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Denis de Senneville B, Frulio N, Laumonier H, Salut C, Lafitte L, Trillaud H. Liver contrast-enhanced sonography: computer-assisted differentiation between focal nodular hyperplasia and inflammatory hepatocellular adenoma by reference to microbubble transport patterns. Eur Radiol 2020; 30:2995-3003. [PMID: 32002637 DOI: 10.1007/s00330-019-06566-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE A new computer tool is proposed to distinguish between focal nodular hyperplasia (FNH) and an inflammatory hepatocellular adenoma (I-HCA) using contrast-enhanced ultrasound (CEUS). The new method was compared with the usual qualitative analysis. METHODS The proposed tool embeds an "optical flow" algorithm, designed to mimic the human visual perception of object transport in image series, to quantitatively analyse apparent microbubble transport parameters visible on CEUS. Qualitative (visual) and quantitative (computer-assisted) CEUS data were compared in a cohort of adult patients with either FNH or I-HCA based on pathological and radiological results. For quantitative analysis, several computer-assisted classification models were tested and subjected to cross-validation. The accuracies, area under the receiver-operating characteristic curve (AUROC), sensitivity and specificity, positive predictive values (PPVs), negative predictive values (NPVs), false predictive rate (FPRs) and false negative rate (FNRs) were recorded. RESULTS Forty-six patients with FNH (n = 29) or I-HCA (n = 17) with 47 tumours (one patient with 2 I-HCA) were analysed. The qualitative diagnostic parameters were accuracy = 93.6%, AUROC = 0.94, sensitivity = 94.4%, specificity = 93.1%, PPV = 89.5%, NPV = 96.4%, FPR = 6.9% and FNR = 5.6%. The quantitative diagnostic parameters were accuracy = 95.9%, AUROC = 0.97, sensitivity = 93.4%, specificity = 97.6%, PPV = 95.3%, NPV = 96.7%, FPR = 2.4% and FNR = 6.6%. CONCLUSIONS Microbubble transport patterns evident on CEUS are valuable diagnostic indicators. Machine-learning algorithms analysing such data facilitate the diagnosis of FNH and I-HCA tumours. KEY POINTS • Distinguishing between focal nodular hyperplasia and an inflammatory hepatocellular adenoma using dynamic contrast-enhanced ultrasound is sometimes difficult. • Microbubble transport patterns evident on contrast-enhanced sonography are valuable diagnostic indicators. • Machine-learning algorithms analysing microbubble transport patterns facilitate the diagnosis of FNH and I-HCA.
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Affiliation(s)
- Baudouin Denis de Senneville
- Institut de Mathématiques de Bordeaux (IMB), UMR 5251 CNRS/Université de Bordeaux, 351 cours de la Libération, F-33405, Talence, France.
| | - Nora Frulio
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France
| | - Hervé Laumonier
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France
| | - Cécile Salut
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France
| | - Luc Lafitte
- Institut de Mathématiques de Bordeaux (IMB), UMR 5251 CNRS/Université de Bordeaux, 351 cours de la Libération, F-33405, Talence, France
| | - Hervé Trillaud
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France.,EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie), Université de Bordeaux, F-33000, Bordeaux, France
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Poullenot F, Bioulac-Sage P, Laumonier H, Saric J, Carteret T, Blanc JF. Hepatocellular carcinoma treated by sorafenib with complete radiological response according to mRECIST criteria: could we stop the treatment? About four cases. Acta Oncol 2014; 53:420-3. [PMID: 23713857 DOI: 10.3109/0284186x.2013.795286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Florian Poullenot
- Department of Gastroenterology and Hepatology, Saint-André Hospital, University Hospital of Bordeaux and Victor Segalen University , Bordeaux , France
