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Resume Introduction Les brulures caustiques graves de l’estomac sans critere de gravite clinico-biologique (CGCB) peuvent etre traitees de facon conservatrice. Cependant, meme en l’absence de CGCB a l’admission, 20 % des patients ont necessite une intervention en urgence differee pour peritonite par perforation gastrique montrant ainsi les limites de cette strategie dans le diagnostic des lesions de necrose digestives irreversibles. Le but de cette etude a ete d’identifier des signes scanographiques fiables de necrose gastrique irreversible chez des patients au stade 3 endoscopique gastrique. Patients et methode Dans une etude prospective de Mars 2014 a Janvier 2017, nous avons realise une tomodensitometrie thoraco-abdomino-pelvienne chez 30 patients consecutifs presentant des lesions gastriques caustiques de stade 3 endoscopique. Les resultats scanographiques ont ete tenus secrets pour les cliniciens et compare aux resultats des CGCB. Resultats Vingt patients ont ete traites de facon conservatrice et 10 patients ont ete operes. Soixante-dix pour cent des patients ont ete operes avec retard, en urgence differee, devant l’apparition secondaire de CGCB. A l’inverse, le scanner a montre un defaut de rehaussement de la muqueuse gastrique chez l’ensemble des patients operes pour souffrance digestive posant sans delai le diagnostic de necrose gastrique irreversible. Conclusion Le scanner a ete plus efficace qu’une strategie basee sur l’endoscopie digestive et l’utilisation de CGCB dans le diagnostic de la necrose gastrique irreversible post-ingestion de caustique. Il devrait a terme remplacer l’endoscopie digestive dans l’evaluation en urgence des brulures caustiques œsogastriques.

To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive. Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies. Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures. This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols. • National reference levels are proposed for 17 categories of interventional procedures under CT guidance. • Reference levels are useful for benchmarking practices and optimizing protocols. • Reference levels are proposed for dose length product and the number of helical acquisitions.

BACKGROUND The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lemann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability. AIMS To measure the Lemann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. METHODS We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lemann Index and the IBD Disability Index questionnaire in all patients. RESULTS One hundred and thirty CD patients were consecutively included. The mean Lemann Index (±SD) was 11.9 ± 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P

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The aim of the study was to identify factors associated with a radiological response and to assess the impact of radiological improvement in long-term outcomes in small bowel (SB) Crohn’s disease (CD) patients. We performed a retrospective study from June 2011 to June 2017 in the tertiary center, Claude Huriez Hospital in Lille, France. All SB CD patients, who underwent two magnetic resonance enterographies (MRE) 3–12 months apart, with at least 1-year follow-up after the second MRE, were included. Signs of radiological inflammation were identified by two expert radiologists in CD. Patients were classified as radiological responders (RR) and non-responders (NR). Hospitalization rates, adjustment of treatment, and surgical or endoscopic interventions were assessed and compared between RR and NR. Factors associated with a radiological response were also studied using the Cox model. One hundred and fifteen SB CD patients were included with a median follow-up of 17 months (IQR 11.6–28.3). There were 54 (47%) RR and 61 (53%) NR. The risk of surgical or endoscopic intervention was higher in NR than RR (p = 0.04), and the median delay until a surgical or endoscopic intervention was shorter in NR (p = 0.04). Multifocal disease, a hypersignal on diffusion-weighted or dynamic contrast-enhanced imaging, a stricture, or a fistula was significantly associated with a decreased probability of a radiological response (p

To evaluate the lesion-to-liver visual signal intensity ratio (SIR) before and at the hepatobiliary phase MRI (HBP-MRI) after gadobenate dimeglumine (Gd-BOPTA) injection, using several T1-weighted images (T1-WI), for the characterization of benign hepatocellular lesions. Patients with histologically proven focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), who underwent Gd-BOPTA-enhanced HBP-MRI from 2009 to 2017, were retrospectively identified. The lesion-to-liver SIR was visually assessed by two radiologists on HBP (post-HBP analysis) and compared with that of unenhanced sequences (pre/post-HBP analysis) on T1-WI in-phase (T1-IP), out-of-phase (T1-OP), and fat suppression (T1-FS). Lesions were classified as hyper-, iso-, or hypointense on post-HBP, and as decreasing, stable, or increasing SIR on pre/post-HBP analyses. The performance of the different T1-WI sequences for the diagnostic of FNH was evaluated on post-HBP analysis. Twenty-nine FNHs and 33 HCAs were analyzed. On post-HBP analysis, FNHs appeared hyper-/isointense in 89.7% of all T1-WI. HCAs appeared hypointense in 93.9%, 63.6%, and 69.7% of T1-IP, T1-OP, and T1-FS, respectively. FNHs exhibited an increasing SIR in 55.2–58.6%, a stable SIR in 44.8–58.6%, and a decreasing SIR in 0%, whereas HCAs exhibited a decreasing SIR in 66.7–93.9%, a stable SIR in 6.1–33.3%, and an increasing SIR in 0% (p

International audience; Purpose :The purpose of this study was to build and train a deep convolutional neural networks (CNN) algorithm to segment muscular body mass (MBM) to predict muscular surface from a two-dimensional axial computed tomography (CT) slice through L3 vertebra.Materials and methods :An ensemble of 15 deep learning models with a two-dimensional U-net architecture with a 4-level depth and 18 initial filters were trained to segment MBM. The muscular surface values were computed from the predicted masks and corrected with the algorithm's estimated bias. Resulting mask prediction and surface prediction were assessed using Dice similarity coefficient (DSC) and root mean squared error (RMSE) scores respectively using ground truth masks as standards of reference.Results :A total of 1025 individual CT slices were used for training and validation and 500 additional axial CT slices were used for testing. The obtained mean DSC and RMSE on the test set were 0.97 and 3.7 cm2 respectively.Conclusion :Deep learning methods using convolutional neural networks algorithm enable a robust and automated extraction of CT derived MBM for sarcopenia assessment, which could be implemented in a clinical workflow.

