Johannes P. M. van Heesewijk

St. Antonius Ziekenhuis

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study

BMJ (2009)

Wytze Laméris Adriënne van Randen H. Wouter van Es Johannes P. M. van Heesewijk Bert van Ramshorst

To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain.Fully paired multicentre diagnostic accuracy study with prospective data collection.Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands.1021 patients with non-traumatic abdominal pain of >2 hours' and <5 days' duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock.All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent.Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain.661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity.Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation.

Abdominal ultrasonography

Supine position

10.1136/bmj.b2431

Cite

Citations (397)

Effective Dose during Needle Interventions: Cone-beam CT Guidance Compared with Conventional CT Guidance

Journal of Vascular and Interventional Radiology (2011)

Sicco J. Braak Marco J. L. van Strijen Hendrik W. van Es Rutger A. J. Nievelstein Johannes P. M. van Heesewijk

Cone-Beam CT

10.1016/j.jvir.2011.02.011

Cite

Citations (57)

Pulmonary Masses: Initial Results of Cone-beam CT Guidance with Needle Planning Software for Percutaneous Lung Biopsy

CardioVascular and Interventional Radiology (2011)

Sicco J. Braak Gerarda J.M. Herder Johannes P. M. van Heesewijk Marco J. L. van Strijen

Target lesion

10.1007/s00270-011-0302-z

Cite

Citations (48)

Letters

Spine (2013)

Martin J. Willemink Hendrik W. van Es Pieter H. Helmhout Johannes C. Kelder Johannes P. M. van Heesewijk

Willemink, Martin J. MD; van Es, Hendrik W. MD, PhD; Helmhout, Pieter H. PhD; Kelder, Johannes C. MD; van Heesewijk, Johannes P.M. MD, PhD Author Information

10.1097/brs.0b013e31829e3ccb

Cite

Citations (0)

Case 190: Papillary Fibroelastoma of the Pulmonary Valve

Radiology (2013)

M.H. van Werkum Martin J. Swaans Hendrik W. van Es Benno Rensing Johannes P. M. van Heesewijk

Papillary fibroelastoma

Heart neoplasms

Cardiac magnetic resonance

10.1148/radiol.12110495

Cite

Citations (9)

Comparison of Imaging Strategies with Conditional versus Immediate Contrast-Enhanced Computed Tomography in Patients with Clinical Suspicion of Acute Appendicitis

European Radiology (2015)

Jasper J. Atema Sarah L. Gans Adriënne van Randen Wytze Laméris H. Wouter van Es

To compare the diagnostic accuracy of conditional computed tomography (CT), i.e. CT when initial ultrasound findings are negative or inconclusive, and immediate CT for patients with suspected appendicitis. Data were collected within a prospective diagnostic accuracy study on imaging in adults with acute abdominal pain. All patients underwent ultrasound and CT, read by different observers who were blinded from the other modality. Only patients with clinical suspicion of appendicitis were included. An expert panel assigned a final diagnosis to each patient after 6 months of follow-up (clinical reference standard). A total of 422 patients were included with final diagnosis appendicitis in 251 (60 %). For 199 patients (47 %), ultrasound findings were inconclusive or negative. Conditional CT imaging correctly identified 241 of 251 (96 %) appendicitis cases (95 %CI, 92 % to 98 %), versus 238 (95 %) with immediate CT (95 %CI, 91 % to 97 %). The specificity of conditional CT imaging was lower: 77 % (95 %CI, 70 % to 83 %) versus 87 % for immediate CT (95 %CI, 81 % to 91 %). A conditional CT strategy correctly identifies as many patients with appendicitis as an immediate CT strategy, and can halve the number of CTs needed. However, conditional CT imaging results in more false positives. • Conditional CT (CT after negative/inconclusive ultrasound findings) can be used for suspected appendicitis. • Half the number of CT examinations is needed with a conditional strategy. • Conditional CT correctly identifies as many patients with appendicitis as immediate CT. • Conditional imaging results in more false positive appendicitis cases.

