimentary Pharmacology & Therapeutics, 2013

Long-acting lanreotide (LAN) 120 mg every 4 weeks reduces liver volume (LV) in patients with poly... more Long-acting lanreotide (LAN) 120 mg every 4 weeks reduces liver volume (LV) in patients with polycystic liver diseases (PCLD). Animal studies demonstrated that the inhibition of hepatic and renal cystogenesis is dose dependent. To investigate the safety and efficacy of two different LAN doses in PCLD patients. The 6-month results of the LOCKCYST I trial, its extension study and the LOCKCYST II trial were pooled. LV at baseline and month 6 was measured by CT-scan and blindly re-analysed by two independent radiologists. The study population [132 treatment periods, age 49 years (IQR: 45-55), 114 women] consisted of three groups. Each received treatment every 4 weeks during 6 months: placebo (n = 26); LAN 90 mg (n = 55) or LAN 120 mg (n = 51). The inter-observer variability and agreement in the calculation of LV were excellent. Severe side effects occurred with placebo, LAN 90 mg and LAN 120 mg in respectively 0%, 7% and 16%. Change in LV&amp;amp;amp;amp;#39;s after 6 months in these three groups were respectively: increase of +36 mL [(-45)-(+138)]; decrease of -82 mL [(-285)-(+92)] and decrease of -123 mL [(-312)-(+4)] (Kruskal-Wallis One Way anova on Ranks; P = 0.002). Based on ROC analysis, a reduction of ≥120 mL in LV has a positive predictive value of 64% for improving symptoms (ROC analysis AUC: 0.729; sensitivity 73%, specificity 69%, P &amp;amp;amp;amp;lt; 0.0001). Both LAN 90 mg and LAN 120 mg reduce liver volume. LAN 90 mg has less side effects. This suggests that in case of intolerance to LAN 120 mg, a dose reduction to LAN 90 mg is meaningful.