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Hervé Trillaud

Publications and source records attributed to Hervé Trillaud.

12 recordsLinked to original sources
PubMed2006

Quantitative magnetic resonance temperature mapping for real-time monitoring of radiofrequency ablation of the liver: an ex vivo study.

We evaluated the feasibility and accuracy of real-time magnetic resonance (MR) thermometry for monitoring radiofrequency (RF) ablation in the liver. Continuous MR temperature mapping was used to monitor bipolar RF ablations performed in ex vivo livers with and without flow using two parallel electrodes. Macroscopic inspection of ablation zones was compared with thermal dose maps (TDm) and T1-weighted inversion recovery turbo spin echo (IR-TSE) images for their size and shape and the influence of flow. Pearson's correlation (r), Bland and Altman tests and kappa (chiK) tests were performed. The mean differences in ablation zone size between macroscopic and TDm and IR-TSE measurements were +4 mm and -2 mm, respectively. TDm was well correlated with macroscopy (r=0.77 versus r=0.44 for IR-TSE). TDm was found to be more precise for shape recognition (chiK=0.73 versus chiK=0.55 for IR-TSE) and for detection of an intact ring of liver due to the cooling effect of flow which was impossible with IR-TSE. Simultaneous monitoring of RF ablation by MR thermometry is feasible and reliable for predicting the shape of ablation zones and the impact of the heat-sink effect of flow. Further studies are needed to confirm these results in vivo.

Animals↗
PubMed2006

Real-time monitoring of radiofrequency ablation of rabbit liver by respiratory-gated quantitative temperature MRI.

PURPOSE: To evaluate the feasibility and precision of magnetic resonance imaging (MRI) thermometry for monitoring radiofrequency (RF) liver ablation in vivo and predicting the size of the ablation zone. MATERIALS AND METHODS: At 1.5T, respiratory-triggered real-time MR temperature mapping (the proton resonance frequency (PRF) method) was used to monitor RF ablation in rabbit liver (N = 6) under free breathing. The size of the ablation zones, as assessed by histological analyses, was compared with that predicted from MR thermal dose (TD) maps or derived from conventional T1-weighted (T1w), T2-weighted (T2w), and T1w gadolinium (Gd)-enhanced (T1w-Gd) images acquired immediately after the ablation, and on days 4 and 8 postprocedure. RESULTS: MR temperature uncertainty remained under 1-2 degrees C even during RF deposition. The TD maps were shown to be more predictive and precise than the other MR images, with an average predictive precision for the final ablation zone size of about 1 mm as compared to the histologically proven lesion on day 8. CONCLUSION: Quantitative temperature MRI during RF ablation is feasible and offered a precise indication of the ablation zone size in this preclinical study based on the lethal dose threshold.

Animals↗
PubMed2005

Hypervascular nodule in a fibrotic liver overloaded with iron: identification of a premalignant area with preserved liver architecture.

BACKGROUND: The presence of a hypervascular nodule in a patient with cirrhosis is highly suggestive of a hepatocellular carcinoma. CASE PRESENTATION: A 55 year old man with idiopathic refractory anaemia was addressed for the cure of a recently appeared 3.3 cm hypervascular liver nodule. The nodule was not visible on the resected fresh specimen, but a paler zone was seen after formalin fixation. The surrounding liver was fibrotic (METAVIR score F3) and overloaded with iron. However, the paler zone, thought to be the nodule, had in fact a normal architecture, was less fibrotic, and contained some "portal tract-like structures" (but with arteries only); moreover, this paler area was devoid of iron, contained less glycogen and was characterized by foci of clear hepatocytes. CONCLUSION: In spite of the absence of architectural distortion, and a normal proliferative index, the possibility of premalignancy or malignancy should be considered in this type of hypervascular and hyposiderotic nodule, occurring in the context of an iron overloaded liver.

Journal Article↗
PubMed2004

Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients.

