[Imaging of acute urinary infections in adults. Radiologic findings and strategy for imaging procedures]. / Infection urinaire aiguë non tuberculeuse de l'adulte. Aspects radiologiques et stratégie d'exploration.

Urinary infection is very common in women. Generally no imaging is needed. The role of imaging is mandatory in the following cases: renal infection, urinary obstructive syndrome, immuno-compromised patients. The results of imaging in pathology are described: pyelonephritis, renal and perinephric abscesses with or without phlegmon, perinephritis and emphysematous perinephritis. A strategy for imaging procedures is proposed.

[Evaluation of radiological medical practice at a hospital during night duty]. / Evaluation de l'activité radiologique de garde dans un centre hospitalier.

PURPOSE: To evaluate the radiological activity during night duty, in a University Hospital. Materials and methods. During 100 days, the radiological activity has been evaluated from examinations requiring radiologist (including US and CT, special X-ray examinations). The urgent nature and the agreement between the suspected disease and the final diagnose have been compared with the level of the clinician (medical student, resident, senior). RESULTS: 981 radiological examinations were performed on an emergency basis. In 39%, the examination was urgent or very urgent and for 61%, little urgent or non-urgent. The level of the clinician was correlated with the degree of emergency evaluated by the radiologist and with the agreement between suspected disease and the final diagnose (p<0. 0001). CONCLUSION: During night duty, the medical activity in radiology is not justified only by emergency, but also by the continuous hospital activities. Better formation of the physician is required to limit the number of examinations.

Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures.

BACKGROUND: Magnetic resonance cholangiography (MRC) is currently under investigation for non-invasive biliary tract imaging. AIM: To compare MRC with endoscopic retrograde cholangiography (ERC) for pretreatment evaluation of malignant hilar obstruction. METHODS: Twenty patients (11 men, nine women; median age 74 years) referred for endoscopic palliation of a hilar obstruction were included. The cause of the hilar obstruction was a cholangiocarcinoma in 15 patients and a hilar compression in five (one hepatocarcinoma, one metastatic breast cancer, one metastatic leiomyoblastoma, two metastatic colon cancers). MRC (T2 turbo spin echo sequences; Siemens Magnetomvision 1.5 T) was performed within 12 hours before ERC, which is considered to be the ideal imaging technique. Tumour location, extension, and type according to Bismuth's classification were determined by the radiologist and endoscopist. RESULTS: MRC was of diagnostic quality in all but two patients (90%). At ERC, four patients (20%) had type I, seven (35%) had type II, seven (35%) had type III, and two (10%) had type IV strictures. MRC correctly classified 14/18 (78%) patients and underestimated tumour extension in four (22%). Successful endoscopic biliary drainage was achieved in 11/17 attempted stentings (65%), one of which was a combined procedure (endoscopic + percutaneous). One patient had a percutaneous external drain, one had a surgical bypass, and in a third a curative resection was attempted. Effective drainage was not achieved in six patients (30%). If management options had been based only on MRC, treatment choices would have been modified in a more appropriate way in 5/18 (28%) patients with satisfactory MRC. CONCLUSION: MRC should be considered for planning treatment of malignant hilar strictures. Accurate depiction of high grade strictures for which endoscopic drainage is not the option of choice can preclude unnecessary invasive imaging.

Intraluminal duodenal diverticulum: radiological and endoscopic ultrasonography findings of an unusual cause of acute pancreatitis.

Intraluminal duodenal diverticulum is a rare congenital web of membrane which may be symptomatic when it becomes distended. This report describes a case revealed by presenting as an acute pancreatitis. The radiological findings are reported. The findings at CT, upper gastro-intestinal series, endoscopic ultrasound and endoscopic retrograde cholangiopancreatography are described and differential diagnostic features from choledochocele and duodenal duplication are discussed. By endoscopic ultrasonography, observation of a thin wall, without different layers such as choledochocele or duodenal duplication, may be useful for diagnosis.

[Emphysematous pyelonephritis: apropos of 4 cases]. / Pyélonéphrite emphysémateuse: à propos de quatre observations.

