[MRI in static and dynamic disfunction of the female floor]. / Troubles de la statique et de la dynamique pelvienne chez la femme en IRM.

MRI is taking a growing place for pelvic prolapse diagnosis. A strict technical protocol with static and dynamic sequences is required with rectal and vaginal ultrasound gel. A good knowledge of physiology and anatomy of pelvic and perineal muscles is mandatory as well as a clinical approach of various pathologic prolapses. MRI fundings are presented and correlated with several clinical situations of prolapse and post operative features.

[Imaging of female infertility]. / Imagerie de l'infertilité féminine.

Medical treatment of a couple's infertility depends upon the cause(s) of infertility. The goals of imaging are to determine these causes (male, female, mixed, unexplained), to evaluate their severity and type on the female side central, ovarian, uterine, tubal, peritoneal, endometriosis, in order to propose an adapted treatment. Imaging modalities are essentially non ionising (US and MRI). Hysterosalpingogram retains its indication to study tubal patency, it can be completed by tubal catheterisation in cases of proximal tubal obstruction.

Tubal sterilization by selective catheterization in an animal model.

RATIONAL AND OBJECTIVES: The feasibility of tubal occlusion by selective salpingography was tested in an animal model; three novel occluding materials also were tested for this application. METHODS: Unilateral selective salpingography was performed in three groups of six rabbits; fallopian tubes were embolized with ethanol (group 1), a hydrogel (group 2), or an occluding emulsion (Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; tubal patency and histologic modifications were evaluated. RESULTS: Selective tubal catheterization was obtained in 100% of the cases. In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. CONCLUSION: Selective salpingography proved a suitable method for gaining access to the fallopian tube and allowed selective injection of occluding materials. More research is needed to determine a suitable occluding material, focusing on biocompatibility and on long-term efficacy.

PIP: Unilateral selective salpingography was performed in 3 groups of 6 rabbits. 4-6 month old, virgin New Zealand White female rabbits were used with a mean weight of 4.4 kg. The fallopian tubes were embolized with ethanol (group 1); a viscous radiopaque solution which solidifies rapidly after injection to produce a biocompatible and inert hydrogel (group 2); or an occluding emulsion (a radiopaque heterogeneous alcoholic solution of zein, poppy seed oil, propylene glycol, and sodium amidotrizoate from Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; and tubal patency and histologic modifications were evaluated. Selective tubal catheterization was possible in all 18 cases, in 12 cases on the right side (66%), in 6 cases on the left side (33%); in 11 cases with a 5F catheter (61%), in 7 cases with a 2.5F catheter (39%). In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; and in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. The fallopian tubes were selectively catheterized over variable lengths: over 10 mm in 5 rabbits (28%), between 5 and 10 mm in 4 rabbits (22%), and between 1 and 5 mm in 9 rabbits (50%). Before injection of the occluding materials, all the catheterized tubes were patent. Mean volume of occluding material injected was 0.36 mL in group 1, 0.30 mL in group 2, and 0.83 mL in group 3. The ethanol injected reached the peritoneum in all 6 rabbits. The gel was injected an average length of 11 mm in the tube, while the emulsion opacified all the volume of the tubes with a peritoneal spill of emulsion in 3 of 6 cases. Reflux of occluding material into the uterus was noted in 1 of 6 rabbits in group 1, in 4 of 6 rabbits in group 2, in 3 of 6 rabbits in group 3. Selective salpingography proved a suitable method and allowed selective injection of occluding materials.

Endoscopic transvaginal approach to the rabbit uterine cervix: improvement in the technique of selective tubal catheterization.

RATIONALE AND OBJECTIVES: The authors compared two methods of selective fallopian tube catheterization in female rabbits. METHODS: Technical success rates and procedure times in two groups of animals were compared. Group 1 consisted of 20 female rabbits catheterized with a fluoroscopic technique. Group 2 consisted of 55 rabbits catheterized with a combination of endoscopic and fluoroscopic guidance. RESULTS: The technique used in group 2 allowed a statistically significant reduction in the time required for cervical catheterization and the total procedural time (P < .01). There was a parallel statistically significant reduction in fluoroscopy time (P < .01). Technical success rates and adverse effects were similar for the two techniques. CONCLUSION: The combined endoscopic-fluoroscopic technique requires a shorter time than the established fluoroscopic technique and should be considered for future selective tubal catheterization experiments in rabbits.

