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Summary Background Scientific societies recommend to seek cancer prior to bariatric surgery. In our tertiary referral center, we aimed to study performance of abdominal CT-scan before bariatric surgery. Patients and methods We retrospectively included all patients who underwent bariatric surgery and a pre-operative abdominal CT-scan in our academic center, between January 2015 and December 2018. Results We included 521 patients (417 women and 104 men) with a mean age of 48.0 ± 11.5 years. Mean preoperative body mass index was 44.9 ± 7.0 kg/m2. Among the 392 patients with abnormal CT-scan, mean number of anomalies per patient was of 2.2 ± 1.2. Vast majority of anomalies (91.8%) were non-significant. Only 5 (1%) patients needed treatment prior to bariatric surgery. No factor predictive of abnormal CT-scan was found. Conclusion Only few patients had severe anomaly on CT-scan before bariatric surgery. Abdominal CT-scan could not be advocated to seek cancer before bariatric surgery.

Resume Introduction Il est recommande par les principales societes scientifiques de rechercher un cancer chez les patients avant chirurgie bariatrique. Dans notre centre universitaire, nous avons voulu etudier l’interet de realiser un scanner abdominal avant chirurgie bariatrique. Patients et methodes Nous avons inclus retrospectivement tous les patients ayant eu une chirurgie bariatrique avec un scanner abdominal pre-operatoire dans notre centre entre janvier 2015 et decembre 2018. Resultats Nous avons inclus 521 patients (417 femmes et 104 hommes) avec une moyenne d’âge de 48,0 ± 11,5 ans. L’indice de masse corporelle moyen en preoperatoire etait de 44,9 ± 7,0 kg/m2. Parmi les 392 patients avec un scanner anormal, le nombre moyen d’anomalies par patient etait de 2,2 ± 1,2. La grande majorite (91,8 %) des anomalies etaient non significatives. Seulement 5 (1 %) des patients ont eu besoin d’un traitement de leur anomalie en preoperatoire. Aucun facteur de risque de developper des anomalies sur le scanner n’a ete retrouve. Conclusion Peu de patients avaient une anomalie severe sur le scanner abdominal avant chirurgie bariatrique. Le scanner abdominal n’est donc pas a recommander en pre-operatoire chez ces patients.

Background The aim of this ancillary study of the SARAH trial is to compare health-related quality of life (HRQoL) in patients with locally advanced or inoperable hepatocellular carcinoma (HCC) treated with transarterial radioembolisation (TARE) or sorafenib. Methods This study included randomised patients who received either TARE or at least one dose of sorafenib with no major deviation in the protocol and who had at least one QoL follow-up assessment in addition to the baseline evaluation. QoL was assessed from the date of randomisation using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire, until disease progression or other reasons for stopping study participation. Data were analysed using linear mixed and time-dependent models. Results A total of 285 patients were included (122 and 163, in the TARE and sorafenib groups, respectively). Questionnaire completion rates were similar (77.5% versus 80.4%, in the TARE and sorafenib groups, respectively, p = 0.25). Longitudinal HRQoL analysis showed a significant treatment and time effects for fatigue and global health status, and significant treatment, time and treatment by time interaction effects for appetite loss, diarrhoea and social functioning. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7–4.3) versus 2.6 months (95% CI 2.0–3.0) in the TARE and sorafenib groups, respectively. Conclusions HRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. These data could be used to optimise management of patients with advanced or inoperable HCC.

Pancreas transplantation exposes to high rates of complications, either vascular (thrombosis, stenosis, pseudoaneurysm, arteriovenous fistula) or nonvascular (fluid collection, graft rejection). With advances in percutaneous and endovascular techniques, interventional radiologists are increasingly involved in the management of these complications. In this article, we review the anatomical considerations relevant to pancreas transplantation, the techniques used for image-guided interventions for vascular and nonvascular complications, and the expected outcomes of these interventions.

Introduction This document is a summary of the French Intergroup guidelines regarding the management of digestive neuroendocrine neoplasms (NEN) published in February 2020 ( www.tncd.org ). Methods All French medical societies involved in the management of NEN took part in this work. Recommendations were graded into four categories (A, B, C or D), according to the level of evidence found in the literature until May 2019. Results The management of NEN is challenging because of their heterogeneity and the increasing complexity of diagnostic and therapeutic procedures. Pathological analysis is required for their diagnostic and prognostic characterization, which mainly relies on differentiation, grade and stage. The two main emergency situations are functioning syndromes and poorly-differentiated carcinoma. Chromogranin A is the main biochemical marker of NET, although of limited clinical interest. Initial characterization relies on morphological and isotopic imaging. The treatment of localized NET relies on watchful follow-up and local or surgical resection depending on its supposed aggressiveness. Treatment options for metastatic disease include surgery, somatostatin analogues, chemotherapy, targeted therapies, organ-driven locoregional therapies and peptide-receptor radionuclide therapy. As specific predictive factors of treatment efficacy are yet to be identified and head-to-head comparisons have not or only rarely been performed, the therapeutic strategy currently depends on prognostic factors. Cumulative toxicity and the impact of treatment on quality of life must be considered since survival is relatively long in most patients with NET. Conclusion These guidelines are proposed to achieve the most beneficial therapeutic strategy in clinical practice as the therapeutic landscape of NEN is becoming ever more complex. These recommendations are permanently being reviewed.

