Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fon... more Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fonctionnels du ventricule droit (VD) en IRM et les facteurs influençant cette reproductibilité. Matériels et méthodes : Cinquante patients consécutifs adressés pour une IRM cardiaque (Siemens® Symphony l,ST) dans notre centre ont été inclus prospectivement. L'analyse des paramètres fonctionnels VD et VG a été réalisée sur des coupes petit axe jointives à l'aide de séquences SSFP (TRUFISp®). Les coupes basales diastoliques et systoliques étaient déterminées sur un plan 4 cavités en repérant les anneaux mitral et tricuspidien. Trois observateurs (2 experts, 1 débutant) ont réalisé 2 fois les mesures des volumes, fractions d'éjections (FE) et masses VD et VG. L'analyse statistique de la variabilité a été réalisée par la méthode de Bland Altman et le calcul du coefficient de variabilité (CV).
Journal de Radiologie Diagnostique et Interventionnelle, 2013
ABSTRACT Objectif Comparer les capacités du coefficient de diffusion apparent (ADC) et de l’ADC n... more ABSTRACT Objectif Comparer les capacités du coefficient de diffusion apparent (ADC) et de l’ADC normalisé utilisant comme référence le parenchyme pancréatique dans la caractérisation des lésions pancréatiques focales en IRM. Patients et méthodes Trente-six patients ayant des lésions pancréatiques focales (tumeurs malignes, n = 18 ; tumeurs bénignes, n = 10 ; pancréatites focales, n = 8) ont bénéficié d’un examen d’imagerie par résonance magnétique de diffusion à 1,5 tesla avec trois valeurs de b (b = 0, 400, 800 s/mm2). Nous avons comparé l’ADC lésionnel et l’ADC lésionnel normalisé (se définissant par le rapport de l’ADC lésionnel sur l’ADC du pancréas adjacent apparemment normal) pour chaque type de lésion avec des tests non paramétriques. Résultats Nous avons trouvé des différences significatives, d’une part, entre les ADC des tumeurs malignes (1,150 × 10−3 mm2/s) et les ADC des tumeurs bénignes (2,493 × 10−3 mm2/s) (p = 0,004) et, d’autre part, entre les ADC des tumeurs bénignes et les ADC des pancréatites pseudotumorales (1,160 × 10−3 mm2/s) (p = 0,0005) mais pas entre les ADC des tumeurs malignes et les ADC des pancréatites pseudotumorales (p = 0,1092). L’utilisation de l’ADC normalisé nous a permis de trouver des différences significatives entre les tumeurs malignes (0,933 × 10−3 mm2/s), les tumeurs bénignes (1,807 × 10−3 mm2/s) et les pancréatites pseudotumorales (0,839 × 10−3 mm2/s) (p < 0,0001). Conclusion Nos résultats préliminaires laissent penser que la normalisation de l’ADC des lésions pancréatiques focales avec l’ADC du parenchyme pancréatique adjacent apparemment normal permet une meilleure caractérisation des lésions pancréatiques focales que l’ADC classique.
To qualitatively and quantitatively analyze the presentation of intrahepatic and hilar mass-formi... more To qualitatively and quantitatively analyze the presentation of intrahepatic and hilar mass-forming cholangiocarcinoma with diffusion-weighted magnetic resonance imaging (DW-MRI). Twenty-eight patients with histopathologically proven mass-forming cholangiocarcinoma (hilar, n=17; intrahepatic, n=11) underwent hepatic DW-MRI at 1.5-T using free-breathing acquisition and three b-values (0,400,800s/mm(2)). Cholangiocarcinomas were evaluated qualitatively using visual analysis of DW-MR images and quantitatively with conventional ADC and normalized ADC measurements using liver and spleen as reference organs. All cholangiocarcinomas (28/28; 100%) were visible on DW-MR images. DW-MRI yielded best conspicuity of cholangiocarcinomas than the other MRI sequences (P<0.001). Seven cholangiocarcinomas (7/11; 64%) showed hypointense central area on DW-MR images. Conventional ADC value of cholangiocarcinomas (1.042×10(-3)mm(2)/s±0.221×10(-3)mm(2)/s; range: 0.616×10(-3)mm(2)/s to 2.050×10(-3)mm(2)/s) was significantly lower than that of apparently normal hepatic parenchyma (1.362×10(-3)mm(2)/s±0.187×10(-3)mm(2)/s) (P<0.0001), although substantial overlap was found. No significant differences in ADC and normalized ADC values were found between intrahepatic and hilar cholangiocarcinomas. The use of normalized ADC using the liver as reference organ resulted in the most restricted distribution of ADC values of cholangiocarcinomas (variation coefficient=16.6%). There is a trend towards a common appearance of intrahepatic and hilar mass-forming cholangiocarcinomas on DW-MRI but variations may be observed. Familiarity with these variations may improve the diagnosis of mass-forming cholangiocarcinoma.
Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive... more Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive care unit (ICU) management and prompt surgical treatment to reduce morbidity and mortality. The aim of this study was to estimate the incidence and factors associated with severe complications of CNF. We reviewed the medical records of consecutive patients hospitalized in an ICU from 2007 to 2012. The data were collected retrospectively; initial cervical and thoracic computed tomography (CT) scans, performed on admission, were reviewed by an experienced and blinded radiologist to determine CNF complications. A cohort of 160 patients admitted for CNF was included. The following complications of CNF were found: bilateral extension of CNF (28 %), internal jugular vein thrombosis (21 %), descending necrotic effusion (14 %), mediastinitis (24 %), and mortality (4 %); 53 % had at least one complication, and 48 % had at least one cervical complication. On the basis of a univariate analysis, the significant independent factors are odynophagia, dyspnea, oral glucocorticoids intake before admission, and pharyngeal source. Oral nonsteroidal anti-inflammatory drug intake before admission does not have any impact. The initial CNF complications increased both the duration of mechanical ventilation and the length of stay in the ICU. On the basis of a multivariate analysis, the independent factors for severe complications are pharyngeal CNF and oral glucocorticoid intake before admission. Our study demonstrated that an initial cervico-thoracic CT scan revealed a high incidence of cervical and mediastinal CNF complications that all needed immediate management. Those severe complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoid intake.
Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fon... more Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fonctionnels du ventricule droit (VD) en IRM et les facteurs influençant cette reproductibilité. Matériels et méthodes : Cinquante patients consécutifs adressés pour une IRM cardiaque (Siemens® Symphony l,ST) dans notre centre ont été inclus prospectivement. L'analyse des paramètres fonctionnels VD et VG a été réalisée sur des coupes petit axe jointives à l'aide de séquences SSFP (TRUFISp®). Les coupes basales diastoliques et systoliques étaient déterminées sur un plan 4 cavités en repérant les anneaux mitral et tricuspidien. Trois observateurs (2 experts, 1 débutant) ont réalisé 2 fois les mesures des volumes, fractions d'éjections (FE) et masses VD et VG. L'analyse statistique de la variabilité a été réalisée par la méthode de Bland Altman et le calcul du coefficient de variabilité (CV).
World journal of gastroenterology : WJG, Jan 21, 2014
Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease linked to a mutation of the ST... more Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease linked to a mutation of the STK 11 gene and is characterized by the development of benign hamartomatous polyps in the gastrointestinal tract in association with a hyperpigmentation on the lips and oral mucosa. Patients affected by PJS have an increased risk of developing gastrointestinal and extra-digestive cancer. Malignancy most commonly occurs in the small-bowel. Extra-intestinal malignancies are mostly breast cancer and gynecological tumors or, to a lesser extent, pancreatic cancer. These polyps are also at risk of acute gastrointestinal bleeding, intussusception and bowel obstruction. Recent guidelines recommend regular small-bowel surveillance to reduce these risks associated with PJS. Small-bowel surveillance allows for the detection of large polyps and the further referral of selected PJS patients for endoscopic enteroscopy or surgery. Video capsule endoscopy, double balloon pushed enteroscopy, multidetector ...
Pneumatosis intestinalis is a rare condition, which is defined by the presence of gas within the ... more Pneumatosis intestinalis is a rare condition, which is defined by the presence of gas within the bowel wall. In adult patients, pneumatosis intestinalis can be depicted in various circumstances. Owing to the routine use of CT to investigate patients with abdominal pain, pneumatosis intestinalis can be seen as an incidental finding or can be observed in association with a life-threatening disease such as bowel infarction. On CT images, pneumatosis intestinalis can display two different appearances; one that has a cystic or bubbly appearance can be considered as a chronic pneumatosis and is suggestive for a benign cause while the other, which has a linear appearance can be considered as a symptom and is more frequently secondary to a life-threatening cause. However, none of these two CT characteristics can be considered pathognomonic for any of these two categories of causes. In such situations, the analysis of the location, extent and, if any, associated findings may help to differen...
