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Oloukoi C, Dohan A, Gaillard M, Hoeffel C, Groussin-Rouiller L, Bertherat J, Jouinot A, Assié G, Fuks D, Sibony M, Soyer P, Jannot AS, Barat M. Differentiation between adrenocortical carcinoma and lipid-poor adrenal adenoma using a multiparametric MRI-based diagnostic algorithm. Diagn Interv Imaging 2024:S2211-5684(24)00081-0. [PMID: 38575426 DOI: 10.1016/j.diii.2024.03.005] [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: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the capabilities of multiparametric magnetic resonance imaging (MRI) in differentiating between lipid-poor adrenal adenoma (LPAA) and adrenocortical carcinoma (ACC). MATERIALS AND METHODS Patients of two centers who underwent surgical resection of LPAA or ACC after multiparametric MRI were retrospectively included. A training cohort was used to build a diagnostic algorithm obtained through recursive partitioning based on multiparametric MRI variables, including apparent diffusion coefficient and chemical shift signal ratio (i.e., tumor signal intensity index). The diagnostic performances of the multiparametric MRI-based algorithm were evaluated using a validation cohort, alone first and then in association with adrenal tumor size using a cut-off of 4 cm. Performances of the diagnostic algorithm for the diagnosis of ACC vs. LPAA were calculated using pathology as the reference standard. RESULTS Fifty-four patients (27 with LPAA and 27 with ACC; 37 women; mean age, 48.5 ± 13.3 [standard deviation (SD)] years) were used as the training cohort and 61 patients (24 with LPAA and 37 with ACC; 47 women; mean age, 49 ± 11.7 [SD] years) were used as the validation cohort. In the validation cohort, the diagnostic algorithm yielded best accuracy for the diagnosis of ACC vs. LPAA (75%; 46/61; 95% CI: 55-88) when used without lesion size. Best sensitivity was obtained with the association of the diagnostic algorithm with tumor size (96%; 23/24; 95% CI: 80-99). Best specificity was obtained with the diagnostic algorithm used alone (76%; 28/37; 95% CI: 60-87). CONCLUSION A multiparametric MRI-based diagnostic algorithm that includes apparent diffusion coefficient and tumor signal intensity index helps discriminate between ACC and LPAA with high degrees of specificity and accuracy. The association of the multiparametric MRI-based diagnostic algorithm with adrenal lesion size helps maximize the sensitivity of multiparametric MRI for the diagnosis of ACC.
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Affiliation(s)
- Carmelia Oloukoi
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France
| | - Martin Gaillard
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Pancreatic and Endocrine Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré, CRESTIC, URCA, 51000 Reims, France
| | - Lionel Groussin-Rouiller
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Jérome Bertherat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Anne Jouinot
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Guillaume Assié
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France; Department of Endocrinology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - David Fuks
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Pancreatic and Endocrine Surgery, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Mathilde Sibony
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Pathology, Hôpital Cochin, AP-HP, 75014 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anne-Sophie Jannot
- AP-HP.Centre- Université Paris Cité, Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, 75015, Paris, France; INSERM, UMR_S1138, Cordeliers Research Center, Université Paris Cité, 75006 Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France.
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Barat M, Pellat A, Hoeffel C, Dohan A, Coriat R, Fishman EK, Nougaret S, Chu L, Soyer P. CT and MRI of abdominal cancers: current trends and perspectives in the era of radiomics and artificial intelligence. Jpn J Radiol 2024; 42:246-260. [PMID: 37926780 DOI: 10.1007/s11604-023-01504-0] [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: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Abdominal cancers continue to pose daily challenges to clinicians, radiologists and researchers. These challenges are faced at each stage of abdominal cancer management, including early detection, accurate characterization, precise assessment of tumor spread, preoperative planning when surgery is anticipated, prediction of tumor aggressiveness, response to therapy, and detection of recurrence. Technical advances in medical imaging, often in combination with imaging biomarkers, show great promise in addressing such challenges. Information extracted from imaging datasets owing to the application of radiomics can be used to further improve the diagnostic capabilities of imaging. However, the analysis of the huge amount of data provided by these advances is a difficult task in daily practice. Artificial intelligence has the potential to help radiologists in all these challenges. Notably, the applications of AI in the field of abdominal cancers are expanding and now include diverse approaches for cancer detection, diagnosis and classification, genomics and detection of genetic alterations, analysis of tumor microenvironment, identification of predictive biomarkers and follow-up. However, AI currently has some limitations that need further refinement for implementation in the clinical setting. This review article sums up recent advances in imaging of abdominal cancers in the field of image/data acquisition, tumor detection, tumor characterization, prognosis, and treatment response evaluation.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Anna Pellat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hopital Robert Debré, CHU Reims, Université Champagne-Ardennes, 51092, Reims, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, 34000, Montpellier, France
- PINKCC Lab, IRCM, U1194, 34000, Montpellier, France
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France.
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France.
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Barat M, Dohan A, Kohi M, Marcelin C, Pelage JP, Denys A, Mafeld S, Kaufman CS, Soyer P, Cornelis FH. Treatment of adenomyosis, abdominal wall endometriosis and uterine leiomyoma with interventional radiology: A review of current evidences. Diagn Interv Imaging 2024; 105:87-96. [PMID: 38065817 DOI: 10.1016/j.diii.2023.11.005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Abstract
Interventional radiology shows promises in the field of women's health, particularly in pelvic interventions. This review article discusses the latest advancements in interventional radiology techniques for pelvic conditions affecting women including adenomyosis, abdominal wall endometriosis and uterine leiomyoma. Extraperitoneal endometriosis involving the abdominal wall may be treated by percutaneous thermal ablation, such as cryoablation, whereas uterine leiomyoma and adenomyosis can be managed either using percutaneous thermal ablation or using uterine artery embolization. Continued research and development in interventional radiology will further enhance the minimally-invasive interventions available for women's health, improving outcomes and quality of life for this large patient population of women.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Maureen Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, NC 27599, USA
| | - Clement Marcelin
- Department of Radiology, Centre Hospitalo-Universitaire de Bordeaux, 33076 Bordeaux, France
| | - Jean-Pierre Pelage
- Department of Radiology, Research Institute of McGill University Health Centre, McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne and University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Sebastian Mafeld
- Department of Medical Imaging, Division of Vascular and Interventional Radiology, Toronto General Hospital, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Claire S Kaufman
- Dotter Interventional Institute, Oregon Health & Science University, Portland, OR 97239-3011, USA
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA.
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Barat M, Milot L. Is robotic assistance the future of percutaneous interventional radiology? Diagn Interv Imaging 2024:S2211-5684(24)00019-6. [PMID: 38403506 DOI: 10.1016/j.diii.2024.01.007] [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: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69005 Lyon, France; LabTAU, INSERM U1032, 69003 Lyon, France; Université Claude Bernard Lyon 1, 69003 Lyon, France
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5
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Jajodia A, Soyer P, Barat M, Patlas MN. Imaging of hepato-pancreato-biliary emergencies in patients with cancer. Diagn Interv Imaging 2024; 105:47-56. [PMID: 38040558 DOI: 10.1016/j.diii.2023.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
Hepato-pancreato-biliary (HPB) emergencies in patients with cancer encompass an extensive array of various conditions, including primary malignancies that require prompt treatment, associated severe complications, and life-threatening consequences arising from treatment. In patients with cancer, the liver can be affected by chemotherapy-induced hepatotoxicity, veno-occlusive disease, Budd-Chiari syndrome, liver hemorrhage, and other complications arising from cancer therapy with all these complications requiring timely diagnosis and prompt treament. Cholecystitis induced by systemic anticancer therapies can result in severe conquences if not promptly identified and treated. The application of immunotherapy in cancer therapy is associated with cholangitis. Hemobilia, often caused by medical interventions, may require arterial embolization in patients with severe bleeding and hemodynamic instability. Malignant biliary obstruction in patients with biliary cancers may necessitate palliative strategies such as biliary stenting. In pancreatic cancer, patients often miss surgical treatment due to advanced disease stages or distant metastases, leading to potential emergencies at different treatment phases. This comprehensive review underscores the complexities of diagnostic and treatment roles of medical imaging in managing HPB emergencies in patients with cancer. It illustrates the crucial role of imaging techniques, including magnetic resonance imaging, computed tomography and ultrasound, in diagnosing and managing these conditions for timely intervention. It provides essential insights into the critical nature of early diagnosis and intervention in cancer-related HPB emergencies, ultimately impacting patient outcomes and survival rates.
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Affiliation(s)
- Ankush Jajodia
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1W7, Canada
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France
| | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1W7, Canada.
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Hedjoudje M, Barat M, Dohan A, Lucas A, Dautry R, Coriat R, Marchese U, Pol S, Parlati L, Soyer P. Comparison Between Radial and Femoral Artery Access for Transarterial Chemoembolisation in Patients With Hepatocellular Carcinoma. Can Assoc Radiol J 2024; 75:178-186. [PMID: 37563785 DOI: 10.1177/08465371231186524] [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] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The purpose of this study was to compare the technical success rate, the selectivity of transarterial chemoembolisation (TACE), the complication rate, the radiation dose given to the patients and the hospitalization stay between TACE performed using femoral artery approach (FAA) and TACE performed using radial artery approach (RAA) in patients with hepatocellular carcinoma (HCC). METHODS Between June 2020 and April 2022, 49 patients with HCC who underwent 116 TACEs (75 using FAA and 41 using RAA) were included. Differences in technical success rate, selectivity of micro-catheterization, radiation dose given to the patients, fluoroscopy time, hospitalization stay duration, and complication rate were compared between FAA and RAA using Fisher exact or Student t tests. RESULTS No differences in technical success rates were found between RAA (93%; 39/41 TACEs) and FAA (100%; 75/75 TACEs) (P = .12). There were no differences between the two groups in terms of selectivity of catheterization, radiation dose, fluoroscopy time and hospitalization stay duration. Five patients had Grade 2 complications (hematoma) after FAA vs. one patient with one Grade 1 complication (radial artery occlusion) after RAA (5/75 [7%] vs. 1/41 [2%], respectively; P = .42). No major arterial access site complications occurred with FAA or RAA. CONCLUSIONS This study confirms that RAA is a safe approach that does not compromise the technical efficacy and the selectivity of TACE compared to FAA in patients with HCC.
