O Ernst

University of Lille Nord de France, Lille, Nord-Pas-de-Calais, France

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Publications (98)187.77 Total impact

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    ABSTRACT: Most transplant centers use chemoembolisation as locoregional bridge therapy for hepatocellular carcinoma (HCC) before liver transplantation (LT). Chemoembolisation using beads loaded with doxorubicin (DEBDOX) is a promising technique that enables delivery of a large quantity of drugs against HCC. We sought to assess the imaging-histologic correlation after DEBDOX chemoembolisation.
    Cardiovascular and interventional radiology. 10/2014;
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    ABSTRACT: A replaced right hepatic artery (RHA) is the most common anatomical variation in pancreatic surgery. The RHA is frequently encountered and can be problematic in pancreatic carcinoma. The preservation of the RHA is necessary to avoid ischemic complications but can impact margins resection in pancreaticoduodenectomy (PD). We report a case of a 53-year-old man with a head pancreatic carcinoma. There was a close contact between the tumor and the RHA arising from superior mesenteric artery (SMA). Preoperative embolization of the RHA was performed prior to PD.
    Journal of gastrointestinal oncology 08/2014; 5(4):E80-3.
  • Paul Borde, Olivier Ernst, Vincent Maunoury
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    ABSTRACT: For ten years, a lot of advances have been achieved for the morphological exploration of the small intestine as well as with CT and MR enterography than with wireless capsule endoscopy. These investigations have renewed the approaches of different diseases that can affect the small intestine: tumors, especially sub-mucosal tumors (CT enterography), iron-deficiency anemia (capsule endoscopy) and follow-up of patients with Crohn's disease of the small intestine (MR enterography). Balloon enteroscopy may then allow therapeutic approach when needed (treatment of bleeding angiodysplasia).
    La Revue du praticien 09/2013; 63(7):904-6.
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    ABSTRACT: The objective was to determine the liver volumetric recovering capacity and postoperative course after major hepatectomy in obese patients through a case-matched study. In literature, the impact of obesity on liver recovering has been analyzed only indirectly in terms of morbimortality but never through volumetric assessment. Between 2005 and 2011, 42 patients with body mass index (BMI) 30 or higher (Ob group) underwent major hepatectomy and were matched with 42 patients with BMI 25 or lower (NonOb group) on the magnitude of resection (number of resected segments ±1, remnant liver volume to total liver volume, RLV/TLV, ±5%). The RLV was measured on computed tomographic slices preoperatively and postoperatively at 1 month (RLV-1M) for all patients and within 3 to 12 months in 42 paired patients (median = 6 months, RLV-6M). Considering hepatomegaly in Ob group, RLV was also normalized to body weight (RLVBWR). The liver volumetric gain was expressed as a relative increase [(RLV-1M - RLV)/RLV] or increase in RLVBWR. The Ob and NonOb groups were comparable regarding clinicopathological data, except for arterial hypertension (48% vs 19%; P = 0.005), mean steatosis (24% vs 10%; P = 0.03), and fibrosis incidence (33% vs 10%; P = 0.008). Ob group showed longer operative time and higher blood losses. There were no intergroup differences in liver failure (both 7.1%) and 90-day morbimortality. Despite comparable RLV/TLV (38.1% vs 37.7%; P = 0.13), the relative liver volumetric gain at 1 month was significantly lower in Ob group (+93% vs +115%; P = 0.002), as well as RLVBWR increase (+0.59% vs +0.79%; P < 0.001). The RLV-1M represented 66.2% of initial TLV in Ob group compared with 73.8% (P = 0.005) in NonOb group. This delay in relative volumetric gain persisted at 6 months (+105.4% vs +137.6%; P = 0.009), the RLV-6M representing 71.2% vs 82.4% of initial TLV (P = 0.014). In a methodologically robust trial in the first cohort reported up to date, the regenerative response in obese patients was comparatively slower based on their initial TLV or body weight.
