Publications by authors named "Jean-Michel Bartoli"

58 Publications

Prevalence of Thoracic Aortic Aneurysms in Patients with Degenerative Abdominal Aortic Aneurysms: Results from the Prospective ACTA Study.

Eur J Vasc Endovasc Surg 2021 06 20;61(6):930-937. Epub 2021 Apr 20.

Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France. Electronic address:

Objective: There are no recommendations for screening for thoracic aortic aneurysms (TAAs), even in patients with infrarenal abdominal aortic aneurysms (AAAs). The aims of this study were to determine the prevalence of TAAs in patients with AAAs and to analyse the risk factors for this association.

Methods: This was a multicentre prospective study. The Aortic Concomitant Thoracic and Abdominal Aneurysm (ACTA) study included 331 patients with infrarenal AAAs > 40 mm between September 2012 and May 2016. These patients were prospectively enrolled in three French academic hospitals.

Results: Patients were classified as having a normal, aneurysmal, or ectatic (non-normal, non-aneurysmal) thoracic aorta according to their maximum aortic diameter indexed by sex, age, and body surface area. Thoracic aortic ectasia (TAE) was defined as above or equal to the 90th percentile of normal aortic diameters according to gender and body surface area. Descending TAA was defined as ≥ 150% of the mean normal value, and ascending TAA as > 47 mm in men and 42 mm in women; 7.6% (n = 25) had either an ascending (seven cases; 2.2%) or descending aortic TAA (18 cases; 5.4%), and 54.6% (n = 181) had a TAE. Among the 25 patients with TAAs, five required surgery; two patients had TAAs related to penetrating aortic ulcers < 60 mm in diameter, and three had a TAA > 60 mm. In the multinomial regression analysis, atrial fibrillation (AF) (odds ratio [OR] 11.36, 95% confidence interval [CI] 2.18 - 59.13; p = .004) and mild aortic valvulopathy (OR 2.89, 1.04-8.05; p = .042) were independent factors associated with TAAs. Age (OR 1.06, CI 1.02 - 1.09; p = .003) and AF (OR 4.36, 1.21 - 15.61; p = .024) were independently associated with ectasia.

Conclusion: This study confirmed that TAAs coexisting with AAAs are not rare, and one fifth of these TAAs are treated surgically. Systematic screening by imaging the whole aorta in patients with AAAs is clinically relevant and should lead to an effective prevention policy.
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http://dx.doi.org/10.1016/j.ejvs.2021.03.004DOI Listing
June 2021

Proposals for the use of artificial intelligence in emergency radiology.

Diagn Interv Imaging 2021 Feb 2;102(2):63-68. Epub 2020 Dec 2.

Department of Musculoskeletal Imaging, Lille University Hospital, 59000 Lille, France; Lille University School of Medicine, 59000 Lille, France; Collège des Enseignants en Radiologie de France (CERF), 75013 Paris, France; Société Française de Radiologie, 75013 Paris, France.

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http://dx.doi.org/10.1016/j.diii.2020.11.003DOI Listing
February 2021

Efficacy of Chest CT for COVID-19 Pneumonia Diagnosis in France.

Radiology 2021 02 1;298(2):E81-E87. Epub 2020 Sep 1.

From the University Hospital Centre Poitiers, Radiology, 2 rue de la Milétrie, 86000 Poitiers, Vienne, France (G. Herpe.); Laboratoire de Mathématiques et Applications Université de Poitiers, DACTIM-MIS TEAM, Chasseneuil, Nouvelle Aquitaine, France (G. Herpe.); University Hospital of Rennes, Radiology, Rennes, Ille-et-Vilaine, France (M. Lederlin.); University of Rennes, Rennes, Ille-et-Vilaine, France (M. Lederlin.); Université de Poitiers Laboratoire de Mathématiques et Applications, DACTIM-MIS, Chasseneuil, Nouvelle Aquitaine, France (M.N.); University Hospital Centre Poitiers, DACTIM-MIS, Poitiers, France (M.N.); Nouvel Hôpital Civil, Radiology, Strasbourg, Alsace, France (M.O.); APHM, Radiology, Marseille, PACA, France (K.C.); AMU, Marseille, PACA, France (K.C.); Beaujon Hospital Department of Medical Imaging, Radiology, Clichy, France (J.G.); Beaujon University Hospitals Paris Nord Val de Seine, Radiology, Clichy, Hauts-de-Seine, France (V.V.); CHU Nîmes, Nîmes, Gard, France (C.A.F.); Hôpital Saint-Louis, Radiology, Paris, Île-de-France, France (C.D.M.M.); Université de Paris, INSERM U1149-Center for Research on Inflammation, Paris, Île-de-France, France (C.D.M.M.); Centre Hospitalier Universitaire de Nice Hôpital Pasteur, Radiology, Nice, Alpes Maritimes, France (V.F.); Centre Hospitalier Annecy Genevois, Radiology, Epagny Metz-Tessy, Auvergne-Rhône-Alpes, France (M. Ludwig.); CHU Nice, Radiology, Nice, PACA, France (L.M.); European Hospital Group Georges-Pompidou, Radiology, Paris, Île-de-France, France (I.F.); Université de la Méditérranée, Faculté de Médecine de Marseille, Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS no. 6612, Marseille, BdR, France (A.R.R.J.); Centre Hospitalo Universitaire la Timone, Service de Radiologie Cardiovasculaire, Marseille, France (A.R.R.J.); Centre Hospitalier de la Côte Basque, Bayonne, Nouvelle Aquitaine, France (P.A.); CHRU de Nancy, Radiology, Nancy, Grand Est, France (I.P.); HIA Legouest, Service d'Imagerie Médicale, Metz, France (A.G.); CHU Nancy, Service D'imagerie Guilloz, Nancy, France (A.G.); Hôpital Saint-Joseph, Radiology, Marseille, PACA, France (O.B.); Clinique Emilie de Vialar, IMEV, Radiologie, Rhône, France (A.C.); CH Douai, NORD, Loffre, France (M.M.S.); University Hospital Centre Poitiers, Poitiers, Vienne, France (C.T.); CHRDS, Neuilly-sur-Seine, Neuilly-sur-Seine, France (G. Henry.);, Île de France, France (V.B.); Hôpital d'Instruction des Armées Begin, Radiology, Saint Mande, Île-de-France, France (T.L.T.); Hôpital d'Instruction des Armées Percy, Radiology, Clamart, Île-de-France, France (T.L.T.); CHU Limoges, Radiology, Limoges, Nouvelle Aquitaine, France (M.S.G.); CHU Dupuytren, Radiologie, Limoges, Haute-Vienne, France (P.G.); Military Teaching Hospital Clermont-Tonnerre, Radiology, Brest, Bretagne, France (M.G.); Hôpital Argenteuil, Argenteuil, Île-de-France, France (E.B.); Centre Hospitalier Pierre-le-Damany Lannion Trestel, Kergomar, Lannion, Bretagne, France (C.M.); Institut Bergonie, Bordeaux, Nouvelle Aquitaine, France (B.L.); CH Douai, Radiology, Douai, Nord, France (A.K.); Centre Hospitalier de Vienne Lucien Hussel, Medical Imaging, Vienne, Aura, France (H.K.); Hôpital d'Instruction des Armées Laveran, Radiology, Marseille, Bouches-du-Rhône, France (F.D.); CHU Tivoli, La Louvière, Wallonie, Belgium (B.D.); CHU Poitiers, Clinical Investigation Center CIC1402, Poitiers, Vienne, France (P.J.S.); CHU Poitiers, Radiology, Poitiers, Poitou-Charentes, France (R.G.); La Timone Hospital, Radiology, Marseille, BdR, France (J.M.B.); University Hospital Center of Nîmes, Radiology, Nîmes, Gard, France (J.P.B.); Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France, France (J.P.T.); and CHU de Poitiers, Service de Radiologie, Poitiers, France, France (J.P.T.) .

