Primary lower limb lymphoedema: classification with non-contrast MR lymphography.

PURPOSE: The purpose of the present study was to analyse the performance of non-contrast MR lymphography for the classification of primary lower limb lymphoedema in 121 consecutive patients with 187 primary lower limb lymphoedemas. MATERIALS AND METHODS: 121 consecutive patients with clinically diagnosed primary lower limb lymphoedema underwent non-contrast MR lymphography with a free-breathing 3D fast spin-echo sequence with a very long TR/TE (4000/884 ms). MR examinations were retrospectively reviewed for severity of lymphoedema (absent, mild, moderate, severe) and characteristics of inguinal lymph nodes and iliac and inguinal lymphatic trunks graded as aplasic (no lymph nodes or lymphatic trunks), hypoplasic (less lymph nodes or lymphatic trunks), normal and hyperplasic (more lymph nodes or more and/or dilated trunks). RESULTS: There was an excellent correlation between clinical stage and severity of lymphoedema (Cramer's V of 0,73 (p < 0.001)). Differentiation was feasible between inguinal lymphatic vessel aplasia (21%), hypoplasia (15%), normal pattern (53%) and hyperplasia (11%). Severe lymphoedema was observed in 46% of aplasic patterns and in 37% of hyperplasic patterns, but in only 15% of hypoplasic patterns and never observed in normal patterns (p < 0.001). CONCLUSION: Non-contrast MR lymphography is able to classify primary lower limb lymphoedemas into hyperplasic, aplasic, hypoplasic and normal patterns. KEY POINTS: • Non-contrast MR lymphography is able to classify primary lower limb lymphoedemas. • Lymphoedema can be classified in hyperplasic, aplasic, hypoplasic and normal patterns. • Non-contrast MR lymphography can optimize clinical management of primary lower limb lymphoedemas.

[Diffusion-weighted MR imaging of liver pathology: principles and clinical applications]. / Imagerie par résonance magnétique de diffusion (IRMD) en pathologie hépatique: principe et applications cliniques.

Due to ongoing technological advances, the range of clinical applications for diffusion-weighted MR imaging has expanded to now include abdominal pathology. Current applications for liver pathology include two main directions. First, oncologic imaging with detection, characterization and follow-up of lesions. Second, evaluation of diffuse liver diseases, including hepatic fibrosis. The diagnostic impact and role of diffusion-weighted MR imaging remain under investigation, but appear promising. Because of its short acquisition time, sensitivity, and additional information it provides, diffusion-weighted MR imaging should be included in routine liver imaging protocols.

[Imaging of incidental cystic lesions of the pancreas]. / Imagerie des lésions kystiques du pancréas de découverte fortuite.

Cystic lesions of the pancreas, with an estimated prevalence of 20%, frequently are incidental findings at imaging on asymptomatic patients. Pseudocysts, typically in a setting of pancreatitis, should first be excluded. Characterization of cystic tumors is more complicated. Still, it is important to differentiate between benign and malignant lesions. Multi-detector row CT and MRI allow characterization of such lesions in over 75% of cases. Indeterminate lesions should undergo endoscopic US with biopsy/aspiration and fluid analysis, especially for mucin producing tumors (rounded with thick enhancing wall). When imaging fails to fully characterize a lesion, follow-up may be proposed for lesions less than 3 cm in size, that are either unilocular with thin nonenhancing wall (simple cyst) or lobulated multilocular with thin nonenhancing wall (serous cystadenoma, isolated side branch IPMTP). Follow-up imaging shows that these tumors usually show very little change over time. Management is based on comparing estimated patient survival without treatment to surgical risks (morbidity, mortality, functional sequelae from the procedure).

MR lymphography of abdominal and retroperitoneal lymphatic vessels.

