[Alveolar echinococcosis of the liver. Mass ultrasound screening in the Haut Cantal area]. / Echinococcose alvéolaire hépatique. Dépistage échographique de masse dans le haut cantal.

OBJECTIVE: Mass systematic screening for alveolar echinococcosis (AE) of the liver in the Haut Cantal endemic area. MATERIAL AND METHODS: Targeted population was composed of the members of the Mutualité Sociale Agricole of the area, from 16 to 65 years old. 2077 notifications were sent, corresponding to 20% of the population of this area, defined by a triangle between Egliseneuve d'Entraigues, Riom ès Montagne and Saint Flour. Two screening tests were performed: Elisa serology test and liver ultrasound examination. RESULTS: Participation levels were relatively low-ultrasound: 18.92%, serology: 17%. Among 350 liver examinations, 2 suspicions of AE were found: CT and serology confirmed the diagnosis in the first symptomatic patient; CT and biopsy confirmed the diagnosis in the other asymptomatic patient in whom serology was normal. CONCLUSION: Ultrasound screening showed at least a 0.57% prevalence of AE, i.e., 2 cases out of 350. This low rate however confirms that Haut Cantal is an endemic area, but with a lower incidence rate than in other endemic areas.

[Prevalence and morphology of pineal cysts discovered at pituitary MRI: review of 1844 examinations]. / Prévalence et morphologie des kystes épiphysaires: à propos de 1844 IRM hypophysaires.

PURPOSE: To evaluate the frequency, morphology and clinical long term evolution of pineal cysts depicted on MRI. PATIENTS AND METHODS: one thousand eight hundred and forty four (1 532 women and 126 men) MRI examinations were retrospectively reviewed. Coronal and sagittal spin echo T1 weighted sequences without and with gadolinium injection were performed, completed with spin echo T2 weighted images when a cystic sellar lesion was suspected. A pineal cyst was diagnosed as a rounded well defined lesion, with fluid signal in an enlarged pineal gland. Follow-up examinations were performed to evaluate the efficacy of the treatment of the sellar lesion. RESULTS: Twenty one epiphyseal cysts (1.27%) were diagnosed in 20 women (1.31%) and one man (0.79%). Their size was 1,2 +/- 0,4 cm (0,3 to 2 cm). They were asymptomatic. In 10 patients, follow-up MRI examinations did not show any change in size. During the clinical follow-up, these twenty-one patients remained asymptomatic (6 months to 5 years). CONCLUSION: The incidental detection of a pineal cyst at MRI is not exceptional. This lesion's pattern appears characteristic and their reputation of benignity is confirmed in our study.

Infrapopliteal percutaneous transluminal angioplasty for limb salvage.

PURPOSE: To evaluate long-term results of infrapopliteal percutaneous transluminal angioplasty (PTA) for limb salvage. MATERIAL AND METHODS: A retrospective study of 71 consecutive infrapopliteal PTAs in 49 patients with rest pain (n = 20) or ulceration (n = 29) was conducted. In 18 patients, surgical minor amputation or debridment was also performed. RESULTS: Technical success was achieved in 45 patients. Four failures necessitated 2 amputations. One patient died in the postoperative course. Global morbidity rate was 16%, including minor complications in 5 patients and major vascular complications in 3 patients. After technical success during the follow-up (median duration 21 months), restenoses occurred in 4 patients, of whom 3 had a successful re-PTA (clinical success rate 72%). Survival, primary patency, secondary patency and limb salvage rates were, respectively, 75%, 81%, 88% and 87% after 3 years. The only positive predictive factor for primary patency was the presence of diabetes mellitus. CONCLUSION: Infrapopliteal PTA is a safe and effective procedure, allowing good patency and limb salvage rates with low mortality and morbidity.

Spiral CT quantification of aorto-renal calcification and its use in the detection of atheromatous renal artery stenosis: A study in 42 patients.

