Jean-François Deux

University of Paris-Est, La Haye-Descartes, Centre, France

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Publications (72)222.76 Total impact

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    ABSTRACT: The acute chest syndrome (ACS) is the main cause of mortality among adult patients with sickle cell disease (SCD). Its pathophysiology is still unclear. Using positron emission tomography (PET) with F-fluorodeoxyglucose [18F-fluorodeoxyglucose (F-FDG)], we explored the relationship between regional lung density and lung metabolism, as a reflection of lung neutrophilic infiltration during ACS.Patients were prospectively enrolled in a single-center study. Dual modality chest PET/computed tomography (CT) scans were performed, with F-FDG emission scans for quantification of regional F-FDG uptake and CT scans with radiocontrast agent to check for pulmonary artery thrombosis. Regional lung F-FDG uptake was quantified in ACS patients and in SCD patients without ACS (SCD non-ACS controls). Maximal (SUVmax) and mean (SUVmean) standardized uptake values were computed.Seventeen patients with ACS (mean age 28.3 ± 6.4 years) were included. None died nor required invasive mechanical ventilation. The main lung opacity on CT scans was lower lobe consolidation. Lungs of patients with ACS exhibited higher SUVmax than those of SCD non-ACS controls (2.5 [2.1-2.9] vs 0.8 [0.6-1.0]; P < 0.0001). Regional SUVmax and SUVmean was higher in lower than in upper lobes of ACS patients (P < 0.001) with a significant correlation between lung density and SUVmax (R = 0.78). SUVmean was higher in upper lobes of ACS patients than in lungs of SCD non-ACS controls (P < 0.001). Patients with SUVmax >2.5 had longer intensive care unit (ICU) stay than others (7 [6-11] vs 4 [3-6] days; P = 0.016).Lungs of patients with ACS exhibited higher F-FDG uptake than SCD non-ACS controls. Lung apices had normal aeration and lower F-FDG uptake than lung bases, but higher F-FDG uptake than lungs of SCD non-ACS controls. Patients with higher lung F-FDG uptake had longer ICU stay than others.
    Medicine 05/2015; 94(18):e821. DOI:10.1097/MD.0000000000000821 · 4.87 Impact Factor
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    ABSTRACT: To evaluate both in vivo and in phantom studies, dose reduction, and image quality of body CT reconstructed with model-based iterative reconstruction (MBIR), performed during patient follow-ups for lymphoma. This study included 40 patients (mean age 49 years) with lymphoma. All underwent reduced-dose CT during follow-up, reconstructed using MBIR or 50 % advanced statistical iterative reconstruction (ASIR). All had previously undergone a standard dose CT with filtered back projection (FBP) reconstruction. The volume CT dose index (CTDIvol), the density measures in liver, spleen, fat, air, and muscle, and the image quality (noise and signal to noise ratio, SNR) (ANOVA) observed using standard or reduced-dose CT were compared both in patients and a phantom study (Catphan 600) (Kruskal Wallis). The CTDIvol was decreased on reduced-dose body CT (4.06 mGy vs. 15.64 mGy p < 0.0001). SNR was higher in reduced-dose CT reconstructed with MBIR than in 50 % ASIR or than standard dose CT with FBP (patients, p ≤ 0.01; phantoms, p = 0.003). Low contrast detectability and spatial resolution in phantoms were not altered on MBIR-reconstructed CT (p ≥ 0.11). Reduced-dose CT with MBIR reconstruction can decrease radiation dose delivered to patients with lymphoma, while keeping an image quality similar to that obtained on standard-dose CT. • In lymphoma patients, CT dose reduction is a major concern. • Reduced-dose body CT provides a fourfold radiation dose reduction. • Optimized CT reconstruction techniques (MBIR) can maintain image quality.
