Publications by authors named "Augustin Lecler"

66 Publications

Diagnostic accuracy of Quantitative Colour Doppler Flow imaging in distinguishing Persistent Fetal Vasculature from Retinal Detachment.

Acta Ophthalmol 2021 Feb 24. Epub 2021 Feb 24.

Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France.

Purpose: Distinguishing posterior persistent fetal vasculature (PFV) from retinal detachment (RD) may be very challenging clinically and ultrasonographically, as they share common morphological features. However, it is crucial, considering their substantially distinct management and treatment. We aimed to assess the relevance of quantitative colour Doppler flow imaging to distinguish PFV from RD in children.

Methods: This retrospective bi-centre study included 66 children (30 females and 36 males, mean age: 244 ± 257 days) with a clinically suspected diagnosis of RD or posterior PFV. All children underwent systematic and standardized conventional ultrasonography and colour Doppler flow imaging under general anaesthesia with a qualitative and quantitative analysis of the retrolental tissue's vascularization. Peak systolic velocity, end-diastolic velocity and resistive index were recorded for analysis. Whenever available, surgical findings were deemed gold standard for diagnosis. A Mann-Whitney U-test was used to compare quantitative colour Doppler flow imaging data.

Results: Peak systolic velocity and end-diastolic velocity were significantly lower in children with PFV versus RD: 2.7 (IQR: 0.5) versus 5.1 (IQR: 2.8), p < 0.001, and 0.0 (IQR: 0.0) versus 2.0 (IQR: 1.2), p < 0.001, respectively. Resistive index was significantly higher in children with PFV versus RD: 1 (IQR: 0) versus 0.6 (IQR: 0.1), p < 0.001. Area under curves (AUCs) were of 0.94, 0.99 and 1, respectively. No differences between PFV and RD were observed on structural ultrasound or qualitative analysis of colour Doppler.

Conclusion: Quantitative colour Doppler flow imaging has an excellent accuracy in distinguishing PFV from RD in children. It may help to improve management and treatment.
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http://dx.doi.org/10.1111/aos.14793DOI Listing
February 2021

Color-doppler Flow Imaging Might Help Diagnose Optic Nerve Glioma.

Ophthalmology 2021 Mar;128(3):392

Department of Neuro-Radiology, Foundation Adolphe de Rothschild Hospital, Paris, France.

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http://dx.doi.org/10.1016/j.ophtha.2020.10.004DOI Listing
March 2021

Bisphosphonate-induced Posterior Scleritis.

Ophthalmology 2021 Mar;128(3):371

Department of Neuroradiology, Fondation Ophtalmologique A. Rothschild, Paris, France.

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http://dx.doi.org/10.1016/j.ophtha.2020.09.041DOI Listing
March 2021

Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study.

Radiology 2021 Feb 16:204394. Epub 2021 Feb 16.

From the Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France (A.L., F.H.); Department of Neuroradiology, CHU Lyon, Lyon, France (F.C.); Department of Neuroradiology, CHU Strasbourg, Strasbourg, France (F.L., S.K.).

COVID-19 may affect various organs. This paper reports 9 patients (1/9 [11%] woman and 8/9 [89%] men, mean age 56 ± 13 years) with globe MRI abnormalities obtained from a multicenter cohort of 129 patients presenting with severe COVID-19 from March 4th to May 1st, 2020. 9/129 (7%) patients had one or several FLAIR-WI hyperintense nodules of the posterior pole of the globe. All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening of these patients might improve the management of potentially severe ophthalmological manifestations of the virus. See also the editorial by Kirsch.
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http://dx.doi.org/10.1148/radiol.2021204394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887777PMC
February 2021

Hypocomplementemic Urticarial Vasculitis Syndrome revealed by Bilateral Sudden Sensorineural Hearing Loss.

Rheumatology (Oxford) 2021 Feb 12. Epub 2021 Feb 12.

Department of Internal Medicine, Adolphe de Rothschild Foundation Hospital, Paris, France.

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http://dx.doi.org/10.1093/rheumatology/keab131DOI Listing
February 2021

High-resolution MRI demonstrates signal abnormalities of the 3rd cranial nerve in giant cell arteritis patients with 3rd cranial nerve impairment.

Eur Radiol 2021 Jan 13. Epub 2021 Jan 13.

Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, 29 rue Manin, 75019, Paris, France.

Objective: To determine the sensitivity and specificity of high-resolution (HR) MRI for detecting signal abnormalities of cranial nerves (CN) in giant cell arteritis (GCA) patients presenting with diplopia.

Methods: This IRB-approved retrospective single-center study included GCA patients who underwent 3-T HR MRI from December 2014 to January 2020. Two radiologists, blinded to all data, individually assessed for the presence of enhancement of the 3rd, 4th, and/or 6th CN on post-contrast HR imaging and high signal intensity on HR T2-WI, for signal abnormalities of extraocular muscles and the brainstem, and for inflammatory changes of the ophthalmic and extracranial arteries. A Fisher's exact test was used to compare patients with or without diplopia.