PURPOSE: To investigate whether a correlation exists between aortic and renal arterial calcifications detected with spiral CT and significant angiographic renal artery stenosis (RAS). METHODS: Forty-two patients (mean age 67 years, range 37-84 years), of whom 24 were hypertensive, prospectively underwent abdominal helical CT and aortic and renal arteriography. The 3-mm thickness CT scans (pitch = 1) were reconstructed each millimeter. A manual outline of the renal artery including its ostial portion was produced. Calcific hyperdensities were defined as areas of density more than 130 HU. CT data were compared with the presence or absence of RAS on angiography (24 cases); hypertension and age were taken into account (Mann-Whitney U-test). RESULTS: CT detection and quantification appeared to be reliable and reproducible. We did not find any correlation between aortic and renal arterial calcifications and RAS, even for the patients above 65 years, with or without hypertension. There was no correlation either between calcifications and hypertension in patients without RAS. CONCLUSION: In this population, aortic and renal arterial calcifications have no predictive value for RAS.

Visualisation of the portal flows by porto-scanner.

This study presents a retrospective analysis of 15 portal vein CT scans, conducted for the evaluation of hepatic metastasis in patients suffering from colorectal cancer, with the aim of verifying in vivo the presence of laminar flow as reported by Pironcof. After selective catheterization of the superior mesenteric artery, CT scans were performed during opacification of the portal vein. Different flows were identified by the incomplete opacification they induced in the portal vein. Splenic flows could always be identified, however right colic and superior mesenteric flows were only seen in 3 cases (20%) and gastrocolic flow in 2 (13.6%). Even though incremental (i.e. slower than helical) the CT acquisitions allowed the flows to be viewed by modifying the visualisation window. In vivo evidence of laminar flow is provided which supports Pironcof's experimental observations.

Endovascular Doppler guide wire in renal arteries. Correlation with angiography in 20 patients.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of endovascular Doppler recording in renal arteries and to compare the reliability of Doppler parameters for detection of renal artery stenosis. METHODS: The authors examined 36 renal arteries in 20 patients with a 0.018" endovascular flow wire. Peak systolic velocity and the renal artery-to-aortic peak were measured in the main renal artery. From intrarenal waveforms, acceleration, acceleration time, and the renal resistive index were obtained. Spectral analysis with consensus scoring of early systolic peak was also performed. RESULTS: Twelve significantly stenosed renal arteries and 26 normal renal arteries were examined with the Doppler guide wire, without complications. Peak systolic velocity was the only parameter significantly different in renal artery stenosis (P = 0.037). Peak systolic velocity also differed significantly between hypertensive and normotensive patients. Tardus parvus was specific for severe renal artery stenosis. CONCLUSIONS: Endovascular Doppler is a safe and accurate method for the determination of velocity measurements and may be useful during percutaneous renal artery revascularization.

Dynamic magnetic resonance imaging of the female pelvis: radio-anatomy and pathologic applications. Preliminary results.

Dynamic MRI of the pelvis was performed in 16 young nulliparous, normally continent women. The examinations were performed in the dorsal decubitus position. Using Turbo-Flash scans (acquisition time: 2.1 sec), sagittal images were obtained at rest and with maximal pelvic straining. The sacral promontory-subpubic (PSP) and the subpubic-subsacral axes (SPSS) measured respectively 80.5 degrees and 30 degrees in relation to the horizontal plane, without a statistically significant difference between rest and straining. A marked deformation of the posterior wall of the bladder was observed in 13 cases and the bladder neck was frontally deformed in 10 cases. With straining, the base of the bladder did not descend beyond 15 mm below the SPSS, and the cervix stayed at least 14 mm above the SPSS. These were established as the normal criteria for pelvic assessment. 20 multiparous patients (mean age 65 years), referred for urinary stress incontinence and/or prolapse, were investigated using the criteria previously established. The PSP, SPSS, and vaginal angle measured 80.95 degrees, 30.57 degrees, and 69.69 degrees respectively in relation to the horizontal. No statistically significant difference was detected between straining and rest conditions. The angle of the uterus in relation to the horizontal was 57.36 degrees at rest and 65.90 degrees in straining with a difference that was statistically significant. In six patients, the base of the bladder descended more than 1.5 cm while straining and in seven patients the cervix descended at least 1.4 cm below the SPSS while straining, both statistically significant differences. Overall, between our control and study populations, there were no significant differences between PSP and SPSS measured on straining and at rest. However, differences were detected in the vaginal angle, bladder-base position, and cervical position. These results suggest the potential substitution of MRI for colpocystography.

