Prevalence of Rathke cleft cysts in children on magnetic resonance imaging.

PURPOSE: The purposes of this study were to estimate the prevalence of Rathke cleft cysts (RCC) in a pediatric population on brain MRI, to describe their appearance, and to estimate interobserver agreement in the detection of RCC. MATERIALS AND METHODS: The brain MRI examinations of 460 children were retrospectively reviewed by two radiologists for the presence of RCC. There were 223 boys and 237 girls with a mean age of 8.8±4.3 (standard deviation [SD]) years (range: 0.1-14.9 years). When present, RCC were analyzed with respect to internal contain and further classified as serous RCC (i.e., high signal on T2-weighted sequences and iso or low signal on T1-weighted sequences) or mucosal RCC (i.e., low signal on T2-weighted sequences and high or iso signal on T1-weighted sequences). Cohen's Kappa coefficient was used to estimate interobserver agreement between the interpretations performed by the two radiologists for the presence of RCC. RESULTS: A total of 14 children had a RCC present on brain MRI, yielding a prevalence of 3.04% (14/460); of these, 3/14 RCCs (21%) were of serous type and 11/14 (79%) were of mucosal type. Interobserver agreement for the presence of RCC was strong (Kappa=0.85; 95% CI: 0.70; 0.99). CONCLUSION: The results of our study suggest that the prevalence of RCC in children is greater than previously described.

'Reverse expansion': A new technique of breast reconstruction with autologous tissue.

The treatment for breast cancer is sometimes long and requires a multidisciplinary approach. In 2010, in our centre, we began to perform fat grafting for breast reconstruction using the so-called 'reverse expansion' technique. This consists of the insertion of a skin expander during mastectomy, in its expansion and then in its gradual deflation in the surgical theatre during fat grafting. We performed a complete breast reconstruction in 57 patients by reverse expansion. We harvested fat from the fat excess areas using a normal liposuction cannula. From each patient, an average of 640 ccs of was collected and then centrifuged in a 4000-rpm centrifuge for 3 min. The obtained adipocytes were then injected in the operated breast using a normal lipofilling cannula. We injected an average of 318.05 ccs of adipocytes for each patient each time. The average number of sessions per patient was 3.6. Reverse expansion can be a safe and effective technique for breast reconstruction in all the breast cancer patients.

Advantages of susceptibility-weighted magnetic resonance sequences in the visualization of intravascular thrombi in acute ischemic stroke.

BACKGROUND: In gradient echo magnetic resonance imaging (MRI), intravascular thrombi (IT) can appear as vascular susceptibility artifacts, linked to local presence of intra-arterial deoxyhaemoglobin, and called susceptibility vessel signs (SVS). AIMS: Our objectives were to evaluate the sensitivity of susceptibility-weighted sequences, such as T2* weighted angiography (SWAN) in the visualization of SVS compared with T2*, to consider whether it enabled a better understanding of the importance of SVS, and to compare cerebral circulation regulation profiles according to the localization of the SVS (i.e. proximal or distal). METHODS: We prospectively studied the clinical and imaging data of 78 consecutive patients admitted for acute cerebral ischemia to the stroke unit of Besançon University Hospital between 1 April 2009 and 31 January 2010. RESULTS: An SVS was visualized in 44/78 (56%) patients using SWAN and in 13/78 (16%) patients using T2*. All the SVS visible using T2* were also visible on the SWAN. The inter-observer kappa score was 0·72 [CI (0·53-0·91)] for T2*, 0·72 [CI (0·57-0·87)] for SWAN, and weighted kappa was 0·77 [CI (0·61-0·92)] for both T2* and SWAN. When an MCA occlusion was visible on MRA imaging (22/78 patients), a SVS was visualized in 7/22 cases (31·8%) using T2* and in 20/22 cases (91%) using SWAN. When the occlusion was visible in the M1 or M2 segments (17/78 patients), an SVS was visualized in 6/17 cases (35·3%) using T2* and in 15/17 cases (88·2%) using SWAN. When the occlusion was visible in the M3 segment (5/78 patients), an SVS was visualized in 1/5 cases (20%) using T2* and in 5/5 cases (100%) using SWAN. Presence of SVS was not associated with cardioembolic etiology of the stroke. CONCLUSIONS: SWAN was more sensitive than T2* in the visualization of SVS in the intracranial arteries during the acute phase of ischemic stroke. Our study shows that the low number of SVS visualized using T2* in previous studies is probably related to a lack of sensitivity of the sequence, rather than to the nature or age of the thrombus. The greater sensitivity of SWAN seems to be linked to the visualization of SVS in cases of small thrombi.

About locoregional recurrence risk after lipofilling in breast cancer patients: our experience.

