المؤلفون: Fillias, Quentin, Millet, Ingrid, Guiu, Boris, Orliac, Celine, Curros Doyon, Fernanda, Gamon, Lucie, Molinari, Nicolas, Taourel, Patrice

المصدر: European Radiology; Sep2022, Vol. 32 Issue 9, p6355-6366, 12p, 4 Black and White Photographs, 2 Diagrams, 4 Charts, 1 Graph

مصطلحات موضوعية: PREDICTIVE tests, RISK assessment, RETROSPECTIVE studies, ISCHEMIC colitis, PROGNOSIS

مستخلص: Objective: To develop a simple scoring system in order to predict the risk of severe (death and/or surgery) ischemic colitis METHODS: In this retrospective study, 205 patients diagnosed with ischemic colitis in a tertiary hospital were consecutively included over a 6-year period. The study sample was sequentially divided into a training cohort (n = 103) and a validation cohort (n = 102). In the training cohort, multivariable analysis was used to identify clinical, biological, and CT variables associated with poor outcome and to build a risk scoring system. The discriminative ability of the score (sensitivity, specificity, positive predictive value, negative predictive value) was estimated in the two cohorts to externally validate the score, and a receiver operating characteristic curve was established to estimate the area under the curve of the score. Bootstrapping was used to validate the score internally.Results: In the training cohort, four independent variables were associated with unfavorable outcome: hemodynamic instability (2 pts), involvement of the small bowel (1 pt), paper-thin wall pattern (3 pts), no stratified enhancement pattern (1 pt). The score was used to categorize patients into low risk (score: 0, 1), high risk (score: 2-3), and very high risk (score: 4-7) groups with sensitivity and specificity of 97% and 67%, respectively, and a good discriminating capability, with a C-statistic of 0.94. Internal and external validation showed good discrimination capability (C-statistics of 0.9 and 0.84, respectively).Conclusion: A simple risk score can stratify patients into three distinct prognosis groups, which can optimize patient management.Clinical Trial Number: NCT04662268 KEY POINTS: • Simple scoring system predicting the risk of severe ischemic colitis • First study to include CT findings to the clinical and biological data used to determine a severity score. [ABSTRACT FROM AUTHOR]

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المؤلفون: Faget, Claire, Millet, Ingrid, Sebbane, Mustapha, Thuret, Rodolphe, Verheyden, Cécile, Curros-Doyon, Fernanda, Molinari, Nicolas, Taourel, Patrice

المصدر: European Radiology; May2021, Vol. 31 Issue 5, p2983-2993, 11p, 1 Diagram, 3 Charts, 2 Graphs

مصطلحات موضوعية: RENAL colic, COMPUTED tomography, COLIC, ULTRASONIC imaging, SUSPICION, DIAGNOSIS

مستخلص: Objective: Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU). Materials and methods: A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US. Results: One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%. Conclusion: In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold. Key Points: • For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold. • For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Nougaret, Stephanie, Monsonis, Benjamin, Molinari, Nicolas, Riviere, Benjamin, Piron, Lauranne, Kassam, Zahra, Cassinotto, Christophe, Guiu, Boris

المصدر: European Radiology; Sep2020, Vol. 30 Issue 9, p4752-4761, 10p, 3 Diagrams, 3 Charts, 3 Graphs

مصطلحات موضوعية: LIVER, LIVER tumors, FATTY liver, MAGNETIC resonance imaging, RETROSPECTIVE studies, CONTRAST media, DIFFERENTIAL diagnosis, LIVER diseases, HEPATOCELLULAR carcinoma

مستخلص: Objectives: To quantify and compare the fat fraction of background liver and primary liver lesions using a triple-echo-gradient-echo sequence. M&M: This IRB-approved study included 128 consecutive patients who underwent a liver MRI for lesion characterization. Fat fraction from the whole lesion volume and the normal liver parenchyma were computed from triple-echo (consecutive in-phase, opposed-phase, in-phase echo times) sequence.Results: Forty-seven hepatocellular carcinoma (HCCs), 25 hepatocellular adenomas (HCAs), and 56 focal nodular hyperplasia (FNH) were included. The mean intralesional fat fraction for various lesions was 7.1% (range, 0.5-23.6; SD, 5.6) for HCAs, 5.7% (range, 0.8-14; SD, 2.9) for HCCs, and 2.3% (range, 0.8-10.3; SD, 1.9) for FNHs (p = 0.6 for HCCs vs HCA, p < 0.001 for FNH vs HCCs or HCA). A fat fraction threshold of 2.7% enabled distinction between HCA and FNH with a sensitivity of 80% and a specificity of 77%. The mean normal liver parenchyma fat fraction was lower than the intralesional fat fraction in the HCC group (p = 0.04) and higher in the FNH group (p = 0.001), but not significantly different in the HCA group (p = 0.51).Conclusion: Triple-echo-gradient-echo is a feasible technique to quantify fat fraction of background liver and primary liver lesions. Intralesional fat fraction obtained from lesion whole volume is greater for HCCs and HCA compared to FNH. When trying to distinguish FNH and HCA, an intralesional fat fraction < 2.7% may orient toward the diagnosis of FNH.Key Points: • Triple-echo technique is feasible to quantify intralesional fat fraction of primary liver lesions. • Whole volume intralesional fat fraction is greater for HCCs and HCA compared to FNH. • An intralesional fat fraction < 2.7% may orient toward the diagnosis of FNH. [ABSTRACT FROM AUTHOR]