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Affiliation(s)
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Alexandre Lucas
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Raphael Dautry
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hopital Cochin, AP-HP, Paris, France
| | - Ugo Marchese
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Digestive, Hepatobiliary, and Endocrine Surgery, Hopital Cochin, AP-HP, Paris, France
| | - Stanislas Pol
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Hepatology, Hopital Cochin, AP-HP, Paris, France
| | - Lucia Parlati
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Hepatology, Hopital Cochin, AP-HP, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
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Abstract
Gastrointestinal stromal tumors (GISTs) are defined as mesenchymal tumors of the gastrointestinal tract that express positivity for CD117, which is a c-KIT proto-oncogene antigen. Expression of the c-KIT protein, a tyrosine kinase growth factor receptor, allows the distinction between GISTs and other mesenchymal tumors such as leiomyoma, leiomyosarcoma, schwannoma and neurofibroma. GISTs can develop anywhere in the gastrointestinal tract, as well as in the mesentery and omentum. Over the years, the management of GISTs has improved due to a better knowledge of their behaviors and risk or recurrence, the identification of specific mutations and the use of targeted therapies. This has resulted in a better prognosis for patients with GISTs. In parallel, imaging of GISTs has been revolutionized by tremendous progress in the field of detection, characterization, survival prediction and monitoring during therapy. Recently, a particular attention has been given to radiomics for the characterization of GISTs using analysis of quantitative imaging features. In addition, radiomics has currently many applications that are developed in conjunction with artificial intelligence with the aim of better characterizing GISTs and providing a more precise assessment of tumor burden. This article sums up recent advances in computed tomography and magnetic resonance imaging of GISTs in the field of image/data acquisition, tumor detection, tumor characterization, treatment response evaluation, and preoperative planning.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Anna Pellat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Christine Hoeffel
- Reims Medical School, Department of Radiology, Hopital Robert Debré, CHU Reims, Université Champagne-Ardennes, Reims, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
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Barat M, Pellat A, Terris B, Dohan A, Coriat R, Fishman EK, Rowe SP, Chu L, Soyer P. Cinematic Rendering of Gastrointestinal Stromal Tumors: A Review of Current Possibilities and Future Developments. Can Assoc Radiol J 2023:8465371231211278. [PMID: 37982314 DOI: 10.1177/08465371231211278] [Citation(s) in RCA: 1] [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] [Indexed: 11/21/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are defined as CD117-positive primary, spindled or epithelioid, mesenchymal tumors of the gastrointestinal tract, omentum, or mesentery. While computed tomography (CT) is the recommended imaging modality for GISTs, overlap in imaging features between GISTs and other gastrointestinal tumors often make radiological diagnosis and subsequent selection of the optimal therapeutic approach challenging. Cinematic rendering is a novel CT post-processing technique that generates highly photorealistic anatomic images based on a unique lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generate depth in the final three-dimensional display. Early studies have shown that cinematic rendering produces high-quality images with enhanced detail by comparison with other three-dimensional visualization techniques. Cinematic rendering shows promise in improving the visualization of enhancement patterns and internal architecture of abdominal lesions, local tumor extension, and global disease burden, which may be helpful for lesion characterization and pretreatment planning. This article discusses and illustrates the application of cinematic rendering in the evaluation of GISTs and the unique benefit of using cinematic rendering in the workup of GIST with a specific emphasis on tumor characterization and preoperative planning.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Anna Pellat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Benoit Terris
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Pathology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P Rowe
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, Université Paris Cité, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, Université Paris Cité, Paris, France
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Homps M, Soyer P, Coriat R, Dermine S, Pellat A, Fuks D, Marchese U, Terris B, Groussin L, Dohan A, Barat M. A preoperative computed tomography radiomics model to predict disease-free survival in patients with pancreatic neuroendocrine tumors. Eur J Endocrinol 2023; 189:476-484. [PMID: 37787635 DOI: 10.1093/ejendo/lvad130] [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: 03/21/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/04/2023]
Abstract
IMPORTANCE Imaging has demonstrated capabilities in the diagnosis of pancreatic neuroendocrine tumors (pNETs), but its utility for prognostic prediction has not been elucidated yet. OBJECTIVE The aim of this study was to build a radiomics model using preoperative computed tomography (CT) data that may help predict recurrence-free survival (RFS) or OS in patients with pNET. DESIGN We performed a retrospective observational study in a cohort of French patients with pNETs. PARTICIPANTS Patients with surgically resected pNET and available CT examinations were included. INTERVENTIONS Radiomics features of preoperative CT data were extracted using 3D-Slicer® software with manual segmentation. Discriminant features were selected with penalized regression using least absolute shrinkage and selection operator method with training on the tumor Ki67 rate (≤2 or >2). Selected features were used to build a radiomics index ranging from 0 to 1. OUTCOME AND MEASURE A receiving operator curve was built to select an optimal cutoff value of the radiomics index to predict patient RFS and OS. Recurrence-free survival and OS were assessed using Kaplan-Meier analysis. RESULTS Thirty-seven patients (median age, 61 years; 20 men) with 37 pNETs (grade 1, 21/37 [57%]; grade 2, 12/37 [32%]; grade 3, 4/37 [11%]) were included. Patients with a radiomics index >0.4 had a shorter median RFS (36 months; range: 1-133) than those with a radiomics index ≤0.4 (84 months; range: 9-148; P = .013). No associations were found between the radiomics index and OS (P = .86).
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Affiliation(s)
- Margaux Homps
- Department of Diagnostic and Interventional Imaging, APHP, Hôpital Cochin, Paris F-75014, France
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
| | - Philippe Soyer
- Department of Diagnostic and Interventional Imaging, APHP, Hôpital Cochin, Paris F-75014, France
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Gastroenterology and Digestive Oncology, AP-HP, Hôpital Cochin, Paris F-75014, France
| | - Solène Dermine
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Gastroenterology and Digestive Oncology, AP-HP, Hôpital Cochin, Paris F-75014, France
| | - Anna Pellat
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Gastroenterology and Digestive Oncology, AP-HP, Hôpital Cochin, Paris F-75014, France
| | - David Fuks
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Surgery, Hôpital Cochin, APHP, Paris F-75014, France
| | - Ugo Marchese
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Surgery, Hôpital Cochin, APHP, Paris F-75014, France
| | - Benoit Terris
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Pathology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris F-75014, France
| | - Lionel Groussin
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
- Department of Endocrinology, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, Paris F-75014, France
| | - Anthony Dohan
- Department of Diagnostic and Interventional Imaging, APHP, Hôpital Cochin, Paris F-75014, France
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
| | - Maxime Barat
- Department of Diagnostic and Interventional Imaging, APHP, Hôpital Cochin, Paris F-75014, France
- Faculté de Médecine, Université Paris Cité, Paris F-75006, France
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11
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Sindayigaya R, Barat M, Tzedakis S, Dautry R, Dohan A, Belle A, Coriat R, Soyer P, Fuks D, Marchese U. Modified Appleby procedure for locally advanced pancreatic carcinoma: A primer for the radiologist. Diagn Interv Imaging 2023; 104:455-464. [PMID: 37301694 DOI: 10.1016/j.diii.2023.05.008] [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: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most prevalent pancreatic neoplasm accounting for more than 90% of pancreatic malignancies. Surgical resection with adequate lymphadenectomy remains the only available curative strategy for patients with PDAC. Despite improvements in both chemotherapy regimen and surgical care, body/neck PDAC still conveys a poor prognosis because of the vicinity of major vascular structures, including celiac trunk, which favors insidious disease spread at the time of diagnosis. Body/neck PDAC involving the celiac trunk is considered locally advanced PDAC in most guidelines and therefore not eligible for upfront resection. However, a more aggressive surgical approach (i.e., distal pancreatectomy with splenectomy and en-bloc celiac trunk resection [DP-CAR]) was recently proposed to offer hope for cure in selected patients with locally advanced body/neck PDAC responsive to induction therapy at the cost of higher morbidity. The so-called "modified Appleby procedure" is highly demanding and requires optimal preoperative staging as well as appropriate patient preparation for surgery (i.e., preoperative arterial embolization). Herein, we review current evidence regarding DP-CAR indications and outcomes as well as the critical role of diagnostic and interventional radiology in patient preparation before DP-CAR, and early identification and management of DP-CAR complications.
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Affiliation(s)
- Rémy Sindayigaya
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| | - Maxime Barat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Stylianos Tzedakis
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Raphael Dautry
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Arthur Belle
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Philippe Soyer
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - David Fuks
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Ugo Marchese
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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12
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Barat M, Soyer P, Audard V. Nodular fasciitis: PET/CT and MR imaging features. Diagn Interv Imaging 2023; 104:451-452. [PMID: 37330412 DOI: 10.1016/j.diii.2023.06.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France; Université Paris Cité, 75006 Paris, France.
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Virginie Audard
- Université Paris Cité, 75006 Paris, France; Department of Pathology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France
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13
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Pellat A, Barat M, Cottereau AS, Terris B, Coriat R. [Well-differentiated neuroendocrine tumors of the digestive tract: Focus on pancreatic neuroendocrine tumors]. Bull Cancer 2023; 110:955-967. [PMID: 36935319 DOI: 10.1016/j.bulcan.2023.03.001] [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: 01/09/2023] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Abstract
Pancreatic neuroendocrine tumors are rare tumors showing a rising incidence. They are well-differentiated tumors, classified by grade according to their Ki67 index value (grade 1 to 3). Pancreatic neuroendocrine tumors are mainly sporadic tumors but about 10% arise within endocrine tumor syndromes such as multiple endocrine neoplasia type 1. They can be responsible for functional syndromes or non-specific clinical symptoms depending on tumor extension. However, there is also an increase of incidental diagnoses of nonfunctional pancreatic neuroendocrine tumors with the widespread use of high-quality imaging techniques. About 50 % of pancreatic neuroendocrine tumors are diagnosed at a metastatic stage, with metastases often located in the liver. Chromogranin A, CT-scan and often an abdominal MRI, and functional imaging should be performed for tumor staging and follow-up. Imaging with PET/CT with 68Ga-labeled somatostatin analogues has the highest sensitivity for the diagnosis of pancreatic neuroendocrine tumors, while 18fluorodeoxyglucose PET/CT can sometimes be useful. Overall, they are rather indolent tumors with prolonged survival. Surgery is the recommended treatment in the localized setting, with the exception of small<2cm nonfunctional tumors that can be monitored with imaging techniques. For advanced tumors, there are several available treatments such as somatostatine analogues, chemotherapy, targeted therapies (sunitinib, everolimus), locoregional ablative therapies and Peptide Receptor Radiolabelled Therapy. The treatment strategy will depend on the initial tumor staging, tumor grade, aggressiveness and patient's choice.
