Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer.

BACKGROUND: Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments. PATIENTS AND METHODS: The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted. RESULTS: Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis. CONCLUSION: Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types.

Small-bowel capsule endoscopy diagnoses early and advanced neoplasms in asymptomatic patients with Lynch syndrome.

BACKGROUND AND STUDY AIMS: Patients with Lynch syndrome are at increased risk of developing small-bowel adenocarcinoma, which usually has a bad prognosis and needs to be diagnosed early. Our aim was to evaluate the yield of capsule endoscopy and CT enteroclysis in this situation. PATIENTS AND METHODS: We performed a prospective, blinded, comparative study of capsule endoscopy and CT enteroclysis in five academic centers. Thirty-five consecutive asymptomatic patients with Lynch syndrome, all with one proven deleterious mutation, were included. A double reading was performed blind for both types of examination. RESULTS: Histologically confirmed small-bowel neoplasms were diagnosed in three patients (8.6 %): one adenocarcinoma (T3N0M0) and two adenomas with low-grade dysplasia. Capsule endoscopy identified all neoplasms. CT enteroclysis raised suspicion of one neoplasm (adenocarcinoma) but missed the two others. Concordance between the two capsule readings was high with a κ value of 0.78 (95 %CI 0.55 to 1.0), which was not the case for CT enteroclysis, where the κ value was 0.15 (95 %CI -0.27 to 0.58). CONCLUSION: Curable early or advanced neoplasms in asymptomatic patients with Lynch syndrome using capsule endoscopy can be detected with a better reproducibility than with CT enteroclysis. The clinical usefulness of systematic small-bowel screening in these patients should be confirmed through large prospective studies.

Pain as the only consistent sign of acute appendicitis: lack of inflammatory signs does not exclude the diagnosis.

BACKGROUND: The clinical diagnosis of acute appendicitis in adults remains tricky, but radiological examinations are very helpful to determine the diagnosis even when the adult patient presents atypically. This study was designed to quantify the proportion of patients with a preoperative diagnosis of acute appendicitis that had isolated right lower quadrant pain without biological inflammatory signs and then to determine which imaging examination led to the determination of the diagnosis. METHODS: In this monocentric study based on retrospectively collected data, we analyzed a series of 326 patients with a preoperative diagnosis of acute appendicitis and isolated those who were afebrile and had isolated right lower quadrant pain and normal white blood cell counts and C-reactive protein levels. We determined whether the systematic ultrasonography examination was informative enough or a complementary intravenous contrast media computed tomography scan was necessary to determine the diagnosis, and whether the final pathological diagnosis fit the preoperative one. RESULTS: A total of 15.6% of the patients with a preoperative diagnosis of acute appendicitis had isolated rebound tenderness in the right lower quadrant, i.e., they were afebrile and their white blood cell counts and C-reactive protein levels were normal. In 96.1% of the cases, the ultrasonography examination, sometimes complemented by an intravenous contrasted computed tomography scan if the ultrasonography result was equivocal, fit the histopathological diagnosis of acute appendicitis. CONCLUSIONS: The diagnosis of acute appendicitis cannot be excluded when an adult patient presents with isolated rebound tenderness in the right lower quadrant even without fever and biological inflammatory signs. In our study, ultrasonography and computed tomography were very helpful when making the final diagnosis.

Transcatheter local thrombolysis in patients with extensive TIPS thrombosis.

BACKGROUND: Transcatheter local thrombolytic therapy in patients with portosplanchnic venous thrombosis has been used in few cases. CASE REPORTS: Here, we present our single-center experience with transcatheter thrombolytic therapy in three patients with extensive refractory portal and transjugular intrahepatic portosystemic shunt (TIPS) thrombosis. Thrombolytic therapy was successful for all three patients. Two patients developed minor procedure-related bleeding. CONCLUSION: Local thrombolysis could be proposed in case of TIPS thrombosis for patients in whom the venous flow cannot be restored by using conventional anticoagulant therapy and stent mechanical revision.

[Acute lower gastrointestinal bleeding: role of imaging]. / Hémorragies digestives basses aiguës: intérêt de l'imagerie.

