Publications by authors named "Alain Luciani"

140 Publications

Impact of the F-FDG-PET/MRI on Metastatic Staging in Patients with Hepatocellular Carcinoma: Initial Results from 104 Patients.

J Clin Med 2021 Sep 6;10(17). Epub 2021 Sep 6.

Medical Imaging Department, Henri Mondor Hospital, APHP, 94000 Créteil, France.

Optimal HCC therapeutic management relies on accurate tumor staging. Our aim was to assess the impact of F-FDG-WB-PET/MRI on HCC metastatic staging, compared with the standard of care CT-CAP/liver MRI combination, in patients with HCC referred on a curative intent or before transarterial radioembolization. One hundred and four consecutive patients followed for HCC were retrospectively included. The WB-PET/MRI was compared with the standard of care CT-CAP/liver MRI combination for HCC metastatic staging, with pathology, followup, and multidisciplinary board assessment as a reference standard. Thirty metastases were identified within 14 metastatic sites in 11 patients. The sensitivity of WB-PET/MRI for metastatic sites and metastatic patients was significantly higher than that of the CT-CAP/liver MRI combination (respectively 100% vs. 43%, = 0.002; and 100% vs. 45%, = 0.01). Metastatic sites missed by CT-CAP were bone ( = 5) and distant lymph node ( = 3) in BCLC C patients. For the remaining 93 nonmetastatic patients, three BCLC A patients identified as potentially metastatic on the CT-CAP/liver MRI combination were correctly ruled out with the WB-PET/MRI without significant increase in specificity (100% vs. 97%; = 0.25). The WB-PET/MRI may improve HCC metastatic staging and could be performed as a "one-stop-shop" examination for HCC staging with a significant impact on therapeutic management in about 10% of patients especially in locally advanced HCC.
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http://dx.doi.org/10.3390/jcm10174017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432497PMC
September 2021

Utility of Early Posttreatment PET/CT Evaluation Using FDG or F-FCH to Predict Response to Y Radioembolization in Patients With Hepatocellular Carcinoma.

AJR Am J Roentgenol 2021 Sep 8. Epub 2021 Sep 8.

Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.

Assessment of hepatocellular carcinoma (HCC) treatment response after transarterial radioembolization (TARE) is challenging, as response by conventional imaging criteria may not become apparent until 6 months after treatment. Though HCC exhibits variability avidity for FDG, some cases of HCC without avidity for FDG show avidity for 18F-FCH. To evaluate the utility of early posttreatment evaluation by PET/CT using FDG or 18F-FCH to predict 6-month treatment response and survival after TARE in patients with HCC. This retrospective study included 37 patients (mean age 67 years; 34 men, 3 women) with documented HCC treated by TARE who underwent both pretreatment FDG PET/CT and 18F-FCH PET/CT, as well as early FDG PET/CT and/or 18F-FCH PET/CT 4-8 weeks after treatment; FDG PET/CT and 18F-FCH PET/CT examinations were performed on separate dates. Only one of 73 initially identified potentially eligible patients was excluded due to lack of HCC avidity for both FDG and 18F-FCH. Response assessment by mRECIST on multiphase CT or MRI was performed at one-month and six-months in 23 patients. Early PET/CT response and one-month mRECIST response were assessed as predictors of six-month mRECIST response. Univariable and multivariable predictors of overall survival (OS) were identified. On pretreatment PET/CT, 28 (76%) patients were FDG-positive, 15 (41%) FCH-positive 6 (16%) both FDG-positive and FCH-positive. Twelve of 28 FDG-positive HCCs exhibited early response by FDG PET/CT; 7 of 15 FCH-positive HCCs exhibited early response by 18F-FCH PET/CT. Twelve (52%) patients exhibited six-month mRECIST response. Early posttreatment PET/CT response exhibited 100% (12/12) sensitivity and 100% (11/11) specificity for six-month mRECIST response, whereas one-month mRECIST response exhibited 67% (8/12) sensitivity and 100% (11/11) specificity for six-month mRECIST response. Early postteatment PET/CT response was a significant independent predictor of OS on univariable (hazard ratio: 0.37, 95% CI: 0.15-0.93, p=.03) and multivariable analyses (hazard ratio: 0.24, 95% CI: 0.08-0.76, p=.01). Early post-TARE evaluation by PET/CT using FDG or 18F-FCH may predict six-month response and OS in patients with HCC. Early posttreatment evaluation with PET/CT could help more reliably identify true nonresponders after TARE, which in turn could prompt early adapted therapeutic management.
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http://dx.doi.org/10.2214/AJR.21.26485DOI Listing
September 2021

NON-INVASIVE DIAGNOSIS AND FOLLOW-UP OF PRIMARY MALIGNANT LIVER TUMOURS.

Clin Res Hepatol Gastroenterol 2021 Jul 28:101766. Epub 2021 Jul 28.

Service d'hépatologie, Hôpital Avicenne, APHP, Université Sorbonne Paris Nord, Bobigny. Electronic address:

Among a wide range of malignant liver tumours, hepatocellular carcinoma (HCC) developed on a background of cirrhosis represents the most frequent clinical situation. In this setting, HCC is one of the rare solid tumours for which histological confirmation is not mandatory. The convergence of multiple arguments obtained by non-invasive parameters using radiological findings allows to avoid liver biopsy in a large proportion of patients when a diagnosis of underlying cirrhosis is ascertained. Conversely, in case of atypical presentation or in order to exclude other rare malignant tumours mostly developed in the absence of cirrhosis, liver biopsy will then be essential. Based on typical radiological patterns described by contrast-enhanced imaging, numerous clinical guidelines have endorsed non-invasive diagnosis, staging and monitoring of HCC patients under treatment since 20 years. These algorithms have evolved over the years, taking into account progress in radiological technology and advances in curative or palliative procedures. Large cohort studies have also helped to refine diagnostic criteria and prognostication in the setting of complex therapeutic strategy. Unsupervised multi-analysis approaches both at the biological and radiological levels will in the future enrich the panel of non-invasive markers useful in clinical practice to manage HCC and other malignant tumours.
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http://dx.doi.org/10.1016/j.clinre.2021.101766DOI Listing
July 2021

NON-INVASIVE DIAGNOSIS AND FOLLOW-UP OF CHRONIC INFECTION WITH HEPATITIS C VIRUS.