Background The role and performance of chest CT in the diagnosis of the coronavirus disease 2019 (COVID-19) pandemic remains under active investigation. Purpose To evaluate the French national experience using chest CT for COVID-19, results of chest CT and reverse transcription polymerase chain reaction (RT-PCR) assays were compared together and with the final discharge diagnosis used as the reference standard. Materials and Methods A structured CT scan survey (NCT04339686) was sent to 26 hospital radiology departments in France between March 2, 2020, and April 24, 2020. These dates correspond to the peak of the national COVID-19 epidemic. Radiology departments were selected to reflect the estimated geographic prevalence heterogeneities of the epidemic. All symptomatic patients suspected of having COVID-19 pneumonia who underwent both initial chest CT and at least one RT-PCR test within 48 hours were included. The final discharge diagnosis, based on multiparametric items, was recorded. Data for each center were prospectively collected and gathered each week. Test efficacy was determined by using the Mann-Whitney test, Student test, χ test, and Pearson correlation coefficient. < .05 indicated a significant difference. Results Twenty-six of 26 hospital radiology departments responded to the survey, with 7500 patients entered; 2652 did not have RT-PCR test results or had unknown or excess delay between the RT-PCR test and CT. After exclusions, 4824 patients (mean age, 64 years ± 19 [standard deviation], 2669 male) were included. With final diagnosis as the reference, 2564 of the 4824 patients had COVID-19 (53%). Sensitivity, specificity, negative predictive value, and positive predictive value of chest CT in the diagnosis of COVID-19 were 2319 of 2564 (90%; 95% CI: 89, 91), 2056 of 2260 (91%; 95% CI: 91, 92), 2056 of 2300 (89%; 95% CI: 87, 90), and 2319 of 2524 (92%; 95% CI: 91, 93), respectively. There was no significant difference for chest CT efficacy among the 26 geographically separate sites, each with varying amounts of disease prevalence. Conclusion Use of chest CT for the initial diagnosis and triage of patients suspected of having coronavirus disease 2019 was successful. © RSNA, 2021
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http://dx.doi.org/10.1148/radiol.2020202568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465292PMC
February 2021

COVID-19 impact assessment on the French radiological centers: a nationwide survey.

Eur Radiol 2020 Dec 3;30(12):6537-6544. Epub 2020 Jul 3.

University Hospital Center of Nîmes, Radiology, Nîmes, Gard, France.

Purpose: To determine the impact of the COVID-19 on the CT activities in French radiological centers during the epidemic peak.

Materials And Methods: A cross-sectional prospective CT scan survey was conducted between March 16 and April 12, 2020, in accordance with the local IRB. Seven hundred nine radiology centers were invited to participate in a weekly online survey. Numbers of CT examinations related to COVID-19 including at least chest (CT) and whole chest CT scan activities (CT) were recorded each week. A sub-analysis on French departments was performed during the 4 weeks of the study. The impact of the number of RT-PCRs (reverse transcriptase polymerase chain reactions) on the CT workflow was tested using two-sample t test and Pearson's test.

Results: Five hundred seventy-seven structures finally registered (78%) with mean response numbers of 336 ± 18.9 (323; 351). Mean CT activity per radiologic structure ranged from 75.8 ± 133 (0-1444) on week 12 to 99.3 ± 138.6 (0-1147) on week 13. Mean ratio of CT on CT varied from 0.36 to 0.59 on week 12 and week 14 respectively. There was a significant relationship between the number of RT-PCR performed and the number of CT (r = 0.73, p = 3.10) but no link with the number of positive RT-PCR results.

Conclusion: In case of local high density COVID-19, CT workflow is strongly modified and redirected to the management of these specific patients.

Key Points: • Over the 4-week survey period, 117,686 chest CT (CT) were performed among the responding centers, including 61,784 (52%) CT performed for COVID-19 (CT). • Across the country, the ratio CT/CT varied from 0.36 to 0.59 and depended significantly on the local epidemic density (p = 0.003). • In clinical practice, in a context of growing epidemic, in France, chest CT was used as a surrogate to RT-PCR for patient triage.
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http://dx.doi.org/10.1007/s00330-020-07035-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333367PMC
December 2020

Combining Volumetric and Wall Shear Stress Analysis from CT to Assess Risk of Abdominal Aortic Aneurysm Progression.

Radiology 2020 06 31;295(3):722-729. Epub 2020 Mar 31.

From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.).

Background Despite known limitations, the decision to operate on abdominal aortic aneurysm (AAA) is primarily on the basis of measurement of maximal aneurysm diameter. Purpose To identify volumetric and computational fluid dynamics parameters to predict AAAs that are likely to progress in size. Materials and Methods This study, part of a multicenter prospective registry (NCT01599533), included 126 patients with AAA. Patients were sorted into stable (≤10-mL increase in aneurysm volume) and progression (>10-mL increase in aneurysm volume) groups. Initial AAA characteristics of the derivation cohort were analyzed (maximal diameter and surface, thrombus and lumen volumes, maximal wall pressure, and wall shear stress [WSS]) to identify relevant parameters for a logistic regression model. Model and maximal diameter diagnostic performances were assessed in both cohorts and for AAAs smaller than 50 mm by using area under the receiver operating characteristic curve (AUC). Results Eighty-one patients were included (mean age, 73 years ± 7 years [standard deviation]; 78 men). The derivation and validation cohorts included, respectively, 50 and 31 participants. In the derivation cohort, there was higher mean lumen volume and lower mean WSS in the progression group compared with the stable group (60 mL ± 14 vs 46 mL ± 18 [ = .005] and 66% ± 6 vs 53% ± 9 [ = .02], respectively). Mean lumen volume and mean WSS at baseline were correlated to total volume growth ( = 0.47 [ = .002] and -0.42 [ = .006], respectively). In the derivation cohort, a regression model including lumen volume and WSS to predict aneurysm enlargement was superior to maximal diameter alone (AUC, 0.78 vs 0.52, respectively; = .003); although no difference was found in the validation cohort (AUC, 0.79 vs 0.71, respectively; = .51). For AAAs smaller than 50 mm, a regression model that included both baseline WSS and lumen volume performed better than maximal diameter (AUC, 0.79 vs 0.53, respectively; = .01). Conclusion Combined analysis of lumen volume and wall shear stress was associated with enlargement of abdominal aortic aneurysms at 1 year, particularly in aneurysms smaller than 50 mm in diameter. © RSNA, 2020 See also the editorial by Mitsouras and Leach in this issue.
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http://dx.doi.org/10.1148/radiol.2020192112DOI Listing
June 2020

[Emborrhoid: Rectal arteries embolization for hemorrhoid treatment].

Presse Med 2019 Apr 3;48(4):454-459. Epub 2019 May 3.

Assistance publique-hôpitaux de Marseille, hôpital de la Timone, service d'imagerie diagnostic et interventionnelle, 264, rue Sainte-Pierre, 13005 Marseille, France; Université Aix-Marseille, CERIMED, faculté de médecine, EA 4264, laboratoire d'imagerie interventionnelle expérimentale (LIIE), 27, boulevard Jean-Moulin, 13005 Marseille, France.

Although hemorrhoids are recognized as a very common cause of rectal bleeding and known for a long time, its treatment has evolved dramatically over the last twenty years. Among the new minimally invasive methods, the "Emborrhoid" technique consists into selective embolization of hemorrhoidal arteries, branches arising from the superior rectal arteries using microcoils. This technique is based on a demonstrated pathophysiological concept of arterial network hypertrophy in hemorrhoid disease. This technique was evaluated in an animal model and then in clinical research on more than 100 patients. No ischemic complications were identified. Studies describe an improvement of 60 to 80% of the symptoms, with on average 30% recurrences at two years. The recurrence rae is likely related to a technically incomplete embolization. Future prospects are focused on more selective embolization with Particulate embolic agents.
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http://dx.doi.org/10.1016/j.lpm.2019.04.011DOI Listing
April 2019

Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors.

J Vasc Interv Radiol 2018 07 5;29(7):975-980. Epub 2018 May 5.

Hôpital de la Timone, 264 Rue Saint Pierre, 13005 Marseille, France; Institut Paoli Calmettes, Marseille, France.

Purpose: To evaluate the safety and efficacy of endovascular management of pulmonary artery lesions caused by lung tumors.

Materials And Methods: Nineteen patients (15 men, 4 women; average age: 60.3 years, range, 51-86 years) treated for massive or recurrent hemoptysis with transarterial pulmonary artery embolization between 2010 and 2016 were included in this multicenter, retrospective study. Inclusion criteria were: patients with lung cancer and at least 1 episode of hemoptysis with a pulmonary artery lesion detected by computed tomography (CT) angiography or after failed bronchial artery embolization. No patient undergoing pulmonary embolization for a lung tumor was excluded. Technical success, clinical success, and complications were recorded. The survival curve was estimated using the Kaplan-Meier method RESULTS: Mean follow-up was 188.1 days (range, 0-1440 days). Primary and assisted technical success rates were 73.7% (14/19) and 84.2% (16/19), respectively. Two patients died during the procedure due to massive hemoptysis and cardiac arrest, and 1 patient was treated with surgery. All patients with technical success achieved clinical success without further bleeding. No complications were noted, and no pulmonary infarction was detected on CT scan during follow-up. Survival rates after embolization at 1 and 3 months were 67% (95% confidence interval [CI]: 40%-90%) and 46% (95% CI: 23%-80%), respectively, with 36.8% (n = 7) of the patients still alive at the end of the study.

Conclusions: Embolization is an effective and safe treatment of lung tumors with pulmonary arterial bleeding.
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http://dx.doi.org/10.1016/j.jvir.2018.01.773DOI Listing
July 2018

Embolization of the Superior Rectal Arteries for Hemorrhoidal Disease: Prospective Results in 25 Patients.

J Vasc Interv Radiol 2018 06 30;29(6):884-892.e1. Epub 2018 Apr 30.

Department of Interventional Radiology, Marseille Public University Hospital System, La Timone University Hospital, 264 Rue Saint Pierre, Marseille 13385, Cedex 05, France; Experimental Interventional Imaging Laboratory, Aix Marseille University, Marseille, France.

Purpose: To evaluate efficacy and safety of superior rectal artery embolization of hemorrhoidal disease as a first-line invasive treatment.

Materials And Methods: This prospective study was conducted between 2014 and 2015 on 25 consecutive patients (16 men and 9 women with a mean age of 53 y [range, 30-76 y]) with grade II-III hemorrhoids refractory to medical treatment. A transfemoral superselective superior rectal artery branch embolization was performed using 2- and 3-mm diameter microcoils. Over the following 12 months, clinical outcomes were evaluated using the French bleeding score, Goligher prolapse score, visual analog scale (VAS) score for pain, quality-of-life score. The primary endpoint was relief of symptoms by 12 months based on a 2-point minimum improvement on VAS score and bleeding score.

Results: At 12 months after embolization, clinical success was obtained in 18 patients (72%), 8 of whom had 2 embolizations. VAS score decreased from 4.6 to 2.3 (P < .01), and bleeding score decreased from 5.5 to 2.3 (P < .01). Quality-of-life and prolapse scores also showed improvement (P < .05), and no patients experienced any early or late complications. Complete clinical failure was observed in 7 patients. After coil embolization, the collateral supply to the hemorrhoidal cushions was significantly related to any recurrence (P = .001).

Conclusions: Hemorrhoidal artery coil embolization was found to be a safe and effective treatment for grade II-III hemorrhoids.
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http://dx.doi.org/10.1016/j.jvir.2018.01.778DOI Listing
June 2018

A rare case of a venous malformation of the clitoris.

Eur J Obstet Gynecol Reprod Biol 2018 05 16;224:202-203. Epub 2018 Mar 16.

Department of Medical Imaging, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, 13005 Marseille, Aix Marseille University, France; Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France; Department of Medical Imaging, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, 13005 Marseille, Aix Marseille University, France; Department of Obstetrics and Gynecology, Assistance Publique Hôpitaux de Marseille, La Conception Hospital, 13005 Marseille, Aix Marseille University, France. Electronic address:

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http://dx.doi.org/10.1016/j.ejogrb.2018.03.018DOI Listing
May 2018

Embolisation of pulmonary radio frequency pathway - a randomised trial.

Int J Hyperthermia 2017 11 23;33(7):814-819. Epub 2017 Apr 23.

a Hopital de la Timone , Marseille , France.

