Publications by authors named "Pierre-Yves Brillet"

89 Publications

Epicardial adipose tissue volume and myocardial ischemia in asymptomatic people living with diabetes: a cross-sectional study.

Cardiovasc Diabetol 2021 Nov 24;20(1):224. Epub 2021 Nov 24.

Unit of Diabetology, Jean Verdier Hospital, CRNH-IdF, CINFO, AP-HP, Université Paris 13, Sorbonne Paris Cité, Bondy, France.

Background: Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes-independently of confounding factors-and whether it could predict this condition.

Methods: We included asymptomatic patients with diabetes and no coronary history, who had undergone both a stress a myocardial scintigraphy to diagnose myocardial ischemia, and a computed tomography to measure their coronary artery calcium (CAC) score. EAT volume was retrospectively measured from computed tomography imaging. Determinants of EAT volume and asymptomatic myocardial ischemia were evaluated.

Results: The study population comprised 274 individuals, including 153 men. Mean (± standard deviation) age was 62 ± 9 years, and 243, 23 and 8 had type 2, type 1, or another type of diabetes, respectively. Mean body mass index was 30 ± 6 kg/m, and mean EAT volume 96 ± 36 cm. Myocardial ischemia was detected in 32 patients (11.7%). EAT volume was positively correlated with age, body mass index and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol levels. Furthermore, EAT volume was lower in people with retinopathy, but higher in men, in current smokers, in patients with nephropathy, those with a CAC score > 100 Agatston units, and finally in individuals with myocardial ischemia (110 ± 37 cm vs 94 ± 37 cm in those without myocardial ischemia, p < 0.05). The association between EAT volume and myocardial ischemia remained significant after adjustment for gender, diabetes duration, peripheral macrovascular disease and CAC score. We also found that area under the ROC curve analysis showed that EAT volume (AROC: 0.771 [95% confidence interval 0.683-0.858]) did not provide improved discrimination of myocardial ischemia over the following classic factors: gender, diabetes duration, peripheral macrovascular disease, retinopathy, nephropathy, smoking, atherogenic dyslipidemia, and CAC score (AROC 0.773 [0.683-0.862]).

Conclusions: EAT may play a role in coronary atherosclerosis and coronary circulation in patients with diabetes. However, considering EAT volume is not a better marker for discriminating the risk of asymptomatic myocardial ischemia than classic clinical data.
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http://dx.doi.org/10.1186/s12933-021-01420-5DOI Listing
November 2021

Prevalence and Disease Spectrum of Extracoronary Arterial Abnormalities in Spontaneous Coronary Artery Dissection.

JAMA Cardiol 2021 Nov 24. Epub 2021 Nov 24.

Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.

Importance: Spontaneous coronary artery dissection (SCAD) has been associated with fibromuscular dysplasia (FMD) and other extracoronary arterial abnormalities. However, the prevalence, severity, and clinical relevance of these abnormalities remain unclear.

Objective: To assess the prevalence and spectrum of FMD and other extracoronary arterial abnormalities in patients with SCAD vs controls.

Design, Setting, And Participants: This case series included 173 patients with angiographically confirmed SCAD enrolled between January 1, 2015, and December 31, 2019. Imaging of extracoronary arterial beds was performed by magnetic resonance angiography (MRA). Forty-one healthy individuals were recruited to serve as controls for blinded interpretation of MRA findings. Patients were recruited from the UK national SCAD registry, which enrolls throughout the UK by referral from the primary care physician or patient self-referral through an online portal. Participants attended the national SCAD referral center for assessment and MRA.

Exposures: Both patients with SCAD and healthy controls underwent head-to-pelvis MRA (median time between SCAD event and MRA, 1 [IQR, 1-3] year).

Main Outcome And Measures: The diagnosis of FMD, arterial dissections, and aneurysms was established according to the International FMD Consensus. Arterial tortuosity was assessed both qualitatively (presence or absence of an S curve) and quantitatively (number of curves ≥45%; tortuosity index).

Results: Of the 173 patients with SCAD, 167 were women (96.5%); mean (SD) age at diagnosis was 44.5 (7.9) years. The prevalence of FMD was 31.8% (55 patients); 16 patients (29.1% of patients with FMD) had involvement of multiple vascular beds. Thirteen patients (7.5%) had extracoronary aneurysms and 3 patients (1.7%) had dissections. The prevalence and degree of arterial tortuosity were similar in patients and controls. In 43 patients imaged with both computed tomographic angiography and MRA, the identification of clinically significant remote arteriopathies was similar. Over a median 5-year follow-up, there were 2 noncardiovascular-associated deaths and 35 recurrent myocardial infarctions, but there were no primary extracoronary vascular events.

Conclusions And Relevance: In this case series with blinded analysis of patients with SCAD, severe multivessel FMD, aneurysms, and dissections were infrequent. The findings of this study suggest that, although brain-to-pelvis imaging allows detection of remote arteriopathies that may require follow-up, extracoronary vascular events appear to be rare.
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http://dx.doi.org/10.1001/jamacardio.2021.4690DOI Listing
November 2021

Diagnosis yield and safety of surgical biopsy in interstitial lung diseases: a prospective study.

Ann Thorac Surg 2021 Sep 29. Epub 2021 Sep 29.

APHP-Hôpital Bichat, Pneumologie A, Université de Paris, Paris, France.

Background: Surgical lung biopsy is essential in the diagnostic algorithm of interstitial lung disease (ILD) of unknown cause. Safety concerns have been recently reiterated. The aim of this study was to prospectively assess the yield of diagnosis and safety of video-assisted thoracoscopic surgical lung biopsy (VATS-LB) for ILD diagnosis.

Methods: This prospective study, conducted in 6 ILD-referral Paris hospitals, included 103 patients with ILD. After initial multidisciplinary discussion, VATS-LB was proposed. A final diagnosis was made after the procedure, during a second multidisciplinary discussion. The main outcome was to determine the final diagnoses and their proportion after VATS-LB. Other outcomes were the percentage of change in diagnosis and treatment propositions after VATS-LB and adverse events during 3 months after surgery, postoperative pulmonary function, quality of life and pain.

