Evaluation by electron beam computed tomography of intracardiac masses suspected by transoesophageal echocardiography.

OBJECTIVES: To assess the suitability of electron beam computed tomography (EBT) in evaluating and subsequently managing cardiac masses suspected as a result of examination by transthoracic and transoesophageal cross sectional echocardiography. DESIGN AND PATIENTS: In 76 consecutive patients with suspected cardiac masses, the impact of the EBT examination was analysed by reviewing whether EBT examination altered management by confirming or excluding a mass, whether EBT imaging substantially contributed to decision-making, and lastly whether EBT influenced the decision to operate on the patient. RESULTS: EBT modified the diagnosis or confirmed results which had been questionable with cross sectional echocardiography in 53 cases (70%): these cases included those with anatomical features such as dense calcifications or fatty structures (n = 20), lipomatous lesions (n = 5), equivocal thrombi (n = 5), pericardial masses (n = 5), or hydatid cysts (n = 2). EBT gave information over and above cross sectional echocardiography in all patients with malignant tumours (n = 16) by providing a better delineation of the relation between intracavity masses and normal structures, including the mural site of tumour attachment and tumour extension to the great vessels and the adjacent extracardiac mediastinal structures. EBT provided no additional information over cross sectional echocardiography in the remaining patients (n = 23), particularly in those with myxomas (n = 11) or small valvar lesions (n = 6). EBT only confirmed that the lesion was well demarcated, limited in extent, or not associated with a mass. CONCLUSIONS: EBT has considerable potential for clinical management and surgical planning and may help clinicians to decide against surgery, particularly in patients with unresectable tumours.

[Contribution of the electron beam scanner (Imatron) in aortic pathology]. / Apport du scanner à faisceau d'électrons (Imatron) en pathologie aortique.

Electron Beam CT (SFE, Imatron) uses electron beam to generate X rays. This allows the shortest acquisition time today available (50-100 ms). It is the best CT examination for moving structures. In vascular disease arterial wall study is the most important end point, especially in aortic pathology. EBCT is effective in aortic aneurysm, dissection and aortitis diagnosis. It allows a pre-surgical mapping of the lesion and follow-up. We believe that EBCT is superior to other diagnostic mean in the assessment of the ascending aorta and of small arterial lesions.

[Isolated stenosing calcified lesions of the aorta]. / Les bourgeons calcifiés sténosants isolés de l'aorte.

Two cases of isolated calcified lesions of the aorta are reported. The first observation is that of a 25 years old man suffering from mild intermittent claudication predominant in the left leg. Radiological examination showed a calcified isolated lesion of the infra renal abdominal aorta. The patient underwent surgical treatment (thromboendarteriectomy) and was asymptomatic after 6 months. The second observation concerns a 30 years old man treated for benign thrombocytemia in whom a severe arterial hypertension associated with a thoracic bruit was discovered incidentally. Radiological workup demonstrated a solitary calcified lesion of the descending thoracic aorta. Endarteriectomy was performed and the patient was still asymtomatic at 12 months. A review of the literature as well as physiopathological hypothesis and diagnostic and therapeutic management of these uncommon lesions is proposed.

[Contribution of imaging in the diagnosis and follow-up of thoracic tuberculosis]. / Apport de l'imagerie dans le diagnostic et le suivi de la tuberculose thoracique.

Imaging as an essential tool for diagnosis and follow-up of pulmonary tuberculosis. Standard radiography is of prime importance, while in a large number of cases computed tomography (CT) and in selected exceptional cases with spinal involvement, magnetic resonance imaging (MRI) offer further precisions. CT is particularly important for diagnosis because of a better spatial visualization of the lesions and a better evaluation of their structure, both in the parenchyma and in the mediastinum; this indication is especially important in black Africans and in AIDS patients. CT can also be used to guide biopsies. It is particularly important for prognosis in the acute phase even though the tuberculosis may be patent and the bacterial strain identified. There is however still room for discussion on the balance between requirements, usefulness and cost. Finally CT is an excellent means of conducting long-term follow-up of sequellae as long as it is performed at least one year after the initial manifestations of the disease.

[Imaging of thoracic tuberculosis]. / Imagerie de la tuberculose thoracique.

This paper reviews the various radiological signs of tuberculosis including cavities and nodules, alveolar foci, hilar or mediastinal lymphadenopathy and serosal, bronchial and vertebral involvement. It describes the various clinical features and the clinical course of tuberculosis depending on the presence or absence of these signs and their combinations and according to the particular clinical context.

Idiopathic renal arteriovenous fistula: treatment with embolization.

We report a case of idiopathic renal arteriovenous fistula revealed by microscopic hematuria in a 36-year-old man with no predisposing history. Treatment with selective embolization achieved complete resolution with no parenchymal damage.

Endomyocardial fibrosis: electron-beam CT features.

PURPOSE: To present morphologic and functional electron-beam computed tomographic (CT) features of endomyocardial fibrosis. MATERIALS AND METHODS: Twelve patients with histologic evidence of endomyocardial fibrosis and/or definitive echocardiographic and angiocardiographic findings were examined with electron-beam CT. RESULTS: Endomyocardial fibrosis was depicted as linear calcifications and/or a thin tissue band of low attenuation within the endomyocardium. In right ventricular involvement, CT depicted obliteration of the apex associated with extension along the free wall and/or papillary muscles of the tricuspid valve. In left ventricular involvement, a large amount of endocardial tissue led to severe obliteration within the inflow tract and/or of the apex. At ventricular volume analysis, restrictive patterns of the disease were determined. CONCLUSION: Electron-beam CT allows direct visualization of endomyocardial fibrosis and the resulting volumetric changes and enables distinction of the disease from constrictive pericarditis.

Hepatic metastases: detection with multisection FLASH MR imaging during gadolinium chelate-enhanced arterial portography.

PURPOSE: To determine the feasibility and sensitivity of multisection fast low-angle shot (FLASH) magnetic resonance (MR) imaging in the depiction of hepatic metastases. MATERIALS AND METHODS: The cases of 10 patients with 39 surgically proved hepatic metastases were prospectively evaluated. After unenhanced T1- and T2-weighted spin-echo (SE) and FLASH imaging, 4 mL of a 0.5 mol/L solution of a gadolinium chelate (tetraazacyclododecanetetraacetic acid) was injected into the superior mesenteric artery during FLASH imaging in a single breath-holding period. RESULTS: No side effects were noted. With multisection FLASH MR arterial portography, tumor-to-liver contrast-to-noise ratio (34.5 +/- 4.4) was significantly increased compared with unenhanced MR imaging. Sensitivity was 74% (29 of 39) for combined SE and multisection FLASH imaging and 95% (37 of 39) for multisection FLASH MR arterial portography (McNemar test, P < .02). CONCLUSION: Multisection FLASH MR arterial portography is a safe, feasible, and sensitive technique with which to detect hepatic metastases.