Pelvic prolapse: static and dynamic MRI.

Pelvic magnetic resonance is a simple and non-invasive imaging technique for dynamic and static assessment of the pelvic floor. The morphology of the support system is assessed by T2-weighted images. Dynamic sequences are used to assess pelvic prolapse. In this study we illustrate the normal and pathologic features of the levator ani muscle which represents the main active support of pelvic organs. Furthermore we describe the different types of prolapses, floor by floor, and the different staging techniques.

[Percutaneous vertebroplasty in symptomatic osteoporotic vertebral compression fractures: review of 50 patients]. / Résultats de la vertébroplastie percutanée dans le traitement des fractures vertébrales ostéoporotiques hyperalgiques (50 cas).

PURPOSE: Evaluation of percutaneous vertebroplasty (PVP) in symptomatic osteoporotic vertebral compression fractures after failure of conservative management. MATERIALS AND METHODS: Retrospective study of cases performed between 2002 and 2005 in a single institution. Outcome was measured using Huskisson's visual analogue scale. RESULTS: A total of 77 vertebrae in 50 patients were treated. Mean follow-up was 12.9 months (1-36 months). Significant symptomatic improvement (p<0.001) was noted with pre PVP pain score of 7.4 (+/-0.99), 24 hour and 1 month post PVP score of 2.31 (+/-2.65), 6 month post PVP score of 2.4 (+/-2.7) and 18 month post PVP score of 2.91 (+/-2.91). Seven patients presented with a new symptomatic vertebral compression fracture, with 5 cases adjacent to the treated level. CONCLUSION: Percutaneous vertebroplasty is reliable and effective in the treatment of symptomatic osteoporotic vertebral compression fractures.

[Imaging of inflammatory pseudotumors of the liver]. / Imagerie des pseudo-tumeurs inflammatoires hépatiques.

PURPOSE: To describe the imaging features of inflammatory pseudotumors of the liver. INTRODUCTION: Inflammatory pseudotumors of the liver are rare benign lesions that may simulate malignancy on imaging studies. Diagnosis is most frequently confirmed after surgical resection of the lesion. MATERIALS AND METHODS: Retrospective study from 1998 to 2006 of histologically proven cases of inflammatory pseudotumors of the liver. A combination of the following imaging modalities were utilized: US, contrast enhanced US, helical CT and MRI. RESULTS: A total of seven lesions (mean diameter of 61.4 mm) were detected in 6 patients (mean age of 66 years). Clinical and laboratory results were non-specific. The following imaging studies were available: US in 5 cases, including one with contrast material, CT in 5 cases and MRI in 3 cases. All tumors were hypoechoic on US, with no enhancement after injection of Levovist. The tumors were generally hypodense on noncontrast CT and enhancement, when present, was delayed and moderate. On MRI, the tumors were iso- or slightly hyperintense on T2W images and iso- or slightly hypointense on T1W images with subtle peripheral enhancement on delayed imaging. CONCLUSION: The differential diagnosis of inflammatory pseudotumor of the liver should be known to radiologists and could be suggested in a clinical context of chronic inflammatory process in patients with non-specific liver mass showing imaging features of partial fibrosis with delayed enhancement.

[Transcatheter embolization for endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage]. / Traitement par embolisation endovasculaire d'hémorragies gastro-intestinales hautes non variqueuses et aiguës après échec du traitement endoscopique.

OBJECTIVES: Evaluate the efficacy of endovascular embolization for patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage as well as the factors that may influence mortality. MATERIALS AND METHODS. Retrospective study over a 4-year period including a historical cohort of 37 consecutive patients (22 men), with a mean age of 69.2 years (range, 22-93 years). In most cases (54%), the hemorrhage stemmed from a gastrointestinal ulcer. Technical, primary clinical, and secondary clinical success rates, as well as complication rates, were calculated. Several clinical and angiographic parameters were compared to the early mortality rate using Kruskal-Wallis or Fisher tests. RESULTS: Technical, primary clinical, secondary clinical success rates, and complication rates were, respectively, 89.2%, 83.8%, 88.9%, and 10.8%. The early mortality rate was 32.4%. The APACHE II and IGS II scores were strongly correlated with mortality (p=0.001 and p=0.003, respectively). CONCLUSION: Endovascular embolization in patients with endoscopically unmanageable acute nonvariceal upper gastrointestinal hemorrhage is effective. However, the mortality rate remains high because of the changes in the clinical condition of these patients.

