F E Lecouvet

Catholic University of Louvain, Walloon Region, Belgium

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Publications (198)443.8 Total impact

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    ABSTRACT: We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.
    Acta clinica Belgica. 08/2014; 69(4):296-8.
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    ABSTRACT: Drug-induced tendon toxicity is rare but often underestimated. To date, four main drug classes have been incriminated in tendinopathies. Quinolones and long-term glucocorticoids are the most widely known, but statins and aromatase inhibitors can also induce tendon damage. The specific pathophysiological mechanisms responsible for drug-induced tendinopathies remain unknown. Proven risk factors have been identified, such as age older than 60years, pre-existing tendinopathy, and potentiation of toxic effects when several drug classes are used in combination. Mean time to symptom onset varies from a few days with quinolones to several months with statins and several years for long-term glucocorticoid therapy. The most common sites of involvement are the lower limb tendons, most notably the body of the Achilles tendon. The first part of this review discusses tendon anatomy and the pathophysiology and radiological manifestations of tendinopathies. The second part provides details on the main characteristics of each of the drugs classes associated with tendon toxicity.
    Joint, bone, spine: revue du rhumatisme 06/2014; · 2.25 Impact Factor
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    ABSTRACT: Examination of ligament reconstructions, particularly of the anterior cruciate ligament (ACL), are common situations in everyday knee imaging practice. Knowledge of normal appearances, the expected changes over time and the potential complications of these plasties are essential. MRI is the imaging method of choice. This article illustrates the main complications specific to this procedure: suboptimal positioning of the femoral or tibial tunnels, impingement between the graft and bony contours, rupture (partial or complete) of the plasty due to friction or injury, arthrofibrosis and particularly the "Cyclops" syndrome, fragmentation or migration of the fixation materials and a granulomatous reaction to biomaterials.
    Diagnostic and interventional imaging. 06/2014;
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    ABSTRACT: To determine the means and the reference intervals of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in normal hips with high-resolution computed tomography (CT). We prospectively included 94 adult individuals who underwent CT for thoracic, abdominal or urologic pathologies. Patients with a clinical history of hip pathology and/or with osteoarthritis on CT were excluded. We calculated means and 95 % reference intervals for imaging signs of cam-type (alpha angle at 90° and 45° and femoral head-neck offset) and pincer-type impingement (acetabular version angle, lateral centre-edge angle and acetabular index). The 95 % reference interval limits were all far beyond the abnormal thresholds found in the literature for cam-type and to a lesser extent for pincer-type FAI. The upper limits of the reference intervals for the alpha angles (at 90°/45°) were 68°/83° (men) and 69°/84° (women), compared to thresholds from the literature (50°, 55° or 60°). Reference intervals were similar between genders for cam-type parameters, and slightly differed for pincer-type. The 95 % reference intervals of morphometric measurements of FAI in asymptomatic hips were beyond the abnormal thresholds, which was especially true for cam-type FAI. Our results suggest the need for redefining the current morphometric parameters used in the diagnosis of FAI. • 95 % reference intervals limits of FAI morphotype were beyond currently defined thresholds. • Reference intervals of pincer-type morphotype measurements were close to current definitions. • Reference intervals of cam-type morphotype measurements were far beyond the current definitions. • Current morphometric definitions of cam-type morphotype should be used with care.
    European Radiology 04/2014; · 4.34 Impact Factor
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    ABSTRACT: The exponential growth of novel therapies for the treatment of metastatic castration-resistant prostate cancer (mCRPC) over the last decade has created an acute need for education and guidance of clinicians regarding optimal strategies for patient management. A multidisciplinary panel of 21 European experts in mCRPC assembled for comprehensive discussion and consensus development, seeking to move the field forward and provide guidance and perspectives on optimal selection and sequencing of therapeutic agents and monitoring of response to treatment and disease progression. A total of 110 clinically-relevant questions were addressed and a modified Delphi method was utilised to obtain a consensus. The panel reached a consensus on several important issues, providing recommendations on appropriate phase III clinical trial end-points and optimal strategies for imaging and monitoring of bone metastases. Guidance regarding selection and sequencing of therapy in patients with newly diagnosed or progressive mCRPC is emphasised, including the use of novel bone-targeted agents, chemotherapy, androgen receptor pathway-targeted agents and immunotherapy. The impact of drug resistance and prostate-specific antigen flare on treatment decisions was also addressed. Ultimately, individualised therapy for patients with mCRPC is dependent on continued refinement of clinical decision-making based on patient and disease characteristics. This consensus statement offers clinicians expert guidance on the implementation of recent advances to improve patient outcome, focusing on the future of prostate cancer care.