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Affiliation(s)
- Anna Pellat
- AP-HP, hôpital Cochin, service de gastroentérologie et d'oncologie digestive, 27, rue du faubourg Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France.
| | - Maxime Barat
- AP-HP, hôpital Cochin, service de radiologie, 27, rue du faubourg Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Anne-Ségolène Cottereau
- AP-HP, hôpital Cochin, service de médecine nucléaire, 27, rue du faubourg Saint-Jacques, 75014 Paris, France
| | - Benoit Terris
- AP-HP, hôpital Cochin, service d'anatomopathologie, 27, rue du faubourg Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Romain Coriat
- AP-HP, hôpital Cochin, service de gastroentérologie et d'oncologie digestive, 27, rue du faubourg Saint-Jacques, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
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14
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Cocquempot R, Bonnin A, Barat M, Naveendran G, Dohan A, Fuks D, Terris B, Coriat R, Hoeffel C, Marchese U, Soyer P. Interobserver Variability and Accuracy of Preoperative CT and MRI in Pancreatic Ductal Adenocarcinoma Size Estimation: A Retrospective Cohort Study. Can Assoc Radiol J 2023; 74:570-581. [PMID: 36347588 DOI: 10.1177/08465371221137885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
Purpose: To assess interobserver variability and accuracy of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) in pancreatic ductal adenocarcinoma (PDAC) size estimation using surgical specimens as standard of reference. Methods: Patients with PDAC who underwent preoperative CT and MRI examinations before surgery were included. PDAC largest axial dimension was measured by 2 readers on 8 MRI sequence and 2 CT imaging phases (pancreatic parenchymal and portal venous). Measurements were compared to actual tumour size at pathologic examination. Interobserver variability was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots. Differences in tumour size (Δdiameter) between imaging and actual tumour size were searched using Wilcoxon rank sum test. Results: Twenty-nine patients (16 men; median age, 70 years) with surgically resected PDAC were included. Interobserver reproducibility was good to excellent for all MRI sequences and the 2 CT imaging phases with ICCs between .862 (95%CI: .692-.942) for fat-saturated in-phase T1-weighted sequence and .955 (95%CI: .898-.980) for portal venous phase CT images. Best accuracy in PDAC size measurement was obtained with pancreatic parenchymal phase CT images with median Δdiameters of -2 mm for both readers, mean relative differences of -9% and -6% and no significant differences with dimensions at histopathological analysis (P = .051). All MRI sequences led to significant underestimation of PDAC size (median Δdiameters, -6 to -1 mm; mean relative differences, -21% to -11%). Conclusions: Most accurate measurement of PDAC size is obtained with CT images obtained during the pancreatic parenchymal phase. MRI results in significant underestimation of PDAC size.
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Affiliation(s)
- Romain Cocquempot
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Angèle Bonnin
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Gaanan Naveendran
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hopital Cochin, AP-HP, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - David Fuks
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hopital Cochin, AP-HP, Paris, France
| | - Benoit Terris
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Pathology, Hopital Cochin, AP-HP, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Gastroenterology, Hopital Cochin, AP-HP, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hopital Robert Debré, CHU Reims, Reims Medical School, University of Champagne Ardennes, Reims, France
| | - Ugo Marchese
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hopital Cochin, AP-HP, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
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15
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Barat M, Dohan A, Soyer P. Factors affecting citation counts of articles published in Diagnostic and Interventional Imaging. Diagn Interv Imaging 2023:S2211-5684(23)00147-X. [PMID: 37355364 DOI: 10.1016/j.diii.2023.06.010] [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: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 75014, Paris, France; Université Paris Cité, 75006 Paris, France.
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 75014, Paris, France; Université Paris Cité, 75006 Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 75014, Paris, France; Université Paris Cité, 75006 Paris, France
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16
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Gaillard M, Razafinimanana M, Challine A, Araujo RLC, Libé R, Sibony M, Barat M, Bertherat J, Dousset B, Fuks D, Gaujoux S. Laparoscopic or Open Adrenalectomy for Stage I-II Adrenocortical Carcinoma: A Retrospective Study. J Clin Med 2023; 12:jcm12113698. [PMID: 37297891 DOI: 10.3390/jcm12113698] [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: 04/13/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Surgical resection of adrenocortical carcinoma (ACC) is the only curative treatment. Even in localized (I-II) stages, open adrenalectomy (OA) is the gold standard, though laparoscopic adrenalectomy (LA) can be proposed in selected patients. Despite the postoperative benefits of LA, its role in the surgical management of patients with ACC remains controversial regarding oncologic outcomes. The aim of this retrospective study was to compare the outcomes of patients with localized ACC submitted to LA or OA in a referral center from 1995 to 2020. Among 180 consecutive patients operated on for ACC, 49 presented with localized ACC (19 LA and 30 OA). Baseline characteristics were similar between groups, except for tumor size. Kaplan-Meier estimates of 5-year overall survival were similar in both groups (p = 0.166) but 3-year disease-free survival was in favor of OA (p = 0.020). Though LA could be proposed in highly selected patients, OA should still be considered the standard approach in patients with known or suspected localized ACC.
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Affiliation(s)
- Martin Gaillard
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Meva Razafinimanana
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Alexandre Challine
- Department of Digestive Surgery, Hôpital Saint-Antoine, APHP.Sorbonne Université, 75012 Paris, France
| | - Raphael L C Araujo
- Department of Surgery, Hospital Israelita Albert Einstein, Universidade Federal de Sao Paulo, Sao Paulo 05652-900, Brazil
| | - Rossella Libé
- Department of Endocrinology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Mathilde Sibony
- Department of Pathology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Sebastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, APHP.Sorbonne Université, 75013 Paris, France
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17
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Kedra A, Dohan A, Biau D, Belbachir A, Dautry R, Lucas A, Aissaoui M, Feydy A, Soyer P, Barat M. Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience. Cancers (Basel) 2023; 15:cancers15092657. [PMID: 37174122 PMCID: PMC10177012 DOI: 10.3390/cancers15092657] [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: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.
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Affiliation(s)
- Alice Kedra
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - David Biau
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anissa Belbachir
- Department of Anesthesiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Raphael Dautry
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Alexandre Lucas
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Mathilde Aissaoui
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Antoine Feydy
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Musculoskeletal Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Philippe Soyer
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Maxime Barat
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
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18
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Libé R, Pais A, Violon F, Guignat L, Bonnet F, Huillard O, Assié G, Gaillard M, Dousset B, Gaujoux S, Barat M, Dohan A, Sibony M, Bertherat J, Cottereau AS, Tenenbaum F, Coste J, Groussin L. Positive Correlation Between 18 F-FDG Uptake and Tumor-Proliferating Antigen Ki-67 Expression in Adrenocortical Carcinomas. Clin Nucl Med 2023; 48:381-386. [PMID: 36758555 DOI: 10.1097/rlu.0000000000004593] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF THE REPORT Adrenocortical carcinoma (ACC) is an extremely rare endocrine malignancy, which cannot always be diagnosed during conventional radiology and hormonal investigations. 18 F-FDG PET could help predict malignancy, but more data are necessary to support future guidelines. METHODS A cohort of 63 patients with histologically proven ACC (n = 55) or metastatic ACC with steroid oversecretion (n = 8) was assembled. All patients underwent an 18 F-FDG PET, and the SUV max and the adrenal-to-liver SUV max ratio were calculated. The 18 F-FDG PET parameters were compared with clinical, pathological, and outcome data. RESULTS Fifty-six of 63 patients (89%) had an ACC with an adrenal-to-liver SUV max ratio >1.45, which was a previously defined cutoff value to predict malignancy with 100% sensitivity. Seven ACCs (11%) had a lower uptake (adrenal-to-liver SUV max <1.45), most of them with a proliferation marker Ki-67 expression level <10%. A positive correlation between 18 F-FDG PET parameters (SUV max and adrenal-to-liver SUV max ratio) and tumor size, ENSAT (European Network for the Study of Adrenal Tumors) staging, total Weiss score, and the Ki-67 was found. The strong correlation between SUV max and Ki-67 ( r = 0.47, P = 0.0009) suggests a relationship between 18 F-FDG uptake levels and tumor proliferation. No statistically significant associations between outcome parameters (progression-free or overall survival) and 18 F-FDG PET parameters were found. CONCLUSIONS This large cohort study shows that most cases of ACC demonstrate high 18 F-FDG uptake. However, the positive correlation observed between SUV max and Ki-67 expression levels seems to explain the possibility of identifying some ACC with a low or inexistent 18 F-FDG uptake. These findings have practical implications for the management of patients with an adrenal mass.
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Affiliation(s)
- Rossella Libé
- From the Service Endocrinologie, French National Network for Adrenal Cancers ENDOCAN-COMETE
| | - Aurore Pais
- From the Service Endocrinologie, French National Network for Adrenal Cancers ENDOCAN-COMETE
| | | | - Laurence Guignat
- From the Service Endocrinologie, French National Network for Adrenal Cancers ENDOCAN-COMETE
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19
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Violon F, Bouys L, Berthon A, Ragazzon B, Barat M, Perlemoine K, Guignat L, Terris B, Bertherat J, Sibony M. Impact of Morphology in the Genotype and Phenotype Correlation of Bilateral Macronodular Adrenocortical Disease (BMAD): A Series of Clinicopathologically Well-Characterized 35 Cases. Endocr Pathol 2023. [PMID: 36864263 DOI: 10.1007/s12022-023-09751-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Bilateral macronodular adrenocortical disease (BMAD) is characterized by the development of adrenal macronodules resulting in a pituitary-ACTH independent Cushing's syndrome. Although there are important similarities observed between the rare microscopic descriptions of this disease, the small series published are not representative of the molecular and genetic heterogenicity recently described in BMAD. We analyzed the pathological features in a series of BMAD and determined if there is correlation between these criteria and the characteristics of the patients. Two pathologists reviewed the slides of 35 patients who underwent surgery for suspicion of BMAD in our center between 1998 and 2021. An unsupervised multiple factor analysis based on microscopic characteristics divided the cases into 4 subtypes according to the architecture of the macronodules (containing or not round fibrous septa) and the proportion of the different cell types: clear, eosinophilic compact, and oncocytic cells. The correlation study with genetic revealed subtype 1 and subtype 2 are associated with the presence of ARMC5 and KDM1A pathogenic variants, respectively. By immunohistochemistry, all cell types expressed CYP11B1 and HSD3B1. HSD3B2 staining was predominantly expressed by clear cells whereas CYP17A1 staining was predominant on compact eosinophilic cells. This partial expression of steroidogenic enzymes may explain the low efficiency of cortisol production in BMAD. In subtype 1, trabeculae of eosinophilic cylindrical cells expressed DAB2 but not CYP11B2. In subtype 2, KDM1A expression was weaker in nodule cells than in normal adrenal cells; alpha inhibin expression was strong in compact cells. This first microscopic description of a series of 35 BMAD reveals the existence of 4 histopathological subtypes, 2 of which are strongly correlated with the presence of known germline genetic alterations. This classification emphasizes that BMAD has heterogeneous pathological characteristics that correlate with some genetic alterations identified in patients.
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Affiliation(s)
- Florian Violon
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
- Department of Pathology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lucas Bouys
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Annabel Berthon
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Bruno Ragazzon
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Maxime Barat
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Karine Perlemoine
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France
| | - Laurence Guignat
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Benoit Terris
- Department of Pathology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jérôme Bertherat
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France.
- Department of Endocrinology and National Reference Center for Rare Adrenal Disorders, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Mathilde Sibony
- Université Paris-Cité, Institut Cochin, CNRS UMR8104, Inserm U1016, Paris, France.