Results: In total, 64 patients (42/64 (66%) women and 22/64 (34%) men, mean age 76.3 ± 8 years) were included. Of the 64 patients, 14 (21.9%) presented with diplopia. Third CN enhancement was detected in 7/8 (87.5%) patients with 3rd CN impairment, as compared to no patients with 4th or 6th CN impairment or to patients without diplopia (p < 0.001). Third CN abnormal high signal intensity on HR T2-WI was detected in 4/5 patients (80%) with 3rd CN impairment versus none of other patients (p < 0.001). Sensitivity, specificity, positive predictive value, and negative predictive value for detecting 3rd CN signal abnormalities were of 0.88, 1, 1, and 0.99 and 0.8, 1, 1, and 0.98 for post-contrast HR imaging and HR T2-WI, respectively.

Conclusions: HR MRI had excellent diagnostic sensitivity and specificity when detecting signal abnormalities of the 3rd CN in GCA patients presenting with 3rd CN impairment.

Key Points: • Third cranial nerve enhancement was detected in all patients with 3rd cranial nerve impairment except for one with transient diplopia. • The "check mark sign" might be useful to identify 3rd cranial nerve signal abnormalities in the orbital apex. • No signal abnormalities of the 4th or 6th cranial nerves could be detected on high-resolution MRI.
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http://dx.doi.org/10.1007/s00330-020-07595-xDOI Listing
January 2021

Dixon-T2WI magnetic resonance imaging at 3 tesla outperforms conventional imaging for thyroid eye disease.

Eur Radiol 2021 Jan 6. Epub 2021 Jan 6.

Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, 25 rue Manin, 75019, Paris, France.

Objectives: To determine the diagnostic performances of a single Dixon-T2-weighted imaging (WI) sequence compared to a conventional protocol including T1-, T2-, and fat-suppressed T2-weighted MRI at 3 T when assessing thyroid eye disease (TED).

Materials And Methods: This IRB-approved prospective single-center study enrolled participants presenting with confirmed TED from April 2015 to October 2019. They underwent an MRI, including a conventional protocol and a Dixon-T2WI sequence. Two neuroradiologists, blinded to all data, read both datasets independently and randomly. They assessed the presence of extraocular muscle (EOM) inflammation, enlargement, fatty degeneration, or fibrosis as well as the presence of artifacts. The Wilcoxon signed-rank test was used.

Results: Two hundred six participants were enrolled (135/206 [66%] women, 71/206 [34%] men, age 52.3 ± 13.2 years). Dixon-T2WI was significantly more likely to detect at least one inflamed EOM as compared to the conventional set (248/412 [60%] versus 228/412 [55%] eyes; (p = 0.02). Dixon-T2WI was more sensitive and specific than the conventional set for assessing muscular inflammation (100% versus 94.7% and 71.2% versus 68.5%, respectively). Dixon-T2WI was significantly less likely to show major or minor artifacts as compared to fat-suppressed T2WI (20/412 [5%] versus 109/412 [27%] eyes, p < 0.001, and 175/412 [42%] versus 257/412 [62%] eyes, p < 0.001). Confidence was significantly higher with Dixon-T2WI than with the conventional set (2.35 versus 2.24, p = 0.003).

Conclusion: Dixon-T2WI showed higher sensitivity and specificity and showed fewer artifacts than a conventional protocol when assessing thyroid eye disease, in addition to higher self-reported confidence.

Key Points: • Dixon-T2WI has better sensitivity and specificity than a conventional protocol for assessing inflamed extraocular muscles in patients with thyroid eye disease. • Dixon-T2WI shows significantly fewer artifacts than fat-suppressed T2WI. • Dixon-T2WI is faster and is associated with significantly higher self-reported reader confidence as compared to a conventional protocol when assessing inflammatory extraocular muscles.
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http://dx.doi.org/10.1007/s00330-020-07540-yDOI Listing
January 2021

Assessment of BOLD response in the fetal lung.

Eur Radiol 2021 May 30;31(5):3090-3097. Epub 2020 Oct 30.

EA FETUS and LUMIERE PLATEFORM - Faculte Paris Descartes, Paris, France.

Objective: Assessment of lung development and maturity is of utmost importance in prenatal counseling. Blood oxygen level-dependent (BOLD) effect MRI was developed for functional evaluations of organs. To date, no data are available in fetal lungs and nothing is known about the existence of a BOLD effect in the lungs. The aim of our study was to evaluate if a BOLD response could be detected in fetal lungs.

Materials And Methods: From January 2014 to December 2016, 38 healthy pregnant women were prospectively enrolled. After a routine scan on a 1.5-T MRI device (normoxic period), maternal hyperoxia was induced for 5 min before the BOLD sequence (hyperoxic period). R2* was evaluated by fitting average intensity of the signal, both for normoxic (norm) and hyperoxic (hyper) periods.

