Interventional planning and assistance for ascending aorta dissections

International audienceIn this paper, we present our global image processing framework of interventional planning and assistance for ascending aorta dissections. The preoperative stage of that framework performs the extraction of aortic dissection features in Computed Tomography Angiography (CTA) images. It mainly consists of a customized fast marching segmentation. The intraoperative stage of that framework realizes medical images registration and proposes data visualization enhancement; standard X-ray fluoroscopic images are used as the reference modality. We use our recently introduced registration method based on image transformation descriptors (ITDs) and usual 3D/2D techniques (based on digitally reconstructed radiographs). The first stage provides aortic dissection features and is to help clinicians for the planning. The second stage provides an augmented reality visualization and would be used for assistance during the intervention. As far as we know, this is the first complete image processing framework which focuses on the ascending aorta dissection (minimally invasive) endovascular treatment

Contribution in computed tomography of impact on the left heart of pulmonary diseases.

La pathologie pulmonaire et la pathologie cardiaque interagissent et le bloc “Cœur- poumon” est à considérer comme une seule et même entité en imagerie: la lecture du cœur, des vaisseaux, des poumons et du médiastin doit être globale et intégrée, quelle que soit la modalité d’imagerie. Nous avons pu ainsi illustrer la contribution de la TDM dans l’évaluation de la prévalence de la pathologie coronarienne asymptomatique au cours de la fibrose pulmonaire idiopathique, l’analyse du volume de l’oreillette gauche au cours des BPCO, la corrélation entre volume pulmonaire hypoperfusé et le rapport VD/VG, et l’évaluation de l’envahissement cardiaque au cours des néoplasies pulmonaires. Les avancées techniques en scannographie nous permettent désormais d’approcher outre la morphologie le versant fonctionnel, notamment par l’évaluation de la fonction cardiaque, de la perfusion pulmonaire, en attendant le développement en routine clinique de l’approche par TDM de la fonction de ventilation. Notre thèse avait pour ambition de contribuer modestement à la promotion d’une approche morphologique et fonctionnelle intégrée de l’imagerie du cœur, des vaisseaux thoraciques et du poumon, dont les bénéfices cliniques nous apparaissent quotidiens et dont l’enseignement nous apparait indissociable.Pulmonary and cardiac pathology interact and the « heart-lung » bloc is to consider as one and same entity in imaging: heart, vessels, lungs and mediastinum analysis must be global and integrated, whatever imaging modality.In this work, we have illustrated computed tomography contribution in: evaluating asymptomatic coronary disease in cystic fibrosis pathology, left atrial volume in COPD patients, correlation of hypo perfused lung volume and RV/LV ratio, and cardiac invasion evaluation in broncho-pulmonary neoplasm.Computed tomography technological advances allow us to evaluate morphology and functional side, in evaluating cardiac function, pulmonary perfusion, waiting for the development of pulmonary ventilation in routine. Our work contributes to the development of a morphological and functional approach in heart, great vessels and lung imaging

Contribution à l'étude par TDM du retentissement sur le coeur gauche de la pathologie pulmonaire.

Pulmonary and cardiac pathology interact and the « heart-lung » bloc is to consider as one and same entity in imaging: heart, vessels, lungs and mediastinum analysis must be global and integrated, whatever imaging modality.In this work, we have illustrated computed tomography contribution in: evaluating asymptomatic coronary disease in cystic fibrosis pathology, left atrial volume in COPD patients, correlation of hypo perfused lung volume and RV/LV ratio, and cardiac invasion evaluation in broncho-pulmonary neoplasm.Computed tomography technological advances allow us to evaluate morphology and functional side, in evaluating cardiac function, pulmonary perfusion, waiting for the development of pulmonary ventilation in routine. Our work contributes to the development of a morphological and functional approach in heart, great vessels and lung imaging.La pathologie pulmonaire et la pathologie cardiaque interagissent et le bloc “Cœur- poumon” est à considérer comme une seule et même entité en imagerie: la lecture du cœur, des vaisseaux, des poumons et du médiastin doit être globale et intégrée, quelle que soit la modalité d’imagerie. Nous avons pu ainsi illustrer la contribution de la TDM dans l’évaluation de la prévalence de la pathologie coronarienne asymptomatique au cours de la fibrose pulmonaire idiopathique, l’analyse du volume de l’oreillette gauche au cours des BPCO, la corrélation entre volume pulmonaire hypoperfusé et le rapport VD/VG, et l’évaluation de l’envahissement cardiaque au cours des néoplasies pulmonaires. Les avancées techniques en scannographie nous permettent désormais d’approcher outre la morphologie le versant fonctionnel, notamment par l’évaluation de la fonction cardiaque, de la perfusion pulmonaire, en attendant le développement en routine clinique de l’approche par TDM de la fonction de ventilation. Notre thèse avait pour ambition de contribuer modestement à la promotion d’une approche morphologique et fonctionnelle intégrée de l’imagerie du cœur, des vaisseaux thoraciques et du poumon, dont les bénéfices cliniques nous apparaissent quotidiens et dont l’enseignement nous apparait indissociable