OBJECTIVE: The abdominal and retroperitoneal lymphatic system is characterized by numerous anatomic variations. Our objective is to review MR lymphographic features of normal anatomy and abnormal conditions. CONCLUSION: MR lymphography is a noninvasive technique that is well suited for the examination of abdominal and retroperitoneal lymphatic vessels.

[Imaging of thoracic pathology in patients with AIDS]. / Imagerie des pathologies thoraciques chez le patient VIH au stade sida.

The imaging features of infectious and non-infectious pathologies in HIV patients with AIDS (less than 200 CD4/mm3) are illustrated. Opportunistic infections, tumors and vascular pathologies have variable appearances based on the degree of immunosuppression and patient compliance with opportunistic infection prophylaxis. Because of advances in retroviral treatments and wider use of anti-infectious prophylaxis, thoracic pathologies in AIDS patients are less frequent but must nonetheless be recognized, and diagnosis should be suggested in patients with unknown serologic status.

[Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography]. / Utilisation du jus d'ananas en tant qu'agent de contraste négatif en cholangiopancréatographie par résonance magnétique*

PURPOSE: The quality of magnetic resonance cholangiopancreatography (MRCP) images is frequently degraded by high signal from the gastrointestinal tract on heavily T2W images. The purpose of this study is to evaluate pineapple juice (PJ) as an oral negative contrast agent in MRCP. MATERIALS AND METHODS: Results from MRCP in 50 patients with PJ and 50 patients with paramagnetic contrast (ferumoxsil-Lumirem) were compared. Reviewers were blinded to the type of contrast agent. Exam quality was recorded with regards to signal suppression in the stomach, duodenum and proximal small bowel and with regards to pancreatic duct and biliary ducts visualization. In vitro, the signal characteristics of several commercially available brands of PJ were assessed using T1W, T2W and MRCP sequences. Signal intensity was correlated with the manganese concentration measured using atomic absorption spectrometry. Finally, the reviewers compared the taste of PJ and ferumoxsil. RESULTS: On MRCP sequences, results were similar with regards to signal suppression in the stomach, duodenum and proximal small bowel with PJ and ferumoxsil. Visualization of the pancreatic duct, intrahgepatic bile ducts and CBD was similar with PJ and ferumoxsil. The signal intensity of commercially available brands of PJ on T2W and MRCP sequences correlated well with the measured manganese concentration on spectroscopy. Variations in manganese concentration were observed, with values ranging from 3.65 to 27.24 mg/L. The reviewers noted that PJ tasted "good" or "very good" and that ferumoxsil tasted "bad" or "very bad". CONCLUSION: Ingestion of PJ provides effective signal suppression in the GI tract on MRCP, similar to paramagnetic contrast agents. Because manganese concentration is highly variable in commercially available PJ brands, a brand with high manganese concentration should be selected.

Computer-aided diagnosis for interstitial infiltrates in chest radiographs: optical-density dependence of texture measures.

We have been developing a computerized scheme for automated detection and characterization of interstitial infiltrates based on the Fourier transform of lung texture. To improve the performance of the scheme, which was developed using digitized screen-film radiographs, optical-density dependence of both the gradient of the film used and the system noise associated with the laser scanner were investigated. Two hundred chest radiographs, including 100 abnormal cases with interstitial infiltrates, were digitized using a laser scanner. The root-mean-square (RMS) variations and the first moments of the power spectra, which correspond to the magnitude and coarseness of lung texture, were determined by Fourier transform of lung textures in numerous regions of interest (ROIs). The RMS variation was dependent upon the average optical density in the ROI, though no obvious trend existed for the first moment of the power spectrum. Dependence of the RMS variations on optical density was corrected for using the gradient curve of the film. Also, system noise associated with the laser scanner was corrected. Results indicated that the specificity was improved from 81% (without correction) to 89% (with corrections), without any loss of sensitivity (90%). Thus, the correspondence between the computer output and consensus interpretation of radiologists was improved with the new scheme compared to the previous one. This improved computerized scheme may be useful to radiologists in detecting interstitial infiltrates in chest radiographs.

