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Biomedical subjects

A Sibert

Publications and source records attributed to A Sibert.

At least 19 recordsLinked to original sources
PubMed2006

Utility of staging laparoscopy in subsets of biliary cancers : laparoscopy is a powerful diagnostic tool in patients with intrahepatic and gallbladder carcinoma.

BACKGROUND: The aim of this study was to evaluate the utility of staging laparoscopy in patients with biliary cancers in the era of modern diagnostic imaging. METHODS: From September 2002 through August 2004, 39 consecutive patients with potentially resectable cholangiocarcinoma underwent preoperative staging laparoscopy before laparotomy. Preoperative imaging included ultrasonography and triphasic computed tomography for all patients and magnetic resonance cholangiography in 35 patients (90%). Final pathological diagnosis included 20 hilar cholangiocarcinomas (HC), 11 intrahepatic cholangiocarcinomas (IHC), and eight gallbladder carcinomas (GBC). RESULTS: During laparoscopy, unresectable disease was found in 14/39 patients (36%). The main causes of unresectability were peritoneal carcinomatosis (11/14) and liver metastases (5/14). At laparotomy, nine patients (37%) were found to have advanced disease precluding resection. Vascular invasion and nodal metastases were the main causes of unresectability during laparotomy (eight out of nine). In detecting peritoneal metastases and liver metastases, laparoscopy had an accuracy of 92 and 71%, respectively. All patients with vascular or nodal involvement were missed by laparoscopy. For prediction of unresectability disease, the yield and accuracy of laparoscopy were highest for GBC (62% yield and 83% accuracy), followed by IHC (36% yield and 67% accuracy) and HC (25% yield and 45% accuracy) CONCLUSION: Staging laparoscopy ensured that unnecessary laparotomy was not performed in 36% of patients with potentially resectable biliary carcinoma after extensive preoperative imaging. In patients with biliary carcinoma that appears resectable, staging laparoscopy allows detection of peritoneal and liver metastasis in one third of patients. Both vascular and lymph nodes invasions were not diagnosed by this procedure. Due to these limitations, laparoscopy is more useful in ruling out dissemination in GBC and IHC than in HC.

Adult↗
PubMed2006

Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma.

BACKGROUND: Selective transarterial chemoembolization (TACE) and portal vein embolization (PVE) could improve the rate of hypertrophy of the future liver remnant (FLR) in patients with chronic liver disease. This study evaluated the feasibility and efficacy of this combined procedure. METHODS: Between November 1998 and October 2004, 36 patients with cirrhosis and hepatocellular carcinoma underwent right hepatectomy after PVE. Additional TACE preceded PVE by 3-4 weeks in 18 patients (TACE+PVE group) and the remaining 18 patients had PVE alone (PVE group). RESULTS: PVE was well tolerated in all patients. The mean increase in percentage FLR volume was significantly higher in the TACE+PVE group than in the PVE group (mean(s.d.) 12(5) versus 8(4) percent; P=0.022). The rate of hypertrophy was more than 10 percent in 12 patients in the TACE+PVE group and in five who had PVE alone (P=0.044). Duration of surgery, blood loss, incidence of liver failure and mortality (two patients in each group) were similar in the two groups. None of the 17 patients with an increase in FLR volume of more than 10 percent died, whereas there were four deaths among 19 patients with a smaller increase. The incidence of complete tumour necrosis was significantly higher in the TACE+PVE group (15 of 18 versus one of 18; P<0.001), with a higher 5-year disease-free survival rate (37 versus 19 percent; P=0.041). CONCLUSION: Sequential TACE and PVE before operation increases the rate of hypertrophy of the FLR and leads to a high rate of complete tumour necrosis associated with longer recurrence-free survival.

Aged↗
PubMed2002

[Liver and vascular abnormalities].

The liver is a parenchyma which contains many vessels. They are composed of two inflow vessels: the portal vein and the hepatic artery, and one outflow system represented by the hepatic veins. We will see in the chapter most of the abnormalities and their consequences due to decrease or an increase of the blood flow of these vessels. Many illustrations will be provided with a special focus on CT findings with multiphasic images.

Female↗
PubMed2001

Haemobilia causing acute pancreatitis after percutaneous liver biopsy: diagnosis by magnetic resonance cholangiopancreatography.

Magnetic resonance cholangiopancreatography (MRCP) has received much attention as a non-invasive alternative to endoscopic retrograde cholangiopancreatography, primarily for investigation of choledocholithiasis, but also for evaluation of less common biliary anomalies. We present a case of haemobilia causing acute pancreatitis after percutaneous liver biopsy in which the diagnosis could be made clearly by MRCP, thus avoiding endoscopic retrograde cholangiopancreatography and sphincterotomy.

