R Sigal

Institut de Cancérologie Gustave Roussy, Île-de-France, France

Are you R Sigal?

Claim your profile

Publications (106)161.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the feasibility of cine-MRI for non-invasive swallowing evaluation after surgery for lingual carcinoma with reconstruction using microvascular free flaps. Ten patients with stage IV carcinoma of the mobile tongue and/or tongue base treated by surgical resection and reconstruction with a free flap were evaluated after an average of 4.3 years (range: 1.5-11 years), using cine-MRI in "single-shot fast spin echo" (SSFSE) mode. Fiberoptic laryngoscopy of swallowing was performed before MRI to detect aspiration. The tolerance and ability to complete the exam were noted. The mobilities of the oral and pharyngeal structures visualized were evaluated as normal, reduced or increased. Cine-MRI was well tolerated in all cases; "dry" swallow was performed for the 2 patients with clinical aspiration. Tongue base-pharyngeal wall contact was observed in 5 cases. An increased anterior tongue recoil, increased mandibular recoil, increased posterior oropharyngeal wall advancement and an increased laryngeal elevation were observed in 4 cases. One case of a passive "slide" mechanism was observed. Cine-MRI is a safe, non-invasive technique for the evaluation of the mobility of oral and oropharyngeal structures after free-flap reconstruction of the tongue. For selected cases, it may be complementary to clinical examination for evaluation of dysphagia after surgery and free-flap reconstruction. Further technical advances will be necessary before cine-MRI can replace videofluoroscopy, however.
    European journal of radiology 01/2009; 73(1):108-13. · 2.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To prospectively determine the diagnostic accuracy of optical absorption imaging in patients with Breast Imaging Reporting and Data System (BI-RADS) 3-5 breast lesions. Forty-six patients with BI-RADS classification 3 (11%), 4 (44%) or 5 (44%) lesions, underwent a novel optical imaging examination using red light to illuminate the breast. Pressure was applied on the breast, and time-dependent curves of light absorption were recorded. Curves that consistently increased or decreased over time were classified as suspicious for malignancy. All patients underwent a core or surgical biopsy. Optical mammography showed a statistical difference in numbers of suspect pixels between benign (N=12) and malignant (N=35) lesions (respectively 1325 vs. 3170, P=0.002). In this population, optical imaging had a sensitivity of 74%, specificity of 92%, and diagnostic accuracy of 79%. The optical signal did not vary according to any other parameter including breast size or density, age, hormonal status or histological type of lesions. Optical imaging is a low-cost, non-invasive technique, yielding physiological information dependent on breast blood volume and oxygenation. It appears to have a good potential for discriminating benign from malignant lesions. Further studies are warranted to define its potential role in breast cancer imaging.
    European journal of radiology 10/2008; 69(1):43-9. · 2.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess and compare the performance of CT and 18F-FDG-PET/CT in the evaluation of peritoneal carcinomatosis (PC). Thirty consecutive patients with PC and scheduled for a surgery underwent a CT of the abdomen and pelvis and a whole-body 18F-FDG PET/CT. The extent of PC was assessed precisely using the peritoneal cancer index combining the distribution of tumor throughout 11 abdominopelvic regions with a lesion size score. CT and PET/CT imaging results were compared in all patients with intraoperative findings using an interclass correlation test. The presence of PC was correctly determined on CT and PET/CT in 23/28 and 16/28 patients, respectively. The extent of PC was understaged with CT and PET/CT in 27 patients and overstaged with CT and PET/CT in 1 and 2 patients, respectively. The interclass correlation was 0.53 (moderate) between CT and surgery and 0.12 (low) between PET/CT and surgery. The interclass correlation was higher for mucinous tumor (0.63) than for non-mucinous (0.16) on CT imaging whereas no difference was found in PET/CT. The intraperitoneal assessment of the extent of carcinomatosis, necessary to assess prognosis and treatment planning, is not accurate enough with CT and PET/CT imaging.
