[MR imaging of large and rare pelvic masses from non-gynecological etiology]. / IRM des masses pelviennes volumineuses et rares d'origine non gynécologique.

The diagnosis and characterization of pelvic masses may be problematic, especially when they are larger than 5 cm in diameter. The majority of large pelvic masses in women originate from gynecological structures. However, they may also originate from the GI tract, urinary tract, retroperitoneum, pelvic soft tissue structures, peritoneum and bones. MRI is the imaging modality of choice because it provides excellent contrast resolution and allows direct multiplanar imaging capabilities. Diagnosis is usually suggested after careful evaluation of the tumor location, anatomical relationships, morphology and signal characteristics. In this article, we will discuss the MR imaging features of large rare pelvic masses of non-gynecological origin, along with associated clinical and histological findings.

Simple and complex renal cysts in adults: Classification system for renal cystic masses.

Ultrasound and slice imaging are currently the key modalities for diagnosing simple renal cysts. Benign simple renal cysts are defined by a set of strict criteria. Any cystic lesions that do not meet these criteria should be classified as "atypical" or "complex" and considered as suspicious. For over three decades, the Bosniak classification has been the central tool for diagnosing renal cystic masses larger than 1 cm. The Bosniak classification is based upon the results of a well-established pre- and post-contrast computed tomography (CT) protocol. Lesions that are difficult to classify or that remain indeterminate after CT can benefit from a multimodal diagnostic approach combining CT, non-contrast-enhanced and contrast-enhanced ultrasound, and magnetic resonance imaging.

[CT anatomy of the normal spleen: variants and pitfalls]. / Scanographie de la rate: anatomie normale, variantes et pièges.

Normally, the spleen is located in the left hypochondrium. It is attached by the gastrosplenic and splenorenal ligaments. Its tissue composition made up of red pulp and white pulp explains the heterogenous aspect when contrast medium is injected in the arterial phase. This can make it difficult to detect intrasplenic masses. The adult spleen has no lobulations or incisures; however, the persistence of fissures separating the fetal spleen's lobules can indicate splenic lacerations in a trauma context. The ectopic spleen is a migration of the spleen from its normal anatomic location because its ligaments have not developed properly. The spleen can migrate anywhere in the abdomen or pelvis. The accessory spleen can be found in 10% of the population; it is usually located near the hilum of the main spleen or the pacreatic tail. It can be located in many other places and be confused with a mass. Polysplenia is a complex congenital syndrome associating visceral heterotaxis and concomitant bilateral left-sidedness. The spleen is divided into several splenules of the same size. Splenosis is defined by the implantation of splenic tissues in the peritoneum following traumatic rupture of the spleen.

[Renal oncocytoma: CT diagnostic criteria revisited]. / Adénome oncocytaire du rein: redéfinition des critères diagnostiques en tomodensitométrie.

PURPOSE: To redefine and evaluate the computed tomographic criteria for the diagnosis of renal oncocytoma (RO) for which renal sparing surgery should be preferred. MATERIAL AND METHOD: Retrospective study of 57 patients with 69 RO. Macroscopic and histological correlation was obtained in all cases. A double blinded comparative study was made of 60 renal tumors (containing adenocarcinomas and oncocytomas) larger than 3 cm in diameter in order to evaluate the redefined CT diagnostic criteria. RESULTS: Among RO larger than 3 cm in diameter, 55% presented a sharply defined low attenuation scar on post-contrast scans at the tubular nephrographic phase, central or eccentric, with homogeneous attenuation throughout the remainder of the hypervascular tumor which was classified in 3 different groups. The use of our CT diagnostic criteria gave a statistically significant (p < 0.05) Kappa index of inter-observer concordance of 0.71 and a specificity of 96% for the diagnosis of RO. CONCLUSION: Our redefined computed tomographic criteria for the diagnosis of renal oncocytoma, eventually associated with renal biopsy, should increase the indications for renal sparing surgery for RO larger than 3 cm in diameter.

Intraoperative localization of renal calculi by real-time ultrasonography.

Experimental and intraoperative experiences in ultrasonographic localization of calculi are reported. With a small high-resolution real-time probe, we localized 1-mm calculi introduced in ex situ cadaver kidneys. During 13 operations all calculi of various sizes and nature were localized 11 times. This method seems to have many advantages: it is easy to use, it localizes calcific and noncalcific small calculi bidimensionally, and it shortens operative time.

Correlations between radiography, ultrasonography, computed tomography and pathologic findings in prostatic disease.

A total of 20 macroscopically normal or hypertropic prostates were taken from cadavers of men older than fifty, who died of causes other than urologic ones. The samples were studied in vitro by nonscreen x-ray films, ultrasonography, computed tomography, and then by a pathologist. There were 4 normal prostates, 12 with benign prostatic hypertrophy, 3 with carcinoma, and 1 with prostatitis. Conventional radiography which showed only prostatic calcifications was of no pathologic interest. Computed tomography is by no means of diagnostic use in distinguishing between benign prostatic hypertrophy and carcinoma, and should be used only as an alternative in the evaluation of regional extension of prostatic carcinoma. On the other hand, ultrasonography appears to be sensitive to detection of very small nonpalpable nodules. However, its specificity is poor and its use should be restricted as a guide in obtaining biopsy specimens or as a means of evaluating tumor volume.

