58 research outputs found
Optimisation de lâangiomammographie et de lâangiotomosynthĂšse double-Ă©nergie
Objectives: The purpose was to optimize the exposure parameters of CESM examinations, to assess the feasibility of contrast-enhanced DBT (CE-DBT) for the detection and the characterization of breast tumors, and to assess CESM-guided stereotactic biopsies. Methods: At first, we optimized the CESM exposure parameters in four different clinical applications for which different levels of average glandular dose and different low energy image quality are required. The optimization of exposure parameters (anode/filter, kVp, mAs) for low energy (LE) and high energy (HE) images at different levels of average glandular dose and different ratios between LE and total doses has been conducted using a simulator of the x-ray mammographic image chain. An experimental validation was then performed through phantom experiments. Secondly, we assessed the potential of CE-DBT based on a dual-energy approach. A new mesh-based anthropomorphic breast phantom was improved and used to evaluate the performance of CESM and then to compare CESM and CE-DBT. Finally, we evaluated the technical feasibility of CESM-guided biopsy. After identifying some technical constraints, we assessed the performance of the recombination of LE and HE images acquired at different times after injection, using simulated images of a geometric phantom with uniform texture, and simulated images of an anthropomorphic textured phantom with and without motion artifacts.Results and conclusion : For the four different clinical indications, optima found by simulation, with resulting SDNRpixel and SDNR2pixel/Dosetotal, were confirmed through real acquisition of images on phantoms. Our results indicate that the SDNR per pixel in recombined CESM images increased in all of the four clinical indications compared to recombined images obtained using SenoBright Âź (commercial product used as reference). This result suggests the possibility to detect more subtle contrast enhancements and to decrease the number of false negatives found in clinical CESM examinations. The impact of a new dose allocation between LE and HE exposures was also evaluated on LE image quality. Results from CDMAM phantom experiments indicate that optimized parameters provide similar or acceptable detection compared to standard mammography, except for screening indication when considering the very small diameter objects.The human observer study on anthropomorphic phantom images, taking into account tumor and breast parenchyma enhancement, revealed that detection and characterization sensitivity of iodine-enhanced lesions are not statistically different between 2D CESM and 3D CE-DBT. The most influencing parameters for the detectability and the lesion size assessment were the lesion iodine concentration and the breast density. CESM was significantly more specific than CE-DBT. One of the assumptions to explain this result is the presence of higher noise in CE-DBT than in CESM images. A future improvement for CE-DBT could therefore be the design of a specific reconstruction algorithm minimizing reconstructed noise.With respect to CESM-guided biopsy the proposed scenario pointed out two major constraints, one related to the thermal load of the x-ray tube, the second related to the increased dose due to the repetition of LE and HE images. One proposed solution was to limit the number of LE exposures, requiring the possibility to recombined LE and HE images acquired at different injection time points. Our study showed that the recombination of a HE image with a LE image acquired earlier leads to SDNR changes compared to paired recombination. These changes are function of the enhancement time to peak and the washout of the lesion, and had a limited impact on the lesion detectability.Objectifs : Lâobjectif a Ă©tĂ© de dâoptimiser les protocoles dâacquisition des examens dâangiomammographie double-Ă©nergie, dâĂ©tudier la faisabilitĂ© de lâangiotomosynthĂšse pour la dĂ©tection et la caractĂ©risation des tumeurs mammaires, et dâĂ©tudier la faisabilitĂ© des biopsies stĂ©rĂ©otaxiques sous guidage