Results: A significant BOLD response was observed after maternal hyperoxia in the lungs with a mean R2* decrease of 12.1 ± 2.5% (p < 0.001), in line with the placenta response with a mean R2* decrease of 19.2 ± 5.9% (p < 0.0001), confirming appropriate oxygen uptake. Conversely, no significant BOLD effect was observed for the brain nor the liver with a mean ∆R2* of 3.6 ± 3.1% (p = 0.64) and 2.8 ± 3.7% (p = 0.23).

Conclusion: This study shows for the first time in human that a BOLD response can be observed in the normal fetal lung despite its prenatal "non-functional status." If confirmed in congenital lung and chest malformations, this property could be used in addition to the lung volume for a better prediction of postnatal respiratory status.

Key Points: • Blood oxygen level-dependent (BOLD) effect MRI was developed for functional evaluations of organs and could have interesting implications for the fetal organs. • Assessment of lung development is of utmost importance in prenatal counseling, but to date no data are available in fetal lungs. • BOLD response can be observed in the normal fetal lung opening the way to studies on fetus with pathological lungs.
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http://dx.doi.org/10.1007/s00330-020-07272-zDOI Listing
May 2021

Optic Nerve Cavernous Venous Malformation.

Neurology 2021 01 22;96(1):31-32. Epub 2020 Oct 22.

From the Department of Neuroradiology, Adolphe de Rothschild Foundation Hospital, Paris, France.

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http://dx.doi.org/10.1212/WNL.0000000000011092DOI Listing
January 2021

Visual Recovery with Iloprost Added to Corticosteroids in a Case of Giant Cell Arteritis.

Ocul Immunol Inflamm 2020 Sep 25:1-3. Epub 2020 Sep 25.

Department of Ophthalmology (Neuro-ophthalmology Section), Rothschild Foundation Hospital , Paris, France.

Introduction: To date, corticosteroids remain the cornerstone treatment of ocular involvement of GCA, and no other treatment has proven to be effective in this setting. We herein report on a unique case of GCA with ocular involvement worsening despite high dose corticosteroids and recovering with intravenous iloprost.

Case Report: A 70-year-old man presented with acute vision loss in his left eye related to anterior ischemic optic neuropathy. The diagnosis of giant-cell arteritis was confirmed by a temporal artery biopsy. Despite intravenous pulse methylprednisolone for 3 days then oral prednisone at 60 mg/day, the patient developed from day 5 fluctuating vision loss in the right eye, related to ocular ischemia by occlusion of the ophthalmic artery, and responsive to hyperhydration. Iloprost, an analog of prostacyclin PGI2, was then administered intravenously for 5 days and resulted in a stable improvement in visual acuity in the right eye.

Conclusion: This case highlights the potential role of vasodilatator agents in giant cell arteritis with ocular involvement.
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http://dx.doi.org/10.1080/09273948.2020.1802489DOI Listing
September 2020

How can we combat multicenter variability in MR radiomics? Validation of a correction procedure.

Eur Radiol 2021 Apr 25;31(4):2272-2280. Epub 2020 Sep 25.

Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), Inserm, Institut Curie Centre de Recherche, Université Paris-Saclay, Bât 101B, rue Henri Becquerel, 91401, Orsay, France.

Objective: Test a practical realignment approach to compensate the technical variability of MR radiomic features.

Methods: T1 phantom images acquired on 2 scanners, FLAIR and contrast-enhanced T1-weighted (CE-T1w) images of 18 brain tumor patients scanned on both 1.5-T and 3-T scanners, and 36 T2-weighted (T2w) images of prostate cancer patients scanned in one of two centers were investigated. The ComBat procedure was used for harmonizing radiomic features. Differences in statistical distributions in feature values between 1.5- and 3-T images were tested before and after harmonization. The prostate studies were used to determine the impact of harmonization to distinguish between Gleason grades (GGs).

Results: In the phantom data, 40 out of 42 radiomic feature values were significantly different between the 2 scanners before harmonization and none after. In white matter regions, the statistical distributions of features were significantly different (p < 0.05) between the 1.5- and 3-T images for 37 out of 42 features in both FLAIR and CE-T1w images. After harmonization, no statistically significant differences were observed. In brain tumors, 41 (FLAIR) or 36 (CE-T1w) out of 42 features were significantly different between the 1.5- and 3-T images without harmonization, against 1 (FLAIR) or none (CE-T1w) with harmonization. In prostate studies, 636 radiomic features were significantly different between GGs after harmonization against 461 before. The ability to distinguish between GGs using radiomic features was increased after harmonization.

Conclusion: ComBat harmonization efficiently removes inter-center technical inconsistencies in radiomic feature values and increases the sensitivity of studies using data from several scanners.

