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Valérie Vilgrain

Publications and source records attributed to Valérie Vilgrain.

At least 19 recordsLinked to original sources
PubMed2006

Cirrhosis: CT and MR imaging evaluation.

In this article, we present the CT and MR imaging characteristics of the cirrhotic liver. We describe the altered liver morphology in different forms of viral, alcoholic and autoimmune end-stage liver disease. We present the spectrum of imaging findings in portal hypertension, such as splenomegaly, ascites and varices. We describe the patchy and lacelike patterns of fibrosis, along with the focal confluent form. The process of hepatocarcinogenesis is detailed, from regenerative to dysplastic nodules to overt hepatocellular carcinoma. Different types of non-neoplastic focal liver lesions occurring in the cirrhotic liver are discussed, including arterially enhancing nodules, hemangiomas and peribiliary cysts. We show different conditions causing liver morphology changes that can mimic cirrhosis, such as congenital hepatic fibrosis, "pseudo-cirrhosis" due to breast metastases treated with chemotherapy, Budd-Chiari syndrome, sarcoidosis and cavernous transformation of the portal vein.

Humans↗
PubMed2006

Liver adenomatosis: classification of MR imaging features and comparison with pathologic findings.

PURPOSE: To retrospectively compare the clinical manifestation and magnetic resonance (MR) imaging features of liver adenomatosis with pathologic findings. MATERIALS AND METHODS: This study had institutional review board approval, and informed consent was waived. Twenty patients were classified on the basis of pathologic findings into three groups: those with a steatotic, those with a peliotic, and those with a mixed (steatotic and peliotic) form of liver adenomatosis. MR images were reviewed in consensus by two abdominal radiologists, and findings were compared with the pathologic classification. Statistical evaluation was performed with the Student t test. RESULTS: All patients were women (mean age, 39 years +/- 10 [standard deviation]). Lesions of the steatotic form (n = 7) showed (a) a mean diameter of 6.3 cm +/- 1.7, (b) slightly hyperintense signal on T2-weighted images, (c) hyper- or isointense signal on T1-weighted images with a signal dropout with fat suppression sequences, and (d) moderate enhancement at the arterial phase with no delayed enhancement. Lesions of the peliotic form (n = 7) showed (a) a somewhat larger size (8.3 cm +/- 3.6), (b) markedly hyperintense signal on T2-weighted images, (c) iso- or hyperintensity on T1-weighted images with no signal dropout with fat suppression sequences, and (d) strong arterial enhancement and persistent enhancement at the portal and delayed phase. Lesions of the mixed form (n = 6) included a combination of imaging features of the steatotic and peliotic forms. Lesions, however, were significantly larger in the mixed form than in the steatotic form (10.3 cm +/- 4, P < .05). CONCLUSION: There are three patterns of MR imaging features of liver adenomatosis that are associated with three pathologic forms (steatotic, peliotic, and mixed).

Adenoma, Liver Cell↗
PubMed2006

Atrophy-hypertrophy complex in patients with cavernous transformation of the portal vein: CT evaluation.

PURPOSE: To retrospectively evaluate the morphologic changes in the liver associated with cavernous transformation of the portal vein. MATERIALS AND METHODS: This study was institutional review board approved. Informed patient consent was not required. The computed tomographic (CT) results for 22 patients (14 male, eight female; mean age, 54 years) with cavernous transformation of the portal vein and no evidence of chronic liver disease at liver biopsy were retrospectively reviewed and compared with the CT results for 36 control subjects. Various morphologic changes in the hepatic lobes were qualitatively and quantitatively assessed by using the Student t test for unpaired data. RESULTS: Qualitative analysis revealed the atrophy-hypertrophy complex in most (n = 20, 91%) of the patients with cavernous transformation and in no control subjects. Atrophy of the left lateral segment and right liver lobe was seen in 16 (73%) and seven (32%) patients, respectively. Hypertrophy of the caudate lobe and liver segment IV was identified in 19 (86%) and 11 (50%) patients, respectively. All mean caudate lobe volume index values and mean caudate lobe-to-right lobe ratio values were significantly greater (P < .05) in the cavernous transformation group than in the control group. The mean segment IV diameter was significantly greater (41.6 vs 28.1 mm, P < .001) in the patients with cavernous transformation. Hepatic nodules and hepatic contour nodularity were not seen in the patients with cavernous transformation. CONCLUSION: The atrophy-hypertrophy complex is frequently observed in patients with cavernous transformation of the portal vein. Some findings, such as hypertrophy of the caudate lobe, mimic chronic liver disease or signs of portal hypertension, but left lateral segment atrophy and a normal or enlarged segment IV are distinctive findings of cavernous transformation.

