Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia in Critically Ill Patients: A Cluster Analysis According to Baseline Characteristics, Biological Features, and Chest CT Scan on Admission.

BACKGROUND: Inconsistent results from COVID-19 studies raise the issue of patient heterogeneity. OBJECTIVE: The objective of this study was to identify homogeneous subgroups of patients (clusters) using baseline characteristics including inflammatory biomarkers and the extent of lung parenchymal lesions on CT, and to compare their outcomes. DESIGN: Retrospective single-center study. SETTING: Medical ICU of the University Hospital of Clermont-Ferrand, France. PATIENTS: All consecutive adult patients aged greater than or equal to 18 years, admitted between March 20, 2020, and August 31, 2021, for COVID-19 pneumonia. INTERVENTIONS: Characteristics at baseline, during ICU stay, and outcomes at day 60 were recorded. On the chest CT performed at admission the extent of lung parenchyma lesions was established by artificial intelligence software. MEASUREMENTS AND MAIN RESULTS: Clusters were determined by hierarchical clustering on principal components using principal component analysis of admission characteristics including plasma interleukin-6, human histocompatibility leukocyte antigen-DR expression rate on blood monocytes (HLA-DR) monocytic-expression rate (mHLA-DR), and the extent of lung parenchymal lesions. Factors associated with day 60 mortality were investigated by univariate survival analysis. Two hundred seventy patients were included. Four clusters were identified and three were fully described. Cluster 1 (obese patients, with moderate hypoxemia, moderate extent of lung parenchymal lesions, no inflammation, and no down-regulation of mHLA-DR) had a better prognosis at day 60 (hazard ratio [HR] = 0.27 [0.15-0.46], p < 0.01), whereas cluster 2 (older patients with comorbidities, moderate extent of lung parenchyma lesions but significant hypoxemia, inflammation, and down-regulation of mHLA-DR) and cluster 3 (patients with severe parenchymal disease, hypoxemia, inflammatory reaction, and down-regulation of mHLA-DR) had an increased risk of mortality (HR = 2.07 [1.37-3.13], p < 0.01 and HR = 1.52 [1-2.32], p = 0.05, respectively). In multivariate analysis, only clusters 1 and 2 were independently associated with day 60 death. CONCLUSIONS: Three clusters with distinct characteristics and outcomes were identified. Such clusters could facilitate the identification of targeted populations for the next trials.

Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study.

OBJECTIVES: The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA). METHODS: COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated. RESULTS: In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2-4.8%) and 10.1% (8.5-11.9%), respectively, increasing to 1.0% (0.2-5.3%) and 16.4% (14.4-18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4-14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2-5.3%) for efficiency of 16.8% (14.7-19.1%), and 16.9% (14.8-19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594-0.623) with an efficiency of 20.5% (18.4-22.8%) when its failure was set to 0.8%. CONCLUSIONS: The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor. KEY POINTS: • D-dimer level remains the most important predictor of pulmonary embolism in COVID-19 patients. • The AUCs of the revised Geneva and Wells scores using an age-adjusted D-dimer threshold were 0.587 (95%CI, 0.572 to 0.603) and 0.588 (95%CI, 0.572 to 0.603). • The AUC of COVID-19-specific strategy to rule out pulmonary embolism ranged from 0.513 (95%CI: 0.503 to 0.522) to 0.609 (95%CI: 0.594 to 0.623).

Optimized radiological alert thresholds based on device dosimetric information and peak skin dose in vascular fluoroscopically guided intervention.