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المؤلفون: Cassinotto, Christophe, Pierredon-Foulongne, Marie-Ange, Belgour, Ali, Delicque, Julien, Escal, Laure, Molinari, Nicolas, Anselme, Sophie, Jacq, Tony, Chamard-Champliaud, Ugo, Nicolan, Bastien, Allimant, Carole, Guiu, Boris

المصدر: European Radiology; Feb2020, Vol. 30 Issue 2, p1088-1095, 8p, 1 Color Photograph, 2 Diagrams, 1 Chart, 1 Graph

مصطلحات موضوعية: ACOUSTIC radiation force impulse imaging, AREA measurement, LIVER, ELASTOGRAPHY, ULTRASONIC imaging, CHRONICALLY ill

مستخلص: Objectives: To assess the learning curve for performing reliable liver stiffness measurements using a new hybrid machine composed of transient elastography (TE) interfaced with an ultrasound device for radiographers and radiologists with different levels of expertise in ultrasound imaging.Methods: Ten novice operators who had never performed TE measurements were prospectively evaluated from April to October 2018: senior radiologists, young radiologists, fellows, radiographers, and residents, with different levels of experience in abdominal ultrasound imaging. All operators had a short theoretical training followed by a training session under supervision in three patients. Then, each operator had to perform TE in 50 consecutive patients with chronic liver disease, using beforehand ultrasound examination to select measurement area in the right liver lobe, and if needed, the XL probe. Percentages of failures and reliable measurements were compared.Results: The rates of failures of measurements, poorly reliable, reliable, and very reliable results, were of 4.2% (21/500), 2.4% (12/500), 47.6% (238/500), and 45.8% (229/500), respectively. The rates of reliable plus very reliable results were excellent, ranging from 91 to 96% among all the subgroups. The rates of very reliable, reliable, and unreliable results did not differ between operator subgroups and especially between junior radiologists, senior radiologists, and radiographers. No breaking point was observed in the interquartile range/median values over time.Conclusion: TE interfaced with ultrasound in this hybrid machine presents no learning curve effect. After a short initial training session, a novice observer is able to perform high rates of reliable and very reliable TE measurements.Key Points: • When performing liver stiffness measurements using a new hybrid machine composed of transient elastography interfaced with ultrasound, the rate of failures of measurements is very low, below 5%. • After a short training session and using ultrasound planning, a novice operator, whatever its expertise in ultrasound imaging, is capable of performing high rates of reliable and very reliable measurements. • No learning curve is needed for performing reliable liver stiffness measurements using this new hybrid machine. [ABSTRACT FROM AUTHOR]

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المؤلفون: El Hentour, Kim, Millet, Ingrid, Pages-Bouic, Emmanuelle, Curros-Doyon, Fernanda, Molinari, Nicolas, Taourel, Patrice

المصدر: European Radiology; Feb2018, Vol. 28 Issue 2, p673-682, 10p, 4 Black and White Photographs, 2 Diagrams, 3 Charts

مصطلحات موضوعية: PELVIC inflammatory disease, DECISION trees, APPENDICITIS, ABDOMINAL pain, REGRESSION trees

مستخلص: Purpose: To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome.Materials and Methods: This retrospective study was approved by our institutional review board and informed consent was waived. Contrast-enhanced CT studies of 109 women with acute PID and 218 age-matched women with AA were retrospectively and independently reviewed by two radiologists to identify CT findings predictive of PID or AA. Surgical and laboratory data were used for the PID and AA reference standard. Appropriate tests were performed to compare PID and AA and a CT decision tree using the classification and regression tree (CART) algorithm was generated.Results: The median patient age was 28 years (interquartile range, 22-39 years). According to the decision tree, an appendiceal diameter ≥ 7 mm was the most discriminating criterion for differentiating acute PID and AA, followed by a left tubal diameter ≥ 10 mm, with a global accuracy of 98.2 % (95 % CI: 96-99.4).Conclusion: Appendiceal diameter and left tubal thickening are the most discriminating CT criteria for differentiating acute PID from AA.Key Points: • Appendiceal diameter and marked left tubal thickening allow differentiating PID from AA. • PID should be considered if appendiceal diameter is < 7 mm. • Marked left tubal diameter indicates PID rather than AA when enlarged appendix. • No pathological CT findings were identified in 5 % of PID patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Millet, Ingrid, Sebbane, Mustapha, Molinari, Nicolas, Pages-Bouic, Emma, Curros-Doyon, Fernanda, Riou, Bruno, Taourel, Patrice

