Abstractboek 2019 by az groeninge

ABSTRACT BOEK 2019

Wetenschappelijke publicaties van AZ Groeninge

CENTRA 02 ABDOMINALE CHIRURGIE

37 NEFROLOGIE

07 ANESTHESIE

38 NEUROLOGIE

09 CARDIOLOGIE

39 NUCLEAIRE GENEESKUNDE

12 GYNAECOLOGIE

49 ONCOLOGIE

13 INWENDIGE ZIEKTEN

55 ORTHOPEDIE

19 KLINISCH LABORATORIUM

62 PATHOLOGISCHE ANATOMIE

25 LONGZIEKTEN

63 PSYCHIATRIE

27 MEDISCHE BEELDVORMING

66 RADIOTHERAPIE 67 VASCULAIRE EN THORACALE CHIRURGIE

VU Inge Buyse, Pres. Kennedylaan 4 | 8500 Kortrijk Uitgegeven in opdracht van het wetenschappelijk comitÃ© van AZ Groeninge Eindredactie Laurence Beels, Eline Lamaire

ABSTRACTBOEK | 2019

Dit abstractboek is ook te raadplegen via azg.site/abstractboek

VOORWOORD

Geachte lezer

2020 wordt een jaar om nooit te vergeten! Na enkele weken van toenemende ongerustheid over een nakende epidemie met een nieuwe variant van het coronavirus werd op vrijdag 13 maart het federaal noodplan afgekondigd en werden de ziekenhuizen quasi volledig gesloten. Alleen dringende of noodzakelijk zorg kon nog worden toegediend. Dit leverde de eerste dagen hallucinante beelden op van een leeglopend ziekenhuis, met nagenoeg lege poliklinieken en op dit ogenblik nog praktisch geen Covid-19 patiënten. Het vervolg van het verhaal is alom bekend. De eerste golf kwam, bereikte een vrij hoge piek en geleidelijk aan was er hoop op een quasi normalisatie van de activiteit, die er uiteindelijk ook kwam. Er is nu (augustus 2020) echter nog geen uitgebreid getest vaccin beschikbaar en echt effectieve therapieën laten nog steeds op zich wachten. De ongerustheid voor één of meer nieuwe golven bestaat nog steeds; allerlei restricties zijn nog van kracht. Bij een terugblik op deze onwaarschijnlijke eerste jaarhelft is hetgeen mij misschien nog het meeste zal bijblijven de ongelofelijke eendracht, de sereniteit en het professionalisme die aan de dag gelegd werden door onze artsen, verpleegkundigen, paramedici en alle andere medewerkers in het ziekenhuis. Vrij snel na de start van de epidemie richtten we een medisch-farmaceutische multidisciplinaire wetenschappelijke task force op die alle circulerende informatie over het SARS-CoV-2 virus, de epidemie en therapieschema’s bundelde, screende en omzette naar onze eigen interne guidelines. Zoals gebruikelijk werd er naar gestreefd zo evidence based mogelijk te werken en de prille literatuur werd op de voet te gevolgd. Tegelijk werd er ook naar gestreefd om de eigen ervaringen goed te documenteren. Het sterkt het hele team en alle betrokkenen tot eer, zelfs in deze ongeziene crisis, nog steeds het wetenschappelijk gedachtengoed te koesteren. Ongetwijfeld zullen we daar in de volgende editie van ons abstractboek enkele sporen van vinden. In deze editie vindt u alvast een overzicht van alle publicaties van het jaar 2019. Groot respect voor alle artsen en medewerkers die eens te meer de dagelijkse warme patiëntenzorg combineerden met wetenschappelijke drive.

DR. SERGE VANDERSCHUEREN MEDISCH DIRECTEUR 24 AUGUSTUS 2020

CENTRUM

ABDOMINALE CHIRURGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Laparoscopic combined resection of liver metastases and colorectal cancer: a multicenter, case-matched study using propensity scores.

A comparison of the learning curves of laparoscopic liver surgeons in differing stages of the IDEAL paradigm of surgical innovation: standing on the shoulders of pioneers.

van der Poel MJ, Tanis PJ, D'Hondt M, et al. Surgical Endoscopy, 2019, 33(4), 1124-1130

INTRODUCTION/BACKGROUND Halls MC, Alseidi A, Berardi G, D'Hondt M, et al. Annals of Surgery, 2019, 269(2), 221-228

INTRODUCTION/BACKGROUND It is expected that a wider adoption of a laparoscopic approach to liver surgery will be seen in the next few years. Current guidelines stress the need for an incremental, stepwise progression through the learning curve in order to minimize harm to patients. Previous studies have examined the learning curve in Stage 2 of the IDEAL paradigm of surgical innovation; however, LLS is now in stage 3 with specific training being provided to surgeons.

OBJECTIVE To compare the learning curves of the self-taught "pioneers" of laparoscopic liver surgery (LLS) with those of the trained "early adopters" in terms of short- and medium-term patient outcomes to establish if the learning curve can be reduced with specific training.

MATERIALS/METHODS Using risk-adjusted cumulative sum analysis, the learning curves and short- and medium-term outcomes of 4 "pioneering" surgeons from stage 2 were compared with 4 "early adapting" surgeons from stage 3 who had received specific training for LLS.

RESULTS After 46 procedures, the short- and medium-term outcomes of the "early adopters" were comparable to those achieved by the "pioneers" following 150 procedures in similar cases.

Combined laparoscopic resection of liver metastases and colorectal cancer (LLCR) may hold benefits for selected patients but could increase complication rates. Previous studies have compared LLCR with liver resection alone. Propensity score-matched studies comparing LLCR with laparoscopic colorectal cancer resection (LCR) alone have not been performed.

MATERIALS/METHODS A multicenter, case-matched study was performed comparing LLCR (2009-2016, 4 centers) with LCR alone (20092016, 2 centers). Patients were matched based on propensity scores in a 1:1 ratio. Propensity scores were calculated with the following preoperative variables: age, sex, ASA grade, neoadjuvant radiotherapy, type of colorectal resection and T and N stage of the primary tumor. Outcomes were compared using paired tests.

RESULTS Out of 1020 LCR and 64 LLCR procedures, 122 (2 × 61) patients could be matched. All 61 laparoscopic liver resections were minor hepatectomies, mostly because of a solitary liver metastasis (n = 44, 69%) of small size (≤ 3 cm) (n = 50, 78%). LLCR was associated with a modest increase in operative time [206 (166-308) vs. 197 (148-231) min, p = 0.057] and blood loss [200 (100-700) vs. 75 (5-200) ml, p = 0.011]. The rate of Clavien-Dindo grade 3 or higher complications [9 (15%) vs. 13 (21%), p = 0.418], anastomotic leakage [5 (8%) vs. 4 (7%), p = 1.0], conversion rate [3 (5%) vs. 5 (8%), p = 0.687] and 30-day mortality [0 vs. 1 (2%), p = 1.0] did not differ between LLCR and LCR.

CONCLUSION CONCLUSION With specific training, "early adapting" laparoscopic liver surgeons are able to overcome the learning curve for minor and major liver resections faster than the "pioneers" who were self-taught in LLS. The findings of this study are applicable to all surgical specialties and highlight the importance of specific training in the safe expansion of novel surgical practice.

ABSTRACTBOEK | 2019

In selected patients requiring minor hepatectomy, LLCR can be safely performed without increasing the risk of postoperative morbidity compared to LCR alone.

ABSTRACT 3

ABSTRACT 4

Hepatopancreatoduodenectomy -a controversial treatment for bile duct and gallbladder cancer from a European perspective.

Laparoscopic right posterior sectionectomy: singlecenter experience and technical aspects.

D'Souza MA, Valdimarsson VT, D'Hondt M, et al. Hepato-Pancreato-Biliary (HPB) Oxford, 2019, S1365182X(19), 33224-1

INTRODUCTION/BACKGROUND Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist.

D'Hondt M, Ovaere S, Knol J, et al. Langenbeck's archives of surgery, 2019, 404(1), 21-29

INTRODUCTION/BACKGROUND Laparoscopic right posterior sectionectomy (LRPS) is a technically demanding procedure.

OBJECTIVE The aim of this article is to share our experience with LRPS and to highlight technical aspects of this procedure.

MATERIALS/METHODS OBJECTIVE The purpose of this study was to evaluate safety and efficacy for HPD in European centers.

MATERIALS/METHODS Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed.

RESULTS In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival.

This is a single-center retrospective analysis of all patients who underwent LRPS between September 2011 and October 2017. Data were retrieved from a prospectively maintained database. Video-in-picture (VIP) technology is used to facilitate and to highlight the technical aspects of this procedure.

RESULTS In total, 18 patients underwent LRPS. Indication for surgery was mainly liver metastases (n = 11) and hepatocellular carcinoma (n = 6). The Glissonean approach for inflow control was used in 13 patients. Median operative time was 162 (140-190) minutes. Median blood loss was 325 mL (IQR: 150-450). One conversion (5.5%) was required. There were two minor complications and one major complication. Median hospital stay was 6 days (range 5-8 days). All patients had an R0 resection. There was no 90-day mortality.

CONCLUSION The results of our experience in LRPS add weight to the feasibility and safety of this approach.

CONCLUSION HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer. To achieve negative resection margins is paramount for an improved survival outcome.

ABSTRACT 5 Stepwise implementation of laparoscopic pancreatic surgery. Case series of a single centre's experience. Vandeputte M, D'Hondt M, Willems E, et al. International Journal of Surgery, 2019, 72, 137-143

INTRODUCTION/BACKGROUND Laparoscopic pancreatic surgery still represents a challenge for surgeons. However, in recent decades the experience is expanding. Recent systematic reviews and meta-analyses confirm that laparoscopic pancreatic resection (LPR) is safe,

ABDOMINALE CHIRURGIE

feasible and worthwhile.

INTRODUCTION/BACKGROUND

OBJECTIVE

Small bowel obstruction (SBO) is a frequent complication after laparoscopic Roux-en-y gastric bypass (LRYGB).

This study analyses the first 100 consecutive LPRs in our centre.

MATERIALS/METHODS A retrospective analysis was conducted of the first 100 LPRs in a single supra-regional Belgian centre, performed between January 2012 and January 2019. Pre-, peri- and postoperative data were retrieved from a prospectively maintained database. All procedures were performed laparoscopically by two attending surgeons, specialized in minimally invasive and hepatopancreatobiliary surgery.

RESULTS Of 100 procedures, 62 laparoscopic pancreatoduodenectomies (LPD) and 36 laparoscopic distal pancreatectomies (LDP) were performed, along with 1 enucleation and 1 central pancreatectomy. Indication was malignancy in 70%. Conversion rate was 24,2% in LPD and 11% in LDP. Median operative time was 330 min (IQR 300-360) in LPD and 150 min (IQR 142.5-210) in LDP. Median blood loss was 200 mL (IQR 100-487.5) in LPD and 150 mL (IQR 50-500) in LDP, transfusion rate was 22.6% and 8.3% respectively. Median length of stay (LOS) was 13 days (IQR 10-19.25) in LPD and 9 days (IQR 9-14) in LDP. R0 resection rate was 88.6% (62/70). Major complication rate (Clavien-Dindo grade III-IV) was 12%. Thirty-day mortality was 0%, 90day mortality was 2%.

CONCLUSION Our results confirm that LPR is a feasible and safe alternative to open pancreatic surgery. Safe implementation with a clear strategy is fundamental to gain experience and overcome the learning curve of this technically demanding procedures.

MATERIALS/METHODS This study was a retrospective cohort study of 1364 patients who underwent a LRYGB between July 2003 and October 2015. Cohort 1 contained 724 patients in whom mesenteric defects were not closed. Cohort 2 contained 640 patients in whom mesenteric defects were closed. Main outcome parameters were the incidence of SBO and postoperative complications as well as potential risk factors for SBO.

RESULTS Closure of the mesenteric defects was associated with a reduction in the incidence of SBO due to internal herniation (4.8% vs. 5.5, p = 0.02) but resulted in a higher incidence of SBO due to postoperative adhesions (4.8% vs. 1.7%, p = 0.004). Multivariate analysis identified smoking as a risk factor for SBO (p = 0.0187). We observed a higher incidence of late postoperative pain in cohort 2 (5.3% vs. 2.1%, p = 0.007).

CONCLUSION Although closure of the mesenteric defects is associated with a lower incidence of SBO due to internal herniation, this effect is countered by a higher incidence of SBO due to postoperative adhesions. Smoking is an independent risk factor for SBO after LRYGB. Closure of the mesenteric defects is associated with a higher incidence of late postoperative pain.

ABSTRACT 6

ABSTRACT 7

Closure of mesenteric defects is associated with a higher incidence of small bowel obstruction due to adhesions after laparoscopic antecolic Roux-en-y gastric bypass: A retrospective cohort study.

Adverse effects of bevacizumab in metastatic colorectal cancer : a case report and literature review.

Nuytens F, D'Hondt M, Van Rooy F, Vansteenkiste F, Devriendt D, et al. International Journal of Surgery, 2019, 71, 149-155

OBJECTIVE We wanted to evaluate the effect of closure of the mesenteric defects on the incidence of SBO and postoperative complications after LRYGB. Furthermore, we wanted to identify possible risk factors for SBO.

ABSTRACTBOEK | 2019

Willems E, George C, D'Hondt M, et al. Acta Gastro-enterologica Belgica, 2019, 82(2), 322-325

INTRODUCTION/BACKGROUND Colorectal cancer is one of the most frequently diagnosed malignancies worldwide. One of the most important developments in the management of metastatic colorectal

cancer is targeted therapy.

RESULTS Bevacizumab, a monoclonal antibody inhibiting VEGF induced angiogenesis, has been accepted as safe and efficient in the treatment of metastatic colorectal cancer for more than a decade. Addition of bevacizumab to fluorouracil-based chemotherapy is also associated with severe adverse events.

CONCLUSION We present a case of bevacizumab-induced bowel ischaemia associated with gastrointestinal haemorrhage.

RESULTS Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.42.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy.

ABSTRACT 8

CONCLUSION

Updated alternative fistula risk score (ua-frs) to include minimally invasive pancreatoduodenectomy: paneuropean validation.

The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged.

Mungroop TH, Klompmaker S, Wellner UF, D'Hondt M, et al. Annals of surgery, 2019, Volume Published Ahead of Print, Issue doi: 10.1097/SLA.0000000000003234

INTRODUCTION/BACKGROUND

ABSTRACT 9

MIPD may be associated with an increased risk of postoperative pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD.

Multicentre propensity score-matched study of laparoscopic versus open repeat liver resection for colorectal liver metastases. van der Poel MJ, Barkhatov L, D'Hondt M, et al. The British Journal of Surgery, 2019, 106(6), 783-789

OBJECTIVE

INTRODUCTION/BACKGROUND

The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort.

Repeat liver resection is often the best treatment option for patients with recurrent colorectal liver metastases (CRLM). Repeat resections can be complex, however, owing to adhesions and altered liver anatomy. It remains uncertain whether the advantages of a laparoscopic approach are upheld in this setting.

MATERIALS/METHODS A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance.

OBJECTIVE The aim of this retrospective, propensity score-matched study was to compare the short-term outcome of laparoscopic (LRLR) and open (ORLR) repeat liver resection.

MATERIALS/METHODS A multicentre retrospective propensity score-matched study was performed including all patients who underwent LRLRs and ORLRs for CRLM performed in nine high-volume centres from seven European countries between 2000 and 2016. Patients were matched based on propensity scores

ABDOMINALE CHIRURGIE

in a 1 : 1 ratio. Propensity scores were calculated based on 12 preoperative variables, including the approach to, and extent of, the previous liver resection. Operative outcomes were compared using paired tests.

RESULTS Overall, 425 repeat liver resections were included. Of 271 LRLRs, 105 were matched with an ORLR. Baseline characteristics were comparable after matching. LRLR was associated with a shorter duration of operation (median 200 (i.q.r. 123273) versus 256 (199-320) min; P < 0·001), less intraoperative blood loss (200 (50-450) versus 300 (100-600) ml; P = 0·077) and a shorter postoperative hospital stay (5 (3-8) versus 6 (5-8) days; P = 0·028). Postoperative morbidity and mortality rates were similar after LRLR and ORLR.

CONCLUSION

LRLR for CRLM is feasible in selected patients and may offer advantages over an open approach.

In experienced hands, LLR of lesions in proximity to MVs is safe and feasible with acceptable short and long-term results.

ABSTRACT 10 Laparoscopic liver resection for liver tumours in proximity to major vasculature: A single-center comparative study. D'Hondt M, Parmentier I, Vansteenkiste F, Verslype C, et al. European Journal of Surgical Oncology, 2020, 46(Issue 4 Part A), 539-547

INTRODUCTION/BACKGROUND With growing popularity and experience in laparoscopic liver surgery, the options for more difficult procedures increase. Only small case series have been published regarding laparoscopic liver resection (LLR) for tumours in proximity to major vessels (MVs).

OBJECTIVE The aim was to compare outcomes of LLR for tumours located less or more than 15 mm from MVs.

MATERIALS/METHODS This was a retrospective analysis of a prospectively collected database of consecutive LLR (October 2011-August 2017). Proximity to MVs (PMV) was defined as lesions located within 15 mm to the caval vein, hepatic veins and portal vein (main trunk and first branches). The control group were all lesions located more than 15 mm from MVs.

RESULTS Some 60/235 LLR were performed for lesions in proximity to major vasculature (24%). In the PMV group, median IWATE Difficulty Score was higher (8.5 (IQR: 6.0-9.0) VS 5.0 (IQR: 3.0-6.0), p < 0.001) as was the use of CUSA® (45.0% VS 8.6%, p < 0.001) and Pringle manoeuvre (8.3% VS 1.7%; p = 0.028). Operative time was longer (180min (IQR: 140210) VS 120min (IQR: 75-150), p < 0.001) and blood loss was higher (190 ml (IQR: 100-325) VS 75 ml (IQR: 50-220), p < 0.001) in the PMV group. There was no difference in perioperative blood transfusion (3.3% VS 1.7%, p = 0.60) or postoperative morbidity (15.0% VS 14.3%, p = 0.89). There was no mortality in both groups. On mean follow-up of 21 months, no significant differences could be found in disease free (p = 0.77) and overall survival (p = 0.12).

ABSTRACTBOEK | 2019

CENTRUM

ANESTHESIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Ruminococcus gnavus bacteremia, an uncommon presentation of a common member of the human gut microbiota: case report and literature review.

Feasibility of an ultrasound guided approach to radiofrequency ablation of the superolateral, superomedial and inferomedial genicular nerve, a cadaveric study.

Lefever S, Van Moerkercke W, D'Hondt M, Pampols M, De Bel A, Boudewijns M, et al. Acta Clinica Belgica, 2019, Dec 74(6), 435-438

Vanneste B, Tomlinson J, Desmet M, et al. Regional Anesthesia & Pain Medicine, 2019, 44(10), 966-70

INTRODUCTION/BACKGROUND Genicular nerve radiofrequency (RF) denervation appears to be a promising treatment for knee pain in patients with degenerative osteoarthritis of the knee, when candidates are not suitable for arthroplasty. This study aimed to assess the accuracy and reliability of ultrasound-guided placement of RF cannulas in cadavers for genicular nerve treatment, by measuringthe needle-to-nerve proximity.

MATERIALS/METHODS Five soft-fix human cadavers were included in this study, totaling 10 knees (meanage 93.8 years). Using the ultrasoundguided technique,which we have described previously, RF cannulas were directed toward the superolateral genicular nerve(SLGN), the superomedial genicular nerve (SMGN) and the inferomedial genicular nerve (IMGN). Indocyaninegreen (ICG) dye (0.1 mL) was infiltrated. An anatomical dissection was performed and the distance from the center of the ICG mark to the genicular nerve concerned was measured.

INTRODUCTION/BACKGROUND Case report: We present a case of a 66-year-old female diagnosed with R. gnavus bacteremia associated with fecal peritonits secondary to small-bowel herniation and perforation. Identification as R. gnavus was delayed because of absence of this species in the MALDI-TOF MS database (Vitek MS, bioMérieux). Identification was provided by 16S rRNA gene sequencing. Review: R. gnavus, a Gram-positive, strictly anaerobic bacterium, is a member of the human gut microbiota. Dysbiosis in the gut microbiota, with increased amounts of R. gnavus, has been described in inflammatory bowel disease. R. gnavus has only been reported occasionally as the cause of infections. Hence the potential pathogenicity is not yet fully recognized, and data regarding the antimicrobial susceptibility profile are rare. Identification of anaerobic bacteria such as R. gnavus is greatly accelerated as a result of the introduction of MALDI-TOF MS. However, as illustrated in this case report, an extensive and up-todate MALDI-TOF MS database is necessary for providing an accurate identification.

ABSTRACT 3 RESULTS The mean distances from the center of the ICG mark to the SLGN, SMGN and IMGN were 2.33 mm(range 0.00–6.05 mm), 3.44 mm (range 0.00–10.59mm) and 1.32 mm (range 0.00–2.99 mm), respectively. There was no statistical difference in distances from the center of the ICG mark to the targeted nerve between the different nerves (p=0.18).

Lethal injection of a castor bean extract: ricinine quantification as a marker for ricin exposure using a validated LC–MS/MS method. Verougstraete N, Helsloot D, Casier I, et al. Journal of Analytical Toxicology, 2019, 43(3), e1-e5

INTRODUCTION/BACKGROUND CONCLUSION The results of this study demonstrate that ultrasound-guided treatment of the genicular nerves is feasible. However, for RF ablations, there are some limitations, which mostly can be overcome by using appropriate RF ablation settings.

Ricin is a highly toxic agent derived from the castor bean plant (Ricinus communis). Poisoning occurs commonly by oral ingestion of the beans. Injection of ricin is believed to be more lethal. Ricin is a large glycosylated protein difficult to detect in clinical samples. Instead, ricinine, a small alkaloid found in the same beans, is used as surrogate marker for ricin exposure. We describe a simple LC–MS/MS method for the detection of ricinine in serum, blood and urine, validated according to EMA guidelines and successfully applied to patient samples of a suicidal death after injection of

ANESTHESIE

a castor bean extract. A 26-year-old man self-presented to the emergency department with severe abdominal cramps and nausea after injection of a castor bean extract. Due to rapid deterioration of his hemodynamic function despite early aggressive fluid resuscitation, he was transferred to ICU. Abdominal cramps worsened and a fulminant diarrhea developed, resulting in hypovolemic shock and cardiorespiratory collapse. Despite full supportive therapy, the patient died approximately 10 hours after injection due to multiple organ failure. Ricinine was quantified by LCâ&#x20AC;&#x201C;MS/ MS after LLE with diethyl ether using ricinine-D3 as internal standard. Six hours after injection, ricinine concentrations in serum and blood were 16.5 and 12.9 ng/mL, respectively, which decreased to 12.4 and 10.6 ng/mL, 4 hours later. The urinary concentration was 81.1 ng/mL 7 hours after injection, which amply exceeded the levels previously reported in similar cases with lethal outcome. Concentrations of ricinine, compatible with a lethal exposure to castor beans, were detected in serum, blood and urine. Ricinine was also found in bile and liver tissue.

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Current antibiotic policy for comatose patients with suspected aspiration. 39th Annual Meeting of the Belgian Society of Intensive Care Vandebroek A, Lamote S, De Corte W June 2019, Brussels, Belgium

INTRODUCTION/BACKGROUND An antibiotic (AB) restrictive strategy remains a challenge in comatose patients admitted to Intensive Care Unit (ICU) as they are at high risk for aspiration. Consequently, antimicrobial therapy is frequently initiated in this subgroup of patients, notwithstanding the lack of data supporting this prophylactic strategy. As part of our ICU antibiotic stewardship program, we assessed our current clinical practice in comatose out-ofhospital patients with suspected aspiration admitted to ICU.

CONCLUSION 1. The vast majority of comatose out-of-hospital patients were put on AB therapy for suspected aspiration pneumonia, although fewer than 50% of the cases could be classi-

ABSTRACTBOEK | 2019

fied as aspiration syndrome and only 20% as BAP. 2. Nearly one third of the patients had no TBA taken before start of AB. 3. AB course, when started, lasted frequently longer than 7 days, even in those patients without aspiration syndrome at admission. 4. The higher incidence of more resistant pathogens observed in the AB-group was not significant. 5. Targets for improvement: 5.1. Verifiying that TBA samples are collected before AB initiation. 5.2. Thorough evaluation of need for AB continuation on a daily basis.

ABSTRACT 2 Cervical mediastinoscopy: Always Safe? European Society of Thoracic Surgeons (ESTS) Dublin 2019 Clement C, Janssen M, Vanacker P, FranĂ§ois O, Missant C, Lerut P, et al. Juni 2019, Dublin, Ierland Er is geen abstract beschikbaar.

CENTRUM

CARDIOLOGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Graft patency after FFR-guided versus angiographyguided coronary artery bypass grafting: the GRAFFITI trial.

Image focus: renovascular hypertension. Dhont S, De Niel C, Van Mieghem C, et al. Acta Cardiologica, 2019, [Epub ahead of print], 1-2

Toth G, De Bruyne B, Van Mieghem C, et al. EuroIntervention, 2019, 15(11), e999-e1005

OBJECTIVE INTRODUCTION/BACKGROUND Four out of ten adults worldwide have arterial hypertension, in about 5–10% there is an identifiable cause named as secondary hypertension. Early detection and treatment of these entities are important to minimize/prevent irreversible changes in the vasculature and target organs. Renovascular hypertension results from a lesion that impairs blood flow to one or both kidneys.