Clin Res Hepatol Gastroenterol 2021 Jul 28:101771. Epub 2021 Jul 28.

Service d'hépato-gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, pessac & INSERM U1053, Université de Bordeaux, Bordeaux.

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease. Clinical care for patients with HCV-related liver disease has advanced considerably with developments in screening, diagnostic procedures to evaluate liver fibrosis and improvements in therapy with pangenotypic direct antivirals and prevention. These AFEF guidelines on the non-invasive diagnosis and follow up of chronic infection with HCV describe the optimal management of HCV positive patients with non-invasive methods in screening, in assessing viral disease and liver fibrosis and the follow-up of these patients according to the value of FibroScan®, Fibrotest® or Fibrometer®. Hepatocellular carcinoma screening must continue in patients with liver stiffness by FibroScan® ≥10 kPa or Fibrotest® >0.58 or Fibrometer® >0.78 prior to treatment initiation. After reaching sustained virologic response, patients with a measurement of liver stiffness by FibroScan®<10 kPa or Fibrotest®≤0.58 or Fibrometer®≤0.78 before treatment initiation and without liver comorbidity (alcohol consumption, metabolic syndrome, HBV co-infection etc.) no longer require specific monitoring. The role of liver biopsy is discussed in some rare situations.
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http://dx.doi.org/10.1016/j.clinre.2021.101771DOI Listing
July 2021

Three artificial intelligence data challenges based on CT and ultrasound.

Diagn Interv Imaging 2021 Jul 23. Epub 2021 Jul 23.

Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France.

Purpose: The 2020 edition of these Data Challenges was organized by the French Society of Radiology (SFR), from September 28 to September 30, 2020. The goals were to propose innovative artificial intelligence solutions for the current relevant problems in radiology and to build a large database of multimodal medical images of ultrasound and computed tomography (CT) on these subjects from several French radiology centers.

Materials And Methods: This year the attempt was to create data challenge objectives in line with the clinical routine of radiologists, with less preprocessing of data and annotation, leaving a large part of the preprocessing task to the participating teams. The objectives were proposed by the different organizations depending on their core areas of expertise. A dedicated platform was used to upload the medical image data, to automatically anonymize the uploaded data.

Results: Three challenges were proposed including classification of benign or malignant breast nodules on ultrasound examinations, detection and contouring of pathological neck lymph nodes from cervical CT examinations and classification of calcium score on coronary calcifications from thoracic CT examinations. A total of 2076 medical examinations were included in the database for the three challenges, in three months, by 18 different centers, of which 12% were excluded. The 39 participants were divided into six multidisciplinary teams among which the coronary calcification score challenge was solved with a concordance index > 95%, and the other two with scores of 67% (breast nodule classification) and 63% (neck lymph node calcifications).
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http://dx.doi.org/10.1016/j.diii.2021.06.005DOI Listing
July 2021

Factors associated with remission at 5-year follow-up in recent onset axial spondyloarthritis: results from the DESIR cohort.

Rheumatology (Oxford) 2021 Jul 16. Epub 2021 Jul 16.

EpiDermE, Université Paris Est Créteil, Créteil, France.

Objective: The factors contributing to long-term remission in axial spondyloarthritis (axSpA) are unclear. We aimed to characterize individuals with axSpA at 5-year follow-up to identify baseline factors associated with remission.

Methods: We included all patients from the DESIR cohort (recent onset axSpA) with available Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) at 5-year follow-up. Patients in remission (ASDAS-CRP<1.3) were compared to those with active disease by demographic, clinical, biological and imaging characteristics. A logistic model stratified on tumor necrosis factor inhibitor (TNFi) exposure was used.

Results: Overall, 111/449 (25%) patients were in remission after 5 years. Among those never exposed to TNFi, 31% (77/247) were in remission compared to 17% (34/202) of those exposed to TNFi. Patients in remission after 5-years were more likely to be male, HLA-B27+, have a lower body mass index (BMI), and a higher education level. Baseline factors associated with 5-year remission in patients never exposed to TNFi, included lower BASDAI (adjusted odds ratio [ORa] 0.9, 95% confidence interval [95%CI] 0.8-0.9) and history of peripheral arthritis (ORa 2.1, 95%CI 1.2-5.3). In those exposed to TNFi, remission was associated with higher education level (ORa 2.9, 95%CI 1.6-5.1), lower enthesitis index (ORa 0.8, 95%CI 0.7-0.9), lower BASDAI (ORa 0.9, 95%CI 0.9-0.9), and lower BMI (ORa 0.8, 95%CI 0.7-0.9).

Conclusion: This study highlights the difficulty in achieving 5-year remission in those with recent onset axSpA, especially for the more active cases, despite the use of TNFi. Socio-economic factors and BMI are implicated in the outcome at 5 years.
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http://dx.doi.org/10.1093/rheumatology/keab565DOI Listing
July 2021

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.

World J Emerg Surg 2021 Jun 10;16(1):30. Epub 2021 Jun 10.

Rothschild Hospital, AP-HP, Paris, and Université de Paris, Paris, France.

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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http://dx.doi.org/10.1186/s13017-021-00369-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190978PMC
June 2021

[Malignant Triton tumour: A case report].

Ann Pathol 2021 Jun 27;41(3):317-322. Epub 2021 Apr 27.

Département de pathologie et université Paris Est Créteil (UPEC), AP-HP, Hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.

