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Article: Redescending Stomach: A Rare and Potentially Lethal Complication of Gastric Herniation.

Verrept, Sam / Lefere, Mathieu / De Bruecker, Yves

Journal of the Belgian Society of Radiology

2024 Volume 108, Issue 1, Page(s) 22

Abstract: Large gastric hernias are common and usually cause minor symptoms. Rarely, complete intrathoracic herniation of the stomach is complicated by strangulation. The underlying mechanism can be gastric volvulus or the less recognized phenomenon of gastric ... ...

Abstract	Large gastric hernias are common and usually cause minor symptoms. Rarely, complete intrathoracic herniation of the stomach is complicated by strangulation. The underlying mechanism can be gastric volvulus or the less recognized phenomenon of gastric fundus redescent. We describe a case where this rare but potentially lethal complication of gastric herniation is present. Additionally, we show that gastric pneumatosis, a sign associated with ischemia, can be initially visualized on a plain chest radiograph in this setting.
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Case Reports
ZDB-ID	2834839-4
ISSN	2514-8281
ISSN	2514-8281
DOI	10.5334/jbsr.3448
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Article ; Online: A Rare Case of Subcutaneous Amyloidoma Associated with Localized Lymphoplasmacytic Lymphoma: Diagnostic Challenges and Treatment Considerations.

Vivian, Lisa Francesca / Marcelis, Lukas / Leoni, Eleonora / De Bruecker, Yves / Maes, Helena / Pierré, Erwin / Ballaux, Florence M / Tousseyn, Thomas

The American journal of case reports

2023 Volume 24, Page(s) e940789

Abstract: BACKGROUND AL amyloidomas are solitary, localized, tumor-like deposits of immunoglobulin light-chain-derived amyloid fibrils in the absence of systemic amyloidosis. A rare entity, they have been described in various anatomical sites, typically in spatial ...

Abstract	BACKGROUND AL amyloidomas are solitary, localized, tumor-like deposits of immunoglobulin light-chain-derived amyloid fibrils in the absence of systemic amyloidosis. A rare entity, they have been described in various anatomical sites, typically in spatial association with a sparse lymphoplasmacytic infiltrate, ultimately corresponding to a clonal, malignant, lymphomatous disorder accounting for the amyloidogenic activity. Most frequently, the amyloidoma-associated hematological disorder corresponds to either a solitary plasmacytoma or an extranodal marginal zone lymphoma of MALT. Much rarer is the association with lymphoplasmacytic lymphoma, which by itself is usually a bone marrow-bound disorder with systemic burden. The almost anecdotic combination of an amyloidoma and a localized lymphoplasmacytic lymphoma deserves attention, as it entails a thorough diagnostic workup to exclude systemic involvement and a proportionate therapeutic approach to avoid overtreatment. A review of the literature provides an insight on pathogenesis and prognosis, and can assist both pathologists and clinicians in establishing optimal patient management strategies. CASE REPORT We herein report the incidental finding of a subcutaneous amyloidoma caused by a spatially related, similarly localized lymphoplasmacytic lymphoma diagnosed in a 54-year-old female patient with no other disease localizations and a complete remission following 2 subsequent surgical excisions. CONCLUSIONS Whatever the specific combination of an amyloidoma and the related hematological neoplasm, a multidisciplinary collaboration and a comprehensive clinical-pathological staging are warranted to exclude systemic involvement and identify patients with localized diseases who would benefit from local active treatment and close follow-up.
MeSH term(s)	Female ; Humans ; Middle Aged ; Amyloidosis/diagnosis ; Amyloidosis/therapy ; Amyloid ; Lymphoma, B-Cell, Marginal Zone/diagnosis ; Lymphoma, B-Cell, Marginal Zone/therapy ; Waldenstrom Macroglobulinemia/complications ; Waldenstrom Macroglobulinemia/diagnosis ; Waldenstrom Macroglobulinemia/therapy ; Plasmacytoma/diagnosis ; Plasmacytoma/therapy ; Soft Tissue Neoplasms
Chemical Substances	Amyloid
Language	English
Publishing date	2023-10-02
Publishing country	United States
Document type	Review ; Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.940789
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Article ; Online: Accuracy of whole-body diffusion-weighted MRI (WB-DWI/MRI) in diagnosis, staging and follow-up of gastric cancer, in comparison to CT: a pilot study.