Purpose The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference. Materials and methods Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59 ± 19 (SD) (range: 25–93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%). Results Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO. Conclusion PI and PVG are not specific signs of bowel necrosis in mechanical SBO.

Body composition may be modified after improvement of portal hypertension (PHT) by transjugular intrahepatic portosystemic shunt (TIPSS) insertion.To evaluate changes in body composition following TIPSS placement, their relationship with radiological TIPSS patency and function, and the predictive value of these parameters METHODS: We retrospectively included 179 patients with cirrhosis who underwent TIPSS placement in our centre for severe PHT from 2011 to 2017. CT scan-based surveillance was performed at baseline, 1-3 (M1-M3) and 6 months (M6).The median model for end-stage liver disease (MELD) score was 11.4 (8.8-15.1) and Child-Pugh score 8 (7-9). Only the MELD score (HR 1.14, 95% CI 1.08-1.20) and sarcopenia assessed by transversal right psoas muscle thickness at the umbilical level/height (TPMPT/height) (HR 0.86, 95% CI 0.79-0.96) were independently associated with 6-month mortality on multivariate analysis. After TIPSS insertion, TPMT/height increased from 19 mm/m (baseline) to 19.6 mm/m (M1-M3, P = 0.004) and 21.1 mm/m (M6, P0.0001). The improvement and its extent were dependent on the radiological patency and dysfunction of TIPSS. Subcutaneous fat surface (SCFS) increased from 183.4 to 193 cmSarcopenia is independently associated with 6-month outcome and improves after TIPSS placement, together with an inverse evolution of subcutaneous and visceral fat. TIPSS not only treats PHT but also improves body composition.

Summary Introduction Serious caustic burns of the stomach that present with no clinico-biological severity criteria (CBSC) can be treated conservatively. However, even if there are no CBSC at admission, 20% of patients still require delayed emergency surgery for peritonitis due to gastric perforation thus showing the limitations of this strategy in the diagnosis of irreversible gastric necrosis lesions. The aim of this study was to identify reliable computed tomography (CT) signs of irreversible gastric necrosis in patients with stage 3 endoscopic lesions. Patients and Methods In a prospective study from March 2014 to January 2017, thoraco-abdomino-pelvic CT scan was performed in 30 consecutive patients with stage 3 endoscopic gastric lesions. The CT results were concealed from the clinicians and compared to CBSC results. Results Twenty patients were treated conservatively and ten patients were operated on. Seventy percent of the patients underwent urgent delayed surgery for symptoms that developed late but before alterations in the CBSC. The CT scan showed a perfusion defect (PD) of gastric mucosal enhancement in all patients operated on for gastrointestinal distress, and could have provided an early diagnosis of irreversible gastric necrosis. Conclusion CT was a more effective diagnostic tool for the diagnosis of irreversible gastric necrosis following caustic ingestion than a strategy based on digestive endoscopy and the use of CBSC. CT could eventually replace gastrointestinal endoscopy in the emergency evaluation of gastroesophageal caustic burns.

International audience; Purpose: The second edition of the artificial intelligence (AI) data challenge was organized by the French Society of Radiology with the aim to: (i), work on relevant public health issues; (ii), build large, mul-ticentre, high quality databases; and (iii), include three-dimensional (3D) information and prognostic questions. Materials and methods: Relevant clinical questions were proposed by French subspecialty colleges of radiology. Their feasibility was assessed by experts in the field of AI. A dedicated platform was set up for inclusion centers to safely upload their anonymized examinations in compliance with general data protection regulation. The quality of the database was checked by experts weekly with annotations performed by radiologists. Multidisciplinary teams competed between September 11 th and October 13 th 2019. Results: Three questions were selected using different imaging and evaluation modalities, including: pulmonary nodule detection and classification from 3D computed tomography (CT), prediction of expanded disability status scale in multiple sclerosis using 3D magnetic resonance imaging (MRI) and segmentation of muscular surface for sarcopenia estimation from two-dimensional CT. A total of 4347 examinations were gathered of which only 6% were excluded. Three independent databases from 24 individual centers were created. A total of 143 participants were split into 20 multidisciplinary teams. Conclusion: Three data challenges with over 1200 general data protection regulation compliant CT or MRI examinations each were organized. Future challenges should be made with more complex situations combining histopathological or genetic information to resemble real life situations faced by radiologists in routine practice.

