Francine Thouveny

Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival

AimsTo compare selective and non-selective TACE techniques in the treatment of HCC with a special emphasis on clinical and liver tolerance, tumour response and survival.Methods184 patients with advanced HCC were retrospectively included. Three different TACE techniques were compared: non selective lipiodol-chemotherapy + non selective embolisation (TACE-technique group 1), non selective lipiodol-chemotherapy + selective embolisation (group 2), and selective lipiodol-chemotherapy + selective embolisation (group 3).ResultsIn multivariate analysis TACE-technique group is an independently significant prognostic factor for poor clinical tolerance, poor liver tolerance and tumour response. The rate of patients with poor clinical tolerance was lower in group 3 (27.0%) than in groups 1 (64.1%, p < 10−3) or 2 (66.7%, p < 10−3). The rate of patients with poor liver tolerance was higher in group 2 (34.0%) than in groups 1 (17.6%, p = 0.050) or 3 (6.9%, p = 0.011). The rate of patients with tumour response was higher when embolisation was selective versus non-selective, i.e., group 2 + 3 (78.7%) versus group 1 (62.5%, p = 0.054). Overall survival was not significantly different between the three groups (p = 0.383).ConclusionBoth selective techniques resulted in better tumour response. As for improving tolerance, our study suggests that the main technical factor is the use of selective lipiodol-chemotherapy injection.

Portosystemic collateral vessels in liver cirrhosis: a three-dimensional MDCT pictorial review

PurposePortosystemic collateral vessels (PSCV) are a consequence of the portal hypertension that occurs in chronic liver diseases. Their prognosis is strongly marked by the risk of digestive hemorrhage and hepatic encephalopathy.Materials and methodsCT was performed with a 16-MDCT scanner. Maximum intensity projection and volume rendering were systematically performed on a workstation to analyze PSCV.ResultsWe describe the PSCV according to their drainage into either the superior or the inferior vena cava. In the superior vena cave group, we found gastric veins, gastric varices, esophageal, and para-esophageal varices. In the inferior vena cava group, the possible PSCV are numerous, with different sub groups: gastro and spleno renal shunts, paraumbilical and abdominal wall veins, retroperitoneal shunts, mesenteric varices, gallbladder varices, and omental collateral vessels. Regarding clinical consequences esophageal and gastric varices are most frequently involved in digestive bleeding; splenorenal shunts often lead to hepatic encephalopathy; the paraumbilical vein is an acceptable derivation pathway for natural decompression of the portal system.ConclusionKnowledge of precise cartography of PSCV is essential to therapeutic decisions. MDCT is the best way to understand and describe the different types of PSCV.

Planned caesarean in the interventional radiology cath lab to enable immediate uterine artery embolization for the conservative treatment of placenta accreta.

AIM To evaluate the feasibility and efficacy of routine uterine artery embolization (UAE) immediately after planned caesareans performed in the cath lab for conservative treatment of placenta accreta. MATERIALS AND METHODS A retrospective study included all patients who had a planned caesarean in the cath lab for conservative treatment of placenta accreta at Angers University Hospital, which is a tertiary care centre, from April 2001 to September 2010. Twelve patients underwent UAE immediately after caesarean with the placenta left partially or totally in situ. The success rate of embolization, blood loss, and complications were reported. RESULTS Diagnosis of abnormal placentation was confirmed by caesarean findings in 14 cases. Four patients had a percreta form with bladder invasion. In seven cases blood loss was insignificant and UAE was prophylactic; no secondary haemorrhage was observed in this group. Postpartum haemorrhage occurred in five cases: control of immediate postpartum bleeding by embolization was successful in three and failed in two leading to hysterectomy. In one case uterine necrosis occurred 6 weeks after embolization, requiring a hysterectomy. Delayed complications resulted in hysterectomy and partial bladder resection 3 months after delivery for one of the patients with placenta percreta. CONCLUSION UAE immediately after a caesarean performed in the cath lab is a feasible therapeutic option for conservative treatment of placenta accreta. Advantages include reducing stress and risks associated with transferring women with potentially unstable haemodynamics.

