Prediction of tumor grade and lymphovascular space invasion in endometrial adenocarcinoma with MR imaging-based radiomic analysis.

PURPOSE: To evaluate the capabilities of two-dimensional magnetic resonance imaging (MRI)-based texture analysis features, tumor volume, tumor short axis and apparent diffusion coefficient (ADC) in predicting histopathological high-grade and lymphovascular space invasion (LVSI) in endometrial adenocarcinoma. MATERIALS AND METHODS: Seventy-three women (mean age: 66±11.5 [SD] years; range: 45-88 years) with endometrial adenocarcinoma who underwent MRI of the pelvis at 1.5-T before hysterectomy were retrospectively included. Texture analysis was performed using TexRAD® software on T2-weighted images and ADC maps. Primary outcomes were high-grade and LVSI prediction using histopathological analysis as standard of reference. After data reduction using ascending hierarchical classification analysis, a predictive model was obtained by stepwise multivariate logistic regression and performances were assessed using cross-validated receiver operator curve (ROC). RESULTS: A total of 72 texture features per tumor were computed. Texture model yielded 52% sensitivity and 75% specificity for the diagnosis of high-grade tumor (areas under ROC curve [AUC]=0.64) and 71% sensitivity and 59% specificity for the diagnosis of LVSI (AUC=0.59). Volumes and tumor short axis were greater for high-grade tumors (P=0.0002 and P=0.004, respectively) and for patients with LVSI (P=0.004 and P=0.0279, respectively). No differences in ADC values were found between high-grade and low-grade tumors and for LVSI. A tumor short axis≥20mm yielded 95% sensitivity and 75% specificity for the diagnosis of high-grade tumor (AUC=0.86). CONCLUSION: MRI-based texture analysis is of limited value to predict high grade and LVSI of endometrial adenocarcinoma. A tumor short axis≥20mm is the best predictor of high grade and LVSI.

Determinants of aspirin resistance in patients with type 2 diabetes.

BACKGROUND: Cardiovascular disease is a leading cause of mortality among patients with type 2 diabetes mellitus (T2DM). Numerous patients with T2DM show resistance to aspirin treatment, which may explain the higher rate of major adverse cardiovascular events observed compared with non-diabetes patients, and it has recently been shown that aspirin resistance is mainly related to accelerated platelet turnover with persistent high platelet reactivity (HPR) 24h after last aspirin intake. The mechanism behind HPR is unknown. The aim of this study was to investigate the precise rate and mechanisms associated with HPR in a population of T2DM patients treated with aspirin. METHODS: Included were 116 consecutive stable T2DM patients who had attended our hospital for their yearly check-up. HPR was assessed 24h after aspirin intake using light transmission aggregometry (LTA) with arachidonic acid (AA) and serum thromboxane B2 (TXB2) measurement. Its relationship with diabetes status, insulin resistance, inflammatory markers and coronary artery disease (CAD) severity, using calcium scores, were investigated. RESULTS: Using LTA, HPR was found in 27 (23%) patients. There was no significant difference in mean age, gender ratio or cardiovascular risk factors in patients with or without HPR. HPR was significantly related to duration of diabetes and higher fasting glucose levels (but not consistently with HbA1c), and strongly related to all markers of insulin resistance, especially waist circumference, HOMA-IR, QUICKI and leptin. There was no association between HPR and thrombopoietin or inflammatory markers (IL-6, IL-10, indoleamine 2,3-dioxygenase activity, TNF-α, C-reactive protein), whereas HPR was associated with more severe CAD. Similar results were found with TXB2. CONCLUSION: Our results reveal that 'aspirin resistance' is frequently found in T2DM, and is strongly related to insulin resistance and severity of CAD, but weakly related to HbA1c and not at all to inflammatory parameters. This may help to identify those T2DM patients who might benefit from alternative antiplatelet treatments such as twice-daily aspirin and thienopyridines.

Preoperative evaluation of small bowel complications in Crohn's disease: comparison of diffusion-weighted and contrast-enhanced MR imaging.

