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Gaujoux S.,Pole des Maladies de lAppareil Digestif PMAD | Gaujoux S.,University Paris Diderot | Bucau M.,Pole des Maladies de lAppareil Digestif PMAD | Ronot M.,Beaujon University Hospitals Paris Nord Val Of Seine | And 9 more authors.
Digestive Surgery | Year: 2014

Background: Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Rendu-Weber disease, is a rare genetic disorder characterized by widespread telangiectasia and vascular malformations involving the liver in most of the cases. The consequences of this pathologically underlying parenchyma on liver resection have been poorly described. Methods: More than 2,000 liver resections were performed at our institution over a 14-year period, whereby 2 major hepatectomies for malignancy were performed on patients with HHT with liver involvement. In addition, a systematic search was performed in the PubMed database to identify all original articles on hepatectomy in patients with HHT. Results: The first patient underwent a left hepatectomy for cholangiocarcinoma with an uneventful postoperative course. The second patient underwent right hepatectomy and segment 3 resection for colorectal liver metastases. The postoperative course was marked by ascites without liver failure. For both patients, 90-day mortality was nil. Conclusion: In selected HHT patients with liver involvement, liver resections, including major hepatectomies, can be safely performed. Specific attention should be paid to postoperative liver function and ascites. © 2013 S. Karger AG, Basel. Source


Pommier R.,Beaujon University Hospitals Paris Nord Val Of Seine | Ronot M.,Beaujon University Hospitals Paris Nord Val Of Seine | Ronot M.,University Paris Diderot | Ronot M.,French Institute of Health and Medical Research | And 13 more authors.
Annals of Surgical Oncology | Year: 2014

Purpose. To compare tumor progression in both embolized and non-embolized liver lobes after portal vein embolization (PVE) in patients with bilobar colorectal liver metastases (CLM), according to the initial response to induction chemotherapy. Methods. From 2002 to 2012, a total of 42 consecutive patients with bilobar CLM initially treated using induction chemotherapy underwent right PVE to achieve adequate future liver remnant volume. Tumoral and liver parenchyma volumes, as well as their volume variations, were measured on computed tomography before and after PVE in both embolized and non-embolized. Patients were classified as fast (≤6 cycles of induction chemotherapy) and slow (>6 cycles) responders. Results. Overall, 432 metastases were analyzed in 42 patients. Patients were slow responders in 29 (69 %) cases. Tumoral volume increased in 29 (69 %) cases in the embolized liver (+48 %; p < 0.0001), and in 28 (66 %) cases in the non-embolized liver (+31 %; p < 0.0001). Fast responders had a tumoral volume decrease in both embolized (-4 %) and non-embolized (-9 %) lobes. On the opposite side, slow responders had tumoral volume increase in both embolized (+79 %) and non-embolized (+32 %) lobes. On multivariate analysis, a 'slow' response to induction chemotherapy was the only factor associated with tumoral progression in both embolized (p = 0.0012) and non-embolized (p = 0.001) lobes. Conclusion. Tumor growth after PVE is observed in both embolized and non-embolized liver lobes in most patients but is significantly associated with slow response to induction chemotherapy. © 2014 Society of Surgical Oncology. Source


Wijnands T.F.M.,Radboud University Nijmegen | Ronot M.,Beaujon University Hospitals Paris Nord Val Of Seine | Gevers T.J.G.,Radboud University Nijmegen | Benzimra J.,Beaujon University Hospitals Paris Nord Val Of Seine | And 3 more authors.
European Radiology | Year: 2016

Objectives: To identify predictive variables of treatment response following aspiration sclerotherapy of large symptomatic hepatic cysts. Methods: We collected individual patient data from two tertiary referral centres and included all patients treated with aspiration sclerotherapy of a large (>5 cm), symptomatic hepatic cyst. At six months, clinical response was defined as complete or incomplete. Secondary, suboptimal technical response was defined as lower quartile of cyst reduction. Predictive variables of clinical and technical response were analyzed by logistic regression analysis. Results: We included 86 patients (58 ± 10 years; female 90 %). Complete clinical response rate was 55 %. Median cyst diameter and volume reduction were 71 % (IQR 50-87 %) and 98 % (IRQ 88-100 %), respectively. Patients with complete clinical response had a significantly higher cyst reduction compared to incomplete responders (OR 1.02, 95 % CI 1.00-1.04). Aspiration of haemorrhagic cyst fluid (OR 4.39, 95 % CI 1.34-14.39) or a lower cyst reduction at one month (OR 1.06, 95 % CI 1.02-1.10) was associated with a suboptimal technical response at six months. Conclusion: Complete clinical response is associated with effective cyst reduction. Aspiration of haemorrhagic cyst fluid or a restricted diameter reduction at one month predicts a suboptimal technical treatment response, however, these variables did not predict symptom disappearance. Key Points: • Aspiration sclerotherapy of hepatic cysts shows excellent clinical and technical efficacy.• Optimal clinical responders have a markedly higher cyst reduction.• Haemorrhagic aspirate and a strong fluid reaccumulation predict suboptimal cyst reduction. © 2016 The Author(s) Source