[MR Features of hepatic macronodular mycobacteriosis]. / IRM des atteintes macronodulaires hépatiques à mycobactéries.

Hepatic macronodular mycobacteriosis is rare. Its diagnosis is challenging and is most often proposed on the basis of histological analysis. Final diagnosis, except for germ-proven cases, is made in conjunction with clinical, biological, and radiological arguments. We retrospectively report the MR features of ten hepatic lesions discovered on five patients. MRI is sensitive but has a low specificity in demonstrating pseudotumoral lesions most often exhibiting hypointensity on the T1-weighted sequence, hyperintensity on the T2-weighted sequence, and a slight rim enhancement after gadolinium-enhanced T1-weighted sequences.

Descending necrotizing mediastinitis: a rare pathology to keep in mind.

The spreading of a cervical infection to the mediastinum is a complication rarely observed, and its prognosis is still very severe. The infectious spreading follows known anatomical tracts, leading to the invasion of definite mediastinal spaces. The cervicothoracic scanning is the ideal procedure leading to the diagnosis, the localization of the infectious sites, and to the demonstration of an abscess and the presence of air in the mediastinum. We report a case of a patient in whom the early use of specific imaging and of proper aggressive surgical intervention did not allow the elimination of a fatal outcome.

Percutaneous nucleotomy: preliminary communication on a decompression probe (Dekompressor) in percutaneous discectomy. Ten case reports.

For the past years, new therapeutic options have been proposed secondary to the progress in the interventional imaging. The purpose of this article is to report a preliminary study on the use of the 1.5 mm "Dekompressor probe" (Stryker, Kalamazoo, MI, USA) in the percutaneous discectomy by decompression. We have conducted, from September 2003 to March 2004, a retrospective review on 10 patients (mean age of 49.8), chosen at random, presenting a nonextruded herniated disc resisting all medical treatments. The procedure is CT guided or performed under fluorosocopy, a discography is performed by introducing the probe at the level of the protruded disc. After local anesthesia, an incision of a few millimeters is performed, allowing the introduction of a coxial trocar to the level of the disc. The decompression probe is then introduced. No technical failure occurred. The results in our series show, in eight patients, a satisfactory result with a decrease of the initial VAS of more than 70% and a complete elimination of the medical therapy. Our preliminary results are encouraging but should also be confirmed by a multicentric based on a large series, and the criteria of inclusion or exclusion must be strictly respected to obtain satisfactory clinical results.

MRI features of a pancreatic schwannoma.

A case of a pancreatic schwannoma is presented. The patient, a previously healthy woman, is hospitalized with the diagnosis of purulent pleuritis. Ultrasonography (US) of the abdomen shows a 3-cm mass in the head of the pancreas. Magnetic resonance imaging (MRI) reveals, in T1-weighted sequences, the mass to be hypointense, and an early and persistent enhanced signal is noted following the administration of gadolinium. In T2-weighted fat saturation sequences, the lesion appears markedly hyperintense. A duodenopancreatotomy is performed, and the pathologic specimen demonstrates a schwannoma of the pancreas with Antoni A pattern.

MR features of gastrointestinal stromal tumors.

We report on two patients presenting with gastrointestinal stromal tumors (GIST). The important tumor size and the marked tissular hypersignal seen on T2-weighted magnetic resonance images (MRI) should be considered as magnetic resonance (MR) features strongly indicating diagnosis of GIST.

