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Cartier L, Loiez A, Nachury M, Azahaf M, Hambli S, Blondeaux A, Gérard R, Desreumaux P, Louvet A, Wils P. Changes Over Time in the Lémann Index and the Inflammatory Bowel Disease Disability Index in a Prospective Cohort of Patients With Crohn's Disease. Inflamm Bowel Dis 2024:izae073. [PMID: 38597799 DOI: 10.1093/ibd/izae073] [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] [Received: 09/24/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Crohn's disease (CD) is a progressive, destructive, and disabling disorder. Our study aimed to assess changes over time in the Lémann index (LI) and the Inflammatory Bowel Disease Disability Index (IBD-DI) in a cohort of CD patients. METHODS This was a single-center prospective cohort study of 130 consecutive CD patients with a follow-up of at least 4 years. The LI 1 and the IBD-DI 1 questionnaires were assessed in 2016 and again between September 2020 and October 2021 (LI 2 and IBD-DI 2). RESULTS Of the 130 patients with assessment of both LI 1 and IBD-DI 1, 61 had calculation of the LI 2 and 98 patients answered the IBD-DI 2 questionnaire, with a median time between the 2 evaluations of 4.2 years. The LI increased for 16 (26%), decreased for 26 (43%), and remained unchanged for 19 (31%) patients. The median LI did not change over time (9.6 vs 9.3; P = .14). Clinical disease activity was significantly associated with bowel damage progression. A high initial LI (>7.9) was not associated with CD progression (surgery, drug dose escalation, or change of biologic). The IBD-DI decreased for 59 (60.2%), increased for 37 (37.8%), and remained unchanged for 2 (2%) patients. The median IBD-DI decreased significantly over time (23.2 vs 21.4; P = .006). There was no correlation between the 2 indexes. CONCLUSIONS This is the first prospective cohort study assessing changes over time in both the LI and the IBD-DI in CD patients. After 4 years, the LI appeared to be stable and the IBD-DI decreased, with no correlation between the 2 indexes.
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Affiliation(s)
- Laurine Cartier
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
- Gastroenterology Department, Douai Hospital, Douai, France
| | - Apolline Loiez
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Maria Nachury
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
- U1286-INFINITE-Institute for Translational Research in Inflammation, Inserm, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Mustapha Azahaf
- Radiology Department, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
| | - Sofia Hambli
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Aurélie Blondeaux
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Romain Gérard
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Pierre Desreumaux
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Alexandre Louvet
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - Pauline Wils
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
- U1286-INFINITE-Institute for Translational Research in Inflammation, Inserm, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
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Kouidrat Y, Le Collen L, Vaxillaire M, Dechaume A, Toussaint B, Vaillant E, Amanzougarene S, Derhourhi M, Delemer B, Azahaf M, Froguel P, Bonnefond A. Dominant PDX1 deficiency causes highly penetrant diabetes at different ages, associated with obesity and exocrine pancreatic deficiency: Lessons for precision medicine. Diabetes Metab 2024; 50:101507. [PMID: 38141807 DOI: 10.1016/j.diabet.2023.101507] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Heterozygous pathogenic or likely pathogenic (P/LP) PDX1 variants cause monogenic diabetes. We comprehensively examined the phenotypes of carriers of P/LP PDX1 variants, and delineated potential treatments that could be efficient in an objective of precision medicine. METHODS The study primarily involved a family harboring a novel P/LP PDX1 variant. We then conducted an analysis of documented carriers of P/LP PDX1 variants, from the Human Gene Mutation Database (HGMD), RaDiO study, and Type 2 Diabetes Knowledge Portal (T2DKP) including 87 K participants. RESULTS Within the family, we identified a P/LP PDX1 variant encoding p.G232S in four relatives. All of them exhibited diabetes, albeit with very different ages of onset (10-40 years), along with caudal pancreatic agenesis and childhood-onset obesity. In the HGMD, 79 % of carriers of a P/LP PDX1 variant displayed diabetes (with differing ages of onset from eight days of life to 67 years), 63 % exhibited pancreatic insufficiency and surprisingly 40 % had obesity. The impact of P/LP PDX1 variants on increased risk of type 2 diabetes mellitus was confirmed in the T2DKP. Dipeptidyl peptidase 4 inhibitor (DPP4i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), enabled good glucose control without hypoglycemia and weight management. CONCLUSIONS This study reveals diverse clinical presentations among the carriers of a P/LP PDX1 variant, highlighting strong variations in diabetes onset, and unexpectedly high prevalence of obesity and pancreatic development abnormalities. Clinical data suggest that DPP4i and GLP1-RA may be the best effective treatments to manage both glucose and weight controls, opening new avenue in precision diabetic medicine.