Key Points: • Radiomic feature values obtained using different MR scanners or imaging protocols can be harmonized by combining off-the-shelf image standardization and feature realignment procedures. • Harmonized radiomic features enable one to pool data from different scanners and centers without a substantial loss of statistical power caused by intra- and inter-center variability. • The proposed realignment method is applicable to radiomic features from different MR sequences and tumor types and does not rely on any phantom acquisition.
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http://dx.doi.org/10.1007/s00330-020-07284-9DOI Listing
April 2021

A Magnetic Resonance Imaging Radiomics Signature to Distinguish Benign From Malignant Orbital Lesions.

Invest Radiol 2021 Mar;56(3):173-180

Department of Orbitopalpebral Surgery, Fondation Adolphe de Rothschild Hospital.

Objectives: Distinguishing benign from malignant orbital lesions remains challenging both clinically and with imaging, leading to risky biopsies. The objective was to differentiate benign from malignant orbital lesions using radiomics on 3 T magnetic resonance imaging (MRI) examinations.

Materials And Methods: This institutional review board-approved prospective single-center study enrolled consecutive patients presenting with an orbital lesion undergoing a 3 T MRI prior to surgery from December 2015 to July 2019. Radiomics features were extracted from 6 MRI sequences (T1-weighted images [WIs], DIXON-T2-WI, diffusion-WI, postcontrast DIXON-T1-WI) using the Pyradiomics software. Features were selected based on their intraobserver and interobserver reproducibility, nonredundancy, and with a sequential step forward feature selection method. Selected features were used to train and optimize a Random Forest algorithm on the training set (75%) with 5-fold cross-validation. Performance metrics were computed on a held-out test set (25%) with bootstrap 95% confidence intervals (95% CIs). Five residents, 4 general radiologists, and 3 expert neuroradiologists were evaluated on their ability to visually distinguish benign from malignant lesions on the test set. Performance comparisons between reader groups and the model were performed using McNemar test. The impact of clinical and categorizable imaging data on algorithm performance was also assessed.

Results: A total of 200 patients (116 [58%] women and 84 [42%] men; mean age, 53.0 ± 17.9 years) with 126 of 200 (63%) benign and 74 of 200 (37%) malignant orbital lesions were included in the study. A total of 606 radiomics features were extracted. The best performing model on the training set was composed of 8 features including apparent diffusion coefficient mean value, maximum diameter on T1-WIs, and texture features. Area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity on the test set were respectively 0.869 (95% CI, 0.834-0.898), 0.840 (95% CI, 0.806-0.874), 0.684 (95% CI, 0.615-0.751), and 0.935 (95% CI, 0.905-0.961). The radiomics model outperformed all reader groups, including expert neuroradiologists (P < 0.01). Adding clinical and categorizable imaging data did not significantly impact the algorithm performance (P = 0.49).

Conclusions: An MRI radiomics signature is helpful in differentiating benign from malignant orbital lesions and may outperform expert radiologists.
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http://dx.doi.org/10.1097/RLI.0000000000000722DOI Listing
March 2021

Increased rather than decreased incidence of giant-cell arteritis during the COVID-19 pandemic.

Ann Rheum Dis 2020 Aug 7. Epub 2020 Aug 7.

Internal Medicine, The Fondation Adolphe de Rothschild Hospital, Paris, France.

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http://dx.doi.org/10.1136/annrheumdis-2020-218343DOI Listing
August 2020

Intravoxel incoherent motion (IVIM) 3 T MRI for orbital lesion characterization.

Eur Radiol 2021 Jan 1;31(1):14-23. Epub 2020 Aug 1.

Université de Paris, PARCC, INSERM, F-75015, Paris, France.

Objectives: To determine the diagnostic accuracy of MRI intravoxel incoherent motion (IVIM) when characterizing orbital lesions, which is challenging due to a wide range of locations and histologic types.

Methods: This IRB-approved prospective single-center study enrolled participants presenting with an orbital lesion undergoing a 3-T MRI prior to surgery from December 2015 to July 2019. An IVIM sequence with 15 b values ranging from 0 to 2000 s/mm was performed. Two neuroradiologists, blinded to clinical data, individually analyzed morphological MRIs. They drew one region of interest inside each orbital lesion, providing apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion fraction (f), and pseudodiffusion coefficient (D*) values. T test, Mann-Whitney U test, and receiver operating characteristic curve analyses were performed to discriminate between orbital lesions and to determine the diagnostic accuracy of the IVIM parameters.

Results: One hundred fifty-six participants (84 women and 72 men, mean age 54.4 ± 17.5 years) with 167 orbital lesions (98/167 [59%] benign lesions including 54 orbital inflammations and 69/167 [41%] malignant lesions including 32 lymphomas) were included in the study. ADC and D were significantly lower in malignant than in benign lesions: 0.8 × 10 mm/s [0.45] versus 1.04 × 10 mm/s [0.33], p < 0.001, and 0.75 × 10 mm/s [0.40] versus 0.98 × 10 mm/s [0.42], p < 0.001, respectively. D* was significantly higher in malignant lesions than in benign ones: 12.8 × 10 mm/s [20.17] versus 7.52 × 10 mm/s [7.57], p = 0.005. Area under curve was of 0.73, 0.74, 0.72, and 0.81 for ADC, D, D*, and a combination of D, f, and D*, respectively.