de lâangiomammographie. MĂ©thodes : Une Ă©tude dâoptimisation des paramĂštres dâacquisition de lâangiomammographie a Ă©tĂ© rĂ©alisĂ©e dans 4 situations cliniques pour lesquelles la qualitĂ© diagnostique requise des images de basse Ă©nergie et la dose totale dĂ©livrĂ©e Ă la patiente ne sont pas identiques. Lâoptimisation des paramĂštres d'exposition (anode/filtre, kVp, mAs) des images de basse Ă©nergie (BE) et haute Ă©nergie (HE) a Ă©tĂ© rĂ©alisĂ©e Ă partir dâune modĂ©lisation thĂ©orique de la chaĂźne dâacquisition. Une validation a Ă©tĂ© effectuĂ©e par mesures expĂ©rimentales sur des images de fantĂŽme dâinserts dâiode. Nous avons ensuite Ă©tudiĂ© la technique dâangiotomosynthĂšse mammaire basĂ©e sur une approche double-Ă©nergie. Un nouveau fantĂŽme anthropomorphique numĂ©rique du sein et de ses lĂ©sions, basĂ© sur lâutilisation de primitives gĂ©omĂ©triques complexes et dâune technique de maillage surfacique, a Ă©tĂ© amĂ©liorĂ© et utilisĂ© pour Ă©valuer les performances de lâangiomammographie optimisĂ©e, puis de lâangiotomosynthĂšse en comparaison Ă lâangiomammographie. Enfin, nous avons proposĂ© un scĂ©nario pour la rĂ©alisation dâun examen de stĂ©rĂ©otaxie avec injection dâun agent de contraste iodĂ© et Ă©tudiĂ© la faisabilitĂ© de recombinaison dâimage de haute et de basse Ă©nergie acquises Ă des temps diffĂ©rents de lâinjection.RĂ©sultats et conclusion : Les optima des paramĂštres dâexposition trouvĂ©s par simulation avec les valeurs de SDNRpixel et SDNR2pixel /Dosetotale qui en rĂ©sultent, ont Ă©tĂ© confirmĂ©s expĂ©rimentalement. Les valeurs de SDNR par pixel dans les images recombinĂ©es sont augmentĂ©es pour toutes les indications cliniques en comparaison Ă celle obtenues avec SenoBright Âź (produit commercial de rĂ©fĂ©rence). L'impact sur la qualitĂ© de lâimage de BE, Ă©valuĂ© par des expĂ©rimentations sur fantĂŽme CDMAM, a montrĂ© que les paramĂštres optimisĂ©s fournissent une dĂ©tection similaire ou acceptable par rapport Ă la mammographie standard, Ă lâexception de l'indication de dĂ©pistage lorsque lâon considĂšre les objets de trĂšs petits diamĂštres.LâĂ©tude de lecture humaine dâimages simulĂ©es dâun fantĂŽme anthropomorphique du sein incluant le rehaussement glandulaire physiologique et diffĂ©rents modĂšle tumoraux nâa pas montrĂ© dâaugmentation significative de sensibilitĂ© de dĂ©tection des acquisition 3D dâangiotomosynthĂšse comparativement aux acquisitions 2D dâangiomammographie. Les deux paramĂštres qui influençaient le plus la sensibilitĂ© Ă©tait la concentration en iode des tumeurs et la densitĂ© du sein. Lâangiomammographie Ă©tait par ailleurs significativement plus spĂ©cifique que lâangiotomosynthĂšse. Une perspective dâamĂ©lioration pour lâangiotomosynthĂšse pourrait donc ĂȘtre lâutilisation dâalgorithmes de reconstruction 3D spĂ©cifiques de cette modalitĂ© qui minimiseraient le bruit de reconstruction. Le scĂ©nario proposĂ© pour la rĂ©alisation de biopsies sous guidage de lâangiomammographie, a mis en Ă©vidence deux contraintes techniques que sont lâĂ©chauffement du tube Ă rayons X et le surcroit de dose dĂ» Ă la rĂ©pĂ©tition des paires dâacquisitions en haute et basse Ă©nergies. Une des solutions envisagĂ©es a Ă©tĂ© de limiter le nombre dâacquisitions de BE. Notre Ă©tude a montrĂ© que la recombinaison dâune image HE avec une image BE acquise antĂ©rieurement modifiait le SDNR des lĂ©sions simulĂ©es comparativement Ă une recombinaison appariĂ©e dâimages BE et HE acquises au mĂȘme temps de lâinjection. Ces modifications dĂ©pendaient du temps du pic de rehaussement maximal et du washout de la lĂ©sion
Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study
