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Biomedical subjects

M Levesque

Publications and source records attributed to M Levesque.

At least 37 records · Page 2Linked to original sources
PubMed1994

Ectopic production of prostate specific antigen by a breast tumor metastatic to the ovary.

We have recently reported that about 30% of breast tumors produce prostate specific antigen (PSA). We examined here, 99 primary ovarian cancer tumors and found relatively low levels of PSA in only three tumors. One patient with metastatic ovarian cancer from a primary breast tumor, produced relatively high levels of PSA and responded well to antiestrogen treatment although she was steroid receptor-negative. Another patient with metastatic ovarian cancer from a primary breast tumor did not produce PSA and did not respond to treatment although she was steroid hormone receptor-positive. This data describe for the first time, ectopic PSA production by a breast tumor at the ovarian metastatic site and further support the view that PSA is a favourable prognostic indicator in breast cancer.

Breast Neoplasms↗
PubMed1994

Focal hepatic masses: comparison of detection during arterial portography with MR imaging and CT.

PURPOSE: A prospective study was performed to compare the sensitivity and specificity of magnetic resonance (MR) imaging and computed tomography (CT) both performed during arterial portography in depicting focal hepatic masses. MATERIALS AND METHODS: Eleven patients with 31 pathologically proved focal hepatic masses were prospectively evaluated. MR arterial portography was performed with 4 mL of a 0.5 mmol/kg solution of gadolinium tetraazacyclododecanetetraacetic acid (DOTA) injected through a catheter into the superior mesenteric artery during multisection gradient-echo imaging. RESULTS: MR arterial portography depicted 29 of the 31 masses (sensitivity, 94%). CT arterial portography depicted 27 of the 31 masses (sensitivity, 87%). Two masses not depicted with either CT or MR had a diameter of 3 and 7 mm, respectively. Neither MR nor CT demonstrated a false-positive finding (specificity, 100%). The difference in sensitivity and specificity between the two techniques was not statistically significant. CONCLUSION: MR arterial portography does not enable detection of significantly more focal hepatic masses than does CT arterial portography.

Female↗
PubMed1994

CT of hepatic tumors: prevalence and specificity of retraction of the adjacent liver capsule.

OBJECTIVE: The purpose of this study was to describe the CT features of capsular retraction of the liver adjacent to hepatic tumors and to test the hypothesis that this finding is specific for malignant hepatic tumors. MATERIALS AND METHODS: We first retrospectively reviewed the CT scans of eight patients with pathologically proved malignant hepatic tumors (five secondary and three primary) who had CT scans that showed retraction of the overlying liver capsule. Then, using criteria developed from the first eight cases, we prospectively studied 253 patients with pathologically proved hepatic tumors (75 benign, 178 malignant) to determine the prevalence of retraction of the liver capsule shown by CT and the specificity of this finding for malignant hepatic tumors. RESULTS: CT scans in the first eight patients showed two types of capsular retraction. In seven patients, the retracted liver capsule was smooth and regular. In one patient, capsular retraction was associated with central ulceration extending to and eroding the liver capsule. Four of 253 patients studied prospectively had hepatic tumors with associated capsular retraction (prevalence, 2%). In those four cases, the retracted liver capsule was smooth and regular. All four tumors were malignant (one fibrolamellar hepatocellular carcinoma, two carcinoid tumors, one colorectal metastasis). CONCLUSION: Capsular retraction of the liver adjacent to hepatic tumors is an uncommon CT finding that appears to be specific for malignant hepatic tumors.

Carcinoma, Hepatocellular↗
PubMed1994

Detection of recurrent hepatic metastases after partial hepatectomy: value of CT combined with arterial portography.

OBJECTIVE: We did a retrospective study to evaluate the sensitivity of CT combined with arterial portography in detecting recurrent hepatic metastases after partial hepatectomy. MATERIALS AND METHODS: CT scans combined with arterial portography in 18 patients who had partial hepatectomy and suspected intrahepatic recurrence of metastases were retrospectively reviewed. Eleven of the patients had further surgery, and recurrent hepatic metastases were proved; seven patients were inoperable. The sensitivity of CT with arterial portography for detecting recurrent intrahepatic metastases was determined and correlated with intraoperative findings and findings on follow-up imaging studies in the 11 patients (with a total of 23 hepatic metastases) who had further surgery. RESULTS: Not one of the 18 CT examinations combined with arterial portography was compromised by inhomogeneous perfusion of contrast material in the portal vein. Of the 23 metastases that were found in the 11 patients who had further surgery, 21 (91%) were shown on CT with arterial portography. In two patients, CT with arterial portography showed two subcapsular hypoattenuating pseudolesions that were correctly identified as nontumorous perfusion defects, as confirmed by intraoperative findings and follow-up imaging studies. CONCLUSION: This study shows that postoperative CT with arterial portography is efficacious in the detection of intrahepatic recurrent metastases in patients who have had a partial hepatectomy. Furthermore, prior partial hepatectomy does not compromise the quality of this examination.