Syndromes aortiques aigus et traitement endovasculaire : les bonnes indications de la fenestration et des endoprothèses, couvertes ou non

International audienc

The role of computed tomography in adrenal gland infarction diagnosis during pregnancy: Two case reports

International audienc

Eligibility for minithoracotomy aortic valve replacement: from Van Praet classification to complex scanner measurements

International audienceAbstract Van Praet proposed a classification to predict the ease of minithoracotomy aortic valve replacement (MT-AVR) based on the position of the aorta in the thorax. We have evaluated the relevance of complex computed tomography (CT) scan measurements to predict the ease of performing a MT-AVR. The first 57 patients who underwent MT-AVR from February 2018 to June 2020 were selected prior to surgery using Van Praet's IA and IB classes. We made additional measurements on aorta position related to the chest and the incision on the preoperative CT scan. The main objective was to correlate complex CT measurements with different operating durations. Van Praet criteria were significantly related to the distance from the center of the aorta to the midline ( p value < 0.001 ), the distance from the center of the aortic ring to the midline ( p value = 0.013 ) and aorto-sternal angle ( p < 0.001). We did not find a correlation between CT criteria and the different surgical steps durations in patients belonging to Van Praet classes IA and IB. Our cohort of Van Praet class Ia and Ib patients were able to benefit from a MT-AVR without the need for conversion. Complex CT measurements do not provide additional information to predict surgical difficulties. This classification appears to be sufficient to determine a patient's eligibility for MT-AVR, even for a surgeon experienced in sternotomy in his first MT-AVR

Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?

This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver TransplantationMalnutrition is a common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver diseases. It has a major impact on both morbi-mortality before and after liver transplantation. Being now integrated in the definition of malnutrition and recognized as a new entity in the international classification of diseases, physicians have taken great interest in sarcopenia. Its negative consequences on the fate of patients with cirrhosis are well-demonstrated. The concept of frailty has recently been enlarged to chronic liver diseases as symptoms of impaired global physical functioning. In this article, we will discuss the definitions of malnutrition and emphasize its links with sarcopenia and frailty. We will show the relevance of frailty and sarcopenia in the course of liver diseases. The emerging role of muscle depletion on the cardiorespiratory system will also be highlighted. The importance of body composition will be demonstrated and the main tools reviewed. Finally, we adapted the definition of malnutrition to patients with cirrhosis based on the assessment of sarcopenia together with reduced food intakes

Estimation of Myocardial Strain and Contraction Phase From Cine MRI Using Variational Data Assimilation

International audienceThis paper presents a new method to estimate left ventricle deformations using variational data assimilation that combines image observations from cine MRI and a dynamic evolution model of the heart. The main contribution of the model is that it embeds parameters modeling the contraction / relaxation process. It estimates myocardial motion and contraction parameters simultaneously, providing accurate complementary information for diagnosis. The method was applied to synthetic datasets with known ground truth motion and to 47 patients MRI datasets acquired at three slice locations (base, mid-ventricle and apex). Radial and circumferential strain components were compared to those obtained with a reference tag tracking software, exhibiting good agreement with intraclass correlation coefficients (ICC) above 0.8. Results were also evaluated against wall motion score indices used to assess cardiac kinetics in clinical practice. The assimilation process overcame issues caused by temporal artifacts as a result of the dynamic model, compared to using the observation term alone. Moreover we found that the new dynamic model, consisting of a piecewise transport model acting independently on systole and diastole performed better than the standard continuous transport model, which oversmooths temporal variations. Estimated strain and contraction parameters significantly correlated to clinical scores, making them promising features for diagnosing not only hypokinesia but also dyskinesia

Interventional Radiologists: A Necessary Evolution of Leaded Protective Aprons Design

International audienc

Recurrent Bleeding Within 24 Hours After Uterine Artery Embolization for Severe Postpartum Hemorrhage: Are There Predictive Factors?

International audienc