Solitary fibrous tumor of the pleura: Can computed tomography features help predict malignancy? A series of 56 patients with histopathological correlates.

OBJECTIVE: To identify computed tomography (CT) predictors of malignancy, from a retrospective study of preoperative CT scans of patients with solitary fibrous tumors (SFT) of the pleura. PATIENTS AND METHODS: The CT scans of 56 patients with histopathologically confirmed SFT (33 women and 23 men; mean age, 60years) who underwent surgery between December 2004 and November 2012 were retrospectively analyzed by three radiologists working in consensus, blinded to the final histological diagnosis. RESULTS: SFT was asymptomatic and incidentally discovered in 22 patients (45.8%). Resection specimen analysis (R0 resection in all cases) revealed that 23 tumors (41%) were malignant. The CT features, which significantly differed between malignant and benign SFTs were tumor size (P=0.002) with a discriminative threshold value of 10cm, tumor heterogeneity before (P=0.02) and after (P=0.03) intravenous administration of iodinated contrast material, presence of intratumoral hydric attenuation areas (P=0.01), pleural effusion (P=0.01), measurable intratumoral vessels (P=0.02), hypervascularization with visible intratumoral vessels and/or marked enhancement (P=0.001). Presence of intratumoral calcifications (P=0.2) and maximum post-contrast enhancement value (P=0.6) were not significantly different between the two groups. CONCLUSION: A size greater than or equal to 10cm, hypervascularization, attenuation heterogeneity and association with pleural effusion are individual variables that suggest malignant SFT on CT.

Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer.

Nineteen patients with middle and lower rectal carcinomas were operated on, with abdominoperineal resection in 10 patients, lower anterior resection with coloanal anastomosis in 6 patients, and colorectal anastomosis in 3 patients. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by computed tomography in 12 (63%) of 19 patients and by magnetic resonance imaging in 13 (68%) of 19 patients, while digital examination correctly assessed the distance in 15 (79%) of 19 patients. Computed tomography and magnetic resonance imaging were unable to assess extension through the rectal wall. No significant difference was observed between computed tomography and magnetic resonance imaging in assessing extension to the perivesical fat, adjacent organs, pelvic side wall, or lymph nodes. According to the TNM classification, magnetic resonance imaging correctly staged 74% (14/19) of carcinomas, while computed tomography correctly staged 68% (13/19).

Association of macrophagic myofasciitis and fibromuscular dysplasia with renal fibromuscular dysplasia: first case report.

Two rare muscular diseases, macrophagic myofasciitis and fibromuscular dysplasia, are associated in the patient reported here. Their respective etiologies are unknown. The possible link has to be discussed.

Mature cystic teratomas of the ovary: CT and MR findings.

OBJECTIVE: To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). SUBJECTS AND METHODS: CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. RESULTS: At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: -95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on T1 and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from -13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. CONCLUSION: Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.

Fat suppression techniques in MR imaging of mature ovarian teratomas: comparison with CT.

OBJECTIVE: The aim of this study is to analyze the ability of MR fat suppression techniques to characterize fat components of ovarian mature cystic teratomas (MCT) shown by CT. SUBJECTS AND METHODS: MR images of eight MCTs of the ovary were obtained using standard sequences followed by a SPIR (spectral presaturation with inversion recovery) sequence in six cases and by Dixon sequences in two cases. In all cases correlation with CT and pathologic findings was achieved. RESULTS: MR fat suppression sequences showed to be as accurate as CT in detecting fat inside the cystic part of the teratomas (8/8). CONCLUSION: MR fat suppression sequences should be performed when presence of fat is suspected on images of ovarian tumors produced by standard MR sequences.

[Suspected acute appendicitis. Role of enhanced helical computed tomography. Prospective study of 100 patients]. / Suspicion d'appendicite aiguë. Intérêt de l'examen tomodensitométrique hélicoïdal. Etude prospective chez 100 patients.