PURPOSE: To compare the accuracy of MR enterography (MRE) using combined T2-weighted and contrast-enhanced (CE) sequences with that of combined T2- and diffusion-weighted (DW) sequences for the detection of complex enteric Crohn's disease (CD). MATERIALS: Thirty-eight patients who underwent surgery for CD complications and preoperative MRE from 2011 to 2016 were included. MRE examinations were blindly analyzed independently by one junior and one senior abdominal radiologist for the presence of fistula, stenosis and abscesses. During a first reading session, T2-weighted images (WI), steady-state sequences and DW-MRE were reviewed (set 1). During a separate distant session, T2-WI, True-FISP and CE-MRE were reviewed (set 2). Performance of each reader was evaluated by comparison with the standard of reference established using intraoperative and pathological findings. RESULTS: Forty-eight fistulas, 43 stenoses and 11 abscesses were found. For the senior radiologist, sensitivity for the detection of fistula, stenosis and abscess ranged from 80% to 100% for set 1 and 88% to 100% for set 2 and specificity ranged from 56% to 70% for set 1 and 53% to 93% for set 2, with no significant difference between the sets (p = 0.342-0.429). For the junior radiologist, sensitivity ranged from 53% to 63% for set 1 and 64% to 88% for set 2 and specificity ranged from 0% to 25% for set 1 and 17% to 40% for set 2 (p = 0.001 and 0.007, respectively). CONCLUSION: For a senior radiologist, DW-MRE has similar sensitivity as CE-MRE for the detection of CD complications. For a junior radiologist, CE-MRE yields the best results compared with DW-MRE. KEY POINTS: • For experienced readers, DWI has similar diagnostic capability as contrast-enhanced MR imaging for the diagnosis of Crohn's disease complications. • For senior radiologists, gadolinium chelate injection could be waived for the diagnosis of Crohn's disease complications. • The interpretation of DWI for Crohn's disease complications requires some experience.

Volvulus of the sigmoid colon is associated with hypotrophy of the left lateral segment of the liver and the absence of sigmoid diverticulum.

PURPOSE: To investigate the possible relationships between sigmoid diverticula, the volume of the left lateral segment of the liver and sigmoid colon volvulus. MATERIAL AND METHODS: The presence of sigmoid diverticula was analyzed in 36 patients (24 men, 12 women; mean age, 70.77±19.86 [SD] years) with sigmoid volvulus (group 1). The volumes of left lateral segment of the liver (i.e., segments 2 and 3 and further referred to as liver 1), liver 2 (i.e., segments 1, 4, 5, 6, 7 and 8), total liver volume and liver volume ratio (LVR) (i.e., [liver 1/liver 2]×100) were calculated from abdominal CT performed distantly from the acute episode of sigmoid volvulus. Results of volumetric measurements in group 1 were compared with those of two groups of age and gender-matched control patients without hepatopathy: one patient group with sigmoid diverticula (group 2) and one group without sigmoid diverticula (group 3). RESULTS: No patients with sigmoid volvulus had diverticulum. Liver 1 volume was lower in group 1 (193.8cm3) than in group 2 (273.75cm3) (P=0.0003). Mean LVR was greater in group 2 (24.18%) than in group 1 (14.46%) (P=1×10-7) and group 3 (18.36%) (P=0.003). Mean LVR was greater in group 3 than in group 1 (P=0.01). No significant differences in liver 2 volume and total liver volumes were found between the 3 groups. CONCLUSION: Elasticity of colon wall associated with relative hypotrophy of left lateral segment of the liver are significantly associated with sigmoid volvulus. Further studies are needed to elucidate the pathophysiological mechanisms behind this association.

Diagnosis of acute overt gastrointestinal bleeding with CT-angiography: Comparison of the diagnostic performance of individual acquisition phases.

PURPOSE: To compare the respective values of arterial phase, portal venous phase and combination of phases using 64-section multidetector computed tomography (MDCT) for diagnosing acute overt gastrointestinal bleeding (AOGIB). PATIENTS AND METHODS: Forty-nine patients with AOGIB were included. There were 30 men and 19 women, with a mean age of 65.4±15.6 (SD) years [range, 34-91years]. Two observers reviewed MDCT examinations in consensus for presence of active bleeding, location of bleeding site and nature of causative lesion. The different acquisition phases were reviewed independently. RESULTS: AOGIB was identified in 28/49 patients (57%) with the multiphasic set, in 26/49 patients (53%) with arterial phase and in 25/49 patients (51%) with portal venous phase. Multiphasic set helped locate the bleeding site in 40/49 patients (82%). The cause was elucidated in 23/49 patients (47%) with multiphasic set. The differences between set performances were not statistically significant. Sensitivity for depicting AOGIB with the multiphasic set was 92% and specificity was 76%. CONCLUSION: Multiphasic 64-section MDCT has high diagnostic performances in patients with AOGIB. Further studies with a larger population are needed to reach statistical significance and demonstrate better diagnostic performance of multiphasic MDCT in comparison with the arterial or portal phase alone.

