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Kastler A, Carneiro I, Perolat R, Rudel A, Pialat JB, Lazard A, Isnard S, Krainik A, Amoretti N, Grand S, Stacoffe N. Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations. Neuroradiology 2024; 66:855-863. [PMID: 38453715 DOI: 10.1007/s00234-024-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France.
| | - Inês Carneiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Romain Perolat
- Radiology Unit, Carémeau University Hospital, Nimes, France
| | - Alexandre Rudel
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | | | - Arnaud Lazard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Stephanie Isnard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Alexandre Krainik
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Amoretti
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | - Sylvie Grand
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Stacoffe
- Diagnostic and Interventional Radiology Unit, Lyon Sud Hospital, Lyon, France
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Lucchino N, Pialat JB, Marquette C, Courtial E, Erhard L, Voulliaume D, Mojallal A, Gazarian A. 3D MODEL of an anatomically inert human hand: feasibility study. Hand Surg Rehabil 2024:101709. [PMID: 38685316 DOI: 10.1016/j.hansur.2024.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Surgery for congenital malformation of the hand is complex and protocols are not available. Simulation could help optimize results. The objective of the present study was to design, produce and assess a 3D-printed anatomical support, to improve success in rare and complex surgeries of the hand. MATERIAL AND METHODS We acquired MRI imaging of the right hand of a 30 year-old subject, and analyzed and split the various skin layers for segmentation. We created the prototype of a healthy hand, using 3D multi-material and silicone printing devices, and drew up a printing protocol suitable for all patients. We printed a base, comprising bones, muscles and tendons, with a multi-material 3D printer, then used a 3D silicone printer for skin and subcutaneous fatty cell tissues in a glove-like shape. To evaluate the characteristics of the prototype, we performed a series of dissections on the synthetic hand and on a cadaveric hand in the anatomy lab, comparing realism, ease of handling and the final result of the two supports, and evaluated their respective advantages in surgical and training contexts. A grading form was given to each surgeon to establish a global score. RESULTS This evaluation highlighted the positive and negative features of the model. The model avoided intrinsic problems of cadavers, such as muscle rigidity and tissue fragility and atrophy and enables the anatomy of a specific patient to be rigorously respected. On the other hand, vascular and nervous networks, with their potential anatomical variants, are lacking. This preliminary phase highlighted the advantages and inconveniences of the prototype, to optimize the design and printing of future models. It is an indispensable prerequisite before performing studies in eligible pediatric patients with congenital hand malformation. CONCLUSION The validation of 3D-printed anatomical model of a human hand opens a large field of applications in the area of preoperative surgical planning. The postoperative esthetic and functional benefit of such pre-intervention supports in complex surgery needs assessing.
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Affiliation(s)
- Noé Lucchino
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, Hôpital Saint Joseph Saint Luc, 20 Quai Claude Bernard, 69007 Lyon, France.
| | - Jean-Baptiste Pialat
- Department of Radiology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France, CREATIS Université Lyon 1, CREATIS-LRMN.
| | - Christophe Marquette
- 3d.FAB, Université Lyon, Université Lyon1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246, 43, Bd du 11 novembre 1918, 69622, Villeurbanne Cedex, France, CNRS/UMR/5220-INSERM U630, 69100 Villeurbanne, France, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.
| | - Edwin Courtial
- 3d.FAB, Université Lyon, Université Lyon1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246, 43, Bd du 11 novembre 1918, 69622, Villeurbanne Cedex, France, CNRS/UMR/5220-INSERM U630, 69100 Villeurbanne, France, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France.
| | - Lionel Erhard
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet 69100 Villeurbanne, France.
| | - Delphine Voulliaume
- Service de Chirurgie Plastique, Reconstructrice et Esthétique, Hôpital Saint Joseph Saint Luc, 20 Quai Claude Bernard, 69007 Lyon, France.
| | - Ali Mojallal
- Department of Plastic Reconstructive and Aesthetic Surgery, University of Lyon, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France.
| | - Aram Gazarian
- Chirurgie de la Main et du Membre Supérieur, Polyclinique Orthopédique de Lyon, Lyon, France
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Lavigne J, Stacoffe N, Heidelberg D, Wagner P, Pialat JB. A Feasibility Study of CT-Guided Osteosynthesis under Local Anesthesia. J Pers Med 2023; 13:1493. [PMID: 37888104 PMCID: PMC10608047 DOI: 10.3390/jpm13101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Evaluation of local anesthesia for perioperative pain control in patients undergoing CT-guided percutaneous osteosynthesis. METHODS A total of 12 patients underwent percutaneous osteosynthesis under local anesthesia. Intraoperative pain was assessed after the procedure using numerical rating scale (NRS). Patients were also asked to rate their overall experience of the operation using the following scale: "highly comfortable, comfortable, hardly comfortable, uncomfortable" and, finally, "Would you be willing to repeat this intervention again under the same conditions if necessary?" Patients were also clinically followed up at 1 month, 3 months, and 6 months using the EQ5D5L scale to assess their pain and quality of life. RESULTS Patients underwent percutaneous osteosynthesis for osteoporotic (n = 9), pathological (n = 2), or traumatic fractures (n = 1), including the thoraco-lumbar spine (n = 8) or the pelvis (n = 4). The mean of NRS value experienced during the procedure was 3.4/10 (0-8). The overall feeling was highly comfortable (42%), comfortable (50%), hardly comfortable (8%), and uncomfortable (0%). Finally, 75% of patients answered "YES" to the question of repeating the operation under the same conditions if necessary. At follow-up, a significant reduction in pain was observed postoperatively. According to the EQ5D5L scale, there was a significant improvement in pain, mobility, self-activities, autonomy, and perceived quality of life at 3 and 6 months. CONCLUSION Radiological percutaneous osteosynthesis is an effective technique that can be performed under local anesthesia with a comfortable experience for most of the patients.
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Affiliation(s)
- Joris Lavigne
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Nicolas Stacoffe
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Damien Heidelberg
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Philippe Wagner
- Centre D’étude des Maladies Osseuses, INSERM U1033, Université Lyon 1, 69008 Lyon, France;
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
- Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
- Unité CNRS UMR 5220, INSERM U1294, Université Lyon 1, INSA Lyon, Université Jean Monnet, 42100 Saint-Etienne, France
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Dandache C, Confavreux CB, Gavoille A, Massy E, Chambard L, Rambaud J, Geye M, Brevet M, Girard N, Subtil F, Pialat JB. Peripheral but not axial muscle mass is associated with early mortality in bone metastatic lung cancer patients at diagnosis. Joint Bone Spine 2023; 90:105613. [PMID: 37442335 DOI: 10.1016/j.jbspin.2023.105613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Identification of sarcopenia is a key issue in oncology. Several methods may be used to evaluate muscle mass in patients. Routine cancer follow-up computed tomography (CT) provides axial muscle mass whereas whole-body densitometry (DEXA) measures appendicular lean mass (ALM). Up to now, no studies have assessed, in cancer patients, the correlation between CT and DEXA muscle mass indicators and compared their prognostic value. METHODS We included patients with synchronous bone metastases from lung adenocarcinoma at diagnosis. Diagnosis was confirmed by bone biopsy. Skeletal muscle area was determined semi-automatically on initial CT scan at the T7, T12, and L3 vertebral level using Osirix® software. The skeletal muscle index (SMI) was calculated as the ratio of muscle area to height squared. Standardised ALM/height squared data were obtained by DEXA assessment within a 30-day window of CT. RESULTS A total of 65 patients were included; 47 (72%) were male. Mean±SD age was 65±11.4years. DEXA was available for 46 patients. The performance status was good (<1) for 39 patients. SMI indicators were significantly correlated with each other (rho from 0.3 to 0.7) but moderately correlated with ALM (rho from 0.1 to 0.7). ALM had a good discriminatory ability on 6-month survival (AUC 0.87 [0.76; 0.97]). ALM was associated with early mortality (<6months) (HR=0.29, 95% CI [0.15; 0.57]; P<0.001) but not with later mortality (>6months). In contrast, no significant effect was found for SMI. CONCLUSIONS Peripheral muscle mass (standardized ALM by DEXA) but not axial muscle mass (SMI assessed by CT) was associated with early mortality (<6months) suggesting that cancer-induced muscle loss would affect differently appendicular muscles and axial muscles.
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Affiliation(s)
- Célia Dandache
- Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Département de Radiologie, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France
| | - Cyrille B Confavreux
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Inserm UMR1033, LYOS, Université de Lyon, 69003 Lyon, France.
| | - Antoine Gavoille
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Service de Biostatistiques, Hospices Civils de Lyon, 69003 Lyon, France
| | - Emmanuel Massy
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Inserm UMR1033, LYOS, Université de Lyon, 69003 Lyon, France
| | - Lauriane Chambard
- Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Julien Rambaud
- Département de Radiologie, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France
| | - Madiane Geye
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département de Rhumatologie, Centre Expert des Métastases Osseuses (CEMOS), Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Marie Brevet
- Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; Département d'Anatomopathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, 69003 Lyon, France
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, 75014 Paris, France
| | - Fabien Subtil
- CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, 69100 Villeurbanne, France; Service de Biostatistiques, Hospices Civils de Lyon, 69003 Lyon, France
| | - Jean-Baptiste Pialat
- Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, Université de Lyon, 69100 Lyon, France; CREATIS, CNRS UMR 5220, Inserm 1206 Unit, Université Lyon 1, INSA Lyon, 69100 Villeurbanne, France
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Savary T, Fieux M, Douplat M, Tournegros R, Daubie S, Pavie D, Denoix L, Pialat JB, Tringali S. Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy. JAMA Netw Open 2023; 6:e239158. [PMID: 37079301 PMCID: PMC10119737 DOI: 10.1001/jamanetworkopen.2023.9158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
Importance There is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]). Objectives To estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later. Design, Setting, and Participants This retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France. Interventions All patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images. Main Outcomes and Measures The proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described. Results Among the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP. Conclusions and Relevance These preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.
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Affiliation(s)
- Thibault Savary
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Maxime Fieux
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Mondor Institute for Biomedical Research (IMRB), Créteil, France
- Centre National de la Recherche Scientifique (CNRS) Equipe Mixte de Recherche 7000, Créteil, France
| | - Marion Douplat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service des Urgences, Hospices Civils of Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Research on Healthcare Performance, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Unité Mixte de Recherche (UMR) Adés 7268, Aix-Marseille University, Etablissement Français du Sang–CNRS, Espace Éthique Méditerranéen, Marseille, France
| | - Romain Tournegros
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Sophie Daubie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Dylan Pavie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Luna Denoix
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jean-Baptiste Pialat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Creatis CNRS UMR 5220, INSERM U1294, Université Lyon 1, Villeurbanne, France
| | - Stephane Tringali
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d’Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS Université Claude Bernard Lyon 1, Lyon, France
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Galzin E, Roche L, Vlachomitrou A, Nempont O, Carolus H, Schmidt-Richberg A, Jin P, Rodrigues P, Klinder T, Richard JC, Tazarourte K, Douplat M, Sigal A, Bouscambert-Duchamp M, Si-Mohamed SA, Gouttard S, Mansuy A, Talbot F, Pialat JB, Rouvière O, Milot L, Cotton F, Douek P, Duclos A, Rabilloud M, Boussel L. Additional value of chest CT AI-based quantification of lung involvement in predicting death and ICU admission for COVID-19 patients. Res Diagn Interv Imaging 2022; 4:100018. [PMID: 37284031 PMCID: PMC9716289 DOI: 10.1016/j.redii.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
Objectives We evaluated the contribution of lung lesion quantification on chest CT using a clinical Artificial Intelligence (AI) software in predicting death and intensive care units (ICU) admission for COVID-19 patients. Methods For 349 patients with positive COVID-19-PCR test that underwent a chest CT scan at admittance or during hospitalization, we applied the AI for lung and lung lesion segmentation to obtain lesion volume (LV), and LV/Total Lung Volume (TLV) ratio. ROC analysis was used to extract the best CT criterion in predicting death and ICU admission. Two prognostic models using multivariate logistic regressions were constructed to predict each outcome and were compared using AUC values. The first model ("Clinical") was based on patients' characteristics and clinical symptoms only. The second model ("Clinical+LV/TLV") included also the best CT criterion. Results LV/TLV ratio demonstrated best performance for both outcomes; AUC of 67.8% (95% CI: 59.5 - 76.1) and 81.1% (95% CI: 75.7 - 86.5) respectively. Regarding death prediction, AUC values were 76.2% (95% CI: 69.9 - 82.6) and 79.9% (95%IC: 74.4 - 85.5) for the "Clinical" and the "Clinical+LV/TLV" models respectively, showing significant performance increase (+ 3.7%; p-value<0.001) when adding LV/TLV ratio. Similarly, for ICU admission prediction, AUC values were 74.9% (IC 95%: 69.2 - 80.6) and 84.8% (IC 95%: 80.4 - 89.2) respectively corresponding to significant performance increase (+ 10%: p-value<0.001). Conclusions Using a clinical AI software to quantify the COVID-19 lung involvement on chest CT, combined with clinical variables, allows better prediction of death and ICU admission.