- Department of Pathology, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
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Pellat A, Barat M. Tumor microenvironment: A new application for radiomics. Diagn Interv Imaging 2023; 104:93-94. [PMID: 36880939 DOI: 10.1016/j.diii.2022.10.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Anna Pellat
- Gastroenterology and Digestive Oncology Unit, Hôpital Cochin, AP-HP Centre, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| | - Maxime Barat
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, APHP, 75014 Paris, France
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21
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Soyer P, Dohan A, Barat M. Applications of Artificial Intelligence in Urological Oncology Imaging: More Data Are Needed. Can Assoc Radiol J 2023:8465371231152230. [PMID: 36630653 DOI: 10.1177/08465371231152230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Philippe Soyer
- Department of Radiology, Assistance Publique-Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France,Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Anthony Dohan
- Department of Radiology, Assistance Publique-Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France,Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Maxime Barat
- Department of Radiology, Assistance Publique-Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France,Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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22
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Boeken T, Feydy J, Lecler A, Soyer P, Feydy A, Barat M, Duron L. Artificial intelligence in diagnostic and interventional radiology: Where are we now? Diagn Interv Imaging 2023; 104:1-5. [PMID: 36494290 DOI: 10.1016/j.diii.2022.11.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [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: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Abstract
The emergence of massively parallel yet affordable computing devices has been a game changer for research in the field of artificial intelligence (AI). In addition, dramatic investment from the web giants has fostered the development of a high-quality software stack. Going forward, the combination of faster computers with dedicated software libraries and the widespread availability of data has opened the door to more flexibility in the design of AI models. Radiomics is a process used to discover new imaging biomarkers that has multiple applications in radiology and can be used in conjunction with AI. AI can be used throughout the various processes of diagnostic imaging, including data acquisition, reconstruction, analysis and reporting. Today, the concept of "AI-augmented" radiologists is preferred to the theory of the replacement of radiologists by AI in many indications. Current evidence bolsters the assumption that AI-assisted radiologists work better and faster. Interventional radiology becomes a data-rich specialty where the entire procedure is fully recorded in a standardized DICOM format and accessible via standard picture archiving and communication systems. No other interventional specialty can bolster such readiness. In this setting, interventional radiology could lead the development of AI-powered applications in the broader interventional community. This article provides an update on the current status of radiomics and AI research, analyzes upcoming challenges and also discusses the main applications in AI in interventional radiology to help radiologists better understand and criticize articles reporting AI in medical imaging.
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Affiliation(s)
- Tom Boeken
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges Pompidou, APHP, Paris 75015, France; HeKA team, INRIA, Paris 75012 , France.
| | | | - Augustin Lecler
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Radiology, Rothschild Foundation Hospital, Paris 75019, France
| | - Philippe Soyer
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Radiology, Hôpital Cochin, APHP, Paris 75014, France
| | - Antoine Feydy
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Radiology, Hôpital Cochin, APHP, Paris 75014, France
| | - Maxime Barat
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Radiology, Hôpital Cochin, APHP, Paris 75014, France
| | - Loïc Duron
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Radiology, Rothschild Foundation Hospital, Paris 75019, France
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23
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Barat M, Gaillard M, Cottereau AS, Fishman EK, Assié G, Jouinot A, Hoeffel C, Soyer P, Dohan A. Artificial intelligence in adrenal imaging: A critical review of current applications. Diagn Interv Imaging 2023; 104:37-42. [PMID: 36163169 DOI: 10.1016/j.diii.2022.09.003] [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: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/10/2023]
Abstract
In the elective field of adrenal imaging, artificial intelligence (AI) can be used for adrenal lesion detection, characterization, hypersecreting syndrome management and patient follow-up. Although a perfect AI tool that includes all required steps from detection to analysis does not exist yet, multiple AI algorithms have been developed and tested with encouraging results. However, AI in this setting is still at an early stage. In this regard, most published studies about AI in adrenal gland imaging report preliminary results that do not have yet daily applications in clinical practice. In this review, recent developments and current results of AI in the field of adrenal imaging are presented. Limitations and future perspectives of AI are discussed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France; Université Paris Cité, Faculté de Médecine, Paris 75006, France.
| | - Martin Gaillard
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Digestive, Hepatobiliary and Pancreatic Surgery, Hôpital Cochin, AP-HP, Paris 75014, France
| | - Anne-Ségolène Cottereau
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Nuclear Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Guillaume Assié
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Endocrinology, Center for Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France
| | - Anne Jouinot
- Université Paris Cité, Faculté de Médecine, Paris 75006, France; Department of Endocrinology, Center for Rare Adrenal Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France
| | | | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France; Université Paris Cité, Faculté de Médecine, Paris 75006, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris 75014, France; Université Paris Cité, Faculté de Médecine, Paris 75006, France
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24
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Barat M, Terris B, Soyer P. Cinematic rendering of leiomyosarcoma of the superior mesenteric vein. Diagn Interv Imaging 2022; 104:202-203. [PMID: 36513592 DOI: 10.1016/j.diii.2022.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, 75014, Paris, France; Université Paris Cité, 75006 Paris, France.
| | - Benoit Terris
- Université Paris Cité, 75006 Paris, France; Department of Pathology, Assistance Publique-Hôpitaux de Paris, APHP, Hôpital Cochin, 75014, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, 75014, Paris, France; Université Paris Cité, 75006 Paris, France
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25
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Bessiène L, Moutel S, Lataud M, Jouinot A, Bonnet-Serrano F, Guibourdenche J, Villa C, Baussart B, Gaillard S, Barat M, Dohan A, Bertagna X, Dousset B, Bertherat J, Assié G. Corticotroph tumor progression speed after adrenalectomy. Eur J Endocrinol 2022; 187:797-807. [PMID: 36206174 DOI: 10.1530/eje-22-0536] [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: 06/17/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES After bilateral adrenalectomy in Cushing's disease, corticotroph tumor progression occurs in one-third to half of patients. However, progression speed is variable, ranging from slow to rapid. The aim was to explore corticotroph progression speed, its consequences and its risk factors. DESIGN A retrospective single-center observational study. METHODS In total,103 patients with Cushing's disease who underwent bilateral adrenalectomy between 1990 and 2020 were included. Clinical, biological, histological and MRI features were collected. Median duration of follow-up after bilateral adrenalectomy was 9.31 years. RESULTS In total,44 patients progressed (43%). Corticotroph tumor progression speed ranged from 1 to 40.7 mm per year. Progression speed was not different before and after bilateral adrenalectomy (P = 0.29). In univariate analyses, predictive factors for rapid corticotroph tumor progression included the severity of Cushing's disease before adrenalectomy as the cause of adrenalectomy, high ACTH in the year following adrenalectomy and high Ki67 immunopositivity in the tumor. During follow-up, early morning ACTH absolute variation was associated with corticotroph tumor progression speed (P-value = 0.001). ACTH measurement after dynamic testing did not improve this association. CONCLUSION After adrenalectomy, corticotroph progression speed is highly variable and manageable with MRI and ACTH surveillance. Progression speed does not seem related to bilateral adrenalectomy but rather to intrinsic properties of highly proliferative and secreting tumors.
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Affiliation(s)
- Laura Bessiène
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sandrine Moutel
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marine Lataud
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Jouinot
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Fidéline Bonnet-Serrano
- Department of Hormonology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Jean Guibourdenche
- Department of Hormonology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chiara Villa
- Department of Pathological Cytology and Anatomy, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Bertrand Baussart
- Department of Neurosurgery, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Stephan Gaillard
- Department of Neurosurgery, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Xavier Bertagna
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Bertrand Dousset
- Department of Visceral and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
| | - Guillaume Assié
- Department of Endocrinology, Hôpital Cochin, Reference and Competence Center Rare Adrenal Diseases and for Rare Pituitary Diseases, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, CNRS UMR8104, INSERM U1016, Institut Cochin, F-75014, Paris, France
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Barat M, Jannot AS, Dohan A, Soyer P. How to report and compare quantitative variables in a radiology article. Diagn Interv Imaging 2022; 103:571-573. [PMID: 36280585 DOI: 10.1016/j.diii.2022.09.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Maxime Barat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Radiology, Hôpital Cochin, 75014, Paris, France; Université Paris Cité, 75006 Paris, France.
| | - Anne-Sophie Jannot
- Université Paris Cité, 75006 Paris, France; Banque Nationale de Données Maladies Rares, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France; HeKA Team, Centre de Recherche des Cordeliers, INRIA Paris, Inserm, Université Paris Cité, 75006 Paris, France
| | - Anthony Dohan
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Radiology, Hôpital Cochin, 75014, Paris, France; Université Paris Cité, 75006 Paris, France
| | - Philippe Soyer
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Radiology, Hôpital Cochin, 75014, Paris, France; Université Paris Cité, 75006 Paris, France
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27
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Cornud F, Lefevre A, Camparo P, Barat M, Dumonceau O, Galiano M, Flam T, Soyer P, Barral M. Post-MRI transrectal micro-ultrasonography of transition zone PI-RADS > 2 lesions for biopsy guidance. Eur Radiol 2022; 32:7504-7512. [PMID: 35451606 DOI: 10.1007/s00330-022-08788-2] [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: 11/09/2021] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To prospectively determine the value of post-MRI micro-ultrasonography (microUS) in the diagnosis of transition zone (TZ) significant prostate cancer (sPCa). PATIENTS AND METHODS Eighty-four consecutive men (66 ± 6.3 years) with a mean PSA level of 10.2 ± 7.4 ng/mL and at least one TZ-PI-RADS > 2 lesion were included. All patients had MRI-directed microUS and biopsy. Sensitivity and specificity of post-MRI microUS to visualize PI-RADS > 2 TZ lesions, the cancer detection rate of TZ-sPCa, and tumor characteristics according to their visibility on microUS were evaluated. Interreader agreement for detecting microUS+ lesions was evaluated using Cohen's kappa test. RESULTS Of the 92 PI-RADS > 2 lesions, 71 (71/92; 77%) were visible on microUS and biopsy was performed without image fusion, which was required for the 21 invisible lesions (21/92; 22.8%). TZ-sPCa detection rate was 51.1% (47/92). Sensitivity and specificity of MRI-directed microUS were 83% (39/47; 95% CI: 69.2-92.4%) and 28.9% (13/45; 95% CI: 16.4-44.3%), on a per-lesion basis and 86.4% (38/45; 95% CI: 72.6-94.8%) and 27.5% (11/40; 95% CI: 14.6-43.9%) on a per-patient basis. Visible tumors on microUS exhibited a larger volume and a lower mean ADC value than non-visible tumors (15.8 ± 5.1 vs. 12.5 ± 3.6 mm and 0.82 ± 1.1 × 103 vs. 0.9 ± 1.4 × 10-3 mm2/s) (p = 0.02). Non-visible tumors showed a heterogeneous non-specific echotexture or were masked by the shadowing caused by corpora amylacea. Interreader agreement was almost perfect (kappa = 0.88; 95% CI: 0.79-0.95). The main limitation is the single-center feature of the study. CONCLUSION MRI-targeted transrectal microUS is effective to detect TZ-sPCa. TRUS-MRI image fusion helps overcome limitations due to TZ tissue heterogeneity. KEY POINTS microUS can visualize the majority of MRI-detected PI-RADS > 2 TZ lesions (sensitivity = 83%). Interreader agreement of MRI-directed microUS in the detection of TZ lesions appears excellent (kappa = 0.88). In 77% of PI-RADS > 2 TZ lesions, biopsy was performed under microUS visual control. MRI fusion system was only used to overcome limitations due to tissue heterogeneity of benign prostatic hyperplasia.
