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Leclerc X, Guillaud O, Reyns N, Hodel J, Outteryck O, Bala F, Bricout N, Bretzner M, Ramdane N, Pruvo JP, Hacein-Bey L, Kuchcinski G. Follow-Up MRI for Small Brain AVMs Treated by Radiosurgery: Is Gadolinium Really Necessary? AJNR Am J Neuroradiol 2020; 41:437-445. [PMID: 32029465 DOI: 10.3174/ajnr.a6404] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/17/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Follow-up MR imaging of brain AVMs currently relies on contrast-enhanced sequences. Noncontrast techniques, including arterial spin-labeling and TOF, may have value in detecting a residual nidus after radiosurgery. The aim of this study was to compare noncontrast with contrast-enhanced MR imaging for the differentiation of residual-versus-obliterated brain AVMs in radiosurgically treated patients. MATERIALS AND METHODS Twenty-eight consecutive patients with small brain AVMs (<20 mm) treated by radiosurgery were followed with the same MR imaging protocol. Three neuroradiologists, blinded to the results, independently reviewed the following: 1) postcontrast images alone (4D contrast-enhanced MRA and postcontrast 3D T1 gradient recalled-echo), 2) arterial spin-labeling and TOF images alone, and 3) all MR images combined. The primary end point was the detection of residual brain AVMs using a 5-point scale, with DSA as the reference standard. RESULTS The highest interobserver agreement was for arterial spin-labeling/TOF (κ = 0.81; 95% confidence interval, 0.66-0.93). Regarding brain AVM detection, arterial spin-labeling/TOF had higher sensitivity (sensitivity, 85%; specificity, 100%; 95% CI, 62-97) than contrast-enhanced MR imaging (sensitivity, 55%; specificity, 100%; 95% CI, 27-73) and all MR images combined (sensitivity, 75%; specificity, 100%; 95% CI, 51-91) (P = .008). All nidus obliterations on DSA were detected on MR imaging. In 6 patients, a residual brain AVM present on DSA was only detected with arterial spin-labeling/TOF, including 3 based solely on arterial spin-labeling images. CONCLUSIONS In this study of radiosurgically treated patients with small brain AVMs, arterial spin-labeling/TOF was found to be superior to gadolinium-enhanced MR imaging in detecting residual AVMs.
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Affiliation(s)
- X Leclerc
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France .,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
| | - O Guillaud
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - N Reyns
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology (N. Reyns), University of Lille, Lille, France
| | - J Hodel
- Department of Neuroradiology (J.H.), Hôpital Henri Mondor, Créteil, France; EA 2694-Public Health: Epidemiology and Quality of Care (N. Ramdane), University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - O Outteryck
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
| | - F Bala
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - N Bricout
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - M Bretzner
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France
| | - N Ramdane
- Department of Neuroradiology (J.H.), Hôpital Henri Mondor, Créteil, France; EA 2694-Public Health: Epidemiology and Quality of Care (N. Ramdane), University of Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - J-P Pruvo
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
| | - L Hacein-Bey
- Neuroradiology, Radiology Department (L.H.-B.), University of California Davis School of Medicine, Sacramento, California
| | - G Kuchcinski
- From the Departments of Neuroradiology (X.L., O.G., O.O., F.B., N.B., M.B., J.-P.P., G.K.), Neurosurgery (N. Reyns), Neurology (O.O.), Centre Hospitalier Universitaire Lille, Lille, France.,Inserm U1171, Degenerative and Vascular Cognitive Disorders (X.L., O.O., J.-P.P., G.K.), University of Lille, Lille, France
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Walter T, Zhenzhen Wang C, Guillaud O, Cotte E, Pasquer A, Vinet O, Poncet G, Ponchon T, Saurin JC. Management of desmoid tumours: A large national database of familial adenomatous patients shows a link to colectomy modalities and low efficacy of medical treatments. United European Gastroenterol J 2016; 5:735-741. [PMID: 28815038 DOI: 10.1177/2050640616678150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Desmoid tumours represent a major complication of familial adenomatous polyposis. Our aims were to study the factors associated with the development of desmoid tumours in familial adenomatous polyposis patients, and to describe presentation and management of desmoid tumours. METHODS