De Vuysere, Sofie / Vandecaveye, Vincent / De Bruecker, Yves / Carton, Saskia / Vermeiren, Koen / Tollens, Tim / De Keyzer, Frederik / Dresen, Raphaëla Carmen

BMC medical imaging

2021 Volume 21, Issue 1, Page(s) 18

Abstract: Background: Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed tomography (CT) is currently used as primary staging tool, being widely available with a relatively high ... ...

Abstract	Background: Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed tomography (CT) is currently used as primary staging tool, being widely available with a relatively high accuracy for the detection of parenchymal metastases, but with low sensitivity for the detection of peritoneal metastases. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has a very high contrast resolution, suggesting a higher diagnostic performance in the detection of small peritoneal lesions. The aim of this study was to retrospectively evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for detection of peritoneal carcinomatosis (PC) and distant metastases in the preoperative staging of gastric cancer. Methods: This retrospective study included thirty-two patients with a suspicion of gastric cancer/recurrence, who underwent WB-DWI/MRI at 1.5 T, in addition to CT of thorax and abdomen. Images were evaluated by two experienced abdominal radiologists in consensus. Histopathology, laparoscopy and/or 1-year follow-up were used as reference standard. Results: For overall tumour detection (n = 32), CT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 83.3%, 100%, 100% and 82.4% respectively. For WB-DWI/MRI these values were 100%, 92.9%, 94.7% and 100%, respectively. For staging (n = 18) malignant lymph nodes and metastases, CT had a sensitivity, specificity/PPV/NPV of 50%/100%/100%/71.4%, and 15.4%/100%/100%/31.3% respectively. For WB-DWI/MRI, all values were 100%, for both malignant lymph nodes and metastases. WB-DWI/MRI was significantly better than CT in detecting tumour infiltration of the mesenteric root, serosal involvement of the small bowel and peritoneal metastases for which WB-DWI/MRI was correct in 100% of these cases, CT 0%. Conclusions: WB-DWI/MRI is highly accurate for diagnosis, staging and follow-up of patients with suspected gastric cancer.
MeSH term(s)	Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Signet Ring Cell/diagnostic imaging ; Carcinoma, Signet Ring Cell/pathology ; Contrast Media ; Diffusion Magnetic Resonance Imaging/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Peritoneal Neoplasms/diagnostic imaging ; Peritoneal Neoplasms/secondary ; Pilot Projects ; Predictive Value of Tests ; Preoperative Period ; Retrospective Studies ; Stomach Neoplasms/diagnostic imaging ; Stomach Neoplasms/pathology ; Tomography, X-Ray Computed ; Whole Body Imaging/methods
Chemical Substances	Contrast Media
Language	English
Publishing date	2021-02-05
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	2061975-3
ISSN	1471-2342 ; 1471-2342
ISSN (online)	1471-2342
ISSN	1471-2342
DOI	10.1186/s12880-021-00550-2
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Article: Unicornuate Uterus with Noncommunicating Cavitary Horn.

Lefere, Mathieu / De Vuysere, Sofie / De Bruecker, Yves / Demeyere, Annick

Journal of the Belgian Society of Radiology

2016 Volume 100, Issue 1, Page(s) 80

Language	English
Publishing date	2016-09-26
Publishing country	England
Document type	Journal Article
ISSN	2514-8281
ISSN	2514-8281
DOI	10.5334/jbr-btr.1160
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Article ; Online: Accuracy and Reproducibility of Low-Dose Submillisievert Chest CT for the Diagnosis of COVID-19.