Background Recent guidelines advocate a step-up approach for managing suspected infected pancreatic necrosis (IPN) during acute pancreatitis. Nearly half the patients require secondary necrosectomy after catheter drainage. Our primary objective was to assess the external validity of a previously reported nomogram for catheter drainage, based on four predictors of failure. Our secondary objectives were to identify other potential predictors of catheter-drainage failure. We retrospectively studied consecutive patients admitted to the intensive care units (ICUs) of three university hospitals in France between 2012 and 2016, for severe acute pancreatitis with suspected IPN requiring catheter drainage. We assessed drainage success and failure rates in 72 patients, with success defined as survival without subsequent necrosectomy and failure as death and/or subsequent necrosectomy required by inadequate improvement. We plotted the receiver operating characteristics (ROC) curve for the nomogram and computed the area under the curve (AUROC). Results Catheter drainage alone was successful in 32 (44.4%) patients. The nomogram predicted catheter-drainage failure with an AUROC of 0.71. By multivariate analysis, catheter-drainage failure was independently associated with a higher body mass index [odds ratio (OR), 1.12; 95% confidence interval (95% CI), 1.00–1.24; P = 0.048], heterogeneous collection (OR, 16.7; 95% CI, 1.83–152.46; P = 0.01), and respiratory failure onset within 24 h before catheter drainage (OR, 18.34; 95% CI, 2.18–154.3; P = 0.007). Conclusion Over half the patients required necrosectomy after failed catheter drainage. Newly identified predictors of catheter-drainage failure were heterogeneous collection and respiratory failure. Adding these predictors to the nomogram might help to identify patients at high risk of catheter-drainage failure. ClinicalTrials.gov number: NCT03234166.

International audience; Purpose: The SARAH (Sorafenib Versus Radioembolization in Advanced Hepatocellular Carcinoma) trial (ClinicalTrials.gov Identifier NCT01482442) did not show a significant survival benefit for patients treated with transarterial radioembolization (TARE) compared with continuous oral sorafenib. The improved toxicity profile of patients treated with TARE in the trial, however, could result in a quality of life benefit in economic evaluations. Our objective was to perform a cost-utility analysis of TARE versus sorafenib for locally advanced and inoperable hepatocellular carcinoma.Methods: This study used patient-level data of the SARAH trial regarding resource use, progression-free and overall survival, and quality of life for the within-trial period for the patients who received at least 1 dose of sorafenib or 1 treatment with TARE according to their randomization arm. Data were extrapolated by using a partitioned survival model that incorporated costs and health outcomes, measured in life-years and quality-adjusted life-years (QALYs).Findings: The use of TARE resulted in an average loss of 0.036 life-year and a gain of 0.006 QALY compared with sorafenib. The aerage cost for the TARE arm was €17,179 (95% CI, 9,926-24,280) higher than the sorafenib arm, for an incremental cost-effectiveness ratio of €3,153,086/QALY. The probabilistic sensitivity analysis revealed a 50% risk that the TARE strategy was dominated. TARE was consistently dominated by sorafenib or had an incremental cost-effectiveness ratio more than €450,000/QALY in all sensitivity analyses.Implications: This economic evaluation of SARAH found that using radioembolization with yttrium-90 microspheres for the treatment of hepatocellular carcinoma was not a cost-effective option at the usually accepted willingness-to-pay thresholds.

Background & Aims We developed and validated a magnetic resonance imaging–based index to predict Crohn’s disease (CD) postoperative recurrence (POR). Methods Patients with CD who underwent a postoperative evaluation for recurrence (with colonoscopy and MRI no longer than 105 days apart) were included between 2006 and 2016 in University Hospital of Nancy, France. MRI items with good levels of intra-rater and inter-rater agreement (Gwet’s coefficient ≥0.5) were selected. The MRI in Crohn’s Disease to Predict Postoperative Recurrence (MONITOR) index’s performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and accuracy, by considering the Rutgeerts score as the gold standard. The MONITOR index was validated with a bootstrap method and an independent cohort. Results Seventy-three MRI datasets were interpreted by 2 radiologists. Seven items (bowel wall thickness, contrast enhancement, T2 signal increase, diffusion-weighted signal increase, edema, ulcers, and the length of the diseased segment) had a Gwet’s coefficient ≥0.5 and were significantly associated with the Rutgeerts score, leading to their inclusion in the MONITOR index. All the items had a weighting of 1, except the “ulcers” item weighting 2.5, reflecting the higher adjusted odds ratio. The AUROC [95% confidence interval] for the prediction of endoscopic POR (Rutgeerts score >i1) was 0.80 [0.70–0.90]. The optimal threshold was a MONITOR index ≥1, giving a sensitivity of 79%, a specificity of 55%, a predictive positive value of 68%, and a predictive negative value of 68%. The bootstrap validation gave an AUROC of 0.85 [0.73–0.97]. In the validation cohort, a MONITOR index ≥1 gave a sensitivity of 87%, a specificity of 75%, a predictive positive value of 84.6%, and a predictive negative value of 75%. Conclusions The MONITOR index is an efficient, reliable, easy-to-apply tool that can be used in clinical practice to predict the POR of CD.