Results: A definite diagnosis was reached in 87 cases (84.4%), while 16 remained unclassifiable (15.6%). Hypothesized diagnosis and treatment changed after VATS-LB in 65 (63.1%) and in 41 patients (39.8%), respectively. There was one death due to acute exacerbation. In-hospital complications were predicted by a lower preoperative distance at 6-minute walking test and by forced vital capacity lower than 77%. Postoperative quality of life was not modified at 3 months while forced vital capacity decreased slightly. Postoperative neuropathic pain was revealed in 5% and 2% patients at 1 and 3 months, respectively.

Conclusions: VATS-LB dramatically changed preoperative hypothetical diagnoses and treatment in ILD of unknown cause with good patient survival in ILD-referral centers.
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http://dx.doi.org/10.1016/j.athoracsur.2021.08.056DOI Listing
September 2021

Cyclophosphamide added to glucocorticoids in acute exacerbation of idiopathic pulmonary fibrosis (EXAFIP): a randomised, double-blind, placebo-controlled, phase 3 trial.

Lancet Respir Med 2021 Sep 7. Epub 2021 Sep 7.

APHP, Service de Radiologie, Hôpital Avicenne, Bobigny, Paris, France.

Background: The use of cyclophosphamide in patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF) is unknown. Our study was designed to evaluate the efficacy and safety of four cyclophosphamide pulses in addition to high-dose methylprednisolone in this population.

Methods: In this double-blind, placebo-controlled trial done in 35 departments across 31 hospitals in France, adult patients (≥18 years) with acute exacerbation of IPF and those with suspected acute exacerbation of IPF were randomly assigned in a 1:1 ratio using a web-based system to receive either intravenous pulses of cyclophosphamide (600 mg/m) plus uromitexan as haemorrhagic cystitis prophylaxis (200 mg/m) at the time of cyclophosphamide administration and then again, 4 h later, or placebo at days 0, 15, 30, and 60. Random assignment was stratified according to the severity of IPF and was block-balanced with variable block sizes of four or six patients. Patients receiving mechanical ventilation, with active infection, with active cancer, or who were registered on the lung transplant waiting list were excluded. All patients received standardised high-dose glucocorticoids. The investigators, patients, and the sponsor were masked to the treatment assignments. The primary endpoint was 3-month all-cause mortality, analysed by a χ test adhering to an intention-to-treat principle. The trial is now complete and registered with ClinicalTrials.gov, NCT02460588.

Findings: Between Jan 22, 2016, and July 19, 2018, 183 patients were assessed for eligibility, of whom 120 patients were randomly assigned and 119 patients (62 [52%] with severe IPF) received at least one dose of cyclophosphamide (n=60) or placebo (n=59), all of whom were included in the intention-to-treat analysis. The 3-month all-cause mortality was 45% (27/60) in patients given cyclophosphamide compared with 31% (18/59) in the placebo group (difference 14·5% [95% CI -3·1 to 31·6]; p=0·10). Similar results were found after adjustment by IPF severity (odds ratio [OR] 1·89 [95% CI 0·89-4·04]). The risk of death at 3 months, independent of the treatment received, was higher with severe than non-severe IPF (OR 2·62 [1·12-6·12]) and was lower with the use of antifibrotic therapy (OR 0·33 [0·13-0·82]). Adverse events were similar between groups by 6 months (25 [42%] in the cyclophosphamide group vs 30 [51%] in the placebo group) and their proportion, including infections, did not differ. Overall infection was the main adverse event and occurred in 20 (33%) of 60 patients in the cyclophosphamide group versus 21 (36%) of 59 patients in the placebo group.

Interpretation: In patients with acute exacerbation of IPF, adding intravenous cyclophosphamide pulses to glucocorticoids increased 3-month mortality. These findings provide evidence against the use of intravenous cyclophosphamide in such patients.

Funding: Programme Hospitalier de Recherche Clinique of the French Ministry of Health (PHRC 2014-502), Roche Pharmaceuticals.
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http://dx.doi.org/10.1016/S2213-2600(21)00354-4DOI Listing
September 2021

Pulmonary Involvement in Secondary Syphilis.

Eur J Case Rep Intern Med 2021 19;8(7):002487. Epub 2021 Jul 19.

Sorbonne Paris Nord University, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France.

In secondary syphilis, can spread to the lungs. A new case is described of a patient with multiple excavated subpleural pulmonary nodules, a rare localization of secondary syphilis. Despite the numerous pulmonary samples analysed in the literature, is rarely visualised directly on bronchial fibroscopy or biopsy. The diagnosis of secondary syphilis is suspected from historical and physical findings and confirmed by high values obtained from non-treponemal tests.

Learning Points: The clinical and radiological presentation of pulmonary involvement in secondary syphilis is non-specific, described as solitary or multiple subpleural nodular opacities that are rarely infiltrating.We confirm here that for this localization, biopsy of these nodules is not necessary for diagnosis.
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http://dx.doi.org/10.12890/2021_002487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336746PMC
July 2021

Epicardial adipose tissue and severe Coronavirus Disease 19.

Cardiovasc Diabetol 2021 07 20;20(1):147. Epub 2021 Jul 20.

Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Hôpital Avicenne, 125 route de Stalingrad, 93009, Bobigny, France.

Background: Both visceral adipose tissue and epicardial adipose tissue (EAT) have pro-inflammatory properties. The former is associated with Coronavirus Disease 19 (COVID-19) severity. We aimed to investigate whether an association also exists for EAT.

Material And Methods: We retrospectively measured EAT volume using computed tomography (CT) scans (semi-automatic software) of inpatients with COVID-19 and analyzed the correlation between EAT volume and anthropometric characteristics and comorbidities. We then analyzed the clinicobiological and radiological parameters associated with severe COVID-19 (O2 [Formula: see text] 6 l/min), intensive care unit (ICU) admission or death, and 25% or more CT lung involvement, which are three key indicators of COVID-19 severity.