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Affiliation(s)
- Youssef Kouidrat
- Department of Rehabilitation, Nutrition and Obesity, Berck Maritime Hospital, Greater Paris University Hospitals, AP-HP, Berck, France
| | - Lauriane Le Collen
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France; Department of Clinical Genetic, University Hospital Center of Reims, Reims, France.
| | - Martine Vaxillaire
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Aurélie Dechaume
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Bénédicte Toussaint
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Emmanuel Vaillant
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Souhila Amanzougarene
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Mehdi Derhourhi
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France
| | - Brigitte Delemer
- Department of Endocrinology Diabetology, University Hospital Center of Reims, Reims, France
| | - Mustapha Azahaf
- Department of Radiology, Groupement des Hôpitaux de l'Institut Catholique de Lille, Saint Philibert Hospital, Lille, France
| | - Philippe Froguel
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France; Department of Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
| | - Amélie Bonnefond
- Inserm UMR1283, CNRS UMR8199, Pasteur Institute of Lille, European Genomic Institute for Diabetes, Université de Lille, Lille University Hospital, Cedex, Lille 59045, France; University of Lille, Lille University Hospital, Lille, France; Department of Metabolism, Imperial College London, Hammersmith Hospital, London, UK.
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Pariente B, Torres J, Burisch J, Arebi N, Barberio B, Duricova D, Ellul P, Goldis A, Kaimakliotis I, Katsanos K, Krznaric Ž, McNamara D, Pedersen N, Sebastian S, Azahaf M, Weimers P, Lung P, Lacognata C, Horak M, Christodoulou D, Domislovic V, Murphy I, Lambert J, Ungaro R, Colombel JF, Mary JY. Validation and Update of the Lémann Index to Measure Cumulative Structural Bowel Damage in Crohn's Disease. Gastroenterology 2021; 161:853-864.e13. [PMID: 34052277 PMCID: PMC8609534 DOI: 10.1053/j.gastro.2021.05.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/15/2021] [Accepted: 05/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating. METHODS This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples. RESULTS In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other. CONCLUSIONS The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.
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Affiliation(s)
- Benjamin Pariente
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France.
| | - Joana Torres
- Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Johan Burisch
- Department of Gastroenterology, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark’s Hospital and Imperial College London, London, United Kingdom
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Dana Duricova
- Inflammatory Bowel Diseases Clinical and Research Center, ISCARE a.s., Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pierre Ellul
- Mater Dei Hospital, Department of Medicine, Division of Gastroenterology, Msida, Malta
| | - Adrian Goldis
- Department of Gastroenterology, University of Medicine, Timișoara, România
| | | | - Konstantinos Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Željko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Deirdre McNamara
- TAGG Research Centre, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Natalia Pedersen
- Department of Gastroenterology, Slagelse Hospital, Slagelse, Denmark
| | - Shaji Sebastian
- Inflammatory Bowel Diseases Unit, Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom
| | - Mustapha Azahaf
- Radiology Department, Claude Huriez hospital, University of Lille, Lille, France
| | - Petra Weimers
- Department of Gastroenterology, North Zealand University Hospital, Capital Region, Denmark
| | - Philip Lung
- Radiology Department, St Mark’s Hospital and Imperial College, London, United Kingdom
| | | | - Martin Horak
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Dimitrios Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ian Murphy
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Jérôme Lambert
- INSERM U1135 Centre de Recherche Epidémiologie et Statistiques, Equipe Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Ryan Ungaro
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frédéric Colombel
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Yves Mary
- INSERM U1135 Centre de Recherche Epidémiologie et Statistiques, Equipe Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments, Université de Paris, Hôpital Saint-Louis, Paris, France
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Vermersch M, Azahaf M, Ernst O. Editorial for "Multi-Shot Diffusion-Weighted Imaging With Multiplexed Sensitivity Encoding (MUSE) in the Assessment of Active Inflammation in Crohn's Disease". J Magn Reson Imaging 2021; 55:138-139. [PMID: 34145675 DOI: 10.1002/jmri.27795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Mustapha Azahaf
- Medical Imaging Department, Lille University Hospital, Lille, France
| | - Olivier Ernst
- Medical Imaging Department, Lille University Hospital, Lille, France
