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Diesler R, Legendre M, Si-Mohamed S, Brillet PY, Wemeau L, Manali ED, Gagnadoux F, Hirschi S, Lorillon G, Reynaud-Gaubert M, Bironneau V, Blanchard E, Bourdin A, Dominique S, Justet A, Macey J, Marchand-Adam S, Morisse-Pradier H, Nunes H, Papiris SA, Traclet J, Traore I, Crestani B, Amselem S, Nathan N, Borie R, Cottin V. Similarities and differences of interstitial lung disease associated with pathogenic variants in SFTPC and ABCA3 in adults. Respirology 2024; 29:312-323. [PMID: 38345107 DOI: 10.1111/resp.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 01/21/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Variants in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults, with few studies in adults. METHODS We conducted a multicentre retrospective study of all consecutive adult patients diagnosed with ILD associated with variants in SFTPC or ABCA3 in the French rare pulmonary diseases network, OrphaLung. Variants and chest computed tomography (CT) features were centrally reviewed. RESULTS We included 36 patients (median age: 34 years, 20 males), 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between groups. Baseline median FVC was 59% ([52-72]) and DLco was 44% ([35-50]). An unclassifiable pattern of fibrosing ILD was the most frequent on chest CT, found in 85% of patients, however with a distinct phenotype with ground-glass opacities and/or cysts. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Annually, FVC and DLCO declined by 1.87% and 2.43% in the SFTPC group, respectively, and by 0.72% and 0.95% in the ABCA3 group, respectively (FVC, p = 0.014 and DLCO , p = 0.004 for comparison between groups). Median time to death or lung transplantation was 10 years in the SFTPC group and was not reached at the end of follow-up in the ABCA3 group. CONCLUSION SFTPC and ABCA3-associated ILD present with a distinct phenotype and prognosis. A radiologic pattern of fibrosing ILD with ground-glass opacities and/or cysts is frequently found in these rare conditions.
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Affiliation(s)
- Rémi Diesler
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Hospices civils de Lyon, Université Lyon 1, UMR754, INRAE, ERN-LUNG, Lyon, France
| | - Marie Legendre
- U.F. de Génétique moléculaire, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
- Childhood Genetic Diseases, UMR_S933, Inserm, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
| | - Salim Si-Mohamed
- Department of Thoracic Imaging, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, INSA-Lyon, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, Lyon, France
| | - Pierre-Yves Brillet
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Lidwine Wemeau
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Hôpital Calmette, Lille, France
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Frédéric Gagnadoux
- Service de Pneumologie et Allergologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sandrine Hirschi
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Gwenaël Lorillon
- National Reference Centre for Histiocytoses, Pulmonary Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie, Équipe de Transplantation Pulmonaire, Centre de Compétence des Maladies Pulmonaires Rares, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, CHU Nord, Marseille, France
| | - Vanessa Bironneau
- Service de Pneumologie CHU de Poitiers, INSERM CIC 1402, IS-ALIVE Research Group, Université de Poitiers, UFR Médecine et Pharmacie, Poitiers, France
| | - Elodie Blanchard
- Service de Pneumologie, Hôpital Haut Lévêque, CHU de Bordeaux, Bordeaux, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases and PhyMedExp, Centre National de la Recherche Scientifique, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | | | - Aurélien Justet
- Service de Pneumologie, CHU de Caen, Centre de compétence des maladies pulmonaires rares, ISTCT, UMR6030-CNRS-CEA-Université de Caen, Caen, France
| | - Julie Macey
- Respiratory Medicine and Cystic Fibrosis Center, University Hospital Center of Bordeaux, Bordeaux, France
| | - Sylvain Marchand-Adam
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHU Tours, Université François Rabelais, Tours, France
| | | | - Hilario Nunes
- Service de Pneumologie et Oncologie Thoracique, Centre Constitutif Maladies Pulmonaires Rares de l'Adulte, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Paris, France
| | - Spyros A Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Julie Traclet
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Hospices civils de Lyon, Université Lyon 1, Lyon, France
| | - Ibrahim Traore
- Service de Pneumologie, CHU Jean Minjoz, Besançon, France
| | - Bruno Crestani
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Serge Amselem
- U.F. de Génétique moléculaire, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
- Childhood Genetic Diseases, UMR_S933, Inserm, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
| | - Nadia Nathan
- Childhood Genetic Diseases, UMR_S933, Inserm, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Armand Trousseau, Paris, France
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases and Laboratory of Childhood Genetic Diseases Inserm UMR_S933, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Armand Trousseau Hospital, Paris, France
| | - Raphaël Borie
- Université Paris Cité, INSERM U1152, Laboratoire D'Excellence Inflamex, Assistance Publique-Hôpitaux de Paris, Service de Pneumologie A, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Fédération Hospitalo-Universitaire Apollo, Hôpital Bichat, Paris, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Hospices civils de Lyon, Université Lyon 1, UMR754, INRAE, ERN-LUNG, Lyon, France
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Nunes H, Brillet PY, Bernaudin JF, Gille T, Valeyre D, Jeny F. Fibrotic Pulmonary Sarcoidosis. Clin Chest Med 2024; 45:199-212. [PMID: 38245367 DOI: 10.1016/j.ccm.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Fibrotic pulmonary sarcoidosis (fPS) affects about 20% of patients. fPS carries a significant morbidity and mortality. However, its prognosis is highly variable, depending mainly on fibrosis extent, functional impairment severity, and the development of pulmonary hypertension. Moreover, fPS outcomes are also influenced by several other complications, including acute exacerbations, and infections. fPS natural history is unknown, in particular regarding the risk of progressive self-sustaining fibrosis. The management of fPS is challenging, including anti-inflammatory treatment if granulomatous activity persists, rehabilitation, and in highly selected patients antifibrotic treatment and lung transplantation.
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Affiliation(s)
- Hilario Nunes
- AP-HP, Pulmonology Department, Avicenne Hospital, Bobigny, 93009, France; INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France.
| | - Pierre-Yves Brillet
- INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France; AP-HP, Radiology Department, Avicenne Hospital, Bobigny, 93009, France
| | | | - Thomas Gille
- INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France; AP-HP, Physiology Department, Avicenne Hospital, Bobigny, 93009, France
| | - Dominique Valeyre
- INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France; Groupe Hospitalier Paris Saint-Joseph, Pulmonology Department, Paris, 75014 France
| | - Florence Jeny
- AP-HP, Pulmonology Department, Avicenne Hospital, Bobigny, 93009, France; INSERM UMR 1272, Sorbonne Paris-Nord University, Bobigny, 93009, France
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3
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Djahnine A, Lazarus C, Lederlin M, Mulé S, Wiemker R, Si-Mohamed S, Jupin-Delevaux E, Nempont O, Skandarani Y, De Craene M, Goubalan S, Raynaud C, Belkouchi Y, Afia AB, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Talbot H, Luciani A, Lassau N, Boussel L. Detection and severity quantification of pulmonary embolism with 3D CT data using an automated deep learning-based artificial solution. Diagn Interv Imaging 2024; 105:97-103. [PMID: 38261553 DOI: 10.1016/j.diii.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this study was to propose a deep learning-based approach to detect pulmonary embolism and quantify its severity using the Qanadli score and the right-to-left ventricle diameter (RV/LV) ratio on three-dimensional (3D) computed tomography pulmonary angiography (CTPA) examinations with limited annotations. MATERIALS AND METHODS Using a database of 3D CTPA examinations of 1268 patients with image-level annotations, and two other public datasets of CTPA examinations from 91 (CAD-PE) and 35 (FUME-PE) patients with pixel-level annotations, a pipeline consisting of: (i), detecting blood clots; (ii), performing PE-positive versus negative classification; (iii), estimating the Qanadli score; and (iv), predicting RV/LV diameter ratio was followed. The method was evaluated on a test set including 378 patients. The performance of PE classification and severity quantification was quantitatively assessed using an area under the curve (AUC) analysis for PE classification and a coefficient of determination (R²) for the Qanadli score and the RV/LV diameter ratio. RESULTS Quantitative evaluation led to an overall AUC of 0.870 (95% confidence interval [CI]: 0.850-0.900) for PE classification task on the training set and an AUC of 0.852 (95% CI: 0.810-0.890) on the test set. Regression analysis yielded R² value of 0.717 (95% CI: 0.668-0.760) and of 0.723 (95% CI: 0.668-0.766) for the Qanadli score and the RV/LV diameter ratio estimation, respectively on the test set. CONCLUSION This study shows the feasibility of utilizing AI-based assistance tools in detecting blood clots and estimating PE severity scores with 3D CTPA examinations. This is achieved by leveraging blood clots and cardiac segmentations. Further studies are needed to assess the effectiveness of these tools in clinical practice.
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Affiliation(s)
- Aissam Djahnine
- Philips Research France, 92150 Suresnes, France; CREATIS, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France.
| | | | | | - Sébastien Mulé
- Medical Imaging Department, Henri Mondor University Hospital, AP-HP, Créteil, France, Inserm, U955, Team 18, 94000 Créteil, France
| | | | - Salim Si-Mohamed
- Department of Radiology, Hospices Civils de Lyon, 69500 Lyon, France
| | | | | | | | | | | | | | - Younes Belkouchi
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Université Paris Cité, 75006 Paris, France, Department of Radiology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Hôpital Ambroise Paré Hospital, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, Hôpital La Pitié-Salpêtrière, APHP, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay. 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France
| | - Hugues Talbot
- OPIS - Optimisation Imagerie et Santé, Université Paris-Saclay, Inria, CentraleSupélec, CVN - Centre de vision numérique, 91190 Gif-Sur-Yvette, France
| | - Alain Luciani
- Medical Imaging Department, Henri Mondor University Hospital, AP-HP, Créteil, France, Inserm, U955, Team 18, 94000 Créteil, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, Université Paris-Saclay. 94800 Villejuif, France
| | - Loic Boussel
- CREATIS, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1294, Lyon, France; Department of Radiology, Hospices Civils de Lyon, 69500 Lyon, France
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4
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Soliman S, Soliman H, Crézé M, Brillet PY, Montani D, Savale L, Jais X, Bulifon S, Jutant EM, Rius E, Devilder M, Beurnier A, Colle R, Gasnier M, Pham T, Morin L, Noel N, Lecoq AL, Becquemont L, Figueiredo S, Harrois A, Bellin MF, Monnet X, Meyrignac O. Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort. Eur Radiol 2024; 34:1037-1052. [PMID: 37572192 DOI: 10.1007/s00330-023-10044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. MATERIALS AND METHODS We conducted a prospective single-center study among patients hospitalized for COVID-19 between March and May 2020. Patients with residual symptoms or admitted into intensive care units were investigated 4 months after discharge by a chest CT (CCT) and pulmonary function tests (PFTs). The primary endpoint was the rate of persistent radiological fibrotic lesions after 4 months. Secondary endpoints included further CCT evaluation at 9 and 16 months, correlation of fibrotic lesions with clinical and PFT evaluation, and assessment of predictive factors. RESULTS Among the 1151 patients hospitalized for COVID-19, 169 patients performed a CCT at 4 months. CCTs showed pulmonary fibrotic lesions in 19% of the patients (32/169). These lesions were persistent at 9 months and 16 months in 97% (29/30) and 95% of patients (18/19) respectively. There was no significant clinical difference based on dyspnea scale in patients with pulmonary fibrosis. However, PFT evaluation showed significantly decreased diffusing lung capacity for carbon monoxide (p < 0.001) and total lung capacity (p < 0.001) in patients with radiological lesions. In multivariate analysis, the predictive factors of radiological pulmonary fibrotic lesions were pulmonary embolism (OR = 9.0), high-flow oxygen (OR = 6.37), and mechanical ventilation (OR = 3.49). CONCLUSION At 4 months, 19% of patients investigated after hospitalization for COVID-19 had radiological pulmonary fibrotic lesions; they persisted up to 16 months. CLINICAL RELEVANCE STATEMENT Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. The prevalence of persisting lesions after COVID-19 remains unclear. We assessed this prevalence and predictive factors leading to fibrotic lesions in a large cohort. The respiratory clinical impact of these lesions was also assessed. KEY POINTS • Nineteen percent of patients hospitalized for COVID-19 had radiological fibrotic lesions at 4 months, remaining stable at 16 months. • COVID-19 fibrotic lesions did not match any infiltrative lung disease pattern. • COVID-19 fibrotic lesions were associated with pulmonary function test abnormalities but did not lead to clinical respiratory manifestation.
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Affiliation(s)
- Samer Soliman
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
| | - Heithem Soliman
- Service de Gastro-Entérologie, Université Paris-Cité, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
| | - Maud Crézé
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Pierre-Yves Brillet
- Service de Radiologie Diagnostique, Université Sorbonne Paris-Nord, AP-HP, Hôpital Avicenne, Bobigny, France
| | - David Montani
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Sophie Bulifon
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Etienne-Marie Jutant
- DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Emily Rius
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Matthieu Devilder
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Antoine Beurnier
- DMU 5 Thorinno, Service de Physiologie Et d'Explorations Fonctionnelles Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Romain Colle
- DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France
| | - Matthieu Gasnier
- DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France
| | - Tài Pham
- DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Luc Morin
- Service de Réanimation Pédiatrique Et Médecine Néonatale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Santé de L'Enfant Et de L'Adolescent, Le Kremlin-Bicêtre, France
| | - Nicolas Noel
- DMU 7 Endocrinologie-Immunités-Inflammations Cancer-Urgences, Service de Médecine Interne Et Immunologie Clinique, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anne-Lise Lecoq
- DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - Laurent Becquemont
- DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France
| | - Samy Figueiredo
- DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Marie-France Bellin
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France
| | - Olivier Meyrignac
- Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
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5
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Guerra X, Rennotte S, Fetita C, Boubaya M, Debray MP, Israël-Biet D, Bernaudin JF, Valeyre D, Cadranel J, Naccache JM, Nunes H, Brillet PY. U-net convolutional neural network applied to progressive fibrotic interstitial lung disease: Is progression at CT scan associated with a clinical outcome? Respir Med Res 2023; 85:101058. [PMID: 38141579 DOI: 10.1016/j.resmer.2023.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Computational advances in artificial intelligence have led to the recent emergence of U-Net convolutional neural networks (CNNs) applied to medical imaging. Our objectives were to assess the progression of fibrotic interstitial lung disease (ILD) using routine CT scans processed by a U-Net CNN developed by our research team, and to identify a progression threshold indicative of poor prognosis. METHODS CT scans and clinical history of 32 patients with idiopathic fibrotic ILDs were retrospectively reviewed. Successive CT scans were processed by the U-Net CNN and ILD quantification was obtained. Correlation between ILD and FVC changes was assessed. ROC curve was used to define a threshold of ILD progression rate (PR) to predict poor prognostic (mortality or lung transplantation). The PR threshold was used to compare the cohort survival with Kaplan Mayer curves and log-rank test. RESULTS The follow-up was 3.8 ± 1.5 years encompassing 105 CT scans, with 3.3 ± 1.1 CT scans per patient. A significant correlation between ILD and FVC changes was obtained (p = 0.004, ρ = -0.30 [95% CI: -0.16 to -0.45]). Sixteen patients (50%) experienced unfavorable outcome including 13 deaths and 3 lung transplantations. ROC curve analysis showed an aera under curve of 0.83 (p < 0.001), with an optimal cut-off PR value of 4%/year. Patients exhibiting a PR ≥ 4%/year during the first two years had a poorer prognosis (p = 0.001). CONCLUSIONS Applying a U-Net CNN to routine CT scan allowed identifying patients with a rapid progression and unfavorable outcome.
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Affiliation(s)
- Xavier Guerra
- Department of Radiology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
| | - Simon Rennotte
- Samovar Laboratory, Télécom SudParis, Institut Polytechnique de Paris, Evry, France
| | - Catalin Fetita
- Samovar Laboratory, Télécom SudParis, Institut Polytechnique de Paris, Evry, France
| | - Marouane Boubaya
- Clinical Research Unit, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Sorbonne Paris-Nord, Bobigny, France
| | - Marie-Pierre Debray
- Department of Radiology, Bichat-Claude Bernard Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Israël-Biet
- Department of Pulmonology, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris - Cité, Paris, France
| | - Jean-François Bernaudin
- INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France; Medicine Sorbonne Université, Paris, France
| | - Dominique Valeyre
- INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France; Department of Pulmonology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Jacques Cadranel
- Medicine Sorbonne Université, Paris, France; Department of Pulmonology, Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jean-Marc Naccache
- Department of Pulmonology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Hilario Nunes
- INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France; Department of Pulmonology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Pierre-Yves Brillet
- Department of Radiology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France; INSERM UMR 1272 Hypoxie & Poumon SMBH, Université Sorbonne Paris - Nord, Bobigny, France
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6
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Laville C, Fetita C, Gille T, Brillet PY, Nunes H, Bernaudin JF, Genet M. Comparison of optimization parametrizations for regional lung compliance estimation using personalized pulmonary poromechanical modeling. Biomech Model Mechanobiol 2023; 22:1541-1554. [PMID: 36913005 PMCID: PMC10009868 DOI: 10.1007/s10237-023-01691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/09/2023] [Indexed: 03/14/2023]
Abstract
Interstitial lung diseases, such as idiopathic pulmonary fibrosis (IPF) or post-COVID-19 pulmonary fibrosis, are progressive and severe diseases characterized by an irreversible scarring of interstitial tissues that affects lung function. Despite many efforts, these diseases remain poorly understood and poorly treated. In this paper, we propose an automated method for the estimation of personalized regional lung compliances based on a poromechanical model of the lung. The model is personalized by integrating routine clinical imaging data - namely computed tomography images taken at two breathing levels in order to reproduce the breathing kinematic-notably through an inverse problem with fully personalized boundary conditions that is solved to estimate patient-specific regional lung compliances. A new parametrization of the inverse problem is introduced in this paper, based on the combined estimation of a personalized breathing pressure in addition to material parameters, improving the robustness and consistency of estimation results. The method is applied to three IPF patients and one post-COVID-19 patient. This personalized model could help better understand the role of mechanics in pulmonary remodeling due to fibrosis; moreover, patient-specific regional lung compliances could be used as an objective and quantitative biomarker for improved diagnosis and treatment follow up for various interstitial lung diseases.