CT measurement of lung density: the role of patient position and value for total body irradiation.

To obtain more precise data on pulmonary doses in preparation for total body irradiation, the lung density of patients was systematically analyzed in treatment positions using data obtained by computed tomography (CT). With the patient supine, the lung density was not significantly different for the right and left lungs. In contrast, considerable differences were noted between the two lungs in lateral decubitus positions owing to variations in ventilation and perfusion. The relative electron density of lung was also found to decrease with age, dropping to pe = 0.160 at 71 years.

Perfluoroctylbromide and hepatosplenic computed tomography. Preliminary clinical study.

The preliminary results of perfluorocytlbromide (PFOB) emulsion when used as an intravenous contrast agent for hepatosplenic CT imaging in humans are reported. Ten patients were examined using dosages ranging from 1 to 2 g/kg. There was good clinical and biochemical tolerance. Diagnostic dose for liver enhancement seems to be at least 2 g/kg, whereas 1 g/kg was sufficient for splenic enhancement.

Relationship between systemic 5-FU passage and response in colorectal cancer patients treated with intrahepatic chemotherapy.

The study described herein was conducted to analyze the relationship between tumor exposure to 5-FU and clinical response. Six patients were placed on continuous 5-day intrahepatic 5-FU chemotherapy for colorectal cancer metastasized to the liver. The starting dose was 600-800 mg/m2 per day; cycles were repeated at 4-week intervals. The 5-FU dose was increased by 250 mg/day at each cycle. All six patients received 3 or more cycles, for a total of 37 cycles. Response was evaluated after each cycle by ultrasonography or computed tomography (CT). Pharmacokinetic data revealed a high individual cycle-to-cycle variability for all six patients in the 5-FU area under the curve (AUC day 1 to day 5) corrected for the dose. These variations in drug biodisposition, reflecting hepatic 5-FU uptake, were significantly related to measurable modifications in the tumor mass in 71% of cycles. The correlation between the reduction in local drug exposure and tumor regrowth was better than that between the increase in local drug exposure and tumor reduction. These findings constitute an original illustration in humans of the experimental concept of the drug exposure/tumor response relationship for 5-FU.

Pancreatic cystic neoplasms.

Cystic neoplasms are an uncommon group among pancreatic tumors. Because of advances in noninvasive diagnostic procedures, these lesions are more frequently detected and surgically treated. New pathological entities have been recently described with their own prognosis. 1. In a large number of cases, the imaging procedures can differentiate microcystic adenoma from mucinous cystadenoma, the more frequently encountered lesions. A well-defined mass with innumerable small cysts producing a honeycomb appearance with central stellate septae is suggestive of microcystic adenoma. A well-defined multilocular mass containing thin, straight or curvilinear septae with papillary projections and local thickening is suggestive of mucinous cystadenoma. 2. No sonographic or CT finding allows the differentiation between mucinous cystadenoma and cystadenocarcinoma, however; the imaging features depend on the grade of malignancy. 3. Thus, in the majority of cases of cystic lesions, fine needle aspiration with appropriate stains is recommended.

Magnetic resonance imaging of von Meyenburg complexes: report of a pathologically documented case.

Von Meyenburg complexes (VMC) are rare malformations of the bile ducts. They are usually associated with adult dominant polycystic disease (ADPCD). Although generally benign, they may give rise to cholangiocarcinomas. Herein, we report the third MR documented case of VMC. The comparative diagnostic value of ultrasound (US), computed tomography (CT), and magnetic resonance (MR) examinations is discussed.

Echography in hepatic angiomas.

All US patterns can be observed in hepatic angiomas; if the lesion is less than 3 cm, however, the echostructure is often hyperechoic and homogeneous.

Ultrasonography of hepatic cavernous haemangiomas.