Malignant Triton tumour (MTT) is a subtype of malignant peripheral nerve sheaths tumour (MPNST) with exclusive heterologous rhabdomyosarcomatous contingent. MTT is rare and of poor prognosis. This entity illustrates the great heterogeneity of MPNST, the diagnosis of which is difficult in the absence of a specific marker, especially in sporadic forms. Although MTT preferentially develop in patients with type 1 neurofibromatosis, sporadic cases may occur. We herein present a case of MTT of the left arm, occurring in a 74-year-old patient, without clinical context of NF1. The fast-growing tumour reached 9.2cm of greater dimension at the time of surgical excision. Histology showed a spindle cell sarcoma with rhabdoid cell areas expressing myogenin. In the absence of neural crest markers expression, the diagnosis of MPNST was based on a significant loss of expression of the histone 3 tri-methylated lysine 27, a classical although not specific epigenetic mark for this sarcoma group, and on the identification of the heterologous rhabdomyosarcomatous contingent, previously described in the context of MTT.
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http://dx.doi.org/10.1016/j.annpat.2021.02.002DOI Listing
June 2021

Virtual unenhanced imaging of the liver derived from 160-mm rapid-switching dual-energy CT (rsDECT): Comparison of the accuracy of attenuation values and solid liver lesion conspicuity with native unenhanced images.

Eur J Radiol 2020 Dec 2;133:109387. Epub 2020 Nov 2.

Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; Faculté de Médecine de Créteil, Université Paris Est Créteil, 94000 Créteil, France; INSERM IMRB, U 955, Equipe 18, Créteil, France.

Objectives: To evaluate the reliability of attenuation values of the liver parenchyma and focal liver lesions on virtual unenhanced images from arterial (VUEart) and portal venous phases (VUEport) compared to native unenhanced (NU) attenuation values in patients referred for assessment of malignant liver lesions.

Methods: Seventy-three patients with confirmed primary or metastatic liver tumors who underwent a multiphase contrast-enhanced rapid-switching kVp dual-energy CT (rsDECT) were included in this IRB-approved retrospective study. Both qualitative and quantitative analyses - including the lesion-to-liver contrast-to-noise ratio (LL-CNR) - were performed and compared between NU and both VUEart and VUEport images.

Results: The mean liver attenuation values were significantly lower in VUEart images (56.7 ± 6.7 HU) than in NU images (59.6 ± 7.5 HU, p = 0.008), and were comparable between VUEart and VUEport images (57.9 ± 6 UH, p = 0.38) and between VUEport and NU images (p = 0.051). The mean liver lesions attenuation values were comparable between NU, VUEart and VUEport images (p = 0.60). Strong and significant correlations values were found both in liver lesions and tumor-free parenchyma (r = 0.82-0.91, p < 0.01). The mean LL-CNR was significantly higher in VUEart and VUEport images than in NU images (1.7 ± 1 and 1.6 ± 1.1 vs 0.9 ± 0.6; p < 0.001), but was comparable between VUEart and VUEport images (p > 0.9). Lesion conspicuity was significantly higher in VUEport images than in NU images (p < 0.001).

Conclusion: VUEport images derived from 3rd generation rsDECT could confidently replace NU images in patients undergoing assessment for malignant liver lesions. These images provide comparable attenuation values in both liver lesions and liver parenchyma while reducing the radiation dose and scanning time.
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http://dx.doi.org/10.1016/j.ejrad.2020.109387DOI Listing
December 2020

Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area.

JHEP Rep 2021 Feb 22;3(1):100199. Epub 2020 Dec 22.

Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France.

Background & Aims: Patients affected by hepatocellular carcinoma (HCC) represent a vulnerable population during the COVID-19 pandemic and may suffer from altered allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of patients with HCC within 6 referral centres in the metropolitan area of Paris, France.

Methods: We performed a multicentre, retrospective, cross-sectional study on the management of patients with HCC during the first 6 weeks of the COVID-19 pandemic (exposed group), compared with the same period in 2019 (unexposed group). We included all patients discussed in multidisciplinary tumour board (MTB) meetings and/or patients undergoing a radiological or surgical programmed procedure during the study period, with curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treat.

Results: After screening, n = 670 patients were included (n = 293 exposed to COVID, n = 377 unexposed to COVID). Fewer patients with HCC presented to the MTB in 2020 ( = 0.034) and fewer had a first diagnosis of HCC (n = 104 exposed to COVID, n = 143 unexposed to COVID,  = 0.083). Treatment strategy was modified in 13.1% of patients, with no differences between the 2 periods. Nevertheless, 21.5% 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared with 2019 ( <0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) patients were hospitalised and 4 (19.1%) patients died.

Conclusions: In a metropolitan area highly impacted by the COVID-19 pandemic, we observed fewer patients with HCC, and similar rates of treatment modification, but with a significantly longer treatment delay in 2020  2019.

Lay Summary: During the coronavirus disease 2019 (COVID-19) pandemic era, fewer patients with hepatocellular carcinoma (HCC) presented to the multidisciplinary tumour board, especially with a first diagnosis of HCC. Patients with HCC had a treatment delay that was longer in the COVID-19 period than in 2019.
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http://dx.doi.org/10.1016/j.jhepr.2020.100199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604130PMC
February 2021

Whole-Body Functional MRI and PET/MRI in Multiple Myeloma.

Cancers (Basel) 2020 Oct 27;12(11). Epub 2020 Oct 27.

SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010 Créteil, France.

Bone disease is one of the major features of multiple myeloma (MM), and imaging has a pivotal role in both diagnosis and follow-up. Whole-body magnetic resonance imaging (MRI) is recognized as the gold standard for the detection of bone marrow involvement, owing to its high sensitivity. The use of functional MRI sequences further improved the performances of whole-body MRI in the setting of MM. Whole-body diffusion-weighted (DW) MRI is the most attractive functional technique and its systematic implementation in general clinical practice is now recommended by the International Myeloma Working Group. Whole-body dynamic contrast-enhanced (DCE) MRI might provide further information on lesions vascularity and help evaluate response to treatment. Whole Body PET/MRI is an emerging hybrid imaging technique that offers the opportunity to combine information on morphology, fat content of bone marrow, bone marrow cellularity and vascularization, and metabolic activity. Whole-body PET/MRI allows a one-stop-shop examination, including the most sensitive technique for detecting bone marrow involvement, and the most recognized technique for treatment response evaluation. This review aims at providing an overview on the value of whole-body MRI, including DW and DCE MRI, and combined whole-body F-FDG PET/MRI in diagnosis, staging, and response evaluation in patients with MM.
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http://dx.doi.org/10.3390/cancers12113155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693006PMC
October 2020

Diagnostic Performance of Transesophageal Echocardiography and Cardiac Computed Tomography in Infective Endocarditis.