    European journal of cancer (Oxford, England: 1990) 04/2014; · 4.12 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this article is to evaluate and compare the prevalence and measurement values of CT signs of femoroacetabular impingement (FAI) in asymptomatic hips without CT signs of osteoarthritis between two age groups: younger than 40 years and older than 60 years. SUBJECTS AND METHODS. We prospectively included patients undergoing thoracoabdominopelvic MDCT for nonorthopedic indications with asymptomatic hips and excluded hips with signs of osteoarthritis seen on CT. Two age groups including 75 hips each were enrolled (< 40 years old: mean age, 31 years; 15 women; > 60 years old: mean age, 66 years; 21 women). Two observers independently performed the image analysis. Prevalences and quantitative values of the cam (alpha angle and femoral head-neck offset) and pincer (acetabular version angle, acetabular index, lateral center-edge angle, crossover sign, and posterior wall sign) FAI morphotypes were compared using both difference and equivalence tests. Intraobserver agreement was assessed. RESULTS. The prevalence of CT signs of FAI were high and showed great variation depending on the signs and cutoff values, in both groups (9-63% for cam; 3-50% for pincer). The prevalence and measurement values of CT signs of the cam morphotype were equivalent between the two age groups. The prevalence and measurement values of CT signs of the pincer morphotype were statistically equivalent between the age groups except for the acetabular version angle, lateral center-edge angle, and crossover sign for which no statistical difference was found, but statistical equivalence was not reached. Interobserver and intraobserver agreement were moderate to almost perfect (κ = 0.72-0.89; intraclass correlation coefficient, 0.42-0.94). CONCLUSION. The prevalence and measurement values of most CT signs of FAI morphotypes were high and equivalent between the two age groups of patients with asymptomatic nonosteoarthritic hips.
    American Journal of Roentgenology 03/2014; · 2.90 Impact Factor
  • 03/2014; 97(2):124.
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    ABSTRACT: Patients with high-risk localised prostate cancer (PCa) are at risk of developing bone metastases (BMs). Zoledronic acid (ZA) significantly reduces the incidence of skeletal complications in castration-resistant metastatic PCa versus placebo. To investigate ZA for the prevention of BMs in high-risk localised PCa. Randomised open-label multinational study with patients having at least one of the following: prostate-specific antigen ≥20 ng/ml, node-positive disease, or Gleason score 8-10. Standard PCa therapy alone or combined with 4mg ZA intravenously every 3 mo for ≤4 yr. BMs were assessed using locally evaluated bone-imaging procedures (BIPs), with subsequent blinded central review. Patients with BMs, time to BMs, overall survival, and adverse events were compared between treatment groups. A total of 1393 of 1433 randomised patients were used for intention-to-treat (ITT) efficacy analyses, with 1040 patients with BIP-BM outcome status at 4±0.5 yr. The local urologist/radiologist diagnosed BIP-BMs in 88 of 515 patients (17.1%) in the ZA group and 89 of 525 patients (17.0%) in the control group (chi-square test: p=0.95), with a difference between proportions of 0.1% (95% confidence interval [CI], -4.4 to 4.7) in favour of the control group. In the ITT population (n=1393), the Kaplan-Meier estimated proportion of BMs after a median follow-up of 4.8 yr was 14.7% in the ZA group versus 13.2% in the control group (log-rank: p=0.65). Low hot spot numbers on bone scans were confirmed as metastases with additional imaging. Central reviews of BIPs were possible only on a subset of patients. ZA administered every 3 mo was demonstrated to be ineffective for the prevention of BMs in high-risk localised PCa patients at 4 yr. Zoledronic acid administered every 3 mo was demonstrated to be ineffective for the prevention of bone metastases in high-risk nonmetastatic PCa patients at 4 yr. The ZEUS trial is registered in the Dutch trial register www.trialregister.nl and the ISRCTN register at http://www.controlled-trials.com/ISRCTN66626762.