    Annals of surgery 08/2013; · 7.90 Impact Factor
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    ABSTRACT: Objectif Le dépistage des surcharges cardiaques en fer se fait habituellement en IRM avec un raccourcissement du T2* myocardique en dessous 20 ms (1,5 T). Cette mesure a été validée avec une séquence spécifique et le logiciel de calcul CMRTools® (technique de référence). Le but de cette étude était de valider l’emploi de séquences et de logiciels disponibles en routine clinique pour dépister ces surcharges. Matériel et méthodes Dans un premier temps, un fantôme de 11 tubes de T2* compris entre 4 à 33 ms a été testé sur trois sites ayant un appareil IRM de marque différente. Dans un second temps, les valeurs du T2* myocardique de 75 patients ont été mesurées en routine clinique par deux méthodes. La première méthode employait la séquence de référence spécialement implantée sur les machines associée au logiciel CMRTools®. La seconde méthode employait les séquences d’acquisitions disponibles en standard sur les machines suivi du calcul sur tableur informatique. Résultats Sur fantôme, la moyenne des différences de T2* entre chaque appareil est de 0,6 ms. Treize patients avaient une valeur abaissée du T2* avec la technique de référence. Trois cas étaient mal classés en technique de routine et correspondaient à des faux-positifs de faible surcharge (T2* compris entre 18–20 ms). Conclusion Le dépistage des surcharges myocardiques en fer peut se faire en IRM en employant des séquences et des logiciels de calcul disponibles en routine clinique pendant le même examen que celui de l’évaluation des surcharges hépatiques en fer.
    Journal de Radiologie Diagnostique et Interventionnelle. 06/2013; 94(6):618–625.
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    ABSTRACT: PURPOSE: Screening for cardiac iron overload is generally done by magnetic resonance imaging (MRI) and demonstrated by a shortening of the myocardial T2* below 20ms at 1.5Tesla. This measurement was validated with a specific sequence and the CMRTools(®) calculation software (reference technique). The objective of this study was to validate the use of sequences and software programs that are available in routine clinical practice to screen for iron overload. MATERIAL AND METHODS: First, a phantom of 11 tubes with a T2* between 4 and 33ms was tested at three sites that had MRI machines of different brands. Second, the myocardial T2* values of 75 patients were measured in routine clinical practice using two methods. The first method used the reference sequence specially installed in the machines associated with the CMRTool software. The second method used the standard acquisition sequences available in the machines followed by calculation on a computer spreadsheet. RESULTS: In the phantom, the mean of the differences in T2* between each machine was 0.6ms. Thirteen patients had a lowered T2* value with the reference technique. Three cases were poorly classified using the routine technique and corresponded with false positives of low overload (T2* between 18 and 20ms). CONCLUSION: Screening for myocardial iron overload can be done by MRI by using sequences and calculation software available in routine clinical practice during the same examination as the one for the evaluation of hepatic iron overload.
    Diagnostic and interventional imaging. 05/2013;
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    British Journal of Haematology 05/2013; · 4.94 Impact Factor
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    ABSTRACT: Objectif L’hématome non traumatique du foie est une pathologie rare compliquant volontiers l’évolution des tumeurs hépatiques. Chez certains patients, l’hémorragie constitue le premier évènement clinique et l’enjeu diagnostique reste entier. Patients et méthodes Cette étude rétrospective s’est déroulée entre juillet 2001 et mars 2011. Les imageries scanner et IRM à la phase aiguë de patients ayant présenté un hématome hépatique inaugural ont été relues, relevant les caractéristiques radio-sémiologiques des hématomes et des lésions hépatiques découvertes, ensuite été confrontées aux diagnostics finals des patients. Résultats Douze patients ont été inclus (âge moyen de 42 ans). Chez sept d’entre eux, une lésion hépatique était visible dès la première imagerie scanographique ou IRM, dont cinq fortement hypervasculaires. Finalement, l’hémorragie a fait découvrir un hépatocarcinome chez quatre patients, un adénome chez deux et une hyperplasie nodulaire focale chez un autre. Conclusion Il est important dans les hémorragies hépatiques spontanées à la phase aiguë de ne pas méconnaître une lésion intrahépatique en réalisant une imagerie injectée suivant un protocole complet. Il faut, dans cette situation particulière où l’hématome est inaugural de la pathologie sous-jacente, envisager une lésion hépatocarcinomateuse même en l’absence d’hépatopathie, et chez les patients jeunes.
    Journal de Radiologie Diagnostique et Interventionnelle. 03/2013; 94(3):299–306.
