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Biomedical subjects

D Revel

Publications and source records attributed to D Revel.

At least 73 records · Page 4Linked to original sources
PubMed1994

Screening patients for renal artery stenosis: value of three-dimensional time-of-flight MR angiography.

OBJECTIVE: The purpose of this study was to determine the value of three-dimensional time-of-flight MR angiography in screening patients for the presence of renal artery stenoses. SUBJECTS AND METHODS: Fifty-three patients who were thought to have renovascular hypertension on clinical grounds were prospectively examined with three-dimensional time-of-flight MR angiography. IV digital subtraction angiograms and duplex sonograms were available for all patients. For 21 patients in whom IV angiograms were of high quality and showed the renal arteries to be normal, as confirmed with duplex sonograms, intraarterial digital subtraction angiograms were not obtained for MR correlation. In the other 32 patients, intraarterial angiograms of the abdominal aorta were obtained. MR angiograms were interpreted independently by two radiologists who were unaware of the findings on angiography and duplex sonography. Our preliminary clinical experience suggested that a signal loss in the renal arteries on maximum-intensity-projection MR angiograms indicated a potential stenosis and that the degree of stenosis could not be measured accurately with MR angiography. The search for stenoses was focused on the proximal and middle parts of the vessel, as far as 3 cm from the origin of the vessel. We used intraarterial angiography to measure and grade renal artery stenoses. On intraarterial angiograms, stenoses that involved more than 50% of the vessel's section were considered significant (n = 24) and stenoses that involved 50% or less of the section were considered insignificant (n = 7). These 31 stenoses were found in 26 of the 32 patients who had intraarterial digital subtraction angiography. RESULTS: All 24 significant stenoses appeared as a cutoff of signal intensity on MR angiograms. Results were false-positive in 20 cases: in eight cases, arteries were of small diameter; in seven cases, the stenoses were insignificant; in two cases, the acquisition volume was incorrectly positioned; in two cases, there was a sharp angle in the proximal part of the renal artery; and in one case, no explanation was found. MR angiography had a sensitivity of 100% for detecting stenoses in the proximal 3 cm of the renal artery; stenoses more than 3 cm from the origin of the arteries could not be detected reliably. CONCLUSION: Our results suggest that three-dimensional time-of-flight MR angiography is a simple method for detecting stenoses of the proximal portion of the main renal arteries. However, more work is needed before widespread clinical use of such a technique is feasible.

Angiography, Digital Subtraction↗
PubMed1994

Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography.

OBJECTIVE: Subsecond contrast-enhanced MR angiography, which is not a flow-based technique and does not require cardiac gating or breath-holding, provides multiplanar, rapid, dynamic visualization of the pulmonary arteries. Accordingly, we evaluated the use of this technique in the diagnosis of thrombi in both the proximal and peripheral portions of the pulmonary arteries. Digital subtraction angiography was used as the gold standard for the diagnosis. SUBJECTS AND METHODS: Twenty-three consecutive patients with suspected pulmonary embolism were included in the study. All patients had intraarterial digital subtraction angiography, which showed emboli in 12 patients (13 proximal and six peripheral emboli). MR angiography was done within 24 hr of digital subtraction angiography. Subsecond contrast-enhanced MR angiograms were obtained in the long axis of each pulmonary artery after a unique injection of contrast medium (0.1 mmol/kg) in an antecubital vein. Fifteen dynamic frames of each pulmonary artery were alternately obtained in less than 1 min. MR angiograms were interpreted by two observers who had no knowledge of the findings on digital subtraction angiography. A diagnosis of pulmonary emboli was made when MR angiograms showed a constant intraluminal filling defect or an abrupt vascular cutoff. RESULTS: All thrombi in the proximal branches of the pulmonary arteries were visualized on MR angiograms (n = 13), whereas none of the thrombi in the distal part of the pulmonary arteries were seen (n = 6). In the 11 patients in whom no pulmonary emboli were shown by digital subtraction angiography, findings on MR angiograms were normal (sensitivity, 0.7; specificity, 1.0). CONCLUSION: Our results suggest that dynamic contrast-enhanced MR angiography is an accurate method for detecting emboli in the proximal portions of the pulmonary arteries but is of no value in detecting peripheral emboli.