The purpose of our study was to retrospectively evaluate the efficacy, the limitations and the co... more The purpose of our study was to retrospectively evaluate the efficacy, the limitations and the complications of real-time CT fluoroscopy (Carevision) as an adjunct to CT guidance for percutaneous abdominopelvic interventional procedures. Materials and methods. During a 28 month period, 99 patients (55 men, 44 women) with a mean age of 59 years had percutaneous abdominopelvic interventional procedure under CT guidance using CT fluoroscopy. Sixty-four patients had a percutaneous drainage of an abdominopelvic fluid collection with a Seldinger technique using an 8.5- to 14-F drainage catheter and 35 patients had a percutaneous biopsy using an 18-G automatic core biopsy needle. In all cases, the quality of the real-time CT fluoroscopic images allowed to securely monitor needle advancement towards the target lesion and to confirm correct position of the needle tip. The diameters of target lesions ranged from 1.5 to 10 cm, with a mean value of 4.75 cm. No immediate complications were obser...
Transjugular liver biopsy; Tissue sample; Diffuse liver disease Abstract Transjugular liver biops... more Transjugular liver biopsy; Tissue sample; Diffuse liver disease Abstract Transjugular liver biopsy is a safe, effective and well-tolerated technique to obtain liver tissue specimens in patients with diffuse liver disease associated with severe coagulopathies or massive ascites. Transjugular liver biopsy is almost always feasible. The use of ultrasonographic guidance for percutaneous puncture of the right internal jugular vein is recommended to decrease the incidence of local cervical minor complications. Semiautomated biopsy devices are very effective in obtaining optimal tissue samples for a precise and definite histological diagnosis with a very low rate of complication. The relative limitations of transjugular liver biopsy are the cost, the radiation dose given to the patient, the increased procedure time by comparison with the more common percutaneous liver biopsy, and the need of a well-trained interventional radiologist.
Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fon... more Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fonctionnels du ventricule droit (VD) en IRM et les facteurs influençant cette reproductibilité. Matériels et méthodes : Cinquante patients consécutifs adressés pour une IRM cardiaque (Siemens® Symphony l,ST) dans notre centre ont été inclus prospectivement. L'analyse des paramètres fonctionnels VD et VG a été réalisée sur des coupes petit axe jointives à l'aide de séquences SSFP (TRUFISp®). Les coupes basales diastoliques et systoliques étaient déterminées sur un plan 4 cavités en repérant les anneaux mitral et tricuspidien. Trois observateurs (2 experts, 1 débutant) ont réalisé 2 fois les mesures des volumes, fractions d'éjections (FE) et masses VD et VG. L'analyse statistique de la variabilité a été réalisée par la méthode de Bland Altman et le calcul du coefficient de variabilité (CV).
Journal de Radiologie Diagnostique et Interventionnelle, 2013
ABSTRACT Objectif Comparer les capacités du coefficient de diffusion apparent (ADC) et de l’ADC n... more ABSTRACT Objectif Comparer les capacités du coefficient de diffusion apparent (ADC) et de l’ADC normalisé utilisant comme référence le parenchyme pancréatique dans la caractérisation des lésions pancréatiques focales en IRM. Patients et méthodes Trente-six patients ayant des lésions pancréatiques focales (tumeurs malignes, n = 18 ; tumeurs bénignes, n = 10 ; pancréatites focales, n = 8) ont bénéficié d’un examen d’imagerie par résonance magnétique de diffusion à 1,5 tesla avec trois valeurs de b (b = 0, 400, 800 s/mm2). Nous avons comparé l’ADC lésionnel et l’ADC lésionnel normalisé (se définissant par le rapport de l’ADC lésionnel sur l’ADC du pancréas adjacent apparemment normal) pour chaque type de lésion avec des tests non paramétriques. Résultats Nous avons trouvé des différences significatives, d’une part, entre les ADC des tumeurs malignes (1,150 × 10−3 mm2/s) et les ADC des tumeurs bénignes (2,493 × 10−3 mm2/s) (p = 0,004) et, d’autre part, entre les ADC des tumeurs bénignes et les ADC des pancréatites pseudotumorales (1,160 × 10−3 mm2/s) (p = 0,0005) mais pas entre les ADC des tumeurs malignes et les ADC des pancréatites pseudotumorales (p = 0,1092). L’utilisation de l’ADC normalisé nous a permis de trouver des différences significatives entre les tumeurs malignes (0,933 × 10−3 mm2/s), les tumeurs bénignes (1,807 × 10−3 mm2/s) et les pancréatites pseudotumorales (0,839 × 10−3 mm2/s) (p < 0,0001). Conclusion Nos résultats préliminaires laissent penser que la normalisation de l’ADC des lésions pancréatiques focales avec l’ADC du parenchyme pancréatique adjacent apparemment normal permet une meilleure caractérisation des lésions pancréatiques focales que l’ADC classique.