J Am Soc Echocardiogr 2020 12 25;33(12):1442-1453. Epub 2020 Sep 25.

Radiology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; INSERM U955, Team 8, Paris-Est Creteil University, Val-de-Marne, Créteil, France.

Background: Multimodality imaging is essential for infective endocarditis (IE) diagnosis. The aim of this work was to evaluate the agreement between transesophageal echocardiography (TEE) and cardiac computed tomography (CT) findings in patients with surgically confirmed IE.

Methods: Sixty-eight patients (mean age 63 ± 2 years) with a definite diagnosis of left-side IE according to the modified European Society of Cardiology Duke criteria, on both native and prosthetic valves, underwent TEE and cardiac CT before surgery. The presence of valvular (vegetations, erosion) and paravalvular (abscess, pseudoaneurysm) IE-related lesions were compared between both modalities. Perioperative inspection was used as reference.

Results: TEE performed better than CT in detecting valvular IE-related lesions (TEE area under the curve [AUC] = 0.881 vs AUC = 0.720, P = .02) and was similar to CT with respect to paravalvular IE-related lesions (AUC = 0.830 vs AUC = 0.816, P = .835). The ability of TEE to detect vegetation was significantly better than that of CT (AUC = 0.863 vs AUC = 0.693, P = .02). The maximum size of vegetations was moderately correlated between modalities (Spearman's rho = 0.575, P < .001). Computed tomography exhibited higher sensitivity than TEE for pseudoaneurysm detection (100% vs 66.7%, respectively) but was similar with respect to diagnostic accuracy (AUC = 0.833 vs AUC = 0.984, P = .156).

Conclusions: In patients with a definite diagnosis of left-side IE according to the modified European Society of Cardiology Duke criteria, TEE performed better than CT for the detection of valvular IE-related lesions and similar to CT for the detection of paravalvular IE-related lesions.
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http://dx.doi.org/10.1016/j.echo.2020.07.017DOI Listing
December 2020

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience.

World J Emerg Surg 2020 06 29;15(1):40. Epub 2020 Jun 29.

Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group).

Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival.

Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality.

Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.
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http://dx.doi.org/10.1186/s13017-020-00321-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325045PMC
June 2020

Hepatobiliary MR contrast agent uptake as a predictive biomarker of aggressive features on pathology and reduced recurrence-free survival in resectable hepatocellular carcinoma: comparison with dual-tracer 18F-FDG and 18F-FCH PET/CT.

Eur Radiol 2020 Oct 13;30(10):5348-5357. Epub 2020 May 13.

Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.

Objectives: To compare the performance of the quantitative analysis of the hepatobiliary phase (HBP) tumor enhancement in gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI and of dual-tracer 18F-FDG and 18F-fluorocholine (FCH) PET/CT for the prediction of tumor aggressiveness and recurrence-free survival (RFS) in resectable hepatocellular carcinoma (HCC).

Methods: This retrospective, IRB approved study included 32 patients with 35 surgically proven HCCs. All patients underwent Gd-BOPTA-enhanced MRI including delayed HBP images, 18F-FDG PET/CT, and (for 29/32 patients) 18F-FCH PET/CT during the 2 months prior to surgery. For each lesion, the lesion-to-liver contrast enhancement ratio (LLCER) on MRI HBP images and the SUV tumor-to-liver ratio (SUV) for both tracers were calculated. Their predictive value for aggressive pathological features-including the histological grade and microvascular invasion (MVI)-and RFS were analyzed and compared using area under receiver operating characteristic (AUROC) curves and Cox regression models, respectively.

Results: The AUROCs for the identification of aggressive HCCs on pathology with LLCER, 18F-FDG SUV, and 18F-FCH SUV were 0.92 (95% CI 0.78, 0.98), 0.89 (95% CI 0.74, 0.97; p = 0.70), and 0.64 (95% CI 0.45, 0.80; p = 0.035). At multivariate Cox regression analysis, LLCER was identified as an independent predictor of RFS (HR (95% CI) = 0.91 (0.84, 0.99), p = 0.022). LLCER - 4.72% or less also accurately predicted moderate-poor differentiation grade (Se = 100%, Sp = 92.9%) and MVI (Se = 93.3%, Sp = 60%) and identified patients with poor RFS after surgical resection (p = 0.030).

Conclusions: HBP tumor enhancement after Gd-BOPTA injection may help identify aggressive HCC pathological features, and patients with reduced recurrence-free survival after surgical resection.

Key Points: • In patients with resectable HCC, the quantitative analysis of the HBP tumor enhancement in Gd-BOPTA-enhanced MRI (LLCER) accurately identifies moderately-poorly differentiated and/or MVI-positive HCCs. • After surgical resection for HCC, patients with LLCER - 4.72% or less had significantly poorer recurrence-free survival than patients with LLCER superior to - 4.72%. • Gd-BOPTA-enhanced MRI with delayed HBP images may be suggested as part of pre-surgery workup in patients with resectable HCC.
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http://dx.doi.org/10.1007/s00330-020-06923-5DOI Listing
October 2020

Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis.

PLoS One 2020 22;15(4):e0230914. Epub 2020 Apr 22.

Department of Geriatrics, CHU La Milétrie, Poitiers University Hospital, Grand Poitiers, France.

Objective: The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients.

Methods: A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short- and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged ≥65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients.

Results: After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in older patients (n = 7). When comparing older vs. younger patients undergoing liver surgery for mCRC, pooled data analysis showed higher postoperative mortality [RR = 2.53 (95%CI: 2.00-3.21)] and shorter overall survival [HR = 1.17 (95%CI: 1.07-1.18)] in older patients, whereas no differences in operative outcomes, postoperative complications and disease-free survival were found. When comparing laparoscopy vs. open surgery for liver resection in older mCRC patients, laparoscopy was associated with fewer postoperative complications [RR = 0.27 (95%CI: 0.10-0.73)].