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Affiliation(s)
- François Cornud
- Department of Radiology, Clinique de l'Alma, 75007, Paris, France
| | - Arnaud Lefevre
- Department of Radiology, Clinique de l'Alma, 75007, Paris, France
| | | | - Maxime Barat
- Department of Radiology, Hôpital Cochin, 75014, Paris, France
| | | | - Marc Galiano
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Thierry Flam
- Department of Urology, Clinique de l'Alma, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, 75014, Paris, France
| | - Matthias Barral
- Service de Radiologie, Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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Berzan D, Barat M, Tzedakis S. Reversible portal and mesenteric venous gas due to sigmoid diverticulitis. Diagn Interv Imaging 2022; 103:566-567. [PMID: 36266193 DOI: 10.1016/j.diii.2022.09.008] [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: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Diana Berzan
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hopital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France.
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, 75014 Paris, France
| | - Stylianos Tzedakis
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Hopital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, 75014 Paris, France
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Armignacco R, Assié G, Barat M, Bertherat J, Berthon A, Bonnet-Serrano F, Cavalcante IP, Dousset B, Giannone G, Groussin L, Guignat L, Jouinot A, Libé R, North MO, Pasmant E, Perlemoine K, Ragazzon B, Ribes C, Sibony M, Vaczlavik A, Vaduva P, Violon F, Bouys L. OR04-3 Genetic Alterations of ARMC5 and KDM1A Are Associated With Different Expression Profiles of Illegitimate Receptors in Primary Bilateral Macronodular Adrenal Hyperplasia. J Endocr Soc 2022. [DOI: 10.1210/jendso/bvac150.167] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Introduction
Primary Bilateral Macronodular Adrenal Hyperplasia (PBMAH) is a heterogeneous disease characterized by bilateral adrenal macronodules responsible for adrenal Cushing. To date, two genetic causes of PBMAH are known: germline inactivating variants of the tumor suppressor genes ARMC5 identified in 2013 (Assié, N Eng J Med 2013), responsible for 20 to 25% of index cases, and KDM1A, identified recently (Vaczlavik, GIM 2021; Chasseloup, Lancet D&E 2021), responsible for the rare presentation associated with food-dependent Cushing's syndrome (FDCS) due to aberrant expression of the GIP receptor (GIPR) in adrenocortical cells. Multiple other illegitimate receptors are known to be responsible for abnormal cortisol response to various physiological stimuli in PBMAH. A recent multiomic analysis, identified three distinct molecular PBMAH groups: G1 with ARMC5-mutated tumors, G2 with KDM1A-mutated tumors from FDCS patients, and G3 with no identified genetic cause at present. We aimed to identify specific expression profiles of illegitimate receptors in the three groups.
Methods
Based on the transcriptome data obtained by RNA sequencing (Illumina) of the tumors from 31 patients (G1/ARMC5, 16 patients; G2/KDM1A, 6 patients; G3, 9 patients), expression of the following genes, encoding potential illegitimate receptors, were compared: ADRA1A, ADRA1B, ADRA1D, ADRA2A, ADRA2B, ADRA2C, ADRB1, ADRB2, ADRB3, AVPR1A, AVPR1B, AVPR2, GCGR, GIPR, HTR4, HTR7, LHCGR. Calculations were performed using R statistical software. The Bioconductor limma package was used to analyze mRNA differential expression.
Results
G1/ARMC5 tumors showed a relative overexpression of the vasopressin receptors AVPR1A and AVPR1B compared to the two other groups (fold-change [FC] =7.39, p<0.001 and 3.98, p<0.001, respectively) but a lower expression of AVPR2 (FC=0.43, p=0.015). G2/KDM1A tumors showed a dramatic overexpression of GIPR compared to the two other groups (FC=105.02, p<0.001) but also of the adrenergic receptors ADRA1D and ADRA2A (FC=2.93, p=0.027 and 9.99, p<0.001, respectively) and of the LH/hCG receptor (LHCGR) (FC=12.20, p<0.001). G3 tumors showed a slight overexpression of the adrenergic receptor ADRA1B (FC=3.49, p=0.001) and in few tumors ADRA1D, AVPR2 and LHCGR were highly expressed suggesting molecular heterogeneity in G3.
Conclusion
This study reveals specific expression profiles of illegitimate receptors related to the three molecular groups. ARMC5 tumors are associated with the overexpression of two vasopressin receptors, while, besides GIPR, KDM1A inactivation seems to drive the overexpression of the LH/hCG receptor, as previously suggested in patients with FDCS (Bertherat, JCE&M 2005), potentially responsible for Cushing's syndrome associated with pregnancy and menopause. These molecular patterns need to be corroborated by clinical data with a systematic testing of the aberrant cortisol responses. Additionally, further studies would be needed to investigate the clinical relevance and significance of moderate fold-changes in gene expression (e.g. <4).
Presentation: Saturday, June 11, 2022 12:00 p.m. - 12:15 p.m.
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Barat M, Marchese U, Pellat A, Dohan A, Coriat R, Hoeffel C, Fishman EK, Cassinotto C, Chu L, Soyer P. Imaging of Pancreatic Ductal Adenocarcinoma: An Update on Recent Advances. Can Assoc Radiol J 2022; 74:351-361. [PMID: 36065572 DOI: 10.1177/08465371221124927] [Citation(s) in RCA: 1] [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] [Indexed: 12/26/2022] Open
Abstract
Pancreatic ductal carcinoma (PDAC) is one of the leading causes of cancer-related death worldwide. Computed tomography (CT) remains the primary imaging modality for diagnosis of PDAC. However, CT has limitations for early pancreatic tumor detection and tumor characterization so that it is currently challenged by magnetic resonance imaging. More recently, a particular attention has been given to radiomics for the characterization of pancreatic lesions using extraction and analysis of quantitative imaging features. In addition, radiomics has currently many applications that are developed in conjunction with artificial intelligence (AI) with the aim of better characterizing pancreatic lesions and providing a more precise assessment of tumor burden. This review article sums up recent advances in imaging of PDAC in the field of image/data acquisition, tumor detection, tumor characterization, treatment response evaluation, and preoperative planning. In addition, current applications of radiomics and AI in the field of PDAC are discussed.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris543341, Paris, France.,Université Paris Cité, Faculté de Médecine, 555089Paris, France
| | - Ugo Marchese
- Université Paris Cité, Faculté de Médecine, 555089Paris, France.,Department of Digestive, Hepatobiliary and Pancreatic Surgery, 26935Hopital Cochin, AP-HP, Paris, France
| | - Anna Pellat
- Université Paris Cité, Faculté de Médecine, 555089Paris, France.,Department of Gastroenterology, 26935Hopital Cochin, AP-HP, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris543341, Paris, France.,Université Paris Cité, Faculté de Médecine, 555089Paris, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, 555089Paris, France.,Department of Gastroenterology, 26935Hopital Cochin, AP-HP, Paris, France
| | | | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Christophe Cassinotto
- Department of Radiology, CHU Montpellier, 27037University of Montpellier, Saint-Éloi Hospital, Montpellier, France
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris543341, Paris, France.,Université Paris Cité, Faculté de Médecine, 555089Paris, France
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Bonnet-Serrano F, Barat M, Vaczlavik A, Jouinot A, Bouys L, Laguillier-Morizot C, Zientek C, Simonneau C, Larger E, Guignat L, Groussin L, Assié G, Guibourdenche J, Nicolis I, Menet MC, Bertherat J. Decreased steroidogenic enzyme activity in benign adrenocortical tumors is more pronounced in bilateral lesions as determined by steroid profiling in LC-MS/MS during ACTH stimulation test. Endocr Connect 2022; 11:EC-22-0063. [PMID: 35731238 PMCID: PMC9346343 DOI: 10.1530/ec-22-0063] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Large response of steroid precursors, including 17-hydroxyprogesterone, to adrenocorticotropic hormone (ACTH) has been described in adrenocortical tumors, suggesting the existence of intra-tumoral enzymatic deficiencies. This study aimed to compare steroidogenesis enzymes activity in unilateral and bilateral benign tumors using serum steroid profiling in liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) in the basal state and after ACTH 1-24 stimulation. DESIGN AND METHODS A serum profile of seven consecutive adrenal steroids was determined in LC-MS/MS in the basal state (T0) and after ACTH 1-24 stimulation (T60) in 35 patients with bilateral adrenocortical tumors (BL), 38 patients with unilateral tumors (UL) and 37 control subjects (CT). Response amplitude of each individual steroid was evaluated by T60/T0 ratio, whereas enzymatic activity was assessed by the downstream/upstream steroid ratio. Adrenal volume was quantified by a semi-automatic segmentation method. RESULTS For the seven steroids assayed, the amplitude of response to ACTH was higher in BL than in UL and in CT. The difference between BL and UL persisted even after matching patients on adrenal volume. On glucocorticoids pathway, enzymatic activity of CYP11B1 was significantly decreased in BL (78.3 (43.1-199.4)) in comparison to both UL (122.7 (13.8-228.4), P = 0.0002) and CT (186.8 (42.1-1236.3), P < 0.0001). On mineralocorticoids and androgens pathways, the enzymatic activity of CYP11B2 and CYP17A1-17,20 lyase was also lower in BL than UL and CT. CONCLUSIONS Decreased activity of distal steroidogenesis enzymes CYP11B1, CYP11B2 and CYP17A1-17,20 lyase, responsible for an explosive response to ACTH of upstream precursors in bilateral tumors, limits the synthesis of bioactive steroids, in particular cortisol, despite the increase in adrenal mass. SIGNIFICANCE STATEMENT Activity of distal steroidogenesis enzymes (CYP11B1, CYP11B2 and CYP17A1 on glucocorticoids, mineralocorticoids and androgens pathways, respectively) is decreased in adrenocortical benign tumors. This decrease is more pronounced in bilateral lesions and seems to depend more on the nature of the lesion than on the increase in adrenal volume. It is responsible for the explosive response to ACTH of steroid precursors located upstream of these enzymes. It probably allows bioactive steroids, particularly cortisol, to stay in the normal range for a long time despite the increase in adrenal mass.