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Affiliation(s)
- Eloise Galzin
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - Laurent Roche
- Department of Biostatistics, Hospices Civils de Lyon, Lyon F-69003, France
- Université de Lyon, Lyon F-69000, France
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR5558, Equipe Biostatistique-Santé, Villeurbanne F-69622, France
| | - Anna Vlachomitrou
- Philips France, 33 rue de Verdun, CS 60 055, Suresnes Cedex 92156, France
| | - Olivier Nempont
- Philips France, 33 rue de Verdun, CS 60 055, Suresnes Cedex 92156, France
| | - Heike Carolus
- Philips Research, Röntgenstrasse 24-26, Hamburg D-22335, Germany
| | | | - Peng Jin
- Philips Medical Systems Nederland BV (Philips Healthcare), the Netherlands
| | - Pedro Rodrigues
- Philips Medical Systems Nederland BV (Philips Healthcare), the Netherlands
| | - Tobias Klinder
- Philips Research, Röntgenstrasse 24-26, Hamburg D-22335, Germany
| | - Jean-Christophe Richard
- Department of Critical Care Medicine, Hôpital De La Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Karim Tazarourte
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Emergency department and SAMU 69, Hospices civils de Lyon, France
| | - Marion Douplat
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Emergency department and SAMU 69, Hospices civils de Lyon, France
| | - Alain Sigal
- Emergency department and SAMU 69, Hospices civils de Lyon, France
| | - Maude Bouscambert-Duchamp
- Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon F-69317, France
- Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, Lyon F-69372, France
| | - Salim Aymeric Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | | | - Adeline Mansuy
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
| | - François Talbot
- Department of Information Technology, Hospices Civils de Lyon, Lyon, France
| | - Jean-Baptiste Pialat
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Olivier Rouvière
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- LabTAU INSERM U1032, Lyon, France
| | - Laurent Milot
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- LabTAU INSERM U1032, Lyon, France
| | - François Cotton
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Philippe Douek
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Muriel Rabilloud
- Department of Biostatistics, Hospices Civils de Lyon, Lyon F-69003, France
- Université de Lyon, Lyon F-69000, France
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, CNRS, UMR5558, Equipe Biostatistique-Santé, Villeurbanne F-69622, France
| | - Loic Boussel
- Department of Radiology, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, Lyon U1294, France
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Vacheron CH, Bitker L, Thiolliére F, Subtil F, Abraham P, Collange V, Balança B, Haïne M, Guichon C, Leroy C, Simon M, Malapert A, Roche M, Pialat JB, Jallades L, Lepape A, Friggeri A, Falandry C. Prognosis of Old Intensive Care COVID-19 Patients at a Glance: The Senior COVID Study. Turk J Anaesthesiol Reanim 2022; 50:S57-S61. [PMID: 35775799 PMCID: PMC9629196 DOI: 10.5152/tjar.2022.21321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Admission in the intensive care unit of the old patient with coronavirus disease 19 raises an ethical question concerning the scarce resources and their short-term mortality. METHODS Patients aged over 60 from 7 different intensive care units admitted between March 1, 2020 and May 6, 2020, with a diagnosis of coronavirus disease 19 were included in the cohort. Twenty variables were collected during the admission, such as age, severity (Simplified Acute Physiology Score [SAPS] II), several data on physiological status before intensive care unit comorbidities, evaluation of autonomy, frailty, and biological variables. The objective was to model the 30-day mortality with relevant variables, compute their odds ratio associated with their 95% CI, and produce a nomogram to easily estimate and communicate the 30-day mortality. The performance of the model was estimated with the area under the receiving operating curve. RESULTS We included 231 patients, among them 60 (26.0%) patients have died on the 30th day. The relevant variables selected to explain the 30-day mortality were Instrumental Activities of Daily Living (IADL) score (0.82 [0.71-0.94]), age 1.12 (1.07-1.18), SAPS II 1.05 (1.02-1.08), and dementia 6.22 (1.00-38.58). A nomogram was computed to visually represent the final model. Area under the receiving operating curve was at 0.833 (0.776-0.889). CONCLUSIONS Age, autonomy, dementia, and severity at admission were important predictive variables for the 30-day mortality status, and the nomogram could help the physician in the decision-making process and the communication with the family.
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Affiliation(s)
- Charles-Hervé Vacheron
- Department of Anaesthesiology and Reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, Hospices Civils de Lyon, Villeurbanne, France
- Division of Public Health, Department of Biostatistics and Bioinformatics, Lyon, France
| | - Laurent Bitker
- Department of Intensive Medicine and Resuscitation, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fabrice Thiolliére
- Department of Anaesthesiology and Reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, Hospices Civils de Lyon, Villeurbanne, France
| | - Paul Abraham
- Department of Anaesthesia and Resuscitation, Édouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Claude Bernard University Faculty of Medicine, Lyon, France
| | | | - Baptiste Balança
- Department of Anaesthesia and Resuscitation, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | - Max Haïne
- North West Hospital of Villefranche, France
| | - Céline Guichon
- Inter-University Laboratory of Human Movement Biology, Villeurbanne, France
- Department of Anaesthesia and Surgical Resuscitation, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Christophe Leroy
- Department of Intensive Care Medicine, Emile Roux Hospital Center, le Puy en Velay, France
| | - Marie Simon
- Department of Anaesthesia and Resuscitation, Édouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Amélie Malapert
- Plateforme IC-HCL, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Mélanie Roche
- Plateforme IC-HCL, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Jallades
- Department of Biological Hematology, Lyon Sud Hospital South Biology and Pathology Center, Pierre-Bénite, France
| | - Alain Lepape
- Department of Intensive Care, Henry Gabrielle Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Critical Care, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Friggeri
- Department of Anaesthesiology and Reanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Division of Geriatrics, Center Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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8
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Stacoffe N, Pialat JB, Heidelberg D, Adnane S, Lavigne J, Cotton F, Confavreux CB, Grange S. Percutaneous osteosynthesis for the treatment of traumatic odontoid fractures in elderly patients. Diagn Interv Imaging 2022; 103:378-380. [DOI: 10.1016/j.diii.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
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9
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Wagner PP, Roux JP, Chuzel Q, Szulc P, Bermond F, Duboeuf F, Chapurlat R, Follet H, Pialat JB. Dual-energy CT hybridation and kernel processing effects on the estimation of bone mineral mass and density: a calcination study on ex vivo human femur. Osteoporos Int 2022; 33:909-920. [PMID: 34837503 DOI: 10.1007/s00198-021-06210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent technological advances with dual-energy quantitative computed tomography (DEQCT) allow to combine two images of different level of energy to obtain simulated mono-energetic images at 60 keV (SIM60KeV-QCT) with improved image contrast in clinical practice. This study includes three topics: (1) compare bone mineral content (BMC), areal and volumetric bone mineral density (aBMD, vBMD) obtained with SIM60KeV-QCT, single-energy QCT (SEQCT), and dual X-ray absorptiometry (DXA); (2) compare ash density and weight with respective vBMD and BMC assessed on SIM60KeV-QCT, SEQCT, and DXA; and (3) compare the influence of reconstruction kernels on the accuracy of vBMD and BMC using ash density and ash weight as the reference values. METHODS DXA, SEQCT, and DEQCT acquisitions were performed ex vivo on 42 human femurs. Standard kernel (SK) and bone kernel (BK) were applied to each stack of images. Ten diaphyses and 10 femoral necks were cut, scanned, and reconstructed using the techniques described above. Finally, the bone specimens were calcined to obtain the ash weight. RESULTS QCT analysis (SEQCT, SIM60KeV-QCT) underestimated BMC value compared to DXA. For femoral necks, all QCT analyses provided an unbiased estimate of ash weight but underestimated ash density regardless of the kernel used. For femoral diaphysis, SEQCT BK, SIM60KeV-QCT BK, and SK underestimated ash weight but not ash density. CONCLUSION BMC and vBMD quantifications with the SIM60KeV-QCT gave similar results as the SEQCT. Further studies are needed to optimize the use of SIM60KeV-QCT in clinical situations. SK should be used given the effect of kernels on QCT assessment.
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Affiliation(s)
- Philippe Paul Wagner
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Jean-Paul Roux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Quentin Chuzel
- Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Pawel Szulc
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - François Bermond
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
| | - François Duboeuf
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Roland Chapurlat
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Hélène Follet
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France
| | - Jean-Baptiste Pialat
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR1033, 69008, Lyon, France.
- Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon, France.
- Department of Radiology, Hospices Civils de Lyon, Service de Radiologie, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand Revoyet 69310, Pierre-Bénite, France.
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10
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Falandry C, Bitker L, Abraham P, Subtil F, Collange V, Balança B, Haïne M, Guichon C, Leroy C, Simon M, Malapert A, Pialat JB, Jallades L, Lepape A, Friggeri A, Thiolliere F. Senior-COVID-Rea Cohort Study: A Geriatric Prediction Model of 30-day Mortality in Patients Aged over 60 Years in ICU for Severe COVID-19. Aging Dis 2022; 13:614-623. [PMID: 35371615 PMCID: PMC8947822 DOI: 10.14336/ad.2021.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
The SARS-COV2 pandemic induces tensions on health systems and ethical dilemmas. Practitioners need help tools to define patients not candidate for ICU admission. A multicentre observational study was performed to evaluate the impact of age and geriatric parameters on 30-day mortality in patients aged ≥60 years of age. Patients or next of kin were asked to answer a phone questionnaire assessing geriatric covariates 1 month before ICU admission. Among 290 screened patients, 231 were included between March 7 and May 7, 2020. In univariate, factors associated with lower 30-day survival were: age (per 10 years increase; OR 3.43, [95%CI: 2.13-5.53]), ≥3 CIRS-G grade ≥2 comorbidities (OR 2.49 [95%CI: 1.36-4.56]), impaired ADL, (OR 4.86 [95%CI: 2.44-9.72]), impaired IADL8 (OR 6.33 [95%CI: 3.31-12.10], p<0.001), frailty according to the Fried score (OR 4.33 [95%CI: 2.03-9.24]) or the CFS ≥5 (OR 3.79 [95%CI: 1.76-8.15]), 6-month fall history (OR 3.46 [95%CI: 1.58-7.63]). The final multivariate model included age (per 10 years increase; 2.94 [95%CI:1.78-5.04], p<0.001) and impaired IADL8 (OR 5.69 [95%CI: 2.90-11.47], p<0.001)). Considered as continuous variables, the model led to an AUC of 0.78 [95% CI: 0.72, 0.85]. Age and IADL8 provide independent prognostic factors for 30-day mortality in the considered population. Considering a risk of death exceeding 80% (82.6% [95%CI: 61.2% - 95.0%]), patients aged over 80 years with at least 1 IADL impairment appear as poor candidates for ICU admission.
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Affiliation(s)
- Claire Falandry
- Hospices Civils de Lyon, Service de Gériatrie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université de Lyon, Laboratoire CarMeN, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Mérieux Medical School, Pierre-Bénite, France.,Correspondence should be addressed to: Dr. Claire Falandry, Hospices Civils de Lyon, Service de Gériatrie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Laurent Bitker
- Hospices Civils de Lyon, Service de Réanimation Médicale, Hôpital de La Croix Rousse, Lyon, France.,Université de Lyon, CREATIS INSERM 1044 CNRS 5220, Villeurbanne, France.
| | - Paul Abraham
- Hospices Civils de Lyon, Département d’anesthésie et reanimation médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Fabien Subtil
- Université de Lyon, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Université Claude Bernard Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.
| | - Vincent Collange
- Medipole Lyon-Villeurbanne, Département anesthésie réanimation, Villeurbanne, France.
| | - Baptiste Balança
- Hospices Civils de Lyon, Département of d’Anesthésie Réanimation Neurologique, Hôpital Wertheimer, Bron, France.,Hôpital Pierre Wertheimer; Université de Lyon, Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Bron, France.
| | - Max Haïne
- Hôpital Nord-Ouest, Service de Gériatrie, Gleizé, France.
| | - Céline Guichon
- Hospices Civils de Lyon, Service de réanimation, Centre hospitalier universitaire de la Croix Rousse, Lyon, France.,Université de Lyon, Lyon, France.
| | - Christophe Leroy
- Centre Hospitalier Emile Roux, Service de réanimation, Le Puy-en-Velay, France.
| | - Marie Simon
- Hospices Civils de Lyon, Service de Médecine Intensive-Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France.
| | - Amélie Malapert
- Hospices Civils de Lyon, Plateforme Transversale de Recherche de l'ICHCL, Pierre-Bénite, France.
| | - Jean-Baptiste Pialat
- Hospices Civils de Lyon, Service de radiologie, Groupement Hospitalier Sud; Pierre-Bénite, France.,Université de Lyon, CREATIS CNRS UMR 5220 INSERM U1206, Villeurbanne, France.
| | - Laurent Jallades
- Hospices Civils de Lyon, Service d'Hématologie biologique - Groupement Hospitalier Sud, Pierre-Bénite, France.