Purpose: Pneumothorax is the most common complication following a pulmonary percutaneous radiofrequency ablation (RFA), and thoracic drainages are the most frequent causes of an extended hospital stay. Our main objective was to show that the use of gelatin torpedoes may significantly decrease the number of chest tube placement.

Materials And Methods: Seventy-three patients were prospectively included in this study and then randomised into two groups: 34 with embolisation and without 39 without embolisation. Each group was comparable for different pneumothorax risk factors.

Results: There were 16 (47%) pneumothorax in Group A ("with embolisation"), which was significantly lower (p < .0001) than the 35 pneumothorax (90%) in Group B ("without embolisation"). The pneumothorax volume (p = .02) was significantly lower in Group A (22.7% average, standard deviation 15.6%) than in Group B (average 34.1%, standard deviation 17.1%). The number of drainages was significantly smaller in those with embolisation (3 drainages or 8%) than those without embolisation (25 drainages or 64%) (p < .001).

Conclusion: When using absorbable gelatin torpedoes, pulmonary RFA pathways embolisation significantly decreased the number of pneumothorax and thoracic drainages to the advantage of therapeutic abstention and exsufflation, non-invasive and functional operational techniques.
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http://dx.doi.org/10.1080/02656736.2017.1309578DOI Listing
November 2017

Pathological effects of lung radiofrequency ablation that contribute to pneumothorax, using a porcine model.

Int J Hyperthermia 2017 11 17;33(7):713-716. Epub 2017 Apr 17.

a Hopital de la Timone , Marseille , France.

Objectives: The incidence of pneumothorax is 7 times higher after lung radiofrequency ablation (RFA) than after lung biopsy. The reasons for such a difference have never been objectified. The histopathologic changes in lung tissue are well-studied and established for RF in the ablation zone. However, it has not been previously described what the nature of thermal injury might be along the shaft of the RF electrode as it traverses through normal lung tissue to reach the ablation zone. The purpose of this study was to determine the changes occurring around the RF needle along the pathway between the ablated zone and the pleura.

Material And Methods: In 3 anaesthetised and ventilated swine, 6 RFA procedures (right and left lungs) were performed using a 14-gauge unipolar multi-tined retractable 3 cm radiofrequency LeVeen probe with a coaxial introducer positioned under CT fluoroscopic guidance. In compliance with literature guidelines, we implemented a gradually increasing thermo-ablation protocol using a RF generator. Helical CT images were acquired pre- and post-RFA procedure to detect and evaluate pneumothorax. Four percutaneous 19-gauge lung biopsies were also performed on the fourth swine under CT guidance. Swine were sacrificed for lung ex vivo examinations, scanning electron microscopy (SEM) and pathological analysis.

Results: Three severe (over 50 ml) pneumothorax were detected after RFA. In each one of them, pathological examination revealed a fistulous tract between ablation zone and pleura. No fistulous tract was observed after biopsies. In the 3 cases of severe pneumothorax, the tract was wide open and clearly visible on post procedure CT images and SEM examinations. The RFA tract differed from the needle biopsy tract. The histological changes that are usually found in the ablated zone were observed in the RFA tract's wall and were related to thermal lesions. These modifications caused the creation of a coagulated pulmonary parenchyma rim between the thermo-ablation zone and the pleural space. The structural properties of the damage can explain why the RFA tract is remains patent after needle withdrawal.

Conclusion: Our study demonstrates for the first time that the changes around the RF needle are the same as in the ablated zone. The damage could create fistulous tracts along the needle path between thermo-ablation zone and pleural space. These fistulas could certainly be responsible for severe pneumothorax that occurs in many patients treated with lung RFA.
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http://dx.doi.org/10.1080/02656736.2017.1309577DOI Listing
November 2017

Role of dual-energy computed tomography in detecting early recurrences of lung tumours treated with radiofrequency ablation.

Int J Hyperthermia 2017 09 23;33(6):653-658. Epub 2017 Mar 23.

a Department of Medical Imaging , University Hospital Timone , Marseille , France.

Purpose: Detecting a recurrence after lung radiofrequency ablation (RFA) is based on a group of arguments that include CT, positron emission tomography (PET-CT) at 3 months and clinical patient follow-up. There is no one examination that is absolutely reliable. Recurrences are diagnosed tardily, when the cancers are locally extended, or when the patients are metastatic. The purpose of this article is to investigate the utility of dual-energy computed tomography (DECT) in order to assess therapeutic responses to RFA for lung neoplasia.

Materials And Methods: This institutional review board-approved study enroled 70 patients with lung tumours who underwent DECT after RFA. All patients provided a written informed consent for the study.

Results: The study included 70 consecutive patients, and 191 DECT measures were performed. We collected the enhancement values of all scars without establishing a prior threshold of positivity. The optimal threshold value areas appeared to be located between 20 and 35 Hounsfield unit (HU) with sensitivity between 70% and 82%; specificity between 72% and 90%; a negative predictive value (NPV) between 96% and 97% and a diagnostic accuracy index between 73% and 87%. At the one month follow-up, 53 nodules were analysed with DECT and four nodules had recurred, all of which were detected by DECT. The sensitivity, which was calculated at 100%, was excellent; the NPV was at 100% (CI: 91.62, 100) and the specificity was at 85.71% (CI: 73.33, 92.9). The diagnostic accuracy index was 86.79% (CI: 75.16, 93.45) and the average DECT acquisitions dosimetry was 106 mGy.cm (33mGy.cm 245mGy.cm).

Conclusion: DECT could be a conceivable alternative for detecting early recurrence after lung RFA. Key points After lung RFA, a PET CT has a high rate of false positives in the initial phase; The study of enhancement in the follow-up of lung lesions treated with RFA, and especially by DECT, can be relevant; Dual Energy CT has a good efficiency for a threshold between 20 and 35 HU, especially in the first month after RFA; DECT could be a conceivable alternative for detecting early recurrence.
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http://dx.doi.org/10.1080/02656736.2016.1274435DOI Listing
September 2017

Persistent pathways after lung radiofrequency ablation as a risk factor of drain placement.

Int J Hyperthermia 2017 09 15;33(6):659-663. Epub 2017 Mar 15.

a Hopital de la Timone , Marseille , France.

Purpose: The risk factors of pneumothorax after lung radiofrequency (RF) ablation are long known. The objective was to demonstrate that the visualisation of an aeric RF path after the needle withdrawal was predictive of pneumothorax occurrence and chest tube placement.

Materials And Methods: A total of 70 patients were retrospectively included in this study. For each patient, we determined the pneumothorax risk factors (age, gender, previous surgery, emphysema, lesion size, distance between pleura and lesion), visualisation of a RF track, length and thickness, presence of pneumothorax, volume, chest tube placement, duration of drainage and hospital stay.

