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Biomedical subjects

P Soyer

Publications and source records attributed to P Soyer.

At least 145 records · Page 8Linked to original sources
PubMed1989

[Spontaneous intrahepatic hemorrhage: a severe complication of the Hellp syndrome. Value of early radiologic diagnosis. Apropos of a case].

One case of spontaneous hepatic hemorrhage during a severe pre-eclampsia and Hellp syndrome (hemolysis, elevated liver function tests, low platelet count) is reported. This serious complication can be detected by ultrasonography and C.T. The normal sonographic appearance of the liver must prompt a new sonographic examination as soon as possible. C.T. of the abdomen confirmes the diagnosis and delineates the lesions more precisely. It is suggested that with the availability of ultrasound and computed tomography to diagnose and stage the hepatic hemorrhage, they have a systematic indication during the Hellp syndrome.

Adult↗
PubMed1988

Treatment of herpes zoster. Recombinant alpha interferon versus acyclovir.

Sixty-four patients received systemic alpha-interferon (10 million units subcutaneously daily) and 63 received systemic acyclovir (5 mg/kg body weight intravenously thrice daily) in a randomized study of acute herpes zoster. Start of healing, complete healing, development of new skin lesions in the primarily affected and in other dermatomes, and degree and duration of pain were evaluated. Both drugs proved equally clinically efficient without statistically different findings between the two groups; herpes zoster neuralgia was not prevented by either interferon or acyclovir therapy. Minor clinical side effects occurred slightly more frequently during interferon treatment and included fever and nausea. Transient and moderate leukopenia was observed in nearly all patients in the interferon group.

Acyclovir↗
PubMedDate not supplied

MR arterial portography with gadolinium-DOTA: analysis of nontumoral perfusion abnormalities.

The purpose of this article was to determine the frequency and imaging characteristics of nontumoral perfusion abnormalities observed on magnetic resonance imaging (MRI) obtained during arterial portography (MRAP). MRAP examinations done in 23 consecutive patients with malignant hepatic tumors were retrospectively and blindly reviewed by two readers for the presence of nontumoral perfusion abnormalities. MR Images were assessed for the presence, location, shape, and type of nontumoral perfusion abnormalities, and correlated with intraoperative findings or follow-up imaging studies. Fourteen nontumoral perfusion abnormalities were found in 10 patients (43%). Nontumoral perfusion abnormalities were categorized into these five types: triangular nontumoral perfusion defects not associated with a more proximal tumor (n = 6), triangular nontumoral perfusion abnormalities distal to a tumor (n = 2), hypoperfusion involving 1 or >1 segment (n = 2), hyperenhancement of the posterior part of the right hemiliver (n = 2), and gravity-effect-related perfusion abnormality (n = 2). Nontumoral perfusion abnormalities are seen frequently on MRAP examination. Recognition of these abnormalities remains crucial to avoid misdiagnosis.

Contrast Media↗
PubMedDate not supplied

MR imaging of the liver: effect of portal hypertension on hepatic parenchymal enhancement using a gadolinium chelate.

The purpose of this study was to prospectively investigate the extent to which reduced portal blood flow in patients with hepatic cirrhosis and portal hypertension affects hepatic parenchymal enhancement during gadolinium-chelate-enhanced dynamic MR imaging. Breath-hold three-dimensional (3D) spoiled gradient-recalled echo (GRE) MR imaging technique obtained after intravenous administration of a gadolinium chelate was used to measure hepatic parenchymal enhancement and time to peak enhancement in 20 patients with hepatic cirrhosis and clinical evidence of portal hypertension (group 1) and in 20 control subjects without portal hypertension (group 2) who were matched for age, sex, and body weight. Mean peak hepatic enhancement values +/- SD and times to peak enhancement +/- SD were determined for both groups of patients. Mean peak enhancement value (+/-SD) was 78.7% +/- 36.2 in group 1 and 91.6% +/- 46.2 in group 2 (not significant). However, in the nine patients in group 1 with splenomegaly, mean peak enhancement value was 61.3% +/- 14.4, whereas it was 93.0% +/- 42.7 in the 11 patients without splenomegaly (P < .05). Mean time to peak enhancement was 84 seconds +/- 23 in group 1 and 54.0 sec +/- 25.0 in group 2 (P < .01). Our results show that mean peak enhancement value of hepatic parenchyma after intravenous administration of a gadolinium chelate is significantly altered for patients with portal hypertension and splenomegaly. In addition, the time to peak enhancement is delayed significantly when portal hypertension is present. Thus, it is possible that the optimal time for imaging the liver during the portal phase must be tailored to the status of the portal system of the patient.

Adult↗
PubMedDate not supplied

MRI of Budd-Chiari syndrome.