| | - Alain Lepape
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université de Lyon, Centre International de Recherche en Infectiologie (CIRI), Lyon, France. On behalf of the Senior-COVID-Rea study group. ^Membership of the Senior-COVID-Rea study group is provided in the Acknowledgments section.;
| | - Arnaud Friggeri
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
| | - Fabrice Thiolliere
- Hospices Civils de Lyon, Service d’Anesthésie-Réanimation, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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Miailhes P, Conrad A, Sobas C, Laurent F, Lustig S, Ferry T, Ferry T, Valour F, Perpoint T, Ader F, Roux S, Becker A, Triffault-Fillit C, Conrad A, Pouderoux C, Chauvelot P, Chabert P, Lippman J, Braun E, Lustig S, Servien E, Batailler C, Gunst S, Schmidt A, Sappey-Marinier E, Ode Q, Fessy MH, Viste A, Besse JL, Chaudier P, Louboutin L, Van Haecke A, Mercier M, Belgaid V, Gazarian A, Walch A, Bertani A, Rongieras F, Martres S, Trouillet F, Barrey C, Mojallal A, Brosset S, Hanriat C, Person H, Céruse P, Fuchsmann C, Gleizal A, Aubrun F, Dziadzko M, Macabéo C, Patrascu D, Laurent F, Beraud L, Roussel-Gaillard T, Dupieux C, Kolenda C, Josse J, Craighero F, Boussel L, Pialat JB, Morelec I, Tod M, Gagnieu MC, Goutelle S, Mabrut E. Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure. Arthroplasty 2021; 3:43. [PMID: 35610714 PMCID: PMC8796341 DOI: 10.1186/s42836-021-00097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended treatment is combined doxycycline and hydroxychloroquine for 18 months, with cotrimoxazole as another option. Coxiella burnetti infection has been implicated in rare cases of prosthetic joint infection (PJI), and the medical and surgical management and outcome in such cases have been little reported. Case presentation We report an unusual case of chronic Q fever involving a hip arthroplasty in an immunocompromised woman treated with tumor necrosis factor (TNF)-α blockers for rheumatoid arthritis. Numerous surgical procedures (explantation, “second look”, femoral resection and revision by megaprosthesis), modification of the immunosuppressant therapy and switch from doxycycline-hydroxychloroquine to prolonged ofloxacin-rifampin combination therapy were needed to achieve reconstruction and treat the PJI, with a follow-up of 7 years. Conclusions Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced reference center. Combined use of ofloxacin-rifampin can be effective.
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Fantino O, Bouysset M, Pialat JB. Can the axial cross-sectional area of the tibial nerve be used to diagnose tarsal tunnel syndrome? An ultrasonography study. Orthop Traumatol Surg Res 2021; 107:102630. [PMID: 32682728 DOI: 10.1016/j.otsr.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 11/11/2019] [Accepted: 02/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The axial cross-sectional area (CSA) of the tibial nerve can be measured with ultrasonography. In patients who have posteromedial tarsal tunnel syndrome (TTS), there is little information on the nerve's CSA even though this information could be useful for determining whether the nerve is damaged. This led us to carry out a case-control study in which the tibial nerve's axial CSA was measured in healthy patients and in patients with TTS. HYPOTHESIS The tibial nerve's axial CSA can be used as a diagnostic criterion for TTS. METHODS Twenty-three patients (27 feet) (11 men, 12 women, mean age=54±14 years), who had clinical and electroneuromyography signs of TTS, were compared to 21 healthy adults (8 men, 13 women, mean age 39±10 years). An ultrasonography examination was carried out to look for a source of nerve compression, then the axial CSA of the tibial nerve was measured 10cm above the tarsal tunnel (lCSA) and inside the tunnel itself (ttCSA). The difference between the two measurements was then calculated: ΔCSA=ttCSA-lCSA. The data were analysed using correlation tests and non-parametric tests, a multivariate linear regression and ROC tests. RESULTS A compressive cause was found by ultrasonography in 13 patients. The mean values of ttCSA and ΔCSA were 20.1±8.8 mm2 [6-42] vs. 10.3±2.3 mm2 [8-14] (p=0.0001) and 9.8±6.7 mm2 [0-29] vs. -0.2±1.8 mm2 [-3-4] (p<0.0001) in the patients and the controls, respectively. The differences in ΔCSA remained significant in the multivariate analysis after adjusting for age and weight. The best threshold for ttCSA in the TTS group was 15 mm2 with 74% sensitivity and 100% specificity. The best threshold for ΔCSA was 5mm2 with 81% sensitivity and 100% specificity. DISCUSSION The difference in the measured axial CSA of the tibial nerve by ultrasonography between the posteromedial tarsal tunnel and 10cm above the tunnel is a key data point for the diagnosis of tarsal tunnel syndrome with and without compressive etiology. LEVEL OF EVIDENCE III, diagnostic case-control study.
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Affiliation(s)
- Olivier Fantino
- Imagerie Médicale du Parc, Clinique du Parc, 155 bis, boulevard Stalingrad, 69006 Lyon, France; Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France.
| | - Maurice Bouysset
- Cabinet de Rhumatologie, 19, cours Lafayette, 69006 Lyon, France
| | - Jean-Baptiste Pialat
- Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France; Université de Lyon, Lyon, France
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13
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Falandry C, Malapert A, Roche M, Subtil F, Berthiller J, Boin C, Dubreuil J, Ravot C, Bitker L, Abraham P, Collange V, Balança B, Goutte S, Guichon C, Gadea E, Argaud L, Dayde D, Jallades L, Lepape A, Pialat JB, Friggeri A, Thiollière F. Risk factors associated with day-30 mortality in patients over 60 years old admitted in ICU for severe COVID-19: the Senior-COVID-Rea Multicentre Survey protocol. BMJ Open 2021; 11:e044449. [PMID: 34230013 PMCID: PMC8264162 DOI: 10.1136/bmjopen-2020-044449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION With the spread of COVID-19 epidemic, health plans must be adapted continuously. There is an urgent need to define the best care courses of patients with COVID-19, especially in intensive care units (ICUs), according to their individualised benefit/risk ratio. Since older age is associated with poorer short-term and long-term outcomes, prediction models are needed, that may assist clinicians in their ICU admission decision. Senior-COVID-Rea was designed to evaluate, in patients over 60 years old admitted in ICU for severe COVID-19 disease, the impact of age and geriatric and paraclinical parameters on their mortality 30 days after ICU admission. METHODS AND ANALYSIS This is a multicentre survey protocol to be conducted in seven hospitals of the Auvergne-Rhône-Alpes region, France. All patients over 60 years old admitted in ICU for severe COVID-19 infection (or their legally acceptable representative) will be proposed to enter the study and to fill in a questionnaire regarding their functional and nutritional parameters 1 month before COVID-19 infection. Paraclinical parameters at ICU admission will be collected: lymphocytes and neutrophils counts, high-fluorescent lymphoid cells and immature granulocytes percentages (Sysmex data), D-dimers, C-reactive protein, lactate dehydrogenase (LDH), creatinine, CT scan for lung extension rate as well as clinical resuscitation scores, and the delay between the first signs of infection and ICU admission. The primary outcome will be the overall survival at day 30 post-ICU admission. The analysis of factors predicting mortality at day 30 will be carried out using univariate and multivariate logistic regressions. Multivariate logistic regression will consider up to 15 factors.The ambition of this trial, which takes into account the different approaches of geriatric vulnerability, is to define the respective abilities of different operational criteria of frailty to predict patients' outcomes. ETHICS AND DISSEMINATION The study protocol was ethically approved. The results of the primary and secondary objectives will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04422340.
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Affiliation(s)
- Claire Falandry
- Service de Gériatrie, Centre Hospitaliser Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Laboratoire CarMeN, Inserm U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Faculté de Médecine et de Maïeutique Charles Mérieux, Université de Lyon, Oullins, France
| | - Amélie Malapert
- Plateforme Transversale de Recherche de l'ICHCL, C, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mélanie Roche
- Plateforme Transversale de Recherche de l'ICHCL, C, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Fabien Subtil
- CNRS UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Julien Berthiller
- Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- SREC - PSP - Cellule innovation, Hospices Civils de Lyon, Bron, France
| | | | - Justine Dubreuil
- Plateforme Transversale de Recherche de l'ICHCL - Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Ravot
- Service de Gériatrie, Centre Hospitaliser Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Bitker
- Service de Réanimation Médicale, Hôpital de La Croix Rousse, Hospices Civils de Lyon, Lyon, France
- CREATIS INSERM 1044 CNRS 5220, Université de Lyon, Lyon, France
| | - Paul Abraham
- Département d'anesthésie-réanimation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Vincent Collange
- Département Anesthésie-réanimation, Medipôle Lyon-Villeurbanne, Villeurbanne, France
| | - Baptiste Balança
- Département d'anesthésie et réanimation neurologique, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, University of Lyon, Lyon, France
| | - Sylvie Goutte
- Service de gériatrie, Hôpital Nord-Ouest, Gleizé, France
| | - Céline Guichon
- Service d'anesthésie - réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Université de Lyon, Lyon, France
| | - Emilie Gadea
- Département de Recherche Clinique, Centre Hospitalier Emile Roux, Le Puy en Velay, France
| | - Laurent Argaud
- Faculté de médecine Lyon-Est, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service de Médecine Intensive-Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - David Dayde
- Plateforme Transversale de Recherche de l'ICHCL, C, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Jallades
- Service d'Hématologie biologique - Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Alain Lepape
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie, Université de Lyon, Lyon, France
| | - Jean-Baptiste Pialat
- Département de Radiologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- CREATIS CNRS UMR 5220 INSERM U1206, Université de Lyon, Lyon, France
| | - Arnaud Friggeri
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Fabrice Thiollière
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Fieux M, Zaouche S, Pialat JB, Tringali S. Giant Sphenoidal Mucocele Revealed by Orbital Pain. Ann Neurol 2020; 89:619-620. [PMID: 33274498 DOI: 10.1002/ana.25984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Maxime Fieux
- Department of Otology, Oto-Neurosurgery, Head and Neck Surgery, Lyon Sud University Hospital, Lyon, France
| | - Sandra Zaouche
- Department of Otology, Oto-Neurosurgery, Head and Neck Surgery, Lyon Sud University Hospital, Lyon, France
| | - Jean-Baptiste Pialat
- Department of Medical Imaging, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Stephane Tringali
- Department of Otology, Oto-Neurosurgery, Head and Neck Surgery, Lyon Sud University Hospital, Lyon, France
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15
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Eerdekens M, Peerlinck K, Staes F, Pialat JB, Hermans C, Lobet S, Scheys L, Deschamps K. Blood-induced cartilage damage alters the ankle joint load during walking. J Orthop Res 2020; 38:2419-2428. [PMID: 32401397 DOI: 10.1002/jor.24715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/10/2020] [Accepted: 04/23/2020] [Indexed: 02/04/2023]
Abstract
Ankle cartilage damage due to repeated joint bleeds often leads to altered gait in adult patients with hemophilia. It is therefore of clinical importance to develop an understanding of the biomechanical gait features in hemophilia patients with and without blood-induced cartilage damage and age-matched control subjects. We recruited a control group (n = 17), patients with hemophilia (PwH) without blood-induced ankle cartilage damage (PwH_NoCartDam , n = 5) and PwH with severe blood-induced ankle cartilage damage (PwH_CartDam , n = 19). We collected three-dimensional gait analysis data with following outcome variables in the ankle, Chopart and the first metatarsophalangeal (MTP 1) joints: range of motion (ROM) during stance phase, peak joint moment and powers. Biomechanical loading (BW) was quantified as the joint reaction forces using inverse dynamic analysis. Loading rate (BW/s) and impulse (BW*s) were calculated between 50% and 70% of stance phase. All biomechanical variables of the ankle joint were significantly lowered in the PwH_CartDam group compared with both the control subjects and the PwH_NoCartDam group. No compensatory biomechanical function was observed in other foot joints. An ankle loading rate of 2.64 ± 0.83 BW/s was observed in the control group, which was significantly higher than 1.75 ± 0.43 BW/s (P = .049) and 1.22 ± 0.59 BW/s (P < .001) in respectively the PwH_NoCartDam group and PwH_CartDam group. Patients with severe blood-induced cartilage damage demonstrated a (mal)adaptive gait strategy as they experience difficulties to properly unload the ankle cartilage during walking.