AIM OF STUDY: To assess the diagnosis accuracy of helical computed tomography (CT) in patients with suspected appendicitis. PATIENTS AND METHODS: This prospective study included 100 consecutive patients hospitalized for suspected appendicitis. There were 57 men and 43 women with a median age of 30 years (range: 17-91). An enhanced helical CT was performed at admission, without digestive opacification. Four criteria were interpreted as positive signs for appendicitis: appendix enlarged > or = 7 mm, right lower quadrant inflammation, stercorolith, and peri-appendicular collection. The patient was managed by the surgeon without knowing the result of CT. The final diagnosis was made pathologically. RESULTS: Eighty-one patients were operated on laparoscopically for suspected appendicitis. Intraoperative diagnosis was corrected in three cases and 78 appendectomies were performed (73 histological appendicitis, six normal appendix). Final diagnosis was a medical disease in 19 patients. The findings of 67 CT were interpreted as positive (63 true positive and four false positive) and the findings of 33 CT were interpreted as negative (24 true negative, nine false negative). Sensitivity was 87%, specificity was 86%, positive predictive value was 94%, and negative predictive value was 73%. If the nine false negative cases with minimal lesions at pathological examination were considered as true negative, the rates would be 100%, 89%, 94%, 100%, respectively. CONCLUSION: Enhanced helical CT is a good imaging diagnostic tool for suspected appendicitis. It may reduce the number of patients admitted for observation and decrease the rate of negative appendectomy.

[Recent modifications to remotely controlled tables employed in radiological diagnosis (author's transl)]. / L'évolution des tables télécommandées en radiodiagnostic.

Remotely controlled tables are still largely employed as diagnostic tools, but they have not evolved during the recent past when compared with computed tomography or ultrasonography. The most recent attempts at improvement have been the introduction of complex stands capable of numerous integrated movements, but very heavy and costly, and integrated development systems for the films. Current technological possibilities should permit very much greater progress. New high definition wide field amplifiers associated with high performance TV could suppress the directly exposed film and thus the selector. As with other systems employing a video image, a multi-image camera could be used. Acquisition of data in this way, combined with the use of visual treatment of this data, should considerably reduce patient irradiation. The introduction of the microcomputer and the lightening of stands (absence of the selector...) should simplify the obtaining of complex movements. These "revolutions" in the conception of remotely controlled tables are now possible, and all that remains is to evaluate possible improvements in diagnostic value and to assess the various economic implications.

[Echographic image of gallbladder partitioning. 8 cases]. / Image échographique de cloisonnement vésiculaire. 8 observations.

Correlations between ultrasonographic and pathological findings were studied in 8 patients presenting "partitions" of the gallbladder. These partitions were due to an acute cholecystitis in 7 patients. This ultrasonographic image appears to be a clinically significant valid finding of cholecystitis.

[Malignant tumors of the ovaries: role of imaging]. / Tumeurs malignes de l'ovaire. Rôle de la radiologie.

Malignant ovarian tumors are developed in more than 95% in the epithelium surface of the ovary. In the mainly cystic forms, vegetations greater than 2cm, with an irregular surface, with a broad base on implantation, containing vessels on color Doppler are very suggestive of malignancy. Ultrasound is highly accurate in these forms. In most of the mixed forms on mainly solid forms, the irregular solid portions with degenerative changes containing tumoral vessels are very suggestive of malignancy. CT scan or MR imaging are usually more indicative of showing malignancy than ultrasound. In the multilocular forms, diagnosis of malignancy or benignity is often difficult. Extension to the pelvis, peritoneum and lymph nodes is easier to define on CT scan.

[Cystic lymphangioma of the abdomen in an adult. Contribution of echography and computed x-ray tomography. Apropos of a case]. / Lymphangiome kystique de l'abdomen chez un adulte. Apport de l'échographie et de la tomodensitométrie. A propos d'un cas.