المصدر: European Radiology; Feb2017, Vol. 27 Issue 2, p868-877, 10p

مصطلحات موضوعية: EMERGENCY medical diagnosis, EMERGENCY medical services, TOMOGRAPHY, ABDOMINAL radiography, OLDER patients, ABDOMINAL pain, AORTIC diseases, APPENDICITIS, BILIOUS diseases & biliousness, COLIC, COLITIS, COMPUTED tomography, DIGESTIVE system diseases, DIVERTICULITIS, FECAL impaction, HOSPITAL emergency services, BOWEL obstructions, KIDNEY diseases, LONGITUDINAL method, PANCREATITIS, PEPTIC ulcer, PYELONEPHRITIS, DISCHARGE planning, CONTRAST media, ACUTE diseases, MESENTERIC ischemia, DISEASE complications

مستخلص: Objectives: To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms.Methods: Institutional review board approval and informed consent were obtained. This prospective study included 401 consecutive patients 75 years of age or older, admitted to the ED with acute abdominal symptoms, and investigated by early systematic unenhanced abdominal CT scan. ED diagnosis and intended management before CT, after unenhanced CT, and after contrast CT if requested, were recorded. Diagnosis and management accuracies were evaluated and compared before CT (clinical strategy) and for two conditional strategies (current practice and systematic unenhanced CT). An expert clinical panel assigned a final diagnosis and management after a 3-month follow-up.Results: Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1x10-6) and management (88.5% to 95.8%, p=2.6x10-6) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement.Conclusions: Systematic unenhanced abdominal CT improves ED diagnosis accuracy and appropriate management in elderly patients presenting with acute abdominal symptoms compared to current practice.Key Points: • Systematic unenhanced CT improves significantly diagnosis accuracy compared to current practice. • Systematic unenhanced CT optimizes appropriate hospitalization by increasing the number of discharged patients. • Systematic unenhanced CT allows detection of about one-third of acute unsuspected abdominal conditions. • It should allow boosting emergency department management decision-making confidence in old patients. [ABSTRACT FROM AUTHOR]

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المؤلفون: Faget, Claire, Taourel, Patrice, Charbit, Jonathan, Ruyer, Alban, Alili, Chakib, Molinari, Nicolas, Millet, Ingrid

المصدر: European Radiology; Dec2015, Vol. 25 Issue 12, p3620-3628, 9p, 2 Black and White Photographs, 1 Diagram, 4 Charts, 1 Graph

مصطلحات موضوعية: ABDOMINAL surgery, ABDOMINAL injuries, BLUNT trauma, COMPUTED tomography, MESENTERY, PREDICTIVE tests, RETROSPECTIVE studies, WOUNDS & injuries

مستخلص: Objectives: To evaluate the performance of a computed tomography (CT) diagnostic score to predict surgical treatment for blunt bowel and/or mesentery injury (BBMI) in consecutive abdominal trauma.Methods: This was a retrospective observational study of 805 consecutive abdominal traumas with 556 patients included and screened by an abdominal radiologist blinded to the patient outcome, to evaluate numerous CT findings and calculate their diagnostic performances. These CT findings were compared using univariate and multivariate analysis between patients who had a laparotomy-confirmed BBMI requiring surgical repair, and those without BBMI requiring surgery. A CT score was obtained with an internal bootstrap validation.Results: Fifty-six patients (10.1 %) had BBMI requiring surgery. Nine CT signs were independently associated with BBMI requiring surgery and were used to develop a CT diagnostic score. The AUC of our model was 0.98 (95 % CI 0.96-100), with a ≥5 cut-off. Its diagnostic performance was determined by internal validation: sensitivity 91.1-100 %, specificity 85.7-97.6 %, positive predictive value 41.4-82.3 % and negative predictive value 98.9-100 %. Bowel wall discontinuity and mesenteric pneumoperitoneum had the strongest association with BBMI requiring surgery (OR = 128.9 and 140.5, respectively).Conclusion: We developed a reliable CT scoring system which is easy to implement and highly predictive of BBMI requiring surgery.Key Points: • Finding of bowel wall discontinuity or mesenteric pneumoperitoneum indicates BBMI requiring surgery. • Arterial mesenteric vessel extravasation requires surgery when in association with other CT findings. • Our CT scoring system has excellent diagnostic performance in predicting BBMI requiring surgery. [ABSTRACT FROM AUTHOR]