Conclusions: Our study showed that IVIM might help better characterize orbital lesions.

Key Points: • Intravoxel incoherent motion (IVIM) helps clinicians to assess patients with orbital lesions. • Intravoxel incoherent motion (IVIM) helps clinicians to characterize orbital lymphoma versus orbital inflammation. • Management of patients becomes more appropriate.
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http://dx.doi.org/10.1007/s00330-020-07103-1DOI Listing
January 2021

Re: Vahdani et al.: Presentation and treatment of deep orbital dermoid cysts. (Ophthalmology. 2020 Mar 5;S0161-6420(20)30225-6. doi: 10.1016/j.ophtha.2020.02.037. Online ahead of print.).

Ophthalmology 2020 08;127(8):e60-e61

Department of Orbitopalpebral Surgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.

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http://dx.doi.org/10.1016/j.ophtha.2020.04.011DOI Listing
August 2020

Neurologic and neuroimaging findings in patients with COVID-19: A retrospective multicenter study.

Neurology 2020 09 17;95(13):e1868-e1882. Epub 2020 Jul 17.

From the Hôpitaux Universitaires de Strasbourg (S.K., F.L., S.B., F.-D.A., T.W.), Service d'imagerie 2, Hôpital de Hautepierre; Engineering Science, Computer Science and Imaging Laboratory (S.K., N.M.), UMR 7357, University of Strasbourg-CNRS; Service de Neurologie (M. Anheim), Hôpitaux Universitaires de Strasbourg; Institut de Génétique et de Biologie Moléculaire et Cellulaire (M. Anheim), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch; Fédération de Médecine Translationnelle de Strasbourg (M. Anheim), Université de Strasbourg; Hôpitaux universitaires de Strasbourg (H.M., F.M., J.H.), Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil; INSERM (French National Institute of Health and Medical Research) (H.M., F.M.), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg; Médecine Intensive-Réanimation (M.S., F.S.), Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg; Service de Neuroradiologie (H.O., F.B., J.M.), Hôpitaux Civils de Colmar; Service d'Imagerie (A. Khalil, A.G.), Unité de Neuroradiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard; Université Paris Diderot (A. Khalil), Paris; Service de Neurologie (S. Carré, C.L.), Centre Hospitalier de Haguenau; Service de Radiologie (M. Alleg), Centre Hospitalier de Haguenau; Service de Neuroradiologie, (E.S., R.A., F.Z.) Hôpital Central, CHU de Nancy; CHIC Unisanté (L.J., P.N., Y.T.M.), Hôpital Marie Madeleine, Forbach; Neuroimaging Department (G.H., J. Benzakoun, C.O., G. Boulouis, M.E.-G., B.K.), GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Université de Paris, INSERM U1266, F-75014; CHU Rennes (J.-C.F., B.C.-N.), Department of Neuroradiology; CHU Rennes (A.M.), Medical Intensive Care Unit; Department of Neuroradiology (P.-O.C., F.R., P.T.), University Hospital of Dijon, Hôpital François Mitterrand; Service de Radiologie (C.B.), CHU de Saint-Etienne; Service de Réanimation (X.F.), CH de Roanne; Service de Neuroradiologie (G.F., S.S.), CHU de Limoges; Radiology Department (I.d.B., G. Bornet), Hôpital Privé d'Antony; Department of Diagnostic and Interventional Neuroradiology (H.D.), University Hospital, Nantes; Neuroradiology Department (J. Berge), CHU de Bordeaux; Service de Neuroradiologie (A. Kazémi), CHU de Lille; Assistance Publique Hôpitaux de Paris (N.P.), Service de Neuroradiologie, Hôpital Pitié-Salpêtrière; Sorbonne Université (N.P.), Univ Paris 06, UMR S 1127, CNRS UMR 7225, ICM, F-75013; Service de Neuroradiologie Diagnostique (A.L.), Foundation A. Rothschild Hospital, Paris; EA CHIMERE 7516 (J.-M.C.), Université de Picardie Jules Verne; Service de NeuroRadiologie, pôle Imagerie Médicale, Centre Hospitalo-Universitaire d'Amiens; Hôpitaux Universitaires de Strasbourg (P.-E.Z., M.M.), UCIEC, Pôle d'Imagerie, Strasbourg; Observatoire Français de la Sclérose en Plaques (J.-C.B.), Lyon; Nephrology and Transplantation Department (S. Caillard), Hôpitaux Universitaires de Strasbourg; Inserm UMR S1109 (S. Caillard), LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg; Hôpitaux Universitaires de Strasbourg (O.C., P.M.M.), Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil; Hôpitaux Universitaires de Strasbourg (S.F.-K.), Laboratoire de Virologie Médicale; Radiology Department (M.O.), Nouvel Hôpital Civil, Strasbourg University Hospital; CHU de Strasbourg (N.M.), Service de Santé Publique, GMRC, F-67091 Strasbourg; Immuno-Rhumatologie Moléculaire (S.F.-K., J.H.), INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg; MRI Center (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France.