Background Thoracic multidetector computed tomography (MDCT) is essential for the detection of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). Thoracic MDCT assessment can reveal the presence of thoracic lymphadenopathies (LAP) whose signification remains uncertain. The purpose of the study was to describe the characteristics and to assess the significance of thoracic LAP in patients with diffuse SSc. Methods We conducted a monocentric observational study on adult patients with diffuse SSc, and collected general patient and first thoracic MDCT characteristics, PET-CT and outcome data. Comparisons were made between patients with and without thoracic LAP. Results Forty-eight patients were included. There were 30 patients (62.5%) with an ILD and 23 (48%) with at least one thoracic LAP on the first MDCT assessment. Median number per patient of thoracic LAP was 3 [1–8], with a mean size of 11.7 ± 1.7 mm, mainly located in right para-tracheal area (22.8% of the total number of LAP), right hilar area (20.3%), left hilar area (6.5%), and sub-carinal area (15.2%). PET-CT showed lymph node hypermetabolism in 11/15 patients (73.3%) with mean SUVmax at 4 ± 1.3. There were significantly more males (p = 0.002) and more patients exposed to silica (p = 0.001) in patients with thoracic LAP. ILD was significantly more extended according to Goh score (p = 0.03), and using semi-quantitative score for mixed ground-glass reticulation (p = 0.01) and global abnormalities (p = 0.03) in patients with thoracic LAP and ILD. Thirteen patients (27.1%) died during follow-up without significant difference according to the presence or not of thoracic LAP (p = 0.15). There was also no significant difference concerning immunosuppressive treatment initiation (p = 0.17). Conclusions Thoracic LAP are common in diffuse SSc and are generally multiple, not bulky, moderately hypermetabolic, and located at the base of the mediastinum lymph node chains. Their presence correlates with the extent of ILD. In absence of ILD, thoracic LAP presence seems to be often explained by silica exposure. Trial Registration: NA.

PURPOSE The aim of this study was to compare retrospectively 18F-DOPA PET/CT versus 68Ga-DOTANOC PET/CT in a group of patients affected by midgut NET. PATIENTS AND METHODS Patients with histologically proven grade 1 or grade 2 midgut NET were explored after injection of 150 MBq of 68Ga-DOTANOC and 210 MBq of 18F-DOPA. The PET/CTs were analyzed visually and semiquantitatively at the patient level, regional level (7 defined regions), and lesion level (maximum of 5 lesions/organ). The criterion standard was determined on the basis of histology and imaging follow-up. RESULTS Thirty patients (17 males and 13 females; median age, 63.5 years [37-82 years]) were included. Both PET/CTs were negative in 3 patients and positive in 25 patients. PET/CTs were discordant in 2 patients, with 18F-DOPA positive and 68Ga-DOTANOC negative. 18F-DOPA PET/CT detected more involved regions and more metastatic lesions than 68Ga-DOTANOC PET/CT in 6 (20%) and 10 (33.3%) patients, respectively. Of the 81 confirmed affected regions, 77 (95%) were detected by 18F-DOPA PET/CT and 71 (87.7%) by 68Ga-DOTANOC PET/CT (P < 0.0001). 18F-DOPA PET/CT detected significantly more lesions (211/221) than 68Ga-DOTANOC PET/CT (195/221), corresponding to a sensitivity of 95.5% and 88.2%, respectively (P < 0.0001). Tumor-to-background ratios were more favorable in liver for 18F-DOPA than for 68Ga-DOTANOC. Interestingly, a correlation was found between 18F-DOPA SUVmax and tumor burden and especially with the number of regions involved by the disease (P = 0.019). CONCLUSIONS 18F-DOPA PET/CT is superior to 68Ga-DOTANOC PET/CT for the detection of lesions, and when available, this tracer may be recommended as the first-line examination for an accurate staging of midgut NET.

International audience; Background: Advanced non-small cell lung cancer (NSCLC) with a PD-L1 tumour proportion score ≥ 50% can be treated with pembrolizumab alone. Our aim was to assess the impact of baseline tumour size (BTS) on overall survival (OS) in NSCLC patients treated with pembrolizumab versus chemotherapy.Methods: This retrospective, multicentre study included all patients with untreated advanced NSCLC receiving either pembrolizumab (PD-L1 ≥ 50%) or platinum-based chemotherapy (any PD-L1). The primary endpoint was the impact of BTS (defined as the sum of the dimensions of baseline target lesions according to RECIST v1.1 criteria) on OS.Results: Between 09-2016 and 06-2020, 188 patients were included, 96 in the pembrolizumab (P-group) and 92 in the chemotherapy group (CT-group). The median follow-up was 26.9 months (range 0.13-37.91) and 44.4 months (range 0.23-48.62), respectively, while the median BTS was similar, 85.5 mm (IQR 57.2-113.2) and 86.0 mm (IQR 53.0-108.5), respectively (p = 0.42). The median P-group OS was 18.2 months [95% CI 12.2-not reached (NR)] for BTS > 86 mm versus NR (95% CI 27.2-NR) for BTS ≤ 86 mm (p = 0.0026). A high BTS was associated with a shorter OS in univariate analyses (p = 0.009) as well as after adjustment on confounding factors (HR 2.16, [95% CI 1.01-4.65], p = 0.048). The CT-group OS was not statistically different between low and high BTS patients, in univariate and multivariate analyses (p = 0.411).Conclusions: After adjustment on major baseline clinical prognostic factors, BTS was an independent prognostic factor for OS in PD-L1 ≥ 50% advanced NSCLC patients treated first-line with pembrolizumab.