CONCLUSION A 56-year-old man was referred because of resistant arterial hypertension. Lab results showed renal impairment after recently adding an angiotensin converting enzyme inhibitor: creatinine 1.83 mg/dL (baseline creatinine 0.93 mg/dL) corresponding to a calculated clearance of 41 ml/ min/1.73m2 according to the formula of CKD-EPI. A computer tomographic examination of the abdominal blood vessels showed an osteal occlusion of the right renal artery with a hypotrophic occurrence of the right kidney (Figure 1). Renin level on serum was 24.6 ug/L/h; normal values for patients older than 40 years are 0.6–3.0 ug/L/h. Additionally, a dimercaptosuccinic acid (DMSA) renal scan was performed to measure the kidney function: the right kidney turned out to be non-functional (almost absent captation, Figure 2). Studies with DMSA-scan present high specificity and are useful in patients with high probability for renovascular hypertension. After laparoscopic nephrectomy, the antihypertensive drugs could be systematically phased out. During the operation, the renal artery was dissected and confirmed the presence of severe atherosclerosis. Peri-operative renin levels showed extremely high values at the right renal vein and immeasurably low dosage at left renal vein (Table 1). The arterial stenosis thus causes local renal ischaemia which stimulates renin release and activation of the renin-angiotensinaldosterone system, which in turn results in secondary hypertension.

The aim of this study was to assess prospectively the clinical benefits of fractional flow reserve (FFR) in guiding coronary artery bypass grafting (CABG).

MATERIALS/METHODS GRAFFITI is a single-blinded, prospective, multicentre, randomised controlled trial of FFR-guided versus angiography-guided CABG. We enrolled patients undergoing coronary angiography, having a significantly diseased left anterior descending artery or left main stem and at least one more major coronary artery with intermediate stenosis, assessed by FFR. Surgical strategy was defined based on angiography, blinded to FFR values prior to randomisation. After randomisation, patients were operated on either following the angiography-based strategy (angiography-guided group) or according to FFR, i.e., with an FFR ≤0.80 as cutoff for grafting (FFR-guided group). The primary endpoint was graft patency at 12 months. Between March 2012 and December 2016, 172 patients were randomised either to the angiography-guided group (84 patients) or to the FFR-guided group (88 patients). The patients had a median of three [3; 4] lesions; diameter stenosis was 65% (50%; 80%), FFR was 0.72 (0.50; 0.82). Compared to the angiography-guided group, the FFR-guided group received fewer anastomoses (3 [3; 3] vs 2 [2; 3], respectively; p=0.004). One-year angiographic follow-up showed no difference in overall graft patency (126 [80%] vs 113 [81%], respectively; p=0.885). One-year clinical follow-up, available in 98% of patients, showed no difference in the composite of death, myocardial infarction, target vessel revascularisation and stroke.

CONCLUSION FFR guidance of CABG has no impact on one-year graft patency, but it is associated with a simplified surgical procedure.

CARDIOLOGIE

ABSTRACT 3

CONCLUSION

High-sensitivity cardiac troponin release after conventional and minimally invasive cardiac surgery.

Differentiation between cardiac surgery–related necrosis and PMI remains challenging. This study emphasizes the importance of a clinically reliable biomarker cut-off value in addition to electrocardiography and echocardiography to optimize PMI diagnosis.

De Mey N, Cammu G, Van Mieghem C, et al. Anaesthesia and Intensive Care, 2019, 47(3), 255–266

INTRODUCTION/BACKGROUND After cardiac surgery, a certain degree of myocardial injury is common. The arbitrarily proposed biomarker cut-off point in the Third Universal Definition for diagnosing coronary artery bypass grafting (CABG)–related perioperative myocardial infarction (PMI) is controversial and unvalidated for non-CABG surgery. Minimally invasive cardiac surgery is often thought to be associated with less myocardial damage compared to conventional surgical approaches.

OBJECTIVE We therefore conducted a real-life prospective study with serial sampling of high sensitivity cardiac troponin T (hscTnT), the preferred cardiac biomarker in our institution, to determine its postoperative release pattern after conventional as well as minimally invasive cardiac surgery. Second, we compared hs-cTnT levels with the cut-off values for PMI described in the Third Universal Definition of PMI. Third, we sought to identify outcome-associated variables related to increased hs-cTnT release.

MATERIALS/METHODS We conducted a real-life prospective study with serial sampling of high-sensitivity cardiac troponin T (hs-cTnT) in patients undergoing conventional and minimally invasive cardiac surgery. Four different types of cardiac surgery were performed in 400 patients (February 2014–January 2015): CABG, aortic valve replacement, minimally invasive mitral/tricuspid valve surgery through the HeartPort (HP) technique and combined CABG/valve surgery. Each group was further subdivided for comparison between the different surgical techniques. Blood samples were collected consecutively at intensive care unit (ICU) admission and 3, 6, 9, 12, 18, 24 and 48 h thereafter.

RESULTS The hs-cTnT values by peak timepoint differed significantly depending on the surgical approach. The overall peak timepoint for hs-cTnT occurred 6 h after ICU admission. The combined surgery and multiple-valve HP groups had the highest values (medians of 1067.5 (744.9–1455) ng/L and 1166 (743.7–2470) ng/L, respectively). The peak hs-cTnT values for patients developing PMI showed high variability.

ABSTRACT 4 Secundaire hypertensie. Dhont S, De Niel C, Van Mieghem C, et al. Tijdschrift voor Geneeskunde, 2020, 76(4), 128-132

INTRODUCTION/BACKGROUND Het behoud van een normale bloeddruk is essentieel voor een adequate orgaanperfusie. De drie belangrijkste factoren die de bloeddruk bepalen, zijn het sympathische zenuwstelsel, het renine-angiotensine-aldosteronsysteem (RAAS) en het bloedvolume. Hypertensie of verhoogde bloeddruk blijft de best behandelbare risicofactor voor vroegtijdige cardiovasculaire ziekte. De bloeddruk is een normaal verdeelde biologische variabele. De meest gangbare Europese criteria die worden gehanteerd ter definiëring van arteriële hypertensie, zijn samengevat in tabel 1. Bij meting in het dokterskabinet moet er bij herhaling een systolische bloeddruk opgemeten worden hoger dan of gelijk aan 140 mmHg en/of een diastolische druk hoger dan of gelijk aan 90 mmHg. Boven deze waarden wegen de voordelen van therapie ontegensprekelijk op tegen de risico’s. Doorgaans kent hypertensie geen eenduidige etiologie en spreekt men over „primaire”, „idiopathische” of „essentiële hypertensie”. Bij 5% tot 10% van de patiënten kan men echter een oorzaak aantonen. In die gevallen spreekt men over „secundaire hypertensie”. Men moet hieraan in het bijzonder denken bij een jonge patiënt met verhoogde bloeddrukken die resistent blijven tegen een combinatietherapie: per definitie drie voldoende hoog gedoseerde antihypertensiva van verschillende klassen (waaronder zeker een diureticum). Tijdige doorverwijzing en vroege detectie van een secundaire oorzaak van hypertensie zijn zeer belangrijk aangezien een snelle interventie curatief kan zijn. Op die manier wordt het levenslang innemen van antihypertensiva met de daaraan geassocieerde kosten en bijwerkingen vermeden. De diagnostische screening bestaat uit bloeden urinetesten, abdominale beeldvorming en een echocardiografie. De belangrijkste entiteiten worden verder in dit artikel uiteengezet.

CONCLUSION Slechts bij 5% tot 10% van de hypertensieve patiënten vindt

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men een aanwijsbare oorzaak en kan men spreken over secundaire hypertensie. Screening is duur en tijdrovend en wordt bij voorkeur enkel uitgevoerd bij patiĂŤnten met een sterk klinisch vermoeden. Vroegdetectie en een snelle behandeling zijn essentieel om een curatieve interventie toe te laten. Indien niet gediagnosticeerd, kan secundaire hypertensie leiden tot refractair verhoogde bloeddrukken, cardiovasculaire en renale complicaties en uiteindelijk tot een verhoogde morbiditeit en cardiovasculaire mortaliteit.

CARDIOLOGIE

CENTRUM

GYNAECOLOGIE ARTIKELS ABSTRACT 1 Le Fort-colpocleisis als behandeling voor urogenitale prolaps van graad 3 en 4. Bauters E, Batyr A, Ghesquiere S, et al. Bunaïkeia, 2019, 23(9), 18-21

INTRODUCTION/BACKGROUND Urogenitale prolaps is een descensus van de pelvische organen veroorzaakt door een verzwakking van de bekkenbodem. De prevalentie van de aandoening stijgt met de leeftijd. Bij oudere patiënten, met vaak belangrijke comorbiditeit – en dus een groot chirurgisch risico – kan men proberen om de prolaps eerst conservatief aan te pakken. Wanneer deze therapie faalt, is de Le Fort-colpocleisis (LFC), waarbij de prolaps gereduceerd wordt door een obliteratie van het vaginale kanaal, een goed chirurgisch alternatief bij oudere patiënten die geen vaginale betrekkingen meer nastreven. De ingreep geeft niet alleen een goed anatomisch resultaat, maar zorgt bij tot 93% van de patiënten ook subjectief voor een verbetering van de prolapsklachten, alsook van de geassocieerde functionele symptomen. Daarnaast is de duur van de ingreep gering en de hoeveelheid bloedverlies beperkt. Perioperatieve complicaties zijn zeldzaam. De frequentste postoperatieve complicaties op korte termijn zijn urinaire klachten. De bemoeilijkte diagnose en behandeling van een eventuele uteriene maligniteit en het onvermogen tot vaginale penetratie zijn de belangrijkste nadelen van de ingreep. Desondanks is de tevredenheid bij patiënten postoperatief groot (bij ≥ 90% van de patiënten). LFC is dus zeker te overwegen bij oudere vrouwen met comorbiditeit, die niet meer seksueel actief zijn en waarbij een duurzame oplossing voor ernstige prolaps gewenst is.

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CENTRUM

INWENDIGE ZIEKTEN

ARTIKELS

ABSTRACT 3 Whipple's disease in a man of North African descent : case report and brief review of the literature.

ABSTRACT 1 Adverse effects of bevacizumab in metastatic colorectal cancer: a case report and literature review. Willems E, George C, D'Hondt M, et al. Acta Gastro-enterologica Belgica, 2019, 82(2), 322-325 Het abstract is terug te vinden op pagina 4.

ABSTRACT 2 How dyspepsia led to the diagnosis of Morbus Crohn. Maertens A, Persyn D, Van Moerkercke W, et al. Acta Clinica Belgica, 2019, Online ahead of print, 1-3

OBJECTIVE It is well known that Crohn's disease can involve the stomach. However, most often this upper gastrointestinal tract involvement is asymptomatic. Typically, there is involvement of the small intestine with the typical associated symptoms of Crohn's disease: abdominal cramps, diarrhoea and weight loss.

Lenfant M, Alaerts H, Van Moerkercke W, et al. Acta Gastro-enterologica Belgica, 2019, 82(1), 83-86

OBJECTIVE A 62-year-old man of North African descent presented with weight loss in the past year and diarrhea for three weeks. His medical history included erosive rheumatoid arthritis, treated with methotrexate and adalimumab. Histological examination of a duodenal biopsy showed foamy macrophages in the lamina propria, with PAS-positive cytoplasmatic inclusions. These findings are compatible with Whipple's disease, a rare chronic infectious disease caused by Tropheryma whipplei, an opportunistic bacterium. It is typically seen in middle-aged Caucasian men and the immunocompromised host. The classical presentation of Whipple's disease consists of intermittent migratory arthralgia, followed by intestinal symptoms which typically occur six to seven years later.

MATERIALS/METHODS The clinical image can be very variable, and this complicates the diagnostic process. PAS-staining and PCR are the diagnostic cornerstones.

MATERIALS/METHODS We report a case of a young woman with complaints of dyspepsia since 2 months.

RESULTS Gastroscopy revealed severe aphthous pangastritis with biopsies showing a focal active and chronic gastritis with presence of granulomas. We therefore performed a coloscopy showing an aphthous terminal ileum. The pathologic report indicated granulomatous reaction concordant with a slightly active, mildly chronic terminal ileitis typical for Crohn's disease.

RESULTS In our case, treatment consisted of a prolonged cure of antibiotics: intravenous ceftriaxone for two weeks, followed by an oral maintenance therapy of doxycycline and hydroxychloroquine for at least one year.

CONCLUSION A therapeutic dilemma arose as continued anti-TNF blockade was necessary to maintain remission of the rheumatoid arthritis. Lifelong follow-up is necessary because relapse is possible.

CONCLUSION The incidence of upper gastrointestinal tract involvement of Crohn's disease is still underestimated, partially due to the asymptomatic nature in two thirds of patients. IBD gastritis should always be included in the differential diagnosis of gastritis, considering the increased risk of a more severe disease course and complications.

ABSTRACT 4 A toothpick a day, keeps the doctor away? Depoorter L, Billiet T, Van Moerkercke W, et al. Acta Gastro-enterologica Belgica, 2019, 82(1), 97-98

OBJECTIVE A toothpick is a dreaded offender when ingested, as it is risky to cause impaction, obstruction or perforation of the

INWENDIGE ZIEKTEN

gut. When ingestion of a toothpick leads to one of these complications, it clinically mimics an acute abdomen. Often the patient doesn't recall the ingestion, leading to misdiagnosis as inflammatory bowel disease, appendicitis/diverticulitis, etc. We describe the case of a 50-year old woman presenting to the emergency department with right lower abdominal pain.

CONCLUSION CT-scan showed an obstruction without clear underlying cause. The hypothesis of obstruction due to intestinal adhesions without strangulation was assumed and non-operative management lead to recovery and dismissal of the patient. However, she presented 3 weeks later with identical complaints, this time showing a terminal ileitis on CT-scan. Surprisingly, a toothpick perforating the terminal ileum was found during endoscopy and could by removed. A clinician should think of foreign body ingestion when patients present with an acute abdomen with no clear underlying pathology.

ABSTRACT 5 Long-term clinical effectiveness of ustekinumab in patients with Crohn's disease who failed biologic therapies: a national cohort study. Liefferinckx C, Verstockt B, Van Moerkercke W, et al. Journal of Crohn’s Colitis, 2019, 13(11), 1401-1409

INTRODUCTION/BACKGROUND Ustekinumab [UST] was recently approved in Europe for the treatment of moderate to severe Crohn's disease [CD]. Long-term real-world data are currently scarce for CD patients previously exposed to several biologics.

MATERIALS/METHODS This is an observational, national, retrospective multicentre study. Patients received intravenous UST ~6 mg/kg at baseline, with 90 mg subcutaneously thereafter every 8 weeks. Response and remission rates were assessed at Weeks 8, 16, and 52.

remission, respectively; 38.8% of patients discontinued therapy during the 12 months of follow-up. Colonic location was predictive of clinical response at 1 year, and low body mass index [BMI] at baseline was a negative predictor of clinical remission. Resolution of arthralgia was associated with clinical response over time. De novo arthralgia was reported by 17.9% of patients at Week 8 and 13.5% of patients at Week 52. No impact of UST on arthralgia was observed in patients with concomitant ankylosing spondylitis [n = 17]. Others adverse events were reported in 7.2% of patients.

CONCLUSION This real-world cohort study confirms the effectiveness of UST in CD patients previously exposed to several biologics. Ustekinumab was well tolerated with respect to adverse events.

ABSTRACT 6 Standardized approach to idiopathic retroperitoneal fibrosis: a comprehensive review of the literature. Roussel E, Callemeyn J, Van Moerkercke W, et al. Acta Clinica Belgica, 2019, Online ahead of print, 1-6

INTRODUCTION/BACKGROUND Idiopathic retroperitoneal fibrosis (iRPF) is a rare fibro-inflammatory disease, characterized by inflammation of the abdominal aorta and its surrounding structures. The exact pathophysiology remains unclear. Diagnosis is often troublesome due to the non-specific and highly variable clinical presentation. Standardized treatment protocols are lacking.

OBJECTIVE This article presents a review on iRPF, addressing clinical and diagnostic modalities as well as its pathophysiology and the possible inclusion within the IgG4-related disease (IgG4-RD) spectrum. Finally, a diagnostic-therapeutic algorithm for a standardized approach to iRPF is proposed.

MATERIALS/METHODS

RESULTS

The PubMed Internet database was searched. Articles were selected based on the relevance of abstract, article type and impact of the journal.

Data from 152 patients were analysed. All patients were exposed to at least one anti-TNFα agent, with 69.7% were exposed to even two anti-TNFα and vedolizumab. After 1 year, 42.1% and 25.7% of patients had experienced clinical response and clinical remission, respectively, and 38.8% and 24.3% had achieved steroid-free clinical response and

iRPF and IgG4-RD share a common autoimmune aetiology. Diagnostics are multimodal and based on imaging. Ruling out malignancy should be of primary concern. Complications are mostly of renal or vascular origin due to compres-

ABSTRACTBOEK | 2019

RESULTS

sion of retroperitoneal structures. Corticosteroids remain the first-line treatment regimen and are mostly successful, but evidence supporting alternative immunosuppressive and anti-inflammatory treatments is growing. Long-term therapy, as well as follow-up, is paramount in this chronic and often relapsing disease.

ABSTRACT 9 Impact of first-line infliximab on the pharmacokinetics of second-line vedolizumab in inflammatory bowel diseases. Liefferinckx C, Verstockt B, Van Moerkercke W, et al. United European Gastroenterology Journal, 2019, 7(6), 750–758

ABSTRACT 7 Uveitis as a window to diagnosis of sarcoidosis - case report and review of the literature. Dhont S, Leys M, Van Moerkercke W, Alaerts H, et al. Acta Clinica Belgica, 2019, May 5, 1-5

CONCLUSION Sarcoidosis is a multisystem disease of unclear etiology with a variable clinical profile characterized by the presence of non-caseating granuloma in involved organs. The diagnosis is often challenging and based on clinical, radiological and anatomopathological data. Sarcoidosis can be benign and self-limiting, but some cases may follow a chronic, progressive course and result in severe morbidity. The disease has a predilection for the lungs and thoracic lymph nodes but can involve nearly any part of the body, possible more commonly in areas with contact to the external environment, such as the eyes and the skin. This paper is based on a case in which a recurrent uveitis led to the diagnosis of an underlying sarcoidosis.

ABSTRACT 8 Polypectomy of a colonic mucosubmucosal elongated polyp. Persyn D, Moubax K, Van Moerkercke W, Alaerts H, et al. Gastrointestinal endoscopy, 2019, 90(4), 693-694

INTRODUCTION/BACKGROUND A 53-year-old man was referred to our department after a positive fecal immunochemical test result. He had no symptoms or signs of iron deficiency anemia. Colonoscopy showed a large elongated polyp in the descending colon. An endoloop-assisted polypectomy was performed after placement of 2 hemostatic clips. The resected specimen (8 × 3 × 0.7 cm) was covered with normal mucosa. Histopathologic examination showed normal mucosa without dysplasia or inflammation (H&E, orig. mag. × 40). The diagnosis of a colonic mucosubmucosal elongated polyp (CMSEP) was made.

INTRODUCTION/BACKGROUND Very little is known about the impact of the wash-out period on the pharmacokinetics of a second-line biologic.

OBJECTIVE The objective of this article is to explore the impact of two different wash-out periods on the pharmacokinetics of vedolizumab and infliximab.

MATERIALS/METHODS Patients switching from infliximab to vedolizumab were retrospectively identified. The population was divided into two groups according to wash-out period: <6 weeks or >6 weeks. Vedolizumab and infliximab trough levels (TLs) were determined and correlated with clinical and biological outcomes.

RESULTS A total of 71 inflammatory bowel disease patients were included. At week 6, in patients previously treated with infliximab, median vedolizumab TLs were 21.9 µg/ml and 24.9 µg/ml for the <6 weeks and >6 weeks wash-out period, respectively (p = 0.31), whereas median residual infliximab TLs were 0.5 µg/ml and 0 µg/ml (p = 0.034). The rate of treatment discontinuation was similar (p = 0.64), and the infectious events were six and two for the <6 weeks and >6 weeks wash-out period, respectively (p = 0.12) by week 30.

CONCLUSION This study suggests clinicians may not need to be concerned about the impact of wash-out period on the pharmacokinetics of the second-line biologic when switching infliximab to vedolizumab. More data are required on the impact of wash-out period on safety.

ABSTRACT 10 Unexplained fever in a young man with Crohn's disease: a case report and review of literature. Deroo L, Elewaut A, Van Moerkercke W, et al. Acta Clinica Belgica, 2019, Online ahead of print, 1-5

INWENDIGE ZIEKTEN

RESULTS

OBJECTIVE

A 23-year-old man with a known history of Crohn's disease (CD), who underwent an ileocaecal resection for localized disease activity three months ago, suffered from persistent fever with chills since 10 days. Despite the empirical antibiotic therapy that was started, his fever remained. A computed tomography (CT) angiography of the thorax and abdomen revealed a thrombosis of the iliacal veins bilateral and a pulmonary embolism (PE) in the right lower lobe with adjacent infiltrate. Venous thromboembolism (VTE) can be a life-threatening extraintestinal manifestation of inflammatory bowel disease (IBD). The risk that IBD patients develop a VTE is three times higher in comparison with healthy controls. They have a higher risk of recurrence and a higher mortality ratio. The pathogenesis of VTE in IBD is complex and until now not fully understood. More awareness should be raised, given the fact that it can be prevented by appropriate thromboprophylaxis.

This study aimed to explore whether an open-label treatment with beclomethasone dipropionate is an effective treatment for MC.

MATERIALS/METHODS Prospectively collected data of 30 patients from six centres were retrospectively analysed. All patients had a confirmed diagnosis of idiopathic MC (lymphocytic and collagenous colitis) and were symptomatic (i.e. ≥ 21 loose stools over a seven-day period). Treatment consisted of 10 mg beclomethasone daily for four weeks, followed by 5 mg daily for another four weeks. The primary end point was the proportion of patients in remission (i.e. a mean of < 3 stools/day and a mean of <1 watery stool per day) after an eight-week treatment period. Secondary end points were the proportion of patients responding to therapy at weeks 4 and 8, remission at weeks 4 and 12 and relapse at week 12. Reported adverse events were collected.

ABSTRACT 11

RESULTS

Ruminococcus gnavus bacteremia, an uncommon presentation of a common member of the human gut microbiota: case report and literature review.

Overall, at week 8, remission was achieved in 70%, and 77% of patients were responding to treatment. After four weeks of treatment, 80% were responding, and 67% were in remission. Four weeks after stopping treatment, 60% were still in remission.

Lefever S, Van Moerkercke W, D'Hondt M, Pampols M, De Bel A, Boudewijns M, et al. Acta Clinica Belgica, 2019, Dec 74(6), 435-438 Het abstract is terug te vinden op pagina 7.

CONCLUSION This open-label study suggests that an eight-week course of beclomethasone could be a promising and relatively safe treatment for MC. A randomised controlled study is warranted.

ABSTRACT 12 Beclomethasone dipropionate in microscopic colitis: Results of an exploratory open-label multicentre study (COLCO). Corte T, Janssens E, Van Moerkercke W, et al. United European Gastroenterololgy Journal, 2019, 7(9), 1183-1188

INTRODUCTION/BACKGROUND Budesonide has been proven to be an effective treatment for microscopic colitis (MC). However, the two current commercially available preparations are released in the ileum. Beclomethasone dipropionate (Clipper®) is a synthetic corticosteroid with topical colonic release.

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ABSTRACT 13 Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study. Moens A, Van der Woude CJ, Van Moerkercke W, et al. Alimentary Pharmacology & Therapeutics, 2020, 51(1), 129-138

INTRODUCTION/BACKGROUND Women with inflammatory bowel diseases (IBD) often receive biologicals during pregnancy to maintain disease remission. Data on outcome of vedolizumab-exposed pregnancies (VDZE) are sparse.

OBJECTIVE

ABSTRACT 15

To assess pregnancy and child outcomes of VDZE pregnancies and to compare these results to anti-TNF exposed (TNFE) or both immunomodulatory and biologic unexposed (CON IBD) pregnancies.

Golimumab dried blood spot analysis (GOUDA): a prospective trial showing excellent correlation with venepuncture samples and more detailed pharmacokinetic information.

MATERIALS/METHODS

Van Moerkercke W, Detrez I, Schops G, et al. The American Association of Pharmaceutical scientists (AAPS) Journal, 2019 21(1), 10. doi: 10.1208/s12248-0180282-x.

A retrospective multicentre case-control observational study was performed.

RESULTS VDZE group included 79 pregnancies in 73 IBD women. The TNFE and CON IBD group included 186 pregnancies (162 live births) in 164 IBD women and 184 pregnancies (163 live births) in 155 IBD women, respectively. At conception, cases more often had active disease ([VDZE: 36% vs TNFE: 17%, P = .002] and [VDZE: 36% vs CON IBD: 24%, P = .063]). No significant difference in miscarriage rates were found between groups (VDZE and TNFE: 16% vs 13%, P = .567; VDZE and CON IBD: 16% vs 10%, P = .216). In live-born infants, median gestational age and birthweight were similar between groups. Median Apgar score at birth was numerically equal. Prematurity was similar in the VDZE group compared to the control groups, even when correcting for disease activity during pregnancy. The frequency of congenital anomalies was comparable between groups as were the percentages of breastfed babies. During the first year of life, no malignancies were reported and infants' infection risk did not significantly differ between groups.

CONCLUSION No new safety signal was detected in VDZE pregnancies although larger, prospective studies are required for cofirmation.