Conclusion: Liver resection for mCRC should not be disregarded a priori in older patients, who show similar operative and postoperative outcomes as younger patients. However, clinicians should consider that they are at increased risk of postoperative mortality and have a worse overall survival, which may reflect comorbidities and frailty.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230914PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176093PMC
July 2020

Predicting Difficult Laparoscopic Total Mesorectal Excision for Locally-advanced Mid-low Rectal Cancer: The Score Validation.

Anticancer Res 2020 Apr;40(4):2079-2087

1 Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy.

Background/aim: The European MRI and Rectal Cancer Surgery (EuMaRCS) score was proposed to identify preoperatively difficult laparoscopic total mesorectal excision (L-TME) for locally advanced rectal cancer (LARC). This study aimed to test EuMaRCS's validity.

Patients And Methods: Data were retrieved from a European multicenter database, including patients with mid/low LARC, treated with neoadjuvant chemoradiation therapy and L-TME with primary anastomosis. The EuMaRCS score was calculated on: BMI>30 (3 points), interspinous distance<96.4 mm (2 points), ymrT stage≥T3b (4 points), and male sex (1 point).

Results: The sample was composed of 141 patients, of whom 23 (16.3%) had a difficult L-TME. The EuMaRCS score demonstrated high accuracy in predicting difficult surgery (AROC: 0.806, 95%CI=0.72-0.88), with a cut-off >3 being associated with the best balance in sensitivity (82.6%) and specificity (66.1%).

Conclusion: The EuMaRCS score represents a validated tool to predict preoperatively difficult L-TME in LARC patients.
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http://dx.doi.org/10.21873/anticanres.14166DOI Listing
April 2020

Multiphase Liver MRI for Identifying the Macrotrabecular-Massive Subtype of Hepatocellular Carcinoma.

Radiology 2020 06 31;295(3):562-571. Epub 2020 Mar 31.

From the Medical Imaging Department, AP-HP, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France (S.M., A.G.P., R.K., L.B., M.D., F.P., V.T., H.K., A. Luciani); Faculté de Médecine, Université Paris Est Créteil, Créteil, France (S.M., G.A., A. Laurent, D.S., V.T., H.K., J.C., A. Luciani); INSERM IMRB, U 955, Team 18, Créteil, France (S.M., G.A., V.T., J.C., A. Luciani); Laboratoire des Signaux et Systèmes, Paris-Saclay University, Gif sur Yvette, France (A.T.); Hepatology Department, AP-HP, Henri Mondor University Hospital, Créteil, France (G.A., H.R.); Digestive Surgery Department, AP-HP, Henri Mondor University Hospital, Créteil, France (A. Laurent, D.S.); and Pathology Department, AP-HP, Henri Mondor University Hospital, Créteil, France (J.C.).

Background The recently described "macrotrabecular-massive" (MTM) histologic subtype of hepatocellular carcinoma (HCC) (MTM-HCC) represents an aggressive form of HCC and is associated with poor survival. Purpose To investigate whether preoperative MRI can help identify MTM-HCCs in patients with HCC. Materials and Methods This retrospective study included patients with HCC treated with surgical resection between January 2008 and February 2018 and who underwent preoperative multiphase contrast material-enhanced MRI. Least absolute shrinkage and selection operator (LASSO)-penalized and multivariable logistic regression analyses were performed to identify clinical, biologic, and imaging features associated with the MTM-HCC subtype. Early recurrence (within 2 years) and overall recurrence were evaluated by using Kaplan-Meier analysis. Multivariable Cox regression analysis was performed to determine predictors of early and overall recurrence. Results One hundred fifty-two patients (median age, 64 years; interquartile range, 56-72 years; 126 men) with 152 HCCs were evaluated. Twenty-six of the 152 HCCs (17%) were MTM-HCCs. LASSO-penalized logistic regression analysis identified substantial necrosis, high serum α-fetoprotein (AFP) level (>100 ng/mL), and Barcelona Clinic Liver Cancer (BCLC) stage B or C as independent features associated with MTM-HCCs. At multivariable analysis, substantial necrosis (odds ratio = 32; 95% confidence interval [CI] = 8.9, 114; < .001), high serum AFP level (odds ratio = 4.4; 95% CI = 1.3, 16; = .02), and BCLC stage B or C (odds ratio = 4.2; 95% CI = 1.2, 15; = .03) were independent predictors of MTM-HCC subtype. Substantial necrosis helped identify 65% (17 of 26; 95% CI: 44%, 83%) of MTM-HCCs (sensitivity) with a specificity of 93% (117 of 126; 95% CI: 87%, 97%). In adjusted models, only the presence of satellite nodules was independently associated with both early (hazard ratio = 3.7; 95% CI: 1.5, 9.4; = .006) and overall (hazard ratio = 3.0; 95% CI: 1.3, 7.2; = .01) tumor recurrence. Conclusion At multiphase contrast-enhanced MRI, substantial necrosis helped identify macrotrabecular-massive hepatocellular carcinoma subtype with high specificity. © RSNA, 2020.
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http://dx.doi.org/10.1148/radiol.2020192230DOI Listing
June 2020

Predicting Survival After Hepatocellular Carcinoma Resection Using Deep Learning on Histological Slides.

Hepatology 2020 12;72(6):2000-2013

Paris Est Créteil University, UPEC, Créteil, France.

Background And Aims: Standardized and robust risk-stratification systems for patients with hepatocellular carcinoma (HCC) are required to improve therapeutic strategies and investigate the benefits of adjuvant systemic therapies after curative resection/ablation.