Abstract Introduction The purpose of this study was to compare the diagnostic accuracy of dual-energy contrast-enhanced digital mammography (CEDM) as an adjunct to mammography (MX) ± ultrasonography (US) with the diagnostic accuracy of MX ± US alone. Methods One hundred ten consenting women with 148 breast lesions (84 malignant, 64 benign) underwent two-view dual-energy CEDM in addition to MX and US using a specially modified digital mammography system (Senographe DS, GE Healthcare). Reference standard was histology for 138 lesions and follow-up for 12 lesions. Six radiologists from 4 institutions interpreted the images using high-resolution softcopy workstations. Confidence of presence (5-point scale), probability of cancer (7-point scale), and BI-RADS scores were evaluated for each finding. Sensitivity, specificity and ROC curve areas were estimated for each reader and overall. Visibility of findings on MX ± CEDM and MX ± US was evaluated with a Likert scale. Results The average per-lesion sensitivity across all readers was significantly higher for MX ± US ± CEDM than for MX ± US (0.78 vs. 0.71 using BIRADS, p = 0.006). All readers improved their clinical performance and the average area under the ROC curve was significantly superior for MX ± US ± CEDM than for MX ± US ((0.87 vs 0.83, p = 0.045). Finding visibility was similar or better on MX ± CEDM than MX ± US in 80% of cases. Conclusions Dual-energy contrast-enhanced digital mammography as an adjunct to MX ± US improves diagnostic accuracy compared to MX ± US alone. Addition of iodinated contrast agent to MX facilitates the visualization of breast lesions
Target heterogeneity in oncology : the best predictor for differential response to radioligand therapy in neuroendocrine tumors and prostate cancer
Tumor or target heterogeneity (TH) implies presence of variable cellular populations having
different genomic characteristics within the same tumor, or in different tumor sites of the same
patient. The challenge is to identify this heterogeneity, as it has emerged as the most common cause
of âtreatment resistanceâ, to current therapeutic agents. We have focused our discussion on âProstate
Cancerâ and âNeuroendocrine Tumorsâ, and looked at the established methods for demonstrating
heterogeneity, each with its advantages and drawbacks. Also, the available theranostic radiotracers
targeting PSMA and somatostatin receptors combined with targeted systemic agents, have been
described. Lu-177 labeled PSMA and DOTATATE are the âstandard of careâ radionuclide therapeutic
tracers for management of progressive treatment-resistant prostate cancer and NET. These approved
therapies have shown reasonable benefit in treatment outcome, with improvement in quality of
life parameters. Various biomarkers and predictors of response to radionuclide therapies targeting
TH which are currently available and those which can be explored have been elaborated in details.
Imaging-based features using artificial intelligence (AI) need to be developed to further predict the
presence of TH. Also, novel theranostic tools binding to newer targets on surface of cancer cell should
be explored to overcome the treatment resistance to current treatment regimens.http://www.mdpi.com/journal/cancerspm2021Nuclear Medicin
Proposal of early CT morphological criteria for response of liver metastases to systemic treatments in gastroenteropancreatic neuroendocrine tumors:Alternatives to RECIST
RECIST 1.1 criteria are commonly used with computed tomography (CT) to evaluate the efficacy of systemic treatments in patients with neuroendocrine tumors (NETs) and liver metastases (LMs), but their relevance is questioned in this setting. We aimed to explore alternative criteria using different numbers of measured LMs and thresholds of size and density variation. We retrospectively studied patients with advanced pancreatic or small intestine NETs with LMs, treated with systemic treatment in the first-and/or second-line, without early progression, in 14 European expert centers. We compared time to treatment failure (TTF) between responders and non-responders according to various criteria defined by 0%, 10%, 20% or 30% decrease in the sum of LM size, and/or by 10%, 15% or 20% decrease in LM density, measured on two, three or five LMs, on baseline (â€1 month before treatment initiation) and first revaluation (â€6 months) contrast-enhanced CT scans. Multivariable Cox proportional hazard models were performed to adjust the association between response criteria and TTF on prognostic factors. We included 129 systemic treatments (long-acting somatostatin analogs 41.9%, chemotherapy 26.4%, targeted therapies 