    European Urology 02/2014; · 10.48 Impact Factor
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    ABSTRACT: The exponential growth of novel therapies for the treatment of metastatic castration-resistant prostate cancer (mCRPC) over the last decade has created an acute need for education and guidance of clinicians regarding optimal strategies for patient management. A multidisciplinary panel of 21 European experts in mCRPC assembled for comprehensive discussion and consensus development, seeking to move the field forward and provide guidance and perspectives on optimal selection and sequencing of therapeutic agents and monitoring of response to treatment and disease progression. A total of 110 clinically-relevant questions were addressed and a modified Delphi method was utilised to obtain a consensus. The panel reached a consensus on several important issues, providing recommendations on appropriate phase III clinical trial end-points and optimal strategies for imaging and monitoring of bone metastases. Guidance regarding selection and sequencing of therapy in patients with newly diagnosed or progressive mCRPC is emphasised, including the use of novel bone-targeted agents, chemotherapy, androgen receptor pathway-targeted agents and immunotherapy. The impact of drug resistance and prostate-specific antigen flare on treatment decisions was also addressed. Ultimately, individualised therapy for patients with mCRPC is dependent on continued refinement of clinical decision-making based on patient and disease characteristics. This consensus statement offers clinicians expert guidance on the implementation of recent advances to improve patient outcome, focusing on the future of prostate cancer care.
    European Journal of Cancer. 01/2014;
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    ABSTRACT: L’étude des ligamentoplasties, en particulier du ligament croisé antérieur (LCA), est une indication fréquente dans la pratique quotidienne de l’imagerie du genou. La connaissance de l’aspect normal, de l’évolution attendue dans le temps, et des potentielles complications de ces plasties est indispensable. L’IRM est la méthode d’imagerie de choix. Cet article illustre les principales complications spécifiques de cette intervention, qui sont le positionnement suboptimal des tunnels d’insertion, le conflit entre le greffon et les reliefs osseux, la rupture (partielle ou complète) de la plastie par friction ou traumatisme, l’arthrofibrose et en particulier le syndrome « du cyclope », la fragmentation ou migration du matériel de fixation, la réaction granulomateuse sur biomatériel.
    Journal de Radiologie Diagnostique et Interventionnelle. 01/2014;
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    ABSTRACT: In 12 patients operated on for bone sarcoma resection, a postoperative magnetic resonance imaging of the resection specimens was obtained in order to assess the surgical margins. Margins were classified according to MRI in R0, R1, and R2 by three independent observers: a radiologist and two orthopaedic surgeons. Final margin evaluation (R0, R1, and R2) was assessed by a confirmed pathologist. Agreement for margin evaluation between the pathologist and the radiologist was perfect (κ = 1). Agreement between the pathologist and an experienced orthopaedic surgeon was very good while it was fair between the pathologist and a junior orthopaedic surgeon. MRI should be considered as a tool to give quick information about the adequacy of margins and to help the pathologist to focus on doubtful areas and to spare time in specimen analysis. But it may not replace the pathological evaluation that gives additional information about tumor necrosis. This study shows that MRI extemporaneous analysis of a resection specimen may be efficient in bone tumor oncologic surgery, if made by an experienced radiologist with perfect agreement with the pathologist.
    Sarcoma 01/2014; 2014:967848.
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    ABSTRACT: Assessment of the response to treatment of metastases is crucial in daily oncological practice and clinical trials. For soft tissue metastases, this is done using computed tomography (CT), Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET) using validated response evaluation criteria. Bone metastases, which frequently represent the only site of metastases, are an exception in response assessment systems, because of the nature of the fixed bony defects, their complexity, which ranges from sclerotic to osteolytic and because of the lack of sensitivity, specificity and spatial resolution of the previously available bone imaging methods, mainly bone scintigraphy. Techniques such as MRI and PET are able to detect the early infiltration of the bone marrow by cancer, and to quantify this infiltration using morphologic images, quantitative parameters and functional approaches. This paper highlights the most recent developments of MRI and PET, showing how they enable early detection of bone lesions and monitoring of their response. It reviews current knowledge, puts the different techniques into perspective, in terms of indications, strengths, weaknesses and complementarity, and finally proposes recommendations for the choice of the most adequate imaging technique.
    European Journal of Cancer. 01/2014;
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    ABSTRACT: La toxicité tendineuse d’origine médicamenteuse est un phénomène rare souvent sous-estimé. À ce jour, quatre classes thérapeutiques ont été principalement mises en cause. Les quinolones et la corticothérapie au long cours sont les plus connues, auxquelles il faut ajouter les statines et les inhibiteurs de l’aromatase. Les mécanismes physiopathologiques précis à l’origine de cette toxicité restent à établir. Des facteurs de risque ont été identifiés de manière formelle tels qu’un âge supérieur à 60 ans et une tendinopathie pré-existante ainsi qu’un effet de potentialisation lors de l’association de ces différentes classes thérapeutiques. Le délai moyen d’apparition des symptômes est variable, allant de quelques jours pour les quinolones, à plusieurs mois pour les statines voire plusieurs années pour la corticothérapie au long cours. L’atteinte est préférentiellement localisée aux tendons des membres inférieurs et particulièrement au corps du tendon calcanéen. Au cours de cette mise au point seront abordées dans une première partie l’anatomie du tendon, la physiopathologie et la séméiologie radiologique des tendinopathies. Puis dans une seconde partie seront développées successivement les principales caractéristiques des médicaments ayant une toxicité tendineuse.