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Alberti N, Frulio N, Bioulac-Sage P, Laumonier H, Balabaud C, Perez JT, Teixeira F, Harbonnier N, Trillaud H. Interest of contrast-enhanced sonography to identify focal nodular hyperplasia with sinusoidal dilatation. Diagn Interv Imaging 2014; 95:77-83. [DOI: 10.1016/j.diii.2013.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Jeannot E, Lacape G, Gin H, Couchy G, Saric J, Laumonier H, Le Bail B, Bioulac-Sage P, Balabaud C, Zucman-Rossi J. Double heterozygous germline HNF1A mutations in a patient with liver adenomatosis. Diabetes Care 2012; 35:e35. [PMID: 22517943 PMCID: PMC3329811 DOI: 10.2337/dc12-0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Geneviève Lacape
- Molecular Biology Laboratory, Haut Lévêque Hospital, CHU-Bordeaux, Bordeaux, France; the
| | - Henri Gin
- Department of Diabetology, Haut Lévêque Hospital, CHU-Bordeaux, Bordeaux, France; the
| | | | - Jean Saric
- Department of Digestive Surgery, Saint André Hospital, CHU-Bordeaux, Bordeaux, France; the
| | - Hervé Laumonier
- Department of Radiology, CHU-Bordeaux, Bordeaux, France; the
| | - Brigitte Le Bail
- Department of Pathology, Pellegrin Hospital, CHU-Bordeaux, Bordeaux, France; and
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Heresbach D, Djabbari M, Riou F, Marcus C, Le Sidaner A, Pierredon-Foulogne MA, Ponchon T, Boudiaf M, Seyrig JA, Laumonier H, Luet D, Giraud-Cohen M, Pelletier AL, Charachon A, Ramaholimihaso F, Bouillet P, Veyrac M, Ficarelli S, Vahedi K, Keruhel J, Lamouliatte H, Ridereau-Zins C, Bouhnik Y, Tissier M, Diris B, Zagdanski AM, Josselin JM, Hamonic S, Gandon Y. Accuracy of computed tomographic colonography in a nationwide multicentre trial, and its relation to radiologist expertise. Gut 2011; 60:658-65. [PMID: 21266723 DOI: 10.1136/gut.2010.225623] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Reports on the accuracy of computed tomographic colonography (CTC) mainly involve series from expert institutions. The aims of this study were to assess CTC accuracy in a nationwide population and to relate it to radiologist performance in their initial training. DESIGN Nationwide multicentre trial. SETTING Twenty-eight radiologists, working in 26 mostly academic clinical units, were involved in the study after having attended a formal specialised 2-day training session on CTC. They worked through a training set of 52 cases with automatic feedback after an attempt at each case. PATIENTS The study enrolled 845 patients with average and high risk of colorectal cancer, 737 of whom had both complete CTC and videocolonoscopy data, which constituted the dataset. INTERVENTIONS Patients underwent same-day CTC followed by videocolonoscopy with segmental unblinding of CTC results. MAIN OUTCOME MEASURES Sensitivity, specificity and positive and negative predictive values for detection of polyps ≥ 6 mm in per-patient and per-lesion analyses of CTC without computer-aided detection. RESULTS Sensitivity, specificity and positive and negative predictive values for patients with polyps ≥ 6 mm were 69% (95% CI 61% to 77%), 91% (95% CI 89% to 94%), 67% (95% CI 59% to 74%) and 92% (95% CI 90% to 94%), respectively. Univariate analysis showed that the detection rate for polyps ≥ 6 mm was linked to neither radiologist case volume nor number of polyps, but was related to sensitivity achieved in the training set. Pooled sensitivity was 72% (95% CI 63% to 80%) versus 51% (95% CI 40% to 60%) for radiologists achieving above and below median sensitivity in the training set (61%), respectively. Multivariate analysis showed that sensitivity for polyps ≥ 6 mm in the training set was the only remaining significant predictive factor for subsequent performance. CONCLUSIONS Radiologist sensitivity CTC for detection of polyps ≥ 6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps.
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Affiliation(s)
- D Heresbach
- Department of Gastroenterology, University Hospital, CHU Rennes, France.