The results of angiographic studies of abdominal masses.

This study reveals the continuing great viability of angiography in the investigation of abdominal masses. It is a fundamentally important procedure within the context of presurgical evaluation. Certain points should be underlined. - The radiological definition of the histological nature of an abdominal mass during angiography remains difficult, practically impossible in certain regions. - Borrowed vascularizations still pose complex diagnostic problems at different levels. - The benefit of angiography should be compared with other modern radiodiagnostic methods, especially the less aggressive ones. - The importance of each of these points has led us to develop them separately: - The diagnostic reliability of angiography in abdominal masses (from anatomico-radiological correlations). To be published - The borrowed vascularisation of abdominal masses. To be published - The tomodensitometry of abdominal masses. To be published - Diagnostic strategy in case of an abdominal mass. To be published.

Direct percutaneous approach to the upper pole of the kidney: MRI anatomy with assessment of the visceral risk.

PURPOSE: In an attempt to determine the visceral risk secondary to a direct percutaneous puncture of the upper renal calix, the anatomic relations of the upper pole of the kidney were studied by magnetic resonance imaging. METHODS: Examination was performed on 25 normal volunteers placed successively in the right and left prone oblique position. The kidney axis and minimal distances from the cutaneous plane at the level of the upper and lower poles were measured. Axial and tangential simulated percutaneous approaches to the upper renal calix were compared in term of risk of damage to the pulmonary, splenic, and hepatic parenchyma. RESULTS: The transversal anteversion angle was statistically comparable for right and left kidneys, but the sagittal anteversion angle was significantly higher for right kidneys (p = 0.05). The minimal distance from the cutaneous plane was statistically comparable for the upper and lower poles. The lower pole was significantly deeper for left than right kidneys (p = 0.01). The visceral risk was statistically comparable for left and right kidneys and was significantly higher in case of an approach in the axis of the upper renal calix or through the 10th intercostal space compared to a puncture via the l1th space (p = 0.0001). CONCLUSION: A percutaneous puncture of the upper pole of the kidney above the 11th rib increases the risk of visceral damage. Preoperative evaluation, with the aid of CT scan or MRI, of the risk of pulmonary, splenic, or hepatic injury could be carried out in these cases.

The parasitic blood supply of abdominal masses.

Many lesions, and particularly hyper-vascularized ones, acquire an aberrant blood supply. These parasitic vascular supplies are defined as tumour vascularizations derived from neighbouring organs or structures, and supplement the normal blood supply of the diseased organ. Their existence is essential for the angiography of abdominal masses. We selected 35 cases of abdominal masses with parasitic vascular networks. Twenty-four belonged to an initial review of 117 angiographic studies of abdominal masses. Eleven have been added in accordance with the theme of this work. Parasitic circulations should be taken into account because of their effects on the angiographic technique, their diagnostic possibilities and limitations, and their importance in the management of the patient.

Computed tomography of lethal midline granuloma. 5 case reports.

Five cases of lethal midline granuloma are evaluated with computed tomography. CT examination is indispensable to appreciate extension of facial lesions, and detect lymphoma often associated.

A method for the characterization of the echostructures of normal and pathological breast tissues.

Since a valid macroscopic investigation fundamentally cannot exist without its basis in microscopy, we are seeking to identify characteristic echo structures by means of acoustical microscopy at frequencies of 600 MHZ and 1 GHZ in order to better understand ultrasonography in everyday practice and to determine reliable and specific imaging characteristics of the different components of breast tissues. We have studied slices of mammary tissue 5-10 microns thick which had been removed during surgery. Acoustical imaging has to be performed in transmission mode as well as reflection mode. The intrinsic acoustic contrast is more than sufficient to obtain good visualization of different tissue components of the mammary gland. We noted, however, that even if the microscopic acoustic images were of good quality--often as good as light microscopy--certain tissue components such as the epithelium are irregularly visualized. It appears that the effective visualization of a structure depends entirely upon this acoustical environment.