Colorectal Neoplasms↗
PubMed1993

Hodgkin's and non-Hodgkin's hepatic lymphoma: sonographic findings.

The sonographic studies of 72 patients with pathologically proven Hodgkin's or non-Hodgkin's hepatic lymphoma were retrospectively reviewed. Sixty-eight patients (94%) had secondary hepatic lymphoma (nine of them had AIDS-related lymphoma) and four patients (6%) had primary lymphoma of the liver. Forty-six of 72 patients (64%) had diffuse hepatic involvement, and 26 of 72 patients (36%) had focal liver lesions as demonstrated by sonography. Four patterns of disease were identified: (a) hepatomegaly was depicted by sonography in 26 of the 59 patients with secondary hepatic lymphoma not related to AIDS, in two of the nine patients with AIDS-related secondary hepatic lymphoma, and in one of the four patients with primary hepatic lymphoma; (b) multiple rounded well-delineated hypoechoic liver lesions were found in 22 of the 68 patients with secondary hepatic lymphoma; (c) a large heterogeneous echoic mass, which was an evocating clue to the diagnosis of primary lymphoma of the liver, was found in the four patients with primary lymphoma of the liver; and (d) an absence of sonographic abnormalities was found in 20 of the 59 patients with secondary lymphoma not related to AIDS. Liver involvement with lymphoma should be considered in any patient who develops multiple homogeneous hypoechoic liver masses, even in the absence of known underlying lymphomatous disease.

Adult↗
PubMed1993

High-resolution sonographic guidance for transjugular liver biopsy.

A prospective randomized study was performed to compare conventional right internal jugular vein catheterization technique with high-resolution sonographically guided catheterization for transjugular liver biopsy. Forty-seven patients were assigned to undergo either conventional or high-resolution sonographically guided right internal jugular vein catheterization for transjugular liver biopsy. Sonographic guidance was significantly better than conventional guidance, reducing the number of failed catheterizations, from 22% (5 of 23) to 0% (0 of 24) (p < .05). Sonography also reduced the mean number (+/- SD) of passes required to catheterize the vein from 4.21 +/- 1.53 to 1.54 +/- 0.66 (p < .001) and was successful in 100% (5 of 5) of patients in whom conventional catheterization failed. High-resolution sonographic guidance is strongly recommended for transjugular liver biopsy in patients at high risk for bleeding.

Adult↗
PubMed1993

Mesoinnominate shunt for the treatment of Budd-Chiari syndrome: evaluation with multimodality imaging.

The construction of a mesoinnominate shunt between the superior mesenteric vein and the left innominate vein is a recent surgical procedure for the treatment of Budd-Chiari syndrome with vena caval obstruction. The purpose of this study was to determine the role of the different imaging modalities for the follow-up of mesoinnominate shunts. Doppler US (n = 32), and MR imaging examinations (n = 32) were prospectively performed in 10 patients with mesoinnominate shunts. Shunt patency or thrombosis was confirmed with angiography (n = 32) and transhepatic portography with pressure measurement (n = 6). For each follow-up evaluation, all examinations were performed within 4 days. Shunt patency was correctly demonstrated in 28/28 cases with Doppler US, CT and MR imaging. Shunt thrombosis was correctly demonstrated in 4/4 cases with Doppler US, CT and MR imaging. Since Doppler US, CT and MR imaging have the same accuracy for diagnosing mesoinnominate shunt patency and detecting thrombosis, our study suggests that redundant screening methods can be avoided. Doppler US is accurate enough and should be the preferred technique in the evaluation of mesoinnominate shunts.

Adult↗
PubMed1993

Primary lymphoma of the liver: MR findings.

Primary lymphoma of the liver is a rare disease. The MR appearances of three cases of pathologically confirmed primary non-Hodgkin's lymphoma of the liver are presented. All three lymphomatous lesions appeared as unique well demarcated focal liver lesions on MR images. On T1-weighted images, two lesions were hypointense and one slightly hyperintense to the liver. On T2-weighted images, the three lesions were slightly heterogeneous and hyperintense. Lobulation, which was better seen on T2-weighted images, was noticed in one lesion. One lesion was studied after gadopentetate dimeglumine injection and showed marked and heterogeneous enhancement.

Contrast Media↗
PubMed1993

False-positive CT portography: correlation with pathologic findings.