Angiography, Digital Subtraction↗
PubMed1994

[Closed hepatic injuries. Role of computerized axial tomography in the non-surgical therapy].

We studied 33 patients with acute abdominal trauma, hepatic lesions and intraperitoneal hemorrhage. No surgical attitude was adopted, analyzing the CT appearance of the intraparenchymal lesions as well as the associated hemoperitoneum. One of the patients who had suffered left hepatic laceration did not have a good evolution. The most frequent lesions were intraparenchymal hematoma, lobar lacerations and subcapsular hematoma. In two cases, drainage of the intrahepatic collections were needed. The presence of hemoperitoneum was not an indication for emergency surgery. These results confirm the present tendency of conservative management with clinical, CT and ultrasound control of the different hepatic injuries, when the patients are hemodynamically stable.

Abdominal Injuries↗
PubMed1994

[Re-stenosis of aortic coarctation in children. Comparison between aortic angioplasty and surgery].

The use of aortic angioplasty rather than surgery for restenosis of coarctation of the aorta after initial surgery remains controversial. The efficacy and complications of these two techniques have never been compared in prospective and retrospective studies. Between 1976 and 1992, 56 patients were treated for secondary restenosis of coarctation of the aorta: 29 by angioplasty and 27 by surgery. The case reports of these patients were reviewed retrospectively. The average follow-up was 1.5 +/- 0.3 years of the angioplasty group and 5.4 +/- 0.8 years for the surgical group. The reduction of systolic blood pressure in the right arm was significant and identical in the two groups (p < 0.05). The residual pressure gradient was less immediately and at term in the surgical group (p < 0.05). No fatalities were observed in either group. There were no aneurysmal complications. A neurological complication (posterior column syndrome) was observed after surgery (3.7%). The global rate of complications was higher after surgery (6.7% vs 33%). The rate of further restenosis was higher after angioplasty (18.5% vs 3.7%). The low rate of complications, the shorter hospital stay without repeat thoracotomy were in favour of the angioplasty procedure but the greater immediate and long-term efficacy of surgery on the pressure gradient was in favour of the latter solution. A prospective long-term study is necessary.

Adolescent↗
PubMed1993

Early events in the experimental interstitial lung disease induced in sheep by the Visna-maedi virus.

Visna-maedi virus is a lentivirus closely related to the human immunodeficiency virus type I (HIV-I). During spontaneous infection of sheep by Visna-maedi virus an interstitial lung disease is observed. It is characterized by an alveolitis, peribronchovascular lymphoid nodules, alveolar wall thickening and myomatosis. In order to decipher the pathology of this lentiviral infection we have induced this disease in colostrum-deprived newborn lambs.

Animals↗
PubMed1993

Contrast-enhanced magnetic resonance tomoangiography: a new imaging technique for studying thoracic great vessels.

The authors propose a new imaging approach for studying thoracic great vessels, using high-speed MR imaging combined with intravenous rapid bolus injection of a paramagnetic contrast media. The decrease of the T1 relaxation time of flowing blood induced by the contrast agent (Gd-DOTA) caused an increased signal intensity within the vessel lumen for a time period allowing multiplanar imaging of various vascular structures. The intraluminal signal enhancement is mainly related to the blood concentration of the contrast agent as in conventional X-ray angiography. Information on the aorta and pulmonary arteries obtained by the so-called contrast-enhanced magnetic resonance tomoangiography appears complementary to that obtained with other vascular MR imaging procedures such as cine-MRI and magnetic resonance angiography (MRA).

Aortic Dissection↗
PubMed1993

Superparamagnetic iron oxide particles and positive enhancement for myocardial perfusion studies assessed by subsecond T1-weighted MRI.