Objective: To describe neuroimaging findings and to report the epidemiologic and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with neurologic manifestations.

Methods: In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI.

Results: The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20-92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome ( = 0.006) and more frequently had corticospinal tract signs ( = 0.02). Patients with encephalitis were younger ( = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement ( = 0.009).

Conclusions: Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF.

Clinicaltrialsgov Identifier: NCT04368390.
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http://dx.doi.org/10.1212/WNL.0000000000010112DOI Listing
September 2020

Visual field loss and structure-function relationships in optic neuritis associated with myelin oligodendrocyte glycoprotein antibody.

Mult Scler 2020 Jul 7:1352458520937281. Epub 2020 Jul 7.

Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France.

Background: A paradoxical discrepancy between severe peripapillary retinal nerve fiber layer (pRNFL) atrophy and good visual outcome had been reported in patients with myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG)-associated optic neuritis (ON). However, only visual acuity (VA) was assessed.

Objectives: To study visual field (VF) outcomes of patients with MOG-IgG-associated ON and evaluate the correlation between functional eye outcome and retinal structural changes assessed by optical coherence tomography.

Methods: The records of 32 patients with MOG-IgG-associated ON who underwent ophthalmological examination at least 12 months after ON onset were reviewed. Degree of VF disability was determined by mean deviation (MD).

Results: At final assessment (median, 35 months), 4.2% of 48 affected eyes (AE) had VA ⩽ 0.1, 40% had abnormal MD, and among AE with final VA ⩾ 1.0, 31% had mild to moderate damage. Thinning of the inner retinal layers was significantly correlated with MD impairment. Analysis demonstrated a threshold of pRNFL thickness (50 µm), below which MD was significantly worse (mean, -2.27 dB vs -17.72 dB;  = 0.0003). ON relapse was significantly associated with poor visual outcome assessed by MD.

Conclusion: Functional impairment measured with VF is not rare, and MD assessment better reflects actual structural damage.
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http://dx.doi.org/10.1177/1352458520937281DOI Listing
July 2020

Optic Pathways Enlargement on Magnetic Resonance Imaging in Patients with Morning Glory Disc Anomaly.

Ophthalmology 2021 01 2;128(1):172-174. Epub 2020 Jul 2.

Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France.

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http://dx.doi.org/10.1016/j.ophtha.2020.06.060DOI Listing
January 2021

Consensus Guidelines of the French Society of Neuroradiology (SFNR) on the use of Gadolinium-Based Contrast agents (GBCAs) and related MRI protocols in Neuroradiology.

J Neuroradiol 2020 Nov 18;47(6):441-449. Epub 2020 Jun 18.

MRI center, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Lyon 1, CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France.

Gadolinium-based contrast agents (GBCAs) are used in up to 35% of magnetic resonance imaging (MRI) examinations and are associated with an excellent safety profile. Nevertheless, two main issues have arisen in the last two decades: the risk of nephrogenic systemic fibrosis and the risk of gadolinium deposition and retention. As a first step, this article reviews the different categories of GBCAs available in neuroradiology, their issues, and provides updates regarding the use of these agents in routine daily practice. Recent advances in MRI technology, as well as the development of new MRI sequences, have made GBCA injection avoidable in many indications, especially in patients with chronic diseases when iterative MRIs are required and when essential diagnostic information can be obtained without contrast enhancement. These recent advances also lead to changes in recommended MRI protocols. Thus, in a second step, this review focuses on consensus concerning brain MRI protocols in 10 common situations (acute ischemic stroke, intracerebral hemorrhage, cerebral venous thrombosis, multiple sclerosis, chronic headache, intracranial infection, intra- and extra-axial brain tumors, vestibular schwannoma and pituitary adenoma). The latter allowing the standardization of practices in neuroradiology. Recommendations were also made concerning the use of GBCAs in neuroradiology, based on evidence in the literature and/or by consensus between the different coauthors.
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http://dx.doi.org/10.1016/j.neurad.2020.05.008DOI Listing
November 2020

Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study.

Radiology 2020 11 16;297(2):E242-E251. Epub 2020 Jun 16.

From the Hôpitaux Universitaires de Strasbourg, Service d'Imagerie 2, Hôpital de Hautepierre, Strasbourg, France (S.K.).

Background Brain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Purpose To describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection. Materials and Methods This was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were () positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, () severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, () neurologic manifestations, and () abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student test or Wilcoxon test. < .05 represented a significant difference. Results Thirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8-78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid. Conclusion Patients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described. © RSNA, 2020.
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http://dx.doi.org/10.1148/radiol.2020202222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301613PMC
November 2020

Neurologic Involvement of Patients with Coronavirus Disease 2019: Making the Most of MRI.

