American journal of nuclear medicine and molecular imaging, 2021
18F-fluordeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET-C... more 18F-fluordeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET-CT) and ultrasound guided fine-needle aspiration cytology (USgFNAC) are commonly used to detect nodal metastases in head and neck squamous cell carcinoma (HNSCC). FDG PET-CT helps to guide selection of borderline suspicious nodes to aspirate using USgFNAC. Real time image fusion of FDG PET-CT with US is a new available technique and can improve this selection. The aim of this study was to determine optimal SUVmax values for USgFNAC node selection to improve USgFNAC sensitivity. 118 patients, with histopathological proven HNSCC or proven lymph nodes metastases of SCC of unknown primary, referred for staging of HNSCC with FDG PET-CT and ultrasound, were prospectively included. Additionally to standard USgFNAC of suspicious nodes fusion was performed to confirm that USgFNAC took place in FDG-positive nodes and to add Fused-USgFNAC in missed FDG-positive nodes. Fusion was performed on nodes w...
Background Extremely dense breast tissue is associated with increased breast cancer risk and limi... more Background Extremely dense breast tissue is associated with increased breast cancer risk and limited sensitivity of mammography. The DENSE trial showed that additional magnetic resonance imaging (MRI) screening in women with extremely dense breasts resulted in a substantial reduction in interval cancers. The cost-effectiveness of MRI screening for these women is unknown. Methods We used the MISCAN-breast microsimulation model to simulate several screening protocols containing mammography and/or MRI to estimate long-term effects and costs. The model was calibrated using results of the DENSE trial and adjusted to incorporate decreases in breast density with increasing age. Screening strategies varied in the number of MRIs and mammograms offered to women ages 50-75 years. Outcomes were numbers of breast cancers, life-years, quality-adjusted life-years (QALYs), breast cancer deaths, and overdiagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated (3% discounting), with a...
Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in... more Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in head and neck squamous cell cancer (HNSCC). Peripheral vascularity is a described feature for node metastasis. Micro-flow imaging (MFI) is a new sensitive technique to evaluate micro-vascularization. Our goal is to assess the additional value of MFI to detect malignancy in lymph nodes. A total of 102 patients with HNSCC were included prospectively. USgFNAC was performed with the Philips eL18–4 transducer. Cytological results served as a reference standard to evaluate the prediction of cytological malignancy depending on ultrasound features such as resistive index (RI), absence of fatty hilum sign, and peripheral vascularization. Results were obtained for all US examinations and for the subgroup of clinically node-negative neck (cN0). USgFNAC was performed in 211 nodes. Peripheral vascularization had a positive predictive value (PPV) of 83% (cN0: 50%) and the absence of a fatty hilum had...
AIM To determine the willingness of women with extremely dense breasts to undergo breast cancer s... more AIM To determine the willingness of women with extremely dense breasts to undergo breast cancer screening with magnetic resonance imaging (MRI) in a research setting, and to examine reasons for women to participate or not. MATERIALS AND METHODS Between 2011 and 2015, 8,061 women (50-75 years) were invited for supplemental MRI as part of the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial (ClinicalTrials.gov Identifier: NCT01315015), after a negative screening mammography in the national population-based mammography screening programme. Demographics of participants and non-participants were compared. All invitees were asked to report reasons for (non)participation. Ethical approval was obtained. Participants provided written informed consent. RESULTS Of the 8,061 invitees, 66% answered that they were interested, and 59% eventually participated. Participants were on average 54-years old (interquartile range: 51-59 years), comparable to women with extremely dense breasts in the population-based screening programme (55 years). Women with higher socio-economic status (SES) were more often interested in participation than women with lower SES (68% versus 59%, p<0.001). The most frequently stated reasons for non-participation were "MRI-related inconveniences and/or self-reported contraindications to MRI" (27%) and "anxiety regarding the result of supplemental screening" (21%). "Expected personal health benefit" (68%) and "contribution to science" (43%) were the most frequent reasons for participation. CONCLUSION Of women invited for MRI because of extremely dense breasts, 59% participated. Common reasons for non-participation were "MRI-related inconveniences" and "anxiety regarding the result of supplemental screening". In case of future implementation, availability of precise evidence on benefits and harms might reduce this anxiety.