Results: We included 100 consecutive patients; 63% were men, mean age was 61.8 ± 16.2 years, 47% were obese, 54% had hypertension, 42% diabetes, and 17.2% a cardiovascular event history. Severe COVID-19 (n = 35, 35%) was associated with EAT volume (132 ± 62 vs 104 ± 40 cm, p = 0.02), age, ferritinemia, and 25% or more CT lung involvement. ICU admission or death (n = 14, 14%) was associated with EAT volume (153 ± 67 vs 108 ± 45 cm, p = 0.015), hypertension and 25% or more CT lung involvement. The association between EAT volume and severe COVID-19 remained after adjustment for sex, BMI, ferritinemia and lung involvement, but not after adjustment for age. Instead, the association between EAT volume and ICU admission or death remained after adjustment for all five of these parameters.

Conclusions: Our results suggest that measuring EAT volume on chest CT scans at hospital admission in patients diagnosed with COVID-19 might help to assess the risk of disease aggravation.
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http://dx.doi.org/10.1186/s12933-021-01329-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8290380PMC
July 2021

Study of Thoracic CT in COVID-19: The STOIC Project.

Radiology 2021 10 29;301(1):E361-E370. Epub 2021 Jun 29.

From the Department of Radiology, Université de Paris, APHP, Hôpital Cochin, 27 rue du Fg Saint Jacques, 75014 Paris, France (M.P.R., I.S., G.C., S. Bennani, F.B., S.D., C.H., C.J.); Department of Radiology, Sorbonne Université, APHP, Hôpital Pitié Salpétrière, Paris, France (S. Boussouar, A.R.); Department of Radiology, Université de Paris, APHP, Hôpital Saint-Louis, Paris, France (C.d.M.M.); Department of Radiology, Université Rennes 1, Hôpital Pontchaillou, Rennes, France (T.L., M.L.); Department of Radiology, Université Paris-Saclay, APHP, Hôpital Raymond Poincaré, Garches, France (D.M.); Department of Radiology, Sorbonne Université, APHP, Hôpital Tenon, Paris, France (A.M.); Department of Radiology, Université de Strasbourg, Hôpital de Hautepierre, Strasbourg, France (S.M.); Department of Radiology, Université de Paris, APHP, Hôpital Bichat, Paris, France (M.P.D., A.K.); Department of Radiology, Université de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France (M.O.); Department of Radiology, Université de Montpellier, Hôpital Arnaud de Villeneuve, Montpellier France (S. Bommart); Department of Radiology, Université Paris-Saclay, APHP, Hôpital Ambroise Paré, Boulogne, France (M.E.H.); Department of Radiology, Université de Lorraine, Hôpital Brabois, Vandoeuvre, France (I.P.); Department of Radiology, Université de Paris, APHP, Hôpital Européen Georges Pompidou, INSERM U970, PARCC, Paris, France (L.F.); Department of Radiology, Sorbonne Université, APHP, Hôpital Avicenne, Bobigny, France (P.Y.B.); Department of Radiology, Université Paris-Saclay, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.F.B.); Department of Radiology, Université Paris-Saclay, APHP, Hôpital Antoine Béclère, Clamart, France (L.R.); Department of Radiology, Université de Paris, APHP, Hôpital Lariboisière, Paris, France (V.B.); Department of Radiology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite, France (P.R.); Department of Radiology, Université de Paris, APHP, Hôpital Beaujon, Clichy, France (J.G.); Department of Radiology, Université Paris Est, APHP, Hôpital Henri Mondor, Créteil, France (J.F.D.); Departments of Radiology (E.D.) and Clinical Epidemiology (R.P.), Université de Paris, APHP, Hôtel-Dieu, Paris, France; Sorbonne Université, APHP, Hôpital Avicenne, Department of Pneumology, INSERM UMR 1272, Bobigny, France (D.V.); and Université de Paris APHP, Clinical Research Unit Paris Centre, Paris, France (L.J., H.A.).

Background There are conflicting data regarding the diagnostic performance of chest CT for COVID-19 pneumonia. Disease extent at CT has been reported to influence prognosis. Purpose To create a large publicly available data set and assess the diagnostic and prognostic value of CT in COVID-19 pneumonia. Materials and Methods This multicenter, observational, retrospective cohort study involved 20 French university hospitals. Eligible patients presented at the emergency departments of the hospitals involved between March 1 and April 30th, 2020, and underwent both thoracic CT and reverse transcription-polymerase chain reaction (RT-PCR) testing for suspected COVID-19 pneumonia. CT images were read blinded to initial reports, RT-PCR, demographic characteristics, clinical symptoms, and outcome. Readers classified CT scans as either positive or negative for COVID-19 based on criteria published by the French Society of Radiology. Multivariable logistic regression was used to develop a model predicting severe outcome (intubation or death) at 1-month follow-up in patients positive for both RT-PCR and CT, using clinical and radiologic features. Results Among 10 930 patients screened for eligibility, 10 735 (median age, 65 years; interquartile range, 51-77 years; 6147 men) were included and 6448 (60%) had a positive RT-PCR result. With RT-PCR as reference, the sensitivity and specificity of CT were 80.2% (95% CI: 79.3, 81.2) and 79.7% (95% CI: 78.5, 80.9), respectively, with strong agreement between junior and senior radiologists (Gwet AC1 coefficient, 0.79). Of all the variables analyzed, the extent of pneumonia at CT (odds ratio, 3.25; 95% CI: 2.71, 3.89) was the best predictor of severe outcome at 1 month. A score based solely on clinical variables predicted a severe outcome with an area under the curve of 0.64 (95% CI: 0.62, 0.66), improving to 0.69 (95% CI: 0.6, 0.71) when it also included the extent of pneumonia and coronary calcium score at CT. Conclusion Using predefined criteria, CT reading is not influenced by reader's experience and helps predict the outcome at 1 month. ClinicalTrials.gov identifier: NCT04355507 Published under a CC BY 4.0 license. See also the editorial by Rubin in this issue.
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http://dx.doi.org/10.1148/radiol.2021210384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267782PMC
October 2021

Pulmonary artery sarcoma: A differential diagnosis of persistent pulmonary embolism.

Respir Med Res 2021 Jun 7;80:100842. Epub 2021 Jun 7.

Department of Pulmonology, Avicenne Hospital, AP-HP, Bobigny, France; Inserm UMR1272, Université Sorbonne Paris Nord, Paris, France.