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Laumonier H, Frulio N, Laurent C, Balabaud C, Zucman-Rossi J, Bioulac-Sage P. Focal nodular hyperplasia with major sinusoidal dilatation: a misleading entity. BMJ Case Rep 2010; 2010:2010/nov30_1/bcr0920103311. [PMID: 22798311 DOI: 10.1136/bcr.09.2010.3311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is a benign liver lesion thought to be a non-specific response to locally increased blood flow. Although the diagnosis of FNH and hepatocellular adenoma (HCA) has made great progress over the last few years using modern imaging techniques, there are still in daily practice some difficulties concerning some atypical nodules. Here, the authors report the case of a 47-year-old woman with a single liver lesion thought to be, by imaging, an inflammatory HCA with major sinusoidal congestion. This nodule was revealed to be, at the microscopical level and after specific immunostaining and molecular analysis, an FNH with sinusoidal dilatation (so-called telangiectatic focal nodular hyperplasia).
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Affiliation(s)
- Hervé Laumonier
- Radiology Department, Hôpital St André CHU Bordeaux, Bordeaux, France.
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7
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Boursault L, Scasso A, Laumonier H, Lalanne N, Versapuech J, Taieb A, Jouary T. Deux cas de métastases pulmonaires de mélanome traitées par radiofréquence : une alternative à la chirurgie. Ann Dermatol Venereol 2010; 137:799-802. [DOI: 10.1016/j.annder.2010.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 07/06/2010] [Accepted: 08/25/2010] [Indexed: 11/15/2022]
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Laumonier H, Leblanc F, Balabaud C, Bioulac-Sage P. Spontaneous regression of focal nodular hyperplasia: a pathological report. BMJ Case Rep 2010; 2010:2010/sep23_1/bcr0220102704. [PMID: 22778370 DOI: 10.1136/bcr.02.2010.2704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is a benign tumour of the liver, occurring in 0.6-3% of the general population. Most lesions are diagnosed incidentally. With the increasing use and improvement of diagnostic imaging, FNH is being observed more often. It has been shown, using radiological approaches, that most FNH remain stable, or even regress, over a long follow-up period. In addition, it is extremely rare that FNH were discovered in elderly. However, to our knowledge, there is no pathological report illustrating the regression of FNH. We report here a case showing the pathological changes occurring during the regression phase of FNH, with dense fibrous tissue mixed with arteries replacing hepatocytes nodules.
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Affiliation(s)
- H Laumonier
- Department of Radiology, Hôpital St André CHU Bordeaux, Bordeaux, France.
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Bioulac-Sage P, Laumonier H, Cubel G, Rossi JZ, Balabaud C. Hepatic resection for inflammatory hepatocellular adenomas: pathological identification of micronodules expressing inflammatory proteins. Liver Int 2010; 30:149-54. [PMID: 19845852 DOI: 10.1111/j.1478-3231.2009.02098.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammatory hepatocellular adenoma (IHCA) defines a subgroup of hepatocellular adenomas characterized by the expression of members of the acute-phase inflammatory response [(serum amyloid A protein (SAA) and C-reactive protein (CRP)]. IHCA are unique or multiple as defined by the presence of several nodule(s) larger than 10 mm using both imaging and macroscopic observation. Frequently, additional micronodules (<10 mm), previously undetected by imaging, can be observed in resected specimens. AIMS To analyse micronodules in multiple (group 1, nine patients) and single (group 2, eight patients) IHCA cases, immunohistochemistry using SAA and CRP antibodies was performed on all nodules detected under macroscopic examination as well as on surrounding tissue with no visible nodules. RESULTS Nodules of different sizes (>5 < or = 10 mm, > or = 1 < or = 5 mm) were found in group 1, whereas only rare nodules in the mm range were found in group 2. Micronodules shared the characteristics of large nodules, which justified surgery such as inflammatory infiltrates, abnormal arteries, sinusoidal dilatation or peliosis. However, the number of these characteristics was proportional to the size of the nodules. CONCLUSION This study demonstrates that the real number of IHCA is greater than that predicted from imaging-based analyses. In addition, we show that patients with more than one nodule present a greater chance to display more and larger undetected micronodules than patients with a single nodule.
