Janneke L. M. Bruggink

Accuracy of FDG-PET–CT in the Diagnostic Work-up of Vascular Prosthetic Graft Infection

OBJECTIVES To investigate the diagnostic accuracy of fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PET-CT in diagnosing vascular prosthetic graft infection. DESIGN Prospective cohort study with retrospective analysis. MATERIALS Twenty five patients with clinically suspected vascular prosthetic infection underwent CT and FDG-PET scanning. METHODS Two nuclear medicine physicians assessed the FDG-PET scans; all CT scans were assessed by two radiologists. Fused FDG-PET/CT were judged by the radiologist and the nuclear medicine physician. The concordance between CT and FDG-PET and the inter-observer agreement between the different readers were investigated. RESULTS Fifteen patients had a proven infection by culture. Single FDG-PET had the best results (sensitivity 93%, specificity 70%, positive predictive value 82% and negative predictive value 88%). For CT, these values were 56%, 57%, 60% and 58%, respectively. Fused CT and FDG-PET imaging also showed high sensitivity and specificity rates and high positive and negative values. Inter-observer agreement for FDG-PET analysis was excellent (kappa = 1.00) and moderate for CT and fused FDG-PET-CT analysis (0.63 and 0.66, respectively). CONCLUSION FDG-PET scanning showed a better diagnostic accuracy than CT for the detection of vascular prosthetic infection. This study suggests that FDG-PET provides a useful tool in the work-up for diagnosis of vascular prosthetic graft infection.

The quality of the early motor repertoire in preterm infants predicts minor neurologic dysfunction at school age.

OBJECTIVE The quality of a childs motor repertoire at age 3 to 4 months postterm is predictive of later cerebral palsy (CP). Its predictive power for minor neurologic dysfunction (MND) is unclear. This study aimed to investigate the predictive value of the quality of the early motor repertoire for the development of MND at school age. STUDY DESIGN We assessed the motor repertoire from video recordings made at 6 to 24 weeks postterm in 82 preterm infants (mean gestational age, 29.7 +/- 1.9 weeks; mean birth weight, 1183 +/- 302 g). At age 7 to 11 years, Touwens neurologic examination was performed, and the children were classified as normal (n = 49; 60%), MND (n = 18; 22%), or CP (n = 15; 18%). RESULTS Multiple logistic regression analysis showed that the quality of fidgety movements (FMs) and the quality of the concurrent motor repertoire had independent prognostic value for MND at school age. Abnormal FMs evolved into MND in 64% of the children. Nine of the 28 children with normal FMs and an abnormal concurrent motor repertoire developed abnormally (32%). Only 1 child of the 21 children with normal FMs and a normal concurrent motor repertoire developed MND (5%). CONCLUSIONS Assessment of the quality of the early motor repertoire can accurately identify individual infants at high and low risk for MND at school age.

The early motor repertoire of children born preterm is associated with intelligence at school age.

OBJECTIVE: The goal was to determine whether the quality of general movements (GMs) for preterm children had predictive value for cognitive development at school age. METHODS: In this prospective cohort study, 60 preterm infants (gestational age, median: 30.0 weeks [range: 25–33 weeks]; birth weight, median: 1130 g [range: 595–1800 g]) without cerebral palsy were studied. The quality of GMs was assessed prospectively as normal or abnormal, from video recordings that were made at regular intervals until 17 weeks after term. At 7 to 11 years, intelligence was tested by using the Wechsler Intelligence Scale for Children III, Dutch version. Total IQ (TIQ), verbal IQ (VIQ), and performance IQ (PIQ) scores were calculated. RESULTS: The median TIQ was 93 (range: 67–113), VIQ 96 (range: 68–117), and PIQ 92 (range: 65–119). Fifteen children (25%) had low TIQ scores (<85). When the quality of GMs normalized before 8 weeks after term, TIQ, VIQ, and PIQ scores were in the normal range. Consistently abnormal GMs to 8 weeks after term were associated with lower TIQ, VIQ, and PIQ scores. With correction for male gender and the educational levels of the parents, the likelihood ratio of consistently abnormal GMs for a low TIQ was 4.9 (95% confidence interval: 1.3–17.6). The model explained 22.4% of the variance. CONCLUSIONS: The quality of GMs during the early postterm period is a marker for intelligence at school age. Abnormal GMs during the early postterm period may reflect injury or developmental disruptions of brain areas involved in cognitive development.