PURPOSE: The propose of this study was to describe the imaging findings in four patients with emphysematous pyelonephritis and to perform a review of the literature. MATERIAL AND METHODS: Four cases of emphysematous pyelonephritis are presented. US and CT examinations were available for all patients. RESULTS: Gas within the kidney may be diagnosed by plain film or rarely by ultrasound, but its location and its extent are best evaluated by CT. A review of the literature shows that emphysematous pyelonephritis is a rare and life-threatening infection typically occurring in diabetic patients. CONCLUSION: CT is useful for diagnosing emphysematous pyelonephritis, especially when symptoms fail to resolve promptly with medical therapy.

Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas--CT evaluation and functional correlation.

PURPOSE: To compare the computed tomographic (CT) features of pancreatic fatty replacement in adolescents and adults with cystic fibrosis (CF) with those in control subjects and to correlate the degree of fatty replacement with the functional status of the pancreas. MATERIALS AND METHODS: CT scans in 15 patients with CF (group 1) and in 15 control subjects without CF (group 2) were evaluated for thickness and degree of pancreatic fatty replacement. Thickness was measured at four anatomic levels. The pattern of pancreatic fatty replacement was visually evaluated in four pancreatic regions. Images were semiquantitatively analyzed by two readers. The degree of fatty replacement was correlated with the functional status of the pancreas. RESULTS: In group 1, pancreatic glandular tissue was significantly thinner (P < .001) and the degree of fatty replacement was significantly greater in the four regions (P < .001) than those in group 2. In Group 1, no relationship was found between the degree of pancreatic fatty replacement and that of pancreatic endocrine dysfunction. A significant relationship was found between the degree of fatty replacement and that of pancreatic exocrine dysfunction (P < .001). CONCLUSION: In patients with CF, pancreatic glandular tissue is significantly reduced in size. Pancreatic fatty replacement is the most frequent pattern in older patients with CF and correlates with pancreatic exocrine dysfunction.

Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method.

BACKGROUND: Magnetic resonance cholangiography (MRC) is a new technique for non-invasive imaging of the biliary tract. AIM: To assess the results of MRC in patients with suspected bile duct stones as compared with those obtained with reference imaging methods. PATIENTS/METHODS: 70 patients (34 men and 36 women, mean (SD) age 71 (15.5) years; median 75) with suspected bile duct stones were included (cholangitis, 33; pancreatitis, three; suspected post-cholecystectomy choledocholithiasis, nine; cholestasis, six; stones suspected on ultrasound or computed tomography scan, 19). MR cholangiograms with two dimensional turbo spin echo sequences were acquired. Endoscopic retrograde cholangiography with or without sphincterotomy (n = 63), endosonography (n = 5), or intraoperative cholangiography (n = 2) were the reference imaging techniques used for the study and were performed within 12 hours of MRC. Radiologists were blinded to the results of endoscopic retrograde cholangiography and previous investigations. RESULTS: 49 patients (70%) had bile duct stones on reference imaging (common bile duct, 44, six of which impacted in the papilla; intrahepatic, four; cystic duct stump, one). Stone size ranged from 1 to 20 mm (mean 6.1, median 5.5). Twenty seven patients (55%) had bile duct stones smaller than 6 mm. MRC diagnostic accuracy for bile duct lithiasis was: sensitivity, 57.1%; specificity, 100%; positive predictive value, 100%; negative predictive value, 50%. CONCLUSIONS: Stones smaller than 6 mm are still often missed by MRC when standard equipment is used. The general introduction of new technical improvements is needed before this method can be considered reliable for the diagnosis of bile duct stones.

[MRI cholangiography with rapid spin-echo technique: prospective evaluation of 20 patients]. / Cholangio-IRM en écho de spin rapide: évaluation prospective chez 20 patients.