Mass-forming lesions of the duodenum: A pictorial review.

Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.

The presence of cardiophrenic angle lymph nodes is not an indicator of peritoneal carcinomatosis from colorectal cancer on MDCT: Results of a case-control study.

OBJECTIVE: To determine if the presence of cardiophrenic angle lymph nodes (CPALNs) on multidetector-row computed tomography (MDCT) can be considered as an indicator of peritoneal carcinomatosis (PC) in patients with colorectal cancer (CRC). MATERIAL AND METHODS: Two groups of 101 patients each were retrospectively included. Group 1 included patients with PC from CRC and Group 2 included patients with CRC without PC. MDCT examinations were analyzed by two readers working in consensus for the presence or absence of CPALNs and, when present for their dimensions (short and long axis), location (right, left or bilateral) and shape (oval or rounded). RESULTS: Prevalence of CPALNs was 29% in Group 1 and 32% in Group 2. No differences in prevalence of CPALNs were found between the two groups (P = 0.458). Presence of CPALNs had a sensitivity of 29% (95%CI: 23-35%) for the diagnosis of PC and a specificity of 68% (95%CI = 62-74%). No differences in CPALN dimensions, location and shape were found between these two groups. CONCLUSION: Presence of CPALNs cannot be considered as an indicator of PC in patients with CRC. In addition, when present, CPALNs have similar dimensions, location and shapes in patients with PC from CRC than in those without PC.

Extra-intestinal malignancies in inflammatory bowel diseases: An update with emphasis on MDCT and MR imaging features.

Inflammatory bowel diseases (IBD) are associated with an increased risk of gastrointestinal cancers and more specifically in sites affected by chronic inflammation. However, patients with IBD have also an increased risk for developing a variety of extra-intestinal cancers. In this regard, hepatobiliary cancers, such as cholangiocarcinoma, are more frequently observed in IBD patients because of a high prevalence of primary sclerosing cholangitis, which is considered as a favoring condition. Extra-intestinal lymphomas, mostly non-Hodgkin lymphomas, and skin cancers are also observed with an increased incidence in IBD patients by comparison with that in patients without IBD. This review provides an update on demographics, risk factors and clinical features of extra-intestinal malignancies, including cholangiocarcinoma, hepatocellular carcinoma and lymphoma, that occur in patients with IBD along with a special emphasis on the multidetector row computed tomography and magnetic resonance imaging features of these uncommon conditions.

Major complications due to transjugular liver biopsy: Incidence, management and outcome.

PURPOSE: The purpose of this study was to retrospectively evaluate the incidence of intraperitoneal bleeding and other major complications of transjugular liver biopsy (TJLB) and analyze their outcome and management. MATERIALS AND METHODS: The clinical files of 341 consecutive patients who had TJLB were retrospectively analyzed. There were 237 men and 104 women (mean age: 51.38±12.8 years; range: 17-89 years). All patients had TJLB because standard percutaneous transhepatic biopsy was contraindicated. Patients' files were reviewed to search for major and minor procedure-related complications during or immediately after TJLB. RESULTS: TJLBs were technically successful in 331/341 patients (97.07%; 95%CI: 94.67-98.58%). Major complications consisted exclusively of intraperitoneal bleeding due to liver capsule perforation and were observed in 2/341 patients (0.59%; 95%CI: 0.07-2.10%). They were treated using transcatheter arterial or venous embolization with a favorable outcome. The most frequent minor complications were abdominal pain (35/341; 10.26%; 95%CI: 7.25-13.99%) and supraventricular arrhythmia (15/341; 4.40%; 95%CI: 2.48-7.15%). No cases of inadvertent injury of the carotid artery were observed. CONCLUSION: Major complications during TJLB are extremely rare and can be managed using arterial or venous embolization with a favorable outcome. Our results reinforce the general assumption that TJLB is a safe and well-tolerated technique.

MDCT and MR imaging of the jejunum.

Recent refinements in cross-sectional imaging have dramatically modified the investigation of the jejunum. Improvements in multidetector row computed tomography (MDCT) and magnetic resonance (MR) imaging technology have made detection and characterization of jejunal abnormalities easier. Current options include MDCT and MR imaging using either enterography or enteroclysis. The goal of this pictorial review is to outline the current imaging techniques that are used to investigate the jejunum and illustrate the most common conditions that affect this small bowel segment with a specific focus on MDCT and MR imaging using enterography or enteroclysis. MR imaging used in conjunction with optimal jejunal distension appears as the modality of choice for the diagnosis of a wide range of jejunal abnormalities. MDCT remains the first line imaging modalities because of an acute presentation in a substantial number of patients.

