Frederic Pigneur

Sarcopenia Impacts on Short- and Long-term Results of Hepatectomy for Hepatocellular Carcinoma.

OBJECTIVE To evaluate the prevalence of sarcopenia among European patients with resectable hepatocellular carcinoma (HCC) and to assess its prognostic impact on overall and disease-free survival. BACKGROUND Identification of preoperative prognostic factors in liver surgery for HCC is required to better select patients and improve survival. Recent studies have shown that preoperative discrimination of patients with low skeletal muscle mass (sarcopenic patients) using computed tomography was associated with morbidity and mortality after liver and colorectal surgery. Assessment of sarcopenia could be used to evaluate patients before hepatectomy for HCC. METHODS All consecutive patients who underwent hepatectomy for HCC in our institution, between February 2006 and September 2012, were included. Univariate and multivariate analyses evaluating prognostic factors of postoperative mortality and cancer recurrence were performed, including preoperative, surgical, and histopathological factors. RESULTS Among 198 patients who underwent hepatectomy for HCC, 109 patients had an available computed tomographic scan and represent the study cohort. After a median follow-up of 21.23 months, 27 patients (24.8%) died. There were 20 deaths among the 59 patients who had sarcopenia and only 7 deaths in the nonsarcopenic group. Sarcopenic patients had significantly shorter median overall survival than nonsarcopenic patients (52.3 months vs 70.3 months; P = 0.015). On multivariate analysis, sarcopenia was found to be an independent predictor of poor overall survival (hazard ratio = 3.19; P = 0.013) and disease-free survival (hazard ratio = 2.60; P = 0.001). CONCLUSIONS Sarcopenia was found to be a strong and independent prognostic factor for mortality after hepatectomy for HCC in European patients and could be used to evaluate eligibility of patients with HCC before surgery.

Whole-body diffusion-weighted imaging with apparent diffusion coefficient mapping for treatment response assessment in patients with diffuse large B-cell lymphoma: pilot study.

Objectives:The aim of this pilot study was to assess post-treatment apparent diffusion coefficient (ADC) changes of diffuse large B-cell lymphoma lesions on respiratory-gated whole-body diffusion-weighted imaging (DWI), with integrated 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography (PET/CT) as the reference standard. Materials and Methods:A total of 15 patients underwent both whole-body DWI (b = 50, 400, 800 s/mm2) and PET/CT before initiation and after 4 cycles of chemotherapy. ADC of residual masses (lymph node and organ lesions) was assessed both visually and quantitatively, including measurement of mean ADC (SYMBOL).Symbol. No caption available. Results:After chemotherapy, among 85 examined lymph node regions, residual nodes were present in 62 (73%) regions on DWI. Of these 62 regions, 26 had persistent lymph nodes with longest transverse diameter >10 mm, ie, positive based on DWI size criteria. The mean SYMBOL of these 26 regions increased from 0.658 × 10−3 ± 0.153 mm2/s (standard deviation) at baseline to 1.501 × 10−3 ± 0.307 mm2/s (paired t test, P < 0.0001). Only 6 of these 26 regions were considered positive on PET/CT. Combining visual ADC analysis to size criteria reduced the number of false-positive results of DWI from 20 to 2 regions. For organ involvement, SYMBOL values also increased compared with baseline (1.558 × 10−3 ± 0.424 mm2/s vs. 0.675 ×10−3 ± 0.135 mm2/s, respectively; P = 0.0009). Conclusions:Whole-body DWI with ADC mapping can show a significant increase in ADC values of residual masses persisting after treatment and may help to assess the treatment response in patients with diffuse large B-cell lymphoma.

