A Pitfall in the Diagnosis of Unresectable Liver Metastases: Multiple Bile Duct Hamartomas (von Meyenburg Complexes)

Von Meyenburg complexes (VMC) are a cluster of benign liver malformations including biliary cystic lesions, with congenital fibrocollagenous stroma. This rare entity can mimick multiple secondary hepatic lesions. We report a case of a 56-year-old woman who had multiples liver lesions 12 years after operation for breast cancer. Biopsy of the hepatic lesion confirmed the diagnosis of VMC. Preoperative discovery of multiple gray-white nodular lesions scattered on the surface of the liver should not always contraindicate curative liver resection. The diagnosis of VMC should be known and confirmed with liver biopsy

Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging

Background & Aims Hepatic venous pressure gradient (HVPG) measurement is currently the only validated technique to accurately evaluate changes in portal pressure. In this study, we evaluate the use of non-contrast quantitative magnetic resonance imaging (MRI) as a surrogate measure of portal pressure. Methods Thirty patients undergoing HVPG measurement were prospectively recruited. MR parameters of longitudinal relaxation time (T1), perfusion of the liver and spleen (by arterial spin labelling), and blood flow in the portal, splanchnic and collateral circulation (by phase contrast MRI) were assessed. We estimated the liver stiffness measurement (LSM) and enhanced liver fibrosis (ELF) score. The correlation of all non-invasive parameters with HVPG was evaluated. Results The mean (range) HVPG of the patients was 9.8 (1–22) mmHg, and 14 patients (48%) had clinically significant portal hypertension (CSPH, HVPG ⩾10 mmHg). Liver T1 relaxation time, splenic artery and superior mesenteric artery velocity correlated significantly with HVPG. Using multiple linear regression, liver T1 and splenic artery velocity remained as the two parameters in the multivariate model significantly associated with HVPG (R = 0.90, p <0.001). This correlation was maintained in patients with CSPH (R = 0.85, p <0.001). A validation cohort (n = 10) showed this linear model provided a good prediction of HVPG. LSM and ELF score correlated significantly with HVPG in the whole population but the correlation was absent in CSPH. Conclusions MR parameters related to both hepatic architecture and splanchnic haemodynamics correlate significantly with HVPG. This proposed model, confirmed in a validation cohort, could replace the invasive HVPG measurement

Multi organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging

Background and Aims: Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit versus harm for therapies. Our aim was to establish the feasibility of Magnetic Resonance Imaging to assess changes in compensated cirrhosis (CC), and relate this to disease severity and future liver related outcomes (LROs). Methods: 60 CC patients, 40 healthy volunteers and 7 decompensated cirrhotics were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T1 longitudinal relaxation time and volume assessment of liver, spleen and kidneys, heart rate and cardiac index. We explore MRI parameters with disease severity and differences in baseline MRI parameters in those 11 (18%) of CC patients who had future LROs. Results: In the liver compositional changes were reflected by increased T1 in progressive disease (p<0.001) and an increase in liver volume in CC (p=0.006), with associated progressive reduction in liver (p < 0.001) and splenic (p<0.001) perfusion. A significant reduction in renal cortex T1 and increase in cardiac index and superior mesenteric arterial (SMA) blood flow was seen with increasing disease severity. Baseline liver T1 (p=0.01) and perfusion (p< 0.01), and renal cortex T1 (p<0.01) were significantly different in CC patients who subsequently developed negative LROs. Conclusions: MRI allows the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement of contrast agent. MRI parameters of liver T1, renal T1, hepatic and splenic perfusion, and SMA blood flow were related to risk of LROs

Letter: combination of biologics in inflammatory bowel diseases

International audienc

Imagerie des lésions focales du foie (développement d'un site internet pédagogique et diagnostique)

La caractérisation des lésions hépatiques en imagerie est un challenge de tous les jours du fait de l amélioration de la détection par des examens d imagerie en coupes. Du compte rendu dépendra la prise en charge ultérieure du patient, mais la caractérisation des lésions hépatiques même pour le radiologue senior reste parfois difficile. L objectif de ce travail est de développer un outil simple, didactique et accessible à tous permettant d apporter des réponses rapides aux jeunes internes, aux radiologues et cliniciens s interrogeant devant une lésion focale du foie mise en évidence par un examen d imagerie. Une collaboration étroite entre le service de radiologie digestive du CHU, la faculté de sciences et le laboratoire d imagerie a permis de développer à l aide de données pertinentes de la littérature et de la base d iconographie du CHU d Amiens un outil informatique complexe mais d utilisation aisée .Ce site web se présente en deux parties : un index alphabétique des lésions ramenant à une fiche descriptive pour chacune, regroupant ses caractéristiques épidémiologiques, cliniques, anatomopathologiques et radiologiques (échographie, scanner et IRM) et une partie sémiologie regroupant une définition des principaux signes de l imagerie hépatique. Ce site a été conçu de manière à permettre des évolutions et surtout l ajout d une aide au diagnostic.The imaging characterization of the hepatic hurts is an every day challenge because of improvements of detection according to examinations of imaging in sections. Later care of the patient will depend of report but characterization of the hepatic hurts, even for (experimented) senior radiologist, is still sometimes difficult. The purpose of this work is to develop a simple, didactic and every body accessible tool allowing to bring fast answers to young internals, radiologists and clinical practitioners, wondering in front of a focal hurt of the liver made obvious by an examination of imaging. A close collaboration between CHU digestive radiology department, faculty of sciences and imaging laboratory enabled development, thanks to relevant data of the literature and Amiens 's CHU iconography base, of a computing tool, complicated but easy to use. This website is coming in two parts : an alphabetical index of hurts leading to a descriptive form for each of them grouping together epidemiologic, clinical, anatomopathologic and radiologic ( ultrasound, scan and MRI ) characteristics. And a semiological part grouping together a definition of main hepatic imaging signs. This website was conceived so as to evolve and especially to add an help to diagnosis.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Imagerie des traumatismes abdominaux (site web d'enseignement)

Les traumatismes abdominaux sont majoritairement dus aux accidents de la voie publique et intéressent une population jeune. Le pronostic de ces patients repose sur une prise en charge adaptée. Le rôle de l imagerie et plus particulièrement la tomodensitométrie est essentiel en permettant un bilan lésionnel précis. Le but de ce travail est de réaliser une revue et d illustrer les différentes lésions rencontrées lors de traumatismes abdominaux afin de constituer un outil pédagogique moderne et didactique sous forme d un site Web. Les différentes lésions radiologiques et leurs conséquences thérapeutiques sont analysées à partir de cas clinique de notre centreAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF