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Fulbert M, El Amrani M, Baillet C, Lecolle K, Ernst O, Louvet A, Pruvot FR, Huglo D, Truant S. Sarcopenia does not affect liver regeneration and postoperative course after a major hepatectomy. A prospective study on 125 patients using CT volumetry and HIDA scintigraphy. Clin Res Hepatol Gastroenterol 2024; 48:102332. [PMID: 38574887 DOI: 10.1016/j.clinre.2024.102332] [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: 11/15/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND & OBJECTIVES Sarcopenia is a morbi-mortality risk factor in digestive surgery, though its impact after major hepatectomy (MH) remains unknown. This prospective pilot study investigated whether volume and function of a regenerating liver is influenced by body composition. METHODS From 2011 to 2016, 125 consecutive patients had computed tomography and 99mTc-labelled-mebrofenin SPECT-scintigraphy before and after MH at day 7 and 1 month for measurements of liver volumes and functions. L3 vertebra muscle mass identified sarcopenia. Primary endpoint was the impact of sarcopenia on regeneration capacities (i.e. volume/function changes and post-hepatectomy liver failure (PHLF) rate). Secondary endpoint was 3-month morbi-mortality. RESULTS Sarcopenic patients (SP; N = 69) were significantly older than non-sarcopenic (NSP), with lower BMI and more malignancies, but with comparable liver function/volume at baseline. Postoperatively, SP showed higher rates of ISGLS_PHLF (24.6 % vs 10.9 %; p = 0.05) but with comparable rates of severe morbidity (23.2 % vs 16.4 %; p = 0.35), overall (8.7 % vs 3.6 %; p = 0.3) and PHLF-related mortality (8,7 % vs 1.8 %; p = 0.075). After matching on the extent of resection or using propensity score, regeneration and PHLF rates were similar. CONCLUSION This prospective study using first sequential SPECT-scintigraphy showed that sarcopenia by itself does not affect liver regeneration capacities and short-term postoperative course after MH.
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Affiliation(s)
- Maxence Fulbert
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France; CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies" UMR-S1277, Team "Mucins, Cancer and Drug Resistance", Lille F-59000, France
| | - Clio Baillet
- Department of Nuclear Medicine, CHU Lille, University Lille, Lille F-59000, France
| | - Katia Lecolle
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France
| | - Olivier Ernst
- Department of Digestive Radiology, CHU Lille, University Lille, Lille F-59000, France
| | - Alexandre Louvet
- Department of Hepatogastroenterology, CHU Lille, University Lille, Lille F-59000, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France
| | - Damien Huglo
- Department of Nuclear Medicine, CHU Lille, University Lille, Lille F-59000, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille F-59000, France; CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies" UMR-S1277, Team "Mucins, Cancer and Drug Resistance", Lille F-59000, France.
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Demondion E, Ernst O, Louvet A, Robert B, Kafri G, Langzam E, Vermersch M. Hepatic fat quantification in dual-layer computed tomography using a three-material decomposition algorithm. Eur Radiol 2023:10.1007/s00330-023-10382-z. [PMID: 37955671 DOI: 10.1007/s00330-023-10382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate a three-material decomposition algorithm for hepatic fat quantification using a dual-layer computed tomography (DL-CT) and MRI as reference standard on a large patient cohort. METHOD A total of 104 patients were retrospectively included in our study, i.e., each patient had an MRI exam and a DL-CT exam in our institution within a maximum of 31 days. Four regions of interest (ROIs) were positioned blindly and similarly in the liver, by two independent readers on DL-CT and MRI images. For DL-CT exams, all imaging phases were included. Fat fraction agreement between CT and MRI was performed using intraclass correlation coefficients (ICC), determination coefficients R2, and Bland-Altman plots. Diagnostic performance was determined using sensitivity, specificity, and positive and negative predictive values. The cutoff for steatosis was 5%. RESULTS Correlation between MRI and CT data was excellent for all perfusion phases with ICC calculated at 0.99 for each phase. Determination coefficients R2 were also good for all perfusion phases (about 0.95 for all phases). Performance of DL-CT in the diagnosis of hepatic steatosis was good with sensitivity between 89 and 91% and specificity ranging from 75 to 80%, depending on the perfusion phase. The positive predictive value was ranging from 78 to 93% and the negative predictive value from 82 to 86%. CONCLUSION Multi-material decomposition in DL-CT allows quantification of hepatic fat fraction with a good correlation to MRI data. CLINICAL RELEVANCE STATEMENT The use of DL-CT allows for detection of hepatic steatosis. This is especially interesting as an opportunistic finding CT performed for other reasons, as early detection can help prevent or slowdown the development of liver metabolic disease. KEY POINTS • Hepatic fat fractions provided by the dual-layer CT algorithm is strongly correlated with that measured on MRI. • Dual-layer CT is accurate to detect hepatic steatosis ≥ 5%. • Dual-layer CT allows opportunistic detection of steatosis, on CT scan performed for various indications.
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Affiliation(s)
- Emilie Demondion
- Medical Imaging Department, Lille University Hospital, 2 Avenue Oscar-Lambret, Lille, France.
| | - Olivier Ernst
- Medical Imaging Department, Lille University Hospital, 2 Avenue Oscar-Lambret, Lille, France
| | - Alexandre Louvet
- Department of Gastroenterology and Hepatology, Lille University Hospital, 2 Avenue Oscar-Lambret, Lille, France
| | | | - Galit Kafri
- CT Clinical Science, Philips Healthcare, Haifa, Israel
| | - Eran Langzam
- CT Clinical Science, Philips Healthcare, Haifa, Israel
| | - Mathilde Vermersch
- Medical Imaging Department, Lille University Hospital, 2 Avenue Oscar-Lambret, Lille, France
- Medical Imaging Department, Valenciennes Hospital Center, 114 Avenue Desandrouin, Valenciennes, France
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Cadour F, Ernst O, Dacher JN. Can cardiac magnetic resonance imaging be used as a screening tool for iron overload? Diagn Interv Imaging 2023:S2211-5684(23)00172-9. [PMID: 37689505 DOI: 10.1016/j.diii.2023.08.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Farah Cadour
- Department of Radiology, Cardiac Imaging Unit, University Hospital of Rouen, 76000 Rouen, France
| | - Olivier Ernst
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Jean-Nicolas Dacher
- Department of Radiology, Cardiac Imaging Unit, University Hospital of Rouen, 76000 Rouen, France; UNIROUEN, Inserm U1096, UFR Médecine Pharmacie, 76183 Rouen Cedex, 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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Lebert P, Ernst O, Zins M, Lanchou M, Nzamushe JR, Vermersch M. Pneumatosis intestinalis and portal venous gas in mechanical small bowel obstruction: Is it worrisome? Diagn Interv Imaging 2021; 102:545-551. [PMID: 34030989 DOI: 10.1016/j.diii.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference. MATERIALS AND METHODS Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25-93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%). RESULTS Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO. CONCLUSION PI and PVG are not specific signs of bowel necrosis in mechanical SBO.
