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P Taourel

Publications and source records attributed to P Taourel.

At least 55 records · Page 3Linked to original sources
PubMed1998

Diaphragmatic and subcutaneous seeding of hepatocellular carcinoma following fine-needle aspiration biopsy.

AIMS/BACKGROUND: We report the discovery of associated metastatic subcutaneous and metastatic diaphragmatic nodules on the needle track after fine-needle biopsy aspiration under echography, which has not yet been reported in the literature. METHODS: A 35-year-old man with non-replicating hepatitis B virus presented with a tumor that suggested hepatocarcinoma with cirrhosis. A diagnostic needle biopsy was carried out before surgery. Twelve months later, he presented with a series of four continuous metastatic diaphragmatic nodules on the inner wall lining the needle track. Surgery was performed, followed by external radiation (40 Gy). CONCLUSIONS: The risk of seeding following fine-needle biopsy aspiration of hepatocellular carcinoma can no longer be considered negligable. The real risk is probably underestimated. Even for biopsy of lesions localized to the inferior part of the liver, diaphragmatic seeding is possible. This seeding necessitates surgical resection, increasing the therapeutic morbidity of hepatocellular carcinomas. We believe that in cases where investigation of a small hepatic tumor suggests a hepatocellular carcinoma that could be resected, or for candidate patients for liver transplantation. one should not puncture the tumor. If this diagnostic biopsy is essential, then the needle track could be resected upon surgery, after cutaneous external tattooing.

Adult↗
PubMed1998

Choledocholithiasis: evaluation of MR cholangiography for diagnosis.

PURPOSE: To evaluate the test performance of magnetic resonance (MR) cholangiography for help in diagnosing choledocholithiasis. MATERIALS AND METHODS: Fast spin-echo MR cholangiography was performed by using a torso multicoil array in 110 patients suspected of having bile duct obstruction. Axial and coronal images were reviewed by two observers who were blinded to results of direct cholangiography and final diagnoses. The final diagnosis was established by using direct cholangiographic (n = 103) or surgical (n = 7) findings. RESULTS: Of the 110 patients, 30 (27%) had choledocholithiasis, and 80 (73%) did not. Reviewer 1 used MR cholangiograms to achieve a sensitivity of 90%, specificity of 100%, positive predictive value of 100%, negative predictive value of 96%, and overall accuracy of 97%. Reviewer 2 achieved a sensitivity of 90%, specificity of 93%, positive predictive value of 82%, negative predictive value of 96%, and overall accuracy of 92%. Interobserver agreement for MR cholangiograms was 93% (kappa = 0.82). CONCLUSION: MR cholangiography exhibited excellent test performance and resulted in excellent interobserver agreement for the diagnosis of choledocholithiasis.

Cholangiography↗
PubMed1997

Acute colonic diverticulitis: prospective comparative evaluation with US and CT.

PURPOSE: To compare the accuracy of ultrasonographic (US) and computed tomographic (CT) findings for diagnosis of acute colonic diverticulitis. MATERIALS AND METHODS: US and CT were prospectively performed in 64 consecutive patients suspected of having acute colonic diverticulitis. Images were interpreted independently in a blinded fashion. Imaging data were compared with the final diagnosis, which was based on initial clinical and follow-up examination results (n = 64) and pathologic (n = 22), endoscopic (n = 21), and contrast enema (n = 15) examination findings. RESULTS: Final diagnosis was acute colonic diverticulitis (n = 33), other acute abdominal condition (n = 24), or unknown (n = 7). Both CT and US findings yielded 84% accuracy. US and CT findings were not statistically significant different in terms of sensitivity (85% and 91%, respectively) and specificity (84% and 77%, respectively). Positive predictive value was 85% for US and 81% for CT; negative predictive value was 84% for US and 88% for CT. When determining alternative diagnoses, US and CT findings yielded sensitivity of 33% and 50%, respectively (difference not statistically significant). CT scans depicted a small pneumoperitoneum overlooked on plain radiographs and US scans. Six pericolic abscesses were depicted with both techniques; three were depicted with CT only. CONCLUSION: US and CT findings result in similar accuracy for the evaluation of patients suspected of having diverticulitis.

Acute Disease↗
PubMed1997

Flow pulsatility in the portal venous system: a study of Doppler sonography in healthy adults.