Superparamagnetic iron oxide particles (SPIOs) are usually referred to as T2 MR contrast agents, reducing signal intensity (SI) on T2-weighted MR images (negative enhancement). This study reports the original use of SPIOs as T1-enhancing contrast agents, primarily assessed in vitro, and then applied to an in vivo investigation of a myocardial perfusion defect. Using a strongly T1-weighted subsecond MR sequence with SPIOs intravenous (IV) bolus injection, MR imaging of myocardial vascularization after reperfusion was performed, on a dog model of coronary occlusion followed by reperfusion. Immediately after the intravenous bolus injection of 20 mumol/kg of SPIOs, a positive signal intensity enhancement was observed respectively, in the right and left ventricular cavity and in the nonischemic left myocardium. Moreover, compared to normal myocardium, the remaining ischemic myocardial region (anterior wall of the left ventricle) appeared as a lower and delayed SI enhancing area (cold spot). Mean peak SIE in the nonischemic myocardium (posterior wall) was significantly higher than in the ischemic myocardium (anterior wall) (110 +/- 23% vs. 74 +/- 22%, Mann-Whitney test alpha < 1%, n1 = 6, n2-n1 = 0, U > 2). In conclusion, the T1 effect of SPIOs at low dose, during their first intravascular distribution, suggests their potential use as positive markers to investigate the regional myocardial blood flow and some perfusion defects such as the "no-reflow phenomenon."

Animals↗
PubMed1992

Assessment of a model for overall left ventricular three-dimensional motion from MRI data.

In this paper we present a complete methodology to evaluate a model for overall three-dimensional (3D) motion of the human left ventricle (LV) from MRI data. The left ventricular motion is approximated by a linear model associated with an affine transformation to determine parameters for non-rigid motion of the LV. The proposed method has been applied to a normal patient and to a patient with cardiac disease. Results obtained show that the linear model provides a fairly good approximation of normal left ventricular motion, whereas serious cardiac disease produces abnormal motion, yielding altered model performances.

Heart Diseases↗
PubMed1992

[Diverticulum of the right atrium. A case report and review of the literature].

Congenital atrial diverticula are rare, especially those involving the right atrium. This condition was observed in a 52 year old man who presented with palpitations. The diagnosis was made by two-dimensional echocardiography and confirmed by CT scan, magnetic resonance imaging and angiography. In the absence of significant invalidity, no treatment was recommended. Only three other cases of this condition have been previously reported, all of which were referred for surgery for thrombotic complications, arrhythmias and cardiac failure. Anatomo-pathological analysis showed different appearances: fibrous tissue and lipomatous degeneration. In the absence of associated heart disease, these aneurysms are probably congenital.

Angiocardiography↗
PubMed1992

[Use of the internal mammary artery as a free graft with reimplantation of the proximal end onto the ascending aorta. Apropos of 39 cases].

From January 1987 to January 1991, 104 patients received bilateral internal mammary artery grafts and 39 of them had coronary bypass with a free graft implanted on the ascending aorta. There were 35 men, with a mean age of 57.35 years (range 41 to 70 years). 87% of them had stable angina, and 23 had preoperative myocardial infarction. The left ventricular function was good in 77 per cent of cases. 23 patients had three vessel disease (61.5%), 13 two vessel diseases (30.7%), 2 one vessel disease (5.12%) and one a left main coronary stenosis. Left internal mammary artery was used in two patients on the left descending artery and the right internal mammary artery was used in 37 patients: 15 on the circumflex, 15 on the right coronary, 4 on the LDA and 3 on the diagonal artery. Five patients had one graft, 32 two grafts and one three grafts (bilateral mammary and saphenous vein). Hospital mortality was 2.56% (1 patient) and there were 2 late deaths (5.12%). There were 5 perioperative myocardial infractions (12.8%) and no sternal infections. The mean follow up is 21 months (range 3 to 46 months). At follow-up, 34 patients (87.2%) were asymptomatic, and there were no myocardial infarctions. Postoperative angiography in 8 patients (mean postoperative time 2.5 months) showed that all the grafts were patent. This analysis demonstrates that free IMA graft has a low operative risk and provides excellent long term functional improvement and survival.

Adult↗
PubMed1992

[Localized pleural fibrous mesothelioma (submesothelial pleural fibroma). Anatomo-clinical study of 25 cases].