Approach And Results: In this study, we used two deep-learning algorithms based on whole-slide digitized histological slides (whole-slide imaging; WSI) to build models for predicting survival of patients with HCC treated by surgical resection. Two independent series were investigated: a discovery set (Henri Mondor Hospital, n = 194) used to develop our algorithms and an independent validation set (The Cancer Genome Atlas [TCGA], n = 328). WSIs were first divided into small squares ("tiles"), and features were extracted with a pretrained convolutional neural network (preprocessing step). The first deep-learning-based algorithm ("SCHMOWDER") uses an attention mechanism on tumoral areas annotated by a pathologist whereas the second ("CHOWDER") does not require human expertise. In the discovery set, c-indices for survival prediction of SCHMOWDER and CHOWDER reached 0.78 and 0.75, respectively. Both models outperformed a composite score incorporating all baseline variables associated with survival. Prognostic value of the models was further validated in the TCGA data set, and, as observed in the discovery series, both models had a higher discriminatory power than a score combining all baseline variables associated with survival. Pathological review showed that the tumoral areas most predictive of poor survival were characterized by vascular spaces, the macrotrabecular architectural pattern, and a lack of immune infiltration.

Conclusions: This study shows that artificial intelligence can help refine the prediction of HCC prognosis. It highlights the importance of pathologist/machine interactions for the construction of deep-learning algorithms that benefit from expert knowledge and allow a biological understanding of their output.
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http://dx.doi.org/10.1002/hep.31207DOI Listing
December 2020

Prognostic value of anthropometric measures extracted from whole-body CT using deep learning in patients with non-small-cell lung cancer.

Eur Radiol 2020 Jun 13;30(6):3528-3537. Epub 2020 Feb 13.

Department of Nuclear Medicine, Henri Mondor Hospital/AP-HP, Créteil, F-94010, France.

Introduction: The aim of the study was to extract anthropometric measures from CT by deep learning and to evaluate their prognostic value in patients with non-small-cell lung cancer (NSCLC).

Methods: A convolutional neural network was trained to perform automatic segmentation of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and muscular body mass (MBM) from low-dose CT images in 189 patients with NSCLC who underwent pretherapy PET/CT. After a fivefold cross-validation in a subset of 35 patients, anthropometric measures extracted by deep learning were normalized to the body surface area (BSA) to control the various patient morphologies. VAT/SAT ratio and clinical parameters were included in a Cox proportional-hazards model for progression-free survival (PFS) and overall survival (OS).

Results: Inference time for a whole volume was about 3 s. Mean Dice similarity coefficients in the validation set were 0.95, 0.93, and 0.91 for SAT, VAT, and MBM, respectively. For PFS prediction, T-stage, N-stage, chemotherapy, radiation therapy, and VAT/SAT ratio were associated with disease progression on univariate analysis. On multivariate analysis, only N-stage (HR = 1.7 [1.2-2.4]; p = 0.006), radiation therapy (HR = 2.4 [1.0-5.4]; p = 0.04), and VAT/SAT ratio (HR = 10.0 [2.7-37.9]; p < 0.001) remained significant prognosticators. For OS, male gender, smoking status, N-stage, a lower SAT/BSA ratio, and a higher VAT/SAT ratio were associated with mortality on univariate analysis. On multivariate analysis, male gender (HR = 2.8 [1.2-6.7]; p = 0.02), N-stage (HR = 2.1 [1.5-2.9]; p < 0.001), and the VAT/SAT ratio (HR = 7.9 [1.7-37.1]; p < 0.001) remained significant prognosticators.

Conclusion: The BSA-normalized VAT/SAT ratio is an independent predictor of both PFS and OS in NSCLC patients.

Key Points: • Deep learning will make CT-derived anthropometric measures clinically usable as they are currently too time-consuming to calculate in routine practice. • Whole-body CT-derived anthropometrics in non-small-cell lung cancer are associated with progression-free survival and overall survival. • A priori medical knowledge can be implemented in the neural network loss function calculation.
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http://dx.doi.org/10.1007/s00330-019-06630-wDOI Listing
June 2020

Reply to "Intrapatient Comparison of the Hepatobiliary Phase of Gd-BOPTA and Gd-EOB-DTPA in the Differentiation of Hepatocellular Adenoma From Focal Nodular Hyperplasia".

J Magn Reson Imaging 2020 10 5;52(4):1279-1280. Epub 2020 Feb 5.

Department of Radiology, APHP, HU Henri Mondor, Creteil, France.

Level Of Evidence: 5 TECHNICAL EFFICACY STAGE: 3 CONFLICT OF INTEREST: None.

Financial Support: None. J. Magn. Reson. Imaging 2020;52:1279-1280.
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http://dx.doi.org/10.1002/jmri.27074DOI Listing
October 2020

Acute Biliary Obstruction after Transarterial Radioembolization with Yttrium-90.

J Vasc Interv Radiol 2019 Dec 26;30(12):2043-2045. Epub 2019 Oct 26.

Service d'Hépatologie, Centre hospitalier universitaire Henri-Mondor, Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.

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http://dx.doi.org/10.1016/j.jvir.2019.08.024DOI Listing
December 2019

Good clinical practice recommendations for the use of PET/CT in oncology.

Eur J Nucl Med Mol Imaging 2020 01 21;47(1):28-50. Epub 2019 Oct 21.

Nuclear Medicine, Jean Perrin Cancer Institute, Clermont-Ferrand, France.

Positron emission tomography/computed tomography (PET/CT) is a nuclear medicine functional imaging technique with proven clinical value in oncology. PET/CT indications are continually evolving with fresh advances made through research. French practice on the use of PET in oncology was framed in recommendations based on Standards-Options-Recommendations methodology and coordinated by the French federation of Comprehensive Cancer Centres (FNLCC). The recommendations were originally issued in 2002 followed by an update in 2003, but since then, a huge number of scientific papers have been published and new tracers have been licenced for market release. The aim of this work is to bring the 2003 version recommendations up to date. For this purpose, a focus group was set up in collaboration with the French Society for Nuclear Medicine (SFMN) to work on developing good clinical practice recommendations. These good clinical practice recommendations have been awarded joint French National Heath Authority (HAS) and French Cancer Institute (INCa) label status-the stamp of methodological approval. The present document is the outcome of comprehensive literature review and rigorous appraisal by a panel of experts, organ specialists, clinical oncologists, surgeons and imaging specialists. These data were also used for the EANM referral guidelines.
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http://dx.doi.org/10.1007/s00259-019-04553-8DOI Listing
January 2020

F-sodium fluoride PET/MRI myocardial imaging in patients with suspected cardiac amyloidosis.