Objectif Decrire le phenotype osseux de patientes FPLD2, un modele d’insulinoresistance hypoleptinemique, contrastant avec l’obesite, modele d’insulinoresistance hyperleptinemique. Patients et methodes Les parametres cliniques (âge, poids, taille, IMC), biologiques (metaboliques, osseux, leptine) et de composition corporelle (masse grasse, maigre, et T-score en DEXA ; graisse intra-abdominale (GIA) et abdominale totale (GT) en IRM) ont ete compares entre 3 groupes de femmes : 20 FPLD2 (mutation LMNA R482) ; 20 obeses dont 8 diabetiques et 11 temoins de poids normal. Resultats Poids, IMC, pourcentage de sujets diabetiques, glycemie et C-peptide a jeun, HbA1c, masses grasses et maigre absolues ou rapportees a la taille au carre, GIA, GT, rapport GIA/GT, leptine, phosphatemie, 25-OH vitamine et osteocalcine differaient significativement entre les 3 groupes. L’âge, la taille, la calcemie, le T-score, la PTH et le crosslaps ne differaient pas. Il existait une correlation negative significative entre osteocalcine et glycemie, C-peptide a jeun, HbA1c, masse maigre, masse maigre/taille2, T-score, GIA, GIA/GT et une correlation positive entre osteocalcine et cross laps. Il n’existait pas de correlation entre osteocalcine et poids, IMC, masse grasse et leptine. Discussion Les FPLD2 differaient des sujets obeses ou temoins par la phosphatemie, l’osteocalcine et le crosslaps plus bas dans les FPLD2, en lien avec un degre d’insulinoresistance et d’adiposite viscerale plus eleves, peut-etre par l’intermediaire du FGF23. L’osteocalcine est donc un marqueur d’insulinoresistance, correle negativement au T-score mais aussi a la masse maigre, soulignant les relations entre os, muscle et insulinoresistance.

Contexte L’insulinome, tumeur neuroendocrine pancreatique rare, parfois multiple, en particulier dans le cadre de la neoplasie endocrinienne multiple de type 1, est a l’origine d’une secretion inappropriee d’insuline, responsable d’hypoglycemies severes. Le traitement curatif est chirurgical. L’exerese de la lesion doit etre ciblee afin d’eviter le risque de diabete secondaire. Sa localisation preoperatoire est donc indispensable. Les examens actuellement realises lors du bilan morphologique preoperatoire ont une sensibilite variable mais ne sont pas specifiques. Objectif Evaluer l’apport de l’imagerie fonctionnelle aux analogues du GLP-1 sur la prise en charge chirurgicale de l’insulinome. Methode De 2000 a 2018, 54 patients ont ete explores chirurgicalement pour suspicion d’insulinome. Le bilan preoperatoire comprenait scanner, echo-endoscopie, IRM, OctreoscanO, echographie, TEP F-DOPA, imagerie aux analogues du GLP-1, TEP 18FDG, SACS et arteriographie. Resultats 54 insulinomes ont ete resequees chez 51 patients, 1 lesion a ete laissee en place devant un rapport benefice/risque defavorable, 1 lesion n’a pas ete retrouvee, 1 patiente presentait une nesidioblastose. La confrontation des examens radiologiques aux resultats anatomopathologique retrouvait des sensibilites bonnes pour le scanner, l’IRM et l’echo-endoscopie (78,6, 84,8 et 89,2 %) mais des specificites moyennes a faible (74,1, 50 et 22,2 %). Seule l’imagerie au GLP-1 avait une bonne sensibilite (88,9 %) et une bonne specificite (100 %). Conclusion Le developpement de nouvelles techniques d’imagerie fonctionnelle comme l’imagerie aux analogues du GLP-1, tres sensible et specifique de l’insulinome, ameliore la chirurgie ciblee de l’insulinome, en particulier en cas de lesions multiples. Sa plus grande disponibilite lui permettrait de devenir l’examen de reference.

CYP24A1 gene mutations induce infantile hypercalcemia, with high 1,25(OH)2D contrasting with low PTH levels. The adult phenotype is not well known. Two unrelated adult patients were referred for nephrolithiasis, hypertension, hypercalcemia, hypercalciuria, normal 25-OHD levels, and inappropriate PTH levels (22 to 92pg/mL;N: 15-68) suggesting primary hyperparathyroidism, leading to surgery. Hypercalciuria improved despite persistent hypercalcemia, treated with cinacalcet. The ratio 25-OHD3/24-25-(OH)2D3>100 (N

International audience; OBJECTIVE: Acute jejunoileal diverticulitis is a very rare and potentially serious disease affecting mostly elderly patients. The diagnosis is based on imaging but remains underrecognized. The purpose of this study is to describe the clinical and CT features and the outcomes of patients with acute jejunoileal diverticulitis. MATERIALS AND METHODS: Cases of acute jejunoileal diverticulitis managed at three French hospitals November 2005 through January 2015 were identified retrospectively. The final diagnosis relied either on a clinical and radiologic data review by a panel of experts or on surgical findings. Demographic, clinical, laboratory, and 18-month outcome data were collected. CT scans were reviewed by two radiologists who reached a consensus about the presence of an inflammatory diverticulum, evidence of complications, and presence of other bowel diverticula. RESULTS: We identified 33 cases of acute jejunoileal diverticulitis in 33 patients with a median age of 78 years, including 30 (91%) patients in whom an inflammatory diverticulum was identified at the jejunum (n = 26, 87%) or ileum (n = 4, 13%). Extraintestinal gas was seen in 10 (30%) patients and extraintestinal fluid in 11 (33%) patients. Other small-bowel diverticula were visible in all 33 patients. The diverticulitis was mild and resolved with nonoperative treatment in 22 (67%) patients and was severe in the remaining 11 (33%) patients, eight of whom required emergent surgery. CONCLUSION: Acute jejunoileal diverticulitis is a rare and usually nonserious condition that chiefly involves the jejunum. A detailed CT assessment may allow nonoperative treatment.