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Affiliation(s)
- Fidéline Bonnet-Serrano
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Hormonology Department, Cochin Hospital, Paris, France
- Correspondence should be addressed to F Bonnet-Serrano:
| | - Maxime Barat
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Radiology Department, Cochin Hospital, Paris, France
| | - Anna Vaczlavik
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | | | - Lucas Bouys
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Christelle Laguillier-Morizot
- Université Paris Cité, Paris, France
- Hormonology Department, Cochin Hospital, Paris, France
- INSERM, Physiopathologie et Pharmacotoxicologie Placentaire Humaine : Microbiote Pré & Post natal, Paris, France
| | | | | | - Etienne Larger
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Diabetology Department, Cochin Hospital, Paris, France
| | - Laurence Guignat
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Lionel Groussin
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Guillaume Assié
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
| | - Jean Guibourdenche
- Université Paris Cité, Paris, France
- Hormonology Department, Cochin Hospital, Paris, France
- INSERM, Physiopathologie et Pharmacotoxicologie Placentaire Humaine : Microbiote Pré & Post natal, Paris, France
| | - Ioannis Nicolis
- Université Paris Cité, Paris, France
- UR 7537 BioSTM, Paris, France
| | - Marie-Claude Menet
- Institut de Chimie Physique, Université Paris-Saclay-CNRS, UMR8000, Orsay, France
| | - Jérôme Bertherat
- Université Paris Cité, Paris, France
- Inserm U1016-CNRS UMR8104, Paris, France
- Reference Center for Rare Adrenal Diseases, Endocrinology Department, Cochin Hospital, Paris, France
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Dimov IP, Tous C, Li N, Barat M, Bomberna T, Debbaut C, Jin N, Moran G, Tang A, Soulez G. Assessment of hepatic arterial hemodynamics with 4D flow MRI: in vitro analysis of motion and spatial resolution related error and in vivo feasibility study in 20 volunteers. Eur Radiol 2022; 32:8639-8648. [PMID: 35731288 DOI: 10.1007/s00330-022-08890-5] [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: 01/25/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the ability of four-dimensional (4D) flow MRI to measure hepatic arterial hemodynamics by determining the effects of spatial resolution and respiratory motion suppression in vitro and its applicability in vivo with comparison to two-dimensional (2D) phase-contrast MRI. METHODS A dynamic hepatic artery phantom and 20 consecutive volunteers were scanned. The accuracies of Cartesian 4D flow sequences with k-space reordering and navigator gating at four spatial resolutions (0.5- to 1-mm isotropic) and navigator acceptance windows (± 8 to ± 2 mm) and one 2D phase-contrast sequence (0.5-mm in -plane) were assessed in vitro at 3 T. Two sequences centered on gastroduodenal and hepatic artery branches were assessed in vivo for intra - and interobserver agreement and compared to 2D phase-contrast. RESULTS In vitro, higher spatial resolution led to a greater decrease in error than narrower navigator window (30.5 to -4.67% vs -6.64 to -4.67% for flow). In vivo, hepatic and gastroduodenal arteries were more often visualized with the higher resolution sequence (90 vs 71%). Despite similar interobserver agreement (κ = 0.660 and 0.704), the higher resolution sequence had lower variability for area (CV = 20.04 vs 30.67%), flow (CV = 34.92 vs 51.99%), and average velocity (CV = 26.47 vs 44.76%). 4D flow had lower differences between inflow and outflow at the hepatic artery bifurcation (11.03 ± 5.05% and 15.69 ± 6.14%) than 2D phase-contrast (28.77 ± 21.01%). CONCLUSION High-resolution 4D flow can assess hepatic artery anatomy and hemodynamics with improved accuracy, greater vessel visibility, better interobserver reliability, and internal consistency. KEY POINTS • Motion-suppressed Cartesian four-dimensional (4D) flow MRI with higher spatial resolution provides more accurate measurements even when accepted respiratory motion exceeds voxel size. • 4D flow MRI with higher spatial resolution provides substantial interobserver agreement for visualization of hepatic artery branches. • Lower peak and average velocities and a trend toward better internal consistency were observed with 4D flow MRI as compared to 2D phase-contrast.
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Affiliation(s)
- Ivan P Dimov
- Laboratory of Clinical Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada
| | - Cyril Tous
- Laboratory of Clinical Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada
| | - Ning Li
- Laboratory of Clinical Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada
| | - Maxime Barat
- Laboratory of Clinical Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada.,Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Tim Bomberna
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Charlotte Debbaut
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Cleveland, OH, USA
| | - Gerald Moran
- Siemens Healthineers Canada, Oakville, ON, Canada
| | - An Tang
- Laboratory of Clinical Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada.,Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.,Department of Radiology, Radiation Oncology and Nuclear Medicine, Faculty of Medecine, Université de Montréal, 2900 Bd Edouard-Montpetit , Montreal, QC, H3T 1J4, Canada
| | - Gilles Soulez
- Laboratory of Clinical Image Processing (LCTI), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900, rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada. .,Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. .,Department of Radiology, Radiation Oncology and Nuclear Medicine, Faculty of Medecine, Université de Montréal, 2900 Bd Edouard-Montpetit , Montreal, QC, H3T 1J4, Canada.
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Beunon P, Barat M, Dohan A, Cheddani L, Males L, Fernandez P, Etain B, Bellivier F, Marlinge E, Vrtovsnik F, Vidal-Petiot E, Khalil A, Haymann JP, Flamant M, Tabibzadeh N. MRI-based kidney radiomic analysis during chronic lithium treatment. Eur J Clin Invest 2022; 52:e13756. [PMID: 35104368 DOI: 10.1111/eci.13756] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lithium therapy during bipolar disorder is associated with an increased risk of chronic kidney disease (CKD) that is slowly progressive and undetectable at early stages. We aimed at identifying kidney image texture features as possible imaging biomarkers of decreased measured glomerular filtration rate (mGFR) using radiomics of T2-weighted magnetic resonance imaging (MRI). METHODS One hundred and eight patients treated with lithium were evaluated including mGFR and kidney MRI, with T2-weighted sequence single-shot fast spin-echo. Computed radiomic analysis was performed after kidney segmentation. Significant features were selected to build a radiomic signature using multivariable Cox analysis to detect an mGFR <60 ml/min/1.73 m². The texture index was validated using a training and a validation cohort. RESULTS Texture analysis index was able to detect an mGFR decrease, with an AUC of 0.85 in the training cohort and 0.71 in the validation cohort. Patients with a texture index below the median were older (59 [42-66] vs. 46 [34-54] years, p = .001), with longer treatment duration (10 [3-22] vs. 6 [2-10] years, p = .02) and a lower mGFR (66 [46-84] vs. 83 [71-94] ml/min/1.73m², p < .001). Texture analysis index was independently and negatively associated with age (β = -.004 ± 0.001, p < .001), serum vasopressin (-0.005 ± 0.002, p = .02) and lithium treatment duration (-0.01 ± 0.003, p = .001), with a significant interaction between lithium treatment duration and mGFR (p = .02). CONCLUSIONS A renal texture index was developed among patients treated with lithium associated with a decreased mGFR. This index might be relevant in the diagnosis of lithium-induced renal toxicity.
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Affiliation(s)
- Paul Beunon
- Sorbonne Université, Paris, France.,Radiologie A, APHP.Centre Hôpital Cochin, Paris, France
| | - Maxime Barat
- Radiologie A, APHP.Centre Hôpital Cochin, Paris, France.,Université de Paris, Paris, France
| | - Anthony Dohan
- Radiologie A, APHP.Centre Hôpital Cochin, Paris, France.,Université de Paris, Paris, France
| | - Lynda Cheddani
- Université Paris Saclay, INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Paris, France.,Nephrologie, APHP Hôpital Ambroise Paré, Paris, France
| | - Lisa Males
- Université de Paris, Paris, France.,Radiologie, APHP.Nord Hôpital Bichat, Paris, France
| | | | - Bruno Etain
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France
| | - Frank Bellivier
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France
| | - Emeline Marlinge
- Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France
| | - François Vrtovsnik
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France.,Néphrologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Emmanuelle Vidal-Petiot
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France.,Explorations Fonctionnelles, Physiologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Antoine Khalil
- Université de Paris, Paris, France.,Radiologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Jean-Philippe Haymann
- Sorbonne Université, Paris, France.,Explorations Fonctionnelles et laboratoire de la lithiase, APHP. Sorbonne Hôpital Tenon, Paris, France
| | - Martin Flamant
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, APHP.Nord, GH Lariboisière-Fernand-Widal, DMU Neurosciences, Paris, France.,Explorations Fonctionnelles, Physiologie, APHP.Nord Hôpital Bichat, Paris, France
| | - Nahid Tabibzadeh
- Explorations Fonctionnelles, Physiologie, APHP.Nord Hôpital Bichat, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France.,CNRS ERL 8228-Unité Métabolisme et Physiologie Rénale, Paris, France
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Barat M, Duran J, Sung K, Brown M, Lin A, King K, Adler E, Aslam S. Breakthrough Infections and Low Mortality Observed in Heart Transplant Recipients Infected with COVID-19 at UC San Diego. J Heart Lung Transplant 2022. [PMCID: PMC8988601 DOI: 10.1016/j.healun.2022.01.805] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusion
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Cruz Rodriguez J, Barat M, Adler E, Urey M. Characteristics and Outcomes of Patients with Cardiac Amyloidosis Requiring Orthotopic Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1662] [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] [Indexed: 11/28/2022] Open
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Barat M, Rodriguez JBC, Mariski M, Adler E, Urey M. Amyloid-Targeted Immunosuppression After Orthotopic Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1408] [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] [Indexed: 10/18/2022] Open
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Malgras B, Najah H, Dohan A, Barat M, Soyer P. Diagnosis and treatment of focal splenic lesions. J Visc Surg 2022; 159:121-135. [DOI: 10.1016/j.jviscsurg.2021.11.010] [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] [Indexed: 11/26/2022]
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Gaillard M, Soyer P, Barat M. Right-sided adrenocortical carcinoma with inferior vena cava tumor thrombus. Diagn Interv Imaging 2022; 103:327-328. [DOI: 10.1016/j.diii.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
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Fromentin M, Barat M, Ricard JD, Roux D. Ultrasound Guidance for Internal Jugular Vein Catheterization: Don't Forget the Basics. Asian J Anesthesiol 2022; 60:41-42. [PMID: 35483679 DOI: 10.6859/aja.202203_60(1).0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Mélanie Fromentin
- Department of Anesthesiology and Intensive Care Unit, AP-HP, Cochin University Hospital, Paris, France
- Université Paris Cité, UMR1137 IAME, INSERM, F-75018 Paris, France
| | - Maxime Barat
- Radiology Unit, AP-HP, Cochin University Hospital, Paris, France
| | - Jean-Damien Ricard
- Université Paris Cité, UMR1137 IAME, INSERM, F-75018 Paris, France
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, F-92700 Colombes, France
| | - Damien Roux
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, F-92700 Colombes, France
- Université Paris Cité, Institut Necker-Enfants Malades, INSERM U1151, CNRS UMR 8253, 75015 Paris, France
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40
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Dohan A, Barat M, Coriat R, Soyer P. A step toward a better understanding of hepatocellular progression after transarterial embolization. Diagn Interv Imaging 2022; 103:125-126. [DOI: 10.1016/j.diii.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 01/01/2023]
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41
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Barat M, Cottereau AS, Gaujoux S, Tenenbaum F, Sibony M, Bertherat J, Libé R, Gaillard M, Jouinot A, Assié G, Hoeffel C, Soyer P, Dohan A. Adrenal Mass Characterization in the Era of Quantitative Imaging: State of the Art. Cancers (Basel) 2022; 14:cancers14030569. [PMID: 35158836 PMCID: PMC8833697 DOI: 10.3390/cancers14030569] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Non-invasive characterization of adrenal lesions requires a rigorous approach. Although CT is the cornerstone of adrenal lesion characterization, a multimodality multiparametric imaging approach helps improve confidence in adrenal lesion characterization. Abstract Detection and characterization of adrenal lesions have evolved during the past two decades. Although the role of imaging in adrenal lesions associated with hormonal secretion is usually straightforward, characterization of non-functioning adrenal lesions may be challenging to confidently identify those that need to be resected. Although many adrenal lesions can be readily diagnosed when they display typical imaging features, the diagnosis may be challenging for atypical lesions. Computed tomography (CT) remains the cornerstone of adrenal imaging, but other morphological or functional modalities can be used in combination to reach a diagnosis and avoid useless biopsy or surgery. Early- and delayed-phase contrast-enhanced CT images are essential for diagnosing lipid-poor adenoma. Ongoing studies are evaluating the capabilities of dual-energy CT to provide valid virtual non-contrast attenuation and iodine density measurements from contrast-enhanced examinations. Adrenal lesions with attenuation values between 10 and 30 Hounsfield units (HU) on unenhanced CT can be characterized by MRI when iodinated contrast material injection cannot be performed. 18F-FDG PET/CT helps differentiate between atypical benign and malignant adrenal lesions, with the adrenal-to-liver maximum standardized uptake value ratio being the most discriminative variable. Recent studies evaluating the capabilities of radiomics and artificial intelligence have shown encouraging results.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 75014 Paris, France; (M.B.); (P.S.)
