RESUMEN
Adenomyosis is frequent, mostly asymptomatic. A hypertrophy of the smooth muscular cells around ectopic endometrial glands might induce a compressive syndrome. We report the case of an embolization of a voluminous adenomyosic uterus which has triggered venous iliac's compression in patient refusing surgery. This treatment was efficient in reduction of uterin volume, without recurrence after three years. MR imaging is the exam of choice particularly when diagnosis is still uncertain and allows a non-invasive and good evaluation, and follow-up. Embolization is not actually recommended. But, it appears to be efficient, relatively safe and contributes to the conservation of fertility.
Asunto(s)
Adenomiosis/terapia , Adenomiosis/complicaciones , Adenomiosis/patología , Adulto , Embolización Terapéutica , Femenino , Humanos , Vena Ilíaca/patología , Imagen por Resonancia MagnéticaRESUMEN
PURPOSE: To assess the technical success, clinical success and complications after 1 month of percutaneous biliary drainage with the placement of several metallic endoprostheses in complex hilar liver tumours. MATERIALS AND METHODS: This is a retrospective study, on a homogenous target population of 68 consecutive patients, who underwent multiple percutaneous biliary drainage for complex hilar tumour (Bismuth type II, III and IV) between August 1998 and August 2010. Patients benefiting from previous endoscopic drainage were excluded from the study. The clinical data, biological data, imaging and interventional radiology procedures were studied. RESULTS: The rate of success of the technique was 98.5% and the clinical rate of success was 84% after 1 week and 93% after 1 month. The rate of minor and major complications was 25 and 13% respectively. CONCLUSION: Multiple percutaneous biliary drainage in complex hilar tumour is a safe and effective first intention procedure.
Asunto(s)
Colangiocarcinoma/cirugía , Neoplasias Hepáticas/cirugía , Stents , Adulto , Anciano , Anciano de 80 o más Años , Conductos Biliares Intrahepáticos , Drenaje/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Embolización Terapéutica/efectos adversos , Esponja de Gelatina Absorbible/efectos adversos , Hemostáticos/efectos adversos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Hemorragia Posparto/terapia , Sepsis/patología , Perforación Uterina/patología , Útero/irrigación sanguínea , Útero/patología , Adulto , Angiografía , Cesárea Repetida , Femenino , Humanos , Histerectomía , Necrosis , Hemorragia Posparto/patología , Embarazo , Sepsis/cirugía , Perforación Uterina/cirugíaRESUMEN
MRI has emerged for several years as the imaging examination of second-line indications in the majority of female pelvic imaging, after ultrasonography. Recent technical advances have allowed the widespread use of new MRI sequences, allowing a morphological and functional analysis of the pelvic organs. Diffusion weighted-imaging has a definite interest for the detection, characterization and staging of uterine and adnexal lesions. Dynamic contrast-enhanced imaging is an essential tool for characterizing adnexal lesions and to optimize the staging of uterine cancers. The 3D morphological imaging allows multiplanar reconstructions and is particularly useful in mapping fibroids, uterine malformations and in endometriosis.
Asunto(s)
Enfermedades de los Anexos/diagnóstico , Imagen por Resonancia Magnética , Enfermedades Uterinas/diagnóstico , Medios de Contraste , Endometriosis/diagnóstico , Femenino , Humanos , Pelvis/anomalías , Sensibilidad y Especificidad , Útero/anomalíasAsunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Tomografía Computarizada Espiral/métodos , Enfermedades de la Médula Ósea/diagnóstico por imagen , Enfermedades de la Médula Ósea/genética , Medios de Contraste/administración & dosificación , Análisis Mutacional de ADN , Diagnóstico Diferencial , Insuficiencia Pancreática Exocrina/diagnóstico por imagen , Insuficiencia Pancreática Exocrina/genética , Pruebas Genéticas , Humanos , Lipomatosis , Masculino , Páncreas/diagnóstico por imagen , Síndrome de Shwachman-Diamond , Adulto JovenRESUMEN
Splenic artery aneurysms are now diagnosed more frequently thanks to the increase and improvement in different imaging techniques. In case of rupture they are potentially life threatening and thus in certain cases may require appropriate preventive treatment. This treatment should be offered to patients with suspected pseudoaneurysms, with an aneurysm larger than 20mm in diameter, or which is progressing. The development of interventional endovascular radiology has provided new therapeutic options for the management of aneurysms, by excluding the sac from the arterial circulation with coil embolisation or with a covered stent. The success rate of these treatments is between 75 and 100% with significantly less morbidity and mortality than with surgical techniques.