International audience; But: L’objectif principal de cette étude était de déterminer l’exactitude diagnostique de la biopsie guidée par tomodensitométrie (TDM) percutanée des consolidations pulmonaires persistantes. L’objectif secondaire était de déterminer le taux de complications et d’identifier les facteurs affectant le rendement diagnostique.Matériaux et méthodes: Deux radiologues ont examiné rétrospectivement 98 biopsies percutanées guidées par tomodensitométrie réalisées chez 93 patients (60 hommes, 33 femmes; âge moyen, 62±14,0 ans (ET); intervalle: 18-88 ans) avec des consolidations pulmonaires persistantes. Les diagnostics finaux étaient basés sur les résultats chirurgicaux ou les résultats du suivi clinique à 12 mois. Les résultats de la biopsie ont été comparés au diagnostic final pour estimer le rendement diagnostique.Résultats: Un diagnostic final a été obtenu pour tous les patients : 51/93 (54,8 %) présentaient des lésions malignes, 12/93 (12,9 %) des lésions bénignes spécifiques définies (dont 9 infections, deux pneumoconioses et une pneumonie lipoïde) et 30/93 (32,3 %) des lésions bénignes non spécifiques. La biopsie guidée par tomodensitométrie a donné un rendement diagnostique global de 60 % (59/98) avec un diagnostic correct pour 50/51 lésions malignes (rendement diagnostique de 98 % pour la malignité) et pour 9/47 lésions bénignes (rendement diagnostique de 19 % pour les affections bénignes). Des complications majeures sont survenues dans 4/98 (4 %) des biopsies pulmonaires (quatre pneumothorax nécessitant la pose d’un tube thoracique).Conclusion: La biopsie percutanée guidée par tomodensitométrie est une alternative à la biopsie endoscopique ou chirurgicale pour le diagnostic de consolidation persistante avec un faible risque de complication grave.

International audience; Introduction: This pilot study evaluated the imaging performance of pretargeted immunological positron emission tomography (immuno-PET) using an anti-carcinoembryonic antigen (CEA) recombinant bispecific monoclonal antibody (BsMAb), TF2 and the [68Ga]Ga-labelled HSG peptide, IMP288, in patients with metastatic colorectal carcinoma (CRC).Patients and methods: Patients requiring diagnostic workup of CRC metastases or in case of elevated CEA for surveillance were prospectively studied. They had to present with elevated CEA serum titre or positive CEA tumour staining by immunohistochemistry of a previous biopsy or surgical specimen. All patients underwent endoscopic ultrasound (EUS), chest-abdominal-pelvic computed tomography (CT), abdominal magnetic resonance imaging (MRI) and positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET). For immuno-PET, patients received intravenously 120 nmol of TF2 followed 30 h later by 150 MBq of [68Ga]Ga-labelled IMP288, both I.V. The gold standard was histology and imaging after 6-month follow-up.Results: Eleven patients were included. No adverse effects were reported after BsMAb and peptide injections. In a per-patient analysis, immuno-PET was positive in 9/11 patients. On a per-lesion analysis, 12 of 14 lesions were positive with immuno-PET. Median SUVmax, MTV and TLG were 7.65 [3.98-13.94, SD 3.37], 8.63 cm3 [1.98-46.64; SD 14.83] and 37.90 cm3 [8.07-127.5; SD 43.47] respectively for immuno-PET lesions. Based on a per-lesion analysis, the sensitivity, specificity, positive-predictive value and negative-predictive value were, respectively, 82%, 25%, 82% and 25% for the combination of EUS/CT/MRI; 76%, 67%, 87% and 33% for FDG-PET; and 88%, 100%, 100% and 67% for immuno-PET. Immuno-PET had an impact on management in 2 patients.Conclusion: This pilot study showed that pretargeted immuno-PET using anti-CEA/anti-IMP288 BsMAb and a [68Ga]Ga-labelled hapten was safe and feasible, with promising diagnostic performance.

Resume Les douleurs pelviperineales chroniques neurogenes sont largement dominees a l’etage perineal par la nevralgie pudendale. Son etiologie principale est un syndrome canalaire. Il peut se situer a trois niveaux differents : le canal sous piriforme, la pince ligamentaire entre le ligament sacroepineux et le ligament sacrotuberal, le canal d’Alcock. Elle est diagnostiquee par les seules donnees de l’interrogatoire et de l’examen clinique perineal. L’imagerie complementaire par resonance magnetique pelvienne ne sera realisee qu’en cas d’atypie clinique, relativement rare, a la recherche d’une autre cause de nevralgie pudendale : principalement a la recherche d’un syndrome de masse sur le trajet de son tronc nerveux. Les autres entites de nevralgie perineales sont rares et de diagnostic principalement clinique. Le radiologue a une place importante dans le diagnostic positif de nevralgie perineale puisque l’infiltration, idealement sous controle scanographique, en est une etape incontournable.

