Biomedical subjects

V Vilgrain

Publications and source records attributed to V Vilgrain.

117 records · Page 7Linked to original sources

PubMedDate not supplied

Nontumorous attenuation changes on CT arterial portography.

OBJECTIVE: We prospectively studied the frequency and the distribution of nontumorous attenuation changes during CT arterial portography. MATERIALS AND METHODS: Computed tomography arterial portograms were obtained in 67 consecutive patients. The frequency and distribution of nontumorous attenuation changes (pseudolesions, areas of hypo- or hyperperfusion) were analyzed and related to the size of the tumor, the vascular status assessed by Doppler examination, and the presence of chronic liver disease. RESULTS: Pseudolesions were detected in 19 patients (28%). They were typical in 13 cases and atypical (round shaped or located in the caudate or right lobe) in 6. Segmental, lobar, or diffuse perfusion defects were seen in 36 patients (54%). In 56% of the cases, they were adjacent to large tumors and related to compression or thrombosis of intrahepatic portal branches as demonstrated by sonographic and Doppler findings. Areas of hyperperfusion were detected in 14 patients (21%). Of these cases, eight (57%) were peritumoral hyperperfusion. In all cases, the mean diameter of the tumors was large and there was compression of adjacent hepatic vein as demonstrated by sonographic and Doppler findings. CONCLUSION: Nontumorous attenuation changes are common in CT arterial portography. Factors leading to these artifacts include size of the tumor and vascular consequences of the tumor. Sonographic and Doppler studies may play a role in predicting these factors.

Adolescent↗

PubMedDate not supplied

Inflammatory pseudotumor of the liver: radiologic-pathologic correlation.

OBJECTIVE: To report the imaging appearance of inflammatory pseudotumor of the liver with pathologic correlation in three cases. MATERIALS AND METHODS: Sonography and CT were performed in all cases. Two lesions were evaluated with MRI. All lesions were resected, and imaging data and histopathology were correlated. RESULTS: In all three cases ultrasonography revealed a hypoechoic well-circumscribed mass. In one case CT showed a hypodense homogeneous lesion with central calcifications. No enhancement was demonstrated on postcontrast CT. The lesion appeared hypointense relative to the adjacent liver on T1-weighted MRI and isointense on T2-weighted MRI. A perilesional rim was detected in all cases on postcontract CT and/or MRI. This rim correlated with the histopathologic demonstration of a fibrous capsule in all three cases. CONCLUSION: The following features may be encountered in inflammatory pseudotumor: a homogeneous avascular appearance on CT, isointense signal on T2-weighted MRI, and the presence of a capsule. All these findings correlated well with histopathologic findings.

Adult↗

PubMedDate not supplied

Intrahepatic cholangiocarcinoma: MRI and pathologic correlation in 14 patients.

PURPOSE: Our goal was to determine the MR features of intrahepatic cholangiocarcinoma and to correlate them with pathologic findings in a surgical series. METHOD: MRI in 14 patients with intrahepatic cholangiocarcinoma who had undergone resection was reviewed. All patients had T1- and T2-weighted SE sequences. Contrast-material-enhanced MRI was performed in 12 cases. Comparison between findings at MRI and pathologic examination was made. RESULTS: MRI depicted all the lesions but one satellite nodule of 2 cm diameter. All lesions were hypointense relative to the liver on T1-weighted images. On T2-weighted images, the tumors were predominantly isointense or slightly hyperintense relative to liver parenchyma in nine cases (64%) and were strongly hyperintense in five cases (36%). Central hypointense areas or bands were seen in eight cases. No capsule was detected. On contrast-enhanced MR studies, all lesions had progressive and concentric filling with contrast material. Associated findings such as vascular encasement, focal liver atrophy, or dilatation of intrahepatic bile ducts were observed in 10 cases (71%). Comparison with pathologic examination revealed that lesion signal intensity on T2-weighted MR images was due mostly to the amount of fibrosis, necrosis, and mucous secretion within the lesion. The nine isointense or slightly hyperintense lesions contained abundant fibrosis and had a low content of mucous secretion or necrosis, whereas the five hyperintense lesions contained low or moderate fibrosis and prominent mucous secretion and/or necrosis. CONCLUSION: Our study suggests that the MR features of intrahepatic cholangiocarcinoma are well correlated with pathologic findings, but are nonspecific. Associated findings may strengthen the diagnosis of intrahepatic cholangiocarcinoma at MRI.