31.8%), administered as first-line (53.5%) or second-line therapies (46.5%) in 91 patients. A decrease â„10% in the size of three LMs was the response criterion that best predicted prolonged TTF, with significance at multivariable analysis (HR 1.90; 95% CI: 1.06â3.40; p =.03). Conversely, response defined by RECIST 1.1 did not predict prolonged TTF (p =.91), and neither did criteria based on changes in LM density. A â„10% decrease in size of three LMs could be a more clinically relevant criterion than the current 30% threshold utilized by RECIST 1.1 for the evaluation of treatment efficacy in patients with advanced NETs. Its implementation in clinical trials is mandatory for prospective validation. Criteria based on changes in LM density were not predictive of treatment efficacy. Clinical Trial Registration: Registered at CNIL-CERB, Assistance publique hopitaux de Paris as âE-NETNET-L-E-CTâ July 2018. No number was assigned. Approved by the Medical Ethics Review Board of University Medical Center Groningen.</p
Optimization of contrast enhanced digital mammography and contrast enhanced digital breast tomosynthesis
Objectifs : Lâobjectif a Ă©tĂ© de dâoptimiser les protocoles dâacquisition des examens dâangiomammographie double-Ă©nergie, dâĂ©tudier la faisabilitĂ© de lâangiotomosynthĂšse pour la dĂ©tection et la caractĂ©risation des tumeurs mammaires, et dâĂ©tudier la faisabilitĂ© des biopsies stĂ©rĂ©otaxiques sous guidage de lâangiomammographie. MĂ©thodes : Une Ă©tude dâoptimisation des paramĂštres dâacquisition de lâangiomammographie a Ă©tĂ© rĂ©alisĂ©e dans 4 situations cliniques pour lesquelles la qualitĂ© diagnostique requise des images de basse Ă©nergie et la dose totale dĂ©livrĂ©e Ă la patiente ne sont pas identiques. Lâoptimisation des paramĂštres d'exposition (anode/filtre, kVp, mAs) des images de basse Ă©nergie (BE) et haute Ă©nergie (HE) a Ă©tĂ© rĂ©alisĂ©e Ă partir dâune modĂ©lisation thĂ©orique de la chaĂźne dâacquisition. Une validation a Ă©tĂ© effectuĂ©e par mesures expĂ©rimentales sur des images de fantĂŽme dâinserts dâiode. Nous avons ensuite Ă©tudiĂ© la technique dâangiotomosynthĂšse mammaire basĂ©e sur une approche double-Ă©nergie. Un nouveau fantĂŽme anthropomorphique numĂ©rique du sein et de ses lĂ©sions, basĂ© sur lâutilisation de primitives gĂ©omĂ©triques complexes et dâune technique de maillage surfacique, a Ă©tĂ© amĂ©liorĂ© et utilisĂ© pour Ă©valuer les performances de lâangiomammographie optimisĂ©e, puis de lâangiotomosynthĂšse en comparaison Ă lâangiomammographie. Enfin, nous avons proposĂ© un scĂ©nario pour la rĂ©alisation dâun examen de stĂ©rĂ©otaxie avec injection dâun agent de contraste iodĂ© et Ă©tudiĂ© la faisabilitĂ© de recombinaison dâimage de haute et de basse Ă©nergie acquises Ă des temps diffĂ©rents de lâinjection.RĂ©sultats et conclusion : Les optima des paramĂštres dâexposition trouvĂ©s par simulation avec les valeurs de SDNRpixel et SDNR2pixel /Dosetotale qui en rĂ©sultent, ont Ă©tĂ© confirmĂ©s expĂ©rimentalement. Les valeurs de SDNR par pixel dans les images recombinĂ©es sont augmentĂ©es pour toutes les indications cliniques en comparaison Ă celle obtenues avec SenoBright Âź (produit commercial de rĂ©fĂ©rence). L'impact sur la qualitĂ© de lâimage de BE, Ă©valuĂ© par des expĂ©rimentations sur fantĂŽme CDMAM, a montrĂ© que les paramĂštres optimisĂ©s fournissent une dĂ©tection similaire ou acceptable par rapport Ă la mammographie standard, Ă lâexception de l'indication de dĂ©pistage lorsque lâon considĂšre les objets de trĂšs petits diamĂštres.LâĂ©tude de lecture humaine dâimages simulĂ©es dâun fantĂŽme anthropomorphique du sein incluant le rehaussement glandulaire physiologique et diffĂ©rents modĂšle tumoraux nâa pas montrĂ© dâaugmentation significative de sensibilitĂ© de dĂ©tection des acquisition 3D dâangiotomosynthĂšse comparativement aux acquisitions 2D dâangiomammographie. Les deux paramĂštres qui influençaient le plus la sensibilitĂ© Ă©tait la concentration en iode des tumeurs et la densitĂ© du sein. Lâangiomammographie Ă©tait par ailleurs significativement plus spĂ©cifique que lâangiotomosynthĂšse. Une perspective dâamĂ©lioration pour lâangiotomosynthĂšse