Embolisation de varices stomiales par injection percutanée de colle biologique

Resume Les varices stomiales presentes chez les malades avec cirrhose et stomies digestives peuvent saigner. Il s’agit d’un evenement rare mais souvent recidivant et assez difficile a traiter de maniere efficace. Dans certains cas les consequences de l’hemorragie peuvent etre severes. Nous rapportons 2 cas de varices stomiales hemorragiques traites par embolisation percutanee par injection de colle biologique. Chez chacun des malades, apres echec des traitements pharmacologique classique (propranolol) de l’hypertension portale, un traitement par injection percutanee de colle biologique a permis de traiter de maniere efficace les varices hemorragiques. Apres un suivi respectif de 8 et 16 mois, aucun effet secondaire, ni de recidive hemorragique n’etait note. Le traitement des hemorragies stomiales par injection de colle biologique apparait etre un traitement efficace, aise, et sans complication.

MRI and venographic aspects of pelvic venous insufficiency.

Pelvic venous insufficiency is a frequent pathology in multiparous women. Diagnosis can be made by chance or suspected in the case of symptoms suggesting pelvic congestion syndrome or atypical lower limb varicosity fed by pelvic leaks. After ultrasound confirmation, dynamic venography is the reference pretherapeutic imaging technique, searching for pelvic varicosity and possible leaks to the lower limbs. MRI is less invasive and allows a three-dimensional study of the varicosity and, with dynamic angiography, it can assess ovarian reflux. It also helps to plan or even sometimes avoid diagnostic venography.

Syndrome aortique : quelle imagerie réaliser ?

Acute aortic syndrome is an emergency that requires prompt diagnosis and treatment because of its high morbidity and mortality rates. The chosen imaging modality should allow to diagnose or eliminate the presence of an acute aortic syndrome but also identify signs of severity of the aortic disease. Computed tomography, transesophageal echocardiography and MRI have high sensitivity and specificity values and roughly equivalent for the diagnosis of acute aortic syndromes. Computed tomography has the advantage of identifying involvement of aortic collaterals including visceral branches of the abdominal aorta. In clinical practice, Computed tomography is the diagnostic modality the most often performed, followed by trans esophageal echocardiography. If a high clinical suspicion exists for acute aortic syndrome but initial aortic imaging is negative, a second imaging study should be obtained without delay.

Aneurysms of the sinus of Valsalva revealed by an acute coronary syndrome.

r Masson SAS. Tous droits réservés. Document téléchargé le 15/04/2020 Il est interdit et illégal he heart, and was contrast-enhanced (80 ml of iodixanol, 20 mg iodine per ml, at 5 ml/s). The acquisition parameters ere as follows: cardiac synchronisation through retrospecive gating, no ECG-based dose modulation, slice thickness: 4 × 0.625 mm, kilovoltage: 120 kV, rotation time: 0.4 s, econstruction of 1.2 mm every 0.8 mm, using phases covring the whole RR interval from 0 to 90%. This CT scan meant that we could perform a morphologcal analysis of these two ASV (Figs. 3—5) at the anterior ight and left sinuses, which measured 25 × 23 mm and 0 × 27 mm respectively. The ascending aorta was dilated, easuring 39 mm at the sinuses (excluding the ASV), 29 mm t the sinotubular junction, and 30 mm in its mid-portion. phase-by-phase analysis using multiplanar reformatting llowed us to examine the free movement of the aortic alve, which showed no abnormality in spite of its proximity o the two ASV. The right coronary stenosis was considered to be the ause of the coronary syndrome and a double angioplasty as carried out on the second day of the admission. Further to this, the indication for an ascending aorta eplacement was considered. This non-emergent surgical

