Apport de l'imagerie de diffusion thoracique dans la caractérisation tissulaire des cancers broncho-pulmonaires

Objectifs : Evaluer la pertinence de l'imagerie de diffusion thoracique dans la caractérisation tissulaire des cancers pulmonaires par mesure de l'ADC (Apparent Diffusion Coefficient) et étudier le lien entre les valeurs de ce dernier et le SUV (standardized uptake value) mesuré à la TEP-TDM au 18-FDG (Tomographie par Emission de Positons au 18-Fluoro-Désoxy-Glucose). Matériels et méthodes : Quarante quatre patients atteints de cancers pulmonaires ont été inclus prospectivement au CHU de Poitiers entre 2011 et 2013. Une IRM de diffusion et une TEP-TDM au 18FDG ont été réalisées lors du bilan initial pré-thérapeutique. Des mesures quantitatives d'ADC et de SUV ont été effectuées pour tous les patients retenus. Résultats : Trente neuf patients ont été finalement retenus pour notre étude (20 patients atteints d'adénocarcinomes, treize avaient un carcinome épidermoïde et six atteints de carcinomes neuro-endocrines à petites cellules). Il existait une différence statistiquement significative entre la valeur de l'ADC des adénocarcinomes et celle des carcinomes neuroendocrines (p=0.017), nous avons retrouvé également une différence statistiquement significative entre l'ADC des carcinomes différenciés et celui des carcinomes peu ou moyennement différenciés quel que soit le type histologique .La valeur de l'ADC des adénocarcinomes bien différenciés était la plus élevée. Par ailleurs, nous avons objectivé une corrélation inverse entre les valeurs de l'ADC et celles du SUV. Conclusion : L'IRM de diffusion permet de fournir des informations indispensables à la caractérisation tissulaire des cancers du poumon. Elle pourrait être considérée dans l'avenir comme un outil supplémentaire pour l'évaluation de la réponse tumorale aux traitements.POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Evaluation de la fonction diastolique du ventricule gauche par tomodensitométrie

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Transarterial Chemoembolization of Hepatocellular Carcinoma with Idarubicin-Loaded Tandem Drug-Eluting Embolics

Objective: To describe the responses, toxicities and outcomes of HCC patients treated by transarterial chemoembolization (TACE) using idarubicin-loaded TANDEM beads. Materials and Methods: Seventy-two consecutive patients (mean age: 71 years (58–84 years)) with HCC were treated by TACE using idarubicin-loaded TANDEM in a first line, over a five-year period. Most patients (89%) had liver cirrhosis classified as Child–Pugh A (90%). BCLC B classification applied in 85% of cases. Baseline tumor burden was limited to one to three nodules in 92% of cases, unilobar in 88% cases, with a median tumor diameter of 55 mm (range: 13–150 mm). Toxicity was assessed using NCI CTC AE v4.0. Response was assessed using mRECIST criteria. Time-to-treatment failure (TTTF) and overall survival (OS) were also calculated based on Kaplan–Meier method. Result: Of 141 TACE sessions performed with bead sizes of 100 and 75 µm in 42 (29.8%) and 99 (70.2%) sessions, respectively. In 78% of all TACE sessions, the full dose of idarubicin-loaded beads was injected. Grade 3–4 AE were observed after 73 (52%) sessions, most of them being biological. Multi-organ failure was observed three days after the first TACE in a Child B patients, unfortunately leading to death. Overall, the best objective response rate (ORR) was 65%. Median follow-up lasted 14.3 months (95% CI: 11.2–18.8 months). Median TTTF and OS were 14.4 months (95% CI: 7.2–24.6 months) and 34.6 months (95% CI: 24.7—not reached) respectively. Conclusion: In this retrospective study involving well-selected HCC patients, high ORR and long TTTF and OS are observed after TACE using idarubicin-loaded TANDEM. A randomized trial is needed

Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes

Background: We previously showed that embolization of portal inflow and hepatic vein (HV) outflow (liver venous deprivation, LVD) promotes future liver remnant (FLR) volume (FLR-V) and function (FLR-F) gain. Here, we compared FLR-V and FLR-F changes after portal vein embolization (PVE) and LVD. Methods: This study included all patients referred for liver preparation before major hepatectomy over 26 months. Exclusion criteria were: unavailable baseline/follow-up imaging, cirrhosis, Klatskin tumor, two-stage hepatectomy. 99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7, 14 and 21 after PVE or LVD. FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models (joint modelling) with/without missing data imputation. Results: Baseline FLR-F was lower in the LVD (n=29) than PVE group (n=22) (P<0.001). Technical success was 100% in both groups without any major complication. Changes in FLR-V at day 14 and 21 (+14.2% vs. +50%, P=0.002; and +18.6% vs. +52.6%, P=0.001), and in FLR-F at day 7, 14 and 21 (+23.1% vs. +54.3%, P=0.02; +17.6% vs. +56.1%, P=0.006; and +29.8% vs. +63.9%, P<0.001) differed between PVE and LVD group. LVD (P=0.009), age (P=0.027) and baseline FLR-V (P=0.001) independently predicted FLR-V variations, whereas only LVD (P=0.01) predicted FLR-F changes. After missing data handling, LVD remained an independent predictor of FLR-V and FLR-F variations. Conclusions: LVD is safe and provides greater FLR-V and FLR-F increase than PVE. These results are now evaluated in the HYPERLIV-01 multicenter randomized trial

Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes

International audienceBackground: We previously showed that embolization of portal inflow and hepatic vein (HV) outflow (liver venous deprivation, LVD) promotes future liver remnant (FLR) volume (FLR-V) and function (FLR-F) gain. Here, we compared FLR-V and FLR-F changes after portal vein embolization (PVE) and LVD.Methods: This study included all patients referred for liver preparation before major hepatectomy over 26 months. Exclusion criteria were: unavailable baseline/follow-up imaging, cirrhosis, Klatskin tumor, two-stage hepatectomy. 99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7, 14 and 21 after PVE or LVD. FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models (joint modelling) with/without missing data imputation.Results: Baseline FLR-F was lower in the LVD (n=29) than PVE group (n=22) (P<0.001). Technical success was 100% in both groups without any major complication. Changes in FLR-V at day 14 and 21 (+14.2% vs. +50%, P=0.002; and +18.6% vs. +52.6%, P=0.001), and in FLR-F at day 7, 14 and 21 (+23.1% vs. +54.3%, P=0.02; +17.6% vs. +56.1%, P=0.006; and +29.8% vs. +63.9%, P<0.001) differed between PVE and LVD group. LVD (P=0.009), age (P=0.027) and baseline FLR-V (P=0.001) independently predicted FLR-V variations, whereas only LVD (P=0.01) predicted FLR-F changes. After missing data handling, LVD remained an independent predictor of FLR-V and FLR-F variations.Conclusions: LVD is safe and provides greater FLR-V and FLR-F increase than PVE. These results are now evaluated in the HYPERLIV-01 multicenter randomized trial