L’objectif principal est de décrire les modalités de prise en charge des patients hypertendus en fonction de leur sexe et de leur niveau de risque cardiovasculaire calculé selon l’HAS 2005 et en particulier l’attitude thérapeutique retenue
au décours de la consultation et le traitement prescrit.
L’objectif principal est de décrire les modalités de prise en charge des patients hypertendus en fonction de leur sexe et de leur niveau de risque cardiovasculaire calculé selon l’HAS 2005 et en particulier l’attitude thérapeutique retenue
au décours de la consultation et le traitement prescrit.
Heart Failure in Haiti (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Heart Failure in Haiti (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
PARTICULARITÉS DE LA SCLÉROTHÉRAPIE CHEZ LE PATIENT SOUS ANTICOAGULANTNessie Productions
•Sclérothérapie chez les patients sous anticoagulants possible, sûre et même préférable à la chirurgie dans de nombreuses circonstances
•mais attention car sujets souvent fragiles, âgés, à comorbidités
•Balance bénéfice/risque à réévaluer au cas par cas
•Possible diminution de l’efficacité de la sclérothérapie si anticoagulants à doses « efficaces »
•Néanmoins traitement sclérosant initial : mêmes doses (augmenter secondairement avec prudence)
Heart Failure in Haiti (French) Symposia - The CRUDEM FoundationThe CRUDEM Foundation
Heart Failure in Haiti (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
PARTICULARITÉS DE LA SCLÉROTHÉRAPIE CHEZ LE PATIENT SOUS ANTICOAGULANTNessie Productions
•Sclérothérapie chez les patients sous anticoagulants possible, sûre et même préférable à la chirurgie dans de nombreuses circonstances
•mais attention car sujets souvent fragiles, âgés, à comorbidités
•Balance bénéfice/risque à réévaluer au cas par cas
•Possible diminution de l’efficacité de la sclérothérapie si anticoagulants à doses « efficaces »
•Néanmoins traitement sclérosant initial : mêmes doses (augmenter secondairement avec prudence)
Common: 200 000 TC/an, 12 000 death
Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury
CT: first-line of imaging
MR imaging being recommended in specific settings
MR imaging DTI, blood oxygen level–dependent fMRI, MR spectroscopy, perfusion imaging are of particular interest in identifying further injury CT and MRI are normal, as well as for prognostication in patients with persistent symptoms
However, it is an invasive procedure that is not straightforward to perform so is often reserved as a problem-solving tool when both the aortic root and valve are the prime source of interest.
This document provides information to help diagnose cervical masses. It discusses the location, onset, and elements that help determine diagnosis, such as anatomy, structure, clinical data and imaging findings. Common pathologies included cysts, solid lesions, infections and tumors. Dermoid cysts, ranulas, branchial cleft cysts, lipomas and lymphangiomas are described as typical cystic lesions. Lymphomas, schwannomas and metastases are examples of solid lesions discussed. Imaging like CT scans and MRI can help characterize lesions and rule out other conditions.
The document discusses Horner syndrome, which is caused by a lesion along the ipsilateral oculosympathetic pathway. It describes the three-neuron pathway and the clinical signs caused by disruption at different points along the pathway, including ptosis, miosis, and anhidrosis on the affected side of the face. Common causes of Horner syndrome include trauma, tumors, carotid dissection, lung cancer, and neuroblastoma in children. Imaging workup may include MRI of the brain, neck, and chest to localize the lesion causing the syndrome depending on whether it is a first, second, or third-order lesion.
This document provides guidance on avoiding errors in uterine imaging through proper technique and interpretation. It emphasizes using ultrasound first for clinical symptoms, then MRI if the diagnosis is unknown or for pre-treatment planning of uterine fibroids or carcinoma of the cervix or endometrium. Key factors for accurate assessment of cervical and endometrial cancers include using motion-corrected T2 sequences, diffusion-weighted imaging, and dynamic contrast-enhanced MRI to evaluate lesion size, myometrial invasion, and lymph node involvement. Following standardized protocols and being aware of limitations and pitfalls can help optimize uterine imaging.