Dangis, Anthony / Gieraerts, Christopher / De Bruecker, Yves / Janssen, Lode / Valgaeren, Hanne / Obbels, Dagmar / Gillis, Marc / Van Ranst, Marc / Frans, Johan / Demeyere, Annick / Symons, Rolf

Radiology. Cardiothoracic imaging

2020 Volume 2, Issue 2, Page(s) e200196

Abstract: Purpose: To demonstrate the accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of coronavirus disease 2019 (COVID-19) infection in patients in the emergency department.: Materials and methods: This was a Health ... ...

Abstract	Purpose: To demonstrate the accuracy and reproducibility of low-dose submillisievert chest CT for the diagnosis of coronavirus disease 2019 (COVID-19) infection in patients in the emergency department. Materials and methods: This was a Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective study. From March 14 to 24, 2020, 192 patients in the emergency department with symptoms suggestive of COVID-19 infection were studied by using low-dose chest CT and real-time reverse transcription polymerase chain reaction (RT-PCR). Image analysis included the likelihood of COVID-19 infection and the semiquantitative extent of lung involvement. CT images were analyzed by two radiologists blinded to the RT-PCR results. Reproducibility was assessed using the McNemar test and intraclass correlation coefficient. Time between CT acquisition and report was measured. Results: When compared with RT-PCR, low-dose submillisievert chest CT demonstrated excellent sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of COVID-19 (86.7%, 93.6%, 91.1%, 90.3%, and 90.2%, respectively), in particular in patients with clinical symptoms for more than 48 hours (95.6%, 93.2%, 91.5%, 96.5%, and 94.4%, respectively). In patients with a positive CT result, the likelihood of disease increased from 43.2% (pretest probability) to 91.1% or 91.4% (posttest probability), while in patients with a negative CT result, the likelihood of disease decreased to 9.6% or 3.7% for all patients or those with clinical symptoms for >48 hours. The prevalence of alternative diagnoses based on chest CT in patients without COVID-19 infection was 17.6%. The mean effective radiation dose was 0.56 mSv ± 0.25 (standard deviation). Median time between CT acquisition and report was 25 minutes (interquartile range: 13-49 minutes). Intra- and interreader reproducibility of CT was excellent (all intraclass correlation coefficients ≥ 0.95) without significant bias in the Bland-Altman analysis. Conclusion: Low-dose submillisievert chest CT allows for rapid, accurate, and reproducible assessment of COVID-19 infection in patients in the emergency department, in particular in patients with symptoms lasting longer than 48 hours. Chest CT has the additional advantage of offering alternative diagnoses in a significant subset of patients.© RSNA, 2020.
Language	English
Publishing date	2020-04-21
Publishing country	United States
Document type	Journal Article
ISSN	2638-6135
ISSN (online)	2638-6135
DOI	10.1148/ryct.2020200196
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Article ; Online: Prognostic Value and Reproducibility of AI-assisted Analysis of Lung Involvement in COVID-19 on Low-Dose Submillisievert Chest CT: Sample Size Implications for Clinical Trials.

Gieraerts, Christopher / Dangis, Anthony / Janssen, Lode / Demeyere, Annick / De Bruecker, Yves / De Brucker, Nele / van Den Bergh, Annelies / Lauwerier, Tine / Heremans, André / Frans, Eric / Laurent, Michaël / Ector, Bavo / Roosen, John / Smismans, Annick / Frans, Johan / Gillis, Marc / Symons, Rolf

Radiology. Cardiothoracic imaging

2020 Volume 2, Issue 5, Page(s) e200441

Abstract: Purpose: To compare the prognostic value and reproducibility of visual versus AI-assisted analysis of lung involvement on submillisievert low-dose chest CT in COVID-19 patients.: Materials and methods: This was a HIPAA-compliant, institutional review ...