Results: Among 70 patients included retrospectively, 26 needed a chest tube placement (37%). Considering the group with path visualisation (37 patients, group A) and the patients without path visualisation (group B), the 2 groups were comparable for pneumothorax risk factors. Considering the patients who needed a chest drain, the visualisation of the path was significatively more important (23 cases, 88.4%) (p< 10) than in the group without (8 patients, 31.8%). Multivariate analyses were significant in the three analyses after adjustments on the risk factors for the occurrence of pneumothorax. Incidence of drains was significantly more (p < 10) important in group A (23 drainages 62%) than in group B (4 drainages or 12%). The length and thickness of the tracks were not predictable of drain placement.

Conclusions: Besides the well-known risk factors of severe pneumothorax after lung RFA, the simple visualisation of an aeric path just after the RF needle withdrawal is significantly associated with chest tube placement and can be considered as a risk factor as itself.
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http://dx.doi.org/10.1080/02656736.2017.1288931DOI Listing
September 2017

Evaluation of Changes in Sexual Function Related to Uterine Fibroid Embolization (UFE): Results of the EFUZEN Study.

Cardiovasc Intervent Radiol 2017 Aug 20;40(8):1169-1175. Epub 2017 Mar 20.

APHP Paris, Paris, France.

Objectives: The main goal of the study was to evaluate sexual function before and one year after UFE. The secondary goals were to evaluate the quality of life before and one year after UFE and to determine the relation of imaging findings (MRI data) before and 3-6 months after UFE to changes in sexual function and quality of life.

Materials And Methods: Study design: a prospective, multicenter (25 centers) observational study was conducted.

Patients: a total of 264 consecutive symptomatic women undergoing UFE using Embozene® (Celonova) from March 2012 to May 2013 were enrolled. Clinical data: the sexual function score and the quality of life score were calculated using the previously validated Female Sexual Function Index (FSFI) by Rosen and UFS-QOL by Spies, respectively, before and one year after UFE. Imaging data: MRI were performed before and 3-6 months after UFE. Data recorded were uterine and main fibroid volume, percentage of fibroid enhancement after injection of gadolinium. Impact of imaging data before and after UFE FSFS scores and QOL scores after UFE was searched.

Results: Complete FSFI study and QOL study were obtained in 170 and 192 women, respectively. At 1 year post-UFE, improvement of FSFI score was seen in 134/170 women (78.8%), QOL scores were improved in 183/203 women (90.2%) and symptoms severity in 163/192 (84.9%). The relation between main fibroid reduction, decrease of fibroid enhancement and global UFS-QOL and FSFI scores was not established.

Conclusion: At one year post-embolization, UFE significantly improves all aspects of sexual function and quality of life.
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http://dx.doi.org/10.1007/s00270-017-1615-3DOI Listing
August 2017

New Alcohol and Onyx Mixture for Embolization: Feasibility and Proof of Concept in Both In Vitro and In Vivo Models.

Cardiovasc Intervent Radiol 2017 May 3;40(5):735-743. Epub 2017 Jan 3.

Radiology Department, King Faisal Specialist Hospital and Research Center, MBC 28, PO Box 3354, Riyadh, 11211, Saudi Arabia.

Introduction: Onyx and ethanol are well-known embolic and sclerotic agents that are frequently used in embolization. These agents present advantages and disadvantages regarding visibility, injection control and penetration depth. Mixing both products might yield a new product with different characteristics. The aim of this study is to evaluate the injectability, radiopacity, and mechanical and occlusive properties of different mixtures of Onyx 18 and ethanol in vitro and in vivo (in a swine model).

Materials And Methods: Various Onyx 18 and ethanol formulations were prepared and tested in vitro for their injectability, solidification rate and shrinkage, cohesion and occlusive properties. In vivo tests were performed using 3 swine. Ease of injection, radiopacity, cohesiveness and penetration were analyzed using fluoroscopy and high-resolution CT.

Results: All mixtures were easy to inject through a microcatheter with no resistance or blockage in vitro and in vivo. The 50%-ethanol mixture showed delayed copolymerization with fragmentation and proximal occlusion. The 75%-ethanol mixture showed poor radiopacity in vivo and was not tested in vitro. The 25%-ethanol mixture showed good occlusive properties and accepted penetration and radiopacity.

Conclusion: Mixing Onyx and ethanol is feasible. The mixture of 25% of ethanol and 75% of Onyx 18 could be a new sclero-embolic agent. Further research is needed to study the chemical changes of the mixture, to confirm the significance of the added sclerotic effect and to find out the ideal mixture percentages.
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http://dx.doi.org/10.1007/s00270-016-1559-zDOI Listing
May 2017

Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis.

PLoS One 2016 9;11(9):e0161716. Epub 2016 Sep 9.

APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.

Background: Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis.

Methods: We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death).

Results: A total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6-171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis.

Conclusion: We identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161716PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017627PMC
August 2017

Young Women with a Long Past of Resistant Hypertension Cured after Surgery of Severe Bilateral Ostial Renal Artery Stenosis.

Ann Vasc Surg 2016 Jul 10;34:272.e5-8. Epub 2016 May 10.

Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France. Electronic address:

Fibromuscular dysplasia (FMD) is an underdiagnosed disease which can affect young people and with poor prognosis such as dissection or aneurysm rupture if unknown. This case illustrates a multi-vessel FMD with symptomatic severe bilateral ostial renal artery stenosis and intracranial aneurysms. One of the original features is a very late delay to diagnosis with 23 years between onset of hypertension and renal stenosis diagnosis, particularly due to lower quality of initial CT scan with milder and uncommon abnormalities. The experiment neuroradiologist had suspected the diagnosis of renal FMD because she developed intracranial aneurysms and he confirmed this diagnosis with an artery renal contrast injection during an intracranial angiogram Because of very tight and short stenosis, surgery was chosen for treatment and permitted the cure of hypertension, with normal home blood pressure after 6 months. Several particularities of FMD were presented in this case: important delay diagnosis due to rare lesion and lower sensitivity of CT in this form, the possibility to perform an angiography in high suspicion of FMD, poor prognosis risk with intracranial aneurisms and premature birth child, and the choice for surgery with cure of hypertension. We thought that hypertension etiologic evaluation must be repeated in case of resistant hypertension in young patients, particularly when they developed intracranial aneurysms.
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http://dx.doi.org/10.1016/j.avsg.2016.01.017DOI Listing
July 2016

Intranuclear expression of progesterone receptors in smooth muscle cells of renovascular fibromuscular dysplasia: a pilot study.

Ann Vasc Surg 2015 13;29(4):830-5. Epub 2015 Jan 13.

Unité d'Hypertension Artérielle, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone, Marseille, France.

Background: The pathogenesis of fibromuscular dysplasia (FMD) remains poorly understood. Yet, understanding this mechanism has taken on new urgency after recent evidence indicating that FMD is not as rare as previously thought. We speculated that hormonal receptors in the walls of dysplastic renal arteries were implicated in the pathogenesis of FMD.