Acute lower gastrointestinal bleeding is a frequent cause of hospital admission. Their management is complex and typically requires a multidisciplinary approach. The imaging techniques are variable. Because of the rapid image acquisition, excellent spatial resolution and multiplanar reformatting capabilities, multidetector-row CT is the imaging modality of choice in these patients. The authors will review the different types of imaging work-up and management of patients with acute lower gastrointestinal bleeding.

Hereditary-hemorrhagic telangiectasia: one-step magnetic resonance examination in evaluation of liver involvement.

PURPOSE: To describe the magnetic resonance imaging (MRI) features of hepatic involvement in hereditary-hemorrhagic telangiectasia (HHT) and to determine the interobserver agreement for all of them. PATIENTS AND METHODS: Twenty-three consecutive patients (including 17 women, mean age: 55 years) with HHT, according to the Curaçao criteria, underwent prospective MRI of the liver, including parenchymal, angiographic and biliary sequences, in one step. The scans were analyzed to determine the presence of vascular, biliary and parenchymal abnormalities (Mann-Whitney U test, kappa). The diameters of the hepatic vessels in the 23 patients were compared with those of 23 subjects with no signs of HHT or vascular or liver disease. RESULTS: MRI of the liver was abnormal in 21 patients with suspected HHT (91%). Vascular abnormalities were found in 21 patients (91%), consisting of marked dilatation of the hepatic artery (N=14), intrahepatic telangiectases (N=21), arteriosystemic venous shunting (N=19), arterioportal shunting (N=11) and aneurysms of the hepatic artery (N=3). Regenerative nodular hyperplasia was identified in 17 patients (74%) and ischemic cholangitis in nine (39%). No such lesions were found in the controls. The diameter of the hepatic artery proper was greater in patients with HHT than in the controls: 8.69+/-1.63 mm versus 5.17+/-0.44 mm, respectively (P<0.05). Good interobserver agreement was found with parenchymal and vascular abnormalities (0.62) and moderate interobserver agreement (0.42) with biliary abnormalities. CONCLUSION: One-step MRI of the liver appears to be an excellent tool for the evaluation of liver involvement in HHT, revealing vascular abnormalities, telangiectases, arteriovenous shunting, focal-liver lesions and ischemic cholangitis.

Multimodal imaging for the detection and characterization of liver lesions in a mouse model of neuroendocrine tumor.

BACKGROUND: The aim of this study was to compare in vivo magnetic resonance imaging (MRI) and ex vivo autoradiography with histopathological results for the detection and characterization of liver lesions in an experimental model of human neuroendocrine tumors. MATERIAL AND METHODS: Intestinal STC-1 endocrine tumor cells were injected into 30 nude mice to achieve hepatic dissemination. Seven to 30 days after injection, T2-weighted in vivo images covering the entire liver were acquired with a 7-T system. Autoradiographs were also obtained in 28 mice after injection of fluorodeoxyglucose (18F-FDG). The autoradiographic liver samples were then stained with an antichromogranin antibody before histological analysis. Tumor size and the hepatic tumor fraction were measured using the three imaging modalities. RESULTS: Metastatic tumors visualized on the histological liver sections ranged in size from 50 microm (day 7) to 3 mm (day 30). The hepatic tumor fraction increased with time, reaching 30% of the hepatic surface area on day 30. Visual analysis revealed variable tumor distribution and type (solid and/or cystic). On MRI, lesions were identified from day 12 (about 100 icrom in diameter) and the hepatic tumor fraction was up to 48% at day 30. The smallest lesions (350 microm in diameter) were also detected at day 12 on the autoradiographs. There was good correlation between tumor fractions determined from autoradiographic and histological data. CONCLUSION: In vivo, MRI appears to be well suited to the follow-up of liver lesions in a mouse model of neuroendocrine tumor. Preliminary results using 18F-FDG in this animal model are promising, showing differences in FDG uptake.

[Bile duct involvement in autoimmune pancreatitis: classification and treatment]. / Atteinte biliaire au cours d'une pancréatite auto-immune: quel cadre nosologique et quel traitement?