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
| | - Anne-Ségolène Cottereau
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 75014 Paris, France;
| | - Sébastien Gaujoux
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Pancreatic and Endocrine Surgery, Pitié-Salpetrière Hospital, AP-HP, 75013 Paris, France
| | - Florence Tenenbaum
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, 75014 Paris, France;
| | - Mathilde Sibony
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Pathology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Jérôme Bertherat
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Rossella Libé
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Martin Gaillard
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Anne Jouinot
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | - Guillaume Assié
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Department of Endocrinology, Cochin Hospital, AP-HP, 75014 Paris, France
| | | | - Philippe Soyer
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 75014 Paris, France; (M.B.); (P.S.)
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
| | - Anthony Dohan
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 75014 Paris, France; (M.B.); (P.S.)
- Faculté de Médecine, Université de Paris, 75006 Paris, France; (A.-S.C.); (S.G.); (M.S.); (J.B.); (R.L.); (M.G.); (A.J.); (G.A.)
- Correspondence:
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Pozzessere C, Boudiaf M, Cirigliano A, Dohan A, Mazzei MA, Barat M, Volterrani L, Soyer P. MR-enterography: role in the assessment of suspected anastomotic recurrence of Crohn disease after ileocolic resection. Radiol Med 2022; 127:238-250. [PMID: 35050452 DOI: 10.1007/s11547-022-01452-1] [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: 05/20/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the potential of magnetic resonance-enterography (MRE) in the assessment of the anastomotic status in patients with Crohn disease and prior ileocolic resection. METHODS A total of 62 MRE examinations obtained in 52 patients with Crohn disease who had previously undergone ileocolic resection were retrospectively reviewed by two readers in consensus. MRE features (anastomotic wall thickening, wall stratification, wall enhancement pattern and degree, DWI signal intensity, ADC values, lymph nodes, comb sign and complications) were compared to clinical, endoscopic and histological findings that served as standard of reference. Sensitivity, specificity and accuracy of MRE were calculated. RESULTS At univariate analysis, anastomotic wall thickening, anastomotic wall stratification, segmental wall enhancement, moderate wall enhancement, early and mucosal enhancement, and moderate/marked hyperintensity on diffusion-weighed imaging (DWI) were the most discriminative MRE features for differentiating between normal and abnormal anastomoses (p < 0.001 for all variables). Anastomotic wall thickening and segmental anastomotic wall enhancement were the two most sensitive and accurate MRE variables for the diagnosis of abnormal anastomosis with sensitivities of 82% (95% CI: 67-92%) and accuracies of 84% (95% CI: 72-92%). At univariate analysis, hyperintensity on DWI of the anastomotic site was the most sensitive finding for distinguishing between inflammatory recurrence and fibrostenosis (sensitivity, 89%; 95% CI: 67-99%). CONCLUSIONS MRE provides objective and relatively specific morphological criteria that help detect abnormal ileocolic anastomosis, but performances are lower when differentiating between inflammatory recurrence and fibrostenosis. DWI may be useful in identifying pathologic anastomosis and, in particular, in distinguishing between inflammatory recurrence and fibrostenosis.
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Affiliation(s)
- Chiara Pozzessere
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy. .,Department of Radiology, AUSL Toscana Centro, San Giuseppe Hospital, Viale Giovanni Boccaccio, 16, 50053, Empoli, Italy.
| | - Mourad Boudiaf
- Department of Radiology, AP-HP Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 5014, Paris, France
| | - Alfredo Cirigliano
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy
| | - Anthony Dohan
- Department of Radiology, AP-HP Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 5014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Maria Antonietta Mazzei
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy
| | - Maxime Barat
- Department of Radiology, AP-HP Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 5014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Luca Volterrani
- Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, University Hospital of Siena, Azienda Ospedaliera Universitaria Senese, 53100, Siena, Italy
| | - Philippe Soyer
- Department of Radiology, AP-HP Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 5014, Paris, France.,Université de Paris, 75006, Paris, France
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Marchese U, Gaillard M, Pellat A, Tzedakis S, Abou Ali E, Dohan A, Barat M, Soyer P, Fuks D, Coriat R. Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors. Cancers (Basel) 2022; 14:433. [PMID: 35053593 PMCID: PMC8773540 DOI: 10.3390/cancers14020433] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.
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Affiliation(s)
- Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Anna Pellat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
| | - Anthony Dohan
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - Maxime Barat
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - Philippe Soyer
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - David Fuks
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
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Veziant J, Gaillard M, Barat M, Leconte M, Marchese U, Dohan A. Early radiologic intervention for postesophagectomy chylothorax. J Vasc Surg Venous Lymphat Disord 2021; 10:222-223. [PMID: 34920848 DOI: 10.1016/j.jvsv.2021.10.008] [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: 07/21/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Julie Veziant
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP Centre - Université de Paris, Paris, France
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP Centre - Université de Paris, Paris, France.
| | - Maxime Barat
- Department of Radiology, Cochin Hospital, APHP Centre - Université de Paris, Paris, France
| | - Mahaut Leconte
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP Centre - Université de Paris, Paris, France
| | - Ugo Marchese
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP Centre - Université de Paris, Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, APHP Centre - Université de Paris, Paris, France
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Bonnin A, Durot C, Barat M, Djelouah M, Grange F, Mulé S, Soyer P, Hoeffel C. CT texture analysis as a predictor of favorable response to anti-PD1 monoclonal antibodies in metastatic skin melanoma. Diagn Interv Imaging 2021; 103:97-102. [PMID: 34666945 DOI: 10.1016/j.diii.2021.09.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to determine whether texture analysis features on pretreatment contrast-enhanced computed tomography (CT) images and their evolution can predict treatment response of metastatic skin melanoma (SM) treated with anti-PD1 monoclonal antibodies. MATERIALS AND METHODS Sixty patients (29 men, 31 women; median age, 56 years; age range: 27-91 years) with metastatic SM treated with pembrolizumab (43/60; 72%) or nivolumab (17/60; 28%) were included. Texture analysis of SM metastases was performed on baseline and first post-treatment evaluation CT examinations. Mean gray-level, entropy, kurtosis, skewness, and standard deviation values were derived from the pixel distribution histogram before and after spatial filtration at different anatomic scales, ranging from fine to coarse. Lasso penalized Cox regression analyses were performed to identify independent variables associated with favorable response to treatment. RESULTS A total of 127 metastases were analyzed, with a median of two metastases per patient. Skewness at fine texture scale (spatial scale filtration [SSF] = 2; Hazard ratio [HR]: 3.51; 95% CI: 2.08-8.57; P = 0.010), skewness at medium texture scale (SSF = 3; HR: 0.56; 95% CI: 0.11-1.59; P = 0.014), variation of entropy at fine texture scale (SSF = 2; HR: 37.76; 95% CI: 3.48-496.22; P = 0.008) and LDH above the threshold of 248 UI/L (HR: 3.56; 95% CI: 1.78-21.35; P = 0.032] were independent predictors of response to treatment. CONCLUSION Pretreatment CT texture analysis-derived tumor skewness and variation of entropy between baseline and first control CT examination may be used as predictors of favorable response to anti-PD1 monoclonal antibodies in patients with metastatic SM.
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Affiliation(s)
- Angèle Bonnin
- Department of Abdominal Radiology, Reims University Hospital, 51092 Reims, France; Department of Radiology, Cochin Hospital, AP-HP, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Carole Durot
- Department of Abdominal Radiology, Reims University Hospital, 51092 Reims, France
| | - Maxime Barat
- Department of Radiology, Cochin Hospital, AP-HP, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Manel Djelouah
- Department of Abdominal Radiology, Reims University Hospital, 51092 Reims, France
| | - Florent Grange
- Department of Dermatology, Valence Hospital, 26000 Valence, France
| | - Sébastien Mulé
- Department of Radiology, Henri Mondor University Hospital, APH-HP, 94000 Créteil, France
| | - Philippe Soyer
- Department of Radiology, Cochin Hospital, AP-HP, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Christine Hoeffel
- Department of Abdominal Radiology, Reims University Hospital, 51092 Reims, France; CRESTIC, Reims Champagne-Ardenne University, 51000 Reims, France.
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Barat M, Marchese U, Shotar E, Chousterman B, Barret M, Dautry R, Coriat R, Kedra A, Fuks D, Soyer P, Dohan A. Contrast extravasation on computed tomography angiography in patients with hematochezia or melena: Predictive factors and associated outcomes. Diagn Interv Imaging 2021; 103:177-184. [PMID: 34657834 DOI: 10.1016/j.diii.2021.09.006] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to identify variables associated with extravasation on computed tomography angiography (CTA) in patients with hematochezia/melena and compare the outcome of patients with extravasation on CTA to those without extravasation. MATERIAL AND METHODS Ninety-four patients (51 men, 38 women; mean age, 69 ± 16 [SD] years) who underwent CTA within 30 days of hematochezia/melena were included. Variables associated with extravasation on CTA were searched using univariable and multivariable analyses. Outcomes of patients with visible extravasation on CTA were compared with those without visible extravasation. RESULTS One hundred and one CTA examinations were included. Extravasation was observed on 26/101 CTA examinations (26%). At multivariable analysis the need for vasopressor drugs (odds ratio [OR], 7.6; P = 0.040), high transfusion requirements (> 2 blood units) (OR, 7.1; P = 0.014), CTA performed on the day of a hemorrhagic event (OR, 46.2; P = 0.005) and repeat CTA (OR, 27.8; P = 0.011) were independently associated with extravasation on CTA. Extravasation on CTA was followed by a therapeutic procedure in 25/26 CTAs (96%; 26 patients) compared to 13/75 CTAs (17%; 68 patients) on which no extravasation was present (P < 0.001). No patients (0/26; 0%) with contrast extravasation on CTA died while 8 patients (8/61; 13%) without contrast extravasation died, although the difference was not significant (P = 0.099). CONCLUSION Extravasation on CTA in the setting of hematochezia or melena is especially seen in clinically unstable patients who receive more than two blood units. Presence of active extravasation on CTA leads to more frequent application of a therapeutic procedure; however, this does not significantly affect patient outcome.