Computerized analysis of interstitial infiltrates on chest radiographs: a new scheme based on geometric pattern features and Fourier analysis.

RATIONALE AND OBJECTIVES: Detection of interstitial infiltrates on chest radiographs is difficult and subjective. Therefore, we developed a computerized method to provide quantitative analysis of lung texture to increase diagnostic accuracy. METHODS: Two hundred chest radiographs--100 healthy and 100 abnormal with interstitial infiltrates--were digitized using a laser scanner. They were analyzed by an automated computerized scheme that uses a combination of two methods for detection of interstitial infiltrates: a lung texture analysis based on the Fourier transform and a geometric pattern feature analysis based on filtering techniques. RESULTS: The overall sensitivity and specificity of the computerized scheme were 92% and 90%, respectively. The scheme achieved a sensitivity of 80% in subtle cases (n = 15) and 88% in cases with localized interstitial disease (n = 26), whereas the specificity remained unchanged. There was good correlation between the computer output and the radiologists' severity rating. CONCLUSION: This enhanced computerized scheme exhibits high sensitivity and specificity with a large database.

[Post-traumatic intramural hematoma of the colon]. / Hématome intramural colique post-traumatique.

Intramural hematoma of the colon is a rare complication of blunt abdominal trauma. We report the case of a 32-year-old man who presented with abdominal pain related to blunt trauma. The initial diagnosis of post-traumatic intramural hematoma of the colon was performed at CT scan and proven at colonoscopy. Although the majority of cases warrant surgery, conservative therapy was proposed in the present case with spontaneous resolution of the hematoma demonstrated by CT scan.

[Spontaneous pulmonary hernia and Recklinghausen disease]. / Hernie pulmonaire spontanée et maladie de Recklinghausen.

The pulmonary hernia is a rare entity defined by protrusion of pulmonary tissue through an abnormal weakness of the thoracic wall. We describe a case of spontaneous pulmonary hernia associated with osseous sternocostal abnormalities in a patient with a Recklinghausen disease.

[Publication rate of original papers orally presented at the Journées Françaises de Radiologie 1996]. / Taux de publication des travaux originaux présentés oralement lors des Journées Françaises de Radiologie 1996.

OBJECTIVE: The purpose of the present study was to determine the publication rate in Medline-indexed journals of papers originally presented at the Journées Françaises de Radiologie (JFR96). MATERIALS AND METHODS: Proceedings from the JFR 96 were reviewed by two observers in conference. A Medline search encompassing 1997-1999 was performed for the lead author of all abstracts of original papers. Publication year and the journal of publication were recorded. RESULTS: 456 oral presentations were analysed, 39 papers were subsequently published corresponding to a publication rate of 8.5%. 10 papers were published in Radiology, 4 in European Radiology and 4 in the Journal de Radiologie, the other 21 in other journals. Publication rate was significantly higher for two sessions: Research session (publication rate was 22%) and Bone and Joint session (publication rate was 16%). CONCLUSION: Less than 10% of abstracts presented at JFR 96 were subsequently published in Medline-indexed journals. This rate is lower than the publication rate of papers presented at other medical meetings.

[Spontaneous resolution of asymptomatic false aneurysm of the pulmonary artery induced by Swan-Ganz catheter]. / Résolution spontanée d'un faux anévrisme asymptomatique de l'artère pulmonaire induit par sonde de Swan-Ganz.

A pulmonary artery pseudoaneurysm developed after placement of a Swan-Ganz catheter for liver surgery is described. This observation is unusual for two reasons. Pulmonary artery pseudoaneurysm was discovered on a simple post-operative chest radiograph. Spontaneous thrombosis and radiographic regression were observed.

[Imaging of primary hepatic pheochromocytoma]. / Imagerie d'un phéochromocytome hépatique primitif.