OBJECTIVES: The National Council on Radiation Protection (NCRP) report no. 168 recommended that during fluoroscopically guided interventions (FGIs), each patient should be monitored when one of the following thresholds is reached: an air kerma > 5 Gy, a kerma area product (KAP) > 500 Gy.cm2, a fluoroscopy time > 60 min, or a peak skin dose (PSD) > 3 Gy. Whereas PSD is the most accurate metric regarding the prevention of radiological risks, it remains the most difficult parameter to assess. We aimed to evaluate the relevance of the other, more accessible metrics and propose new optimized threshold (OT) for improved patient follow-up. METHODS: Overall, 108 patients who underwent FGI in which at least one NCRP threshold was reached and PSD was measured were considered. The correlation between all metrics was assessed using principal component analysis (PCA). ROC curves and the sensitivity/specificity of both NCRP and OT to predict PSD > 3 Gy were evaluated. RESULTS: The PCA shows that FGI can be decomposed with two components based on time and dose variables. Only KAP and kerma were correlated with PSD. The overall sensitivity and specificity of the new OT regarding KAP (67.6/93.0), kerma (97.3/81.7), and time (62.2/62.0) were better compared with NCRP thresholds (97.3/16.9, 40.5/95.4, and 21.6/74.7). CONCLUSIONS: This study shows that fluoroscopy time is not a relevant metric when used to predict PSDs > 3 Gy. By adapting KAP and kerma thresholds to predict PSD over 3 Gy, patient follow-ups following vascular FGI can be improved. KEY POINTS: • In vascular fluoroscopically guided interventions, principal component analysis demonstrates that between fluoroscopy time, KAP, and kerma, only the two last were correlated to the peak skin dose. • Optimized thresholds replacing NRCP ones obtained with ROC curves analysis were 85,451 µGy.cm2, 2938 mGy, and 41 min for KAP, kerma, and fluoroscopy time respectively. • Improvements to trigger patient follow-up after vascular fluoroscopically guided interventions may be obtained by using the optimized thresholds.

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

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 (CTcovid) and whole chest CT scan activities (CTchest) 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 CTchest 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 CTcovid on CTchest 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 CTcovid (r = 0.73, p = 3.10-16) 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 (CTtotal) were performed among the responding centers, including 61,784 (52%) CT performed for COVID-19 (CTcovid). • Across the country, the ratio CTcovid/CTtotal 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.

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

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.

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

The original version of this article, published on 02 May 2020, unfortunately contained a mistake.

Assessment of four different cardiac softwares for evaluation of LVEF with CZT-SPECT vs CMR in 48 patients with recent STEMI.

PURPOSE: To compare, vs CMR, four softwares: quantitative gated SPECT (QGS), myometrix (MX), corridor 4DM (4DM), and Emory toolbox (ECTb) to evaluate left ventricular ejection fraction (LVEF), end-systolic (ESV), and end-diastolic volumes (EDVs) by gated MPI CZT-SPECT. METHODS: 48 patients underwent MPI CZT-SPECT and CMR 6 weeks after STEMI, LV parameters were measured with four softwares at MPI CZT-SPECT vs CMR. We evaluated (i) concordance and correlation between MPI CZT-SPECT and CMR, (ii) concordance MPI CZT-SPECT/CMR for the categorical evaluation of the left ventricular dysfunction, and (iii) impacts of perfusion defects > 3 segments on concordance. RESULTS: LVEF: LCC QGS/CMR = 0.81 [+ 2.2% (± 18%)], LCC MX/CMR = 0.83 [+ 1% (± 17.5%)], LCC 4DM/CMR = 0.73 [+ 3.9% (± 21%)], LCC ECTb/CMR = 0.69 [+ 6.6% (± 21.1%)]. ESV: LCC QGS/CMR = 0.90 [- 8 mL (± 40 mL)], LCC MX/CMR = 0.90 [- 9 mL (± 36 mL)], LCC 4DM/CMR = 0.89 [+ 4 mL (± 45 mL)], LCC ECTb/CMR = 0.87 [- 3 mL (± 45 mL)]. EDV: LCC QGS/CMR = 0.70 [- 16 mL (± 67 mL)], LCC MX/CMR = 0.68 [- 21 mL (± 63 mL], LCC 4DM/CMR = 0.72 [+ 9 mL (± 73 mL)], LCC ECTb/CMR = 0.69 [+ 10 mL (± 70 mL)]. CONCLUSION: QGS and MX were the two best-performing softwares to evaluate LVEF after recent STEMI.