Abstract	Purpose: To compare the prognostic value and reproducibility of visual versus AI-assisted analysis of lung involvement on submillisievert low-dose chest CT in COVID-19 patients. Materials and methods: This was a HIPAA-compliant, institutional review board-approved retrospective study. From March 15 to June 1, 2020, 250 RT-PCR confirmed COVID-19 patients were studied with low-dose chest CT at admission. Visual and AI-assisted analysis of lung involvement was performed by using a semi-quantitative CT score and a quantitative percentage of lung involvement. Adverse outcome was defined as intensive care unit (ICU) admission or death. Cox regression analysis, Kaplan-Meier curves, and cross-validated receiver operating characteristic curve with area under the curve (AUROC) analysis was performed to compare model performance. Intraclass correlation coefficients (ICCs) and Bland- Altman analysis was used to assess intra- and interreader reproducibility. Results: Adverse outcome occurred in 39 patients (11 deaths, 28 ICU admissions). AUC values from AI-assisted analysis were significantly higher than those from visual analysis for both semi-quantitative CT scores and percentages of lung involvement (all P<0.001). Intrareader and interreader agreement rates were significantly higher for AI-assisted analysis than visual analysis (all ICC ≥0.960 versus ≥0.885). AI-assisted variability for quantitative percentage of lung involvement was 17.2% (coefficient of variation) versus 34.7% for visual analysis. The sample size to detect a 5% change in lung involvement with 90% power and an α error of 0.05 was 250 patients with AI-assisted analysis and 1014 patients with visual analysis. Conclusion: AI-assisted analysis of lung involvement on submillisievert low-dose chest CT outperformed conventional visual analysis in predicting outcome in COVID-19 patients while reducing CT variability. Lung involvement on chest CT could be used as a reliable metric in future clinical trials.
Language	English
Publishing date	2020-10-22
Publishing country	United States
Document type	Journal Article
ISSN	2638-6135
ISSN (online)	2638-6135
DOI	10.1148/ryct.2020200441
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Article ; Online: Infliximab Exposure Associates With Radiologic Evidence of Healing in Patients With Crohn's Disease.

Bossuyt, Peter / Dreesen, Erwin / Rimola, Jordi / Devuysere, Sofie / De Bruecker, Yves / Vanslembrouck, Ragna / Laurent, Valérie / Zappa, Magaly / Savoye-Collet, Céline / Pariente, Benjamin / Filippi, Jérôme / Baert, Filip / D'Haens, Geert / Laharie, David / Peyrin-Biroulet, Laurent / Vermeire, Séverine

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association

2020 Volume 19, Issue 5, Page(s) 947–954.e2

Abstract: Background & aims: Higher infliximab trough levels are associated with clinical and endoscopic remission in patients with Crohn's disease (CD). We investigated pharmacodynamic features of infliximab and radiological healing.: Methods: We performed a ... ...

Abstract	Background & aims: Higher infliximab trough levels are associated with clinical and endoscopic remission in patients with Crohn's disease (CD). We investigated pharmacodynamic features of infliximab and radiological healing. Methods: We performed a substudy of the TAILORIX trial (patients with active luminal CD in Europe, treated with infliximab), analyzing baseline and week 54 magnetic resonance enterography (MRE) data. MREs were scored using the MaRIA score by blinded central readers. Radiologic response and remission were defined, based on MaRIA criteria in all segments, as scores below 11 and 7, respectively. We collected data on infliximab trough levels, biomarkers, and endoscopic findings. Our primary aim was to evaluate pharmacodynamic features associated with radiologic response and remission, based on MRE assessments at baseline and at 54 weeks after initiation of infliximab therapy. Results: We analyzed data from 36 patients (50% female; median age 35.7 years; interquartile age range, 25.6-48.6 years; median disease duration, 1.5 months; interquartile duration range, 0.6-22.4 months). At week 54 of treatment, 36.4% of patients had a radiologic response, 30.3% of patients were in remission, and 71% had endoscopic features of remission. At baseline, there was a correlation between the CD endoscopic index of severity and MaRIA scores (κ = 0.46; P = .008), but we found no correlation at week 54 (κ = 0.06; P = .75). Radiologic remission correlated with infliximab trough level at week 14 (P = .049) when the infliximab trough level cut-off value was set at 7.8 μg/mL (area under the curve, 0.74; 75% sensitivity; 86% specificity; 90% negative predictive value; 57% positive predictive value). Radiologic response correlated with infliximab trough levels at week 14 (P = .048) when the infliximab trough level cut-off value was set at 7.8 μg/mL (area under the curve, 0.73; 70% sensitivity; 90% specificity; 86% negative predictive value; 78% positive predictive value) and with continuous pharmacologic evidence of response (infliximab trough levels above 5.0 μg/mL at all time points) (P = .034). Conclusions: In a substudy of data from the TAILORIX trial of patients with active luminal CD, we identified a relationship between exposure to infliximab and radiologic evidence of outcomes.
MeSH term(s)	Adult ; Crohn Disease/diagnostic imaging ; Crohn Disease/drug therapy ; Female ; Gastrointestinal Agents/therapeutic use ; Humans ; Infliximab/therapeutic use ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome
Chemical Substances	Gastrointestinal Agents ; Infliximab (B72HH48FLU)
Language	English
Publishing date	2020-04-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2119789-1
ISSN	1542-7714 ; 1542-3565
ISSN (online)	1542-7714
ISSN	1542-3565
DOI	10.1016/j.cgh.2020.04.052
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Article ; Online: Quarter-millimeter spectral coronary stent imaging with photon-counting CT: Initial experience.