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Artru F, Miquet X, Azahaf M, Labreuche J, Ntandja Wandji LC, Sergent G, Nobécourt A, Toumelin P, Lassailly G, Dharancy S, Ernst O, Mathurin P, Louvet A. Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT-based surveillance. Aliment Pharmacol Ther 2020; 52:1516-1526. [PMID: 32931618 DOI: 10.1111/apt.16080] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/31/2020] [Accepted: 08/19/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Body composition may be modified after improvement of portal hypertension (PHT) by transjugular intrahepatic portosystemic shunt (TIPSS) insertion. AIMS To evaluate changes in body composition following TIPSS placement, their relationship with radiological TIPSS patency and function, and the predictive value of these parameters METHODS: We retrospectively included 179 patients with cirrhosis who underwent TIPSS placement in our centre for severe PHT from 2011 to 2017. CT scan-based surveillance was performed at baseline, 1-3 (M1-M3) and 6 months (M6). RESULTS The median model for end-stage liver disease (MELD) score was 11.4 (8.8-15.1) and Child-Pugh score 8 (7-9). Only the MELD score (HR 1.14, 95% CI 1.08-1.20) and sarcopenia assessed by transversal right psoas muscle thickness at the umbilical level/height (TPMPT/height) (HR 0.86, 95% CI 0.79-0.96) were independently associated with 6-month mortality on multivariate analysis. After TIPSS insertion, TPMT/height increased from 19 mm/m (baseline) to 19.6 mm/m (M1-M3, P = 0.004) and 21.1 mm/m (M6, P < 0.0001). The improvement and its extent were dependent on the radiological patency and dysfunction of TIPSS. Subcutaneous fat surface (SCFS) increased from 183.4 to 193 cm2 (P < 0.0001) and 229.8 cm2 (P < 0.0001), respectively. We observed a decrease in visceral fat surface (VFS) between baseline and M1-M3 (163.5-140.5 cm2 [P < 0.0001]), but not between M1-M3 and M6 (140.5-141.2 cm2 [P = 0.9]). SCFS and VFS did not seem to be modified by radiological TIPSS patency and dysfunction. CONCLUSIONS Sarcopenia is independently associated with 6-month outcome and improves after TIPSS placement, together with an inverse evolution of subcutaneous and visceral fat. TIPSS not only treats PHT but also improves body composition.
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Affiliation(s)
- Florent Artru
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France.,Service de gastroentérologie et d'hépatologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Xavier Miquet
- Service de radiologie digestive, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - Mustapha Azahaf
- Service de radiologie digestive, Hôpital Claude Huriez, CHU Lille, Lille, France
| | | | - Line Carolle Ntandja Wandji
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France
| | - Géraldine Sergent
- Service de radiologie digestive, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - Amélie Nobécourt
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France
| | - Pierre Toumelin
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - Guillaume Lassailly
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France
| | - Sébastien Dharancy
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France
| | - Olivier Ernst
- Service de radiologie digestive, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France
| | - Alexandre Louvet
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, CHU Lille, Lille, France.,U995 - LIRIC - Lille Inflammation Research Center, Université de Lille/Inserm/CHU de Lille, Lille, France
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Lauriot Dit Prevost C, Azahaf M, Nachury M, Branche J, Gerard R, Wils P, Lambin T, Desreumaux P, Ernst O, Pariente B. Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index. Aliment Pharmacol Ther 2020; 51:889-898. [PMID: 32221985 DOI: 10.1111/apt.15681] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/15/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lémann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability. AIMS To measure the Lémann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. METHODS We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lémann Index and the IBD Disability Index questionnaire in all patients. RESULTS One hundred and thirty CD patients were consecutively included. The mean Lémann Index (±SD) was 11.9 ± 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P < 0.005). Among patients exposed to anti-TNF, the Lémann Index was lower in those who were exposed in the first 2 years of their disease (P = 0.015). The mean IBD Disability Index was 28.8 ± 6.3 and ranged from 0 to 71 points. The factors associated with high disability score were: female gender, anal location, extra digestive manifestations, clinical and biological disease activity and exposure to anti-TNF (P < 0.005). No correlation was observed between the Lémann Index and IBD Disability Index (P = 0.15). CONCLUSIONS This is the first study to prospectively evaluate the Lémann Index and the IBD Disability Index in a large cohort of CD patients in a tertiary centre. Early introduction of anti-TNF treatment was associated with lower bowel damage scores, and no correlation was observed between the Lémann Index and the IBD Disability Index. Further dedicated prospective studies are necessary to confirm these results.