A retrospective study was undertaken to reassess the various magnetic resonance imaging (MRI) features of Budd-Chiari syndrome (BCS). MRI examinations of 22 patients with pathologically confirmed BCS were studied. Spin-echo (SE) T1- (TR = 300-450 ms/TE = 12-15 ms), and SE T2-weighted (TR = 1600-2000 ms/TE = 30-60/90-120 ms) MRI images were obtained in all patients. Gradient-recalled-echo (GRE) images (TR = 7-60 ms/TE = 3-19 ms, flip angle = 10-40 degrees) were obtained in 14 patients. MRI showed thrombosis of three or two hepatic veins in 19 (86%) and 3 (14%) patients, respectively. Spontaneous intrahepatic anastomoses was depicted in five (23%) patients. Ascites appeared in 15 patients (68%). Thrombosis or external compression of the inferior vena cava (IVC) by an enlarged caudate lobe was depicted in six (27%) and five (23%) patients, respectively. Prominent azygos and hemiazygos veins were demonstrated in seven (32%) patients (six of whom had thrombosis of the IVC). MRI showed hepatomegaly in all patients and enlarged caudate lobe in 18 (82%) patients. SE T1- and SE T2-weighted MRI images revealed inhomogeneous signal intensity of hepatic parenchyma in 14 (64%) patients. SE T1- and SE T2-weighted MRI images showed homogeneous signal intensity of hepatic parenchyma in eight (36%) patients. Our results demonstrate that BCS displays various features on MRI images, and such information is important for diagnosis.

Adult↗
PubMedDate not supplied

Intrahepatic bile duct dilatation secondary to hepatocellular carcinoma: CT features in 10 patients.

BACKGROUND: To determine the computed tomographic (CT) features of bile duct obstruction secondary to hepatocellular carcinoma (HCC). METHODS: CT examinations of 10 patients (mean age, 58 years) with bile duct obstruction secondary to HCC were retrospectively reviewed. RESULTS: All tumors were intrahepatic. Eight tumors were well-delineated and two were ill-defined. The largest diameters of tumor ranged from 1.5-6.0 cm (mean, 3.6 cm). All tumors were hypodense before contrast and did not contain calcification. After contrast, four tumors became hypodense, three were isodense, and three were hyperdense to the liver. No tumor demonstrated encapsulation. Diffuse intrahepatic bile duct dilation was observed in seven patients. One patient had extrahepatic bile duct dilatation. Localized bile duct dilatation was observed in three patients, in the hemi-liver which contained the tumor. No tumor invaded the portal vein. CONCLUSION: Although rare, HCC should be included in the differential diagnosis of bile duct obstruction. This diagnosis should be suggested in patients with bile duct obstruction when CT shows an associated intra- or extrahepatic mass. Our results suggest that HCC responsible for bile duct obstruction is remarkable for the absence of encapsulation.

Adult↗
PubMedDate not supplied

Bile duct involvement in hepatocellular carcinoma: MR demonstration.

BACKGROUND: To determine the magnetic resonance (MR) features of hepatocellular carcinoma (HCC) with associated bile duct involvement. METHODS: MR examinations of six patients (mean age, 62 years) demonstrating bile duct involvement due to HCC were retrospectively reviewed and compared to surgical and pathologic findings. RESULTS: Three of the tumors were solitary, and three were multifocal. In two patients, MR showed direct biliary duct invasion by tumor. On T1-weighted MR images, four tumors were hypointense compared to the liver and two were isointense. On T2-weighted MR images, four tumors were hyperintense, and two were isointense. The two tumors studied with dynamic T1-weighted MR images obtained after intravenous administration of a gadolinium chelate, displayed enhancement similar to that of the liver. There was no evidence of a tumor capsule on either unenhanced or enhanced MR images. Intrahepatic bile duct dilatation was seen in five patients. The extrahepatic bile duct was normal in all cases. CONCLUSION: Although rare, HCC should be included when considering the etiology of intrahepatic bile duct obstruction. Imaging features suggestive of the diagnosis by MR include intrabiliary tumor or bile duct obstruction with an associated hepatic mass.

Aged↗
PubMedDate not supplied

MR imaging of intrahepatic cholangiocarcinoma.

BACKGROUND: The purpose of this study was to determine the magnetic resonance (MR) features of intrahepatic cholangiocarcinoma. METHODS: MR imaging studies of seven cases of pathologically proven intrahepatic cholangiocarcinoma were retrospectively reviewed. RESULTS: On MR images the tumors presented as a single mass (N = 5) or multiple nodules (N = 2), as well-delineated (N = 5) or ill-defined (N = 2), and as nonencapsulated (N = 7). Mean tumor diameter ranged from 6-14 cm (mean, 10 cm). On T1-weighted (TR/TE = 400-600/10-17 msec) images, the tumors were hypointense compared to the liver. The five tumors studied with dynamic MR imaging showed progressive centripetal filling-in after intravenous administration of a gadolinium chelate. On T2-weighted (TR/TE = 2000-2500/80-100 msec) images, all tumors were hyperintense compared to the liver; five were markedly hyperintense and two moderately hyperintense. Vascular encasement, bile duct dilatation within the tumor, and central scar were depicted on MR images in four, three, and two tumors respectively. CONCLUSION: The typical MR appearance of intrahepatic cholangiocarcinoma is a large well-delineated nonencapsulated tumor associated with intrahepatic venous encasement.

