Accurate late gadolinium enhancement prediction by early T1-based quantitative synthetic mapping

OBJECTIVES: Early synthetic gadolinium enhancement (ESGE) imaging from post-contrast T1 mapping after adenosine stress-perfusion cardiac magnetic resonance (CMR) was compared to conventional late gadolinium enhancement (LGE) imaging for assessing myocardial scar. METHODS: Two hundred fourteen consecutive patients suspected of myocardial ischaemia were referred for stress-perfusion CMR. Myocardial infarct volume was quantified on a per-subsegment basis in both synthetic (2-3 min post-gadolinium) and conventional (9 min post-gadolinium) images by two independent observers. Sensitivity, specificity, PPV and NPV were calculated on a per-patient and per-subsegment basis. RESULTS: Both techniques detected 39 gadolinium enhancement areas in 23 patients. The median amount of scar was 2.0 (1.0-3.1) g in ESGE imaging and 2.2 (1.1-3.1) g in LGE imaging (p=0.39). Excellent correlation (r=0.997) and agreement (mean absolute difference: -0.028±0.289 ml) were found between ESGE and LGE images. Sensitivity, specificity, PPV and NPV of ESGE imaging were 96 (78.9-99.9), 99 (97.1-100.0)%, 96 (76.5-99.4) and 99.5 (96.6-99.9) in patient-based and 99 (94.5-100.0), 100 (99.9-100.0)%, 97.0 (91.3-99.0) and 100.0 (99.8-100.0) in subsegment-based analysis. CONCLUSION: ESGE based on post-contrast T1 mapping after adenosine stress-perfusion CMR imaging shows excellent agreement with conventional LGE imaging for assessing myocardial scar, and can substantially shorten clinical acquisition time. KEY POINTS: • Synthetic gadolinium enhancement images can be used for detection of myocardial scar. • Early synthetic gadolinium enhancement images can substantially shorten clinical acquisition time. • ESGE has high diagnostic accuracy as compared to conventional late gadolinium enhancement. • Quantification of myocardial scar with ESGE closely correlates with conventional LGE. • ESGE after stress perfusion CMR avoids need for additional gadolinium administration

Effects of caffeine intake prior to stress cardiac magnetic resonance perfusion imaging on regadenoson- versus adenosine-induced hyperemia as measured by T1 mapping

The antagonistic effects of caffeine on adenosine receptors are a possible cause of false-negative stress perfusion imaging. The purpose of this study was to determine the effects of coffee intake <4 h prior to stress perfusion cardiac magnetic resonance imaging (CMR) in regadenoson- versus adenosine-induced hyperemia as measured with T1-mapping. 98 consecutive patients with suspected coronary artery disease referred for either adenosine or regadenoson perfusion CMR were included in this analysis. Twenty-four patients reported coffee consumption <4 h before CMR (15 patients with adenosine, and 9 patients with regadenoson); 74 patients reported no coffee intake (50 patients with adenosine, and 24 patients with regadenoson). T1 mapping was performed using a modified look-locker inversion recovery sequence. T1 reactivity was determined by subtracting T1(rest) from T1(stress). T1(rest), T1(stress), and T1 reactivity in patients referred for regadenoson perfusion CMR were not significantly different when comparing patients with <4 h coffee intake and patients who reported no coffee intake (976 +/- 4 ms, 1019 +/- 48 ms, and 4.4 +/- 3.2% vs 971 +/- 33 ms, 1023 +/- 43 ms, and 5.4 +/- 2.4%) (p = 0.70, 0.79, and 0.40), and similar to values in patients without coffee intake undergoing adenosine CMR. In patients with <4 h coffee intake, T1(stress), and T1 reactivity were significantly lower for adenosine (898 +/- 51 ms, and -7.8 +/- 5.0%) compared to regadenoson perfusion CMR (p <0.001). Coffee intake <4 h prior to regadenoson perfusion CMR has no effect on stress-induced hyperemia as measured with T1 mapping

Ontwikkeling van enkele mosselbanken in de Nederlandse Waddenzee; situatie 2010

In dit project wordt de lange termijnontwikkeling van mosselbanken, en de factoren die het al dan niet overleven van mosselbanken bepalen, onderzocht. Hiervoor worden door IMARES enkele individuele mosselbanken in detail bestudeerd. Drie mosselbanken worden sinds 1997 gevolgd, één sinds 1998, twee sinds 2002, één sinds 2003 en zeven mosselbanken worden sinds 2006 gevolgd. In deze rapportage wordt de ontwikkeling van deze veertien mosselbanken tot en met 2010 beschreven. De meeste mosselbanken uit het project bestaan inmiddels uit mosselen van meerdere jaarklassen. Uit de gegevens die gedurende de jaren zijn verzameld blijkt dat naarmate een mosselbank ouder wordt het percentage levende mosselen langzaam afneemt tot ongeveer 40%. De rest van het oppervlak van de mosselbank bestaat dan uit lege mosselschelpen, ingevangen schelpen van andere soorten, slakken, andere schelpdieren, pokken en macro-algen. De afname in levende mosselen op een mosselbank wordt voornamelijk veroorzaakt door stormen en predatie. Lokale, matige mosselbroedvallen op individuele mosselbanken kunnen de afnemende mosselpopulatie op de korte termijn in stand houden, maar af en toe optredende goede broedvallen zijn nodig voor lange termijnoverleving van een mosselbank. De laatste jaren zijn veel van de onderzochte mosselbanken bedekt geraakt met Japanse oesters. Toch zijn er tussen de oesters nog veel mosselen te vinden en kan gesproken worden van gemengde mosselbanken. De oesters in de mosselbanken lijken in sommige gevallen voor extra stevigheid te zorgen, hoewel er ook delen met oesters verdwijnen tijdens winterstormen