Autoimmune pancreatitis is a rare disease characterized by inflammation of the pancreatic parenchyma, irregular narrowing of the pancreatic duct, periductal lymphoplasmacytic infiltration and fibrosis at histological examination, the presence of autoantibodies and hypergammaglobulinemia, as well as the possible association of cholangitis and other autoimmune diseases. There is a favorable response to steroid therapy. We report the case of a patient with autoimmune pancreatitis with bile duct involvement and peripheral eosinophilia, requiring long-term immunosuppressant treatment. The diagnosis of a diffuse form of AIP was made without direct histological evidence and based on indirect imaging, clinical and laboratory findings in an autoimmune context. The histological and imaging studies of bile duct involvement and the favourable response to steroids were additional arguments.

[Splanchnic vein aneurysms: a report of 13 cases]. / Les anévrismes veineux du réseau splanchnique: à propos de 13 patients.

PURPOSE: Splanchnic vein aneurysms are a rare and poorly known entity. From a review of 13 cases and reports from the literature, we have defined the imaging features and modalities for their diagnosis and management. PATIENTS AND METHODS: Retrospective study of 13 patients (7 females, 6 males, mean age of 53.5 years) who presented between 1993 and 2005 with splanchnic vein aneurysms. All patient charts were reviewed to collect and analyze epidemiological data, underlying etiologies, imaging work-up for diagnosis and management. Aneurysms were defined as fusiform or saccular enlargement of the portal venous vein or its branches, superior mesenteric vein and splenic vein. RESULTS: A total of 16 splanchnic vein aneurysms were identified. Four patients had portal venous hypertension. The imaging work-up was variable and included mainly non-invasive modalities (US: 8 patients; CTA: 8 patients and MRA: 9 patients) and conventional angiography in 2 patients. Eight aneurysms involved the portal vein (50%), 5 the splenic vein (31.3%), and 3 the superior mesenteric vein (18.7%). None of the patients underwent surgical or endovascular management. Imaging follow-up was performed in 12 patients, with no interval change over time with up to 10 years follow-up. CONCLUSION: In our series, the portal vein was most frequently involved. Diagnosis was exclusively based on imaging and management was limited to follow-up.

[Pelvic trauma: impact of iodinated contrast material extravasation at MDCT on patient management]. / Traumatisme pelvien: impact de l'extravasation du produit de contraste iodé au scanner multidétecteur dans la prise en charge thérapeutique.

PURPOSE: To determine the impact of iodinated contrast material extravasation at MDCT in selecting patients with pelvic fractures that require vascular embolization. PATIENTS AND METHODS: All patients with severe pelvic fracture admitted to the trauma unit between 1998 and 2004 underwent contrast enhanced MDCT prior to additional specific treatment. All patients with extravasation underwent immediate vascular embolization for hemodynamic stabilization. Orthopedic management was proposed when no contrast extravasation was demonstrated. The presence or absence of contrast extravasation on MDCT and the hemodynamic status of the patients were recorded. RESULTS: Seventy-four patients with pelvic fracture (mean age: 34 years) underwent contrast enhanced MDCT prior to therapeutic management. Vascular embolization was performed in 42 patients: 38 showed contrast extravasation and 4 were in hemodynamic shock but showed no extravasation. Orthopedic management was performed in 27 patients after negative MDCT and 5 hemodynamically stable patients with positive MDCT. CONCLUSION: In our patient population, the presence of iodinated contrast material extravasation at MDCT was a determinant factor in the selection of patients for vascular embolization.

[Value of double reading of whole body CT in polytrauma patients]. / Intérêt de la double lecture du scanner corps entier dans la prise en charge des polytraumatisés.

PURPOSE: To assess the value of standard double reading of whole body CT in the management of polytrauma patients. MATERIALS AND METHODS: Prospective study between January and July 2005. Two senior radiologists with expertise in trauma imaging, blinded to clinical findings, reviewed 105 initial CT examinations of polytrauma patients. These examinations had initially been interpreted by the on-call radiologist. The second interpretations were performed within 12 hours of admission, and were considered the gold standard. RESULTS: A total of 105 patients were included with 82 males (78%) and 23 females (22%), aged between 2 and 83 years. The level of admission was graded III (n=64), II (n=30) and I (n=11). The second reading identified 3 lesions that were not initially described, each requiring a change in management, including splenic rupture (n=1), thoracic spine fracture (n=1) and epidural hematoma (n=1), with no unfavorable impact on mortality. Additional errors in the initial interpretation were identified: peripheral fractures (n=38), chest (n=36), brain (n=31), abdominal (n=28), spine (n=19) and maxillofacial (17) lesions and contrast extravasation (n=6). CONCLUSION: Based on the large number and severity of some lesions missed at initial interpretation of whole body CT of polytrauma patients, we recommend standard double reading of these examinations.

