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Biomedical subjects

J Drouillard

Publications and source records attributed to J Drouillard.

At least 19 recordsLinked to original sources
PubMed2001

Superior vena cava obstruction: is stenting necessary?

No therapy is currently available for patients with recurrent vascular obstruction of the superior vena cava (SVC) caused by tumor regrowth after chemotherapy or radiation therapy. Intravascular stenting is a new option for the treatment of vena cava syndrome. Forty cancer patients with SVC syndrome (SVCS) were evaluated by computed tomography (CT) and venography. The SVC or its tributaries were stenosed or thrombosed in all patients. The etiology was malignant in all but 2 cases: non-small-cell lung carcinoma (n = 28), mediastinal nodal metastasis (n = 5), lymphoma (n = 2), pleural mesothelioma (n = 2), small-cell lung carcinoma (n = 1), and postradiation fibrous mediastinitis (n = 2). Stenting was achieved in 39 of the 40 patients, and clinical symptoms subsided in 92%. Stents remained patent in 36 of these 39 patients throughout a mean follow-up of 24 weeks (range 3 days to 24 months). SVC stenting is safe, effective and allows rapid cure of SVCS and port catheter implantation in patients in poor health.

Adolescent↗
PubMed1999

Inflammatory myofibroblastic tumor of the lung (inflammatory pseudotumor): uncommon cause of solitary pulmonary nodule.

Lung inflammatory myofibroblastic tumor is an uncommon cause of solitary lung nodule (0.7 % of lung tumors). The principal site of inflammatory pseudotumor is the lung, but it can also occur elsewhere in various organs. Although benign, they may be locally very aggressive. Recurrent and multifocal forms have been described. Since they are likely to mimic malignant neoplasms, accurate histopathologic diagnosis is necessary in order to guide appropriate surgical excision and avoid aggressive treatments. We report a case of lung involvement in a young adult with radiologic and pathologic correlations.

Adult↗
PubMed1999

Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study.

BACKGROUND: Endoscopic ultrasonography (EUS) appears to be the best imaging method for the diagnosis of choledocholithiasis. The aim of this preliminary, prospective, controlled study was to assess the accuracy of EUS and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of common bile duct stones. METHODS: From December 1995 through April 1997, all patients referred because of suspicion of the presence of common bile duct stones were included in the study. EUS and MRCP were performed. Each examination was performed by a different operator unaware of the result of the other procedure. The definitive diagnosis was established by means of endoscopic retrograde cholangiography with sphincterotomy or a surgical procedure. RESULTS: Forty-three patients (18 men, 25 women) with a mean age of 60.9 +/- 14.5 years (range 25 to 81 years) were included in the study. Eleven patients were excluded because of unavailability of magnetic resonance imaging(n = 5) or EUS (n = 6). Ten patients (31.2%) had choledocholithiasis. For this diagnosis, the sensitivity of EUS was 100%, the specificity was 95.4%, the positive predictive value was 90.9%, and the negative predictive value was 100%. The corresponding values for MRCP were 100%, 72.7%, 62.5%, and 100%, not significantly different from EUS results. The accuracy of EUS was 96.9%, and that of MRCP was 82.2%. CONCLUSION: This preliminary study confirmed EUS as an accurate and noninvasive procedure for the diagnosis of common bile duct stones. MRCP, which had a high sensitivity and high negative predictive value, might be an accurate technique for patients with a contraindication to EUS.

Adult↗
PubMed1999

Segmented 5 versus nonsegmented flow quantitation: comparison of portal vein flow measurements.

RATIONALE AND OBJECTIVES: Times of acquisition, mean velocities, mean flows, and their respective standard deviations provided by segmented and nonsegmented flow quantifications (FQ) were compared in the main portal veins of ten healthy adults. METHODS: The segmented FQ performed five phase-encoding lines per segment. The authors successively applied the two electrocardiogram-triggered techniques in the same slice perpendicular to the portal flow direction. Their measurements were compared in particular by means of the statistical analysis proposed by Bland and Altman. RESULTS: The segmented 5 FQ reduced the acquisition time by two compared with the nonsegmented FQ. The mean velocity and mean flow values of the two techniques were not significantly different. The standard deviations were similar. CONCLUSIONS: The segmented 5 FQ showed its major advantage in the portal vein: the acquisition time was reduced without any loss of accuracy or any uncertainty enhancement.