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Affiliation(s)
- Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium.,Department of Physical Medicine, Clinical Motion Analysis Laboratorium (CMAL), University Hospitals Leuven, Pellenberg, Belgium.,Department of Cardiovascular Sciences, Haemophilia Reference Center, University Hospitals Leuven, Leuven, Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Sciences, Haemophilia Reference Center, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Department of Radiology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Cedric Hermans
- Division of Haemostasis and Thrombosis (Haematology), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sébastien Lobet
- Division of Haemostasis and Thrombosis (Haematology), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Division of Health Sciences, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Department of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, Belgium.,Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Deschamps
- Department of Physical Medicine, Clinical Motion Analysis Laboratorium (CMAL), University Hospitals Leuven, Pellenberg, Belgium.,Department of Rehabilitation Sciences, Musculoskeletal Rehabilitations Research Group, KU Leuven, Brugge, Belgium
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16
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Fieux M, Daubie S, Pialat JB, Tringali S. Petrous Apex Cholesterol Granuloma Revealed by Facial Palsy. Ann Neurol 2020; 89:414-415. [PMID: 33015882 DOI: 10.1002/ana.25924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Maxime Fieux
- Department of ENT Surgery, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Sophie Daubie
- Department of Medical Imaging, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Jean-Baptiste Pialat
- Department of Medical Imaging, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Stephane Tringali
- Department of ENT Surgery, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
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17
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Hoballah A, Lukas C, Leplat C, Taourel P, Pialat JB, Sans N, Ramos-Pascual S, Saffarini M, Cyteval C. Response to: 'Case of postpartum axial spondyloarthritis' by Furuhashi et al. Ann Rheum Dis 2020; 81:annrheumdis-2020-218687. [PMID: 32826273 DOI: 10.1136/annrheumdis-2020-218687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Adel Hoballah
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Cédric Lukas
- Department of Rheumatology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Christophe Leplat
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Patrice Taourel
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Jean-Baptiste Pialat
- Department of Radiology, Groupement Hospitalier Edouard Herriot, Lyon, Rhône-Alpes, France
| | - Nicolas Sans
- Department of Radiology, Toulouse University Hospital, Paul Sabatier University, Toulouse, Occitanie, France
| | | | | | - Catherine Cyteval
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
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18
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Fessy MH, Riglet L, Gras LL, Neyra H, Pialat JB, Viste A. Ilio-psoas impingement with a dual-mobility liner: an original case report and review of literature. SICOT J 2020; 6:27. [PMID: 32648849 PMCID: PMC7350691 DOI: 10.1051/sicotj/2020025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022] Open
Abstract
Ilio-psoas impingement after total hip arthroplasty often occurs with the metallic rim of the acetabular cup. The main causes are poor cup anteversion or anterior wall defect. We firstly report here the case of a patient complaining of iliopsoas impingement due to contact with the liner of a dual-mobility device. Ultrasonography and Computed Tomographic scan clearly showed the direct mechanical contact of the dual-mobility liner with the iliopsoas tendon.
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Affiliation(s)
- Michel Henri Fessy
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique, 165 Chemin du Grand Revoyet, 69495 Pierre Benite Cedex, France - Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69622 Lyon, France
| | - Louis Riglet
- Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69622 Lyon, France
| | - Laure-Lise Gras
- Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69622 Lyon, France
| | - Hadrien Neyra
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Radiologie, 165 Chemin du Grand Revoyet, 69495 Pierre Benite Cedex, France
| | - Jean-Baptiste Pialat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Radiologie, 165 Chemin du Grand Revoyet, 69495 Pierre Benite Cedex, France
| | - Anthony Viste
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique, 165 Chemin du Grand Revoyet, 69495 Pierre Benite Cedex, France - Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69622 Lyon, France
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19
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Hoballah A, Lukas C, Leplat C, Taourel P, Pialat JB, Sans N, Ramos-Pascual S, Cyteval C. MRI of sacroiliac joints for the diagnosis of axial SpA: prevalence of inflammatory and structural lesions in nulliparous, early postpartum and late postpartum women. Ann Rheum Dis 2020; 79:1063-1069. [PMID: 32522743 DOI: 10.1136/annrheumdis-2020-217208] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the prevalence of bone marrow oedema (BME) at the sacroiliac joint (SIJ) in early postpartum (EPP), nulliparous (NP) and late postpartum (LPP) women, and to identify factors associated with BME presence at the SIJ. METHODS Three groups were obtained: NP (never given birth), EPP (given birth within 12 months) and LPP (given birth more than 24 months). The primary outcome was the presence of BME and/or structural lesions (erosions, osteophytes, ankylosis and sclerosis) at the SIJ MRI. RESULTS BME prevalence was greater among EPP (33%) than NP (14%, p=0.001), but was not different to LPP (21%, p=0.071). The Assessment of SpondyloArthritis international Society (ASAS) MRI criteria for sacroiliitis were positive in 75%, 71% and 80%, respectively, of EPP, NP and LPP women with BME. EPP (38%) had similar prevalence of sclerosis than LPP (28%, p=0.135), but greater than NP (18%, p=0.001). Lastly, EPP (28%) had similar prevalence of osteophytes than LPP (42%) and NP (27%), although there was a difference between LPP and NP (p=0.006). CONCLUSIONS EPP have higher BME prevalence at the SIJ than NP, EPP tend to have higher BME prevalence compared with LPP and BME presence decreases with time from delivery. Three-quarters of women with BME at the SIJ had a positive ASAS MRI criteria for sacroiliitis, indicating that BME presence as the main criterion for a positive diagnosis can lead to false-positive results. SIJ MRIs should not be interpreted in isolation, since age, time from delivery and other factors may outweigh the pertinence of MRI findings. Trial registration number NCT02956824.
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Affiliation(s)
- Adel Hoballah
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Cédric Lukas
- Department of Rheumatology, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Christophe Leplat
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Patrice Taourel
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Jean-Baptiste Pialat
- Department of Radiology, Groupement Hospitalier Edouard Herriot, Lyon, Rhône-Alpes, France
| | - Nicolas Sans
- Department of Radiology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
| | | | - Catherine Cyteval
- Osteoarticular Medical Imaging Section, Department of Medical Imaging, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
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20
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Eerdekens M, Peerlinck K, Staes F, Pialat JB, Hermans C, Lobet S, Deschamps K. Clinical gait features are associated with MRI findings in patients with haemophilic ankle arthropathy. Haemophilia 2020; 26:333-339. [PMID: 31944497 DOI: 10.1111/hae.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Haemophilic ankle arthropathy due to repeated joint bleeds often leads to altered gait in adult patients with haemophilia. AIM To investigate the association between clinical gait features and blood-induced ankle joint damage scored using MRI findings in patients with haemophilic ankle arthropathy. METHODS This observational study investigated 48 ankles of 24 patients with severe haemophilia (median age of 33 years). Blood-induced ankle joint damage was scored by an experienced radiologist using the International Prophylaxis Study Group (IPSG-)MRI score which evaluates the presence or absence of effusion, synovial hypertrophy, haemosiderin, surface erosions, subchondral cysts and cartilage degeneration. Using 3D gait analysis, peak ankle joint power generation and absorption (W/kg) were measured for each ankle since these are surrogate measures for joint loading during walking. Associations between MRI findings and these two clinical gait features were calculated using Spearman's ρ correlation with an α-level correction (α = 0.01) for multiple tests. RESULTS We found large negative associations between ankle joint peak power generation and IPSG-MRI score (ρ = -0.631; P = <.001), IPSG-MRI osteochondral subscore (ρ = -0.701; P = <.001), severity of synovial hypertrophy (ρ = -0.507; P = <.001) and haemosiderin (ρ = -0.400; P = .005). Associations were also found for ankle joint peak power absorption and IPSG-MRI score (ρ = -0.425; P = .003) and IPSG-MRI osteochondral subscore (ρ = -0.556; P = <.001). CONCLUSION Severe blood-induced ankle joint damage relates to a lowered tolerance towards ankle joint mechanical loading during walking in patients with haemophilia.
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Affiliation(s)
- Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Haemophilia Center, UZ Leuven, Leuven, Belgium
| | - Kathelijne Peerlinck
- Haemophilia Center, UZ Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Cédric Hermans
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sébastien Lobet
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kevin Deschamps
- Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Brugge, Belgium
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21
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Pontarollo G, Confavreux CB, Pialat JB, Isaac S, Forest F, Yvorel V, Maury JM, Girard N, Brevet M. Bone decalcification to assess programmed cell death ligand 1 expression in bone metastases of non-small cell lung cancers. J Bone Oncol 2020; 21:100275. [PMID: 31956475 PMCID: PMC6957852 DOI: 10.1016/j.jbo.2020.100275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/11/2019] [Accepted: 01/03/2020] [Indexed: 12/16/2022] Open
Abstract
Rapid determination of PD-L1 expression has become a necessity in lung cancer. The decalcification process is a critical point for bone metastasis specimens. EDTA or formic acid decalcification may be used for PD-L1 IHC in routine practice.
As for molecular alterations of lung adenocarcinoma, it is critical that pathologists are able to give PD-L1 expression status before first-line of treatment. The present study compared PD-L1 expression (clone 22-C3) in decalcified using EDTA or formic acid and non-decalcified lung cancer metastases bone samples. Amongst the 84 bone samples analysed for PD-L1 expression, and independently of decalcification, TPS ≥ 1% was 25.0% and ≥ 50% was 11.4%. There was no significant difference between decalcified samples (n = 45) and non-decalcified samples (n = 39) for both TPS ≥ 1% (p = 0.32) and TPS ≥ 50% (p = 1). To conclude, we confirm decalcified bone metastasis specimens may be used for PD-L1 IHC in routine practice. These results also highlight potentially interesting specificities of the bone microenvironment that should be further studied
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Affiliation(s)
- Guillaume Pontarollo
- Hospices Civils de Lyon, Institut de pathologie multisite des Hospices Civils de Lyon Site Est, Bron cedex 69677, France.,Université Lyon-1, Lyon 69008, France
| | - Cyrille B Confavreux
- Université Lyon-1, Lyon 69008, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de rhumatologie, Pierre-Bénite F-69370, France.,INSERM UMR 1033, Centre Expert des Metastases et Oncologie Osseuse Secondaire (CEMOS), Lyon, 69008, France
| | - Jean-Baptiste Pialat
- Université Lyon-1, Lyon 69008, France.,Hospices Civils de Lyon, Service de radiologie, Pierre-Bénite 69370, France
| | - Sylvie Isaac
- Université Lyon-1, Lyon 69008, France.,Hospices Civils de Lyon, Institut de pathologie multisite des Hospices Civils de Lyon Site Sud, Pierre-Bénite 69370, France
| | - Fabien Forest
- Hôpital universitaire de Saint Etienne - Site Nord, Service de pathologie, Saint Etienne, France
| | - Violaine Yvorel
- Hôpital universitaire de Saint Etienne - Site Nord, Service de pathologie, Saint Etienne, France
| | - Jean-Michel Maury
- Université Lyon-1, Lyon 69008, France.,Hospices Civils de Lyon, Hôpital Cardio-vasculaire et pneumologique de Louis Pradel, service de chirurgie cardio-vasculaire, Bron Cedex 69677, France
| | - Nicolas Girard
- Université Lyon-1, Lyon 69008, France.,Institut Curie, Institut du Thorax Curie-Montsouris, Paris Cedex 75248, France
| | - Marie Brevet
- Hospices Civils de Lyon, Institut de pathologie multisite des Hospices Civils de Lyon Site Est, Bron cedex 69677, France.,Université Lyon-1, Lyon 69008, France
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Legrand M, Nouvier M, Paulin L, Deschamps B, Pialat JB, Coury F. [A systemic disease mimicking a rheumatoid arthritis]. Rev Med Interne 2019; 40:831-836. [PMID: 31444022 DOI: 10.1016/j.revmed.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Rare systemic diseases such as amyloidosis can mimic inflammatory rheumatic diseases. Because of their poor prognosis, physicians should rule them out at the onset of inflammatory rheumatism. We report a case of AL amyloidosis misdiagnosed as rheumatoid arthritis. CASE REPORT A 71-year-old woman was referred for seronegative rheumatoid arthritis, resistant to three biologic therapies. She had an IgA lambda monoclonal gammopathy of undetermined significance (MGUS). The patient subsequently developed glomerular proteinuria. Abdominal fat and accessory salivary glands biopsies revealed amyloid light-chain (AL) amyloidosis. Treatment with bortezomib-cyclophosphamide-dexamethasone, led to complete hematologic, renal and rheumatologic remission. Ten months after treatment interruption, the patient had an articular and hematologic relapse. CONCLUSION Amyloid light-chain amyloidosis arthropathy is probably underdiagnosed. A review of amyloid arthropathy associated with multiple myeloma found that 33% of patients had been misdiagnosed with rheumatoid arthritis.