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    ABSTRACT: To evaluate myocardial enhancement of patients with cardiac amyloidosis (CA) using computed tomography (CT). Thirteen patients with CA and 11 control patients were examined with first-pass and delayed CT acquisition. A qualitative and quantitative analysis of images was performed. Myocardial attenuation, myocardial signal-to-noise ratio (SNRmyoc), blood pool SNR (SNRblood), contrast-to-noise ratio between blood pool and myocardium (CNRblood-myoc) and relative attenuation index (RAI) defined as variation of myocardial attenuation between delayed and first-pass acquisitions were calculated. Two false negative cases (15 %) and three false positive cases (27 %) were detected on qualitative analysis. SNRmyoc of patients with CA was significantly (p < 0.05) lower on first-pass (4.08 ± 1.9) and higher on delayed acquisition (7.10 ± 2.7) than control patients (6.1 ± 2.2 and 5.03 ± 1.8, respectively). Myocardial attenuation was higher in CA (121 ± 39 HU) than control patients (81 ± 17 HU) on delayed acquisition. CNRblood-myoc was significantly (p < 0.05) lower in CA (1.51 ± 0.7) than control patients (2.85 ± 1.2) on delayed acquisition. The RAI was significantly (p < 0.05) higher in CA (0.12 ± 0.25) than in control patients (-0.56 ± 0.21). Dual phase MDCT can detect abnormal myocardial enhancement in patients with CA. • CT can detect abnormal first-pass and delayed enhancement in cardiac amyloidosis. • Measurement of relative myocardial enhancement between acquisitions helps to detect cardiac amyloidosis. • CT may provide useful data to diagnose cardiac amyloidosis.
    European Radiology 02/2015; DOI:10.1007/s00330-015-3642-2 · 4.34 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2015; 7(1):27-28. DOI:10.1016/S1878-6480(15)71566-1
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    ABSTRACT: Abstract Background: Most of the studies that described cardiac amyloidosis using cardiac magnetic resonance (CMR) imaging refer to patients with primary light chain (AL) amyloidosis. The goal of this study was to evaluate cardiac involvement in patients with hereditary transthyretin associated (ATTR) amyloidosis and asymptomatic carriers and its relationships with clinical symptoms and genotype, using CMR imaging. Methods and results: Fifty-three patients with hereditary ATTR amyloidosis and 14 asymptomatic carriers were included in this study. Morphological, functional and late gadolinium enhancement (LGE) findings were noted on CMR images. A positive LGE suggesting cardiac amyloidosis was detected in 60% of patients. The pattern of LGE was diffuse, focal and circumferential in 32, 26 and 2% of patients, respectively. The inferior basal segment was the most frequently involved (93%) in case of focal involvement. Diffuse pattern was exclusively encountered in patients with cardiac symptoms. Nineteen percent of patients with isolated neurological symptoms and 20% of subjects without left ventricular wall thickening exhibited cardiac abnormalities on CMR. Conclusion: Cardiac involvement can be detected in patients with hereditary ATTR amyloidosis with isolated neurological symptoms and without left ventricular wall thickening, suggesting that CMR could be useful in detecting preclinical cardiac amyloidosis.
    Amyloid 09/2014; 21(4):1-10. DOI:10.3109/13506129.2014.956924 · 2.51 Impact Factor
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    ABSTRACT: The mechanisms of myocardial depression during sepsis are not fully understood. Two patients with severe sepsis exhibited acute heart failure with decreased left ventricle ejection fraction (LVEF ≤ 40 %) on transesophageal echocardiography and increased troponin levels (seven and ten times the normal range). Cardiac magnetic resonance imaging (MRI) showed wall motion abnormalities with decreased contractility (LVEF of 24 and 40 %, respectively), normal or moderately increased size (left ventricle end diastolic volume, LVEDV of 58 and 88 mL/m2, respectively), a homogenous myocardial enhancement, and a normal viability of all myocardial segments with no evidence of myocarditis [Fig. 1/Video 1 in ESM (first patient) and Video 2 in ESM (second patient)]. Under treatment, hemodynamic failure resolved within a few days in both patients and myocardial dysfunction and dilatation had completely reversed on a control transthoracic echocardiography. Control cardiac MRI performed 6 weeks after the ...