Adult↗
PubMed1998

Localized fibrous tumor of the liver: imaging findings.

We report the imaging of a localized fibrous tumor of the liver, focusing on color Doppler US, CT, MR imaging, and angiographic findings. We discuss the differential diagnosis of such a rare, benign lesion of the liver. Detailed imaging of this tumor has not been reported in the literature previously.

Aged↗
PubMed1998

Mediastinal masses: diagnostic approach.

In most clinical situations the modern radiological approach to a mediastinal mass consists of performing a CT scan following the chest radiograph. Magnetic resonance imaging is indicated when CT findings are equivocal and as the first-line method in particular situations such as suspected involvement of the posterior mediastinum. In both techniques, tissular components of the mass assessed by density or signal intensity analysis, together with the precise location, are the leading edge of the radiological diagnosis. This review deals mainly with the differential diagnosis of primary neoplasms according to CT and MRI findings.

Diagnosis, Differential↗
PubMed1998

Comparative evaluation of conventional and dynamic magnetic resonance imaging of the pituitary gland for the diagnosis of Cushing's disease.

OBJECTIVES: The ability of MRI to detect pituitary ACTH-secreting adenomas in patients with Cushing's disease is limited. Owing to different dynamics of contrast enhancement between adenomas and normal pituitary tissue, it has been suggested that obtaining images within seconds after gadolinium (Gad) injection using dynamic procedures increases the sensitivity of MRI in the detection of pituitary microadenomas. The objective of this study was to compare the ability of conventional magnetic resonance imaging (CMRI) and dynamic MRI (DMRI) to detect ACTH-secreting pituitary adenomas. DESIGN: Twenty-six consecutive patients with ACTH-dependent Cushing's syndrome and 10 normal subjects were investigated. According to the results of inferior petrosal sinus sampling, 21 patients had Cushing's disease and five had ectopic ACTH syndrome. Patients with Cushing's disease were operated regardless of the results of imaging studies. All underwent identical MRI and DMRI procedures using a 1.0 T magnet. Image sampling time during DMRI was 19 sec. Scans were randomly mixed and analysed blind, retrospectively and independently by two experienced radiologists. The clarity of the images was assessed by the analysis of agreement among radiologists. MRI findings were compared to surgical and histopathological findings. RESULTS: Surgical exploration identified three macrodenomas and 14 microadenomas. One microadenoma was found at pathological examination after subtotal hypophysectomy and no tumour was found in three cases. According to the combined opinion of radiologists, the three macroadenomas were identified equally well with CMRI and DMRI. Eight ACTH-secreting microadenomas were detected with CMRI and 11 with DMRI. The three microadenomas detected with DMRI only were visualized within 60 sec following Gad injection. No false positives occurred with CMRI. Three false positives were obtained with DMRI: one in a patient with ectopic ACTH syndrome while a silent microprolactinoma and normal tissue were found at the site of the radiological abnormality in two patients with Cushing's disease. In our study, the sensitivity of DMRI is greater than that of CMRI (0.67 vs. 0.52) but is associated with a loss in specificity (0.80 vs. 1.00). False positives may result from the increased sensitivity of DMRI which detects incidental pituitary lesions, technical artefacts or lowest clarity of images, as suggested by a lower observer agreement of DMRI (Kappa statistic 0.66 vs. 0.83). Overall, the two MR procedures had equivalent diagnostic power (0.72). CONCLUSIONS: In our hands, dynamic procedures did not improve the usefulness of MRI in Cushing's syndrome.

ACTH Syndrome, Ectopic↗
PubMed1997

[Venous endoprosthesis. Palliative treatment of superior caval syndrome of neoplastic origin].

