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Article ; Online: Natural Language Processing Algorithm Used for Staging Pulmonary Oncology from Free-Text Radiological Reports: "Including PET-CT and Validation Towards Clinical Use".

Nobel, J Martijn / Puts, Sander / Krdzalic, Jasenko / Zegers, Karen M L / Lobbes, Marc B I / F Robben, Simon G / Dekker, André L A J

Journal of imaging informatics in medicine

2024 Volume 37, Issue 1, Page(s) 3–12

Abstract: Natural language processing (NLP) can be used to process and structure free text, such as (free text) radiological reports. In radiology, it is important that reports are complete and accurate for clinical staging of, for instance, pulmonary oncology. A ... ...

Abstract	Natural language processing (NLP) can be used to process and structure free text, such as (free text) radiological reports. In radiology, it is important that reports are complete and accurate for clinical staging of, for instance, pulmonary oncology. A computed tomography (CT) or positron emission tomography (PET)-CT scan is of great importance in tumor staging, and NLP may be of additional value to the radiological report when used in the staging process as it may be able to extract the T and N stage of the 8th tumor-node-metastasis (TNM) classification system. The purpose of this study is to evaluate a new TN algorithm (TN-PET-CT) by adding a layer of metabolic activity to an already existing rule-based NLP algorithm (TN-CT). This new TN-PET-CT algorithm is capable of staging chest CT examinations as well as PET-CT scans. The study design made it possible to perform a subgroup analysis to test the external validation of the prior TN-CT algorithm. For information extraction and matching, pyContextNLP, SpaCy, and regular expressions were used. Overall TN accuracy score of the TN-PET-CT algorithm was 0.73 and 0.62 in the training and validation set (N = 63, N = 100). The external validation of the TN-CT classifier (N = 65) was 0.72. Overall, it is possible to adjust the TN-CT algorithm into a TN-PET-CT algorithm. However, outcomes highly depend on the accuracy of the report, the used vocabulary, and its context to express, for example, uncertainty. This is true for both the adjusted PET-CT algorithm and for the CT algorithm when applied in another hospital.
Language	English
Publishing date	2024-01-12
Publishing country	Switzerland
Document type	Journal Article
ISSN	2948-2933
ISSN (online)	2948-2933
DOI	10.1007/s10278-023-00913-x
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Article ; Online: Pulmonary embolism in hospitalized COVID-19 patients: Short- and long-term clinical outcomes.

Luu, Inge H Y / Buijs, Jacqueline / Krdzalic, Jasenko / de Kruif, Martijn D / Mostard, Guy J M / Ten Cate, Hugo / Dormans, Tom P J / Mostard, Remy L M / Leers, Math P G / van Twist, Daan J L

Thrombosis update

2024 Volume 12, Page(s) None

Abstract: Introduction: Pulmonary embolism (PE) is a frequent complication in COVID-19. However, the influence of PE on the prognosis of COVID-19 remains unclear as previous studies were affected by misclassification bias. Therefore, we evaluated a cohort of ... ...

Abstract	Introduction: Pulmonary embolism (PE) is a frequent complication in COVID-19. However, the influence of PE on the prognosis of COVID-19 remains unclear as previous studies were affected by misclassification bias. Therefore, we evaluated a cohort of COVID-19 patients whom all underwent systematic screening for PE (thereby avoiding misclassification) and compared clinical outcomes between patients with and without PE. Materials and methods: We included all COVID-19 patients who were admitted through the ED between April 2020 and February 2021. All patients underwent systematic work-up for PE in the ED using the YEARS-algorithm. The primary outcome was a composite of in-hospital mortality and ICU admission. We also evaluated long-term outcomes including PE occurrence within 90 days after discharge and one-year all-cause mortality. Results: 637 ED patients were included in the analysis. PE was diagnosed in 46 of them (7.2%). The occurrence of the primary outcome did not differ between patients with PE and those without (28.3% vs. 26.9%, Conclusions: In a cohort of COVID-19 patients who underwent systematic PE screening in the ED, we found no differences in mortality rate and ICU admissions between patients with and without PE. This may indicate that proactive PE screening, and thus timely diagnosis and treatment of PE, may limit further clinical deterioration and associated mortality in COVID-19 patients.
Language	English
Publishing date	2024-04-02
Publishing country	England
Document type	Journal Article
ISSN	2666-5727
ISSN (online)	2666-5727
DOI	10.1016/j.tru.2023.100142
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Article ; Online: Three-month follow-up after severe COVID-19 infection: are chest CT results associated with respiratory outcomes and respiratory recovery in COVID-19 patients?