Adult↗
PubMed2006

Fat in the liver: diagnosis and characterization.

The purpose of this article is to provide an update on imaging techniques useful for detection and characterization of fat in the liver. Imaging findings of liver steatosis, both diffuse steatosis and focal fatty change, as well as focal fatty sparing, are presented. In addition, we will review computed tomography (CT) and magnetic resonance (MR) findings of focal liver lesions with fatty metamorphosis, including hepatocellular carcinoma, hepatocellular adenoma, focal nodular hyperplasia, angiomyolipoma, lipoma, and metastases.

Diagnosis, Differential↗
PubMed2006

Respiratory complications: a major concern after right hepatectomy in living liver donors.

BACKGROUND: One of the main concerns after living donor liver transplantation is the risk of morbidity and/or mortality that it imposes on the donors. Respiratory postoperative complications in living liver donors have already been reported but their frequency seems to be underestimated. We designed a prospective study to evaluate the rate and the nature of postoperative pulmonary complications in 112 consecutive donors. METHODS: The medical records of the 112 living liver donors operated on at our center from 1998 to 2003 were reviewed and all the cases of respiratory complications were retrieved. Moreover, since 2000, all patients had a computed tomography angiography of the thorax at day 7 on a prospective basis. RESULTS: In all, 112 hepatectomies (44 right and 68 left) for adult-to-adult or adult-to-child liver donation were performed in our center. No postoperative mortality was recorded. Fourteen major respiratory complications developed in of 11 of 112 donors (9.8%), in all cases after right hepatectomy, and included nonsevere pulmonary embolism (n=7), right pleural empyema (n=3), and bacterial pneumonia (n=3). Minor respiratory complications (7.1% of the donors) included iatrogenic pneumothorax (n=3) and pleural effusion requiring thoracocentesis (n=5). Abdominal complications (mainly biliary leak) developed in 10 donors (8.9%), who in the vast majority remained free of pulmonary complications. CONCLUSIONS: In our series, pulmonary complications are frequent in living liver donors. These complications are mainly observed after right hepatectomy. The particular prevalence of pulmonary embolism should lead to focus on its early diagnosis and prevention.

Adolescent↗
PubMed2006

Focal nodular hyperplasia.

Focal nodular hyperplasia is the second most common benign liver tumor after hemangioma and occurs predominantly in young women. Imaging techniques are crucial in the diagnosis of this lesion. In this article, we will present the imaging findings of the classic and non-classic FNHs. The role of percutaneous biopsy will also be detailed.

Biopsy↗
PubMed2006

Aiming at minimal invasiveness as a therapeutic strategy for Budd-Chiari syndrome.

The 1-year spontaneous mortality rate in patients with Budd-Chiari syndrome (BCS) approaches 70%. No prospective assessment of indications and impact on survival of current therapeutic procedures has been performed. We evaluated a therapeutic strategy uniformly applied during the last 8 years in a single referral center. Fifty-one consecutive patients first received anticoagulation and were treated for associated diseases. Symptomatic patients were considered for hepatic vein recanalization; then for transjugular intrahepatic portosystemic shunt (TIPS), and finally for liver transplantation. The absence of a complete response led to the next procedure. Assessment was according to the strategy, whether procedures were technically applicable and successful. At entry, median (range) Child-Pugh score and Clichy prognostic index were 8 (5-12), and 5.4 (3.1-7.7), respectively. A complete response was achieved on medical therapy alone in 9 patients; after recanalization in 6, TIPS in 20, liver transplantation in 9, and retransplantation in 1. Of the 41 patients considered for recanalization, the procedure was not feasible in 27 and technically unsuccessful in 3. Of the 34 patients considered for TIPS, the procedure was considered not feasible in 9 and technically unsuccessful in 4. At 1 year of follow-up, a complete response to TIPS was achieved in 84%. One- and 5-year survival from starting anticoagulation were 96% (95% CI, 90-100) and 89% (95% CI, 79-100), respectively. In conclusion, excellent survival can be achieved in BCS patients when therapeutic procedures are introduced by order of increasing invasiveness, based on the response to previous therapy rather than on the severity of the patient's condition.