[Early embolization in the non-operative management of blunt splenic injuries: a retrospective multicenter study]. / L'embolisation précoce dans le traitement non opératoire des traumatismes fermés de la rate. Etude rétrospective multicentrique.

AIM OF THE STUDY: Splenic artery embolization has been used as an adjunct to the non-surgical management of blunt splenic injury. No consensus on its indications has emerged from the literature. This multicentric study aimed to evaluate the results of this technique in France. PATIENTS AND METHODS: Between March 2000 and April 2006, 22 patients older than 15 years of age (mean age 29, range: 15-59) with splenicv rupture due to blunt trauma underwent splenic artery embolization in six Level I Trauma Centers in France. Splenic rupture was classified Moore II in 3 cases, Moore III in 12 cases, and Moore IV in 7 cases. Angiography was performed within 4 hours of admission in half of the cases. The main indications for splenic artery embolization were: extravasation of contrast medium on CT scan (10 cases, 45%); early pseudo-aneurysm (6 cases, 23%); hypotension despite fluid resuscitation and/or progressive need for transfusion (5 cases, 22%). RESULTS: There was no mortality. Nine patients experienced complications (41%) including 6 (27%) who developed left pleural effusion. Two patients eventually underwent splenectomy (one for persistent hemorrhage, one for splenic necrosis). The overall splenic salvage rate was 91%. CONCLUSION: Splenic artery embolization is a valuable techniche that hels to lower the rate of splenectomy for traumatic splenic rupture with relatively low morbidity.

[Value of MRCP with Mangafodipir Trisodium (Teslascan) injection in the diagnosis and management of bile leaks]. / Intérêt de la cholangio-IRM avec perfusion de Mangafodipir Trisodium (Teslascan) dans le diagnostic topographique et la prise en charge des fuites biliaires.

PURPOSE: To assess the value of MRCP with Mangafodipir Trisodium (Teslascan) injection in the diagnosis and management of bile leaks. PATIENTS AND METHODS: Retrospective study of 25 patients (18 males, 7 females) with a mean age of 49.7 years and high clinical suspicion of bile leak who underwent MRCP with Mangafodipir Trisodium (Teslascan) injection between 2002 and 2006. The suspected etiology for bile leak was surgical (n=17), traumatic (n=7) or medical (n=1). The clinical suspicion was based on a combination of clinical, laboratory and imaging findings. RESULTS: MRCP with Teslascan injection demonstrated a bile leak in 20 patients. The site of leak was depicted in 17 cases: second order of smaller bile duct, (n=9), hepatic duct (n=3), confluence (n=2), cystic duct (n=1), bilioenteric anastomosis (n=2). Management based on MR findings included biloma drainage (n=7), biliary drainage (n=5), endoscopic management (n=2), repeat surgery (n=3), expectant management (n=1), and medical management (n=1). Outcome was favourable in 18 cases. Two patients died from infectious complications. CONCLUSION: In addition to confirming a diagnosis of bile leak, MRCP with Teslascan injection depicts the site of leak allowing optimal management.

[Radiological management of vascular lesions secondary to pelvic injuries]. / Prise en charge radiologique des lésions vasculaires secondaires aux traumatismes du bassin.

Pelvic injuries are serious, with mortality higher than 40% if the patient is in shock upon arrival at the hospital. These injuries are generally secondary to traffic accidents with violent kinetics, which explains the frequency of the associated extrapelvic lesions. With the vital prognosis at stake, management of these patients is a true challenge from both the radiographic and emergency care points of view. The objectives of this review are to present the epidemiological and physiological issues involved in pelvic injuries and the place of imaging today, necessarily integrated within a multidisciplinary team associating emergency physicians, surgeons, radiologists, and biologists.