AND PATIENTS We reviewed all patients with familial adenomatous polyposis followed at our institution between 1965-2013, with either identified adenomatous polyposis coli gene mutation, or a personal and family history suggesting adenomatous polyposis coli-related polyposis. Response to treatment of desmoid tumours was assessed by Response Evaluation Criteria In Solid Tumor (RECIST) criteria. RESULTS A total of 180 patients with familial adenomatous polyposis were included with a median follow-up of 19 years since diagnosis. Thirty-one (17%) patients developed 58 desmoid tumours, a median (range) 4.7 (0.8-41.6) years after their diagnosis of familial adenomatous polyposis. The only factor significantly associated with occurrence of desmoid tumours was the type of surgery: 12 (12%) desmoid tumours in 104 patients treated by colectomy, versus 19 (25%) desmoid tumours in 76 patients treated by proctocolectomy, p = 0.027. The localisation of desmoid tumours was: mesenteric (n = 25), abdominal wall (n = 30) or extra-abdominal (n = 3). Nineteen patients underwent 36 surgical procedures for desmoid tumours. Recurrence occurred in 26 (72%) cases and the recurrence-free survival was 2.6 (95% confidence interval (CI), 0.2-5.9) years. Thirteen patients received 27 medical treatments over a median 14 months. Objective response was observed in four (15%) patients and the median progression-free survival was nine (95% CI, 1.1-16.9) months. CONCLUSION If confirmed, colectomy (versus proctocolectomy) should be performed in adenomatous polyposis coli-related familial adenomatous polyposis patients to avoid desmoid tumours. We show that there is a high prevalence of post-surgical recurrence and the low efficacy of available medical treatments for desmoid tumours.
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Affiliation(s)
- T Walter
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - C Zhenzhen Wang
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France.,Ruijin Hospital, Shanghai Jiaotong University, China
| | - O Guillaud
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - E Cotte
- Surgery Department, Lyon Sud Hospital, Lyon, France
| | - A Pasquer
- Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - O Vinet
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - G Poncet
- Surgery Department, Edouard Herriot Hospital, Lyon, France
| | - T Ponchon
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
| | - J-C Saurin
- Gastroenterology Department, Edouard Herriot Hospital, Lyon, France
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Guillaud O, Gurram KC, Puglia M, Lilly L, Adeyi O, Renner EL, Selzner N. Angiotensin blockade does not affect fibrosis progression in recurrent hepatitis C after liver transplantation. Transplant Proc 2014; 45:2331-6. [PMID: 23953545 DOI: 10.1016/j.transproceed.2013.01.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 01/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Liver transplantation (LT) for hepatitis C virus (HCV)-related end-stage liver disease is impaired by universal disease recurrence and suboptimal response to antiviral therapy. Inhibition of angiotensin-II signalling by angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II receptor blockers (ARB) decreases hepatic stellate cell activation in vitro and hepatic fibrogenesis in animal models. A single-center retrospective analysis suggested that angiotensin blockade (AB) inhibits fibrosis progression in recurrent HCV post-LT. This study assessed the effect of AB on fibrosis progression in an independent patient cohort. METHODS Chart review of all patients who underwent transplantation in our institution for HCV-related ESLD between January 2000 and February 2008 revealed 109 patients with ≥2 protocol liver biopsies and free of antiviral therapy post-LT up to the last biopsy analyzed; 27 of 109 patients were treated with ACE-I/ARB for ≥12 months, 82 were not. Fibrosis was staged using METAVIR. RESULTS Live-donor LT was more frequent in controls than in the AB group (25% vs 11%; P < .05). However, parameters known to affect outcome of recurrent HCV, including donor age, prevalence of diabetes, acute cellular rejection, and immunosuppression, were similar in both groups. Time between first and last biopsy (median, 23 months), stage of fibrosis, fibrosis progression rates (median 0.47 vs 0.45 unit/y; P = .46), and time to develop fibrosis stage ≥2 did not differ between groups. Results held true if deceased-donor LT were analyzed separately. CONCLUSION Our study does not support the contention of a previous report that use of AB reduces fibrosis progression in recurrent HCV post-LT.