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http://dx.doi.org/10.1016/j.resmer.2021.100842DOI Listing
June 2021

Vascular Ehlers-Danlos syndrome (vEDS): CT and histologic findings of pleural and lung parenchymal damage.

Eur Radiol 2021 Aug 2;31(8):6275-6285. Epub 2021 Mar 2.

Université de Paris - Service de Pneumologie et Soins Intensifs, Centre de Compétences Maladies Rares Pulmonaires - Hôpital Européen Georges Pompidou - AP-HP - INSERM UMRS 1140, Paris, France.

Objectives: To describe CT features of lung involvement in patients with vascular Ehlers-Danlos syndrome (vEDS), a rare genetic condition caused by pathogenic variants within the COL3A1 gene, characterized by recurrent arterial, digestive, and pulmonary events.

Material And Methods: All consecutive vEDS patients referred to the national tertiary referral center for vEDS, between 2004 and 2016, were included. Chest CT scans obtained during the initial vascular work-up were reviewed retrospectively by two chest radiologists for lung involvement. Five surgical samples underwent histologic examination.

Results: Among 136 enrolled patients (83 women, 53 men; mean age 37 years) with molecularly confirmed vEDS, 24 (17.6%) had a history of respiratory events: 17 with pneumothorax, 4 with hemothorax, and 3 with hemoptysis that required thoracic surgery in 11. CT scans detected lung parenchymal abnormalities in 78 (57.3%) patients: emphysema (mostly centrilobular and paraseptal) in 44 (32.3%), comparable for smokers and non-smokers; clusters of calcified small pulmonary nodules in 9 (6.6%); and cavitated nodules in 4 (2.9%). Histologic examination of surgical samples found arterial abnormalities, emphysema with alveolar ruptures in 3, accompanied by diffuse hemorrhage and increased hemosiderin resorption.

Conclusion: In vEDS patients, identification of lung parenchymal abnormalities is common on CT. The most frequently observed CT finding was emphysema suggesting alveolar wall rupture which might facilitate the diagnostic screening of the disease in asymptomatic carriers of a genetic COL3A1 gene mutation. The prognostic value and evolution of these parenchymal abnormalities remain to be evaluated.

Key Points: • Patients with vEDS can have lung parenchymal changes on top of or next to thoracal vascular abnormalities and that these changes can be present in asymptomatic cases. • The presence of these parenchymal changes is associated with a slightly higher incidence of respiratory events (although not statistically significant). • Identification of the described CT pattern by radiologists and chest physicians may facilitate diagnostic screening.
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http://dx.doi.org/10.1007/s00330-021-07710-6DOI Listing
August 2021

Epicardial adipose tissue volume and coronary calcification among people living with diabetes: a cross-sectional study.

Cardiovasc Diabetol 2021 02 5;20(1):35. Epub 2021 Feb 5.

Department of Endocrinology-Diabetology-Nutrition, AP-HP, Avicenne Hospital, Université Paris 13, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France.

Background: Epicardial adipose tissue (EAT) has anatomic and functional proximity to the heart and is considered a novel diagnostic marker and therapeutic target in cardiometabolic diseases. The aim of this study was to evaluate whether EAT volume was associated with coronary artery calcification (CAC) in people living with diabetes, independently of confounding factors.

Methods: We included all consecutive patients with diabetes whose EAT volume and CAC score were measured using computed tomography between January 1, 2019 and September 30, 2020 in the Department of Diabetology-Endocrinology-Nutrition at Avicenne Hospital, France. Determinants of EAT volume and a CAC score ≥ 100 Agatston units (AU) were evaluated.

Results: The study population comprised 409 patients (218 men). Mean (± standard deviation) age was 57 ± 12 years, and 318, 56 and 35 had type 2 (T2D), type 1 (T1D), or another type of diabetes, respectively. Mean body mass index (BMI) was 29 ± 6 kg/m, mean AET volume 93 ± 38 cm. EAT volume was positively correlated with age, BMI, pack-year smoking history and triglyceridaemia, but negatively correlated with HDL-cholesterol level. Furthermore, it was lower in people with retinopathy, but higher in men, in Caucasian people, in patients on antihypertensive and lipid-lowering medication, in people with nephropathy, and finally in individuals with a CAC ≥ 100 AU (CAC < 100 vs CAC ≥ 100: 89 ± 35 vs 109 ± 41 cm, respectively, p < 0.05). In addition to EAT volume, other determinants of CAC ≥ 100 AU (n = 89, 22%) were age, T2D, ethnicity, antihypertensive and lipid-lowering medication, cumulative tobacco consumption, retinopathy, macular edema and macrovascular disease. Multivariable analysis considering all these determinants as well as gender and BMI showed that EAT volume was independently associated with CAC ≥ 100 AU (per 10 cm increase: OR 1.11 [1.02-1.20]).

Conclusions: EAT volume was independently associated with CAC. As it may play a role in coronary atherosclerosis in patients with diabetes, reducing EAT volume through physical exercise, improved diet and pharmaceutical interventions may improve future cardiovascular risk outcomes in this population.
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http://dx.doi.org/10.1186/s12933-021-01225-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863354PMC
February 2021

Reversible diaphragmatic dysfunction in primary hyperparathyroidism.

Clin Exp Rheumatol 2021 Jan-Feb;39 Suppl 128(1):29-30. Epub 2021 Jan 20.

Sorbonne Paris Nord University, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France.

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May 2021

Lung transplantation for sarcoidosis: outcome and prognostic factors.

Eur Respir J 2021 08 5;58(2). Epub 2021 Aug 5.

Dept of Respiratory Medicine, Hannover Medical School, Hanover, Germany.

Study Question: In patients with sarcoidosis, past and ongoing immunosuppressive regimens, recurrent disease in the transplant and extrapulmonary involvement may affect outcomes of lung transplantation. We asked whether sarcoidosis lung phenotypes can be differentiated and, if so, how they relate to outcomes in patients with pulmonary sarcoidosis treated by lung transplantation.

Patients And Methods: We retrospectively reviewed data from 112 patients who met international diagnostic criteria for sarcoidosis and underwent lung or heart-lung transplantation between 2006 and 2019 at 16 European centres.