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    ABSTRACT: BACKGROUND AND AIMS: Anti TNF therapy induces mucosal healing in patients with Crohn's disease, but the effects on transmural inflammation in the ileum are not well understood. Magnetic resonance-enteroclysis (MRE) offers excellent imaging of transmural and peri-enteric lesions in Crohn's ileitis and we aimed to study its responsiveness to anti TNF therapy. METHODS: In this multi-center prospective trial, anti TNF naïve patients with ileal Crohn's disease and with increased CRP and contrast enhanced wall thickening received infliximab 5mg/kg at weeks 0, 2 and 6, and q8 weeks maintenance MRE was performed at baseline, 2 weeks and 6 months and assessed based on a predefined MRE score of severity in ileal Crohn's Disease. RESULTS: Twenty patients were included; of those, 18 patients underwent MRE at week 2 and 15 patients at weeks 2 and 26 as scheduled. Inflammatory components of the MRE index decreased by ≥2 points and by ≥50% at week 26 (primary endpoint) in 40% and 32% of patients (per protocol and intention to treat analysis, respectively). The MRE index improved in 44% at week 2 and in 80% at week 26. Complete absence of inflammatory lesions was observed in 0/18 at week 2 and 13% (2/15) at week 26. The obstructive elements did not change. Clinical and CRP improvement occurred as early as wk 2, but only CDAI correlated with the MRE index. CONCLUSION: Improvement of MRE occurs from 2 weeks after infliximab therapy onwards and correlates with clinical response but normalization of MRE is rare.
    Journal of Crohn s and Colitis 02/2013; · 3.39 Impact Factor
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    ABSTRACT: PURPOSE: Although rare, non-traumatic hepatic haemorrhage is a known complication of liver tumors. In cases where the haemorrhage is the first clinical event, diagnostic work-up is critical. MATERIAL AND METHODS: This retrospective study was conducted between July 2001 and March 2011. Acute phase CT-scan and MRI imaging in patients diagnosed with non-traumatic liver hematomas were interpreted with particular attention to the radio-semiotic characteristics of hematomas and liver lesions. Those findings were then confronted to the patients' final diagnoses. RESULTS: Twelve patients were included (mean age of 42 years). In seven of them a suspect liver lesion was discovered in the acute CT-Scan or MRI imaging. All lesions were strongly hyper vascular.The haemorrhage revealed hepatocarcinoma in four patients, liver adenoma in two and focal nodular hyperplasia in an other. CONCLUSION: It is important in spontaneous liver haemorrhage to consider the high probability of hepatocarcinoma or potentially malignant lesions even when the patient has no known hepatic disorders, and especially in young patients. The results of this study show that imaging is a key issue at the acute phase of inaugural non-traumatic hepatic haemorrhages and requires a simple but complete triphasic injected protocol.
    Diagnostic and interventional imaging. 01/2013;
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    ABSTRACT: To compare the densities of parathyroid adenomas, lymph nodes and the thyroid parenchyma during multi-phase cervico-thoracic computed tomography to determine the differentiating threshold values. This study comprises 30 patients operated for a parathyroid adenoma after computed tomography without injection and then 45 and 70 seconds after the injection of an iodine based contrast product (350 mgI/mL, 150 mL, 3 mL/s). The density of the adenomas, lymph nodes and thyroid was measured during the three phases (D0, D45, D70). The relative enhancement (RE) at 45 seconds was calculated: RE=(D45-D0)/D0. A significant difference was found in the spontaneous density of the parathyroid adenomas of the thyroid (P<0.01) with a threshold value of 75 HU. A significant difference is found in the enhancement after injection of the adenomas and lymph nodes (P<0.01). The adenomas present an enhancement peak at 45 seconds while the maximum enhancement of the lymph nodes is at 70 seconds. At 45 seconds, a threshold value of 114 HU and an RE 125% allows them to be distinguished (sensitivity and specificity 0.96). Measurement of the densities can differentiate between the parathyroid adenomas, lymph nodes and thyroid.
    Diagnostic and interventional imaging. 06/2012; 93(7-8):597-603.