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Affiliation(s)
- Paul Lebert
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France.
| | - Olivier Ernst
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Marc Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 75014 Paris, France
| | - Marie Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Jean-Robert Nzamushe
- Department of Emergency Surgery, Lille University Hospital, 59037 Lille Cedex, France
| | - Mathilde Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
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Blanc-Durand P, Schiratti JB, Schutte K, Jehanno P, Herent P, Pigneur F, Lucidarme O, Benaceur Y, Sadate A, Luciani A, Ernst O, Rouchaud A, Creze M, Dallongeville A, Banaste N, Cadi M, Bousaid I, Lassau N, Jegou S. Abdominal musculature segmentation and surface prediction from CT using deep learning for sarcopenia assessment. Diagn Interv Imaging 2020; 101:789-794. [DOI: 10.1016/j.diii.2020.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
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Lassau N, Bousaid I, Chouzenoux E, Lamarque J, Charmettant B, Azoulay M, Cotton F, Khalil A, Lucidarme O, Pigneur F, Benaceur Y, Sadate A, Lederlin M, Laurent F, Chassagnon G, Ernst O, Ferreti G, Diascorn Y, Brillet P, Creze M, Cassagnes L, Caramella C, Loubet A, Dallongeville A, Abassebay N, Ohana M, Banaste N, Cadi M, Behr J, Boussel L, Fournier L, Zins M, Beregi J, Luciani A, Cotten A, Meder J. Three artificial intelligence data challenges based on CT and MRI. Diagn Interv Imaging 2020; 101:783-788. [DOI: 10.1016/j.diii.2020.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
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Raufaste Tistet M, Ernst O, Lanchou M, Vermersch M, Lebert P. Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas. Abdom Radiol (NY) 2020; 45:3589-3607. [PMID: 32296900 DOI: 10.1007/s00261-020-02525-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/12/2022]
Abstract
PURPOSE The aim of the study is to describe the imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas (ACLs). RESULTS ACLs are benign lymphatic malformations that mainly arise in the subperitoneal space and the retroperitoneum. The typical presentation of an ACL is a multilocular lesion with homogenous serous content, presenting a thin wall and septa, usually free from adjacent organ compression. Atypical findings, including fat or hemorrhagic content, septal calcifications and unilocular presentation, are not uncommon. Rarely, ACLs can be revealed by acute complications, such as infection, hemorrhage, intussusception, complications with a twisting mechanism (including torsion around its own pedicle) or spontaneous rupture, which can be diagnosed by imaging. Ultrasonography and CT are the most useful modalities in emergency situations. MRI performs best in the noninvasive characterization of cystic lesions. ACLs should be differentiated from normal anatomic structures (e.g., cisterna chyli) or pitfalls (e.g., ascites, extrapancreatic necrosis, lymphocele) that can simulate ACLs. Among other primary peritoneal cystic lesions, benign cystic mesothelioma can be difficult to differentiate from ACL. Some neoplastic peritoneal lesions may have cystic components or content that looks like fluid on imaging (such as mucinous or myxoid content) and be misdiagnosed as ACL. Nodular or thick enhancement of the wall or septa should then be considered worrisome features and should not suggest ACL. ACLs mostly require a simple follow-up. If treatment is necessary, percutaneous sclerotherapy is a safe and effective alternative to surgery. CONCLUSION Imaging, especially MRI, allows the noninvasive diagnosis of ACL and helps to exclude potential malignant differential diagnoses.
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Affiliation(s)
- M Raufaste Tistet
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France.
| | - O Ernst
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - M Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - M Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
| | - P Lebert
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonoski, 59037, Lille Cedex, France
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Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, André M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. Correction to: National dose reference levels in computed tomography–guided interventional procedures—a proposal. Eur Radiol 2020; 30:6384-6386. [DOI: 10.1007/s00330-020-06948-w] [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: 11/27/2022]
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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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Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, André M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. National dose reference levels in computed tomography–guided interventional procedures—a proposal. Eur Radiol 2020; 30:5690-5701. [DOI: 10.1007/s00330-020-06903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
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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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Abstract
INTRODUCTION Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions. PATIENTS AND METHODS In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results. RESULTS Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis. CONCLUSION CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.
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Affiliation(s)
- A Mensier
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France
| | - T Onimus
- Pôle anesthésie et réanimation, université Lille Nord de France, hôpital Roger-Salengro, CHU de Lille, 59037 Lille, France
| | - O Ernst
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - C Leroy
- Radiologie digestive, université Lille Nord de France, hôpital Hopital Claude-Huriez, CHU de Lille, 59037 Lille, France
| | - P Zerbib
- Service de chirurgie digestive et transplantation, université Lille Nord de France, hôpital Claude-Huriez, CHU de Lille, rue Michel-Polonovski, 59037 Lille, France.
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Abstract
PURPOSE To present radiological aspects of jejunoileal diverticulosis and its complications. RESULTS Jejunoileal diverticulosis is a relatively rare and underestimated condition, which mostly affects the elderly. It is frequently asymptomatic but it can lead to significant complications requiring surgical treatment. Jejunoileal diverticulosis is far less common than colonic diverticulosis. Acquired small bowel diverticula are often numerous but the complication rate is low. Acute diverticulitis is the most frequent complication; its classic presentation involves the jejunum and is often non-severe. Diverticular hemorrhage is the second most common complication; CT scan examination is essential to determine the accurate topography of the pathological diverticula. Small bowel obstruction can occur through several mechanisms: adhesions, enterolith, and intussusception. Extra-intestinal gas without perforation and "pseudo-ischemic" appearance are non-pathological conditions that are important to diagnose in order to avoid surgery. CONCLUSION Jejunoileal diverticulosis usually does not show any symptoms but can lead to diagnostic challenges requiring evaluation by CT. CT scan signs of these complications and some pitfalls must be known.