pourrait donc ĂȘtre lâutilisation dâalgorithmes de reconstruction 3D spĂ©cifiques de cette modalitĂ© qui minimiseraient le bruit de reconstruction. Le scĂ©nario proposĂ© pour la rĂ©alisation de biopsies sous guidage de lâangiomammographie, a mis en Ă©vidence deux contraintes techniques que sont lâĂ©chauffement du tube Ă rayons X et le surcroit de dose dĂ» Ă la rĂ©pĂ©tition des paires dâacquisitions en haute et basse Ă©nergies. Une des solutions envisagĂ©es a Ă©tĂ© de limiter le nombre dâacquisitions de BE. Notre Ă©tude a montrĂ© que la recombinaison dâune image HE avec une image BE acquise antĂ©rieurement modifiait le SDNR des lĂ©sions simulĂ©es comparativement Ă une recombinaison appariĂ©e dâimages BE et HE acquises au mĂȘme temps de lâinjection. Ces modifications dĂ©pendaient du temps du pic de rehaussement maximal et du washout de la lĂ©sion.Objectives: The purpose was to optimize the exposure parameters of CESM examinations, to assess the feasibility of contrast-enhanced DBT (CE-DBT) for the detection and the characterization of breast tumors, and to assess CESM-guided stereotactic biopsies. Methods: At first, we optimized the CESM exposure parameters in four different clinical applications for which different levels of average glandular dose and different low energy image quality are required. The optimization of exposure parameters (anode/filter, kVp, mAs) for low energy (LE) and high energy (HE) images at different levels of average glandular dose and different ratios between LE and total doses has been conducted using a simulator of the x-ray mammographic image chain. An experimental validation was then performed through phantom experiments. Secondly, we assessed the potential of CE-DBT based on a dual-energy approach. A new mesh-based anthropomorphic breast phantom was improved and used to evaluate the performance of CESM and then to compare CESM and CE-DBT. Finally, we evaluated the technical feasibility of CESM-guided biopsy. After identifying some technical constraints, we assessed the performance of the recombination of LE and HE images acquired at different times after injection, using simulated images of a geometric phantom with uniform texture, and simulated images of an anthropomorphic textured phantom with and without motion artifacts.Results and conclusion : For the four different clinical indications, optima found by simulation, with resulting SDNRpixel and SDNR2pixel/Dosetotal, were confirmed through real acquisition of images on phantoms. Our results indicate that the SDNR per pixel in recombined CESM images increased in all of the four clinical indications compared to recombined images obtained using SenoBright Âź (commercial product used as reference). This result suggests the possibility to detect more subtle contrast enhancements and to decrease the number of false negatives found in clinical CESM examinations. The impact of a new dose allocation between LE and HE exposures was also evaluated on LE image quality. Results from CDMAM phantom experiments indicate that optimized parameters provide similar or acceptable detection compared to standard mammography, except for screening indication when considering the very small diameter objects.The human observer study on anthropomorphic phantom images, taking into account tumor and breast parenchyma enhancement, revealed that detection and characterization sensitivity of iodine-enhanced lesions are not statistically different between 2D CESM and 3D CE-DBT. The most influencing parameters for the detectability and the lesion size assessment were the lesion iodine concentration and the breast density. CESM was significantly more specific than CE-DBT. One of the assumptions to explain this result is the presence of higher noise in CE-DBT than in CESM images. A future improvement for CE-DBT could therefore be the design of a specific reconstruction algorithm minimizing reconstructed noise.With respect to CESM-guided biopsy the proposed scenario pointed out two major constraints, one related to the thermal load of the x-ray tube, the second related to the increased dose due to the repetition of LE and HE images. One proposed solution was to limit the number of LE exposures, requiring the possibility to recombined LE and HE images acquired at different injection time points. Our study showed that the recombination of a HE image with a LE image acquired earlier leads to SDNR changes compared to paired recombination. These changes are function of the enhancement time to peak and the washout of the lesion, and had a limited impact on the lesion detectability