    Intensive Care Medicine 08/2014; 40(11). DOI:10.1007/s00134-014-3428-z · 5.54 Impact Factor
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    ABSTRACT: Aims: We evaluated the safety and feasibility of an intracardiac echocardiography probe through the oesophageal route (ICE-TEE) for the monitoring of left atrial appendage (LAA) closure to avoid general anaesthesia. Methods and results: The study included 16 consecutive patients (75±7 years) in atrial fibrillation with high embolism (CHADS-VASc=5±1.4) and bleeding risk (HAS-BLED=4±0.9) referred for LAA closure (Amplatzer Cardiac Plug [ACP]). Standard TEE was performed before device implantation for LAA analysis. During the procedure, ICE-TEE was used under local anaesthesia to determine LAA size and monitor ACP positioning. Maximum and minimum LAA diameter by standard TEE averaged 21±3 mm and 18±1 mm, respectively. Eccentricity index (1.1±0.2) increased with LAA diameter (r=0.73, p=0.001). Maximum LAA size (21±3 mm) obtained by ICE-TEE during the procedure closely correlated with standard TEE measurement (r=0.9, p<0.0001). LAA closure was successfully performed in 15 patients without complication (one failed despite testing three ACP). Implanted ACP size averaged 25±3 mm (range 22-30 mm) and correlated with the size predicted by ICE-TEE (r=0.89) and standard TEE (r=0.57). Procedure duration (62±27 min) correlated with LAA size by ICE-TEE (r=0.71, p=0.002) and eccentricity index (r=0.58, p=0.02). Conclusions: An ICE-TEE probe through the oesophageal route without general anaesthesia may be used for the monitoring of ACP device implantation.
  • Circulation 06/2014; 129(24):2576-7. DOI:10.1161/CIRCULATIONAHA.114.009330 · 14.95 Impact Factor
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    ABSTRACT: PurposeTo determine if intra-voxel incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters, including free molecular-based (D) and perfusion-related (D*, f) diffusion parameters, correlate with the degree of tumor necrosis and viable tumor in colo-rectal cancer (CRC) metastasis. Materials and Methods Fifteen patients referred for resection of liver metastases from CRC were retrospectively included in this Institutional Review Board approved study. An IVIM-DWI sequence was performed on a 1.5 Tesla MR imaging system, with 10 b factors (0, 10, 20, 30, 50, 80, 100, 200, 400 and 800 s/mm(2)). Mean D, D*, f and apparent diffusion coefficient (ADC) values were determined in metastases with a longest diameter above 10 mm. Correlations between the diffusion parameters and the degree of liver tumor necrosis and viable tissue were determined (Spearman). ResultsCorrelation between diffusion parameters and histopathological findings was performed in 35 hepatic metastases with a diameter of more than 10 mm (mean size of 17.9 mm; range, 1-68 mm). Both D (r=0.36; P=0.035) and ADC (r=0.4; P=0.02) correlated with the degree of tumor necrosis but not with viable tumor. ConclusionADC variation observed in CRC metastases following systemic chemotherapy reflects a specific increase in free-molecular diffusion (D), in itself correlated to the degree of metastasis necrosis. J. Magn. Reson. Imaging 2014;39:317-325. (c) 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 02/2014; 39(2). DOI:10.1002/jmri.24172 · 2.79 Impact Factor