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    ABSTRACT: Objectifs Comparer les densités des adénomes parathyroïdiens, des ganglions lymphatiques et du parenchyme thyroïdien, lors d’un scanner cervico-thoracique multiphasique pour déterminer les valeurs seuils permettant de les différencier. Patients et méthodes Il s’agit d’une étude portant sur 30 patients opérés d’un adénome parathyroïdien après un examen scanographique réalisé sans injection puis 45 et 70 secondes après injection d’un produit de contraste iodé (350 mgI/mL, 150 mL, 3 mL/s). La mesure de la densité des adénomes, des ganglions lymphatiques et de la thyroïde a été effectuée sur les trois phases (D0, D45, D70). Le rehaussement relatif (RR) à 45 secondes a été calculé : RR = (D45–D0)/D0. Résultats La densité spontanée des adénomes parathyroïdiens est significativement différente de la densité de la thyroïde (p < 0,01) avec une valeur seuil de 75 unités Hounsfield (UH). Le rehaussement après injection des adénomes et des ganglions est significativement différent (p < 0,01). Les adénomes présentent un pic de rehaussement à 45 secondes alors que le rehaussement maximum des ganglions est à 70 secondes. À 45 secondes, une valeur seuil de 114 UH et un RR 125 % permet de les différencier (sensibilité et spécificité 0,96). Conclusion La mesure des densités permet de différencier les adénomes parathyroïdiens, les ganglions lymphatiques et la thyroïde.
    Journal de Radiologie Diagnostique et Interventionnelle. 01/2012; 93(s 7–8):632–638.
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    ABSTRACT: Sorafenib increases median survival and time to radiological progression in patients with advanced hepatocellular carcinoma, but its benefit for Child-Pugh B patients remains uncertain. To evaluate the safety and efficacy of sorafenib in real-life clinical practice conditions and to assess the influence of Child-Pugh class B on safety and efficacy. All patients treated with sorafenib for advanced hepatocellular carcinoma in our institution were included prospectively. Adverse events, overall survival and time to progression were recorded. A case control study was performed to compare outcome of patients with comparable stages of hepatocellular carcinoma, but a different Child-Pugh class. From March 2007 to May 2009, 120 patients were included. Overall survival was 11.1 months, Child-Pugh A patients (n=100) had significantly higher median survival than Child-Pugh B patients (n=20) (13 vs. 4.5 months, P=0.0008). In multivariate analysis, Child-Pugh class B, α-fetoprotein level and total size of lesions were independent predictive factors of death. Patients with radiological progression in the first 3 months had shorter median survival (5.4 vs. 17.4 months). In a case control study, time to symptomatic progression (2.5 vs. 3.6 months), frequency of adverse events and discontinuation of sorafenib were not correlated with Child-Pugh class. Patients with advanced hepatocellular carcinoma treated with sorafenib had a median survival of 11 months. Sorafenib therapy must be considered with caution in Child-Pugh B patients due to their poor survival. Radiological assessment of tumour progression at an early stage may be advantageous when tailoring sorafenib therapy.
    Alimentary Pharmacology & Therapeutics 09/2011; 34(10):1193-201. · 4.55 Impact Factor
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    ABSTRACT: Serous cystadenoma is a common benign neoplasm that can be managed without surgery in asymptomatic patients provided that the diagnosis is certain. We describe a patient, whose pancreatic cyst exhibited a radiological appearance distinct from that of typical serous cystadenoma, resulting in diagnostic difficulties. CT and MRI showed a 10 cm-polycystic tumor with upstream dilatation of the main pancreatic duct (MPD), suggestive of intraductal papillary mucinous tumor (IPMT). Ultrasonographic aspect and EUS-guided fine-needle aspiration gave arguments for serous cystadenoma. ERCP showed a communication between cysts and the dilated MPD, compatible with IPMT. The patient underwent left pancreatectomy with splenectomy. Pathological examination concluded in a serous cystadenoma, with only a ductal obstruction causing proximal dilatation.
    HPB Surgery 01/2011; 2011:574378.