Results: Patient survival was the main outcome measure. At transplantation, median (interaquartile range (IQR)) age was 52 (46-59) years; 71 (64%) were male. Lung phenotypes were individualised as follows: 1) extended fibrosis only; 2) airflow obstruction; 3) severe pulmonary hypertension (sPH) and airflow obstruction; 4) sPH, airflow obstruction and fibrosis; 5) sPH and fibrosis; 6) airflow obstruction and fibrosis; 7) sPH; and 8) none of these criteria, in 17%, 16%, 17%, 14%, 11%, 9%, 5% and 11% of patients, respectively. Post-transplant survival rates after 1, 3, and 5 years were 86%, 76% and 69%, respectively. During follow-up (median (IQR) 46 (16-89) months), 31% of patients developed chronic lung allograft dysfunction. Age and extended lung fibrosis were associated with increased mortality. Pulmonary fibrosis predominating peripherally was associated with short-term complications.

Answer To The Study Question: Post-transplant survival in patients with pulmonary sarcoidosis was similar to that in patients with other indications for lung transplantation. The main factors associated with worse survival were older age and extensive pre-operative lung fibrosis.
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http://dx.doi.org/10.1183/13993003.03358-2020DOI Listing
August 2021

AI-driven quantification, staging and outcome prediction of COVID-19 pneumonia.

Med Image Anal 2021 01 15;67:101860. Epub 2020 Oct 15.

Radiology Department, Hopital Avicenne - AP-HP.Hopitaux universitaires Paris Seine-Saint-Denis, 125 Rue de Stalingrad, Bobigny 93000, France; Université Sorbonne Paris Nord, 99 Avenue Jean Baptiste Clément, Villetaneuse 93430, France.

Coronavirus disease 2019 (COVID-19) emerged in 2019 and disseminated around the world rapidly. Computed tomography (CT) imaging has been proven to be an important tool for screening, disease quantification and staging. The latter is of extreme importance for organizational anticipation (availability of intensive care unit beds, patient management planning) as well as to accelerate drug development through rapid, reproducible and quantified assessment of treatment response. Even if currently there are no specific guidelines for the staging of the patients, CT together with some clinical and biological biomarkers are used. In this study, we collected a multi-center cohort and we investigated the use of medical imaging and artificial intelligence for disease quantification, staging and outcome prediction. Our approach relies on automatic deep learning-based disease quantification using an ensemble of architectures, and a data-driven consensus for the staging and outcome prediction of the patients fusing imaging biomarkers with clinical and biological attributes. Highly promising results on multiple external/independent evaluation cohorts as well as comparisons with expert human readers demonstrate the potentials of our approach.
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http://dx.doi.org/10.1016/j.media.2020.101860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558247PMC
January 2021

Focal bronchial dilatations after thermoplasty for severe asthma.

ERJ Open Res 2020 Jul 14;6(3). Epub 2020 Sep 14.

Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares, Inserm UMR 1152, Paris, France.

https://bit.ly/2AYuhMj.
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http://dx.doi.org/10.1183/23120541.00117-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487351PMC
July 2020

Predictors of mortality in fibrosing pulmonary sarcoidosis.

Respir Med 2020 08 12;169:105997. Epub 2020 May 12.

INSERM UMR 1272, Université Sorbonne Paris Nord, Bobigny, France; AP-HP, service de pneumologie, hôpital Avicenne, Bobigny, France.

Introduction: Pulmonary fibrosing sarcoidosis is associated with increased mortality. This study was aimed to explore the prognosis value of a panel of parameters for predicting mortality.

Methods: This retrospective study included 216 patients with confirmed stage 4 pulmonary sarcoidosis. Stage 4 diagnosis date served as baseline. The following information was systematically present at baseline: epidemiological characteristics; treatments; pulmonary function; composite physiologic index (CPI); systolic pulmonary artery pressure at echocardiography; pulmonary fibrosis extent, main pulmonary artery/ascending aorta diameters ratio (MPAD/AAD) and MPAD/body surface area (BSA) measured and calculated using computed tomography, Walsh's algorithm based on CPI, lung fibrosis extent and MPAD/AAD ratio, and modified Walsh's algorithm with MPAD/BSA replacing MPAD/AAD allowed to estimate good or bad prognosis profiles. The primary outcome of the study was all cause mortality and lung transplantation. The value of baseline parameters was tested as predictors of mortality using univariate and multivariate analyses.

Results: Median follow-up was 105 months. There were 41 deaths and 5 transplantations. At multivariate analysis, survival was independently predicted by several parameters including CPI, lung fibrosis extent, pulmonary hypertension at echography or MPAD/BSA ratio, Walsh's algorithm, and geographic origin. The modified Walsh's algorithm was most highly predictive.

Conclusion: Survival was best predicted by geographic origin, lung fibrosis extent, PH at echography or MPAD/BSA ratio, as well as by various scores among them the modified Walsh's algorithm had very high predictive value thanks to MPAD/BSA ratio which accurately predicted mortality.
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http://dx.doi.org/10.1016/j.rmed.2020.105997DOI Listing
August 2020

Phenotype and Outcomes of Pulmonary Hypertension Associated with Neurofibromatosis Type 1.

Am J Respir Crit Care Med 2020 09;202(6):843-852

School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.

Pulmonary hypertension (PH) associated with neurofibromatosis type 1 (NF1) is a rare and largely unknown complication of NF1. To describe characteristics and outcomes of PH-NF1. We reported the clinical, functional, radiologic, histologic, and hemodynamic characteristics, response to pulmonary arterial hypertension (PAH)-approved drugs, and transplant-free survival of patients with PH-NF1 from the French PH registry. We identified 49 PH-NF1 cases, characterized by a female/male ratio of 3.9 and a median (minimum-maximum) age at diagnosis of 62 (18-82) years. At diagnosis, 92% were in New York Heart Association functional class III or IV. The 6-minute-walk distance was 211 (0-460) m. Pulmonary function tests showed low Dl (30% [12-79%]) and severe hypoxemia (Pa 56 [38-99] mm Hg). Right heart catheterization showed severe precapillary PH with a mean pulmonary artery pressure of 45 (10) mm Hg and a pulmonary vascular resistance of 10.7 (4.2) Wood units. High-resolution computed tomography images revealed cysts (76%), ground-glass opacities (73%), emphysema (49%), and reticulations (39%). Forty patients received PAH-approved drugs with a significant improvement in functional class and hemodynamic parameters. Transplant-free survival at 1, 3, and 5 years was 87%, 54%, and 42%, respectively, and four patients were transplanted. Pathologic assessment showed nonspecific interstitial pneumonia and major pulmonary vascular remodeling. PH-NF1 is characterized by a female predominance, a low Dl, and severe functional and hemodynamic impairment. Despite a potential benefit of PAH treatment, prognosis remains poor, and double-lung transplantation is an option for eligible patients.
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http://dx.doi.org/10.1164/rccm.202001-0105OCDOI Listing
September 2020

National dose reference levels in computed tomography-guided interventional procedures-a proposal.