[Hepatocellular carcinoma in cirrhosis: semeiology and performance of magnetic resonance imaging and lipiodol computed tomography]. / Carcinome hépatocellulaire sur cirrhose: sémiologie et performances de l'imagerie par résonance magnétique et de la tomodensitométrie après artériographie lipiodolée.

OBJECTIVES: a) Describe hepatocellular semiology in magnetic resonance imaging and lipiodol computerized tomography in patients with cirrhosis, who are candidates for surgery; b) Clarify the respective roles of magnetic resonance imaging and lipiodol computerized tomography in hepatocellular detection. METHODS: Twenty four patients with suspected hepatocellular carcinoma underwent successive magnetic resonance imaging and lipiodol computerized tomography. Thirty-four of the 67 lesions seen by lipiodol computerized tomography and 28 of 52 lesions seen by magnetic resonance imaging were confirmed histologically. RESULTS: In lipiodol computerized tomography, 44% of hepatocellular carcinomas had a dense and homogeneous pattern; 24% had a homogeneous but slightly dense pattern. Sixteen distinct deposits were described: 4 were confirmed as hepatocellular carcinoma and 12 were not controlled histologically. In magnetic resonance imaging 57% of hepatocellular carcinomas have a high intensity on T1 and T2 weighted spin echo images, 38% were hyperintense on T2 and hypo or isointense on T1 weighted images. Eighty-six percent of hyperintense T1 and T2 weighted images were hepatocellular carcinoma. When the gold standard was histology, lipiodol computerized tomography sensitivity (81%) was higher than magnetic resonance imaging (68%). When the gold standard was lipiodol computerized tomography, the sensitivity of magnetic resonance imaging was 47 +/- 12%. CONCLUSIONS: a) The sensitivity of lipiodol computerized tomography was better than resonance magnetic imaging; b) the homogeneous and slightly dense pattern corresponded to a hepatocellular carcinoma in 50% of cases; c) on magnetic resonance imaging any lesions with high intensity on T1 and T2 spin echo images strongly suggests hepatocellular carcinoma; d) if surgical resection after ultrasonography is being considered, the second step should be an magnetic resonance imaging.

[Radio-anatomic study of the angle of origin of dysplastic renal arteries]. / Etude radio-anatomique de l'angle d'origine des artères rénales dysplasiques.

PURPOSE: To compare the angulation at the origin of dysplastic renal arteries compared to atherosclerotic renal arteries, in order to improve the technique for percutaneous transluminal angioplasty of FMD. MATERIALS AND METHODS: Retrospective analysis of 40 aortograms in patients who underwent renal angioplasty for dysplastic stenosis, with comparison with 45 control aortograms (with or without atherosclerotic lesions of the renal arteries). The angle of implantation of the renal arteries was measured relative to the aortic axis in the frontal plane, taking into account only the angulation of its proximal segment. We identified three types of kidneys with regard to their position relative to the renal artery ostium. RESULTS: The angle of implantation of dysplastic renal arteries is significantly sharper compared with the control group (63.8 degrees vs 80.9 degrees, p = 0.0001), irrespective of the side. The angulation did not correlate with the position of the kidney or the direction of the renal artery, suggesting a congenital origin. CONCLUSION: The angle of implantation of the dysplastic renal arteries relative to the aortic axis in the frontal plane is sharper than the angle measured in non dysplastic renal arteries.

[Regression of a focal nodular hyperplasia after stopping oral contraceptives]. / Régression d'une hyperplasie nodulaire focale après arrêt d'une contraception orale.

The complete regression of a focal nodular hyperplasia of the liver with typical MRI patterns 5 years after withdrawal of oral contraceptives was observed. Effects of oral contraceptives on this tumor's evolution and appropriate imaging by MRI are discussed.

Study of the inferior oblique muscle of the eye by MRI.