Adult↗
PubMed2006

Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction.

In patients with multiple colorectal liver metastases, the technical limits of curative surgery can be overcome by both reducing tumor volume with preoperative chemotherapy and by increasing the future remnant liver with portal vein embolization. Chemotherapy is generally discontinued before the embolization because it is alleged to impair hypertrophy of the future remnant liver. We have tested this assumption by comparing two groups of patients who had undergone right portal vein obstruction: 10 patients in whom chemotherapy was maintained until surgery and 10 patients in whom it was interrupted at least 1 month prior to portal obstruction. The two groups, with and without chemotherapy, were comparable for patient's age (60 +/- 9 versus 61 +/- 9 years), number of metastases (7.7 +/- 3 versus 6.2 +/- 3), and future remnant liver volume (25 +/- 9% versus 23 +/- 5% of the total liver). After right portal vein obstruction, the increase of the future remnant liver was comparable in the two groups (33 +/- 26% versus 25 +/- 7%). Liver resection was performed in 14 patients (7 in each group) with a similar morbidity rate (57% in each group). In conclusion, continuing chemotherapy while portal vein obstruction is performed did not impair the hypertrophy of the future remnant volume nor the postoperative course after liver resection. Therefore, chemotherapy can be safely continued until liver surgery, when portal vein obstruction is indicated.

Colorectal Neoplasms↗
PubMed2006

Percutaneous radiofrequency ablation for hepatocellular carcinoma before liver transplantation: a prospective study with histopathologic comparison.

OBJECTIVE: The aims of this study were to determine the feasibility and efficacy of percutaneous radiofrequency ablation in patients with hepatocellular carcinoma waiting for liver transplantation and to compare the radiologic and pathologic findings. SUBJECTS AND METHODS: Twenty-six patients with 35 hepatocellular carcinomas were addressed for transplantation. Complications of the procedures were recorded. Primary and secondary technique effectiveness and causes of exclusion from the waiting list were assessed. After transplantation, tumor recurrence was evaluated for at least 1 year in all patients. Radiologic-pathologic comparison of the explant was performed. RESULTS: Percutaneous radiofrequency ablation was performed in 21 (81%) patients for 28 tumors. Both minor and major complications occurred in three patients (10% each per session). The rates of primary technique effectiveness, secondary technique effectiveness for percutaneous radiofrequency ablation alone (seven tumors), and combined percutaneous radiofrequency ablation and transcatheter arterial chemoembolization (three tumors) were 56%, 76%, and 86%, respectively. After a mean follow-up of 11.9 months, 16 patients (76%) received transplants, whereas five patients were excluded from the waiting list because of distant tumor progression (n =3, 14%) or other causes (n = 2, 10%). After transplantation, tumor recurred in one (6%) of 16 patients. Histopathologic examinations were performed for 13 (81%) of 16 patients and showed complete necrosis and satellite nodules in, respectively, 12 (75%) and seven (44%) of 16 tumors. CONCLUSION: Percutaneous radiofrequency ablation can be performed on hepatocellular carcinoma patients waiting for transplantation, allows most patients to undergo transplantation, and does not impair posttransplantation outcomes. The procedure produces complete necrosis of the treated tumor in most cases but is associated with a high rate of satellite nodules.

Carcinoma, Hepatocellular↗
PubMed2005

Tumour detection in the liver: role of multidetector-row CT.

The purpose of this article is to emphasize the role of multidetector row CT in the tumour detection of the liver. Optimization of the examination is crucial; scan parameters, CT protocols and intravenous contrast medium will be detailed. Lastly, accuracy of CT in detecting liver tumours will be discussed according to the causes.

Contrast Media↗
PubMed2004

Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy.