Ronot M.,Beaujon University Hospitals Paris Nord Val Of Seine | Ronot M.,University Paris Diderot | Ronot M.,French Institute of Health and Medical Research | Lambert S.A.,University Paris Diderot | And 21 more authors.
PLoS ONE | Year: 2014

Objective: To assess in a high-resolution model of thin liver rat slices which viscoelastic parameter at three-dimensional multifrequency MR elastography has the best diagnostic performance for quantifying liver fibrosis. Materials and Methods: The study was approved by the ethics committee for animal care of our institution. Eight normal rats and 42 rats with carbon tetrachloride induced liver fibrosis were used in the study. The rats were sacrificed, their livers were resected and three-dimensional MR elastography of 5±2 mm liver slices was performed at 7T with mechanical frequencies of 500, 600 and 700 Hz. The complex shear, storage and loss moduli, and the coefficient of the frequency power law were calculated. At histopathology, fibrosis and inflammation were assessed with METAVIR score, fibrosis was further quantified with morphometry. The diagnostic value of the viscoelastic parameters for assessing fibrosis severity was evaluated with simple and multiple linear regressions, receiver operating characteristic analysis and Obuchowski measures. Results: At simple regression, the shear, storage and loss moduli were associated with the severity of fibrosis. At multiple regression, the storage modulus at 600 Hz was the only parameter associated with fibrosis severity (r = 0.86, p<0.0001). This parameter had an Obuchowski measure of 0.89+/-0.03. This measure was significantly larger than that of the loss modulus (0.78+/-0.04, p = 0.028), but not than that of the complex shear modulus (0.88+/-0.03, p = 0.84). Conclusion: Our high resolution, three-dimensional multifrequency MR elastography study of thin liver slices shows that the storage modulus is the viscoelastic parameter that has the best association with the severity of liver fibrosis. However, its diagnostic performance does not differ significantly from that of the complex shear modulus. © 2014 Ronot et al. Source


Ronot M.,Beaujon University Hospitals Paris Nord Val Of Seine | Ronot M.,University Paris Diderot | Ronot M.,French Institute of Health and Medical Research | Lambert S.,University Paris Diderot | And 22 more authors.
European Radiology | Year: 2014

Objective: To assess the value of the liver and spleen viscoelastic parameters at multifrequency MR elastography to determine the degree of portal hypertension and presence of high-risk oesophageal varices in patients with cirrhosis. Methods: From January to September 2012, 36 consecutive patients with cirrhosis evaluated for transplantation were prospectively included. All patients underwent hepatic venous pressure gradient (HVPG) measurements and endoscopy to assess oesophageal varices. Multifrequency MR elastography was performed within the liver and spleen. The shear, storage and loss moduli were calculated and compared to the HVPG with Spearman coefficients and multiple regressions. Patients with and without severe portal hypertension and high-risk varices were compared with Mann-Whitney tests, logistic regression and ROC analysis. Results: The liver storage and loss moduli and the spleen shear, storage and loss moduli correlated with the HVPG. At multiple regression, only the liver and the spleen loss modulus correlated with the HVPG (r = 0.44, p = 0.017, and r = 0.57, p = 0.002, respectively). The spleen loss modulus was the best parameter for identifying patients with severe portal hypertension (p = 0.019, AUROC = 0.81) or high-risk varices (p = 0.042, AUROC = 0.93). Conclusions: The spleen loss modulus appears to be the best parameter for identifying patients with severe portal hypertension or high-risk varices. Key points 1. Noninvasive HVPG assessment can be performed with liver and spleen MR elastography 2. The spleen loss modulus enables the detection of high-risk oesophageal varices 3. The spleen loss modulus enables the detection of severe portal hypertension. © European Society of Radiology 2014. Source

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