Purpose Using a limited temporal resolution dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) dataset to assess the impact of the arterial input function (AIF) choice on the transfer constant (Ktrans) to distinguish prostate carcinoma (PCa) from benign tissue. Materials and Methods Thirty-eight patients with clinically important peripheral PCa (≥0.5 cc) were retrospectively studied. These patients underwent 1.5T multiparametric prostate MR with PCa and benign regions of interest (ROIs) selected using a visual registration with morphometric reconstruction obtained from radical prostatectomy. Using three pharmacokinetic (PK) analysis software programs, the mean Ktrans of ROIs was computed using three AIFs: an individual AIF (Ind-AIF) and two literature population average AIFs of Weinmann (W-AIF) and of Fritz-Hansen (FH-AIF). A pairwise comparison of the area under the receiver operating characteristic curves (AUROCC) obtained with different AIFs was performed. Results AUROCCs obtained with W-AIF (ranging from 0.801 to 0.843) were significantly higher than FH-AIF (ranging from 0.698 to 0.780, 0.002 ≤ P ≤ 0.045) and similar to or higher than Ind-AIF (ranging from 0.591 to 0.839, 0.014 ≤ P ≤ 0.9). Ind-AIF and FH-AIF provided similar AUROCC (0.34 ≤ P ≤ 0.81). The pairwise correlation of Ktrans values was moderate to very strong when comparing W-AIF with FH-AIF (the Spearman's correlation coefficients [SCCs] ranged from 0.55 to 0.93) and very weak to moderate when comparing W-AIF with Ind-AIF (the SCCs ranged from 0.018 to 0.59) or FH-AIF with Ind-AIF (the SCCs ranged from 0.30 to 0.51). Conclusion W-AIF yielded a higher performance than FH-AIF and a similar or higher performance than Ind-AIF in distinguishing PCa from benign tissue. J. Magn. Reson. Imaging 2015.

International audience; OBJECTIVE: The Response Evaluation Criteria in Solid Tumors (RECIST) can have limitations when used to evaluate local treatments for cancer, especially for liver malignancies treated by stereotactic body radiation therapy (SBRT). The aim of this study was to validate the relationship between the occurrence of lobulated enhancement (LE) and local relapse and to evaluate the utility of this relationship for predicting local progression.METHODS: Imaging data of 59 lesions in 46 patients, including 281 computed tomographic (CT) scans, were retrospectively and blindly reviewed by 3 radiologists. One radiologist measured the lesion size, for each CT and overall, to classify responses using RECIST threshold criteria. The second studied LE occurrence. A third radiologist was later included and studied LE occurrence to evaluate the interobserver consistency for LE evaluation.RESULTS: The mean duration of follow-up was 13.6 months. LE was observed in 16 of 18 progressive lesions, occurring before size-based progression in 50% of cases, and the median delay of LE detection was 3.2 months. The sensitivity of LE to predict progression was 89%, and its specificity was 100%. The positive predictive value was 100%, the negative predictive value was 95.3%, and the overall accuracy was 97%. The probability of local progression-free survival at 12 months was significantly higher for lesions without LE compared with all lesions: 0.80 (CI 95%: 0.65-0.89) versus 0.69 (CI 95%: 0.54-0.80), respectively. The overall concordance rate between the 2 readers of LE was 97.9%.CONCLUSIONS: Response assessment of liver metastases treated by SBRT can be improved by including LE. This study demonstrates the diagnostic and predictive utility of LE for assessing local progression at a size still eligible for local salvage treatment.

Aim The adipo-myokine irisin regulates energy expenditure and fat metabolism. LMNA-associated familial partial lipodystrophy (FPLD2) comprises insulin resistance, muscle hypertrophy and lipoatrophy. The aim of this study was to investigate whether irisin could be a biomarker of FPLD2. Patients and methods This case control study included 19 FPLD2 subjects, 13 obese non-diabetic (OND) patients and 19 healthy controls (HC) of normal weight (median BMI: 26, 39 and 22 kg/m2, respectively). Serum irisin and leptin levels, body composition (DXA/MRI) and metabolic/inflammatory parameters were compared in these three groups. Results BMI and MRI intra-abdominal fat significantly differed among these three groups, whereas DXA total fat mass and leptin levels were higher in the OND group, but did not differ between HC and FPLD2. Lipodystrophy patients had higher intra-abdominal/total abdominal fat ratios than the other two groups. Irisin levels were higher in FPLD2 and OND patients than in HC (medians: 944, 934 and 804 ng/mL, respectively). However, irisin/leptin ratios and lean body mass percentages were strikingly higher, and lean mass indices lower, in FPLD2 and HC than in the OND (median irisin/leptin ratios: 137, 166 and 21, respectively). In the entire study group, irisin levels positively correlated with BMI, lean body mass and index, intra-abdominal/total abdominal fat ratio, triglyceride, cholesterol, insulin, glucose and HbA1c levels. Also, intra-abdominal/total abdominal fat ratio and lean body mass better differentiated the three groups only in female patients. Conclusion Circulating irisin is similarly increased in FPLD2 and OND patients, who are characterized by higher lean body mass regardless of their clearly different fat mass. However, irisin/leptin ratios, strikingly higher in FPLD2 than in OND patients, could help to make the diagnosis and prompt genetic testing in clinically atypical cases.