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Affiliation(s)
- M Legrand
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France.
| | - M Nouvier
- Service de néphrologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - L Paulin
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - B Deschamps
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France
| | - J B Pialat
- Université Lyon 1, 69007 Lyon, France; Service d'imagerie médicale et interventionnelle, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Service d'imagerie médicale et interventionnelle, Hospices civils de Lyon, hôpital Édouard-Herriot, 69003 Lyon, France
| | - F Coury
- Service de rhumatologie, hospices civils de Lyon, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite, France; Université Lyon 1, 69007 Lyon, France
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23
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Gaudé M, Chapurlat R, Pialat JB, Szulc P. Long term prognosis of Scheuermann's disease: The association with fragility fracture - The MINOS cohort. Bone 2018; 117:116-122. [PMID: 30244156 DOI: 10.1016/j.bone.2018.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
Abstract
The aim was to assess the association of Scheuermann's disease (SCD) with fracture risk (vertebral, peripheral) and bone mineral density (BMD) in older men. SCD was assessed on the baseline lateral spine radiographs using the Berlin criteria in 766 men aged 50-85. We evaluated the association of SCD and its diagnostic criteria with incident fracture (vertebral over 7.5 years, peripheral over 10 years) and BMD (baseline). SCD prevalence was 25.2%. SCD and its criteria showed inconsistent associations with BMD at different skeletal sites. Eighty-four men had incident fractures. After adjustment for age, weight, spine BMD, prevalent vertebral fractures, prior falls and score of disc space narrowing due to osteoarthritis (DSN-OA), SCD was not associated with vertebral fracture risk. Vertebral endplate irregularities (EI), one of its diagnostic criteria, were associated with higher vertebral fracture risk (OR = 3.26, 95% CI: 1.34-7.94, p < 0.01). Vertebral fracture risk was higher in men with EI and low spine BMD vs. men without these characteristics (OR = 12.84, 95% CI: 3.12-52.83, p < 0.005). EI was associated with higher vertebral fracture risk in men without severe DSN-OA and without prevalent vertebral fractures. Peripheral fracture risk was lower in men with SCD (HR = 0.39, 95% CI: 0.18-0.83, p < 0.02) and EI. Peripheral fracture risk was higher in men without SCD who had low femoral neck BMD vs. men with SCD and normal BMD (HR = 4.68, 95% CI: 1.09-20.03, p < 0.05). In conclusion, EI were associated with high vertebral fracture risk. SCD and EI were associated with lower peripheral fracture risk. The associations of SCD and its criteria with BMD were inconsistent.
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Affiliation(s)
- Marine Gaudé
- INSERM UMR 1033, University of Lyon, Lyon, France; Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Lyon, France; Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Baptiste Pialat
- INSERM UMR 1033, University of Lyon, Lyon, France; Department of Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Lyon, France.
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24
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Debeaupte M, Hermann R, Pialat JB, Martinon A, Truy E, Ltaief Boudrigua A. Cone beam versus multi-detector computed tomography for detecting hearing loss. Eur Arch Otorhinolaryngol 2018; 276:315-321. [DOI: 10.1007/s00405-018-5214-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/16/2018] [Indexed: 11/24/2022]
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Ferry T, Boucher F, Fevre C, Perpoint T, Chateau J, Petitjean C, Josse J, Chidiac C, L’hostis G, Leboucher G, Laurent F, Ferry T, Valour F, Perpoint T, Boibieux A, Biron F, Miailhes P, Ader F, Becker A, Roux S, Triffault-Fillit C, Conrad A, Bosch A, Daoud F, Lippman J, Braun E, Chidiac C, Lustig S, Servien E, Gaillard R, Schneider A, Gunst S, Batailler C, Fessy MH, Herry Y, Viste A, Chaudier P, Courtin C, Louboutin L, Martres S, Trouillet F, Barrey C, Jouanneau E, Jacquesson T, Mojallal A, Braye F, Boucher F, Shipkov H, Chateau J, Gleizal A, Aubrun F, Dziadzko M, Macabéo C, Laurent F, Rasigade JP, Dupieux C, Craighero F, Boussel L, Pialat JB, Morelec I, Janier M, Giammarile F, Tod M, Gagnieu MC, Goutelle S, Mabrut E. Innovations for the treatment of a complex bone and joint infection due to XDR Pseudomonas aeruginosa including local application of a selected cocktail of bacteriophages. J Antimicrob Chemother 2018; 73:2901-2903. [DOI: 10.1093/jac/dky263] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Tristan Ferry
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Fabien Boucher
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Chirurgie Plastique et reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Perpoint
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Joseph Chateau
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Chirurgie Plastique et reconstructrice, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Jérôme Josse
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Service de Maladies Infectieuses, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | | | - Gilles Leboucher
- Pharmacie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
- Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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de Bruin F, Treyvaud MO, Feydy A, de Hooge M, Pialat JB, Dougados M, Gossec L, Bloem JL, van der Heijde D, Reijnierse M. Prevalence of degenerative changes and overlap with spondyloarthritis-associated lesions in the spine of patients from the DESIR cohort. RMD Open 2018; 4:e000657. [PMID: 29955382 PMCID: PMC6018874 DOI: 10.1136/rmdopen-2018-000657] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/11/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives To describe the prevalence of degenerative changes on MRI and conventional radiographs of the spine in a young population with suspicion of axial spondyloarthritis (axSpA) and assess whether it is possible to discriminate between degenerative changes and lesions associated with axSpA. Methods Whole spine MRI and cervical and lumbar radiographs of patients ≥18 years with chronic back pain (≥3 months, ≤3 years, onset <50 years) were assessed for degeneration by two readers, and for SpA lesions by two other readers, all blinded for clinical information and results of the other readers. Degenerative scores were adjudicated in case of disagreement (by a third reader). Patients fulfilling and not fulfilling the Assessment of SpondyloArthritis international Society axSpA criteria were compared for prevalence of degenerative lesions. Scores for degenerative and SpA lesions were compared, and overlap was defined as the presence of both types of lesions in a single vertebral unit (VU). Results In 456/648 (70.4%) patients (46.8% men, mean age 33.6), degenerative lesions were found with similar percentages in patients with no axSpA and with axSpA (72.4% and 69.2%, p=0.45). Modic changes were found more often in patients with no axSpA (29/239, 12.1%) versus patients with axSpA (19/409, 4.6%, p=0.01). Other lesions were evenly distributed. Overlap was minimal in 19 patients (3.0%) and 32/14 674 (0.2%) VUs for SpA reader 1 and in 23 patients (3.6%) and 34/14 674 VUs (0.2%) for SpA reader 2. Conclusion The prevalence of degeneration is high in an early inflammatory back pain cohort. Discrimination between degeneration and axSpA lesions is very well possible with little overlap between degenerative and axSpA readings.
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Affiliation(s)
- Freek de Bruin
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco O Treyvaud
- Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Antoine Feydy
- Service de radiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean-Baptiste Pialat
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Lyon, Lyon, France
| | - Maxime Dougados
- Service de Rhumatologie B, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Descartes, Paris, France
| | - Laure Gossec
- Department of Rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Confavreux CB, Pialat JB, Bellière A, Brevet M, Decroisette C, Tescaru A, Wegrzyn J, Barrey C, Mornex F, Souquet PJ, Girard N. Bone metastases from lung cancer: A paradigm for multidisciplinary onco-rheumatology management. Joint Bone Spine 2018; 86:185-194. [PMID: 29631067 DOI: 10.1016/j.jbspin.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Bone is the third metastatic site after liver and lungs. Bone metastases occur in one out of three lung cancers and are usually of osteolytic aspect. Osteolytic bone metastases are responsible of long bone and vertebral fractures leading to restricted mobility, surgery and medullar compression that severely alter quality of life and that have a huge medico-economic impact. In the recent years, Bone Metastatic Multidisciplinary Tumour Board (BM2TB) have been developed to optimize bone metastases management for each patient in harmony with oncology program. In this review, we will go through all the different aspects of bone metastases management including diagnosis and evaluation (CT scan, Tc 99m-MDP bone scan, 18FDG-PET scan and biopsy for molecular diagnosis), systemic bone treatments (zoledronic acid and denosumab) and local treatments (interventional radiology and radiotherapy). Surgical strategies will be discussed elsewhere. Based on the last 2017-Lung Cancer South East French Guidelines, we present a practical decision tree to help the physicians for decision making in order to reach a personalized locomotor strategy for every patient.
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Affiliation(s)
- Cyrille B Confavreux
- Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France.
| | - Jean-Baptiste Pialat
- Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Service de radiologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Aurélie Bellière
- Centre régional de lutte contre le cancer Jean-Perrin, 63000 Clermont-Ferrand, France
| | - Marie Brevet
- Département d'anatomopathologie, groupement hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Chantal Decroisette
- Centre Hospitalier Annecy-Genevois, 1, boulevard de l'hôpital, 74370 Metz-Tessy, France
| | - Agnès Tescaru
- Service de médecine nucléaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Julien Wegrzyn
- Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Département de chirurgie orthopédique - Pavillon T, hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Cédric Barrey
- Département de neurochirurgie et chirurgie du Rachis, université Claude-Bernard Lyon I, hôpital Pierre-Wertheimer, Hospices Civils de Lyon, 69500 Bron, France; Laboratoire de biomécanique, ENSAM, Arts et Métiers Paris Tech, 75003 Paris, France
| | - Françoise Mornex
- Département de radiothérapie oncologie, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université Claude-Bernard Lyon 1-EMR 3738, 69921 Oullins, France
| | - Pierre-Jean Souquet
- Service de pneumologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Nicolas Girard
- Université de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Institut du Thorax Curie Montsouris, Institut Curie, 75005 Paris, France
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Chambard L, Girard N, Ollier E, Rousseau JC, Duboeuf F, Carlier MC, Brevet M, Szulc P, Pialat JB, Wegrzyn J, Clezardin P, Confavreux CB. Bone, muscle, and metabolic parameters predict survival in patients with synchronous bone metastases from lung cancers. Bone 2018; 108:202-209. [PMID: 29337225 DOI: 10.1016/j.bone.2018.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/11/2017] [Accepted: 01/04/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. PATIENTS AND METHODS POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. RESULTS Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10-2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01-1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10-7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40-6.27]; p = .005). CONCLUSIONS In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.
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Affiliation(s)
- Lauriane Chambard
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Rheumatology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France.
| | - Nicolas Girard
- Respiratory Medicine Department, Hospices Civils de Lyon, Bron F-69500, France.
| | - Edouard Ollier
- Université Claude Bernard Lyon 1, Villeurbanne F-69100, France
| | | | | | | | - Marie Brevet
- Pathology Department, Hospices Civils de Lyon, Bron F-69500, France.
| | - Pawel Szulc
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France.
| | - Jean-Baptiste Pialat
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Radiology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France.
| | - Julien Wegrzyn
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Orthopedic Department, Hospices Civils de Lyon, Lyon F-69003, France.
| | | | - Cyrille B Confavreux
- INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Rheumatology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France.
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Chapurlat R, Pialat JB, Merle B, Confavreux E, Duvert F, Fontanges E, Khacef F, Peres SL, Schott AM, Lespessailles E. The QUALYOR (QUalité Osseuse LYon Orléans) study: a new cohort for non invasive evaluation of bone quality in postmenopausal osteoporosis. Rationale and study design. Arch Osteoporos 2017; 13:2. [PMID: 29282548 DOI: 10.1007/s11657-017-0412-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/13/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED The diagnostic performance of densitometry is inadequate. New techniques of non-invasive evaluation of bone quality may improve fracture risk prediction. Testing the value of these techniques is the goal of the QUALYOR cohort. INTRODUCTION The bone mineral density (BMD) of postmenopausal women who sustain osteoporotic fracture is generally above the World Health Organization definition for osteoporosis. Therefore, new approaches to improve the detection of women at high risk for fracture are warranted. METHODS We have designed and recruited a new cohort to assess the predictive value of several techniques to assess bone quality, including high-resolution peripheral quantitative computerized tomography (HRpQCT), hip QCT, calcaneus texture analysis, and biochemical markers. We have enrolled 1575 postmenopausal women, aged at least 50, with an areal BMD femoral neck or lumbar spine T-score between - 1.0 and - 3.0. Clinical risk factors for fracture have been collected along with serum and blood samples. RESULTS We describe the design of the QUALYOR study. Among these 1575 women, 80% were aged at least 60. The mean femoral neck T-score was - 1.6 and the mean lumbar spine T-score was -1.2. This cohort is currently being followed up. CONCLUSIONS QUALYOR will provide important information on the relationship between bone quality variables and fracture risk in women with moderately decreased BMD.
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Affiliation(s)
- Roland Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon cedex 03, France.
| | - Jean-Baptiste Pialat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon cedex 03, France
| | - Blandine Merle
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon cedex 03, France
| | - Elisabeth Confavreux
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon cedex 03, France
| | - Florence Duvert
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon cedex 03, France
| | - Elisabeth Fontanges
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437, Lyon cedex 03, France
| | - Farida Khacef
- Hopital d'Orleans, 14 avenue de l'hôpital, 45067, Orléans Cedex 2, France
| | | | - Anne-Marie Schott
- EA 4708-I3MTO, Université d'Orléans, 45067, Orléans, France.,EA 7425 HESPER, Université de Lyon, Lyon, France
| | - Eric Lespessailles
- Hopital d'Orleans, 14 avenue de l'hôpital, 45067, Orléans Cedex 2, France.,EA 4708-I3MTO, Université d'Orléans, 45067, Orléans, France
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de Hooge M, Pialat JB, Reijnierse M, van der Heijde D, Claudepierre P, Saraux A, Dougados M, Feydy A. Assessment of typical SpA lesions on MRI of the spine: do local readers and central readers agree in the DESIR-cohort at baseline? Clin Rheumatol 2017; 36:1551-1559. [PMID: 28536822 DOI: 10.1007/s10067-017-3643-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
Comparing local reading (LocR) with central reading (CentR) of typical spondyloarhritis lesions including bone marrow edema (BME) and structural lesions on magnetic resonance imaging of the spine (MRI-spine), in patients with inflammatory back pain (IBP; ≥3 months, <3 years). Baseline data of 667 patients, age 18-50 years, from the Devenir des Spondylarthopathies Indifferenciees Recentes (DESIR)-cohort were used. Two trained central readers scored anterior and posterior corner BME, fatty lesions, erosions and syndesmophytes on MRI-spine. Presences of lesions, based on average scores, were used for CentR. A local radiologist and/or rheumatologist scored MRI-spine on presence/doubt/absence of 'inflammation' and 'structural lesions'. Agreement between central readers and readings was calculated (Cohen's kappa: κ). Agreement between central readers was moderate (BME κ = 0.55, fatty lesions κ = 0.50) to slight (erosions κ = 0.12, syndesmophytes κ = 0.19). Agreement between LocR and CentR was κ = 0.32 (BME) and κ = 0.13 (structural lesions). In 78/160 patients (48.8%) LocR were in doubt while CentR scored BME lesions, for structural lesions this was 17.8% (28/157 patients). Agreement between 2 central readers for scoring spondyloarhritis-like lesions on MRI-spine was moderate but better compared to LocR and CentR agreement. LocR often doubt about the presence of MRI-spine lesions while central trained readers score lesions.