Authors present a case of cystic lymphangioma of the abdomen in an adult patient. Pre-operative investigations are based on ultrasound and computed tomography since plain films, excretory urograms and barium enema are less helpful. Opportunity of such a diagnosis in adult is not frequent.

[Gas in a pyelic calculus (author's transl)]. / Présence de gaz dans un calcul pyélique.

An original case of a gas-containing pyelic calculus is described. This phenomenon in a radiolucent calculus spontaneously visible by computed tomography is attributed to the fissuration of a crystallin calculus. The hypothesis is emitted that, like gallstones, the apparition of gas is a fissuration that may precede the spontaneous disappearance of the calculus.

[Gas in a pyelic calculus (author's transl)]. / Présence de gaz dans un calcul pyélique.

An original case of a gas-containing pyelic calculus is described. This phenomenon in a radiolucent calculus spontaneously visible by computed tomography is attributed to the fissuration of a crystallin calculus. The hypothesis is emitted that, like gallstones, the apparition of gas is a fissuration that may precede the spontaneous disappearance of the calculus.

[Castleman's disease. X-ray computed tomographic aspect. Apropos of 2 mediastinal forms and a multicentric form]. / La maladie de Castleman. Aspect TDM. A propos de deux formes médiastinales et d'une forme multicentrique.

A multicentric form of Castleman's disease is described, this being a rare affection for which CT image characteristics have not, to our knowledge, been reported. Two cases of localized and one case of multicentric Castleman's disease are reported, and differential characters of these two forms with common histology: angio-follicular lymphoid hyperplasia, outlined. The localized form is found mainly in the mediastinum in young patients and follows a favorable course with recovery after exeresis. The diffuse form develops in later life and presents with severe systemic signs and a marked biological inflammatory syndrome Glands and viscera are affected and its course is grave, with mostly fatal relapses. Angiography suggests diagnosis when images show hypervascular lesions in lymph glands. CT scan imaging with contrast is very suggestive when glandular lesions are present that take up contrast strongly. This appearance should always raise the possibility of Castleman's disease.

[X-ray computed tomography of endometrioid cancers of the ovary. Apropos of 4 cases]. / Tomodensitométrie des cancers endométrioïdes de l'ovaire. A propos de 4 cas.

The preoperative CT scan of 4 patients who had surgery for endometrioid adenocarcinoma of the ovaries were studied retrospectively and the results correlated to operative and pathological findings. 1) All tumors were bilateral. 2) Uterine involvement was diagnosed in 1 out of 3 cases. 3) Fallopian tubes involvement was present in 3 cases but was never seen on CT scan. 4) Ascites and peritoneal metastasis were correctly diagnosed in 2 out of 3 cases.

[Computed tomography diagnosis of anomalies of aortic arch of the adult (author's transl)]. / Le diagnostic tomodensitométrique des anomalies des arcs aortiques chez l'adulte.

Seven cases of anomalies of aortic arch investigated by computed tomography are described. The authors emphasized the interest of such an exam in the investigation of these anomalies. It is very interesting to know this pathology in sight to obviate some mistakes in the diagnostic of the tumors of the mediastinum. They describe three specific criterions of CT diagnosis of a right aberrant subclavian artery. The indications of computed tomography in the diagnostic and evaluation of the anomalies of aortic arch are discussed.

[Magnetic resonance imaging of the pelvis. Methodological aspects]. / L'imagerie par résonance magnétique du pelvis. Aspects méthodologiques.

Multiparametric choice is needed in Magnetic Resonance Imaging (MRI). In addition to matrix definition, section thickness, accumulation number, the repetition time TR, the echo time TE (for the spin echo technique) and the plane selection are of great importance. In pelvic examination, information supplied by T1 and by T2 weighted images is complementary. So, comparison between the three dimensional sections is of great interest. Although long acquisition times could, in theory, provide better images and therefore more clinical information, the patient comfort must be considered in choosing a reasonable examination time. We believe that it is possible, without great loss of information, not to make inversion recovery sequences. Using a 0.5 T superconducting magnet, sequences were done with TR of 1,200 ms for T2 weighted images and two echoes with TE of 40 or 50 ms. Twice repeated sequences (for averaging purpose) and 256(2) matrix (with a 42 cm field diameter) seem to be well adapted to MRI clinical applications.