Les etudes sur la TEP/TDM aux analogues de la somatostatine radiomarques au 68Ga chez les patients atteints de TNE sont pour la plupart retrospectives ou heterogenes en termes de recrutement. Cette etude multicentrique a analyse prospectivement l’interet de la TEP/TDM-68Ga-DOTANOC comparativement au bilan conventionnel optimise (BCO: scintigraphie a l’Octreoscan® corps entier avec TEMP/TDM, scanner thoraco-abdomino-pelvien multiphase et lorsque necessaire IRM hepatique), chez les patients presentant une TNE-GEP grade 1–2. Le gold standard incluait l’histologie, les donnees de l’ensemble des imageries et du suivi a 12 mois. Les donnees de 105 patients ont ete analysees : 45 femmes, 60 hommes, d’âge median: 62,8 ans, explores pour bilan initial (n = 48), suspicion de rechute/progression (n = 31), suivi (n = 15) ou caracterisation d’une lesion suspecte de TNE en imagerie conventionnelle (n = 11). Les primitifs etaient majoritairement pancreatiques (42,9 %) puis greliques (30,5 %), et les tumeurs de grade 2 dans 52,0 % des cas. La sensibilite de la TEP/TDM-68Ga-DOTANOC etait significativement superieure a celle du BCO dans l’analyse par patient (97,7 % vs 88,6 %, p = 0,043), par region (96,9 % vs 75,6 %, p Cette etude confirme la superiorite de la TEP/TDM-68Ga-DOTANOC par rapport au BCO pour le bilan lesionnel des TNE-GEP grade 1–2, notamment dans des localisations de petite taille ou d’analyse difficile comme la carcinose peritoneale.

Purpose Magnetic resonance imaging (MRI) and positron emission tomography–computed tomography (PET-CT) are important imaging techniques in multiple myeloma (MM). We conducted a prospective trial in patients with MM aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques. Patients and Methods One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS). Results At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS. Conclusion There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.

The goal of this prospective study was to analyze the potential of S100B protein as a negative predictive marker for intracranial hemorrhage (ICH) after mild head trauma (MHT) in patient under antithrombotic medication.Patients under antithrombotic medication who had MHT were consecutively included in this study. S100B blood levels were determined from samples drawn within 6hours after injury and were analyzed with the results of head CT performed within the 24hours after injury. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of S100B levels for the detection of ICH, with a cut-off set at 0.105μg/L, were calculated.A total of 308 patients (151 men and 157 women) with a mean age of 79.1±10.5years (SD) were included in the analysis. CT was positive for the presence of ICH in 33 patients (10.7%; 95% CI: 7.5-14.7%). In the study population, S100B showed a sensitivity of 84.8% (95%CI: 68.1-94.9%), a specificity of 30.2% (95% CI: 24.8-36.0%), a NPV of 94.3% (95% CI: 87.2-98.1%), and a PPV of 12.7% (95% CI: 8.6-17.9%) for the diagnosis of ICH.The results of this study suggest that a S100B serum level0.105μg/L has a high NPV for ICH after mild head trauma in patients under antithrombotic medication.

Resume Le syndrome nutcracker (casse-noisettes) englobe toutes les manifestations liees aux stases veineuses induites par une striction de la veine renale gauche : soit entre l’aorte et l’artere mesenterique superieure (syndrome nutcracker anterieur), soit entre l’aorte et le rachis (syndrome nutcracker posterieur). Une stase veineuse du pelvis s’y associe dans au moins la moitie des cas, du fait de la distension de la veine ovarienne (ou spermatique) gauche, qui se draine dans la veine renale gauche. Il se revele dans la moitie des cas par des douleurs atypiques du « flanc » gauche, faisant errer le diagnostic vers des souffrances des dernieres cotes ou de la charniere dorsolombaire, d’autant que la lordose et la station debout aggravent les signes. Dans ce contexte, il faut suspecter un syndrome nutcracker sur un faisceau d’arguments : hematurie, souvent seulement microscopique ; proteinurie orthostatique ; varicocele et infertilite ; dyspareunie et autres troubles gynecologiques ; varices pelviennes, des fesses, ou du haut des cuisses ; hypotension orthostatique et fatigue ; douleurs abdominales. La presence d’une striction de la veine renale sur l’imagerie est necessaire mais tres insuffisante pour affirmer le diagnostic. Celui-ci repose surtout sur la conjonction de plusieurs signes et la demonstration d’un gradient de pression marque entre la veine renale gauche et la veine cave. Aux traitements realises par les urologues, voire les chirurgiens vasculaires, se substituent la pose de stents par voie endovasculaire, couplee ou non a l’embolisation des veines gonadiques dilatees, afin de traiter dans le meme temps l’insuffisance acquise de ces dernieres.