The risk and clinical significance of cardiac iron overload due to chronic transfusion varies with the underlying disease. Cardiac iron overload shortens the life expectancy of patients with thalassemia, whereas its effect is unclear in those with myelodysplastic syndromes (MDS). In patients with sickle cell anemia (SCA), iron does not seem to deposit quickly in the heart. Our primary objective was to assess through a multicentric study the prevalence of cardiac iron overload, defined as a cardiovascular magnetic resonance T2*8 ECs in the past year, and age older than 6 years. We included from 9 centers 20 patients with thalassemia, 41 with SCA, and 25 with MDS in 2012-2014. Erythrocytapharesis did not consistently prevent iron overload in patients with SCA. Cardiac iron overload was found in 3 (15%) patients with thalassemia, none with SCA, and 4 (16%) with MDS. The liver iron content (LIC) ranged from 10.4 to 15.2 mg/g dry weight, with no significant differences across groups (P = 0.29). Abnormal T2* was not significantly associated with any of the measures of transfusion or chelation. Ferritin levels showed a strong association with LIC. Non-transferrin-bound iron was high in the thalassemia and MDS groups but low in the SCA group (P

Most transplant centers use chemoembolisation as locoregional bridge therapy for hepatocellular carcinoma (HCC) before liver transplantation (LT). Chemoembolisation using beads loaded with doxorubicin (DEBDOX) is a promising technique that enables delivery of a large quantity of drugs against HCC. We sought to assess the imaging–histologic correlation after DEBDOX chemoembolisation. All consecutive patients who had undergone DEBDOX chemoembolisation before receiving liver graft for HCC were included. Tumour response was evaluated according to Response Evaluation Criteria in Solid Tumours (RECIST) and modified RECIST (mRECIST) criteria. The result of final imaging made before LT was correlated with histological data to predict tumour necrosis. Twenty-eight patients underwent 43 DEBDOX procedures for 45 HCC. Therapy had a significant effect as shown by a decrease in the mean size of the largest nodule (p = 0.02) and the sum of viable part of tumour sizes according to mRECIST criteria (p

Objectif : comparer la dose delivree aux patients et la qualite d’image en routine clinique lors de la realisation d’un scanner abdominal ne disposant pas des techniques de reconstructions iteratives (RI) par rapport a un examen realise sur un scanner disposant des RI. Materiels et methodes : il s’agit d’une etude retrospective incluant 30 patients ayant eu deux examens abdominaux sur un scanner 40 coupes (TDM40) et sur un scanner 256 coupes avec RI (TDM256). Les patients, suivis pour une pathologie abdominale chronique, ont eu un examen de meme indication sur chaque scanner avec un protocole comprenant une phase abdomino-pelvienne au temps portal. La longueur d’acquisition, la dose efficace et le Produit Dose Longueur (PDL) ainsi que des evaluations quantitatives et qualitatives de l’image ont ete compares. Resultats : la dose efficace moyenne pour un examen etait de 17,3 mSv avec le TDM40 (PDL : 1019 mGy.cm) contre 11,1 mSv avec le TDM256 (PDL : 654 mGy.cm) soit une reduction de 35,8 % (p : l’utilisation d’un scanner equipe de RI permet une reduction significative de la dose efficace tout en preservant une bonne qualite d’image.

Objective: The objective was to determine the liver volumetric recovering capacity and postoperative course after major hepatectomy in obese patients through a case-matched study. Background: In literature, the impact of obesity on liver recovering has been analyzed only indirectly in terms of morbimortality but never through volumetric assessment. Patients and Method: Between 2005 and 2011, 42 patients with body mass index (BMI) 30 or higher (Ob group) underwent major hepatectomy and were matched with 42 patients with BMI 25 or lower (NonOb group) on the magnitude of resection (number of resected segments ±1, remnant liver volume to total liver volume, RLV/TLV, ±5%). The RLV was measured on computed tomographic slices preoperatively and postoperatively at 1 month (RLV-1M) for all patients and within 3 to 12 months in 42 paired patients (median = 6 months, RLV-6M). Considering hepatomegaly in Ob group, RLV was also normalized to body weight (RLVBWR). The liver volumetric gain was expressed as a relative increase [(RLV-1M − RLV)/RLV] or increase in RLVBWR. Results: The Ob and NonOb groups were comparable regarding clinicopathological data, except for arterial hypertension (48% vs 19%; P = 0.005), mean steatosis (24% vs 10%; P = 0.03), and fibrosis incidence (33% vs 10%; P = 0.008). Ob group showed longer operative time and higher blood losses. There were no intergroup differences in liver failure (both 7.1%) and 90-day morbimortality. Despite comparable RLV/TLV (38.1% vs 37.7%; P = 0.13), the relative liver volumetric gain at 1 month was significantly lower in Ob group (+93% vs +115%; P = 0.002), as well as RLVBWR increase (+0.59% vs +0.79%; P < 0.001). The RLV-1M represented 66.2% of initial TLV in Ob group compared with 73.8% (P = 0.005) in NonOb group. This delay in relative volumetric gain persisted at 6 months (+105.4% vs +137.6%; P = 0.009), the RLV-6M representing 71.2% vs 82.4% of initial TLV (P = 0.014). Conclusions: In a methodologically robust trial in the first cohort reported up to date, the regenerative response in obese patients was comparatively slower based on their initial TLV or body weight.

Resume Objectif L’hematome non traumatique du foie est une pathologie rare compliquant volontiers l’evolution des tumeurs hepatiques. Chez certains patients, l’hemorragie constitue le premier evenement clinique et l’enjeu diagnostique reste entier. Patients et methodes Cette etude retrospective s’est deroulee entre juillet 2001 et mars 2011. Les imageries scanner et IRM a la phase aigue de patients ayant presente un hematome hepatique inaugural ont ete relues, relevant les caracteristiques radio-semiologiques des hematomes et des lesions hepatiques decouvertes, ensuite ete confrontees aux diagnostics finals des patients. Resultats Douze patients ont ete inclus (âge moyen de 42 ans). Chez sept d’entre eux, une lesion hepatique etait visible des la premiere imagerie scanographique ou IRM, dont cinq fortement hypervasculaires. Finalement, l’hemorragie a fait decouvrir un hepatocarcinome chez quatre patients, un adenome chez deux et une hyperplasie nodulaire focale chez un autre. Conclusion Il est important dans les hemorragies hepatiques spontanees a la phase aigue de ne pas meconnaitre une lesion intrahepatique en realisant une imagerie injectee suivant un protocole complet. Il faut, dans cette situation particuliere ou l’hematome est inaugural de la pathologie sous-jacente, envisager une lesion hepatocarcinomateuse meme en l’absence d’hepatopathie, et chez les patients jeunes.

