[The role of cardiac magnetic resonance imaging in pulmonary arterial hypertension and chronic thrombo-embolic pulmonary hypertension]. / Place de l'IRM cardiaque dans l'hypertension artérielle pulmonaire et l'hypertension pulmonaire thrombo-embolique chronique.

INTRODUCTION: Cardiac MRI is increasingly used to assess and monitor pulmonary vascular disease. STATE OF THE ART: In pulmonary arterial hypertension, the role of cardiac MRI has become more clearly defined due to its proven capacity to assess the morphology and function not only of the heart, but also of pulmonary circulation. Complementarily to echocardiography, technological advances have rendered it possible for MRI to search and assess shunts. More generally, MRI provides prognostic information on the follow-up of patients undergoing treatment. In cases of chronic thromboembolic pulmonary hypertension, chest MRI locates lesions and assesses pulmonary microcirculation, thereby guiding therapeutic choice. It is also an important prognostic marker in diagnosis and follow-up of patients undergoing treatment. To ensure high-quality examination, it is essential that the patient having to carry out repeated apneas cooperate. PROSPECTS: Studies are ongoing in view of clarifying the role of cardiac MRI as compared to right cardiac catheterization in the follow-up of patients with pulmonary arterial hypertension. CONCLUSIONS: Cardiac MRI is the examination of choice in assessment of right ventricular morphology and function. It is a minimally invasive technique with good inter- and intra-operator reproducibility in the evaluation of patients with pulmonary arterial hypertension and chronic pulmonary thromboembolic hypertension.

Design and evaluation of an abbreviated pixelwise dynamic contrast enhancement analysis protocol for early extracellular volume fraction estimation.

INTRODUCTION: T1-based method is considered as the gold standard for extracellular volume fraction (ECV) mapping. This technique requires at least a 10 min delay after injection to acquire the post injection T1 map. Quantitative analysis of Dynamic Contrast Enhancement (DCE) images could lead to an earlier estimation of an ECV like parameter (2 min). The purpose of this study was to design a quantitative pixel-wise DCE analysis workflow to assess the feasibility of an early estimation of ECV. METHODS: Fourteen patients with mitral valve prolapse were included in this study. The MR protocol, performed on a 3 T MR scanner, included MOLLI sequences for T1 maps acquisition and a standard SR-turboFlash sequence for dynamic acquisition. DCE data were acquired for at least 120 s. We implemented a full DCE analysis pipeline with a pre-processing step using an innovative motion correction algorithm (RC-REG algorithm) and a post-processing step using the extended Tofts Model (ECVETM). Estimated ECVETM maps were compared to standard T1-based ECV maps (ECVT1) with both a Pearson correlation analysis and a group-wise analysis. RESULTS: Image and map quality assessment showed systematic improvements using the proposed workflow. Strong correlation was found between ECVETM, and ECVT1 values (r-square = 0.87). CONCLUSION: A DCE analysis workflow based on RC-REG algorithm and ETM analysis can provide good quality parametric maps. Therefore, it is possible to extract ECV values from a 2 min-long DCE acquisition that are strongly correlated with ECV values from the T1 based method.

[Evaluation of cardiac MRI in the follow up assessment of patients with pulmonary arterial hypertension]. / Évaluation de l'IRM cardiaque dans le suivi des patients ayant une hypertension artérielle pulmonaire (EVITA). IRM cardiaque dans le suivi de l'hypertension artérielle pulmonaire.

Haemodynamic follow up in pulmonary arterial hypertension (PAH) is currently based on right heart catheterisation (RHC). The primary objective of the EVITA study is to compare the use of cardiac magnetic resonance imaging (cMRI) with RHC in the identification of an unfavourable hemodynamic status. The secondary objectives are to determine the role of cMRI in the follow up process. Patients will undergo at diagnosis and at follow up visits both RHC and cMRI. Patients will be followed and treated according to the current guidelines. The primary endpoint will be an unfavourable haemodynamic status defined by cardiac index<2.5L/min/m2 or a right atrial pressure≥8mm Hg measured with RHC compared with a cardiac index<2.5L/min/m2 or right ventricle ejection fraction<35% or an absolute decrease of 10% from the previous measurement with cMRI. Exact values of sensitivity, specificity and 95% confidence intervals will be computed. A population of 180 subjects will have a power of 90% with an α risk of 5%. Univariate and multivariate Cox analysis will allow answering to the secondary objectives. We expect to demonstrate that cMRI could be partly used instead of RHC in the follow up of patients with PAH.

[Paraneoplastic hypoglycemia: The hopes of pathophysiological documentation]. / Hypoglycémie paranéoplasique : les espoirs d'une documentation physiopathologique.