Embolisation d'un anévrisme rompu de l'artère ovarienne du post-partum

Une femme multipare de 39 ans consultait aux urgences pour des douleurs abdominales aigues. Cette patiente, 5 e geste, 4 e pare, sans antecedent medicochirurgical notable, avait accouche d’un garcon en bonne sante apres 39 semaines d’amenorrhee. Les suites de couches avaient ete simples. Au cinquieme jour apres l’accouchement, elle presentait des douleurs abdominales brutales, diffuses, associees a une pâleur cutanee. A l’admission, la tension arterielle etait de 100/50 mmHg, la frequence cardiaque a 88 battements par minute et la temperature a 36,8 ° C. L’examen clinique ne montrait pas de contracture ni de defense abdominale. L’hemoglobine etait a 8,1 g/dL. Il n’y avait pas d’autre anomalie du bilan biologique. Une echographie abdominale et pelvienne ne montrait pas d’epanchement intra-peritoneal et l’uterus semblait bien retracte. Il a donc ete evoque dans un premier temps des douleurs d’origine digestive ou des tranchees, contractions douloureuses survenant dans les suites de couches qui permettent l’evacuation des debris placentaires. La patiente a ete gardee en observation. Les douleurs abdominales se sont intensifiees 48 heures plus tard et l’etat de la patiente s’est aggrave avec notamment une chute de l’hemoglobinemie a 5 g/dL. Une nouvelle echographie decouvrait une masse retroperitoneale heterogene evocatrice d’un hemoretroperitoine. Un scanner abdomino-pelvien etait alors realise comportant une acquisition volumique en contraste spontane suivie d’une acquisition apres injection de produit de contraste iode (Xenetix 350 : 120 ml a 3 ml/s) a un temps portal. Il revelait un volumineux epanchement retro-peritoneal, heterogene avec des hyperdensites spontanees traduisant une composante hematique recente, sans extravasation de produit de contraste visible, ainsi qu’un epanchement intraperitoneal de moyenne abondance (fig. 1 et 2) . Des structures tubulaires variqueuses latero-uterines droites etaient decrites (fig. 2) . Une arteriographie etait realisee secondairement devant l’instabilite hemodynamique de la patiente malgre le remplissage vasculaire et les transfusions. Apres une

Comment realiser et interpreter un scanner des arteres des membres inferieurs

Objectifs Savoir optimiser les parametres d’acquisition et d’injection de produit de contraste. Savoir adapter le protocole face aux conditions particulieres : stenoses ou thromboses etagees, troubles trophiques, pathologie anevris-mal aortique et/ou poplite. Connaitre les differents modes de reconstructions. Messages a retenir Le temps de progression du produit de contraste est variable selon la situation clinique : augmente en cas de stenoses ou thrombose etagees, de pathologie anevrismale, raccourci en cas de troubles trophiques distaux. On doit prendre garde, notamment avec les appareils 64 barrettes, a ne pas depasser la progression du produit de contraste lors de l’acquisition. Resume L’acquisition doit durer environs 40 secondes ; ceci necessite le ralentissement du temps de rotation (0,5 a 0,75 s) et du deplacement de table ; ceci doit etre adapte a la situation clinique. Une injection de 120-140 ml de produit de contraste a 3-3,5 ml/s permet d’obtenir une phase de plateau de rehaussement suffisamment longue tout le long de l’acquisition. Une seconde acquisition centree sur les jambes peut etre enchainee rapidement en cas d’absence d’opacifica-tion du reseau jambier. Les reconstructions de type angiographique donnent une vision globale de l’arbre vasculaire ; elles doivent etre completees par l’analyse des coupes axiales transverses et des reconstructions en mode 2D curviligne automatisees.

RI-WP-9 Reste-t-il un interet pour la lymphographie au XXIE siecle ?

Objectifs Rappeler la technique de la lymphographie. Rappeler les indications passees et actuelles de la lymphographie notamment comme methode therapeutique pour les fistules lymphatiques. Connaitre la physiopathologie et le traitement des fistules lymphatiques. Points cles L’interet de la lymphographie persiste chez les patients avec une fistule lymphatique, notamment a l’etage thoracique. La methode a un double but : traiter l’ecoulement et orienter une eventuelle future chirurgie si l’ecoulement persiste.