Journal of hypertension. Supplement : official journal of the International Society of Hypertension, 1985
Using long-term automatic blood pressure recording it has previously been shown that subjects wit... more Using long-term automatic blood pressure recording it has previously been shown that subjects with family history of hypertension show a minute fall of blood pressure during sodium restriction, which is reversible by high sodium intake. Thus normotensives with hypertensive antecedents as a group are salt-sensitive, whereas normotensives without heredity of hypertension as a group are salt-resistant. The present study compares intracellular sodium, potassium and calcium, sodium pump activity, NaK-cotransport of red blood cells and density and affinity of alpha 2-adrenergic receptors of platelets in normotensive subjects classified according to family history of hypertension and according to 'salt sensitivity' and 'salt resistance'. Neither the family history of hypertension nor salt sensitivity correlated with intracellular sodium, potassium, calcium, Na-pump activity and NaK-cotransport. Alpha 2-adrenergic density was higher in salt-sensitive than in salt-resistant s...
Ultraschall in der Medizin (Stuttgart, Germany : 1980), 1998
To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter f... more To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter for screening examination in routine follow-up after TIPS implantation. 35 patients underwent duplex sonographic examination by a 3.5 MHz transducer with a follow-up for 12.4 months. A reduction of TAM about 60% from baseline proved with a sensitivity of 90% and a specificity of 93.7% the presence of a hemodynamic relevant stenosis, which was confirmed with angiography. We failed to establish a threshold which pointed out with acceptable accuracy the presence of shunt dysfunction. TAM is a good parameter in colour-duplex sonography which permits an objective view of TIPS-function. Angiography should be performed only in patients with suspect duplex-results or clinical worsening. A secondary sign of shunt dysfunction is increasing ascites.
Ultraschall in der Medizin (Stuttgart, Germany : 1980), 1998
Doppler sonographic assessment of physiological bloodflow characteristic in arteriovenous shunts ... more Doppler sonographic assessment of physiological bloodflow characteristic in arteriovenous shunts of the fingertip and calculation of vascular resistance. Identification and definition of a peripheral, physiological resistive index in healthy volunteers. Doppler sonographic measurement of bloodflow values in Hoyer-Grosser organs of the fingertip in 20 healthy volunteers. Measurements were repeated at normal air temperature (21 degrees C) and after submersion in water (15 degrees C). The resistive index was calculated from peak systolic velocity and minimal diastolic velocity. Although bloodflow values vary in a wide range, the resistive index is constant with 0.54 (range 0.45-0.69) in healthy volunteers. Characteristic sonographic flow patterns could be achieved in all tests. Colour Doppler sonography allows identification of small arterio-venous shunts of the fingertip, measurement of bloodflow in these vessels and calculation of vascular resistance. At normal air temperature the ph...
To evaluate the usefulness of magnetic resonance (MR) imaging in the assessment of inconclusive f... more To evaluate the usefulness of magnetic resonance (MR) imaging in the assessment of inconclusive findings at mammography, such as indeterminate focal or diffuse breast abnormalities, post-treatment breasts with extensive scarring, dense breasts, and findings suggesting multifocal or multicentric breast cancer. 254 patients underwent mammography, sonography, and MRI of the breast. Dynamic MR imaging was done using a thin-section three-dimensional gradient-echo sequence (FLASH, TR = 11.8 ms; TE = 5 ms; flip angle = 25 degrees) which was applied in a dynamic fashion before and every 90 seconds after injection of gadopentetate dimeglumine. Diagnoses were confirmed at biopsy (n = 165) or by follow-up (n = 89). Among various breast anomalies, the highest proportion of breast cancers was associated with dense breast tissue (27.8%), architectural distortion (26.9%), and irregular scars (15.8%). Sensitivity of dynamic MR imaging was 93.7%, and specificity was 83.3%. As compared to mammography...
