[CT Scan in early detection of lung cancer in patients with chronic obstructive pulmonary disease : a retrospective monocentric study]. / Apport de la tomodensitométrie à la détection précoce du cancer pulmonaire associé à la bronchopneumopathie chronique obstructive : étude rétrospective monocentrique.

OBJECTIVE: To explore the possible benefit of detecting lung cancer in COPD patients and to assess the pulmonologist's compliance with the Fleischner Society guidelines for management of pulmonary nodules. METHODS: This monocentric retrospective study was approved by the institutional ethical Committee. Patients with COPD undergoing a CT scan between January 2010 and March 2017 were included. Depending on CT indication (respectively screening or other indications), patients were divided into Group 1 and 2. Follow-up intervals were compared to those recommended in the Fleischner Society guidelines. Data were compared between groups using Chisquared test, Student test, or Wilcoxon test when appropriate. RESULTS: 254 patients were included (134 in Group 1 and 120 in Group 2). 235 opacities were found in 119 patients (47 %). 13 among 254 patients had a lung cancer; 9 in Group 1 (6.7 %) and 4 in Group 2 (3.3 %). The median follow-up by CT after nodule detection was six months regardless of their diameter or attenuation. No statistical significance was found between the observed follow-up and recommendations (P = 0.058). CONCLUSION: COPD in patients with a history of smoking is associated with a higher CT detection rate of lung cancer. This finding may be useful when evaluating selection criteria in lung screening programs. In contrast with the recommendations, CT detected nodules are followed-up regardless of their diameter and attenuation.

INTRODUCTION: Evaluer la tomodensitométrie (TDM) dans la détection des cancers pulmonaires chez les patients BPCO et l'adhésion aux recommandations quant au suivi des nodules détectés. Matériel et méthodes : Les patients BPCO qui ont eu une TDM entre janvier 2010 et mars 2017 prescrite par un des trois pneumologues du Service de Pneumologie impliqués dans la BPCO ont été identifiés et séparés en deux groupes selon l'indication de la TDM - dépistage (Groupe 1) ou une autre indication (Groupe 2). L'intervalle de suivi des nodules a été comparé aux recommandations de la Fleischner Society. En fonction des conditions, les comparaisons ont été effectuées par des tests Chicarré, de Student ou de Wilcoxon. Résultats : 254 patients ont été inclus (134 dans le Groupe 1 et 120 dans le Groupe 2) et 235 opacités décrites chez 119 d'entre eux (47 %). Parmi ces 254 patients, 13 étaient porteurs d'une tumeur pulmonaire maligne (5,1 %) dont 9 dans le Groupe 1 (6,7 %) et 4 dans le Groupe 2 (3,3 %). La médiane de suivi des opacités était de 6 mois indépendamment de leur atténuation ou de leur taille. Ce délai n'était statistiquement pas différent (P = 0,058) des recommandations. CONCLUSION: Chez des sujets tabagiques, la BPCO est associée à une détection par TDM plus fréquente de tumeurs pulmonaires malignes. Ce résultat suggère que la BPCO est un critère de sélection dans les programmes de dépistage. Contrairement aux recommandations, le suivi des opacités est indépendant de leur atténuation ou de leur taille.

Value of the "spine sign" on lateral chest views.

OBJECTIVE: To determine the performance of the spine sign in detecting lower chest abnormalities in the lateral view. METHODS: This retrospective study included 200 patients who had undergone lateral view and CT scans of the chest within 1 week. Two radiologists independently read the lateral views, and a third radiologist, blinded to the aim of the study, read the scans. The spine sign was considered as positive if the progressive increase in lucency of the vertebral bodies was altered. Interreader agreement was calculated through k-statistics. Sensitivity, specificity, positive- and negative-predictive values, and accuracy were calculated compared with CT. RESULTS: Agreements between readers ranged from 0.12 to 0.68. Positive spine sign could appear in two ways: absent or inversed progressive increase in lucency of the vertebral bodies. Sensitivity, specificity, positive- and negative-predictive values, and accuracy were, respectively, 60% and 70%; 64% and 84%; 91% and 97%; 19% and 29%; and 61% and 72% for each reader (p-value ranging from 0.026 to 0.196). Abnormalities most frequently associated with positive spine sign were plate-like atelectasis, ground-glass opacity, pleural effusion and consolidation. CONCLUSION: The spine sign can present as an absent or inversed progressive increase in lucency of the vertebral bodies. It has a moderate sensitivity but a good positive-predictive value, so it can be useful especially when it appears as inversed progressive increase in lucency of the vertebral bodies to detect various abnormalities usually identifiable on chest radiographs. ADVANCES IN KNOWLEDGE: On lateral chest radiographs, the spine sign is useful to detect lower chest abnormalities and is related to various underlying abnormalities and is, per se, non-specific.

Pneumonitis complicating low-dose methotrexate therapy for rheumatoid arthritis. Discrepancies between lung biopsy and bronchoalveolar lavage findings.

Two very similar cases of drug-induced pneumonitis complicating treatment of rheumatoid arthritis with low-dose methotrexate are presented. Diagnosis was suggested by clinical history and findings, but the bronchoalveolar lavage showed a high percentage of neutrophils, an unusual feature in methotrexate-induced pneumonitis. Transbronchial lung biopsies (TBB) confirmed the diagnosis by showing interstitial lymphocytic infiltrate with microgranulomas. Although histologic findings are not strictly pathognomonic, when a differential diagnosis has to be made with infectious and rheumatoid lung disease, TBB appears to be of great promise.

Dextroposition of the left lower lobe after heart-lung transplantation.

Immediately after heart-lung transplantation for cystic fibrosis, a patient had development of a right lower lobe retrocardiac density that persisted on all postoperative chest radiographs. A computed tomographic examination of the thorax performed 3 weeks after surgery showed that there was partial collapse of the left lower lobe in the right hemithorax. The patient required a posterolateral thoracotomy for cure.

Whole lung sections for computed tomographic-pathologic correlations. Modified Gough-Wentworth technique.

RATIONALE AND OBJECTIVES: High-resolution computed tomography of the lung has been advocated in the evaluation of interstitial lung diseases and emphysema. To provide material for correlations with gross pathology and macroscopic quantitation of emphysema, the authors have shortened and simplified the Gough-Wentworth technique. METHODS: The method permits more precise correlation of cross-sectional images and pathologic specimens and is less time-consuming. RESULTS AND CONCLUSIONS: This modified method can be routinely performed in a clinical laboratory of pathology and provides paper-mounted whole lung sections within four days. The sections are protected by a transparency film.

Macroscopic assessment of pulmonary emphysema by image analysis.

AIMS: To propose a computerised image analysis based method for measuring, on paper mounted lung sections, the area macroscopically occupied by emphysema. METHODS: The study was based on the assessment of 69 lung sections prepared following a modified Gough-Wentworth technique. The results obtained from image analysis, point counting, and panel grading methods were compared, as was the repeatability of image analysis and panel grading. RESULTS: The results from image analysis and from point counting were not significantly different (p = 0.609) and significant quadratic regressions (r = 0.96, p < 0.001) were found between measurements from image analysis and from panel grading, the computerised technique being shown to be the most reproducible. CONCLUSIONS: Image analysis is a valuable and reproducible method to measure the area of lung macroscopically involved by emphysema.

Simultaneous neurofibroma and schwannoma of the sciatic nerve.

The authors report a case of simultaneously occurring neurofibroma and schwannoma of the sciatic nerve and discuss the complementary aspects of MR and US. The schwannoma was well-defined and showed distal enhancement on sonographic evaluation, whereas the neurofibroma was ill-defined; both tumors were hypoechoic. T1- and T2-weighted MR images revealed similar signal characteristics of the two tumors, but intense enhancement following administration of gadolinium-DTPA distinguished the schwannoma from the neurofibroma.

Magnetic resonance imaging of the normal prostate at 1.5 T.

Prostatic magnetic resonance images of 22 male volunteers less than 30 years old and with no known genito-urinary tract disease were obtained at 1.5 T. Normal anatomical features of the prostate were studied with spin-echo techniques. Different zones of the normal gland are shown by T2-weighted images: the anterior fibromuscular fascia, the central prostate, the peripheral prostate and the periurethral zone can be differentiated. The normal prostate gland is shown on T1-weighted images as a homogeneous appearance. It is important to recognize the normal zonal anatomy of the prostate since prostatic disorders arise in different anatomical zones.

Non-obstructive kidney transplant dysfunction: magnetic resonance evaluation.

The value of magnetic resonance imaging in the differential diagnosis of non-obstructive dysfunction of renal allografts was studied in a series of 58 examinations at 0.5 T. Four parameters were evaluated: the corticomedullary differentiation; the relative thickness of the cortex; the evolution, with echo number, of the relative signal intensities of kidney parenchyma and adjacent fatty tissue on images generated by a long time to repeat multiecho sequence; and the proximal vascularization. The loss of corticomedullary differentiation is the major finding in acute rejection, but it is not specific as it is also observed in chronic rejection and in the much rarer acute glomerulonephritis. Thickening of the cortex is helpful for the detection of rejected transplants with visible corticomedullary delineation (26% of the cases). Uncomplicated acute tubular necrosis appears as a normal transplant.