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Affiliation(s)
| | - Mustapha Azahaf
- Department of Digestive Diagnostic and Interventional Radiology, Claude Huriez Hospital, University of Lille, Lille, France
| | - Maria Nachury
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Julien Branche
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Romain Gerard
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Pauline Wils
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Thomas Lambin
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Pierre Desreumaux
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
| | - Olivier Ernst
- Department of Digestive Diagnostic and Interventional Radiology, Claude Huriez Hospital, University of Lille, Lille, France
| | - Benjamin Pariente
- Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France
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Lebert P, Adens-Fauquembergue M, Azahaf M, Gnemmi V, Behal H, Luciani A, Ernst O. MRI for characterization of benign hepatocellular tumors on hepatobiliary phase: the added value of in-phase imaging and lesion-to-liver visual signal intensity ratio. Eur Radiol 2019; 29:5742-5751. [PMID: 30993437 DOI: 10.1007/s00330-019-06210-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the lesion-to-liver visual signal intensity ratio (SIR) before and at the hepatobiliary phase MRI (HBP-MRI) after gadobenate dimeglumine (Gd-BOPTA) injection, using several T1-weighted images (T1-WI), for the characterization of benign hepatocellular lesions. METHODS Patients with histologically proven focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), who underwent Gd-BOPTA-enhanced HBP-MRI from 2009 to 2017, were retrospectively identified. The lesion-to-liver SIR was visually assessed by two radiologists on HBP (post-HBP analysis) and compared with that of unenhanced sequences (pre/post-HBP analysis) on T1-WI in-phase (T1-IP), out-of-phase (T1-OP), and fat suppression (T1-FS). Lesions were classified as hyper-, iso-, or hypointense on post-HBP, and as decreasing, stable, or increasing SIR on pre/post-HBP analyses. The performance of the different T1-WI sequences for the diagnostic of FNH was evaluated on post-HBP analysis. RESULTS Twenty-nine FNHs and 33 HCAs were analyzed. On post-HBP analysis, FNHs appeared hyper-/isointense in 89.7% of all T1-WI. HCAs appeared hypointense in 93.9%, 63.6%, and 69.7% of T1-IP, T1-OP, and T1-FS, respectively. FNHs exhibited an increasing SIR in 55.2-58.6%, a stable SIR in 44.8-58.6%, and a decreasing SIR in 0%, whereas HCAs exhibited a decreasing SIR in 66.7-93.9%, a stable SIR in 6.1-33.3%, and an increasing SIR in 0% (p < 0.0001). The specificity of T1-IP was significantly higher than that of T1-OP (p = 0.015) and T1-FS (p = 0.042). CONCLUSION T1-IP is the most reliable sequence due to misleading tumor/liver signal ratio in the case of fatty liver when using T1-FS or T1-OP. The pre/post-HBP lesion-to-liver SIR is accurate to classify benign hepatocellular lesions and contributes to avoid biopsy. KEY POINTS •The T1-weighted images in-phase should be systematically included in the HBP-MRI protocol, as it is the most reliable sequence especially in the case of fatty liver. •The comparison between lesion-to-liver signal intensity ratios on unenhanced and at the hepatobiliary phase sequences is useful to classify benign hepatocellular lesions in three categories without misclassification: FNH (increasing signal intensity ratio), HCA (decreasing signal intensity ration), and indeterminate lesions (stable signal intensity ratio).
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Affiliation(s)
- P Lebert
- Department of Gastrointestinal Imaging, Lille University Hospital, Rue Michel Polonovski, 59037, Lille Cedex, France.