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المؤلفون: Millet, Ingrid, Taourel, Patrice, Ruyer, Alban, Molinari, Nicolas

المصدر: European Radiology; Jun2015, Vol. 25 Issue 6, p1823-1835, 13p

مصطلحات موضوعية: BOWEL obstructions, MEDICAL databases, MESENTERY, PATIENTS, ISCHEMIA

مستخلص: Purpose: Our aim was to assess the diagnostic performance in determining strangulation in small bowel obstruction (SBO) for five CT findings commonly considered in published small bowel obstruction (SBO) management guidelines. Materials and methods: Medical databases were searched for 'bowel obstruction', 'computed tomography', 'strangulation', and related terms. Two reviewers independently selected articles for CT findings investigated with surgical or histological reference standards for strangulation. Bivariate random-effects meta-analytical methods were used. Results: A total of 768 patients, including 205 with strangulation from nine studies, were evaluated. The reduced bowel wall enhancement CT sign had the highest specificity (95 %, CI 75-99), with a positive LR of 11.07 (2.27-53.88) and DOR of 22.86 (4.99-104.61). The mesenteric fluid sign had the highest sensitivity (89 %, CI 75-96) with a negative LR of 0.16 (0.07-0.39) and a DOR of 13.9 (5.73-33.75). The bowel wall thickness had a sensitivity of 48 % (CI 41-54), a specificity of 83 % (CI 74-89), a positive LR of 2.84 (1.83-4.41) and a negative LR of 0.62 (0.53-0.72). The other CT findings had lower diagnostic performance. Conclusion: Two CT findings should be used in clinical practice: reduced enhanced bowel wall is highly predictive of ischemia, and absence of mesenteric fluid is a reliable finding to rule out strangulation. Key Points: • Reduced bowel wall enhancement on CT increases the probability of strangulation 11- fold. • Absence of mesenteric fluid on CT decreases the probability of strangulation 6-fold. • The clinical reliability of other CT signs is doubtful for predicting strangulation. [ABSTRACT FROM AUTHOR]

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المؤلفون: Nougaret, Stephanie, Reinhold, Caroline, Chong, Jaron, Escal, Laure, Mercier, Gregoire, Fabre, Jean, Guiu, Boris, Molinari, Nicolas

المصدر: European Radiology; May2014, Vol. 24 Issue 5, p1020-1029, 10p, 2 Color Photographs, 2 Black and White Photographs, 3 Diagrams, 3 Charts, 1 Graph

مصطلحات موضوعية: MAGNETIC resonance imaging, PANCREATIC cysts, GADOLINIUM, DIAGNOSTIC imaging, MEDICAL imaging systems, DIAGNOSIS

مستخلص: Objectives: To examine the natural history of incidentally detected pancreatic cysts and whether a simplified MRI protocol without gadolinium is adequate for lesion follow-up. Methods: Over a 10-year period, 301-patients with asymptomatic pancreatic cysts underwent follow-up (45 months ± 30). The magnetic resonance imaging (MRI) protocol included axial, coronal T2-weighted images, MR cholangiopancreatographic and fat suppressed T1-weighted sequences before and after gadolinium. Three radiologists independently reviewed the initial MRI, the follow-up studies using first only unenhanced images, then secondly gadolinium-enhanced-sequences. Lesion changes during follow-up were recorded and the added value of gadolinium-enhanced sequences was determined by classifying the lesions into risk categories. Results: Three hundred and one patients (1,174 cysts) constituted the study population. Only 35/301 patients (12 %) showed significant lesion change on follow-up. Using multivariate analysis the only independent factor of lesion growth (OR = 2.4; 95 % CI, 1.7-3.3; P < 0.001) and mural nodule development (OR = 1.9; 95 % CI, 1.1-3.4, P = 0.03) during follow-up was initial lesion size. No patient with a lesion initial size less than 2 cm developed cancer during follow-up. Intra-observer agreement with and without gadolinium enhancement ranged from 0.86 to 0.97. After consensus review of discordant cases, gadolinium-enhanced sequences demonstrated no added value. Conclusion: Most incidental pancreatic cystic lesions did not demonstrate change during follow-up. The addition of gadolinium-enhanced-sequences had no added-value for risk assignment on serial follow-up. Key points: • Significant growth of pancreatic cysts occurred in a minority of patients only. • No lesion <2 cm demonstrated any change during the first year of follow-up. • Intra-observer agreement between MR pancreatic protocols with and without gadolinium was excellent. • Gadolinium application had limited value for follow-up of asymptomatic pancreatic cystic lesions. [ABSTRACT FROM AUTHOR]

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