1) Thoracic biopsies and ablations often have complications that can be avoided by following lessons learned from past errors and cases.
2) Three case examples are described where complications such as pneumothorax, hemorrhage, and nerve damage occurred but were managed by applying techniques like choosing shorter needle paths, coagulating bleeding with ablation, and preventing direct contact with nearby structures.
3) Overall the document emphasizes knowing anatomy, being cautious with new devices or patients with other health factors, and applying preventative measures to avoid life-threatening complications during thoracic procedures.
This document discusses non-contrast MR lymphography for evaluating the lymphatic system. It can be used to diagnose lymphedema through detecting fluid collections, infiltration patterns, and dermal thickening. It also describes evaluating lymph node metastasis, lymphangiomas, and other lymphatic abnormalities and complications. MR lymphography is non-invasive and can uniquely image lymphatic anatomy while having limitations in spatial resolution. It provides diagnosis and localization of various lymphatic diseases and postoperative conditions.
1) Arterial spin labeling (ASL) is an MRI technique that allows non-invasive measurement of cerebral blood flow without using an exogenous contrast agent. It works by magnetically labeling arterial blood water protons upstream of the imaging region.
2) There are different ASL techniques including continuous, pulsed, and pseudo-continuous ASL. Image processing is needed to generate perfusion maps from labeled and control image pairs.
3) ASL has applications in neurology for assessing cerebral perfusion in conditions such as dementia. It is also used for functional MRI to localize brain activity with improved spatial precision compared to BOLD imaging.
The document discusses the use of MRI in diagnosing dementia. It recommends performing an MRI scan in all newly diagnosed cases of dementia to rule out other causes and search for evidence of primary degenerative dementia. The standard MRI protocol includes 3D T1, axial FLAIR, coronal T2, axial T2*, and axial diffusion sequences. The diagnostic approach involves assessing for atrophy patterns characteristic of different dementias, as well as white matter abnormalities, hemorrhages, and perfusion changes. Quantification of hippocampal atrophy and global atrophy progression over time can aid diagnosis. Multimodal imaging such as PET-MRI may provide further insights in the future.
This document discusses advanced imaging techniques for pancreatic lesions. It begins by introducing new concepts in pancreatic imaging including downstaging of adenocarcinoma and prognostic stratification of neuroendocrine tumors. It then describes the multi-parametric MR protocol used, highlighting the added value of different sequences for detecting and characterizing lesions. Advanced techniques such as texture analysis of downstaged tumors on CT and 3D texture analysis of neuroendocrine neoplasms are also mentioned. The document emphasizes that imaging is becoming more quantitative and able to provide prognostic information beyond simple detection and characterization of lesions.
This document summarizes current approaches to diagnosing small hepatocellular carcinoma (HCC) in patients with liver cirrhosis. It discusses that cirrhosis is associated with an increased risk of HCC due to factors like hepatitis B, C, alcohol, and non-alcoholic fatty liver disease. Guidelines recommend ultrasound surveillance every 6 months for HCC detection in cirrhotic patients. While ultrasound has reasonable sensitivity, specificity is improved when combined with tumor markers or additional imaging modalities. The document reviews vascular changes, imaging features, and protocols for CT, MRI, and contrast agents that optimize detection of small HCCs in this high-risk population.
Stereotactic body radiotherapy (SBRT) delivers high doses of radiation to liver lesions while sparing surrounding tissues. For hepatocellular carcinoma (HCC), SBRT results in local control rates of 87% at 1 year and median overall survival of 17 months. For liver metastases, SBRT achieves complete and partial response rates of 60-80% and median progression-free survival of 15.1 months. Response is evaluated using multiparametric MRI and RECIST/mRECIST criteria. Persistent enhancement after SBRT may indicate fibrosis rather than tumor in some cases. SBRT is a feasible, low toxicity treatment option for selected liver lesions.