Validation of cadmium-zinc-telluride camera for measurement of left ventricular systolic performance.

BACKGROUND: There are paucity of data comparing measurements of left ventricular systolic performance using cadmium-zinc-telluride (CZT) semiconductor cameras with other imaging modalities. This study compared the new system with echocardiography (echo) and cardiac magnetic resonance (CMR) imaging. METHODS: 60 Patients presenting with ST-elevated myocardial infarction (MI) were included. Each patient underwent echo, myocardial perfusion imaging using Spectrum Dynamics D-SPECT(r) (CZT-SPECT), and CMR 6 weeks after MI. The primary endpoint was the agreement between CZT-SPECT and CMR for left ventricular ejection fraction (LVEF) measurement. RESULTS: 48 of the 60 patients underwent all 3 studies (echo, CMR, and CZT-SPECT) 40 days after admission. CZT-SPECT and CMR LVEF were well correlated (r = .79, P < .0001), as well as CZT-SPECT vs echo and CMR vs echo (r = .79 and .84, respectively, P < .0001). The segmental LV wall thickening and wall motion also showed good concordance between three techniques. CONCLUSIONS: CZT-SPECT is reliable for LVEF measurement.

Comparative anatomy on 3-D MRI of the urogenital sinus and the periurethral area before and during the second stage of labor during childbirth.

PURPOSE OF THE STUDY: To describe the observable MRI changes in the urogenital sinus during the second stage of labor and delivery by comparing the changes in the positions of the anatomical structures of the maternal perineum using MRI-based vector 3-D models. MATERIALS AND METHODS: Seven pregnant women underwent 3-D MRI sequences using a Philips 1 T Panorama open MRI during the pre-labor period and during the second stage of labor. A 3-D vector reconstruction platform (BABYPROGRESS, France) enabled the transformation of volumes of 2-D images into finite element meshes. The polygonal meshes labeled with the principal components of the urogenital sinus were used as part of a biomechanical study of the pressure exerted on the perineum during fetal descent. RESULTS: The expansion of the urogenital sinus was observed in all patients. Qualitative stretching was observed toward the rear and bottom of the iliococcygeus, pubococcygeus, puborectalis and obturator internus muscles. Significant length differences were measured along the iliococcygeus and pubococcygeus muscles but not along the tendinous arch of the levator ani or the puborectalis muscle. The inversion of the levator ani muscle curvature was accompanied by the transmission of pressure generated during fetal descent to the pubic muscle insertions and the descent of the tendinous arch of the levator ani. CONCLUSION: Mechanical pressures responsible for the tensioning of the constituent muscles of the urogenital sinus were qualitatively identified during the second stage of labor. MRI-based vector 3-D models allow the quantitative assessment of levator ani muscle stretching during labor, but 2-D MRI is not sufficient for describing perineal expansion. Vector 3-D models from larger scale studies have the potential to aid in the calibration of a realistic simulation based on the consideration of the reaction of each muscular element. These models offer perspectives to enhance our knowledge regarding perineal expansion during childbirth as a risk factor for postpartum perineal defects.

Lymphovenous anastomosis for recurrent swelling syndrome and chylous effusion due to cervical thoracic duct cyst.

Thoracic duct (TD) cyst is an uncommon abnormality that can be manifested as a cervical swelling. Pathogenesis includes congenital or degenerative weakness of the wall of the TD and obstruction of the lymphoid flow. Diagnosis is crucial to eliminate malignant disease or vein thrombosis and can be established by imaging and needle aspiration. We report a case of recurrent cervical swelling with spontaneous chylothorax and chyloperitoneum. A TD cyst with a terminal obstruction of the TD was diagnosed on lymphangiography. Treatment by microsurgical lymphovenous anastomosis was successful, and the patient was free of symptom 3 years later.

Use of a prototype radioprotection cabin in vascular neuroradiology: Dosimetry and ergonomics.