BACKGROUND: The interest of laparoscopy in the preoperative staging of pancreatic head adenocarcinoma before curative pancreaticoduodenectomy is a matter of controversy and depends on the accuracy of preoperative imaging techniques. AIM: To assess the potential value of laparoscopy when a standardised and optimal preoperative staging is performed, including spiral computed tomography (CT) and endoscopic ultrasonography (EUS). METHODS: All consecutive patients operated on with a view to curative pancreaticoduodenectomy for pancreatic head or ampullary adenocarcinoma in our centre from January 1998 to August 2000 were retrospectively studied. All of them had preoperative spiral CT and EUS. Tumour resectability was considered as highly probable (HP) or uncertain (U) according to well-defined criteria. Operative records of patients were reviewed to indirectly assess the effective resectability rate and the criteria responsible for unresectability and which of them would have been identified by laparoscopy if initially performed. RESULTS: 69 consecutive patients were studied. Resectability was HP (n = 56) or U (n = 13) after preoperative staging. Curative pancreatoduodenectomy was performed in 53 patients (77%) (48 HP, 5 U). Positive predictive value of preoperative imaging for highly probable resectability was 86% (48/56). Among the 16 unresectable tumours (8 HP, 8 U), the cause of non-resection would have been found at laparoscopy in 9 patients (56%) (6 HP, 3 U). Finally, if initially performed, laparoscopy would have avoided laparotomy in 9/69 patients (13%) (6/56 HP (11%); 3/13 U (23%)). CONCLUSIONS: With accurate preoperative staging using spiral CT and EUS, laparoscopy would detect tumours which were unresectable in 13% of patients with pancreatic head cancer. Laparoscopy remains useful in selected patients, such as those with preoperative uncertain resectability, in whom it can prevent unnecessary laparotomy in one fourth of patients.

Adenocarcinoma↗
PubMed2004

Congenital hepatic fibrosis: CT findings in 18 adults.

PURPOSE: To evaluate the computed tomographic (CT) findings in adult patients with pathologically proved congenital hepatic fibrosis. MATERIALS AND METHODS: This was a retrospective review of congenital hepatic fibrosis cases identified at two institutions over the course of 8 years. Eight men and 10 women with an age range of 22-72 years (mean age, 39 years) were included. Contrast material-enhanced and unenhanced CT scans were obtained through the liver in all patients. Two radiologists evaluated size of and morphologic findings (atrophy or hypertrophy localized according to hepatic segments) in the liver; increased diameter or number of hepatic arteries at the hilum; presence of hepatic nodules, varices, spontaneous splenorenal shunts, and splenomegaly; and association with other hepatic ductal plate malformations and renal abnormalities. RESULTS: Sixteen patients had morphologic abnormalities in the liver, 15 had splenomegaly (three underwent splenectomy for portal hypertension), and 14 had varices or spontaneous splenorenal shunts. An enlarged hepatic artery and a tangle of abnormally enlarged arterial vessels were identified in five and four patients, respectively, and four of these nine patients had large benign regenerative nodules. Ten patients had renal abnormalities and nine had an associated ductal plate malformation. CONCLUSION: This retrospective study shows that certain findings (ie, liver morphologic and associated ductal plate abnormalities, varices, splenomegaly, and renal abnormalities) are frequently observed in combination in patients with congenital hepatic fibrosis.

Adult↗
PubMed2004

Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor.