  • Gastroenterology 01/2011; 140(5). · 12.82 Impact Factor
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    ABSTRACT: Operative excision of abdominal extra-adrenal paragangliomas (EAPs) does not preclude the late development of local-regional recurrence. We describe the incidence, characteristics, and outcome of this rarely reported feature. Retrospective analysis of local-regional recurrence that occurred during follow-up of 51 consecutive patients operated for a sporadic (n = 26) or hereditary (n = 25) EAP. Seven patients with a sporadic or syndromic EAP (n = 4: von Hippel-Lindau syndrome and SDHB, SDHC, and SDHD gene mutations) underwent reoperation for a local-regional recurrence after a median time of 46 months (interquartile range [IQR], 16-100). The Kaplan-Meier estimated incidence of local-regional recurrence (+/- standard error of the mean) reached 15% +/- 7% at 5 years and 23% +/- 9% after 10 years. Recurrent EAPs were all secreting and 38% provoked clinical symptoms. New lesions were smaller than the primary EAP (P = .01) and more often associated with lymph node metastases (43% vs 4%, P = .01). Operative excision seemed complete in 5 patients. Clinical remission was maintained in 4 patients after a median follow-up of 57 months (IQR, 22-102). Local-regional recurrence of sporadic and syndromic EAPs is frequent and may be delayed beyond 10 years, requiring lifelong follow-up after the initial operation. When technically feasible, operative excision can lead to prolonged remission.
    Surgery 12/2009; 146(6):986-92. · 3.37 Impact Factor
  • Gastroentérologie Clinique et Biologique 06/2009; 33(6-7):502-3. · 1.14 Impact Factor
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    ABSTRACT: Tumor necrosis factor is an adipocytokine possessing a well-established lipolytic effect. In Crohn's disease (CD) patients, infliximab therapy may thus result in visceral fat accumulation, which is associated with an increased risk of metabolic syndrome. A total of 132 CD patients were investigated. In a first prospective study, magnetic resonance imaging (MRI) quantification of subcutaneous and visceral abdominal fat was performed before and 8 weeks after initiation of infliximab induction therapy (5 mg/kg at weeks 0, 2, and 6) in 21 responding patients treated for perianal disease. In a second prospective study, fasting glycemia, glycated hemoglobin (HbA1c), HDL, LDL, and total cholesterol and triglyceride levels were assessed in 111 responding patients receiving infliximab infusions every 8 weeks, with a mean follow-up of 41 weeks. A significant homogeneous 18% increase in total abdominal fat was observed in the 21 CD patients after infliximab induction therapy (P = 0.027), independently of body mass index evolution. Infliximab maintenance therapy was associated with a decrease in glycemia (P < 0.0001) and HbA1c (P = 0.0005) concentrations, together with an increase in both total cholesterol (P = 0.02) and HDL cholesterol (P = 0.008) concentrations. All glycemic and lipid parameters remained within the normal range throughout the study. Infliximab induction therapy is associated with a significant increase in abdominal fat tissue in CD patients. Infliximab maintenance therapy has no deleterious effects on lipid profile and is accompanied by a decrease in glycemia and HbA1c concentrations, probably by reversing the impairment of tumor necrosis factor-induced insulin-mediated glucose uptake.
    Inflammatory Bowel Diseases 03/2009; 15(10):1476-84. · 5.12 Impact Factor
  • Gastroenterologie Clinique Et Biologique - GASTROEN CLIN BIOL. 01/2009; 33(3).
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    O. Ernst
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    ABSTRACT: 3-Phase contrast material enhanced CT provides great sensitivity for accurate localization of hyperfunctioning parathyroid glands. Density measurements can assist in differentiating adenomas from lymph nodes and normal thyroid tissue. The spontaneous attenuation of parathyroid adenomas is lower than 80 HU, whereas the density of normal thyroid tissue is above 80 HU. Forty five seconds after contrast injection, adenomas have a density >130 HU, whereas lymph nodes have a density 20UH) whereas the attenuation of lymph nodes increases.
    Journal De Radiologie - J RADIOL. 01/2009; 90(3):409-411.

Publication Stats

1k Citations
187.77 Total Impact Points

Institutions

  • 2005–2013
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 1997–2013
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
    • Centre Hospitalier Universitaire de Nice
      Nice, Provence-Alpes-Côte d'Azur, France
  • 2006
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 1998–2002
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 1999
    • University Hospital Estaing of Clermont-Ferrand
      Clermont, Auvergne, France