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Affiliation(s)
- P Lebert
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonowski, 59037, Lille Cedex, France.
| | - O Ernst
- Department of Digestive Diagnostic and Interventional Radiology, University Hospital Claude Huriez - Regional University Hospital Center, rue Michel Polonowski, 59037, Lille Cedex, France
| | - M Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674, Paris, 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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Truant S, El Amrani M, Baillet C, Ploquin A, Lecolle K, Ernst O, Hebbar M, Huglo D, Pruvot FR. Laparoscopic Partial ALPPS: Much Better Than ALPPS! Ann Hepatol 2019; 18:269-273. [PMID: 31113604 DOI: 10.5604/01.3001.0012.7937] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/20/2017] [Accepted: 04/20/2018] [Indexed: 02/04/2023]
Abstract
Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has emerged as an alternative for patients with bilobar colorectal liver metastasis deemed unresectable due to inadequate future remnant liver (FRL). Nevertheless, high morbidity and mortality rates have been reported. In this setting, including hepatobiliary scintigraphy in the clinical and surgical management of patients offered ALPPS has been advocated to both assess eligibility for ALPPS stagel and suitable time for ALPPS stage2. Recently, it was stated that partial ALPPS with a liver split restricted to 50% of the transection line (or up to the middle hepatic vein in case of right extended hepatectomy) and a shortened stagel allows improving the postoperative course without precluding the inter-stages FRL hypertrophy. We describe a case series of p-ALPPS with stagel performed laparoscopically, including sequential assessments of the FRL volumes and functions via pre-stagel and pre-stage2 computed tomography volumetry and HIDA SPECT-scintigraphy. In five patients, laparoscopic p-ALPPS was associated with rapid and significant gain of remnant functional volume - much better than previously observed for ALPPS - facilitating early stage2 without inflammatory adherences. In conclusion, laparoscopic p-ALPPS is feasible and seems less aggressive than the original ALPPS technique with total transection. It may be an interesting alternative to the classical portal vein embolization (PVE) and two-stage hepatectomy strategy.
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Affiliation(s)
- Stéphanie Truant
- Department of Digestive Surgery and Transplantation, Huriez Hospital, University of Lille, France.
| | - Mehdi El Amrani
- Department of Digestive Surgery and Transplantation, Huriez Hospital, University of Lille, France
| | - Clio Baillet
- Department of Nuclear Medicine, Huriez Hospital, University of Lille, France
| | - Anne Ploquin
- Department of Medical Oncology, Huriez Hospital, University of Lille, France
| | - Katia Lecolle
- Department of Digestive Surgery and Transplantation, Huriez Hospital, University of Lille, France
| | - Olivier Ernst
- Department of Radiology, Huriez Hospital, University of Lille, France
| | - Mohamed Hebbar
- Department of Medical Oncology, Huriez Hospital, University of Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, Huriez Hospital, University of Lille, France
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Huriez Hospital, University of Lille, France
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El Amrani M, Vermersch M, Fulbert M, Prodeau M, Lecolle K, Hebbar M, Ernst O, Pruvot FR, Truant S. Impact of sarcopenia on outcomes of patients undergoing pancreatectomy: A retrospective analysis of 107 patients. Medicine (Baltimore) 2018; 97:e12076. [PMID: 30278487 PMCID: PMC6181530 DOI: 10.1097/md.0000000000012076] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To evaluate the prevalence of sarcopenia in patients undergoing pancreatic surgery and to examine its impact on the surgical outcomes and survival of patients.Skeletal muscle index (SMI) was measured on preoperative CT. A patient was considered sarcopenic if SMI was <38.5 cm/m for a female or <52.4 cm/m for a male. Postoperative pancreatic fistula (POPF) and severe morbidity (Clavien≥3) were analyzed. Survival of patients with cancer was calculated using the Kaplan-Meier method.In total, 107 consecutive patients were included. Among them, 50 (47%) patients were sarcopenic and 65 (60%) were undernourished. The rates of severe morbidity and mortality were comparable between sarcopenic and nonsarcopenic groups. However, all POPF grade B or C and deaths occurred in the sarcopenic or nonsarcopenic overweight group (BMI > 25) with significantly lengthened hospital stays (P = .003). After pancreatectomy for cancer, 31 (40.2%) patients showed postoperative recurrence and 23 (29.9%) died after a median follow-up of 15 ± 13.5 months. Despite comparable histological types and stages, the median overall and disease-free survivals were lower in sarcopenic patients (16 months vs not reached, P = .02 and 11.1 months vs 22.5 months; P = .04, respectively). The multivariate analysis revealed that, sarcopenia trended to increase the risk of death (HR = 2.04, P = .07).Sarcopenia negatively impacted short- and long-term outcomes in patients undergoing pancreatectomy.
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Affiliation(s)
| | | | | | | | | | | | - Olivier Ernst
- Department of Digestive and Interventional Radiology
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19
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de Montalembert M, Ribeil JA, Brousse V, Guerci-Bresler A, Stamatoullas A, Vannier JP, Dumesnil C, Lahary A, Touati M, Bouabdallah K, Cavazzana M, Chauzit E, Baptiste A, Lefebvre T, Puy H, Elie C, Karim Z, Ernst O, Rose C. Cardiac iron overload in chronically transfused patients with thalassemia, sickle cell anemia, or myelodysplastic syndrome. PLoS One 2017; 12:e0172147. [PMID: 28257476 PMCID: PMC5336214 DOI: 10.1371/journal.pone.0172147] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/31/2017] [Indexed: 01/09/2023] Open
Abstract
The risk and clinical significance of cardiac iron overload due to chronic transfusion varies with the underlying disease. Cardiac iron overload shortens the life expectancy of patients with thalassemia, whereas its effect is unclear in those with myelodysplastic syndromes (MDS). In patients with sickle cell anemia (SCA), iron does not seem to deposit quickly in the heart. Our primary objective was to assess through a multicentric study the prevalence of cardiac iron overload, defined as a cardiovascular magnetic resonance T2*<20 ms, in patients with thalassemia, SCA, or MDS. Patient inclusion criteria were an accurate record of erythrocyte concentrates (ECs) received, a transfusion history >8 ECs in the past year, and age older than 6 years. We included from 9 centers 20 patients with thalassemia, 41 with SCA, and 25 with MDS in 2012-2014. Erythrocytapharesis did not consistently prevent iron overload in patients with SCA. Cardiac iron overload was found in 3 (15%) patients with thalassemia, none with SCA, and 4 (16%) with MDS. The liver iron content (LIC) ranged from 10.4 to 15.2 mg/g dry weight, with no significant differences across groups (P = 0.29). Abnormal T2* was not significantly associated with any of the measures of transfusion or chelation. Ferritin levels showed a strong association with LIC. Non-transferrin-bound iron was high in the thalassemia and MDS groups but low in the SCA group (P<0.001). Hepcidin was low in thalassemia, normal in SCA, and markedly elevated in MDS (P<0.001). Two mechanisms may explain that iron deposition largely spares the heart in SCA: the high level of erythropoiesis recycles the iron and the chronic inflammation retains iron within the macrophages. Thalassemia, in contrast, is characterized by inefficient erythropoiesis, unable to handle free iron. Iron accumulation varies widely in MDS syndromes due to the competing influences of abnormal erythropoiesis, excess iron supply, and inflammation.
