[Radiofrequency ablation for palliation of soft tissue tumor pain]. / La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles.

PURPOSE: To assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain. MATERIALS AND METHODS: Retrospective study of 12 patients receiving palliative treatment for soft tissue tumors (5 primary tumors including 4 sarcomas and 1 PEComa and 7 metastatic tumors) with pain refractory to standard management. RF ablation was performed under CT or ultrasound guidance. RESULTS: The efficacy was determined by using pain scores and treatment regimen modifications after RF ablation. Response was graded as absent, partial or complete. Short term symptomatic relief was observed in 100% of cases, with complete response in 43% of cases ; Mid term and long term symptomatic relief was observed in 70% and 83% of cases respectively. We also observed dosage reduction for narcotics with corresponding reduction in related side-effects and functional improvement in some patients. A single case of complication with serosanguinous collection within a region of necrosis was observed. CONCLUSION: Radiofrequency ablation for palliation of soft tissue tumor pain may be a useful complement to standard management. It results in symptomatic improvement with few complications.

[Single shot fast spin echo sequence MRI cholangiopancreatography]. / Cholangio-pancréatographie IRM en séquence single shot fast spin echo.

PURPOSE: To assess the value of single shot fast spin echo MR sequence (SS-FSE) in the morphological analysis of the biliary tree and pancreatic ducts and to compare its accuracy with other imaging methods. MATERIAL AND METHODS: 95 consecutive patients referred for clinical and/or biological suspicion of biliary obstruction were explored with MR cholangiopancreatography (MRCP). All patients were explored with a Signa 1.5 T GE MR unit, with High Gradient Field Strength and Torso Phased Array Coil. Biliary ducts were explored with SS-FSE sequence, coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Total acquisition time was 1 second. Native pictures were reviewed by two radiologists blinded to clinical information. In case of disagreement, a third radiologist's judgement was requested. In 88 cases, MRCP results were compared with direct biligraphy methods. RESULTS: In all cases, MRCP produced high quality images without MIP or other post-processing methods. For detection of biliary tree distensions, the concordance value of MRCP was over 91% (Kappa 0.82). For detection of biliary tree and/or pancreatic duct obstruction, MR sensitivity was 100% and specificity 91%. The overall diagnostic concordance value of MRCP was > or = 93%. Difficulties in MRCP were caused by functional diseases or benign stenosis. MRCP accurately diagnosed all lithiasic obstructions starting from a stone size of 3 mm. CONCLUSION: MRCP produces fastly high-quality images. As it is totally safe, it can be proposed as a first intention method in biliopancreatic duct explorations.

[Radiologic aspects of endoscopic sphincterotomy complications]. / Aspects radiologiques des complications des sphinctérotomies endoscopiques.

Endoscopic sphincterotomy (ES) is a minimally invasive technique which is the standard of reference in many clinical situations (e.g distal choledocolithiasis, recurrent lithiasis or bile duct stenosis). Complication are rare but are often misdiagnosed although radiological aspects are demonstrative. The purpose of this study is to illustrate the patterns of the complications. Ten patients have been treated for the last four years in our institution for ES complications. There were eight cases of pancreatitis, three of which had associated perforation, one arterioportal fistula, and one isolated perforation. Diagnosis was reached with CT in all but one case. Two patients have been successfully treated with percutaneous treatment (one embolization with Gianturco coils, and one drainage). Two patients died, one of necrotizing pancreatitis and the second of decubitus complication. The other patient were followed with CT. We give exemples of different observations and discuss their follow up. The severity and extent of post ES pancreatitis were readily assessed by CT and response to therapy monitored by serial examinations. Severity of disease, evaluated according to the length of hospitalization, correlated well with the presence and degree of pancreatic necrosis. CT also highlights perforations including minimal effusions. In our study differential diagnosis between post ES pancreatitis and perforation is not significant regarding the initial conservative therapy in both situations. CT scan helps us to opt for a surgical decision or for a percutaneous drainage. It also permits to follow the evolution of the lesions. In our cases involving perforations, we noted a spontaneous complete resolution of gas effusion on control and we also observed that pancreatitis evolution was similar to standard pancreatitis evolution. In a life threatening post ES hemobilia, not responding to standard medical treatment, angiography is the diagnostic exam of choice before embolization which is regarded as the best initial treatment of vascular lesions. We conclude that CT is the exam of choice in the initial diagnosis and follow up post ES complications.

[Selective arteriography of the supra-aortic trunks by right humeral approach with a 4F catheter]. / Artériographie sélective des troncs supra-aortiques par voie humérale droite avec un cathéter 4F.

Three hundred and sixty seven patients were studied for cerebrovascular disease with intra-arterial digital subtraction. Examination were performed using a right transbrachial approach with a 4F catheter. Selective catheterization of the carotid arteries was possible in 98% for the left and 99% for the right. Image quality was consistently good or excellent. There was 2 neurologic complications and 1 local complication (hematoma) requiring surgery few weeks later. Selective carotid and vertebral catheterizations by the brachial route is safe, simple, accurate and rapid (15 mn) and can be employed in outpatients.

[Imaging of severe forms of hematoma in the rectus abdominis under anticoagulants]. / Imagerie des formes graves de l'hématome des grands-droits sous anticoagulants.