Early motor repertoire is related to level of self-mobility in children with cerebral palsy at school age.

Aim  To determine the predictive value of the early motor repertoire for the level of self‐mobility in children with cerebral palsy (CP) at school age.

Current Role of Imaging in Diagnosing Aortic Graft Infections

Vascular prosthetic graft infection is a rare but serious complication after aortic graft replacement, with high morbidity and mortality rates. Therefore, adequate diagnostics are needed to detect and treat these infections as early as possible. Several imaging modalities provide different diagnostic values for detecting prosthetic graft infection. Previous studies reported on the diagnostic value of ultrasound, computed tomography imaging, magnetic resonance imaging, fluorodeoxyglucose-positron emission tomography, and single-photon emission computed tomography. In addition, adjunctive studies on new and promising techniques to detect prosthetic graft infection (eg, bio-optical imaging and target imaging with nuclear techniques) have also been investigated. This review provides a summary of noninvasive imaging modalities and their diagnostic values in order to evaluate and treat possible vascular graft infections as early as possible.

Pilot use of the early motor repertoire in infants with inborn errors of metabolism: outcomes in early and middle childhood.

BACKGROUND Predicting later outcome in neonates presenting with severe inborn errors of metabolism (IEM) is difficult. The assessment of the early motor repertoire is a reliable method of evaluating the integrity of the central nervous system in young infants. This method is based on an age-specific qualitative assessment of general movements (GMs, 0-8 weeks of age), fidgety movements (FMs) and the concurrent motor repertoire (9-20 weeks of age). AIM To determine the quality of the early motor repertoire (at 0-20 weeks post term age) in relation to later neurological outcome in infants with severe IEM. STUDY DESIGN Prospective cohort study. The quality of the motor repertoire was assessed from serial videotape recordings. SUBJECTS Five infants with IEM. Four presented with a severe IEM in the neonatal period: an undefined gluconeogenesis defect, propionic acidemia, arginosuccinate synthetase and arginosuccinate lyase deficiency. One neonate was antenatally diagnosed with arginosuccinate synthetase deficiency. OUTCOME MEASURES Outcome at the age of at least 18 m was determined by neurological examination and developmental tests. RESULTS All infants initially had abnormal GMs: hypokinesia, followed by GMs of a poor repertoire. The quality of the early motor repertoire normalised in 3 infants, and remained abnormal in 2. The more severe and persistent abnormalities of the motor repertoire were considered with the more abnormal neurological and developmental scores, later on. CONCLUSIONS The quality of the early motor repertoire might be related to later neurological outcome in infants with inborn errors of metabolism.

Spectroscopy to improve identification of vulnerable plaques in cardiovascular disease

Many apparent healthy persons die from cardiovascular disease, despite major advances in prevention and treatment of cardiovascular disease. Traditional cardiovascular risk factors are able to predict cardiovascular events in the long run, but fail to assess current disease activity or nearby cardiovascular events. There is a clear relation between the occurrence of cardiovascular events and the presence of so-called vulnerable plaques. These vulnerable plaques are characterized by active inflammation, a thin cap and a large lipid pool. Spectroscopy is an optical imaging technique which depicts the interaction between light and tissues, and thereby shows the biochemical composition of tissues. In recent years, impressive advances have been made in spectroscopy technology and intravascular spectroscopy is able to assess the composition of plaques of interest and thereby to identify and actually quantify plaque vulnerability. This review summarizes the current evidence for spectroscopy as a measure of plaque vulnerability and discusses the potential role of intravascular spectroscopic imaging techniques.