Imagerie par résonance magnétique avec séquence de diffusion des tumeurs endocrines du pancréas
Les tumeurs endocrines du pancrĂ©as (TEP) sont rares. Elles sont sporadiques dans 95% des cas, mais peuvent ĂȘtre associĂ©es Ă des maladies gĂ©nĂ©tiques comme la nĂ©oplasie endocrinienne multiple de type 1. L imagerie de ces tumeurs fait intervenir diffĂ©rentes modalitĂ©s diagnostiques (Ă©cho-endoscopie, scintigraphie Ă l octrĂ©otate marquĂ©, angiographie, prĂ©lĂšvements veineux Ă©tagĂ©s). La place de la tomodensitomĂ©trie avec injection de produit de contraste et surtout de l imagerie par rĂ©sonance magnĂ©tique (IRM) est actuellement mal dĂ©finie. De plus, il existe des controverses quant Ă l aspect de ces tumeurs (signal et cinĂ©tique de rehaussement) et quant Ă la sĂ©quence la plus sensible pour leur dĂ©tection. Par ailleurs, l utilisation des sĂ©quences de diffusion, prometteuses dans l imagerie abdominale, n a jamais Ă©tĂ© utilisĂ©e dans les TEP. L objectif de notre travail est d Ă©valuer la sensibilitĂ© de l IRM avec sĂ©quences de diffusion dans la dĂ©tection des TEP, de dĂ©terminer les meilleures sĂ©quences Ă utiliser et de dĂ©crire les caractĂ©ristiques morphologiques et la cinĂ©tique de rehaussement de ces tumeurs.PARIS6-Bibl.PitiĂ©-SalpĂȘtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Apport des techniques d'imagerie dans le diagnostic et l'Ă©valuation des tumeurs neuro-endocrines de la tĂȘte et du cou, laryngĂ©es et extra laryngĂ©es
Introduction: Les tumeurs neuro-endocrine (TNE) sont rares, de localisation ubiquitaire. Leur frĂ©quence dans la forme laryngĂ©e est estimĂ©e Ă 3%. Ces tumeurs sont caractĂ©risĂ©es par leur fixation en immuno histochimie et l association au syndrome de prĂ©disposition aux tumeurs . MatĂ©riels et mĂ©thode: Nous avons revu les dossiers de 17 patients traitĂ©s Ă l institut Gustave Roussy pour des TNE laryngĂ©es et extra-laryngĂ©es entre janvier 1984 et janvier 2002. Notre Ă©tude comprenait 12 hommes et 5 femmes, ĂągĂ©s entre 13 et 70 ans et d Ăąge moyen estimĂ© Ă 61 ans. L analyse a portĂ© sur les donnĂ©es cliniques, biologiques et d imagerie (scintigraphie, TDM et IRM). RĂ©sultats L aspect des TNE en TDM Ă©tait celui d une tumeur bourgeonnante et infiltrante chez 53% des patients. La taille moyenne des lĂ©sions laryngĂ©es Ă©tait infĂ©rieure Ă 3cm chez 70% des patients plutĂŽt supĂ©rieure Ă 4 cm pour les formes extra-laryngĂ©es (57%). La prise de contraste s effectuait de façon homogĂšne sans rehaussement de la muqueuse pour 76% des tumeurs. Les calcifications Ă©taient exceptionnelles. Les TNE sont des tumeurs lymphophiles, 47% d extension ganglionnaire lors du diagnostic initial. L extension mĂ©tastatique Ă©tait frĂ©quente, observĂ©e chez 58% des patients. La survie variait de façon significative en fonction du type histologique, le pronostic le plus dĂ©favorable Ă©tant attribuĂ© aux formes peu diffĂ©renciĂ©es et Ă petites cellules. Conclusion: Notre Ă©tude confirme le caractĂšre rare des TNE. L aspect en imagerie conventionnelle par TDM et IRM est aspĂ©cifique, cependant ces investigations demeurent indispensables au bilan d extension loco-rĂ©gional prĂ©-thĂ©rapeutique. La TDM a montrĂ© sa supĂ©rioritĂ© sur l IRM pour le diagnostic des extensions osseuses, tandis que l IRIVI Ă©tait supĂ©rieure pour le bilan d extension des TNE extra-laryngĂ©es. La scintigraphie aux rĂ©cepteurs de la somatostatine prĂ©sente une sensibilitĂ© et une spĂ©cificitĂ© Ă©levĂ©e lors du diagnostic. MalgrĂ© le faible caractĂšre sĂ©crĂ©toire, le bilan biologique doit ĂȘtre rĂ©alisĂ© Ă titre systĂ©matique.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF
Imaging of Small Bowel, Colon and Rectum
XIII, 182 p. 26 illus., 7 illus. in color.online
- âŠ