[Contrast-enhanced ultrasound and liver imaging: review of the literature]. / Performance de l'échographie de contraste en pathologie hépatique: synthèse de la littérature.

The advent of second-generation microbubble ultrasound contrast agents and the development of contrast specific ultrasound techniques improved the ability of contrast enhanced ultrasound (CEUS) in detecting and characterizing focal liver lesions, opening new prospects in liver imaging. A Medline search in June 2008 identified 72 published studies that used CEUS in focal liver lesion detection, characterization, and follow-up to monitor tumor ablation procedures and antiangiogenic treatment. The purpose of this paper, based on literature review, is to describe the technical recommendations when using CEUS for liver imaging and to define the different vascular patterns of the most relevant benign and malignant lesions. Diagnostic performance of CEUS and the important clinical indications are also presented and discussed. CEUS is increasingly accepted in clinical use for diagnostic imaging and post-interventional workup liver imaging. It may replace many computed tomography and magnetic resonance imaging examinations in the near future, according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines.

[Real-time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study]. / Echographie de contraste temps réel dans la prise en charge diagnostique des lésions nodulaires hépatiques: évaluation des performances diagnostiques et de l'impact économique sur une étude multicentrique française.

The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

Imaging techniques to evaluate the response to treatment in oncology: current standards and perspectives.

Response evaluation in solid tumours currently uses radiological imaging techniques to measure changes under treatment. Imaging requires a well-defined anatomical lesion to be viewed and relies on the measurement of a reduction in tumour size during treatment as the basis for presumed clinical benefit. However, with the development of anti-angiogenesis agents, anatomical imaging has became inappropriate as certain tumours would not reduce in size. Functional studies are therefore necessary and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), DCE-computed tomography (CT) and DCE-ultrasonography (US) are currently being evaluated for monitoring treatments. Diffusion-weighted MR imaging (DW-MRI) and magnetic resonance spectroscopy (MRS) are also capable of detecting changes in cell density and metabolite content within tumours. In this article, we review anatomical and functional criteria currently used for monitoring therapy. We review the published data on DCE-MRI, DCE-CT, DCE-US, DW-MRI and MRS. This literature review covers the following area: basic principles of the technique, clinical studies, reproducibility and repeatability, limits and perspectives in monitoring therapy. Anatomical criteria such as response evaluation criteria in solid tumours (RECIST) will require adaptation to employ not only new tools but also different complementary techniques such as functional imaging in order to monitor therapeutic effects of conventional and new anti-cancer agents.

Advances in radiological imaging of gastrointestinal tumors.

This article summarizes the recent advances in radiological imaging in the hepatogastrointestinal field in terms of detection, characterization and staging of tumors. Introduction of multidetector row computed tomography technology has helped computed tomography to excel in its already established indications, and has expanded its capabilities by adding new clinical applications, such as computed tomography angiography, liver perfusion, computed tomography enterography or enteroclysis, and virtual colonoscopy. Contrast-enhanced ultrasound has dramatically changed the role of ultrasound in liver tumor characterization, detection, and other applications. Combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging of the gastrointestinal tract has become increasingly used clinically. Moreover, substantial progress in molecular and cellular magnetic resonance imaging has been achieved in the past few years. Particularly, the increasing number of available specific contrast agents dedicated to the evaluation of the liver and lymph nodes shows promises in the area of oncologic abdominal imaging.

[Endometriomas of the abdominal wall: Imaging findings]. / Endométriomes de la paroi abdominale: apport de l'imagerie.

Endometrioma of the abdominal wall is a not well-recognized disease and usually develops after pelvic surgery. The most common presentation is a mass of the abdominal wall associated with pain during menstruation. We report six cases of parietal endometriomas studied with ultrasonography, CT, and in one case with MRI. Our results are compared with recent findings in the literature. The purpose of this study was to describe the clinical and imaging findings in abdominal wall endometriomas that can help reach a presurgical diagnosis.

Surgical anatomy and embryology of the adrenal glands.

Gross anatomy explains the different surgical approaches to adrenalectomy and the difficulties encountered by surgeons during this procedure. Development of the adrenal glands explains the location of the ectopic sites and excess hormone production by adrenal tumors. The choice of a surgical approach is sometimes difficult and is dependent on (1) the morphology of the body; (2) the volume of the tumor, which necessitates immediate vascular control; and (3) the type of disease, which may necessitate a complete exploration of the abdominal cavity.