Eur Radiol 2020 Oct 2;30(10):5690-5701. Epub 2020 May 2.

Pole de radiologie, CHU de Clermont + TGI - Institut Pascal, UMR 6602 UCA /CNRS /SIGMA Clermont, Clermont Ferrand, France.

Objectives: To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive.

Methods: Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies.

Results: Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures.

Conclusions: This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols.

Key Points: • National reference levels are proposed for 17 categories of interventional procedures under CT guidance. • Reference levels are useful for benchmarking practices and optimizing protocols. • Reference levels are proposed for dose length product and the number of helical acquisitions.
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http://dx.doi.org/10.1007/s00330-020-06903-9DOI Listing
October 2020

Correction for Magnetic Field Inhomogeneities and Normalization of Voxel Values Are Needed to Better Reveal the Potential of MR Radiomic Features in Lung Cancer.

Front Oncol 2020 31;10:43. Epub 2020 Jan 31.

Laboratoire IMIV, UMR 1023 Inserm-CEA-Université Paris Sud, ERL 9218 CNRS, Université Paris Saclay, Orsay, France.

To design and validate a preprocessing procedure dedicated to T2-weighted MR images of lung cancers so as to improve the ability of radiomic features to distinguish between adenocarcinoma and other histological types. A discovery set of 52 patients with advanced lung cancer who underwent T2-weighted MR imaging at 3 Tesla in a single center study from August 2017 to May 2019 was used. Findings were then validated using a validation set of 19 additional patients included from May to October 2019. Tumor type was obtained from the pathology report after trans-thoracic needle biopsy, metastatic lymph node or metastasis samples, or surgical excisions. MR images were preprocessed using N4ITK bias field correction and by normalizing voxel intensities with fat as a reference region. Segmentation and extraction of radiomic features were performed with LIFEx software on the raw images, on the N4ITK-corrected images and on the fully preprocessed images. Two analyses were conducted where radiomic features were extracted: (1) from the whole tumor volume (3D analysis); (2) from all slices encompassing the tumor (2D analysis). Receiver operating characteristic (ROC) analysis was used to identify features that could distinguish between adenocarcinoma and other histological types. Sham experiments were also designed to control the number of false positive findings. There were 31 (12) adenocarcinomas and 21 (7) other histological types in the discovery (validation) set. In 2D, preprocessing increased the number of discriminant radiomic features from 8 without preprocessing to 22 with preprocessing. 2D analysis yielded more features able to identify adenocarcinoma than 3D analysis (12 discriminant radiomic features after preprocessing in 3D). Preprocessing did not increase false positive findings as no discriminant features were identified in any of the sham experiments. The greatest sensitivity of the 2D analysis applied to preprocessed data was confirmed in the validation set. Correction for magnetic field inhomogeneities and normalization of voxel values are essential to reveal the full potential of radiomic features to identify the tumor histological type from MR T2-weighted images, with classification performance similar to those reported in PET/CT and in multiphase CT in lung cancers.
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http://dx.doi.org/10.3389/fonc.2020.00043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006432PMC
January 2020

Spectrum and Prognosis of Antineutrophil Cytoplasmic Antibody-associated Vasculitis-related Bronchiectasis: Data from 61 Patients.

J Rheumatol 2020 10 1;47(10):1522-1531. Epub 2019 Dec 1.

J.F. Subra, MD, PhD, Department of Nephrology-Dialysis-Transplantation, Angers University Hospital, Angers.

Objective: To report on a large series of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and bronchiectasis, with a specific focus on the timeline of occurrence of both features.

Methods: Retrospective nationwide multicenter study of patients diagnosed with both AAV and bronchiectasis.

Results: Sixty-one patients were included, among whom 27 (44.25%) had microscopic polyangiitis (MPA), 27 (44.25%) had granulomatosis with polyangiitis (GPA), and 7 (11.5%) had eosinophilic GPA. Thirty-nine (64%) had myeloperoxidase (MPO)-ANCA and 13 (21%) had proteinase 3-ANCA. The diagnosis of bronchiectasis either preceded (n = 25; median time between both diagnoses: 16 yrs, IQR 4-54 yrs), was concomitant to (n = 12), or followed (n = 24; median time between both diagnoses: 1, IQR 0-6 yrs) that of AAV. Patients in whom bronchiectasis precedes the onset of AAV (B-AAV group) have more frequent mononeuritis multiplex, MPA, MPO-ANCA, and a 5-fold increase of death. The occurrence of an AAV relapse tended to be protective against bronchiectasis worsening (HR 0.6, 95% CI 0.4-0.99, = 0.049), while a diagnosis of bronchiectasis before AAV (HR 5.8, 95% CI 1.2-28.7, = 0.03) or MPA (HR 18.1, 95% CI 2.2-146.3, = 0.01) were associated with shorter survival during AAV follow-up.

Conclusion: The association of bronchiectasis with AAV is likely not accidental and is mostly associated with MPO-ANCA. Patients in whom bronchiectasis precedes the onset of AAV tend to have distinct clinical and biological features and could carry a worse prognosis.
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http://dx.doi.org/10.3899/jrheum.190313DOI Listing
October 2020

Lower respiratory tract amyloidosis: Presentation, survival and prognostic factors. A multicenter consecutive case series.

Am J Hematol 2019 11 23;94(11):1214-1226. Epub 2019 Aug 23.