PURPOSE: To evaluate a MR cholangiographic technique using a non breath-hold fast spin-echo technique in patients with suspected bile duct obstruction. MATERIAL AND METHODS: Twenty patients with suspected bile duct obstruction were prospectively investigated with MR cholangiography using a T2-weighted non breath-hold fast spin-echo technique (TR = 8000-9000 mse, effective TE = 120-266 msec, ETL = 16-32, acquisition time = 1-3 min) with a body coil. Results of MR cholangiography were compared to those obtained with endoscopic retrograde cholangiography (n = 20 patients) and endoscopic sonography (n = 12 patients) that were considered as reference. RESULTS: MR cholangiography provided high-quality images in 19 out of 20 cases (95%). MR cholangiography had 100% sensitivity, 100% specificity and 100% accuracy in the diagnosis of bile duct dilation. MR cholangiography had 73% sensitivity, 75% specificity and 73% accuracy in the diagnosis of bile duct obstruction. MR cholangiography failed to depict small stones (< 3 mm) of the main bile duct in 4 cases in which no bile duct dilatation was found. CONCLUSION: MR cholangiography using a non breath-hold fast spin-echo technique depicts bile duct dilatation with a degree of accuracy comparable to that achieved with endoscopic examination. In the absence of bile duct dilatation, small stones of the main bile duct may be undetected with MR cholangiography.

Nontumorous hepatic pseudolesion around the falciform ligament: prevalence on gadolinium chelate-enhanced MR examination.

OBJECTIVE: Our objective was to determine the prevalence of nontumorous hepatic pseudolesions seen around the falciform ligament on dynamic spoiled three-dimensional (3D) gradient-recalled echo (GRE) MR imaging obtained during i.v. injection of a gadolinium chelate. SUBJECTS AND METHODS: The gadolinium chelate-enhanced spoiled 3D GRE examinations of the liver of 103 patients were prospectively analyzed by two readers for the presence of a nontumorous hepatic pseudolesion around the falciform ligament to determine the prevalence of this finding. For all pseudolesions, pathologic examination or follow-up imaging studies excluded true tumors. RESULTS: A total of 15 nontumorous hepatic pseudolesions were found on 13 (13%) of 103 examinations. The size of pseudolesions ranged from 5 to 15 mm (mean, 9 mm). Twelve pseudolesions were located in segment IV, and three were in segment III. On two MR examinations, two pseudolesions (one in segment IV and one in segment III) were found. Fourteen (93%) of 15 pseudolesions were seen during the arterial phase of the bolus injection. All pseudolesions (100%) were seen during the portal phase, and one pseudolesion (7%) remained visible during the equilibrium phase. The presence of true tumors was excluded in one case by pathologic examination and in twelve cases by follow-up imaging examinations. CONCLUSION: Nontumorous hepatic pseudolesions around the falciform ligament are not rarely seen on gadolinium chelate-enhanced spoiled 3D GRE examinations. Thus, recognition of these pseudolesions is crucial because they may be misinterpreted as true tumors.

T1-weighted spoiled gradient-echo MR imaging of focal hepatic lesion: comparison of in-phase vs opposed-phase pulse sequence.

The goal of our prospective study was to compare quantitatively and qualitatively in-phase and opposed-phase T1-weighted breath-hold spoiled gradient-recalled-echo (GRE) MR imaging technique for imaging focal hepatic lesion. Thirty-eight patients with 53 focal hepatic lesions had in-phase (TR = 12.3 ms, TE = 4.2 ms) and opposed-phase (TR = 10.1 ms, TE = 1.9 ms) GRE (flip angle = 30 degrees , bandwidth +/- 32 kHz, matrix size 256 x 128, one signal average) MR imaging at 1.5 T. Images were analyzed quantitatively by measuring the lesion-to-liver contrast and for lesion detection. In addition, images were reviewed qualitatively for lesion conspicuity. Quantitatively, lesion-to-liver contrast obtained with in-phase (3. 22 +/- 1.86) and opposed-phase pulse sequence (3.72 +/- 2.32) were not statistically different (Student's t-test). No difference in sensitivity was found between in-phase and opposed-phase pulse sequence (31 of 53, sensitivity 58 % vs 30 of 53, sensitivity 57 %, respectively). Two lesions not seen with opposed-phase imaging were detected with in-phase imaging. Conversely, one lesion not seen on in-phase imaging was detected on opposed-phase imaging so that the combination of in-phase and opposed-phase imaging yielded detection of 32 of 53 lesions (sensitivity 60 %). Qualitatively, lesion conspicuity was similar with both techniques. However, in-phase images showed better lesion conspicuity than opposed-phase images in 9 cases, and opposed-phase images showed better lesion conspicuity than in-phase images in 7 cases. No definite advantage (at a significant level) emerged between in-phase and opposed-phase spoiled GRE imaging. Because differences in lesion conspicuity and lesion detection may be observed with the two techniques in individual cases, MR evaluation of patients with focal hepatic lesion should include both in-phase and opposed-phase spoiled GRE imaging.