    Abdominal Imaging 01/2008; 33(1):87-93. · 1.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: L’imagerie mammaire connaît depuis quelques années de nouveaux développements. Ces nouvelles méthodes d’imagerie sont principalement orientées sur l’étude fonctionnelle des tumeurs et ont pour objectif d’améliorer la détection et la caractérisation des tumeurs, mais également de fournir de nouveaux critères pronostiques et de guider la thérapeutique des tumeurs mammaires. Une des études fonctionnelles la plus prometteuse que ce soit par ultrasons, par rayons X ou par IRM est l’étude de l’angiogenèse tumorale qui joue un rôle majeur dans le développement des tumeurs et leur potentialité à métastaser. Nous allons présenter dans cet article les principaux développements de l’imagerie fonctionnelle mammaire concernant toutes les méthodes d’imagerie que ce soit les rayons X, l’échographie, l’IRM et la médecine nucléaire. Après un bref rappel technique nous présenterons les premiers résultats cliniques ainsi que les perspectives de chacune de ces techniques. In recent years, breast imaging has benefited from a number of new advances. The resulting new imaging methods mainly focus on the functional examination of tumours and aim to improve tumour detection and characterization, provide new prognosis criteria, and guide the therapeutic management of breast cancer. One of the most promising functional assessments — whether performed through the use of ultrasound, X-rays or MRI — is the analysis of tumour angiogenesis, which plays a major role in tumour development and metastatic potential. In this article, we discuss the major developments in functional imaging of the breast, including imaging methods such as X-rays, ultrasound, MRI and nuclear medicine. After a brief technology overview, we present the early clinical results and prospects of each of the techniques.
    Oncologie 03/2007; 9(4):279-285. · 0.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Some radiological cases are presented in this article to train the reader to the BIRADS classification in mammography. Each case is described according to the fourth American version of the BIRADS lexicon. Some classifications difficulties will also be presented, in order to show the complexity and the observer variability, commonly encountered in BIRADS 3 and 4 categories.
    European Journal of Radiology 03/2007; 61(2):195-201. · 2.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Breast Imaging Report and Data System (BIRADS) of the American College of Radiology (ACR) is today largely used in most of the countries where breast cancer screening is implemented. It is a tool defined to reduce variability between radiologists when creating the reports in mammography, ultrasonography or MRI. Some changes in the last version of the BIRADStrade mark have been included to reduce the inaccuracy of some categories, especially for category 4. The BIRADStrade mark includes a lexicon and descriptive diagrams of the anomalies, recommendations for the mammographic report as well as councils and examples of mammographic cases. This review describes the mammographic items of the BIRADS classification with its more recent developments, while detailing the advantages and limits of this classification.
    European Journal of Radiology 03/2007; 61(2):192-4. · 2.51 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Retroperitoneal sarcomas are rare neoplasms. The aim of this article is to expose imaging protocols and useful radiological signs, to show the core biopsy technique for diagnosis, to precise imaging key points before treatment and for survey.
    Bulletin du cancer 01/2007; 93(12):1167-74. · 0.61 Impact Factor
  • Journal De Radiologie - J RADIOL. 01/2007; 88(10):1373-1373.
  • Journal De Radiologie - J RADIOL. 01/2007; 88(10):1317-1318.
  • Journal De Radiologie - J RADIOL. 01/2007; 88(10):1338-1338.
  • Journal De Radiologie - J RADIOL. 01/2007; 88(10):1383-1383.
  • Journal De Radiologie - J RADIOL. 01/2007; 88(10):1545-1545.
  • Oncologie. 01/2007; 9(4):279-285.