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Affiliation(s)
- Mariane de Montalembert
- Pediatrics Department, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
- * E-mail:
| | - Jean-Antoine Ribeil
- Biotherapy Department, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France
| | - Valentine Brousse
- Pediatrics Department, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Agnes Guerci-Bresler
- Hematology Department, Hôpital d’Adultes du Brabois, Vandoeuvre les Nancy, France
| | | | - Jean-Pierre Vannier
- Pediatric Oncology and Hematology Unit, Hôpital Charles Nicolle, Rouen, France
| | - Cécile Dumesnil
- Pediatric Oncology and Hematology Unit, Hôpital Charles Nicolle, Rouen, France
| | - Agnès Lahary
- Department of Biochemistry, Hôpital Charles Nicolle, Rouen, France
| | - Mohamed Touati
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU, Limoges, France
| | | | - Marina Cavazzana
- Biotherapy Department, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
- INSERM UMR 1163, Laboratory of Human Lymphopoiesis, Paris France
| | - Emmanuelle Chauzit
- Département de Pharmacologie clinique et toxicologique, CHU, Bordeaux, France
| | - Amandine Baptiste
- Paris Descartes Clinical Research Unit, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibaud Lefebvre
- Laboratory of Excellence GR-Ex, Paris, France
- INSERM UMR 1149/ERL. CNRS 8252, Centre de Recherche sur l’inflammation, Paris, France
- French center for Porphyria, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - Hervé Puy
- Laboratory of Excellence GR-Ex, Paris, France
- INSERM UMR 1149/ERL. CNRS 8252, Centre de Recherche sur l’inflammation, Paris, France
- French center for Porphyria, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France
| | - Caroline Elie
- Paris Descartes Clinical Research Unit, Necker Children’s Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zoubida Karim
- Laboratory of Excellence GR-Ex, Paris, France
- INSERM UMR 1149/ERL. CNRS 8252, Centre de Recherche sur l’inflammation, Paris, France
| | - Olivier Ernst
- Radiology Department, Hopital Huriez, CHRU, Lille, France
| | - Christian Rose
- Hématologie clinique, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
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Loyer C, Leroy C, Molin A, Odou MF, Huglo D, Lion G, Ernst O, Hoffmann M, Porchet N, Carnaille B, Pattou F, Kottler ML, Vantyghem MC. Hyperparathyroidism complicating CYP 24A1 mutations. Annales d'Endocrinologie 2016; 77:615-619. [DOI: 10.1016/j.ando.2016.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022]
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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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Jarraya H, Borde P, Mirabel X, Ernst O, Boulanger T, Lartigau E, Ceugnart L, Kramar A, Taieb S. Lobulated enhancement evaluation in the follow-up of liver metastases treated by stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2015; 92:292-8. [PMID: 25968825 DOI: 10.1016/j.ijrobp.2015.01.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/29/2014] [Accepted: 01/20/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The Response Evaluation Criteria in Solid Tumors (RECIST) can have limitations when used to evaluate local treatments for cancer, especially for liver malignancies treated by stereotactic body radiation therapy (SBRT). The aim of this study was to validate the relationship between the occurrence of lobulated enhancement (LE) and local relapse and to evaluate the utility of this relationship for predicting local progression. PATIENTS AND METHODS Imaging data of 59 lesions in 46 patients, including 281 computed tomographic (CT) scans, were retrospectively and blindly reviewed by 3 radiologists. One radiologist measured the lesion size, for each CT and overall, to classify responses using RECIST threshold criteria. The second studied LE occurrence. A third radiologist was later included and studied LE occurrence to evaluate the interobserver consistency for LE evaluation. RESULTS The mean duration of follow-up was 13.6 months. LE was observed in 16 of 18 progressive lesions, occurring before size-based progression in 50% of cases, and the median delay of LE detection was 3.2 months. The sensitivity of LE to predict progression was 89%, and its specificity was 100%. The positive predictive value was 100%, the negative predictive value was 95.3%, and the overall accuracy was 97%. The probability of local progression-free survival at 12 months was significantly higher for lesions without LE compared with all lesions: 0.80 (CI 95%: 0.65-0.89) versus 0.69 (CI 95%: 0.54-0.80), respectively. The overall concordance rate between the 2 readers of LE was 97.9%. CONCLUSION Response assessment of liver metastases treated by SBRT can be improved by including LE. This study demonstrates the diagnostic and predictive utility of LE for assessing local progression at a size still eligible for local salvage treatment.
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Affiliation(s)
- Hajer Jarraya
- Department of Radiology, Oscar Lambret Oncologic Center, Lille, France.
| | - Paul Borde
- Department of Radiology, Oscar Lambret Oncologic Center, Lille, France
| | - Xavier Mirabel
- Department of Radiotherapy, Oscar Lambret Oncologic Center, Lille, France
| | - Olivier Ernst
- Department of Body Imaging, Claude Huriez University Hospital, Lille, France
| | - Thomas Boulanger
- Department of Radiology, Oscar Lambret Oncologic Center, Lille, France
| | - Eric Lartigau
- Department of Radiotherapy, Oscar Lambret Oncologic Center, Lille, France
| | - Luc Ceugnart
- Department of Radiology, Oscar Lambret Oncologic Center, Lille, France
| | - Andrew Kramar
- Statistical Unit, Oscar Lambret Oncologic Center, Lille, France
| | - Sophie Taieb
- Department of Radiology, Oscar Lambret Oncologic Center, Lille, France
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El Amrani M, Leteurtre E, Sergent G, Ernst O, Maunoury V, Branche J, Pruvot FR, Truant S. Pancreatic head carcinoma and right hepatic artery: embolization management-A case report. J Gastrointest Oncol 2014; 5:E80-3. [PMID: 25083312 DOI: 10.3978/j.issn.2078-6891.2014.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/10/2014] [Indexed: 12/19/2022] Open
Abstract
A replaced right hepatic artery (RHA) is the most common anatomical variation in pancreatic surgery. The RHA is frequently encountered and can be problematic in pancreatic carcinoma. The preservation of the RHA is necessary to avoid ischemic complications but can impact margins resection in pancreaticoduodenectomy (PD). We report a case of a 53-year-old man with a head pancreatic carcinoma. There was a close contact between the tumor and the RHA arising from superior mesenteric artery (SMA). Preoperative embolization of the RHA was performed prior to PD.