Janssen, Marlou Thf / Thijssen, Mark Gh / Krdzalic, Jasenko / Gronenschild, Michiel Hm / Ramiro, Sofia / Magro-Checa, César / Landewé, Robert Bm / Mostard, Rémy Lm

BMC pulmonary medicine

2023 Volume 23, Issue 1, Page(s) 74

Abstract: Background: CT Severity Score (CT-SS) can be used to assess the extent of severe coronavirus disease 19 (COVID-19) pneumonia. Follow-up CT-SS in patients surviving COVID-19-associated hyperinflammation and its correlation with respiratory parameters ... ...

Abstract	Background: CT Severity Score (CT-SS) can be used to assess the extent of severe coronavirus disease 19 (COVID-19) pneumonia. Follow-up CT-SS in patients surviving COVID-19-associated hyperinflammation and its correlation with respiratory parameters remains unknown. This study aims to assess the association between CT-SS and respiratory outcomes, both in hospital and at three months after hospitalization. Methods: Patients from the COVID-19 High-intensity Immunosuppression in Cytokine storm Syndrome (CHIC) study surviving hospitalization due to COVID-19 associated hyperinflammation were invited for follow-up assessment at three months after hospitalization. Results of CT-SS three months after hospitalization were compared with CT-SS at hospital admission. CT-SS at admission and at 3-months were correlated with respiratory status during hospitalization and with patient reported outcomes as well as pulmonary- and exercise function tests at 3-months after hospitalization. Results: A total of 113 patients were included. Mean CT-SS decreased by 40.4% (SD 27.6) in three months (P < 0.001). CT-SS during hospitalization was higher in patients requiring more oxygen (P < 0.001). CT-SS at 3-months was higher in patients with more dyspnoea (CT-SS 8.31 (3.98) in patients with modified Medical Council Dyspnoea scale (mMRC) 0-2 vs. 11.03 (4.47) in those with mMRC 3-4). CT-SS at 3-months was also higher in patients with a more impaired pulmonary function (7.4 (3.6) in patients with diffusing capacity for carbon monoxide (DLCO) > 80%pred vs. 14.3 (3.2) in those with DLCO < 40%pred, P = 0.002). Conclusion: Patients surviving hospitalization for COVID-19-associated hyperinflammation with higher CT-SS have worse respiratory outcome, both in-hospital and at 3-months after hospitalization. Strict monitoring of patients with high CT-SS is therefore warranted.
MeSH term(s)	Humans ; COVID-19/complications ; Follow-Up Studies ; Hospitalization ; Hospitals ; Dyspnea
Language	English
Publishing date	2023-03-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-023-02370-2
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Article ; Online: Diagnostic performance of chest CT in screening patients with suspected COVID-19 infection in a Western population.

Krdzalic, Jasenko / de Jaegere, Tom M H / Kwee, Robert M

The British journal of radiology

2020 Volume 93, Issue 1113, Page(s) 20200643

Abstract: Objective: To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population.: Methods: Consecutive patients who underwent chest CT because of clinical suspicion of ... ...

Abstract	Objective: To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population. Methods: Consecutive patients who underwent chest CT because of clinical suspicion of COVID-19 were included. CT scans were prospectively evaluated by frontline general radiologists who were on duty at the time when the CT scan was performed and retrospectively assessed by a chest radiologist in an independent and blinded manner. Real-time reverse transcriptase-polymerase chain reaction was used as reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity and specificity of the frontline general radiologists were compared to those of the chest radiologist using the McNemar test. Results: 56 patients were included. Sensitivity, specificity, PPV, and NPV for the frontline general radiologists were 89.3% [95% confidence interval (CI): 71.8%, 97.7%], 32.1% (95% CI: 15.9%, 52.4%), 56.8% (95% CI: 41.0%, 71.7%), and 75.0% (95% CI: 42.8%, 94.5%), respectively. Sensitivity, specificity, PPV, and NPV for the chest radiologist were 89.3% (95% CI: 71.8%, 97.7%), 75.0% (95% CI: 55.1%, 89.3%), 78.1% (95% CI: 60.0%, 90.7%), and 87.5% (95% CI: 67.6%, 97.3%), respectively. Sensitivity was not significantly different ( Conclusion: Chest CT interpreted by frontline general radiologists achieves insufficient screening performance. Although specificity of a chest radiologist appears to be significantly higher, sensitivity did not improve. A negative chest CT result does not exclude COVID-19. Advances in knowledge: Our study shows that chest CT interpreted by frontline general radiologists achieves insufficient diagnostic performance to use it as an independent screening tool for COVID-19. Although specificity of a chest radiologist appears to be significantly higher, sensitivity is still insufficiently high.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnostic imaging ; Female ; Humans ; Lung/diagnostic imaging ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/diagnostic imaging ; Prospective Studies ; Radiography, Thoracic/methods ; Reproducibility of Results ; Retrospective Studies ; SARS-CoV-2 ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods
Keywords	covid19
Language	English
Publishing date	2020-08-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20200643
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Article ; Online: Systematic screening versus clinical gestalt in the diagnosis of pulmonary embolism in COVID-19 patients in the emergency department.