Transverse geniculate ligament of the knee: appearance and frequency on plain radiographs.

The aims of the study were to determine the frequency of visualization of the normal transverse geniculate ligament (TGL) of the knee on lateral plain radiographs with magnetic resonance imaging (MRI) as a reference, and to determine features that make this ligament apparent on plain radiographs. 50 consecutive lateral plain radiographs and sagittal T1-weighted images of corresponding knees were evaluated prospectively. A TGL was considered visualized on plain radiographs when an opacity of soft-tissue density was apparent in the posterior part of the Hoffa's fat pad. The TGL was identified in 29 of the 50 (58%) sagittal MR images; a TGL was observed on the lateral plain radiographs of six patients (12%). Correlation with the MR images showed that, when visualized on plain radiographs, the ligament is at least 3 mm thick and completely surrounded by fat. Our study shows that the TGL is a normal variant that can be recognized frequently on lateral plain radiographs of the knee.

[NMR evaluation of neoplastic invasion of the pulmonary artery]. / NMR-Beurteilung neoplastischer Pulmonalarterien-Invasionen.

Bronchial tumors that invade the mediastinum are not necessarily inoperable. Whether surgery is possible depends, among other things, on the extent of pulmonary artery invasion. The authors have studied the value of cardiac-gated MRI and compared it with CT and venous DSA for staging tumor invasion. CT demonstrated the areas of contact between tumor and mediastinum. The MRI planes were transverse and also in the main axis of the pulmonary arteries. Twenty-one patients were studied and in 16 the findings could be checked during surgery. In all cases the findings on MRI were confirmed. In eight patients MRI provided more information than CT and DSA combined and thereby showed its superiority for evaluating arterial invasion.

Pulmonary lymphangiomyomatosis mimicking Langerhans cell histiocytosis.

The authors describe a patient with histologically confirmed pulmonary lymphangiomyomatosis and thin-section computed tomography findings mimicking Langerhans cell histioctytosis. The description emphasizes the nonspecificity of the computed tomography findings in this patient. This report also suggests that the computed tomography diagnosis of lymphangioleiomyomatosis can be difficult at an early stage of the disease and should be complemented by biopsy verification.

[Prostatic pathology imaged by magnetic resonance. 58 cases]. / Pathologie prostatique en résonance magnétique. 58 observations.

Forty-eight patients with prostatic disease (benign prostatic hyperplasia (B.P.H.), carcinoma, cysts, myoma and prostatitis) and 10 normal volunteers underwent magnetic resonance imaging (M.R.I.) of the prostate. The prostatic parenchyma was best evaluated by a T2-weighted spin-echo pulse sequence. The prostate in patients with B.P.H. often had a homogeneous or more rarely a nodular appearance on T2-weighted images. In most cases, a peripheral dark rim is observed. All prostate in patients with carcinoma had an heterogeneous appearance on T2-weighted images. While most of the prostatic carcinomas appeared hypo-intense relative to adjacent prostatic parenchyma, some of the neoplasms had a high or mixed-high and low signal. The myoma showed a low-signal nodule like carcinoma. The cyst appears as a liquid tumor. The prostatitis had an homogeneous bright signal. With the used methodology, MRI can differentiate prostatic diseases in many cases. Nevertheless the technique has to be optimized to improve its accuracy.

[Leiomyoma of the prostate. Appearance on the MRI. Apropos of 2 cases]. / Léiomyome de la prostate. Aspect en I.R.M. A propos de 2 cas.

Two cases of leiomyoma of the prostate are reported. They are the first studies by M.R.I. Based on the results of M.R.I. of these lesions, differential diagnosis with malignant processes of the prostate is discussed. Associated with a benign prostatic hypertrophy, the leiomyoma must be distinguished from additional neoplasm.

[Cyst of the seminal vesicle. Images on ultrasonography, x-ray computed tomography and magnetic resonance. Apropos of a case]. / Kyste de la vésicule séminale. Aspect en échotomographie, tomodensitométrie et résonance magnétique. A propos d'un cas.

A case of seminal vesicle cyst is reported. Magnetic resonance (M.R.) appearance of the seminal vesicle cyst is described first. A brief review of the literature for seminal vesicle cysts is made. New imaging modalities (ultrasound, C.T. scan an M.R.) are illustrated, their role is discussed.

[Magnetic resonance imaging, with surface coil, of a transplanted kidney]. / Imagerie en résonance magnétique avec antenne de surface du rein transplanté.