ABSTRACT 14 Terminale ileïtis met een scherp kantje. Persyn D, D’heygere F, Moubax K Tijdschrift voor Geneeskunde, 2019, 75(4), 286-287

INTRODUCTION/BACKGROUND

INTRODUCTION Development of a dried blood spot (DBS) method for golimumab will facilitate sample collection in a study setting and will give a more complete insight in the total drug exposure (area under the curve, AUC). We established a DBS method and assessed its robustness, user-friendliness and clinical usefulness in 10 patients with ulcerative colitis during golimumab induction and maintenance regimens. DBS was obtained through spotting of golimumab spiked in whole citrated blood to a filter paper. Several extraction conditions were evaluated and the selected extraction condition analytically validated. In a clinical setting, DBS and serum samples were taken simultaneously through intensive sampling regimens and a conversion factor was determined. Golimumab concentrations were measured using an in-house-developed ELISA and a CEmarked ELISA kit. User-friendliness was evaluated using a questionnaire. Mucosal healing was evaluated at week 14. A total of 79 matched pairs of serum and DBS sample golimumab concentrations revealed an overall conversion factor of 3.9. DBS golimumab concentrations after conversion correlated strongly with serum golimumab concentrations (ICC = 0.984). During induction, no linear correlation was found between golimumab trough concentration (TC) and AUC (R2 = 0.29). Multiple peaks emerged during drug absorption. Patients who achieved mucosal healing appeared to have less fluctuating TC and a constant AUC over time. Nine out of 10 patients reported DBS sampling as user-friendly. The GOUDA study showed that DBS sampling is a robust and patient-friendly alternative to venous blood collection. DBS sampling may provide better insights into golimumab absorption and exposure.

A 35-year-old Caucasian male was admitted because of right iliac fossa pain. Blood analysis showed a C-reactive protein of 42.9 mg/l. A contrast-enhanced CT scan of the abdomen revealed terminal ileitis. Surprisingly, a toothpick entrapped in the terminal ileum was found during the endoscopy and was successfully removed.

INWENDIGE ZIEKTEN

PRESENTATIES / CONGRESSEN ABSTRACT 1 Effectiveness and safety of Vedolizumab maintenance therapy for Inflammatory Bowel Disease: findings from a Belgian registry. European Crohn’s and Colitis Organisation (ECCO) / Belgian Week of Gastroenterology (BWGE) D’Heygere F, Louis E, Muls V, et al. March 2019, Copenhagen, Denmark

INTRODUCTION/BACKGROUND Clinical trials have demonstrated the efficacy and safety of vedolizumab (VDZ) as maintenance therapy for Crohn’s disease (CD) and ulcerative colitis (UC). This report presents outcome data for VDZ maintenance therapy in real life practice in Belgium.

MATERIALS/METHODS The Belgium VDZ Registry includes 202 VDZtreated adult patients from 19 Belgian centres. Inclusion criteria were on going VDZ therapy started 15+ days prior to recruitment and patient not in a clinical trial or VDZ PASS study. This interim analysis presents safety data for the all 202 registry participants, and clinical remission rates on the subset of 156 participants with at least one 6monthly investigator update on clinical management and outcomes. Clinical remission was defined as HarveyBradshaw Index <5 or partial Mayo Score < 3 with no subscore >1. Patients who discontinued VDZ were considered not in remission from that point forwards. An imputation analysis was included to account for missing disease activity scores, where a missing activity score was assumed not in remission, thereby giving a minimum imputation estimate.

RESULTS The characteristics of the 202 participants were 52% female, 66% had CD, predominantly ileal or ileocolonic CD, and 34% had UC, predominantly leftsided UC. Median age at onset of IBD was 28 years, and median duration of IBD prior to starting VDZ was 10 years. t recruitment, median length of ongoing VDZ therapy was 11 months, and 63% of UC and 60% of CD patients were in remission. Median duration of followup in the outcomes subset was 11 months (range 418 months). Clinical remission rates are shown below. The corresponding rates of corticosteroidfree clinical remission were 3040% for both CD and UC. All reported serious adverse events (SAEs) and nonserious AEs were

ABSTRACTBOEK | 2019

considered unrelated to VDZ therapy. 34 patients (16.8%) had a SAE, the most frequent being worsening of CD/UC (4.0%) and small intestine obstruction (1.5%). 80 patients (39.6%) had a nonserious AE, the most frequent being constipation (2.5%), gastroenteritis (2.0%), nasopharyngitis (2.0%), and upper respiratory tract infection (2%). There were no reports of hepatic injury, infusionrelated reactions, hypersensitivity or opportunistic infection.

CONCLUSION These reallife data collected from 19 gastroenterology centres across Belgium demonstrate sustained clinical benefit with up to 36 months of VDZ maintenance therapy in everyday clinical practice.

CENTRUM

KLINISCH LABORATORIUM ARTIKELS ABSTRACT 1 Lethal injection of a castor bean extract: ricinine quantification as a marker for ricin exposure using a validated LC–MS/MS method.

CONCLUSION DMAS-qPCR comes with a complimentary online assay design tool, available for the whole scientific community, enabling researchers to design custom assays and implement those as a diagnostic test.

ABSTRACT 3 Verougstraete N, Helsloot D, Casier I, et al. Journal of Analytical Toxicology, 2019, 43(3), e1-e5

ALK positively regulates MYCN activity through repression of HBP1 expression.

Het abstract is terug te vinden op pagina 7.

Claeys S, Denecker G, Van Maerken T, et al. Oncogene, 2019, 38(15), 2690-2705

ABSTRACT 2

INTRODUCTION/BACKGROUND

Cost-effective and robust genotyping using doublemismatch allele-specific quantitative PCR.

ALK mutations occur in 10% of primary neuroblastomas and represent a major target for precision treatment. In combination with MYCN amplification, ALK mutations infer an ultra-high-risk phenotype resulting in very poor patient prognosis.

Lefever S, Rihani A, Van Maerken T, et al. Scientific Reports, 2019, 9(1), 2150

INTRODUCTION/BACKGROUND

OBJECTIVE

For a wide range of diseases, SNPs in the genome are the underlying mechanism of dysfunction. Therefore, targeted detection of these variations is of high importance for early diagnosis and (familial) screenings. While allele-specific PCR has been around for many years, its adoption for SNP genotyping or somatic mutation detection has been hampered by its low discriminating power and high costs.

To open up opportunities for future precision drugging, a deeper understanding of the molecular consequences of constitutive ALK signaling and its relationship to MYCN activity in this aggressive pediatric tumor entity will be essential.

OBJECTIVE To tackle this, we developed a cost-effective qPCR based method, able to detect SNPs in a robust and specific manner.

MATERIAL/METHODS This study describes how to combine the basic principles of allele-specific PCR (the combination of a wild type and variant primer) with the straightforward readout of DNA-binding dye based qPCR technology. To enhance the robustness and discriminating power, an artificial mismatch in the allele-specific primer was introduced.

RESULTS The resulting method, called double-mismatch allele-specific qPCR (DMAS-qPCR), was successfully validated using 12 SNPs and 15 clinically relevant somatic mutations on 48 cancer cell lines. It is easy to use, does not require labeled probes and is characterized by high analytical sensitivity and specificity.

RESULTS We show that mutant ALK downregulates the 'HMG-box transcription factor 1' (HBP1) through the PI3K-AKT-FOXO3a signaling axis. HBP1 inhibits both the transcriptional activating and repressing activity of MYCN, the latter being mediated through PRC2 activity. HBP1 itself is under negative control of MYCN through miR-17~92. Combined targeting of HBP1 by PI3K antagonists and MYCN signaling by BET- or HDAC-inhibitors blocks MYCN activity and significantly reduces tumor growth, suggesting a novel targeted therapy option for high-risk neuroblastoma.

ABSTRACT 4 Nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences. Noël A, Vastrade C, Van Maerken T, et al. Journal of Hospital Infection, 2019, 102(1), 54-60

KLINISCH LABORATORIUM

INTRODUCTION/BACKGROUND

Enterobacteriaceae are recognized as leading pathogens of healthcare-associated infections.

We report a recurrent outbreak of postoperative infections with extended-spectrum β-lactamase (ESBL)-producing E. cloacae complex in cardiac surgery patients, describe the outbreak investigation and highlight the infection control measures.

OBJECTIVE To report the investigation of a nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae affecting cardiothoracic surgery patients in a Belgian academic hospital.

MATERIALS/METHODS Cases were defined based on epidemiological and microbiological investigations, including molecular typing using repetitive element-based polymerase chain reaction and multi-locus sequence typing. Case-control studies followed by field evaluations allowed the identification of a possible reservoir, and the retrospective assessment of human and financial consequences.

MATERIALS/METHODS Cases were defined as cardiac surgery patients in Ghent University Hospital who were not known preoperatively to carry ESBL-producing E. cloacae complex and who postoperatively had a positive culture for this multiresistant organism between May 2017 and January 2018. An epidemiological investigation, including a case-control study, and environmental investigation were conducted to identify the source of the outbreak. Clonal relatedness of ESBL-producing E. cloacae complex isolates collected from case patients was assessed using whole-genome sequencing-based studies.

RESULTS Over a three-month period, 42 patients were infected or colonized by CTX-M-15-producing E. cloacae strains that belonged to the same clonal lineage. Acquisition mainly occurred in the intensive care unit (N = 23) and in the cardiothoracic surgery ward (N = 16). All but one patient had, prior to acquisition, undergone a cardiothoracic surgical procedure, monitored by the same transoesophageal echocardiography (TOE) probe in the operating room. Despite negative microbiological culture results, the exclusion of the suspected probe resulted in rapid termination of the outbreak. Overall, the outbreak was associated with a high mortality rate among infected patients (40%) as well as significant costs (€266,550).

RESULTS Three separate outbreak episodes occurred over the course of 9 months. A total of 8, 4 and 6 patients met the case definition, respectively. All but one patients developed a clinical infection with ESBL-producing E. cloacae complex, most typically postoperative pneumonia. Overall mortality was 22% (4/18). Environmental cultures were negative, but epidemiological investigation pointed to transesophageal echocardiography (TEE) as the outbreak source. Of note, four TEE probes showed a similar pattern of damage, which very likely impeded adequate disinfection. The first and second outbreak episode were caused by the same clone, whereas a different strain was responsible for the third episode.

CONCLUSION The outbreak was indirectly shown to be associated with the contamination of a manually disinfected TOE probe used per-operatively during cardiothoracic surgery procedures, because withdrawal of the putative device led to rapid termination of the outbreak.

CONCLUSION Health professionals caring for cardiac surgery patients and infection control specialists should be aware of TEE as possible infection source. Caution must be exercised to prevent and detect damage of TEE probes.

ABSTRACT 5

ABSTRACT 6

A recurrent and transesophageal echocardiography– associated outbreak of extended-spectrum β-lactamase–producing Enterobacter cloacae complex in cardiac surgery patients.

Interference of anti-streptavidin antibodies in immunoassays : a very rare phenomenon or a more common finding?

Van Maerken T, De Brabandere E, Noël A, et al. Antimicrobial Resistance & Infection Control, 2019, 8, 152

20 ABSTRACTBOEK | 2019

Verougstraete N, Berth M, Callewaert N, et al. Clinical Chemistry And Laboratory Medicine, 2019, Online adead of print, doi: 10.1515/cckl-2019-1064

INTRODUCTION/BACKGROUND

OBJECTIVE

Anti-streptavidin antibodies (ASA) may cause analytical interference on certain immunoassay platforms. Streptavidin is purified from the non-pathogenic Streptomyces avidinii soil bacterium. In contrast to interference with biotin, ASA interference is supposed to be much rarer. In-depth studies on this topic are lacking. Therefore, we carried out an analysis toward the prevalence and the possible underlying cause of this interference.

The aim of this exploratory clinical study was to evaluate whether the preanalytical quality of blood samples subjected to delayed centrifugation and transport – as a result of home-sampling – is affected in a way it alters the clinical decision-making for patients under systemic cancer therapy. This evaluation is part of a comprehensive investigation of the opportunities for oncological home-hospitalization.

MATERIALS/METHODS

Forty-nine patients with cancer donated two additional blood samples during their ambulatory hospital visit. Fifteen blood analytes were compared between routine blood samples and samples that were subjected to transport and delayed centrifugation in order to mimic a locally implemented model for oncological home-hospitalisation. Deviations were analysed by means of Deming regression. For those analytes showing statistically significant intercepts and/ or slopes, the mean deviations were compared to the desirable analytical bias; and the intra-individual differences were compared with the limits for clinical decision-making.

MATERIALS/METHODS Anti-streptavidin (AS)-immunoglobulin G (IgG) and AS-IgM concentrations were determined on multiple samples from two patients with ASA interference and on 500 random samples. On a subset of 100 samples, thyroid-stimulating hormone (TSH) was measured on a Cobas analyzer before and after performing a neutralization protocol which removes ASA. The relationship between the ratio of TSH after neutralization/TSH before neutralization and the ASA concentration was evaluated. Subsequently, an extract of S. avidinii colonies was analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting.

RESULTS A positive correlation between AS-IgM concentrations and TSH ratio was obtained. Eight samples out of 500 exceeded the calculated AS-IgM cut-off value. In comparison to the AS-IgM concentrations in the population, titers from the two described cases clearly stood out. The isolated cases represent the end of a broader spectrum as there is a continuum of AS-IgM reactivity in the general population. We could not observe any differences in the immunoblot patterns between the cases and controls, which may indicate the general presence of ASA in the population.

CONCLUSION Interference due to ASA is more prevalent than initially thought and is caused by IgM antibodies.

RESULTS Statistically significant intercepts and/or slopes were observed for haematocrit (HCT), mean cellular volume (MCV), platelets count (PLT) and C-reactive protein (CRP). Differences exceeding the allowable margins of desirable analytical bias were observed for HCT and MCV. Risk of different clinical decision-making couldn’t be observed for any of the analytes showing statistically significant differences.

CONCLUSION These results demonstrate that home-collection of blood samples, transported at room temperature and centrifuged within a mean time of five hours after sampling, has no effect on clinical decision-making with regards to systemic cancer therapy. However, attention should be paid to the potential occurrence of haemolysis during the preanalytical phase, which can negatively influence haemolysis-dependent variables.

ABSTRACT 7 Quality of blood samples collected at home does not affect clinical decision making for the administration of systemic cancer treatment. Cool L, Callewaert N, Van Eygen K, Tack L, Missiaen J, Debruyne P, et al. Scandinavian Journal of Clinical and Laboratory Investigation, 2020, 80(3), 215-221

KLINISCH LABORATORIUM

PRESENTATIES / CONGRESSEN ABSTRACT 1

CONCLUSION We provide a proof-of-concept for the RNA-based detection of tumor signal in plasma of PDX mice. In addition, we present guidelines for both experimental and computational pipelines to optimally detect tumor RNA in liquid biopsies.

Whole transcriptome profiling of liquid biopsies from patient-derived xenograft (PDX) models.

ABSTRACT 2 RNGS19: Revolutionizing Next-Generation Sequencing Vermeirssen V, Decock A, Van Maerken T, et al. March 2019, Antwerpen, België

INTRODUCTION/BACKGROUND Grafting of patient-derived primary tumors in mice models complex interactions within a heterogeneous tumor and is crucial for the development of optimal cancer treatment. Using minimally invasive liquid biopsies, RNA molecules, which are released from the tumor into the circulation, are promising biomarkers for cancer detection and progression. PDX models offer the advantage of characterizing the tumor RNA fraction in blood. Until now, there is no standardized protocol, both for the experimental and computational analysis of total RNA from blood, to obtain the highest and purest tumor RNA profile.

Evaluation of the Xpert HBV VL test for cartridge-based quantitative HBV DNA analysis on plasma. European Meeting on Molecular Diagnostics Wallaert A, De Bel A, Boudewijns M October 2019, Noordwijk, Nederland

INTRODUCTION/BACKGROUND The Xpert HBV VL test (Cepheid) is a cartridge-based assay for the quantification of Hepatitis B Virus DNA in HBV-infected patients using the GeneXpert system.

OBJECTIVE The aim was to evaluate the performance of the Xpert HBV VL test on plasma samples and to compare it with the Artus HBV RG PCR test (Qiagen).

OBJECTIVE

MATERIALS/METHODS

We examined the transcriptome of a PDX model of Invasive Ductal Carcinoma.

For precision evaluation of the Xpert HBV VL test, three-fold dilutions of the Accurun 325 series 200 HBV QC (Seracare) and the Acrometrix HBV High Control (Thermo Fisher Scientific), representing low and high viral loads, were analyzed twelve times. Accuracy was tested with EQC panels (19 samples, including genotypes A, B and D) and method comparison with the Artus HBV RG PCR test was performed on 48 samples.

MATERIALS/METHODS We collected platelet-rich, platelet-poor and platelet-free plasma, and primary tumors in 5 PDX mice. RNA was prepared by SMARTer® Stranded Total RNA-Seq Kit v2 - Pico and libraries were sequenced on an Illumina NextSeq 500, generating 75 bp paired-end reads.

RESULTS RESULTS Analysis of the tumor transcriptome in PDX mice is complex, since the RNA does not only contain reads from the grafted human cancer, but also from the murine host. However, the analysis of the tumor transcriptome from blood samples is even more challenging, due to degradation and dilution of human tumor RNA in a pool of mouse RNA in the liquid biopsy. We assessed the efficiency of two computational pipelines: 1) parallel mapping to a human and mouse reference genome, followed by quality filtering, and 2) mapping to an in silico combined human-mouse reference genome.

Precision evaluation resulted in an SD of 0.19 log IU/mL for the low control (͞x– = 1.48 log IU/mL) and an SD of 0.08 log IU/mL for the high control (͞x = 6.41 log IU/mL). Accuracy evaluation showed 100% concordance, with an average absolute difference of 0.12 log IU/mL compared to the reference data (range between -0.11 and 0.49 log IU/mL). Method comparison denoted good correlation (Pearson’s r=0.97) with a Bland-Altman plot showing a mean difference of 0.16 log IU/mL (CI95%: -0.83 - 1.15), compatible with a modestly higher quantification with the Xpert assay.

CONCLUSION The Xpert HBV VL assay showed good performance both in precision and accuracy. There was a good correlation with

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the Artus HBV RG PCR test. This implies that the Xpert HBV VL assay, an all-in-one assay, can be used as alternative for batch analysis with the Artus HBV RG PCR test.

NG assay and the S-DiaMGTV PCR kit. Samples in Cobas PCR medium can be stored at 4°C for two weeks and DNA extracts at -20°C for at least four weeks.

ABSTRACT 3

ABSTRACT 4

The S-DiaMGTV kit on cobas 4800: simplifying mycoplasma genitalium and trichomonas vaginalis detection.

Reducing catheter induced hemolysis by use of the holdex tube holder.

European Meeting on Molecular Diagnostics Wallaert A, De Bel A, Boudewijns M October 2019, Noordwijk, Nederland

Royal Belgian Society of Laboratory Medicine Strubbe G, Callewaert N November 2019, Brussels, Belgium

OBJECTIVE INTRODUCTION/BACKGROUND Standard STD analysis is performed for Chlamydia trachomatis and Neisseria gonorrhoeae, although there is increasing evidence that Mycoplasma genitalium and Trichomonas vaginalis should be tested more routinely. The S-DiaMGTV kit (Diagenode) is a multiple PCR kit for the detection of M. genitalium and T. vaginalis.

OBJECTIVE Our aim was to evaluate the performance of this kit on extracts of urogenital samples obtained from the Cobas 4800 CT/NG assay (Roche).

MATERIALS/METHODS Extracts of the Cobas 4800 CT/NG assay were pipetted into the S-DiaMGTV PCR reaction mix, containing MGTV probes and primers (Diagenode) and LightCycler 480 Probes Master mastermix (Roche). PCR analysis was performed on the Cobas Z480 analyzer (Roche). Precision was evaluated on two concentrations for M. genitalium and T. vaginalis (both for swab and urine samples) and accuracy was tested with the QCMD 2018 EQA pilots. Finally, storage of low positive samples in Cobas PCR medium (two weeks at 4°C) and DNA extracts (four weeks at -20°C) was evaluated.

RESULTS Precision was good with an average SD of 0.48 (0.141.12) for the intra-run variability and 0.51 (0.08-0.72) for inter-run variability. Accuracy evaluation showed 100% concordance (n=17, no positive T. vaginalis urine sample). Storage of samples in Cobas PCR medium for two weeks (SD: 0.08-0.78) and DNA extracts for four weeks (SD: 0.050.72) appeared stable.

CONCLUSION STD diagnosis can easily be expanded with M. genitalium and T. vaginalis by using extracts from the Cobas 4800 CT/

Phlebotomy through a peripheral intravenous catheter is common practice in emergency departments. Though often timesaving and less invasive, this practice is known to cause in vitro hemolysis, frequently leading to analytical interference and compromised test results. Here we investigate whether the Holdex® Single-Use Holder (Greiner Bio-One), with its eccentrically placed Luer adapter and flash chamber, is able to reduce hemolysis by decreasing the pressure gradient between blood tube and punctured vein.

MATERIALS/METHODS Blood was drawn via a Becton Dickinson (BD) Insyte Autoguard catheter from 100 newly admitted patients by emergency nurses alternatively employing either the Holdex® Single-Use Holder (n=50) or a reusable BD Vacutainer® Pronto Quick Release holder (n=50). A sodium citrate tube was drawn first, followed by a serum tube (BD Vacutainer® SST II Advance 6 mL), in accordance with CLSI guidelines. Impact on primary endpoint, cell-free hemoglobin (cf-Hb) in serum (as estimated by hemolysis index), as well as on secondary measures (i.e. test panel comprising hemolysis sensitive parameters K, LDH, AST, ALT, CK, conjugated bilirubin and iron) was assessed. The latter were flagged when hemolysis exceeded the respective upper threshold specified by Roche, indicating potentially spurious results. All analyses were performed on serum using a Roche Cobas 6000 c501 analyzer.

RESULTS Median estimated cf-Hb differed significantly (p < 0.05, Mann-Whitney U test) between the Holdex® group (median 8.5 mg/dL, IQR 10.3 mg/dL) and the control group (median 15 mg/dL, IQR 20.8 mg/dL). Of 350 performed tests in each group, 20 results were potentially compromised in the Holdex® group vs. 60 in the control group (RR 0.33, 95% CI 0.21-0.54), leading to an absolute reduction of 11.4% (95%

KLINISCH LABORATORIUM

CI 6.8-16%) in flagged results.

CONCLUSION The Holdex® device appears an effective measure in reducing catheter induced hemolysis in a general emergency department patient population.

CONCLUSION IgM anti-streptavidin antibodies may cause interferences on certain immunoassays. We assume that these antibodies may arise after exposure to S. avidinii. This is the first report dealing with immunoblotting as a tool to study the anti-streptavidin antibodies. Further research is necessary to prove this hypothesis.

ABSTRACT 5 Exploring anti-streptavidin antibodies interference. EuroMedLab Verougstraete N, Callewaert N May 2019, Barcelona, Spain

INTRODUCTION/BACKGROUND Anti-streptavidin antibodies may cause analytical interference in immunoassays based on biotin-streptavidin interaction. Recently, we observed a case in which a 29-year-old female was misdiagnosed with hyperthyroidism and incorrectly treated with thiamazol, based on results obtained on a Cobas e602 analyzer (Roche). Thyroid function tests on another detection principle were within normal limits (Abbott). Little is still known about the origin of anti-streptavidin antibodies. The aim of this study was to explore the cause of this interference.

MATERIALS/METHODS The concentration of both IgG and IgM anti-streptavidin antibodies in 3 consecutive serum samples was measured using specific assays on a Phadia 250 (Thermo Fisher). Subsequently, an extract of Streptomyces avidinii colonies was analysed using SDS-PAGE electrophoresis. Next, immunoblotting with the patient’ serum and anti-human IgM coupled to horseradish peroxidase as secondary antibody, was carried out to elucidate the interference mechanism. This blotting experiment was also performed with a control sample without anti-streptavidin antibodies.

RESULTS IgM antibodies were initially 273 µg/L, 183 µg/L 2 months later and 177 µg/L after another 5 months. No anti-streptavidin IgG (< 2.0 μg/L) could be demonstrated in any sample. On the S. avidinii immunoblot of the patient’s serum, an IgM band in the 100 kDa range was seen, which was not observed in the control subject, suggesting an antibody induced in the patient by exposure to S. avidinii (nonpathogenic soil bacteria) antigens.

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ABSTRACT 6 Ruminococcus gnavus bacteremia, an uncommon presentation of a common member of the human gut microbiota: case report and literature review. Lefever S, Van Moerkercke W, D'Hondt M, Pampols M, De Bel A, Boudewijns M, et al. Acta Clinica Belgica, 2019, Dec 74(6), 435-438 Het abstract is terug te vinden op pagina 7.

CENTRUM

LONGZIEKTEN

ARTIKELS ABSTRACT 1 Uveitis as a window to diagnosis of sarcoidosis - case report and review of the literature. Dhont S, Leys M, Van Moerkercke W, Alaerts H, et al. Acta Clinica Belgica, 2019, May, 5, 1-5 Het abstract is terug te vinden op pagina 15.

ed. Invasive hemodynamics significantly improved, with a cardiac index increase of 15% (P = .0333), decrease of mean pulmonary artery pressure of 30% (P = .0013), and decrease of pulmonary vascular resistance of 45% (P = .0048). Stroke volume index (P = .0171) and pulmonary arterial compliance (P = .0004) were also significantly enhanced.

CONCLUSION BPA significantly improves cardiopulmonary hemodynamics with an acceptable safety profile. Further studies assessing the long-term efficacy of BPA are required.

ABSTRACT 2

ABSTRACT 3

Balloon pulmonary angioplasty for the treatment of nonoperable chronic thromboembolic pulmonary hypertension: single-center experience with low initial complication rate.

Longitudinal clinical outcomes in a real-world population of patients with idiopathic pulmonary fibrosis: the PROOF registry.

