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Biomedical subjects

P Soyer

Publications and source records attributed to P Soyer.

At least 109 records · Page 6Linked to original sources
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

Hepatic metastases: detection with multisection FLASH MR imaging during gadolinium chelate-enhanced arterial portography.

PURPOSE: To determine the feasibility and sensitivity of multisection fast low-angle shot (FLASH) magnetic resonance (MR) imaging in the depiction of hepatic metastases. MATERIALS AND METHODS: The cases of 10 patients with 39 surgically proved hepatic metastases were prospectively evaluated. After unenhanced T1- and T2-weighted spin-echo (SE) and FLASH imaging, 4 mL of a 0.5 mol/L solution of a gadolinium chelate (tetraazacyclododecanetetraacetic acid) was injected into the superior mesenteric artery during FLASH imaging in a single breath-holding period. RESULTS: No side effects were noted. With multisection FLASH MR arterial portography, tumor-to-liver contrast-to-noise ratio (34.5 +/- 4.4) was significantly increased compared with unenhanced MR imaging. Sensitivity was 74% (29 of 39) for combined SE and multisection FLASH imaging and 95% (37 of 39) for multisection FLASH MR arterial portography (McNemar test, P < .02). CONCLUSION: Multisection FLASH MR arterial portography is a safe, feasible, and sensitive technique with which to detect hepatic metastases.

Adult↗
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

Segmental anatomy of the liver: utility of a nomenclature accepted worldwide.

A major use of imaging techniques in the preoperative evaluation of hepatic tumors is to help the surgeon determine the feasibility of hepatic resection. Although the segmental location of tumors is not the sole criterion for determining resectability, such information is crucial for the preoperative planning of the type of resection.

Humans↗
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↗
PubMed1992

Hepatic metastases from colorectal cancer: influence of hepatic volumetric analysis on surgical decision making.

A prospective study was performed to determine the impact of preoperative assessment of estimated postoperative liver volume on surgical decision making for liver metastases from colorectal cancer. Assessment of estimated postoperative liver volume was performed before surgery in 25 patients. Mean estimated postoperative liver volume +/- standard deviation (SD) was 697 cm3 +/- 317 (range, 320-1,532 cm3). Mean relative estimated postoperative liver volume +/- SD was 51% +/- 16 (range, 20%-90%). In two patients, relative estimated postoperative liver volumes of less than 35% prevented resection. These two patients underwent preoperative portal vein embolization, which resulted in marked hypertrophy of the unembolized healthy part of the liver and subsequent safe resection. Before surgery, all patients had a relative estimated postoperative liver volume of greater than 35%, and no cases of postoperative liver failure occurred. The results demonstrated that assessment of estimated postoperative liver volume provides vital preoperative data for reducing the risk of postoperative liver failure.

Adult↗
PubMed1992

Preoperative assessment of resectability of hepatic metastases from colonic carcinoma: CT portography vs sonography and dynamic CT.

OBJECTIVE: A retrospective study was performed to determine the influence of CT portography vs sonography and dynamic CT on the preoperative assessment of the resectability of hepatic metastases from colorectal cancer. MATERIALS AND METHODS: Results of sonography, bolus dynamic CT, and CT portography in 28 patients who underwent surgical exploration (resection or intraarterial catheter placement) for hepatic metastases from colorectal cancer were retrospectively reviewed by two abdominal radiologists and one hepatic surgeon. For each patient, the resectability and surgical approach were decided on the basis of the results of combined sonography-bolus dynamic CT and compared with the decision made from the CT portographic results alone. The final approach suggested was compared retrospectively with the surgical procedure actually performed. RESULTS: Sixty-nine metastases were identified at surgery and pathologically proved. Combined sonography-bolus dynamic CT and CT portography showed 52 (75%) and 64 (93%) metastases, respectively. Twelve metastases in five patients were seen only with CT portography. In four patients, CT portography depicted additional metastases, which changed the surgical approach that had been chosen on the basis of results of sonography and bolus dynamic CT. In one patient, CT portography showed four additional metastases, precluding hepatic resection. CONCLUSION: Findings from CT portography provide vital data unattainable with sonography and bolus dynamic CT that improve the preoperative assessment of the resectability of liver metastases from colonic carcinoma.

Colorectal Neoplasms↗