Ex vivo MRI of axillary lymph nodes in breast cancer

PURPOSE To provide a strategy for precise co-localization of lymph nodes on axillary lymph-node dissection (ALND) specimens both on pathology and MR. To identify nodal features suggestive of metastatic involvement on a node-to-node basis. MATERIALS AND METHODS National Institutional review-board approved this prospective study of 18 patients with breast cancer referred for ALND. Ex vivo T1 and inversion recovery (IR) T2 WI of ALND specimens tightly positioned within scaled plastic cranes was performed immediately after surgery. The correspondence of MR-based or pathologically based nodes location was assessed. The MR size and morphological presentation of metastatic and normal nodes were compared (Students t-test or Mann-Whitney test). Quantitative variables were compared using Pearson coefficient. RESULTS 207 nodes were retrieved on pathology and 165 on MR. MR-pathological correlation of nodes location was high regarding MR-identified nodes (r=0.755). An MR short axis threshold of 4mm yielded the best predictive value for metastatic nodal involvement (Se=78.6%; Sp=62.3%). Irregular contours (Se=35.7%; Sp=96.7%), central nodal hyper-intensity on IR T2 WI (Se=57.1%; Sp=91.4%), and a cortical thickness above 3mm (Se=63.6%; Sp=83.2%) were significantly associated with metastatic involvement. CONCLUSION Ex vivo MR allows node-to-node correlation with pathology. Morphological MR criteria can suggest metastatic involvement.

Intravoxel Incoherent Motion Diffusion-weighted Imaging of Multiple Myeloma Lesions: Correlation with Whole-Body Dynamic Contrast Agent–enhanced MR Imaging

PURPOSE To correlate intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters with the enhancement patterns of bone marrow and focal lesion obtained on whole-body (WB) dynamic contrast agent-enhanced (DCE) magnetic resonance (MR) images in patients with stage-III multiple myeloma (MM) before and after systemic therapy. MATERIALS AND METHODS Twenty-seven patients with MM were retrospectively included in this institutional review board-approved study. Requirement for written informed consent was waived. All patients underwent WB DCE MR imaging before treatment and 18 patients underwent repeat MR imaging 3 months after treatment. A transverse IVIM DWI sequence with 10 b values (0, 10, 20, 30, 50, 80, 100, 200, 400, and 800 sec/mm(2)) was acquired within bone marrow and focal lesions. The IVIM parameters (perfusion fraction [f], molecular diffusion coefficient [D], and perfusion-related D [D*]) and apparent diffusion coefficient (ADC) were extracted for both focal lesions and bone marrow and correlated with focal lesions and maximal bone marrow enhancement (BMEmax) (Spearman correlation coefficient) at baseline and at follow-up (Wilcoxon signed-rank test). RESULTS D and ADC values positively correlated with BMEmax (r = 0.7, P < .001; and r = 0.455, P = .0435, respectively). Patients with increased BMEmax showed significantly increased ADC and D within bone marrow versus patients who did not have increased BMEmax (ADC, 0.67 × 10(-3) mm(2)/sec vs 0.54 × 10(-3) mm(2)/sec, P = .03; D, 0.58 × 10(-3) mm(2)/sec vs 0.42 × 10(-3) mm(2)/sec, P < .001). Within focal lesions, f was the maximum in lesions that showed enhancement followed by washout. After treatment in good responders, the significant decrease in maximal enhancement value of focal lesions (baseline vs after treatment, 213.9% ± 78.7 [standard deviation] vs 131% ± 53.6, respectively; P < .001) was accompanied by a significant decrease in f (baseline vs after treatment, 11% ± 3.8 vs 5.8% ± 4.7, respectively; P < .001). CONCLUSION Diffuse bone marrow involvement is associated with increased D. Hypervascular focal lesions with high maximal enhancement value of focal lesions also show high f value. Likewise, the decreased maximal enhancement value of focal lesions after treatment is accompanied by decreased f.

Differentiation of focal nodular hyperplasia from hepatocellular adenoma: Role of the quantitative analysis of gadobenate dimeglumine-enhanced hepatobiliary phase MRI.

To determine the value of quantitative analysis of the hepatobiliary phase (HBP) in gadobenate dimeglumine (Gd‐BOPTA)‐enhanced magnetic resonance imaging (MRI) to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA).