INSERM UMR-1272, Paris 13 University and AP-HP, Pneumology Department, Avicenne Hospital, Bobigny, France.

Lower-respiratory-tract (LRT) amyloidosis has rarely been investigated. Our study presents characteristics, outcomes and survival of LRT amyloidosis. This multicenter retrospective study, from 1995 to 2017, included 73 patients with amyloidosis and LRT involvement. Respiratory patterns were: tracheobronchial (n = 17), nodular (n = 10), interstitial (n = 14) or composite (several respiratory involvements, n = 32). Interstitial and composite patterns were associated with multi-organ amyloidosis (n = 37, 80%) while tracheobronchial and nodular patterns were associated with organ-limited amyloidosis (n = 21, 78%). Amyloid light chain (AL) amyloidosis was diagnosed in 43 patients (59%), mainly of lambda type (n = 33, 77%). Smokers' proportion was higher in tracheobronchial (71%) and nodular (90%) patterns than in interstitial (14%) and composite (34%) patterns. The B-cell neoplasms involved 15 patients (21%), solid neoplasms 8 (11%), connective tissue diseases 8 (11%) and multiple myeloma 6 (8%). The B-cell and solid neoplasms were most prevalent in nodular pattern. Median follow-up was 4.4 years (2.2-8.9). Twenty-four patients died, mostly from respiratory infection. Survival at 1, 5, 10 years was respectively 88%, 70% and 54% for multi-organ amyloidosis, 96%, 89% and 69% for organ-limited amyloidosis (P = .125). Tracheobronchial and nodular patterns survival was better than in other respiratory patterns (P = .039). Death risk factors (multivariate analysis) were: cardiac localization (hazard-ratio [HR] 4.3 [95% confidence interval 1.6-11.5]; P = .004), age (HR 2.1 [1.2-3.7]; P = .008) and dyspnea at diagnosis (HR 4.0 [1.3-12.3]; P = .014). Various LRT amyloidosis patterns depend on smoking habits, organ-limited or multi-organ extension and comorbidities. They are associated with a different survival, which is also predicted by age, cardiac localization and dyspnea at presentation.
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http://dx.doi.org/10.1002/ajh.25608DOI Listing
November 2019

Thoracic aorta involvement in giant cell arteritis: a case-control analysis of morphological data at diagnosis.

Clin Exp Rheumatol 2020 Jan-Feb;38(1):140-143. Epub 2019 Aug 3.

Service de Médecine Interne, AP-HP, Hôpital Univ. Seine Saint Denis, Bobigny; Faculté de Médecine SMBH Université Paris 13, Sorbonne Paris Cité, Bobigny; and Université Paris 13, Sorbonne Paris Cité, UMR1125, LI2P, Bobigny, France.

Objectives: Giant cell arteritis (GCA) is a cause of potentially fatal aortic aneurysms. Descriptive data on thoracic aorta measurements at the beginning of the disease are lacking. We aimed to compare aortic diameters between a recently diagnosed GCA population and an age- and sex-matched control group.

Methods: Patients with GCA and with an available thoracic CT concomitant with diagnosis were included. Controls were patients matched for age and sex and hospitalised in the same care centre for pneumonia. The main criteria were the anteroposterior and lateral diameters of the ascending thoracic aorta, which were measured by a blinded evaluator.

Results: 90 cases and 90 controls were included. Each group comprised 30 males and 60 females for a mean age of 75.1±9 and 75.7±10.1 years old. At the time of GCA diagnosis no difference was found between the two groups (anteroposterior diameter 37.1±5 mm for cases vs. 36.7±5 mm for controls, p=0.6; lateral diameter 36.6±5 mm for cases vs. 35.9±4 mm for controls, p=0.3). Thoracic aorta diameter was not significantly higher in patients with aortitis at diagnosis (n=44) than in cases without aortitis (n=46).

Conclusions: Morphologic comparison of thoracic aorta at diagnosis of GCA with an age- and sex-matched control population showed no significant difference. Morphologic evaluation of aorta cannot predict accurately the occurrence of aortic aneurysm. Systematic follow-up according to current recommendations is thus justified.
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July 2020

Immunotherapy for LELC: Case Report and a Focused Review.

Clin Lung Cancer 2019 05 21;20(3):e393-e401. Epub 2018 Dec 21.

Oncologie Médicale, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny Laboratoire d'Oncoim, Oncology, Bobigny, France. Electronic address:

Lymphoepithelioma-like carcinoma of the lung (LELC) is a rare, Epstein-Barr virus-associated tumor. LELC occurs mostly in young, Asian nonsmokers. A few hundred cases have been reported, mostly from retrospective Asian studies. Optimal treatment has not been clearly established. Treatment options are based on surgery for early stage and on cisplatin-based chemotherapy as first-line therapy for metastatic disease. Prognosis may seem better than for other types of non-small-cell lung cancer, but it remains poor in advanced disease, with a median survival of 24 months, and new treatments options are still warranted. Immunotherapies are now key players in the treatment of non-small-cell lung cancer. However, few data are available for this rare histologic subgroup. We have reviewed the available data on LELC with a focus on the first few cases reported with a response to a programmed cell death 1 inhibitor.
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http://dx.doi.org/10.1016/j.cllc.2018.12.008DOI Listing
May 2019

The place of high-resolution computed tomography imaging in the investigation of interstitial lung disease.

Expert Rev Respir Med 2019 01 12;13(1):79-94. Epub 2018 Dec 12.

a Université Paris 13, EA2363 "Hypoxie & Poumon" , Sorbonne-Paris-Cité , Bobigny, France.