Acute Disease↗
PubMed1999

Helical CT assessment in hilar cholangiocarcinoma: correlation with surgical and pathologic findings.

OBJECTIVE: Our goal was to assess the usefulness of helical CT in the presurgical evaluation of hilar cholangiocarcinoma. CONCLUSION: Helical CT aids in tumor localization and in assessment of parenchymal, biliary intrahepatic, and portal involvement in hilar cholangiocarcinoma. However, helical CT is not effective in the assessment of biliary extrahepatic, arterial, and lymph node involvement.

Adult↗
PubMed1997

[Congenital cystic dilatation of the common bile duct. Radio-anatomical correlations in 14 patients].

OBJECTIVES: The aim of this study was to compare imaging and pathological results of congenital cystic enlargement of the biliary tract to determine the best preoperative management strategy. PATIENTS AND METHODS: Radiological findings of 14 cases treated by surgery were reviewed. Radiological examinations were reviewed: ultrasound (n = 20), computed tomography (n = 13), endoscopic ultrasound (n = 8), endoscopic retrograde cholangiopancreatography (n = 10), percutaneous transhepatic cholangiography (n = 3), peroperative cholangiography (n = 11). Imaging and surgical or pathological correlations were obtained with regard to topographical type using Todani's classification, pancreatobiliary junction, and associated diseases, especially biliary malignancies (cystic wall and gallbladder). RESULTS: Cystic enlargement of the biliary tract was type Ia in 2 patients, type Ib in 1, type Ic in 4, type IVa in 5, and type IVb in 2. The radio-pathological correlation was excellent for the topographical type, and quite good for intrahepatic extension. An abnormal pancreatobiliary junction was identified in 5 cases, and visualized before surgery in I case. This junction was not opacified pre- or pre-operatively in 7 cases. Gallbladder stones were present in 2 cases, choledocal stones, in 2 cases, and intrahepatic stones in one cases, always seen on ultrasound. Malignant degeneration was present in the cyst in one case in the pathological specimen, but was not visualized by imaging procedures or peroperatively; one intrahepatic degeneration was visualized on CT and histologically proven in the surgical specimen. CONCLUSION: Ultrasound and CT allow positive diagnosis of cystic enlargement of the biliary tract, and diagnosis of intrahepatic cyst and associated diseases. The bifurcation extension and the study of pancreatobiliary junction require peroperative or retrograde cholangiography.

Adolescent↗
PubMed1997

[Comparison of scanners and porto-scanners, both in helical mode, for the study of hepatic metastases. Prospective study in 12 patients].

PURPOSE: The aim of this study was to compare helical CTAP and helical CT-scan in the preoperative assessment of liver metastases. METHODS: A prospective unicentric study in 12 patients was performed with helical CTAP and helical CT-scan. All patients underwent partial hepatectomy with intraoperative palpation and sonography within 19 days (mean: 9 days). RESULTS: Examination of resected liver specimens found 38 metastases, from colorectal cancer in 36 cases. The sensitivity was 92.1% for helical CTAP and 79% for helical CT-scan. This sensitivity was 85% for helical CTAP and 60% for helical CT-scan for nodules 1 cm or less in diameter (P = 0.08). CONCLUSION: In the preoperative screening of liver metastases, helical CT-scan should be performed as the first choice examination. When hepatic lesions seem to be curable by resection based on helical dynamic CT-scan results, helical CTAP should be performed to increase the sensitivity of detection of lesions 1 cm or less in diameter.

Adult↗
PubMed1997

[Imaging of atypical cysts of the liver. Study of 26 surgically treated cases].

OBJECTIVES: Differential diagnosis between a benign cystic hepatic lesion, biliary cyst, and a potentially malignant lesion or biliary cystadenoma, is difficult. The aim of this study was to evaluate imaging features of atypical cystic liver lesions and the role of imaging techniques in determining a specific diagnosis. METHODS: Twenty-six patients with atypical cystic hepatic lesions were included in this study. All patients underwent surgery and pathological diagnosis was atypical hepatic cyst (n = 18), biliary cystadenoma (n = 4), hydatic cyst (n = 3), and ciliated hepatic foregut cyst (n = 1). We systematically reviewed US (n = 24), CT (n = 24), and MRI (n = 8) examinations. RESULTS: Septum were seen in both cystadenomas (US: n = 4, CT: n = 1) and hepatic cysts (US: n = 11, CT: n = 6). No mural nodules were seen. A thin wall was noted in both hepatic cysts (n = 2) and cystadenomas (n = 3). The intrahepatic biliary tract was dilated in 3 patients with hepatic cysts, 1 patient with cystadenoma, and 2 patients with hydatic cysts. Calcifications were noted in 1 patient with hepatic cyst, 3 patients with hydatic cysts, and in the case of ciliated hepatic foregut cyst. We found an associated typical hepatic cyst in 77% of cases (14/18) with atypical hepatic cysts; this was never found in other atypical cystic lesions (P < 0.01). CONCLUSION: In this series, no imaging features provided a differential diagnosis of atypical hepatic cysts and cystadenomas. The presence of associated typical hepatic cysts is helpful in suggesting the diagnosis of hepatic cyst.