AIM: Lipofilling is a part of the clinical practice for breast reshaping in patients who underwent surgery for breast cancer. A strong debate in the Literature is open about a higher risk of cancer relapse caused by growth factors produced by adipocyte stem cells after their engraftment in the recipient tissue. Nowadays there is no agreement over the use of autologous fat tissue for the correction of aesthetic defects following breast conservative surgery. METHODS: We have considered 151 patients who underwent a breast conservative surgery in the period April 2004-April 2009, followed by one or more lipofilling sessions in the period June 2006-August 2012. A careful pre-operative evaluation of the tumor characteristics has been made, through imaging exams, MRI included. An intraoperative evaluation of the tumor dimensions and its distance from the surgical edges has also been made, followed by a microscopic analysis through a shaving technique. Lipofilling has been offered to all the patients on average 24 months after surgery. RESULTS: We have found no cancer relapses after a mean follow up of 45 months (17-76) after lipofilling and of 69 (27-100) months after surgery. CONCLUSIONS: Considering oncologic surgery, we can affirm that lipofilling is safe for the risk of cancer relapses, if performed using all the parameters included in our clinical protocol.

Oncoplastic surgery and cancer relapses: cosmetic and oncological results in 489 patients.

During the past 20 years, breast conservation has become the preferred treatment modality for breast carcinoma, and in recent times there is an increased expectation from breast cancer patients to retain their "normal breast appearance". For large tumor-to-breast ratio excision, the subspecialty of oncoplastic surgery is born, helping to achieve a good oncologic and esthetic result. In our study we have considered 767 patients undergone a mastectomy or quadrantectomy, and especially 489 undergone quadrantectomy. We have used our protocol for breast reshaping and analyzed our data in terms of oncologic safety and esthetic results. Considering the lesions, they were placed like this: 214 (44%) in the SEQ, 58 lesions (12%) in the SIQ, 54 lesions (11%) in the IEQ, 24 lesions (5%) in the IIQ, 45 lesions (9%) respectively in the CQ and between the SQ, 39 lesions (8%) between the EQ, 5 lesions (1%) respectively between the internal quadrants and between the inferior quadrants. We have chosen simple breast reshapings in case of operations on the superior quadrants, while, in case of operations on the inferior quadrants, we have chosen complex techniques, like reshapings according to a "key hole" reductive mammaplasty, which requires also a contralateral reshaping. We have done simple and monolateral reshapings respectively in 372 (76%) and 296 (60.5%) cases. We have had early complications in 98 (20%) cases: 12 infections (2.4%), 10 hematomas (2%), 11 seromas (2.2%), 65 liponecrosis. As late complications, we have found scar retractions and minus areas in 20 cases (4.08%), while we have found asymmetries and bigger deformities in 34 cases (6.95%). We have not found any cancer relapse after one year of follow up, while we have had 3 cases of relapse (0.6%) after 5 years of follow up, respectively after 5, 4 and 2 years. This result has to be attributed to our preoperatory project of surgery derived from many factors, among which stands out the MRI done in all the cases. We think that an immediate breast reshaping following quadrantectomy is the best esthetic and psychologic option for breast cancer patients.

The MRI as a valid help for oncoplastic surgery: esthetic and oncologic results analysis in a group of 489 patients.

AIM: There is an increased expectation from breast cancer patients to retain their "normal breast appearance". To help to achieve this expectation, many radiologic exams have been created to get the exact extension and position of the tumor. MRI is effective to obtain correct information about neoplasms, especially those with shaded edges, like DCIS. MRI might change the surgical project, thus avoiding second operations for cancer relapses. METHODS: We have performed MRI to all the patients except those with big lesions or adypous breasts. We have chosen for reconstruction various oncoplastic techniques. We have had early complications in 98/489 (20%) cases. RESULTS: As late complications, we have found scar retractions and minus areas in 20/489 cases (4.08%), while we have found asymmetries and bigger deformities in 34/489 cases (6.95%). We have not found any cancer relapse after one year, we have had 3 cases of relapse (0.6%) after five years of follow-up, after 5, 4 and 2 years. Our good oncologic and plastic results have to be attributed to many factors, among which stands out the MRI done in all the cases. CONCLUSION: We think that an immediate breast reshaping following quadrantectomy is the best esthetic and psychologic option for breast cancer patients.

The bovine pericardial patch in breast reconstruction: a case report.

In the last years there has been a growing demand of plastic surgery for soft tissue reconstruction. In response to this, many biological and synthetic devices have been produced, aiming to allow wide and complex body reshapings. Acellular dermal matrices are one of these devices, and are made of human or animal tissues made acellular after their sampling. They are used for cervical, breast and abdominal wall reconstruction. Tutopatch®, generally used for face reconstruction or neurosurgery, is made of acellular bovine pericardium, and its high amount of collagen allows a fast tissue healing and a scaffold for the surrounding tissue regeneration. In our case report Tutopatch® has been used in immediate breast reconstruction after mastectomy. This device has been used to close laterally the subpectoral pocket, allowing a bigger volume prosthesis to be placed We have not experienced particular postoperatory complications, and after 12 months of follow up we have found a valid functional and aesthetic result. We consider Tutopatch® as a valid alternative to other acellular dermal matrices specifically designed for breast reconstruction.

[Surgical treatment of extraoesophageal symptoms of GERD. Critical points in the diagnostic-therapeutic pathway]. / Trattamento chirurgico dei sintomi extraesofagei da MRGE. Punti critici nel percorso diagnostico-terapeutico.