Renal angiomyolipoma with calcification: CT-pathology correlation.

Fat containing renal tumours are usually considered as angiomyolipomas on imaging modalities. Some cases of renal cell carcinoma have been reported. Although it has been previously reported, angiomyolipomas containing calcifications are very rare. We report a case of a fatty renal tumour with calcification which was an angiomyolipoma. The calcification within the tumour was secondary to osseous metaplasia.

165 renal carcinomas: accuracy of imaging for diagnosis and spread--cost efficiency.

Based on a study of 165 cases of renal carcinoma, we compare the relative diagnosis efficiency of different methods: intravenous urography (IVU), ultrasound (U.S.), arteriography and computed tomography (C.T.). Our evidence enables us to assert the excellent diagnostic accuracy of ultrasound and the superiority of computed tomography for good staging of renal carcinoma. The cost efficient methods for the evaluation of this tumour are intravenous urography (to show and localize the renal mass), ultrasound (to assert the echogenic structure) and computed tomography (to establish the diagnosis of carcinoma and judge its spread).

[Castleman's disease and chromophobe carcinoma of the kidney. An incidental association?]. / Maladie de Castleman et carcinome chromophobe du rein. Une association fortuite?

We report a case of Castleman's disease in a 65-year-old female, revealed by a renal tumor associated with inter-aortico-cava adenopathies and renal chromophobe cell carcinoma. This observation points to the difficulties in differentiating local Castleman's disease, which may be cured by surgical excision, from multicentric disease associated with a dysimmune syndrome of uncertain prognosis. The association of multicentric Castleman's disease with a carcinoma has rarely been described. It could be the emergence of a neoplasia in a context of dysimmunity or Castleman's disease might be related to the production of interleukin 6 by a renal carcinoma.

[FluoroCT guided biopsies: a simplified technique]. / Ponctions sous fluoroscanner: une technique simplifiée.

We report the use of a specific handle we designed for interventional procedures guided by fluoro-CT. This handle, easy to use and low cost, improves the procedures reducing dramatically the procedure time.

[Imaging and pathology of bladder tumors]. / Imagerie et pathologie tumorale de la vessie.

Epithelial bladder tumors are very common. Multiple lesions are possible with variable degrees of malignant potential. Benign and mesenchymal tumors are much less frequent. The role of imaging is to first raise the possibility of such a tumor and then to provide pretreatment staging. Cystoscopy with tumoral resection and histological diagnosis remains essential for adequate treatment selection. Ultrafast MR imaging may be very valuable for evaluation of these tumors. Posttreatment follow-up is needed to detect recurrent tumors. Intravenous urography remains valuable for evaluation of the upper tracts.

[Incisional subcutaneous endometrioma of the abdominal wall: report of two cases]. / Endométriose sous cutanée sur cicatrice de la paroi abdominale antérieure: à propos de deux observations.

Endometriosis occurs in up to 15% of menstruating women. Abdominal wall involvement is rare and always secondary to an invasive procedure. The authors report the imaging and clinical findings of two patients with subcutaneous endometrioma following cesarean section.

[Rhinopharyngeal craniopharyngioma. CT X-ray and MRI aspects]. / Craniopharyngiome "rhinopharyngé". Aspect TDM et IRM.

The authors report about a rare site of craniopharyngioma, purely extracerebral and located in the sphenoid sinus and the rhinopharynx. No CT or MRI sign is pathognomonic for the lesion, but the presence of a fleshy process containing calcifications and cystic formations must lead to evoking this diagnosis. MRI assesses the extent of the lesions perfectly, but fails to detect small calcifications or ossifications accurately.

[Primary retroperitoneal tumors in adults]. / Tumeurs rétropéritonéales primitives de l'adulte.

Primary retroperitoneal tumors are rare and most of the time malignant. Because of the large space in which they grow, they are often discovered lately as they are large. CT and MR are the imaging techniques of choice for the primary diagnosis and the follow up of these tumors. Multiplanar reconstructions , signal and density resolution help for the nature diagnosis. The examinations allowed to find associated signs that helps also for the right diagnosis. The purpose of this paper is to answer a serie of questions: Is the mass in the retroperitoneal space? Are they imaging signs that helps for the diagnosis of nature? Are they associated signs that helps for the diagnosis of nature? What are the most common diagnosis? Is there any place for percutaneous biopsies? What is the role of imaging in the follow up? Are there any other processes that can mimic retroperitoneal tumors?

[Diagnostic imaging of peripheral renal vascular disorders]. / Imagerie diagnostique de la pathologie vasculaire rénale périphérique.