PURPOSE: To retrospectively assess the frequency of adverse events related to percutaneous preoperative portal vein embolization (PPVE). MATERIALS AND METHODS: Institutional review board did not require its approval or patient informed consent for this study. The adverse events that occurred during PPVE or until planned hepatic surgery was performed or cancelled were retrospectively obtained from clinical, imaging, and laboratory data files in 188 patients (109 male and 79 female patients; mean age, 60 years; range, 16-78 years). Liver resection was planned for metastases (n = 137), hepatocarcinoma (n = 31), cholangiocarcinoma (n = 15), fibrolamellar hepatoma (n = 1), and benign disease (n = 4). PPVE was performed with a single-lumen 5-F catheter and a contralateral approach with n-butyl cyanoacrylate mixed with iodized oil as the main embolic agent. The rate of complications in patients with cirrhosis was compared with that in patients without cirrhosis by using the chi(2) test. RESULTS: Adverse events occurred in 24 (12.8%) of 188 patients, including 12 complications and 12 incidental imaging findings. Complications included thrombosis of the portal vein feeding the future remnant liver (n = 1); migration of emboli in the portal vein feeding the future remnant liver, which necessitated angioplasty (n = 2); hemoperitoneum (n = 1); rupture of a metastasis in the gallbladder (n = 1); transitory hemobilia (n = 1); and transient liver failure (n = 6). Incidental findings were migration of small emboli in nontargeted portal branches (n = 10) and subcapsular hematoma (n = 2). Among the 187 patients in whom PPVE was technically successful, there was a significant difference (P < .001) between the occurrence of liver failure after PPVE in patients with cirrhosis (five of 30) and those without (one of 157). Sixteen liver resections were cancelled due to cancer progression (n = 12), insufficient hypertrophy of the nonembolized liver (n = 3), and complete portal thrombosis (n = 1). CONCLUSION: PPVE is a safe adjuvant technique for hypertrophy of the initially insufficient liver reserve. Post-PPVE transient liver failure is more common in patients with cirrhosis than in those without cirrhosis.

Acrylates↗
PubMed2004

Stability of real-time MR temperature mapping in healthy and diseased human liver.

PURPOSE: To determine the stability and quality of MR temperature mapping using the proton resonance frequency (PRF) method in the liver of hepatic tumor patients. MATERIALS AND METHODS: The standard deviation (SD) of a series of temperature maps was determined in 30 patients (21 patients with cirrhotic livers with carcinoma, and nine patients with noncirrhotic livers with metastasis or angioma) and in five volunteers at normal body temperature under free breathing. A respiratory-gated segmented echo-planar imaging (EPI) sequence (three slices in one expiration phase) was performed with sensitivity encoding (SENSE) acceleration on a 1.5 T scanner. Motion-corrupted images were identified by calculation of the cross-correlation coefficient, and discarded. RESULTS: A T2* range of 10-33 msec was found, with especially low values in advanced cirrhotic livers. The mean temperature SD in patients was 2.3 degrees C (range = 1.5-5.0 degrees C). The stability in healthy livers was slightly better than that in cirrhotic livers, and it was higher in the right liver than in the left liver. The gating failed in 4% of the images when the respiratory cycle was irregular, leading to motion artifacts and errors in the temperature maps. CONCLUSION: The achieved temperature stability and image quality makes real-time quantitative monitoring of thermal ablation of liver tumors feasible on a clinical scanner.

Artifacts↗
PubMed2003

Association of adenoma and focal nodular hyperplasia: experience of a single French academic center.

BACKGROUND: We report our experience of the simultaneous occurrence of adenoma and focal nodular hyperplasia (FNH). Liver cell adenoma together with FNH was found in five out of 30 cases of "multiple benign hepatocytic nodules" collected in our files of the Department of Pathology of the University Hospital of Bordeaux, during the last 12 years. All five cases were women on oral contraceptives. In all cases, the reason for surgery was the discovery, by imaging techniques, of an adenoma (4 cases) or of an unidentified benign tumor, possibly an adenoma. RESULTS: Four cases of FNH were discovered by imaging techniques, prior to surgery. Additional small nodules were diagnosed either during surgery or during the slicing of the specimen in 3 cases. Adenoma and the FNH cases identified by imaging techniques were confirmed as such by light microscopy. Some small nodules could not be categorized with certainty because they contained biliary structures without ductular reaction. In one case, the non-nodular liver was abnormal around the area in which there were multiple nodules: there was approximation of portal tracts with portal and hepatic venous thromboses, and portal tract remnants with arteries surrounded with a rim of fibrosis. In two cases, some large hepatic veins had thickened walls. CONCLUSIONS: The association of FNH and adenoma could be coincidental or secondary to shared causal mechanisms: a) systemic and local angiogenic abnormalities induced by oral contraceptives; b) tumor-induced growth factors; c) thrombosis and local arterio-venous shunting. A better recognition of the association of adenoma and FNH, particularly in the context of multiple nodules, could be useful in clinical practice.