Carotid arterial stenosis: evaluation at CT angiography with the volume-rendering technique.

PURPOSE: To determine whether computed tomographic (CT) angiography with the volume-rendering technique (VRT) can be used to accurately quantify carotid arterial stenosis and to identify occlusions. MATERIALS AND METHODS: Spiral CT was performed in 23 patients who were referred for carotid stenosis evaluation. VRT images and shaded-surface display (SSD) images of 46 carotid arterial bifurcations were compared with findings from digital subtraction angiography (DSA). RESULTS: Agreement on stenosis category between VRT CT angiography and DSA was found in 39 (85%) of the 46 carotid arteries studied. VRT CT angiography was 92% (49 of 53) sensitive and 96% (82 of 85) specific for the detection of grade 2-3 stenoses (> or = 70% stenosis). Agreement on stenosis category between SSD CT angiography and DSA was found in 38 (83%) of the 46 carotid arteries studied. SSD CT angiography was 91% (48 of 53) sensitive and 93% (79 of 85) specific for the detection of grade 2-3 stenoses. Calcified stenoses were correctly graded at VRT CT angiography in 10 of the 10 cases with heavy mural calcified plaques, while eight of the 10 stenoses were accurately quantified at SSD CT angiography. CONCLUSION: These results indicate that VRT CT angiography is as accurate as SSD CT angiography in the evaluation of carotid arterial bifurcations.

Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases.

The authors report 17 cases of a right non-recurrent inferior laryngeal n. (NRILN) observed during 15 years of practice of thyroid and parathyroid surgery. In their last two cases, the existence of an aberrant right subclavian a., constantly associated with NRILN, was confirmed by MRI angiography. On the basis of the literature and their own experience, the authors review the incidence of this double anomaly, its embryologic explanation and its anatomic and surgical importance. They stress the diagnostic factors and the therapeutic implications, very different in children and adults, of a particular vascular anomaly whose outcome is little understood.

[Volume rendering technique in 3D vascular imaging]. / Apport de la technique de rendu de volume en imagerie 3D vasculaire.

We used volume rendering technique (VRT) for generating three-dimensional (3D) images of the vasculature from spiral computed tomography (CT) data sets. This paper describes the methods used for volume rendering and focuses on the specific aspects of volume rendering as applied to vascular imaging.

MR imaging of osteomyelitis and neuropathic osteoarthropathy in the feet of diabetics.

Distinguishing between osteomyelitis and neuropathic osteoarthropathy of the foot frequently presents a clinical and radiologic challenge in patients with diabetes. Magnetic resonance (MR) imaging was performed in 26 diabetic patients to observe changes in signal intensity in the complicated diabetic foot. In every patient with osteomyelitis (n = 13), signal intensity abnormalities were seen within the bone marrow (low signal intensity on T1-weighted images and high signal intensity on T2-weighted images in 12 cases). Most of these patients had cortical lesions (n = 9) or associated soft-tissue infection (n = 12). Normal bone marrow signal intensity was observed in three of the four patients without osteomyelitis. Characteristic MR imaging findings (decreased signal intensity in bone marrow regardless of pulse sequence) were seen in patients with chronic neuropathic osteoarthropathy (n = 7), who were easily distinguished from patients with osteomyelitis. Conversely, in patients with acutely evolving neuropathic osteoarthropathy (n = 2), signal intensity changes within the bone marrow were similar to those observed in osteomyelitis, leading to potential diagnostic pitfalls. Familiarity with MR imaging findings observed in osteomyelitis and neuropathic osteoarthropathy can help identify these two entities, allowing early diagnosis and appropriate therapy.

[Mycotic aneurysm of the posterior tibial artery and pseudo-phlebitis: contribution of color Doppler ultrasonography]. / Anévrisme mycotique de l'artère tibiale postérieure et pseudophlébite: apport de l'échographie Doppler couleur.

Mycotic aneurysm of the posterior tibial artery and pseudophlebitis: role of color Doppler sonography A case of a 78-year-old male patient presenting with endocarditis caused by Streptococcus bovis and pseudophlebitis of the left lower limb is described. Color Doppler sonography ruled out thrombophlebitis and showed a large pulsatile mass of the posterior compartment of the leg due to a mycotic aneurysm of the posterior tibial artery. This aneurysm was confirmed by angiography and treated by surgery. The important role of color Doppler sonography for the diagnosis of this particular case is emphasized.