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J M Bruel

Publications and source records attributed to J M Bruel.

At least 37 records · Page 2Linked to original sources
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

[Hemostatic embolization of hepatocellular carcinoma with portal vein thrombosis complicated by hemoperitoneum].

A 59-year-old chronic drinker (120 g alcohol/day) was hospitalized for sudden increase in abdominal volume found to be caused by a hemoperitonoff resulting from ruptured hepatocellular carcinoma with thrombosis of the portal vein. Emergency arterial embolization with gelatin sponge successfully stopped intraperitoneal bleeding. No surgical treatment could be attempted due the severity of the cirrhosis. This patient survived for 4.5 month. Based on this observation and a review of the literature, it can be suggested that hemostatic embolization is an effective treatment for spontaneous hemorrhage of hepatocellular carcinoma even in cases with portal vein thrombosis.

Carcinoma, Hepatocellular↗
PubMed1996

Angiographic embolization of intrahepatic arterioportal fistula.

We report the case of a posttraumatic arteriovenous fistula between the right hepatic artery and the right portal vein remarkable in that clinical manifestations, including portal hypertension and mesenteric insufficiency findings, appeared latently and progressively worsened. This hepatoportal fistula was diagnosed by Doppler sonography and successfully treated by transcatheter embolization of feeding hepatic artery branch with steel coils. We emphasize the interest of pulsed Doppler in the diagnosis of hepatoportal fistula, in assessment of hemodynamic changes related to the fistula and in follow-up after treatment.

Angiography↗
PubMed1996

Acute mesenteric ischemia: diagnosis with contrast-enhanced CT.

PURPOSE: To evaluate the accuracy of dynamic, contrast material-enhanced computed tomography (CT) in the diagnosis of acute mesenteric ischemia. MATERIALS AND METHODS: Reviewers blinded to patient diagnoses retrospectively compared the CT scans in a study group with those in a control group. The study group comprised 39 consecutive patients (23 men, 16 women; aged 55-88 years) with surgically proved acute mesenteric ischemia. The control group comprised 24 patients (13 men, 11 women; aged 50-82 years) with suspected acute mesenteric ischemia that was disproved at surgery. RESULTS: For the diagnosis of acute mesenteric ischemia, each of the following findings had a specificity of more than 95% and a sensitivity of less than 30%: arterial or venous thrombosis, intramural gas, portal venous gas, focal lack of bowel-wall enhancement, and liver or splenic infarcts. When CT was used in the diagnosis of suspected acute mesenteric ischemia, the detection of at least one of these signs resulted in a sensitivity of 64% (25 of 39; confidence interval, 0.49, 0.79), a specificity of 92% (22 of 24; confidence interval, 0.81, 1.00), and an accuracy of 75% (47 of 63; confidence interval, 0.64, 0.86). CONCLUSION: Dynamic, contrast-enhanced CT is a valuable tool in the diagnosis of and determination of prognosis in acute mesenteric ischemia.

Acute Disease↗
PubMed1996

Detection of hepatic metastases: ferumoxides-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography.

PURPOSE: To prospectively compare the diagnostic accuracy of computed tomography (CT) during arterial portography (CTAP) with that of unenhanced and ferumoxides-enhanced magnetic resonance (MR) imaging at 0.5 T in the detection of hepatic metastases. MATERIALS AND METHODS: Four pairs of radiologists independently assessed the metastatic involvement of 134 hepatic segments (31 with and 103 without metastasis) in 17 patients at unenhanced and ferumoxides-enhanced spin-echo and gradient-echo MR imaging (alone and in combination) and at CTAP. The diagnostic performance of the various imaging modalities was assessed by means of receiver operating characteristic analysis. RESULTS: The accuracy of CTAP, unenhanced MR imaging (combined unenhanced sequences), and ferumoxides-enhanced MR imaging (combined contrast material-enhanced sequences) was 0.925, 0.908, and 0.951, respectively. Ferumoxides-enhanced MR imaging was significantly more accurate (P < .05) than unenhanced MR imaging and CTAP. When 14 segments containing cysts were excluded, the difference between ferumoxides-enhanced MR imaging and CTAP was no longer statistically significant (P = .1). CONCLUSION: Ferumoxides-enhanced MR imaging is more accurate than unenhanced MR imaging and at least as accurate as CTAP for the detection of hepatic metastases.

