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Biomedical subjects

J M Bruel

Publications and source records attributed to J M Bruel.

At least 19 recordsLinked to original sources
PubMed2006

[Acute cholangitis: imaging diagnosis and management].

Cholangitis is an infection of the biliary ductal system that results from biliary obstruction. Choledocholithiasis has been the leading cause of acute cholangitis. Acute cholangitis remains a life-threatening complication of biliary obstruction that needs emergency diagnosis and treatment. Ultrasound (US) is the primary imaging modality for assessment of patients with suspected acute cholangitis. US is both sensitive and specific in demonstrating biliary dilatation. However, biliary dilatation is not always present at the early stage of bile duct obstruction and the performance of US in demonstrating choledocholithiasis is poor. Computed tomography (CT) without contrast injection is more sensitive than US in demonstrating choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic sonography (EUS) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis. In patients without previous cholecystectomy, clinical, biological, and US results allow to determine patients with high probability of having choledocholithiasis even if the stone is not directly visible on US. Patients undergoing cholecystectomy require laparoscopic common bile duct exploration, especially if the common bile duct clearance is not checked before surgery by MRCP or EUS.

Acute Disease↗
PubMed2005

Multidetector CT of bowel obstruction: value of post-processing.

The value of imaging in patients with suspicion of bowel obstruction is dependent on the ability to answer questions relevant to the clinical management of patients. Is there mechanical obstruction? Is it a small bowel obstruction (SBO) or a large bowel obstruction (LBO)? What is the transition point? What is the cause of the obstruction? What is the severity of the obstruction? The results of studies published more than 10 years ago using axial and single-slice helical CT gave rise to findings based on axial slices that enables CT to answer these different questions. With the recent advent of multislice CT, large numbers of thin sections can be generated with short image intervals, which is well suited to postprocessing. Postprocessing techniques include standard reformatting methods such as sagittal, coronal and oblique reformatting, curved reformatting, maximum and minimum-intensity projection, variable thickness viewing, and volume and surface rendering. This pictorial review illustrates the added value of postprocessing for answering different questions concerning patients with suspicion of bowel obstruction.

Humans↗
PubMed2004

[Disorders of the peritoneum].

The peritoneum is an important actor in diseases of the abdomen: defects of the peritoneum or mesos may lead to internal hernias; developmental anomalies of the peritoneum may lead to volvulus and bowel obstruction; diffuse or localized primary or secondary tumors of the peritoneum may develop; infectious, inflammatory or ischemic primary diseases of the peritoneum may cause abdominal pain, sepsis or result in the formation of fluid collections. The purpose of this presentation is to illustrate the role of imaging in the diagnosis of these different diseases and to provide some guidelines allowing their detection and characterization.

Hernia↗
PubMed2003

[Spontaneous regression of a focal nodular hyperplasia].

The authors report a case of near complete regression of a focal nodular hyperplasia of the liver over a course of 10 years in a 39 year old woman. This presentation is atypical because of its imaging features (initially typically hypervascular, to eventually become a fibrous scar after undergoing a pseudo-angiomatous phase) and because of its near complete spontaneous regression.

Adult↗
PubMed2002

Non-traumatic abdominal emergencies: imaging of acute intestinal obstruction.

The purpose of this paper is to give an overview of the main clinical questions in bowel obstruction, to discuss the value of various imaging modalities, including conventional radiography, ultrasound, and CT, to underline the impact of imaging in the management of patients with suspect bowel obstruction, and then to suggest a diagnostic triage in such patients.

Acute Disease↗
PubMed2002

High resolution unenhanced computed tomography in patients with swollen legs.

PURPOSE: To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs. MATERIAL AND METHODS: CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primary lymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement. RESULTS: Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema. CONCLUSION: Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.

Adolescent↗
PubMed2002

[Acute appendicitis: to image or not to image?].

Acute appendicitis is frequently clinically suspected. However, about 50% of emergency room patients with such a diagnosis do not have acute appendicitis and between 20-25% of patients undergoing appendectomy based on clinical diagnosis have a normal appendix. On the other hand, if left untreated acute appendicitis may result in peritonitis. The purpose of this article is to review the indications for imaging patients with clinical suspicion of acute appendicitis, to describe the US and CT features of acute appendicitis, to review the advantages and limitations of US and CT, and to present the differential diagnosis to be considered in patients with right lower quadrant pain.

Acute Disease↗
PubMed1999

[Needle-tract seeding after ultrasound-guided puncture of hepatocellular carcinoma. A study of 150 patients].

OBJECTIVES: To study the frequency of tumor seeding after percutaneous biopsy of hepatocellular carcinoma and to evaluate the impact on long-term survival. METHODS: Records of 150 patients with cirrhosis who underwent ultrasound-guided aspiration biopsy for hepatocellular carcinoma between 1989 and 1996 were reviewed in June 1998. Liver transplantation was performed in 7 patients. One to three needle passes were performed with 18 to 20 gauge needles. Follow-up included regular clinical examinations and ultrasonography or computerized tomography. RESULTS: Four cases (2.66%) of subcutaneous metastasis were noted at the needle insertion site; none in transplanted patients. All patients had viral cirrhosis, Okuda class I. Nodules were detected 4, 12, 22 and 24 months after biopsy. The second patient is alive 24 months after tumor seeding. For other patients, survival time was 4, 24 and 60 months respectively, without local tumor extension after surgical resection or radiotherapy. During a mean 11.8 months of follow-up, 127 patients died without tumor seeding. Eleven patients are still being followed and have no signs of needle tract implantation of hepatocellular carcinoma (mean follow-up 34.7 months). CONCLUSION: The prevalence of tumoral seeding after percutaneous biopsy of hepatocellular carcinoma was 2.66%, which is higher than in previous studies. After liver transplantation, no evidence of needle tract seeding was identified. Survival did not seem to be influenced by local evolution.