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Affiliation(s)
- Colin Laville
- Laboratoire de Mécanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France
- Inria, Palaiseau, France
| | | | - Thomas Gille
- Hypoxie et Poumon, Université Sorbonne Paris Nord/INSERM, Bobigny, France
- Hôpital Avicenne, APHP, Bobigny, France
| | - Pierre-Yves Brillet
- Hypoxie et Poumon, Université Sorbonne Paris Nord/INSERM, Bobigny, France
- Hôpital Avicenne, APHP, Bobigny, France
| | - Hilario Nunes
- Hypoxie et Poumon, Université Sorbonne Paris Nord/INSERM, Bobigny, France
- Hôpital Avicenne, APHP, Bobigny, France
| | | | - Martin Genet
- Laboratoire de Mécanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France
- Inria, Palaiseau, France
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7
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Belkouchi Y, Lederlin M, Ben Afia A, Fabre C, Ferretti G, De Margerie C, Berge P, Liberge R, Elbaz N, Blain M, Brillet PY, Chassagnon G, Cadour F, Caramella C, Hajjam ME, Boussouar S, Hadchiti J, Fablet X, Khalil A, Luciani A, Cotten A, Meder JF, Talbot H, Lassau N. Detection and quantification of pulmonary embolism with artificial intelligence: The SFR 2022 artificial intelligence data challenge. Diagn Interv Imaging 2023; 104:485-489. [PMID: 37321875 DOI: 10.1016/j.diii.2023.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE In 2022, the French Society of Radiology together with the French Society of Thoracic Imaging and CentraleSupelec organized their 13th data challenge. The aim was to aid in the diagnosis of pulmonary embolism, by identifying the presence of pulmonary embolism and by estimating the ratio between right and left ventricular (RV/LV) diameters, and an arterial obstruction index (Qanadli's score) using artificial intelligence. MATERIALS AND METHODS The data challenge was composed of three tasks: the detection of pulmonary embolism, the RV/LV diameter ratio, and Qanadli's score. Sixteen centers all over France participated in the inclusion of the cases. A health data hosting certified web platform was established to facilitate the inclusion process of the anonymized CT examinations in compliance with general data protection regulation. CT pulmonary angiography images were collected. Each center provided the CT examinations with their annotations. A randomization process was established to pool the scans from different centers. Each team was required to have at least a radiologist, a data scientist, and an engineer. Data were provided in three batches to the teams, two for training and one for evaluation. The evaluation of the results was determined to rank the participants on the three tasks. RESULTS A total of 1268 CT examinations were collected from the 16 centers following the inclusion criteria. The dataset was split into three batches of 310, 580 and 378 C T examinations provided to the participants respectively on September 5, 2022, October 7, 2022 and October 9, 2022. Seventy percent of the data from each center were used for training, and 30% for the evaluation. Seven teams with a total of 48 participants including data scientists, researchers, radiologists and engineering students were registered for participation. The metrics chosen for evaluation included areas under receiver operating characteristic curves, specificity and sensitivity for the classification task, and the coefficient of determination r2 for the regression tasks. The winning team achieved an overall score of 0.784. CONCLUSION This multicenter study suggests that the use of artificial intelligence for the diagnosis of pulmonary embolism is possible on real data. Moreover, providing quantitative measures is mandatory for the interpretability of the results, and is of great aid to the radiologists especially in emergency settings.
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Affiliation(s)
- Younes Belkouchi
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France; Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France.
| | | | - Amira Ben Afia
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Clement Fabre
- Department of Radiology, Centre Hospitalier de Laval, 53000 Laval, France
| | - Gilbert Ferretti
- Universite Grenobles Alpes, Service de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, 38000 Grenoble, France
| | - Constance De Margerie
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, 75010 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Pierre Berge
- Department of Radiology, CHU Angers, 49000 Angers, France
| | - Renan Liberge
- Department of Radiology, CHU Nantes, 44000 Nantes, France
| | - Nicolas Elbaz
- Department of Radiology, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Maxime Blain
- Department of Radiology, Hopital Henri Mondor, AP-HP, 94000 Créteil, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, 93000 Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology, Hopital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Farah Cadour
- APHM, Hôpital Universitaire Timone, CEMEREM, 13005 Marseille, France
| | - Caroline Caramella
- Department of Radiology, Groupe hospitalier Paris Saint-Joseph, Île-de-France, 75015 Paris, France
| | - Mostafa El Hajjam
- Department of Radiology, Ambroise Paré Hospital GH AP-HP Paris Saclay, UMR 1179 INSERM/UVSQ, Team 3, 92100 Boulogne-Billancourt, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Unité d'Imagerie Cardiovasculaire et Thoracique (ICT), 75013 Paris, France
| | - Joya Hadchiti
- Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Xavier Fablet
- Department of Radiology, CHU Rennes, 35000 Rennes, France
| | - Antoine Khalil
- Department of Radiology, APHP Nord, Hôpital Bichat, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alain Luciani
- Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 94000 Créteil, France; INSERM, U955, Team 18, 94000 Créteil, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Univ. Lille, CHU Lille, MABlab ULR 4490, 59000 Lille, France
| | - Jean-Francois Meder
- Department of Neuroimaging, Sainte-Anne Hospital, 75013 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Hugues Talbot
- OPIS, CentraleSupelec, Inria, Université Paris-Saclay, 91190 Gif-Sur-Yvette, France
| | - Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay, BIOMAPS, UMR 1281, Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
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Fetita C, Richeux J, Didier A, Maury M, Flint J, Brillet PY, Bergot E, Bernaudin JF, Justet A. Comparison between computerised lung SPECT-CT and noncontrast thoracic HRCT for quantitative analysis of post-acute COVID-19 pulmonary vascular pruning. ERJ Open Res 2023; 9:00076-2023. [PMID: 37868150 PMCID: PMC10588800 DOI: 10.1183/23120541.00076-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/09/2023] [Indexed: 10/24/2023] Open
Abstract
Computerised processing of images from routine noncontrast HRCT could be an efficient, costless and safe tool to investigate the vascular remodelling that occurs in the months after COVID-19 in a large number of patients https://bit.ly/3qAQZDW.
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Affiliation(s)
- Catalin Fetita
- SAMOVAR, Telecom SudParis, Institut Polytechnique de Paris, Evry, France
- These authors contributed equally
| | - Jean Richeux
- Service de Pneumologie, CHU de Caen, Caen, France
| | - Antoine Didier
- SAMOVAR, Telecom SudParis, Institut Polytechnique de Paris, Evry, France
| | - Mathilde Maury
- SAMOVAR, Telecom SudParis, Institut Polytechnique de Paris, Evry, France
| | - Jasper Flint
- Internal Medicine Department, Pulmonary Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA
| | - Pierre-Yves Brillet
- Service de Radiologie Hôpital Avicenne, AP-HP, Bobigny, France
- INSERM 1272 Université Sorbonne Paris-Nord, Bobigny, France
| | - Emmanuel Bergot
- Service de Pneumologie, CHU de Caen, Caen, France
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, Caen, France
| | - Jean-Francois Bernaudin
- INSERM 1272 Université Sorbonne Paris-Nord, Bobigny, France
- Faculté de Médecine Sorbonne Université Paris, Paris, France
- These authors contributed equally
| | - Aurélien Justet
- Service de Pneumologie, CHU de Caen, Caen, France
- Internal Medicine Department, Pulmonary Critical Care and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA
- Université de Caen Normandie, CNRS, Normandie Université, ISTCT, UMR6030, GIP Cyceron, Caen, France
- These authors contributed equally
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Sigaux J, Cavalin C, Lescoat A, El Rharras S, Macchi O, Brillet PY, Sesé L, Nunes H, Boissier MC, Rosental PA, Semerano L. Are cleaning activities a source of exposure to crystalline silica in women with rheumatoid arthritis? A case-control study. RMD Open 2023; 9:e003205. [PMID: 37532470 PMCID: PMC10401212 DOI: 10.1136/rmdopen-2023-003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Inhalation of crystalline silica (silicon dioxide, SiO2) is associated with a wide range of acute and chronic diseases, including rheumatoid arthritis (RA). The objectives of this work were to identify the main sources of exposure to SiO2 in a series of patients with RA not selected on the basis of their professional activity, compared with a representative sample of the French general population, and to assess the association between silica exposure and disease features. METHODS The Dust Exposure Life-Course Questionnaire (DELCQ) is a tool that enables retrospective quantification of both occupational and non-occupational lifetime exposure to SiO2. DELCQ-previously validated in a large representative sample of the French general population-was administered to 97 consecutive RA patients, and exposure scores were compared between cases and age, gender and smoking status-matched controls (1:4). The main sources of SiO2 exposure were identified in cases and controls, and source-specific exposure levels were compared. The association between DELCQ scores and disease variables in cases was tested via univariable and multivariable analyses. RESULTS In women with RA, the main sources of SiO2 exposure were cleaning activities and dusty clothes laundry, with higher exposure levels from these sources versus the general population (p<0.005). Across the whole series of RA patients, high SiO2 exposure was independently associated with mediastinal lymphadenopathy (OR 6.3, 95% CI 1.4 to 27.7). CONCLUSION Cleaning activities and dusty clothes laundry may be underestimated sources of SiO2 exposure in women with RA.
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Affiliation(s)
- Johanna Sigaux
- UMR Inserm U1125, Université Sorbonne Paris Nord, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Catherine Cavalin
- UMR CNRS-INRAE 7170-1427, Université Paris Dauphine, Paris, France
- Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Paris, France
| | - Alain Lescoat
- University Hospital Centre Rennes, Rennes, France
- Institut de Recherche en Santé, Environnement et Travail, INSERM, Paris, France
| | - Sarah El Rharras
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Odile Macchi
- Centre d'études des mouvements sociaux, Ecole des Hautes Etudes en Sciences Sociales (EHESS), Paris, France
| | - Pierre-Yves Brillet
- Radiology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Lucile Sesé
- Physiology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Hilario Nunes
- Respiratory Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Marie-Christophe Boissier
- UMR Inserm U1125, Université Sorbonne Paris Nord, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | | | - Luca Semerano
- UMR Inserm U1125, Université Sorbonne Paris Nord, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
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10
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Chassagnon G, El Hajjam M, Boussouar S, Revel MP, Khoury R, Ghaye B, Bommart S, Lederlin M, Tran Ba S, De Margerie-Mellon C, Fournier L, Cassagnes L, Ohana M, Jalaber C, Dournes G, Cazeneuve N, Ferretti G, Talabard P, Donciu V, Canniff E, Debray MP, Crutzen B, Charriot J, Rabeau V, Khafagy P, Chocron R, Leonard Lorant I, Metairy L, Ruez-Lantuejoul L, Beaune S, Hausfater P, Truchot J, Khalil A, Penaloza A, Affole T, Brillet PY, Roy C, Pucheux J, Zbili J, Sanchez O, Porcher R. Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study. Eur Radiol 2023; 33:5540-5548. [PMID: 36826504 PMCID: PMC9951833 DOI: 10.1007/s00330-023-09475-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA). METHODS COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated. RESULTS In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%. CONCLUSIONS The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor. KEY POINTS • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623).
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Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Mostafa El Hajjam
- Radiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne UniversitéLaboratoire d'imagerie Biomédicale, INSERM, ICAN Institute of Cardiometabolism and Nutrition, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Ralph Khoury
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Benoît Ghaye
- Radiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Sebastien Bommart
- Radiology Department, Hôpital Arnaud de Villeneuve, PHYMEDEXP - INSERM U1046 - CNRS UMR 9214, Université de Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France
| | - Mathieu Lederlin
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Stephane Tran Ba
- Radiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Constance De Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, AP-HP, Université Paris Cité, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Laure Fournier
- Radiology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Lucie Cassagnes
- Radiology Department, CHU Gabriel Montpied, Institut Pascal, TGI, UMR6602 CNRS SIGMA UCA, Université Clermont Auvergne, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Mickael Ohana
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Carole Jalaber
- Radiology Department, CHU Saint Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Gael Dournes
- Department of Cardio-Thoracic Imaging, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, 1 Avenue Magellan, 33600, Pessac, France
| | - Nicolas Cazeneuve
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Gilbert Ferretti
- Radiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France
| | - Pauline Talabard
- Radiology Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Victoria Donciu
- Radiology Department, Hôpital Pitié Salpêtrière, AP-HP, Sorbonne Université 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Emma Canniff
- Radiology Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marie-Pierre Debray
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Bernard Crutzen
- Radiology Department, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Jeremy Charriot
- Pulmonology Department, Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 Avenue Doyen Gaston Giraud, 34090, Montpellier, France
| | - Valentin Rabeau
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Philippe Khafagy
- Radiology Department, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Richard Chocron
- Emergency Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Ian Leonard Lorant
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Loic Metairy
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Lea Ruez-Lantuejoul
- Radiology Department, CHU de Grenoble Alpes, Université Grenoble Alpes, avenue des Maquis du Grésivaudan, 38700 La Tronche, 38043, Grenoble, France
| | - Sébastien Beaune
- Emergency Department, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Pierre Hausfater
- Emergency Department, Hôpital Pitié Salpêtrière, AP-HP, GRC-14 BIOSFAST Sorbonne Université, UMR INSERM 1166, IHU ICAN, Sorbonne Université, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Jennifer Truchot
- Emergency Department, Hôpital Cochin, AP-HP, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Antoine Khalil
- Radiology Department, Hôpital Bichat, AP-HP, Université Paris Cité, 46 Rue Henri Huchard, 75018, Paris, France
| | - Andrea Penaloza
- Services Des Urgences, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Bruxelles, Belgium
| | - Thibaut Affole
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Pierre-Yves Brillet
- Radiology Department, Hôpital Avicenne, AP-HP, UMR U1272 Hypoxie Et Poumon INSERM, Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Catherine Roy
- Radiology Department, Nouvel Hôpital Civil, CHU de Strasbourg, Université de Strasbourg, 1 Place de L'Hôpital, 67000, Strasbourg, France
| | - Julien Pucheux
- Radiology Department, Hôpital Trousseau, CHU Tours, Avenue de La République, 37170, Chambray-Lès-Tours, France
| | - Jordan Zbili
- Radiology Department, Hôpital Pontchaillou, CHU Rennes, Université de Rennes, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - Olivier Sanchez
- Pulmonology Department, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Raphael Porcher
- Center for Clinical Epidemiology, Hôtel Dieu, AP-HP, Université Paris Cité, 1 Place du Parvis de, 75004, Paris, France
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Laville C, Fetita C, Gille T, Brillet PY, Nunes H, Bernaudin JF, Genet M. Correction to: Comparison of optimization parametrizations for regional lung compliance estimation using personalized pulmonary poromechanical modelling. Biomech Model Mechanobiol 2023:10.1007/s10237-023-01719-0. [PMID: 37294483 DOI: 10.1007/s10237-023-01719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Colin Laville
- Laboratoire de Mécanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France
- Inria, Palaiseau, France
| | | | - Thomas Gille
- Hypoxie et Poumon, Université Sorbonne Paris Nord/INSERM, Bobigny, France
- Hôpital Avicenne, APHP, Bobigny, France
| | - Pierre-Yves Brillet
- Hypoxie et Poumon, Université Sorbonne Paris Nord/INSERM, Bobigny, France
- Hôpital Avicenne, APHP, Bobigny, France
| | - Hilario Nunes
- Hypoxie et Poumon, Université Sorbonne Paris Nord/INSERM, Bobigny, France
- Hôpital Avicenne, APHP, Bobigny, France
| | | | - Martin Genet
- Laboratoire de Mécanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France.
- Inria, Palaiseau, France.
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12
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Roeser A, Sese L, Chassagnon G, Chaigne B, Dunogue B, Tran Ba S, Jebri S, Brillet PY, Revel MP, Aubourg F, Dhote R, Caux F, Annesi-Maesano I, Mouthon L, Nunes H, Uzunhan Y. The association between air pollution and the severity at diagnosis and progression of systemic sclerosis-associated interstitial lung disease: results from the retrospective ScleroPol study. Respir Res 2023; 24:151. [PMID: 37291562 DOI: 10.1186/s12931-023-02463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To investigate the association of air pollution exposure with the severity of interstitial lung disease (ILD) at diagnosis and ILD progression among patients with systemic sclerosis (SSc)-associated ILD. METHODS We conducted a retrospective two-center study of patients with SSc-associated ILD diagnosed between 2006 and 2019. Exposure to the air pollutants particulate matter of up to 10 and 2.5 µm in diameter (PM10, PM2.5), nitrogen dioxide (NO2), and ozone (O3) was assessed at the geolocalization coordinates of the patients' residential address. Logistic regression models were used to evaluate the association between air pollution and severity at diagnosis according to the Goh staging algorithm, and progression at 12 and 24 months. RESULTS We included 181 patients, 80% of whom were women; 44% had diffuse cutaneous scleroderma, and 56% had anti-topoisomerase I antibodies. ILD was extensive, according to the Goh staging algorithm, in 29% of patients. O3 exposure was associated with the presence of extensive ILD at diagnosis (adjusted OR: 1.12, 95% CI 1.05-1.21; p value = 0.002). At 12 and 24 months, progression was noted in 27/105 (26%) and 48/113 (43%) patients, respectively. O3 exposure was associated with progression at 24 months (adjusted OR: 1.10, 95% CI 1.02-1.19; p value = 0.02). We found no association between exposure to other air pollutants and severity at diagnosis and progression. CONCLUSION Our findings suggest that high levels of O3 exposure are associated with more severe SSc-associated ILD at diagnosis, and progression at 24 months.