MR appearance of the kidney transplant is evaluated on a series of 80 examinations performed on a supraconductive unit operating at 0.5 T. Normal function kidneys displayed a clearly delineated corticomedullary differentiation (CMD); the ratio between the thickness of cortex and medulla didn't exceed 0.6. The same appearance was observed in non complicated acute tubular necrosis. Complete loss of CMD was the major finding in acute rejection (74% of the cases), but it was not specific as it was also observed in chronic rejection and in acute glomerulonephritis. Cortex thickening was helpful for the detection of rejected transplants with visible CMD. The sensitivity of MR in the detection of acute rejection was 94%. Specificity of MR findings for acute rejection depended on the transplant age: it varied from 100% for examinations performed during the first 3 months after transplantation, to less than 50% for examinations of the second year.

[MRI of the prostate. Calculated imaging. Preliminary experience: 28 cases]. / IRM de la prostate. Imagerie calculée. Expérience préliminaire: 28 observations.

The majority of studies with MR imaging in prostate disease are based on a semiology obtained using images weighted in T1 and T2. A study was carried out to evaluate effects of images calculated in T1 and T2 obtained at 0.5 T. This preliminary study concerns 28 prostate examinations with spin-echo acquisition and inversion-recuperation parameters, and provided images calculated in T1, weighted and calculated in T2. Images allowed detection and characterization of prostate lesions. However, although calculated images accentuate discrimination of the method, the weighted images conserve their place because of their improved spatial resolution.

[Neoplastic invasion of the pulmonary arteries. Evaluation by MRI. Preliminary experience]. / Envahissement néoplasique des artères pulmonaires. Evaluation par IRM. Expérience préliminaire.

Bronchial tumors invading the mediastinum are no longer systematically regarded as inoperable. Curative surgery has produced a significant survival rate and led to the adaptation of the TNM classification. The degree of invasion of the pulmonary artery is a criterion of operability. The authors are trying to assess the role of MRI with regard to CT and DSA for the measurement of invasion. Their study deals with the prospective assessment of ten patients. The MRI examinations have been carried out with a 0.5 and 1.5 T supraconductive magnet (Philips Gyroscan). Cardiac gating has been used for acquisition. The planes of section are axial, transverse or oblique along the greater axis of the pulmonary arteries. CT examinations in 9-mm thick sections with and IV contrast injection demonstrate the contact of the tumor with the mediastinum. The digital angiograms have been taken with an intravenous injection into a vein of the bend of the elbow or into a femoral vein. Six cases have been verified at surgery. In all cases, the invasion predicted with MRI proved to be correctly assessed. In three cases, MRI provides additional information to the combined findings of CT and DSA. MRI is a good complement for the preoperative assessment of patients with large tumors invading the mediastinum but for which curative surgery is indicated.

[Quantitative computed tomography of pulmonary emphysema]. / Quantification tomodensitométrique de l'emphysème pulmonaire.

Computed tomography, and particularly high-resolution computed tomography, allows a detailed exploration of the pulmonary parenchyma. We discuss here work on the use of this technique in the diagnosis and quantification of pulmonary emphysema. We stress first the subjective quantification then the objective approach based on specific software. We summarize our work which has demonstrated. 1) that the relative surface with density below -950 Hounsfield units and measured on millimetric tomographic slices obtained at the end of maximal inspiration is a valuable measurement of the extent of the macroscopic emphysema and reflects the microscopic emphysema; 2) that subjective quantification overestimates minimally extensive emphysema and shows important intra- and inter-operator variability; 3) that indexes derived from computed tomographic images acquired at the end of expiration reflect more the obstructive syndrome than emphysematous destruction; 4) that age and the size of the lungs influence computed tomographic measurements while hyperinflation appears to have no effect. Finally, we present an example of recent work applying the computed tomographic technique.

[Bronchiolitis obliterans organizing pneumonia: eight cases and review of the literature]. / La bronchiolite oblitérante avec pneumopathie organisée: à propos de 8 cas et revue de la littérature.

Bronchiolitis obliterans and organizing pneumonia is characterized histologically by plugs of granulation tissue in terminal air spaces. Patients usually present with flu-like illness followed by cough, dyspnea and fever. The chest X-ray pattern is characterized by pneumonia like infiltrate which can migrate. Outcome is good with steroid treatment. The aim of this article is to define the clinical, biological, including bronchoalveolar lavage and radiological aspects of BOOP on the basis of 8 clinical cases. The pathophysiology, diagnosis methods and treatment of BOOP are also discussed.