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Affiliation(s)
- O Guillaud
- Multiorgan Transplant Program, and Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
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Mrani S, Chemin I, Menouar K, Guillaud O, Pradat P, Borghi G, Trabaud MA, Chevallier P, Chevallier M, Zoulim F, Trépo C. Occult HBV infection may represent a major risk factor of non-response to antiviral therapy of chronic hepatitis C. J Med Virol 2007; 79:1075-81. [PMID: 17596829 DOI: 10.1002/jmv.20943] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Occult hepatitis B virus (HBV) infection is common in chronic hepatitis C patient. However, its significance and consequences are still unclear. The aim of this study was to evaluate the prevalence of occult HBV among HCV chronic carriers in France and to assess its impact on liver histology and response to antiviral therapy. To this end a cohort of 203 patients with chronic hepatitis C without hepatitis B surface antigen (HBsAg) has been examined. Serum HBV-DNA was detected using a highly sensitive PCR with primers located in the S and X genes. HBV viraemia levels were further determined by real-time PCR. Results showed that 47 of 203 (23%) patients had occult HBV infection with a low HBV load (10(2)-10(4) copies/ml) but significantly higher HCV-RNA titers (P < 0.05). No significant difference in age, gender, serum ALT level, HCV genotypes, and the presence of anti-HBc was observed between patients with or without HBV-DNA. When compared histologically, patients with occult HBV infection had higher activity (A2-A3 in 53% vs. 38%, P < 0.01) and more advanced fibrosis (60% vs. 33%, P < 0.001) than HBV-DNA negative cases. Sustained response to combination therapy against Chronic hepatitis C was achieved in 11 (28%) of 40 HBV-DNA positive cases, compared with 65 (45%) of the 144 HBV-DNA negative cases (P < 0.05). Among the 144 HBV-DNA negative HCV patients those with genotype 1 responded less frequently to therapy as compared to other genotypes infected patients (38% vs. 55%, P < 0.05). Surprisingly, when considering all patients studied, irrespective to the HBV-DNA status no significant difference was observed in response to combination therapy regarding HCV genotypes (39% vs. 44%, P > 0.05). In conclusion, HBV-DNA is found in 1/4 of French chronic hepatitis C patients regardless of the presence of anti-HBc. Such an occult HBV co-infection is associated with more severe liver disease, higher HCV viral load and decreased response to antiviral therapy irrespective of HCV genotypes.
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Affiliation(s)
- S Mrani
- INSERM U271, 151 Cours A Thomas, 69003 Lyon, France
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10
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Hervieu V, Lepinasse F, Gouysse G, Guillaud O, Barel C, Chambonniere ML, Bringuier PP, Poncet G, Lombard-Bohas C, Partensky C, Chayvialle JA, Scoazec JY. Expression of beta-catenin in gastroenteropancreatic endocrine tumours: a study of 229 cases. J Clin Pathol 2006; 59:1300-4. [PMID: 16731593 PMCID: PMC1860549 DOI: 10.1136/jcp.2005.035097] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2006] [Indexed: 11/03/2022]
Abstract
AIMS To clarify the role of beta-catenin in digestive endocrine carcinogenesis, a large and representative series of gastroenteropancreatic endocrine tumours was analysed in order to determine the incidence and pattern of beta-catenin changes and to analyse the clinical and histological characteristics of the tumours presenting immunohistochemically detectable changes in beta-catenin expression. METHODS 229 cases of gastroenteropancreatic endocrine tumours (stomach, 11; duodenum and ampulla, 29; jejunum and ileum, 51; appendix, 13; colon and rectum, 17; and pancreas, 108) were studied by immunohistochemistry to assess the pattern of distribution of beta-catenin (membranous, cytoplasmic or nuclear). DNA was analysed to detect mutations in exon 3 of the CTNNB1 gene. RESULTS The distribution of immunoreactive beta-catenin protein was membranous in 164 cases, cytoplasmic in 58 cases and nuclear in seven cases. No mutation was detected in exon 3 of the CTNNB1 gene in any case. The seven cases with nuclear accumulation of beta-catenin were large tumours (mean size 44 (standard deviation (SD) 18.5) mm) with metastases, including liver metastases in five cases, high Ki-67 index (mean 34% (SD 16.5%)) and cyclin D1 overexpression; p53 accumulation was detected in six cases. Five patients died of disease; the mean (SD) survival was 13.6 (4.8) months. CONCLUSIONS Immunohistochemically detectable nuclear accumulation of beta-catenin is infrequent in gastroenteropancreatic endocrine tumours and is usually not associated with mutations in CNNTB1 exon 3. Changes in beta-catenin expression are late events in digestive endocrine carcinogenesis, associated with tumour progression and dissemination.