Doege-Potter syndrome is a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia secondary to a solitary fibrous tumor. These tumors are rare and usually asymptomatic. The syndrome of hypoglycemia is seen in less than 5% of the cases, and the associated tumors are large with a high mitotic rate. The cause of hypoglycemia is related to insulin-like growth factors produced by these tumors called "big" IGF-2. Several biological tests can demonstrate the increase of "big" IGF-2 plasma levels confirming the diagnosis of non-islet cell tumor induced hypoglycemia. The diagnosis is suggested by imaging but diagnostic confirmation is provided by the surgery, which remains the treatment of choice. Resection in many cases is the cure leading to hypoglycemia resolution. Recurrences and malignant transformations are possible which imposes a long-term monitoring. We report a case with relapsed malignant pleural fibrous tumor for which the pathophysiological mechanism of hypoglycemia could be documented as a paraneoplastic syndrome.

[Multicystic presentation of a lepidic mucinous adenocarcinoma]. / Présentation multi-kystique d'un adénocarcinome lépidique mucineux.

INTRODUCTION: The pneumonic form is very characteristic of lepidic pattern adenocarcinoma of the lung. However, the diagnosis and treatment of the disease when it presents in this way may be delayed by atypical radiological findings and severity of hypoxemia. CASE REPORT: A 48-year-old female, non-smoker, asthmatic since the age of 20 years, was hospitalized for a diffuse infiltrative pneumonia complicated by severe respiratory failure. The history included chronic cough, gradually increasing dyspnoea on exertion lasting for 14 months and the onset of haemoptysis of low abundance associated with arthralgia in the previous month. She had no professional or domestic exposure to any risk factors. Chest CT scan revealed bilateral alveolar condensations, ground glass areas with thickened septa creating a crazy paving pattern, and numerous large cysts of various sizes and locations, often with irregular thin walls. Microbiological and immunological tests were negative. She required early invasive ventilation and then venovenous ECMO together with broad-spectrum empiric antibiotic therapy, but died after 39 days in intensive care. The autopsy revealed lesions consistent with mucinous lepedic adenocarcinoma with no EGFR mutation and KRAS mutation. There was also associated pulmonary suppuration. CONCLUSION: Mucinous lepidic adenocarcinoma is an alternative diagnosis for pneumonic consolidation associated with multiple cysts.

Influence of Thoracic Aortic Inflammation and Calcifications on Arterial Stiffness and Cardiac Function in Older Subjects.

BACKGROUND: Vascular aging is accompanied by gradual remodeling affecting both arterial and cardiac structure and mechanical properties. Hypertension is suggested to exert pro-inflammatory actions enhancing arterial stiffness. OBJECTIVE: To determine the influence of thoracic aortic inflammation and calcifications on arterial stiffness and cardiac function in hypertensive and normotensive older subjects. DESIGN: A prospective study. SETTING: An acute geriatrics ward of the University Hospital of Nancy in France. SUBJECTS: Thirty individuals ≥ 65 years were examined, including 15 hypertensive subjects and 15 controls well-matched for age and sex. MEASUREMENTS: Applanation tonometry was used to measure aortic pulse wave velocity (AoPWV) and carotid/brachial pulse pressure amplification (PPA). Left ventricular parameters were measured with magnetic resonance imaging. Local thoracic aortic inflammation and calcification were measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Biomarkers of low-grade inflammation were also quantified. RESULTS: AoPWV was higher in elderly hypertensive subjects comparatively to normotensive controls (15.5±5.3 vs. 11.9±2.5, p=0.046), and hypertensives had a higher calcification volume. In the overall population, calcifications of the thoracic descending aorta and inflammation of the ascending aorta accounted for respectively 18.1% (p=0.01) and 9.6% (p=0.07) of AoPWV variation. Individuals with high levels of calcifications and/or inflammation had higher AoPWV (p=0.003). Inflammation had a negative effect on PPA explaining 13.8% of its variation (p<0.05). CONCLUSION: This study highlights the importance of local ascending aortic inflammation as a potential major actor in the determination of PPA while calcifications and hypertension are more linked to AoPWV. Assessment of PPA in the very elderly could provide complementary information to improve diagnostic and therapeutic strategies targeting ascending aortic inflammation.

[Vascular complications following renal transplantation: diagnostic evaluation]. / Complications vasculaires de la transplantation rénale: conduite diagnostique.

Vascular complications after renal transplantation are the most frequent type of complication following urological complications. They may affect the function of the transplant. Early vascular complications include renal artery or vein thrombosis, lesions to the iliac vessels and cortical necrosis. Delayed complications mainly include renal artery stenosis, arteriovenous fistula, and rarely false aneurysm. Doppler sonography, sometimes with the use of intravenous contrast, is the imaging modality of choice in the acute setting or routine follow-up. MRI may be performed for additional morphological and functional evaluation while CT may provide additional evaluation of the arterial supply. Angiography is performed prior to endovascular treatment.