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11
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Bioulac-Sage P, Laumonier H, Couchy G, Le Bail B, Sa Cunha A, Rullier A, Laurent C, Blanc JF, Cubel G, Trillaud H, Zucman-Rossi J, Balabaud C, Saric J. Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 2009; 50:481-9. [PMID: 19585623 DOI: 10.1002/hep.22995] [Citation(s) in RCA: 282] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED We took advantage of the reported genotype/phenotype classification to analyze our surgical series of hepatocellular adenoma (HCA). The series without specific known etiologies included 128 cases (116 women). The number of nodules varies from single, <5, and >or=5 in 78, 38, and 12 cases, respectively. The resection was complete in 95 cases. We identified 46 HNF1alpha-inactivated HCAs (44 women), 63 inflammatory HCAs (IHCA, 53 women) of which nine were also beta-catenin-activated, and seven beta-catenin-activated HCAs (all women); six additional cases had no known phenotypic marker and six others could not be phenotypically analyzed. Twenty-three of 128 HCAs showed bleeding. No differences were observed in solitary or multiple tumors in terms of hemorrhagic manifestations between groups. In contrast, differences were observed between the two main groups. Steatosis (tumor), microadenomas (resected specimen), and additional benign nodules were more frequently observed in HNF1alpha-inactivated HCAs (P < 0.01) than in IHCAs. Body mass index > 25, peliosis (tumor), and steatosis in background liver were more frequent in IHCA (P < 0.01). After complete resection, new HCAs in the centimetric range were more frequently found during follow-up (>1 year) in HNF1alpha-inactivated HCA. After incomplete resection (HCA left in nonresected liver), the majority of HCA remained stable in the two main groups and even sometimes regressed. Six patients of 128 developed hepatocellular carcinoma (HCC) (all were beta-catenin-activated, whether inflammatory or not). CONCLUSION There were noticeable clinical differences between HNF1alpha-inactivated HCA and IHCA; there was no increased risk of bleeding or HCC related to the number of HCAs; beta-catenin-activated HCAs are at higher risk of HCC. As a consequence, we believe that management of HCA needs to be adapted to the phenotype of these tumors.
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Affiliation(s)
- Paulette Bioulac-Sage
- Service d'Anatomie Pathologique, Hôpital Pellegrin, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
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12
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Staub F, Tournoux-Facon C, Roumy J, Chaigneau C, Morichaut-Beauchant M, Levillain P, Prevost C, Aubé C, Lebigot J, Oberti F, Galtier JB, Laumonier H, Trillaud H, Bernard PH, Blanc JF, Sironneau S, Machet F, Drouillard J, de Ledinghen V, Couzigou P, Foucher P, Castéra L, Tranquard F, Bacq Y, d'Altéroche L, Ingrand P, Tasu JP. Liver fibrosis staging with contrast-enhanced ultrasonography: prospective multicenter study compared with METAVIR scoring. Eur Radiol 2009; 19:1991-7. [PMID: 19259683 DOI: 10.1007/s00330-009-1313-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 12/27/2008] [Indexed: 12/13/2022]
Abstract
We prospectively assessed contrast-enhanced sonography for evaluating the degree of liver fibrosis as diagnosed via biopsy in 99 patients. The transit time of microbubbles between the portal and hepatic veins was calculated from the difference between the arrival time of the microbubbles in each vein. Liver biopsy was obtained for each patient within 6 months of the contrast-enhanced sonography. Histological fibrosis was categorized into two classes: (1) no or moderate fibrosis (F0, F1, and F2 according to the METAVIR staging) or (2) severe fibrosis (F3 and F4). At a cutoff of 13 s for the transit time, the diagnosis of severe fibrosis was made with a specificity of 78.57%, a sensitivity of 78.95%, a positive predictive value of 78.33%, a negative predictive value of 83.33%, and a performance accuracy of 78.79%. Therefore, contrast-enhanced ultrasound can help with differentiation between moderate and severe fibrosis.
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Affiliation(s)
- F Staub
- Department of Radiology, CHU de Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France.