The utility of the inferior oblique m. radioanatomical study by a FLASH 3D sequence in magnetic resonance imaging (MRI). Twenty eyes (ten healthy volunteers aged 21-32 years, without any history of significant ocular pathology) were explored by MRI (1 Tesla; cranial coil) and comparisons were made between spin echo (SE) T1 sequence (through the neuro-ocular and coronal planes; thickness of slices = 3 mm) and a gradient echo FLASH 3D sequence (thickness of slices = 1 mm). This enabled a mm by mm reformation of the inferior oblique m through the frontal-oblique plane, made possible by new SE T1 sequences through the same plane. Position, height, and signal of the m. were estimated. The mean frontal angle formed by the muscle and the sagittal axis measured 29 degrees for the right eye and 27 degrees for the left eye. The muscle was always identifiable in the reformation despite its thin dimensions: 1.9 mm (1.5 - 2.8) on the right and 2 mm (1.7 - 2.5) on the left, in low signal silhouetted by the high signal of orbital fat. Thus, thanks to mm by mm reconstructions using FLASH 3D sequence, a good radioanatomic study of the inferior oblique m. by MRI is possible. This could be useful particularly for the strabismus of children.

[Angioplasty of renal artery stenoses before surgical treatment of subrenal abdominal aortic lesions]. / Angioplastie des sténoses de l'artère rénale avant traitement chirurgical de lésions aortiques abdominales sous-rénales.

PURPOSE: To evaluate the results of the association of a percutaneous transluminal renal angioplasty before a surgical revascularization of the infra-renal aorta. PATIENTS AND METHODS: Percutaneous transluminal angioplasty of one (n = 12) or two (n = 2) renal arteries have been performed in 14 patients (11 hypertensive and one with azotemia), 2 to 240 days (mean 54) before infra-renal aortic surgery (aneurysms: 8, occlusive disease: 6). RESULTS: 15 of the 16 dilatations were completely technically successful (residual stenosis less than 20%), with one groin hematoma treated medically. Mean duration of the surgical intervention were 137 minutes (occlusive disease) and 147 minutes (aneurysm). In the post-operative course were noted resolutive infections in two patients, and one death because of myocardial infarction. At the end of the follow-up (3 to 60 months, mean 32), all of the 13 patients alive had improved in terms of vascular disease. Hypertension was improved for 2 patients, stable for 10, worse for 1. Creatinine serum level was stable for 12 patients, and the renal insufficient was worsened. CONCLUSION: Combined percutaneous transluminal renal angioplasty and aortic revascularization seems to be reliable and safe; it can be an alternative to a simultaneous aortic and renal revascularization, notably for high-risk patients.

[Bilateral adrenal cysts and hepatorenal polycystic disease]. / Kystes surrénaliens bilatéraux et polykystose hépato-rénale.

BACKGROUND: Cyst formation may occur in many localization in patients with polycystic renal disease. Adrenal gland cysts have not previously been reported. CASE REPORT: Hepatorenal polycystic disease was diagnosed in a 38-year-old man who underwent abdominal ultrasound examination for acute back pain. Subsequent computed tomography evidenced several cysts in both adrenal glands. DISCUSSION: Incidental discovery of cysts in the adrenal glands accounts for 4 to 22% of all cyst formations in this organ. Four types of cysts are observed: parasite cysts, epithelial cysts and adenomas, pseudocysts, and endothelial cysts. Appropriate treatment depends on the size of the cyst, the etiology context, and clinical manifestations. Treatment is indicated in case of symptomatic disease or when the ultrasound or CT-scan aspect is atypical.

[Laryngo-tracheal involvement in chronic atrophic polychondritis. X-ray computed tomographic aspects]. / Atteinte laryngo-trachéale d'une polychondrite chronique atrophiante. Aspects tomodensitométriques.

CT patterns of a relapsing polychondritis affecting the laryngeal cartilages are reported in a 42-year-old man with a 10-year medical history of this disease, corresponding to an irregular enlargement of the cricoid, thyroid cartilages and tracheal rings, with a moderate endoluminal narrowing. CT is useful to differentiate this rare inflammatory disease from others causes of airway narrowing, and could help in certain cases of diagnosis of beginning polychondritis.