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Affiliation(s)
- Anaïs Roeser
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Lucile Sese
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
- INSERM UMR1272 Hypoxie et poumon, Paris 13 - Université Paris Nord, Bobigny, France
| | - Guillaume Chassagnon
- Department of Radiology A, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Benjamin Chaigne
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Bertrand Dunogue
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Stéphane Tran Ba
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Salma Jebri
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Pierre-Yves Brillet
- Department of Radiology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
| | - Marie Pierre Revel
- Department of Radiology A, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Frédérique Aubourg
- Department of Physiology, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Robin Dhote
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - Frédéric Caux
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Paris, France
| | - Isabella Annesi-Maesano
- INSERM, Department of Allergic and Respiratory Disease, Montpellier University Hospital, Institute Desbrest of Epidemiology and Public Health, University of Montpellier, Montpellier, France
| | - Luc Mouthon
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris (APHP), Cochin Hospital, Paris, France
| | - Hilario Nunes
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France
- INSERM UMR1272 Hypoxie et poumon, Paris 13 - Université Paris Nord, Bobigny, France
| | - Yurdagül Uzunhan
- Department of Pulmonology, Assistance Publique-Hôpitaux de Paris (APHP), Avicenne Hospital, Bobigny, France.
- INSERM UMR1272 Hypoxie et poumon, Paris 13 - Université Paris Nord, Bobigny, France.
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13
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Mankikian J, Caille A, Reynaud-Gaubert M, Agier MS, Bermudez J, Bonniaud P, Borie R, Brillet PY, Cadranel J, Court-Fortune I, Crestani B, Debray MP, Gomez E, Gondouin A, Hirschi-Santelmo S, Israel-Biet D, Jouneau S, Juvin K, Leger J, Kerjouan M, Marquette CH, Naccache JM, Nunes H, Plantier L, Prevot G, Quetant S, Traclet J, Valentin V, Uzunhan Y, Wémeau-Stervinou L, Bejan-Angoulvant T, Cottin V, Marchand-Adam S. Rituximab and mycophenolate mofetil combination in patients with interstitial lung disease (EVER-ILD): a double-blind, randomised, placebo-controlled trial. Eur Respir J 2023; 61:2202071. [PMID: 37230499 DOI: 10.1183/13993003.02071-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/21/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Standard of care for interstitial lung disease (ILD) with a nonspecific interstitial pneumonia (NSIP) pattern proposes mycophenolate mofetil (MMF) as one of the first-step therapies while rituximab is used as rescue therapy. METHODS In a randomised, double-blind, two-parallel group, placebo-controlled trial (NCT02990286), patients with connective tissue disease-associated ILD or idiopathic interstitial pneumonia (with or without autoimmune features) and a NSIP pattern (defined on NSIP pathological pattern or on integration of clinicobiological data and a NSIP-like high-resolution computed tomography pattern) were randomly assigned in a 1:1 ratio to receive rituximab (1000 mg) or placebo on day 1 and day 15 in addition to MMF (2 g daily) for 6 months. The primary end-point was the change in percent predicted forced vital capacity (FVC) from baseline to 6 months analysed by a linear mixed model for repeated measures analysis. Secondary end-points included progression-free survival (PFS) up to 6 months and safety. FINDINGS Between January 2017 and January 2019, 122 randomised patients received at least one dose of rituximab (n=63) or placebo (n=59). The least-squares mean change from baseline to 6 months in FVC (% predicted) was +1.60 (se 1.13) in the rituximab+MMF group and -2.01 (se 1.17) in the placebo+MMF group (between-group difference 3.60, 95% CI 0.41-6.80; p=0.0273). PFS was better in the rituximab+MMF group (crude hazard ratio 0.47, 95% CI 0.23-0.96; p=0.03). Serious adverse events occurred in 26 (41%) patients of the rituximab+MMF group and in 23 (39%) of the placebo+MMF group. Nine infections were reported in the rituximab+MMF group (five bacterial infections, three viral infections, one other) and four bacterial infections in the placebo+MMF group. INTERPRETATION Combination of rituximab and MMF was superior to MMF alone in patients with ILD and a NSIP pattern. The use of this combination must take into consideration the risk of viral infection.
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Affiliation(s)
- Julie Mankikian
- CHRU Tours, Service de Pneumologie et d'Explorations Fonctionnelles Respiratoires, Tours, France
| | - Agnès Caille
- CIC, INSERM 1415, CHRU Tours, Tours, France
- Methods in Patients-Centered Outcomes and Health Research, INSERM UMR 1246, Nantes, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie, Centre de Compétences des Maladies Pulmonaires Rares, APHM, CHU Nord, 13015 Marseille, France
- Aix Marseille Université, Marseille, France
| | - Marie-Sara Agier
- CHRU Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance, Tours, France
| | - Julien Bermudez
- Service de Pneumologie, Centre de Compétences des Maladies Pulmonaires Rares, APHM, CHU Nord, 13015 Marseille, France
- Aix Marseille Université, Marseille, France
| | - Philippe Bonniaud
- Centre de Référence Constitutif des Maladies Pulmonaires Rares de l'Adulte, Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Dijon-Bourgogne, Dijon, France
- UFR des Sciences de Santé, Université de Bourgogne-Franche Comté et INSERM UMR 1231, Dijon, France
| | - Raphael Borie
- Université de Paris, Inserm, U1152, laboratoire d'excellence INFLAMEX, F-75018 Paris, France
- Hôpital Bichat, APHP, Service de Pneumologie A, Centre Constitutif du Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, F-75018 Paris, France
| | - Pierre-Yves Brillet
- APHP, Service de Radiologie, Hôpital Avicenne, Université Paris Sorbonne Nord, Bobigny, France
| | - Jacques Cadranel
- APHP, Service de Pneumologie et Oncologie Thoracique, Centre Constitutif Maladies Pulmonaires Rares de l'adulte et Sorbonne Université, Hôpital Tenon, Paris, France
| | - Isabelle Court-Fortune
- Sainbiose DVH U1059 Inserm, Faculté de Médecine J Lisfranc, Université Jean Monnet, Saint Etienne, France
| | - Bruno Crestani
- Université de Paris, Inserm, U1152, laboratoire d'excellence INFLAMEX, F-75018 Paris, France
- Hôpital Bichat, APHP, Service de Pneumologie A, Centre Constitutif du Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, F-75018 Paris, France
| | - Marie-Pierre Debray
- Université de Paris, Inserm, U1152, laboratoire d'excellence INFLAMEX, F-75018 Paris, France
- APHP, Service de Radiologie, Hôpital Bichat, Paris, France
| | - Emmanuel Gomez
- Service de Pneumologie et Transplantation, Hopitaux Universitaires de Strasbourg - Nouvel Hôpital Civil, Strasbourg, France
| | - Anne Gondouin
- Université de Paris, APHP, Service de Pneumologie, Centre de Compétences Maladies Pulmonaires Rares, Hôpital Européen Georges Pompidou, Paris, France
| | - Sandrine Hirschi-Santelmo
- Hôpital de Pontchaillou, Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, Rennes, France
| | | | - Stéphane Jouneau
- Université Côte d'Azur, Département de Pneumologie, CHU de Nice, Nice, France
- Groupe Hospitalier Paris Saint Joseph, Service de Pneumologie-Allergologie-Oncologie Thoracique, Paris, France
| | - Karine Juvin
- Université de Paris, APHP, Service de Pneumologie, Centre de Compétences Maladies Pulmonaires Rares, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Mallorie Kerjouan
- Hôpital de Pontchaillou, Service de Pneumologie, Centre de Compétences pour les Maladies Pulmonaires Rares, Rennes, France
| | - Charles-Hugo Marquette
- APHP, Service de Pneumologie et Oncologie Thoracique, Centre Constitutif Maladies Pulmonaires Rares de l'Adulte, Hôpital Avicenne, Bobigny, France
| | - Jean-Marc Naccache
- APHP, Service de Pneumologie et Oncologie Thoracique, Centre Constitutif Maladies Pulmonaires Rares de l'adulte et Sorbonne Université, Hôpital Tenon, Paris, France
- Université de Tours, Centre d'Etude des Pathologies Respiratoires (CEPR) INSERM U1100 Faculté de Médecine, Tours, France
| | - Hilario Nunes
- Service de Pneumologie, Hôpital Larrey, Toulouse, France
| | - Laurent Plantier
- CHRU Tours, Service de Pneumologie et d'Explorations Fonctionnelles Respiratoires, Tours, France
- CHU de Grenoble-Alpes Service de Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, La Tronche, France
| | - Grégoire Prevot
- Centre National de Référence des Maladies Pulmonaires Rares, Hôpital Louis-Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Service de Pneumologie, Lyon, France
| | - Sébastien Quetant
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence des Maladies Pulmonaires Rares (site constitutif), Lille, France
| | | | - Victor Valentin
- CHRU de Tours, Service de Pharmacologie Clinique, Tours, France
| | - Yurdagul Uzunhan
- APHP, Service de Pneumologie et Oncologie Thoracique, Centre Constitutif Maladies Pulmonaires Rares de l'Adulte, Hôpital Avicenne, Bobigny, France
| | - Lidwine Wémeau-Stervinou
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence des Maladies Pulmonaires Rares (site constitutif), Lille, France
| | - Theodora Bejan-Angoulvant
- Université de Tours, EA 4245, Tours, France
- CHRU de Tours, Service de Pharmacologie Clinique, Tours, France
| | - Vincent Cottin
- Centre National de Référence des Maladies Pulmonaires Rares, Hôpital Louis-Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Service de Pneumologie, Lyon, France
| | - Sylvain Marchand-Adam
- CHRU Tours, Service de Pneumologie et d'Explorations Fonctionnelles Respiratoires, Tours, France
- Université de Tours, Centre d'Etude des Pathologies Respiratoires (CEPR) INSERM U1100 Faculté de Médecine, Tours, France
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Cottin V, Blanchard E, Kerjouan M, Lazor R, Reynaud-Gaubert M, Taille C, Uzunhan Y, Wemeau L, Andrejak C, Baud D, Bonniaud P, Brillet PY, Calender A, Chalabreysse L, Court-Fortune I, Desbaillets NP, Ferretti G, Guillemot A, Hardelin L, Kambouchner M, Leclerc V, Lederlin M, Malinge MC, Mancel A, Marchand-Adam S, Maury JM, Naccache JM, Nasser M, Nunes H, Pagnoux G, Prévot G, Rousset-Jablonski C, Rouviere O, Si-Mohamed S, Touraine R, Traclet J, Turquier S, Vagnarelli S, Ahmad K. French recommendations for the diagnosis and management of lymphangioleiomyomatosis. Respir Med Res 2023; 83:101010. [PMID: 37087906 DOI: 10.1016/j.resmer.2023.101010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The present article is an English-language version of the French National Diagnostic and Care Protocol, a pragmatic tool to optimize and harmonize the diagnosis, care pathway, management and follow-up of lymphangioleiomyomatosis in France. METHODS Practical recommendations were developed in accordance with the method for developing a National Diagnosis and Care Protocol for rare diseases of the Haute Autorité de Santé and following international guidelines and literature on lymphangioleiomyomatosis. It was developed by a multidisciplinary group, with the help of patient representatives and of RespiFIL, the rare disease network on respiratory diseases. RESULTS Lymphangioleiomyomatosis is a rare lung disease characterised by a proliferation of smooth muscle cells that leads to the formation of multiple lung cysts. It occurs sporadically or as part of a genetic disease called tuberous sclerosis complex (TSC). The document addresses multiple aspects of the disease, to guide the clinicians regarding when to suspect a diagnosis of lymphangioleiomyomatosis, what to do in case of recurrent pneumothorax or angiomyolipomas, what investigations are needed to make the diagnosis of lymphangioleiomyomatosis, what the diagnostic criteria are for lymphangioleiomyomatosis, what the principles of management are, and how follow-up can be organised. Recommendations are made regarding the use of pharmaceutical specialties and treatment other than medications. CONCLUSION These recommendations are intended to guide the diagnosis and practical management of pulmonary lymphangioleiomyomatosis.
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Affiliation(s)
- Vincent Cottin
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France; UMR 754, INRAE, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France.
| | - Elodie Blanchard
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), GH Sud Haut-Lévêque, Avenue Magellan, 33600 Pessac, France
| | - Mallorie Kerjouan
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), CHU Pontchailloux, 2 rue Henri le Guilloux, 35000 Rennes, France
| | - Romain Lazor
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, BU44/07.2137, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Martine Reynaud-Gaubert
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), Hôpital Nord, Chemin Bourrely, 13015 Marseille, France; URMITE-CNRS-IRD UMR 6236, Aix-Marseille Université, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - Camille Taille
- Centre de Référence Constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France; Université Paris-Diderot, 17 rue Jean Antoine de Baïf, 75013 Paris, France
| | - Yurdagül Uzunhan
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France; Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France
| | - Lidwine Wemeau
- Centre de Référence constitutif des maladies pulmonaires rares, CHRU, 5 rue Oscar Lambret, 59000 Lille, France
| | - Claire Andrejak
- Service de pneumologie, CHU Amiens, 1 Place Victor Pauchet, 80054 Amiens, France; UFR de médecine, 3 rue Louvels, 80000 Amiens, France
| | - Dany Baud
- Hôpital Suisse de Paris, 10 rue Minard, 92130 Issy les Moulineaux, France
| | - Philippe Bonniaud
- Centre de Référence constitutif des maladies pulmonaires rares, CHU de Dijon, BP 77908, 21079, Dijon, France; INSERM, LNC UMR1231, LipSTIC LabEx Team, 21000 Dijon, France
| | - Pierre-Yves Brillet
- Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France; Service de radiologie, hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Alain Calender
- Département de génétique, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France; IBCP, Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France
| | - Lara Chalabreysse
- Service de pathologie, Groupe hospitalier est, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France; Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France
| | | | | | - Gilbert Ferretti
- Pole imagerie, CHU Grenoble Alpes, Boulevard Chantourne, 38700 La Tronche, France
| | - Anne Guillemot
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Laurane Hardelin
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Marianne Kambouchner
- Service d'anatomopatholologie, Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Violette Leclerc
- Association France Lymphangioléiomyomatose, 4, Rue des Vieux-Moulins, 56 680 Plouhinec, France
| | - Mathieu Lederlin
- Service de radiologie, CHU Pontchailloux, 2 rue Henri le Guilloux, 35000 Rennes, France
| | | | - Alain Mancel
- Association France Lymphangioléiomyomatose, 4, Rue des Vieux-Moulins, 56 680 Plouhinec, France
| | - Sylvain Marchand-Adam
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), Hôpital Bretonneau, CHRU Tours, 2 Boulevard Tonnellé, 37000 Tours, France; Université de Tours, CEPR INSERMU1100, 10 Boulevard Tonnellé, 37000 Tours, France
| | - Jean-Michel Maury
- Service de chirurgie thoracique, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Jean-Marc Naccache
- Service de pneumologie, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France
| | - Mouhamad Nasser
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Hilario Nunes
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France; Université Sorbonne Paris Nord, INSERM UMR 1272 "Hypoxie et Poumon", 1 rue Chablis, 93000 Bobigny, Paris, France
| | - Gaële Pagnoux
- Service de radiologie, Hôpital Edouard Herriot, 5 place d'Arsonval, 69008 Lyon, France
| | - Grégoire Prévot
- Centre de Compétence des maladies pulmonaires rares (OrphaLung), service de pneumologie, hôpital Larrey, 24 chemin de Pouvourville, 31059 Toulouse cedex 9, France
| | | | - Olivier Rouviere
- Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France; Service de radiologie, Hôpital Edouard Herriot, 5 place d'Arsonval, 69008 Lyon, France
| | - Salim Si-Mohamed
- Université Claude Bernard Lyon 1, 8 avenue Rockefeller, 69008 Lyon, France; Service d'imagerie, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Renaud Touraine
- Laboratoire de Génétique Chromosomique et Moléculaire, CHU-Hôpital Nord, Laboratoire AURAGEN (Plan France Médecine Génomique 2025), 42270 Saint Priest en Jarest, France
| | - Julie Traclet
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
| | - Ségolène Turquier
- Service d'exploration fonctionnelle respiratoire, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, 69677 Lyon, France
| | - Stéphane Vagnarelli
- Centre de Référence constitutif des maladies pulmonaires rares (OrphaLung), Hôpital Avicenne, 125 rue Stalingrad, 93000 Bobigny, France
| | - Kaïs Ahmad
- Centre de Référence Coordinateur des maladies pulmonaires rares (OrphaLung), Hôpital Louis Pradel, Hospices Civils de Lyon, 28 avenue Doyen Lepine, ERN-LUNG, 69677 Lyon, France
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Brillet PY, Tran Ba S, Nunes H. How does the MESA Lung Study sharpen blurry edges in interstitial lung abnormalities? Eur Respir J 2023; 61:2300397. [PMID: 37290811 DOI: 10.1183/13993003.00397-2023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Pierre-Yves Brillet
- Inserm UMR 1272 "Hypoxie et Poumon", UFR SMBH, Université Sorbonne Paris-Nord, 93000 Bobigny, France
- Service de Radiologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, 93009 Bobigny cedex, France
| | - Stéphane Tran Ba
- Service de Radiologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, 93009 Bobigny cedex, France
| | - Hilario Nunes
- Inserm UMR 1272 "Hypoxie et Poumon", UFR SMBH, Université Sorbonne Paris-Nord, 93000 Bobigny, France
- Service de Pneumologie, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, 93009 Bobigny cedex, France
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16
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Schlemmer F, Valentin S, Boyer L, Guillaumot A, Chabot F, Dupin C, Le Guen P, Lorillon G, Bergeron A, Basille D, Delomez J, Andrejak C, Bonnefoy V, Goussault H, Assié JB, Choinier P, Ruppert AM, Cadranel J, Mennitti MC, Roumila M, Colin C, Günther S, Sanchez O, Gille T, Sésé L, Uzunhan Y, Faure M, Patout M, Morelot-Panzini C, Laveneziana P, Zysman M, Blanchard E, Raherison-Semjen C, Giraud V, Giroux-Leprieur E, Habib S, Roche N, Dinh-Xuan AT, Sifaoui I, Brillet PY, Jung C, Boutin E, Layese R, Canoui-Poitrine F, Maitre B. Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study. Eur Respir J 2023; 61:13993003.01532-2022. [PMID: 36669777 PMCID: PMC10066566 DOI: 10.1183/13993003.01532-2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Survivors of severe-to-critical COVID-19 may have functional impairment, radiological sequelae and persistent symptoms requiring prolonged follow-up. This pragmatic study aimed to describe their clinical follow-up and determine their respiratory recovery trajectories, and factors that could influence them and their health-related quality of life. METHODS Adults hospitalised for severe-to-critical COVID-19 were evaluated at 3 months and up to 12 months post-hospital discharge in this prospective, multicentre, cohort study. RESULTS Among 485 enrolled participants, 293 (60%) were reassessed at 6 months and 163 (35%) at 12 months; 89 (51%) and 47 (27%) of the 173 ones initially managed with standard oxygen were reassessed at 6 and 12 months, respectively. At 3 months, 34%, 70% and 56% of the participants had a restrictive lung defect, impaired DLCO and significant radiological sequelae, respectively. During extended follow-up, DLCO and FVC (% of predicted value) increased by means of +4 points at 6 months, and +6 points at 12 months. Sex, body mass index, chronic respiratory disease, immunosuppression, pneumonia extent or corticosteroid use during acute COVID-19 and prolonged invasive mechanical ventilation (IMV) were associated with DLCO at month 3, but not its trajectory thereafter. Among 475 (98%) patients with at least one chest computed-tomography scan during follow-up, 196 (41%) had significant sequelae on their last images. CONCLUSION Although pulmonary function and radiological abnormalities improved up to 1 year post-acute-COVID-19, high percentages of severe-to-critical disease survivors, including a notable proportion of those managed with standard oxygen, had significant lung sequelae and residual symptoms justifying prolonged follow-up.