Patients with GERD and atypical symptoms represent a particular category with a less clear definition of the physiopatological mechanisms and thereby need a precise attention toward the indication to surgery. The less good response to surgery therefore requires a careful evaluation and selection of patients with atypical symptoms.

[Diagnostic significance of T2W hypointensity of the sella]. / Valeur diagnostique d'un hyposignal T2 de la région sellaire.

Normal anatomical structures and lesions characterized by low T2W signal intensity are reviewed in this pictorial essay. The purpose is to demonstrate how evaluation of the appearance, shape and exact anatomical location of the T2W hypointense sellar region structure, correlated with its T1W signal intensity, can based on the clinical context lead to an appropriate differential diagnosis.

Diagnostic efficacy of SonoVue, a second generation contrast agent, in the assessment of extracranial carotid or peripheral arteries using colour and spectral Doppler ultrasound: a multicentre study.

The purpose of this study was to demonstrate the improvement in diagnostic quality and diagnostic accuracy of SonoVue microbubble contrast-enhanced ultrasound (CE-US) versus unenhanced ultrasound imaging during the investigation of extracranial carotid or peripheral arteries. 82 patients with suspected extracranial carotid or peripheral arterial disease received four SonoVue doses (0.3 ml, 0.6 ml, 1.2 ml and 2.4 ml) with Doppler ultrasound performed before and following each dose. Diagnostic quality of the CE-US examinations was evaluated off-site for duration of clinically useful contrast enhancement, artefact effects and percentage of examinations converted from non-diagnostic to diagnostic. Accuracy, sensitivity and specificity were assessed as agreement of CE-US diagnosis evaluated by an independent panel of experts with reference standard modality. The median duration of clinically useful signal enhancement significantly increased with increasing SonoVue doses (p< or =0.002). At the dose of 2.4 ml of SonoVue, diagnostic quality evaluated as number of inconclusive examinations significantly improved, falling from 40.7% at baseline down to 5.1%. Furthermore, SonoVue significantly (p<0.01) increased the accuracy, sensitivity and specificity of assessment of disease compared with baseline ultrasound. SonoVue increases the diagnostic quality of Doppler images and improves the accuracy of both spectral and colour Doppler examinations of extracranial carotid or peripheral arterial disease.

[Tinnitus and stenosis of the cavernous internal carotid artery]. / Acouphènes et sténose de l'artère carotide interne intracaverneuse.

We report a case of isolated unilateral pulsatile tinnitus. Cerebral angiography showed a right intra-cranial internal carotid artery stenosis. Treatment by dilatation and stenting resulted in symptom resolution.

[MRI of the pituitary gland: indications and results in gynaecology and in obstetrics]. / L'IRM hypophysaire: indications et résultats en gynécologie et en obstétrique.

MRI is the sole radiological examination to be obtained if abnormal menses, galactorrhea or anovulation evokes the diagnosis of prolactinoma. Nevertheless, iatrogenic hyperprolactinemia or presence of big prolactin has to be ruled out before MRI is asked for. MRI of the pituitary gland must be technically optimal; analysis of the images has to be directed by clinical and biological data.

[Imaging of the extracranial carotid arteries: when, how and why?]. / Quand, comment et pourquoi réaliser une imagerie des carotides extracrâniennes?

The indications for treating carotid artery stenosis are related to the symptomatic nature of the lesion and the degree of stenosis. Duplex sonography is adequate for screening. While some groups believe that Duplex US alone or in combination with transcranial Doppler imaging may be sufficient for presurgical evaluation, it often is recommended to complete the evaluation with either MRA or CTA. Both techniques are advantageous since they allow evaluation of the cervical and intracranial arteries as well as cerebral parenchyma hence providing valuable information prior to definitive management. Catheter angiography remains indicated in patients with multi-vessel disease and ischemic cardiomyopathy, when results at non-invasive evaluation are discordant or in an emergency setting. Duplex US is used for routine follow-up of non-surgical lesions and after endarterectomy. Transcranial Doppler as well as advances in MRA and CTA techniques will be reviewed. Even though the treatment of atherosclerotic carotid artery stenoses remains primarily surgical, specific considerations related to angioplasty will be reviewed. Finally, diseases of the intracranial carotid artery and non-atherosclerotic diseases (dissection...) will also be discussed.

[Rathke's cleft cyst]. / Kystes de la poche de Rathke.

Rathke's cleft cyst (RCC) are frequent benign cystic sellar lesions. Most RCC are small, intrasellar and asymptomatic. Larger cysts may compress adjacent structures and rarely become symptomatic. Diagnosis is strongly suggested at MRI by the presence of a midline non-enhancing lesion located exactly between the anterior and posterior lobes of the pituitary gland. Even if its signal is variable and related to intracystic protein concentration, it must be homogeneous with no fluid-fluid level. Once a diagnosis of RCC made, routine MR and clinical follow-up is sufficient for incidental asymptomatic cysts whereas the rare symptomatic lesions are neurosurgically resected.