Luu, Inge H Y / Frijns, Tim / Buijs, Jacqueline / Krdzalic, Jasenko / de Kruif, Martijn D / Mostard, Guy J M / Ten Cate, Hugo / Martens, Remy J H / Mostard, Remy L M / Leers, Math P G / van Twist, Daan J L

PloS one

2023 Volume 18, Issue 3, Page(s) e0283459

Abstract: Background: Diagnosing concomitant pulmonary embolism (PE) in COVID-19 patients remains challenging. As such, PE may be overlooked. We compared the diagnostic yield of systematic PE-screening based on the YEARS-algorithm to PE-screening based on ... ...

Abstract	Background: Diagnosing concomitant pulmonary embolism (PE) in COVID-19 patients remains challenging. As such, PE may be overlooked. We compared the diagnostic yield of systematic PE-screening based on the YEARS-algorithm to PE-screening based on clinical gestalt in emergency department (ED) patients with COVID-19. Methods: We included all ED patients who were admitted because of COVID-19 between March 2020 and February 2021. Patients already receiving anticoagulant treatment were excluded. Up to April 7, 2020, the decision to perform CT-pulmonary angiography (CTPA) was based on physician's clinical gestalt (clinical gestalt cohort). From April 7 onwards, systematic PE-screening was performed by CTPA if D-dimer level was ≥1000 ug/L, or ≥500 ug/L in case of ≥1 YEARS-item (systematic screening cohort). Results: 1095 ED patients with COVID-19 were admitted. After applying exclusion criteria, 289 were included in the clinical gestalt and 574 in the systematic screening cohort. The number of PE diagnoses was significantly higher in the systematic screening cohort compared to the clinical gestalt cohort: 8.2% vs. 1.0% (3/289 vs. 47/574; p<0.001), even after adjustment for differences in patient characteristics (adjusted OR 8.45 (95%CI 2.61-27.42, p<0.001) for PE diagnosis). In multivariate analysis, D-dimer (OR 1.09 per 1000 μg/L increase, 95%CI 1.06-1.13, p<0.001) and CRP >100 mg/L (OR 2.78, 95%CI 1.37-5.66, p = 0.005) were independently associated with PE. Conclusion: In ED patients with COVID-19, the number of PE diagnosis was significantly higher in the cohort that underwent systematic PE screening based on the YEARS-algorithm in comparison with the clinical gestalt cohort, with a number needed to test of 7.1 CTPAs to detect one PE.
MeSH term(s)	Humans ; COVID-19/complications ; COVID-19/diagnosis ; Pulmonary Embolism/diagnostic imaging ; Patients ; Fibrin Fibrinogen Degradation Products/analysis ; Emergency Service, Hospital ; Retrospective Studies ; COVID-19 Testing
Chemical Substances	Fibrin Fibrinogen Degradation Products
Language	English
Publishing date	2023-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283459
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Article ; Online: Een jongen met een zeldzame longziekte.

van Gansewinkel, Tessa A G / de Rooy, Rick / Latten, Gideon / Krdzalic, Jasenko / Rosias, Philippe R

Nederlands tijdschrift voor geneeskunde

2020 Volume 164

Abstract: Background: In times of coronavirus, a patient with respiratory symptoms whose chest CT scan reveals ground-glass opacities, COVID-19 may seem an obvious diagnosis.: Case description: At the (currently assumed) peak of the coronavirus crisis, a 12- ... ...