Resume La procidence interne du rectum (PRI) decrit une anomalie anatomique de la statique rectale se revelant lors d’un effort de poussee abdominale. L’expression symptomatique de la PRI est extremement variee associant des troubles de l’evacuation (85 %) et de la continence (56 %), parfois extremement invalidants. La PRI est difficile a apprecier cliniquement et le developpement de la defecographie dynamique (standard, mais surtout maintenant en IRM) a ameliore nettement sa comprehension. A partir de l’imagerie, differents degres de gravite (score d’Oxford) ont ete decrits et permettent de structurer la prise en charge. Un traitement medical, notamment par biofeedback, est generalement recommande en premiere intention, puis la decision d’un traitement chirurgical est prise apres bilan complet, au mieux en reunion de concertation pluridisciplinaire, lorsque le traitement conservateur, bien conduit et suffisamment prolonge, est en echec. Une information complete doit etre donnee au patient en precisant les buts du traitement et ses resultats esperes. Depuis que la rectopexie ventrale par laparoscopie a demontre son efficacite dans le PRI, la resection trans-anale agrafee du rectum (STARR) ou equivalent a perdu de son interet, du fait de resultats inconstants (echec dans environ 20 % des cas) et se degradants dans le temps, mais aussi en raison d’un risque accru d’incontinence fecale estime a 25 % a 1 an. La rectopexie ventrale (anterieure) prothetique est en effet efficace pour resoudre les problemes fonctionnels lies a la PRI, tant sur les symptomes d’evacuation (efficacite comprise entre 65 et 92 %) que de continence (efficacite entre 73 et 97 %), ce qui en fait aujourd’hui le traitement de reference dans le PRI lorsque la chirurgie est decidee.

Les abces perisigmoidiens representent une complication frequente des diverticulites, survenant dans 15 a 40 % des cas. Le scanner abdominal est l’examen de reference pour le diagnostic des abces perisigmoidiens avec une sensibilite de 95 %. Depuis les dernieres recommandations etablies en 2006, de nombreuses publications sur le traitement radiologique interventionnel de cette complication sont disponibles. Le niveau de preuve des essais reste faible (C) ; mais les conclusions sont toujours en faveur de cette approche lorsqu’elle est comparee a la chirurgie plus morbide. D’ailleurs, les donnees epidemiologiques montrent que le recours a l’acte de radiologie est en constante augmentation aux depens de la chirurgie en urgence. Le taux d’echec du drainage varie de 15 a 30 % et la presence d’une fistule digestive explique la plupart des echecs. Dans ces cas, la chirurgie de rattrapage est necessaire et reste morbide. Les complications representent 2,5 % des cas, liees a des perforations digestives sur le trajet du drain et des complications hemorragiques en cas de drainage transgluteal.

Pancreatic ductal carcinoma is one of the deadliest cancers in the world. The only hope for prolonged survival still remains surgery with complete R0 resection even if most patients will promptly develop metastases and/or local relapses. Due to the silent nature of the disease, fewer than 20% of patients are eligible for a curative-intent resection. As no gain in survival is expected in case of residual tumor, imaging plays a major role for diagnosis and staging to select patients who will undergo surgery. Multidetector-row computed tomography and magnetic resonance imaging are the key stones and radiologists must be aware of imaging protocols, standardized terms and critical points for structured reporting to assess the tumor staging, minimize potential the morbidity associated with surgery and offer patients the best therapeutic strategy.

Resume L’adenocarcinome pancreatique (ACP) est un cancer a forte mortalite. Le seul espoir de survie prolongee repose sur la chirurgie complete R0, meme si les patients developperont frequemment par la suite des metastases et/ou des recidives locales. Du fait d’une evolution silencieuse, moins de 20 % des patients sont eligibles a une resection curative. En l’absence de gain de survie en cas de chirurgie incomplete, l’imagerie joue un role majeur pour le diagnostic et le bilan d’extension afin de selectionner les patients. Le scanner et l’IRM en sont les pierres angulaires et le radiologue doit connaitre les protocoles d’imagerie adaptes, la terminologie et les points critiques a preciser dans le cadre de comptes rendus standardises pour evaluer le stade tumoral, minimiser la morbidite chirurgicale et offrir au patient la meilleure prise en charge.

International audience; Background: Beyond the hepatobiliary pathway, studies have demonstrated that direct TransIntestinal Cholesterol Efflux (TICE) of plasma-derived cholesterol may contribute to reverse cholesterol transport. The clinical evidence of TICE in human remains challenged due to the difficulty to discriminate the hepatobiliary and transintestinal routes in vivo. Objective: To provide the first proof of concept that TICE exists in vivo in humans by demonstrating that plasma labeled cholesterol can be excreted in the feces of patients with complete bile duct obstruction. Methods: Plasma, bile and fecal cholesterol excretion was measured by mass spectrometry 24, 48 and 72h after intravenous injection of D7-cholesterol in two patients presenting cholangiocarcinomas with a total obstruction of their primary bile duct. Results: No trace of bile acids was detected in the feces of the two patients. Despite this, a significant amount of plasma D7-cholesterol was quantified in the feces of the two patients 48h and 72h after the intravenous injection. Conclusion: our data bring a direct proof that TICE is an active pathway in humans. ClinicalTrials.gov Registration number: NCT01958216 Highlights: The transintestinal (TICE) route is crucial for plasma cholesterol excretion in rodent To date, the physiological relevance of TICE in humans remains questioned Patients with obstructed biliary route can excrete plasma cholesterol in their feces TICE is an active pathway in humans

To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98–42.19), 5.8 (95% CI 1.12–30.07), and 6.74 (95% CI 1.23–36.77), respectively. Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.

