Predictive factors for complete response of chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma.

OBJECTIVES: To identify clinical and imaging features associated with complete response (CR) to first session of transarterial chemoembolization (TACE) with drug-eluting beads (DEB) in patients with hepatocellular carcinoma. METHODS: In this prospective historical cohort, 172 patients with 315 tumours who received at least one DEB-TACE from 2007 to 2013 were studied. Imaging response was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Age, gender, aetiology of cirrhosis, Child and BCLC scores, particles size, location in the liver, size of the tumour, presence of a capsule, hypervascularisation on DSA and CT/MRI scans, and blush extinction were analysed. RESULTS: After one session of treatment, CR was observed in 36 % of the 315 tumours treated. Nodule size, location in the liver, and complete blush extinction on DSA was statistically correlated to complete response, whereas capsule aspect on imaging and demographic criteria were not. In multivariate analysis only, location in the liver and nodule size were significant features. CONCLUSIONS: Tumour location in the segments 1 and 4 is a pejorative factor for CR, whereas tumour size <5 cm is a positive predictive factor. These criteria could, therefore, be taken into consideration to improve the selection of patients for DEB-TACE. KEY POINTS: • Literature on predictive factors of complete response after DEB-TACE is under-studied. • Tumour size <5 cm is associated with complete response. • Location in segments 1 or 4 is a pejorative factor for response. • No demographic parameter influences complete response.

What is the pelvic lymph node normal size? Determination from normal MRI examinations.

PURPOSE: There are few previous reports on maximal pelvic lymph node sizes and no data on normal mesorectal nodes. Therefore, the aim of the study was to estimate the normal size of pelvic lymph nodes and to determine the upper limits of the normal range. MATERIALS AND METHODS: Pelvic magnetic resonance imaging (MRI) examinations were prospectively carried out using a Intera 1.5 T magnet (Philips, the Netherlands), on 36 healthy volunteers (22 females, 14 males, mean age 25 years). A balanced fast field echo (b-FFE) sequence was used with the following parameters: 3-mm-thick contiguous slice, matrix 512 × 512. Short axis diameters of pelvic and inguinal lymph nodes were measured in each anatomic territory (internal iliac, external iliac, common iliac, mesorectum and inguinal). After normalization of the measurements, the influences of age, gender, laterality and territory were evaluated. Upper limits (95th percentile) were then calculated. RESULTS: A total of 1147 lymph nodes were measured. Age, gender and side (right/left) had no significant influence on size. The upper limits of the normal range were, respectively, 5.3, 4.4, 6.3 and 3.9 mm for the external and common iliac, internal iliac, inguinal and mesorectum nodes. CONCLUSION: This work presents maximal normal values for each pelvic area, and the values for mesorectum nodes are reported for the first time. ADVANCES IN KNOWLEDGE: The mesorectum nodes should be considered as abnormal when they are over 4 mm in short diameter. For the other node areas, the upper limits of the normal range were, respectively, 6, 6, 5, 7 mm for the external and common iliac, internal, iliac and inguinal nodes for the short axis.

About a singular anatomic specimen given by Dominique Larrey to Paris medical school.

The Dupuytren Museum in Paris has a remarkable anatomic specimen which figures in the surgeon Larrey's works of 1812 and 1829. It consists of a soldier's skull impaled by the ramrod of the musket of one of his co-soldiers. The wounded soldier survived two days with this ramrod through his head. Besides this singular case, Larrey reports several observations of the uses and misuses of trephination with local and general appropriate cares to provide. Indications are also exposed in the Dictionnaire des sciences medicales Panckoucke published in 1821.

[In the footsteps of Dr. François Ribes, surgeon of the 1st division of the so-called ambulance of the battlefield]. / Sur les traces du docteur François Ribes, chirurgien de la 1ère division d'ambulance dite du champ de bataille.

François Ribes was a surgeon at Emperor Napoleon's so called ambulance of the battle field but he is not well known despite his high offices. On his record of service there are 20 battles, 17 fights and 3 sieges during the Revolution and Empire. Beside his numerous campaigns he was a surgeon at the parisian Invalides Hospital and was highly thought of as a good anatomist. He wrote 84 articles and 47 memoirs of which the best known is entitled History of the autopsy and embalming of Louis XVIII's corpse. However, as a health officer, he only wrote 40 pages about his military campaigns, published in 1845.

Evaluation of hepatic iron concentration heterogeneities using the MRI R2* mapping method.

OBJECTIVE: To measure hepatic iron concentration (HIC) heterogeneities using a magnetic resonance R2* mapping method. PATIENTS AND METHODS: Ninety-four patients with suspected hepatic iron overload and 10 volunteers were included prospectively. A multi-echo R2* sequence with fat saturation and with three post-processing fitting methods (a single exponential decay model with or without truncation, SED and SEDt, and a constant offset model, COS) was compared to a signal intensity ratio method (SIR), considered as the reference. HIC heterogeneity was evaluated from R2* mapping after placing a ROI on each liver segment. RESULTS: A strong linear correlation between SIR and R2* methods using the SEDt and COS models was observed (r = 0.973 and 0.955, respectively). Volunteers and patient liver variabilities, quantified by mean intra-liver standard deviation (SD) were 1.58 µmol/g (mean range 5.06 µmol/g) and 4.73 µmol/g (mean range 19.08 µmol/g), respectively. For the patient group, the highest HIC was observed in the IVth segment. Heterogeneity increased for patients with an HIC > 60 µmol/g (mean intra-liver SD = 13.90 µmol/g; mean range = 50.60 µmol/g). CONCLUSION: This study is the first to demonstrate in vivo HIC heterogeneities using whole-liver mapping analysis. These preliminary results require confirmation through further studies, but might be useful in cases of single ROI analysis.

Irreversible Electroporation for Locally Advanced Pancreatic Cancer: Where Do We Stand in 2017?

Pancreatic adenocarcinoma has a very poor prognosis. Complete surgical resection remains the only current curative treatment. Locally advanced pancreatic cancers are considered as unresectable because of involvement of celiac and/or mesenteric vessels. Irreversible electroporation has recently been introduced to induce permanent cell death by apoptosis. Irreversible electroporation is a nonthermal cell-destruction technique that was claimed to allow destruction of cancerous cells with less damage to surrounding supporting connective tissues with collagenic structure (such as nearby blood vessels, biliary ducts, and nerves) than other types of treatment. Applications on pancreatic adenocarcinoma seem promising, and this article is an up-to-date review of the first results.