Methods: We undertook a pilot prospective case-control study comparing histologic findings from renal arteries that were surgically removed in 2 patient groups. The case group included 6 samples from FMD patients who underwent surgery for stenosis or aneurysm caused by FMD. The control group included 3 FMD-free patients who underwent nephrectomy for nonvascular causes. Surgical specimens were sent to the histology laboratory. FMD was defined preoperatively using conventional radiologic criteria and was confirmed by histologic examination.

Results: Immunohistochemical staining detected intense progesterone receptor expression in the nuclei of smooth muscle cells in FMD patients. No progesterone receptor expression was found in the FMD-free patients. Estrogen receptor expression was not noted in the 2 groups.

Conclusions: This preliminary finding may suggest that progesterone plays a key role in the pathogenesis of FMD and opens the fields of genetic and therapeutic approaches.
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http://dx.doi.org/10.1016/j.avsg.2014.10.025DOI Listing
February 2016

Transjugular intrahepatic porto-systemic shunt is a risk factor for liver dysplasia but not hepatocellular carcinoma: a retrospective study of explanted livers.

Dig Liver Dis 2015 Jan 11;47(1):57-61. Epub 2014 Oct 11.

Department of Hepato-Gastroenterology, Hôpital de la Conception, Marseille, France; UMR 911, Université de la Méditerranée, Marseille, France.

Background: Conflicting data exist regarding the risk for hepatocellular carcinoma after transjugular intrahepatic porto-systemic shunt (TIPS) insertion in cirrhotic patients.

Methods: We retrospectively analysed histopathological data from 214 patients who were transplanted in our Institution including 68 patients who underwent TIPS placement before transplantation. Pathological lesions from explanted livers, including incidental hepatocellular carcinoma, small cell dysplasia and large cell dysplasia were recorded.

Results: Pathological lesions were found in 36.4% of explanted livers. TIPS insertion was an independent risk factor for pathological lesion (HR = 2.11, p < 0.05), concurrently with age (HR = 1.10 per year, p < 0.001) and viral aetiology of cirrhosis (HR = 3.05, p < 0.001). When considering the different type of lesions, TIPS insertion was not associated with an increased risk for hepatocellular carcinoma but was an independent risk factor for liver dysplasia (HR = 2.15, p = 0.042).

Conclusion: Although a direct relationship between TIPS insertion and hepatocellular carcinoma risk was not demonstrated in this study, the increased frequency of liver dysplasia observed in TIPS-bearing explanted livers deserves further prospective investigations with adequate follow-up.
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http://dx.doi.org/10.1016/j.dld.2014.09.009DOI Listing
January 2015

Prognostic value of preoperative coronary computed tomography angiography in patients treated by orthotopic liver transplantation.

Eur J Gastroenterol Hepatol 2012 May;24(5):558-62

Department of Radiology, Timone Hospital, Marseille Cedex, France.

Objectives: The aim of this study was to assess the feasibility of 64-slice coronary computed tomography (CT) angiography in patients treated by orthotopic liver transplantation, and to compare prognostic values of CT angiography and dobutamine stress echocardiography in the same population.

Methods: Eighty-two consecutive patients, without known coronary artery disease, who underwent orthotopic liver transplantation, were included in this study. A CT angiography was performed along with usual explorations including dobutamine stress echography. A one-year minimal follow-up was performed to seek cardiac events.

Results: Fifty-two (65.8%) patients underwent a CT angiography. Thirty-seven (71%) were totally normal or showed nonobstructive coronary plaque, six (12%) showed at least one obstructive coronary plaque greater than 50%. Nine (17%) of the examined patients had at least one nonassessable segment. A total of six (7.6%) major cardiac events occurred in a mean-time follow-up of 17.8 ± 12.7 months.

Conclusion: CT angiography that is normal or with a nonobstructive coronary plaque has a negative predicting value of 95% [0.82-0.99] for major cardiac adverse events, and of 100% [0.91-1] for clinical coronary events in patients undergoing orthotopic liver transplantation. The prognostic value of CT angiography was comparable with that of dobutamine stress echography.
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http://dx.doi.org/10.1097/MEG.0b013e3283522df3DOI Listing
May 2012

Gadolinium chelate kinetics in cardiac MR imaging of myocarditis: comparison to acute myocardial infarction and impact on late gadolinium enhancement.

Invest Radiol 2011 Nov;46(11):705-10

Department of Radiology, Université Marseille Méditerrané, Hôpital Universitaire la Timone, Marseille Cedex, France.

Objectives: To compare the kinetics of gadolinium in myocarditis and myocardial infarction and to establish the best interval between contrast injection and late gadolinium-enhanced (LGE) image acquisition for the diagnosis of acute myocarditis.

Methods: Seventeen patients with acute myocarditis and 12 with acute myocardial infarction underwent Look-Locker sequences before and after administration of 0.2 mmol/kg gadolinium chelate for a period of 14 minutes. The apparent longitudinal relaxation rates (R'1) were calculated from left ventricular blood, enhanced and normal myocardium. LGE cardiac magnetic resonance images were acquired at 5, 10, and 15 minutes after contrast injection. The contrast between enhanced and normal myocardium (Contrastenhaced-normal) was measured, and the quality of the images was analyzed.

Results: A faster decline in the R'1 values measured in the areas of myocardial enhancement was recorded in myocarditis than that in myocardial infarction. In myocarditis, the Contrastenhaced-normal values decreased over time (from 60.7 ± 35.1 at 5 minutes vs. 42.1 ± 26.7 at 15 minutes; P = 0.001). However, in myocardial infarction, the Contrastenhaced-normal value remained stable in time (60.7 ± 22.9 at 5 minutes vs. 68.8 ± 16.6 at 15 minutes; P = ns).

Conclusion: The gadolinium kinetics of acute myocarditis are different from those of acute myocardial infarction. In myocarditis, LGE images acquired 5 minutes after contrast injection provide higher Contrastenhaced-normal and better image quality compared with images taken at later points.
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http://dx.doi.org/10.1097/RLI.0b013e31822b049dDOI Listing
November 2011

Incidence, predictors, and prognostic value of intramyocardial hemorrhage lesions in ST elevation myocardial infarction.

Catheter Cardiovasc Interv 2012 Jun 12;79(7):1101-8. Epub 2011 Dec 12.

Department of Cardiology, CHU Nord, University of Marseille School of Medicine, Marseille, France.

Background: Intra myocardial hemorrhage lesions (IMH) are underdiagnosed complication of ST elevation myocardial infarction (STEMI). We sought to determine the incidence, predictors and the prognostic value of IMH in STEMI using cardiac MR imaging (CMR) techniques.

Methods: We screened for inclusion consecutive patients with STEMI treated by percutaneous coronary intervention (PCI) within the first 12 hr of evolution. IMH lesions were identified on T2-weighted sequences on CMR between days 4 and 8 after PCI. Adverse cardiac events were defined as a composite of death + severe ventricular arrhythmias + acute coronary syndrome + acute heart failure.