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Affiliation(s)
- Frédéric Schlemmer
- Unité de Pneumologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Créteil, France .,Univ Paris Est-Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France
| | - Simon Valentin
- CHRU de Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Vandœuvre-lès-Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, INSERM UMR_S 1116, Vandœuvre-lès-Nancy, France
| | - Laurent Boyer
- Univ Paris Est-Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France.,APHP, Hôpitaux Universitaires Henri-Mondor, Service des Explorations Fonctionnelles, Créteil, France
| | - Anne Guillaumot
- CHRU de Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Vandœuvre-lès-Nancy, France
| | - François Chabot
- CHRU de Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Vandœuvre-lès-Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, INSERM UMR_S 1116, Vandœuvre-lès-Nancy, France
| | - Clairelyne Dupin
- APHP, Hôpital Saint-Louis, Service de Pneumologie, Université de Paris, Paris, France
| | - Pierre Le Guen
- APHP, Hôpital Saint-Louis, Service de Pneumologie, Université de Paris, Paris, France
| | - Gwenael Lorillon
- APHP, Hôpital Saint-Louis, Service de Pneumologie, Université de Paris, Paris, France
| | - Anne Bergeron
- Hôpitaux Universitaires de Genève, Service de Pneumologie, Genève, Switzerland
| | - Damien Basille
- CHU Amiens-Picardie, Service de Pneumologie, UR 4294 AGIR, Université Picardie Jules-Verne, Amiens, France
| | - Julia Delomez
- CHU Amiens-Picardie, Service de Pneumologie, UR 4294 AGIR, Université Picardie Jules-Verne, Amiens, France
| | - Claire Andrejak
- CHU Amiens-Picardie, Service de Pneumologie, UR 4294 AGIR, Université Picardie Jules-Verne, Amiens, France
| | - Valentine Bonnefoy
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
| | - Hélène Goussault
- Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France
| | - Jean-Baptiste Assié
- Unité de Pneumologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Pascaline Choinier
- APHP, Service de Pneumologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Anne-Marie Ruppert
- APHP, Service de Pneumologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- APHP, Service de Pneumologie, Hôpital Tenon, Sorbonne Université, Paris, France
| | | | - Mehdi Roumila
- Département de Pneumologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Charlotte Colin
- Département de Pneumologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Sven Günther
- APHP, Hôpital Européen Georges-Pompidou, Service de Physiologie, Université de Paris, Paris, France
| | - Olivier Sanchez
- APHP, Hôpital Européen Georges-Pompidou, Service de Pneumologie, Université de Paris, Paris, France
| | - Thomas Gille
- APHP, Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles, Bobigny, France.,Université Sorbonne Paris Nord, UFR SMBH Léonard de Vinci, Inserm UMR 1272 "Hypoxie et Poumon", Bobigny, France
| | - Lucile Sésé
- APHP, Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Physiologie et Explorations Fonctionnelles, Bobigny, France.,Université Sorbonne Paris Nord, UFR SMBH Léonard de Vinci, Inserm UMR 1272 "Hypoxie et Poumon", Bobigny, France
| | - Yurdagul Uzunhan
- Université Sorbonne Paris Nord, UFR SMBH Léonard de Vinci, Inserm UMR 1272 "Hypoxie et Poumon", Bobigny, France.,APHP, Hôpitaux Universitaire Paris-Seine-Saint-Denis (HUPSSD), Hôpital Avicenne, Service de Pneumologie, Centre de Reference Maladies Pulmonaires Rares de l'Adulte (site constitutif), Bobigny, France
| | - Morgane Faure
- Service de Pneumologie (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Maxime Patout
- Service de Pneumologie (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Capucine Morelot-Panzini
- Service de Pneumologie (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, hôpitaux Pitié-Salpêtrière, Saint-Antoine et Tenon, Paris, France
| | - Maeva Zysman
- Département de Pneumologie, CHU Haut-Lévèque, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-thoracique, INSERM U1045, Pessac, France
| | - Elodie Blanchard
- Département de Pneumologie, CHU Haut-Lévèque, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-thoracique, INSERM U1045, Pessac, France
| | - Chantal Raherison-Semjen
- Département de Pneumologie, CHU Guadeloupe, Guadeloupe, France.,Univ. Bordeaux, Centre de Recherche Cardio-thoracique, INSERM 1219 Epicene Team, Pessac, France
| | - Violaine Giraud
- APHP, Hôpital Ambroise-Paré, Service de Pneumologie et Oncologie thoracique, Boulogne, France
| | - Etienne Giroux-Leprieur
- APHP, Hôpital Ambroise-Paré, Service de Pneumologie et Oncologie thoracique, Boulogne, France.,Univ Paris-Saclay, Université de Versailles-Saint-Quentin (UVSQ), Boulogne, France
| | - Stéfanie Habib
- APHP, Hôpital Cochin, Service de Pneumologie, Université Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Nicolas Roche
- APHP, Hôpital Cochin, Service de Pneumologie, Université Paris Cité, Institut Cochin (UMR1016), Paris, France
| | - Anh Tuan Dinh-Xuan
- APHP, Hôpital Cochin, Service de Physiologie et Explorations Fonctionnelles, Université de Paris, Paris, France
| | - Islem Sifaoui
- Département d'Imagerie Médicale, APHP, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | | | - Camille Jung
- Centre Hospitalier Intercommunal, CRC, Créteil, France
| | - Emmanuelle Boutin
- APHP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France.,Univ Paris-Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Richard Layese
- APHP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France.,Univ Paris-Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France
| | - Florence Canoui-Poitrine
- APHP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, Créteil, France.,Univ Paris-Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Créteil, France.,APHP, Hôpitaux Universitaires Henri-Mondor, Unité de Recherche Clinique (URC Mondor), Créteil, France.,These two authors contributed equally to this work
| | - Bernard Maitre
- Univ Paris Est-Créteil, Faculté de Santé, INSERM, IMRB, Créteil, France.,Service de Pneumologie, Centre Hospitalier Intercommunal, Créteil, France.,These two authors contributed equally to this work
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17
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Bay P, de Chambrun MP, Rothstein V, Mahevas M, De Prost N, Roux A, Zuber B, Biet DI, Hervier B, Tazi A, Mouthon L, Mekinian A, Deligny C, Borie R, Meurice JC, Meyer A, Priou P, Savale L, De Saint Martin L, Gallay L, Cottin V, Blanchard E, Brillet PY, Khafagy P, Benveniste O, Nunes H, Allenbach Y, Uzunhan Y. Efficacy of plasma exchange in patients with anti-MDA5 rapidly progressive interstitial lung disease. J Autoimmun 2022; 133:102941. [PMID: 36323067 DOI: 10.1016/j.jaut.2022.102941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Rapidly progressive interstitial lung disease (RP-ILD) is a frequent and severe manifestation of anti-MDA5 dermatomyositis (MDA5-DM) associated with poor outcome. The optimal treatment regimen for MDA5-DM RP-ILD is yet to be determined. Specifically, the value of adding plasma exchange (PLEX) to corticosteroids and immunosuppressants remains unclear. We aimed to evaluate the effect of PLEX on the outcome of patients with MDA5-DM RP-ILD. METHODS This French nationwide multicentre retrospective study included all MDA5-DM RP-ILD patients from 2012 to 2021 admitted to 18 centres. The primary endpoint was one-year transplant-free survival. RESULTS 51 patients with MDA5-DM RP-ILD (female 67%; mean age at disease onset: 51 ± 11.6 years) were included. Thirty-two (63%) patients required mechanical ventilation and twenty-five (49%) received PLEX. One-year mortality or lung transplant occurred in 63% cases after a median follow-up of 77 [38-264] days. The Cox proportional hazards multivariable model only retained mechanical ventilation but not PLEX (p = 0.7) as independent predictor of the primary endpoint. One-year transplant-free survival rates in PLEX + vs. PLEX-were 20% vs. 54% (p = 0.01), respectively. The Kaplan-Meier estimated probabilities of one-year transplant-free survival was statistically higher in PLEX-compared to PLEX + patients (p = 0.05). PLEX + compared to PLEX-patients more frequently received mechanical ventilation and immunosuppressants suggesting PLEX + patients had a more severe disease. CONCLUSION MDA5-DM RP-ILD is associated with poor rate of one-year transplant-free survival. The use of PLEX was not associated with a better outcome albeit they were mainly given to more severe patients. While our study reports the largest series of MDA5-DM RP-ILD given PLEX, these results needs to be interpreted with caution owing the numerous selection, indication and interpretation bias. Further studies are needed to evaluate their efficacy in this setting.
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Affiliation(s)
- Pierre Bay
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2, Paris, France
| | - Vincent Rothstein
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Université de Paris, Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Matthieu Mahevas
- Université Paris-Est Créteil, Service de Médecine Interne, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas De Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Antoine Roux
- Service de Pneumologie, Hôpital Foch, Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Benjamin Zuber
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | | | - Baptiste Hervier
- Université de Paris Cité, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service de Médecine Interne, Paris, France; Inserm UMR-S 976, "HIPI", Hopital Saint-Louis & Université Paris Cité, France
| | - Abdellatif Tazi
- Service de Pneumologie, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Arsène Mekinian
- DMU I3, Sorbonne Université, Service de Médecine Interne, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Raphaël Borie
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Pneumologie A, Paris, France
| | | | - Alain Meyer
- Département de Physiologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pascaline Priou
- Département de Pneumologie, Centre Hospitalier Universitaire D'Angers, Angers, France
| | - Laurent Savale
- Department Service de Pneumologie et Unité de Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Laure Gallay
- Hospices Civils de Lyon, Médecine Interne, Hôpital Edouard Herriot, Lyon, France; Université de Lyon, France
| | - Vincent Cottin
- Centre National de Référence des Maladies Pulmonaires Rares, Service de Pneumologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Elodie Blanchard
- Service des Maladies Respiratoires,CHU Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Pierre-Yves Brillet
- Service de Radiologie, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Philippe Khafagy
- Service de Radiologie, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Olivier Benveniste
- Centre de Recherche en Myologie, Unité Mixte de Recherche Scientifique 974, Université Pierre et Marie Curie, INSERM, France; Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, DHUi2B, Paris, France
| | - Hilario Nunes
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, France
| | - Yves Allenbach
- Centre de Recherche en Myologie, Unité Mixte de Recherche Scientifique 974, Université Pierre et Marie Curie, INSERM, France; Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, DHUi2B, Paris, France
| | - Yurdagül Uzunhan
- Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France; Université Sorbonne Paris Nord, INSERM U1272, France
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18
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Martinod E, Radu DM, Onorati I, Portela AMS, Peretti M, Guiraudet P, Destable MD, Uzunhan Y, Freynet O, Chouahnia K, Duchemann B, Kabbani J, Maurer C, Brillet PY, Fath L, Brenet E, Debry C, Buffet C, Leenhardt L, Clero D, Julien N, Vénissac N, Tronc F, Dutau H, Marquette CH, Juvin C, Lebreton G, Cohen Y, Zogheib E, Beloucif S, Planès C, Trésallet C, Bensidhoum M, Petite H, Rouard H, Miyara M, Vicaut E. Airway replacement using stented aortic matrices: Long-term follow-up and results of the TRITON-01 study in 35 adult patients. Am J Transplant 2022; 22:2961-2970. [PMID: 35778956 DOI: 10.1111/ajt.17137] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 01/25/2023]
Abstract
Over the past 25 years, we have demonstrated the feasibility of airway bioengineering using stented aortic matrices experimentally then in a first-in-human trial (n = 13). The present TRITON-01 study analyzed all the patients who had airway replacement at our center to confirm that this innovative approach can be now used as usual care. For each patient, the following data were prospectively collected: postoperative mortality and morbidity, late airway complications, stent removal and status at last follow-up on November 2, 2021. From October 2009 to October 2021, 35 patients had airway replacement for malignant (n = 29) or benign (n = 6) lesions. The 30-day postoperative mortality and morbidity rates were 2.9% (n = 1/35) and 22.9% (n = 8/35) respectively. At a median follow-up of 29.5 months (range 1-133 months), 27 patients were alive. There have been no deaths directly related to the implanted bioprosthesis. Eighteen patients (52.9%) had stent-related granulomas requiring a bronchoscopic treatment. Ten among 35 patients (28.6%) achieved a stent free survival. The actuarial 2- and 5-year survival rates (Kaplan-Meier estimates) were respectively 88% and 75%. The TRITON-01 study confirmed that airway replacement using stented aortic matrices can be proposed as usual care at our center. Clinicaltrials.gov Identifier: NCT04263129.
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Affiliation(s)
- Emmanuel Martinod
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Dana M Radu
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ilaria Onorati
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ana Maria Santos Portela
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marine Peretti
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Patrice Guiraudet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marie-Dominique Destable
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Yurdagül Uzunhan
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Olivia Freynet
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Kader Chouahnia
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Boris Duchemann
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Jamal Kabbani
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Cyril Maurer
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Pierre-Yves Brillet
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Radiologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Léa Fath
- Hôpitaux Universitaires de Strasbourg, Oto-Rhino-Laryngologie, Strasbourg, France
| | - Esteban Brenet
- Centre Hospitalier Universitaire de Reims, Oto-Rhino-Laryngologie, Reims, France
| | - Christian Debry
- Hôpitaux Universitaires de Strasbourg, Oto-Rhino-Laryngologie, Strasbourg, France
| | - Camille Buffet
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Endocrinologie, Paris, France
| | - Laurence Leenhardt
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Endocrinologie, Paris, France
| | - Dominique Clero
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Oto-Rhino-Laryngologie, Paris, France
| | - Nicolas Julien
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Oto-Rhino-Laryngologie, Paris, France
| | - Nicolas Vénissac
- Hôpitaux Universitaires de Lille, Chirurgie Thoracique, Lille, France
| | - François Tronc
- Hôpitaux Universitaires de Lyon, Chirurgie Thoracique, Lyon, France
| | - Hervé Dutau
- Assistance Publique - Hôpitaux de Marseille, Pneumologie, Hôpital Universitaire Nord, Marseille, France
| | | | - Charles Juvin
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Chirurgie Cardiaque, Paris, France
| | - Guillaume Lebreton
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Chirurgie Cardiaque, Paris, France
| | - Yves Cohen
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Elie Zogheib
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Sadek Beloucif
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Carole Planès
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Christophe Trésallet
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Digestive, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | | | - Hervé Petite
- B3OA UMR CNRS 7052, Université Paris Cité CNRS, Paris, France
| | - Hélène Rouard
- AP-HP, EFS Ile de France, Banque des Tissus, La Plaine Saint-Denis, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d'Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpitaux Saint Louis-Lariboisière-Fernand Widal, Université Paris Cité, Paris, France
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19
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Patte C, Brillet PY, Fetita C, Bernaudin JF, Gille T, Nunes H, Chapelle D, Genet M. Estimation of Regional Pulmonary Compliance in Idiopathic Pulmonary Fibrosis Based On Personalized Lung Poromechanical Modeling. J Biomech Eng 2022; 144:1139545. [PMID: 35292805 DOI: 10.1115/1.4054106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Indexed: 11/08/2022]
Abstract
Pulmonary function is tightly linked to the lung mechanical behavior, especially large deformation during breathing. Interstitial lung diseases, such as Idiopathic Pulmonary Fibrosis (IPF), have an impact on the pulmonary mechanics and consequently alter lung function. However, IPF remains poorly understood, poorly diagnosed and poorly treated. Currently, the mechanical impact of such diseases is assessed by pressure-volume curves, giving only global information. We developed a poromechanical model of the lung that can be personalized to a patient based on routine clinical data. The personalization pipeline uses clinical data, mainly CT-images at two time steps and involves the formulation of an inverse problem to estimate regional compliances. The estimation problem can be formulated both in terms of "effective", i.e., without considering the mixture porosity, or "rescaled", i.e., where the first-order effect of the porosity has been taken into account, compliances. Regional compliances are estimated for one control subject and three IPF patients, allowing to quantify the IPF-induced tissue stiffening. This personalized model could be used in the clinic as an objective and quantitative tool for IPF diagnosis.
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Affiliation(s)
- Cécile Patte
- Inria, Palaiseau, France, Laboratoire de Mécanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France
| | - Pierre-Yves Brillet
- Hypoxie et Poumon, Universit é Sorbonne Paris Nord/INSERM, Bobigny, France; Hôpital Avicenne, APHP, Bobigny, France
| | - Catalin Fetita
- SAMOVAR, Telecom SudParis/Institut Mines-Télécom/IPP, Évry, France
| | | | - Thomas Gille
- Hypoxie et Poumon, Universit é Sorbonne Paris Nord/INSERM, Bobigny, France; Hôpital Avicenne, APHP, Bobigny, France
| | - Hilario Nunes
- Hypoxie et Poumon, Universit é Sorbonne Paris Nord/INSERM, Bobigny, France; Hôpital Avicenne, APHP, Bobigny, France
| | - Dominique Chapelle
- Inria, Palaiseau, France, Laboratoire de Mécanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France
| | - Martin Genet
- Laboratoire de Mecanique des Solides, École Polytechnique/CNRS/IPP, Palaiseau, France; Inria, Palaiseau, France
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20
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Lasvergnas J, Playe M, Saint-Val L, Brillet PY, Soussan M, Duchemann B. Pitfalls in Cancer Evaluation in Case of Chronic Superior Vena Cava Obstruction: Vertebral Enhancement and Hot Quadrate Sign in the Liver. J Thorac Oncol 2021; 17:324-326. [PMID: 34843990 DOI: 10.1016/j.jtho.2021.11.011] [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: 09/23/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Julie Lasvergnas
- Department of Medical and Thoracic Oncology, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Margot Playe
- Department of Nuclear Medicine, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Laura Saint-Val
- Department of Radiology, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Pierre-Yves Brillet
- Department of Radiology, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Michael Soussan
- Department of Nuclear Medicine, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France
| | - Boris Duchemann
- Department of Medical and Thoracic Oncology, Université Paris Sorbonne Nord, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Avicenne, Bobigny, France.
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21
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Persu A, Lopez-Sublet M, Al-Hussaini A, Pappaccogli M, Radhouani I, Van der Niepen P, Adair W, Beauloye C, Brillet PY, Chan N, Chenu P, Devos H, Escaned J, Garcia-Guimaraes M, Hammer F, Jackson R, Jebri S, Kotecha D, Macaya F, Mahon C, Natarajan N, Neghal K, Nicol ED, Parke KS, Premawardhana D, Sajitha A, Wormleighton J, Samani NJ, McCann GP, Adlam D. Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection. JAMA Cardiol 2021; 7:159-166. [PMID: 34817541 PMCID: PMC8613702 DOI: 10.1001/jamacardio.2021.4690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Question What is the prevalence of fibromuscular dysplasia, aneurysms, dissection, and tortuosity in extracoronary arteries of patients who developed a spontaneous coronary artery dissection (SCAD)? Findings In this case series including 173 patients with SCAD, using magnetic resonance angiography with blinded interpretation of the findings, 32% of the patients had fibromuscular dysplasia, 8% had aneurysms, and 2% had dissections; the prevalence of arterial tortuosity was similar in cases and controls. Extracoronary vascular events over a median 5-year follow-up were rare. Meaning The findings of this blinded analysis suggest that, in patients with SCAD, severe multivessel fibromuscular dysplasia, aneurysms, and dissections are infrequent and seldom associated with clinically evident vascular events. Importance Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear. Objective To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls. Design, Setting, and Participants This case series included 173 patients with angiographically confirmed SCAD enrolled between January 1, 2015, and December 31, 2019. Imaging of extracoronary arterial beds was performed by magnetic resonance angiography (MRA). Forty-one healthy individuals were recruited to serve as controls for blinded interpretation of MRA findings. Patients were recruited from the UK national SCAD registry, which enrolls throughout the UK by referral from the primary care physician or patient self-referral through an online portal. Participants attended the national SCAD referral center for assessment and MRA. Exposures Both patients with SCAD and healthy controls underwent head-to-pelvis MRA (median time between SCAD event and MRA, 1 [IQR, 1-3] year). Main Outcome and Measures The diagnosis of FMD, arterial dissections, and aneurysms was established according to the International FMD Consensus. Arterial tortuosity was assessed both qualitatively (presence or absence of an S curve) and quantitatively (number of curves ≥45%; tortuosity index). Results Of the 173 patients with SCAD, 167 were women (96.5%); mean (SD) age at diagnosis was 44.5 (7.9) years. The prevalence of FMD was 31.8% (55 patients); 16 patients (29.1% of patients with FMD) had involvement of multiple vascular beds. Thirteen patients (7.5%) had extracoronary aneurysms and 3 patients (1.7%) had dissections. The prevalence and degree of arterial tortuosity were similar in patients and controls. In 43 patients imaged with both computed tomographic angiography and MRA, the identification of clinically significant remote arteriopathies was similar. Over a median 5-year follow-up, there were 2 noncardiovascular-associated deaths and 35 recurrent myocardial infarctions, but there were no primary extracoronary vascular events. Conclusions and Relevance In this case series with blinded analysis of patients with SCAD, severe multivessel FMD, aneurysms, and dissections were infrequent. The findings of this study suggest that, although brain-to-pelvis imaging allows detection of remote arteriopathies that may require follow-up, extracoronary vascular events appear to be rare.
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Affiliation(s)
- Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marilucy Lopez-Sublet
- Department of Internal Medicine, ESH Hypertension Excellence Centre, CHU Avicenne, AP-HP, Bobigny, France.,INSERM UMR 942 MASCOT, CHU Avicenne, AP-HP, Bobigny, France
| | - Abtehale Al-Hussaini
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Marco Pappaccogli
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ibtissem Radhouani
- Department of Radiology, CHU Avicenne, AP-HP, UMR INSERM U1272, Université Sorbonne Paris Nord, Bobigny, France
| | - Patricia Van der Niepen
- Department of Nephrology & Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - William Adair
- University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Christophe Beauloye
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre-Yves Brillet
- Department of Radiology, CHU Avicenne, AP-HP, UMR INSERM U1272, Université Sorbonne Paris Nord, Bobigny, France
| | - Nathan Chan
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Patrick Chenu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Javier Escaned
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Marcos Garcia-Guimaraes
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.,Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Frank Hammer
- Division of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Robert Jackson
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Salma Jebri
- Department of Radiology, CHU Avicenne, AP-HP, UMR INSERM U1272, Université Sorbonne Paris Nord, Bobigny, France
| | - Deevia Kotecha
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Fernando Macaya
- Hospital Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Ciara Mahon
- Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom
| | - Nalin Natarajan
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kandiyil Neghal
- University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust London, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Diluka Premawardhana
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Averachan Sajitha
- University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Joanne Wormleighton
- University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
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22
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Cosson E, Nguyen MT, Rezgani I, Berkane N, Pinto S, Bihan H, Tatulashvili S, Taher M, Sal M, Soussan M, Brillet PY, Valensi P. Epicardial adipose tissue volume and myocardial ischemia in asymptomatic people living with diabetes: a cross-sectional study. Cardiovasc Diabetol 2021; 20:224. [PMID: 34819079 PMCID: PMC8613918 DOI: 10.1186/s12933-021-01420-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/14/2021] [Indexed: 12/18/2022] Open
Abstract
Background Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes—independently of confounding factors—and whether it could predict this condition. Methods We included asymptomatic patients with diabetes and no coronary history, who had undergone both a stress a myocardial scintigraphy to diagnose myocardial ischemia, and a computed tomography to measure their coronary artery calcium (CAC) score. EAT volume was retrospectively measured from computed tomography imaging. Determinants of EAT volume and asymptomatic myocardial ischemia were evaluated. Results The study population comprised 274 individuals, including 153 men. Mean (± standard deviation) age was 62 ± 9 years, and 243, 23 and 8 had type 2, type 1, or another type of diabetes, respectively. Mean body mass index was 30 ± 6 kg/m2, and mean EAT volume 96 ± 36 cm3. Myocardial ischemia was detected in 32 patients (11.7%). EAT volume was positively correlated with age, body mass index and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol levels. Furthermore, EAT volume was lower in people with retinopathy, but higher in men, in current smokers, in patients with nephropathy, those with a CAC score > 100 Agatston units, and finally in individuals with myocardial ischemia (110 ± 37 cm3 vs 94 ± 37 cm3 in those without myocardial ischemia, p < 0.05). The association between EAT volume and myocardial ischemia remained significant after adjustment for gender, diabetes duration, peripheral macrovascular disease and CAC score. We also found that area under the ROC curve analysis showed that EAT volume (AROC: 0.771 [95% confidence interval 0.683–0.858]) did not provide improved discrimination of myocardial ischemia over the following classic factors: gender, diabetes duration, peripheral macrovascular disease, retinopathy, nephropathy, smoking, atherogenic dyslipidemia, and CAC score (AROC 0.773 [0.683–0.862]). Conclusions EAT may play a role in coronary atherosclerosis and coronary circulation in patients with diabetes. However, considering EAT volume is not a better marker for discriminating the risk of asymptomatic myocardial ischemia than classic clinical data.
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Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France. .,Unité de Recherche Epidémiologique Nutritionnelle, UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, Bobigny, France.
| | - Minh Tuan Nguyen
- Unit of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Université Paris 13, Bondy, France
| | - Imen Rezgani
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France
| | - Narimane Berkane
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France
| | - Sara Pinto
- Unit of Diabetology, Jean Verdier Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bondy, France
| | - Hélène Bihan
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France.,Laboratoire Educations et Pratiques de Santé UR 3412, UFR Santé, Médecine, Biologie Humaine, Université Paris Sorbonne Paris Nord, 74, Rue Marcel Cachin, 93017, Bobigny Cedex, France
| | - Sopio Tatulashvili
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France
| | - Malak Taher
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France
| | - Meriem Sal
- Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, 125 Rue de Stalingrad, 93000, Bobigny Cedex, France
| | - Michael Soussan
- Department of Nuclear Medicine, Avicenne Hospital, AP-HP, Bobigny, France
| | | | - Paul Valensi
- Unit of Diabetology, Jean Verdier Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bondy, France
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23
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Benainous R, Alunji M, Brillet PY, Dhote R. Pulmonary Involvement in Secondary Syphilis. Eur J Case Rep Intern Med 2021; 8:002487. [PMID: 34377686 DOI: 10.12890/2021_002487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 11/05/2022] Open
Abstract
In secondary syphilis, Treponema pallidum can spread to the lungs. A new case is described of a patient with multiple excavated subpleural pulmonary nodules, a rare localization of secondary syphilis. Despite the numerous pulmonary samples analysed in the literature, T. pallidum is rarely visualised directly on bronchial fibroscopy or biopsy. The diagnosis of secondary syphilis is suspected from historical and physical findings and confirmed by high values obtained from non-treponemal tests. LEARNING POINTS The clinical and radiological presentation of pulmonary involvement in secondary syphilis is non-specific, described as solitary or multiple subpleural nodular opacities that are rarely infiltrating.We confirm here that for this localization, biopsy of these nodules is not necessary for diagnosis.
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Affiliation(s)
- Ruben Benainous
- Sorbonne Paris Nord University, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | - Mohanad Alunji
- Sorbonne Paris Nord University, Service de Dermatologie, Hôpital Avicenne, Bobigny, France
| | - Pierre-Yves Brillet
- Sorbonne Paris Nord University, Service de Radiologie, Hôpital Avicenne, Bobigny, France
| | - Robin Dhote
- Sorbonne Paris Nord University, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
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24
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Revel MP, Boussouar S, de Margerie-Mellon C, Saab I, Lapotre T, Mompoint D, Chassagnon G, Milon A, Lederlin M, Bennani S, Molière S, Debray MP, Bompard F, Dangeard S, Hani C, Ohana M, Bommart S, Jalaber C, El Hajjam M, Petit I, Fournier L, Khalil A, Brillet PY, Bellin MF, Redheuil A, Rocher L, Bousson V, Rousset P, Grégory J, Deux JF, Dion E, Valeyre D, Porcher R, Jilet L, Abdoul H. Study of Thoracic CT in COVID-19: The STOIC Project. Radiology 2021; 301:E361-E370. [PMID: 34184935 PMCID: PMC8267782 DOI: 10.1148/radiol.2021210384] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background There are conflicting data regarding the diagnostic performance of Chest computed tomography (CT) for COVID-19 pneumonia. Disease extent on CT has been reported to influence prognosis. Purpose To create a large publicly available dataset and assess the diagnostic and prognostic value of CT in COVID-19 pneumonia. Materials and Methods This multicenter observational retrospective cohort study (ClinicalTrials.gov: NCT04355507) involved 20 French university hospitals. Eligible subjects presented at the emergency departments of the hospitals involved between March 1st and April 30th, 2020 and underwent both thoracic CT and RT-PCR for suspected COVID-19 pneumonia. CT images were read blinded to initial reports, RT-PCR, demographic characteristics, clinical symptoms, and outcome. Readers classified CT scans as positive or negative for COVID-19, based on criteria published by the French Society of Radiology. Multivariable logistic regression was used to develop a model predicting severe outcome (intubation or death) at 1-month follow-up in subjects positive for both RT-PCR and CT, using clinical and radiological features. Results Of 10,930 subjects screened for eligibility, 10,735 (median age 65 years, interquartile range, 51-77 years; 6,147 men) were included and 6,448 (60.0%) had a positive RT-PCR result. With RT-PCR as reference, the sensitivity and specificity and CT were 80.2% (95%CI: 79.3, 81.2) and 79.7% (95%CI: 78.5, 80.9), respectively with strong agreement between junior and senior radiologists (Gwet's AC1 coefficient: 0.79) Of all the variables analysed, the extent of pneumonia on CT (OR 3.25, 95%CI: 2.71, 3.89) was the best predictor of severe outcome at one month. A score based solely on clinical variables predicted a severe outcome with an AUC of 0.64 (95%CI: 0.62, 0.66), improving to 0.69 (95%CI: 0.6, 0.71) when it also included the extent of pneumonia and coronary calcium score on CT. Conclusion Using pre-defined criteria, CT reading is not influenced by reader's experience and helps predict the outcome at one month. Published under a CC BY 4.0 license. See also the editorial by Rubin.
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Affiliation(s)
- Marie-Pierre Revel
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Samia Boussouar
- Sorbonne Université, APHP, Hôpital Pitié Salpétrière, Dept of Radiology, Paris, France
| | | | - Inès Saab
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Thibaut Lapotre
- Université Rennes1, Hôpital Pontchaillou, Dept of Radiology, Rennes, France
| | - Dominique Mompoint
- Université Paris-Saclay, APHP, Hôpital Raymond Poincaré, Dept of Radiology, Garches, France
| | | | - Audrey Milon
- Sorbonne Université, APHP, Hôpital Tenon, Dept of Radiology, Paris, France
| | - Mathieu Lederlin
- Université Rennes1, Hôpital Pontchaillou, Dept of Radiology, Rennes, France
| | - Souhail Bennani
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Sébastien Molière
- Université de Strasbourg, Hôpital de Hautepierre, Dept of Radiology, Strasbourg, France
| | | | - Florian Bompard
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Severine Dangeard
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Chahinez Hani
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Mickaël Ohana
- Université de Strasbourg, Nouvel Hôpital Civil, Dept of Radiology, Strasbourg, France
| | - Sébastien Bommart
- Université de Montpellier, Hôpital Arnaud de Villeneuve, Dept of Radiology, Montpellier France
| | - Carole Jalaber
- Université de Paris, APHP, Hôpital Cochin, Dept of Radiology, Paris, France
| | - Mostafa El Hajjam
- Université Paris-Saclay, APHP, Hôpital Ambroise Paré, Dept of Radiology, Boulogne, France
| | - Isabelle Petit
- Université de Lorraine, Hôpital Brabois, Dept of Radiology, Vandoeuvre, France
| | - Laure Fournier
- Université de Paris, APHP, Hôpital Européen Georges Pompidou, Dept of Radiology, INSERM U970, PARCC, Paris, France
| | - Antoine Khalil
- Université de Paris, APHP, Hôpital Bichat, Dept of Radiology, Paris, France
| | - Pierre-Yves Brillet
- Sorbonne Université, APHP, Hôpital Avicenne, Dept of Radiology, Bobigny, France
| | - Marie-France Bellin
- Université Paris-Saclay, APHP, Hôpital Bicêtre, Dept of Radiology, Le Kremlin-Bicêtre, France
| | - Alban Redheuil
- Sorbonne Université, APHP, Hôpital Pitié Salpétrière, Dept of Radiology, Paris, France
| | - Laurence Rocher
- Université Paris-Saclay, APHP, Hôpital Antoine Béclère, Dept of Radiology, Clamart, France
| | - Valérie Bousson
- Université de Paris, APHP, Hôpital Lariboisière, Dept of Radiology, Paris, France
| | - Pascal Rousset
- Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Lyon Sud, Dept of Radiology, Pierre-Benite, France
| | - Jules Grégory
- Université de Paris, APHP, Hôpital Beaujon, Dept of Radiology, Clichy, France
| | - Jean-François Deux
- Université Paris Est, APHP, Dept of Radiology, Hôpital Henri Mondor, Créteil, France
| | - Elisabeth Dion
- Université de Paris, APHP, Hôtel-Dieu, Dept of Radiology, Paris, France
| | - Dominique Valeyre
- Sorbonne Université, APHP, Hôpital Avicenne, Dept of Pneumology, Bobigny, INSERM UMR 1272, France
| | - Raphael Porcher
- Université de Paris, APHP, Hôtel-Dieu, Dept of Clinical Epidemiology, Paris, France
| | - Léa Jilet
- Université de Paris APHP, Clinical Research Unit Paris Centre, Paris, France
| | - Hendy Abdoul
- Université de Paris APHP, Clinical Research Unit Paris Centre, Paris, France
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25
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Cosson E, Nguyen MT, Rezgani I, Tatulashvili S, Sal M, Berkane N, Allard L, Brillet PY, Bihan H. Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study. Cardiovasc Diabetol 2021; 20:35. [PMID: 33546697 PMCID: PMC7863354 DOI: 10.1186/s12933-021-01225-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epicardial adipose tissue (EAT) has anatomic and functional proximity to the heart and is considered a novel diagnostic marker and therapeutic target in cardiometabolic diseases. The aim of this study was to evaluate whether EAT volume was associated with coronary artery calcification (CAC) in people living with diabetes, independently of confounding factors. METHODS We included all consecutive patients with diabetes whose EAT volume and CAC score were measured using computed tomography between January 1, 2019 and September 30, 2020 in the Department of Diabetology-Endocrinology-Nutrition at Avicenne Hospital, France. Determinants of EAT volume and a CAC score ≥ 100 Agatston units (AU) were evaluated. RESULTS The study population comprised 409 patients (218 men). Mean (± standard deviation) age was 57 ± 12 years, and 318, 56 and 35 had type 2 (T2D), type 1 (T1D), or another type of diabetes, respectively. Mean body mass index (BMI) was 29 ± 6 kg/m2, mean AET volume 93 ± 38 cm3. EAT volume was positively correlated with age, BMI, pack-year smoking history and triglyceridaemia, but negatively correlated with HDL-cholesterol level. Furthermore, it was lower in people with retinopathy, but higher in men, in Caucasian people, in patients on antihypertensive and lipid-lowering medication, in people with nephropathy, and finally in individuals with a CAC ≥ 100 AU (CAC < 100 vs CAC ≥ 100: 89 ± 35 vs 109 ± 41 cm3, respectively, p < 0.05). In addition to EAT volume, other determinants of CAC ≥ 100 AU (n = 89, 22%) were age, T2D, ethnicity, antihypertensive and lipid-lowering medication, cumulative tobacco consumption, retinopathy, macular edema and macrovascular disease. Multivariable analysis considering all these determinants as well as gender and BMI showed that EAT volume was independently associated with CAC ≥ 100 AU (per 10 cm3 increase: OR 1.11 [1.02-1.20]). CONCLUSIONS EAT volume was independently associated with CAC. As it may play a role in coronary atherosclerosis in patients with diabetes, reducing EAT volume through physical exercise, improved diet and pharmaceutical interventions may improve future cardiovascular risk outcomes in this population.