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Affiliation(s)
- Mehdi El Amrani
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - Emmanuelle Leteurtre
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - Géraldine Sergent
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - Olivier Ernst
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - Vincent Maunoury
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - Julien Branche
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - François-René Pruvot
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
| | - Stéphanie Truant
- 1 Department of Gastrointestinal Surgery and Transplantation, Lille University and Hospital, France ; 2 Department of Pathology, 3 Department of Radiology, 4 Gastroenterology Unit, Hôpital Huriez, Lille University and Hospital, France
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Fotsing G, Antoun S, Danel N, Héron C, Ernst O, Seguy D. P144 Évaluation de la sarcopénie par tomodensitométrie chez le transplanté hépatique. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70476-x] [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]
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Borde P, Ernst O, Maunoury V. [New methods for exploration of the small intestine]. Rev Prat 2013; 63:904-906. [PMID: 24167878] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
For ten years, a lot of advances have been achieved for the morphological exploration of the small intestine as well as with CT and MR enterography than with wireless capsule endoscopy. These investigations have renewed the approaches of different diseases that can affect the small intestine: tumors, especially sub-mucosal tumors (CT enterography), iron-deficiency anemia (capsule endoscopy) and follow-up of patients with Crohn's disease of the small intestine (MR enterography). Balloon enteroscopy may then allow therapeutic approach when needed (treatment of bleeding angiodysplasia).
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Affiliation(s)
- Paul Borde
- Service de radiologie géerale et digestive, hôpital Huriez, CHRU de Lille, 59000, Lille, France
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Ernst O. Quantification de la surcharge en fer par IRM. Transfus Clin Biol 2013. [DOI: 10.1016/j.tracli.2013.04.043] [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: 11/16/2022]
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Uyttenhove F, Leroy C, Nzamushe Lepan Mabla J, Ernst O. Torsion of a fatty fringe of the falciform ligament, a rare cause of right hypochondrial pain. Diagn Interv Imaging 2013; 94:637-9. [DOI: 10.1016/j.diii.2013.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pascal L, Beyne-Rauzy O, Brechignac S, Marechaux S, Vassilieff D, Ernst O, Berthon C, Gyan E, Gourin MP, Dreyfus F, Fenaux P, Rose C. Cardiac iron overload assessed by T2* magnetic resonance imaging and cardiac function in regularly transfused myelodysplastic syndrome patients. Br J Haematol 2013; 162:413-5. [DOI: 10.1111/bjh.12368] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Laurent Pascal
- Service d'Hématologie et de cardiologie Hôpital Saint Vincent de Paul; Université Catholique de Lille; Lille; France
| | | | | | - Sylvestre Marechaux
- Service d'Hématologie et de cardiologie Hôpital Saint Vincent de Paul; Université Catholique de Lille; Lille; France
| | | | - Olivier Ernst
- Radiologie; Hôpital Huriez; CHU de Lille; Lille; France
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Boulouis G, Marmin C, Lemaire S, Boury S, Sergent G, Mordon S, Ernst O. CT and MRI imaging at the acute phase of inaugural non-traumatic hepatic haemorrhages. Diagn Interv Imaging 2013; 94:292-9. [PMID: 23375427 DOI: 10.1016/j.diii.2012.09.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Although rare, non-traumatic hepatic haemorrhage is a known complication of liver tumors. In cases where the haemorrhage is the first clinical event, diagnostic work-up is critical. MATERIAL AND METHODS This retrospective study was conducted between July 2001 and March 2011. Acute phase CT-scan and MRI imaging in patients diagnosed with non-traumatic liver hematomas were interpreted with particular attention to the radio-semiotic characteristics of hematomas and liver lesions. Those findings were then confronted to the patients' final diagnoses. RESULTS Twelve patients were included (mean age of 42 years). In seven of them a suspect liver lesion was discovered in the acute CT-Scan or MRI imaging. All lesions were strongly hyper vascular.The haemorrhage revealed hepatocarcinoma in four patients, liver adenoma in two and focal nodular hyperplasia in an other. CONCLUSION It is important in spontaneous liver haemorrhage to consider the high probability of hepatocarcinoma or potentially malignant lesions even when the patient has no known hepatic disorders, and especially in young patients. The results of this study show that imaging is a key issue at the acute phase of inaugural non-traumatic hepatic haemorrhages and requires a simple but complete triphasic injected protocol.
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Affiliation(s)
- G Boulouis
- Service de Radiologie Digestive et Endocrinienne, Hôpital Huriez, Centre Hospitalier Régional Universitaire de Lille, Université Lille Nord-de-France, 1, place de Verdun, 59037 Lille Cedex, France.
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Dubrulle F, Sufana Iancu A, Vincent C, Tourrel G, Ernst O. Cochlear implant with a non-removable magnet: preliminary research at 3-T MRI. Eur Radiol 2013; 23:1510-8. [DOI: 10.1007/s00330-012-2760-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/15/2012] [Accepted: 11/28/2012] [Indexed: 11/29/2022]
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Marmin C, Toledano M, Lemaire S, Boury S, Mordon S, Ernst O. Computed tomography of the parathyroids: the value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma. Diagn Interv Imaging 2012; 93:597-603. [PMID: 22749201 DOI: 10.1016/j.diii.2012.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the densities of parathyroid adenomas, lymph nodes and the thyroid parenchyma during multi-phase cervico-thoracic computed tomography to determine the differentiating threshold values. MATERIALS AND METHODS This study comprises 30 patients operated for a parathyroid adenoma after computed tomography without injection and then 45 and 70 seconds after the injection of an iodine based contrast product (350 mgI/mL, 150 mL, 3 mL/s). The density of the adenomas, lymph nodes and thyroid was measured during the three phases (D0, D45, D70). The relative enhancement (RE) at 45 seconds was calculated: RE=(D45-D0)/D0. RESULTS A significant difference was found in the spontaneous density of the parathyroid adenomas of the thyroid (P<0.01) with a threshold value of 75 HU. A significant difference is found in the enhancement after injection of the adenomas and lymph nodes (P<0.01). The adenomas present an enhancement peak at 45 seconds while the maximum enhancement of the lymph nodes is at 70 seconds. At 45 seconds, a threshold value of 114 HU and an RE 125% allows them to be distinguished (sensitivity and specificity 0.96). CONCLUSION Measurement of the densities can differentiate between the parathyroid adenomas, lymph nodes and thyroid.