Purpose Although rare, non-traumatic hepatic haemorrhage is a known complication of liver tumors. In cases where the haemorrhage is the first clinical event, diagnostic work-up is critical. Material and methods This retrospective study was conducted between July 2001 and March 2011. Acute phase CT-scan and MRI imaging in patients diagnosed with non-traumatic liver hematomas were interpreted with particular attention to the radio-semiotic characteristics of hematomas and liver lesions. Those findings were then confronted to the patients’ final diagnoses. Results Twelve patients were included (mean age of 42 years). In seven of them a suspect liver lesion was discovered in the acute CT-Scan or MRI imaging. All lesions were strongly hyper vascular.The haemorrhage revealed hepatocarcinoma in four patients, liver adenoma in two and focal nodular hyperplasia in an other. Conclusion It is important in spontaneous liver haemorrhage to consider the high probability of hepatocarcinoma or potentially malignant lesions even when the patient has no known hepatic disorders, and especially in young patients. The results of this study show that imaging is a key issue at the acute phase of inaugural non-traumatic hepatic haemorrhages and requires a simple but complete triphasic injected protocol.

PurposeTo compare the densities of parathyroid adenomas, lymph nodes and the thyroid parenchyma during multi-phase cervico-thoracic computed tomography to determine the differentiating threshold values.Materials and methodsThis study comprises 30 patients operated for a parathyroid adenoma after computed tomography without injection and then 45 and 70seconds after the injection of an iodine based contrast product (350mgI/mL, 150mL, 3mL/s). The density of the adenomas, lymph nodes and thyroid was measured during the three phases (D0, D45, D70). The relative enhancement (RE) at 45seconds was calculated: RE=(D45–D0)/D0.ResultsA significant difference was found in the spontaneous density of the parathyroid adenomas of the thyroid (P

Resume Objectifs Comparer les densites des adenomes parathyroidiens, des ganglions lymphatiques et du parenchyme thyroidien, lors d’un scanner cervico-thoracique multiphasique pour determiner les valeurs seuils permettant de les differencier. Patients et methodes Il s’agit d’une etude portant sur 30 patients operes d’un adenome parathyroidien apres un examen scanographique realise sans injection puis 45 et 70 secondes apres injection d’un produit de contraste iode (350 mgI/mL, 150 mL, 3 mL/s). La mesure de la densite des adenomes, des ganglions lymphatiques et de la thyroide a ete effectuee sur les trois phases (D0, D45, D70). Le rehaussement relatif (RR) a 45 secondes a ete calcule : RR = (D45–D0)/D0. Resultats La densite spontanee des adenomes parathyroidiens est significativement differente de la densite de la thyroide (p Conclusion La mesure des densites permet de differencier les adenomes parathyroidiens, les ganglions lymphatiques et la thyroide.

Objectifs Evaluer les faisabilite et suites de l’ALPPS partiel (« associating liver partition and portal vein ligation for staged hepatectomy » avec split de 50 %) avec temps 1 laparoscopique (Lap-pALPPS). Methodes Cinq patients avec metastases colorectales resecables apres chimiotherapie avaient un Lap-pALPPS laparoscopique, avec evaluation volumetrique et fonctionnelle (scintigraphie SPECT-HIDA) sequentielle. Resultats Deux patients avaient un Lap-pALPPS de sauvetage apres echec d’embolisation portale. Trois patients avaient eu une colectomie anterieure, laparotomique chez deux. Le temps 1 etait mene par laparoscopie avec succes chez tous avec une duree operatoire mediane de 270 min [185–395], pertes sanguines de 250 cc [100–500] et suites simples. Les gains de volume et fonction etaient de +67 % [44,5–76 %] et +47 % [36,4–64 %], respectivement. Le temps 2 etait effectue par laparotomie entre j7 et j13 d’une duree de 190 min [153–259] avec pertes sanguines de 550 cc [100–1400]. Deux patients ont eu une fistule biliaire postoperatoire drainee radiologiquement (Clavien III), ou guerie spontanement (Clavien II). Il n’y avait pas d’insuffisance hepatique ni de deces. La duree d’hospitalisation etait de 18 [13–25] jours. Conclusion Lap-pALPPS est realisable, semblant moins agressif que l’ALPPS complet. Le gain rapide et significatif du volume fonctionnel autorise un temps 2 precoce sans adherence inflammatoire. Lap-pALPPS est une alternative interessante a l’hepatectomie en 2 temps.