Adult↗
PubMed1996

[Imaging of pancreatitis].

Acute and chronic pancreatitis involve different problems. In acute pancreatitis, the method of choice is CT scan, which provides a precise description of the lesions as a basis for establishing criteria of severity. Discovery of infection often requires scan-guided puncture. For chronic pancreatitis, a greater range of examinations is available. The CT scan is the best noninvasive method. Ultrasound examination can be repeated for follow-up. Echoendoscopy shows early signs. Excellent diagnostic results are provided by retrograde endoscopic cholangiopancreatography. It is indispensable for the presurgery work-up and sometimes for differential diagnosis of cancer.

Acute Disease↗
PubMed1995

Assessment of vascular involvement with magnetic resonance angiography (MRA) in Pancoast syndrome.

The purpose of this study was to evaluate the diagnostic value of MRA in determining vascular involvement in bronchogenic carcinoma with Pancoast syndrome. Six patients with Pancoast syndrome were investigated preoperatively by means of MRA. Following standard spin-echo MR imaging in the axial and coronal planes, two successive two-dimensional (2D) time-of-flight acquisitions were obtained in the axial plane, the first with venous, the second with arterial presaturation. MRA data were compared to angiographic data in four cases, and to surgical findings in all six cases. MRA demonstrated displacement (n = 2) and encasement (n = 2) of subclavian and/or brachiocephalic arteries, and encasement or occlusion of subclavian and/or right brachiocephalic vein (n = 3). Close correlation between MRA, angiography and surgery was obtained. These preliminary results suggest that MRA is a noninvasive diagnostic method complementary to MR imaging for detecting vascular involvement in bronchogenic carcinoma with Pancoast syndrome.

Adult↗
PubMed1995

Thoracic aortic dissection: diagnosis with transesophageal echocardiography versus MR imaging.

PURPOSE: To compare transesophageal echocardiography (TEE) and magnetic resonance (MR) imaging in the diagnosis of dissection of the thoracic aorta. MATERIALS AND METHODS: Thirty-one consecutive patients with clinically suspected aortic dissection and 10 postoperative patients underwent transesophageal color Doppler echocardiography and MR imaging. Imaging results were compared at independent double-blind readings. Final diagnosis was obtained from consensual review of all corroborative studies. RESULTS: MR imaging depicted the intimal flap in 95% of aortic dissections; TEE, in 86% (P < .05). In surgical patients, the sensitivity of MR in detection of residual dissection was 100% versus 86% with TEE (P < .05). The inferior extent of the dissected lumen was seen only with MR imaging. False-positive results occurred in two cases with TEE and in one with MR imaging. CONCLUSION: MR imaging is superior to TEE in the evaluation and follow-up of dissection of the thoracic aorta. Because the availability of MR is limited, however, TEE should remain the standard modality for diagnosis.

Adult↗
PubMed1995

[Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma. Value and prognostic factors of hepatic artery embolization].

To assess efficiency and to determine prognostic factors in emergency embolization for intraperitoneal hemorrhage from hepatocellular carcinoma we retrospectively analyzed 12 consecutive procedures. In order to evaluate the extension of tumor thrombus in the intrahepatic portal system before embolization, a portal perfusion rate was defined as the relative patency of the segmental portal veins demonstrated at arteriography. Serum bilirubin level and portal perfusion rate were correlated with length of survival. Successful hemostasis was achieved in all patients. Mean length of survival was 149 days. Two patients are still alive 545 and 195 days, respectively, after the procedure. A significant correlation (p = 0.005) between portal perfusion rate and length of survival was obtained. There was no correlation between serum bilirubin level and prognosis. Emergency embolization is an effective treatment in patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis depends of portal perfusion rate.

Aged↗
PubMed1994

Dynamic Gd-DOTA-enhanced MR imaging of hepatic metastases from pancreatic neuroendocrine tumors.