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Affiliation(s)
- Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France. .,Unité de Recherche Epidémiologique Nutritionnelle, UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, Bobigny, France.
| | - Minh Tuan Nguyen
- Department of Functional Explorations, AP-HP, Jean Verdier Hospital, Université Paris 13, Bondy, France
| | - Imen Rezgani
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Sopio Tatulashvili
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Meriem Sal
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Narimane Berkane
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | - Lucie Allard
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
| | | | - Hélène Bihan
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France.,Laboratoire Educations et Pratiques de Santé UR 3412, UFR Santé, Médecine, Biologie Humaine, Université Paris Sorbonne Paris Nord, 74, rue Marcel Cachin, 93017, Bobigny Cedex, France
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26
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Le Pavec J, Valeyre D, Gazengel P, Holm AM, Schultz HH, Perch M, Le Borgne A, Reynaud-Gaubert M, Knoop C, Godinas L, Hirschi S, Bunel V, Laporta R, Harari S, Blanchard E, Magnusson JM, Tissot A, Mornex JF, Picard C, Savale L, Bernaudin JF, Brillet PY, Nunes H, Humbert M, Fadel E, Gottlieb J. Lung transplantation for sarcoidosis: outcome and prognostic factors. Eur Respir J 2021; 58:13993003.03358-2020. [DOI: 10.1183/13993003.03358-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/25/2020] [Indexed: 01/20/2023]
Abstract
Study questionIn patients with sarcoidosis, past and ongoing immunosuppressive regimens, recurrent disease in the transplant and extrapulmonary involvement may affect outcomes of lung transplantation. We asked whether sarcoidosis lung phenotypes can be differentiated and, if so, how they relate to outcomes in patients with pulmonary sarcoidosis treated by lung transplantation.Patients and methodsWe retrospectively reviewed data from 112 patients who met international diagnostic criteria for sarcoidosis and underwent lung or heart–lung transplantation between 2006 and 2019 at 16 European centres.ResultsPatient survival was the main outcome measure. At transplantation, median (interaquartile range (IQR)) age was 52 (46–59) years; 71 (64%) were male. Lung phenotypes were individualised as follows: 1) extended fibrosis only; 2) airflow obstruction; 3) severe pulmonary hypertension (sPH) and airflow obstruction; 4) sPH, airflow obstruction and fibrosis; 5) sPH and fibrosis; 6) airflow obstruction and fibrosis; 7) sPH; and 8) none of these criteria, in 17%, 16%, 17%, 14%, 11%, 9%, 5% and 11% of patients, respectively. Post-transplant survival rates after 1, 3, and 5 years were 86%, 76% and 69%, respectively. During follow-up (median (IQR) 46 (16–89) months), 31% of patients developed chronic lung allograft dysfunction. Age and extended lung fibrosis were associated with increased mortality. Pulmonary fibrosis predominating peripherally was associated with short-term complications.Answer to the study questionPost-transplant survival in patients with pulmonary sarcoidosis was similar to that in patients with other indications for lung transplantation. The main factors associated with worse survival were older age and extensive pre-operative lung fibrosis.
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27
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Jutant EM, Jaïs X, Girerd B, Savale L, Ghigna MR, Perros F, Mignard X, Jevnikar M, Bourlier D, Prevot G, Tromeur C, Bauer F, Bergot E, Dauphin C, Favrolt N, Traclet J, Soumagne T, De Groote P, Chabanne C, Magro P, Bertoletti L, Gueffet JP, Chaouat A, Goupil F, Moceri P, Borie R, Fadel E, Wolkenstein P, Brillet PY, Simonneau G, Sitbon O, Humbert M, Montani D. Phenotype and Outcomes of Pulmonary Hypertension Associated with Neurofibromatosis Type 1. Am J Respir Crit Care Med 2020; 202:843-852. [PMID: 32437637 DOI: 10.1164/rccm.202001-0105oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Pulmonary hypertension (PH) associated with neurofibromatosis type 1 (NF1) is a rare and largely unknown complication of NF1.Objectives: To describe characteristics and outcomes of PH-NF1.Methods: We reported the clinical, functional, radiologic, histologic, and hemodynamic characteristics, response to pulmonary arterial hypertension (PAH)-approved drugs, and transplant-free survival of patients with PH-NF1 from the French PH registry.Measurements and Main Results: We identified 49 PH-NF1 cases, characterized by a female/male ratio of 3.9 and a median (minimum-maximum) age at diagnosis of 62 (18-82) years. At diagnosis, 92% were in New York Heart Association functional class III or IV. The 6-minute-walk distance was 211 (0-460) m. Pulmonary function tests showed low DlCO (30% [12-79%]) and severe hypoxemia (PaO2 56 [38-99] mm Hg). Right heart catheterization showed severe precapillary PH with a mean pulmonary artery pressure of 45 (10) mm Hg and a pulmonary vascular resistance of 10.7 (4.2) Wood units. High-resolution computed tomography images revealed cysts (76%), ground-glass opacities (73%), emphysema (49%), and reticulations (39%). Forty patients received PAH-approved drugs with a significant improvement in functional class and hemodynamic parameters. Transplant-free survival at 1, 3, and 5 years was 87%, 54%, and 42%, respectively, and four patients were transplanted. Pathologic assessment showed nonspecific interstitial pneumonia and major pulmonary vascular remodeling.Conclusions: PH-NF1 is characterized by a female predominance, a low DlCO, and severe functional and hemodynamic impairment. Despite a potential benefit of PAH treatment, prognosis remains poor, and double-lung transplantation is an option for eligible patients.
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Affiliation(s)
- Etienne-Marie Jutant
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Barbara Girerd
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Laurent Savale
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Maria-Rosa Ghigna
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Service d'Anatomopathologie, and
| | - Frédéric Perros
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Xavier Mignard
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Delphine Bourlier
- Service des Maladies Respiratoires, Hôpital Haut-Lévêque CHU Bordeaux Pessac, France
| | - Grégoire Prevot
- Pneumologie et Maladies Rares, Pôle Voies Respiratoires, Hôpital Larrey, Toulouse, France
| | - Cécile Tromeur
- Service de Pneumologie, Hôpital de la Cavale Blanche, Brest, France
| | - Fabrice Bauer
- INSERM U1096, Heart Failure Clinic and Pulmonary Hypertension Center, Rouen, France.,Service de Chirurgie Cardiaque, Hôpital Charles Nicole, Rouen, France
| | - Emmanuel Bergot
- Service de Pneumologie et Oncologie Thoracique, CHU Côte de Nacre, Caen, France
| | - Claire Dauphin
- Service de Cardiologie et Maladies Vasculaires, Hôpital Gabriel Montpied, Clermont Ferrand, France
| | - Nicolas Favrolt
- Service de Pneumologie et Soins Intensifs Respiratoires, CHU François Mitterrand, Dijon, France
| | - Julie Traclet
- Service de Pneumologie, Hôpital Louis Pradel, Lyon, France
| | | | - Pascal De Groote
- Service de Cardiologie, CHU Lille, Lille, France.,INSERM U1167, Institut Pasteur de Lille, Lille, France
| | - Céline Chabanne
- Service de Chirurgie Thoracique, Cardiaque et Vasculaire, Hôpital Pontchaillou, Rennes, France
| | - Pascal Magro
- Service de Pneumologie, CHU de Tours, Tours, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, St-Etienne, France.,INSERM, UMR1059, Université Jean-Monnet, St-Etienne, France.,INSERM, CIC-1408, CHU Saint-Etienne, Saint-Etienne, France
| | - Jean-Pierre Gueffet
- Unité de Soins et de Cardiologie Interventionnelle, Hôpital Privé du Confluent, Nantes, France
| | - Ari Chaouat
- Centre Hospitalier Régional Universitaire de Nancy, Département de Pneumologie, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France.,INSERM UMR_S 1116, Défaillance Cardiovasculaire Aigüe et Chronique, Faculté de Médecine de Nancy, Université de Lorraine, Nancy, France
| | | | | | - Raphael Borie
- Service de Pneumologie, Hôpital Bichat, AP-HP, Paris, France
| | - Elie Fadel
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Pôle de Chirurgie Cardiaque Congénitale et Pédiatrique, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Pierre Wolkenstein
- Service de Dermatologie, CHU Mondor, AP-HP, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - Pierre-Yves Brillet
- Service de Radiologie, Hôpital Avicenne, AP-HP, Bobigny, France; and.,Unité INSERM 1272, Université Paris 13, Villetaneuse, France
| | - Gérald Simonneau
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Marc Humbert
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - David Montani
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies.,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
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28
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Lhote R, Chilles M, Groh M, Puéchal X, Guilpain P, Ackermann F, Amoura Z, Annesi-Maesano I, Barba T, Catherinot E, Cohen-Aubart F, Cohen P, Cottin V, Couderc LJ, De Boysson H, Delbrel X, Dominique S, Duhaut P, Fain O, Hachulla E, Hamidou M, Kahn JE, Legendre C, Le Quellec A, Lhote F, Lifermann F, Mathian A, Néel A, Nunes H, Subra JF, Terrier B, Mouthon L, Diot E, Guillevin L, Brillet PY, Tcherakian C. Spectrum and Prognosis of Antineutrophil Cytoplasmic Antibody-associated Vasculitis-related Bronchiectasis: Data from 61 Patients. J Rheumatol 2020; 47:1522-1531. [PMID: 31787599 DOI: 10.3899/jrheum.190313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To report on a large series of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and bronchiectasis, with a specific focus on the timeline of occurrence of both features. METHODS Retrospective nationwide multicenter study of patients diagnosed with both AAV and bronchiectasis. RESULTS Sixty-one patients were included, among whom 27 (44.25%) had microscopic polyangiitis (MPA), 27 (44.25%) had granulomatosis with polyangiitis (GPA), and 7 (11.5%) had eosinophilic GPA. Thirty-nine (64%) had myeloperoxidase (MPO)-ANCA and 13 (21%) had proteinase 3-ANCA. The diagnosis of bronchiectasis either preceded (n = 25; median time between both diagnoses: 16 yrs, IQR 4-54 yrs), was concomitant to (n = 12), or followed (n = 24; median time between both diagnoses: 1, IQR 0-6 yrs) that of AAV. Patients in whom bronchiectasis precedes the onset of AAV (B-AAV group) have more frequent mononeuritis multiplex, MPA, MPO-ANCA, and a 5-fold increase of death. The occurrence of an AAV relapse tended to be protective against bronchiectasis worsening (HR 0.6, 95% CI 0.4-0.99, P = 0.049), while a diagnosis of bronchiectasis before AAV (HR 5.8, 95% CI 1.2-28.7, P = 0.03) or MPA (HR 18.1, 95% CI 2.2-146.3, P = 0.01) were associated with shorter survival during AAV follow-up. CONCLUSION The association of bronchiectasis with AAV is likely not accidental and is mostly associated with MPO-ANCA. Patients in whom bronchiectasis precedes the onset of AAV tend to have distinct clinical and biological features and could carry a worse prognosis.
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Affiliation(s)
- Raphael Lhote
- R. Lhote, MD, Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220, and Sorbonne Université, University of Pierre and Marie Curie (UPMC), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris
| | - Marie Chilles
- M. Chilles, MD, Department of Internal Medicine, Orléans, and Department of Internal Medicine, CHU, Tours
| | - Matthieu Groh
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Xavier Puéchal
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Philippe Guilpain
- Philippe Guilpain, MD, PhD, A. Le Quellec, MD, PhD, Department of Internal Medicine, Saint Eloi Hospital, Montpellier
| | - Félix Ackermann
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Zahir Amoura
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Isabella Annesi-Maesano
- I. Annesi-Maesano, MD, PhD, Sorbonne Université, UPMC, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris
| | - Thomas Barba
- T. Barba, MD, V. Cottin, MD, PhD, Department of Pulmonology, Louis Pradel Hospital, Lyon
| | - Emilie Catherinot
- E. Catherinot, MD, PhD, L.J. Couderc, MD, C. Tcherakian, MD, PhD, 1Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220
| | - Fleur Cohen-Aubart
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Pascal Cohen
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Vincent Cottin
- T. Barba, MD, V. Cottin, MD, PhD, Department of Pulmonology, Louis Pradel Hospital, Lyon
| | - Louis-Jean Couderc
- E. Catherinot, MD, PhD, L.J. Couderc, MD, C. Tcherakian, MD, PhD, 1Department of Pulmonology, Hôpital Foch, Suresnes, Faculté des Sciences de la Vie, Simone Veil, Université de Versailles, UPRES EA 220
| | - Hubert De Boysson
- H. De Boysson, MD, Departments of Internal Medicine, University Hospital, Caen
| | - Xavier Delbrel
- X. Delbrel, MD, Department of Internal Medicine, François Mitterand Hospital, Pau
| | - Stéphane Dominique
- S. Dominique, MD, Department of Pulmonology Department, Charles Nicolle University Hospital, Rouen
| | - Pierre Duhaut
- P. Duhaut, MD, PhD, Department of Internal Medicine, University Hospital, Amiens
| | - Olivier Fain
- Olivier Fain, MD, PhD, Department of Internal Medicine, Saint Antoine Hospital, Paris
| | - Eric Hachulla
- E. Hachulla, MD, PhD, Department of Internal Medicine, Centre de Reference des Maladies Auto-immunes Systémique Rares du Nord et du Nord-Ouest de France (CeRAINO), CHRU de Lille, Université de Lille, Lille
| | - Mohamed Hamidou
- M. Hamidou, MD, PhD, A. Néel, MD, PhD, Department of Internal Medicine, CHU, Nantes
| | - Jean-Emmanuel Kahn
- M. Groh, MD, F. Ackermann, MD, J.E. Kahn, MD, PhD, Department of Internal Medicine, CEREO (National Referral Center for Hypereosinophilic Syndromes), Hôpital Foch, Suresnes
| | - Christophe Legendre
- Christophe Legendre, MD, PhD, Department of Nephrology, Necker Enfants Malades Hospital, Paris
| | - Alain Le Quellec
- Philippe Guilpain, MD, PhD, A. Le Quellec, MD, PhD, Department of Internal Medicine, Saint Eloi Hospital, Montpellier
| | - François Lhote
- F. Lhote, MD, Department of Internal Medicine, Delafontaine Hospital, Saint Denis
| | | | - Alexis Mathian
- Z. Amoura, MD, MSc, F. Cohen-Aubart, MD, PhD, A. Mathian, MD, PhD, Sorbonne Université, INSERM UMRS 1135, Department of Internal Medicine 2, Centre National de Référence Maladies Auto-Immunes et Systémiques Rares Lupus et Syndrome des Anticorps Antiphospholipides Centre de Référence des Histiocytoses, Institut E3M, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - Antoine Néel
- M. Hamidou, MD, PhD, A. Néel, MD, PhD, Department of Internal Medicine, CHU, Nantes
| | - Hilario Nunes
- H. Nunes, MD, PhD, Department of Pulmonology, Avicenne Hospital, Bobigny
| | - Jean-François Subra
- J.F. Subra, MD, PhD, Department of Nephrology-Dialysis-Transplantation, Angers University Hospital, Angers
| | - Benjamin Terrier
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Luc Mouthon
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Elisabeth Diot
- E. Diot, MD, PhD, Department of Internal Medicine, CHU, Tours
| | - Loïc Guillevin
- X. Puéchal, MD, PhD, P. Cohen, MD, B. Terrier, MD, PhD, L. Mouthon, MD, PhD, L. Guillevin, MD, Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Pierre-Yves Brillet
- P.Y. Brillet, MD, PhD, Department of Radiology, Avicenne Hospital, Bobigny, France
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Thibaut de Ménonville C, Debray MP, Alavoine L, Dombret MC, Khalil A, Brillet PY, Aubier M, Taillé C. Focal bronchial dilatations after thermoplasty for severe asthma. ERJ Open Res 2020; 6:00117-2020. [PMID: 32963997 PMCID: PMC7487351 DOI: 10.1183/23120541.00117-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022] Open
Abstract
Bronchial thermoplasty (BT) is a non-pharmacological alternative treatment for severe asthma [1, 2]. BT consists of applying radiofrequency energy to the airways that are distal to the lobar bronchi and >3 mm, to reduce airway smooth muscle mass and bronchial hyperreactivity. However, concerns have been raised about long-term safety, especially risk of bronchial stenosis or bronchiectasis. Indeed, morphological changes in bronchial tubes, such as bronchiectasis or widening of the airways, have been occasionally described during follow-up [3–7]. However, bronchial changes have not been systematically assessed by computed tomography (CT), especially in large prospective cohorts [2, 3, 8, 9]. Focal bronchial dilatations develop after bronchial thermoplasty (BT) in 58% of patients with severe asthma.This suggests a need for systematic evaluation by CT scan after BT, with specific focus on bronchial dilatation development.https://bit.ly/2AYuhMj
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Affiliation(s)
- Charlotte Thibaut de Ménonville
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France.,These authors contributed equally
| | - Marie-Pierre Debray
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Radiologie, Paris, France.,These authors contributed equally
| | - Loubna Alavoine
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Centre d'Investigation Clinique, Paris, France
| | - Marie-Christine Dombret
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Paris, France
| | - Antoine Khalil
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Radiologie, Paris, France
| | - Pierre-Yves Brillet
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Radiologie, Bobigny, France
| | - Michel Aubier
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France
| | - Camille Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France
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Benattia A, Boussouar S, Escudié JB, Gibault L, Capron F, Brillet PY, Grenier P, Jeunemaitre X, Mousseaux E, Frank M, Sanchez O. Frequency and patterns of lung involvement in patients with vascular Ehlers Danlos Syndrome: Chest computed tomography features and histological comparisons. Imaging 2020. [DOI: 10.1183/13993003.congress-2020.3363] [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: 11/05/2022] Open
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Jeny F, Uzunhan Y, Lacroix M, Gille T, Brillet PY, Nardi A, Bouvry D, Planès C, Nunes H, Valeyre D. Predictors of mortality in fibrosing pulmonary sarcoidosis. Respir Med 2020; 169:105997. [PMID: 32442108 DOI: 10.1016/j.rmed.2020.105997] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 01/09/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pulmonary fibrosing sarcoidosis is associated with increased mortality. This study was aimed to explore the prognosis value of a panel of parameters for predicting mortality. METHODS This retrospective study included 216 patients with confirmed stage 4 pulmonary sarcoidosis. Stage 4 diagnosis date served as baseline. The following information was systematically present at baseline: epidemiological characteristics; treatments; pulmonary function; composite physiologic index (CPI); systolic pulmonary artery pressure at echocardiography; pulmonary fibrosis extent, main pulmonary artery/ascending aorta diameters ratio (MPAD/AAD) and MPAD/body surface area (BSA) measured and calculated using computed tomography, Walsh's algorithm based on CPI, lung fibrosis extent and MPAD/AAD ratio, and modified Walsh's algorithm with MPAD/BSA replacing MPAD/AAD allowed to estimate good or bad prognosis profiles. The primary outcome of the study was all cause mortality and lung transplantation. The value of baseline parameters was tested as predictors of mortality using univariate and multivariate analyses. RESULTS Median follow-up was 105 months. There were 41 deaths and 5 transplantations. At multivariate analysis, survival was independently predicted by several parameters including CPI, lung fibrosis extent, pulmonary hypertension at echography or MPAD/BSA ratio, Walsh's algorithm, and geographic origin. The modified Walsh's algorithm was most highly predictive. CONCLUSION Survival was best predicted by geographic origin, lung fibrosis extent, PH at echography or MPAD/BSA ratio, as well as by various scores among them the modified Walsh's algorithm had very high predictive value thanks to MPAD/BSA ratio which accurately predicted mortality.