Godinas L, Bonne L, Leys M, et al. Journal of Vascular and Interventional Radiology, 2019, 30(8), 1265-1272

OBJECTIVE To evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) for nonoperable chronic thromboembolic pulmonary hypertension (CTEPH) patients during the initial experience of a single center.

MATERIALS/METHODS A total of 18 CTEPH patients (5 with residual pulmonary hypertension after pulmonary endarterectomy) were treated with BPA during the period 2014–2018 and were retrospectively reviewed. Mean age was 61 ± 19 years; 55% were female; mean pulmonary artery pressure was 44 ± 12 mmHg; cardiac output was 4.3 ± 1.0 l/min; and pulmonary vascular resistance was 8.4 ± 3.6 WU. Patients were evaluated by New York Heart Association functional class, 6-minute walk distance, N-terminal pro b-type natriuretic peptide, echocardiography, right heart catheterization, and before and after completions of BPA.

Wuyts WA, Dahlqvist C, Maddens S, et al. Respiratory Research, 2019, 20, 231

INTRODUCTION/BACKGROUND The PROOF registry is an observational study initiated in October 2013 with the aim to monitor disease progression in a real-world population of patients with idiopathic pulmonary fibrosis (IPF). Here, we present longitudinal clinical outcomes from the PROOF registry.

MATERIALS/METHODS Patients with IPF were enrolled across eight centers in Belgium and Luxembourg. For all patients, clinical outcomes data were collected, including mortality, lung transplant, acute exacerbations, and pulmonary hypertension. For patients treated with pirfenidone at any time during follow-up (2013–2017), for any duration of treatment (the pirfenidone-treated population): pirfenidone treatment patterns were collected; changes in pulmonary function (forced vital capacity [FVC] and carbon monoxide diffusing capacity [DLco]) were reviewed up to 24 months post-inclusion; and time-to-event analyses from the time of registry inclusion were performed.

RESULTS RESULTS A total of 91 procedures were performed, with a median number of 4 BPA sessions per patient (range, 2–8). There were no deaths or major complications requiring extracorporeal support or (non)invasive ventilation. The most common complication was self-limiting hemoptysis (3%). According to Society of Interventional Radiology classification, 4 mild, 4 moderate, and 1 severe adverse events were not-

The PROOF registry enrolled a total of 277 patients. During follow-up, 23.1% of patients died, 5.1% received a lung transplant, 5.4% experienced an acute exacerbation, and 6.1% had comorbid pulmonary hypertension. In the pirfenidone-treated population (N = 233, 84.1%), 12.9% of patients had a temporary dose discontinuation and 31.8% had a temporary dose reduction; 4.3% of patients permanently

LONGZIEKTEN

discontinued pirfenidone due to an adverse drug reaction. Mean percent predicted FVC was 81.2% (standard deviation [SD] 19.0) at Month 0 and 78.3% (SD 25.0) at Month 24, and mean percent predicted DLco was 47.0% (SD 13.2) and 45.0% (SD 16.5), respectively. Rates of ≥ 10% absolute decline in percent predicted FVC and ≥ 15% absolute decline in percent predicted DLco over 24 months were 31.0% and 23.2%, respectively. Mean times from registry inclusion to categorical absolute decline in percent predicted FVC and percent predicted DLco were 20.1 (standard error [SE] 0.6) months and 23.4 (SE 0.5) months, respectively; mean time from registry inclusion to death was 31.0 (SE 0.9) months.

CONCLUSION The PROOF registry is a source of European data characterizing longitudinal clinical outcomes of patients with IPF. Over 12 months of follow-up, pulmonary function remained largely stable in patients with IPF who received pirfenidone for any duration of treatment. Pulmonary function remained similar at 24 months of follow-up, although patient numbers were lower.

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CENTRUM

MEDISCHE BEELDVORMING

ARTIKELS

on outcomewere assessed in uni- and multivariable logistic regression models.

ABSTRACT 1

RESULTS

Large odontogenic keratocyst of the mandible: a combined intra/extra oral approach followed by enucleation.

Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P<0.001) were independent predictors of poor functional outcome.

Vercruysse M, D'Haeseleire P, Kunz S, Lutin B, et al. Stomatology Edu Journal, 2019, 6(2), 129-137

OBJECTIVE An odontogenic keratocyst (OKC) of the mandible is a benign intraosseus lesion of odontogenic origin characterized by a high recurrence rate. In this case report, we highlight the challenging diagnosis and propose a potential treatment for an extensive OKC with lingual expansion.

RESULTS

CONCLUSION

The combined intra/extra oral approach seems a reasonable technique for the treatment of similar extensive OKC’s in order to avoid pathological fractures as well as guaranteeing total removal of the lesion.

Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent-retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.

ABSTRACT 2 Emergency intracranial stenting in acute stroke: predictors for poor outcome and for complications. Stracke CP, Fiehler J, Andersson T, et al. Journal of the American Heart Association, 2020, 9, e012795

ABSTRACT 3 Intracranial stenting after failed thrombectomy in patients with moderately severe stroke: a multicenter cohort study. Meyer L, Fiehler J, Andersson T, et al. Frontiers in Neurology, 2020, 11, 97

INTRODUCTION/BACKGROUND Stent‐retriever thrombectomy is the first-line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent-retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty.

INTRODUCTION/BACKGROUND Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy.

MATERIALS/METHODS We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent-retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0–2; and poor modified Rankin Scale, 4–6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters

MATERIALS/METHODS We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the

MEDISCHE BEELDVORMING

rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS.

RESULTS Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1-4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5-8) on admission to 2.5 (IQR 0-8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41).

safety, a total of 3 passes were performed in each vessel independent of recanalization. Tissues were explanted for histopathological analysis after 3 and 30 days, respectively.

RESULTS First pass reperfusion rates were ANCD+SR: 69% and BGC+SR: 46%. Reperfusion increased after the third pass in both groups (ANCD+SR: 100%, vs BGC+SR: 77%). Recanalization was achieved after an average of 1.4 and 1.9 passes in ANCD+SR and BGC+SR (p=0.095), respectively. Vessel injury was comparable in both groups; endothelial loss at 3 days was the most common injury seen (ANCD+SR: 1.78±1.22; BGC+SR: 2.03±1.20; p=0.73), while other histopathological markers were absent or minimal. Tissues downstream from targeted vessels also showed absence or minimal lesions across both groups.

CONCLUSION ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

CONCLUSION Results in a swine clot model support the high efficacy of the ANCD+SR without causing clinically significant vessel injury potentially related to the new funnel component.

ABSTRACT 4

ABSTRACT 5

Preclinical evaluation of the ANCD thrombectomy device: safety and efficacy in a swine clot model.

Histological stroke clot analysis after thrombectomy: Technical aspects and recommendations.

Sanchez S, Bailey L, Andersson T, et al. Journal of NeuroInterventional Surgery, 2020, DOI: 10.1136/ neurintsurg-2019-015548

Staessens S, Fitzgerald S, Andersson T, et al. International Journal of Stroke, 2019, DOI: 10.1177/1747493019884527

INTRODUCTION/BACKGROUND

The Advanced Thrombectomy System (ANCD) provides a new funnel component designed to reduce clot fragmentation and facilitate retrieval in patients with stroke by locally restricting flow, allowing distal aspiration in combination with a stent retriever (SR).

The recent advent of endovascular procedures has created the unique opportunity to collect and analyze thrombi removed from cerebral arteries, instigating a novel subfield in stroke research. Insights into thrombus characteristics and composition could play an important role in ongoing efforts to improve acute ischemic stroke therapy. An increasing number of centers are collecting stroke thrombi. This paper aims at providing guiding information on thrombus handling, procedures, and analysis in order to facilitate and standardize this emerging research field.

OBJECTIVE To evaluate the preclinical efficacy and safety of the ANCD in a swine clot model.

MATERIALS/METHODS Soft and firm clots were implanted in the lingual and cervical arteries of 11 swine to obtain Thrombolysis in Cerebral Infarction (TICI) 0 blood flow. Mechanical thrombectomy was performed with either a balloon guide catheter+Solitaire 2 stent retriever (BGC+SR, n=13) or ANCD+SR (n=13). TICI flow was evaluated and successful revascularization was defined as TICI 3 (normal perfusion). To characterize

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ABSTRACT 6 Endosaccular flow disruption: where are we now? Bhogal P, Udani S, Andersson T, et al. Journal of NeuroInterventional Surgery, 2019, 11(10), 10241025

INTRODUCTION/BACKGROUND Endosaccular flow disruption is an innovative method of treating wide-necked complex aneurysms. Currently four types of devices have obtained the CE mark for use within Europe. These are the Woven EndoBridge device (WEB), the Luna Aneurysm Embolization System, the Medina Embolic Device (Medtronic), and the Contour Neurovascular System. The aim of this article is to provide an overview of these devices and to summarize the evidence in the literature pertaining to the treatment of intracranial aneurysms with them.

95% CI 1.6 to 13.5) and ANCD+SR (OR 3.9, 95% CI 1.01 to 15.8) were independent predictors of first-pass recanalization.

CONCLUSION In in vitro three-dimensional models replicating MCA-M1 occlusion, ANCD+SR showed significantly better recanalization rates in fewer passes than other commonly used combinations of devices.

ABSTRACT 8 ABSTRACT 7

Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance.

ANCD thrombectomy device: in vitro evaluation. Sanchez S, Cortiñas I, Andersson T, et al. Journal of NeuroInterventional Surgery, 2020, 12(1), 77-81

Staessens S, Vanacker P, Francois O, Andersson T, et al. Haematologica, 2020, 105(2), 498-507

INTRODUCTION/BACKGROUND

Endovascular treatment of stroke, although highly effective, may fail to reach complete recanalization in around 20% of cases. The Advanced Thrombectomy System (ANCD) is a novel stroke thrombectomy device designed to reduce clot fragmentation and facilitate retrieval by inducing local flow arrest and allowing distal aspiration in combination with a stent retriever. We aimed to assess the preclinical efficacy of ANCD.

Ischemic stroke is caused by a thromboembolic occlusion of cerebral arteries. Treatment is focused on fast and efficient removal of the occluding thrombus, either via intravenous thrombolysis or via endovascular thrombectomy. Recanalization, however, is not always successful and factors contributing to failure are not completely understood. Although the occluding thrombus is the primary target of acute treatment, little is known about its internal organization and composition. The aim of this study, therefore, was to better understand the internal organization of ischemic stroke thrombi on a molecular and cellular level. A total of 188 thrombi were collected from endovascularly treated ischemic stroke patients and analyzed histologically for fibrin, red blood cells (RBC), von Willebrand factor (vWF), platelets, leukocytes and DNA, using bright field and fluorescence microscopy. Our results show that stroke thrombi are composed of two main types of areas: RBC-rich areas and platelet-rich areas. RBC-rich areas have limited complexity as they consist of RBC that are entangled in a meshwork of thin fibrin. In contrast, platelet-rich areas are characterized by dense fibrin structures aligned with vWF and abundant amounts of leukocytes and DNA that accumulate around and in these platelet-rich areas. These findings are important to better understand why platelet-rich thrombi are resistant to thrombolysis and difficult to retrieve via thrombectomy, and can guide further improvements of acute ischemic stroke therapy.

MATERIALS/METHODS Soft red blood cell (RBC)-rich (n=20/group) and sticky fibrin-rich (n=30/group) clots were used to create middle cerebral artery (MCA) occlusions in two vascular phantoms. Three different treatment strategies were tested: (1) balloon guide catheter + Solitaire (BGC+SR); (2) distal access catheter + SR (DAC+SR); and (3) ANCD+SR, until complete recanalization was achieved or to a maximum of three passes. The recanalization rate was determined after each pass.

RESULTS After one pass, ANCD+SR resulted in an increased recanalization rate (94%) for all clots together compared with BGC+SR (66%; p<0.01) or DAC+SR (80%; p=0.04). After the final pass the recanalization rate increased in all three groups but remained higher with ANCD+SR (100%) than with BGC+SR (74%; p<0.01) or DAC+SR (90%; p=0.02). The mean number of passes was lower with ANCD+SR (1.06) than with BGC+SR (1.46) or DAC+SR (1.25) (p=0.01). A logistic regression model adjusted for treatment arm, clot type, and model used showed that both RBC-rich clots (OR 8.1,

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ABSTRACT 9

ABSTRACT 10

The unexplained success of stentplasty vasospasm treatment : Insights using Mechanistic Mathematical Modeling.

Why does mechanical thrombectomy in large vessel occlusion sometimes fail? : A review of the literature.

Bhogal P, Pederzani G, Andersson T, et al. Clinical Neuroradiology, 2019, 29(4), 763-774

Yeo LLL, Bhogal P, Andersson T, et al. Clinical Neuroradiology, 2019, 29(3), 401-414

INTRODUCTION/BACKGROUND INTRODUCTION/BACKGROUND Cerebral vasospasm (CVS) following subarachnoid hemorrhage occurs in up to 70% of patients. Recently, stents have been used to successfully treat CVS. This implies that the force required to expand spastic vessels and resolve vasospasm is lower than previously thought.

OBJECTIVE We develop a mechanistic model of the spastic arterial wall to provide insight into CVS and predict the forces required to treat it.

MATERIALS/METHODS The arterial wall is modelled as a cylindrical membrane using a constrained mixture theory that accounts for the mechanical roles of elastin, collagen and vascular smooth muscle cells (VSMC). We model the pressure diameter curve prior to CVS and predict how it changes following CVS. We propose a stretch-based damage criterion for VSMC and evaluate if several commercially available stents are able to resolve vasospasm.

Thrombectomy is a technique that has completely changed the management of acute stroke and current devices have shown that they can achieve upwards of 90% successful recanalization in selected cohorts. However, despite the effectiveness of these devices, there are a proportion of patients who still fail to achieve reperfusion of the affected vascular territory and an even larger portion of patients who have poor functional outcomes in spite of successful recanalization. There are no guidelines on how to treat these patients when such failures occur. In an effort to understand the underpinnings of how failed thrombectomy occurs, we extensively reviewed the current literature in clot properties, vascular access problems, stroke pathogenic mechanisms, embolic complications, failed procedures and pre-procedural imaging. A short summary of each of these contentious areas are provided and the current state of the art. Together these elements give a cohesive overview of the mechanisms of failed thrombectomy as well as the controversies facing the field. New techniques and devices can then be developed to minimize such factors during stroke thrombectomy.

RESULTS The model predicts that dilatation of VSMCs beyond a threshold of mechanical failure is sufficient to resolve CVS without damage to the underlying extracellular matrix. Consistent with recent clinical observations, our model predicts that existing stents have the potential to provide sufficient outward force to successfully treat CVS and that success will be dependent on an appropriate match between stent and vessel.

ABSTRACT 11 Posterior communicating and anterior communicating arteries on pre-thrombectomy computed tomography scans are associated with good outcomes irrespective of leptomeningeal collateral status. Yeo LLL, Andersson T, Holmberg Ă&#x2026;, et al. Interventional Neuroradiology, 2019, 25(4), 364-370

CONCLUSION

INTRODUCTION/BACKGROUND

Mathematical models of CVS can provide insights into biological mechanisms and explore treatment approaches. Improved understanding of the underlying mechanistic processes governing CVS and its mechanical treatment may assist in the development of dedicated stents.

Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality.

MATERIALS/METHODS We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with

30 ABSTRACTBOEK | 2019

the same thrombectomy device from 2013 to 2016. We assessed the leptomeningeal circulation by the Tan, Miteff and Maas validated scoring systems on pre-treatment computed tomographic angiography scans and looked at collateral flow through anterior and posterior communicating arteries. The results were good functional outcomes at 3 months (modified Rankin scale 0-2) and mortality.

RESULTS A total of 147 consecutive acute stroke patients treated with the Embotrap device were included with a median National Institutes of Health stroke scale of 15 (range 2-26). On multivariate analysis only younger age (odds ratio (OR) 0.96/ year, 95% confidence interval (CI) 0.94-0.99, P = 0.026), lower National Institutes of Health stroke scale score (OR 0.87/point, 95% CI 0.80-0.93, P < 0.001), number of attempts (OR 0.80/attempt, 95% CI 0.65-0.99, P = 0.043) and the presence of a patent anterior communicating artery (OR 14.03, 95% CI 1.42-139.07, P = 0.024) were associated with good functional outcomes. The number of attempts (OR 1.66/attempt, 95% CI 1.21-2.29, P = 0.002) was significantly associated with mortality and the presence of a patent posterior communicating artery (OR 0.098, 95% CI 0.016-0.59, P = 0.011) was inversely associated with mortality.

CONCLUSION Our study shows that the presence of anterior and posterior communicating arteries is significantly associated with good functional outcomes and reduced mortality, respectively, independent of the leptomeningeal circulation status.

ABSTRACT 12 The aspirations of direct aspiration for thrombectomy in ischemic stroke: a critical analysis. Andersson T, Wiesmann M, Nikoubashman O, et al. Journal of Stroke, 2019, 21(1), 2-9

INTRODUCTION/BACKGROUND The treatment of acute ischemic stroke by mechanical thrombectomy has been revolutionary, however most of the clinical trials were done with the use a stent retriever. At the same time, an alternative technique of thrombectomy through direct aspiration with a large bore distal access catheter at the face of the clot is rapidly gaining popularity. Nonetheless, the data supporting this new technique is not yet as mature as that available on stent retrievers. This review is a critical analysis of the evidence supporting the principle of direct aspiration thrombectomy and a discussion of its potential strengths and weaknesses in com-

parison to the available studies on stent retrievers. While this is by no means a conclusive review, it should serve as a yardstick of where the science is currently, and what are the next trials that are necessary.

ABSTRACT 13 Analysis of revascularisation in ischaemic stroke with EmboTrap (ARISE I study) and meta-analysis of thrombectomy. Mattle HP, Scarrott C, Andersson T, et al. Interventional Neuroradiology, 2019, 25(3), 261-270

INTRODUCTION/BACKGROUND The goal of the analysis of revascularisation in ischaemic stroke with EmboTrap study (ARISE I) was to demonstrate the effectiveness of EmboTrap.

MATERIALS/METHODS ARISE I was an open label, single arm, multicentre, prospective study for the treatment of acute stroke due to large vessel occlusion. The primary outcome was revascularisation of the target vessel as measured by the modified thrombolysis in cerebrovascular infarction (mTICI) score of at least 2b following thrombectomy with EmboTrap. For comparison of the ARISE I results a meta-analysis of eight randomised controlled trials was performed.

RESULTS ARISE I enrolled 40 patients. Their baseline characteristics that are predictors of stroke outcome and procedure timings in ARISE I were similar to those reported in recent randomised controlled trials. The primary outcome, good revascularisation rates (mTICI 2b/3 scores) after three or fewer passes with EmboTrap were 75% (95% confidence interval (CI) 62-88%), which is the same as 74% found in randomised controlled trials (difference of 0.8%, P = 0.95). After additional EmboTrap passes or the use of another device mTICI 2b/3 scores rose to 85% (95% CI 74-96%), which was also similar to the randomised controlled trials (difference 11%, P = 0.38). The high revascularisation rates in ARISE I converted into 64% good clinical outcomes (modified Rankin scale ≤2) compared to 50% in randomised controlled trials (difference 14%; 95% CI -13.7-41.7%; P = 0.32).

CONCLUSION ARISE I demonstrates that thrombectomy using the EmboTrap stent retriever yields similar results to devices that were used in recent randomised controlled trials for the treatment of stroke due to large vessel occlusions.

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ABSTRACT 14

ABSTRACT 15

Very late leptomeningeal collaterals-potential new way to subdivide modified thrombolysis in cerebral ischemia (mTICI) 2B.

Posterior circulation occlusions may be associated with distal emboli during thrombectomy : factors for distal embolization and a review of the literature.

Yeo LLL, Cervo A, Andersson T, et al. Clinical Neuroradiology, 2020, 30(1), 77-83

Yeo LLL, Holmberg A, Andersson T, et al. Clinical Neuroradiology, 2019, 29(3), 425-433

INTRODUCTION/BACKGROUND

Studies have shown that the modified thrombolysis in cerebral ischemia (mTICI) 2B score is associated with better functional outcome; however, 50-99% reperfusion is a large range and there may be factors which can differentiate this further. The effects of very late leptomeningeal collaterals (VLLC) on mTICI-2B patients were studied.

Distal embolization or movement of the thrombus to previously uninvolved vasculature are feared complications during stroke thrombectomy. We looked at associated factors in a consecutive series of patients who underwent thrombectomy with the same endovascular device.

MATERIALS/METHODS

We included all patients with acute ischemic stroke in the anterior or posterior circulation, who underwent thrombectomy with the same thrombectomy device for acute stroke from 2013 to 2016. Distal embolization was defined as any movement of the thrombus into a previously uninvolved portion of the cerebral vasculature or the presence of thrombotic material further downstream in the affected vessel, which occurred after the initial angiogram. We studied patient-related as well as technical factors to determine their association with distal emboli.

MATERIALS/METHODS A prospectively collected registry of anterior circulation AIS patients treated with the EmboTrap revascularization device from 2013 to 2016 was evaluated. Imaging parameters and timings, including the mTICI score were verified by an external core laboratory blinded to the clinical data. The final angiogram was examined for the appearance of VLLC in predicting 3‑month outcomes including excellent functional outcomes, defined as modified Rankin scale (mRS) 0-1, bleeding risk and mortality.

RESULTS

A total of 177 consecutive anterior circulation stroke patients were included in the analysis. Of these 94 (53.1%) achieved only mTICI-2B reperfusion, 16/94 (17.0%) patients achieved excellent functional outcomes at 3 months and 26 (27.7%) had hyperdensity on follow-up computed tomography (CT). On univariate analysis, the presence of VLLC was inversely associated with excellent functional outcomes at 3 months and positively associated with mortality in patients with mTICI-2B reperfusion. On multivariate analysis VLLC was inversely associated with excellent outcomes (odds ratio 0.075, 95% confidence interval 0.007-0.765, P = 0.029) but not associated with mortality.

In this study 167 consecutive acute stroke patients treated with the emboTrap® device (Cerenovus, Irvine, CA, USA) were included with a median National Institutes of Health Stroke Scale (NIHSS) of 15 (range 2-30) and mean age of 67 years (SD 13.1 years). Of the patients in our cohort 20 (11.9%) experienced distal emboli, with 2.3% into a new territory and 9.6% into a territory distal to the primary occlusion. On univariate analysis, age, intravenous tissue plasminogen activator (tPA), posterior circulation occlusions, and general anesthesia were associated with distal emboli. On multivariate analysis, only posterior circulation occlusions (odds ratio OR 4.506 95% confidence interval CI 1.483-13.692, p = 0.008) were significantly associated with distal emboli. Distal embolization was not significantly associated with worse functional outcomes at 3 months, increased mortality or increased bleeding risk.

CONCLUSION The mTICI-2B grade may be further refined by secondary radiological markers. The VLLC sign is associated with the loss of excellent functional outcomes at 3 months. It is a simple sign to discriminate mTICI-2B into different grades but should be verified in larger populations from other centers.

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CONCLUSION Posterior circulation occlusions were significantly associated with distal emboli during thrombectomy, possibly due to the lack of flow arrest during such procedures. New techniques and devices should be developed to protect against embolic complications during posterior circulation stroke

thrombectomy.

ABSTRACT 17 Surprising bone and soft tissue lesions of the chest: pictorial review.

ABSTRACT 16 The effective and collective dose to patients undergoing abdominopelvic and T trunk computed tomography examinations: A Belgian multicentre study.

Degrieck B, Bazzocchi MD, Verstraete K, et al. Seminars in Musculoskeletal radiology, 2019, 23, 85-96

Verstraeten K, De Roo B, et al. European Journal of Radiology, 2019, 111, 81-87

Although plain radiographs of the chest are usually requested to evaluate the heart, lung, and mediastinum, many bone and soft tissue, metabolic, and congenital lesions can be visible presenting as surprising lesions. Thorough analysis of the lesion characteristics on the chest radiograph, eventually in conjunction with more advanced imaging techniques and in combination with the clinical findings, will lead to the correct diagnosis.

CONCLUSION

OBJECTIVE This study aims to evaluate the radiation exposure to patients undergoing an abdominopelvic or a chest and abdominopelvic (trunk) CT examination and to assess compliance to imaging referral guidelines.

MATERIALS/METHODS To this end, 357 standard abdominopelvic and trunk CT scans were collected from 8 Belgian institutions in 2011 and 2015. Effective dose (E) and collective dose were calculated using CT dose descriptors (CTDIvol and DLP), which were obtained from dose reports generated by the CT scanner. Subsequently, these CT requests were compared against the national referral guidelines to assess compliance. Population estimates for dose and compliance were obtained using multilevel linear regression and generalized estimating equation models.

RESULTS Between 2011 and 2015, a significant decrease of 28% in CTDIvol and DLP was found for abdominopelvic CT. The corresponding E decreased by 27%, and the collective dose by 23%. For trunk CT, a non-significant decrease of 6% was found in CTDIvol and a significant decrease of 14% in both DLP and E. However, the collective dose of trunk examinations increased by 39%. In 2011, 24% of the abdominopelvic examinations were not compliant with the guidelines, whereas this percentage dropped to 17% in 2015. Non-justified examinations accounted for 8% and 12% of all trunk CT scans in 2011 and 2015, respectively.

ABSTRACT 18 Magnetic resonance imaging of third molars in forensic age estimation : comparison of the Ghent and Graz protocols focusing on apical closure. De Tobel J, Parmentier G, Verstraete K, et al. International Journal of Legal Medicine., 2019, 133(2), 583592

OBJECTIVE To compare the Ghent and Graz magnetic resonance imaging (MRI) protocols for third molars, focusing on the assessment of apical closure. To study the influence of (1) voxel size and (2) head fixation using a bite bar. To compare both protocols with a ground truth of apical development.

