Ablation tumorale par radiofréquence des CHC de plus de 3 cm : avec ou sans chimio-embolisation lipiodolée ?: Annoted analysis of the article: Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger t

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Quantifier la stéatose hépatique, pourquoi ? comment ?

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Imaging modalities for the diagnosis of hepatic fibrosis and cirrhosis

Non-invasive methods for liver fibrosis diagnosis are now commonly used as first-intention tests for liver fibrosis diagnosis in chronic liver diseases. Even morphological parameters provided by ultrasound is now challenged by blood fibrosis tests and transient elastography, in experienced hands, it performed well and in certain situations, imaging can still be useful to detect patients with fibrosis. In parallel, to ultrasound and Doppler imaging, various methodologies have been explored. Some of them remain confined to clinical research for the moment, as perfusion, MR diffusion-weighted imaging, intravoxel incoherent motion or acoustic structure quantification; others have already taken a place in clinical practice. Regarding fast growing of new technology some methods may become available for daily practice in the near future. Ultrasound tools or automated quantification of different physical parameters of imaging data could provide an opportunity for early diagnosis of liver diseases; MRI techniques could lead to the development of a “global” liver examination

Diagnosis of hepatocellular carcinoma

AbstractMore than 90% of cases of hepatocellular carcinoma occur on the background of chronic liver disease. Its diagnosis should therefore be based on six-month ultrasound screening, which should be started in these patients. The positive diagnosis of hepatocellular carcinoma is based on its vascularization examined on dynamic CT or MRI images after contrast enhancement. Arterial hypervascularization followed by a washout from the lesion in the portal and/or late phases on a background of cirrhosis provides a positive diagnosis of HCC without histology for nodules over a centimeter in size (international guidelines). Any other appearances require needle biopsy of the nodule and extra-nodular area to confirm the diagnosis. The local staging assessment predominantly involving portal invasion and the general patient assessment should be combined with assessment of the underlying liver disease to guide the treatment decision. The information obtained should be contained in as standardized a report as possible with all of the information required for patient management

Aspects et évaluation post-thérapeutiques des lésions du foie après traitement non chirurgical

The main non-surgical treatments for liver lesions include chemotherapy, targeted treatments, chemoembolization and radiofrequency ablation. The post-treatment imaging features are variable and depend on the initial appearance of the lesion, the type of treatment and the imaging modality. Evaluation of tumour response to treatment is important. RECIST criteria based on unidimensional lesion measurements may not always be appropriate. Other evaluation criteria (Choi for GIST, EASL for HCC or Chun criteria.) may be more relevant

Utility of enhanced CT for patients with suspected uncomplicated renal colic and no acute findings on non-enhanced CT

AIM: To evaluate the utility of contrast-enhanced computed tomography (CECT) for patients with suspected uncomplicated renal colic (URC) and no abnormalities on non-enhanced computed tomography (NECT). MATERIALS AND METHODS: The hospital institutional review board and ethics committee approved this retrospective study with a waiver of informed consent. Between January 2016 and April 2017, all consecutive adult patients who consulted at the adult Emergency Department (ED) with suspected URC and who had undergone both NECT and CECT were included retrospectively. The primary endpoint was prevalence of CECT-only diagnosis without acute findings on NECT. The risk factors for an acute finding were identified by logistic regression analysis. RESULTS: Among 126 patients with suspected URC, 12 were excluded. Among the 76 patients with no acute findings on NECT, CECT led to find acute lesions in 14/76 (18%) cases, but only 2/76 (3%) resulted in a change of management. Predictive factors of abnormal finding on CECT were: low renal clearance and high leukocyte count with OR 0.96 (95% confidence interval [CI]: 0.93-0.99), p=0.0189 and OR 5.79 (95% CI: 1.55-21.64), p=0.0091, respectively. CONCLUSIONS: In most cases, NECT is sufficient for screening patients with suspected URC. If leucocytosis and low renal function are present, stronger consideration may be given to CECT

Gastrointestinal imaging: tips and traps in the diagnosis of small HCC

Improvement in survival of patients with HCC depends on detecting small lesions. This is possible by screening all patients with cirrhosis for HCC. However, these small lesions are difficult to characterise as only 50 to 80% of lesions less than 3cm have a typical HCC appearance, depending on the imaging technique used. MRI, with its various possibilities (dynamic sequences, diffusion-weighting, liver-specific contrast agents), is currently the most effective imaging technique for characterising these small HCCs, but at present we do not know the best combination of imaging examinations for diagnosing the condition

Precise and simple quantitation of liver steatosis by MRI in an animal model and in patients with NAFLD

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Dissociating anticipation from perception: Acute pain activates default mode network.

Few studies have explored the effect of acute pain on attentional networks and on the default mode network. Moreover, these studies convey conflicting results, seemingly caused by design. To reassess this issue, we studied 20 healthy subjects with functional magnetic resonance imaging while delivering painful electric shocks. The design was purposely constructed to separate rest, anticipation, and pain perception. We found that default mode network activity in response to pain was biphasic. It deactivated during anticipation when the dorsal attentional network was activated. During pain perception, the default mode network was activated, as were attentional networks. The left posterior fusiform gyrus showed the same dynamics as the default mode network, and its activity was negatively correlated to the subject\u27s pain intensity rating. The associative pregenual anterior cingulate cortex seemed to play a key role in these coactivations. These results concur with data from the literature showing that enhanced pain perception results in greater default mode network activity and that the anticorrelation between the default mode network and the dorsal attentional network disappears in chronic pain patients

Screening for significant chronic liver disease by using three simple ultrasound parameters

Objectives Chronic liver diseases remain asymptomatic for many years. Consequently, patients are diagnosed belatedly, when cirrhosis is unmasked by lifethreatening complications. We aimed to identify simple ultrasound parameters for the screening of patients with unknown significant chronic liver disease. Methods Three hundred and twenty seven patients with chronic liver disease, liver biopsy, and ultrasound examination were included in the derivation set. 283 consecutive patients referred for ultrasound examination were included in the validation set; those selected according to the ultrasound parameters identified in the derivation set were then referred for specialized consultation including non-invasive fibrosis tests and ultimately liver biopsy if liver fibrosis was suspected. Results In the derivation set, three ultrasound parameters were independent predictors of severe fibrosis: liver surface irregularity, spleen length (>110 mm), and demodulation of hepatic veins. The association of ≥2 of the three above parameters provided 49.1% sensitivity and 86.9% specificity. In the validation set, at ≥2 of the three parameters were present in 23 (8%) of the patients. Among these patients, 8 had liver fibrosis (F ≥ 1), 5 had significant fibrosis (F  ≥2) and two cirrhosis. Conclusion The generalized search of three simple ultrasound signs in patients referred for abdominal ultrasound examination may be an easy way to detect those with silent but significant chronic liver disease