Cure of renovascular hypertension by percutaneous occlusion of a large idiopathic renal arteriovenous fistula. Case report.

Percutaneous balloon occlusion of a large hypertensive idiopathic renal arteriovenous fistula is reported. A lumbar thrill was noted in a 52-year-old hypertensive woman. Intravenous digital substraction angiography identified the lesion. After arteriographic assessment a percutaneous embolisation was performed with a releasable balloon positioned on a coaxial micro-catheter. Immediate post-procedural angiographic control demonstrated complete occlusion with a small segmental area of renal hypoperfusion. The lumbar thrill disappeared. Normalisation of the blood pressure was noted two days later and confirmed eight months later. Persistent occlusion of the fistula was angiographically confirmed, whereas the area of renal hypoperfusion had partially decreased. Releasable balloon percutaneous embolisation appears to be a safe alternative to surgery in the treatment of large renal arteriovenous fistulas.

[Hepatic hamartoma in adults. Apropos of a case documented by MRI]. / Hamartome hépatique de l'adulte. A propos d'un cas documenté par IRM.

A mixed hamartoma of the liver in a 39 year old man is reported. Abdominal ultrasound revealed a 4 cm inhomogeneous echogenic mass with acoustic shadowing. MRI T1 weighted images showed a inhomogeneous low intensity mass with lower gadolinium enhancement than normal liver, a moderate low signal intensity on proton density weighted images, and heterogeneous isosignal intensity on T2 weighted images. Peripheric calcifications were found on pathologic examination.

[Parietal calcifications of the kidney pelvis in Corynebacterium urealyticum urinary infection]. / Calcifications pariétales du bassinet lors d'une infection urinaire par Corynebacterium urealyticum.

Linear renal pelvis calcifications in a native kidney due to Corynebacterium urealyticum are described. These micro-organisms have an opportunistic behaviour and can be responsible for nosocomial urinary tract infection. Alkaline incrusted cystitis with linear vesical calcifications are considered as the most typical pattern. Renal pelvis may also be concerned, with parietal calcifications.

[Spontaneous remission of renal artery stenosis]. / Régression spontanée d'une sténose de l'artère rénale.

Retrogression of a renal artery stenosis after a six months follow-up is reported in a 43 years old woman who stopped smoking after the first angiography and was treated with antiplatelet, suggesting spontaneous atherosclerosis injury revision.

[Ultrasonography and tomodensitometry staging of kidney tumors: anatomo-radiologic correlations in 46 patients]. / Bilan d'extension TDM et IRM des tumeurs du rein: corrrélations anatomo-radiologiques chez 46 patients.

OBJECTIVE: To comparatively evaluate CT scan and MRI in the preoperative staging of renal tumours. METHODS: 46 patients with a solid renal tumour were investigated preoperatively by CT scan (n = 43) and MRI (n = 46), the results of which were compared with pathological data. RESULTS: MRI assessed capsular effraction with a sensitivity of 95.6% and a specificity of 52.1%, versus 95.2 and 40%, respectively, for CT scan. Three cases of perirenal extension were detected by MRI. The sensitivity of MRI was higher than that of CT scan for the demonstration of adenopathy (71.4% versus 57.1%) with specificities of 92.3 and 88.8%, respectively. Fourteen cases were associated with tumour extension into the proximal renal vein, which extended into the distal segment of this vein in 12 cases, into the inferior vena cava in 6 cases and as far as the right atrium in 2 cases. The performance of MRI was always better than that of CT scan in relation to venous segments of surgical interest (respective sensitivities of 70% and 83.33% in the distal renal vein and 66.6% and 83.33% in the inferior vena cava: and respective specificities of 84.8% and 97% in the distal renal vein and 91.8% and 97.5% in the inferior vena cava), provided the results of T1-weighted spin echo sequences and FLASH gradient echo sequences were assessed conjointly. CONCLUSION: These results lead us to now prefer MRI to CT scan for the preoperative staging of renal cancer, in the presence of a contraindication to iodinated contrast agent injection, very large tumours, and whenever venous extension is suspected on ultrasonography.