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Affiliation(s)
- Manouk de Hooge
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Baptiste Pialat
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, INSERM (U1033), Université Lyon 1, Lyon, France
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Pascal Claudepierre
- Department of Rheumatology, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.,Laboratoire d'Investigation Clinique (LIC), Université Paris Est Créteil, Créteil, France
| | - Alain Saraux
- Rheumatology Unit, Hôpital de la Cavale Blanche, Brest University Medical School, 29609, Brest, France
| | - Maxime Dougados
- Rheumatology B Department, Cochin Hôpital, Paris Descartes University, Paris, France.,Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Antoine Feydy
- Radiology B Department, Cochin Hôpital, Paris Descartes University, Paris, France. .,Service de Radiologie B - Hôpital Cochin, Université Paris Descartes, 27 rue du Fbg St Jacques, 75679, Paris Cedex 14, France.
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de Charry C, Boutroy S, Ellouz R, Duboeuf F, Chapurlat R, Follet H, Pialat JB. Clinical cone beam computed tomography compared to high-resolution peripheral computed tomography in the assessment of distal radius bone. Osteoporos Int 2016; 27:3073-82. [PMID: 27121345 DOI: 10.1007/s00198-016-3609-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED Clinical cone beam computed tomography (CBCT) was compared to high-resolution peripheral quantitative computed tomography (HR-pQCT) for the assessment of ex vivo radii. Strong correlations were found for geometry, volumetric density, and trabecular structure. Using CBCT, bone architecture assessment was feasible but compared to HR-pQCT, trabecular parameters were overestimated whereas cortical ones were underestimated. INTRODUCTION HR-pQCT is the most widely used technique to assess bone microarchitecture in vivo. Yet, this technology has been only applicable at peripheral sites, in only few research centers. Clinical CBCT is more widely available but quantitative assessment of the bone structure is usually not performed. We aimed to compare the assessment of bone structure with CBCT (NewTom 5G, QR, Verona, Italy) and HR-pQCT (XtremeCT, Scanco Medical AG, Brüttisellen, Switzerland). METHODS Twenty-four distal radius specimens were scanned with these two devices with a reconstructed voxel size of 75 μm for Newtom 5G and 82 μm for XtremeCT, respectively. A rescaling-registration scheme was used to define the common volume of interest. Cortical and trabecular compartments were separated using a semiautomated double contouring method. Density and microstructure were assessed with the HR-pQCT software on both modality images. RESULTS Strong correlations were found for geometry parameters (r = 0.98-0.99), volumetric density (r = 0.91-0.99), and trabecular structure (r = 0.94-0.99), all p < 0.001. Correlations were lower for cortical microstructure (r = 0.80-0.89), p < 0.001. However, absolute differences were observed between modalities for all parameters, with an overestimation of the trabecular structure (trabecular number, 1.62 ± 0.37 vs. 1.47 ± 0.36 mm(-1)) and an underestimation of the cortical microstructure (cortical porosity, 3.3 ± 1.3 vs. 4.4 ± 1.4 %) assessed on CBCT images compared to HR-pQCT images. CONCLUSIONS Clinical CBCT devices are able to analyze large portions of distal bones with good spatial resolution and limited irradiation. However, compared to dedicated HR-pQCT, the assessment of microarchitecture by NewTom 5G dental CBCT showed some discrepancies, for density measurements mainly. Further technical developments are required to reach optimal assessment of bone characteristics.
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Affiliation(s)
- C de Charry
- Université de Lyon, Lyon, France
- Department of Radiology, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | | | - R Chapurlat
- Université de Lyon, Lyon, France
- INSERM UMR 1033, Lyon, France
- Department of Rheumatology, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - J B Pialat
- Université de Lyon, Lyon, France.
- Department of Radiology, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France.
- INSERM UMR 1033, Lyon, France.
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Cortez CD, Hermitte L, Ramain A, Mesmann C, Lefort T, Pialat JB. Ultrasound shear wave velocity in skeletal muscle: A reproducibility study. Diagn Interv Imaging 2015; 97:71-9. [PMID: 26119864 DOI: 10.1016/j.diii.2015.05.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of the study was threefold: to assess the reliability of shear wave velocities (SWV) measurements in normal skeletal muscles; to evaluate intra- and inter-operator reproducibility of measurements for a specific site of the muscle and for the mean value in the whole muscle. MATERIALS AND METHODS Two sets of measurements were performed at three weeks intervals of each other on 16 volunteers by two radiologists on medial gastrocnemius and tibialis anterior muscles. Each muscle was evaluated in 5 different sites, with three measurements for each site in the transverse and longitudinal planes. Reliability of SWV measurements was assessed by means of intraclass correlation coefficient (ICC). RESULTS Reliability of the three independent SWV measurements was excellent, slightly better in the longitudinal plane. Inter/intra-operator reproducibility per site was fair to good in the longitudinal plane and poor to fair in the transverse plane. For global values of the whole muscle, ICC showed good agreement in the longitudinal plane and fair agreement in the transverse plane. CONCLUSION Quantitative SWV measurements are reliable when performed in rigorous conditions. In conditions that mirror clinical practice, inter/intra-operator reproducibility is moderate, better for longitudinal compared to transverse plane.
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Affiliation(s)
- C Dorado Cortez
- Department of radiology, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France; Laboratory of anatomy, university of medicine Lyon-Est, 8, avenue Rockefeller, 69003 Lyon, France
| | - L Hermitte
- Department of radiology, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France; Department of radiology, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon, France
| | - A Ramain
- Department of radiology, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - C Mesmann
- Department of radiology, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - T Lefort
- Department of radiology, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - J B Pialat
- Department of radiology, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France; Inserm UMR 1033, Pavillion F, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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Confavreux CB, Girard N, Pialat JB, Bringuier PP, Devouassoux-Shisheboran M, Rousseau JC, Isaac S, Thivolet-Bejui F, Clezardin P, Brevet M. Mutational profiling of bone metastases from lung adenocarcinoma: results of a prospective study (POUMOS-TEC). Bonekey Rep 2014; 3:580. [PMID: 25328676 DOI: 10.1038/bonekey.2014.75] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/27/2014] [Indexed: 12/28/2022]
Abstract
Targeted therapies have improved patient survival in metastatic lung adenocarcinoma. Molecular diagnosis is a key element to identify oncogenic drivers predicting the efficacy of these agents. In stage IV patients, histopathological diagnosis is often performed on bone metastases biopsy, but routine procedure of decalcification may alter DNA quality for subsequent molecular tests. We set up a procedure to perform molecular analyses on bone metastasis and describe the results of mutational profiling. POUMOS-TEC is a prospective study conducted in stage IV lung adenocarcinomas. Bone metastasis specimens from surgery and CT-scan guided biopsies were sent fresh for immediate formalin-fixation. Decalcification was performed, only when necessary, using EDTA. Controls were processed with acid decalcification. DNA extraction was performed after laser microdissection. Mutational profiling of oncogenic drivers was conducted as recommended by the French National Cancer Institute. Diagnosis efficiency of the computed tomography (CT)-scan guided biopsy process was assessed. Among 177 collected bone metastases specimens, 49 came from lung adenocarcinomas. Specimens processed with no decalcification or EDTA (n=45) provided high-quality DNA. Molecular profiling was performed in 44/45 (98%) of cases. The results of the whole panel of oncogenic drivers (EGFR, KRAS, BRAF, PIK3CA, HER2 and ALK) were obtained in 41/45 (91%) of cases. A mutation was observed in 50% of cases including 32% of KRAS and 14% of epidermal growth factor receptor (EGFR) mutations. CT-scan biopsy efficiency rate was 96%. We demonstrated the feasibility to routinely conduct mutational profiling on bone metastases biopsies. We observed a higher rate of EGFR mutations (+42%) in comparison with the average rate of all stage IV lung adenocarcinomas. This procedure is a new step toward the goal of personalized medicine to treat lung cancers and other osteophilic tumors.
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Affiliation(s)
- Cyrille B Confavreux
- Inserm UMR1033-Université de Lyon , Lyon, France ; Rheumatology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon , Lyon, France
| | - Nicolas Girard
- Respiratory Medicine, Thoracic Oncology Department, Hôpital Louis Pradel, Hospices Civils de Lyon , Lyon, France
| | - Jean-Baptiste Pialat
- Inserm UMR1033-Université de Lyon , Lyon, France ; Radiology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon , Lyon, France
| | - Pierre-Paul Bringuier
- Pathology Department, Molecular Diagnostics Platform, Hôpital Edouard Herriot, Hospices Civils de Lyon , Lyon, France ; Cancer Research Center of Lyon (CRCL) , Lyon, France
| | - Mojgan Devouassoux-Shisheboran
- Cancer Research Center of Lyon (CRCL) , Lyon, France ; Pathology Department, Hôpital de la Croix Rousse, Hospices Civils de Lyon , Lyon, France
| | | | - Sylvie Isaac
- Pathology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon , Lyon, France
| | | | | | - Marie Brevet
- Inserm UMR1033-Université de Lyon , Lyon, France ; Pathology Department, Groupement Hospitalier Est, Hospices Civils de Lyon , Lyon, France
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Taupin T, Ltaief Boudrigua A, Taief Boudrigua Aicha L, Baggio E, Gensburger M, Pialat JB. [Comparison of 3T dacryo-MRI by instillation with dacryo-CT scan for evaluation of epiphora]. J Fr Ophtalmol 2014; 37:526-34. [PMID: 24972894 DOI: 10.1016/j.jfo.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 02/01/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Epiphora is frequently related to stenosis of the lacrimal drainage pathways. In the evaluation of stenosis, dacryo-CT scan remains the gold standard, despite the need for radiation and catheterization of the lacrimal passages. Evaluation by high field 3T MRI compared to the gold standard in the morphological study of the lacrimal passages and quantification of the stenosis is attractive considering the lack of radiation and non-invasive nature of the technique. METHODS Twenty-four patients were included, including 9 with bilateral epiphora, representing 33 pathological drainage systems out of 48. Twenty-three drainage systems underwent subsequent surgery (18 patients, 5 patients bilaterally). RESULTS The average diameter on CT scan images of the superior canaliculus was 0.70 mm (± 0.46), of the inferior canaliculus 0.69 (±0.42), the common canaliculus 0.68 (± 0.58), the lacrimal sac 4.32 (± 2.10), and the nasolacrimal duct 1.15 mm (±1.42). 3T dacryo-MRI overestimated the diameters by 0.35 to 1mm (up to 20 % of the lacrimal sac size), and the concordance between dacryo-CT scan and 3T dacryo-MRI was of average value (kappa 0.5, P<0.05) concerning the diagnosis of stenosis. Furthermore, dacryo-CT scan demonstrated higher sensitivity (72.7 %) than 3T dacryo-MRI (42.4 %). CONCLUSIONS The two techniques are not equivalent in the diagnosis of stenosis. An optimization of protocols and an evaluation on a larger cohort remain necessary before dacryo-CT scan can be replaced by dacryo-MRI in routine practice.