J Nucl Cardiol 2021 Aug 11;28(4):1586-1595. Epub 2019 Sep 11.

SyMPTOm PET/MRI platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor Hospital, AP-HP/U-PEC, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France.

Background: We evaluated the diagnostic performance of F-NaF PET/MRI in patients with suspected cardiac amyloidosis (CA).

Methods: Twenty-seven consecutive patients underwent myocardial PET 1 hour after injection of 4 MBq/kg F-NaF with simultaneous MRI including cine-MRI, T1 and T2 mapping, first-pass and late gadolinium enhancement (LGE). F-NaF uptake was measured visually and semi-quantitatively by calculating myocardium-to-blood pool (M/B) ratios. CA was confirmed histologically.

Results: Transthyretin (TTR)-CA was diagnosed in 16 patients, light-chain (AL)-CA in 7, and no-CA in 4. Visual interpretation of F-NaF images revealed a relative increase in myocardial uptake in only 3 patients, all with TTR CA, and a relative decrease in 13, including 7 AL CA, 3 no-CA, and 3 TTR CA. M/B ratios were significantly higher in TTR CA (1.00 ± 0.12) than in AL CA (0.81 ± 0.06, P = 0.001) or in no-CA (0.73 ± 0.16, P = 0.006). The optimal M/B cut-off to distinguish TTR CA from AL CA was ≥ 0.90 (Fischer, P = 0.0005). By comparison, classification of patients using Tc-HMDP heart-to-mediastinum ratios with the previously published cut-off ≥ 1.21 reached higher significance (P < 0.0001). Among MRI parameters, myocardial T1, LGE score, and extracellular volume were higher in CA than in no-CA patients, 1409 ± 76 vs 1278 ± 35 ms (P = 0.004), 10.35 ± 5.30 vs 3.50 ± 3.42 (P = 0.03), and 46 ± 10 vs 33 ± 8 % (P = 0.01), respectively.

Conclusion: F-NaF PET/MRI shows good diagnostic performance when semi-quantification is used. However, contrast is low and visual interpretation may be challenging in routine. PET/MRI could constitute a one-stop-shop evaluation of amyloid load and cardiac function in patients needing rapid work-up.
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http://dx.doi.org/10.1007/s12350-019-01885-8DOI Listing
August 2021

Intrahepatic immune changes after hepatitis c virus eradication by direct-acting antiviral therapy.

Liver Int 2020 01 4;40(1):74-82. Epub 2019 Sep 4.

INSERM U955, Team 18, Institut Mondor de Recherche Biomédicale, Créteil, France.

Background & Aims: The recent approval of direct acting anti-virals (DAA) has dramatically changed the landscape of hepatitis C virus (HCV) therapy. Whether viral clearance could promote liver carcinogenesis is debated. It has been hypothesized that changes in intrahepatic immune surveillance following viral cure could favour tumour growth. This study aimed at characterizing the intrahepatic immune changes induced by HCV cure following DAA therapy.

Methods: Patients with compensated cirrhosis who underwent surgical resection for hepatocellular carcinoma (HCC) after sustained virological response (SVR) to DAA therapy were included. A control group of untreated HCV-infected patients with compensated cirrhosis was selected. RNA was extracted from tumoral and non-tumoral tissues and analysed using the Nanostring Immuno-Oncology-360 panel. Immune cells were quantified by immunohistochemistry.

Results: Twenty patients were included: 10 patients with a DAA-induced SVR and 10 untreated controls. All of them had a de novo BCLC 0/A HCC. Non-tumoral tissue profiling showed down-regulation of interferon-related genes (including MX1, ISG15 and IFIT1) after DAA therapy. No other differences in immune profiles/immune cell densities were identified between the two groups. The intra-tumoral immune profiles of HCCs that occurred after DAA therapy were not qualitatively or quantitatively different from those of tumours occurring in untreated patients.

Conclusion: In conclusion, removal of HCV infection after DAA-based therapy results only in a down-regulation of interferon-stimulated genes in non-tumoral tissues from patients with cirrhosis who develop HCC. These minor changes in the liver immune microenvironment are unlikely to favour HCC occurrence or recurrence after DAA-induced SVR.
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http://dx.doi.org/10.1111/liv.14226DOI Listing
January 2020

ESM1 as a Marker of Macrotrabecular-Massive Hepatocellular Carcinoma.

Clin Cancer Res 2019 10 29;25(19):5859-5865. Epub 2019 Jul 29.

INSERM UMR-1162, génomique fonctionnelle des tumeurs solides, Paris, France.

Purpose: Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is a novel morphological subtype of HCC associated with early relapse after resection or percutaneous ablation, independently of classical clinical and radiological prognostic factors. The aim of the present study was to identify immunohistochemical markers of MTM-HCC, to ease its diagnosis and implementation into clinical practice.

Experimental Design: To identify potential biomarkers of MTM-HCC, we first analyzed gene expression profiling data from The Cancer Genome Atlas study and further selected two candidate biomarkers. Performance of both biomarkers for diagnosis of MTM-HCC was further tested by immunohistochemistry in two independent series of 67 and 132 HCC biopsy samples.

Results: Analysis of RNA sequencing data showed that MTM-HCC was characterized by a high expression of neoangiogenesis-related genes. Two candidate biomarkers, Endothelial-Specific Molecule 1 (ESM1) and Carbonic Anhydrase IX (CAIX), were selected. In the discovery series, sensitivity and specificity of ESM1 expression by stromal endothelial cells for the detection of MTM-HCC were 97% (28/29), and 92% (35/38), respectively. Sensitivity and specificity of CAIX were 48% (14/29) and 89% (34/38). In the validation set, sensitivity and specificity of ESM1 for the identification of MTM-HCC were 93% (14/15) and 91% (107/117), respectively. Interobserver agreement for ESM1 assessment was good in both series (Cohen Kappa 0.77 and 0.76).