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Affiliation(s)
- C Marmin
- Department of radiology, Hôpital Huriez, CHRU de Lille, 1 rue Polonovski, Lille, France
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Hollebecque A, Cattan S, Romano O, Sergent G, Mourad A, Louvet A, Dharancy S, Boleslawski E, Truant S, Pruvot FR, Hebbar M, Ernst O, Mathurin P. Safety and efficacy of sorafenib in hepatocellular carcinoma: the impact of the Child-Pugh score. Aliment Pharmacol Ther 2011; 34:1193-201. [PMID: 21958438 DOI: 10.1111/j.1365-2036.2011.04860.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sorafenib increases median survival and time to radiological progression in patients with advanced hepatocellular carcinoma, but its benefit for Child-Pugh B patients remains uncertain. AIM To evaluate the safety and efficacy of sorafenib in real-life clinical practice conditions and to assess the influence of Child-Pugh class B on safety and efficacy. METHODS All patients treated with sorafenib for advanced hepatocellular carcinoma in our institution were included prospectively. Adverse events, overall survival and time to progression were recorded. A case control study was performed to compare outcome of patients with comparable stages of hepatocellular carcinoma, but a different Child-Pugh class. RESULTS From March 2007 to May 2009, 120 patients were included. Overall survival was 11.1 months, Child-Pugh A patients (n=100) had significantly higher median survival than Child-Pugh B patients (n=20) (13 vs. 4.5 months, P=0.0008). In multivariate analysis, Child-Pugh class B, α-fetoprotein level and total size of lesions were independent predictive factors of death. Patients with radiological progression in the first 3 months had shorter median survival (5.4 vs. 17.4 months). In a case control study, time to symptomatic progression (2.5 vs. 3.6 months), frequency of adverse events and discontinuation of sorafenib were not correlated with Child-Pugh class. CONCLUSIONS Patients with advanced hepatocellular carcinoma treated with sorafenib had a median survival of 11 months. Sorafenib therapy must be considered with caution in Child-Pugh B patients due to their poor survival. Radiological assessment of tumour progression at an early stage may be advantageous when tailoring sorafenib therapy.
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Affiliation(s)
- A Hollebecque
- Service d'Hépato-Gastroentérologie, CHRU Lille, France
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Peigné M, Piessen G, Ernst O, Dewailly D, Leroy M. Spontaneous Hemoperitoneum during Pregnancy: A Diagnosis Pitfall. Am Surg 2011. [DOI: 10.1177/000313481107700405] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Maëliss Peigné
- Department of Endocrine Gynaecology and Reproductive Medicine Lille University Hospital Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery Lille University Hospital Lille, France
| | - Olivier Ernst
- Department of Radiology Lille University Hospital Lille, France
| | - Didier Dewailly
- Department of Endocrine Gynaecology and Reproductive Medicine Lille University Hospital Lille, France
| | - Maryse Leroy
- Department of Endocrine Gynaecology and Reproductive Medicine Lille University Hospital Lille, France
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Peigné M, Piessen G, Ernst O, Dewailly D, Leroy M. Spontaneous hemoperitoneum during pregnancy: a diagnosis pitfall. Am Surg 2011; 77:E69-E71. [PMID: 21679538] [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: 05/30/2023]
Affiliation(s)
- Maëliss Peigné
- Department of Endocrine Gynaecologyand Reproductive Medicine, Lille University Hospital, Lille, France.
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Dubrulle F, Kohler R, Vincent C, Puech P, Ernst O. Differential diagnosis and prognosis of T1-weighted post-gadolinium intralabyrinthine hyperintensities. Eur Radiol 2010; 20:2628-36. [PMID: 20862477 DOI: 10.1007/s00330-010-1835-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 05/03/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
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Van Slycke S, Caiazzo R, Pigny P, Cardot-Bauters C, Arnalsteen L, D'Herbomez M, Leteurtre E, Rouaix-Emery N, Ernst O, Huglo D, Vantyghem MC, Wemeau JL, Carnaille B, Pattou F. Local-regional recurrence of sporadic or syndromic abdominal extra-adrenal paraganglioma: incidence, characteristics, and outcome. Surgery 2009; 146:986-92. [PMID: 19958924 DOI: 10.1016/j.surg.2009.10.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 10/19/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Operative excision of abdominal extra-adrenal paragangliomas (EAPs) does not preclude the late development of local-regional recurrence. We describe the incidence, characteristics, and outcome of this rarely reported feature. METHODS Retrospective analysis of local-regional recurrence that occurred during follow-up of 51 consecutive patients operated for a sporadic (n = 26) or hereditary (n = 25) EAP. RESULTS Seven patients with a sporadic or syndromic EAP (n = 4: von Hippel-Lindau syndrome and SDHB, SDHC, and SDHD gene mutations) underwent reoperation for a local-regional recurrence after a median time of 46 months (interquartile range [IQR], 16-100). The Kaplan-Meier estimated incidence of local-regional recurrence (+/- standard error of the mean) reached 15% +/- 7% at 5 years and 23% +/- 9% after 10 years. Recurrent EAPs were all secreting and 38% provoked clinical symptoms. New lesions were smaller than the primary EAP (P = .01) and more often associated with lymph node metastases (43% vs 4%, P = .01). Operative excision seemed complete in 5 patients. Clinical remission was maintained in 4 patients after a median follow-up of 57 months (IQR, 22-102). CONCLUSION Local-regional recurrence of sporadic and syndromic EAPs is frequent and may be delayed beyond 10 years, requiring lifelong follow-up after the initial operation. When technically feasible, operative excision can lead to prolonged remission.