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Affiliation(s)
- Florence Jeny
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de pneumologie, hôpital Avicenne, Bobigny, France.
| | - Yurdagül Uzunhan
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de pneumologie, hôpital Avicenne, Bobigny, France
| | - Maxime Lacroix
- AP-HP, service de radiologie, hôpital Avicenne, Bobigny, France
| | - Thomas Gille
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de physiologie et explorations fonctionnelles, hôpital Avicenne, Bobigny, France
| | - Pierre-Yves Brillet
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de radiologie, hôpital Avicenne, Bobigny, France
| | - Annelyse Nardi
- Service de Pneumologie, CH Général Delafontaine, Saint-Denis, France
| | - Diane Bouvry
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de pneumologie, hôpital Avicenne, Bobigny, France
| | - Carole Planès
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de physiologie et explorations fonctionnelles, hôpital Avicenne, Bobigny, France
| | - Hilario Nunes
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de pneumologie, hôpital Avicenne, Bobigny, France
| | - Dominique Valeyre
- INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de pneumologie, hôpital Avicenne, Bobigny, France
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Lacroix M, Frouin F, Dirand AS, Nioche C, Orlhac F, Bernaudin JF, Brillet PY, Buvat I. Correction for Magnetic Field Inhomogeneities and Normalization of Voxel Values Are Needed to Better Reveal the Potential of MR Radiomic Features in Lung Cancer. Front Oncol 2020; 10:43. [PMID: 32083003 PMCID: PMC7006432 DOI: 10.3389/fonc.2020.00043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/10/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose: To design and validate a preprocessing procedure dedicated to T2-weighted MR images of lung cancers so as to improve the ability of radiomic features to distinguish between adenocarcinoma and other histological types. Materials and Methods: A discovery set of 52 patients with advanced lung cancer who underwent T2-weighted MR imaging at 3 Tesla in a single center study from August 2017 to May 2019 was used. Findings were then validated using a validation set of 19 additional patients included from May to October 2019. Tumor type was obtained from the pathology report after trans-thoracic needle biopsy, metastatic lymph node or metastasis samples, or surgical excisions. MR images were preprocessed using N4ITK bias field correction and by normalizing voxel intensities with fat as a reference region. Segmentation and extraction of radiomic features were performed with LIFEx software on the raw images, on the N4ITK-corrected images and on the fully preprocessed images. Two analyses were conducted where radiomic features were extracted: (1) from the whole tumor volume (3D analysis); (2) from all slices encompassing the tumor (2D analysis). Receiver operating characteristic (ROC) analysis was used to identify features that could distinguish between adenocarcinoma and other histological types. Sham experiments were also designed to control the number of false positive findings. Results: There were 31 (12) adenocarcinomas and 21 (7) other histological types in the discovery (validation) set. In 2D, preprocessing increased the number of discriminant radiomic features from 8 without preprocessing to 22 with preprocessing. 2D analysis yielded more features able to identify adenocarcinoma than 3D analysis (12 discriminant radiomic features after preprocessing in 3D). Preprocessing did not increase false positive findings as no discriminant features were identified in any of the sham experiments. The greatest sensitivity of the 2D analysis applied to preprocessed data was confirmed in the validation set. Conclusion: Correction for magnetic field inhomogeneities and normalization of voxel values are essential to reveal the full potential of radiomic features to identify the tumor histological type from MR T2-weighted images, with classification performance similar to those reported in PET/CT and in multiphase CT in lung cancers.
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Affiliation(s)
- Maxime Lacroix
- Service d'Imagerie Médicale, AP-HP, Hôpital Avicenne, Bobigny, France.,Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France
| | - Frédérique Frouin
- Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France
| | - Anne-Sophie Dirand
- Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France
| | - Christophe Nioche
- Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France
| | - Fanny Orlhac
- Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France
| | | | | | - Irène Buvat
- Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France
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de Margerie-Mellon C, Belin L, Boussouar S, Khafagy P, Debray MP, Levand K, Chabi ML, Khalil A, Benattia A, Israël-Biet D, Crestani B, Nunes H, Cadranel J, Grenier P, Valeyre D, Naccache JM, Brillet PY. Computed tomography assessment of peripheral traction bronchiolectasis: impact of minimal intensity projection. Eur Respir J 2019; 55:13993003.01388-2019. [PMID: 31649065 DOI: 10.1183/13993003.01388-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 10/04/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Constance de Margerie-Mellon
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Radiologie, Paris, France
| | - Lisa Belin
- Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpétrière-Charles Foix, Département Biostatistique, Santé Publique et Information Médicale, Paris, France
| | - Samia Boussouar
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpétrière-Charles Foix, Service de Radiologie, Paris, France
| | | | - Marie-Pierre Debray
- Université de Paris, INSERM UMR 1152 "Physiopathologie et épidémiologie des maladies respiratoires", Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Radiologie, Paris, France
| | - Kim Levand
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Radiologie, Bobigny, France
| | | | - Antoine Khalil
- Université de Paris, INSERM UMR 1152 "Physiopathologie et épidémiologie des maladies respiratoires", Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Radiologie, Paris, France
| | - Amira Benattia
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie, Paris, France
| | - Dominique Israël-Biet
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Pneumologie, Paris, France
| | - Bruno Crestani
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Hilario Nunes
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France
| | - Jacques Cadranel
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de pneumologie et Centre Constitutif des Maladies Pulmonaires Rares, Paris, France
| | - Philippe Grenier
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpétrière-Charles Foix, Service de Radiologie, Paris, France
| | - Dominique Valeyre
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Pneumologie, Bobigny, France
| | - Jean-Marc Naccache
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de pneumologie et Centre Constitutif des Maladies Pulmonaires Rares, Paris, France
| | - Pierre-Yves Brillet
- Université Paris 13, INSERM UMR 1272 "Hypoxie et Poumon", Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Radiologie, Bobigny, France
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Darrason M, Martin A, Soussan M, Chouahnia K, Pailler MC, Boudabous H, Brillet PY, Bousquet G, Zelek L, Duchemann B. Immunotherapy for LELC: Case Report and a Focused Review. Clin Lung Cancer 2018; 20:e393-e401. [PMID: 30691964 DOI: 10.1016/j.cllc.2018.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/09/2017] [Revised: 10/15/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
Lymphoepithelioma-like carcinoma of the lung (LELC) is a rare, Epstein-Barr virus-associated tumor. LELC occurs mostly in young, Asian nonsmokers. A few hundred cases have been reported, mostly from retrospective Asian studies. Optimal treatment has not been clearly established. Treatment options are based on surgery for early stage and on cisplatin-based chemotherapy as first-line therapy for metastatic disease. Prognosis may seem better than for other types of non-small-cell lung cancer, but it remains poor in advanced disease, with a median survival of 24 months, and new treatments options are still warranted. Immunotherapies are now key players in the treatment of non-small-cell lung cancer. However, few data are available for this rare histologic subgroup. We have reviewed the available data on LELC with a focus on the first few cases reported with a response to a programmed cell death 1 inhibitor.
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Affiliation(s)
- Marie Darrason
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Antoine Martin
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Michael Soussan
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Kader Chouahnia
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Marie-Christine Pailler
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Hanene Boudabous
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Pierre-Yves Brillet
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Guilhem Bousquet
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Laurent Zelek
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France
| | - Boris Duchemann
- Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France.
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Jeny F, Brillet PY, Kim YW, Freynet O, Nunes H, Valeyre D. The place of high-resolution computed tomography imaging in the investigation of interstitial lung disease. Expert Rev Respir Med 2018; 13:79-94. [PMID: 30517828 DOI: 10.1080/17476348.2019.1556639] [Citation(s) in RCA: 7] [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] [Indexed: 01/06/2023]
Abstract
INTRODUCTION High-resolution computed tomography (HRCT) has revolutionized the diagnosis, prognosis and in some cases the prediction of therapeutic response in interstitial lung disease (ILD). HRCT represents an essential second step to a patient's clinical history, before considering any other investigation, including lung biopsy. Areas covered: This review describes the current place of HRCT in the diagnosis, prognosis and monitoring of ILD. It also lists some perspectives for the near future. Expert commentary: Since the 1980s, HRCT and its interpretation have improved, the diagnosis value of patterns, and the integration of bio-clinical elements to HRCT have been better standardized. The interobserver agreement has been investigated, allowing a better use of some limits in the interpretation of various signs. It not only takes into account one particular predominant sign, but the combination of patterns and the distribution of findings. Thanks to HRCT, the range of diagnoses and their probability are more accurately identified. The contribution of HRCT has been optimized during the multidisciplinary discussion that a difficult diagnosis calls for. HRCT quantification of the extent of diffuse lung disease becomes possible and is linked to prognosis. In the future, artificial intelligence may significantly modify the practice of radiology.
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Affiliation(s)
- Florence Jeny
- a Université Paris 13, EA2363 "Hypoxie & Poumon" , Sorbonne-Paris-Cité , Bobigny, France.,b Service de pneumologie , hôpital Avicenne , Bobigny , France
| | - Pierre-Yves Brillet
- b Service de pneumologie , hôpital Avicenne , Bobigny , France.,c Service de radiologie , hôpital Avicenne , Bobigny , France
| | - Young-Wouk Kim
- c Service de radiologie , hôpital Avicenne , Bobigny , France
| | - Olivia Freynet
- b Service de pneumologie , hôpital Avicenne , Bobigny , France
| | - Hilario Nunes
- a Université Paris 13, EA2363 "Hypoxie & Poumon" , Sorbonne-Paris-Cité , Bobigny, France.,b Service de pneumologie , hôpital Avicenne , Bobigny , France
| | - Dominique Valeyre
- a Université Paris 13, EA2363 "Hypoxie & Poumon" , Sorbonne-Paris-Cité , Bobigny, France.,b Service de pneumologie , hôpital Avicenne , Bobigny , France
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Rotenberg C, Besnard V, Brillet PY, Giraudier S, Nunes H, Valeyre D. Dramatic response of refractory sarcoidosis under ruxolitinib in a patient with associated JAK2-mutated polycythemia. Eur Respir J 2018; 52:13993003.01482-2018. [DOI: 10.1183/13993003.01482-2018] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/27/2018] [Indexed: 11/05/2022]
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Méchaï F, Fock-Yee C, Bouvry D, Raffetin A, Bouchaud O, Brauner M, Brillet PY. [Pulmonary tuberculosis: Radiological evolution of broncho-pulmonary lesions at the end of treatment]. Rev Mal Respir 2018; 36:22-30. [PMID: 30236440 DOI: 10.1016/j.rmr.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the residual broncho-pulmonary lesions and evaluate the role of CT scanning at the end of treatment of pulmonary tuberculosis. MATERIALS AND METHODS Analysis of the initial and end of treatment CT scans of 56 patients with pulmonary tuberculosis according to a reading grid including parenchymatous and airways lesions. The CT data at the end of treatment were analysed in relation to the clinical and microbiological data, and the original CT scan. RESULTS Active lesions (thick walled cavities and/or centrilobular micronodules) persisted in 24 patients (43%) after a mean treatment period of 7 months. The persistence of these signs of activity was correlated with the initial presence of a cavitary syndrome (p=0.027), with predominant sub-segmentary bronchial involvement, with extensive micronodular spread (p=0.024) and with bronchiectasis (p=0.04). These residual lesions were not associated with an increased risk of relapse. CONCLUSION The persistence of signs of activity on the CT scan at the end of treatment of tuberculosis do not necessarily correspond to an absence of cure but to a radiological delay. This imaging is nevertheless useful to make an assessment of any subsequent changes in the bronchial tree and to estimate the risk of later complications.
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Affiliation(s)
- F Méchaï
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France; Inserm, IAME, UMR 1137, 75018 Paris, France.
| | - C Fock-Yee
- Service de radiologie, hôpital Avicenne, Bobigny, France
| | - D Bouvry
- Service de pneumologie, hôpital Avicenne, Bobigny, France
| | - A Raffetin
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France
| | - O Bouchaud
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France; Laboratoire éducations et pratiques de santé EA 3412, université Paris 13, Bobigny, France
| | - M Brauner
- Service de radiologie, hôpital Avicenne, Bobigny, France
| | - P Y Brillet
- Service de radiologie, hôpital Avicenne, Bobigny, France
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Couture P, Brillet PY, Varin S, Le Goff B, Meyer A, Sibilia J, Jouneau S, Valeyre D, Hervier B, Uzunhan Y. Sarcoidosis in Patients with Antisynthetase Syndrome: Presentation and Outcome. J Rheumatol 2018; 45:1296-1300. [DOI: 10.3899/jrheum.171098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the uncommon co-occurrence of antisynthetase syndrome (AS) and sarcoidosis.Methods.From 2000 to 2015, patients with sarcoidosis were extracted from a retrospective multicentric cohort of 352 patients with AS.Results.Ten patients (2.8%; 6 men, 8 whites, 5 smokers, median age 50 yrs) had both AS and sarcoidosis. Most of the time, sarcoidosis and AS occurred simultaneously (n = 7). Antibody testing revealed anti-Jo1 (n = 5), anti-PL12 (n = 4), or anti-PL7 (n = 1). Finally, no patient had a worsening of muscular condition, 5 patients presented respiratory deterioration, 3 remained stable, and 2 showed improvement.Conclusion.Sarcoidosis may be underdiagnosed in patients with AS.