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Affiliation(s)
- V Hervieu
- INSERM, Unité 45, IFR62, Faculté Laennec, Lyon, France
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Khattab E, Chemin I, Vuillermoz I, Vieux C, Mrani S, Guillaud O, Trepo C, Zoulim F. Analysis of HCV co-infection with occult hepatitis B virus in patients undergoing IFN therapy. J Clin Virol 2004; 33:150-7. [PMID: 15911431 DOI: 10.1016/j.jcv.2004.10.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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: 06/08/2004] [Revised: 10/08/2004] [Accepted: 10/28/2004] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM Occult hepatitis B virus (HBV) infection is characterized by the presence of HBV DNA in the absence of hepatitis B surface antigen (HBsAg) in the patient serum. Although such infections have been identified in patients with chronic hepatitis C, the clinical significance of those co-infections is still not understood. Our aim was, therefore, to assess the prevalence and clinical consequences of occult HBV infection in chronic hepatitis C patients undergoing antiviral therapy. METHODS The study population consisted of 53 HBsAg-negative patients with chronic hepatitis C treated with IFN/ribavirin or IFN/ribavirin/amantadine. Nine patients experienced a viral breakthrough (BT), 30 were non-responders (NR) and 14 were responders (R). HBV-DNA detection by PCR was performed using primers specific for the S region of the HBV genome and HCV-RNA detection by PCR with primers localised in both the 5'NC and core region of HCV genome, before, during and after treatment. Viral genome sequences were also studied. RESULTS Occult HBV genomes were found in the serum of four of 53 (7.5%) patients, unrelated to anti-HBc status. No significant differences in biochemical, virological, or histological markers, age, duration of infection, were observed in patients with or without HBV DNA. There was an inverse correlation in the evolution of HBV DNA and HCV RNA levels. Direct sequencing showed that S gene of occult HBV presented mutations in the "a" determinant while no specific mutation in the core region of HCV was observed. None of the four patients co-infected with HBV and HCV were responders to anti-HCV therapy. CONCLUSION In our clinical setting, the prevalence of occult HBV co-infection among patients with chronic hepatitis C was low and independent of the presence of markers of previous HBV infection. Further studies in larger cohort of patients are warranted to determine if occult HBV co-infection may be involved in HCV resistance to combination therapy.
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MESH Headings
- Adult
- Amantadine/therapeutic use
- Amino Acid Sequence
- Antiviral Agents/therapeutic use
- DNA, Viral/blood
- DNA, Viral/chemistry
- Drug Resistance, Viral
- Female
- France
- Hepacivirus/genetics
- Hepacivirus/isolation & purification
- Hepatitis B virus/genetics
- Hepatitis B virus/isolation & purification
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/drug therapy
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/drug therapy
- Humans
- Interferon alpha-2
- Interferon-alpha/therapeutic use
- Male
- Middle Aged
- Molecular Sequence Data
- Polymerase Chain Reaction
- RNA, Viral/blood
- RNA, Viral/chemistry
- Recombinant Proteins
- Ribavirin/therapeutic use
- Sequence Alignment
- Sequence Analysis, DNA
- Viral Load
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Affiliation(s)
- E Khattab
- INSERM UNIT 271, 151 cours Albert Thomas, 69424 Lyon Cedex 03, France
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