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Affiliation(s)
- T Taupin
- Service de radiologie, centre Léon-Bérard, FNCLCC, 28, promenade Léa-et-Napoléon-Bullukian, 69373 Lyon, France.
| | | | - L Taief Boudrigua Aicha
- Service de radiologie ostéo-articulaire et neurologique, pavillon B, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon, France
| | - E Baggio
- Centre ophtalmologique Kleber, 50, cours Franklin-Roosevelt, 69006 Lyon, France
| | - M Gensburger
- Service d'ophtalmologie, centre hospitalier Lyon-Sud, 130, rue Jules-Guesde, 69495 Pierre-Bénite cedex, France
| | - J B Pialat
- Service de radiologie ostéo-articulaire et neurologique, pavillon B, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69437 Lyon, France
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Ellouz R, Chapurlat R, van Rietbergen B, Christen P, Pialat JB, Boutroy S. Challenges in longitudinal measurements with HR-pQCT: evaluation of a 3D registration method to improve bone microarchitecture and strength measurement reproducibility. Bone 2014; 63:147-57. [PMID: 24614646 DOI: 10.1016/j.bone.2014.03.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/10/2014] [Accepted: 03/02/2014] [Indexed: 02/04/2023]
Abstract
Definition of identical regions between repeated computed tomography (CT) scans is a key factor to monitor changes in bone microarchitecture. In longitudinal studies, accurate determination of the volume of interest (VOI), using three dimensional (3D) registration may improve precision. Therefore, the aim of our study was to investigate the short-term reproducibility of bone geometry, density, microstructure and biomechanical parameters assessed by HR-pQCT and micro-finite element (μFE) derived analyses, using the cross-sectional area (CSA) registration method in comparison with the use of 3D registration, to find overlapping regions between scans. Fifteen healthy individuals (aged 21-47 years) underwent 3 separate scans at the distal radius and tibia, within a one-month interval. Reproducibility was assessed after double contouring the cortical compartment and after applying three different methods to determine the common region between repeated scans: (i) the VOI was determined with no registration, i.e., on 110 slices, (ii) the VOI was determined after CSA-based registration, and (iii) the VOI was determined after 3D registration. Both pre- and post-registration short-term reproducibility for each subject was determined. With no registration, CVrms of geometry parameters ranged from 0.5 to 3.7%, showing a slight variation in the CSA between scans. When the CSA registration method was employed, the variability of geometry (CVrms<1.8%) and density parameters (CVrms<1.8%), was better than that obtained without registration. By removing the effect of repositioning, the 3D registration further improved the reproducibility of cortical bone measurements compared to other methods. Indeed, significant improvements were found for cortical geometry and microstructure measurements (CVrms ranged from 0.4% to 10.7% at both sites; p<0.05), whereas the impact on trabecular bone measurements was restricted to its geometry parameter. The repositioning error was significantly reduced, most markedly at the radius compared to the tibia. For μFE measures, the impact of 3D registration on whole bone stiffness was negligible, indicating adequate assessment of longitudinal changes in estimated biomechanical properties, even without registration. In conclusion, we have shown that the 3D registration improved the identification of the common region retained for longitudinal analysis, contributing to improve the reproducibility of cortical bone parameter measurements. We also quantified the minimally detectable bone changes to help designing future studies with HR-pQCT.
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Affiliation(s)
| | | | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands.
| | - Patrik Christen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands.
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Durel CA, Feurer E, Pialat JB, Berthoux E, Chapurlat RD, Confavreux CB. Etanercept may induce neurosarcoidosis in a patient treated for rheumatoid arthritis. BMC Neurol 2013; 13:212. [PMID: 24373564 PMCID: PMC3878785 DOI: 10.1186/1471-2377-13-212] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/23/2013] [Indexed: 11/13/2022] Open
Abstract
Background TNFα blockers have drastically improved rheumatoid arthritis prognosis by preventing joint destruction in DMARD resistant patients. Altering cytokine balance in immune diseases may expose to paradoxical adverse events. Case presentation We present the case of a 40-year-old woman, with a confirmed erosive and seropositive RA, successfully treated by TNFα blocker (etanercept) for seven years, and who developed a severe neurosarcoidosis. She had lymphocytic meningitis, bilateral peripheral facial paralysis and anosmia, associated with bilateral hilar lymph nodes, papilloedema, anterior uveitis and elevated serum angiotensin-converting enzyme level. Magnetic resonance imaging showed a bilateral thickening of the Gasser’s ganglia walls and enhanced signal of the vestibulocochlear, the facial and the proximal portion of trijeminal nerves. Conclusion This case raised the issue of the imputability of etanercept in the development of neurosarcoidosis. Neurological symptoms onset in patients on TNFα blockers should lead to exclude infections, induced lupus but also paradoxical neurosarcoidosis.
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Affiliation(s)
- Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Université de Lyon, Hospices Civils de Lyon, Lyon 69003, France.
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Burghardt AJ, Pialat JB, Kazakia GJ, Boutroy S, Engelke K, Patsch JM, Valentinitsch A, Liu D, Szabo E, Bogado CE, Zanchetta MB, McKay HA, Shane E, Boyd SK, Bouxsein ML, Chapurlat R, Khosla S, Majumdar S. Multicenter precision of cortical and trabecular bone quality measures assessed by high-resolution peripheral quantitative computed tomography. J Bone Miner Res 2013; 28:524-36. [PMID: 23074145 PMCID: PMC3577969 DOI: 10.1002/jbmr.1795] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 09/28/2012] [Accepted: 10/03/2012] [Indexed: 01/20/2023]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) has recently been introduced as a clinical research tool for in vivo assessment of bone quality. The utility of this technology to address important skeletal health questions requires translation to standardized multicenter data pools. Our goal was to evaluate the feasibility of pooling data in multicenter HR-pQCT imaging trials. Reproducibility imaging experiments were performed using structure and composition-realistic phantoms constructed from cadaveric radii. Single-center precision was determined by repeat scanning over short-term (<72 hours), intermediate-term (3-5 months), and long-term intervals (28 months). Multicenter precision was determined by imaging the phantoms at nine different HR-pQCT centers. Least significant change (LSC) and root mean squared coefficient of variation (RMSCV) for each interval and across centers was calculated for bone density, geometry, microstructure, and biomechanical parameters. Single-center short-term RMSCVs were <1% for all parameters except cortical thickness (Ct.Th) (1.1%), spatial variability in cortical thickness (Ct.Th.SD) (2.6%), standard deviation of trabecular separation (Tb.Sp.SD) (1.8%), and porosity measures (6% to 8%). Intermediate-term RMSCVs were generally not statistically different from short-term values. Long-term variability was significantly greater for all density measures (0.7% to 2.0%; p < 0.05 versus short-term) and several structure measures: cortical thickness (Ct.Th) (3.4%; p < 0.01 versus short-term), cortical porosity (Ct.Po) (15.4%; p < 0.01 versus short-term), and trabecular thickness (Tb.Th) (2.2%; p < 0.01 versus short-term). Multicenter RMSCVs were also significantly higher than short-term values: 2% to 4% for density and micro-finite element analysis (µFE) measures (p < 0.0001), 2.6% to 5.3% for morphometric measures (p < 0.001), whereas Ct.Po was 16.2% (p < 0.001). In the absence of subject motion, multicenter precision errors for HR-pQCT parameters were generally less than 5%. Phantom-based multicenter precision was comparable to previously reported in in vivo single-center precision errors, although this was approximately two to five times worse than ex vivo short-term precision. The data generated from this study will contribute to the future design and validation of standardized procedures that are broadly translatable to multicenter study designs.
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Affiliation(s)
- Andrew J Burghardt
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
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Pialat JB, Vilayphiou N, Boutroy S, Gouttenoire PJ, Sornay-Rendu E, Chapurlat R, Peyrin F. Local topological analysis at the distal radius by HR-pQCT: Application to in vivo bone microarchitecture and fracture assessment in the OFELY study. Bone 2012; 51:362-8. [PMID: 22728912 DOI: 10.1016/j.bone.2012.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 05/25/2012] [Accepted: 06/12/2012] [Indexed: 01/31/2023]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) is an in-vivo technique used to analyze the distal radius and tibia. It provides a voxel size of 82μm. In addition to providing the usual microarchitecture parameters, local topological analysis (LTA) depicting rod- and plate-like trabeculae may improve prediction of bone fragility. Thirty-three women with prevalent wrist fractures from the OFELY cohort were compared with age-matched controls. Bone microarchitecture, including the structural model index (SMI), was assessed by HR-pQCT, and micro-finite element analysis (μFE) was computed on trabecular bone images of the distal radius (XtremeCT, Scanco Medical AG). A new LTA method was applied to label each bone voxel as a rod, plate or node. Then the bone volume fraction (BV/TV*), the rod, plate and node ratios over bone volume (RV/BV*, PV/BV*, NV/BV*) or total volume (RV/TV*, PV/TV*, NV/TV*) and the rod to plate ratio (RV/PV*) were calculated. Associations between LTA parameters and wrist fractures were computed in a conditional logistic regression model. Multivariate models were tested to predict the μFE-derived trabecular bone stiffness. RV/TV* (OR=4.41 [1.05-18.62]) and BV/TV* (OR=6.45 [1.06-39.3]), were significantly associated with prevalent wrist fracture, after adjustment for ultra distal radius aBMD. Multivariate linear models including PV/TV* or BV/TV*+RV/PV* predicted trabecular stiffness with the same magnitude as those including SMI. Conversion from plates into rods was significantly associated with bone fragility, with a negative correlation between RV/PV* and trabecular bone stiffness (r=-0.63, p<0.0001). We conclude that our local topological analysis is feasible for a voxel size of 82μm. After further validation, it may improve bone fragility description.
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Pialat JB, Burghardt AJ, Sode M, Link TM, Majumdar S. Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone 2012; 50:111-8. [PMID: 22019605 DOI: 10.1016/j.bone.2011.10.003] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/10/2011] [Accepted: 10/05/2011] [Indexed: 11/24/2022]
Abstract
Motion artifacts are a common finding during high-resolution peripheral quantitative computed tomography (HR-pQCT) image acquisitions. To date it is not clear (i) when to repeat an acquisition, (ii) when to exclude a motion-degraded dataset post hoc, and (iii) how motion induced artifacts impact measures of trabecular and cortical parameters. In this study we present inter- and intra-observer reproducibility of a qualitative image quality grading score and report the prevalence of repeat acquisitions in our population. Finally the errors in bone density and micro-architectural parameters estimated from repeat acquisitions with and without motion degradation are presented. The relationship between these errors and the image quality grade is evaluated for each parameter. Repeat acquisitions performed due to operator-observed motion in the reconstructed image occurred for 22.7% of the exams (29.7% radius, 15.7% tibia). Of this subset, 88 exams with repeat acquisitions had at least one acquisition graded 1 (best quality). In this subset, the percent differences in bone density and micro-architecture measures tended to increase as the relative image quality decreased. Micro-architectural parameters were more sensitive to motion compared to geometric and densitometric parameters. These results provide estimates of the error in bone quality measures due to motion artifacts and provide an initial framework for developing standardized quality control criteria for cross-sectional and longitudinal HR-pQCT studies.
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Affiliation(s)
- J B Pialat
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
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Pan J, Pialat JB, Joseph T, Kuo D, Joseph GB, Nevitt MC, Link TM. Knee cartilage T2 characteristics and evolution in relation to morphologic abnormalities detected at 3-T MR imaging: a longitudinal study of the normal control cohort from the Osteoarthritis Initiative. Radiology 2011; 261:507-15. [PMID: 21900614 DOI: 10.1148/radiol.11102234] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the frequency of degenerative knee morphologic abnormalities in asymptomatic individuals by using 3-T magnetic resonance (MR) imaging and to investigate the characteristics and evolution of cartilage T2 values in relation to morphologic abnormalities with a longitudinal study. MATERIALS AND METHODS The study was approved by the institutional review board and was compliant with HIPAA. Ninety-five asymptomatic subjects aged 45-78 years who were free of risk factors for osteoarthritis (OA) were selected from the Osteoarthritis Initiative normal control cohort and examined with radiography and 3-T MR imaging. Data obtained at both baseline and 2-year follow-up were analyzed. OA-related knee abnormalities were analyzed by using the whole-organ MR imaging score (WORMS). Cartilage T2 maps were generated by using sagittal two-dimensional multiecho spin-echo images of the right knee. Statistical significance was determined with the Student t test, the paired t test, a mixed random effects model, one-way analysis of variance, and a multiple linear regression model. RESULTS Knee abnormalities were identified with a high frequency (90% at baseline and 92% at 2-year follow-up). The prevalence of hyaline cartilage lesions was particularly high (86% at baseline and 84% at follow-up). A significant longitudinal increase in T2 was detected in the tibiofemoral cartilage but not the patellofemoral cartilage (P = .0072). The longitudinal change in T2 was significantly associated with worsening of the cartilage WORMS (P = .038). CONCLUSION Asymptomatic subjects have a high frequency of OA-related morphologic abnormalities. A significant increase in tibiofemoral cartilage T2 was detected over the 2-year period. A greater increase in T2 was associated with increased progression of cartilage morphologic abnormalities.
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Affiliation(s)
- Judong Pan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif, USA.