MATERIALS/METHODS In eleven healthy volunteers 3T MRI was conducted, including four Ghent sequences and two Graz sequences, with and without bite bar. After removal, 39 third molars were scanned with 7T µMRI and µCT to establish the ground truth of apical development. Three observers in consensus evaluated assessability and allocated developmental stages.

CONCLUSION

RESULTS

Between 2011 and 2015, there was a decrease in dose for patients undergoing abdominopelvic or trunk CT in Belgium. However, a fraction of the estimated doses are linked to unnecessary CT examinations, which should be avoided.

The Ghent T2 FSE sequence (0.33 x 0.33 x 2 mm³) was more assessable than the Graz T1 3D FSE sequence (0.59 x 0.59 x 1 mm³). Comparing assessability in both sequences with bite bar rendered P = 0.02, whereas comparing those without bite bar rendered P < 0.001. Within the same sequence, the bite bar increased assessability, with P = 0.03 for the Ghent T2 FSE and P = 0.07 for the Graz T1 3D FSE. Consid-

MEDISCHE BEELDVORMING

ering µCT as ground truth for staging, allocated stages on MRI were most frequently equal or higher. Among in vivo protocols, the allocated stages did not differ significantly.

PBC and MCM. Further studies will be needed to decipher the significance of SHH and to characterize its function in DWC and HPE.

CONCLUSION Imaging modality-specific and MRI sequence-specific reference data are needed in age estimation. A higher in plane resolution and a bite bar increase assessability of apical closure, whereas they do not affect stage allocation of assessable apices.

PRESENTATIES / CONGRESSEN ABSTRACT 1 Cone-beam CT as a fast and promising technique to assess the microstructure of distal radii in clinical practice. 25th Congress of the European Society of Biomechanics Mys K, Stockmans F, Vanovermeire O, et al. June 2019, Vienna, Austria Er is geen abstract beschikbaar.

ABSTRACT 2 A differential diagnosis pathway to guide genetic testing for SHH mutation. European Society of Radioloogy Xu J, Vanovermeire O, Seynaeve P, et al. March 2020, Electronic Presentation Online System (EPOS)

CONCLUSION MR imaging can play a key role in the differential diagnosis of probable gene-induced malformations, especially when combined supratentorial and posterior fossa lesions are very complex. The imaging features may provide a clue for genetic testing. The supratentorial ventricular abnormalities and midline defects are suggestive for HPE. It is however mandatory in these patients to carefully examine the posterior fossa and check for the presence of cystic malformations. Hypoplasia with rotation and displacement of the vermis, size of and communication with the 4th ventricle, size of the posterior fossa and the presence of associated hydrocephalus allow to differentiate DWM and DWV from

34 ABSTRACTBOEK | 2019

ABSTRACT 3 Endovascular treatment in stroke: Tools of the trade yesterday, today and tomorrow. 9th Annual Conference of the Neurological Society of India Andersson T February 2020, Kolkata, India

INTRODUCTION/BACKGROUND Endovascular treatment of ischemic stroke started with intra-arterial thrombolysis and anecdotal cases treated with snares and balloons. The first successful intra-arterial fibrinolysis for an intracranial artery occlusion was performed in 1979 by Zeumer.

RESULTS This new concept made the treatment easier, safer and more efficient. After this, several similar stent retrievers have been developed and approved but today also new ideas and concepts for EVT in AIS are being developed and tested as well as new pharmaceutical compounds for neuroprotection. Device development remains an interesting market ever since stent retriever thrombectomy for large vessel occlusion in combination with IVT was proven superior to stand-alone IVT in six randomized control studies up t 6-8 hours after onset. More recently this time window was extended for selected patients up to 16 and 24 hours after onset, respectively, increasing the potential number of patients even more.

CONCLUSION At present, mechanical thrombectomy for AIS can technically be done with direct contact aspiration or stent retriever. As the clinical as well as economic importance of a successful retrieval in only one attempt (so called “first pass effect”; FPE) has been clearly shown, a combination of retrievers and aspiration in combination with adjunctive tools like Balloon Guide Catheters (BGC) has been proven to further augment the chance of FPE. New retrievers based on yet other concepts are being developed and tested today. For instance, devices with small filaments actively deployed from a wire-like structure, or devices applying local flow-arrest just proximal to the thrombus before catchment. The last word remains to be said…

ABSTRACT 4

ABSTRACT 5

Flow diversion for intracranial aneurysms: the final solution?

Economic impact of First Pass Effect (FPE) in endovascular stroke treatment with the EMBOTRAP II device from the ARISE II study – Annual healthcare resource use economic analysis from a European perspective.

9th Annual Conference of the Neurological Society of India Andersson T February 2020, Kolkata, India

CONCLUSION Ever since the introduction of the Pipeline flow-diverter (FD), the concept has gained increased popularity. This may not come as a big surprise as the technique can be seen as quite “seductive”. Today there are many FDs on the market, all with slight differences in the basic construction providing them with different features, for instance regarding mesh density, radial force and re-sheath ability. So-called surface modification has lately gained increased interest as this may potentially reduce the need for aggressive anti-aggregation, something that is a clear drawback not least in the treatment of ruptured aneurysms. Even though FDs were originally mainly developed to treat large and giant aneurysms, there has been a shift in FD indications, today often including also easy to coil or clip aneurysms. The risk with an “overuse” of FDs is highlighted in several recent meta-analyses in which the morbidity was around 20-25% whereas the mortality was found to be around 10-15%, reaching as high as 20% for posterior location, especially for fusiform aneurysms. In addition, there are well recognized problems with delayed rupture of the index aneurysm as well as appearance of delayed remote intracranial hemorrhages. One trial, randomizing patients to FD versus standard management, was halted due to safety concerns when an interim analysis revealed that 16% of the patients in the FD-arm were dead or dependent at 3 months and that 42% had not reached angiographic occlusion. Based on this, one may argue for a stricter use of FDs, limited to situations where no other good treatment option is available. This is mostly applicable to giant- as well as so called blood-blister aneurysms, sometimes closely located multiple aneurysms or for retreatment after clip or coil. But only exceptionally for fusiform and wide-necked aneurysms and basically never for those that have ruptured resulting in a subarachnoid hemorrhage. To conclude, FDs are great tools but should be used with care and on strict indications as the complication rate is high and the long-term effects unknown.

World Federation of Interventional and Therapeutic Neuroradiology (WFITN) 15th Annual Meeting Andersson T October 2019, Napels, Italië

INTRODUCTION/BACKGROUND First pass effect (FPE) is the ability of a thrombectomy device and the applied technique to achieve complete or near complete revascularization (modified Thrombolysis in Cerebral Ischemia [mTICI] ≥2c) in a single pass. FPE has been shown to be an independent predictor of good functional outcome (modified Rankin Scale [mRS] ≤2), which subsequently impacts healthcare costs. A post hoc analysis of ARISE-II data showed that FPE was associated with reduced costs for annual care based on 90-day mRS.

OBJECTIVE The purpose of this analysis was to assess the annual economic impact of achieving FPE in four European countries (France, Italy, Sweden, and United Kingdom [UK]).

MATERIALS/METHODS Clinical outcomes data were obtained from the ARISE-II study investigating the safety and efficacy of the EMBOTRAP II device (n=227). Patients who did not achieve mTICI≥2c were excluded. The proportions of patients achieving each mRS score at 90 days were assessed, stratified by FPE status. Costs for annual care after 90-days, based on the 90-day mRS and in 2018 country-specific currencies, were calculated and compared between patients that did or did not achieve FPE; incremental differences were calculated.

RESULTS In ARISE-II, 76% of patients (n=172) achieved mTICI ≥2c; among these patients, 53% achieved FPE. A significantly higher percentage of patients that achieved FPE had good functional outcomes vs. those that did not achieve FPE (80.5% vs. 61.0%, p=0.006) with lower estimated costs for annual care after 90-days, leading to per-patient cost-savings across all countries (€2,140 for France, €694 for Italy, SEK 12,777 for Sweden, and £2,041 for UK) (Table 1). In the absence of healthcare resource use and cost data reported

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in ARISE-II, healthcare resource use after 90-days and subsequently, costs for healthcare resource use were obtained from the literature, which may not be generalizable across settings and is a limitation of this analysis. Additionally, the literature used to obtain the costs for annual care after 90days, based on 90-day mRS, did not report costs for death (i.e. mRS 6), which had a lower incidence among patients who achieved FPE (5.75% vs. 14.29%).

CONCLUSION Among patients with complete or near complete revascularization (mTICIâ&#x2030;Ľ2c), patients benefiting from FPE may be associated with annual cost-savings across European countries (France, Italy, Sweden, and UK) due to improved functional outcomes.

ABSTRACT 6 Cervical mediastinoscopy: Always Safe? European Society of Thoracic Surgeons (ESTS) Dublin 2019 Clement C, Janssen M, Vanacker P, FranĂ§ois O, Missant C, Lerut P, et al. Juni 2019, Dublin, Ierland Er is geen abstract beschikbaar.

ABSTRACTBOEK | 2019

CENTRUM

NEFROLOGIE

ARTIKELS ABSTRACT 1 Hypoxie en somnolentie na een tibiaplateaufractuur: denk aan het vetemboliesyndroom. Detailleur S, Viaene L, Doubel P, et al. Tijdschrift voor Geneneeskunde, 2019, 75, 668-672

INTRODUCTION/BACKGROUND Het vetemboliesyndroom is een slecht omschreven klinische entiteit waarbij vetembolen terechtkomen in de microcirculatie en systemische weerslag veroorzaken. Het wordt gekarakteriseerd door de volgende triade: hypoxie, neurologische deterioratie en petechiën binnen de 12 à 72 uur na het doormaken van een trauma. Het vetemboliesyndroom komt voor bij 0,9% tot 2,2% van de patiënten met langebeenderfracturen. De incidentie van cerebrale vetembolen is niet gekend. Hieraan moet wel gedacht worden bij een patiënt met een langebeenderfractuur met respiratoire distress en neurologische veranderingen. Hoewel cerebrale vetembolen veelal zelflimiterend zijn, kunnen deze patiënten ook overlijden. Het vetemboliesyndroom wordt voornamelijk gezien na een trauma en orthopedische ingrepen, maar ook andere, niet-traumatische aandoeningen kunnen het uitlokken.

RESULTS PET findings suggested medium and large vessel vasculitis. CT angiography and histopathological analysis of the spermatic cord lacked the typical characteristics of Polyarteritis Nodosa (PAN) or medium size vasculitis. In light of a probable medium vessel vasculitis the patient was treated with corticosteroids, with a favorable response.

CONCLUSION Vasculitis should be considered in the differential diagnosis of a funiculitis that does not respond to antibiotic therapy. PET CT is an important tool for the diagnosis of vasculitis in patients with an atypical presentation and inconclusive diagnostic testing.

ABSTRACT 2 A funny case of Funiculitis. Claeys E, Schockaert O, et al. Acta Clinica Belgica, 2019, 23, 1-4

INTRODUCTION/BACKGROUND Funiculitis, an inflammation of the spermatic cord, usually results from infection of adjacent structures like the epididymis, testis or the urethra. It is most frequently caused by a bacterial infection, but has a broad (non-infectious) differential diagnosis.

MATERIALS/METHODS This case illustrates an unusual cause of funiculitis. A 72year old man presented with sequential right- and left side funiculitis. He was non-responsive to antibiotics and developed constitutional symptoms. A non-infectious inflammatory etiology was suspected and further diagnostic procedures were performed.

NEFROLOGIE

CENTRUM

NEUROLOGIE

ARTIKELS ABSTRACT 1 Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance. Staessens S, Vanacker P, Francois O, Andersson T, et al. Haematologica, 2020, 105(2), 498-507 Het abstract is terug te vinden op pagina 29.

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Cervical mediastinoscopy: Always Safe? European Society of Thoracic Surgeons (ESTS) Dublin 2019 Clement C, Janssen M, Vanacker P, Franรงois O, Missant C, Lerut P, et al. Juni 2019, Dublin, Ierland Er is geen abstract beschikbaar.

ABSTRACTBOEK | 2019

CENTRUM

NUCLEAIRE GENEESKUNDE

ARTIKELS ABSTRACT 1 PSMA-targeting positron emission agents for imaging solid tumors other than non-prostate carcinoma: a systematic review.

tigen a suitable target for radioligand therapy of the disease. Here we report on our experience with a series of 73 castration-resistant prostate carcinoma patients treated with 225Ac-PSMA-617, identifying variables predictive for overall survival (OS) and progression-free survival (PFS) after 225Ac-PSMA-617 treatment.

MATERIALS/METHODS Van de Wiele C, Maes A, De Jonghe P, Beels L, et al. International Journal of Molecular Sciences, 2019, 20(19), pii: E4886

INTRODUCTION/BACKGROUND Despite its name, prostate-specific membrane antigen (PSMA) has been shown using immunohistochemistry (IHC) to also be over-expressed in the tumor neovasculature of a wide variety of solid tumors other than prostate carcinoma. Accordingly, positron-emitting radiolabeled small molecules targeting PSMA, initially developed for positron emission tomography in prostate carcinomas, are currently being explored for their staging and restaging potential as an alternative imaging modality in other solid tumor types where 18-F-fluorodeoxyglucose (FDG)-PET imaging has low diagnostic accuracy.

OBJECTIVE In this paper, the currently available literature in this field is reviewed.

RESULTS Preliminary, mainly retrospective studies are encouraging, with evidence of improved diagnostic sensitivity and specificity in clear cell renal carcinoma, glioma, and hepatocellular carcinoma, leading to a change in patient management in several patients. However, the results published thus far warrant confirmation by larger prospective studies additionally assessing the longitudinal impact on patient outcomes.

ABSTRACT 2 Predictors of overall and disease-free survival in metastatic castration-resistant prostate cancer patients receiving 225ac-psma-617 radioligand therapy. Sathekge M, Van de Wiele C, Maes A, et al. Journal of Nuclear Medicine, 2020, 61(1), 62-69

225Ac-PSMA-617 was administered to patients who had metastatic castration-resistant prostate carcinoma and who had exhausted available therapy options for their disease. Full blood count, glomerular filtration rate, and liver function test were obtained at baseline and on follow-up for evaluation of toxicity. 68Ga-PSMA PET/CT was obtained at baseline, before every treatment cycle, and on follow-up for selection of patients for treatment, to determine the activity of the treatment agent to be administered, and for response assessment. Serial prostate-specific antigen (PSA) was obtained for PSA response assessment.

RESULTS Seventy-three men (mean age, 69 y; range, 45-85 y) with metastatic castration-resistant prostate carcinoma were treated with 210 cycles of 225Ac-PSMA-617. In 70% of patients, a PSA decline of greater than or equal to 50% was obtained; 82% of patients had any PSA decline. In 29% of patients, all lesions on 68Ga-PSMA PET resolved in response to treatment. During follow-up, 23 patients experienced disease progression, whereas 13 patients died from their disease. The estimated median PFS and OS were 15.2 mo (95% CI, 13.1-17.4) and 18 mo (95% CI, 16.2-19.9), respectively. In univariate analyses, factors such as baseline PSA, any PSA decline, PSA decline of greater than or equal to 50%, prior chemotherapy, prior radiation therapy, and baseline hemoglobin level were associated with longer PFS and OS (all Ps < 0.05). In multivariate analyses, there was a negative association between prior 177Lu-PSMA therapy and PFS, and a positive association between PSA decline of greater or equal to 50% and PFS. Only a PSA decline of greater than or equal to 50% remained significantly associated with OS on multivariate analyses. Xerostomia was seen in 85% of patients but was not severe enough to warrant discontinuing treatment. Anemia was seen in 27 patients; no patients had grade IV bone marrow toxicity. Renal failure of grade III or IV was seen in 5 patients with baseline renal impairment.

CONCLUSION INTRODUCTION/BACKGROUND Metastatic prostate carcinoma overexpresses prostate-specific membrane antigen (PSMA), making this an-

In this study, a PSA decline of greater than or equal to 50% after treatment with 225Ac-PSMA-617 was proven by multivariate analyses to be significantly associated with OS and

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PFS. Furthermore, previous 177Lu-PSMA treatment was negatively associated with PFS in both univariate and multivariate analyses.

carcinoma recurrence. Advanced disease and histological variant other than SCC are predictive of recurrence.

ABSTRACT 3

Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in nonischemic CRT candidates.

ABSTRACT 4 18F-FDG-PET/CT imaging of uterine cervical cancer recurrence in women with and without HIV infection. Lawal I, Maes A, Van de Wiele C, et al. The Quarterly Journal of Nuclear Medicine and Molecular Imaging, 2019, Epub ahead of print, DOI: 10.23736/S18244785

Degtiarova G, Claus P, Gheysens O, et al. European Journal of Nuclear Medicine and Molecular Imaging Research, 2019, 9(1), 105

INTRODUCTION/BACKGROUND

In order to better understand the concept of mechanical dyssynchrony, a promising hallmark of cardiac resynchronization therapy (CRT) response, we investigated its effect on regional myocardial metabolism and myocardial blood flow (MBF) in non-ischemic CRT candidates.

INTRODUCTION/BACKGROUND To compare the rate, time and, pattern of recurrence of cervical cancer between patients with and without HIV infection and to determine factors predicting cervical cancer recurrence in patients evaluated by 18F-FDG-PET/CT.

MATERIALS/METHODS

RESULTS

We reviewed the 18F-FDG-PET/CT images of patients with histologically proven cervical carcinoma who were presenting with suspected recurrence. We extracted epidemiologic data, previous treatment, histologic subtype, HIV status, viral load and CD4 counts from the electronic laboratory database and the referral form for the 18F-FDG-PET/CT study.

Thirty consecutive non-ischemic CRT eligible patients underwent static 18F-FDG and resting dynamic 13N-NH3 PET/ CT. 18F-FDG uptake and MBF for septal and lateral wall were analysed and septal-to-lateral wall ratios (SLR) were calculated. Based on the presence of mechanical dyssynchrony (septal flash and/or apical rocking) on echocardiography, patients were divided into 2 groups, with (n = 23) and without (n = 7) mechanical dyssynchrony. Patients with mechanical dyssynchrony had significantly lower 18F-FDG SUVmean in the septum compared with the lateral wall (5.58 ± 2.65 vs 11.19 ± 4.10, p < 0.0001), while patients without mechanical dyssynchrony had a more homogeneous 18F-FDG distribution (7.33 ± 2.88 vs 8.31 ± 2.50, respectively, p = 0.30). Similarly, MBF was significantly different between the septal and lateral wall in the dyssynchrony group (0.57 ± 0.11 ml/g/min vs 0.92 ± 0.23 ml/g/min, respectively, p < 0.0001), whereas no difference was observed in the non-dyssynchrony group (0.61 ± 0.23 ml/g/min vs 0.77 ± 0.21 ml/g/min, respectively, p = 0.16). 18F-FDG SLR, but not MBF SLR, was associated with the presence of mechanical dyssynchrony and showed a significant inverse correlation with volumetric reverse remodeling after CRT (r = - 0.62, p = 0.001).

RESULTS We studied 303 women including 112 HIV-infected patients. FIGO stage III disease was present in 131 patients. Of 198 patients with recurrence, 74 were HIV-infected while 124 were not (p=0.849). HIV infected patients were younger (41.99 ± 9.30 years) compared to HIV-uninfected (50.19 ± 11.09), p<0.001. Local recurrence was present in 125 patients while 100 patients had a distant recurrence. Recurrence occurred at a single site in 88 patients and two or more sites in 110 patients. No significant difference in the recurrent patterns between HIV-infected and uninfected patients. Median time to recurrence was 10.50 months (Range: 6.00-156.00) among HIV-infected versus 12.00 months (IQR:7.00-312.00) among the uninfected, p=0.065. FIGO stage III (p=0.042) and the presence of histological sub-types other than SCC (p=0.005) were significant predictors of recurrence. HIV infection by itself was not significant in predicting recurrence (p=0.843).

CONCLUSION HIV infection has no significant impact on the rate, time or pattern of recurrence in women with suspected cervical

40 ABSTRACTBOEK | 2019

CONCLUSION Non-ischemic heart failure patients with mechanical dyssynchrony demonstrate heterogeneous regional metabolism and MBF compared with patients without dyssynchrony. However, only 18F-FDG SLR appeared to be highly associated with the presence of mechanical dyssynchrony.

ABSTRACT 5 Granulomatosis with polyangiitis with breast involvement mimicking metastatic cancer: Case report and literature review. Gadeyne L, Henckaerts L, Gheysens O, et al. European Journal of Rheumatology, 2019, 7(1), 41-43

0.2-11.4). Positive nodes on the preoperative PET/CT scans were mapped and compared to post-operative pathology results. LNs were marked as true positive, false positive, true negative and false negative and a patient- and a region-based analysis was performed. Sensitivity, specificity and positive/negative predictive value (PPV/NPV) were calculated.

INTRODUCTION/BACKGROUND

RESULTS

Granulomatosis with polyangiitis (GPA) is a systemic inflammatory disease, characterized by the presence of necrotizing vasculitis of small and medium-sized vessels, granulomatous inflammation and anti-neutrophil cytoplasmic antibodies (ANCAs). The diagnosis can be challenging due to the variable clinical presentation and possible involvement of virtually all organ systems. A correct diagnosis is indispensable for a timely start of medical treatment and to avoid unnecessary surgery. Therefore, cooperation with and the input of the pathologist is crucial. We report a case of a woman presenting with suspected metastatic cancer. The diagnosis of GPA was made mainly based on breast biopsy, and the patient was treated accordingly, with full recovery. This report provides a case description and a brief review of the literature.

Sixty positive LNs were detected on PET/CT with a median number of two positive nodes per patient (range 1-6). In 29 patients, a super-extended pelvic LND (PLND) was performed combined with a retroperitoneal LND (RPLND) in 13 of those cases. One patient underwent an inguinal LND. One hundred thirty-seven of 644 resected LNs contained metastases. The 11C-choline PET/CT scan correctly predicted 31 positive nodes (55%) while 25 nodes were falsely positive (45%). One hundred and six histologically proven metastatic nodes were not detected on the 11C-choline PET/CT scan (77%). Sensitivity, specificity, PPV and NPV of the 11C-choline PET/CT were 23%, 95%, 55% and 82%, respectively.

CONCLUSION 11C-choline PET/CT has a relatively low detection rate and a moderate PPV for metastatic LNs in patients with biochemical recurrence after radically treated PCa.

ABSTRACT 6 Anatomical mapping of lymph nodes in patients receiving salvage lymphadenectomy based on a positive 11C-choline positron emission tomography/computed tomography scan.

Natural evolution of cardiac sarcoidosis asymptomatic patient: a case report.

Deconinck S, Tosco L, Gheysens O, et al. Central European Journal of Urology, 2019, 72(3), 232-239

Degtiarova G, Gheysens O, Van Cleemput J, et al. European Heart Journal - Case Reports, 2019, 3(3), ytz099

ABSTRACT 7 in

INTRODUCTION/BACKGROUND

This paper aims to assess the diagnostic accuracy of an 11C-choline positron emission tomography/computed tomography (PET/CT) scan in the detection of lymph node (LN) metastases in patients with biochemical recurrence after radically treated prostate cancer (PCa), as compared to histology. The secondary goal is to depict spreading patterns of metastatic LNs in recurrent PCa.

Sarcoidosis is a multi-organ granulomatous disease of unknown aetiology. Adverse outcome related with cardiac involvement, makes early diagnosis of cardiac sarcoidosis crucial.

MATERIALS/METHODS A single center retrospective study comprising of 30 patients who underwent retroperitoneal and/or pelvic salvage lymph node dissection (LND) due to 11C-choline PET/CT-positive nodal recurrences after radical treatment (median Prostate Specific Antigen (PSA) 1.5 ng/ml, range

RESULTS In a 55-year-old man presenting with recurrent pulmonary infections, computed tomography (CT) showed several enlarged mediastinal lymph nodes and no lung pathology. Subsequent mediastinoscopy revealed the diagnosis of sarcoidosis. Further screening for organ involvement showed multifocal cardiac involvement both on cardiac magnetic resonance (CMR) and 18-F-fluorodeoxyglucose-positron emission tomography-computed tomography (18F-FDG

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PET-CT). Because of the lack of functional deterioration and clinical symptoms, no steroid treatment was initiated and regular follow-up of cardiac abnormalities was performed by CMR. Unremarkable progression of cardiac involvement during the first 2 years of follow-up turned into a dramatic involvement after 4 years, with the increase in the number and size of lesions at late gadolinium enhancement (LGE) CMR. Late gadolinium enhancement areas matched the regions of strongly increased 18F-FDG uptake. For the first time, the patient started complaining on shortness of breath, electrocardiography showed an atrioventricular block Grade 1. Cardiac biomarkers and cardiac function were still preserved. Steroid treatment was started. Although an electrophysiology study was negative, Holter monitoring showed ventricular arrhythmia. Cardioverter-defibrillator was implanted.

CONCLUSION This case shows the progression of cardiac sarcoidosis on CMR in an asymptomatic untreated patient over a 4-year period, and rises the awareness of possible severe cardiac damage even in the absence of clinical signs of cardiac involvement. Combination of PET and CMR is appealing to better understand the evolution of cardiac sarcoidosis and may help in the management of such patients.