Introduction: High-resolution computed tomography (HRCT) has revolutionized the diagnosis, prognosis and in some cases the prediction of therapeutic response in interstitial lung disease (ILD). HRCT represents an essential second step to a patient's clinical history, before considering any other investigation, including lung biopsy. Areas covered: This review describes the current place of HRCT in the diagnosis, prognosis and monitoring of ILD. It also lists some perspectives for the near future. Expert commentary: Since the 1980s, HRCT and its interpretation have improved, the diagnosis value of patterns, and the integration of bio-clinical elements to HRCT have been better standardized. The interobserver agreement has been investigated, allowing a better use of some limits in the interpretation of various signs. It not only takes into account one particular predominant sign, but the combination of patterns and the distribution of findings. Thanks to HRCT, the range of diagnoses and their probability are more accurately identified. The contribution of HRCT has been optimized during the multidisciplinary discussion that a difficult diagnosis calls for. HRCT quantification of the extent of diffuse lung disease becomes possible and is linked to prognosis. In the future, artificial intelligence may significantly modify the practice of radiology.
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http://dx.doi.org/10.1080/17476348.2019.1556639DOI Listing
January 2019

Sarcoidosis in Patients with Antisynthetase Syndrome: Presentation and Outcome.

J Rheumatol 2018 08 1;45(9):1296-1300. Epub 2018 Jul 1.

From the AP-HP, Hôpital Avicenne, Service de Pneumologie; AP-HP, Hôpital Avicenne, Service de Radiologie, Bobigny; Centre hospitalier départemental de Vendée, Hôpital La Roche-sur-Yon, Service de Rhumatologie, Les Oudairies, La Roche-sur-Yon; Centre Hospitalier Universitaire de Nantes, Service de Rhumatologie, Nantes; Centre de Référence des Maladies Auto-immunes Rares, Service de Rhumatologie, Strasbourg; Centre Hospitalier Universitaire de Rennes, Service de Pneumologie, Rennes; AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Référence des Maladies Musculaires, Paris, France.

Objective: To investigate the uncommon co-occurrence of antisynthetase syndrome (AS) and sarcoidosis.

Methods: From 2000 to 2015, patients with sarcoidosis were extracted from a retrospective multicentric cohort of 352 patients with AS.

Results: Ten patients (2.8%; 6 men, 8 whites, 5 smokers, median age 50 yrs) had both AS and sarcoidosis. Most of the time, sarcoidosis and AS occurred simultaneously (n = 7). Antibody testing revealed anti-Jo1 (n = 5), anti-PL12 (n = 4), or anti-PL7 (n = 1). Finally, no patient had a worsening of muscular condition, 5 patients presented respiratory deterioration, 3 remained stable, and 2 showed improvement.

Conclusion: Sarcoidosis may be underdiagnosed in patients with AS.
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http://dx.doi.org/10.3899/jrheum.171098DOI Listing
August 2018

Radiological abnormalities following bronchial thermoplasty: is the pathophysiology understood?

Eur Respir J 2017 12 7;50(6). Epub 2017 Dec 7.

Dept of Pneumology A, Bichat Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

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http://dx.doi.org/10.1183/13993003.02067-2017DOI Listing
December 2017

Aortitis in giant cell arteritis: diagnosis with FDG PET/CT and agreement with CT angiography.

Autoimmun Rev 2017 Nov 11;16(11):1131-1137. Epub 2017 Sep 11.

Department of Nuclear Medicine, Hôpital Avicenne, Université Paris 13, Assistance Publique - Hôpitaux de Paris, Bobigny, France. Electronic address:

Objectives: To assess the detection rate of aortitis in giant cell arteritis (GCA) with fluorodeoxyglucose positron emission tomography/computed tomography (PET) and to compare the findings with CT angiography (CTA).

Methods: Fifty-two GCA patients and 27 controls were included. GCA patients had a PET scan at diagnosis (35/52) or during relapse (17/52). Concomitant CTA was performed in 35/52 patients. Aortitis was defined as FDG uptake higher than the liver for PET and wall thickness≥3mm for CTA. Agreement between PET and CTA was evaluated by the kappa coefficient and Spearman correlation coefficient.

Results: Aortitis was diagnosed using PET in 40% (14/35) of patients at diagnosis and in 0% of controls (0/27). Agreement was perfect between PET and CT at a patient-based level, and very good at a vascular segment-based level (kappa: 0.72 to 1). PET was positive in 35% (6/17) of patients scanned during GCA relapse, showing aortitis (n=4) and/or articular uptake (n=4). Discrepancies between PET and CT were observed only in relapsing GCA (n=3). Correlation between the maximum standardized uptake value and wall thickness was moderate at diagnosis (r: 0.57 to 0.7) and not statistically significant during relapse.

Conclusions: The detection rate of aortitis in GCA patients using PET is 40%, approximately in the range of CTA rates, suggesting that the two techniques have similar sensitivity. PET seems valuable in relapsing GCA, allowing the detection of vascular and articular activities.
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http://dx.doi.org/10.1016/j.autrev.2017.09.008DOI Listing
November 2017

Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris.

Eur Respir J 2017 08 3;50(2). Epub 2017 Aug 3.

Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France

The objective of the study was to estimate the prevalence and incidence of interstitial lung diseases (ILDs) in Seine-Saint-Denis, a multi-ethnic county of Greater Paris, France.Patients with ILDs were identified between January and December 2012 by using several sources; all potentially involved medical specialists from public and private hospitals, community-based pulmonologists and general practitioners, and the Social Security system. Diagnoses were validated centrally by an expert multidisciplinary discussion.1170 ILD cases were reported (crude overall prevalence: 97.9/10 and incidence: 19.4/10/year). In the 848 reviewed cases, the most prevalent diagnoses were sarcoidosis (42.6%), connective tissue diseases associated ILDs (CTDs-ILDs) (16%), idiopathic pulmonary fibrosis (IPF) (11.6%), and occupational ILDs (5.0%), which corresponded to a crude prevalence of 30.2/10 for sarcoidosis, 12.1/10 for CTDs-ILDs and 8.2/10 for IPF. The prevalence of fibrotic idiopathic interstitial pneumonias, merging IPF, nonspecific interstitial pneumonia and cases registered with code J84.1 was 16.34/10 An adjusted multinomial model demonstrated an increased risk of sarcoidosis in North Africans and Afro-Caribbeans and of CTDs-ILDs in Afro-Caribbeans, compared to that in Europeans.This study, with a comprehensive recruitment and stringent diagnostic criteria, emphasises the importance of secondary ILDs, particularly CTDs-ILDs and the relatively low prevalence of IPF, and confirms that sarcoidosis is a rare disease in France.
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http://dx.doi.org/10.1183/13993003.02419-2016DOI Listing
August 2017
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