The accuracy of preoperative imaging in measuring the length of the ileocolic segment affected by Crohn's disease: a prospective cohort study.

AIM: The study aimed to evaluate the accuracy of imaging for measurement of the length of the ileocolic segment affected by Crohn's disease. METHOD: Fifty-four consecutive patients who underwent resection between 2011 and 2014 for ileocolic Crohn's disease were prospectively studied. All had preoperative MR or CT enterography. Two independent radiologists measured the length of the diseased intestinal segment. The measurements were compared with the length of disease assessed on pathology of the non-fixed surgical specimen. RESULTS: The median preoperative length of the Crohn's disease segment on imaging was 20.5 (2-73) cm and 20 (3-90) cm, as measured by the two radiologists. Interobserver agreement was substantial (κ = 0.69) with a correlation coefficient (r) of 0.82 (P < 0.001). The median length of the Crohn's disease segment on pathological examination was 16.5 (2-75) cm and was closely correlated with the radiological measurement (r = 0.76, P < 0.001). The length of the Crohn's disease segment on imaging was correct to within 5 cm of the value on pathology. It was correct in 30 (55%) patients and was underestimated and overestimated in 6 (11.1%) and 18 (33.3%). A length of disease of less than 20 cm found on imaging in 26 patients was confirmed in 25 (96%) on pathology, whereas a length of more than 20 cm found on imaging in 28 patients was confirmed in 18 (64%) on pathology. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of imaging for predicting a length of less than 20 cm were 71%, 95%, 96%, 64% and 79%. CONCLUSION: Imaging accurately identifies the length of the ileocolic segment of Crohn's disease when it is 20 cm or less on pathological examination. In patients with more extensive disease, imaging tends to overestimate the length and should be interpreted with caution.

Liver cell adenomas and portosystemic shunt.

We report the case of a young man who developed multiple liver cell adenomas 13 years after a mesentericocaval shunt. Radiological findings did not provide diagnosis. Histological findings of two biopsied nodules were compatible with liver cell adenoma. Our patient had no known risk factors for liver cell adenomas. We discuss the hypothesis that disturbed hepatic vascularisation could promote the development of liver cell adenomas.

[Focal liver lesions in oncology]. / Lésions hépatiques en cancérologie générale.

In order to improve management of oncologic patients, a standardized 5-step approach should be considered: detection, characterization, locoregional and systemic staging, and post treatment follow up. The use of imaging techniques will be adapted to the clinical question at hand during multi-disciplinary review of cases. The role of the radiologist is to review the indications for each imaging modality and incorporate the results in the clinical context.

[What is the thickness of the normal appendix on MDCT?]. / Quelle est l'épaisseur de l'appendice normal au scanner multibarrette?

OBJECTIVE: To determine the wall thickness and external diameter values of the normal appendix on multidetector computed tomography (MDCT). Materials and methods. A senior radiologist with no knowledge of the patient's surgical history prospectively examined the abdominal-pelvic CT scans of 57 consecutive adult patients with no suspicion for appendicitis. Most of the patients (50/57) received an intravenous iodinated contrast material injection, but none had gastrointestinal studies. All slices (1 and 5 mm) and multiplanar reconstructions were analyzed on a treatment console. The external diameter of the appendix, the thickness of the two appendicular walls, and the presence or absence of intraluminal gas were noted. RESULTS: The appendix was visualized in 82% of the cases (47/57). The mean external diameter was 6.7 mm+/-1.2 (range, 5.0-11.0 mm). The mean thickness of the two walls was 4.8 mm+/-1.0 (range, 2.6-6.4 mm). Intraluminal air was visualized in 87% of cases (41/47). CONCLUSION: Contrary to external diameter, the normal thickness of the appendix's two walls does not go beyond the threshold of 6 mm and therefore seems to be a reliable measurement for identifying a normal appendix using MDCT.

[Gastroduodenal perforation: the role of MDCT]. / Le scanner multi détecteurs améliore la détection des perforations d'ulcères gastro duodénaux.

OBJECTIVE: To determine whether multidetector computed tomography (MDCT) is helpful for early detection of gastroduodenal perforation. MATERIAL AND METHODS: Fifteen consecutive gastroduodenal perforations for ulcer were recorded in the HIS of a single institution. Reports were analyzed and classified according to the following signs: Was a pneumoperitoneum detected? Was there mention of a perforation site, and how was it depicted (axial or reformatted slices, thin or thick slices)? What were the other described features, including peritoneal fluid, abdominal fat blurring, and bowel wall thickening? RESULTS: All patients had a gastroduodenal perforation. MDCT identified pneumoperitoneum in 15 of 15 cases as compared with three of nine cases for plain films. The perforation site was seen in eight of 15: it was identified as a defect in the parietal wall (gastroduodenal). Six of eight cases were depicted in axial view. Two of them were only seen on MPR, coronal or sagittal view. CONCLUSION: MDCT improves the detection rate of pneumoperitoneum and provides critical data for locating the perforation using direct and indirect signs. Multiplanar images seem to improve radiologists' confidence.

[Is appendicolith a reliable sign for acute appendicitis at MDCT?]. / Le stercolithe est-il un signe fiable d'appendicite?