Radiology 2020 10 9;297(1):E239. Epub 2020 Jun 9.

Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 29 rue Manin, Paris 75019, France.

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http://dx.doi.org/10.1148/radiol.2020202466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294820PMC
October 2020

Cerebral venous thrombosis associated with COVID-19 infection: Causality or coincidence?

J Neuroradiol 2021 Mar 11;48(2):121-124. Epub 2020 May 11.

Department of Neuroradiology, Adolphe de Rothschild Foundation Hospital, 29, rue Manin, 75019 Paris, France.

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http://dx.doi.org/10.1016/j.neurad.2020.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211586PMC
March 2021

MRI and ultrasonography are useful tools for a non-invasive diagnosis of IgG4-related disease.

Ann Rheum Dis 2020 Mar 30. Epub 2020 Mar 30.

Internal Medicine, The Fondation Adolphe de Rothschild Hospital, Paris, France.

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http://dx.doi.org/10.1136/annrheumdis-2020-217352DOI Listing
March 2020

Increased diagnostic accuracy of giant cell arteritis using three-dimensional fat-saturated contrast-enhanced vessel-wall magnetic resonance imaging at 3 T.

Eur Radiol 2020 Apr 6;30(4):1866-1875. Epub 2019 Dec 6.

Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, 29 rue Manin, 75019, Paris, France.

Objectives: To compare the diagnostic accuracy of 3D versus 2D contrast-enhanced vessel-wall (CE-VW) MRI of extracranial and intracranial arteries in the diagnosis of GCA.

Methods: This prospective two-center study was approved by a national research ethics board and enrolled participants from December 2014 to October 2017. A protocol including both a 2D and a 3D CE-VW MRI at 3 T was performed in all patients. Two neuroradiologists, blinded to clinical data, individually analyzed separately and in random order 2D and 3D sequences in the axial plane only or with reformatting. The primary judgment criterion was the presence of GCA-related inflammatory changes of extracranial arteries. Secondary judgment criteria included inflammatory changes of intracranial arteries and the presence of artifacts. A McNemar's test was used to compare 2D to 3D CE-VW MRIs.

Results: Seventy-nine participants were included in the study (42 men and 37 women, mean age 75 (± 9.5 years)). Fifty-one had a final diagnosis of GCA. Reformatted 3D CE-VW was significantly more sensitive than axial-only 3D CE-VW or 2D CE-VW when showing inflammatory change of extracranial arteries: 41/51(80%) versus 37/51 (73%) (p = 0.046) and 35/50 (70%) (p = 0.03). Reformatted 3D CE-VW was significantly more specific than 2D CE-VW: 27/27 (100%) versus 22/26 (85%) (p = 0.04). 3D CE-VW showed higher sensitivity than 2D CE-VW when detecting inflammatory changes of intracranial arteries: 10/51(20%) versus 4/50(8%), p = 0.01. Interobserver agreement was excellent for both 2D and 3D CE-VW MRI: κ = 0.84 and 0.82 respectively.

Conclusions: 3D CE-VW MRI supported more accurate diagnoses of GCA than 2D CE-VW.

Key Points: • 3D contrast-enhanced vessel-wall magnetic resonance imaging is a high accuracy, non-invasive diagnostic tool used to diagnose giant cell arteritis. • 3D contrast-enhanced vessel-wall imaging is feasible for clinicians to complete within a relatively short time, allowing immediate assessment of extra and intracranial arteries. • 3D contrast-enhanced vessel-wall magnetic resonance imaging might be considered a diagnostic tool when intracranial manifestation of GCA is suspected.
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http://dx.doi.org/10.1007/s00330-019-06536-7DOI Listing
April 2020

3D PSIR MRI at 3 Tesla improves detection of spinal cord lesions in multiple sclerosis.

J Neurol 2020 Feb 26;267(2):406-414. Epub 2019 Oct 26.

Department of Neuroradiology, Foundation Adolphe de Rothschild Hospital, Paris, France.

Background: Spinal imaging in multiple sclerosis remains challenging because of its small size and numerous artifacts.

Objective: To compare 3D Phase-Sensitive Inversion Recovery (PSIR) to a conventional dataset of 3D Short Tau Inversion Recovery (STIR) and T2-weighted imaging at 3 Tesla to detect multiple sclerosis spinal cord lesions.

Methods: This prospective single-center study was approved by a national research ethics board and included 54 patients (median age 44) enrolled from December 2016 to August 2018. Two neuroradiologists individually analyzed the two datasets separately and in random order. Discrepancies were resolved by consensus with a third neuroradiologist. The primary judgment criterion was the number of spinal cord lesions. Secondary judgment criteria included location of the lesions, reader-reported confidence and conspicuity assessed with the lesion-to-cord contrast ratio (LCCR).