Twenty-three patients with SVC syndrome were evaluated with CT and venography. The superior vena cava or its tributaries were either stenosed or thrombosed. The etiology was malignant in all cases: non small cell carcinoma (16 cases), mediastinal nodal metastasis (3 cases), lymphomas (2 cases), pleural mesothelioma (1 case), small cell carcinoma (1 case). The length of the stenosis ranged from 20 to 70 mm. The stents were placed via a femoral, jugular or brachial approach. Stenting was achieved in 22/23 patients (96%). Clinical symptoms subsided in 20/22 patients (87%). Mean follow-up was 15 weeks. Stents remained patent in 17/20 patients (78%). Stenting is a safe and effective treatment of SVC syndrome in patients with malignant conditions.

Adolescent↗
PubMed1997

[MRI cholangiopancreatography in the pathology of the bile ducts and pancreas].

MR cholangiopancreatography (MRCP) is a recent and exciting imaging modality that allows visualization of bile and pancreatic ducts without morbidity. Although the technique of MRCP is in its early stages of development and MRCP technology is progressing MRCP will undoubtedly replace traditional techniques such as diagnostic ERCP. This article describes MRCP findings in bile or pancreatic duct diseases, analyzes the accuracy of MRCP in these diseases, and discusses the potential role of MRCP in evaluating the pathology of the biliary tract and pancreas.

Bile Duct Diseases↗
PubMed1997

[Techniques of MRI cholangiopancreatography. History, current status and future prospects].

Magnetic resonance cholangiopancreatography (MRCP) is a recent, non invasive, diagnostic modality capable of producing high quality images of biliary and pancreatic ducts. On the basis of the literature and our experience, we report the history and the current status of this new technology, including 2D, 3D and single shot fast spin echo sequences. As perspectives echo-planar imaging and functional imaging are discussed.

Bile Ducts↗
PubMed1996

Tolerability and utility of mangafodipir trisodium injection (MnDPDP) at the dose of 5 mumol/kg body weight in detecting focal liver tumors: results of a phase III trial using an infusion technique.

PURPOSE: To evaluate the tolerability of mangafodipir trisodium (MnDPDP) and its utility for enhancing the ability of magnetic resonance (MR) imaging to detect focal hepatic lesions compared with non-enhanced MR and contrast-enhanced computed tomography (CT). MATERIALS AND METHODS: 119 patients with focal hepatic lesions were examined by MR and by contrast-enhanced CT. MR was performed before and after the infusion of 5 mumol/kg MnDPDP, at a concentration of 10 mumol/ml. Histologic confirmation was obtained in 79 patients. RESULTS: There were no severe adverse events. Five patients reported mild adverse events related to the infusion. MnDPDP-enhanced SE T1 and GE T1 sequences revealed more focal lesions than the same sequences before contrast infusion in, respectively 22.6 and 36.1% of the cases, and fewer focal lesions in, respectively 5.9 and 1.7% of the cases. Contrast-enhanced MR demonstrated more focal lesions than the SE T2 sequence in 29.4% of cases and fewer lesions in 5.9% of cases. MnDPDP-enhanced MR revealed more nodules than CT in 31.1% of cases and fewer nodules in 13.4% of cases. The additional information provided by MnDPDP enhancement led to modification of management for 12 patients (10.1%). CONCLUSION: MnDPDP is a well-tolerated contrast agent allowing better MR detection of focal hepatic lesions than non-enhanced MR or contrast-enhanced CT.

Carcinoma, Hepatocellular↗
PubMed1996

Efficacy and safety of iobitridol versus iohexol for contrast-enhanced CT of the head.

PURPOSE: The efficacy and adverse reactions of iobitridol versus iohexol in contrast-enhanced CT (CECT) of the head were investigated. MATERIAL AND METHODS: This double-blind randomized parallel study compared the clinical and biological safety of iobitridol and iohexol (350 mgI/ml), administered intravenously (1 ml/kg) to 276 patients undergoing CECT of the head. Vital signs were assessed just before after injection, and 24 hours after. A biologic examination was performed before and after injection. Both groups were comparable at inclusion. RESULTS AND CONCLUSION: The within-group variation for vital signs after injection and 24 hours after was not clinically relevant and no significant difference was evident between treatment groups. The incidence of adverse events was similar in both groups (11.0% for iobitridol and 7.1 % for iohexol), consisting most often of a sensation of warmth. Biologic parameters remained stable and did not differ significantly between groups. The quality of imaging was rated good or excellent in 70% of cases and a very high diagnostic discrimination was achieved (98%). Iobitridol compared favorably with iohexol for head CECT.