Symons, Rolf / De Bruecker, Yves / Roosen, John / Van Camp, Laurent / Cork, Tyler E / Kappler, Steffen / Ulzheimer, Stefan / Sandfort, Veit / Bluemke, David A / Pourmorteza, Amir

Journal of cardiovascular computed tomography

2018 Volume 12, Issue 6, Page(s) 509–515

Abstract: Purpose: To evaluate the performance and clinical feasibility of 0.25 mm resolution mode of a dual-energy photon-counting detector (PCD) computed tomography (CT) system for coronary stent imaging and to compare the results to state-of-the-art dual- ... ...

Abstract	Purpose: To evaluate the performance and clinical feasibility of 0.25 mm resolution mode of a dual-energy photon-counting detector (PCD) computed tomography (CT) system for coronary stent imaging and to compare the results to state-of-the-art dual-energy energy-integrating detector (EID) CT. Materials and methods: Coronary stents with different diameters (2.0-4.0 mm) were examined inside a coronary artery phantom consisting of plastic tubes filled with iodine-based and gadolinium-based contrast material diluted to approximate clinical concentrations (n = 18). EID images were acquired using 2nd and 3rd generation dual-source CT systems (SOMATOM Flash and SOMATOM Force, Siemens Healthcare) at 0.60 mm (defined as standard-resolution (SR)) isotropic voxel size. Radiation-dose matched PCD images were acquired using a human prototype PCD system (Siemens Healthcare) at 0.50 mm (SR) and 0.25 mm (HR) imaging modes. Images were reconstructed using optimized convolution kernels. Results: Dual-energy HR PCD images significantly better stent lumen visualization (median: 69.5%, IQR: 61.2-78.9%) over dual-energy EID, and standard-resolution PCD images (median: 53.2-57.4%, all P < 0.01). HR PCD acquisitions reconstructed at SR image voxel size showed 25.3% lower image noise compared to SR PCD acquisitions (P < 0.001). High-resolution iodine and gadolinium maps, as well as virtual monoenergetic images, were calculated from the PCD data and enabled estimation of contrast agent concentration in the lumen without interference from the coronary stent. Conclusion: HR spectral PCD imaging significantly improves coronary stent lumen visibility over dual-energy EID. When the PCD-HR data was reconstructed into standard voxel sizes (0.5 mm isotropic) the image noise decreased by 25% compared to SR acquisition of PCD. Both dual-energy systems were consistent in estimating contrast agent concentrations.
MeSH term(s)	Computed Tomography Angiography/instrumentation ; Contrast Media ; Coronary Angiography/instrumentation ; Coronary Angiography/methods ; Coronary Vessels/diagnostic imaging ; Equipment Design ; Feasibility Studies ; Percutaneous Coronary Intervention/instrumentation ; Phantoms, Imaging ; Photons ; Predictive Value of Tests ; Prosthesis Design ; Reproducibility of Results ; Stents ; Tomography Scanners, X-Ray Computed
Chemical Substances	Contrast Media
Language	English
Publishing date	2018-10-15
Publishing country	United States
Document type	Comparative Study ; Evaluation Studies ; Journal Article
ZDB-ID	2394360-9
ISSN	1876-861X ; 1934-5925
ISSN (online)	1876-861X
ISSN	1934-5925
DOI	10.1016/j.jcct.2018.10.008
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Article ; Online: Prognostic Value and Reproducibility of AI-assisted Analysis of Lung Involvement in COVID-19 on Low-Dose Submillisievert Chest CT: Sample Size Implications for Clinical Trials