ABSTRACT 8 Regional myocardial work by cardiac magnetic resonance and non-invasive left ventricular pressure: a feasibility study in left bundle branch block. Larsen C, Aalen J, Gheysens O, et al. European Heart Journal - Cardiovascular Imaging, 2020, 21(2), 143-153

OBJECTIVE Regional myocardial work may be assessed by pressure-strain analysis using a non-invasive estimate of left ventricular pressure (LVP). Strain by speckle tracking echocardiography (STE) is not always accessible due to poor image quality. This study investigated the estimation of regional myocardial work from strain by feature tracking (FT) cardiac magnetic resonance (CMR) and non-invasive LVP.

MATERIALS/METHODS Thirty-seven heart failure patients with reduced ejection fraction, left bundle branch block (LBBB), and no myocardial scar were compared to nine controls without LBBB. Circumferential strain was measured by FT-CMR in a mid-ventricular short-axis cine view, and longitudinal strain by STE.

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Segmental work was calculated by pressure-strain analysis. Twenty-five patients underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography. Segmental values were reported as percentages of the segment with maximum myocardial FDG uptake. In LBBB patients, net CMR-derived work was 51 ± 537 (mean ± standard deviation) in septum vs. 1978 ± 1084 mmHg·% in the left ventricular (LV) lateral wall (P < 0.001). In controls, however, there was homogeneous work distribution with similar values in septum and the LV lateral wall (non-significant). Reproducibility was good. Segmental CMR-derived work correlated with segmental STE-derived work and with segmental FDG uptake (average r = 0.71 and 0.80, respectively).

CONCLUSION FT-CMR in combination with non-invasive LVP demonstrated markedly reduced work in septum compared to the LV lateral wall in patients with LBBB. Work distribution correlated with STE-derived work and energy demand as reflected in FDG uptake. These results suggest that FT-CMR in combination with non-invasive LVP is a relevant clinical tool to measure regional myocardial work.

ABSTRACT 9 Impact of left bundle branch block on myocardial perfusion and metabolism: A positron emission tomography study. Degtiarova G, Claus P, Gheysens O, et al. Journal of Nuclear Cardiology, 2019, Oct 2, doi: 10.1007/ s12350-019-01900-y

INTRODUCTION/BACKGROUND Better understanding of pathophysiological changes, induced by left bundle branch block (LBBB), may improve patient selection for cardiac resynchronization therapy (CRT). Therefore, we assessed the effect of LBBB on regional glucose metabolism, 13N-NH3-derived absolute and semiquantitative myocardial blood flow (MBF), and their relation in non-ischemic CRT candidates.

MATERIALS/METHODS Twenty-five consecutive non-ischemic patients with LBBB underwent 18F-FDG and resting dynamic 13N-NH3 PET/ CT prior to CRT implantation. Regional 18F-FDG uptake, absolute MBF, and late 13N-NH3 uptake were analyzed and corresponding septal-to-lateral wall ratios (SLR) were calculated. Segmental analysis was performed to evaluate "reverse mismatch," "mismatch," and "match" patterns, based on late 13N-NH3/18F-FDG uptake ratios.

RESULTS A significantly lower 18F-FDG uptake was observed in the septum compared to the lateral wall (SLR 0.53 ± 0.17). A similar pattern was observed for MBF (SLR 0.68 ± 0.18), whereas late 13N-NH3 uptake showed a homogeneous distribution (SLR 0.96 ± 0.13). 13N-NH3/18F-FDG "mismatch" and "reverse mismatch" segments were predominantly present in the lateral (52%) and septal wall (61%), respectively.

CONCLUSION Non-ischemic CRT candidates with LBBB demonstrate lower glucose uptake and absolute MBF in the septum compared to the lateral wall. However, late static 13N-NH3 uptake showed a homogenous distribution, reflecting a composite measure of altered regional MBF and metabolism, induced by LBBB.

ABSTRACT 10 PET or MRI to improve response evaluation in clinical trials? Deroose C, Gheysens O, Perez-Lopez R, et al. The Lancet Oncology, 2019, 20(8), 1060-1062

ocardial proteins were potently decreased in AAV8-LDLr TAC mice. The degree of interstitial fibrosis and perivascular fibrosis was 31.0% (p<0.001) and 29.8% (p<0.001) lower, respectively, in AAV8-LDLr TAC mice compared to control TAC mice. These structural differences were associated with improved systolic and diastolic function and decreased lung congestion in AAV8-LDLr TAC mice compared to control TAC mice. Cholesterol lowering gene therapy counteracted myocardial oxidative stress and preserved the potential for myocardial fatty acid oxidation in TAC mice. In conclusion, cholesterol lowering gene therapy attenuates pressure overload-induced heart failure in mice with mild hypercholesterolemia.

ABSTRACT 12 ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. Dorbala S, Ando Y, Gheysens O, et al. Journal of Cardiac Failure, 2019, 25(11), e1-e39 Er is geen abstract beschikbaar.

Er is geen abstract beschikbaar.

ABSTRACT 13 ABSTRACT 11 Cholesterol lowering attenuates pressure overload-induced heart failure in mice with mild hypercholesterolemia.

ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 2 of 2-diagnostic criteria and appropriate utilization.

Muthurama I, Mishra M, Gheysens O, et al. Aging (Albany New York), 2019, 11(17), 6872-6891

Dorbala S, Ando Y, Gheysens O, et al. Journal of Cardiac Failure, 2019, 25(11), 854-865

INTRODUCTION/BACKGROUND

Epidemiological studies support a strong association between non-high-density lipoprotein cholesterol levels and heart failure incidence. The objective of the current study was to evaluate the effect of selective cholesterol lowering adeno-associated viral serotype 8 (AAV8)-mediated low-density lipoprotein receptor (LDLr) gene transfer on cardiac remodelling and myocardial oxidative stress following transverse aortic constriction (TAC) in female C57BL/6 LDLr-/- mice with mild hypercholesterolemia. Cholesterol lowering gene transfer resulted in a 65.9% (p<0.0001) reduction of plasma cholesterol levels (51.2 ± 2.2 mg/dl) compared to controls (150 ± 7 mg/dl). Left ventricular wall area was 11.2% (p<0.05) lower in AAV8-LDLr TAC mice than in control TAC mice. In agreement, pro-hypertrophic my-

Cardiac amyloidosis is emerging as an underdiagnosed cause of heart failure and mortality. Growing literature suggests that a noninvasive diagnosis of cardiac amyloidosis is now feasible. However, the diagnostic criteria and utilization of imaging in cardiac amyloidosis are not standardized. In this paper, Part 2 of a series, a panel of international experts from multiple societies define the diagnostic criteria for cardiac amyloidosis and appropriate utilization of echocardiography, cardiovascular magnetic resonance imaging, and radionuclide imaging in the evaluation of patients with known or suspected cardiac amyloidosis.

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ABSTRACT 14

ABSTRACT 15

Role of 18F-FDG PET/CT in restrictive allograft syndrome after lung transplantation.

Papillary muscles contribute significantly more to left ventricular work in dilated hearts.

Verleden S, Gheysens O, Goffin K, et al. Transplantation, 2019, 103(4), 823-831

Duchenne J, Turco A, Gheysens O, et al. European Heart Journal - Cardiovascular Imaging, 2019, 20(1), 84-91

INTRODUCTION/BACKGROUND Differential diagnosis of phenotypes of chronic lung allograft dysfunction (CLAD) remains troublesome. We hypothesized that F-FDG PET/CT may help in differential diagnosis of CLAD phenotypes, as it showed promising results regarding diagnosis and prognosis in interstitial lung diseases.

OBJECTIVE Left ventricular (LV) dilatation results in increased sphericity and affects position and orientation of papillary muscles (PMs), which may influence their performed work. The aim of this study was to assess the contribution of PM to LV function and its changes with dilatation.

MATERIALS/METHODS A monocentric, retrospective study was performed including all lung transplant recipients suffering from bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS) who underwent F-FDG PET/CT scan, in comparison with stable lung transplant recipients. Maximum standardized uptake value (SUVmax) was associated with pulmonary function and survival. Proof-of-concept microCT and glucose transporter-1 (GLUT1) staining served as morphologic validation for regions with different SUVmax.

RESULTS Maximum standardized uptake value was higher in RAS (median, 2.6; n = 29) compared with BOS (median, 1.0; n = 15) and stable patients (median, 0.59; n = 8) (P < 0.0001). In RAS, high SUVmax was associated with worse survival after F-FDG PET/CT (P = 0.0004; hazard ratio, 1.82). Forced vital capacity at F-FDG PET/CT inversely correlated with SUVmax (R = -0.40, P = 0.03). MicroCT analysis revealed extensive fibrosis in regions of high SUVmax, with an increased number of glucose transporter-1-positive cells.

CONCLUSION F-fluorodeoxyglucose positron emission tomography with CT may noninvasively differentiate RAS from BOS. RAS patients with areas of increased lung metabolism have worse outcome, demonstrating the potential use of F-FDG PET/ CT during follow-up after lung transplantation.

MATERIALS/METHODS Fifteen sheep were investigated. Ten animals were subjected to 8 weeks of rapid (180 bpm) pacing, inducing LV dilatation. Five animals served as controls. High-resolution gated computed tomography was performed to assess LV volumes, left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), sphericity index, and PM angle, width and fractional shortening. 18F-fluorodeoxyglucose positron emission tomography (PET) was used to measure glucose metabolism as surrogate of regional myocardial work. Spatial resolution of PET images was maximized by electrocardiogram- and respiratory-gating. 18F-fluorodeoxyglucose uptake was measured in PM and compared with remaining left ventricular myocardium (MYO) to obtain a PM/MYO ratio.

RESULTS Animals with dilated heart had a more spherical left ventricle, with reduced LVEF (P < 0.0001) and GLS (P < 0.0001). In dilated hearts, PET analysis revealed a higher contribution of both PM to LV myocardial work (P < 0.0001); and PM angle towards LV wall correlated with PM work, together with PM width and the LV sphericity index. Sphericity index and posterior PM angle were strongest determinants of posterior PM/MYO ratio (R2 = 0.754; P < 0.0001), while anterior PM/MYO was mostly determined by sphericity index and the PM width (R2 = 0.805; P < 0.0001).

CONCLUSION In dilated hearts, PM contribute relatively more to LV myocardial work. We hypothesize that this is caused by the more cross-sectional orientation of the subvalvular apparatus, which leads to a higher stress on the PM compared with the spherical LV walls. The reduced cross-sectional area of the PM may further explain their increased stress.

44 ABSTRACTBOEK | 2019

ABSTRACT 16 Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Scofienza LM, Signore A, Gheysens O, et al. European Radiology, 2019, 29(12), 6425-6438

OBJECTIVE Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement).

MATERIALS/METHODS After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging.

3. Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.

ABSTRACT 17 Letter to the Editor regarding Falstie-Jensen et al: "Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in diagnosing chronic periprosthetic shoulder joint infection". Wouthuyzen-Bakker M, Gheysens O, et al. Journal of Shoulder and Elbow Surgery, 2019, 28(7), e250-e251 Er is geen abstract beschikbaar.

ABSTRACT 18 Dose-dependent improvement of cardiac function in a swine model of acute myocardial infarction after intracoronary administration of allogeneic heartderived cells. Crisomoto V, Baez C, Gheysens O, et al. Stem Cell Research & Therapy, 2019, 10(1), 152

INTRODUCTION/BACKGROUND CONCLUSION Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics. Key points: 1. For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities. 2. Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel.

Allogeneic cardiac-derived progenitor cells (CPC) without immunosuppression could provide an effective ancillary therapy to improve cardiac function in reperfused myocardial infarction. We set out to perform a comprehensive preclinical feasibility and safety evaluation of porcine CPC (pCPC) in the infarcted porcine model, analyzing biodistribution and mid-term efficacy, as well as safety in healthy non-infarcted swine.

MATERIALS/METHODS The expression profile of several pCPC isolates was compared with humans using both FACS and RT-qPCR. ELISA was used to compare the functional secretome. One week after infarction, female swine received an intracoronary (IC) infusion of vehicle (CON), 25 × 106 pCPC (25 M), or 50 × 106 pCPC (50 M). Animals were followed up for 10 weeks using serial cardiac magnetic resonance imaging to assess functional and structural remodeling (left ventricular ejection fraction (LVEF), systolic and diastolic volumes, and myocardial salvage index). Statistical comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests. Biodistri-

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bution analysis of 18F-FDG-labeled pCPC was also performed 4 h after infarction in a different subset of animals.

RESULTS Phenotypic and functional characterization of pCPC revealed a gene expression profile comparable to their human counterparts as well as preliminary functional equivalence. Left ventricular functional and structural remodeling showed significantly increased LVEF 10 weeks after IC administration of 50 M pCPC, associated to the recovery of left ventricular volumes that returned to pre-infarction values (LVEF at 10 weeks was 42.1 ± 10.0% in CON, 46.5 ± 7.4% in 25 M, and 50.2 ± 4.9% in 50 M, p < 0.05). Infarct remodeling was also improved following pCPC infusion with a significantly higher myocardial salvage index in both treated groups (0.35 ± 0.20 in CON; 0.61 ± 0.20, p = 0.04, in 25 M; and 0.63 ± 0.17, p = 0.01, in 50 M). Biodistribution studies demonstrated cardiac tropism 4 h after IC administration, with substantial myocardial retention of pCPC-associated tracer activity (18% of labeled cells in the heart), and no obstruction of coronary flow, indicating their suitability as a cell therapy product.

CONCLUSION IC administration of allogeneic pCPC at 1 week after acute myocardial infarction is feasible, safe, and associated with marked structural and functional benefit. The robust cardiac tropism of pCPC and the paracrine effects on left ventricle post-infarction remodeling established the preclinical bases for the CAREMI clinical trial (NCT02439398).

stress-strain relationships which can be seen as a measure of local myocardial work. The proposed method was validated against 18F-fluorodeoxyglucose positron emission tomography, the reference method to clinically assess local metabolism. Averaged over all patients, the mean correlation between FDG-PET and the proposed method was. In conclusion, stress-strain loops were, for the first time, estimated from 3D echocardiography and correlated to the clinical gold standard for local metabolism, showing the future potential of real-time 3D echocardiography (RT3DE) for the assessment of local metabolic activity of the heart.

ABSTRACT 20 Role of interim and end of treatment positron emission tomography for response assessment and prediction of relapse in posttransplant lymphoproliferative disorder. Van Keerberghen C, Goffin K, Gheysens O, et al. Acta Oncology, 2019, 58(7), 1041-1047

INTRODUCTION/BACKGROUND Fluorine-18-fluorodeoxyglucose positron emission tomography (PET) has an established and central role in diagnosis, staging and response evaluation of lymphoproliferative diseases. It has shown a high sensitivity and specificity at diagnosis in posttransplant lymphoproliferative disorders (PTLDs). However, little is known about the performance of interim and end of treatment (EOT) PET in PTLD patients with regards to response assessment, relapse prediction and outcome.

ABSTRACT 19

MATERIALS/METHODS

Non-invasive myocardial performance mapping using 3D echocardiographic stress-strain loops.

We performed a single-center retrospective study in which we analyzed consecutive patients diagnosed with CD20-positive PTLD after solid organ transplantation between 2008 and 2017, who all received risk-stratified sequential treatment according to the PTLD-1 phase II trial. Interim and EOT PET studies were scored according to the Deauville criteria.

Pedrosa J, Duchenne J, Gheysens O, et al. Physics in Medicine and Biology, 2019, 64(11), 115026

INTRODUCTION/BACKGROUND Regional contribution to left ventricular (LV) ejection is of much clinical importance but its assessment is notably challenging. While deformation imaging is often used, this does not take into account loading conditions. Recently, a method for intraventricular pressure estimation was proposed, thus allowing for loading conditions to be taken into account in a non-invasive way. In this work, a method for 3D automatic myocardial performance mapping in echocardiography is proposed by performing 3D myocardial segmentation and tracking, thus giving access to local geometry and strain. This is then used to assess local LV

46 ABSTRACTBOEK | 2019

RESULTS Forty-one patients were included with median follow-up of 41.5 months (range 1-108). Positive and negative predictive values for disease recurrence were 13% and 85% for interim and 33% and 87% for EOT PET, respectively. There was no significant difference in overall survival, progression-free survival nor time to progression between negative versus positive patients on interim and EOT scans.

CONCLUSION

Negative interim and/or negative end of treatment PET identify PTLD patients with low risk of disease recurrence.

Regional LV glucose metabolism closely correlates with regional work. Our data indicate that regionally different LV remodeling after exposure to inhomogeneous loading conditions, such as during LV dyssynchrony, is an adaptive process that helps to equilibrate work distribution. Correction of the inhomogeneous loading conditions, such as during cardiac resynchronization therapy, then triggers a reverse LV remodeling through the same mechanism.

ABSTRACT 21 Left ventricular remodeling results in homogenization of myocardial work distribution. Duchenne J, Turco A, Gheysens O, et al. Circulation: Arrhytmia and Electrophysiology, 2019, 12(5), e007224

INTRODUCTION/BACKGROUND The interaction between regional left ventricular (LV) myocardial work and metabolism in remodeled hearts has not yet been well established. Our aim was to investigate the effect of inhomogeneous LV work distribution on regional metabolism and remodeling in our animal model with reversible dyssynchrony due to pacing.

ABSTRACT 22 Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Signore A, Sconfienza LM, sGheysens O, et al. European Journal of Nuclear Medicine and Molecular Imaging, 2019, 46(4), 971-988

INTRODUCTION/BACKGROUND MATERIALS/METHODS In 12 sheep, 8 weeks of right atrial and right ventricular free wall (DDD) pacing lead to LV dilatation, a thinned septum, and thickened lateral wall. Left bundle branch block-like dyssynchrony caused by DDD pacing could be acutely reverted by right atrial pacing (AAI) only. Invasive hemodynamics and echocardiography were used to assess regional work by stress-strain loop area and compared with regional glucose metabolism measured by 18F-fluorodeoxyglucose positron emission tomography with and without improved spatial resolution by motion and anatomy correction on gated reconstructions.

For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking.

OBJECTIVE To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart.

RESULTS Glucose metabolism by positron emission tomography with anatomic correction on gated positron emission tomography reconstruction showed a different regional distribution than with clinical reconstructions and correlated best and significantly with regional myocardial work. At baseline, work was homogeneously distributed with normal conduction (AAI pacing), whereas during dyssynchrony (DDD pacing), the lateral wall was more loaded, and the septum was unloaded. After 8 weeks of remodeling under DDD pacing, however, an almost homogeneous work distribution was found with DDD pacing, whereas with AAI pacing, the thin septum showed exaggerated loading and the lateral walls a low load. Our experimental observations were confirmed in 5 patient responders to cardiac resynchronization therapy.

RESULTS The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM).

ABSTRACT 23 Local pulmonary drug delivery in the preterm rabbit: feasibility and efficacy of daily intratracheal injections. Salaets T, Gie A, Gheysens O, et al. American Journal of Physiology - Lung Cellular and Molecular Physiology, 2019, 316(4), L589-L597

NUCLEAIRE GENEESKUNDE

INTRODUCTION/BACKGROUND Recent clinical trials in newborns have successfully used surfactant as a drug carrier for an active compound, to minimize systemic exposure. To investigate the translational potential of surfactant-compound mixtures and other local therapeutics, a relevant animal model is required in which intratracheal administration for maximal local deposition is technically possible and well tolerated. Preterm rabbit pups (born at 28 days of gestation) were exposed to either hyperoxia or normoxia and randomized to receive daily intratracheal surfactant, daily intratracheal saline, or no injections for 7 days. At day 7, the overall lung function and morphology were assessed. Efficacy in terms of distribution was assessed by micro-PET-CT on both day 0 and day 7. Lung function as well as parenchymal and vascular structure were altered by hyperoxia, thereby reproducing a phenotype reminiscent of bronchopulmonary dysplasia (BPD). Neither intratracheal surfactant nor saline affected the survival or the hyperoxia-induced BPD phenotype of the pups. Using PET-CT, we demonstrate that 82.5% of the injected radioactive tracer goes and remains in the lungs, with a decrease of only 4% after 150 min. Surfactant and saline can safely and effectively be administered in spontaneously breathing preterm rabbits. The described model and method enable researchers to evaluate intratracheal pharmacological interventions for the treatment of BPD.

ABSTRACT 24 Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Glaudemans AWJM, Jutte PC, Gheysens O, et al. European Journal of Nuclear Medicine and Molecular Imaging, 2019, 46(4), 957-970

INTRODUCTION/BACKGROUND In adults with a suspicion of peripheral bone infection, evidence-based guidelines in choosing the most accurate diagnostic strategy are lacking.

OBJECTIVE To provide an evidence-based, multidisciplinary consensus document on the diagnostic management of adult patients with PBIs, we performed a systematic review of relevant infectious, microbiological, orthopedic, radiological, and nuclear medicine literature. Delegates from four European societies (European Bone and Joint Infection Society, European Society of Microbiology and Infectious Diseases, Euro-

48 ABSTRACTBOEK | 2019

pean Society or Radiology, and European Association of Nuclear Medicine) defined clinical questions to be addressed, thoroughly reviewed the literature pertinent to each of the questions, and thereby evaluated the diagnostic accuracy of each diagnostic technique. Inclusion of the papers per statement was based on a PICO (Population/problem - Intervention/indicator - Comparator - Outcome) question following the strategy reported by the Oxford Centre for Evidence-based Medicine. For each statement, the level of evidence was graded according to the 2011 review of the Oxford Centre for Evidence-based Medicine. All approved statements were addressed taking into consideration the available diagnostic procedures, patient acceptance, tolerability, complications, and costs in Europe. Finally, a commonly agreed-upon diagnostic flowchart was developed.

ABSTRACT 25 Voriconazole-induced periostitis after allogeneic stem cell transplantation. Haemels M, Pans S, Gheysens O, et al. Clinical Nuclear Medicine, 2019, 44(2), 159-160

INTRODUCTION/BACKGROUND A 34-year-old man with history of Hodgkin lymphoma presented 7 months after allogeneic stem cell transplantation with an unexplained severe musculoskeletal pain syndrome. A Tc-MDP bone SPECTCT showed multiple foci with moderate to intense bone uptake across the axial and appendicular skeleton consistent with periostitis. The patient had been on voriconazole daily for 4 months to treat an Aspergillus pneumonia, and in the absence of other causes, a drug-induced periostitis was suspected. Voriconazole was changed to posaconazole with complete resolution of the musculoskeletal symptoms within 3 weeks.

CENTRUM

ONCOLOGIE ARTIKELS ABSTRACT 1 Quality of blood samples collected at home does not affect clinical decision making for the administration of systemic cancer treatment. Cool L, Callewaert N, Van Eygen K, Tack L, Missiaen J, Debruyne P, et al. Scandinavian Journal of Clinical and Laboratory Investigation, 2020, 80(3), 215-221

CONCLUSION The results of this local survey study demonstrated there is support among different stakeholder groups for the implementation of OHH within the Belgian health-care context. However, some barriers impeding transmural continuous care should be tackled before implementing such model into practice. Better communication between health-care professionals and more patients contacts are suggested, and an adjusted legal and financial framework is required.

ABSTRACT 3 Het abstract is te vinden op pagina 21.

An observational pilot study to evaluate the feasibility and quality of oncological home-hospitalization.

ABSTRACT 2

Cool L, Debruyne P, Van Eygen K, De Jonghe PJ, Vergauwe P, et al. European Journal of Oncology Nursing, 2019, 40, 44-52

Shifting specialized oncological care from hospitalto home-setting: Is there support among patients, specialists and general practitioners?

OBJECTIVE Cool L, Missiaen J, Debruyne P, Van Eygen K, Tack L, et al. Acta Clinica Belgica, 2019, 4, 1-8

OBJECTIVE Oncological home-hospitalization (OHH) might be a patient-centred approach to deal with the increasing burden of cancer on health-care facilities and finances. Before implementation into practice, its feasibility, costs and support among stakeholders should be evaluated. The purpose of this trial was to explore patients', specialists' and general practitioners' (GPs) perspectives towards the opportunities of implementing OHH within the Belgian health-care system.

MATERIALS/METHODS A regional cross-sectional survey study was launched in order to investigate the stakeholders' views on OHH and the current cancer care focusing on integration of primary care and continuous care.

RESULTS Of the responders, 37 out of 163 patients (23%), 45 of 62 GPs (73%) and 10 of 15 specialists (67%) feel positive about the opportunities for OHH. Nevertheless, 11/15 specialists (73%) and 51/62 GPs (82%) feel primary care might currently be (too) little involved in order to ensure continuous care for cancer patients. Opportunities for improved continuous care are seen in better communication between primary care and hospital, and more patient contacts for primary care during the cancer treatment process.

The objective of this pilot study was to evaluate the feasibility of oncological home-hospitalization and to compare its quality with standard ambulatory hospital care in terms of patient-reported quality of life and related endpoints by means of a set of validated patient-reported outcome measures (PROMs).

MATERIALS/METHODS An observational cohort study was conducted, allocating patients to (partial) home-hospitalization or standard ambulatory hospital care. PROMs were completed by both cohorts at start of treatment and eight weeks later. An additional study-specific questionnaire was presented to the intervention cohort at study-end assessing their satisfaction with and preferences for the provided homecare.

RESULTS Thirty patients received home-hospitalization, corresponding to 116 interventions. For twenty-eight patients, this comprised all assessments required prior to administration of treatment, which resulted in a significant reduction of waiting time for treatment administration at the hospital in comparison with the control cohort (n = 24) (average reduction of 1:12 h, p < 0.001). Two patients received actual subcutaneous therapy at home. None of the PROM's evaluated revealed significant differences between both cohorts (all p > 0.05). 29/30 patients of the intervention cohort were satisfied with the provided homecare and preferred to have it continued, 22/25 patients declared to feel at home at least as safe as in the hospital. No serious safety concerns were reported.