Het motorrepertoire van te vroeg geborenen is geassocieerd met intelligentie op de schoolleeftijd

Kinderen die te vroeg geboren worden, hebben lagere IQ-scores dan hun leeftijdgenoten die à term geboren worden, zelfs zonder dat sprake is van ernstig hersenletsel of ernstige motorische handicaps (Johnson, 2007). Geschat wordt dat cognitieve stoornissen voorkomen bij 25–50% van de te vroeg geborenen met een zeer laag geboortegewicht (<1500 g) (Johnson, 2007; Bhutta, Cleves, Casey, Cradock & Anand, 2002; Aylward, 2005). Cognitieve stoornissen zonder ernstige motorische stoornissen zijn de meest voorkomende neurologische restverschijnselen bij te vroeg geborenen. Deze cognitieve stoornissen worden steeds duidelijker op de schoolleeftijd, als het kind meer complexe cognitieve taken moet uitvoeren. Het intelligentiequotiënt (IQ) is gemiddeld 4–10 punten lager bij kinderen die geboren zijn vóór 32 weken zwangerschapsduur dan bij à terme geboren leeftijdgenoten (Johnson, 2007; Aylward, 2005). Geschat wordt dat bij elke week van de zwangerschap die korter is dan 32 weken, het IQ ongeveer 1,7 punten lager is (Bhutta, Cleves, Casey, Cradock & Anand, 2002). Dit stijgt zelfs tot 2,5 punten voor elke week minder dan 27 weken zwangerschapsduur (Johnson, 2007).Het blijft lastig om op jonge leeftijd juist dat kind te identificeren, dat een verhoogd risico heeft op het ontwikkelen van deze cognitieve stoornissen. Hoewel MRI-onderzoek bij te vroeg geborenen vaak uitgebreide wittestofafwijkingen en een afname van het volume van de grijze stof laat zien, zijn er geen duidelijke associaties van cognitief functioneren met pathologische afwijkingen bij beeldvormend onderzoek.De kwalitatieve beoordeling van de General Movements (GM’s) bij zuigelingen volgens Prechtl is een betrouwbare, sensitieve en niet-invasieve methode om het functioneren van de hersenen te beoordelen op jonge leeftijd (Prechtl, Einspieler, Cioni, Bos, Ferrari & Sontheimer, 1997). Beoordeling van GM’s is gebaseerd op zogenaamde Gestaltperceptie, waarbij rekening gehouden wordt met de complexiteit en de variabiliteit van de beweging. De kwaliteit van GM’s op jonge leeftijd is een krachtige voorspeller voor motorisch functioneren op latere leeftijd (Bos, Martijn, Van Asperen, Hadders-Algra, Okken & Prechtl, 1998; Cioni et al., 2000; Ferrari et al., 2002; Einspieler et al., 2002; Bruggink et al., 2008). Echter, de toegevoegde waarde van GM’s voor het voorspellen van het cognitief functioneren op latere leeftijd is nog onduidelijk.Het doel van deze studie was om te onderzoeken of de kwaliteit van het bewegingsrepertoire op jonge leeftijd een voorspellende waarde heeft voor intelligentie en school prestaties op de schoolleeftijd.AbstractBackground:The quality of general movements (GMs) during early infancy is a powerful predictor of motor disorders in later childhood.Objective:To determine whether quality of GMs in preterm children also has predictive value for cognitive development at school age.Patients and methods:In this prospective cohort study, 60 preterm infants (median gestational age 30.0 weeks, range 25–33, birth weight 1130 grams [595–1800])) without cerebral palsy were studied. The quality of GMs was prospectively assessed as normal or abnormal from video recordings that were made at regular intervals until 17 weeks postterm. At 7–11 years, intelligence was tested using the WISC-IIINL. Total (TIQ), verbal (VIQ) and performance (PIQ) IQ-scores were calculated.Results:Median TIQ was 93 (67–113), VIQ 96 (68–117) and PIQ 92 (65–119). Fifteen children (25%) had a low TIQ (<85). When the quality of GMs had normalized before 8 weeks postterm, TIQ, VIQ and PIQ were in the normal range. A consistently abnormal quality of GMs before 8 weeks postterm was associated with a lower TIQ, VIQ and PIQ. Corrected for male gender and educational levels of the parents, the likelihood ratio of consistently abnormal GM’s for a low TIQ, was 4.9 (95%CI: 1.3–17.6). The model explained 22.4% of the variance.Conclusions:The quality of GMs during the early postterm period is a marker for intelligence at school age. Abnormal quality of GMs during early postterm period may reflect injury or developmental disruptions of brain areas involved in cognitive development.