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Sode M, Burghardt AJ, Pialat JB, Link TM, Majumdar S. Quantitative characterization of subject motion in HR-pQCT images of the distal radius and tibia. Bone 2011; 48:1291-7. [PMID: 21421091 PMCID: PMC3108045 DOI: 10.1016/j.bone.2011.03.755] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 03/08/2011] [Accepted: 03/14/2011] [Indexed: 11/22/2022]
Abstract
Image quality degradation due to subject motion is a common artifact affecting in vivo high-resolution peripheral quantitative computed tomography (HR-pQCT) of bones. These artifacts confound the accuracy and reproducibility of bone density, geometry, and cortical and trabecular structure measurements. Observer-based systems for grading image quality and criteria for deciding when to repeat an acquisition and post hoc data quality control remain highly subjective and non-standardized. This study proposes an objective, quantitative technique for measuring subject motion in HR-pQCT acquisitions from raw projection data, using image similarity measures applied to parallelized projections at 0° and 180°. A total of 88 HR-pQCT exams with repeated acquisitions of the distal radius (N = 54) or distal tibia (N = 34) of 49 women (age = 59 ± 14 year) and 3 men (46 ± 2 year) were retrospectively evaluated. All images were graded from 1 (no visible motion artifacts) to 5 (severe motion artifacts) according to the manufacturer-suggested image quality grading system. In addition, to serve as the reference case without motion artifacts, two cadaveric wrist and two ankle specimens were imaged twice with repositioning. The motion-induced error was calculated as the percent difference in each bone parameter for the paired scans with and without visually apparent motion artifacts. Quantitative motion estimates (QMEs) for each motion-degraded scan were calculated using two different image similarity measures: sum of squared differences (SSD) and normalized cross-correlation (NCC). The mean values of QME(SSD) and QME(NCC) increased with the image quality grade for both radius and tibia. Quality grades were differentiated between grades 2 and 3 using QME(SSD), but not with QME(NCC), in addition to between grades 4 and 5. Both QMEs correlated significantly to the motion-induced errors in the measurements and their empirical relationship was derived. Subject motion had greater impact on the precision of trabecular structure indices than on the densitometric indices. The results of this study may provide a basis for establishing a threshold for motion artifacts in accordance to the study design as well as a standardized quality control protocol across operators and imaging centers.
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Affiliation(s)
- Miki Sode
- Joint Graduate Group in Bioengineering, University of California at San Francisco and Berkeley, San Francisco and Berkeley, CA, USA.
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Goldenstein J, Schooler J, Crane JC, Ozhinsky E, Pialat JB, Carballido-Gamio J, Majumdar S. Prospective image registration for automated scan prescription of follow-up knee images in quantitative studies. Magn Reson Imaging 2011; 29:693-700. [PMID: 21546186 DOI: 10.1016/j.mri.2011.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/10/2010] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
Abstract
Consistent scan prescription for MRI of the knee is very important for accurate comparison of images in a longitudinal study. However, consistent scan region selection is difficult due to the complexity of the knee joint. We propose a novel method for registering knee images using a mutual information registration algorithm to align images in a baseline and follow-up exam. The output of the registration algorithm, three translations and three Euler angles, is then used to redefine the region to be imaged and acquire an identical oblique imaging volume in the follow-up exam as in the baseline. This algorithm is robust to articulation of the knee and anatomical abnormalities due to disease (e.g., osteophytes). The registration method is performed only on the distal femur and is not affected by the proximal tibia or soft tissues. We have incorporated this approach in a clinical MR system and have demonstrated its utility in automatically obtaining consistent scan regions between baseline and follow-up examinations, thus improving the precision of quantitative evaluation of cartilage. Results show an improvement with prospective registration in the coefficient of variation for cartilage thickness, cartilage volume and T2 relaxation measurements.
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Affiliation(s)
- Janet Goldenstein
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA.
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Wiart M, Davoust N, Pialat JB, Berthezène Y, Nighoghossian N. Magnetic resonance imaging (MRI) of inflammation in stroke. ACTA ACUST UNITED AC 2007; 2007:4316-9. [PMID: 18002957 DOI: 10.1109/iembs.2007.4353291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Magnetic resonance imaging (MRI) of inflammation is based on the in vivo magnetic labelling of macrophages, the most abundant cells involved in the post-ischemic inflammatory response, by nanoparticles of iron oxides. Such approach has been successfully applied to study experimental rodent models of focal cerebral ischemia and has proved feasible in pioneer clinical studies. Despite current limitations, MRI of inflammation may become an important tool for the investigation of novel ischemic stroke therapeutics targeted at inflammation.
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Affiliation(s)
- Marlène Wiart
- Université de Lyon, Creatis-LRMN, UMR CNRS 5220, Inserm U630, INSA de Lyon, Lyon, France.
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Pialat JB, Cho TH, Beuf O, Joye E, Moucharrafie S, Moucharaffie S, Langlois JB, Nemoz C, Janier M, Berthezene Y, Nighoghossian N, Desvergne B, Wiart M. MRI monitoring of focal cerebral ischemia in peroxisome proliferator-activated receptor (PPAR)-deficient mice. NMR Biomed 2007; 20:335-42. [PMID: 17451173 DOI: 10.1002/nbm.1157] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Peroxisome proliferator-activated receptors (PPARs) are a potential target for neuroprotection in focal ischemic stroke. These nuclear receptors have major effects in lipid metabolism, but they are also involved in inflammatory processes. Three PPAR isotypes have been identified: alpha, beta (or delta) and gamma. The development of PPAR transgenic mice offers a promising tool for prospective therapeutic studies. This study used MRI to assess the role of PPARalpha and PPARbeta in the development of stroke. Permanent middle cerebral artery occlusion induced focal ischemia in wild-type, PPARalpha-null mice and PPARbeta-null mice. T(2)-weighted MRI was performed with a 7 T MRI scan on day 0, 1, 3, 7 and 14 to monitor lesion growth in the various genotypes. General Linear Model statistical analysis found a significant difference in lesion volume between wild-type and PPAR-null mice for both alpha and beta isotypes. These data validate high-resolution MRI for monitoring cerebral ischemic lesions, and confirm the neuroprotective role of PPARalpha and PPARbeta in the brain.
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Affiliation(s)
- Jean-Baptiste Pialat
- Université Lyon 1, Laboratoire CREATIS, INSA de Lyon, CNRS UMR 5515, INSERM U630, Villeurbanne, France
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Nighoghossian N, Wiart M, Cakmak S, Berthezène Y, Derex L, Cho TH, Nemoz C, Chapuis F, Tisserand GL, Pialat JB, Trouillas P, Froment JC, Hermier M. Inflammatory Response After Ischemic Stroke. Stroke 2007; 38:303-7. [PMID: 17170357 DOI: 10.1161/01.str.0000254548.30258.f2] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The intensity of the inflammatory response may be related to the volume of acute infarction. Ultra-small superparamagnetic particles of iron oxide (USPIO) may enable assessment of neuroinflammation. We aimed to assess whether the intensity of the inflammatory response might be related to the subacute ischemic lesion volume.
Methods—
We enrolled patients who presented with acute anterior circulation stroke. MRI was performed at day 0, day 6, and day 9. The MRI protocol included T1-weighted imaging, gradient-echo T2*-weighted imaging, diffusion-weighted imaging, perfusion-weighted imaging and MR angiography. Blood-brain barrier disruption was defined as post-gadolinium enhancement on T1-weighted images. USPIO was administered after day 6 MRI. USPIO enhancement ratios were defined as the ratio between USPIO-related signal volume on day 9 T1-weighted imaging (respectively T2*-weighted imaging) and day 6 diffusion-weighted imaging infarct volume. The relationship between day 6 infarct volume and the enhancement ratio was assessed using Pearson and Spearman correlation tests.
Results—
The protocol was completed in 10 patients. Signal alterations after USPIO injection was observed in 9/10 patients on day 9 T1-weighted imaging and in 5/10 patients on day 9 T2*-weighted imaging. USPIO-related MRI enhancement was heterogeneous. Lesion volume on day 6 diffusion-weighted imaging had no impact on USPIO enhancement at day 9 according to the Pearson correlation test (
P
=0.39) or Spearman test (
P
=0.25). There was no relationship between blood-brain barrier disruption and USPIO enhancement.
Conclusions—
USPIO MRI enhancement is heterogeneous and not clearly related to subacute lesion volume.
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Wiart M, Davoust N, Pialat JB, Desestret V, Moucharrafie S, Moucharaffie S, Cho TH, Mutin M, Langlois JB, Beuf O, Honnorat J, Nighoghossian N, Berthezène Y. MRI monitoring of neuroinflammation in mouse focal ischemia. Stroke 2006; 38:131-7. [PMID: 17122417 DOI: 10.1161/01.str.0000252159.05702.00] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE A growing body of evidence suggests that inflammatory processes are involved in the pathophysiology of stroke. Phagocyte cells, involving resident microglia and infiltrating macrophages, secrete both protective and toxic molecules and thus represent a potential therapeutic target. The aim of the present study was to monitor phagocytic activity after focal cerebral ischemia in mice. METHODS Ultrasmall superparamagnetic particles of iron oxide (USPIO) were intravenously injected after permanent middle cerebral artery occlusion and monitored by high resolution MRI for 72 hours. RESULTS We here present the first MRI data showing in vivo phagocyte-labeling obtained in mice with focal cerebral ischemia. USPIO-enhanced MRI kinetic analysis disclosed an inflammatory response surrounding the ischemic lesion and in the contralateral hemisphere via the corpus callosum. The imaging data collected during the first 36 hours postinjury suggested a spread of USPIO-related signal from ipsi- to contralateral hemisphere. Imaging data correlated with histochemical analysis showing inflammation remote from the lesion and ingestion of nanoparticles by microglia/macrophages. CONCLUSIONS The present study shows that MR-tracking of phagocyte cells is feasible in mice, which may have critical therapeutic implications given the potential neurotoxicity of activated microglia/macrophages in central nervous system disorders.
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Gleizal A, Li S, Pialat JB, Beziat JL. Transcriptional expression of calvarial bone after treatment with low-intensity ultrasound: an in vitro study. Ultrasound Med Biol 2006; 32:1569-74. [PMID: 17045878 DOI: 10.1016/j.ultrasmedbio.2006.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 04/18/2006] [Accepted: 05/04/2006] [Indexed: 05/12/2023]
Abstract
The capacity to reossify a calvarial bone defect is very small in mature animals and in humans greater than 2 y of age. The clinical treatment of injured tissue sites of bones by low-intensity pulsed ultrasound is widespread, but little is known about the precise effects of ultrasound on the fundamental processes that promote repair and regeneration. In this study, we used real-time polymerase chain reaction (RT-PCR) to investigate the expression of osteogenesis-associated genes after stimulation by low-intensity ultrasound in adult mouse osteoblast from the parietal calvaria. The gene associated with the Runx2 pathway had notably higher levels after 1, 2 and 3 days of stimulation. Therefore, low-intensity ultrasound seems to have an effect on the transcriptional gene expression of the calvarial bone in vitro.
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Affiliation(s)
- Arnaud Gleizal
- Department of Oral and Maxillofacial Surgery, Hôpitaux Nord, Lyon, France.
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David G, Perpoint T, Boibieux A, Pialat JB, Salord H, Devouassoux M, Chidiac C, Peyramond D. Secondary pulmonary syphilis: report of a likely case and literature review. Clin Infect Dis 2005; 42:e11-5. [PMID: 16392072 DOI: 10.1086/499104] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 09/08/2005] [Indexed: 11/03/2022] Open
Abstract
We report the case of a homosexual, HIV-positive man with typical secondary syphilis and multiple excavated pulmonary subpleural nodules. Syphilis with direct pulmonary involvement was suggested by a positive result of PCR of a bronchoalveolar lavage fluid specimen, then confirmed by a positive therapeutic test result. Only 9 reports of pulmonary involvement in secondary syphilis have been reported to date in the English-language literature. Clinicians should be aware of this atypical localization of syphilis.
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Affiliation(s)
- Gary David
- Department of Infectious Diseases, Croix-Rousse University Hospital, Lyon, France.
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Pialat JB, Wiart M, Nighoghossian N, Adeleine P, Derex L, Hermier M, Froment JC, Berthezene Y. Evolution of lesion volume in acute stroke treated by intravenous t-PA. J Magn Reson Imaging 2005; 22:23-8. [PMID: 15971175 DOI: 10.1002/jmri.20363] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the evolution of the ischemic lesion volumes in a population treated with tissue plasminogen activator (t-PA), MRIs were performed before treatment and 24 hours later; final infarct size was evaluated 60 days later. MATERIALS AND METHODS A total of 42 patients with hemispheric stroke were recruited for a thrombolytic study. Intravenous t-PA was given after MRI within the first seven hours after stroke onset. Volumes were evaluated on day 0 and day 1 with diffusion-weighted imaging (DWI), on day 60 with T2-weighted imaging (T2WI), and recanalization was assessed based on day 1 MR angiography (MRA). RESULTS Lesion volume increased between day 0 and day 1, and decreased between day 1 and day 60. It was lower in the group of patients with recanalization on day 1 MRA. CONCLUSION Volume analysis emphasizes the effectiveness of recanalization as a predictive factor for better outcome, based on final infarct size. The decrease in lesion volumes between day 1 and day 60 suggests that other factors leads to overestimation of day 1 abnormal diffusion volume. This could explain the delayed partial reversibility of the DWI abnormality.
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Affiliation(s)
- Jean-Baptiste Pialat
- Laboratoire CREATIS, Unité Médicale de Recherche CNRS 5515 Unité 630 INSERM, Lyon, France.
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Affiliation(s)
- Jean-Baptiste Pialat
- Service de Radiologie, Hôpital de la Croix Rousse, 103 grande rue de la Croix Rousse, 69317 Lyon cedex 04, France.
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