Aliment Pharmacol Ther 2011; 34: 1193–1201 Summary Background Sorafenib increases median survival and time to radiological progression in patients with advanced hepatocellular carcinoma, but its benefit for Child-Pugh B patients remains uncertain. Aim To evaluate the safety and efficacy of sorafenib in real-life clinical practice conditions and to assess the influence of Child-Pugh class B on safety and efficacy. Methods All patients treated with sorafenib for advanced hepatocellular carcinoma in our institution were included prospectively. Adverse events, overall survival and time to progression were recorded. A case control study was performed to compare outcome of patients with comparable stages of hepatocellular carcinoma, but a different Child-Pugh class. Results From March 2007 to May 2009, 120 patients were included. Overall survival was 11.1 months, Child-Pugh A patients (n = 100) had significantly higher median survival than Child-Pugh B patients (n = 20) (13 vs. 4.5 months, P = 0.0008). In multivariate analysis, Child-Pugh class B, α-fetoprotein level and total size of lesions were independent predictive factors of death. Patients with radiological progression in the first 3 months had shorter median survival (5.4 vs. 17.4 months). In a case control study, time to symptomatic progression (2.5 vs. 3.6 months), frequency of adverse events and discontinuation of sorafenib were not correlated with Child-Pugh class. Conclusions Patients with advanced hepatocellular carcinoma treated with sorafenib had a median survival of 11 months. Sorafenib therapy must be considered with caution in Child-Pugh B patients due to their poor survival. Radiological assessment of tumour progression at an early stage may be advantageous when tailoring sorafenib therapy.

Serous cystadenoma is a common benign neoplasm that can be managed without surgery in asymptomatic patients provided that the diagnosis is certain. We describe a patient, whose pancreatic cyst exhibited a radiological appearance distinct from that of typical serous cystadenoma, resulting in diagnostic difficulties. CT and MRI showed a 10 cm-polycystic tumor with upstream dilatation of the main pancreatic duct (MPD), suggestive of intraductal papillary mucinous tumor (IPMT). Ultrasonographic aspect and EUS-guided fine-needle aspiration gave arguments for serous cystadenoma. ERCP showed a communication between cysts and the dilated MPD, compatible with IPMT. The patient underwent left pancreatectomy with splenectomy. Pathological examination concluded in a serous cystadenoma, with only a ductal obstruction causing proximal dilatation.

To evaluate the prevalence of sarcopenia in patients undergoing pancreatic surgery and to examine its impact on the surgical outcomes and survival of patients. Skeletal muscle index (SMI) was measured on preoperative CT. A patient was considered sarcopenic if SMI was 25) with significantly lengthened hospital stays (P = .003). After pancreatectomy for cancer, 31 (40.2%) patients showed postoperative recurrence and 23 (29.9%) died after a median follow-up of 15 ± 13.5 months. Despite comparable histological types and stages, the median overall and disease-free survivals were lower in sarcopenic patients (16 months vs not reached, P = .02 and 11.1 months vs 22.5 months; P = .04, respectively). The multivariate analysis revealed that, sarcopenia trended to increase the risk of death (HR = 2.04, P = .07). Sarcopenia negatively impacted short- and long-term outcomes in patients undergoing pancreatectomy.

International audience; Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has emerged as an alternative for patients with bilobar colorectal liver metastasis deemed unresectable due to inadequate future remnant liver (FRL). Nevertheless, high morbidity and mortality rates have been reported. In this setting, including hepatobiliary scintigraphy in the clinical and surgical management of patients offered ALPPS has been advocated to both assess eligibility for ALPPS stagel and suitable time for ALPPS stage2. Recently, it was stated that partial ALPPS with a liver split restricted to 50% of the transection line (or up to the middle hepatic vein in case of right extended hepatectomy) and a shortened stagel allows improving the postoperative course without precluding the inter-stages FRL hypertrophy. We describe a case series of p-ALPPS with stagel performed laparoscopically, including sequential assessments of the FRL volumes and functions via pre-stagel and pre-stage2 computed tomography volumetry and HIDA SPECT-scintigraphy. In five patients, laparoscopic p-ALPPS was associated with rapid and significant gain of remnant functional volume - much better than previously observed for ALPPS - facilitating early stage2 without inflammatory adherences. In conclusion, laparoscopic p-ALPPS is feasible and seems less aggressive than the original ALPPS technique with total transection. It may be an interesting alternative to the classical portal vein embolization (PVE) and two-stage hepatectomy strategy.

Le deferasirox est autorise en France depuis 2007 pour traiter les surcharges en fer chez les patients anemies polytransfuses atteints le plus souvent d'une betathalassemie, d'une drepanocytose ou d'un syndrome myelodysplasique (SMD). Cet article a pour objectif de decrire les connaissances et les pratiques actuelles de prescription et de suivi du deferasirox afin d'en ameliorer l'efficacite, la tolerance et l'observance. Le traitement par le deferasirox est contre-indique chez les patients insuffisants renaux (clairance de la creatinine < 60 mL/min) ou ceux ayant une atteinte hepatique severe. La posologie initiale sera etablie en fonction des apports transfusionnels et de l'objectif therapeutique (maintien de la balance en fer ou reduction de la surcharge), puis adaptee en fonction de l'efficacite et de la tolerance. L'efficacite sera evaluee par la mesure de la ferritinemie et des surcharges hepatique et cardiaque au mieux quantifiees par IRM. Chez les patients betathalassemiques, une surveillance reguliere de la surcharge cardiaque par IRM est indiquee a partir de l'âge de 10-12 ans. Les effets indesirables induits sont le plus souvent dose-dependants, transitoires et resolutifs sans arret du traitement. Il s'agit principalement de troubles digestifs, de rashs cutanes et d'une augmentation de la creatininemie d'intensite legere a moderee. L'education therapeutique du patient sur l'importance du traitement, l'existence des effets indesirables et les moyens de les prevenir ou de les limiter devrait permettre d'ameliorer l'observance.