To qualitatively and quantitatively analyze the presentation of intrahepatic and hilar mass-formi... more To qualitatively and quantitatively analyze the presentation of intrahepatic and hilar mass-forming cholangiocarcinoma with diffusion-weighted magnetic resonance imaging (DW-MRI). Twenty-eight patients with histopathologically proven mass-forming cholangiocarcinoma (hilar, n=17; intrahepatic, n=11) underwent hepatic DW-MRI at 1.5-T using free-breathing acquisition and three b-values (0,400,800s/mm(2)). Cholangiocarcinomas were evaluated qualitatively using visual analysis of DW-MR images and quantitatively with conventional ADC and normalized ADC measurements using liver and spleen as reference organs. All cholangiocarcinomas (28/28; 100%) were visible on DW-MR images. DW-MRI yielded best conspicuity of cholangiocarcinomas than the other MRI sequences (P<0.001). Seven cholangiocarcinomas (7/11; 64%) showed hypointense central area on DW-MR images. Conventional ADC value of cholangiocarcinomas (1.042×10(-3)mm(2)/s±0.221×10(-3)mm(2)/s; range: 0.616×10(-3)mm(2)/s to 2.050×10(-3)mm(2)/s) was significantly lower than that of apparently normal hepatic parenchyma (1.362×10(-3)mm(2)/s±0.187×10(-3)mm(2)/s) (P<0.0001), although substantial overlap was found. No significant differences in ADC and normalized ADC values were found between intrahepatic and hilar cholangiocarcinomas. The use of normalized ADC using the liver as reference organ resulted in the most restricted distribution of ADC values of cholangiocarcinomas (variation coefficient=16.6%). There is a trend towards a common appearance of intrahepatic and hilar mass-forming cholangiocarcinomas on DW-MRI but variations may be observed. Familiarity with these variations may improve the diagnosis of mass-forming cholangiocarcinoma.
Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive... more Cervical necrotizing fasciitis (CNF) is a severe and debilitating disease that requires intensive care unit (ICU) management and prompt surgical treatment to reduce morbidity and mortality. The aim of this study was to estimate the incidence and factors associated with severe complications of CNF. We reviewed the medical records of consecutive patients hospitalized in an ICU from 2007 to 2012. The data were collected retrospectively; initial cervical and thoracic computed tomography (CT) scans, performed on admission, were reviewed by an experienced and blinded radiologist to determine CNF complications. A cohort of 160 patients admitted for CNF was included. The following complications of CNF were found: bilateral extension of CNF (28 %), internal jugular vein thrombosis (21 %), descending necrotic effusion (14 %), mediastinitis (24 %), and mortality (4 %); 53 % had at least one complication, and 48 % had at least one cervical complication. On the basis of a univariate analysis, the significant independent factors are odynophagia, dyspnea, oral glucocorticoids intake before admission, and pharyngeal source. Oral nonsteroidal anti-inflammatory drug intake before admission does not have any impact. The initial CNF complications increased both the duration of mechanical ventilation and the length of stay in the ICU. On the basis of a multivariate analysis, the independent factors for severe complications are pharyngeal CNF and oral glucocorticoid intake before admission. Our study demonstrated that an initial cervico-thoracic CT scan revealed a high incidence of cervical and mediastinal CNF complications that all needed immediate management. Those severe complications might be avoidable as they were associated, at least partially, with prehospital oral glucocorticoid intake.
Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fon... more Objectifs: Evaluer la reproductibilité intra-et inter-observateur de l'analyse des paramètres fonctionnels du ventricule droit (VD) en IRM et les facteurs influençant cette reproductibilité. Matériels et méthodes : Cinquante patients consécutifs adressés pour une IRM cardiaque (Siemens® Symphony l,ST) dans notre centre ont été inclus prospectivement. L'analyse des paramètres fonctionnels VD et VG a été réalisée sur des coupes petit axe jointives à l'aide de séquences SSFP (TRUFISp®). Les coupes basales diastoliques et systoliques étaient déterminées sur un plan 4 cavités en repérant les anneaux mitral et tricuspidien. Trois observateurs (2 experts, 1 débutant) ont réalisé 2 fois les mesures des volumes, fractions d'éjections (FE) et masses VD et VG. L'analyse statistique de la variabilité a été réalisée par la méthode de Bland Altman et le calcul du coefficient de variabilité (CV).
World journal of gastroenterology : WJG, Jan 21, 2014
Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease linked to a mutation of the ST... more Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disease linked to a mutation of the STK 11 gene and is characterized by the development of benign hamartomatous polyps in the gastrointestinal tract in association with a hyperpigmentation on the lips and oral mucosa. Patients affected by PJS have an increased risk of developing gastrointestinal and extra-digestive cancer. Malignancy most commonly occurs in the small-bowel. Extra-intestinal malignancies are mostly breast cancer and gynecological tumors or, to a lesser extent, pancreatic cancer. These polyps are also at risk of acute gastrointestinal bleeding, intussusception and bowel obstruction. Recent guidelines recommend regular small-bowel surveillance to reduce these risks associated with PJS. Small-bowel surveillance allows for the detection of large polyps and the further referral of selected PJS patients for endoscopic enteroscopy or surgery. Video capsule endoscopy, double balloon pushed enteroscopy, multidetector ...
Pneumatosis intestinalis is a rare condition, which is defined by the presence of gas within the ... more Pneumatosis intestinalis is a rare condition, which is defined by the presence of gas within the bowel wall. In adult patients, pneumatosis intestinalis can be depicted in various circumstances. Owing to the routine use of CT to investigate patients with abdominal pain, pneumatosis intestinalis can be seen as an incidental finding or can be observed in association with a life-threatening disease such as bowel infarction. On CT images, pneumatosis intestinalis can display two different appearances; one that has a cystic or bubbly appearance can be considered as a chronic pneumatosis and is suggestive for a benign cause while the other, which has a linear appearance can be considered as a symptom and is more frequently secondary to a life-threatening cause. However, none of these two CT characteristics can be considered pathognomonic for any of these two categories of causes. In such situations, the analysis of the location, extent and, if any, associated findings may help to differen...
The purpose of our study was to retrospectively evaluate the efficacy, the limitations and the co... more The purpose of our study was to retrospectively evaluate the efficacy, the limitations and the complications of real-time CT fluoroscopy (Carevision) as an adjunct to CT guidance for percutaneous abdominopelvic interventional procedures. Materials and methods. During a 28 month period, 99 patients (55 men, 44 women) with a mean age of 59 years had percutaneous abdominopelvic interventional procedure under CT guidance using CT fluoroscopy. Sixty-four patients had a percutaneous drainage of an abdominopelvic fluid collection with a Seldinger technique using an 8.5- to 14-F drainage catheter and 35 patients had a percutaneous biopsy using an 18-G automatic core biopsy needle. In all cases, the quality of the real-time CT fluoroscopic images allowed to securely monitor needle advancement towards the target lesion and to confirm correct position of the needle tip. The diameters of target lesions ranged from 1.5 to 10 cm, with a mean value of 4.75 cm. No immediate complications were obser...
Transjugular liver biopsy; Tissue sample; Diffuse liver disease Abstract Transjugular liver biops... more Transjugular liver biopsy; Tissue sample; Diffuse liver disease Abstract Transjugular liver biopsy is a safe, effective and well-tolerated technique to obtain liver tissue specimens in patients with diffuse liver disease associated with severe coagulopathies or massive ascites. Transjugular liver biopsy is almost always feasible. The use of ultrasonographic guidance for percutaneous puncture of the right internal jugular vein is recommended to decrease the incidence of local cervical minor complications. Semiautomated biopsy devices are very effective in obtaining optimal tissue samples for a precise and definite histological diagnosis with a very low rate of complication. The relative limitations of transjugular liver biopsy are the cost, the radiation dose given to the patient, the increased procedure time by comparison with the more common percutaneous liver biopsy, and the need of a well-trained interventional radiologist.
Uploads
Papers by Mourad Boudiaf