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Affiliation(s)
- Maxime Barat
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France; Faculté de Médecine, Université de Paris, Paris 75006, France.
| | - Ugo Marchese
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'Hôpital, Paris 75014, France
| | - Benjamin Chousterman
- Faculté de Médecine, Université de Paris, Paris 75006, France; Intensive Care unit, Hôpital Lariboisière, AP-HP, Paris 75010, France
| | - Maximilien Barret
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Gastroenterology, Hôpital Cochin, APHP, Paris 75014, France
| | - Raphael Dautry
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France
| | - Romain Coriat
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Gastroenterology, Hôpital Cochin, APHP, Paris 75014, France
| | - Alice Kedra
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France
| | - David Fuks
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Philippe Soyer
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France; Faculté de Médecine, Université de Paris, Paris 75006, France
| | - Anthony Dohan
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France; Faculté de Médecine, Université de Paris, Paris 75006, France
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Veziant J, Gaillard M, Barat M, Dohan A, Barret M, Manceau G, Karoui M, Bonnet S, Fuks D, Soyer P. Imaging of postoperative complications following Ivor-Lewis esophagectomy. Diagn Interv Imaging 2021; 103:67-78. [PMID: 34654670 DOI: 10.1016/j.diii.2021.09.003] [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] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023]
Abstract
Postoperative imaging plays a key role in the identification of complications after Ivor-Lewis esophagectomy (ILE). Careful analysis of imaging examinations can help identify the cause of the presenting symptoms and the mechanism of the complication. The complex surgical procedure used in ILE results in anatomical changes that make imaging interpretation challenging for many radiologists. The purpose of this review was to make radiologists more familiar with the imaging findings of normal anatomical changes and those of complications following ILE to enable accurate evaluation of patients with an altered postoperative course. Anastomotic leak, gastric conduit necrosis and pleuropulmonary complications are the most serious complications after ILE. Computed tomography used in conjunction with oral administration of contrast material is the preferred diagnostic tool, although it conveys limited sensitivity for the diagnosis of anastomotic fistula. In combination with early endoscopic assessment, it can also help early recognition of complications and appropriate therapeutic management.
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Affiliation(s)
- Julie Veziant
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France.
| | - Maxime Barat
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, APHP.Centre, 75014, Paris, France
| | - Anthony Dohan
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, APHP.Centre, 75014, Paris, France
| | - Maximilien Barret
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, APHP.Centre, 75014 Paris, France
| | - Gilles Manceau
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of General and Digestive Surgery, Hôpital Européen Georges Pompidou, APHP.Centre, 75015 Paris, France
| | - Mehdi Karoui
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of General and Digestive Surgery, Hôpital Européen Georges Pompidou, APHP.Centre, 75015 Paris, France
| | - Stéphane Bonnet
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 75014 Paris, France
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Cochin, APHP.Centre, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Philippe Soyer
- Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin, APHP.Centre, 75014, Paris, France
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Golse M, Barat M, Costedoat-Chalumeau N, Revel MP. Case 294: Catastrophic Antiphospholipid Syndrome. Radiology 2021; 301:242-246. [PMID: 34543144 DOI: 10.1148/radiol.2021203174] [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: 11/11/2022]
Abstract
History A 50-year-old woman presented to the emergency department of our hospital with a 2-day history of lower limb pain associated with unusual asthenia and diffuse arthralgia over the past 3 weeks. She was a native of Guinea and had lived in France for most of her life, working as a personal care assistant. Her only medical history of note was an occurrence of fetal death at 12 weeks gestation when she was 35 years old. She had bilateral lower limb swelling, without changes in skin temperature or color. All proximal and distal arterial pulses were felt. General physical examination findings were otherwise unremarkable. Her laboratory tests showed a decreased hemoglobin concentration of 8.9 g/dL (normal range, 12-16 g/dL), a decreased platelet count of 45 × 109/L (normal range, [150-400] × 109/L), a C-reactive protein level of 158 mg/L (normal range, <5 mg/L), and a d-dimer level of 2000 mg/L (normal range, <500 mg/L]). Compression US of the lower limbs revealed bilateral calf vein thrombosis involving the fibular and posterior tibial veins. Curative anticoagulation using low-molecular-weight heparin (enoxaparin, subcutaneous injection of 100 units per kilogram of body weight twice a day) was started. The day after the start of anticoagulation therapy, the patient reported dyspnea and acute chest and abdominal pain. Her vital signs were assessed, and she had elevated blood pressure and increased heart rate and respiratory rate, but she remained afebrile. Her cardiac auscultation was unremarkable, besides tachycardia. Skin examination revealed small areas of necrosis on the fingertips of her right hand. Laboratory studies were repeated and showed an increase in serum creatinine level from a baseline value of 0.49 mg/dL to a new value of 1.01 mg/dL (normal range, 0.6-1.1 mg/dL), an apparition of low-grade proteinuria of 0.43 g per day (normal range, <0.3 g/ day), and a high serum troponin level of 1066 ng/L (normal range, <14 ng/L), whereas electrocardiography showed no ST segment modification and echocardiography revealed a moderately altered left ventricular ejection fraction (45%). There was no coronary occlusion seen at emergency coronarography. Contrast-enhanced CT of the chest, abdomen, and pelvis was performed (Figs 1, 2) together with cardiac MRI (Figs 3, 4).
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Affiliation(s)
- Marianne Golse
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP.Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
| | - Maxime Barat
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP.Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
| | - Nathalie Costedoat-Chalumeau
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP.Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
| | - Marie-Pierre Revel
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP.Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
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Chartier M, Barat M, Dohan A, Belle A, Oudjit A, Abou Ali E, Hallit R, Leandri C, Scialom S, Coriat R, Chaussade S, Soyer P, Barret M. Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders. Endosc Int Open 2021; 9:E1355-E1360. [PMID: 34466359 PMCID: PMC8367446 DOI: 10.1055/a-1512-9638] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background and study aims Per oral endoscopic myotomy (POEM) of the lower esophageal sphincter has become a major treatment for esophageal motility disorders, especially achalasia. POEM can result in esophageal bleeding or perforation and pleural and mediastinal effusion. Early routine computed tomography (CT) esophagogram is frequently performed to assess these adverse events (AEs) before resuming oral food intake. We sought to evaluate the value of routine CT esophagogram on postoperative day (POD) 1 after POEM. Patients and methods This single-center retrospective study was performed in a tertiary referral center for interventional digestive endoscopy. We included consecutive patients with POEM and routine CT esophagogram on POD 1 between July 2018 and July 2019. Results Fifty-eight patients were included in the study, 79 % of whom had achalasia. Twenty patients (34 %) presented post-endoscopic AEs, including two patients with severe AEs requiring intensive care admission (one compressive pneumothorax and one mediastinitis); no deaths occurred. Of the 58 CT esophagograms performed, only one was normal. The 57 others (98 %) showed at least one abnormal finding: pneumoperitoneum or retroperitoneal air (91 %), pneumomediastinum (78 %), pleural effusion (34 %), pneumothorax (14 %), pneumonia (7 %), pericardial effusion (2 %), and mediastinal collection (2 %). CT esophagograms revealed AEs and modified therapeutic management in eight patients of 58 (14 %), all of whom had clinical symptoms prior to CT. Conclusions POD 1 CT esophagogram after POEM for esophageal motility disorders diagnosed clinically meaningful AEs in 14 % of patients, all associated with persistent clinical symptoms. Routine use of CT esophagogram after POEM in asymptomatic patients is questionable.
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Affiliation(s)
- Marion Chartier
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maxime Barat
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ammar Oudjit
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Chloé Leandri
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Scialom
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Philippe Soyer
- Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Université de Paris, Paris, France
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Golse M, Barat M, Costedoat-Chalumeau N, Revel MP. Case 294. Radiology 2021; 299:727-729. [PMID: 34029166 DOI: 10.1148/radiol.2021203170] [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: 11/11/2022]
Abstract
History A 50-year-old woman presented to the emergency department of our hospital with a 2-day history of lower limb pain associated with unusual asthenia and diffuse arthralgia over the past 3 weeks. She was a native of Guinea and had lived in France for most of her life, working as a personal care assistant. Her only medical history of note was an occurrence of fetal death at 12 weeks gestation when she was 35 years old. She had bilateral lower limb swelling, without changes in skin temperature or color. All proximal and distal arterial pulses were felt. General physical examination findings were otherwise unremarkable. Her laboratory tests showed a decreased hemoglobin concentration of 8.9 g/dL (normal range, 12-16 g/dL), a decreased platelet count of 45 × 109/L (normal range, 150-400 × 109/L), a C-reactive protein level of 158 mg/L (normal range, <5 mg/L) and a d-dimer level of 2000 mg/L (normal range, <500 mg/L). Compression US of the lower limbs revealed bilateral calf vein thrombosis involving the fibular and posterior tibial veins. Curative anticoagulation using low-molecular-weight heparin (enoxaparin, subcutaneous injection of 100 units per kilogram of body weight twice a day) was started. The day after the start of anticoagulation therapy, the patient reported dyspnea and acute chest and abdominal pain. Her vital signs were assessed, and she had elevated blood pressure and increased heart rate and respiratory rate, but she remained afebrile. Her cardiac auscultation was unremarkable, besides tachycardia. Skin examination revealed small areas of necrosis on the fingertips of her right hand. Laboratory studies were repeated and showed an increase in serum creatinine level from a baseline value of 0.49 mg/dL to a new value of 1.01 mg/dL (normal range, 0.6-1.1 mg/dL), an apparition of low-grade proteinuria of 0.43 g per day (normal range, <0.3 g/day), and a high serum troponin level of 1066 ng/L (normal range, <14 ng/L), whereas electrocardiography showed no ST segment modification and echocardiography revealed a moderately altered left ventricular ejection fraction (45%). There was no coronary occlusion seen at emergency coronarography. Contrast-enhanced CT of the chest, abdomen, and pelvis was performed (Figs 1, 2) together with cardiac MRI (Figs 3, 4).
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Affiliation(s)
- Marianne Golse
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
| | - Maxime Barat
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
| | - Nathalie Costedoat-Chalumeau
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
| | - Marie-Pierre Revel
- From the Departments of Radiology (M.G., M.B., M.P.R.) and Internal Medicine (N.C.C.), Cochin Hospital, APHP Centre, 27 Rue du Fg St Jacques, Paris 75014, France; and Université de Paris, Paris, France (M.B., N.C.C., M.P.R.)
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