Background: Tumor necrosis factor is an adipocytokine possessing a well-established lipolytic effect. In Crohn’s disease (CD) patients, infliximab therapy may thus result in visceral fat accumulation, which is associated with an increased risk of metabolic syndrome. Methods: A total of 132 CD patients were investigated. In a first prospective study, magnetic resonance imaging (MRI) quantification of subcutaneous and visceral abdominal fat was performed before and 8 weeks after initiation of infliximab induction therapy (5 mg/kg at weeks 0, 2, and 6) in 21 responding patients treated for perianal disease. In a second prospective study, fasting glycemia, glycated hemoglobin (HbA1c), HDL, LDL, and total cholesterol and triglyceride levels were assessed in 111 responding patients receiving infliximab infusions every 8 weeks, with a mean follow-up of 41 weeks. Results: A significant homogeneous 18% increase in total abdominal fat was observed in the 21 CD patients after infliximab induction therapy (P ¼ 0.027), independently of body mass index evolution. Infliximab maintenance therapy was associated with a decrease in glycemia (P < 0.0001) and HbA1c (P ¼ 0.0005) concentrations, together with an increase in both total cholesterol (P ¼ 0.02) and HDL cholesterol (P ¼ 0.008) concentrations. All glycemic and lipid parameters remained within the normal range throughout the study. Conclusions: Infliximab induction therapy is associated with a significant increase in abdominal fat tissue in CD patients. Infliximab maintenance therapy has no deleterious effects on lipid profile and is accompanied by a decrease in glycemia and HbA1c concentrations, probably by reversing the impairment of tumor necrosis factor-induced insulin-mediated glucose uptake. (Inflamm Bowel Dis 2009;15:1476–1484)

Using a limited temporal resolution dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) dataset to assess the impact of the arterial input function (AIF) choice on the transfer constant (K(trans) ) to distinguish prostate carcinoma (PCa) from benign tissue.Thirty-eight patients with clinically important peripheral PCa (≥0.5 cc) were retrospectively studied. These patients underwent 1.5T multiparametric prostate MR with PCa and benign regions of interest (ROIs) selected using a visual registration with morphometric reconstruction obtained from radical prostatectomy. Using three pharmacokinetic (PK) analysis software programs, the mean K(trans) of ROIs was computed using three AIFs: an individual AIF (Ind-AIF) and two literature population average AIFs of Weinmann (W-AIF) and of Fritz-Hansen (FH-AIF). A pairwise comparison of the area under the receiver operating characteristic curves (AUROCC) obtained with different AIFs was performed.AUROCCs obtained with W-AIF (ranging from 0.801 to 0.843) were significantly higher than FH-AIF (ranging from 0.698 to 0.780, 0.002 ≤ P ≤ 0.045) and similar to or higher than Ind-AIF (ranging from 0.591 to 0.839, 0.014 ≤ P ≤ 0.9). Ind-AIF and FH-AIF provided similar AUROCC (0.34 ≤ P ≤ 0.81). The pairwise correlation of K(trans) values was moderate to very strong when comparing W-AIF with FH-AIF (the Spearman's correlation coefficients [SCCs] ranged from 0.55 to 0.93) and very weak to moderate when comparing W-AIF with Ind-AIF (the SCCs ranged from 0.018 to 0.59) or FH-AIF with Ind-AIF (the SCCs ranged from 0.30 to 0.51).W-AIF yielded a higher performance than FH-AIF and a similar or higher performance than Ind-AIF in distinguishing PCa from benign tissue.

Objectives: We assessed the safety and efficacy of docetaxel, a microtubule inhibitor, in patients with advanced hepatocellular carcinoma (HCC). Methods: HCC patients that were not suitable for local therapy, but who possessed measurable disease, good performance status and adequate organ function were eligible. Docetaxel was administered every 3 weeks at a dose of 100 mg/m2 (or 75 mg/m2 if transaminase levels were between 1.5 and 3.5 times the upper normal limit). Efficacy was assessed radiologically every three cycles of chemotherapy. Results: Fifteen patients were enrolled: 11 males and 4 females; their median age was 64 years (range, 42–72 years). Nine patients had underlying cirrhosis. Four patients had been surgically treated before relapse (liver resection in 3 cases and transplantation in 1), 3 had been treated with arterial chemoembolization and 1 with arterial chemotherapy (doxorubicin). A total of 57 cycles of docetaxel were delivered (median 3, range 1–6). Significant toxicity was observed: mostly grade 3–4 neutropenia and fatigue (6 and 4 patients, respectively). Treatment had to be stopped because of toxicity in 6 patients, all having underlying cirrhosis. An important partial response was obtained in 1 patient, a result that enabled liver transplantation; this patient is still alive after 34 months. Five patients had transient stable disease. Conclusion: When used in this schedule, docetaxel does not appear to be safe and effective enough in patients with advanced HCC and cirrhosis.

Introduction. The diagnosis of non-HIV lipodystrophies is challenging, especially since borderline forms with type 2 diabetes have been described (Strickland Diabetes Care 2013). Aim: to identify the most specific anthropometric and biological parameters enabling to differentiate lipodystrophic from obese and control subjects. Methods. This prospective study (clin.gov 2009-AO-1169-48) included 94 patients divided in 3 groups adjusted for age and gender: 52 lipodystrophic patients (among whom 16 LMNA –mutated lipodystrophies (LDM), 16 non- LMNA mutated partial lipodystrophies (LDNM), and 20 other types of lipodystrophies), 28 obese (O; 12 diabetic (OD) and 16 non-diabetic (OND)) and 14 normal-weighed healthy subjects (C). The anthropometric (DEXA, MRI) characteristics and leptin levels of the patients were recorded. Three ratios were calculated to assess the respective part of fat and lean mass (FM/LM), intra- and whole abdominal fat (IAF/WAF) and adipose tissue function (leptin/WAF). Results. The three groups differed by the FM, LM, IAF, WAF, leptinemia, trunk FM/LM ( P