Asunto(s)
Aneurisma/diagnóstico , Aneurisma/terapia , Angiografía , Embolización Terapéutica/métodos , Arteria Esplénica , Tomografía Computarizada por Rayos X , Ultrasonografía , Embolización Terapéutica/efectos adversos , Humanos , Resultado del TratamientoRESUMEN
Peripherally inserted central catheters (PICC) have the advantage of limiting the risk of accidents during installation and are easy to remove. Its use in oncology remains debated because of possible infectious complications. We analyzed 52 PICC in patients with hematological tumor from Nice Hospital. An installation failure was noted in 5.8% of cases. After a follow-up of 15 months, the complication rate was 26.9%, mainly mechanical complications: obstruction (13.5%) or accidental removal (9.6%). The organic complications such as infection or thrombophlebitis represented 3.8%. The median duration was 26 days [2-291]. The longest duration was associated with PICC for chemotherapy (median: 58 days). Frequent blood samples (above: 2 week) were associated with lower duration (median: 23 days). In conclusion, PICC represent a simple and effective alternative to intra-venous central devices in onco-hematology. However, physicians have to focus on short-course treatment.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Neoplasias Hematológicas/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/métodos , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no Paramétricas , Tromboflebitis/epidemiología , Factores de Tiempo , Ultrasonografía IntervencionalRESUMEN
We report the case of a 62-year-old man with short-bowel syndrome, referred for intestinal transplantation, who had esophageal varices (EV) due to superior vena cava (SVC) thrombosis. Pretransplantation work-up revealed protein S deficiency. Results of liver function tests were normal. Upper endoscopy showed grade II to III EV in the upper and middle segments of the esophagus. Computed tomography demonstrated thrombosis of the jugular, subclavian, and SVC veins and marked collateral vessels in the chest. Transient elastography yielded normal findings. A liver biopsy specimen showed a normal aspect of the liver, without fibrosis or liver cirrhosis. Presence of EV in a patient with chronic intestinal insufficiency may be related to collateral venous circulation associated with SVC thrombosis in the absence of portal hypertension. In this situation, an isolated intestinal graft is indicated.
Asunto(s)
Intestino Delgado/trasplante , Intestinos/trasplante , Síndrome del Intestino Corto/cirugía , Síndrome de la Vena Cava Superior/complicaciones , Colostomía , Humanos , Yeyunostomía , Masculino , Persona de Mediana Edad , Nutrición Parenteral Total , Deficiencia de Proteína S/complicaciones , Síndrome del Intestino Corto/complicaciones , Listas de EsperaRESUMEN
Many atypical locations for deep endometriosis exist that are not well known to both the radiologist and gynecologist. This work explores these unusual localizations, which we have arbitrarily grouped under the term "anterior endometriosis" in contrast to the more common posterior presentation of deep endometriosis that has been so well described in the literature. Parietal and inguinal involvement is first detailed, followed by a description of deep endometriosis involving the urinary system and anterior supporting ligaments of the uterus. A necessary adaptation to the MRI protocol in order to accurately diagnosis deep anterior endometriosis as well as specific diagnostic criteria for each type of lesion is reviewed.
Asunto(s)
Endometriosis/diagnóstico , Conducto Inguinal/patología , Imagen por Resonancia Magnética/métodos , Pelvis/patología , Enfermedades Urológicas/diagnóstico , Endometriosis/patología , Femenino , Humanos , Enfermedades Urológicas/patologíaRESUMEN
OBJECTIVE: To study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis. MATERIAL AND METHODS: This was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values. RESULTS: Seventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002). CONCLUSION: Opacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum.
Asunto(s)
Medios de Contraste , Endometriosis/diagnóstico , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Pelvis/patología , Recto/patología , Vagina/patología , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
PURPOSE: To determine the usefulness of two classification systems for pelvic prolapse on MRI. MATERIALS AND METHODS: Prospective study of 30 patients with symptoms of pelvic prolapse performed in a single center. All patients underwent clinical evaluation followed by dynamic pelvic MRI within 15 days. All MR examinations were reviewed by three readers using both classification systems based on different anatomical landmarks. The first used the pubococcygeal line and the second used the midpubic line. RESULTS: For prolapse detection, the correlation between clinical examination and MRI was good to very good, ranging between 74 and 89%. For prolapse staging, the correlation was poor to moderate. Inter-observer agreement was good to very good (kappa between 0.67 and 0.95). It was slightly better at the mid stage, with both systems (kappa between 0.83 and 0.97). Comparison of the inter-observer agreement between both MRI classification systems showed better results for the system using the pubococcygeal line (p<0.005). CONCLUSION: The classification system based on the pubococcygeal line appeared more reliable and simple for th eevaluation of pelvic prolapse on MRI.
Asunto(s)
Imagen por Resonancia Magnética , Prolapso de Órgano Pélvico/clasificación , Prolapso de Órgano Pélvico/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: Prospective monocentric study to determine the feasibility, tolerability and diagnostic value of intravaginal contrast to assess female pelvic anatomy on MRI. MATERIALS AND METHODS: Forty-nine consecutive women referred for MRI evaluation of the pelvis, irrespective of the indication, were included in this study. The MR imaging protocol consisted of axial and sagittal T2W images before and after intravaginal instillation of sterile US gel. Eight anatomical regions were analyzed and their visibility graded from 1 to 4 (1=excellent; 4=non-visualized) by 3 radiologists without and with intravaginal gel. The value of intravaginal gel was determined by calculating the difference in the visibility index for each anatomical region by the Wilcoxon and khi2 tests. Inter-observer agreement was also determined using the kappa test. RESULTS: Two women declined vaginal opacification resulting in an acceptance rate of 96%. The gel instillation procedure had a duration of less than 3 minutes on average and was well tolerated by all patients. Intravaginal gel allowed significantly improved visualization of all anatomical regions (p<0.001); improvement between 0.5 and 2.5 points on average per anatomical region. Inter-observer agreement significantly improved after gel instillation increasing from 72% to 92%. CONCLUSION: Intravaginal instillation of US gel is simple, noninvasive, well-accepted and well-tolerated by patients. It increases visibility of pelvic anatomical structures with improved inter-observer agreement.