The document discusses gadolinium retention in brain and other tissues following administration of gadolinium-based contrast agents for MRI. It provides evidence from several studies that small amounts of gadolinium can be retained in brain regions like the dentate nucleus and globus pallidus. Linear agents appear to result in higher retention than macrocyclic agents. While the long-term risks are unknown, no evidence currently suggests harm. European regulators have suspended approval for intravenous linear agents except two. The document emphasizes using contrast only when essential diagnostic information cannot be obtained without.
More from JFIM - Journées Francophones d'Imagerie Médicale (20)
Jean Yves Gauvrit, gadolinium retention in the brain or other tissues jfim if...
Ph douek coronary arteries ct indications jfim hanoi 2015
1. Coronary Arteries Computed Tomography Indications
Philippe DOUEK
Service d’imagerie diagnostique et thérapeutique
Hôpital Louis Pradel
Lyon
JFIM, HANOI, October 2015
2. Indications:
§ Coronary artery diseases:
ü Detection of CAD in
ü Asymptomatic patients
ü Symptomatic patients
ü By pass graft control
ü Stents control
ü Assessment of anomalies of coronary arterial and other
thoracic arteriovenous vessels
§ Cardiac diseases; evaluation of cardiac sructures and function
ü Heart failure
ü Electrophysiological procedure
ü Cardiac anatomy:
ü Congénital heart diseases
ü Tumor
ü TAVI
5. Place de l’imagerie non invasive
quand la probabilité pré test (PTP) est comprise entre 15-85%
• “Non-invasive, imaging-based diagnostic methods for CAD
have typical sensitivities and specificities of approximately
85%. Hence, 15% of all diagnostic results will be false…”
• « This is the reason why this Task Force recommends no
testing in patients with (i) a low PTP <15% and (ii) a high
PTP >85%. In such patients, it is safe to assume that they have
(i) no obstructive CAD or (ii) obstructive CAD »
Montalescot G et al. European Heart Journal (2013) 34, 2949–
3003
7. Prédiction du Risque CV:
Pléthore de facteurs de
risque Besoins de marqueurs
intégrateurs ?
Estimation du
Risque
Age
Sexe
Tabac*
LDLc*
HDLc
Diabete sd metab*
HTA*
Atcd fam
Tour de taille*
Sommation ou équation multivariée
Evenement CV à 10 ans:
Risque faible : < 10%
Risque modéré : 10-20%
Risque fort : > 20%
Risque majeur : >30%
8. Cardiovascular Risk Assessment
• Limitations of clinical risk score in 50 % of patients:
– Lack of
• tabacco exposure duration
• Db duration,
• cholesterol increased duration
• Traditional risk factors does not explain high risk in
sub group of patients, mainly in intermediate CV risk
9. Prédiction du Risque CV: Recalage des Estimations par
Examens Complémentaires
Besoins de marqueurs
intégrateurs ?
Estimation du
Risque
ECG basal
Epreuve effort
EIMc
dysfonction endothéliale
VOP
IPS
Score calcique
10. Calcium Score:Agatston Score*
• Quantification of lésions, density, surface of coronary calcifications-> 130 UH, automatic
segmentation of surface >1mm2 with density weighted factor :
– 1 if 130 HU<CTij Max<200 HU,
– 2 si 200 HU<CTij Max<300 HU,
– 3 si 300HU<CTij Max<400 HU,
– 4 si 400HU<CTij Max
*Agatston AS, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll
Cardiol1990;15:827
11. NRI: taux (%) de reclassification dans la catégorie à
risque intermédiaire du score de framingham
Kavousis M et al Ann Int Med 2012
è
13. CAC and Cardiovascular Risk:
Reclassification of intermediate risk
• 0: Very low risk
• 1 -10: low risk
• 11-100 : intermediate risk
• 101 – 400 : intermediate risk
• > 400 : high risk
14. Asymptomatic Patient
• Calcium scoring*
– Appropriate if intermediate risk A(7)
– Appropriate if low risk and Family history of
premature CHD A(7)