[Von Meyenburg disease found during laparoscopic surgery: report of two cases]. / Maladie des complexes de von Meyenburg (micro-hamartomes biliaires) découverte lors d'une chirurgie laparoscopique: à propos de deux observations.

The authors report two cases of von Meyenburg complexes disease found during laparoscopic surgical procedures. The first patient (41 years old) had multiple gallbladder stones with recurrent hepatic colics. The second patient (45 years old) had gastroesophageal reflux with recurrent peptic esophagitis. In both cases, multiple millimetric and superficial hepatic lesions were found during the exploration of the abdominal cavity. Then, an hepatic biopsy was done because the macroscopic aspect should suspect secondary metastatic lesions. Histological result made the diagnosis of von Meyenburg complexes disease (biliary microhamartomas). It seems to be important to know this anomaly of the ductal plate development and to do a liver biopsy during laparoscopy to affirm the diagnosis and cancel the diagnosis of multiple hepatic metastasis. In fact, this congenital pathology could be associated with increased risk of cholangiocarcinoma of the liver. The modality of radiological monitoring still remains to be defined.

[Asymptomatic or paucisymptomatic CBD dilatation on US after cholecystectomy: management]. / Dilatation a- ou pauci-symptomatique de la voie biliaire principale découverte en échographie chez un(e) patient(e) cholécystectomisé(e). Quelle conduite à tenir?

In western countries, 10-15% of the population has gallbladder stones with 46,000 cholecystectomies performed in France in 2003. So, daily ultrasonography of the abdomen performed in patients without gallbladder is a routine exam. However, identification of an enlarged common bile duct is frequent and the normal nature of this finding remains uncertain. The purpose of this article is to perform a literature review of the impact of cholecystectomy on the diameter of the common bile duct. Furthermore, it is important not to dismiss common bile duct dilatation after cholecystectomy because it may be the result of post operative complication or secondary to a congenital disease of bile duct.

[Magnetic resonance angiography of splanchnic artery aneurysms and pseudoaneurysms]. / Angiographie par résonance magnétique dans les anévrismes et pseudoanévrismes des artères splanchniques.

PURPOSE: To correlate Magnetic resonance angiography (MRA) with computed tomography for the diagnosis of splanchnic artery aneurysms. MATERIALS-METHODS: We retrospectively reviewed the MRA findings of splanchnic arteries performed in 16 patients with known splanchnic aneurysms. Sixteen patients underwent computed tomography (CT), and MRA. Conventional angiogram was performed to confirm the diagnosis in six cases. This study was conducted on a 1.5T MR Symphony system (Siemens, Erlangen, Germany). CE-MRA was performed by using a 3D RF-spoiled FLASH sequence. Acquisition of source images was performed in the coronal plane and reconstructed by means of maximum-intensity projection (MIP) post-processing. RESULTS: Patient population included 7 men and 9 women aged from 31 to 85 years old (mean age 59.5 years old). Splanchnic aneurysms were located as follows: splenic (n=5), hepatic (n=6), celiac trunk (n=4) and gastroduodenal (n=1). In 9 cases, MRA provided results similar to CT. In 3 cases, MRA provided more accurate information on the location of the aneurysm or detected additional aneurysms. In 4 patients, a diagnosis of aneurysm was made first or only made on MRA. CONCLUSION: This small series showed a good correlation between CT and MRA for detection and characterization of splanchnic aneurysms.

Arterial splanchnic aneurysms: Presentation, treatment and outcome in 112 patients.