American journal of nuclear medicine and molecular imaging, 2021
18F-fluordeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET-C... more 18F-fluordeoxyglucose (FDG) positron emission tomography combined with computed tomography (PET-CT) and ultrasound guided fine-needle aspiration cytology (USgFNAC) are commonly used to detect nodal metastases in head and neck squamous cell carcinoma (HNSCC). FDG PET-CT helps to guide selection of borderline suspicious nodes to aspirate using USgFNAC. Real time image fusion of FDG PET-CT with US is a new available technique and can improve this selection. The aim of this study was to determine optimal SUVmax values for USgFNAC node selection to improve USgFNAC sensitivity. 118 patients, with histopathological proven HNSCC or proven lymph nodes metastases of SCC of unknown primary, referred for staging of HNSCC with FDG PET-CT and ultrasound, were prospectively included. Additionally to standard USgFNAC of suspicious nodes fusion was performed to confirm that USgFNAC took place in FDG-positive nodes and to add Fused-USgFNAC in missed FDG-positive nodes. Fusion was performed on nodes w...
Background Extremely dense breast tissue is associated with increased breast cancer risk and limi... more Background Extremely dense breast tissue is associated with increased breast cancer risk and limited sensitivity of mammography. The DENSE trial showed that additional magnetic resonance imaging (MRI) screening in women with extremely dense breasts resulted in a substantial reduction in interval cancers. The cost-effectiveness of MRI screening for these women is unknown. Methods We used the MISCAN-breast microsimulation model to simulate several screening protocols containing mammography and/or MRI to estimate long-term effects and costs. The model was calibrated using results of the DENSE trial and adjusted to incorporate decreases in breast density with increasing age. Screening strategies varied in the number of MRIs and mammograms offered to women ages 50-75 years. Outcomes were numbers of breast cancers, life-years, quality-adjusted life-years (QALYs), breast cancer deaths, and overdiagnosis. Incremental cost-effectiveness ratios (ICERs) were calculated (3% discounting), with a...
Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in... more Ultrasound-guided fine needle aspiration cytology (USgFNAC) is commonly used for nodal staging in head and neck squamous cell cancer (HNSCC). Peripheral vascularity is a described feature for node metastasis. Micro-flow imaging (MFI) is a new sensitive technique to evaluate micro-vascularization. Our goal is to assess the additional value of MFI to detect malignancy in lymph nodes. A total of 102 patients with HNSCC were included prospectively. USgFNAC was performed with the Philips eL18–4 transducer. Cytological results served as a reference standard to evaluate the prediction of cytological malignancy depending on ultrasound features such as resistive index (RI), absence of fatty hilum sign, and peripheral vascularization. Results were obtained for all US examinations and for the subgroup of clinically node-negative neck (cN0). USgFNAC was performed in 211 nodes. Peripheral vascularization had a positive predictive value (PPV) of 83% (cN0: 50%) and the absence of a fatty hilum had...
AIM To determine the willingness of women with extremely dense breasts to undergo breast cancer s... more AIM To determine the willingness of women with extremely dense breasts to undergo breast cancer screening with magnetic resonance imaging (MRI) in a research setting, and to examine reasons for women to participate or not. MATERIALS AND METHODS Between 2011 and 2015, 8,061 women (50-75 years) were invited for supplemental MRI as part of the Dense Tissue and Early Breast Neoplasm Screening (DENSE) trial (ClinicalTrials.gov Identifier: NCT01315015), after a negative screening mammography in the national population-based mammography screening programme. Demographics of participants and non-participants were compared. All invitees were asked to report reasons for (non)participation. Ethical approval was obtained. Participants provided written informed consent. RESULTS Of the 8,061 invitees, 66% answered that they were interested, and 59% eventually participated. Participants were on average 54-years old (interquartile range: 51-59 years), comparable to women with extremely dense breasts in the population-based screening programme (55 years). Women with higher socio-economic status (SES) were more often interested in participation than women with lower SES (68% versus 59%, p<0.001). The most frequently stated reasons for non-participation were "MRI-related inconveniences and/or self-reported contraindications to MRI" (27%) and "anxiety regarding the result of supplemental screening" (21%). "Expected personal health benefit" (68%) and "contribution to science" (43%) were the most frequent reasons for participation. CONCLUSION Of women invited for MRI because of extremely dense breasts, 59% participated. Common reasons for non-participation were "MRI-related inconveniences" and "anxiety regarding the result of supplemental screening". In case of future implementation, availability of precise evidence on benefits and harms might reduce this anxiety.