  • Journal De Radiologie - J RADIOL. 01/2007; 88(10):1412-1412.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the neurologic complications after hematopoietic progenitor cell transplantation (HPCT) in order to design rules for their management. We reviewed 361 consecutive patients over 6 years, including 245 autologous and 116 allogeneic HPCT recipients for hematologic malignancies (87%) and solid cancers (13%). Fifty-seven patients developed 65 symptomatic neurologic complications (16%), with a higher incidence in allogeneic than in autologous HPCT recipients (p = 0.01) and in chronic myelogenous leukemia (42%) than in Hodgkin disease (2.5%) (p < 0.001). CNS infections (4.2%) were the main complications, marked by an early onset (within the first 4 months) after HPCT (87%), diagnostic difficulties, and a high mortality rate (47%). They mainly included cerebral toxoplasmosis, fungal infections, and viral encephalitis. Their incidence was markedly higher in allogeneic than in autologous HPCT recipients (p = 0.002). However, two CD34(+) selected autologous HPCT recipients developed cerebral toxoplasmosis. Other CNS complications included recurrent tumors (3.6%), metabolic encephalopathies (2.8%), and cerebrovascular events (1.7%). Seizures occurred in 5% of patients, most often associated with cerebral lesions. Peripheral nervous system manifestations occurred in 3.3%. Twenty-one patients (5.8%) died directly of neurologic complications. The 4-year probability of survival was markedly lower in the case of neurologic events than in the absence thereof (12% vs 58%, p < 0.0001). Severe neurologic complications after hematopoietic progenitor cell transplantations are common, vary according to the underlying disease and type of transplantation, and are associated with poor survival rates. Better prophylactic protocols and therapy for CNS infections are required in future studies.
    Neurology 12/2006; 67(11):1990-7. · 8.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to assess the accuracy of contrast-enhanced digital mammography in the detection of breast carcinoma and to correlate the findings on the images with those of histologic analysis using microvessel quantification. Twenty patients with a suspicious breast abnormality underwent contrast-enhanced digital mammography using a full-field digital mammography unit that was modified to detect iodinated enhancement. For each patient, a total of six contrast-enhanced craniocaudal views were acquired from 30 seconds to 7 minutes after the injection of a bolus of 100 mL of an iodinated contrast agent. Image processing included a logarithmic subtraction and the analysis of enhancement kinetic curves. Contrast-enhanced digital mammography findings were compared with histologic analysis of surgical specimens, including intratumoral microvessel density quantification evaluated on CD34-immunostained histologic sections obtained from all patients. An area of enhancement was depicted on contrast-enhanced digital mammograms in 16 of the 20 histologically proven breast carcinomas. Excellent correlation was seen between the size of enhancement and the histologic size of tumors, which ranged from 9 to 22 mm. Early enhancement with washout was observed in four cases, early enhancement followed by a plateau in four cases, gradual enhancement in seven cases, and unexpected decrease of enhancement in one case. Intratumoral microvessel density ranged from 11.7 to 216.6 microvessels per square millimeter. A poor correlation was found between data measured on contrast-enhanced digital mammography and intratumoral microvessel density measured on CD34-immunostained histologic sections. Contrast-enhanced digital mammography is able to depict angiogenesis in breast carcinoma. Breast compression and projective images acquisition alter the quantitative assessment of enhancement parameters.
    American Journal of Roentgenology 12/2006; 187(5):W528-37. · 2.90 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate radiological response and findings after Intra Arterial Chemotherapy (IAC) for patients with Squamous Cell Carcinoma (SCC) of the oral cavity. Materials and methods: Patients received 1-2 cycles of IAC. Radiological assessment was performed on day 7 and day 21 after each cycle using CT scan and MRI. Six patients (median age: 52, ranging 46-60; male/female: 5/1) received 10 cycles (4 patients received 2 cycles). Primary tumors were floor of the mouth (4 patients) and oral tongue (2 patients). TNM classification was T2N0-2b in 3 patients and T4N0-1 in 3 patients. All patients had good locoregional/systemic tolerance and 3 showed clinical objective response (OR). Four patients were evaluable on both CT and MRI, 1 patient on MRI only and 1 patient did not tolerate imaging. Three patients showed OR both on CT and MRI, 1 patient showed stable disease (SD) on CT and OR on MRI and 1 patient showed SD on MRI. Contrast-enhancement of hemiperfused tongue was reported in all evaluable patients. Two patients presented intratumoral necrosis and 5 patients displayed local edema (MRI). One patient had modification of the sternocleidomastoid muscle after IAC. Radiological modifications were observed in the infused area and correlated well with clinical response. This study is ongoing.