PURPOSE: To determine the frequency of detection of appendicoliths on normal appendix at multidetector row computed tomography (MDCT) with multiplanar reconstructions (MPR). MATERIALS AND METHODS: A senior radiologist, blinded to patient's surgical history, prospectively and independently reviewed abdominopelvic MDCT scans in 57 consecutive adult patients without symptoms suggesting appendicitis. Most patients had IV iodine injection, but no oral contrast. Thick (5 mm) and thin (1 mm) slices were analyzed on a workstation. MPR were available. Localization of the appendix, overall diameter, intraluminal gas and appendicolith were recorded. RESULTS: The appendix was visualized in 47/57 (82%). An appendicolith was found in 13%. Intraluminal gas was identified in 87%. The localization was retrocaecal (47%), mediocaecal (21%) or pelvic (32%). The mean overall diameter of the normal appendix was 6.7 mm +/- 1.2 (SD). CONCLUSION: Appendicolith was found in a significant number of normal patients at MDCT and don't represent a specific sign for appendicitis.

[Pneumatic anti-shock garment use leading to non-visualization of pelvic arterial bleeding on angiography]. / Un cas de lésion artérielle pelvienne post-traumatique masquée à l'angiographie par l'emploi d'un pantalon antichoc.

Initial reports of pneumatic anti-shock garment (PASG) in severely hypotensive patients appeared promising. Nevertheless, large-scale studies in prehospital settings have shown no overall reduction in mortality rates among hypotensive patients with application of the PASG. However, in a subsample of patients with blood pressure < or =50 mmHg, PASG seems to be useful to reduce bleeding and improve survival. To our knowledge, our case report is the first which directly showns on angiography the hemostatic effect of PASG on pelvic trauma bleeding. In spite of its possible complications, PASG remains one of the tools of trained trauma teams who regularly treated severe haemorrhagic shock.

Postoperative complications in otospongiosis: usefulness of MR imaging.

BACKGROUND AND PURPOSE: Sensorineural hearing loss (SNHL) is a rare complication of stapes surgery that may arise for many reasons. Usually, the pathogenesis of SNHL can be established by clinical and CT examinations. The purpose of this study was to evaluate the utility of MR imaging when CT findings are normal or not contributive. METHODS: Eleven patients with SNHL (in some instances, associated with vertigo) after stapedectomy, in whom CT showed no well-defined cause, were examined by MR imaging. RESULTS: MR studies established the additional findings of reparative intravestibular granuloma (n = 2), intralabyrinthine hemorrhage (n = 1), and bacterial labyrinthitis (n = 1). In five cases, MR findings were similar to CT findings. In two cases, CT and MR results were normal. Revision surgery was performed in five patients and confirmed the MR findings in each case. CONCLUSION: If CT is not contributive as to the origin of SNHL and vertigo occurring after stapes surgery, then MR imaging may be helpful in these patients.

Synovial sarcomas of the head and neck: CT and MR imaging findings of eight patients.

BACKGROUND AND PURPOSE: Synovial sarcomas are soft-tissue tumors that rarely occur in the head and neck. The purpose of this study was to evaluate their CT and MR imaging appearance and to show that they may have a surprisingly benign imaging appearance. METHODS: Eight patients with histologically proved synovial sarcoma underwent CT; additionally, MR imaging examinations were performed in five of the eight cases. Attenuation and signal intensity on CT scans and MR images, respectively, were studied by two radiologists. They analyzed the location, size, margins, homogeneity, presence of adenopathies and infiltrative signs, and enhancement after injection of contrast medium. RESULTS: Four tumors were located in the hypopharynx, two arose from the infratemporal fossa, one arose from the maxillary sinus, and one arose from the faucial tonsil. Tumor sizes ranged from 27 to 70 mm. On CT scans and MR images, six lesions were homogeneous and well defined, with smooth margins. The remaining tumors were heterogeneous. In two cases, adjacent tissues were invaded. Calcifications were observed in one case and adenopathy in two cases. In three cases, the lesions were isointense on T1-weighted MR images and hypointense on T2-weighted MR images, and in the other two cases in which MR imaging was performed, the lesions were both isointense and hypointense on both T1- and T2-weighted images. Only the two local recurrent lesions were multilocular. CONCLUSION: Synovial sarcomas are aggressive sarcomas that may appear "benign" in some cases. In a young man, a synovial sarcoma may be suspected when a well-demarcated, homogeneous lesion is found in the head and neck.

Prospective evaluation of peripheral arterial occlusive disease by 2D MR subtraction angiography.

The purpose of this study was to assess the diagnostic value of two-dimensional (2D) MR subtraction angiography of lower extremities in patients with symptomatic peripheral arterial occlusive disease with conventional angiography as the standard of reference. Twenty patients were prospectively included. 2D subtraction MR angiography (MRA) consisted of multisection gradient-recalled echo (GRE) acquisitions with the shortest TE available on our machine (4 msec), obtained in the coronal plane before and after intravenous bolus administration of gadolinium chelate. MR images were reconstructed after subtraction with a maximum-pixel-intensity-projection (MIP) algorithm. MRA was performed in all cases 1-4 days before diagnostic angiography. In a prospective blinded analysis, the number and location of significant (ie, >50%) stenoses and occlusions were evaluated for each vascular segment. Sensitivity and specificity were used to evaluate MRA data. Significant stenoses (38 of 46, 83%) and occlusions (66 of 67, 99%) seen at conventional angiography were identified with MRA. The sensitivity and specificity of MRA for determination of stenoses >50% or occlusions was 100% and 97%, respectively. The location and extent of stenoses and/or occlusions on MRA and angiograms were well correlated (kappa values, r = .73, P < .05). Contrast 2D MR subtraction angiography, by providing comparable information to that of conventional angiography, is well suited to evaluate the presence and severity of atherosclerotic lesions of the lower limbs.