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Bioulac-Sage P, Laumonier H, Rullier A, Cubel G, Laurent C, Zucman-Rossi J, Balabaud C. Over-expression of glutamine synthetase in focal nodular hyperplasia: a novel easy diagnostic tool in surgical pathology. Liver Int 2009; 29:459-65. [PMID: 18803590 DOI: 10.1111/j.1478-3231.2008.01849.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Glutamine synthetase (GS) is a useful marker in tumour liver pathology, including hepatocellular adenomas and nodules in cirrhosis. We investigated the use of GS as a marker in various clinical situations, in which FNH diagnosis had been firmly established to determine its contribution to diagnosis. METHODS Seventy-nine cases of resected FNH, all on normal (or occasionally steatotic) livers, were retrieved from our collection. The control group was composed of hepatocellular adenomas and well-differentiated hepatocellular carcinoma. The following stains: H&E, Masson's trichrome, Gordon-Sweet, PAS, perls and immunostains: CK7 and 19, and GS were carried out. FNH was diagnosed based on traditional pathological techniques. In case of uncertainty, particularly with hepatocellular adenoma, additional immunostainings including liver fatty acid-binding protein, serum amyloid A and beta-catenin were performed. RESULTS Glutamine synthetase immunostaining was similar in all FNH cases. Positive GS staining of hepatocytic cytoplasms formed large areas, anastomosed in a 'map-like' pattern, often surrounding hepatic veins, whereas GS was not expressed in hepatocytes close to fibrotic bands containing arteries and ductules. In comparison, hepatocellular adenoma staining was completely different, even in cases of fibrotic bands due to tumour remodelling related to necrosis or haemorrhage. In hepatocellular adenomas or well-differentiated hepatocellular carcinoma presenting beta-catenin mutation, GS was positive but with a completely different pattern that appeared diffuse and not 'map-like'. CONCLUSION Regardless of the FNH size or steatotic content, GS produced a similar and characteristic pattern and consequently represents a good marker for easily identifying resected FNH from other hepatocellular nodules.
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Boisserie-Lacroix M, Lebiez-Michel N, Cavagni P, Bentolila J, Laumonier H, Bouzgarrou M, Trillaud H. [Hormones and mammographic breast density]. ACTA ACUST UNITED AC 2008; 89:1196-203. [PMID: 18772804 DOI: 10.1016/s0221-0363(08)73930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast constitutional density may be altered and increased (acquired density) by hormonal interventions such as hormone replacement therapy (HRT). The effects of endogenous (steroids, prolactin, insulin-like factors...) and exogenous (HRT, levonorgestrel IUD, tibolone, tamoxifen, SERMs) hormones will be reviewed. Continuous combined estrogen-progestin preparations are most likely to cause an increase in density. Estrogen alone and tibolone are less likely to cause an increase in density. The sensitivity and specificity of mammography are decreased, with increased risk of interval carcinoma and rate of short interval follow-up from false positive results. The issue with regards to interruption of the hormonal therapy prior to mammography, and the duration of the interruption, are discussed.
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Affiliation(s)
- M Boisserie-Lacroix
- Service de Radiologie, CHU Saint-André, 1 rue Jean Burguet, 33075 Bordeaux cedex, France.
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Laumonier H, Bioulac-Sage P, Laurent C, Zucman-Rossi J, Balabaud C, Trillaud H. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 2008; 48:808-18. [PMID: 18688875 DOI: 10.1002/hep.22417] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Hepatocellular adenomas (HCAs) are a group of benign tumors forming three molecular pathological subgroups: (1) hepatocyte nuclear factor 1alpha (HNF-1alpha)-inactivated, (2) beta-catenin-activated, and (3) inflammatory. Some HCAs present both beta-catenin activation and inflammation. We analyzed magnetic resonance imaging (MRI) data for correlations between features on imaging and pathological classification of HCAs. We included 50 cases for which pathology specimens were classified into three groups based on immunohistochemical staining. Two characteristic MRI profiles were identified corresponding to HNF-1alpha-inactivated and inflammatory HCAs. Fifteen HCAs were HNF-1alpha-inactivated. The corresponding lesions showed (1) diffuse signal dropout on T1-weighted chemical shift sequence due to steatosis, (2) isosignal or slight hypersignal on T2-weighted (T2W) images, and (3) moderate enhancement in the arterial phase, with no persistent enhancement in the portal venous and delayed phases. For the diagnosis of HNF-1alpha-inactivated HCA, the positive predictive value of homogeneous signal dropout on chemical shift images was 100%, the negative predictive value was 94.7%, the sensitivity was 86.7%, and the specificity was 100%. Twenty-three HCAs were inflammatory and showed (1) an absence or only focal signal dropout on chemical shift sequence; (2) marked hypersignal on T2W sequences, with a stronger signal in the outer part of the lesions, correlating with sinusoidal dilatation areas; and (3) strong arterial enhancement, with persistent enhancement in the portal venous and delayed phases. Marked hypersignal on T2W sequences associated with delayed persistent enhancement had a positive predictive value of 88.5%, a negative predictive value of 84%, a sensitivity of 85.2%, and a specificity of 87.5% for the diagnosis of inflammatory HCA. CONCLUSION HNF-1alpha-mutated HCAs and inflammatory HCAs were associated with specific MRI patterns related to diffuse fat repartition and sinusoidal dilatation, respectively.