Conclusions: Using a molecular-driven selection of biomarkers, we identified ESM1 as a reliable microenvironment immunohistochemical marker of MTM-HCC. The results represent a step toward the implementation of HCC morpho-molecular subtyping into clinical practice.
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http://dx.doi.org/10.1158/1078-0432.CCR-19-0859DOI Listing
October 2019

SmartPulse, a machine learning approach for calibration-free dynamic RF shimming: Preliminary study in a clinical environment.

Magn Reson Med 2019 12 30;82(6):2016-2031. Epub 2019 Jun 30.

NeuroSpin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France.

Purpose: A calibration-free pulse design method is introduced to alleviate artifacts in clinical routine with parallel transmission at high field, dealing with significant inter-subject variability, found for instance in the abdomen.

Theory And Methods: From a dual-transmit 3T scanner, a database of and off-resonance abdominal maps from 50 subjects was first divided into 3 clusters based on mutual affinity between their respective tailored k -points pulses. For each cluster, a k -points pulse was computed, minimizing normalized root-mean-square flip angle deviations simultaneously for all subjects comprised in it. Using 30 additional subjects' field distributions, a machine learning classifier was trained on this 80-labeled-subject database to recognize the best pulse from the 3 ones available, relying only on patient features accessible from the preliminary localizer sequence present in all protocols. This so-called SmartPulse process was experimentally tested on an additional 53-subject set and compared with other pulse types: vendor's hard calibration-free dual excitation, tailored static radiofrequency shimming, universal and tailored k -points pulses.

Results: SmartPulse outperformed both calibration-free approaches. Tailored static radiofrequency shimming yielded similar flip angle homogeneity for most patients but broke down for some while SmartPulse remained robust. Although flip angle homogeneity was systematically better with tailored k -points, the difference was barely noticeable on in vivo images.

Conclusion: The proposed method paves the way toward an efficient trade-off between tailored and universal pulse design approaches for large inter-subject variability. With no need for on-line field mapping or pulse design, it can fit seamlessly into a clinical protocol.
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http://dx.doi.org/10.1002/mrm.27870DOI Listing
December 2019

18F-FDG Whole-body PET/MRI of a 30-Week Pregnant Woman With Breast Cancer Revealed Interesting Fetal Findings.

Clin Nucl Med 2019 Oct;44(10):818-820

From the SyMPTOm PET/MRI Platform, Departments of Nuclear Medicine and Radiology, CHU Henri Mondor, AP-HP, U-PEC, Créteil.

A 35-year-old 30-week pregnant woman was referred to our institution for initial staging of a triple negative invasive ductal carcinoma of the left breast. To avoid fetal radiation exposure from CT, a whole-body F-FDG PET/MRI was performed. Simultaneous acquisition of PET, T1-, T2-, and diffusion-weighted sequences revealed left axillary node extension and no distant metastases. Fetal radiation dose was estimated at 1.9 mGy. Interestingly, low fetal brain uptake and high symmetrical myocardial metabolism in both ventricles were found. Delivery was induced at 37 weeks of amenorrhea, and the patient underwent 4 cycles of neoadjuvant chemotherapy.
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http://dx.doi.org/10.1097/RLU.0000000000002663DOI Listing
October 2019

Iso- or hyperintensity of hepatocellular adenomas on hepatobiliary phase does not always correspond to hepatospecific contrast-agent uptake: importance for tumor subtyping.

Eur Radiol 2019 Jul 1;29(7):3791-3801. Epub 2019 Apr 1.

Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France.

Purpose: This study was conducted in order to evaluate if iso- or hyperintensity of HCAs on HBP is systematically related to a high uptake of hepatospecific contrast agent, using a quantitative approach.

Methods: This bicentric retrospective study included all patients with histologically confirmed and subtyped HCA from 2009 to 2017 who underwent MRI with HBP after Gd-BOPTA injection and who showed iso- or hyperintensity on HBP. The signal intensity of tumors on pre- and postcontrast images and the presence of hepatic steatosis were noted. Contrast uptake on HBP was quantified using the liver-to-lesion contrast enhancement ratio (LLCER) and compared between HCA subtypes (Wilcoxon signed-rank test). Categorical variables were compared using chi-square tests.

Results: Twenty-four HCAs showed iso- or hyperintensity on HBP, specifically 17 inflammatory (IHCAs) and 7 β-catenin HCAs (BHCAs). Eighteen HCAs (75%) (17 IHCAs and 1 BHCAs) had a LLCER < 0% (median - 13.6%, group 1), of which 94% were hyperintense on precontrast T1-W images, with background hepatic steatosis. Six HCAs (25%) had LLCER ≥ 0% (median 2.9%, group 2), and all were BHCAs. A LLCER ≥ 1.6% was associated with the diagnosis of BHCA with a sensitivity of 86% and a specificity of 100%.

Conclusion: In conclusion, iso- or hyperintensity of hepatocellular adenomas on HBP does not necessarily correspond to an increased hepatospecific contrast-agent uptake. In IHCA, tumor hyperintensity on precontrast images and the underlying steatosis likely explain such iso- or hyperintensity, which do show reduced HBP contrast-agent uptake. On the other hand, marked contrast uptake can be observed, especially in BHCA.

Key Points: • Iso- or hyperintensity on HBP does not necessarily reflect a high uptake of hepatospecific contrast agent. • Discrepancies between qualitative signal intensity and quantitative hepatospecific contrast uptake can be explained in IHCA by a combination of tumor hyperintensity on precontrast images and underlying hepatic steatosis. • In BHCA, iso- or hyperintensity on HBP does actually correspond to a greater contrast uptake than that of the liver, demonstrated by an increased lesion-to-liver contrast enhancement ratio (LLCER).
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http://dx.doi.org/10.1007/s00330-019-06150-7DOI Listing
July 2019

Correction to: A rare presentation of skull-base osteomyelitis with neurovascular sheath extension following external otitis resolved by PET/MRI.

Eur J Nucl Med Mol Imaging 2018 Dec;45(13):2480-2481

SyMPTOm PET/MRI platform, Nuclear Medicine Department, Henri Mondor University Hospital, AP-HP, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.

The figure in the original published version of this article was omitted.
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http://dx.doi.org/10.1007/s00259-018-4157-2DOI Listing
December 2018
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