The aim of this study was to determine the MR imaging features of hepatic metastases from pancreatic neuroendocrine tumors (HMPNT), and to assess their enhancement characteristics on dynamic gadolinium-chelate-enhanced MR imaging. Twelve consecutive patients with pathologically proven HMPNT underwent spin-echo (SE) and dynamic gradient-recalled echo (GRE) MR imaging before and after intravenous administration of a gadolinium-chelate (gadolinium tetraazacyclododecanetetraacetic acid; Gd-DOTA). MR examinations were performed prospectively and interpreted retrospectively in consensus by two radiologists. Fifty-five HMPNT were identified in matching anatomic sections on the different MR sequences and included in the study. On T1-weighted SE images, 45 HMPNT (82%) were hypointense and 10 HMPNT (18%) were isointense. On T2-weighted SE images 55 HMPNT (100%) were hyperintense. On GRE images obtained 20 s after Gd-DOTA injection, 41 HMPNT (75%) showed slight peripheral enhancement, and 14 HMPNT (25%) showed internal enhancement. Forty-four HMPNT (80%) were heterogeneous. On GRE images obtained 4 min after Gd-DOTA injection, 37 HMPNT (67%) showed peripheral enhancement, and 18 HMPNT (33%) showed a global and almost complete enhancement. Heterogeneity of enhancement was seen in all 55 HMPNT (100%). Although HMPNT exhibit a large spectrum of MR features, early enhancement and heterogeneity on dynamic GRE MR images are suggestive features of HMPNT.

Adult↗
PubMed1994

Focal hepatic masses: comparison of detection during arterial portography with MR imaging and CT.

PURPOSE: A prospective study was performed to compare the sensitivity and specificity of magnetic resonance (MR) imaging and computed tomography (CT) both performed during arterial portography in depicting focal hepatic masses. MATERIALS AND METHODS: Eleven patients with 31 pathologically proved focal hepatic masses were prospectively evaluated. MR arterial portography was performed with 4 mL of a 0.5 mmol/kg solution of gadolinium tetraazacyclododecanetetraacetic acid (DOTA) injected through a catheter into the superior mesenteric artery during multisection gradient-echo imaging. RESULTS: MR arterial portography depicted 29 of the 31 masses (sensitivity, 94%). CT arterial portography depicted 27 of the 31 masses (sensitivity, 87%). Two masses not depicted with either CT or MR had a diameter of 3 and 7 mm, respectively. Neither MR nor CT demonstrated a false-positive finding (specificity, 100%). The difference in sensitivity and specificity between the two techniques was not statistically significant. CONCLUSION: MR arterial portography does not enable detection of significantly more focal hepatic masses than does CT arterial portography.

Female↗
PubMed1994

Hepatic tumors: detection and characterization at 1-T MR imaging enhanced with AMI-25.

PURPOSE: To evaluate the ability of magnetic resonance (MR) imaging enhanced with AMI-25 to depict and characterize hepatic tumors. MATERIALS AND METHODS: Sixty-four patients (41 men and 23 women, aged 24-65 years [mean, 55 years]) underwent 1-T MR imaging: 22 had metastatic disease; 10, hepatocellular carcinoma; seven, hemangioma; three, focal nodular hyperplasia; three, gallbladder adenocarcinoma; two, lymphoma; one, adenoma; and 16, no tumor. Pre- and postcontrast images (alone and in combination) were analyzed by three independent radiologists. Receiver operating characteristic curves were constructed to compare tumor characterization. RESULTS: Signal intensity was decreased in all benign tumors but not in malignant tumors. The number of tumors depicted (nonenhanced images, 657 tumors; enhanced, 753; and combined, 760) was not statistically different. Receiver operating characteristic curves did not show improved characterization with AMI-25. CONCLUSION: AMI-25 does not improve depiction of hepatic tumors. Although characterization of hepatic tumors was not improved with AMI-25, uptake of AMI-25 seems specific for hepatic tumors at MR imaging.

Carcinoma, Hepatocellular↗
PubMed1994

Persistent enhancement after treatment for cerebral toxoplasmosis in patients with AIDS: predictive value for subsequent recurrence.

PURPOSE: To determine the predictive imaging (CT and/or MR) features of brain toxoplasmosis recurrences in acquired immunodeficiency syndrome. METHODS: The imaging studies of patients with brain toxoplasmosis were retrospectively reviewed. Forty-three patients with significant decrease or disappearance of brain lesions under specific treatment on follow-up imaging examinations were included. MR examinations were performed using T2- and T1-weighted sequences, before and after intravenous administration of gadolinium-DOTA. RESULTS: A recurrence occurred in 11 (26%) of 43 cases. Ten (91%) of these 11 patients with recurrence showed focal persistent enhancement after the initial treatment of toxoplasmosis abscess. One of the 11 patients with recurrence showed no persistent enhancement; 3 patients showed persistent enhancement but had no recurrence. CONCLUSIONS: Recurrences of brain toxoplasmosis in our series correlated with persistent contrast enhancement. We hypothesize that demonstration of persistent areas of contrast enhancement after treatment for initial toxoplasmosis may be a valuable sign for identifying patients at risk for recurrence.

AIDS-Related Opportunistic Infections↗