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Affiliation(s)
- Hervé Laumonier
- Department of Radiology, CHU de Bordeaux, Hopital Saint-André, Bordeaux, France
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Abstract
Vascular tumors of the liver in adult patients include cavernous hemangioma, a common benign tumor; epithelioid hemangioendothelioma, a rare, usually low-grade malignant tumor; and angiosarcoma, a rare and very aggressive tumor. All these primary mesenchymal tumors develop on a normal liver and may also affect other organs. Their pathogenesis remains largely unknown. Hepatic tumors are increasingly detected incidentally due to widespread use of modern abdominal imaging techniques. Therefore, reliable noninvasive characterization and differentiation of such liver tumors is of major importance for clinical practice. Hemangioma follows a benign course, and a nonoperative approach for the majority of these lesions is recommended. A definitive diagnosis of epithelioid hemangioendothelioma and angiosarcoma requires histopathologic examination. Liver transplantation at an early stage has greatly improved the prognosis of epithelioid hemangioendothelioma. The prognosis of angiosarcoma remains dismal. Designing a worldwide database that contains all data about patients with these rare diseases is recommended.
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Abstract
Patients (85%) with hepatocellular adenoma (HCA) are women taking oral contraceptives. They can be divided into four subgroups according to their genotype/phenotype features. (1) Hepatocyte nuclear factor 1α (HNF1α) biallelic somatic mutations are observed in 35% of the HCA cases. It occurs in almost all cases in women. HNF1α-mutated HCA are most of the time, highly steatotic, with a lack of expression of liver fatty acid binding protein (LFABP) in immunohistochemistry analyses. Adenomatosis is frequently detected in this context. An HNF1α germline mutation is observed in less than 5% of HCA cases and can be associated with MODY 3 diabetes. (2) An activating β-catenin mutation was found in 10% of HCA. These β-catenin activated HCAs are observed in men and women, and specific risk factors, such as male hormone administration or glycogenosis, are associated with their development. Immunohistochemistry studies show that these HCAs overexpress β-catenin (nuclear and cytoplasmic) and glutamine synthetase. This group of tumours has a higher risk of malignant transformation into hepatocellular carcinoma. (3) Inflammatory HCAs are observed in 40% of the cases, and they are most frequent in women but are also found in men. Lesions are characterised by inflammatory infiltrates, dystrophic arteries, sinusoidal dilatation and ductular reaction. They express serum amyloid A and C-reactive protein. In this group, GGT is frequently elevated, with a biological inflammatory syndrome present. Also, there are more overweight patients in this group. An additional 10% of inflammatory HCAs express β-catenin, and are also at risk of malignant transformation. (4) Currently, less than 10% of HCAs are unclassified. It is hoped that in the near future it will be possible with clinical, biological and imaging data to predict in which of the 2 major groups (HNF1α-mutated HCA and inflammatory HCA) the patient belongs and to propose better guidelines in terms of surveillance and treatment.