Title translation	A boy with a rare pulmonary disease; COVID-19 is clouding our judgment.
Abstract	Background: In times of coronavirus, a patient with respiratory symptoms whose chest CT scan reveals ground-glass opacities, COVID-19 may seem an obvious diagnosis. Case description: At the (currently assumed) peak of the coronavirus crisis, a 12-year-old boy was admitted to the hospital twice for severe respiratory symptoms. A chest CT scan revealed ground-glass opacities.COVID-19 pneumonia was initially thought of. However, it turned out to be a rare interstitial pulmonary disease. Conclusion: Due to the increased awareness about COVID-19, tunnel vision is lurking. Even during a health crisis, doctors should remain alert to alternative diagnoses.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/physiopathology ; COVID-19/psychology ; COVID-19 Testing ; Child ; Clinical Decision-Making ; Diagnosis, Differential ; Humans ; Judgment ; Lung/diagnostic imaging ; Lung/physiopathology ; Lung Diseases, Interstitial/diagnosis ; Lung Diseases, Interstitial/physiopathology ; Male ; SARS-CoV-2 ; Symptom Assessment/methods ; Tomography, X-Ray Computed/methods
Language	Dutch
Publishing date	2020-09-17
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with Reverse-Transcription Polymerase Chain Reaction.

de Jaegere, Tom M H / Krdzalic, Jasenko / Fasen, Bram A C M / Kwee, Robert M

Radiology. Cardiothoracic imaging

2020 Volume 2, Issue 3, Page(s) e200213

Abstract: Purpose: To evaluate the Radiological Society of North America (RSNA) chest CT classification system for reporting coronavirus disease 2019 (COVID-19) pneumonia.: Materials and methods: Chest CT scans of consecutive patients suspected of having COVID- ...

Abstract	Purpose: To evaluate the Radiological Society of North America (RSNA) chest CT classification system for reporting coronavirus disease 2019 (COVID-19) pneumonia. Materials and methods: Chest CT scans of consecutive patients suspected of having COVID-19 were retrospectively and independently evaluated by two chest radiologists and a 5th-year radiology resident using the RSNA chest CT classification system for reporting COVID-19 pneumonia. Interobserver agreement was evaluated by calculating weighted κ coefficients. The proportion of patients with real-time reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 in each of the four chest CT categories (typical, indeterminate, atypical, and negative features for COVID-19) was calculated. Results: In total, 96 patients (61 men; median age, 70 years [range, 29-94]) were included, of whom 45 had RT-PCR-confirmed COVID-19. The number of patients assigned to chest CT categories typical, indeterminate, atypical, and negative by the three readers ranged from 18 to 29, 26 to 43, 19 to 31, and 5 to 8, respectively. The κ coefficient among the chest radiologists was 0.663 (95% confidence interval [CI]: 0.565, 0.761). κ coefficients among the chest radiologists and the 5th-year radiology resident were 0.570 (95% CI: 0.443, 0.696) and 0.564 (95% CI: 0.451, 0.678), respectively. The proportion of patients with RT-PCR-confirmed COVID-19 in the chest CT categories typical, indeterminate, atypical, and negative for the three readers ranged from 76.9% to 96.6%, 51.2% to 64.1%, 2.8% to 5.3%, and 20% to 25%, respectively. Conclusion: The RSNA chest CT classification system for reporting COVID-19 pneumonia has moderate-to-substantial interobserver agreement. However, the proportion of RT-PCR-confirmed COVID-19 cases in the categories atypical appearance and negative for pneumonia is nonnegligible.
Language	English
Publishing date	2020-06-11
Publishing country	United States
Document type	Journal Article
ISSN	2638-6135
ISSN (online)	2638-6135
DOI	10.1148/ryct.2020200213
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Article ; Online: Systematic screening for pulmonary embolism using the YEARS algorithm in patients with suspected COVID-19 in the Emergency Department.

Luu, Inge H Y / Kroon, Féline P B / Buijs, Jacqueline / Krdzalic, Jasenko / de Kruif, Martijn D / Leers, Math P G / Mostard, Guy J M / Martens, Remy J H / Mostard, Remy L M / van Twist, Daan J L

Thrombosis research

2021 Volume 207, Page(s) 113–115

Language	English
Publishing date	2021-09-24
Publishing country	United States
Document type	Letter
ZDB-ID	121852-9
ISSN	1879-2472 ; 0049-3848
ISSN (online)	1879-2472
ISSN	0049-3848
DOI	10.1016/j.thromres.2021.09.010
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Article: Results of a diagnostic imaging audit in a randomised clinical trial in rectal cancer highlight the importance of careful planning and quality control.

Prata, Ilaria / Eriksson, Martina / Krdzalic, Jasenko / Kranenbarg, Elma Meershoek-Klein / Roodvoets, Annet G H / Beets-Tan, Regina / van de Velde, Cornelis J H / van Etten, Boudewijn / Hospers, Geke A P / Glimelius, Bengt / Nilsson, Per J / Marijnen, Corrie A M / Peeters, Koen C M J / Blomqvist, Lennart K

Insights into imaging

2023 Volume 14, Issue 1, Page(s) 206

Abstract: Background: Magnetic resonance (MR) imaging is the modality used for baseline assessment of locally advanced rectal cancer (LARC) and restaging after neoadjuvant treatment. The overall audited quality of MR imaging in large multicentre trials on rectal ... ...

Abstract	Background: Magnetic resonance (MR) imaging is the modality used for baseline assessment of locally advanced rectal cancer (LARC) and restaging after neoadjuvant treatment. The overall audited quality of MR imaging in large multicentre trials on rectal cancer is so far not routinely reported. Materials and methods: We collected MR images obtained within the Rectal Cancer And Pre-operative Induction Therapy Followed by Dedicated Operation (RAPIDO) trial and performed an audit of the technical features of image acquisition. The required MR sequences and slice thickness stated in the RAPIDO protocol were used as a reference. Results: Out of 920 participants of the RAPIDO study, MR investigations of 668 and 623 patients in the baseline and restaging setting, respectively, were collected. Of these, 304/668 (45.5%) and 328/623 (52.6%) MR images, respectively, fulfilled the technical quality criteria. The main reason for non-compliance was exceeding slice thickness 238/668, 35.6% in the baseline setting and 162/623, 26.0% in the restaging setting. In 166/668, 24.9% and 168/623, 27.0% MR images in the baseline and restaging setting, respectively, one or more of the required pulse sequences were missing. Conclusion: Altogether, 49.0% of the MR images obtained within the RAPIDO trial fulfilled the image acquisition criteria required in the study protocol. High-quality MR imaging should be expected for the appropriate initial treatment and response evaluation of patients with LARC, and efforts should be made to maximise the quality of imaging in clinical trials and in clinical practice. Critical relevance statement: This audit highlights the importance of adherence to MR image acquisition criteria for rectal cancer, both in multicentre trials and in daily clinical practice. High-resolution images allow correct staging, treatment stratification and evaluation of response to neoadjuvant treatment. Key points: - Complying to MR acquisition guidelines in multicentre trials is challenging. - Neglection on MR acquisition criteria leads to poor staging and treatment. - MR acquisition guidelines should be followed in trials and clinical practice. - Researchers should consider mandatory audits prior to study initiation.
Language	English
Publishing date	2023-11-24
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2543323-4
ISSN	1869-4101
ISSN	1869-4101
DOI	10.1186/s13244-023-01552-0
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Article: Diagnostic performance of chest CT in screening patients with suspected COVID-19 infection in a Western population

Krdzalic, Jasenko / de Jaegere, Tom M H / Kwee, Robert M

Br J Radiol

Abstract: OBJECTIVE: To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population. METHODS: Consecutive patients who underwent chest CT because of clinical suspicion of COVID- ... ...

Abstract	OBJECTIVE: To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population. METHODS: Consecutive patients who underwent chest CT because of clinical suspicion of COVID-19 were included. CT scans were prospectively evaluated by frontline general radiologists who were on duty at the time when the CT scan was performed and retrospectively assessed by a chest radiologist in an independent and blinded manner. Real-time reverse transcriptase-polymerase chain reaction was used as reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity and specificity of the frontline general radiologists were compared to those of the chest radiologist using the McNemar test. RESULTS: 56 patients were included. Sensitivity, specificity, PPV, and NPV for the frontline general radiologists were 89.3% [95% confidence interval (CI): 71.8%, 97.7%], 32.1% (95% CI: 15.9%, 52.4%), 56.8% (95% CI: 41.0%, 71.7%), and 75.0% (95% CI: 42.8%, 94.5%), respectively. Sensitivity, specificity, PPV, and NPV for the chest radiologist were 89.3% (95% CI: 71.8%, 97.7%), 75.0% (95% CI: 55.1%, 89.3%), 78.1% (95% CI: 60.0%, 90.7%), and 87.5% (95% CI: 67.6%, 97.3%), respectively. Sensitivity was not significantly different (p = 1.000), but specificity was significantly higher for the chest radiologist (p = 0.001). CONCLUSION: Chest CT interpreted by frontline general radiologists achieves insufficient screening performance. Although specificity of a chest radiologist appears to be significantly higher, sensitivity did not improve. A negative chest CT result does not exclude COVID-19. ADVANCES IN KNOWLEDGE: Our study shows that chest CT interpreted by frontline general radiologists achieves insufficient diagnostic performance to use it as an independent screening tool for COVID-19. Although specificity of a chest radiologist appears to be significantly higher, sensitivity is still insufficiently high.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #721360
Database	COVID19

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