OBJECTIVE: The purpose of our study was to describe Doppler sonography patterns of venous flow in the portal system of healthy subjects and to compare pulsatility of flow with subjects' body mass, degree of inspiration, and body position. SUBJECTS AND METHODS: Doppler signals from the main, right, and left portal veins; superior mesenteric vein; splenic vein; and inferior vena cava of 23 healthy adults were prospectively studied. Pulsatility of flow was quantified using an index of venous pulsatility (VPI = [maximum frequency shift-minimum frequency shift]/maximum frequency shift). Antegrade flow peak velocities were also related to ECG tracings the time between two R waves being divided into four equal parts for analysis. The caliber variations of the main portal vein and inferior vena cava were measured with M-mode sonography. Doppler tracings were obtained with subjects in supine and sitting positions and during mid and deep inspiration. The subjects' heights and weights were obtained and the body mass index calculated (weight/[height2]). RESULTS: In the portal vein, the VPI was 0.48 +/- 0.31 (mean +/- SD). Marked pulsatility of venous flow (VPI > 0.5) was found in 12 of 23 subjects. We found an inverse correlation between the VPI and the subjects' body mass index (r = -.76; p < .001). Portal vein pulsatility decreased significantly during sitting (p < .05) and deep inspiration (p < .01). The portal VPI was correlated with caliber variation of the inferior vena cava (r = .59; p < .05). In the portal venous system, antegrade flow peak velocities occurred most often during the third quarter of the cardiac cycle, particularly in the splenic vein. CONCLUSION: Doppler sonography shows pulsatile portal venous flow in healthy adults, especially in thin subjects. This pulsatility has an inverse correlation to body mass. The finding of a pulsatile portal vein needs to be interpreted in clinical context and does not necessarily imply dysfunction of the right side of the heart.

Adult↗
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

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

Pancreas divisum: evaluation with MR cholangiopancreatography.

PURPOSE: To determine the usefulness of magnetic resonance (MR) cholangiopancreatography in the diagnosis of pancreas divisum. MATERIALS AND METHODS: In 310 patients, MR imaging was performed with heavily T2-weighted, two-dimensional, fast-spin-echo sequences. A body coil was used for 139 patients, and a torso multicoil and high-resolution imaging parameters were used for 171 patients. In 108 patients, correlation with endoscopic retrograde cholangiopancreatography (ERCP) was available. RESULTS: Two hundred sixty-eight examinations (86%) were diagnostic. Pancreas divisum was observed with MR imaging in 25 of 268 cases (9%)(interobserver agreement, 98% [kappa = .88]). Among the 171 examinations performed with a torso multicoil, 10% were nondiagnostic and the rate of detection of pancreas divisum was 12%. Pancreas divisum was depicted in six of the 108 patients who underwent ERCP, and there were no false-negative or false-positive MR imaging results in these patients. CONCLUSION: MR cholangiopancreatography is an accurate tool in the diagnosis of pancreas divisum and could replace ERCP.

Case-Control Studies↗
PubMed1996

Anatomic variants of the biliary tree: diagnosis with MR cholangiopancreatography.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) cholangiopancreatography in the diagnosis of anatomic variants of the biliary tree. MATERIALS AND METHODS: In 171 patients, the anatomy of the biliary tree was evaluated with MR cholangiopancreatography. Two independent reviewers evaluated the presence of anatomic variants. Contrast material-enhanced cholangiography that was previously performed opacified the cystic duct in 77 patients and the bile duct bifurcation in 93 patients, and was chosen as the standard of reference in the diagnosis of anatomic variants. RESULTS: MR cholangiopancreatography demonstrated the cystic duct in 126 patients (74%). MR cholangiopancreatography showed a low cystic duct insertion in 11 patients (9%), a medical cystic duct insertion in 22 patients (17%), and a parallel course of the cystic and hepatic ducts in 31 patients (25%). The bile duct bifurcation was demonstrated in 139 patients (81%), and an aberrant right hepatic duct was demonstrated in 12 patients (9%). CONCLUSION: MR cholangiopancreatography is accurate in the diagnosis of anatomic variants of the biliary tree that may increase the risk of bile duct injury during laparoscopic cholecystectomy.

Bile Ducts↗
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↗
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↗