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    ABSTRACT: To evaluate the feasibility of image fusion (IF) of preprocedural arterial-phase computed tomography with intraprocedural fluoroscopy for roadmapping in endovascular repair of complex aortic aneurysms, and to compare this approach versus current roadmapping methods (ie, two-dimensional [2D] and three-dimensional [3D] angiography). Thirty-seven consecutive patients with complex aortic aneurysms treated with endovascular techniques were retrospectively reviewed; these included aneurysms of digestive and/or renal arteries and pararenal and juxtarenal aortic aneurysms. All interventions were performed with the same angiographic system. According to the availability of different roadmapping software, patients were successively placed into three intraprocedural image guidance groups: (i) 2D angiography (n = 9), (ii) 3D rotational angiography (n = 14), and (iii) IF (n = 14). X-ray exposure (dose-area product [DAP]), injected contrast medium volume, and procedure time were recorded. Patient characteristics were similar among groups, with no statistically significant differences (P ≥ .05). There was no statistical difference in endograft deployment success between groups (2D angiography, eight of nine patients [89%]; 3D angiography and IF, 14 of 14 patients each [100%]). The IF group showed significant reduction (P < .0001) in injected contrast medium volume versus other groups (2D, 235 mL ± 145; 3D, 225 mL ± 119; IF, 65 mL ± 28). Mean DAP values showed no significant difference between groups (2D, 1,188 Gy·cm(2) ± 1,067; 3D, 984 Gy·cm(2) ± 581; IF, 655 Gy·cm(2) ± 457; P = .18); nor did procedure times (2D, 233 min ± 123; 3D, 181 min ± 53; IF, 189 min ± 60; P = .59). The use of IF-based roadmapping is a feasible technique for endovascular complex aneurysm repair associated with significant reduction of injected contrast agent volume and similar x-ray exposure and procedure time.
    Journal of vascular and interventional radiology: JVIR 09/2013; DOI:10.1016/j.jvir.2013.07.016 · 2.15 Impact Factor
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    ABSTRACT: Abstract Background: Familial amyloid polyneuropathy (FAP) mainly targets the peripheral nervous system and heart. Early noninvasive detection of cardiac impairment is critical for therapeutic management. Aim: To assess if amino-terminal pro-brain natriuretic peptide (NT-proBNP) or troponin T (cTnT) can predict echocardiographic left-ventricle (LV) impairment in FAP. Methods: Thirty-six asymptomatic carriers and patients with FAP had echocardiographic measurement of left-ventricular (LV) systolic function, hypertrophy (LVH) and estimation of filling pressure (FP). Results: Overall, median age, NT-proBNP, and LV ejection fraction were, respectively, 59 years (41-74), 323 pg/ml (58-1960), and 60% (51-66). Twelve patients had increased cTnT. Prevalence of ATTR gene mutations was 53% for Val30Met. Four individuals were asymptomatic, 6 patients had isolated neurological clinical signs, and 26 had echo-LV abnormalities. The ROC curve identified NT-proBNP patients with echo-LV abnormalities (area: 0.92; (0.83-0.99), p = 0.001) at a threshold >82 pg/ml with a sensitivity of 92%, and a specificity of 90%. Increased in NT-proBNP occurred in patients with SD and/or LVH with or without increase in FP. Elevated cTnT (>0.01ng/ml) was only observed in patients with LVH and systolic dysfunction, with or without FP. Conclusion: In FAP, NT-proBNP was associated with cardiac impairment suggesting that NT-proBNP could be used in carriers or in FAP patients with only neurologic symptoms for identifying the appropriate time to start cardiac echocardiographic assessment and follow-up. cTnT identified patients with severe cardiac disease.