OBJECTIVES: The aim of this work was to compare the performance of a prototype radioprotection cabin in interventional neuroradiology, and to assess its suitability for routine use. MATERIALS AND METHODS: The radioprotection cabin was a prototype derived from the CATHPAX AF(®) model. Three operators carried out 21 procedures (19 brain arteriographies and 2 embolizations) using the radioprotection cabin and not wearing the usual lead individual protection equipment (IPE), and 17 procedures (16 brain arteriographies and 1 embolization) wearing the standard lead IPE (vest, skirt, thyroid shield and goggles), and not using the radioprotection cabin. In all cases, thermoluminescent dosimeters (TLDs) were positioned at head, trunk, pelvic region, and upper and lower limbs to measure the dose equivalent for Hp(0.07) or Hp(3) that they received, attenuated by either the cabin or the lead IPE. Parallel to these dosimetric measurements, the ergonomics of the protection cabin were appraised by each radiologist after each procedure. RESULTS AND CONCLUSION: The cabin procured an overall reduction of 74% of the dose received on the whole body with Hp(0.07)=0.04 mSv ± 0.01 (CL=95%) against Hp(0.07)=0.12 mSv ± 0.04 (CL=95%) for the IPE. Body protection with the cabin was near complete, and close to 100% for the regions not protected by the usual IPE (e.g. the head). We also showed that design weaknesses noted by the operators that hampered procedures (light reflections, reduced hand mobility, awkward access to radioscopy pedal) could be remedied by maker's improvements to the prototype and minor changes in work habits.

Deep learning CT reconstruction improves liver metastases detection.

OBJECTIVES: Detection of liver metastases is crucial for guiding oncological management. Computed tomography through iterative reconstructions is widely used in this indication but has certain limitations. Deep learning image reconstructions (DLIR) use deep neural networks to achieve a significant noise reduction compared to iterative reconstructions. While reports have demonstrated improvements in image quality, their impact on liver metastases detection remains unclear. Our main objective was to determine whether DLIR affects the number of detected liver metastasis. Our secondary objective was to compare metastases conspicuity between the two reconstruction methods. METHODS: CT images of 121 patients with liver metastases were reconstructed using a 50% adaptive statistical iterative reconstruction (50%-ASiR-V), and three levels of DLIR (DLIR-low, DLIR-medium, and DLIR-high). For each reconstruction, two double-blinded radiologists counted up to a maximum of ten metastases. Visibility and contour definitions were also assessed. Comparisons between methods for continuous parameters were performed using mixed models. RESULTS: A higher number of metastases was detected by one reader with DLIR-high: 7 (2-10) (median (Q1-Q3); total 733) versus 5 (2-10), respectively for DLIR-medium, DLIR-low, and ASiR-V (p < 0.001). Ten patents were detected with more metastases with DLIR-high simultaneously by both readers and a third reader for confirmation. Metastases visibility and contour definition were better with DLIR than ASiR-V. CONCLUSION: DLIR-high enhanced the detection and visibility of liver metastases compared to ASiR-V, and also increased the number of liver metastases detected. CRITICAL RELEVANCE STATEMENT: Deep learning-based reconstruction at high strength allowed an increase in liver metastases detection compared to hybrid iterative reconstruction and can be used in clinical oncology imaging to help overcome the limitations of CT. KEY POINTS: Detection of liver metastases is crucial but limited with standard CT reconstructions. More liver metastases were detected with deep-learning CT reconstruction compared to iterative reconstruction. Deep learning reconstructions are suitable for hepatic metastases staging and follow-up.

Endovascular treatment of eight renal artery aneurysms.