The harvesting of the middle hepatic vein (MHV) with a right hepatectomy for living-donor liver transplantation allows an optimal venous drainage for the recipient but can also have adverse effects for the donor. This study compares morbidity, early liver function, and volume regeneration in 2 groups of donors who underwent right hepatectomy with (MHV+, n = 21) or without (MHV-, n = 20) MHV harvesting during 2 successive periods. The operative time was 401 +/- 60 minutes in the MHV+ group compared with 392 +/- 63 minutes in the MHV- group, and the transection time was 152 +/- 53 minutes in the MHV+ group compared with 131 +/- 30 minutes in the MHV- group (not significant). Blood loss in the MHV+ group was 773 +/- 343 mL compared with 613 +/- 361 mL in the MHV- group (not significant). The graft weight and remnant liver volume ratio were similar in the MHV+ and MHV- groups (763 +/- 200 gm vs. 832 +/- 156 gm and 42% +/- 9.5% vs. 43% +/- 8.3%, respectively). Postoperative biologic liver function tests showed that prothrombin time (PT) ratio on postoperative days 1 and 3 were significantly lower in the MHV+ group compared with the MHV- group (53% vs. 65% and 63% vs. 72%, respectively, P <.05). There were no differences in postoperative alanine aminotransferase and aspartate aminotransferase peak levels between the MHV+ and MHV- groups (319 +/- 198 IU /L vs. 310 +/- 110 IU /L and 317 +/- 226 IU /L vs. 296 +/- 125 IU /L, respectively). Bilirubin maximal blood level was similar in the 2 groups (32 +/- 17 micromol/L in the MHV+ group vs. 43 +/- 16 micromol/L in the MHV- group, P <.05). No donor died. The overall morbidity was lower in the MHV+ group compared with the MHV- group (36% vs. 55%; P >.05, not significant). The donor's remnant liver volume regeneration, evaluated by computed tomography (CT) volumetric study on day 7, was similar in the 2 groups (97% +/- 29% in the MHV+ group and 103% +/- 39% in the MHV- group, P >.05). The results of this comparative study show that right hepatectomy with the MHV neither affects morbidity nor impairs early liver function and regeneration in donors.

Alanine Transaminase↗
PubMed2004

Underestimation of the influence of satellite nodules as a risk factor for post-transplantation recurrence in patients with small hepatocellular carcinoma.

Liver transplantation offers good results in patients with small hepatocellular carcinoma. However, 3 to 15% of patients still have recurrence, suggesting that factors other than the size and number of nodules are implicated. The aim of our study was to identify predictive factors of recurrence in patients with small hepatocellular carcinoma. Seventy consecutive patients fulfilling Milano criteria and who were transplanted for hepatocellular carcinoma were studied. Forty-six patients had pretransplantation adjuvant local therapy. The size and number of tumors, the clinical and biological characteristics of the patients were recorded before liver transplantation, and histological analysis was performed on the explanted liver. Overall survival rates at 1 and 3 years were 81% and 66%, respectively. Recurrence-free survival rates at 1 and 3 years were 80% and 65%, respectively. Seven patients had tumor recurrence with 1- and 3-year recurrence rates of 5% and 10%, respectively. Satellite nodules on the explanted liver were the only statistically significant predictor of recurrence (P=.0003). None of the patients who did not have satellite nodules had recurrence. There was a significant correlation between satellite nodules and microvascular invasion. Patients with pretransplantation adjuvant therapy had significantly more tumor necrosis, but did not have less satellite nodules. In conclusion, microscopic satellite nodules are a significant predictive factor of tumor recurrence in patients transplanted for small hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed2004

Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy.

BACKGROUND: Pancreatic fistula (PF), which is a major complication of pancreaticoduodenectomy (PD), can be treated conservatively or by reoperation. The aim of this study was to evaluate conservative management of PF, which was attempted whenever possible as a first-intention treatment in a large series of PD. STUDY DESIGN: From 1990 to 2000, 242 patients underwent PD with pancreaticogastrostomy. PF was observed in 31 (13%) and was defined by an amylase-rich surgical drainage fluid (above fivefold serum amylase) after postoperative day 5, or by presence on CT scan of a fluid collection located close to the anastomosis or containing amylase-rich fluid, or by operative findings in case of reoperation. Conservative management included total parenteral nutrition, nasogastric suction, imaging-guided percutaneous drainage of collection when necessary, and somatostatin or its analogues. RESULTS: PF was symptomatic in 20 patients (65%). Amylase level on surgical drainage fluid was elevated in 23 patients (74%). Four patients (13%), including two with hemorrhage and two with intraabdominal collection not accessible by percutaneous approach, were not considered for conservative management and underwent early reoperation. Conservative management was successful in the 27 patients (100%) in whom it was attempted, including the 10 who required percutaneous drainage. The only death (3%) occurred after massive hemorrhage complicating misdiagnosed PF. Mean hospital stay was 36 +/- 12 days (range 18 to 71) after successful conservative management. CONCLUSIONS: Conservative management of PF complicating PD is feasible and successful in above 85% of patients.

Amylases↗