[Magnetic resonance imaging of the pelvic area. Preliminary results]. / Imagerie par résonance magnétique (IRM) de la région pelvienne. Résultats préliminaires.

Magnetic Resonance Imaging (MRI) is chiefly characterized by its natural contrast and by its capability of producing images in the three spatial directions. Although nearly all pathological tumors have prolonged T1 and T2 relaxation times and therefore it seems to be difficult to distinguish them one from another, significant pathological particularities can be obtained by comparing T1 and T2 weighted images. MRI is of particular interest to provide morphologic data and to demonstrate the relationship of tumors to vascular axes. Furthermore information in three dimensions (scans along transaxial, sagittal and coronal planes) is compared to produce a detailed morphological analysis of the tumor and of the adjacent structures. 0,5 T imaging was performed in 25 patients with pathologic pelvis and in 5 normal volunteers.

[Macrodystrophia lipomatosa. Angiographic aspects (author's transl)]. / Macrodystrophie lipomateuse. Aspect artériographique.

A new case of this unusual entity is reported. The patient, male aged 43 has an hypertrophy of the first and second left fingers. Radiographic examination shows bony overgrowth and marked soft tissue thickening. Arteriography did not show any evidence of angioma or arteriovenous fistula. Histologic examination shows deposits of fat in soft tissue thickening. Macrodystrophia lipomatosa is a rare disease, usually confined to one or two digits of the hand, and sometimes of the foot. A dysembryoplasic aetiology could be sustained, and this entity is very close from others bone or soft-tissue hamartomas.

[Comparative study of MRI and x-ray computed tomography in the preoperative evaluation of rectal carcinoma]. / Etude comparative de l'IRM et de la TDM dans le bilan préopératoire des carcinomes du rectum.

Twenty-one patients with middle and low rectal carcinomas have been operated by abdominoperineal resection (APR) in 11 patients, and low anterior resection (LAR) with coloanal anastomosis in 7 and colorectal anastomosis in 3. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by CT in 15 of 21 cases (71%) and by MR in 14 of 21 (67%) while digital examination correctly assessed the distance in 17 of 21 (81%). CT and MR were unable to assess extension through the rectal wall. No significant discordance was observed between CT and MR in assessing extension to the perivesical fat, adjacent organs, pelvic side wall or lymphnodes. According to the TNM classification, MR correctly staged 76% (16 of 21) of patients while CT correctly staged 71% (15 of 21).

[Rapid imaging in orbito-ocular pathology. Contribution of gadolinium]. / Imagerie rapide en pathologie orbito-orbitaire. Apport du gadolinium.

To evaluate Gradient-Echo Imaging (GEI) in orbito-ocular pathology, 15 volunteers and 34 patients (40 lesions) were examined with GEA T1 and GEA T2 (0.5 T). Results were compared with SE T1 in all cases, with SE T2 in 20 cases and with other imaging modalities (CT). 30 patients were examined before and after injection of gadolinium. Final diagnosis was obtained by surgery or biopsy in 24 cases or by combined results of imaging and clinical findings in 16 cases. Compared with SE, GEA demonstrated a better visualisation of optic nerve, orbital muscles, choroidal-retinal layer, lens capsule and episclera and a better detection of small lesions. It is very helpful for characterisation of lesions containing hemorrhages or paramagnetic components (melanine, gadolinium) or of vascular nature (angioma). Gadolinium was useful for detection of small lesions or characterisation of a few lesions. Thus GEA seems to be an efficient method for the evaluation of orbito-ocular pathology.