• CTA**
– Inapropriate
• but, U(4) in high risk patient
• U(6) in heart transplant patient
*Greenland P et al. Circulation 2007
Oudkerk et al. Int J Cardiovasc Imaging 2008
**The Confirm study :Eur Heart J Cardiovasc Imaging. 2014 May;15(5):586-94.
15. CAC
• 63 years old patient follow up with family
hyperlipemia élévation Lp(a) and
métabolique Sd
• Treadmill test neg ( 2008)
• CAC: 404
• conséquences :
• information about risk
• Treatment intensified: ezetrol LDL
objective1,2 g/l à 0,9 g/l
• Introduction of aspirine primary
prevention
16. CAC
• 65 years old women , untreated HFh statines
intolerance, questran no !
• High LDL 3,5 3,8 g/l HDLc 0,45 g/l.
• EIMc 0,80 mm
Results : Agatson score: 0
Conséquences :
• No aspirine introduction in primary prevention
• No LDL aphéreses
17. The CONFIRM Study
– Estimation du risque de « MACE » après détection de
maladie coronaire (CAD) par Scanner chez des patients non
coronariens connus (n > 15 000 pts; 595 évènements)
– Risque Relatif (Hazard Ratio) CAD / no CAD
• CAD non sténosante 2.43 (p<0.001)
• Sténose obstructive 11.21 (p<0.001)
• 1 vaisseau atteint; 9.15,
• 2 vx; 15,
• 3 vx ou TC; 24.53 (tous p < 0.001)
– Les profils de risque augmentent avec l’âge
Eur Heart J Cardiovasc Imaging. 2014 May;15(5):586-94.
18. • Meta analyse 9592 patients, suivit 20mois
Pas d'événements pour un coroscan normal
19.
20. From: The Napkin-Ring Sign: CT Signature of High-Risk Coronary Plaques?
J Am Coll Cardiol Img. 2010;3(4):440-444. doi:10.1016/j.jcmg.2010.02.003
Figure Legend:
21. Eur Heart J Cardiovasc Imaging. 2014 March;15(3):332-40.
• 543 patients avec EE négative et CT scanner
• Sur le scanner on relevait les sténoses (>50%) et les
signes de vulnérabilité de plaque
– Remodelage positif du vaisseau
– Ring Like sign
– Plaque hypodense
• Analyse des évènements cardiaques à 3.4 ans
– 1.2% MACE par an
– 87% des accidents surviennent chez des patients avec au
moins un des facteurs de vulnérabilité
• 3.2% / an (pts vulnérables) vs 0.8% /an (sans signe de
vulnérabilité)
23. Detection of CAD in Symptomatic Patients
Without Known Heart Disease
• ECG ininterprétable / exercice impossible
– Low risk A(7)
– intermédiate risk A(8)
– High Risk U(4)
24. CT vs Test d’Effort (Angor Stable)
• Analyse du devenir des patients à 1 an évalués par épreuve d’effort (EE)
ou scanner cardiaque (CT)
– 500 patients non coronariens connus
– 245 pts dans le groupe EE, 243 dans le groupe CT
• Questionnaire de Seattle (SAQ):
– Meilleure qualité de vie/stabilité de l’angor dans le groupe CT
– Plus de maladies coronaires significatives et de revascularisations dans le
groupe CT
– Plus d’études non concluantes dans le groupe EE et plus d’examens prescrits
– Pas de différence en termes de MACE, mais plus de réhospitalisations dans
le groupe EE
• Conclusion: le CT est un examen initial plus performant que
l’EE pour la prise en charge d’un patient avec angor stable
McKavanagh P et al. A comparison of cardiac computerized tomography and exercise stress
electrocardiogram test for the investigation of stable chest pain: the clinical
results of the CAPP randomized prospective trial. Eur Heart J Cardiovasc Imaging. 2014 Dec 3
25. Detection of CAD in Acute Symptomatic
Patients Without Known Heart Disease
26. CK- MB or Troponin Troponin elevated or not
ACS without persistent
ST-segment elevation
ACS with persistent
ST-segment elevation
27. Douleur thoracique
Le Syndrome Coronarien Aigu
RULE OUT
• 50% des SCA: ECG normal
• 8% de SCA: ECG et Tropo normaux
• Parmi les 30 à 40% des étiquetés non cardiaques: 3 à
4% d’évènements cardiaques à 1 mois
• Mortalité x 2 pour une SCA manqué
28. CCTA For safe discharge in possible ACS
Ø 1300
pa'ents
SCA
ECG-‐,
tropo-‐,
TIMI
0
à2
Ø Randomisa'on
2CTA/1PEC
classique
Ø Durée
de
séjour
plus
courte
dans
le
groupe
CTA
(moi'é
si
test
néga'f).