Results: 3D PSIR detected significantly more lesions than the conventional dataset (371 versus 173, respectively, p < 0.05). Seven patients had no detected lesion with the conventional dataset, whereas 3D PSIR detected at least one lesion. LCCR mean reader-reported confidence (p < 0.001) and inter-observer agreement were higher using 3D PSIR.

Conclusions: 3D PSIR significantly improved overall spinal cord lesion detection in MS patients, with higher reader-reported confidence, higher lesion contrast, and higher inter-reader agreement.
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http://dx.doi.org/10.1007/s00415-019-09591-8DOI Listing
February 2020

Retrolaminar and Chiasmal Silicone Oil Migration.

Ophthalmology 2019 09;126(9):1305

Department of Neuroradiology.

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http://dx.doi.org/10.1016/j.ophtha.2019.05.024DOI Listing
September 2019

Optimizing 3D FLAIR to detect MS lesions: pushing past factory settings for precise results.

J Neurol 2019 Nov 1;266(11):2786-2795. Epub 2019 Aug 1.

Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75019, Paris, France.

Background: To assess the diagnostic value of three 3D FLAIR sequences with differing repetition-times (TR) at 3-Tesla when detecting multiple sclerosis (MS) lesions.

Methods: In this prospective study, approved by the institutional review board, 27 patients with confirmed MS were prospectively included. One radiologist performed manual segmentations of all high-signal intensity lesions using three 3D FLAIR data sets with different TR of 4800 ms ("FLAIR"), 8000 ms ("FLAIR") and 10,000 ms ("FLAIR") and two radiologists double-checked it. The main judgment criterion was the overall number of lesions; secondary objectives were the assessment of lesion location, as well as measuring contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). A non-parametric Wilcoxon's test was used to compare the differing FLAIR.

Results: The FLAIR and FLAIR detected significantly more overall lesions per patient as compared with the FLAIR [116.1 (± 61.7) (p = 0.02) and 115.8 (± 56.3) (p = 0.03) versus 99.2 (± 66.9), respectively]. The FLAIR and FLAIR detected four and eight times more cortical or juxta-cortical lesions per patient as compared with FLAIR [1.6 (± 2.2) (p = 0.001) and 4.1 (± 5.9) (p = 6 × 10) versus 0.4 (± 1.1), respectively]. CNR was significantly correlated to the TR value. It was significantly higher with FLAIR than it was with FLAIR and FLAIR [16.3 (± 3.5) versus 15 (± 2.4) (p = 0.01) and 12 (± 2.2) (p = 2 × 10), respectively] CONCLUSION: An optimized 3D FLAIR with a long TR significantly improved both overall lesion detection and CNR in MS patients as compared to a 3D FLAIR with factory settings.
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http://dx.doi.org/10.1007/s00415-019-09490-yDOI Listing
November 2019

Three Tesla 3D High-Resolution Vessel Wall MRI of the Orbit may Differentiate Arteritic From Nonarteritic Anterior Ischemic Optic Neuropathy.

Invest Radiol 2019 11;54(11):712-718

From the Departments of Neuroradiology.

Background: Anterior ischemic optic neuropathy (AION) is the most common cause of acute optic neuropathy in older patients. Distinguishing between arteritic AION (A-AION) and nonarteritic (NA-AION) is paramount for improved patient management.

Purpose: The aim of this study was to evaluate 3-dimensional high-resolution vessel wall (HR-VW) magnetic resonance imaging (MRI) at 3 T to discriminate A-AION from NA-AION.

Materials And Methods: This prospective single-center study was approved by a national research ethics board and included 27 patients (17 A-AION and 10 NA-AION) with 36 AIONs from December 2014 to August 2017 who underwent 3 T HR-VW MRI. Two radiologists blinded to clinical data individually analyzed the imaging separately and in random order. Discrepancies were resolved by consensus with a third neuroradiologist. The primary diagnostic criterion was the presence of inflammatory changes of the ophthalmic artery. Secondary diagnostic criteria included the presence of an enhancement of the optic nerve or its sheath, the optic disc, or inflammatory changes of posterior ciliary or extracranial arteries. A Fisher exact test was used to compare A-AION from NA-AION patients.

Results: Inflammatory changes of the ophthalmic artery were present in all patients with A-AION but in none of NA-AION (P < 0.0001). Its sensitivity, specificity, positive predictive value, and negative predictive value were 100%. Inflammatory changes of posterior ciliary arteries were significantly more likely in A-AOIN (82% vs 0%, P < 0.0001). Interreader and intrareader agreements were almost perfect (κ = 0.82-1).

Conclusions: High-resolution vessel wall MRI seems highly accurate when distinguishing A-AION from NA-AION and might be useful to improve patient management.
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http://dx.doi.org/10.1097/RLI.0000000000000595DOI Listing
November 2019

Corneal Salzmann Nodular Degeneration.

JAMA Ophthalmol 2019 Jul 11;137(7):e185473. Epub 2019 Jul 11.

Department of Radiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.

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http://dx.doi.org/10.1001/jamaophthalmol.2018.5473DOI Listing
July 2019