Adult↗

PubMedDate not supplied

Cystic dystrophy of the duodenal wall in the heterotopic pancreas: radiopathological correlations.

PURPOSE: The purpose of this work was to correlate the CT features of cystic dystrophy in heterotopic pancreas (CDHP) with pathological features. METHODS: Patients were selected from 190 patients who underwent pancreatico-duodenectomy over a 10 year period in our institution. CT findings were retrospectively analyzed in 20 cases and correlated with pathological findings. RESULTS: Lesions were found to be located in the inner part of the second portion of the duodenum in all except one case. In all cases, the duodenal wall was thickened, both at CT and at histopathological examination, and moderate to strong contrast enhancement of the duodenal wall was noted at CT in all cases but one. Cysts were multiple in all cases. No heterotopic pancreas was identified with CT. Inflammatory changes with or without enlarged nodes were detected on CT in 15 of 20 cases. Chronic pancreatitis was present in 10 cases at pathology, including 5 cases with calcifications. The radiopathological correlation was excellent for all criteria but two: the size of the cysts and the extent of pyloric involvement. CONCLUSION: In patients with CDHP, CT features correlate well with pathological results. Multiple cysts located in an enlarged duodenal wall with postcontrast enhancement and inflammatory changes are strongly suggestive of CDHP.

Adult↗

PubMedDate not supplied

Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver.

PURPOSE: The purpose of this work was to evaluate the detection and characterization of nodules > or = 8 mm and small hepatocellular carcinomas (HCCs) in liver cirrhosis. METHOD: Pathologic examination and results of US, helical CT, and dynamic MRI with gadolinium were compared after orthotopic liver transplantation (OLT) of 43 cirrhotic patients. Nodules were classified as macroregenerative nodules (MRNs), borderline nodules (BNs), and HCC. RESULTS: Pathologic examination classified 69 nodules: 50 MRNs, 6 BNs, and 13 HCCs. Sensitivities of MRN, BN, and HCC detection were, respectively, for US imaging 2% (1/50), 33.3% (2/6), and 46.2% (6/13); for helical CT 2% (1/50), 50% (3/6), and 53.8% (7/13); and for MRI 42% (21/50), 50% (3/6), and 76.9% (10/13). MRI detected 21 MRNs. They presented on T1/T2-weighted images as hyperintense/hypointense (n = 8), hyperintense/isointense (n = 7), hypointense/hypointense (n = 4), hypointense/isointense (n = 1), and hypointense depicted only on echo planar imaging (n = 1). The three detected BNs were hyperintense/hypointense nodules. The 10 detected HCCs appeared hyperintense/isointense (n = 7), hyperintense/hypointense (n = 2), and hypointense/isointense (n = 1). None of the MRNs but eight HCCs and one BN were enhanced after gadolinium injection. CONCLUSION: Contrast-enhanced MRI is the most sensitive technique for detecting liver nodules. No MR signal intensity pattern characteristic of small HCCs enables differentiation from benign nodules, however. Gadolinium enhancement is the most sensitive and specific characteristic of HCC.

Adult↗

PubMedDate not supplied

Imaging of atypical hemangiomas of the liver with pathologic correlation.

Compared with the imaging features of typical hepatic hemangiomas, the imaging features of atypical hepatic hemangiomas have not been well studied or well described. Knowledge of the entire spectrum of atypical hepatic hemangiomas is important and can help one avoid most diagnostic errors. A frequent type of atypical hepatic hemangioma is a lesion with an echoic border at ultrasonography. Less frequent types are large, heterogeneous hemangiomas; rapidly filling hemangiomas; calcified hemangiomas; hyalinized hemangiomas; cystic or multilocular hemangiomas; hemangiomas with fluid-fluid levels; and pedunculated hemangiomas. Adjacent abnormalities consist of arterial-portal venous shunt, capsular retraction, and surrounding nodular hyperplasia; hemangiomas can also develop in cases of fatty liver infiltration. Associated lesions include multiple hemangiomas, hemangiomatosis, focal nodular hyperplasia, and angiosarcoma. Types of atypical evolution are hemangiomas enlarging over time and hemangiomas appearing during pregnancy. Complications consist of inflammation, Kasabach-Merritt syndrome, intratumoral hemorrhage, hemoperitoneum, volvulus, and compression of adjacent structures. In some cases, such as large heterogeneous hemangiomas, calcified hemangiomas, pedunculated hemangiomas, or hemangiomas developing in diffuse fatty liver, a specific diagnosis can be established with imaging, especially magnetic resonance imaging. However, in other atypical cases, the diagnosis will remain uncertain at imaging, and these cases will require histopathologic examination.