Neuroradiology

Interventional radiology

Intravenous contrast

10.1007/s00330-015-3648-9

Cite

Citations (43)

Case 190

Radiology (2012)

M.H. van Werkum Martin J. Swaans Hendrik W. van Es Benno J. Rensing Johannes P. M. van Heesewijk

10.1148/radiol.12110393

Cite

Citations (0)

The Effects of Dynamic Isolated Lumbar Extensor Training on Lumbar Multifidus Functional Cross-Sectional Area and Functional Status of Patients With Chronic Nonspecific Low Back Pain

Spine (2012)

Martin J. Willemink Hendrik W. van Es Pieter H. Helmhout Arjen L. Diederik Johannes C. Kelder

A prospective single-arm trial.To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP).LM morphology is associated with the recurrence of CNSLBP.Sixteen male patients underwent a dynamic isolated resistance-training program for the lower back muscles of approximately 10 sessions in 12 weeks. In the next 12 weeks, frequency of training was tailored to the patients' need. Participants underwent lumbar magnetic resonance imaging at baseline (T0), after 12 weeks (T12), and after 24 weeks (T24). Functional cross-sectional area was obtained by analyzing the magnetic resonance images. Functional status was assessed using the patient-specific functional scale, Roland-Morris disability questionnaire, and global perceived effect scale.Roland-Morris disability questionnaire and patient-specific functional scale scores showed significant and clinically relevant improvements between baseline and T12, with 44% and 39%, respectively. Between T12 and T24, these scores did not change significantly. Seven participants (44%) reported clinically relevant improvements in global perceived effect at T12. At T24, 1 more participant reported a relevant global perceived effect improvement, whereas 2 participants (13%) reported worsening of their condition. The magnetic resonance imaging analysis showed minor nonsignificant changes in functional cross-sectional area.Our study shows that 10 weeks of dynamic isolated training of the lumbar extensors, once a week, leads to clinically relevant improvements in functional status of men with CNSLBP, without accompanying improvements in functional cross-sectional area of LM. These findings suggest that improvement in LM morphology is not a critical success factor in restoring functional status of patients with CNSLBP, at least in the short term (6 mo).

Cross-sectional study

10.1097/brs.0b013e318274fb2f

Cite

Citations (45)

CT evaluation of chronic thromboembolic pulmonary hypertension

Clinical Radiology (2011)

Martin J. Willemink H. Wouter van Es L. J. Koobs Wim J. Morshuis Repke J. Snijder

Thromboembolic disease

10.1016/j.crad.2011.09.012

Cite

Citations (26)

Real-Time 3D Fluoroscopy Guidance During Needle Interventions: Technique, Accuracy, and Feasibility

American Journal of Roentgenology (2010)

Sicco J. Braak Marco J. L. van Strijen Marc van Leersum H. Wouter van Es Johannes P. M. van Heesewijk

Real-time 3D fluoroscopy guidance using cone beam CT with dedicated needle path planning software is a promising new interventional technique. The objective of this study was to evaluate the procedure and to assess the accuracy and feasibility of this technique for use in needle interventions.All procedures were performed using a flat panel-based fluoroscopy system capable of acquiring cone beam CT images and dedicated needle path-planning software. This new technology allows the use of fluoroscopy coregistered with a 3D data set reconstructed from the acquired attenuation information. The needle trajectory is planned in the 3D data set using the needle path-planning software. The calculated trajectory is then projected on to the real-time fluoroscopy image. Fluoroscopy time, accuracy, technical success of the procedures, median procedure time, and complications were recorded in 145 interventions.One hundred forty-five needle interventions were performed in 139 patients using real-time 3D fluoroscopy guidance. Procedures were divided into five groups according to anatomic region: upper thoracic (n = 19; 13.1%), lower thoracic (n = 18; 12.4%), upper abdominal (n = 65; 44.8%), lower abdominal (n = 13; 9.0%), and musculoskeletal (n = 30; 20.7%). Thirty needle interventions were therapeutic, and 115 were diagnostic biopsies. All interventions were within the predefined 5-mm safety margin and achieved 100% technical success. A histopathologic diagnosis could be made in 91.4% of the diagnostic biopsies. The median interventional procedure time was 28.5 minutes, and the median fluoroscopy time was 2 minutes 58 seconds. There were minor complications in six patients (4.3%) and one major complication (0.7%).Real-time 3D fluoroscopy guidance is a new, promising, and feasible technique providing high accuracy in needle interventions.

10.2214/ajr.09.3647

Cite

Citations (90)