| | - M Adens-Fauquembergue
- Department of Gastrointestinal Imaging, Lille University Hospital, Rue Michel Polonovski, 59037, Lille Cedex, France
| | - M Azahaf
- Department of Gastrointestinal Imaging, Lille University Hospital, Rue Michel Polonovski, 59037, Lille Cedex, France
| | - V Gnemmi
- Department of Pathology, Lille University Hospital, avenue Oscar-Lambret, 59037, Lille Cedex, France
| | - H Behal
- Department of Biostatistics, Lille University Hospital, avenue Oscar-Lambret, 59037, Lille Cedex, France
| | - A Luciani
- Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, AP-HP, 94010, Creteil, France
| | - O Ernst
- Department of Gastrointestinal Imaging, Lille University Hospital, Rue Michel Polonovski, 59037, Lille Cedex, France
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Azahaf M, Haberley M, Betrouni N, Ernst O, Behal H, Duhamel A, Ouzzane A, Puech P. Impact of arterial input function selection on the accuracy of dynamic contrast-enhanced MRI quantitative analysis for the diagnosis of clinically significant prostate cancer. J Magn Reson Imaging 2015; 43:737-49. [DOI: 10.1002/jmri.25034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/06/2015] [Indexed: 01/06/2023] Open
Affiliation(s)
- Mustapha Azahaf
- Department of Gastrointestinal Imaging; CHU Lille, Université de Lille; Lille France
- INSERM, U1189, CHU Lille, Université de Lille; Lille France
| | - Marc Haberley
- Department of Gastrointestinal Imaging; CHU Lille, Université de Lille; Lille France
| | - Nacim Betrouni
- INSERM, U1189, CHU Lille, Université de Lille; Lille France
| | - Olivier Ernst
- Department of Gastrointestinal Imaging; CHU Lille, Université de Lille; Lille France
- INSERM, U1189, CHU Lille, Université de Lille; Lille France
| | - Hélène Behal
- Methodolgy and Biostatistics Units, EA2964, UDSL2, CHU Lille, Université de Lille; Lille France
| | - Alain Duhamel
- Methodolgy and Biostatistics Units, EA2964, UDSL2, CHU Lille, Université de Lille; Lille France
| | - Adil Ouzzane
- INSERM, U1189, CHU Lille, Université de Lille; Lille France
- Department of Urology; CHU Lille, Université de Lille; Lille France
| | - Philippe Puech
- INSERM, U1189, CHU Lille, Université de Lille; Lille France
- Department of Genitourinary Imaging; CHU Lille, Université de Lille; Lille France
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9
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Tartare G, Hamad D, Azahaf M, Puech P, Betrouni N. Spectral clustering applied for dynamic contrast-enhanced MR analysis of time-intensity curves. Comput Med Imaging Graph 2014; 38:702-13. [PMID: 25179917 DOI: 10.1016/j.compmedimag.2014.07.005] [Citation(s) in RCA: 3] [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: 02/12/2014] [Revised: 06/24/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
Dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) represents an emerging method for the prediction of biomarker responses in cancer. However, DCE images remain difficult to analyze and interpret. Although pharmacokinetic approaches, which involve multi-step processes, can provide a general framework for the interpretation of these data, they are still too complex for robust and accurate implementation. Therefore, statistical data analysis techniques were recently suggested as another valid interpretation strategy for DCE-MRI. In this context, we propose a spectral clustering approach for the analysis of DCE-MRI time-intensity signals. This graph theory-based method allows for the grouping of signals after spatial transformation. Subsequently, these data clusters can be labeled following comparison to arterial signals. Here, we have performed experiments with simulated (i.e., generated via pharmacokinetic modeling) and clinical (i.e., obtained from patients scanned during prostate cancer diagnosis) data sets in order to demonstrate the feasibility and applicability of this kind of unsupervised and non-parametric approach.
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Affiliation(s)
- Guillaume Tartare
- INSERM, U703, 152 rue du Docteur Yersin, 59120 CHRU Lille, France; Université Littoral Côte d'Opale, Laboratoire d'Informatique, Signal et Image de la Côte d'Opale, France
| | - Denis Hamad
- Université Littoral Côte d'Opale, Laboratoire d'Informatique, Signal et Image de la Côte d'Opale, France
| | - Mustapha Azahaf
- INSERM, U703, 152 rue du Docteur Yersin, 59120 CHRU Lille, France; Université Littoral Côte d'Opale, Laboratoire d'Informatique, Signal et Image de la Côte d'Opale, France; Service de Radiologie, Hôpital Claude Huriez, CHRU de Lille, France
| | - Philippe Puech
- INSERM, U703, 152 rue du Docteur Yersin, 59120 CHRU Lille, France; Université Littoral Côte d'Opale, Laboratoire d'Informatique, Signal et Image de la Côte d'Opale, France; Service de Radiologie, Hôpital Claude Huriez, CHRU de Lille, France
| | - Nacim Betrouni
- INSERM, U703, 152 rue du Docteur Yersin, 59120 CHRU Lille, France; Université Littoral Côte d'Opale, Laboratoire d'Informatique, Signal et Image de la Côte d'Opale, France.
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