Breast pathology in MRI. First results.

The authors present the first results of the assessment of MRI (0.35 T) with adapted surface reel in the exploration of mammary pathology in 90 cases. On a morphological level, MRI permits a new analysis of signs of dystrophy. As far as MRI is concerned, no specific sign of mammary neoplasia seems to exist. A classification is suggested, taking into account morphology and parameters of relaxation.

Ideal imaging in MR: contrast-enhancing pharmaceuticals. Evaluation of tempo carboxylic acid as nitroxide diagnostic agent.

The meglumine salt of TCA, a piperidinyl nitroxide stable free radical derivative, was tested as an NMR contrast enhancer. This report of its use in animals indicates its usefulness in the enhancement of signal intensity of the kidney and bladder.

[Tubal diseases: from diagnosis to intervention]. / Pathologie tubaire: du diagnostic à l'interventionnel.

Ninety years after it was first performed, hysterosalpingography remains one of the most important tests in helping an infertile couple decide between numerous treatment options. The application of angiographic techniques to hysterosalpingography has revolutionized diagnosis and treatment of proximal tubal obstruction. Results from worldwide centers have shown that nonsurgical catheter recanalization of proximally obstructed tubes can be accomplished in up to 90% of patients using standard techniques. Pregnancy incidence in a population who was recommended for tubal microsurgery or in vitro fertilization, but who underwent catheter tubal recanalization instead without any other therapy, was 58% at one year and all pregnancies were intrauterine. Fluoroscopic fallopian tube catheterization should be the first treatment for proximal tubal obstruction, with the more expensive and invasive procedures reserved for the small number of women who fail the radiologic procedure.

[Abdominal and pelvic segmented T1-weighted echo-planar imaging and MRI. Comparison with T1-TSE and T2-UTSE sequences]. / Echo-planar segmentaire pondéré T1 en IRM abdominale et pelvienne. Comparaison avec les séquences T1 TSE et T2 UTSE.

PURPOSE: To assess, quantitatively and qualitatively, the diagnostic value of a segmented EPI T1W sequence compared to T1W and T2W TSE sequences. MATERIAL AND METHODS: A prospective analysis of abdominal and pelvic MRI examinations of 70 patients (44 women, 26 men, mean age of 61 years), was performed on a 0.5 T supraconductive magnet with 15 mT/m gradients. The sequences were randomized and compared in a blinded fashion by 3 independent reviewers: TSE T1W (TR/TE = 500/12 ms, NSA = 6, turbo factor 5, 3:49 min), EPI T1W (TR/TE = 500/30 ms, NSA = 6, EPI factor = 7, 2:13 min) and UTSE T2W (TR/TE = 1600-2500/100, NSA = 6, turbo factor = 31, 2:20 min). RESULTS: Quantitatively, no significant difference was found between T1W sequences for signal to noise ratio. The EPI T1W sequence had lower signal but stronger enhancement after gadolinium injection. Qualitatively, EPI T1W had significantly less flow artefacts (p < 0.001, wilcoxon test), and more chemical shift artifact (p < 0.01). For lesion detection, differences were not statistically significant between T1W sequences or between paired T1W and T2W sequences (sensitivity and specificity 84 and 86% for TSE T1W 76 and 86% for EPI T1W, 78 and 79% for UTSE T2W, 90 and 65% for TSE T1W-UTSE T2W, 88 and 65% for EPI T1W-UTSE T2W). Kappa concordance test (0.686) and Mac Nemar symmetry test (3.55) were high between T1W sequences. CONCLUSION: The segmented EPI T1W sequence used had equivalent results compared to the TSE T1W sequence, it allows a 40% reduction in acquisition time and this without difference in the diagnostic performances of the reviewers.