    Amyloid: the international journal of experimental and clinical investigation: the official journal of the International Society of Amyloidosis 08/2013; DOI:10.3109/13506129.2013.825240 · 2.51 Impact Factor
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    ABSTRACT: The lung computed tomography (CT) features of acute chest syndrome (ACS) in sickle cell disease patients is not well described, and the diagnostic performance of bedside chest radiograph (CR) has not been tested. Our objectives were to describe CT features of ACS and evaluate the reproducibility and diagnostic performance of bedside CR. We screened 127 consecutive patients during 166 ACS episodes and 145 CT scans (in 118 consecutive patients) were included in the study. Among the 145 CT scans, 139 (96%) exhibited a new pulmonary opacity and 84 (58%) exhibited at least one complete lung segment consolidation. Consolidations were predominant as compared with ground-glass opacities and atelectasis. Lung parenchyma was increasingly consolidated from apex to base; the right and left inferior lobes were almost always involved in patients with a new complete lung segment consolidation on CT scan (98% and 95% of cases, respectively). Patients with a new complete lung segment consolidation on CT scan had a more severe presentation and course as compared with others. The sensitivity of bedside CR for the diagnosis of ACS using CT as a reference was good (>85%), whereas the specificity was weak (<60%). ACS more frequently presented on CT as a consolidation pattern, predominating in lung bases. The reproducibility and diagnostic capacity of bedside CR were far from perfect. These findings may help improve the bedside imaging diagnosis of ACS.
    Thorax 08/2013; 69(2). DOI:10.1136/thoraxjnl-2013-203775 · 8.56 Impact Factor
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    ABSTRACT: Purpose:To evaluate the performance of a low-b-value diffusion-weighted (DW) echo-planar (EP) imaging sequence for detection of regional and diffuse myocardial edema in patients with acute myocarditis.Materials and Methods:This study was approved by the institutional review board, and informed consent was obtained from all subjects. Thirteen patients with acute myocarditis and a control group of seven healthy adults underwent low-b-value (50 sec/mm(2)) DW cardiac magnetic resonance imaging. DW EP images were acquired in the four-chamber long-axis section and analyzed qualitatively and quantitatively. Short inversion time inversion-recovery (STIR) T2-weighted and late gadolinium chelate enhancement images were acquired in the same plane and analyzed. Late gadolinium chelate enhancement was used as the reference standard. Statistical analyses were performed with a receiver operating characteristic analysis and a nonparametric Wilcoxon test.Results:Qualitative analysis showed myocardial high-signal-intensity areas in 100% (13 of 13) of patients on DW EP, 38% (five of 13) on STIR T2-weighted, and 100% (13 of 13) on late gadolinium chelate enhancement images. In eight patients (61%), high-signal-intensity areas were exhibited on DW EP images that were not detected on STIR T2-weighted images, but were colocalized with lesions detected on late gadolinium chelate enhancement images. Similar results were obtained by using an automatic analysis with dedicated cardiac software. The global myocardial signal intensity ratio was significantly higher (P = .03) in patients than in controls for DW EP (2.2 ± 0.4 [standard deviation] vs 1.1 ± 0.4, respectively), and exhibited no significant difference (P = .14) for STIR T2-weighted (1.7 ± 0.6 vs 1.4 ± 0.1, respectively) images. Sensitivity and diagnostic accuracy were higher for DW EP images than for STIR T2-weighted images (92% vs 54%, and 95% vs 70%, respectively), and specificity was the same (100% vs 100%).Conclusion:A low-b-value DW EP imaging sequence is a feasible alternative to the standard STIR T2-weighted sequence for detection of regional and global myocardium edema in patients with acute myocarditis.© RSNA, 2013Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121811/-/DC1.
    Radiology 05/2013; DOI:10.1148/radiol.13121811 · 6.21 Impact Factor
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    ABSTRACT: Senile systemic amyloidosis (SSA) is characterized by infiltration of amyloid transthyretin fibrils in the myocardium. SSA occurs mainly (but not always) in elderly men. SSA leads to hypertrophic and/or restrictive cardiomyopathy complicated by conduction disturbances, atrial arrhythmia and systemic embolization (stroke…). That is why SSA needs a special care and to be diagnosed. Cardiac SSA diagnosis needs to exclude two other forms of cardiac amyloidosis: AL amyloidosis (light chain) and hereditary transthyretin amyloidosis (genetic testing). Scintigraphic 99mTc-DPD heart retention is observed in cardiac amyloidosis. DPD heart retention is more frequent in cardiac transthyretin amyloidosis than in cardiac AL amyloidosis. Specific treatments of cardiac TTR amyloidosis are in development.