Vijftig jaar monitoring en beheer van de Friese en Groninger kwelderwerken: 1960-2009

Dit WOt-werkdocument is een update van het kwelderboek uit 2001 en gaat ook over de bescherming door de kwelderwerken tegen de Allerheiligenvloed van 2006, over de Kaderrichtlijn Water en over de Sylt Conferentie van 2010. In 2007 verscheen in de WOT IN serie al een deel over Monitoring van kwelders in de Waddenzee, met beheermaatregelen voor alle kwelders (www.waddenzee.nl/Kwelders.1982.0.html). In de publicaties is ook aandacht voor beweiding, vegetatiekaarten, veroudering van de vegetatie, zeegras, grondwerk, ontwatering, en duurzaamheid van de rijshoutdammen

The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia

Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto, Siemens Medical Systems). Three short-axis cine and grid series were acquired during rest and at increasing doses of dobutamine (maximum 40 μg/kg/min). On peak dose dobutamine followed immediately by a first pass myocardial perfusion imaging sequence. Images were graded according to the sixteen-segment model, on a four point scale. Ninety-seven patients showed no New (Induced) Wall Motion Abnormalities (NWMA). Perfusion imaging showed absence of perfusion deficits in 67 of these patients (69%). Perfusion deficits attributable to known previous myocardial infarction were found in 30 patients (31%). Eighteen patients had NWMA, indicative for myocardial ischemia, of which 14 (78%) could be confirmed by a corresponding perfusion deficit. Four patients (22%) with NWMA did not have perfusion deficits. In these four patients NWMA were caused by a Left Bundle Branch Block (LBBB). They were free from cardiac events during the follow-up period (median 13.5 months; range 6–20). Addition of first-pass myocardial perfusion imaging during peak-dose dobutamine stress CMR can help to decide whether a NWMA is caused by myocardial ischemia or is due to an (inducible) LBBB, hereby preventing a false positive wall motion interpretation

Indexing and efficient instance-based retrieval of process models using untanglings

Process-Aware Information Systems (PAISs) support executions of operational processes that involve people, resources, and software applications on the basis of process models. Process models describe vast, often infinite, amounts of process instances, i.e., workflows supported by the systems. With the increasing adoption of PAISs, large process model repositories emerged in companies and public organizations. These repositories constitute significant information resources. Accurate and efficient retrieval of process models and/or process instances from such repositories is interesting for multiple reasons, e.g., searching for similar models/instances, filtering, reuse, standardization, process compliance checking, verification of formal properties, etc. This paper proposes a technique for indexing process models that relies on their alternative representations, called untanglings. We show the use of untanglings for retrieval of process models based on process instances that they specify via a solution to the total executability problem. Experiments with industrial process models testify that the proposed retrieval approach is up to three orders of magnitude faster than the state of the art

Comment on "Effect of Age-Related Factors on the Pharmacokinetics of Lamotrigine and Potential Implications for Maintenance Dose Optimisation in Future Clinical Trials".

Pharmacolog

Ecologische ontwikkeling in een voor menselijke activiteiten gesloten gebied in de Nederlandse Waddenzze: tussenrapportage twee jaar na sluiting (najaar 2007)

De Nederlandse overheid heeft in november 2005 een referentiegebied ingesteld om te voldoen aan de internationale verplichting dat voldoende grote gebieden in de Waddenzee worden aangewezen waarbinnen geen exploitaties en verstorende activiteiten mogen plaatsvinden. In dit project wordt de nadruk gelegd op het volgen van de ontwikkeling van het ecosysteem in een voor de visserij gesloten gebied (Schild en Boschwad) en dit te vergelijken met een gebied waar garnalenvisserij zal blijven (Zuidoost Lauwers en Spruit). Om de ontwikkeling van dit ongestoorde gebied te volgen zijn er vóór de instelling van dit gebied bemonsteringen uitgevoerd door IMARES. Na de instelling van het referentiegebied (november 2005) worden jaarlijks bemonsteringen uitgevoerd. In dit rapport wordt een weergave gegeven van de ontwikkelingen in het referentiegebied twee jaar na sluitin