Results: N = 114 patients were included and n = 11 patients (10%) presented IMH lesions. Patients with IMH lesions had a larger myocardial infarction extent (25.6 ± 1.8 vs. 13.5 ± 1.0 % LV mass, P < 0.01), microvascular obstructive lesions extent (4.6 ± 1.0 vs. 1.3 ± 0.3% LV mass, P < 0.01) and lower LV ejection fraction (40.7 ± 2.3% vs. 50.7 ± 1.3%, P < 0.01). The value of glycemia at admission was an independent predictor of IMH development (Odd ratio 1.8 [1.1-2.8] per mmol l(-1), P = 0.01). The incidence of adverse cardiac events was higher in the IMH group than in the non-IMH group during the first year following STEMI (P = 0.01, log-rank analysis). Cox regression analysis identified the presence of IMH lesions as an independent predictor of adverse clinical outcome (Hazard Ratio = 2.8 [1.2-6.8], P = 0.02).

Conclusion: Our study indicates that IMH is a rare but severe finding in STEMI, associated with a larger myocardial infarction and a worse clinical outcome. Per-PCI glycemia might influence IMH development.
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http://dx.doi.org/10.1002/ccd.23278DOI Listing
June 2012

Adrenal venous sampling is crucial before an adrenalectomy whatever the adrenal-nodule size on computed tomography.

J Hypertens 2011 Jun;29(6):1196-202

Rythmologie et Hypertension Artérielle, Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Faculté de Médecine de Marseille, Université de la Méditerranée, Marseille cedex, France.

Objective: To assess the additional value of adrenal venous sampling (AVS) to diagnose primary aldosteronism sub-types in patients who have a unilateral nodule detected by computed tomography (CT scan) and who should undergo an adrenalectomy.

Methods: A retrospective study to assess consecutive patients with primary aldosteronism undergoing an adrenal CT scan and AVS. Criterion for selective cannulation was an equal or higher cortisol level in the adrenal vein compared to the inferior vena cava. An adrenal-vein aldosterone-to-cortisol ratio of at least two times higher than the other side defined lateralization of aldosterone production.

Results: Sixty-seven patients (mean age 52 years, 39 men) underwent a CT scan and AVS. In nine patients (13%), cannulation of the right adrenal vein led to a technical failure. Both procedures led to diagnosis of 29 patients with adenoma-producing aldosterone (APA; 50%), 23 bilateral adrenal hyperplasias (40%), and six unilateral adrenal hyperplasias (10%). Of the 45 patients with a nodule detected by CT, subsequent AVS showed bilateral secretion in 16 patients (36%). Compared to the strategy of coupling CT scans with AVS to diagnosis APA, a CT scan alone had an accuracy of 72.4% (P < 0.001). Among patients with a macronodule detected by CT, 13 (37%) had bilateral secretion as assessed by AVS. The patients with a macronodule detected by CT alone had the same risk of a discrepancy as those with a small nodule (P = 0.99).

Conclusion: AVS is essential to diagnose the unilateral hypersecretion of aldosterone, even in patients in whom a unilateral macronodule is detected by CT, to avoid unnecessary surgery.
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http://dx.doi.org/10.1097/HJH.0b013e32834666afDOI Listing
June 2011

Treatment of venous malformations: first experience with a new sclerosing agent--a multicenter study.

Eur J Radiol 2011 Dec 1;80(3):e366-72. Epub 2011 Apr 1.

Department of Neuroradiology, University Hospital Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.

Purpose: To study the efficacy and safety of a new sclerosing gel of absolute ethanol in the percutaneous treatment of venous malformations (VM).

Materials And Methods: In this prospective, non-randomized multicenter study patients with clinically and by magnetic resonance imaging diagnosed VM were treated. Efficacy and safety of the gel was evaluated. Therapeutic outcome was judged at day 56 after the last sclerosing therapy. Blood ethanol levels of ethanol were measured after each infusion. Local and systemic adverse events were recorded.

Results: Seventy-five (75) patients (age 4-46 y, mean 26 y) were treated in 172 sessions. Compared to no treatment, ethanol gel showed a complete cure rate of about 15% per session (p<0.00001). At the end of the last session, therapeutic outcome was complete (score 2) and partial (score 1) in 28 (37%) and 42 patients (56%), respectively, whereas treatment failure (score 0) was observed in 5 patients (7%). The plasmatic ethanol levels were very low (mean±SEM 0.03±0.06 g L(-1)), with only one patient above the legal 0.5 g L(-1) intoxication limit (0.6 g L(-1)). Forty-six (46) product-related adverse events (all local, none systemic) were reported. They included temporary mild isolated pain (N=21), inflammatory reactions (N=4), and local complications (7 skin necroses, 7 compressive neuropathies, 4 product leakage/fistula, 2 intralesional fibrous or granulomatous tissue, 1 dense node; 12.2% of the infusions). All local complications resolved spontaneously, except for 2 skin necroses requesting surgical paring.

Conclusion: Ethanol gel is an embosclerosing substance that provides high efficiency and improves safety of ethanol in the treatment of VM lesions.
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http://dx.doi.org/10.1016/j.ejrad.2010.12.074DOI Listing
December 2011

Value of a new multiparametric score for prediction of microvascular obstruction lesions in ST-segment elevation myocardial infarction revascularized by percutaneous coronary intervention.

Arch Cardiovasc Dis 2010 Oct 20;103(10):512-21. Epub 2010 Nov 20.

Department of Cardiology, CHU Nord, Aix-Marseille University School of Medicine, Marseille, France.

Background: Despite improvement in revascularization strategies, microvascular obstruction (MO) lesions remain associated with poor outcome after ST-segment elevation myocardial infarction (STEMI).

Aims: To establish a bedside-available score for predicting MO lesions in STEMI, with cardiac magnetic resonance imaging (CMR) as the reference standard, and to test its prognostic value for clinical outcome.

Methods: Patients with STEMI of<12 hours' evolution treated by percutaneous coronary intervention (PCI) were included. CMR was performed 4-8 days later, to measure myocardial infarction (MI) extent, left ventricular ejection fraction (LVEF) and volumes, and to identify MO lesions. An MO score was built from multivariable logistic regression results and included clinical, angiographic and electrocardiographic criteria. Adverse cardiovascular events were recorded prospectively after STEMI.

Results: We analysed data from 112 patients. MO lesions were found in 63 (56%) patients and were associated with larger MI as assessed by higher peak creatine phosphokinase (3755 ± 351 vs 1467 ± 220 IU, p<0.001), lower LVEF (46.7 ± 1.5 vs 53.4 ± 1.6%, p<0.01) and larger MI extent (18.7 ± 1.2 vs 9.0 ± 1.3% LV, p<0.001) on CMR. MO score>4 accurately identified microcirculatory injuries (sensitivity 84%; specificity 82%) and independently predicted the presence of MO lesions on CMR. MO score>4 predicted adverse cardiovascular events during the first year after STEMI (relative risk 2.60 [1.10-6.60], p=0.03).