Asunto(s)
Medios de Contraste , Imagen por Resonancia Magnética , Pelvis/anatomía & histología , Distribución de Chi-Cuadrado , Estudios Transversales , Estudios de Factibilidad , Femenino , Geles/administración & dosificación , Humanos , Variaciones Dependientes del Observador , Estudios Prospectivos , Estadísticas no ParamétricasAsunto(s)
Dolor Abdominal/etiología , Procesamiento de Imagen Asistido por Computador/métodos , Perforación Intestinal/diagnóstico por imagen , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Dolor Abdominal/diagnóstico por imagen , Anciano , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Terapia Combinada , Diagnóstico Diferencial , Humanos , Masculino , Neumoperitoneo/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
The pancreas is an organ that normally does not contain gas. The purpose of this article is to reaffirm the value of CT to detect gas in abnormal locations and illustrate the different causes of gas collections in the pancreatic bed. Abscesses and infected pseudocysts are the most frequent causes of gas in the pancreatic bed followed by malignant and inflammatory fistulae. Iatrogenic etiologies should be considered along with the rare emphysematous pancreatitis associated with very poor prognosis. All of these entities shows multiple imaging findings, including the presence of gas in the pancreatic bed.
Asunto(s)
Aire , Enfermedades Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Prognosis for endometrial carcinoma is closely related to cell type and tumor grade but also to local staging using the FIGO classification. MRI, under specific technical conditions, allows excellent depiction of the degree of myometrial tumor extension. It also has an excellent specificity for the detection of cervical extension. In addition, it allows evaluation of regional nodes, but with sensitivity values that are not perfect. The purpose of this paper is to review the MR imaging features of endometrial carcinoma along with its limitations and pitfalls.
Asunto(s)
Neoplasias Endometriales/diagnóstico , Imagen por Resonancia Magnética , Neoplasias Endometriales/clasificación , Neoplasias Endometriales/patología , Femenino , Humanos , Estadificación de NeoplasiasRESUMEN
Endometriosis is a frequent pathology of adult women. Clinical examination and US are poorly sensitive for detection of deep pelvic implants and MRI is superior for presurgical mapping of disease extent. This is important to optimize complete surgical excision, the only proven treatment to achieve symptomatic relief. The purpose of this pictorial essay is to describe the imaging features of deep pelvic endometriosis and the technical means to optimize its detection.
Asunto(s)
Enfermedades de los Anexos/diagnóstico , Endometriosis/diagnóstico , Imagen por Resonancia Magnética/métodos , Enfermedades del Recto/diagnóstico , Ligamento Redondo del Útero , Enfermedades de la Vejiga Urinaria/diagnóstico , Adulto , Medios de Contraste , Diagnóstico Diferencial , Femenino , Gadolinio DTPA , HumanosAsunto(s)
Ligamentos/patología , Neoplasias Peritoneales , Vena Porta , Trombosis de la Vena , Abdomen/diagnóstico por imagen , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Biopsia , Colangitis/complicaciones , Colelitiasis/complicaciones , Estudios de Seguimiento , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Ligamentos/diagnóstico por imagen , Hígado/diagnóstico por imagen , Masculino , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/patología , Peritoneo/patología , Radiografía Abdominal , Factores de Tiempo , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
A 39-year-old patient was evaluated for pelvic pain and infection following a surgical abortion performed via aspiration curettage. A pelvic computed tomography (CT) revealed an invagination of fat in the uterine wall accompanied by an abscess in the rectouterine pouch. Laparoscopic exploration revealed an incarcerated cecal appendix within the myometrium with necrosis of the appendiceal base as the culprit. A posteriori, CT multiplanar reconstruction allowed identification of the incarcerated appendix within the myometrium. To our knowledge, this CT description is the only case described in the literature.
Asunto(s)
Aborto Inducido/efectos adversos , Apéndice , Perforación Uterina/etiología , Adulto , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/etiología , Medios de Contraste , Femenino , Humanos , Laparoscopía , Embarazo , Tomografía Computarizada por Rayos X/métodos , Perforación Uterina/diagnóstico por imagenRESUMEN
Change detection is a critical task in the diagnosis of many slowly evolving pathologies. This paper describes an approach that semi-automatically performs this task using longitudinal medical images. We are specifically interested in meningiomas, which experts often find difficult to monitor as the tumor evolution can be obscured by image artifacts. We test the method on synthetic data with known tumor growth as well as ten clinical data sets. We show that the results of our approach highly correlate with expert findings but seem to be less impacted by inter- and intra-rater variability.