    La Presse Médicale 05/2013; 42(6). DOI:10.1016/j.lpm.2013.03.004 · 1.17 Impact Factor
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    ABSTRACT: OBJECTIVE: To identify clinical and electrical factors predicting delayed high degree atrio-ventricular block (AVB) after transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI is a new technique for treating severe aortic valve stenosis in patients at high surgical risk but can be followed by high grade AVB requiring permanent pacing. METHODS AND RESULTS: The study included 79 patients (82±17 years, Euroscore=23±10 %) free of permanent pacing need before and immediately after TAVI procedure. Delayed high degree AVB was defined by type 2 or 3 AVB diagnosed at least 24 hours after the index procedure. Permanent pace maker implantation was performed for all these patients. We compared clinical and electrical variables before and after TAVI in patients with delayed AVB or not. TAVI was performed successfully in all patients. The 21 (26%) patients who exhibited delayed high grade AVB had significantly deeper prosthesis implantation (12±4 mm vs. 9±5 mm, P=0.03) and wider post-TAVI QRS duration (155±17 ms vs. 131±25 ms, P=0.0004), with no difference in baseline QRS duration. Post-TAVI QRS duration was the only independent predictor of post-TAVI permanent for delayed high degree AVB (P=0.02). After a mean follow-up of 10±8 months, all 21 patients with post-TAVI QRS ≤128 ms were free of high-grade AVB, while 21/55 (38%) patients with post-TAVI QRS >128 ms had permanent pacing (P=0.0016). CONCLUSION: Delayed ( 24 hours after the procedure) high-grade AVB necessitating permanent pacing is common after TAVI. QRS duration measured immediately after TAVI was the best independent predictor of permanent pacing in this population. Patients with QRS ≤128 ms immediately after TAVI had no risk of requiring permanent pacing. © 2012 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 04/2013; 81(5). DOI:10.1002/ccd.24657 · 2.40 Impact Factor
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    ABSTRACT: To evaluate the feasibility of pre-procedural arterial phase computed tomography image fusion with intra-procedural fluoroscopy (or Image fusion: IF) road-mapping in endovascular repair of thoraco-abdominal aortic aneurysm (EVRTAAA) compared to current road-mapping methods (2D and 3D angiographies) in terms of x-ray exposure, injected contrast volume, and procedure time.Materials and Methods Single-institution prospective study (Internal institute approved), on 37 patients, informed written consent provided, and treated for EVRTAAA. All interventions were performed on the same angiographic system. Patients were consecutively placed in three groups in a seven-month period: “2D angiography” (2DA) (9 patients), “3D rotational angiography” (3DA) (14 patients), and “image fusion” (IF) (14 patients). Injected contrast volume, x-ray exposure (dose-area-product: DAP), and procedure time were recorded. To compare the groups in terms of the above measures and general patient characteristics, statistical tests using Fisher’s Exact, Kruskal-Wallis, and Mann-Whitney were performed.ResultsPatient characteristics and stenting types were similar between all three groups with no statistically significant differences (p-value>0.05). The IF group showed significant reduction (p-value<0.0001) in injected contrast volume compared to the other groups (2DA: 235±145ml; 3DA: 225±119ml; IF: 65±28ml). Although not statistically significant (p-value=0.18), DAP showed a trend in reduction for the IF group (2DA: 1188±1067Gyxcm2; 3DA: 984±581Gyxcm2; IF: 655±457Gyxcm2). There was no statistical difference (p-value=0.59) in procedure time between groups (2DA: 233±123minutes; 3DA: 181±53minutes; IF: 189±60minutes).Conclusion Image fusion road-mapping for EVRTAAA is feasible, and is associated to a statistically significant reduction in contrast volume and a trend towards DAP reduction while maintaining similar procedure time.