OBJECTIVE: A retrospective study was performed to determine the causes of false-positive diagnoses based on CT findings obtained during superior mesenteric arterial portography (CT portography) and to correlate the imaging characteristics of the incorrectly diagnosed lesions with their pathologic findings. MATERIALS AND METHODS: In a series of 52 patients who had CT portography before surgical exploration of the liver, eight had a total of 10 false-positive findings, yielding a false-positive diagnosis rate of 15%. In eight cases, the false-positive findings from CT portography were correlated with the histologic material obtained during partial hepatic resection or intraoperative biopsies at the corresponding sites. RESULTS: Of the 10 false-positive findings on CT portograms, seven led to false-positive diagnoses of hepatic tumors. Conversely, three nontumorous false-positive findings were erroneously considered to be portal perfusion defects. The final diagnoses based on pathologic findings included focal fatty infiltration of the liver (three), cirrhosis (two), and portal perfusion defect (three). Two false-positive findings for which no histologic correlation was possible were considered to be portal perfusion defects on the basis of intraoperative findings. CONCLUSION: Recognition of false-positive findings is crucial in the preoperative evaluation of hepatic tumors because the findings may be interpreted as contraindications for surgery in patients who have operable tumors. The pathologic correlations show that several different entities can cause diagnoses based on CT portographic findings to be false-positive. However, differentiating between those entities remains a diagnostic challenge.

Adult↗
PubMed1993

Surgical treatment of hepatic metastases: impact of intraoperative sonography.

OBJECTIVE: A prospective study was done to determine the influence of intraoperative sonographic findings on surgical decision making in patients with hepatic metastases. SUBJECTS AND METHODS: Thirty-seven consecutive patients with hepatic metastases who underwent surgery (for hepatic resection or intraarterial catheter placement) were prospectively evaluated. For each patient, the resectability of the metastases and the surgical approach were determined preoperatively on the basis of the combined results of sonography, bolus dynamic CT, and CT during arterial portography (CTAP). Those determinations were compared with the decisions made during surgery, which were based on the intraoperative sonographic findings. The surgical procedure that was actually performed was compared with the procedure decided on preoperatively. RESULTS: Eighty-two metastases were surgically and pathologically proved. Preoperatively, 73 (89%) of the 82 metastases were detected with a combination of sonography, bolus dynamic CT, and CTAP. Seventy-nine metastases (96%) were detected with intraoperative sonography. Six metastases in four patients were detected only with intraoperative sonography. Furthermore, in two patients, intraoperative sonography showed four additional metastases, which changed the initial surgical approach decided on preoperatively. CONCLUSION: Our study suggests that intraoperative sonography provides important data that cannot be obtained with preoperative imaging techniques and affect the surgical decision making in patients with hepatic metastases.

Adult↗
PubMed1993

CT arterial portography of the abdomen: effect of injecting papaverine into the mesenteric artery on hepatic contrast enhancement.

OBJECTIVE: The purpose of this study was to determine the effect of precontrast injection of papaverine hydrochloride into the superior mesenteric artery on the degree of contrast enhancement of the hepatic parenchyma during CT arterial portography (CTAP, CT with injection of contrast material into the superior mesenteric artery). SUBJECTS AND METHODS: Twenty-two patients were included in this study. All patients had a baseline unenhanced CT scan and then had CTAP performed with transcatheter injection of 150 ml of nonionic iodinated contrast material (30 g iodine/100 ml) at a rate of 2 ml/sec. Eleven patients received a precontrast injection of 40 mg of papaverine hydrochloride via catheter into the superior mesenteric artery, and 11 patients had CTAP without papaverine hydrochloride. Attenuation of the liver was measured before and after contrast administration in both groups of patients. For each CTAP section, the absolute hepatic enhancement (postcontrast attenuation--precontrast attenuation) and the relative hepatic enhancement ([absolute hepatic enhancement/precontrast attenuation] x 100) were calculated. Also, the mean absolute enhancement and the mean relative enhancement for the entire liver were calculated for each patient. RESULTS: The mean relative enhancement (+/- SD) of hepatic parenchyma was 192 +/- 54% with papaverine hydrochloride and 146 +/- 26% without papaverine hydrochloride. Relative enhancement was significantly higher when papaverine hydrochloride was used (p < .02). The mean absolute enhancement (+/- SD) of hepatic parenchyma was 123 +/- 25 H with papaverine hydrochloride and 91 +/- 19 H without papaverine hydrochloride. Absolute enhancement was significantly higher in patients who had papaverine hydrochloride (p < .01). CONCLUSION: The results show that precontrast transcatheter infusion of papaverine hydrochloride increases the degree of contrast enhancement of the liver during CTAP.

Aged↗
PubMed1993

The variable of hypertrophic changes in hepatic morphology: CT appearance.