BACKGROUND: Renal artery aneurysms (RAA) are a relatively rare vascular entity. Treatment could be either surgical or via an endovascular route. The main aim of therapy is to prevent lethal rupture. PURPOSE: To evaluate the angiographic and clinical results after endovascular treatment (EVT) of eight renal artery aneurysms. MATERIAL AND METHODS: From January 2000 to June 2011, 18 patients presented with 18 renal artery aneurysms. One was classified as Rundback type I, 15 were type II, and two aneurysms were type III. Endovascular treatment was considered unsafe in 10 cases (all were Rundback type II), and were referred to surgery. The remaining eight aneurysms were treated endovascularly during altogether nine sessions. Among these, four patients were asymptomatic, three were hypertensive, and one presented with ipsilateral flank pains. Aneurysmal sac diameter varied between 12 and 50 mm. EVT included selective coil embolization in five cases, covered stents in two cases, and parent artery occlusion in one. RESULTS: Follow-up with CT angiography was obtained in all endovascularly treated aneurysms (range 6-54 months, mean 15 months). Complete durable occlusion was achieved in all aneurysms except one, which showed re-expansion after 20 months and was retreated with covered stent implantation. Clinically silent, branch occlusion occurred after four procedures with subsequent limited (less than 25%) ischemic parenchymal loss. All patients were discharged with preserved renal function. Clinical improvement was noted in all symptomatic patients. CONCLUSION: Endovascular treatment of renal artery aneurysms is an adequate treatment and can be proposed, if feasible, as first step.

Management of isolated non-traumatic renal artery dissection: report of four cases.

BACKGROUND: Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. PURPOSE: To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. MATERIAL AND METHODS: From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34-48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. RESULTS: Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. CONCLUSION: Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.

The role of CT-scan assessment of muscle mass in predicting postoperative surgical complications after renal transplantation.

PURPOSE: Despite a high rate of undernutrition in renal transplantation recipients, prognostic value of sarcopenia remains unclear. We evaluated the relation between sarcopenia and post-operative outcomes after renal transplantation. METHODS: During 7 years, each patient who underwent renal transplantation was retrospectively included. Patients with no recent pre-operative CT-scan were excluded. Sarcopenia was evaluated by measuring the muscle surface area on CT-scan section passing through the third lumbar vertebra. Main outcomes were post-operative complications at 1 month and 1 year according to the Clavien-Dindo classification. RESULTS: Overall, 102 patients were included. One month of complication rate was 63.9%. At 1 year, 60.8% experienced at least one medical complication and 29.4% one surgical complication. At 1 year post transplantation, low muscle density on CT scan was a surgical complication risk factor (OR = 0.6, 95% CI = [0.3-0.9], p = 0.05). The area under the curve of a 1-year complication predictive model including muscle density was 0.64. We did not observe significant relationship between CT-scan sarcopenia indicator and 1-month post-transplantation complication. CONCLUSION: Although no clear link between sarcopenia and complications was exhibited in our study, low CT-scan muscle density was associated with 1-year surgical complications. The role of muscle density and its relation with sarcopenia and post-transplantation outcomes should be further explored.

Eligibility for minithoracotomy aortic valve replacement: from Van Praet classification to complex scanner measurements.

Van Praet proposed a classification to predict the ease of minithoracotomy aortic valve replacement (MT-AVR) based on the position of the aorta in the thorax. We have evaluated the relevance of complex computed tomography (CT) scan measurements to predict the ease of performing a MT-AVR. The first 57 patients who underwent MT-AVR from February 2018 to June 2020 were selected prior to surgery using Van Praet's IA and IB classes. We made additional measurements on aorta position related to the chest and the incision on the preoperative CT scan. The main objective was to correlate complex CT measurements with different operating durations. Van Praet criteria were significantly related to the distance from the center of the aorta to the midline (p value < 0.001), the distance from the center of the aortic ring to the midline (p value = 0.013) and aorto-sternal angle (p < 0.001). We did not find a correlation between CT criteria and the different surgical steps durations in patients belonging to Van Praet classes IA and IB. Our cohort of Van Praet class Ia and Ib patients were able to benefit from a MT-AVR without the need for conversion. Complex CT measurements do not provide additional information to predict surgical difficulties. This classification appears to be sufficient to determine a patient's eligibility for MT-AVR, even for a surgeon experienced in sternotomy in his first MT-AVR.