    Journal of Neuroradiology 11/2006; 33(4):255-8. · 1.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the feasibility of and interest in evaluation of swallowing using dynamic magnetic resonance imaging (cine-MRI) in patients with dysphagia and aspiration caused by an abnormal pharyngeal phase of swallow. A cohort of six patients previously treated for head and neck cancer with persistent dysphagia and/or aspiration were evaluated an average of 47 months after treatment. The morphology and mobility of the oral, oropharyngeal, and laryngeal structures were analyzed using cine-MRI using single-shot fast spin echo technology. The qualitative observations were compared with a clinical fiberoptic swallowing evaluation. Swallowing physiology was analyzable for dry (saliva) swallow in all patients. MRI was well-tolerated by all six patients and no clinical aspiration occurred during the MRI. In five of six cases, further information on the cause of dysphagia was obtained using cine-MRI compared with the clinical evaluation alone. In the remaining case, cine-MRI confirmed the clinical evaluation. Cine-MRI using the dry swallow technique is feasible and without risk in patients with clinical aspiration. Cine-MRI is complementary to clinical evaluation of swallowing in patients with an abnormal pharyngeal phase of swallowing resulting from treatment of cancer.
    Dysphagia 08/2006; 21(3):156-62. · 1.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with adrenocortical cancer are submitted to multiple imaging procedures for diagnosis of recurrence and staging. The aim of this prospective study was to evaluate the diagnostic and prognostic values of fluorodeoxyglucose (FDG) using a combined positron emission tomography and computed tomography (PET/CT) modality, compared with thoracoabdominopelvic computed tomography (TAP-CT). Twenty-eight consecutive patients with adrenocortical cancer referred from November 2003 to December 2004 to the Institut Gustave Roussy were included. Mean time between PET/CT and TAP-CT was 16 d. Independent readers analyzed images of each modality. The gold standard was progression on follow-up TAP-CT or pathology. A total of 269 lesions in 57 organs were depicted in 22 patients. The sensitivities for the detection of distinct lesions and the diagnosis of metastatic organs were 90 and 93% for PET/CT and 88 and 82% for TAP-CT, respectively. Twelve percent of the lesions were seen on PET/CT only and 10% on TAP-CT only. Eighteen percent of the metastatic organs were diagnosed with PET/CT only and 7% with TAP-CT only. Thirty-eight percent of the local relapses were seen only with PET/CT. PET/CT depicted three false-positive lesions. Treatment modalities were modified by PET/CT findings in five cases among which one was falsely positive. Tumor size and mitotic rate were significantly associated with FDG uptake. The intensity of FDG uptake (maximum standardized uptake value > 10) and the volume of FDG uptake (>150 ml) were significant prognostic factors for survival. We show that FDG-PET/CT is complementary to TAP-CT and of special interest in the diagnosis of local relapses.
    Journal of Clinical Endocrinology &amp Metabolism 04/2006; 91(3):920-5. · 6.43 Impact Factor
  • Journal De Radiologie - J RADIOL. 01/2006; 87(10):1270-1270.

Publication Stats

916 Citations
161.31 Total Impact Points

Institutions

  • 1991–2009
    • Institut de Cancérologie Gustave Roussy
      • • Department of Radiotherapy
      • • Department of Medical Imaging
      Île-de-France, France
  • 2003
    • McGill University
      • Department of Radiology
      Montréal, Quebec, Canada
  • 1990
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 1989
    • Hôpital Bicêtre (Hôpitaux Universitaires Paris-Sud)
      Lutetia Parisorum, Île-de-France, France