[Allergic fungal rhinosinusitis: A diagnosis to evoke]. / Rhinosinusite fongique allergique : un diagnostic à évoquer.

Among fungal infections of the nasal sinuses, allergic fungal rhinosinusitis is a recently described, relatively rare and little known pathology. Its diagnosis is based on: clinical criteria (it occurs in young immunocompetent patients, often associated with bilateral nasosinusal polyposis); pathological criteria (allergic mucin: eosinophilic mucus without invasion of the sinusal mucosa and observation of fungal hyphae on surgical samples); biological criteria (hypereosinophilia, total and specific antifungal IgE); and radiological criteria. The combination of tomodensitometry (heterogeneous hyperdense and diffuse filling of nasosinusal cavities with expanded borders and a distended appearance of the bony wall), and MRI scan (extensive character and lesional signal [hypo and asignal T1 and T2], and cerebriform aspect of the fungal process) strongly suggests the diagnosis. It is important to distinguish the most typical forms, as well as unusual forms of allergic fungal rhinosinusitis. Main differential diagnoses are represented by other forms of fungal nasosinusal infections with different treatment and prognosis.

Safety and efficacy of transcatheter embolization with Glubran®2 cyanoacrylate glue for acute arterial bleeding: a single-center experience with 104 patients.

PURPOSE: To assess the efficacy and the safety of Glubran®2 n-butyl cyanoacrylate metacryloxysulfolane (NBCA-MS) transcatheter arterial embolization (TAE) for acute arterial bleeding from varied anatomic sites and to evaluate the predictive factors associated with clinical success and 30-day mortality. METHODS: A retrospective review of consecutive patients who underwent emergent NBCA-MS Glubran®2 TAE between July 2014 and August 2016 was conducted. Variables including age, sex, underlying malignancy, cardiovascular comorbidities, coagulation data, systolic blood pressure, and number of red blood cells units (RBC) transfused before TAE were collected. Clinical success, 30-day mortality, and complication rates were evaluated. Prognostic factors were evaluated by uni- and multivariate logistic regression analyses for clinical success, and by uni- and bivariate analyses after adjustment by bleeding sites for 30-day mortality. RESULTS: 104 patients underwent technically successful embolization with bleeding located in muscles (n = 34, 32.7%), digestive tract (n = 28, 26.9%), and viscera (n = 42, 40.4%). Clinical success rate was 76% (n = 79) and 30-day mortality rate was 21.2% (n = 22). Clinical failure was significantly associated with mortality (p < 0.0001). A number of RBC units transfused greater than or equal to 3 were associated with poorer clinical success (p = 0.025) and higher mortality (p = 0.03). Complications (n = 4, 3.8%) requiring surgery occurred only at puncture site. No ischemic complications requiring further invasive treatment occurred. Mean TAE treatment time was 4.55 min. CONCLUSIONS: NBCA-MS Glubran®2 TAE is a fast, effective, and safe treatment for acute arterial bleeding whatever the bleeding site.

Reproducibility of in vivo magnetic resonance imaging T1 rho and T2 relaxation time measurements of hip cartilage at 3.0T in healthy volunteers.

PURPOSE: To assess the T1 ρ and T2 values in the hip cartilage of healthy volunteers and to evaluate the reproducibility of these measurements. MATERIALS AND METHODS: The right hip joint of 30 asymptomatic volunteers was explored with 3T magnetic resonance imaging (MRI). Quantitative 3D T1 ρ- and T2 -maps sequences were repeated twice with a 30-minute delay (immediate reproducibility). The same protocol was repeated 14 days later (short-term reproducibility). Immediate and short-term reproducibility were estimated using coefficients of variation and correlation concordance coefficients (CCC). The precisions of the measurements were estimated by the ratio of the standard deviations. A mixed linear model was used to analyze the effect of patient's characteristics on T1 ρ and T2 values. RESULTS: Immediate reproducibility was significantly better than short-term reproducibility for T1 ρ (CCC of 0.75 versus 0.55; P = 0.007) and T2 (CCC 0.65 versus 0.32; P < 0.001). The precisions of the measurements were estimated between 5.5% and 9.1%. Median T1 ρ values were 6.0 msec higher in women than in men (P = 0.006), with no significant influence of age, body mass index (BMI), or sports activity. Median T2 values were not significantly different between men and women (0.4 msec lower in women; P = 0.76). There was no significant influence of age, BMI, or sports activity. T1 ρ and T2 values were lower in lateral regions than in medial regions (4.9 msec and 2.5 msec lower respectively; P < 0.0001). CONCLUSION: Immediate reproducibility of T1 ρ and T2 values is better than short-term, with limited effect of 30 minutes decubitus. T1 ρ values are significantly higher in women. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1022-1033.