Journal Article↗
PubMed2003

Real-time MR temperature mapping of rabbit liver in vivo during thermal ablation.

It has been shown that quantitative MRI thermometry using the proton resonance frequency (PRF) method can be used to noninvasively monitor the evolution of tissue temperature, and to guide minimally-invasive tumor ablation based on local hyperthermia. Although hepatic tumors are among the main targets for thermal ablation, PRF-based temperature MRI of the liver is difficult to perform because of motion artifacts, fat content, and low T(*) (2). In this study the stability of real-time thermometry was tested on a clinical 1.5 T scanner for rabbit liver in vivo. The fast segmented EPI principle was used together with respiratory gating to limit respiratory motion artifacts. Lipid signal suppression was achieved with a binomial excitation pulse. Saturation slabs were applied to suppress artifacts due to flowing blood. The respiratory-gated MR thermometry in the rabbit liver in vivo showed a standard deviation (SD) of 1-3 degrees C with a temporal resolution of 3 s per slice and 1.4 mm x 1.9 mm spatial resolution in plane (slice thickness = 5 mm). The method was used to guide thermal ablation experiments with a clinical infrared laser. The estimated size of the necrotic area, based on the thermal dose calculated from MR temperature maps, corresponded well with the actual lesion size determined by histology and conventional MR images obtained 5 days posttreatment. These results show that quantitative MR temperature mapping can be obtained in the liver in vivo, and can be used for real-time control of thermal ablation and for lesion size prediction.

Animals↗
PubMed2003

The identification of small nodules in liver adenomatosis.

BACKGROUND/AIMS: Liver adenomatosis is characterized by the presence of multiple adenomas of various sizes in the liver. The aim of this study was to characterize the morphology of small nodules which can be difficult to identify. METHODS: Seven patients included in this study underwent surgery for the removal of one or several nodules. All, but one, were females. Three out of seven presented with acute bleeding. Five had six or more nodules at presentation, and two only one, who developed nodules later on during follow-up. RESULTS: All of the large nodules that were >2 cm, except one, were typical adenomas with or without hemorrhagic areas. Smaller nodules (1-2 cm), some of which discovered on the resected specimen were either typical adenomas or non-typical nodules. These non-typical nodules were characterized by a polylobulated aspect with steatotic zones, and in between, bands of non-steatotic hepatocytes with portal tracts-like structures containing occasional cytokeratin 7 and less often cytokeratin 19 positive biliary cells. Numerous steatotic foci were also seen in four cases. They were isolated or grouped forming microadenomas or non-typical micronodules (<1 cm) containing biliary elements. Our findings lead to the following hypothesis: adenomatosis is characterized by the simultaneous occurrence of multiple adenomas; if several adenomatous foci expand at the same time in the same area, they will form one polylobulated nodule containing non-adenomatous tissue with portal tracts in between areas of adenomatous tissue (non-typical micronodule). Such a small micronodule may in turn expand and join another micronodule to form a bigger one by the same process (non-typical nodule). As nodules grow, their non-adenomatous components including hepatocytic plates and portal tracts constituents will progressively disappear to end up with the classical aspect of an adenoma. CONCLUSIONS: This hypothesis supports the concept that non-typical nodules/micronodules are adenomas precursors. However, they can be difficult to classify since they resemble focal nodular hyperplasia precursor.

Adenoma↗