Adult↗
PubMed1996

Computed tomography of the lungs in asthma: influence of disease severity and etiology.

Airways remodelling is a feature of longstanding asthma, but may differ in persons with allergic and nonallergic asthma. To assess airways remodelling indirectly, we compared permanent CT-scan abnormalities in 70 subjects with allergic (median age: 30 yr) and 56 with nonallergic asthma (median age: 54.5 yr) who had had asthma of similar duration. None of the subjects were smokers. Asthma severity was assessed by Aas score and FEV1. Permanent high-resolution computed tomographic (HR-CT) scan abnormalities were characterized. In comparison with allergic asthmatic subjects, those with nonallergic asthma had a significantly greater frequency of cylindric (p < 0.0007, Mann-Whitney U test) and varicose (p < 0.004) bronchiectasis, emphysema (p < 0.0003), bronchial recruitment (p < 0.0001), and sequellar linear shadows (p < 0.0001). There was a significant correlation between Aas score and emphysema (p < 0.0001 for nonallergic and p < 0.0005 for allergic asthma; Kendall's test method) or Aas score and sequellar linear shadows (p < 0.007, nonallergic asthma). There was a significant increase in the extent of permanent abnormalities with increasing severity and duration of asthma in both groups. Patients with brittle asthma had few permanent abnormalities. This study confirms that after a similar course of the disease, patients with nonallergic asthma have a more extensive remodelling of the airways than those with allergic asthma.

Adolescent↗
PubMed1995

Role of CT in the acute nontraumatic abdomen.

The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.

Abdomen, Acute↗
PubMed1995

Small hepatocellular carcinoma in patients undergoing liver transplantation: detection with CT after injection of iodized oil.

PURPOSE: To assess computed tomography (CT) with iodized oil for depiction of small hepatocellular carcinoma (HCC) before liver transplantation. MATERIALS AND METHODS: Thirty-five consecutive cirrhotic patients underwent CT with iodized oil to determine the presence, number, size, and location of possible nodules. All patients underwent liver transplantation within 4 months after CT. Explanted livers were cut in 8-mm slices that corresponded to axial CT scan planes. Comparison between CT staging and pathologic findings was made. RESULTS: Pathologic studies showed 17 HCC nodules (diameter, 0.9-4.0 cm) in nine of the 35 livers. CT depicted nine of these 17 nodules. Lesion-by-lesion analysis revealed a sensitivity of 53%; CT falsely depicted three additional nodules not confirmed with pathologic findings. Patient-by-patient analysis revealed an 89% sensitivity and an 88% specificity. CONCLUSION: CT with iodized oil, when assessed lesion by lesion, has a low sensitivity. These results must be considered when liver resection is proposed for HCC.

Carcinoma, Hepatocellular↗
PubMed1995

Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction.