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction.

BACKGROUND: Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs. METHODS: In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre- and post-procedure. RESULTS: Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included. Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE. CONCLUSIONS: SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.

The new Interventional Radiology/Diagnostic Radiology dual certificate: "higher standards, better education".

UNLABELLED: The American Board of Medical Specialties (ABMS) has approved a "new" residency: dual Certification in Interventional Radiology (IR) / Diagnostic Radiology (DR). This IR/DR program intends to better prepare future IR doctors. Residency programs can apply for the IR/DR program beginning in 2015, with full nationwide implementation of the IR/DR residency likely to ramp up by 2022. The IR/DR dual certificate can be attained via an "Integrated" or "Independent" IR/DR residency pathway. The IR/DR training pathway may lead the way to the future training of IR/DR physicians worldwide. Certainly, the ABMS approval of a "new" residency is rare and worth attention; however, as with all things new, questions and concerns will be raised. MAIN MESSAGES: • The ABMS approved a "new" residency, the IR/DR dual Certification. • This IR/DR program intends to better prepare future IR doctors. • Full nationwide implementation of the IR/DR Residency is likely by 2022. • The IR/DR certificate can be attained via the Integrated or the Independent residency pathway. • These programs may lead the way to the future training of IR/DR physicians worldwide.

Image-guided percutaneous microwave ablation of small renal tumours: short- and mid-term outcomes.

BACKGROUND: The purpose is to assess the short- and mid-term outcomes of microwave ablation (MWA) of small renal tumours in selected patients. METHODS: From August 2012 to February 2015, 29 renal tumours in 23 patients (17 male, 6 female, mean age 75 years) were treated by percutaneous MWA under imaging guidance. The tumours were 1-4.7 cm in diameter (mean size, 2.7 cm). Therapeutic effects were assessed at follow-up with magnetic resonance imaging (MRI). All patients were followed up for 2-25 months (mean, 12.2 months) to observe the therapeutic effects and complications. Changes in renal function at day 1 after treatment were statistically analyzed using the Student paired t-test or the paired Wilcoxon test. RESULTS: Technical success was achieved in all cases. One severe bleeding complication post-procedure occurred leading to death. No other unexpected side effects were observed after the MWA procedures. Clinical effectiveness was 100%. None of the patients showed recurrence on MRI imaging follow-up. No significant changes in renal function were noted after treatment (P=0.57). CONCLUSIONS: Our preliminary study demonstrates that the use of MWA for the treatment of small renal tumours can be applied as safely and efficiently as other ablative techniques in selected patients not eligible for surgery.

Cervical foraminal steroid injections under CT guidance: retrospective study of in situ contrast aspects in a serial of 248 cases.

OBJECTIVES: To describe all the CT findings after in situ contrast injection just before steroid injection and to recognize the abnormal aspects associated with intravascular contamination. MATERIAL AND METHODS: We retrospectively evaluated 248 cervical transforaminal steroid injections done at the university hospital in Dijon, France, in 2008-2012, to treat cervicobrachial neuralgia inadequately improved by optimal medical treatment for at least 3 weeks. Features describing the opacification patterns were recorded. RESULTS: Five main nonvascular opacification patterns were identified: clumps of contrast agent outside the foramen (16 %), a crab claw pattern surrounding the ganglion (13 %), a "French" circumflex accent pattern (15 %), reflux along the needle (7 %), and facet joint capsule opacification (22 %). Concerning the situations requiring a change in needle position, intravenous injection occurred in 26 % of the patients, with a crab claw pattern in half the cases and a clump pattern in half the cases. Intraarteriolar injection was noted in two patients. CONCLUSION: CT after in situ contrast injection ensures proper needle positioning outside the blood vessels before steroid injection. Penetration of the needle tip into a vein is very common, whereas arteriolar puncture is extremely rare.