[Comparison of 2D and 3D techniques in the evaluation of global ventricular function on multidetector-row CT]. / Comparaison des méthodes 2D et 3D dans l'évaluation des fonctions ventriculaires globales en scanner multi-détecteurs.

PURPOSE: To compare two methods of post processing cardiac CT data to measure global ventricular function. Materials and methods. Retrospective study where three readers measured the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) of the right (n=22) and left (n=44) ventricles, using a 2D method (extrapolated volumetric method, EVM) and a 3D method (direct volumetric method, DVM) after cardiac CT with retrospective ECG gating. Inter- and intraobserver agreement were calculated based on the intraclass correlation coefficient (ICC) with 95% confidence interval (CI95%), and results obtained with each method were compared using the student t test for paired samples. RESULTS: Inter- and intraobserver reproducibility were very good for both methods, with ICC ranging between 0.694 and 0.992, without significant difference. For the left ventricle, EDV, ESV and EF were 16653 ml, 8351 ml and 5415% for DVM et de 20361 ml, 11558 ml and 4613% for EVM respectively. Right ventricular values were 15247 ml, 7534 ml, 5013% and 17253 ml, 9940 ml, 439% (p<0,0001). CONCLUSION: The very good inter- and intraobserver reproducibility for both methods validate their use in clinical practice. Volume measurements with DVM are always inferior to volumes with EDM, with inverse relationship for EF measurements.

[Cost-effectiveness evaluation of a digital radiography system]. / Evaluation médico-économique d'un système capteur-plan grand champ en radiopédiatrie.

PURPOSE: To evaluate the impact of a completely automated digital radiography (DR) unit in a pediatric radiology department on productivity. Materials and methods. Comparative evaluation of DR and computerized radiography (CR) units on 193 patients imaged in a pediatric radiology department. The time to complete each step of all examinations was recorded. Half of the exams were performed using CR and the other half was performed using DR. RESULTS: There was a 52% time gain for simple projection exams using DR and a 51% time gain for dual projection exams using DR (p<0.001). A workflow study performed a 9 month period showed that DR could absorb 84% of work previously performed on two conventional radiography units. CONCLUSION: DR is necessary for digital imaging departments to increase productivity, while providing added ergonomic comfort and flexibility. It is particularly well suited for pediatric imaging departments.

[Imaging of serious visceral forms of mucormycosis in five immunodepressed patients]. / Imagerie des formes viscérales graves de la mucormycose chez 5 patients immunodéprimés.

OBJECTIVES: Show the contribution of imaging to the diagnosis and follow-up of serious mucormycosis in immunodepressed patients. MATERIALS AND METHODS: Retrospective analysis of the 5-year radiological data in serious forms of mucormycosis occurring in patients with bone marrow allografts who are in refractory chronic graft-versus-host disease after bone marrow transplantation from 2002 to 2005. The positive diagnosis was bacteriologically and pathologically positive in all cases. RESULTS: This study involved three patients with isolated pulmonary involvement and two cases of disseminated mucormycosis. Areas of pulmonary condensations were found in all cases, one of whom had a low-attenuation zone and parenchymal nodules. The kidney, liver, and spleen lesions were clearly limited, hypoechogenic, hypodense, and homogenous with no peripheral contrast material uptake. There was thyroid involvement in the form of hypoechogenic nodules. Rapid growth of the lesions was observed on follow-up CT (n=3) and despite surgical treatment (n=2) and intensive medical management, all cases ended in death. CONCLUSION: Mucormycosis is an integral part of the differential diagnosis of infectious syndromes in immunodepressed patients during the period after bone marrow transplantation. Imaging can assist in the diagnosis but pathological confirmation remains indispensable.

[Sonocystography: a new method for the diagnosis and follow-up of vesico-ureteric reflux in children]. / L'écho-cystographie: une nouvelle méthode de détection et de suivi du reflux vésico-rénal chez l'enfant.

Vesicoureteral reflux (VUR) is a common finding in children presenting with acute urinary infection, with a frequency ranging from 20 to 50%. If radiological retrograde cystography still remains the standard technique, sonocystography now appears as a valuable alternative method, due to the properties of recent ultrasound contrast agents and the wide use of harmonic imaging. The analysis of the literature and the experience acquired by the authors during a clinical trial allow summarizing the current data on this new technique. Because of its accuracy, it may replace radiological cystography in the detection of VUR in girls, the follow-up in both boys and kids, and the management of recurrent infection in children presenting with normal radiological cystography.