Liver magnetic resonance diffusion weighted imaging: 2011 update.

Diffusion-Weighted-Imaging (DWI) assesses proton motion on a cellular scale. Owing to recent instrumentation developments, diffusion sequences are now routinely used for liver imaging. This review will go through the physical principles that underlie this technique, and then highlight up-to-date liver applications including quantification of liver fibrosis, focal lesions detection and characterization, and therapy response monitoring.

Patients with Plasma Cell Disorders Examined at Whole-Body Dynamic Contrast-enhanced MR Imaging: Initial Experience

UNLABELLED This study was approved by the institutional review board, and informed consent was obtained from all subjects. The authors prospectively evaluated the feasibility of multistation whole-body dynamic contrast material-enhanced magnetic resonance (MR) imaging performed in patients with plasma cell disorders to assess disease extension and the time-signal intensity curves of diffuse and focal bone marrow infiltration. Three healthy adult male volunteers (age range, 29-31 years) and 21 patients (12 men, nine women; age range, 34-79 years) underwent whole-body dynamic unenhanced (volunteers) and contrast-enhanced MR imaging, which was performed by using an 18-channel 1.5-T MR system. A five-station (three sagittal and two coronal planes) fat-saturated three-dimensional gradient-echo sequence (3.3-3.6/1.3 [repetition time msec/echo time msec], 20 degrees flip angle, voxel size of 2 x 2.6 x [3-5] mm) was performed seven times. The temporal resolution of the five-station dynamic contrast-enhanced examination was 60 seconds with use of parallel imaging. Time-signal intensity curves for the bone marrow and the focal lesions were successfully obtained in all patients. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/250/3/905/DC1http://radiology.rsnajnls.org/cgi/content/full/250/3/905/DC2http://radiology.rsnajnls.org/cgi/content/full/250/3/905/DC3.

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy.

Background Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results Among 360 patients treated for ILC in 2004–2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2–60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR-guided biopsy is required in case of suspicious MRI images in this context.

Visceral fat area predicts survival in patients with advanced hepatocellular carcinoma treated with tyrosine kinase inhibitors.

BACKGROUND Anthropometric measurements have been linked to resistance to anti-angiogenic treatment and survival. METHODS Patients with advanced hepatocellular carcinoma treated with sorafenib or brivanib in 2008-2011 were included in this retrospective study. Anthropometric measurements were assessed using computed tomography and were correlated with drug toxicity, radiological response, and overall survival. RESULTS 52 patients were included, Barcelona Clinic Liver Classification B (38%) and C (62%), with a mean value of α-fetoprotein of 29,554±85,654 ng/mL, with a median overall survival of 10.5 months. Sarcopenia was associated with a greater rate of hand-foot syndrome (P=0.049). Modified Response Evaluation Criteria In Solid Tumours (mRECIST) and Choi criteria were significantly associated with survival, but RECIST criteria were not. An absence of hand-foot syndrome and high-visceral fat area were associated with progressive disease as assessed by RECIST and mRECIST criteria. In multivariate analyses, high visceral fat area (HR=3.6; P=0.002), low lean body mass (HR=2.4; P=0.015), and presence of hand-foot syndrome (HR=1.8; P=0.004) were significantly associated with overall survival. In time-dependent multivariate analyses; only high visceral fat area was associated with survival. CONCLUSION Visceral fat area is associated with survival and seems to be a predictive marker for primary resistance to tyrosine kinase inhibitors in patients with advanced hepatocellular carcinoma.

Pathologie de l’ouraque : kyste de l’ouraque infecté, à propos d’un cas

a Service d’imagerie médicale, groupe Henri-Mondor Albert-Chenevier, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France b Service de chirurgie urologique, groupe Henri-Mondor Albert-Chenevier, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France c Service d’anatomopathologie, groupe Henri-Mondor Albert-Chenevier, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France