Adult↗
PubMedDate not supplied

Involvement of superior mesenteric vessels and portal vein in pancreatic adenocarcinoma: detection with CT during arterial portography.

A prospective study was designed to determine the utility of computed tomography (CT) during arterial portography (CTAP) in the detection of superior mesenteric vessels and portal vein involvement in patients with pancreatic adenocarcinoma. Eighteen patients with adenocarcinoma of the head of the pancreas and eight patients with benign pancreatic disease were investigated with CTAP, dynamic contrast-enhanced CT, and angiography. Appropriate review was made to determine presence or absence of superior mesenteric vessels and portal vein involvement. Final diagnosis was obtained in all cases by surgical explorations. The overall accuracy rate for detecting or excluding superior mesenteric vessels and portal vein involvement was 96% (25 of 26 patients) with CTAP, 88% (23 of 26 patients) with dynamic contrast-enhanced CT, and 85% (22 of 26 patients) with angiography. No statistically significant difference in accuracy was found among the three techniques. Our results suggest that the use of CTAP is not indicated in the preoperative detection of superior mesenteric vessels and portal vein involvement in patients with pancreatic adenocarcinoma.

Adult↗
PubMedDate not supplied

Hepatocellular carcinoma: findings on spiral CT during arterial portography.

BACKGROUND: To determine characteristic imaging features of hepatocellular carcinoma (HCC) on spiral CT during arterial portography (SCTAP) and to correlate the presence or absence of spontaneous portosystemic shunts with the degree of hepatic parenchymal enhancement during SCTAP in patients with HCC. METHODS: SCTAP scans of 20 patients with HCC were retrospectively analyzed for tumor features, degree of hepatic parenchymal enhancement, and presence or absence of spontaneous portosystemic shunts. RESULTS: Nineteen tumors (95%) were hypoattenuating masses and one (5%) was isoattenuating compared with the liver on SCTAP. In seven patients (35%), the tumor was homogeneous in attenuation. Tumor margins were smooth and regular in 12 patients (60%). Vascular invasion and encapsulation were depicted in 10 patients (50%). A high degree of hepatic parenchymal enhancement was observed in 14 patients; one of them (7%) had spontaneous portosystemic shunts. Poor or moderate enhancement was observed in six patients; five of them (83%) had spontaneous portosystemic shunts (p < .001). CONCLUSION: The presence of a low attenuated homogeneous intrahepatic mass with associated vascular invasion on SCTAP scans should raise the possibility of HCC. The presence of spontaneous portosystemic shunts is associated with poor or moderate parenchymal enhancement.

Adult↗
PubMedDate not supplied

Hepatic pseudolesion around the falciform ligament: prevalence on CT examination.

BACKGROUND: The purpose of this study was to determine the prevalence of hepatic pseudolesions seen around the falciform ligament on computed tomography (CT) of the abdomen obtained with intravenous administration of contrast material. METHODS: We first retrospectively reviewed the CT scans of six patients in whom hepatic pseudolesions were seen around the falciform ligament. The abdominal CT scans of 587 patients were then prospectively analyzed for the presence of hepatic pseudolesions around the falciform ligament to determine the prevalence of this finding on CT examinations. RESULTS: CT scans in the first six patients showed two types of hepatic pseudolesion around the falciform ligament. In three patients, hepatic pseudolesions were focal spared areas in fatty liver. In three patients, hepatic pseudolesions were developed in nonfatty liver. Prospectively, hepatic pseudolesions were found on five of 587 CT examinations (prevalence = 1%). A single hepatic pseudolesion was found in segment 4 on two examinations. Two hepatic pseudolesions (one in segment 4 and one in segment 3) were found together on three CT examinations. CONCLUSION: Hepatic pseudolesions around the falciform ligament are seldom seen on CT scan. However, recognition of these pseudolesions is crucial because they may be interpreted as true tumors.

Adult↗
PubMedDate not supplied

Hepatic metastases from leiomyosarcoma: MR features with histopathologic correlation.