Ø Plus
de
pa'ents
posi'fs
à
la
coro
dans
le
groupe
CTA.
Ø Pas
de
différences
d’évènements
à
30
jours:
Décès
CV
et
Infarctus
du
myocarde.
The new engl and jour nal o f medicine
original article
ngiography for Safe Discharge of Pa
th Possible Acute Coronary Syndrom
d I. Litt, M.D., Ph.D., Constantine Gatsonis, Ph.D., Brad Snyde
it Singh, M.D., Chadwick D. Miller, M.D., Daniel W. Entrikin, M
M. Leaming, M.D., Laurence J. Gavin, M.D., Charissa B. Pacell
and Judd E. Hollander, M.D.
29. Homme
45
ans
pas
de
facteurs
de
risque
CV
Douleur
thoracique
ECG
BBG
30.
31. • Patient jeune ECG sub normal, troponine augmentée,
pas de FRCV
• Scanner coronaire + RT
35. Symptomatic—Pretest Probability of CAD
• 1 Normal ECG and cardiac biomarkers Low or
intermediate pretest probability of CAD: A (7)
• 2 ECG uninterpretable Low and intermediate pretest
probability of CAD: A (7)
• 3 Nondiagnostic ECG or equivocal cardiac biomarkers
Low or intermediate pretest probability of CAD: A (7)
36. Indications
§ Coronary artery diseases
ü Detection of CAD in
ü (A) symptomatic patients
ü With(out) known CAD
ü Preoperative Coronary Assessment Prior to
Noncoronary Cardiac Surgery
ü Use of CTA in the Setting of Prior Test Results
ü By pass graft control
ü Stents control
ü Assessment of anomalies of coronary arterial and other
thoracic arteriovenous vessels
42. Indications
§ Coronary artery diseases
ü Detection of CAD in
ü (A) symptomatic patients
ü With(out) known CAD
ü Preoperative Coronary Assessment Prior to
Noncoronary Cardiac Surgery
ü Use of CTA in the Setting of Prior Test Results
ü By pass graft control
ü Stents control
ü Assessment of anomalies of coronary arterial and other
thoracic arteriovenous vessels
43. After revascularisation : Stent,
• Symptomatic
– Stent > 3mm U(6)
– Stent < 3mm I(3)
• Asymptomatic
– Stent >3mm A(7)
– Stent < ou > 3mm I(2) to U(4)
Van Mieghem CA– Circulation 2006;114:645
45. Indications
§ Coronary artery diseases
ü Detection of CAD in
ü (A) symptomatic patients
ü With(out) known CAD
ü Preoperative Coronary Assessment Prior to
Noncoronary Cardiac Surgery
ü Use of CTA in the Setting of Prior Test Results
ü By pass graft control
ü Stents control
ü Assessment of anomalies of coronary arterial and other
thoracic arteriovenous vessels
47. Situations Cliniques Particulières
• Insuffisance cardiaque
– FE diminuée:
• A(7) si risque bas ou intermédiaire
• U si risque élevé
– FE préservée: U
– Bilan Pré-opératoire: IA IM
48.
49. Conclusions: Recommendations AHA 2011 ESC2014
• CT of coronary arteries :
– Calcium scoring : Screening and prevention
– CTA : intermediate pre test probability of CAD:
• large indications in competition with treadmill test,or functional imaging
test