Radiol Cardiothorac Imaging

Abstract: PURPOSE: To compare the prognostic value and reproducibility of visual versus AI-assisted analysis of lung involvement on submillisievert low-dose chest CT in COVID-19 patients. MATERIALS AND METHODS: This was a HIPAA-compliant, institutional review ... ...

Abstract	PURPOSE: To compare the prognostic value and reproducibility of visual versus AI-assisted analysis of lung involvement on submillisievert low-dose chest CT in COVID-19 patients. MATERIALS AND METHODS: This was a HIPAA-compliant, institutional review board-approved retrospective study. From March 15 to June 1, 2020, 250 RT-PCR confirmed COVID-19 patients were studied with low-dose chest CT at admission. Visual and AI-assisted analysis of lung involvement was performed by using a semi-quantitative CT score and a quantitative percentage of lung involvement. Adverse outcome was defined as intensive care unit (ICU) admission or death. Cox regression analysis, Kaplan-Meier curves, and cross-validated receiver operating characteristic curve with area under the curve (AUROC) analysis was performed to compare model performance. Intraclass correlation coefficients (ICCs) and Bland- Altman analysis was used to assess intra- and interreader reproducibility. RESULTS: Adverse outcome occurred in 39 patients (11 deaths, 28 ICU admissions). AUC values from AI-assisted analysis were significantly higher than those from visual analysis for both semi-quantitative CT scores and percentages of lung involvement (all P<0.001). Intrareader and interreader agreement rates were significantly higher for AI-assisted analysis than visual analysis (all ICC ≥0.960 versus ≥0.885). AI-assisted variability for quantitative percentage of lung involvement was 17.2% (coefficient of variation) versus 34.7% for visual analysis. The sample size to detect a 5% change in lung involvement with 90% power and an α error of 0.05 was 250 patients with AI-assisted analysis and 1014 patients with visual analysis. CONCLUSION: AI-assisted analysis of lung involvement on submillisievert low-dose chest CT outperformed conventional visual analysis in predicting outcome in COVID-19 patients while reducing CT variability. Lung involvement on chest CT could be used as a reliable metric in future clinical trials.
Keywords	covid19
Publisher	PMC
Document type	Article ; Online
DOI	10.1148/ryct.2020200441
Database	COVID19

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Article: Stroke caused by cerebral air embolism during endoscopy.

Demaerel, Philippe / Gevers, Anna-Maria / De Bruecker, Yves / Sunaert, Stefan / Wilms, Guy

Gastrointestinal endoscopy

2003 Volume 57, Issue 1, Page(s) 134–135

MeSH term(s)	Aged ; Aged, 80 and over ; Embolism, Air/complications ; Embolism, Air/therapy ; Endoscopy, Gastrointestinal/adverse effects ; Humans ; Intracranial Embolism/diagnostic imaging ; Intracranial Embolism/etiology ; Intracranial Embolism/therapy ; Laryngectomy ; Magnetic Resonance Imaging ; Male ; Stroke/diagnostic imaging ; Stroke/etiology ; Stroke/therapy ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2003-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1067/mge.2003.43
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