Non-breath-hold fast spin-echo versus breath-hold fast spin-echo and spoiled gradient-recalled echo MR imaging in the detection of hepatic tumors: correlation with surgical findings.

OBJECTIVE: Our objective was to compare the sensitivity of non-breath-hold T2-weighted fast spin-echo with and without fat suppression, breath-hold T2-weighted fast spin-echo without fat suppression, and spoiled gradient-recalled echo (GRE) MR imaging for detecting hepatic tumors using surgical findings as the standard of reference. SUBJECTS AND METHODS: Eighteen patients with 36 surgically proven hepatic tumors had non-breath-hold T2-weighted fast spin-echo (6000/117 [TR/effective TE; echo train length, 16) MR imaging with and without fat suppression, breath-hold T2-weighted fast spin-echo MR imaging (2700/105; echo train length, 20), and spoiled GRE images (10.1/1.9; flip angle, 30 degrees) obtained before and after injection of a gadolinium chelate. Images were analyzed separately by two independent readers, with disagreements resolved by consensus reading. RESULTS: Non-breath-hold T2-weighted fast spin-echo MR imaging with and without fat suppression depicted 22 (61%; 95% confidence interval [CI], 43-77%) and 20 (56%; 95% CI, 37-72%) of 36 hepatic tumors, respectively. Breath-hold T2-weighted fast spin-echo imaging allowed detection of 19 (53%; 95% CI, 35-69%) of 36 hepatic tumors. Unenhanced and gadolinium chelate-enhanced spoiled GRE images allowed depiction of 18 (50%; 95% CI, 33-67%) and 29 (81%; 95% CI, 63-91%) of 36 hepatic tumors, respectively. Gadolinium chelate-enhanced spoiled GRE images allowed depiction of significantly more hepatic tumors than any of the other pulse sequences. CONCLUSION: Gadolinium chelate-enhanced spoiled GRE imaging is more sensitive than T2-weighted MR imaging obtained with a breath-hold or a non-breath-hold technique.

Is immunochemical determination of haptoglobin phenotype dependent?

Immunochemical methods have been used to determine the concentration of haptoglobins. The dependence on the phenotype was tested with highly purified Hp 2-1, Hp 2-2 and Hp 1-1, by immunonephelometry and radial immunodiffusion (RID). Measurements with three different instruments: automated immunonephelometer (AIP, Technicon), laser nephelometer (LN, Behring) and immunochemistry system (ICS, Beckman) were performed. For each type of apparatus antisera against a pool of haptoglobins were provided by the respective manufacturers. Some experiments were done with an antiserum to the haptoglobin heavy chain prepared in the laboratory. This study shows that haptoglobin determination depends neither on the physical geometry of the instruments or on the type of antiserum used in this work. In contrast, the data display a dependence on haptoglobin phenotype. When Hp 2-1, the most common phenotype, is taken as a standard, thd values obtained for Hp 2-2 are in good agreement with those obtained for Hp 2-1. However, the values obtained for Hp 1-1 are overestimated unless they are corrected by an experimental factor which has been determined in this study.

[Immunochemical determination of human hemoglobin in biological fluids (author's transl)]. / Determination immunochimique de l'hémoglobine humaine dans les liquides biologiques.

An assay of human hemoglobin by immunonephelometry-electroimmunodiffusion is proposed. Concentrations in the range from 5 to 180 mg% can be determined to within 2--5% accuracy. The immunonephelometric assay is independent of the presence of haptoglobin whereas the electroimmunodiffusion assay is not. This immunochemical assay, independent of the peroxydase activity of hemoglobin, can be carried out in any biological fluid (plasma, urine, gastric fluid).

[Intravascular hemolysis. Assessment by determination of haptoglobin, hemopexin and orosomucoid].

In 100 patients suffering from intravascular haemolysis, a "protein profile" was made on the basis of measurement of haptoglobin, haemopexin and orosomucoid. The estimations were carried out using a rapid precise automatic technique using monospecific immune serum. The results obtained indicate that these tests are sensitive and reliable.