Toxicity of induction chemotherapy in head and neck cancer: The central role of skeletal muscle mass.

BACKGROUND: To assess the impact of nutritional status on tolerance to induction chemotherapy by docetaxel, cisplatin and 5-fluorouracil (ICT) in head and neck cancer (HNC). METHODS: Ninety-two HNC patients were included. Toxicity was assessed according to common terminology criteria for adverse events. Nutritional status was assessed by body mass index (BMI), serum albumin, nutritional risk index (NRI), and CT scan (skeletal muscle mass index [SMI] at the first lumbar vertebral level). RESULTS: Before treatment, average BMI was 22.7 ± 4.6 kg/m2 , serum albumin 38.7 ± 5.8 g/L, NRI 97.6 ± 10.6, and SMI 36.4 ± 7.9 cm2 /m2 . After treatment, BMI was 23 ± 4.5, serum albumin 30.2 ± 7.1, and NRI 88.1 ± 9.2. During ICT, 52 (62%) patients developed at least one toxicity ≥ Grade 3. Pre-treatment SMI was the only predictive factor of toxicity irrespective of BMI (p = 0.04). CONCLUSION: Low skeletal muscle mass is a predictive factor of toxicity to ICT in HNC.

Characteristics and Prognosis of Patients With Fibromuscular Dysplasia in a Population of Spontaneous Coronary Artery Dissections (from the French Registry of Spontaneous Coronary Artery Dissections "DISCO").

Spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD) are pathologies that appear to be closely related. This study compares the characteristics of the FMD population to the non-FMD population in a SCAD cohort. It thus assesses the involvement of the FMD phenotype in a SCAD population. From the data of the French DISCO registry, we included patients with a diagnosis of SCAD and in whom a search for FMD was performed. We collected the following characteristics of this population: the clinical and angiographic presentation, the data concerning the management, and the events occurring during the follow-up. In the 373 SCADs confirmed in the DISCO registry, we obtained imaging data for 340 of them. FMD was found in 45% of cases. The mean age was higher in the FMD group, 53.2 ± 8.8 years, versus 50.1 ± 11 years in the non-FMD group. High blood pressure and postmenopausal status were significantly higher in the FMD group. Clinical presentation, angiographic data, and management were comparable. The major adverse cardiac event rate and recurrence rate were not different between the 2 groups after 1 year of follow-up. In conclusion, we confirmed a 45% prevalence of FMD in the SCAD population. The median age was higher in the FMD group, suggesting that FMD may develop over time. The rate of major adverse cardiac events and recurrence were similar in the FMD group versus the non-FMD group after 1 year of follow-up.

Assessment of Intramuscular Fat and Correlation with Body Composition in Patients with Rheumatoid Arthritis and Spondyloarthritis: A Pilot Study.

Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are associated with changes in body composition. Ectopic intramuscular fat (IMAT) may alter muscle function and contribute to cardiometabolic disorders. In a pilot study, we analyzed IMAT in the calf with peripheral quantitative computed tomography (pQCT) and examined correlations between IMAT quantity and body composition parameters. In 20 patients with active RA and 23 with active SpA, IMAT was correlated with visceral fat (VAT; r = 0.5143 and 0.6314, respectively; p < 0.05) and total lean mass (r = 0.5414 and 0.8132, respectively; p < 0.05), but not with whole body fat mass. Total lean mass mediated 16% and 33% of the effects of VAT on IMAT in RA and SpA, respectively. In both RA and SpA, calf muscle area was correlated with total lean mass (r = 0.5940 and r = 0.8597, respectively; p < 0.05) and fat area was correlated with total body fat (r = 0.6767 and 0.5089, respectively; p < 0.05) and subcutaneous fat (r = 0.6526 and 0.5524, respectively; p < 0.05). Fat area was inversely correlated with handgrip and walking tests, and it was associated with disease activity and disability. We showed that ectopic IMAT, measured with pQCT, was correlated with VAT, but not with total body fat, in RA and SpA. This result suggests that metabolically active fat was specifically associated with IMAT.