We studied a retrospective series of 25 sub-pleural fibromas (benign localized pleural mesotheliomas) of which 23 where excised, collected over a period of 20 years. The current series confirms the excellent prognostic of these rare tumors. They are sometimes bulky, but not infiltrating and discovered by systematic chest X-ray. Modern imaging using CT-Scan and nuclear magnetic resonance can suggest their diagnostic which is confirmed by histopathologic analysis of the usually pediculate and easily removed tumor. Transthoracic needle aspiration is generally of little help for diagnosis. The histopathologic diversity of the tumor is rather confusing but characteristic features can be found with fusiform cells ans collagen stroma. Immuno-histochemistry is more helpful for diagnosis and histogenesis recognition than electron microscopy.

Adult↗
PubMed1991

Dental materials and magnetic resonance imaging.

Radiologists may encounter patients with fixed dental prostheses that may produce image distortion on MRI scans of the face and jaw. In this work, we assessed the MRI appearances of dental prosthetic materials in vitro, including precious alloys, nonprecious alloys, ceramic prostheses, dental amalgam, and composite materials. For in vivo studies, these materials were placed in the patient's mouth. Nonprecious alloys produce large image deformations, whereas precious alloys had no effect on MRI images. The in vivo study showed the anatomical zones that were most affected on MRI scans. The size of these zones produced by the presence of nonprecious alloys is influenced by the volume of the prosthesis and is related to the scanning sequence used.

Adult↗
PubMed1991

Quantitation of reperfused myocardial infarction by Gd-DOTA-enhanced magnetic resonance imaging. An experimental study.

Because there is evidence that myocardial infarct size is modified by coronary artery reperfusion, an ex vivo experimental model of myocardial infarction was developed to determine the influence of the timing of gadolinium-tetraazacyclododecane tetraacetic acid (Gd-DOTA)-enhanced magnetic resonance imaging (MRI) on the accuracy of infarct size quantitation. Eighteen dogs underwent a 2-hour coronary occlusion followed by 1 (n = 6), 6 (n = 6), or 48 (n = 6) hours of reperfusion. Gd-DOTA was injected 10 minutes before the dogs were killed. T1 (SE 250/26) and T2 (SE 1500/78) weighted images were performed on excised hearts. Gd-DOTA concentration was measured in myocardium by atomic emission spectrometry, and correlated with myocardial blood flow evaluated by radioactive microspheres. All dogs presented with myocardial infarction (mean size 20.4% +/- 3.1% of the left ventricle), and a corresponding area of increased signal intensity on T1-weighted MR images. In none of the three groups did the area of high signal intensity correlate with the ischemic area. By contrast, after 6 and 48 hours of reperfusion, the high signal intensity area (17.9% +/- 2.4%) closely matched the area of nonreversible jeopardized tissue (16.4% +/- 2.5%), as determined on tetrazolium-stained heart slices. Although a noreflow phenomenon was observed in the jeopardized tissue, Gd-DOTA concentration was higher in the subendocardial central ischemic zone than in normally perfused myocardium. Gd-DOTA imaging enhancement seems to be the consequence of a delayed clearance of the agent from the injured tissue. Gd-DOTA-enhanced MRI accurately quantitates the size of reperfused myocardial infarction on the ex vivo heart for more than 6 hours after the beginning of reperfusion. It remains to be determined whether the in vitro results obtained here can be applied to assess the myocardial infarct size in vivo.

Animals↗
PubMed1991

[Obstruction of pulmonary arteries. Contribution of the scanner and MRI. Apropos of 10 cases].

We present a retrospective study of ten patients presenting non specific clinical manifestations in whom the diagnosis of pulmonary embolism was documented by CT scan and/or MRI. Results of CT scan and/or MRI were compared to DSA bi-selective pulmonary angiography findings. In a large number of cases, CT scan and MRI allowed the detection of the obstruction within the right and left pulmonary arteries (RPA and LPA). Although these techniques did not permit the diagnosis of peripheral clots, pulmonary infarcts were usually depicted by these two procedures. CT scan and/or MRI could be performed as first-line investigations in case of atypical clinical symptoms because of their high relevance for proximal pulmonary artery obstruction, although these two non-invasive procedures cannot indicate the aetiology of the obstruction etiology.

Evaluation Studies as Topic↗