Purpose The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and methods Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52.7 ± 10.6 (SD) years (range: 22–82 years). For each procedure, technical success, primary ultrasound guidance success, portosystemic pressure gradient, duration of the intervention, procedural complications, radiation exposure, mortality and morbidity rates at day 30 post-procedure were recorded for data analysis. Results Technical success rate was 100.0% with a success rate of the primary ultrasound guidance of 97.8% (219/224; 95% CI: 95.8–99.7). Mean duration of the procedure was 86.2 ± 41.7 (SD) min (range: 22.0–267.0 min). Mean dose-area product was 62.0 ± 50.2 (SD) Gy.cm2 (range: 3.7–306.5 Gy.cm2). Twelve complications (12/224; 5.4%) occurred in ten patients during TIPS procedures including 8 arterial punctures (3.6%) and 4 biliary punctures (1.8%). Four complications (4/224; 1.8%) were clinically significant. Mortality rate at day 30 after the procedure was 9.8% (22/224), without any patient dying from technical complications. Conclusion Real-time ultrasound guidance is a safe technique to assist in the creation of TIPS and may allow for lower radiation exposure.

Objective To investigate a temporal association between vaccination and subdural hematoma, the main feature of abusive head trauma. Study design From a prospective population-based survey carried out in 1 administrative district in France between January 2015 and April 2017, including all infants between 11 and 52 weeks old who underwent a first cerebral imaging (computerized tomography scan or magnetic resonance imaging), we conducted a nested case-control study. Vaccine exposure was compared between cases (infants with subdural hematoma) and 2-3 paired controls, without subdural hematoma or any other imaging findings compatible with abusive head trauma. Cases and controls were matched on chronological (±7 days) and gestational (≤33 vs >33 weeks) ages, respectively. Vaccination status was collected in the personal national pediatric health booklet. Results Among the 228 prospectively surveyed infants, 28 had subdural hematoma including 22 with abusive head trauma. The mean chronological age at imaging was 5.3 months among the 28 cases and the 62 controls, who did not differ significantly in median time since last vaccination (1.4 vs 1.3 months, P = .62) or frequency of at least 1 vaccination since birth (86% vs 89%; matched-pairs OR 0.77, 95% CI 0.17-3.86) or within 7 days (0.94, 0.08-6.96), 14 days (0.70, 0.12-2.92), or 21 days (0.48, 0.08-1.98) before cerebral imaging. Conclusions We found no significant temporal association between vaccination and subdural hematoma diagnosis, which must continue to be considered a red flag for abusive head trauma and child abuse.

International audience; Purpose: To assess the usefulness of a second biopsy when the first one was inconclusive in patients with a liver nodule found during the follow-up for chronic liver disease.Materials and methods: Among 381 patients (544 nodules) included in a prospective study designed to evaluate the accuracy of imaging for the diagnosis of small hepatocellular carcinoma (HCC) in chronic liver disease, 254 nodules were biopsied. The following histological results were considered as conclusive: HCC, dysplastic or regenerative nodule, and other identified tumors (benign or malignant). For nodules with inconclusive results (e.g. fibrosis or no definite focal lesion), a second biopsy was suggested, but was not mandatory.Results: A total of 242 patients (194 men, 48 women; mean age, 61.9 +/- 9.5 [SD]; range: 40.2-89.0years) with 254 nodules underwent a first biopsy. Mean nodule diameter was 19.2 +/- 5.4mm (range: 10-33mm). The first biopsy was conclusive in 189/254 nodules (74.4%): 157 HCCs (83.1%), 11 regenerative nodules (5.8%), 10 dysplastic nodules (5.3%), 3 cholangiocarcinomas (1.6%), and 8 other tumors (4.2%). Among the 65 nodules for which the first biopsy was inconclusive, a second biopsy was performed for 17 nodules in 16 patients within 6 months of the first one. It was conclusive in 13/17 nodules (76.5%): 10 HCCs (76.9%), 2 dysplastic nodules (15.4%), and 1 other tumor (7.7%). In 4/17 nodules (23.5%), no definitive diagnosis could be provided.Conclusion: The diagnostic yield of a second biopsy of a suspicious lesion suggestive of HCC in chronic liver disease is not decreased compared to the first one. Repeated biopsy after a first negative one could be an alternative option to the follow-up of patients with chronic liver disease. (C) 2018 Societe francaise de radiologie

Background CT volumetry has previously been proposed as an alternative to scintigraphy for the evaluation of pre-donation split renal function and the prediction of post-donation renal function in living kidney donors. The aim of our study was to retrospectively assess the relevance of three CT volumetry techniques for estimating pre-donation kidney function and predicting the risk for chronic kidney disease (CKD) at 1-year post-nephrectomy in a French cohort of living donors using isotopic measures of kidney function. Methods Kidney volume was quantified pre-donation for 105 donors using three methods total parenchymal three-dimensional renal volume (3DRV), total parenchymal renal volume contouring (RVCt), and renal cortical volume (RCoV). Subjects also had a 51Cr-EDTA scintigraphy to measure glomerular filtration rate (mGFR) pre-donation and 1-year after donation. For each volume, we tested for association with mGFR using univariate regression models, and computed receiver operating characteristics analyses to assess their predictive potential of post-donation CKD. Results Our population was composed of healthy subjects, who were predominantly female (69%) with a median age at donation of 51yo. Median mGFR was 102 mL/min/1.73 m2 at pre-donation and 66 mL/min/1.73 m2 1-year after nephrectomy. The pre-donation median volume of the preserved kidney was 156 cm3, 163 cm3 and 99 cm3 for the 3DRV, RVCt and RCoV methods respectively, with a high correlation observed between each technique (R > 0.84). For all methods, total kidney volume was significantly associated with pre-donation mGFR (P Conclusions In our cohort of healthy donors with measured kidney function, cortical volumetry (RCoV) appears as the best volumetric technique to use as a surrogate to scintigraphy for estimating pre-donation split renal function and predicting post-donation renal outcomes.