PURPOSE: The purpose of this study was to identify subgroups with different risks of progression and their appropriate management among the heterogeneous group of 112 patients diagnosed with splanchnic aneurysm. METHODS: Using radiology databases and medical records of our institution (Hospital Édouard-Hérriot, Lyon, France), we undertook a retrospective review of all patients diagnosed with splanchnic artery aneurysms from 1995 to 2011. Cases were analyzed by aneurysm location, etiology and a distinction was also made between true and false aneurysms. RESULTS: False aneurysms were more likely than true aneurysms to be diagnosed as symptomatic and/or ruptured (TA: 50/66 patients asymptomatic vs. FA: 16/46 asymptomatic, P<0.05) with a rupture rate of 59% (27/46) which was unrelated to the size of aneurysms. Percutaneous treatment was carried in the majority of patients with a final success rate of 91%. Peripancreatic true aneurysms were associated in 75% of cases with celiac occlusive disease and diagnosed mostly in symptomatic patients (7/9: 78%) with a rupture rate of 44% unrelated to their size. Radiologic treatment has faced problems due to failure of catheterization and incomplete embolization, although there have been cases in which delayed occlusion was achieved. Common true aneurysms were incidental findings in 87% (57/66) of patients with 3 ruptured aneurysms which were larger than 2 cm. Observation in that group was safe: significant growth was seen only in one patient and the embolization required was successful. Splanchnic false aneurysms and peripancreatic true aneurysms carried a high and an unpredictable risk of rupture that warranted prompt endovascular treatment as soon as possible. CONCLUSIONS: Stratification by localization and by the true or false appearance of the aneurysm was an effective (means of identifying) way to identify subgroups with different risks of progression. False aneurysms and peripancreatic true aneurysms carried a high and unpredictable risk of rupture. The splanchnic aneurysms should have been treated in the case of patients of childbearing age, size ≥ 20 mm, and in the case of liver transplantation. Other splanchnic aneurysms should either have been observed, if smaller than 2 cm. In the absence of rigorous published comparisons, surgical and endovascular methods should have been considered equally suitable in the elective treatment of these patients.

[Out of phase magnetic resonance imaging and liver applications]. / Imagerie par résonance magnétique en opposition de phase et ses applications hépatiques.

The increasing indications for MRI evaluation of diseases of the abdomen, especially liver tumors, has promoted the development of sequences allowing further histological characterization. Out of phase sequences provide suppression of lipids and water signal at the cellular level. Available on all MR imagers, it is the most sensitive sequence to depict small amounts of lipids in the liver. Best applications of this sequence include liver steatosis, tumoral characterization with regards to lipid content (adenoma, hepatocellular carcinoma...) and depiction of tumors in abnormal liver. Performed without contrast injection, and using fast imaging acquisition, we believe that out of phase imaging should be performed for magnetic resonance imaging of the liver.

[Value of contrast-enhanced MR enterography in pediatric Crohn's disease: preliminary study]. / Valeur de l'entéro-IRM avec injection de gadolinium dans la maladie de Crohn en pédiatrie: étude préliminaire.

OBJECTIVE: Feasibility study of contrast enhanced MR enterography without enteroclysis as a new diagnostic tool for children with known or suspected Crohn's disease. METHODS: We prospectively included 15 children, 8-18 years old, with clinical suspicion of Crohn's disease. MR enterography without enteroclysis was performed on a 1,5 T clinical MR system. A total of 1000 ml of mannitol 5% was orally administered 60 minutes prior to MRI. Coronal and axial breath-hold sequences were acquired. The following sequences were obtained: True-FISP, FLASH T1 2D/3D with Fat saturation before and after gadolinium injection. Two radiologists, blinded to patient information, independently reviewed all examinations to record image quality, the degree of distension of the distal ileum, the presence of abnormal bowel segments and the presence of extra-intestinal complications. MRI findings were correlated to sonographic, endoscopic and biological results (sensitivity, specificity, Kappa test). RESULTS: The examinations were considered of satisfactory diagnostic quality in 93.3% of patients. Respiratory artifacts were present in one case. The entire GI tract could be identified on all sequences. Distention of the distal ileum was recorded as good to excellent in 89% of healthy subjects. Five MR examinations were considered abnormal with isolated ileal involvement in 2 cases, ileocolic involvement in 2 cases, and isolated colonic involvement in 1 case. The sensitivity and specificity of MR for the positive diagnosis of Crohn's disease were 100% and 83% respectively. Three extra-intestinal complications were detected: one case of ileo-ileal fistula, not identified on ultrasonography, an asymptomatic anal fistula and a symptomatic inflammatory stricture. CONCLUSION: MR enterography without enteroclysis is a well tolerated, effective non invasive method in the evaluation of known or suspected Crohn's disease. Because of the absence of ionizing radiation, MR enterography should become the gold standard in pediatric patients.