OBJECTIVE: The purpose of this prospective study was to evaluate the role of CT in the diagnosis of patients with suspected acute small-bowel obstruction in whom clinical and plain radiographic findings were inconclusive. SUBJECTS AND METHODS: Fifty-seven nonconsecutive patients with suspected acute small-bowel obstruction were referred for CT to differentiate small-bowel obstruction from ileus (33 patients) or to establish the cause of obstruction (24 patients). The final diagnosis was established either by surgery (42 patients) or by the clinical evolution (15 patients). The change in the prescan diagnosis as to the presence, cause, and severity (strangulation) of small-bowel obstruction made on the basis of the CT findings was noted. Finally, the changes in therapy resulting from the CT information were recorded. RESULTS: CT correctly distinguished between small-bowel obstruction and ileus in all cases except one. CT enabled us to modify an erroneous clinical diagnosis correctly in 12 (21%) of 57 cases, including eight cases for which pre-CT diagnosis was ileus and four cases for which pre-CT diagnosis was small-bowel obstruction. CT allowed us to predict the cause of obstruction correctly in 33 (85%) of 39 patients with confirmed small-bowel obstruction but it failed to differentiate adhesions from internal hernias and radiation enteritis. The pre-CT diagnosis of the cause of obstruction was correctly changed because of CT findings in 17 (44%) of 39 patients with subsequently proved small-bowel obstruction. CT was able to identify strangulation in nine of the 12 patients with proved strangulation, which altered the pre-CT diagnosis in three patients. CT findings correctly modified the management in 12 (21%) of 57 patients, by changing either a conservative management to an operative one in 10 (18%), or an operative to a conservative one by differentiating ileus from obstruction in two patients. CONCLUSION: Our findings show that CT is a valuable diagnostic procedure in patients with suspected acute small-bowel obstruction. CT not only is useful in distinguishing obstruction from paralytic ileus, but it frequently establishes the cause of the obstruction and the presence of strangulation. CT findings lead to decisions to treat patients surgically in a significant number of patients.

Acute Disease↗
PubMed1995

[Prognostic factors of hepatocellular carcinoma: a multivariate analysis in 113 patients].

UNLABELLED: The aim of this study was to identify clinical, biological or morphological prognostic factors in 113 patients with HCC in terms of survival. All patients (100 men, aged 65 [28-85], 95% cirrhosis) were diagnosed between 1982-1990. Mean survival time was 21 +/- 3 weeks. Eleven (over 25) variables were isolated by univariate analysis. A multivariate survival analysis (Cox regression model) disclosed that serum creatinine (p = 0.0002), alkaline phosphatase (p = 0.02) and Okuda's stage (p = 0.025) were independent predictors of survival. Comparison of survival curves for different values of these prognostic variables allows division of patients in three groups of prognostic significance in terms of survival (p < 0.05). CONCLUSION: these results facilitate stratification of patients with HCC to design and evaluate future controlled trials.

Aged↗
PubMed1994

Current CT/MRI examination of the upper intestinal tract.

When properly performed, CT of the abdomen can provide valuable information about mural diseases of the alimentary tract. It can demonstrate the digestive origin of an abdominal mass, categorize a given lesion on the basis of its specific CT appearance and any associated CT findings, assess the extramural spread of gastrointestinal lesion, guide various interventional procedures (biopsy, drainage) and follow a patient's response to therapy.

Crohn Disease↗
PubMed1994

Hemodynamic changes after transcatheter arterial embolization of hepatocellular carcinomas.

PURPOSE: To evaluate the serial hemodynamic changes that occur after transcatheter arterial embolization (TAE) of hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Twenty patients with HCCs treated with TAE were evaluated with color and duplex Doppler sonography before, immediately after, and 2 days after TAE. The changes in hepatic artery and portal vein velocity and flow were evaluated. RESULTS: The portal venous velocity and flow did not change significantly after TAE. The peak systolic velocity in the proximal hepatic artery decreased significantly (P < .01) immediately after TAE then returned to baseline values 2 days after TAE; the resistance index of the proximal hepatic artery increased significantly (P < .01) immediately after embolization, then returned to baseline values 2 days after TAE. Arterial signal in the distal hepatic artery, generally absent immediately after TAE, could be recorded 2 days after. CONCLUSION: There is a rapidly reversible decrease in hepatic arterial flow induced by embolization, without any change in portal venous flow.

Adult↗
PubMed1994

Measurement of the internal size of bronchi using high resolution computed tomography (HRCT)

Computed tomography (CT) of the lungs makes it possible to study individual airways. A technique using high-resolution-CT (HRCT) has been developed to measure the internal size of the bronchi. Five normal subjects had a conventional HRCT scan at full, deep inspiration. The internal size of the airways from segmental to the sixth generation bronchi was measured using an original method of data analysis. The size of the airways ranged 0.5-50 mm2 (approximately 0.8-8 mm in diameter. The technique was found to be highly reproducible, making it possible to study the variation in airways calibre after provocative challenge or administration of bronchodilator in asthma.

Adult↗