ONCOLOGIE

CONCLUSION The results of this pilot study suggest that (partial) oncological home-hospitalization is feasible, safe and statistically not affecting patient-reported quality of life. Furthermore, this care model was acceptable and preferred by a substantial number of cancer patients.

ABSTRACT 4 Underrepresentation of vulnerable older patients with cancer in phase II and III oncology registration trials: A case-control study. Tack L, Debruyne P, Ketelaars L, De Zutter J, Martens E, Stellamans K, Van Eygen K, Werbrouck P, Vergauwe P, et al. Journal of Geriatric Oncology, 2020, 11(2), 320-326

OBJECTIVE We aimed to determine the proportion of “fit” versus “vulnerable” older patients with cancer included in phase II and III oncology registration trials, as compared to the proportions in a real life oncology setting.

clinical trials to enable stratification according to this parameter and allow subgroup analysis. This will broaden the application and interpretation of trial results.

ABSTRACT 5 Effectiveness of adjunctive analgesics in head and neck cancer patients receiving curative (chemo-) radiotherapy: a systematic review. Lefebvre T, Tack L, Debruyne P, Cool L, Goethals L, Van Eygen K, et al. Pain Medicine, 2020, Epub ahead of print, DOI: 10.1093/ pm/pnaa044

INTRODUCTION/BACKGROUND This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched for studies concerning “head neck cancer,” “adjunctive analgesics,” “pain,” and “radiotherapy.”

OBJECTIVE MATERIALS/METHODS Trial and patient characteristics of older (≥70 years) patients treated at the OECI-designated clinical cancer centre in Kortrijk and included in a phase II or III oncology registration trial were collected retrospectively. These patients were matched individually with randomly-selected patients from the general oncology setting, based on gender, age, tumour type, tumour stage, and treatment intent. Patients' fitness, based on routine Geriatric-8 (G8) screening, was retrieved from prospectively constructed databases.

RESULTS Between November 2012 and October 2018, 218 older patients with cancer were included in a phase II or III oncology registration trial. Of those, 41 cases with a mean age of 76.0 years were included in the analyses. A Fisher's Exact Test revealed a statistical significant difference between cases and matched controls, with a higher proportion of “fit” patients included in phase II or III oncology registration trials compared to the proportion in the matched control group (respectively 70.7% and 41.5%, p < .010).

CONCLUSION We provide evidence for the hypothesis that older patients included in phase II or III oncology trials are significantly fitter than the real life oncology population. Some form of geriatric evaluation should be integrated in future cancer

50 ABSTRACTBOEK | 2019

Our aim was to give an overview of the effectiveness of adjunctive analgesics in head and neck cancer (HNC) patients receiving (chemo-) radiotherapy.

MATERIALS/METHODS Outcome Measures: Pain outcome, adverse events, and toxicity and other reported outcomes, for example, mucositis, quality of life, depression, etc.

RESULTS Nine studies were included in our synthesis. Most studies were of low quality and had a high risk of bias on several domains of the Cochrane Collaboration tool. Only two studies comprised high-quality randomized controlled trials in which pregabalin and a doxepin rinse showed their effectiveness for the treatment of neuropathic pain and pain from oral mucositis, respectively, in HNC patients receiving (chemo-) radiotherapy.

CONCLUSION More high-quality trials are necessary to provide clear evidence on the effectiveness of adjunctive analgesics in the treatment of HNC (chemo-) radiation-induced pain.

ABSTRACT 6

ABSTRACT 7

The prognostic value of patient-reported health-related quality of life and geriatric assessment in predicting early death in 6769 older (≥ 70 years) patients with different cancer tumors.

Health related quality of life in older patients with solid tumors and prognostic factors for decline.

Quinten C, Kenis C, Debruyne P, et al. Journal of Geriatric Oncology, 2020, Epub ahead of print, DOI: 10.1016/j.jgo.2020.03.017

OBJECTIVE We aimed to determine the prognostic value of baseline Health-Related Quality Of Life (HRQOL) and geriatric assessment (GA) to predict three-month mortality in older patients with cancer undergoing treatment.

MATERIALS/METHODS Logistic regressions analysed HRQOL, as measured with the EORTC Global Health Status (GHS) scale, and geriatric information prognostic for early mortality controlling for oncology variables. The assessment was established with the odds ratio (OR), 95% confidence interval (CI) and level of significance set at p < 0.05. Discriminative power was evaluated with area under the curve (AUC).

RESULTS In total, 6769 patients were included in the study, of whom 1259 (18.60%) died at three months. Our model showed higher odds of early death for patients with lower HRQOL (GHS, OR 0.98, 95% CI 0.98–0.99; p < 0.001), a geriatric risk profile (G8 Screening Tool, 1.94, 1.14–3.29; p = 0.014), cognitive decline (Mini Mental State Examination, 1.41, 1.15–1.72; p = 0.001), being at risk for malnutrition (Mini Nutritional Assessment–Short Form, 1.54, 1.21–1.98; p = 0.001), fatigue (Visual Analogue Scale for Fatigue, 1.45, 1.16–1.82; p = 0.012) and comorbidities (Charlson Comorbidity index, 1.23, 1.02–1.49; p = 0.033). Additionally, older age, poor ECOG PS and being male increased the odds of early death, although the magnitude differed depending on tumor site and stage, and treatment (all p < 0.05). Predictive accuracy increased with 3.7% when including HRQOL and GA in the model.

CONCLUSION The results suggest that, in addition to traditional clinical measures, HRQOL and GA provide additional prognostic information for early death, but the odds differ by patient and tumor characteristics.

Decoster L, Quinten C, Debruyne P, et al. Journal of Geriatric Oncology, 2019, 10(6), 895-903

OBJECTIVE This study aims to investigate health-related quality of life (HRQOL) at baseline and at follow-up in older patients with cancer and to determine prognostic factors for HRQOL decline.

MATERIALS/METHODS A prospective Belgian multicentre ( n = 22) study was performed. Patients ≥70 years with a malignant tumor and abnormal G8 (≤14/17) screening tool were included. Patients underwent geriatric assessment (GA) and HRQOL evaluation with follow up at three months. Uni- and multivariate regression models were performed to determine factors associated ( p < .05) with baseline HRQOL and HRQOL decline at follow-up.

RESULTS Results reflect data collected from 3673 patients. A multivariate analysis showed that younger patients, and those with poor Eastern Cooperative Oncology Group – Performance Status (ECOG-PS), specific tumor types (gastrointestinal, gynaecological and thorax) and higher stage had lower baseline HRQOL. In addition worse functional status and presence of pain, fatigue, depression and malnutrition were associated with lower baseline HRQOL. During treatment ( n = 2972), improvement in HRQOL was observed in 1037 patients (35%) and a decline in 838 patients (28.2%). In multivariate analysis, stage and presence of baseline comorbidities, pain, fatigue or malnutrition were associated with HRQOL evolution.

CONCLUSION Baseline HRQOL in older patients with cancer and an abnormal G8 depends on tumor and age related parameters. During follow-up, HRQOL improved in one third of patients, indicating that they may benefit from cancer treatment while one quarter demonstrated a HRQOL decline for which prognostic factors were identified.

ONCOLOGIE

ABSTRACT 8

OBJECTIVE

Detection of alcohol abuse in older patients with cancer: the integration of alcohol screening questionnaires in the comprehensive geriatic assessment (CGA).

Cognitive complaints, of objective or subjective nature, may negatively impact cancer patients' quality of life (QoL). Further, the early detection of cognitive alterations may lead to an improved QoL. However, the content of such screening is yet unclear. This paper presents long-term QoL data of cancer patients treated with curative intent and its relation with objective and subjective cognitive complaints, and patient-reported outcome measures (PROMs).

Martens E, Ketelaars L, Debruyne P, Van Eygen K, Cool L, De zutter J, et al. Journal of Geriatric Oncology, 2019, 10(5), 819-823

OBJECTIVE We aimed to evaluate the feasibility of implementing an alcohol screening questionnaire as part of the comprehensive geriatric assessment (CGA) by reporting the prevalence of alcohol abuse in a group of older patients with cancer in a Belgian cancer centre.

MATERIALS/METHODS QoL data, measured by the EORTC QLQ C-30, were obtained at baseline, 6 (T1), 12 (T2), and 24 months (T3) after treatment start, and compared between patients with and without objective and subjective cognitive complaints. The predictive value of PROMs was also examined.

MATERIALS/METHODS Patients were recruited at the Geriatric Oncology Clinic of the Kortrijk Cancer Centre and were evaluated by use of a CGA. Two alcohol screening questionnaires were integrated into the CGA: the Cutdown-Annoyed-Guilty-Eye-opener (CAGE) questionnaire and the Alcohol Use Disorders Identification Test-screening version (AUDIT-C).

RESULTS 193 patients with a mean age of 77.7 years were included in the analyses. Abnormal scores on the CAGE were detected in 6.3% of males and 1.2% of women. Abnormal results on the AUDIT-C were noticed in 30.0% of men, and in 21.7% of women. A regression analysis could not find a significant effect of the CAGE questionnaire when entered as predictor for CGA domain scores. Regarding the AUDIT-C, significant results were detected for predicting the score of the Geriatric-8 questionnaire and polypharmacy in men, and the Independent Activities of Daily Living questionnaire in women. No association with one-year survival was detected for either alcohol screening questionnaire.

RESULTS QoL data at baseline was collected in 125 patients. Response rates at T1, T2, and T3 were 84.7%, 81.5%, and 83.1%, respectively. Eighty-nine patients returned their QoL questionnaires at all times. Baseline subjective cognitive complaints had a stronger association with worse scores on patients' overall QoL and QoL subscale scores than objective cognitive complaints. An exploratory analysis into the value of PROMs in predicting long-term QoL at T3 revealed a significant effect for the Hospital Anxiety and Depression Scale-Depression and FACIT Fatigue scale.

CONCLUSION Self-perceived cognitive alterations are negatively associated with patients' overall QoL. As these troubles may already be present at baseline, oncology nurses should screen for the early signs of subjective cognitive complaints by use of PROMs, in order to refer the patient to proper intervention programs which may lead to an improved long-term QoL and faster reintegration into society.

CONCLUSION It is feasible to implement an alcohol screening questionnaire as part of a CGA as results indicated a rather high level of alcohol abuse in this cohort.

ABSTRACT 10 The added value of an assessment of the patient’s hand grip strength to the comprehensive geriatric assessment in G8-abnormal older patients with cancer in routine practice.

ABSTRACT 9 Subjective, but not objective, cognitive complaints impact long-term quality of life in cancer patients. Debruyne P, Ketelaars L, Stellamans K, Van Eygen K, Vergauwe P, Werbrouk P, Cool L, Liefhooghe N, et al. Journal of Pyschosocial Oncology, 2019, 37(4), 427-440

ABSTRACTBOEK | 2019

Ketelaars L, Martens E, Debruyne P, Van Eygen K, Cool L, et al. Journal of Geriatric Oncology, 2019, 10(6), 931-936

OBJECTIVE A comprehensive geriatric assessment (CGA) is the key

treatment approach to guide decisions in older patients with cancer. In this paper, the added value of an assessment of the patient's hand grip strength to predict survival in patients with an abnormal G8-questionnaire (G8) score is investigated.

MATERIALS/METHODS Patients were screened by the G8, followed by a CGA in case of an abnormal screening (≤14.0). Hand grip strength was assessed by use of the JAMAR® hydraulic hand dynamometer. Cut-offs were applied according to the Fried frailty criteria. The survival rate was calculated twelve months after the CGA date.

treatment. Simultaneously, we assessed baseline patient characteristics prognostic for HRQOL changes.

MATERIALS/METHODS Our analysis included 1424 (G8 ≤ 14) older patients with cancer scheduled to receive chemotherapy (n = 683) or surgery (n = 741). Anchor-based methods, linking the GHS score to clinical indicators, were used to determine MCID between baseline and follow-up at 3 months. A threshold of 0.2 standard deviation (SD) was used to exclude MCID estimates too small for interpretation. Logistic regressions analysed baseline patient characteristics prognostic for HRQOL changes.

RESULTS

We retrospectively reviewed data of 2071 patients who were treated at the Kortrijk Geriatric Oncology Clinic (General Hospital Groeninge, Belgium) between November 2012 and December 2016. Of those, 944 patients with a mean age of 79.6 years were included in the analyses. 64.2% of patients presented an abnormal hand grip strength score. A log rank test revealed a statistical significant result between patients when accounting for the hand grip strength score (p < .01). When added to a Cox regression model, a significant result was found (p < .01). However, this added only 0.4% to the explained variance of the model.

The 15-item Geriatric Depression Scale (GDS15), Visual Analogue Scale (VAS) for Fatigue and ECOG Performance Status (PS) were selected as clinical anchors. In the surgery group, MCID estimates for improvement and deterioration were ECOG PS (5*, 11*), GDS15 (5*, 2) and VAS Fatigue (3, 9*). In the chemotherapy group, MCID estimates for improvement and deterioration were ECOG PS (8*, 7*), GDS15 (5, 4) and VAS Fatigue (5, 5*). Estimates with * were > 0.2 SD threshold. Patients experiencing pain or malnutrition (surgery group) or fatigue (chemotherapy group) at baseline showed a significantly stable or improved HRQOL (p < 0.05) after their treatment.

CONCLUSION While a statistically significant result was detected, when adding the hand grip strength score to a regression model for survival, our data indicate that such assessment may clinically be less relevant when included in an already extensive test battery and may therefore provide only limited information in terms of patient survival.

CONCLUSION The reported MCID for improvement and deterioration depended on the anchor used and treatment received. The estimates can be used to evaluate significant changes in HRQOL and to determine sample sizes in clinical trials.

ABSTRACT 12 ABSTRACT 11 Determining clinically important differences in healthrelated quality of life in older patients with cancer undergoing chemotherapy or surgery. Quinten C, Kenis C, Debruyne P, et al. Quality of Life Research, 2019, 28(3), 663–676

INTRODUCTION/BACKGROUND Using the EORTC Global Health Status (GHS) scale, we aimed to determine minimal clinically important differences (MCID) in health-related quality of life (HRQOL) changes for older cancer patients with a geriatric risk profile, as defined by the geriatric 8 (G8) health screening tool, undergoing

The financial impact of SBRT for oligometastatic disease: A population-level analysis in Belgium. Nevens D, Lievens Y, Kindts I, et al. Radiotherapy and Oncology, 2020, 145, 215-222

INTRODUCTION/BACKGROUND There is a steady rise in Stereotactic Body RadioTherapy (SBRT) utilization in oligometastatic disease (OMD). This may generate important financial consequences for radiotherapy budgets. The National Institute for Health and Disability Insurance of Belgium (NIHDI) initiated a coverage with evidence development (CED) project for innovative radiotherapy, including SBRT, in 2011. A cost calculation

ONCOLOGIE

and budget estimation for SBRT in the OMD setting was carried out.

MATERIALS/METHODS Predictive growth scenarios for future uptake of SBRT for OMD in Belgium were developed using demographics and CED data. The provider cost of SBRT for OMD in Belgium was calculated using the Time-Driven Activity-Based Costing (TD-ABC) model developed by ESTRO-HERO, alimented with national data on resources, treatments and operational parameters, and compared to the new reimbursement. Combining these, the future financial impact of this novel treatment indication for healthcare providers and payers in Belgium was evaluated.

Current international guidelines state that PMRT is recommended for high-risk patients only. However, more recent studies suggest we should also consider PMRT in intermediate-risk patients with 1 to 3 positive axillary lymph nodes. In this respect, Cheng et al. developed and validated a prognostic scoring system based on 4 prognostic factors for locoregional recurrence (LRR) to identify patients most in need for PMRT. These factors include age, estrogen receptor status, lymphovascular status and number of affected axillary lymph nodes. The purpose of this retrospective study is to validate the prognostic scoring system for LRR in BC developed by Cheng et al. By using an independent BC database.

MATERIALS/METHODS RESULTS The number of 428 OMDs treated with SBRT in Belgium in 2017 is expected to increase between 484 and 2073 courses annually by 2025. A provider cost of €4360 per SBRT was calculated (range: €3488–€5654), whereas the reimbursement covers between €4139 and €4654. Large variations in potential extra provider costs by 2025 ensue from the different scenarios, ranging between €1,765,993 and €9,038,754. Provider costs and reimbursement show good agreement.

CONCLUSION Although the financial impact of SBRT for OMD in Belgium is forecasted to remain acceptable, even in extreme scenarios, further clinical trials and real-life clinical and financial monitoring with prospective data gathering are necessary to refine the data.

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Validation of a prognostic scoring system for postmastectomy locoregional recurrence in breast cancer. American Society for Radiation Oncology (ASTRO) Van der Vorst A, Kindts I, Laenen A, Janssens H, et al. September 2019, Chicago – USA

INTRODUCTION/BACKGROUND To date, it remains unclear which breast cancer (BC) patients benefit from post-mastectomy radiotherapy (PMRT).

54 ABSTRACTBOEK | 2019

We included 1586 BC cases treated with mastectomy from 2000 until 2007. Equivalent to the validation of Cheng et al., patients were classified conform the LRR scoring system and the influence of PMRT on the 5-year locoregional control (LRC) rate was determined by subgroup analysis.

RESULTS Median follow-up time was 11.4 years. After excluding patients with missing variables, 1103 patients remained eligible for classification according to the LRR scoring system. 688 (62.38%) patients were at low risk of recurrence (LRR score 0-1), 335 (30.37%) patients were at intermediate risk of recurrence (LRR score 2-3) and 80 (7.25%) patients were at high risk of recurrence (LRR score ≥ 4). 5-year LRC rates with and without PMRT were 99.20% versus 99.21% (p=0.43) in the low-risk group; 98.24% versus 85.74% (p<0.0001) in the intermediate-risk group and 96.87% versus 85.71% (p=0.10) in the high-risk group respectively.

CONCLUSION Our validation of the LRR scoring system by Cheng et al. suggests it can be used to point out patients that would benefit from PMRT. We recommend further validation of this scoring system by other independent institutions before application in clinical practice.

CENTRUM

ORTHOPEDIE

ARTIKELS

tunnel when reconstructing the ATFL and CFL.

ABSTRACT 1

ABSTRACT 2

An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL.

Does subtalar instability really exist? A systematic review.

5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrackech, Morocco

Michels F, Van Der Bauwhede J, Stockmans F, et al. Foot Ankle Surgery, 2020, 26(2), 119-127

INTRODUCTION/BACKGROUND A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).

OBJECTIVE The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm diameter tunnel and surrounding bone.

MATERIALS/METHODS Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30, 45, 60 and 90 degrees in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface.

RESULTS A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30 degrees offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region.

CONCLUSION An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend to drill an oblique fibular

INTRODUCTION/BACKGROUND Subtalar joint instability (STI) is considered as a potential source of chronic lateral hindfoot instability. However, clinical diagnosis of STI is still challenging.

OBJECTIVE This systematic review was conducted to assess the consistency of the clinical entity "subtalar instability", to investigate the reliability of available diagnostic tools and to provide a critical overview of related studies.

MATERIALS/METHODS A systematic review of the Medline, Web of Sciences and EMBASE databases was performed for studies reporting on tests to investigate subtalar instability or lesions of the subtalar ligaments. To investigate the relation with chronic STI, studies focusing on sinus tarsi syndrome (STS) or acute lesions of the subtalar ligaments were also included in the search strategy and were assessed separately.

RESULTS This review identified 25 studies focusing on different topics: chronic STI (16), acute lesions of the subtalar ligaments (5) and STS (4). Twelve studies, assessing STI, demonstrated the existence of a subgroup with instability complaints related to abnormal increased subtalar motion (7) or abnormalities of the subtalar ligaments (6). We found insufficient evidence for measuring subtalar tilting using stress radiographs. MRI was able to assess abnormalities of the ligaments and stress-MRI detected abnormally increased motion.

CONCLUSION Complaints of instability can be related to subtalar ligaments injuries and an abnormally increased motion of the subtalar joint. Stress radiographs should be interpreted with caution and should not have the status of a reference test. Clinical diagnosis should rely on several parameters including MRI.

ORTHOPEDIE

ABSTRACT 3

ABSTRACT 4

Endoscopic anatomic ligament reconstruction is a reliable option to treat chronic lateral ankle instability.

The intrinsic subtalar ligaments have a consistent presence, location and morphology.

Cordier G, Ovigue J, Michels F, et al. Knee Surgery, Sports Traumatology, Arthroscopy, 2020, 28(1), 86-92

Michels F, Vanrietvelde F, Stockmans F, et al. Foot Ankle Surgery, 2020, Epub ahead of print, DOI: 10.1016/j.fas.2020.03.002

INTRODUCTION/BACKGROUND

Anatomic reconstruction of the anterior talofibular ligament and calcaneofibular ligament is a valid treatment of chronic hindfoot instability.

Chronic subtalar instability is a disabling complication after acute ankle sprains. Currently, the literature describing the anatomy of the intrinsic subtalar ligaments is limited and equivocal which causes difficulties in diagnosis and treatment of subtalar instability.

OBJECTIVE The purpose of this study was to investigate the outcomes of this procedure performed by an all-inside endoscopic technique.

MATERIALS/METHODS This study is a retrospective evaluation of a prospective database. Subjects were all patients who underwent an endoscopic lateral ligament reconstruction between 2013 and 2016. All patients had symptoms of ankle instability with positive manual stress testing and failed nonoperative treatment during at least 6 months. At final follow-up the outcome was assessed using the visual analogue score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Karlsson-Peterson scores.

RESULTS After an average follow-up of 31.5 ± 6.9 months, all patients reported significant improvement compared to their preoperative status. The preoperative AOFAS score improved from 76.4 ± 15 to 94.7 ± 11.7 postoperatively (p = 0.0001). The preoperative Karlsson-Peterson score increased from 73.0 ± 16.0 to 93.7 ± 10.6 postoperatively (p = 0.0001). The VAS score improved from 1.9 ± 2.5 to 0.8 ± 1.7 (p < 0.001). Two patients had complaints of recurrent instability.

CONCLUSION Endoscopic ligament reconstruction for chronic lateral ankle instability is a safe procedure and produces good clinical results with minimal complications. In addition, the endoscopic approach allows an assessment of the ankle joint and treatment of associated intra-articular lesions.

ABSTRACTBOEK | 2019

OBJECTIVE The purpose of this study is to assess the anatomical characteristics of the subtalar ligaments and to clarify some points of confusion.

MATERIALS/METHODS In 16 cadaveric feet, the dimensions and locations of the subtalar ankle ligaments were assessed and measured. CT-scans before dissection and after indication of the footprints with radio-opaque paint allowed to generate 3D models and assess the footprint characteristics.

RESULTS The cervical ligament (CL) had similar dimensions as the lateral ligaments: anterior length 13.9 ± 1.5 mm, posterior length 18.5 ± 2.9 mm, talar width 13.6 ± 2.2 mm, calcaneal width 15.8 ± 3.7 mm. The anterior capsular ligament (ACaL) and interosseous talocalcaneal ligament (ITCL) were found to be smaller structures with consistent dimensions and locations.

CONCLUSION This study identified consistent characteristics of the intrinsic subtalar ligaments and clarifies the local anatomical situation. The dimensions and footprints of the intrinsic ligaments of the subtalar joint suggest a more important role of the CL and ACaL in the stability of the subtalar joint. The results of this study are relevant to improve diagnostic tools and offer some guidelines when reconstructing the injured ligaments.

ORTHOPEDIE

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Cone-beam CT as a fast and promising technique to assess the microstructure of distal radii in clinical practice. 25th Congress of the European Society of Biomechanics Mys K, Stockmans F, Vanovermeire O, et al. June 2019, Vienna, Austria Er is geen abstract beschikbaar.

ABSTRACT 2 The anterior tibiotalar fat pad as a source of pain and inflammation in osteoarthritis of the ankle: anatomy, histology and imaging. Osteoarthritis Research Society International (OARSI) Clockaerts S April 2019, Liverpool, United Kingdom

INTRODUCTION/BACKGROUND To gain a better insight in the pathophysiology of ankle osteoarthritis (OA), a pathology which is underrepresented in current and past research. The most important etiological factor in ankle OA is trauma (70-80% of cases), which can result in direct joint damage, malalignment, incongruency or instability. Despite successful conservative treatment or surgical intervention, many cases of ankle trauma evolve towards OA. Posttraumatic inflammation is hypothesized to be an important initiator of posttraumatic ankle OA. Pro-inflammatory mediators in the synovial fluid are elevated after injury, which may increase the imbalance between cartilage destruction and repair. In the knee, the infrapatellar fat pad is identified as an important source of inflammatory mediators. To date, the role of fatty tissues in the ankle joint has not been defined, although arthroscopic findings indicate the presence of adipose tissue anterior to the ankle joint.

MATERIALS/METHODS Three Tesla MRI scans (T1 and T2 sequences) were performed on 3 cadaveric human feet, which were obtained from the human body donation of the university. The anterior compartment of the ankle joint was dissected and the exact location of the anterior adipose tissue was doc-

umented. Histological analyses of the dissected fat pad were performed with hematoxyline eosine staining and immunohistochemistry for the inflammatory marker CD45 (leucocytes). The obtained histological sections were used to confirm structures seen during dissection and on MRI. To investigate the presence of inflammation in the anterior tibiotalar fat pad (ATTFP) of ankle joints, 30 ankle MRI scans of patients with chronic pain after trauma, OA, bone marrow oedema, persistent Achilles tendinopathy or fasciitis plantaris were scored for the presence of ankle pathology (including bone marrow oedema, effusion, synovitis, cartilage lesions, osteophytes, loose bodies). The presence of signal alteration in the adipose tissue on sagittal T2 sequences was scored as the number of slices showing signal alteration. Based on these scores, we categorized ankle pathology and signal alteration into: 0=no pathology, 1-2=mild, 3-5=moderate, >5=severe. Statistical analysis was performed with a Kruskal-Wallis test.