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Debray MP, Dombret MC, Pretolani M, Thabut G, Alavoine L, Brillet PY, Taillé C, Khalil A, Chanez P, Aubier M. Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood? Eur Respir J 2017; 50:50/6/1702067. [PMID: 29217610 DOI: 10.1183/13993003.02067-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Marie-Pierre Debray
- Dept of Radiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Christine Dombret
- Dept of Pneumology A, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marina Pretolani
- Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Paris Diderot University, Faculty of Medicine, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Gabriel Thabut
- Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Paris Diderot University, Faculty of Medicine, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France.,Dept of Pneumology B, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loubna Alavoine
- Clinical Investigation Center, Bichat-Claude Bernard University Hospital, Paris, France
| | - Pierre-Yves Brillet
- Dept of Radiology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Université Paris 13, PRES Sorbonne-Paris-Cité, UPRES EA 2363, Bobigny, France
| | - Camille Taillé
- Dept of Pneumology A, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Paris Diderot University, Faculty of Medicine, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Antoine Khalil
- Dept of Radiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Diderot University, Faculty of Medicine, Paris, France
| | - Pascal Chanez
- Inserm U1067 and CNRS UMR7733, Dept of Respiratory Diseases, Aix-Marseille University, Marseille, France
| | - Michel Aubier
- Dept of Pneumology A, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Paris Diderot University, Faculty of Medicine, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
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Hommada M, Mekinian A, Brillet PY, Abad S, Larroche C, Dhôte R, Fain O, Soussan M. Aortitis in giant cell arteritis: diagnosis with FDG PET/CT and agreement with CT angiography. Autoimmun Rev 2017; 16:1131-1137. [PMID: 28911987 DOI: 10.1016/j.autrev.2017.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/12/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the detection rate of aortitis in giant cell arteritis (GCA) with fluorodeoxyglucose positron emission tomography/computed tomography (PET) and to compare the findings with CT angiography (CTA). METHODS Fifty-two GCA patients and 27 controls were included. GCA patients had a PET scan at diagnosis (35/52) or during relapse (17/52). Concomitant CTA was performed in 35/52 patients. Aortitis was defined as FDG uptake higher than the liver for PET and wall thickness≥3mm for CTA. Agreement between PET and CTA was evaluated by the kappa coefficient and Spearman correlation coefficient. RESULTS Aortitis was diagnosed using PET in 40% (14/35) of patients at diagnosis and in 0% of controls (0/27). Agreement was perfect between PET and CT at a patient-based level, and very good at a vascular segment-based level (kappa: 0.72 to 1). PET was positive in 35% (6/17) of patients scanned during GCA relapse, showing aortitis (n=4) and/or articular uptake (n=4). Discrepancies between PET and CT were observed only in relapsing GCA (n=3). Correlation between the maximum standardized uptake value and wall thickness was moderate at diagnosis (r: 0.57 to 0.7) and not statistically significant during relapse. CONCLUSIONS The detection rate of aortitis in GCA patients using PET is 40%, approximately in the range of CTA rates, suggesting that the two techniques have similar sensitivity. PET seems valuable in relapsing GCA, allowing the detection of vascular and articular activities.
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Affiliation(s)
- Mona Hommada
- Department of Nuclear Medicine, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, UPMC University Paris 06, Paris, France
| | - Pierre-Yves Brillet
- Department of Radiology, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Sébastien Abad
- Department of Internal Medicine, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Claire Larroche
- Department of Internal Medicine, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Robin Dhôte
- Department of Internal Medicine, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, UPMC University Paris 06, Paris, France
| | - Michael Soussan
- Department of Nuclear Medicine, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
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Duchemann B, Annesi-Maesano I, Jacobe de Naurois C, Sanyal S, Brillet PY, Brauner M, Kambouchner M, Huynh S, Naccache JM, Borie R, Piquet J, Mekinian A, Virally J, Uzunhan Y, Cadranel J, Crestani B, Fain O, Lhote F, Dhote R, Saidenberg-Kermanac'h N, Rosental PA, Valeyre D, Nunes H. Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris. Eur Respir J 2017; 50:50/2/1602419. [PMID: 28775045 DOI: 10.1183/13993003.02419-2016] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Abstract
The objective of the study was to estimate the prevalence and incidence of interstitial lung diseases (ILDs) in Seine-Saint-Denis, a multi-ethnic county of Greater Paris, France.Patients with ILDs were identified between January and December 2012 by using several sources; all potentially involved medical specialists from public and private hospitals, community-based pulmonologists and general practitioners, and the Social Security system. Diagnoses were validated centrally by an expert multidisciplinary discussion.1170 ILD cases were reported (crude overall prevalence: 97.9/105 and incidence: 19.4/105/year). In the 848 reviewed cases, the most prevalent diagnoses were sarcoidosis (42.6%), connective tissue diseases associated ILDs (CTDs-ILDs) (16%), idiopathic pulmonary fibrosis (IPF) (11.6%), and occupational ILDs (5.0%), which corresponded to a crude prevalence of 30.2/105 for sarcoidosis, 12.1/105 for CTDs-ILDs and 8.2/105 for IPF. The prevalence of fibrotic idiopathic interstitial pneumonias, merging IPF, nonspecific interstitial pneumonia and cases registered with code J84.1 was 16.34/105 An adjusted multinomial model demonstrated an increased risk of sarcoidosis in North Africans and Afro-Caribbeans and of CTDs-ILDs in Afro-Caribbeans, compared to that in Europeans.This study, with a comprehensive recruitment and stringent diagnostic criteria, emphasises the importance of secondary ILDs, particularly CTDs-ILDs and the relatively low prevalence of IPF, and confirms that sarcoidosis is a rare disease in France.
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Affiliation(s)
- Boris Duchemann
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
| | - Isabella Annesi-Maesano
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris, France
| | | | - Shreosi Sanyal
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris, France
| | - Pierre-Yves Brillet
- Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France.,Assistance Publique - Hôpitaux de Paris, Service de Radiologie, Hôpital Avicenne, Bobigny, France
| | - Michel Brauner
- Assistance Publique - Hôpitaux de Paris, Service de Radiologie, Hôpital Avicenne, Bobigny, France
| | - Marianne Kambouchner
- Assistance Publique - Hôpitaux de Paris, Service d'Anatomie Pathologique, Hôpital Avicenne, Bobigny, France
| | - Sophie Huynh
- Service de Pneumologie, Hôpital Robert Ballanger, Aulnay sous-bois, France
| | - Jean Marc Naccache
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Tenon, Paris, France
| | - Raphael Borie
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie A, Hôpital Bichat, Paris, France
| | - Jacques Piquet
- Service de Pneumologie, Hôpital de Monfermeil, Montfermeil, France
| | - Arsène Mekinian
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne, Hôpital Jean Verdier, Bondy, France
| | - Jerôme Virally
- Service de Pneumologie, Hôpital Robert Ballanger, Aulnay sous-bois, France
| | - Yurdagul Uzunhan
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
| | - Jacques Cadranel
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Tenon, Paris, France
| | - Bruno Crestani
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie A, Hôpital Bichat, Paris, France
| | - Olivier Fain
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne, Hôpital Jean Verdier, Bondy, France
| | - Francois Lhote
- Service de Médecine Interne, Hôpital de Saint-Denis, Saint-Denis, France
| | - Robin Dhote
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | | | | | - Dominique Valeyre
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
| | - Hilario Nunes
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France .,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
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Uzunhan Y, Nunes H, Jeny F, Lacroix M, Brun S, Brillet PY, Martinod E, Carette MF, Bouvry D, Charlier C, Lanternier F, Planès C, Tazi A, Lortholary O, Baughman RP, Valeyre D. Chronic pulmonary aspergillosis complicating sarcoidosis. Eur Respir J 2017; 49:49/6/1602396. [DOI: 10.1183/13993003.02396-2016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 02/18/2017] [Indexed: 11/05/2022]
Abstract
Chronic pulmonary aspergillosis (CPA) complicating sarcoidosis (SA) is associated with high mortality, and there is a lack of clarity regarding the relative contributions of SA or CPA.This was a retrospective single-centre study on CPA-SA.In total, 65 patients (44 men), aged 41.4±13.5 and 48.3±11.9 years at the time of SA and CPA diagnoses, respectively, were included between 1980 and 2015. Of these, 64 had fibrocystic SA, most often advanced, with composite physiological index (CPI) >40 (65% of patients) and pulmonary hypertension (PH) (31%), and 41 patients (63%) were treated for SA (corticosteroids or immunosuppressive drugs). Chronic cavitary pulmonary aspergillosis (CCPA) was the most frequent CPA pattern. Regarding treatment, 55 patients required long-term antifungals, 14 interventional radiology, 11 resection surgery and two transplantation. Nearly half of the patients (27; 41.5%) died (mean age 55.8 years); 73% of the patients achieved 5-year survival and 61% 10-year survival. Death most often resulted from advanced SA and rarely from haemoptysis. CPI, fibrosis extent and PH predicted survival. Comparison with paired healthy controls without CPA did not show any difference in survival, but a higher percentage of patients had high-risk mould exposure.CPA occurs in advanced pulmonary SA. CPA-SA is associated with high mortality due to the underlying advanced SA rather than to the CPA. CPI, fibrosis extent and PH best predict outcome.
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Gille T, Didier M, Boubaya M, Moya L, Sutton A, Carton Z, Baran-Marszak F, Sadoun-Danino D, Israël-Biet D, Cottin V, Gagnadoux F, Crestani B, d'Ortho MP, Brillet PY, Valeyre D, Nunes H, Planès C. Obstructive sleep apnoea and related comorbidities in incident idiopathic pulmonary fibrosis. Eur Respir J 2017; 49:49/6/1601934. [DOI: 10.1183/13993003.01934-2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/28/2017] [Indexed: 11/05/2022]
Abstract
The objectives of this prospective study were: 1) to determine the prevalence and determinants of obstructive sleep apnoea (OSA) in patients with newly diagnosed idiopathic pulmonary fibrosis (IPF); 2) to determine whether OSA was associated with cardiovascular disease (CVD) as well as increased oxidative stress and levels of IPF biomarkers in the blood.A group of 45 patients with newly diagnosed IPF attended polysomnography. The prevalence of CVD and the severity of coronary artery calcification were investigated by high-resolution computed tomography. The levels of 8-hydroxydeoxyguanosine (8-OH-DG) and various IPF biomarkers in the blood were compared between patients with no or mild OSA (apnoea–hypopnoea index (AHI) <15 events·h−1), with moderate OSA (15 ≤AHI <30 events·h−1) and with severe OSA (AHI ≥30 events·h−1).The prevalence of moderate-to-severe OSA and severe OSA was 62% and 40%, respectively. AHI did not correlate with demographic or physiological data. All patients with severe OSA had a medical history of CVD,versus41.2% and 40% of those with no or mild OSA, or with moderate OSA, respectively (p<0.0001). Ischaemic heart disease (IHD) and moderate-to-severe coronary artery calcifications were strongly associated with severe OSA. The 8-OH-DG and matrix metalloproteinase-7 serum levels were significantly increased in the severe OSA group.Moderate-to-severe OSA is highly prevalent in incident IPF and severe OSA is strongly associated with the presence of CVD, particularly IHD.
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Nunes H, Jeny F, Bouvry D, Picard C, Bernaudin JF, Ménard C, Brillet PY, Kannengiesser C, Valeyre D, Kambouchner M. Pleuroparenchymal fibroelastosis associated with telomerase reverse transcriptase mutations. Eur Respir J 2017; 49:49/5/1602022. [DOI: 10.1183/13993003.02022-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/19/2017] [Indexed: 11/05/2022]
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45
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Debray MP, Dombret MC, Pretolani M, Thabut G, Alavoine L, Brillet PY, Taillé C, Khalil A, Chanez P, Aubier M. Early computed tomography modifications following bronchial thermoplasty in patients with severe asthma. Eur Respir J 2017; 49:49/3/1601565. [PMID: 28298402 DOI: 10.1183/13993003.01565-2016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/29/2016] [Indexed: 11/05/2022]
Abstract
Bronchial thermoplasty (BT) is a recent, promising and well-tolerated technique for the treatment of severe asthma. By delivering thermal energy to the airway wall, this procedure can induce early pulmonary opacities seen on computed tomography (CT). We aimed to examine early CT modifications induced by BT and to determine their association with respiratory symptoms.Unenhanced chest CT was performed the day after each BT session in 13 patients with severe asthma, leading to the examination of 38 treated lobes. A total of 15 BT-treated lobes were evaluated in 11 patients at 1 month. The first two patients also underwent CT at 1 week.No symptoms suggestive of pulmonary infection were noted following BT in any patient. Peribronchial consolidations and ground-glass opacities were observed in all treated lobes on day 1, with three lower lobes showing complete collapse. Mild involvement of an adjacent untreated lobe was observed in 12 out of 38 (32%) cases. Opacities had decreased in 5 out of 15 (33%) and disappeared in 10 out of 15 (67%) at 1 month.BT induced early pulmonary peribronchial hyperdensities in all treated lobes. These alterations were unrelated to clinical symptoms and spontaneously decreased or disappeared after 1 month.
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Affiliation(s)
- Marie-Pierre Debray
- Dept of Radiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Christine Dombret
- Dept of Pneumology A, Bichat Claude Bernard Hospital Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marina Pretolani
- Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Faculty of Medicine, Paris Diderot University, Bichat Campus, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Gabriel Thabut
- Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Faculty of Medicine, Paris Diderot University, Bichat Campus, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France.,Dept of Pneumology B, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loubna Alavoine
- Clinical Investigation Center, Bichat-Claude Bernard University Hospital, Paris, France
| | - Pierre-Yves Brillet
- Dept of Radiology, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Université Paris 13, PRES Sorbonne-Paris-Cité, UPRES EA 2363, Bobigny, France
| | - Camille Taillé
- Dept of Pneumology A, Bichat Claude Bernard Hospital Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Faculty of Medicine, Paris Diderot University, Bichat Campus, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Antoine Khalil
- Dept of Radiology, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Faculty of Medicine, Paris Diderot University, Bichat Campus, Paris, France
| | - Pascal Chanez
- Dept of Respiratory Diseases, Inserm U1067 and CNRS UMR7733, Aix-Marseille University, Marseille, France
| | - Michel Aubier
- Dept of Pneumology A, Bichat Claude Bernard Hospital Assistance Publique-Hôpitaux de Paris, Paris, France.,Inserm UMR1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, France.,Faculty of Medicine, Paris Diderot University, Bichat Campus, Paris, France.,Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
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Sverzellati N, Brillet PY. When Deep Blue first defeated Kasparov: is a machine stronger than a radiologist at predicting prognosis in idiopathic pulmonary fibrosis? Eur Respir J 2017; 49:49/1/1602144. [PMID: 28122857 DOI: 10.1183/13993003.02144-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/06/2016] [Indexed: 01/08/2023]
Affiliation(s)
| | - Pierre-Yves Brillet
- Université Paris 13, Sorbonne Paris Cité, EA2363 "Réponses cellulaires et fonctionnelles à l'hypoxie" Assistance Publique Hôpitaux de Paris (AP-HP), Dept of Radiology, Avicenne Hospital, Bobigny, France
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47
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De Margerie-Mellon C, Dion G, Darlay J, Ridene I, Kambouchner M, Brauner N, Brauner M, Valeyre D, Brillet PY. High-resolution computed tomography to differentiate chronic diffuse infiltrative lung diseases with chronic multifocal consolidation patterns using logical analysis of data. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:355-371. [PMID: 28079848] [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] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Chronic lung consolidation has a limited number of differential diagnoses requiring distinct managements. The aim of the study was to investigate how logical analysis of data (LAD) can support their diagnosis at HRCT (high-resolution computed tomography). METHODS One hundred twenty-four patients were retrospectively included and classified into 8 diagnosis categories: sarcoidosis (n=35), connective tissue disease (n=21), adenocarcinoma (n=17), lymphoma (n=13), cryptogenic organizing pneumonia (n=11), drug-induced lung disease (n=9), chronic eosinophilic pneumonia (n =7) and miscellaneous (n=11). First, we investigated the patterns and models (association of patterns characterizing a disease) built-up by the LAD from combinations of HRCT attributes (n=51). Second, data were recomputed by adding simple clinical attributes (n=14) to the analysis. Third, cluster analysis was performed to explain LAD failures. RESULTS HRCT models reached a sensitivity >80% and a specificity >90% for adenocarcinoma and chronic eosinophilic pneumonia. The same thresholds were obtained for sarcoidosis, connective tissue disease, and drug-induced lung diseases when clinical attributes were added to HRCT. LAD failed to provide a satisfactory model for lymphoma and cryptogenic organizing pneumonia, with overlap between both diseases shown on cluster analysis. CONCLUSION LAD provides relevant models that can be used as a diagnosis support for the radiologist. It highlights the need to add clinical data in the analysis due to frequent overlap between diseases at HRCT.
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Affiliation(s)
- Constance De Margerie-Mellon
- Department of Radiology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris 7 Denis Diderot, Sorbonne Paris-Cité, Paris, France.
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Uzunhan Y, Ferrah L, Brillet PY, Dhote R, Valeyre D, Nunes H. Comment on: rituximab in autoimmune connective tissue disease–associated interstitial lung disease: Table 1. Rheumatology (Oxford) 2016; 55:2279-2280. [DOI: 10.1093/rheumatology/kew311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/19/2016] [Indexed: 11/12/2022] Open
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Abstract
Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively.
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Affiliation(s)
- Philippe A Grenier
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
| | - Catalin I Fetita
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
| | - Pierre-Yves Brillet
- 1 Service de Radiologie, APHP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France ; 2 Department of ARTEMIS, Telecom SudParis, Institut Mines-Telecom, CNRS UMR 8145 - UMR 5157, Evry, France ; 3 Service de Radiologie, APHP, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, UPRESS EA 2363, France
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Boussouar S, Medjhoul A, Bernaudin JF, Tayebjee O, Soussan M, Uzunhan Y, Nunes H, Kambouchner M, Martin A, Valeyre D, Brillet PY. Diagnostic efficacy of ultrasound-guided core-needle biopsy of peripheral lymph nodes in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2015; 32:188-193. [PMID: 26422562] [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] [Received: 07/08/2014] [Accepted: 10/29/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND Core-needle biopsy guided by ultrasound can be performed for investigating peripheral lymph node (PLN). The aim of this study was to determine the efficacy of this technique in sarcoidosis. METHODS Retrospective review of files of all patients in the database of the radiology department of Avicenne university hospital who underwent PLN biopsies guided by ultrasound from January 2008 to June 2011 (n=292). Cases with either granulomas at histology with the procedure or with a final diagnosis of sarcoidosis were included in the study. RESULTS The histological specimens were adequate in 282 out of 292 cases (96%) showing non-caseating granulomas in 22 cases (n=20 patients with a final diagnosis of sarcoidosis and n=2 patients with tuberculosis). After reviewing clinical files of the 282 patient, 22 were confirmed to have sarcoidosis, at initial presentation (n=19) or later during flare-up or relapse (n=3) with only 2 patients having no granuloma on PLN biopsy. PLN were palpable in 18 cases and only detected by (18F)FDG-PET/CT showing increased PLN uptake in 4 cases. The sensitivity and specificity of adequate biopsy were 91 and 99% and the positive and negative predictive values were 91 and 99%, respectively. CONCLUSION Core-needle biopsy guided by ultrasound has a high efficacy for evidencing granulomas in sarcoidosis patients with PLN involvement either clinically palpable or in the presence of (18F)FDG-PET/CT uptake.
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