Journal of hypertension. Supplement : official journal of the International Society of Hypertension, 1985
Using long-term automatic blood pressure recording it has previously been shown that subjects wit... more Using long-term automatic blood pressure recording it has previously been shown that subjects with family history of hypertension show a minute fall of blood pressure during sodium restriction, which is reversible by high sodium intake. Thus normotensives with hypertensive antecedents as a group are salt-sensitive, whereas normotensives without heredity of hypertension as a group are salt-resistant. The present study compares intracellular sodium, potassium and calcium, sodium pump activity, NaK-cotransport of red blood cells and density and affinity of alpha 2-adrenergic receptors of platelets in normotensive subjects classified according to family history of hypertension and according to 'salt sensitivity' and 'salt resistance'. Neither the family history of hypertension nor salt sensitivity correlated with intracellular sodium, potassium, calcium, Na-pump activity and NaK-cotransport. Alpha 2-adrenergic density was higher in salt-sensitive than in salt-resistant s...
Ultraschall in der Medizin (Stuttgart, Germany : 1980), 1998
To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter f... more To determine if duplex sonographic measured Time Average Motion (TAM) is an effective parameter for screening examination in routine follow-up after TIPS implantation. 35 patients underwent duplex sonographic examination by a 3.5 MHz transducer with a follow-up for 12.4 months. A reduction of TAM about 60% from baseline proved with a sensitivity of 90% and a specificity of 93.7% the presence of a hemodynamic relevant stenosis, which was confirmed with angiography. We failed to establish a threshold which pointed out with acceptable accuracy the presence of shunt dysfunction. TAM is a good parameter in colour-duplex sonography which permits an objective view of TIPS-function. Angiography should be performed only in patients with suspect duplex-results or clinical worsening. A secondary sign of shunt dysfunction is increasing ascites.
Ultraschall in der Medizin (Stuttgart, Germany : 1980), 1998
Doppler sonographic assessment of physiological bloodflow characteristic in arteriovenous shunts ... more Doppler sonographic assessment of physiological bloodflow characteristic in arteriovenous shunts of the fingertip and calculation of vascular resistance. Identification and definition of a peripheral, physiological resistive index in healthy volunteers. Doppler sonographic measurement of bloodflow values in Hoyer-Grosser organs of the fingertip in 20 healthy volunteers. Measurements were repeated at normal air temperature (21 degrees C) and after submersion in water (15 degrees C). The resistive index was calculated from peak systolic velocity and minimal diastolic velocity. Although bloodflow values vary in a wide range, the resistive index is constant with 0.54 (range 0.45-0.69) in healthy volunteers. Characteristic sonographic flow patterns could be achieved in all tests. Colour Doppler sonography allows identification of small arterio-venous shunts of the fingertip, measurement of bloodflow in these vessels and calculation of vascular resistance. At normal air temperature the ph...
To evaluate the usefulness of magnetic resonance (MR) imaging in the assessment of inconclusive f... more To evaluate the usefulness of magnetic resonance (MR) imaging in the assessment of inconclusive findings at mammography, such as indeterminate focal or diffuse breast abnormalities, post-treatment breasts with extensive scarring, dense breasts, and findings suggesting multifocal or multicentric breast cancer. 254 patients underwent mammography, sonography, and MRI of the breast. Dynamic MR imaging was done using a thin-section three-dimensional gradient-echo sequence (FLASH, TR = 11.8 ms; TE = 5 ms; flip angle = 25 degrees) which was applied in a dynamic fashion before and every 90 seconds after injection of gadopentetate dimeglumine. Diagnoses were confirmed at biopsy (n = 165) or by follow-up (n = 89). Among various breast anomalies, the highest proportion of breast cancers was associated with dense breast tissue (27.8%), architectural distortion (26.9%), and irregular scars (15.8%). Sensitivity of dynamic MR imaging was 93.7%, and specificity was 83.3%. As compared to mammography...
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