Arteriovenous Malformations↗

PubMedDate not supplied

[Pancreatic intraductal adenoma, adenomatosis and adenocarcinoma].

Three cases of adenomatous lesions of the pancreatic ducts are reported. There was 1 case each of adenoma of the main pancreatic duct, adenomas of the uncinate process and diffuse adenomatosis of the cephalic pancreatic ducts with ampullary involvement. On ultrasound and computerized tomography, the main pancreatic duct was enlarged in all cases, associated in 2 cases with a mass in the head of the pancreas, and in 1 case, with pseudocystic dilation of the uncinate process ducts. At duodenoscopy, the papilla was tumoral in 1 case, enlarged with mucous flow in 1 case and normal in the third case in which cytologic examination of secretions disclosed glandular cells. Endoluminal lesions were diagnosed by endoscopic retrograde pancreatography in 2 cases and on gross pathologic examination in 1 case. Treatment was surgical: cephalic pancreatoduodenectomy in 2 cases and local resection in 1 case, which relapsed 3 years later. At pathology, lesions were benign in all 3 cases including 1 case of severe dysplasia. On the basis of these 3 cases and a review of the literature, distinctive features of pancreatic endoluminal adenomas and adenocarcinomas are specified. Pancreatic resection is mandatory because of the risk of pancreatic obstruction and malignant degeneration.

Adenocarcinoma↗

PubMedDate not supplied

[Pancreatic cystadenomas. Pitfalls and limitations of radiologic diagnosis].

Pancreatic cystadenoma (CA) are rare tumors. According to the classification described by Compagno and Oertel, microcystic and macrocystic CA are differentiated. The former is a benign tumor with slow growth, but the latter has a malignant potential. According to the literature, these tumors may be differentiated on the basis of US and CT findings in a high percentage of cases. We report a series of 11 cases (5 microcystic CA, 4 mucinous CA, 1 leiomyoblastoma and 1 adrenal cyst) representing all cases of radiologically suspected CA and all cases of histologically proved CA. A correct diagnosis of microcystic CA was possible in 2 out of 5 cases, and in 3 out of 4 cases of mucinous CA. The 2 extra-pancreatic tumors were misinterpreted as mucinous CA. No patient had a false positive diagnosis of microcystic CA. The diagnosis of mucinous CA was made in 7 cases, but only 3 were true positives. There was 1 false negative of mucinous CA. In other cases, laparotomy and resection are mandatory as sonography and CT cannot accurately detect malignancy or differentiate pancreatic CA from adjacent sites tumors.

Adult↗

PubMedDate not supplied

Imaging assessment before surgical resection.

The improvement of preoperative imaging techniques gets hepatic surgery easier making it more safer and effective. The authors describe the most common hepatic pathologies, benign and malignant, pointing out for each one the principal diagnostic appearances achievable with, the several techniques and, collating these last between them, they optimize the diagnostic-curative pathways for several pathologies. Beyond allowing the diagnosis of the lesion's nature, an important role of the imaging modalities is also to evaluate the resectability of single lesion, weighing up its exact location and the impact on the vascular system esteeming, finally, the volume of remnant liver in case of larger resections. The intra- and extrahepatic, preoperative staging, of the varied hepatic lesions, primitive and secondary, performed comparing the most modern diagnostics techniques, results to be dramatically important arterial portography during, CT (CTAP), contrast-enhanced helical CT, MR imaging. For each patient it's possible to plan the most adequate treatment to his pathology.

Diagnosis, Differential↗