[Pseudotumoral retroperitoneal tuberculosis. Apropos of a case]. / Tuberculose pseudo-tumorale rétropéritonéale. A propos d'un cas.

A case is reported of pseudotumoral retroperitoneal tuberculosis with invasion of left supraclavicular glands. Relative diagnostic efficacy of ultrasound and CT scan imaging is discussed as well as the differential diagnosis of this exceptional lesion. Exploratory procedures suggested with this type of picture are ultrasonography. CT scanning and possibly guided needle puncture biopsy to avoid surgical exploration. The value of the scanner for follow up review of results of antituberculosis treatment is emphasized.

[Muscular metastases. Uncommon manifestation of cystadenocarcinoma of the pancreas]. / Métastases musculaires. Révélation exceptionnelle d'un cystadénocarcinome du pancréas.

The authors report the detection of a cystadenocarcinoma of the caudal pancreas developed by muscular metastasis. They insist on the rarity of that type of localization to distinguish from the lesions of steatonecrosis. In the check-up of the developing metastasis, this observation bears out the interest of the C.T. of first meaning which allows an approach of lesional characterization owing to the analogies of structure existing between the causal pancreatic lesion and its muscular and hepatic metastasis.

[Computerized x-ray tomographic aspects of calcifying hepatic metastases. Incidence of cancer of colorectal origin]. / Aspects tomodensitométriques des métastases hépatiques à forme calcifiante. Incidence des cancers d'origine colorectale.

A total of 24 patients with liver metastases of the calcifying type were detected during CT scan imaging for cancer of different primary origin (colorectal, ovarian, mammary, gastric, prostatic, melanoma). These calcifying metastases represented 27% of the 89 liver metastases cases detected, and the incidence of a colorectal origin for these calcifying lesions (20% of cases) appears to be highly significant, their number being relatively larger than reported in previous studies. Identification of liver calcifications of possible diagnostic importance requires a two-stage CT scan investigation, before and after bolus. Paraclinical examinations should be directed selectively towards the digestive tract when the primary tumor is unknown.

[Imaging of gynecologic malformations]. / Imagerie des malformations gynécologiques.

Female genital tract anomalies are common (1 to 2% of the female population), and may lead to multiple clinical manifestations: amenorrhea, infertility, spontaneous repeated miscarriage, pelvic pain, endometriosis. They are caused by intra-uterine insults between weeks 6 and 18 of gestation. They are classified according to their embryologic origin. Imaging relies essentially on ultrasound and MRI, and indications for hysterosalpingography are less common. Imaging must classify the malformation and detect complications in order to assess the fertility prognosis and treat complications.

[Imaging of the cervix and the vagina]. / Imagerie du col et du vagin.

US and MRI currently are the best imaging modalities to evaluate pathology of the uterine cervix and vagina. Carcinoma of the cervix is the most frequent indication for imaging. MRI allows preoperative staging of cervical carcinoma based on FIGO classification, and post treatment follow-up. Other uterine cervix diseases are less frequently imaged and include a wide range of entities that most frequently cause increased T2W signal at MR imaging. Pathology of the pelvic floor, vagina, vulva, and perineum also includes a wide range of entities that have seldom been described in the imaging literature.

[Acquired uterine arteriovenous fistula: report of one case]. / Fistule artério-veineuse utérine acquise: à propos d'une observation.

A case of acquired uterine arteriovenous fistula in a 28 Year old patient is reported that probably is secondary to a "difficult" delivery. Sono-graphic, MRI and angiographic findings are reported, before and after endovascular management.

[Imaging of benign ovarian tumors]. / L'imagerie des tumeurs bénignes de l'ovaire.

A positive diagnosis of benign ovarian tumor indicates a laparoscopic approach or a conservative treatment. Benign ovarian tumors are often easy to recognize with non ionizing modalities such as US and MRI. The most common benign ovarian tumors are: mature teratomas including dermoid cysts, tumors in the fibro-thecal group including fibromas and thecomas, benign serous and mucinous tumors (cystadenomas). Apart from ovarian tumors, endometriomas are more commonly extra ovarian, but may involve the ovarian stroma.