Extra-adrenal pheochromocytoma are extremely uncommon tumors. They demonstrate abdominal (97% of the cases), thoracic, vesical or cervical localizations. We report the case of a hepatic pheochromocytoma in a young patient with a post history of labile arterial hypertension. Ultrasonography, computed tomography and magnetic resonance imaging features were similar to those of adrenal pheochromocytoma. The presence of neuroendocrine cells was supported by immunohistochemical criteria. Histological observation showed a lack of local extension. In addition, four years after surgery, there was no apparent clinical syndrome suggesting tumor recurrence or metastasis occurrence. These observations supports the diagnosis of non malignant, primary hepatic pheochromocytoma. To our knowledge, this is the first radiologic description of this kind of tumor.

[Imaging of peritoneal mesotheliomas]. / Imagerie des mésothéliomes péritonéaux.

Peritoneal mesothelioma is a rare, either benign or malignant tumor of the peritoneum. We retrospectively analyzed the imaging features of six malignant and three benign peritoneal mesothelioma. Asbestos exposure was proven in three of the six malignant cases and in none of the three benign cases. Ascites was found in seven patients (78%), peritoneal masses in eight patients (88%), small peritoneal nodules in six patients (66%), parietal peritoneal thickening in six patients (66%), thickened mesentery in five patients (55%) and pleural plaques as well as nodules in one patient. These imaging features support the diagnosis of peritoneal mesothelioma but do not allow differentiation between benign and malignant forms of peritoneal mesothelioma.

[Thrombosis of the renal vein and hemorrhagic rectocolitis]. / Thrombose de la veine rénale et rectocolite hémorragique.

Renal vein thrombosis was observed in a patient with acute ulcerative colitis complicated by retroperitoneal perforation. Retroperitoneal inflammation related to colonic perforation may constitute a predisposing factor for local thrombosis in combination with coagulation disorders (protein S deficiency).

[Gastric stenosis as a complication of Nissen laparoscopic fundoplication]. / Sténose gastrique compliquant une fundorlicature selon Nissen par voie laparoscopique.

An uncommon complication of laparoscopic Nissen fundoplication is reported. Suture of the anterior Nissen wrap to the junction of upper and lesser parts of the greater curvature resulted in plication and mediogastric stenosis demonstrated at barium meal.

[Imaging of a case of wirsungorrhagia]. / Imagerie d'une wirsungorragie.

We report a case of wirsungorrhagia related to rupture of a pseudoaneurysm into the duct of Wirsung in a patient with chronic pancreatitis. Upper gastrointestinal endoscopy showed blood coming from the papilla of Vater suggesting wirsungorrhagia. Non-contrast computed tomography showed a spontaneous hyperdensity and arteriography showed an extravasation of contrast within a very large duct of Wirsung confirming wirsungorrhagia. Arteriography and dynamic computed tomography revealed a pseudoaneurysm from the left gastric artery. The pseudoaneurysm was successfully embolized with four steel microcoils, after super-selective catheterization of small branch of the left gastric artery, keeping gastric and liver vascularization.

[Imaging of symptomatic giant hemangioma]. / Imagerie d'un angiome géant symptomatique.

A case of symptomatic giant hemangioma of the liver with fever, anemia, and increased erythrocyte sedimentation rate is reported. Spontaneous hyperdense areas at CT, and high signal-intensity areas at T1-weighted MR images were demonstrated within the hemangioma. Marked hemorrhagic zones demonstrated at pathologic examination may explain these uncommon clinical and imaging features.

[Giant hepatic hemangioma causing dilatation of the intrahepatic biliary ducts]. / Hémangiome hépatique géant responsable d'une dilatation des voies biliaires intrahépatiques.

Giant hepatic hemangiomas are rare entities. They can be symptomatic with pain and increased erythrocyte sedimentation rate. Cholestasis has already been reported. We describe a case of biliary dilatation secondary to a hemorrhagic giant hepatic hemangioma documented on CT and MRI.