Peripheral vascular disorders of the kidney involve the intrarenal branches of the renal vascular tree. It include occlusive (infarction and cortical necrosis) and non-occlusive vascular lesions (acquired arteriovenous fistulas, arteriovenous malformation, false aneurysms and microaneurysms). Initial diagnosis relies on color Doppler US and CT angiography. Angiography plays a therapeutic role. MR imaging provides useful diagnostic information on perfusion disorders especially in patients with renal insufficiency.

[Renal sinus disorders: imaging findings and pitfalls]. / Le sinus du rein: imagerie pathologique et pièges.

Renal sinus pathology can be classified into 3 groups: intrinsic lesions that arise from the anatomical components of the sinus (fatty tissue, collecting system, arteries and veins, lymphatic vessels, and nerves); extrinsic lesions that develop within the renal sinus from the renal parenchyma; secondary lesions including metastases and retroperitoneal tumors with renal sinus involvement. The diagnosis of renal sinus disorders often relies on a multimodality approach including IVU, doppler-ultrasonography, and CT. The wide variety of renal sinus diseases that may origin either from the renal parenchyma or the retroperitoneum, and the numerous pitfalls mostly due to anatomic variations, may prevent from making a right etiological diagnosis in numerous cases.

[Characterization of renal masses]. / Caractérisation des masses rénales.

The characterization of renal masses relies mainly on CT which remains the gold standard in the diagnosis of renal tumors and cysts. Ultrasound enables to diagnose benign cysts which account for the majority of incidentally detected renal masses. MR imaging is useful in the diagnosis of renal masses that remain indeterminate at CT. Moreover, it is efficient as a substitute when CT is contraindicated. Renal masses include three categories with respect to the size and the gross architecture of the lesion: indeterminate very small masses (less than 10mm in diameter); cystic renal masses and solid renal masses that exhibit postcontrast tumor tissue enhancement. Characterization of cystic renal masses relies mainly on the Bosniak classification which consists of four categories: benign simple cysts (cat I); minimally complicated cysts (cat II); indeterminate cystic renal masses that include cystic renal tumors (multiloculated or not) and complex cysts; cystic renal cell carcinomas (cat IV). Solid renal masses include pseudotumors (normal variants, renal dysmorphisms and inflammatory renal masses) and renal neoplasms among which CT enable to distinct: typical large renal cell carcinomas, typical fat-containing angiomyolipomas and indeterminate renal tumors.

[Cystic tumors of the kidney in adults: radio-histopathologic correlations]. / Tumeurs kystiques du rein de l'adulte: corrélations radio-histopathologiques.

The purpose of this study is to provide an updated pathologic-radiologic classification of cystic renal tumors and to assess imaging diagnostic capabilities. Eighty seven cases of cystic renal tumors explored with multimodality imaging (ultrasonography, CT, MRI, arteriography) and with histopathologic correlation are reported. The most common cystic carcinomas were multilocular cystic renal cell carcinoma (33%) and the pseudocystic necrotic carcinoma (31%), which usually belong to category IV. Less common cystic carcinomas were unilocular cystic renal cell carcinoma (6%) and renal cyst wall carcinoma (6%). The association of thin septa and large locules are suggestive findings for multilocular cystic nephroma, but such criteria are not specific enough to recognize benign multilocular cystic nephroma and to exclude multilocular cystic renal cell carcinoma. Since carcinomatous degeneration may occur within the wall of such tumors, especially in von Hippel Lindau disease, surgery is still required. The results of our study corroborate the Bosniak classification of cystic renal masses: no tumors belonged to the category I or II, all cystic masses which belonged to the category IV were malignant tumors, category III included benign and malignant tumors.

[Value of the scanner in acute pyelonephritis]. / Intérêt du scanner dans les pyélonéphrites aiguës.

Twenty patients with clinical acute pyelonephritis were investigated by routine CT scan. This examination was positive in 19 cases, demonstrating either a hypodense triangular image reflecting a disorder of blood supply or a mass syndrome. The CT scan can therefore confirm the diagnosis of acute pyelonephritis. It also defines the severity of the lesions and helps to guide treatment.

Renal papillary carcinoma: CT and MRI features.

PURPOSE: To describe the CT and MRI appearances of papillary renal cell carcinoma. MATERIALS AND METHODS: Retrospective study of 102 papillary carcinomas in 79 patients, 81 tumors examined by CT and 56 by MRI. Tumor size, homogeneity and contrast enhancement were recorded. RESULTS: The most common presentation of papillary renal cell carcinoma was a small homogeneous hypovascular tumor both on CT and MRI. Eighty-nine percent of lesions were hypointense on T2 weighted images compared to the renal parenchyma. Seventeen percent of the lesions did not significantly enhance with contrast on CT. All of the lesions examined on MRI had a significant enhancement percentage. Calcifications were rare and only seen in 7% of cases (CT). The second most common presentation was a bulky necrotic tumor. In addition, atypical types of disease were found which were difficult to diagnose, including infiltrating tumors and tumors with a fatty component. CONCLUSION: A homogeneous hypovascular renal tumor which is hypointense on T2 weighted images should suggest a diagnosis of papillary carcinoma. Some papillary carcinomas do not enhance significantly on CT. MRI is then required to diagnose the renal tumor.