The liver has a particular ability to regenerate and demonstrate hypertrophy under several circumstances. The aim of this essay is to illustrate the computed tomographic (CT) appearances of the hypertrophic changes in hepatic morphology and to focus on the broad spectrum of etiologies. One thousand seven hundred and twenty-one patients who had CT of the abdomen were retrospectively studied. One hundred and fifty-three (9% of them (82 men, 71 women), with a mean age of 50 years (range: 18 to 87 years), had hypertrophic changes in the liver. The different final diagnoses included liver cirrhosis (n = 75), Budd-Chiari syndrome (n = 35), partial hepatectomy (n = 25), cholangiocarcinoma (n = 10), liver metastasis (n = 1), preoperative portal vein embolization (n = 3), schistosomiasis (n = 1), and congenital hypertrophy (n = 3). Hypertrophic changes in hepatic morphology are not uncommon conditions and CT is likely to afford the opportunity to detect them. The discovery of such an abnormality must prompt the radiologist to eliminate the possibility of neoplastic etiology or underlying portal hypertension.

Adolescent↗
PubMed1993

[The role of embolization and chemo-embolization in the emergency treatment of hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma].

Twelve caucasian patients with intraperitoneal hemorrhage due to spontaneous rupture of hepatocellular carcinoma were treated by emergency transcatheter arterial embolization (n = 9) or chemoembolization (n = 3). Pretreatment angiography showed active bleeding (extravasation of contrast medium) in two patients only. Successful hemostasis was initially achieved in all patients. Early recurrence of hemorrhage was noted in 3 patients with large tumors; two were successfully treated by a second embolization and one died immediately after the first embolization. Of the 12 patients, two underwent subsequent chemoembolization while two had surgical resection of their tumors. The mean length of survival was 7 months from the time of rupture. No serious complications related to embolization or chemoembolization were noted. Our data suggest that emergency embolization or chemoembolization is an effective treatment in caucasian patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis of ruptured hepatocellular carcinoma in those patients, however, remains poor.

Adult↗
PubMed1993

[Digestive hemorrhage caused by congestive gastropathy in a patient with liver cirrhosis: emergency treatment by transjugular intrahepatic portosystemic anastomosis].

A 34-year-old woman with liver cirrhosis and portal hypertension was admitted for gastric bleeding due to congestive gastropathy. Her past medical history included 4 episodes of variceal rupture within the last 5 months. As medical treatment was a failure, an emergency transjugular intrahepatic portosystemic shunt was successfully performed, resulting in a marked drop in portal pressure (from 32 to 15 mm Hg) and a subsequent arrest of acute hemorrhage. Four months later, no recurrent bleeding has been observed and the shunt has remained patent as documented by duplex Doppler sonography.

Adult↗
PubMed1993

[Ultrasound-guided biopsy in focal lesions of the liver. Report on an automated biopsy system].

Two techniques for focal liver lesion biopsy were retrospectively evaluated to compare relative safety and efficacy. After sonographic localization of the focal liver lesion and biopsy with a hand-held 18-gauge cutting needle, a pathologically adequate specimen was obtained in 49 of 55 cases (89%) requiring 1 to 4 passes (mean, 2.1 per patient). A major complication occurred in one case and minor complication were noted in three cases. Forty one biopsies were performed by using a single use automatic core biopsy system with a 18-gauge cutting needle and real time sonographic guidance. With this automatized technique, specimens adequate for diagnosis were obtained in 40 of 41 cases (97.5%), requiring only 1 pass in all cases. Neither major nor minor complication was noted with this technique. We conclude that using sonographic guidance, the automatic core biopsy system with a 18-gauge cutting needle yields a slightly better rate of adequate specimens with a lower frequency of complications.

Adult↗
PubMed1992

Detection of liver metastases from colorectal cancer: comparison of intraoperative US and CT during arterial portography.

A prospective study was performed to compare the sensitivities of intraoperative ultrasound (US) and computed tomography during arterial portography (CTAP) in the depiction of hepatic metastases from colorectal cancer. Twenty-five patients with hepatic metastases from colorectal cancer were evaluated. All patients underwent partial hepatectomy, and 56 metastases were pathologically proved. Preoperatively, CTAP depicted 51 of the 56 metastases (91%). Intraoperative US depicted 54 of the 56 metastases (96%). Intraoperative US depicted three metastases (5%) that were not depicted with CTAP and two that were missed with palpation (3%). Furthermore, intraoperative US did not demonstrate any false-positive lesions. There was no statistically significant difference in sensitivity between the two techniques. The authors concluded that intraoperative US does not enable detection of more liver metastases from colorectal cancer when CTAP is considered as the preoperative standard of reference. Nevertheless, the results of the study suggest that intraoperative US and CTAP are complementary techniques, and the preoperative use of CTAP for determining the feasibility of hepatic resection cannot prevent the use of intraoperative US.

Adult↗