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Parmentier-Decrucq E, Duhamel A, Ernst O, Fermont C, Louvet A, Vernier-Massouille G, Cortot A, Colombel JF, Desreumaux P, Peyrin-Biroulet L. Effects of infliximab therapy on abdominal fat and metabolic profile in patients with Crohn's disease. Inflamm Bowel Dis 2009; 15:1476-84. [PMID: 19291781 DOI: 10.1002/ibd.20931] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tumor necrosis factor is an adipocytokine possessing a well-established lipolytic effect. In Crohn's disease (CD) patients, infliximab therapy may thus result in visceral fat accumulation, which is associated with an increased risk of metabolic syndrome. METHODS A total of 132 CD patients were investigated. In a first prospective study, magnetic resonance imaging (MRI) quantification of subcutaneous and visceral abdominal fat was performed before and 8 weeks after initiation of infliximab induction therapy (5 mg/kg at weeks 0, 2, and 6) in 21 responding patients treated for perianal disease. In a second prospective study, fasting glycemia, glycated hemoglobin (HbA1c), HDL, LDL, and total cholesterol and triglyceride levels were assessed in 111 responding patients receiving infliximab infusions every 8 weeks, with a mean follow-up of 41 weeks. RESULTS A significant homogeneous 18% increase in total abdominal fat was observed in the 21 CD patients after infliximab induction therapy (P = 0.027), independently of body mass index evolution. Infliximab maintenance therapy was associated with a decrease in glycemia (P < 0.0001) and HbA1c (P = 0.0005) concentrations, together with an increase in both total cholesterol (P = 0.02) and HDL cholesterol (P = 0.008) concentrations. All glycemic and lipid parameters remained within the normal range throughout the study. CONCLUSIONS Infliximab induction therapy is associated with a significant increase in abdominal fat tissue in CD patients. Infliximab maintenance therapy has no deleterious effects on lipid profile and is accompanied by a decrease in glycemia and HbA1c concentrations, probably by reversing the impairment of tumor necrosis factor-induced insulin-mediated glucose uptake.
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Affiliation(s)
- Erika Parmentier-Decrucq
- Inserm, Université Lille, CHRU Lille, Hôpital Huriez, Service des Maladies de l'Appareil Digestif et de la Nutrition, Lille, France
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Truant S, Maunoury V, Dubucquoi S, Klein O, Saudemont A, Ernst O, Gambiez L, Pruvot FR. [Validity of the intracystic tumoral markers for the diagnosis of the cystic tumors of the pancreas]. Gastroenterol Clin Biol 2009; 33:502-503. [PMID: 19477612 DOI: 10.1016/j.gcb.2009.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 01/16/2009] [Indexed: 05/27/2023]
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Pascal L, Rose C, Fenaux P, Ernst O, Chiavassa H, Beyne-Rauzy O, Brechignac S, Balkaran S, Senechal Q. P088 Evaluation of cardiac iron overload by cardiac MRI T2 in regularly transfused MDS. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70168-7] [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: 11/16/2022]
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Toledano M, Boury S, Leroy C, Sergent-Baudson G, Ernst O. [Oesophagal leiomyomatosis]. Rev Prat 2009; 59:479. [PMID: 19462865] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Manuel Toledano
- Service d'imagerie digestive et endocrinienne, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille Cedex.
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Mirault T, Lucidarme D, Turlin B, Vandevenne P, Gosset P, Ernst O, Rose C. Non-invasive assessment of liver fibrosis by transient elastography in post transfusional iron overload. Eur J Haematol 2008; 80:337-40. [DOI: 10.1111/j.1600-0609.2007.01011.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Rose C, Ernst O, Hecquet B, Maboudou P, Renom P, Noel MP, Yakoub-Agha I, Bauters F, Jouet JP. Quantification by magnetic resonance imaging and liver consequences of post-transfusional iron overload alone in long term survivors after allogeneic hematopoietic stem cell transplantation (HSCT). Haematologica 2007; 92:850-3. [PMID: 17550861 DOI: 10.3324/haematol.11063] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We quantified and studied the impact of post transfusional iron overload alone in post allogeneic HSCT. Median number of RBCs was 18. Ferritin was 532 mg/L. Liver iron content (LIC) was 117 mmoles/gdw. Correlation RBCs and ferritin was (r=0.81); RBCs and LIC was (r=0.84). The high ferritin group differed from normal ferritin group in terms of RBCs transfused (p<10(-3)), ALT (p<0.009). But occurrence of liver dysfunction was not significant. Magnitude of iron overload correlates closely to the number of RBCs and is quantified by MRI. Impact on liver dysfunction is moderate in absence of co-morbidity.
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Affiliation(s)
- Christian Rose
- Service d'Hématologie, Groupe Hospitalier de l'Institut CatholiqueService of Hemotherapy and Hemostasis, Hospital Clínic, Barcelona, Spain.
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Dharancy S, Boitard J, Decaens T, Sergent G, Boleslawski E, Duvoux C, Vanlemmens C, Meyer C, Gugenheim J, Durand F, Boillot O, Declerck N, Louvet A, Canva V, Romano O, Ernst O, Mathurin P, Pruvot FR. Comparison of two techniques of transarterial chemoembolization before liver transplantation for hepatocellular carcinoma: a case-control study. Liver Transpl 2007; 13:665-71. [PMID: 17427172 DOI: 10.1002/lt.21109] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supraselective transarterial chemoembolization (STACE) more efficiently targets chemotherapy delivered via the feeding arterial branches of the tumor than does conventional transarterial chemoembolization (TACE). However, the hypothesis of its greater efficacy compared with the latter is subject to controversy. The aim of the present study was to compare STACE to conventional TACE in a controlled study of candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC). Patients were matched for factors associated with HCC recurrence and survival. Sixty patients were included: 30 who were treated with STACE and 30 treated with conventional TACE. The 2 groups were similar in terms of matched criteria. In the overall population (uni- and multinodular HCC), there was no marked difference between the 2 groups in 5-year disease-free survival: 76.8% vs. 74.8%. In sensitivity analysis of patients considered to be the best candidates for TACE (uninodular HCC < or =5 cm), there was a trend toward significance between STACE and TACE in 5-year disease-free survival: 87% vs. 64% (P = 0.09). The only factor associated with complete tumor necrosis was STACE in the overall population (30.8% vs. 6.9%, P = 0.02), with a similar trend in the subgroup of patients with a single nodule (33.3% vs. 6.7%, P = 0.06), whereas the mean number of procedures was similar in the 2 groups (mean, 1.3 procedures; range 1-5 procedures; P = NS). STACE is more efficient at inducing complete tumor necrosis in the liver. This study observed trends toward improvement in the disease-free survival of patients with uninodular HCC < or =5 cm. Future studies focusing on such patients are warranted.
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Affiliation(s)
- Sébastien Dharancy
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHU Lille, France.