Conclusions: MO lesions are frequent in PCI-treated STEMI and are associated with larger MIs. MO score accurately predicted MO lesions and identified patients with poor outcome post-STEMI.
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http://dx.doi.org/10.1016/j.acvd.2010.09.005DOI Listing
October 2010

Congenital anomalies of inferior vena cava in young patients with iliac deep venous thrombosis.

Ann Vasc Surg 2011 Feb;25(2):265.e5-8

Vascular Medicine and Surgery, Timone Hospital, Marseille, France.

Venous thromboembolism (VTE) in young patients is frequently associated with hereditary biological thrombophilia, autoimmune disorders, or neoplasia. Advances in venous ultrasound and contrast-enhanced computed tomography have allowed for the identification of inferior vena cava (IVC) anomalies as newly considered etiologic factor. We present two cases of VTE in young patients: the first case involves left IVC in a 22-year-old man and the second involves IVC atresia in a 39-year-old man. IVC anomalies should be identified in young patients with spontaneous VTE involving the iliac veins because they are at a high risk for thrombotic recurrence and adaptation to long periods of antithrombotic therapy.
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http://dx.doi.org/10.1016/j.avsg.2010.07.007DOI Listing
February 2011

Effectiveness of endovascular embolization with a collagen-based embolic agent (Marsembol) in an animal model.

J Vasc Interv Radiol 2010 Sep 3;21(9):1419-23. Epub 2010 Aug 3.

School of Medicine, Laboratory of Physiopathology and Vascular Therapeutics, Hôpital La Timone, 27 boulevard Jean Moulin, 13385 Marseille cedex 5, France.

Purpose: To investigate in a porcine experimental model the effectiveness, tissue penetration, and histologic impact of renal artery embolization with a collagen-based nonadhesive embolic agent, marsembol.

Materials And Methods: Fifteen pigs underwent embolization of one interlobular artery of the renal artery with collagen-resorcinol gel emulsified with Lipiodol and further polymerized with glutaraldehyde-formaldehyde mixture. Angiograms were obtained before, during, and after the procedure. Animals were euthanized at day 0 (n = 3), 1 week (n = 3), or 3 months (n = 7), and flat-panel three-dimensional rotational radiologic images of the kidneys were obtained. Arterial, medullary, and cortical samples were taken for histologic and scanning electron microscopic investigations.

Results: Fifteen interlobular renal arteries were successfully embolized by delivering 1.7 mL + or - 0.2 of the embolic agent. All the embolized arteries remained occluded at 3 months, leading to a major atrophy of the embolized portions of the kidneys. Imaging and histologic findings show that the embolic agent provided a distal vessel occlusion and entirely filled the lumen of the arteries up to the glomerular tufts. The homogeneous plug formed by the embolic agent induces very few inflammatory responses. The regenerative tubular processes were arrested at 3 months.

Conclusions: The collagen-based embolic agent described here has the properties required to perform embolization. These specific properties lead to very distal vessel embolization. The embolic agent is effective at 3 months in renal embolization.
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http://dx.doi.org/10.1016/j.jvir.2010.04.026DOI Listing
September 2010

Assessment of left ventricular non-compaction in adults: side-by-side comparison of cardiac magnetic resonance imaging with echocardiography.

Arch Cardiovasc Dis 2010 Mar 10;103(3):150-9. Epub 2010 Mar 10.

Department of Cardiology, University of Marseille Méditerranée, 13385 Marseille cedex 05, France.

Background: Two-dimensional echocardiography images obtained at end-diastole and end-systole and cardiac magnetic resonance (CMR) images obtained at end-diastole represent the three imaging methodologies validated for diagnosis of left ventricular non-compaction (LVNC). No study has compared these methodologies in assessing the magnitude of non-compaction.

Aims: To compare two-dimensional echocardiography with CMR in the evaluation of patients with suspected LVNC.

Methods: Sixteen patients (48+/-17 years) with LVNC underwent echocardiography and CMR within the same week. Echocardiography images obtained at end-diastole and end-systole were compared in a blinded fashion with those obtained by CMR at end-diastole to assess non-compaction in 17 anatomical segments.

Results: All segments could be analysed by CMR, whereas only 238 (87.5%) and 237 (87.1%) could be analysed by echocardiography at end-diastole and end-systole, respectively (p=0.002). Among the analysable segments, a two-layered structure was observed in 54.0% by CMR, 42.9% by echocardiography at end-diastole and 41.4% by echocardiography at end-systole (p=0.006). Similar distribution patterns were observed with the two echocardiographic methodologies. However, compared with echocardiography, CMR identified a higher rate of two-layered structures in the anterior, anterolateral, inferolateral and inferior segments. Echocardiography at end-systole underestimated the NC/C maximum ratio compared with CMR (p=0.04) and echocardiography at end-diastole (p=0.003). No significant difference was observed between CMR and echocardiography at end-diastole (p=0.83). Interobserver reproducibility of the NC/C maximum ratio was similar for the three methodologies.

Conclusion: CMR appears superior to standard echocardiography in assessing the extent of non-compaction and provides supplemental morphological information beyond that obtained with conventional echocardiography.
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http://dx.doi.org/10.1016/j.acvd.2010.01.002DOI Listing
March 2010

Accessory iliac vein: surgical implications.

J Spinal Disord Tech 2010 Aug;23(6):398-403

Department de Radiologie, Hopital Timone, Marseille Cedx, France.

Background: One of the main difficulties in using an anterior retroperitoneal approach in prosthetic lumbar disk replacement surgery is the exposure of the anterior aspect of the spine because of the risk of hemorrhage because of vascular injury when the venous structures are mobilized.

Purpose: The goal of our study was to use computed tomography (CT) to research for anatomic variations of the ileocaval drainage network, which were likely to complicate this type of procedure.

Design: Prospective study.

Patient Sample: Ninety patients (48 males, 42 females) explored between July 2003 and February 2007.

Outcome Measures: Not applicable.

Methods: All the patients had a CT scan before disk replacement surgery to treat degenerative lumbar disk disease by a microinvasive, anterior retroperitoneal approach.

Results: Eighteen of 90 patients presented with variations in their iliocaval drainage network: 3 cases of double inferior vena cava, 1 case of duplication of the inferior vena cava, 5 cases of ectopic internal iliac veins, 9 cases of accessory iliac veins.

Conclusions: Anatomical variations in the iliocaval venous drainage system are fairly frequent but easy to analyze by CT. Even if they have no functional impact, they must be analyzed and described because they can be of great interest in the preoperative workup for retroperitoneal lumbar surgery.
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http://dx.doi.org/10.1097/BSD.0b013e3181b26c88DOI Listing
August 2010
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