    Revue du Rhumatisme. 01/2014;
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    ABSTRACT: Introduction. In surgical oncology, histological analysis of excised tumor specimen is the conventional method to assess the safety of the resection margins. We tested the feasibility of using MRI to assess the resection margins of freshly explanted tumor specimens in rats. Materials and Methods. Fourteen specimen of sarcoma were resected in rats and analysed both with MRI and histologically. Slicing of the specimen was identical for the two methods and corresponding slices were paired. 498 margins were measured in length and classified using the UICC classification (R0, R1, and R2). Results. The mean difference between the 498 margins measured both with histology and MRI was 0.3 mm (SD 1.0 mm). The agreement interval of the two measurement methods was [-1.7 mm; 2.2 mm]. In terms of the UICC classification, a strict correlation was observed between MRI- and histology-based classifications (κ = 0.84, P < 0.05). Discussion. This experimental study showed the feasibility to use MRI images of excised tumor specimen to assess the resection margins with the same degree of accuracy as the conventional histopathological analysis. When completed, MRI acquisition of resected tumors may alert the surgeon in case of inadequate margin and help advantageously the histopathological analysis.
    Sarcoma 01/2014; 2014:686790.
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    ABSTRACT: Drug-induced tendon toxicity is rare but often underestimated. To date, four main drug classes have been incriminated in tendinopathies. Quinolones and long-term glucocorticoids are the most widely known, but statins and aromatase inhibitors can also induce tendon damage. The specific pathophysiological mechanisms responsible for drug-induced tendinopathies remain unknown. Proven risk factors have been identified, such as age older than 60 years, pre-existing tendinopathy, and potentiation of toxic effects when several drug classes are used in combination. Mean time to symptom onset varies from a few days with quinolones to several months with statins and several years for long-term glucocorticoid therapy. The most common sites of involvement are the lower limb tendons, most notably the body of the Achilles tendon. The first part of this review discusses tendon anatomy and the pathophysiology and radiological manifestations of tendinopathies. The second part provides details on the main characteristics of each of the drugs classes associated with tendon toxicity.
    Joint Bone Spine. 01/2014;
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    ABSTRACT: Multiparametric magnetic resonance imaging (mpMRI) is the standard for local prostate cancer (PCa) staging. Whole-body MRI (wbMRI) has shown capabilities for metastatic screening. This study assesses the feasibility and value of an all-in-one AJCC TNM staging of PCa during a unique MRI session combining mpMRI and wbMRI. Thirty consecutive patients with "high-risk" PCa prospectively underwent mpMRI of the prostate and wbMRI, in addition to (99m) Tc bone scan (BS), completed with standard X-rays (±TXR) and contrast enhanced CT for distant staging. For the statistical analysis, a "best valuable comparator" (BVC) combining a panel review of all available baseline and follow-up imaging, biological, and clinical data was used to adjudicate lymph node and bone metastatic status. Prostate mpMRI was analyzed using ESUR guidelines. Sensitivity of BS ± TXR combined with CT and of wbMRI for detecting metastases (bones or nodes) was 85% and 100%, respectively, and specificity was 88% and 100%, respectively. For the overall staging of the patients as being either N0M0 or having disease extension beyond the prostate, wbMRI was superior to the combination of BS and CT (improvement in all ROC characteristics and of AUC by 13.6% (95% CI: +0.7% to +26.5%, P = 0.039)). The main limitation is the limited number of patients. AJCC M and N staging using wbMRI is feasible during the same imaging session as mpMRI performed for T staging, in less then one hour. wbMRI outperforms BS ± TXR and abdomino-pelvic CT work up for discriminating subsets of patients with or without distant spread of the cancer. Prostate © 2013 Wiley Periodicals, Inc.