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Affiliation(s)
- Paulette Bioulac-Sage
- Department of Pathology, Hôpital Pellegrin CHU Bordeaux, Université Bordeaux 2, Inserm 889, Bordeaux Cedex, France
| | - Hervé Laumonier
- Department of Radiology, Hôpital St André CHU Bordeaux, Bordeaux Cedex, France
| | - Christophe Laurent
- Department of Surgery, Hôpital St André CHU Bordeaux, Bordeaux Cedex, France
| | | | - Charles Balabaud
- Department of Hepatology, Hôpital St André CHU Bordeaux, Université Bordeaux 2, Inserm 889, Bordeaux Cedex, France
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Bioulac-Sage P, Laumonier H, Cubel G, Saric J, Balabaud C. Over-expression of glutamine synthase in focal nodular hyperplasia (part 1): early stages in the formation support the hypothesis of a focal hyper-arterialisation with venous (portal and hepatic) and biliary damage. Comp Hepatol 2008; 7:2. [PMID: 18312631 PMCID: PMC2292678 DOI: 10.1186/1476-5926-7-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 02/29/2008] [Indexed: 01/12/2023]
Abstract
Background Most focal nodular hyperplasia (FNH) cases are diagnosed by chance. We studied a case of pre-FNH. We used glutamine synthase as an immunohistochemical marker for perivenous zones. Results Neither fibrotic scars nor hepatocytic nodules surrounded by fibrosis with a ductular reaction were observed in the sections studied. Most sections generally displayed preserved architecture. The glutamine synthase-positive hepatocyte areas were wider than those observed in non-tumoural surrounding liver, and they tended to extend outwards. Portal tracts bordering the nodule were more fibrotic, with an absence of portal veins and ducts and with arterial proliferation often in proximity with large draining veins; isolated arteries were present and hepatic veins were rare in the nodule. These features appeared prior to the identification of other major criteria characteristics of FNH, thus supporting the "hypothesis of Wanless". Conclusion The findings confirm that in FNH there is a portal tract injury leading to local portal vein injury. This leads to a cascade of events, including arterial venous shunts, ductular reaction, and scar formation.
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Boisserie-Lacroix M, Lebiez-Michel N, Cavigni P, Bentolila J, Laumonier H, Bouzgarrou M, Trillaud H. [Breast ultrasonography: an overview]. ACTA ACUST UNITED AC 2006; 34:1170-7. [PMID: 17140836 DOI: 10.1016/j.gyobfe.2006.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 10/11/2006] [Indexed: 11/18/2022]
Abstract
The most important roles of ultrasound in breast imaging include the diagnosis of cysts and the characterization of masses that have been incompletely assessed by mammography. Ultrasonography techniques such as harmonic and compound imaging have recently been introduced and are more efficient than conventional imaging in terms of lesion conspicuity and the characterization of breast nodule. The BI-RADS classification is an important system for describing and classifying breast lesions. With this approach, a population of benign solid breast lesions that does not require biopsy can be accurately defined. Ultrasonography should be performed as first-line examination in juvenile, in pregnant women and in patients with inflammatory syndrome. Ultrasound can detect mammographically occult breast the way they develop.
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Affiliation(s)
- M Boisserie-Lacroix
- Service de radiologie (Docteur-Trillaud), CHU de Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France.
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Jan E, Grenouillet-Delacre M, Le Métayer P, Laumonier H, Etienne G, Delleci C, Rouanes N, Mercié P, Longy-Boursier M. Syndrome cave supérieur iatrogène. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Laumonier H, Blanc JF, Quesson B, Seror O, Laurent C, Bioulac-Sage P, Balabaud C, Trillaud H. Real-time monitoring of hepatocellular carcinoma radiofrequency ablation by quantitative temperature MRI. Semin Liver Dis 2006; 26:391-7. [PMID: 17051453 DOI: 10.1055/s-2006-951605] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hervé Laumonier
- Department of Radiology, Hôpital Saint André, CHU Bordeaux, France
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Laumonier H, Montaudon M, Corneloup O, Brunot S, Laurent F. CT angiography of intrahepatic portal aneurysm. ACTA ACUST UNITED AC 2005; 30:755-7. [PMID: 16132434 DOI: 10.1007/s00261-005-0327-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 01/26/2005] [Indexed: 11/30/2022]
Abstract
We report a case of an asymptomatic portal vein aneurysm diagnosed at ultrasonography and documented with multidetector computed tomography. We describe the features found at quadriphasic multidetector computed tomography with three-dimensional computed tomographic angiography.
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Affiliation(s)
- H Laumonier
- Unité d'Imagerie Thoracique et Cardiovasculaire, Hôpital Haut-Lévêque, Pessac, France
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