Cavernous haemangiomas, the most frequent benign tumours of the liver, are discussed by the authors in connection with 50 personal cases and surveillance of 35 solitary hyperechoic nodules less than 3 cm diam. without clinical or biological abnormalities. All the diagnostic images are reviewed but attention is focussed on ultrasound. All US patterns may be observed, but if the lesion is less than 3 cm, the echostructure is often hyperechoic and homogeneous. In view of their asymptomatic nature and the absence of risk of evolution for these small hyperechoic lesions, it appears legitimate to propose surveillance merely by US if there are no clinical symptoms and if liver function tests are normal.

Lymphography in angio-immunoblastic lymphadenopathy.

Angio-immunoblastic lymphadenopathy (AIL) produces a characteristic lymphoproliferative syndrome, with characteristic lymphographic appearances. The authors studied the lymphographic manifestations of 18 cases of AIL. In 15 out of 18 cases, enlargement is observed in all the lymph nodes with a lacy or reticular storage pattern and sharp, well delimited margins. This lymphographic appearance reflects the histologic changes; only the peripheral sinuses, which are not involved, can be observed on lymphography.

Leiomyoma and leiomyosarcoma of the digestive tract--a report of 45 cases and review of the literature.

The authors discuss the general and radiologic characteristics of leiomyomas and leiomyosarcomas, based on experience with forty-five cases involving the digestive tract and a review of over one thousand cases reported in the literature. Thirty-six leiomyomas (oesophagus 9, stomach 18, small intestine 9) and nine leiomyosarcomas (oesophagus 2, stomach 2, small intestine 4, colon 1) were observed and compared with reports from the literature. Leiomyomas of the oesophagus lend themselves to radiologic surveillance since there is no tendency for lesion degeneration in this location. Leiomyomas of the stomach are frequently asymptomatic and discovered following radiologic or endoscopic examination. With involvement of the small intestine, the most sensitive radiologic examination remains angiography, even though the information provided does not allow evaluation of the evolution of the tumour. Localization in the colon remains rare.

Metastases of the digestive tract. Report of 77 cases and review of the literature.

In addition to personal observations of 77 patients with one or more metastatic sites in the gastrointestinal tract, the authors reviewed over 1000 similar cases in the literature. The general radiologic aspects of each location (oesophagus, stomach, intestine, colon/rectum) are discussed. The pathophysiology of this type of metastasis explains the radiologic images obtained during barium transit examinations. The lymphatic type of spread observed in the oesophageal region in connection with carcinoma of the breast is the origin of stenosis of the middle third. The haematogenous type of diffusion encountered during melanomas creates intramural or intraluminal radiologic images. Two means of spread can be observed in the stomach. Haematogenous spread can result in frequently multiple and ulcerated nodular submucosal lesions from melanomas and bronchogenic carcinomas; it can also cause a more or less stenotic invasive image, especially in connection with carcinoma of the breast. Dissemination by means of the mesenteric reflections, and in particular around the gastrocolic ligament, explains the spread of a carcinoma of the transverse colon towards the stomach. The most frequent secondary sites in the gastrointestinal tract occur in the small intestine, the majority of these metastases being caused by pelvic tumours. Whether occurring in the small intestine or the colon, the pathophysiology is similar: direct invasion by a non-contiguous primary carcinoma along the fascias and mesenteric attachments (more rarely by lymphatic permeation), dissemination by the peritoneal fluid or haematogenuous spread. In the first two types of dissemination cited, the image encountered is often hard to differentiate from radiation-induced lesions.

Comparison of ultrasonographic and histological findings for multinodular lesions of the salivary glands.

Fifteen cases of multinodular lesions of the salivary glands are presented. All nodules were hypoechoic, the largest measuring over 5 mm. The various etiologies represented included: 8 non-Hodgkin's lymphomas, 5 metastases of cancer of the tongue, 1 sarcoidosis limited to the submaxillary gland, and 1 case of oncocytosis involving all four salivary glands. After discussing the rarity and the general characteristics of these lesions, the authors propose a diagnostic strategy following examination by ultrasound.