    The Prostate 12/2013; · 3.84 Impact Factor
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    ABSTRACT: Iterative reconstruction (IR) techniques reduce image noise in multidetector computed tomography (MDCT) imaging. They can therefore be used to reduce radiation dose while maintaining diagnostic image quality nearly constant. However, CT manufacturers offer several strength levels of IR to choose from. To determine the optimal strength level of IR in low-dose MDCT of the cervical spine. Thirty consecutive patients investigated by low-dose cervical spine MDCT were prospectively studied. Raw data were reconstructed using filtered back-projection and sinogram-affirmed IR (SAFIRE, strength levels 1 to 5) techniques. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured at C3-C4 and C6-C7 levels. Two radiologists independently and blindly evaluated various anatomical structures (both dense and soft tissues) using a 4-point scale. They also rated the overall diagnostic image quality using a 10-point scale. As IR strength levels increased, image noise decreased linearly, while SNR and CNR both increased linearly at C3-C4 and C6-C7 levels (P < 0.001). For the intervertebral discs, the content of neural foramina and dural sac, and for the ligaments, subjective image quality scores increased linearly with increasing IR strength level (P ≤ 0.03). Conversely, for the soft tissues and trabecular bone, the scores decreased linearly with increasing IR strength level (P < 0.001). Finally, the overall diagnostic image quality scores increased linearly with increasing IR strength level (P < 0.001). The optimal strength level of IR in low-dose cervical spine MDCT depends on the anatomical structure to be analyzed. For the intervertebral discs and the content of neural foramina, high strength levels of IR are recommended.
    Acta Radiologica 07/2013; · 1.33 Impact Factor
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    ABSTRACT: The therapeutic landscape for the treatment of advanced prostate cancer is rapidly evolving, especially for those patients with metastatic castration-resistant prostate cancer (CPRC). Despite advances in therapy options, the diagnostic landscape has remained relatively static, with few guidelines or reviews addressing the optimal timing or methodology for the radiographic detection of metastatic disease. Given recent reports indicating a substantial proportion of patients with CRPC thought to be nonmetastatic (M0) are in fact metastatic (M1), there is now a clear opportunity and need for improvement in detection practices. Herein, we discuss the current status of predicting the presence of metastatic disease, with a particular emphasis on the detection of the M0 to M1 transition. In addition, we review current data on newer imaging technologies that are changing the way metastases are detected. Whether earlier detection of metastatic disease will ultimately improve patient outcomes is unknown, but given that the therapeutic options for those with metastatic and nonmetastatic CPRC vary, there are considerable implications of how and when metastases are detected.
    The Oncologist 05/2013; · 4.10 Impact Factor
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    ABSTRACT: PURPOSE OF REVIEW: High-risk prostate cancers (PCa), that is, those with prostate-specific antigen greater than 20 ng/dl, Gleason Score of at least 8, or extraprostatic spread, are nowadays commonly treated by surgery and radiotherapy combined with a fixed period of systemic treatment. Implementing these strategies requires an exhaustive assessment of metastatic spread. This review addresses the latest development in integrated imaging techniques. RECENT FINDINGS: In contrast to the progress that has been made in PCa treatment, diagnostic strategies have not much evolved. Most guidelines still recognize Tc bone scintigraphy and computed tomography (CT) as cornerstone modalities to assess metastatic spread in bones and lymph nodes. Therefore, modern imaging techniques should primarily focus on these two targets. PET with various tracers, including C or F-choline and F-sodium fluoride, and MRI with or without diffusion-weighted imaging are competing to supplant bone scan and CT scan as reference imaging techniques. This review focuses on the latest development of these techniques and analyses their potential impact in everyday urology practice. SUMMARY: Although certain hurdles remain, PET and whole-body MRI have the ability to supplant Tc bone scan and CT as upfront test to assess metastatic spread in high-risk PCa.
    Current opinion in urology 04/2013; · 2.50 Impact Factor
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    ABSTRACT: Cartilaginous tumours of the extremities are commonly seen in radiographs. Enchondroma is the most frequently encountered tumour. Since the vast majority of enchondromas are asymptomatic, they are typically discovered as incidental findings or along with a pathologic fracture. The authors propose a pictorial review to illustrate the imaging features of cartilaginous bone lesions of the hand and their specificities, and discuss the main differential diagnoses.
    Diagnostic and interventional imaging. 03/2013;

Publication Stats

2k Citations
443.80 Total Impact Points

Institutions

  • 1996–2014
    • Catholic University of Louvain
      • • Institute of Experimental and Clinical Research (IREC)
      • • Department of Radiology and Medical Imaging - RAIM
      • • Department of Microbiology, Immunology and Genetics - MIGE
      Walloon Region, Belgium
    • Cliniques Universitaires Saint-Luc
      • • Division of Urology
      • • Department of Medical Imaging
      • • Division of Radiology
      • • Division of Orthopedics and Musculoskeletal Trauma
      • • Division of Pediatric Cardiology
      Bruxelles, Brussels Capital Region, Belgium
  • 2012–2013
    • University Hospital of Lausanne
      Lausanne, Vaud, Switzerland
  • 1996–1999
    • University Hospital Brussels
      Bruxelles, Brussels Capital Region, Belgium