BACKGROUND: To determine the magnetic resonance (MR) imaging features of hepatic metastases from leiomyosarcoma and determine the pathologic basis for the MR appearance of these neoplasms. METHODS: MR examinations of eight patients with a total of 16 hepatic metastases from leiomyosarcoma were retrospectively reviewed. Hepatic metastases originated from a primary gastrointestinal (n = 6), uterine (n = 1), or retroperitoneal (n = 1) leiomyosarcoma. Correlation between MR features and pathologic findings was performed in 11 metastases from which histologic material was obtained. RESULTS: Among the 10 metastases seen on T1-weighted MR images, nine were homogeneous and one was heterogeneous. The latter contained areas of necrosis and hemorrhage on pathologic examination. Among the 16 metastases seen on T2-weighted MR images, 12 were well delineated and completely homogeneous, with a marked hyperintense signal ("hemangiomalike" pattern). These neoplasms were composed of smooth fibrous tissue without macroscopically visible areas of necrosis on pathologic examination. The remaining four metastases were heterogeneous and contained varying degrees of necrosis and hemorrhage or gelatinous tissue. CONCLUSION: A hemangiomalike pattern is the most common feature on T2-weighted MR images. We found that homogeneous hyperintensity of hepatic metastases from leiomyosarcoma on T2-weighted MR image does not reflect cystic changes.

Adult↗
PubMedDate not supplied

Fluid-fluid levels within focal hepatic lesions: imaging appearance and etiology.

PURPOSE: To report our experience with fluid-fluid levels within focal hepatic lesions and determine if this finding indicates a specific diagnosis. MATERIALS AND METHODS: We reviewed our experience with eight patients with focal hepatic lesions that showed fluid-fluid level on cross-sectional imaging. Seven CT scans, four MR examinations, and four sonograms were reviewed. The hepatic lesions included metastases (four patients), biliary cystadenoma (two patients), cavernous hemangioma (one patient), and hematoma (one patient). A histologic diagnosis was made in all cases. RESULTS: Fluid-fluid levels were found in both malignant and benign focal hepatic lesions. Fluid-fluid levels were seen on six CT scans, four MR examinations and on none of the four sonograms. Radiologic-pathologic correlation showed that fluid-fluid levels corresponded to internal hemorrhage in all but one case. In the case of cavernous hemangioma, a fluid-fluid level was found to correspond to a sedimentation effect within a large vascular space. CONCLUSION: Fluid-fluid levels in focal hepatic lesions do not indicate a specific diagnosis but can be seen in both malignant and benign conditions affecting the liver.

Adult↗
PubMedDate not supplied

Macrocystic serous cystadenoma of the pancreas: CT and endosonographic features.

Recently, the term "serous cystadenoma" has been adopted in the pathological community to qualify the so-called microcystic adenoma of the pancreas. This change in terminology was based on the emergence of a new type of serous cystadenoma of the pancreas, i.e., the macrocystic variant. We report one case of pathologically proven macrocystic serous cystadenoma of the pancreas for which the diagnosis of mucinous cystadenoma was suggested preoperatively. This rare but benign macrocystic variant exhibits radiological features similar to those of mucinous cystadenoma. In addition, inflammatory changes and foci of hemorrhage within the tumor may simulate mucinous cystadenocarcinoma.

Adenoma↗
PubMedDate not supplied

Carcinoid tumors of the abdomen: CT features.

Carcinoid tumors are rare neuroendocrine neoplasms that belong to a more general category of tumor called the APUDomas. Ninety percent of carcinoid tumors are located in the gastrointestinal tract. Abdominal carcinoid tumors are categorized according to the division of the primitive gut from which they arise. Carcinoid tumors originating from the foregut develop in the gastric wall, duodenum, and pancreas; those originating from the midgut develop from the small bowel, appendix, and right colon; and those originating from the hindgut develop from the transverse or left colon or from the rectum. This report illustrates the computed tomographic appearance of primary and metastatic carcinoid tumors of the abdomen. Among the different organs that may be involved by metastases from carcinoid tumor, special emphasis is placed on the liver.

Abdominal Neoplasms↗
PubMedDate not supplied

Imaging features of nodular regenerative hyperplasia of the liver mimicking hepatic metastases.

We described the sonographic, computed tomographic (CT), and magnetic resonance (MR) imaging features of one atypical case of nodular regenerative hyperplasia of the liver. The presence of multiple hepatic nodules suggested the diagnosis of metastatic disease to the liver because of a peripheral rim of enhancement on CT obtained after intravenous administration of contrast material and a halo sign on T2-weighted spin-echo MR imaging. Examination of the pathologic specimen obtained after surgical biopsy showed that the nodules were made of hepatocytes, with a nodular arrangement surrounded by peliosis, without fibrosis or cirrhosis. These findings suggested that peliosis may cause peripheral rim of enhancement on CT and halo sign on MR imaging. In light of this case, nodular regenerative hyperplasia of the liver should be considered in the differential diagnosis of hepatic metastases.

Adult↗