International audience

The aim of this study was to compare the performances pretargeted immunoPETHepatic tumor burden following intra-portal injection of luciferase-transfected LS174T cells in nude mice was confirmed using bioluminescence. One group of animals was injected intravenously with TF2 and withTumor/organ ratios were significantly higher with

Summary Background Sorafenib is the recommended treatment for patients with advanced hepatocellular carcinoma. We aimed to compare the efficacy and safety of sorafenib to that of selective internal radiotherapy (SIRT) with yttrium-90 ( 90 Y) resin microspheres in patients with hepatocellular carcinoma. Methods SARAH was a multicentre, open-label, randomised, controlled, investigator-initiated, phase 3 trial done at 25 centres specialising in liver diseases in France. Patients were eligible if they were aged at least 18 years with a life expectancy greater than 3 months, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, Child-Pugh liver function class A or B score of 7 or lower, and locally advanced hepatocellular carcinoma (Barcelona Clinic Liver Cancer [BCLC] stage C), or new hepatocellular carcinoma not eligible for surgical resection, liver transplantation, or thermal ablation after a previously cured hepatocellular carcinoma (cured by surgery or thermoablative therapy), or hepatocellular carcinoma with two unsuccessful rounds of transarterial chemoembolisation. Patients were randomly assigned (1:1) by a permutated block method with block sizes two and four to receive continuous oral sorafenib (400 mg twice daily) or SIRT with 90 Y-loaded resin microspheres 2–5 weeks after randomisation. Patients were stratified according to randomising centre, ECOG performance status, previous transarterial chemoembolisation, and presence of macroscopic vascular invasion. The primary endpoint was overall survival. Analyses were done on the intention-to-treat population; safety was assessed in all patients who received at least one dose of sorafenib or underwent at least one of the SIRT work-up exams. This study has been completed and the final results are reported here. The trial is registered with ClinicalTrials.gov, number NCT01482442. Findings Between Dec 5, 2011, and March 12, 2015, 467 patients were randomly assigned; after eight patients withdrew consent, 237 were assigned to SIRT and 222 to sorafenib. In the SIRT group, 53 (22%) of 237 patients did not receive SIRT; 26 (49%) of these 53 patients were treated with sorafenib. Median follow-up was 27·9 months (IQR 21·9–33·6) in the SIRT group and 28·1 months (20·0–35·3) in the sorafenib group. Median overall survival was 8·0 months (95% CI 6·7–9·9) in the SIRT group versus 9·9 months (8·7–11·4) in the sorafenib group (hazard ratio 1·15 [95% CI 0·94–1·41] for SIRT vs sorafenib; p=0·18). In the safety population, at least one serious adverse event was reported in 174 (77%) of 226 patients in the SIRT group and in 176 (82%) of 216 in the sorafenib group. The most frequent grade 3 or worse treatment-related adverse events were fatigue (20 [9%] vs 41 [19%]), liver dysfunction (25 [11%] vs 27 [13%]), increased laboratory liver values (20 [9%] vs 16 [7%]), haematological abnormalities (23 [10%] vs 30 [14%]), diarrhoea (three [1%] vs 30 [14%]), abdominal pain (six [3%] vs 14 [6%]), increased creatinine (four [2%] vs 12 [6%]), and hand-foot skin reaction (one [ vs 12 [6%]). 19 deaths in the SIRT group and 12 in the sorafenib group were deemed to be treatment related. Interpretation In patients with locally advanced or intermediate-stage hepatocellular carcinoma after unsuccessful transarterial chemoembolisation, overall survival did not significantly differ between the two groups. Quality of life and tolerance might help when choosing between the two treatments. Funding Sirtex Medical Inc.

International audience; This paper reviews some aspects and recent developments in the use of antibodies to target radionuclides for tumor imaging and therapy. While radiolabeled antibodies have been considered for many years in this context, only a few have reached the level of routine clinical use. However, alternative radionuclides, with more appropriate physical properties, such as lutetium-177 or copper-67, as well as alpha-emitting radionuclides, including astatine-211, bismuth-213, actinium-225, and others are currently reviving hopes in cancer treatments, both in hematological diseases and solid tumors. At the same time, PET imaging, with short-lived radionuclides, such as gallium-68, fluorine-18 or copper-64, or long half-life ones, particularly iodine-124 and zirconium-89 now offers new perspectives in immuno-specific phenotype tumor imaging. New antibody analogues and pretargeting strategies have also considerably improved the performances of tumor immunotargeting and completely renewed the interest in these approaches for imaging and therapy by providing theranostics, companion diagnostics and news tools to make personalized medicine a reality.

International audience