Adolescent↗
PubMed1996

[Hypoplasia of the inferior vena cava with intrahepatic continuation. Color Doppler ultrasonography and MRI].

We report a rare case of inferior vena cava hypoplasia discovered fortuitously, with intra-hepatic venous shunts, explored only by color-doppler ultrasound and MRI. These noninvasive imaging tests demonstrated that the intra hepatic collateral pathway arose from an inferior (accessory) right hepatic vein and flowed into the right and middle hepatic veins. Due to these findings a cavography was avoided in this asymptomatic patient.

Adult↗
PubMed1995

The bronchial arteries: anatomic study and application to lung transplantation.

The bronchial arterial system (BAS) and its territory was studied in dissections of 40 fresh adult cadavers. The arterial distribution was assessed by catheterisation of the ostia and injection of contrast medium. The number of bronchial aa. varied from 2 to 4. The origin of the arteries was between the upper border of T5 and the lower border of T6 in 90% of cases. The intercostobronchial trunk was the virtually exclusively component of the right bronchial arterial system, present in 97.5% of cases. It was associated with an accessory right bronchial a. in 7.5% of cases, which was merely supplementary. A common arterial trunk for both bronchial systems was present in 50% of cases. The left BAS was characterised by the presence of a direct left bronchial a. (LBA) in 76% of cases, and by the combination of two LBAs in 20%, one of which was usually dominant. However, major anatomic networks between the different vessels found allowed reimplantation of the LBA alone in the former situation, and in the latter it was possible to rely on the dominant LBA alone when reimplantation of the different ostia was impossible. The proximity of the different ostia and the interostial interval, which was less than 1.5 cm on average, permitted multiple revascularisations by the same vascular supply.

Adult↗
PubMed1995

CT of small-bowel neoplasms.

The diagnosis of neoplasms of the small intestine remains a difficult challenge owing to their nonspecific clinical presentation. CT is an efficient and contributive tool in their diagnosis and preoperative staging. Enabled by CT, the evaluation of the intramural and extramural portions of such tumors complements the mucosal analysis allowed by barium examination. Strict technical rules should be applied to minimize pitfalls mainly resulting from insufficient bowel opacification. Although characteristic appearances are rare, typical CT findings may suggest a specific diagnosis where lipomas and carcinoid tumors are concerned.

Adenocarcinoma↗
PubMed1995

Pseudo-tumours of the thymus after correction of hypercortisolism in patients with ectopic ACTH syndrome: a report of five cases.

We report the cases of four patients with occult, and one patient with overt, ectopic ACTH syndrome. Cushing's syndrome was cured by removal of the ACTH secreting tumour, op'DDD, ketoconazole or bilateral adrenalectomy. Six to 14 months after remission of hypercortisolism, follow-up computed tomography or magnetic resonance imaging of the thorax revealed in all five patients an anterior mediastinal mass 3-5 cm in length that suggested a thymic carcinoma. Exploratory thoracotomy was performed in four cases and allowed the removal of an enlarged, but normal, thymus. Histological examination revealed no tumour but showed benign thymic hyperplasia with negative immunostaining for ACTH. Thymic enlargement spontaneously disappeared 11 months after its demonstration in the patient who did not undergo thoracotomy. The mechanism of this abnormality is thought to be thymic depletion resulting from high plasma cortisol concentrations followed by 'rebound' thymic hyperplasia when cortisol levels fall. Physicians involved in the management of patients with Cushing's syndrome must be aware of this entity in order to avert a diagnostic thoracotomy.

ACTH Syndrome, Ectopic↗
PubMed1994

[MRI of the thorax: current applications and perspectives].

Magnetic resonance imaging is an accurate technique in chest investigation, but is used less frequently than computed tomography. The sequences currently available allow visualisation of the mediastinum and chest wall. The most important clinical applications concern staging of tumours of the lung apex, evaluation of mediastinal tumours occupying the posterior mediastinum and laterocardiac region, noninvasive investigation of acquired and congenital lesions of the aorta. The applications of MRI will probably be modified if investigation of the lung is made possible by the use of new sequences.

Adenocarcinoma↗