[Imaging of non-small-cell pulmonary tumors. Therapeutic strategy]. / Imagerie des tumeurs pulmonaires non à petities cellules. La stratégie thérapeutique.

In this work the imagery of non-small cell primary bronchial cancers are reviewed. The standard chest x-ray of the thorax remains irreplaceable for the early detection of these pathologies. On the other hand, progress in imagery has propelled thoracic computed tomographic scanning to the pole position for assessing the local and regional extension of the disease as well as for distance spread of these cancers. The latest developments with spiral CT have again improved the performance of CT scanning. Magnetic resonance imaging has a few precisely defined roles in assessing the extension of bronchopulmonary cancers. In particular with involvement of the apices, the chest wall and in the extension into the cardiovascular system. In this article the emphasis is on the illustration of non-small cell bronchial cancers on computed tomography and on magnetic resonance imaging.

Small leiomyosarcoma of the renal capsule: CT findings.

Three unusual cases of small-size leiomyosarcoma of the perirenal space were studied with CT. The renal capsule has been proved to be the origin of this type of tumor. A CT examination is accurate in suggesting the site of origin and excluding a renal cell carcinoma. However, unless evidence of invasion is noted, it is impossible on CT features to discriminate leiomyosarcoma from a benign leiomyoma.

Small pelvic lymph node metastases: evaluation with MR imaging.

The purpose of this study was to determine if lymph node asymmetry in small (< 1.0 cm) pelvic lymph nodes was a significant prognostic feature in determining metastatic disease. Two hundred and sixteen patients who presented with pelvic carcinoma underwent magnetic resonance imaging (MRI). They were correlated with pathological findings obtained at surgery. We considered the maximum diameter (MAD) of both round- or oval-shaped suspicious masses seen in the axial plane. Two different cut-off values were determined: lymph node diameter greater than 1.0 cm (criterion 1) and lymph node diameter greater than 0.5 cm with asymmetry relative to the opposite side for lymph nodes ranging from 0.5 cm to 1.0 cm (criterion 2). With criterion 1, MRI had an accuracy of 88%, a sensitivity of 65%, a specificity of 96%, a positive predictive value (PPV) of 88% and a negative predictive value (NPV) of 88% in the detection of pelvic lymph node metastasis. By considering criterion 2, MRI had an accuracy of 85%, a sensitivity of 75%, a specificity of 91%, a PPV of 71% and a NPV of 91%. Normal small asymmetric lymph nodes were present in 5.6% of cases. Normal asymmetry of pelvic lymph nodes is not uncommon. It cannot be relied on to diagnose metastatic involvement in cases of small suspicious lymph nodes.