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Viard R, Betrouni N, Rousseau J, Mordon S, Ernst O, Maouche S. Needle positioning in interventional MRI procedure: real time optical localisation and accordance with the roadmap. Annu Int Conf IEEE Eng Med Biol Soc 2007; 2007:2748-2751. [PMID: 18002563 DOI: 10.1109/iembs.2007.4352897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study presents a system designed to assist the surgeon during interventional procedures performed by Magnetic Resonance Imaging (MRI). In order to reach the target during guidance in a double obliquity trajectory, this system provides accurate information about both the entry point and the orientation of the needle.
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Mirault T, Lucidarme D, Turlin B, Deugnier Y, Brissot P, Demory JL, Gosset P, Kanaan K, Vandevenne MD, Charpentier MD, Ernst O, Rose C. Évaluation non invasive de la fibrose hépatique par mesure de l'élastométrie du foie chez 15 patients avec surcharge en fer post-transfusionnelle. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.235] [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]
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Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L, Ernst O, Pruvot FR. Remnant liver volume to body weight ratio > or =0.5%: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 2006; 204:22-33. [PMID: 17189109 DOI: 10.1016/j.jamcollsurg.2006.09.007] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 09/07/2006] [Accepted: 09/12/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Before extended hepatectomy of five or more segments, the remnant liver volume (RLV) is usually calculated as a ratio of RLV to total liver volume (RLV-TLV) and must be >20% to 25%. This method can lead to compare parts of normal liver parenchyma to others compromised by biliary or vascular obstruction or by portal vein embolization. Extrapolating from living-donor liver transplantation, we hypothesized that RLV to body weight ratio (RLV-BWR) could accurately assess the functional limit of hepatectomy. STUDY DESIGN From September 2000 to December 2004, volumetric measurements of RLV using computed tomography were obtained before right-extended hepatectomy in 31 patients. RLV-BWR of 0.5% as a critical point for patient course was compared with stratification by RLV-TLV (< or =25% or >25% and < or =20% or >20%). RESULTS Three-month morbidity and mortality were not significantly different between groups RLV-TLV < or = and >25% and between groups RLV-TLV < or = and >20%, but increased significantly in group RLV-BWR < or = 0.5% compared with group RLV-BWR > 0.5% (p = 0.038 and p = 0.019, respectively) with an non-significant increase in death from liver failure (p = 0.077). CONCLUSIONS RLV-BWR was more specific than RLV-TLV in predicting postoperative course after extended hepatectomy. Patients with an anticipated RLV < or = 0.5% of body weight are at considerable risk for hepatic dysfunction and postoperative mortality.
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Affiliation(s)
- Stéphanie Truant
- Department of Digestive and Transplantation Surgery, University Hospital, Hospital Huriez, Lille, France
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Rose C, Vandevenne P, Bourgeois E, Cambier N, Ernst O. Liver iron content assessment by routine and simple magnetic resonance imaging procedure in highly transfused patients. Eur J Haematol 2006; 77:145-9. [PMID: 16608501 DOI: 10.1111/j.0902-4441.2006.t01-1-ejh2571.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Liver iron content (LIC) assessment by magnetic resonance imaging (MRI) is validated but not standardized. In a single center, we tried to assess the accuracy of a specific, simple MRI procedure adapted to high LIC from a well-established simple and routine procedure known to quantify LIC. METHODS In 27 cases of monthly transfused patients, we compared biochemical values of LIC assessed on liver biopsy specimens and results obtained by two signal intensity ratio of gradient echo imaging (R2*) MRI protocols. The first was Gandon's routine procedure previously validated in liver disease and the second, our own method, was an addition of a gradient echo sequence specifically adapted to high LIC encountered in hematology practice. RESULTS Twenty-seven liver biopsies were performed in 18 adult patients (myelodysplastic syndrome = 5, beta-thalassemia = 13). LIC by biopsy ranged from 1.4 to 54 mg/g liver dry weight (mg/g dw) (median 9.4 mg/g dw). Correlation between LIC by biopsy and by MRI with Gandon's procedure was good (R = 0.80) in patients with LIC falling within the range reported by Gandon. By contrast, a weak correlation was demonstrated (R = 0.52) in patients with high LIC (above 11.2 mg/g dw). With our sequences, the correlation was good both in the entire group of patients (R = 0.83) and in patients with LIC above 11.2 mg/g dw (R = 0.85). CONCLUSION Our results suggest that the addition of a specific shorter-gradient echo sequence to a very simple, fast technique produces an accurate estimation of LIC in post-transfusional iron overload.
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Affiliation(s)
- Christian Rose
- Service d'Hématologie, Groupe Hospitalier de l'Institut Catholique Lillois, GHICL, Hôpital Saint Vincent, Université Catholique de Lille, Lille, France
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Hebbar M, Ernst O, Cattan S, Dominguez S, Oprea C, Mathurin P, Triboulet JP, Paris JC, Pruvot FR. Phase II Trial of Docetaxel Therapy in Patients with Advanced Hepatocellular Carcinoma. Oncology 2006; 70:154-8. [PMID: 16645329 DOI: 10.1159/000093007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 02/25/2006] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We assessed the safety and efficacy of docetaxel, a microtubule inhibitor, in patients with advanced hepatocellular carcinoma (HCC). METHODS HCC patients that were not suitable for local therapy, but who possessed measurable disease, good performance status and adequate organ function were eligible. Docetaxel was administered every 3 weeks at a dose of 100 mg/m(2) (or 75 mg/m(2) if transaminase levels were between 1.5 and 3.5 times the upper normal limit). Efficacy was assessed radiologically every three cycles of chemotherapy. RESULTS Fifteen patients were enrolled: 11 males and 4 females; their median age was 64 years (range, 42-72 years). Nine patients had underlying cirrhosis. Four patients had been surgically treated before relapse (liver resection in 3 cases and transplantation in 1), 3 had been treated with arterial chemoembolization and 1 with arterial chemotherapy (doxorubicin). A total of 57 cycles of docetaxel were delivered (median 3, range 1-6). Significant toxicity was observed: mostly grade 3-4 neutropenia and fatigue (6 and 4 patients, respectively). Treatment had to be stopped because of toxicity in 6 patients, all having underlying cirrhosis. An important partial response was obtained in 1 patient, a result that enabled liver transplantation; this patient is still alive after 34 months. Five patients had transient stable disease. CONCLUSION When used in this schedule, docetaxel does not appear to be safe and effective enough in patients with advanced HCC and cirrhosis.
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Affiliation(s)
- Mohamed Hebbar
- Unité d'Oncologie Médicale, Centre Hospitalo-Universitaire, Lille, France.
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