AIM: To describe the US, CT and MRI pattern of the severe rectus sheath hematoma (RSH) complicating anticoagulant therapy. MATERIALS AND METHODS: CT scans were performed in thirteen patients (12 women, 1 man) aged from 53 to 90 (mean age, 74) with severe RSH. Five patients also underwent ultrasound examination and three MR examination. Nine patients (69%) were receiving subcutaneous injection of heparin, three (23%) oral anticoagulant therapy and one continuous IV infusion of heparin. Clinical diagnosis was reached in 6 cases. Excessive activity of anticoagulant therapy was noted in 4 cases. The location of the RSH, their densities and their signal were analysed. RESULTS: All the RSH were mostly developed in the lower third of the abdominal wall, had a large spreading into the Retzius space and compressed the bladder and/or the bowels. RSH were all hyperdense and in 8 cases (61%) a fluid-fluid level due to the hematocrit effect was noted. In one case, a retroperitoneal hematoma was discovered. The extension of the RSH was well delineated with MRI. The RSH showed itself with heterogeneous signal intensities with areas of high-signal-intensity on T1-weighted images. Fluid-fluid levels and a concentric ring sign were also noted. CONCLUSION: Older women with subcutaneous injection of heparin are especially prone to RSH even though there is no overall excessive activity of anticoagulant therapy. Clinical and biological diagnosis may be difficult. CT scan is the exam of choice to reach a precise and acute diagnosis of RSH.

[Comparative value of MR-angiography, helical CT and digital angiography in the preoperative assessment of abdominal aortic aneurysms]. / Valeur comparative de l'angio-IRM, du scanner hélicoïdal et de l'angiographie numérisée dans le bilan préopératoire des anévrismes de l'aorte abdominale.

PURPOSE: To compare helical CT with MR angiography in pre-operative assessment of abdominal aortic aneurysm (AAA). MATERIAL AND METHODS: Twenty patients with AAA underwent helical-CT, MR-angiography and digital angiography. All exams were interpreted independently by two groups of observers. Kappa and rho were calculated to assess correlations. Sensitivity and specificity were calculated to compare each method with the "gold standard" digital angiography. RESULTS: Inter-observer correlation was excellent. There was a very good agreement between both methods in the assessment of the maximal diameter and the proximal neck of the aneurysm. There was no significant difference in the assessment of stenoses of the visceral and iliac arteries, the number of renal arteries, and iliac extension. CONCLUSION: Helical CT and MR angiography are equivalent in pre-operative assessment of AAA.

[Computed tomography study of the sigmoid colon: discriminating diagnostic criteria and interobserver correlations]. / Exploration tomodensitométrique du côlon sigmoïde: critères diagnostiques discriminants et corrélations interobservateurs.

PURPOSE: To assess the value of pericolonic findings at CT in the evaluation of the sigmoid colon. MATERIALS AND METHODS: A total of 210 CT examinations were retrospectively reviewed by 3 blinded radiologists. Data was analyzed to determine the interobserver correlation and the value of pericolonic and colonic wall findings in diagnosis of sigmoid colon pathology. RESULTS: The interobserver correlation for pericolonic findings was equal to or superior to that for colonic wall findings. The presence of abnormal pericolonic fat was the most sensitive (88%) and specific (93%) sign to differentiate a diseased sigmoid colon from a normal one or from sigmoid diverticulosis. Wall-thickening was less sensitive (82%) and specific (76%). Findings suggesting malignancy over diverticulitis included acute zone of transition, focal fatty infiltration, and lymph nodes. Symmetrical and circumferential wall thickening, target-like enhancement, and local fatty proliferation were findings suggesting colitis over diverticulitis. Wall thickening more than 15 mm, involvement of 15 cm or less, asymmetrical involvement, acute zone of transition, and homogeneous or heterogeneous enhancement were findings suggesting malignancy over colitis. CONCLUSION: To render a diagnosis, the evaluation of the fat infiltration must prevail on the parietal thickening appreciation.

[Imaging of the intrahepatic biliary tree with thick slice MR cholangiography]. / Imagerie des voies biliaires intrahépatiques en cholangiographie-IRM en coupes épaisses.

PURPOSE: To assess the value of single shot fast spin echo MR sequence (SS-FSE) in the evaluation of the normal and pathologic intrahepatic biliary tree. MATERIAL AND METHODS: 418 consecutive patients (457 examinations) referred for clinical and/or biological suspicion of biliary obstruction underwent MR cholangiopancreatography (MRCP). All patients were imaged with a Signa 1.5 T GE MR unit, with High Gradient Field Strength and Torso Phased Array Coil. Biliary ducts were imaged with SS-FSE sequence, coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Total acquisition time was 1 second. Source images were reviewed by two radiologists blinded to clinical information. In case of disagreement, a third radiologist's opinion was requested. In all cases, MRCP results were compared with direct biliary tract evaluation, other imaging studies and clinical and biological follow-up. RESULTS: In all cases, MRCP produced high quality images. Numerous branch of division were observed although the peripheral intrahepatic ducts were well seen in more than 90% in an area 2 cm below the capsule. The number of division was statistically higher when mechanical obstruction was present. Intrahepatic calculi or peripheral cholangiocarcinoma were well detect by MRCP. For the detection of cholangitis, MRCP sensitivity was 87.5% but the positive predictive value was only 57.7% because of a high number of false positive. The diagnosis of primary sclerosing cholangitis must be made only on strict criteria and slightly dilated peripheral bile ducts unconnected to the central ducts in several hepatic segments were a characteristic MR sign of primary sclerosing cholangitis. CONCLUSION: MRCP can be proposed as a first intention imaging technique for the evaluation of intrahepatic ducts.