Adult↗
PubMed1998

Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure.

To determine the relationship between quantitative Doppler parameters of portal, hepatic, and splanchnic circulation and hepatic venous pressure gradient (HVPG), variceal size, and Child-Pugh class in patients with alcoholic cirrhosis, we studied forty patients with proved alcoholic cirrhosis who underwent Doppler ultrasonography, hepatic vein catheterization, and esophagoscopy. The following Doppler parameters were recorded: time-averaged mean blood velocity, volume flow of the main portal vein flow, and resistance index (RI) of the hepatic and of the superior mesenteric artery. Doppler findings were compared with HVPG, presence and size of esophageal varices, and Child-Pugh class. There was a significant inverse correlation between portal velocity and HVPG (r = -.69), as well as between portal vein flow and HVPG (r = -.58). No correlation was found between RI in the hepatic artery or superior mesenteric artery and HVPG. No correlation was found between portal vein measurements and presence and size of varices. Severe liver failure was associated with lower portal velocity and flow. In patients with alcoholic cirrhosis, only portal vein blood velocity and flow, but neither hepatic nor mesenteric artery RI, are correlated to the severity of portal hypertension and to the severity of liver failure.

Adult↗
PubMed1997

Acute colonic diverticulitis: prospective comparative evaluation with US and CT.

PURPOSE: To compare the accuracy of ultrasonographic (US) and computed tomographic (CT) findings for diagnosis of acute colonic diverticulitis. MATERIALS AND METHODS: US and CT were prospectively performed in 64 consecutive patients suspected of having acute colonic diverticulitis. Images were interpreted independently in a blinded fashion. Imaging data were compared with the final diagnosis, which was based on initial clinical and follow-up examination results (n = 64) and pathologic (n = 22), endoscopic (n = 21), and contrast enema (n = 15) examination findings. RESULTS: Final diagnosis was acute colonic diverticulitis (n = 33), other acute abdominal condition (n = 24), or unknown (n = 7). Both CT and US findings yielded 84% accuracy. US and CT findings were not statistically significant different in terms of sensitivity (85% and 91%, respectively) and specificity (84% and 77%, respectively). Positive predictive value was 85% for US and 81% for CT; negative predictive value was 84% for US and 88% for CT. When determining alternative diagnoses, US and CT findings yielded sensitivity of 33% and 50%, respectively (difference not statistically significant). CT scans depicted a small pneumoperitoneum overlooked on plain radiographs and US scans. Six pericolic abscesses were depicted with both techniques; three were depicted with CT only. CONCLUSION: US and CT findings result in similar accuracy for the evaluation of patients suspected of having diverticulitis.

Acute Disease↗
PubMed1997

Flow pulsatility in the portal venous system: a study of Doppler sonography in healthy adults.

OBJECTIVE: The purpose of our study was to describe Doppler sonography patterns of venous flow in the portal system of healthy subjects and to compare pulsatility of flow with subjects' body mass, degree of inspiration, and body position. SUBJECTS AND METHODS: Doppler signals from the main, right, and left portal veins; superior mesenteric vein; splenic vein; and inferior vena cava of 23 healthy adults were prospectively studied. Pulsatility of flow was quantified using an index of venous pulsatility (VPI = [maximum frequency shift-minimum frequency shift]/maximum frequency shift). Antegrade flow peak velocities were also related to ECG tracings the time between two R waves being divided into four equal parts for analysis. The caliber variations of the main portal vein and inferior vena cava were measured with M-mode sonography. Doppler tracings were obtained with subjects in supine and sitting positions and during mid and deep inspiration. The subjects' heights and weights were obtained and the body mass index calculated (weight/[height2]). RESULTS: In the portal vein, the VPI was 0.48 +/- 0.31 (mean +/- SD). Marked pulsatility of venous flow (VPI > 0.5) was found in 12 of 23 subjects. We found an inverse correlation between the VPI and the subjects' body mass index (r = -.76; p < .001). Portal vein pulsatility decreased significantly during sitting (p < .05) and deep inspiration (p < .01). The portal VPI was correlated with caliber variation of the inferior vena cava (r = .59; p < .05). In the portal venous system, antegrade flow peak velocities occurred most often during the third quarter of the cardiac cycle, particularly in the splenic vein. CONCLUSION: Doppler sonography shows pulsatile portal venous flow in healthy adults, especially in thin subjects. This pulsatility has an inverse correlation to body mass. The finding of a pulsatile portal vein needs to be interpreted in clinical context and does not necessarily imply dysfunction of the right side of the heart.

Adult↗