Three-dimensional MDCT angiography of splanchnic arteries: pearls and pitfalls.

Fast scanning along with high resolution of multidetector computed tomography (MDCT) have expanded the role of non-invasive imaging of splanchnic arteries. Advancements in both MDCT scanner technology and three-dimensional (3D) imaging software provide a unique opportunity for non-invasive investigation of splanchnic arteries. Although standard axial computed tomography (CT) images allow identification of splanchnic arteries, visualization of small or distal branches is often limited. Similarly, a comprehensive assessment of the complex anatomy of splanchnic arteries is often beyond the reach of axial images. However, the submillimeter collimation that can be achieved with MDCT scanners now allows the acquisition of true isotropic data so that a high spatial resolution is now maintained in any imaging plane and in 3D mode. This ability to visualize the complex network of splanchnic arteries using 3D rendering and multiplanar reconstruction is of major importance for an optimal analysis in many situations. The purpose of this review is to discuss and illustrate the role of 3D MDCT angiography in the detection and assessment of abnormalities of splanchnic arteries as well as the limitations of the different reconstruction techniques.

Correlation of MRI T2 mapping sequence with knee pain location in young patients with normal standard MRI.

OBJECTIVE: To assess the correlation of T2 mapping abnormalities to knee pain location, in young adults with normal standard knee MRI at 3.0 Tesla. SUBJECTS AND METHODS: Twenty-three consecutive patients were included prospectively from September 2011 to April 2012. Inclusion criteria were age under 50 years old, knee pain without surgical history, and normal knee MRI at 3.0 Tesla (sagittal T1-weighted images, and sagittal, axial and coronal proton-density-weighted images with saturation of fat signal). Ten asymptomatic volunteers were also included as a control group. Patients and controls had a cartilage T2 mapping MRI sequence in addition to the standard MRI protocol. Two musculoskeletal radiologists, blinded to the patient/control condition and pain location, independently reviewed the T2 mapping images. T2 values below 40 ms were considered normal. They rated the number of hyaline cartilage lesions and their grade according to an ICRS-like score (inspired by the International Cartilage Research Society score) in each anatomical compartment (medial and lateral femoro-tibial and anterior patello-femoral joints). In addition, the T2 value of the largest lesion was measured. Patient's pain location was classified in the following categories: anterior, lateral, medial and global. T2 mapping findings were compared to pain location, and retrospectively to the initial standard sequences. Sensitivity and specificity were calculated for MRI with T2 mapping according to pain location for each reader. Kappa coefficient was calculated for inter-reader agreement. We used variance analysis in a linear regression to compare T2 values and ICRS-like classification in each compartment. RESULTS: Sensitivity of MRI with T2 mapping, according to the symptomatic compartment, was respectively: 78% and 87% for Reader 1 and Reader 2 and specificity was 70% for both readers. Kappa coefficient for T2 mapping abnormalities location and pain location was good, with a calculated value of 0.64. There was no significant correlation between ICRS-like classification and T2 values of lesions (p = 0.18). CONCLUSION: Our results suggest that T2 mapping is an interesting MRI sequence for the exploration of young patients knee pain in case of normal MRI with a standard protocol, with a good correlation between pain location and focal prolongations of the cartilage T2 relaxation time.

[Ambulatory practice of breast surgery]. / Pratique ambulatoire de la chirurgie du sein.

Breast surgery on an outpatient basis has been indicated by control trials to investigate the efficacy of mass screening with single-view mammography in reducing mortality. These trials have also increased surgery in benign breast pathology. Sixty patients were investigated and forty-seven answered a questionnaire. Ninety-two per cent of those who answered were satisfied with this short-stay hospitalisation and ninety-four per cent would be willing to do the same again if necessary. Seventeen per cent of the patients would have preferred to stay in the hospital the night after surgery. All patients preferred to be admitted the morning of surgery. Forty-three per cent of patients had local or regional anaesthesia and were satisfied to know the diagnosis during surgery. All personnel of the health service concerned find a benefit of this outpatient arrangement, that is, both patients and hospital authorities. This has been found to be a cost-saving measure as well as an effective way of diagnosing and treating benign breast tumors.