    Journal of Vascular and Interventional Radiology 04/2013; 24(4):S108-S109. DOI:10.1016/j.jvir.2013.01.266 · 2.15 Impact Factor
  • Archives of Cardiovascular Diseases Supplements 01/2013; 5(1):24-25. DOI:10.1016/S1878-6480(13)71004-8
  • Bo Xiang, Jean-Francois Deux, Alain Rahmouni, Nikos Paragios
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    ABSTRACT: This paper proposes a novel framework for image segmentation through a unified model-based and pixel-driven integrated graphical model. Prior knowledge is expressed through the deformation of a discrete model that consists of decomposing the shape of interest into a set of higher order cliques (triplets). Such decomposition allows the introduction of region-driven image statistics as well as pose-invariant (i.e. translation, rotation and scale) constraints whose accumulation introduces global deformation constraints on the model. Regional triangles are associated with pixels labeling which aims to create consistency between the model and the image space. The proposed formulation is pose-invariant, can integrate regional statistics in a natural and efficient manner while being able to produce solutions unobserved during training. The challenging problem of tagged cardiac MR image segmentation is used to demonstrate the performance potentials of the method.
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    ABSTRACT: Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p <0.001), male gender (OR 1.5, p <0.002), diabetes (OR 1.5, p <0.0001), and age (OR 1.2, p <0.0001). In conclusion, in this large multicenter study, CTCA identified significant CAD with high sensitivity. However, in routine clinical practice, each patient should be individually evaluated, and the pretest probability of obstructive CAD should be taken into account when deciding which method, CTCA or CA, to use to diagnose its presence and severity.
    The American journal of cardiology 12/2012; 111(4). DOI:10.1016/j.amjcard.2012.10.029 · 3.43 Impact Factor
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    ABSTRACT: Understanding the levator ani complex architecture is of major clinical relevance. The aim of this study was to determine the feasibility of magnetic resonance (MR) fiber tractography with diffusion tensor imaging (DTI) as a tool for the three-dimensional (3D) representation of normal subdivisions of the levator ani. Ten young nulliparous female volunteers underwent DTI at 1.5 T MR imaging. Diffusion-weighted axial sequence of the pelvic floor was performed with additional T2-weighted multiplanar sequences for anatomical reference. Fiber tractography for visualization of each Terminologia Anatomica-listed major levator ani subdivision was performed. Numeric muscular fibers extracted after tractography were judged as accurate when localized within the boundaries of the muscle, and inaccurate when projecting out of the boundaries of the muscle. From the fiber tracking of each subdivision the number of numeric fibers (inaccurate and accurate) and a score (from 3 to 0) of the adequacy of the 3D representation were calculated. All but two volunteers completed the protocol. The mean number of accurate fibers was 17 ± 2 for the pubovisceralis, 14 ± 6 for the puborectalis and 1 ± 1 for the iliococcygeus. The quality of the 3D representation was judged as good (score = 2) for the pubovisceralis and puborectalis, and inaccurate (score = 0) for the iliococcygeus. Our study is the first step to a 3D visualization of the three major levator ani subdivisions, which could help to better understand their in vivo functional anatomy.
    Journal of Anatomy 07/2012; 221(3):221-8. DOI:10.1111/j.1469-7580.2012.01538.x · 2.23 Impact Factor

Publication Stats

552 Citations
222.76 Total Impact Points

Institutions

  • 2011–2014
    • University of Paris-Est
      La Haye-Descartes, Centre, France
  • 2009–2014
    • Université Paris-Est Créteil Val de Marne - Université Paris 12
      Créteil, Île-de-France, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2005–2014
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Service d’Imagerie Médicale
      Créteil, Île-de-France, France
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2009–2013
    • Hôpital Albert Chenevier – Hôpitaux Universitaires Henri Mondor
      Créteil, Île-de-France, France
  • 2009–2011
    • Assistance Publique – Hôpitaux de Paris
      • Department of Radiology
      Lutetia Parisorum, Île-de-France, France
  • 2008
    • Université Paris 13 Nord
      Île-de-France, France