RESULTS We found adipose tissue to be present posterior to the extensor tendon sheaths, at the level of the ankle joint. It attaches to the periosteum of the tibia, 1 cm proximally to the joint line. It is mediolaterally delimited by the deltoid ligament and the anterior talofibular ligament. Anteromedially, it reaches as far as the neck of the talus. We defined it as the anterior tibiotalar fat pad (ATTFP). There is no joint capsule between the adipose tissue and the joint as determined macroscopically and microscopically. CD45+ cells were found in the ATTFP of cadaveric feet. On MRI, higher signal alterations were mainly present in the ATTFP in ankles with radiological presence of joint pathology, in particular in more severe cases (p=0.01).

CONCLUSION These results indicate that the ATTFP can be considered an active joint tissue in the ankle. The ATTFP should be investigated as a source of inflammation and pain.

ABSTRACT 3 Histologic characteristics of the arciform fibers (poster). 5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F, Batista J, Quintero D, et al. March 2019, Marrakech, Morocco

INTRODUCTION/BACKGROUND The arciform fibers are an expansion of the regular, colla-

ORTHOPEDIE

genous and elastic dense connecting tissue, in the shape of a triangle or a semicircle, and an anteroinferior base, that connects the inferior band of the anterior talofibular ligament, and the calcaneofibular ligament, in a constant manner. These fibers play a critical role within the ankleâ&#x20AC;&#x2122;s lateral ligament complex.

for anatomical landmarks and guidelines.

OBJECTIVE The purpose of this study was to determine some guidelines for tunnel positioning based on external palpable anatomical landmarks.

OBJECTIVE

MATERIALS/METHODS

The purpose of this study was to perform a study of the macroscopic and microscopic morphology of these arciform fibers.

In ten lower leg cadaveric specimens a lateral and a medial procedure were performed. On the lateral side, a pin was drilled on the intersection of 2 lines based on external landmarks. The first line was parallel with the fibula passing through the posterior point of the lateral malleolus. The second line was placed at an angle of 45 degrees to the first one and passed through anteroinferior border of the fibula. During this procedure also a second pin was drilled(blinded to the earlier marked landmarks and pin) to assess the interobserver reliability. Dissection allowed to measure the distance to the anatomical foot print. The medial side was divided in four quadrants based on the upper posterior edge and the lower anterior edge of the tuber calcaneal tuberosity. Anatomical dissection was performed to assess the position of the neurovascular structures relative to the four quadrants.

MATERIALS/METHODS Ten lower leg cadaveric specimens were included in this study: 5 men, 5 women. Four specimens were fresh frozen, 6 embalmed. Anatomical dissection was performed to assess the presence of these arcuate fibers. After preparation, different histologic colourings were performed: Hematoxilin-eosin and Massonâ&#x20AC;&#x2122;s Trichrome.

RESULTS These are arciform fibers were present in all specimens. The histologic structure of these fibers was similar to the ligamentous structures, with an abundance of collagenous fibers, low adipose cell content, plus high vascular content.

RESULTS CONCLUSION The arciform fibers have all characteristics of ligament tissue. This suggests an important mechanical function in the stability of the ankle.

ABSTRACT 4 How to drill the calcaneal tunnel in calcaneofibular ligament reconstruction? 5th International Congress of Foot & Ankle Minimally Invasive Surgery. Michels F, Wastyn H, Stockmans F, et al. March 2019, Marrakech, Morocco

INTRODUCTION/BACKGROUND Anatomical ankle ligament reconstruction has become a common procedure to treat chronic ankle instability. When performing an anatomical reconstruction of the calcaneofibular ligament(CFL), a graft is often fixed in bone tunnels. On the lateral side, the entrance should be at the normal anatomical insertion point. On the medial side, an transosseous bone tunnel should avoid the neurovascular bundle. The advent of new endoscopic and percutaneous techniques to perform this procedure increases the need

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On the lateral side, the mean distance to the centre of the CFL footprint was 1.7 mm (0-11mm). The mean distance between both observers was 3.17 mm. The mean distance to the sural nerve was 1.7 mm. The mean distance to the peroneal tendons was 7.1 mm. On the medial side, a safe zone without important neurovascular structures was found and corresponded to the lower inner quadrant. The upper inner quadrant always contained the neurovascular bundle and thus should be avoided. In the upper outer and lower outer quadrants, sensory branches of the tibial nerve were found in a minority of the specimens.

CONCLUSION The described guidelines are useful when reconstructing the CFL using a less invasive technique. Lateral landmarks allowed to locate the CFL footprint. A medial safe zone could be determined to guide tunnel direction.

ABSTRACT 5

ABSTRACT 6

Distal metatarsal mini-invasive osteotomy (DMMO): a cadaveric study.

Percutaneous treatment of a posterolateral calcaneal bump (Poster).

5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F, Clockaerts S, Stockmans F, et al. March 2019, Marrakech, Morocco

5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrakech, Morocco

INTRODUCTION/BACKGROUND

The distal metatarsal metaphyseal osteotomy (DMMO) is an extraarticular osteotomy performed using minimally invasive technique which may be a viable alternative to the weil osteotomy in treating metatarsalgia operatively.

Surgical treatment of exostoses of the heel is usually performed with open or endoscopic techniques. Endoscopic technique are valuable in case of a central prominence without damage of the achilles tendon. Open resection of the exostosis is related to wound healing problems and a longer rehabilitation period. Often the location of hyper pressure is limited to the lateral aspect of the heel.

OBJECTIVE The purpose of this study was to evaluate a percutaneous technique to perform an osteotomy of the central metatarsals.

MATERIALS/METHODS Ten lower extremity cadaveric specimens were used. An osteotomy of the second, third and fourth metatarsal was performed using a standardised technique. The technique was performed by a trained foot and ankle surgeon with experience in percutaneous foot surgery. The specimens were dissected to expose the local neurovascular structures. The specimens were assessed for macroscopic lesions of the digital nerves, the arteries and veins. In addition, the aspect of the osteotomy was assessed for completeness and orientation.

RESULTS In total 30 osteotomies were performed. The plantar and dorsal interdigital nerves were intact in all specimens. Digital arteries were exposed but no injuries were found. In 2 of the 10 specimens an injury of the dorsal veins were found. All osteotomies were complete and located in the metaphyseal area. The measured angle between the plane of the osteotomy and the metatarsal varied from 40 to 60 degrees.

CONCLUSION The described technique, which involves a percutaneous osteotomy of the central metatarsals is reproducible. The risk to macroscopic damage of the local neurovascular structures is low.

OBJECTIVE The purpose of this study was to evaluate a percutaneous technique to perform a resection of a bump located on the posterolateral side of the calcaneum.

MATERIALS/METHODS Five patients with a bump located on the posterolateral side of the calcaneum were included in this study. All patients were resistant to non-surgical treatment(at least 6 months) which included shoe modification, orthosis, physiotherapy, and anti-inflammatory drugs. Pain was limited to the posterolateral border of the calcaneum without any signs of retrocalcaneal bursitis or achilles tendinopathy. The surgical management consisted of a percutaneous removal of the posterolateral bony ridge of the calcaneus. Using a Beaver blead and a periosteal elevator a working area was created. With burr (Wedge burr 3.1 x 13 mm) the bone of ridge was removed and washed out. The procedure was continued until a smooth surface is obtained.

RESULTS We treated 3 women and 2 men with an average age of 26. Surgery was performed between September 2014 and October 2017. All patients were followed up from 12 to 49 months (mean: 26 months). All surgery was performed in one day clinic under locoregional anaesthesia. Two days of rest and elevation was recommended. Normal walking was possible after 4 days. Local swelling continued until 5 weeks. No wound problems or other complications occurred. At final follow up all patients were without any complaints.

ORTHOPEDIE

CONCLUSION

ABSTRACT 11

Percutaneous resection of a posterolateral exostosis of the heel can be considered in patients with resisting pain limited to the posterolateral side of the heel.

How to optimize the fibular tunnel trajectory in a combined ATFL and CFL reconstruction.

ABSTRACT 7 Current concepts in the pathogenesis and diagnosis of subtalar instability.

5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F, Matricali G, Stockmans F March 2019, Marrakech, Morocco Er is geen abstract beschikbaar.

5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrakech, Morocco Er is geen abstract beschikbaar.

ABSTRACT 8

ABSTRACT 12 Consensus in percutaneous bunionette correction. 5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F, Demeulenaere B March 2019, Marrakech, Morocco

Postoperative treatment of toe deformities.

INTRODUCTION/BACKGROUND 5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrakech, Morocco

The percutaneous treatment of bunionette deformity has been demonstrated as a reliable and satisfying technique with low risk of complications. However, there are some obvious variations in the surgical technique and perioperative protocol.

Er is geen abstract beschikbaar.

OBJECTIVE ABSTRACT 9 Bunionette & quintus varus : results of a survey study. 5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F, Demeulenaere B March 2019, Marrakech, Morocco Er is geen abstract beschikbaar.

The purpose of this study is to analyze the currently used techniques and to look for some agreements. Hypothesis: There are some points of agreement in surgical technique and perioperative protocol when using a percutaneous technique to treat bunionette deformity.

MATERIALS/METHODS A survey was sent to 50 orthopedic surgeons with specific experience in percutaneous techniques. The questions were related to different aspects of the surgical bunionette procedure and the perioperative protocol.

ABSTRACT 10

RESULTS

Ankle instability: repair versus reconstruction.

A response rate of 92.0 % was obtained. Several points of agreement were found. A condylectomy is rarely used while an osteotomy is performed in almost all procedures. This osteotomy is single (95.7%), complete (66.2-72.7%) and performed with a Shannon long burr (73.9%). The location of the osteotomy depends of the deformity (63.0%).

5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrakech, Morocco Er is geen abstract beschikbaar.

CONCLUSION This study demonstrates some consensus in the use of the surgical technique and the peri operative protocol. The per-

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cutaneous oblique osteotomy is the preferred technique while a condylectomy is only rarely used.

ABSTRACT 13 An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL. 5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrackech, Morocco Het abstract is terug te vinden op pagina 55.

ABSTRACT 14 Postoperative treatment of toe deformities. 5th International Congress of Foot & Ankle Minimally Invasive Surgery Michels F March 2019, Marrakech, Morocco

INTRODUCTION/BACKGROUND In percutaneous surgery the bandage techniques are as important as the surgery. We should see them actually as a part of the surgical technique. For this reason, it is important that the surgeon himself(or herself) applies the bandage.

MATERIALS/METHODS There exist different bandage techniques. This allows you to choose the best technique depending of the situation. One should be aware of the preoperative situation and the performed corrections. Often the bandage techniques should be modified to the surgical technique, the deformity and obtained correction. I will present you some commonly used techniques.

RESULTS Elastic tapings using kinesiotape can be very helpful. Because of the stretching capacities they all can put stress on special areas which allows a secondary correction. Often the toes need to be hold in a bended position.

CONCLUSION The surgeon himself/or herself should apply the bandage and be able tot use different techniques. The bandage should be adapted to the corrected deformity.

ORTHOPEDIE

CENTRUM

PATHOLOGISCHE ANATOMIE ARTIKELS ABSTRACT 1 Whipple's disease in a man of North African descent : case report and brief review of the literature. Lenfant M, Callemeyn J, Alaerts H, Van Moerkercke W, et al. Acta Gastro-enterologica Belgica, 2019, Jan-Mar, 82(1), 83-86 Het abstract is terug te vinden op pagina 13.

ABSTRACT 2 Uveitis as a window to diagnosis of sarcoidosis - case report and review of the literature. Dhont S, Leys M, Van Moerkercke W, Alaerts H, et al. Acta Clinica Belgica, 2019, May 5, 1-5 Het abstract is terug te vinden op pagina 15.

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CENTRUM

PSYCHIATRIE

ARTIKELS ABSTRACT 1 Het fossa posterior-meningeoom: een zwarte zwaan. Snauwaert PH, Vervaet J, Geerts PJ, et al. Tijdschrift voor Geneeskunde, 2019, 75, 750-756

INTRODUCTION/BACKGROUND De levensverwachting is de laatste 100 jaar met 40 jaar toegenomen. Ouder worden betekent meer kans op dementie en een toename van leeftijdsgebonden tumoren. Meningeomen zijn langzaam groeiende tumoren. Hun kliniek hangt af van de grootte en de locatie in de hersenen. Wanneer ze zich bevinden in een neurologisch „stille zone”, blijven ze lang asymptomatisch. Het vroegtijdig herkennen van gedragsveranderingen veroorzaakt door een hersentumor blijft moeilijk. Vaak wordt er eerst, zeker in de aanwezigheid van psychosociale stressoren, gedacht aan een psychiatrisch ziektebeeld. Nadien wordt dit vaak weinig in vraag gesteld. De term „zwarte zwaan” wordt als metafoor gebruikt om een ziektebeeld te beschrijven dat niemand had voorspeld, waar geen aanwijzingen voor waren en waarvan de diagnose achteraf wel bijgesteld kan worden. In dit artikel wordt de ziektegeschiedenis besproken van een 81-jarige vrouw met een initiële aanmelding wegens depressieve klachten die al twee jaar last blijkt te hebben van hoofdpijn, duizeligheid en sinds drie maanden een gedragsverandering onder de vorm van apathie. Na beeldvorming en de vaststelling van een fossa posterior-meningeoom wordt de diagnose van een depressie bijgesteld. Bij apathie, een blanco psychiatrische voorgeschiedenis, gedragsveranderingen en een leeftijd boven 50 jaar moet structurele beeldvorming worden overwogen om organiciteit uit te sluiten.

ABSTRACT 2 Late-onset manic episode after bariatric surgery. Dries D, Geerts PJ International Journal of Psychiatry, 2019, 4(1), 1-3

INTRODUCTION/BACKGROUND A manic episode is a clearly recognizable period with an abnormally and persistently elevated, expansive or irritable mood, with an abnormal and persistently increased targeted activity of energy, present for a week and during the biggest part of the day. The episode usually fits within a bipolar disorder, in which also depressive episodes occur.

These episodes often precede the manic phase. When a first manic episode occurs at a later age without any personal history, a somatic cause must always be excluded. Late-onset mania is associated with increased somatic comorbidity in patients aged 50 years and older. In this case report we present a patient with a late-onset (occurring after the age of 50) manic episode, occurring 3 months after a gastric bypass operation. Bariatric surgical outcomes are associated with medical and psychological complications, like neuropsychiatric disorders. In the screening before surgery, it has been generally found that 66% have at least one axis I diagnosis. A comprehensive presurgical approach with different disciplines and including psychiatric evaluation was developed by the National Institute of Health. There is no definitive guideline for post bariatric psychiatry evaluation, despite high post-surgical prevalence of psychiatric complications.

CONCLUSION The manic episode usually fits within a bipolar disorder, and is an invalidating psychiatric disorder. In a de novo presentation after the age of 50 years, it is called a late onset mania. Given no clearly identifiable underlying somatic factor in our case, secondary mania was excluded. The family burden and postoperative psychosocial stress, which affects oxidative and inflammatory pathways, are etiologically important to conclude to a primary manic episode, with a patient with genetic vulnerability for bipolarity. Nonetheless, primary and secondary mania can be considered as a continuum, and complex pathways are involved in both. The clinical distinction between primary and secondary mania is more important than the difference in pathogenesis, since the cause can and must always be treated in secondary mania. This applies even more in an elderly patient population. It is therefore important to be attentive to prodromi or subtle symptoms of manic or psychiatric problems in the post operative phase, also in patients without known psychiatric problems after screening and without preoperative complications. Extra vigilance is also recommended in the following weeks and months after bariatric surgery, as this case shows and provides a long-term follow-up. Further investigation should be done to suggest guidelines regarding follow-up. The cornerstone of treatment of a late onset manic episode remains first of all to exclude or treat underlying causes. Further treatment does not differ from the early onset mania.

PSYCHIATRIE

ABSTRACT 3 Oculogyre crisis als enige extrapiramidaal symptoom bij auto-intoxicatie met risperidone. Van Renterghem L, Titeca K, Geerts PJ, et al. Tijdschrift voor Psychiatrie, 2019, 61 (9), 649-653

INTRODUCTION/BACKGROUND Een 19-jarige patiënte bezocht de spoedgevallendienst met een auto-intoxicatie, waarop zich een oculogyre crisis (ogc) zonder andere extrapiramidale symptomen (eps) voordeed. Patiënte had risperidon 3 mg (een antipsychoticum van de tweede generatie) ingenomen; deze informatie verschafte ze ons echter pas bij een tweede bevraging. Deze bijzondere gevalsbeschrijving van een geïsoleerd voorkomende ogc toont aan dat hulpverleners aandachtig dienen te blijven voor het voorkomen van ogc, ook wanneer de frequentst voorkomende eps niet aanwezig zijn. In tweede instantie benadrukt deze casus het belang van een volledige anamnese om de hulpverlener zo vlot mogelijk naar de correcte diagnose te leiden.

ABSTRACT 4 Electroconvulsive therapy in a patient with multiple cerebreal cavernous malformations. Boonen I, Titeca K, Geerts PJ, et al. Journal of ECT (Electroconclusive Therapy), 2020, Published Ahead of Print, DOI: 10.1097/YCT.0000000000000654

and multiple cerebral cavernous hemangioma (of which one in the brainstem) was treated in our hospital with electroconvulsive therapy (ECT). In her medical history she underwent epilepsy surgery caused by a hemangioma left frontotemporal. Anesthetics used were etomidate, succinylcholine and nicardipine. Diclofenac and ondansetron were given because of complaints of headache and nausea. Each procedure of ECT went safely and without complications. Nortriptyline and lithium carbonate were started during the second half of treatment with ECT as a maintenance treatment. Blood pressure did not reach values higher than 150 mmHg systolic nor higher than 102 mmHg diastolic. Maximum heart rate was 145 beats per minute. She underwent 18 treatments so far and the frequency is gradually decreasing. Electroconvulsive therapy raises the blood pressure and heart rate just after the administration of the electrical pulse. Cavernous hemangioma are malformations of blood vessels in which blood flow is low. The main risk in cavernous hemangioma is bleeding luckily these lesions are less prone for high blood pressure than other vascular malformations like aneurysms. Multiple case reports are published in which ECT was administered safely. We provide a brief summary of the literature and conclude that despite the possible complication of hemorrhage on its own, ECT can be safely administered to patients with cavernous hemangioma with standard of care before, during and after the procedure. Stringent blood pressure regulation and neurological follow-up off course remain advisable.

ABSTRACT 2 Er is geen abstract beschikbaar.

PRESENTATIES/ CONGRESSEN

A comparative study of screening instruments for alcohol use disorders in elderly hospitalized patients. European Alliance for Personalised Medicine (EAPM) Congress Leterme E, Vandenbulcke M, Geerts PJ June 2019, Rotterdam, Nederland

ABSTRACT 1

OBJECTIVE

Electroconvulsive therapy in a patient with multiple cerebral cavernous hemangioma and prior epilepsy surgery: a case-report and literature overview.

Alcohol use disorders constitute an important health risk in the elderly. Accordingly, an important challenge in general hospitals is to identify subjects with an increased risk of alcohol use disorder. By comparing three screening instruments, we aimed to determine the most user-friendly yet valid tool for use in patients above 64 years hospitalized in a general hospital.

3th Bi-Annual meeting of the dutch, german and Belgian ECT workgroups Boonen I, Titeca K, Geerts PJ March 2019, Leuven, België

MATERIALS/METHODS INTRODUCTION/BACKGROUND A 60-year-old Caucasian female with refractory depression

64 ABSTRACTBOEK | 2019

We screened and interviewed all patients above 64 years of age admitted to AZ Groeninge hospital on a census day.

Exclusion criteria were dementia, aphasia, a foreign language, refusing consent and terminal illness. The Modified Single Alcohol Screening Questionnaire (M-SASQ), Alcohol Use Disorders Identification Test (AUDIT) and AUDIT alcohol Consumption questions (AUDIT-C) were used. The MINI-international Neuropsychiatric Interview Plus (M.I.N.I.-Plus) was chosen as golden standard diagnostic test.

RESULTS In total 229 patients were included. The prevalence of alcohol dependence and abuse was low (respectively 1.7% (n = 4) and 1.3% (n = 3)). When screening for alcohol dependence, sensitivity reached maximum (100%) for AUDIT-C and M-SASQ, whereas, AUDIT was associated with one false negative result (sensitivity 75%). For alcohol abuse there were no false negatives (sensitivity 100%). Specificity was 82% (CI 95% 77–87%) for AUDIT-C, 85% (CI 95% 80–89%) for M-SASQ and 96% (CI 95% 92–99%) for AUDIT.

CONCLUSION M-SASQ seems to be a valid and simple screening instrument to detect alcohol use disorders in elderly hospitalized patients. AUDIT was more specific but is more timeconsuming.

PSYCHIATRIE

CENTRUM

RADIOTHERAPIE ARTIKELS

PRESENTATIES/ CONGRESSEN

ABSTRACT 1 Oligometastatic prostate cancer: The game is afoot.

ABSTRACT 1

Lancia A, Zilli T, Liefhooghe N, et al. Cancer Treatment Reviews, 2019, volume 73, 84-90

Validation of a prognostic scoring system for postmastectomy locoregional recurrence in breast cancer.

INTRODUCTION/BACKGROUND Oligometastatic prostate cancer represents an intermediate state between a localized tumor and widespread metastatic disease. Its specific clinical features suggest the existence of a distinct biology which still needs to be elucidated. New imaging techniques like prostate specific membrane antigen (PSMA) PET scans have shown to perform well in the staging and restaging of this category of patients, at different phases of disease evolution. Despite limited prospective evidence, metastasis-directed therapies (MDT) are emerging as valid treatment options able to postpone systemic therapies and probably improve survival outcome. The aim of this review is to shed light on the clinical scenario of prostate cancer patients with limited metastatic disease burden and highlight the role of MDT strategies in this setting.

ABSTRACT 2 The financial impact of SBRT for oligometastatic disease: A population-level analysis in Belgium. Nevens D, Lievens Y, Kindts I, et al. Radiotherapy and Oncology, 2020, 145, 215-222 Het abstract is terug te vinden op pagina 53.

ABSTRACT 3 Underrepresentation of vulnerable older patients with cancer in phase II and III oncology registration trials: A case-control study. Tack L, Debruyne P, Ketelaars L, De Zutter J, Martens E, Stellamans K, Van Eygen K, Werbrouck P, Vergauwe P, et al. Journal of Geriatric Oncology, 2020, 11(2), 320-326 Het abstract is te vinden op pagina 50.

66 ABSTRACTBOEK | 2019

American Society for Radiation Oncology (ASTRO) Van der Vorst A, Kindts I, Laenen A, Janssens H, et al. September 2019, Chicago â&#x20AC;&#x201C; USA Het abstract is te vinden op pagina 54.

CENTRUM

VASCULAIRE EN THORACALE CHIRURGIE ARTIKELS

ABSTRACT 2 Cervical mediastinoscopy: Always Safe?

ABSTRACT 1 Complication méconnue dy bypass gastrique: cas rare d'une tumeur desmoïde intra-abdominale.

European Society of Thoracic Surgeons (ESTS) Dublin 2019 Clement C, Janssen M, Vanacker P, François O, Missant C, Lerut P, et al. Juni 2019, Dublin, Ierland

Jacqmin G, Curca G, Janssen M, et al. Medecine interne et maladies infectieuses, 2019, 138(10), 539-545

Er is geen abstract beschikbaar.

INTRODUCTION/BACKGROUND La tumeur desmoïde est une maladie rare décrite comme une prolifération anarchique de fibroblastes monoclonaux, dont la présentation clinique dépend de son étendue et de sa localisation. Bien que cette tumeur soit bénigne d’un point de vue histologique, elle est localement invasive, et présente un haut taux de récidive locale. Plusieurs facteurs de risques sont incriminés dans cette entité clinique. Cependant, la physiopathologie reste encore mal connue. Bien que les tumeurs desmoïdes puissent être sporadiques, elles peuvent également se développer en association avec la polypose adénomateuse familiale. Le gold standard n’est pas encore établi dans la prise en charge de cette pathologie. Chaque cas clinique se doit d’être évalué par une équipe multidisciplinaire afin de mettre en place une sanction thérapeutique adéquate. À notre connaissance, il s’agit du premier cas décrit de by-pass gastrique en Y-de-Roux compliqué d’une tumeur desmoïde. Nous décrivons dans cet article une tumeur desmoïde mésentérique se manifestant par des phénomènes sub-occlusifs au pied de l’anse grêle montée en Y-de-Roux, chez une patiente de 46 ans ayant bénéficié d’un by-pass gastrique trois ans auparavant.

PRESENTATIES/ CONGRESSEN ABSTRACT 1 Pulmonary mucormycosis: case presentation. BeRS 2019 - Belgian Respiratory Society annual meeting Vintila S, Betancourt A, Janssen M, et al. 2019, België Er is geen abstract beschikbaar.

VASCULAIRE EN THORACALE CHIRURGIE

NOTITIES

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NOTITIES

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AZ Groeninge is internationaal erkend door jci voor veilige zorg en kwaliteit. www.azgroeninge.be/kwaliteit

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Abstractboek 2019

Articles inside

RADIOTHERAPIE

ORTHOPEDIE

ONCOLOGIE

PSYCHIATRIE

NUCLEAIRE GENEESKUNDE

MEDISCHE BEELDVORMING

NEFROLOGIE

INWENDIGE ZIEKTEN

KLINISCH LABORATORIUM

LONGZIEKTEN

GYNAECOLOGIE

ABDOMINALE CHIRURGIE

CARDIOLOGIE