[Value of MRCP for diagnosis of biliary complications after liver transplantation]. / Evaluation de la cholangiographie par résonance magnétique dans le diagnostic des complications biliaires après transplantation hépatique.

PURPOSE: To assess the value of MRCP in the detection of biliary complications after orthotopic liver transplantation. MATERIALS AND METHODS: 27 transplanted patients with suspected biliary complication underwent a total of 34 MR and direct cholangiography procedures. MRCP were reviewed by 2 independent reviewers blinded to clinical and laboratory findings. The biliary tract was divided into 7 segments, and all lesions were evaluated using this segmental anatomy. Each segment was evaluated for the presence of dilatation, stenosis and intra-ductal debris. MRCP results were compared to results frpm direct cholangiography. RESULTS: 216 (98%) of 221 biliary segments could be evaluated on MRCP, with good to excellent visualization in 179 (80%) cases. Segmental analysis showed sensitivity, specificity and accuracy values of 85%, 81% and 83% for the detection of biliary stenosis, 82%, 81% and 81% for the detection of biliary dilatation, and 60%, 88% and 80% for the detection of inyraductal debris. CONCLUSION: MRCP is accurate for the detection of biliary stenosis and dilatation in patients after liver transplantation and provides an alternative to direct cholangiography.

[Acute cholangitis: imaging diagnosis and management]. / Une angiocholite: comment la reconnaître? Quelles conduites à tenir?

Cholangitis is an infection of the biliary ductal system that results from biliary obstruction. Choledocholithiasis has been the leading cause of acute cholangitis. Acute cholangitis remains a life-threatening complication of biliary obstruction that needs emergency diagnosis and treatment. Ultrasound (US) is the primary imaging modality for assessment of patients with suspected acute cholangitis. US is both sensitive and specific in demonstrating biliary dilatation. However, biliary dilatation is not always present at the early stage of bile duct obstruction and the performance of US in demonstrating choledocholithiasis is poor. Computed tomography (CT) without contrast injection is more sensitive than US in demonstrating choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic sonography (EUS) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis. In patients without previous cholecystectomy, clinical, biological, and US results allow to determine patients with high probability of having choledocholithiasis even if the stone is not directly visible on US. Patients undergoing cholecystectomy require laparoscopic common bile duct exploration, especially if the common bile duct clearance is not checked before surgery by MRCP or EUS.

[Laparoscopic adjustable gastric banding for morbid obesity: clinical and radiographic follow-up]. / Traitement de l'obésité morbide par anneau gastrique ajustable: un suivi clinique et radiologique.

PURPOSE: To evaluate the role of imaging for follow-up after treatment of morbid obesity by laparoscopic adjustable gastric banding (LAGB). PATIENTS AND METHODS: Since 1996, more than 1,000 patients underwent gastric banding using 5 different types of devices. Our experience is based on a retrospective study (from September 1996 to September 2002) concerning 663 consecutive patients who underwent LAGB: 114 Lapband system (LB) and 549 Swedish adjustable gastric banding (SAGB). Upper gastrointestinal series were performed within 24-48 hours after surgery in all patients. Radiological examination was also used to detect complications and to adjust gastric band. RESULTS: The five types of gastric band are easily identified on plain films. Early and late complications are illustrated: pouch dilatation, slippage, band migration, rotation of the port, and system disconnection. Radiological criteria for adjustment of gastric band are explained on the basis of barium studies performed before and after any modification of the stoma size. CONCLUSION: In patients treated with LAGB for morbid obesity, radiology plays an important role in evaluating early and late complications.

[Spontaneous regression of a focal nodular hyperplasia]. / Involution spontanée d'une hyperplasie nodulaire focale.

The authors report a case of near complete regression of a focal nodular hyperplasia of the liver over a course of 10 years in a 39 year old woman. This presentation is atypical because of its imaging features (initially typically hypervascular, to eventually become a fibrous scar after undergoing a pseudo-angiomatous phase) and because of its near complete spontaneous regression.

High resolution unenhanced computed tomography in patients with swollen legs.

PURPOSE: To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs. MATERIAL AND METHODS: CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primary lymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement. RESULTS: Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema. CONCLUSION: Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.

Profound hypotension in blunt trauma associated with superior gluteal artery rupture without pelvic fracture.

Superior gluteal artery injury is a rare but well-known complication of abdominal trauma, usually in association with pelvic fractures. Embolization has become the most effective treatment for pelvic hemorrhage with regard to superior gluteal artery injury, due to difficult surgical access. We report an unusual case of a superior gluteal artery rupture without pelvic fracture. The patient presented with profound hypotension after blunt trauma. Angiography revealed an injured superior gluteal artery, which was successfully embolized.

Flow pulsatility in the portal venous system: a study of Doppler sonography in healthy adults.

OBJECTIVE: The purpose of our study was to describe Doppler sonography patterns of venous flow in the portal system of healthy subjects and to compare pulsatility of flow with subjects' body mass, degree of inspiration, and body position. SUBJECTS AND METHODS: Doppler signals from the main, right, and left portal veins; superior mesenteric vein; splenic vein; and inferior vena cava of 23 healthy adults were prospectively studied. Pulsatility of flow was quantified using an index of venous pulsatility (VPI = [maximum frequency shift-minimum frequency shift]/maximum frequency shift). Antegrade flow peak velocities were also related to ECG tracings the time between two R waves being divided into four equal parts for analysis. The caliber variations of the main portal vein and inferior vena cava were measured with M-mode sonography. Doppler tracings were obtained with subjects in supine and sitting positions and during mid and deep inspiration. The subjects' heights and weights were obtained and the body mass index calculated (weight/[height2]). RESULTS: In the portal vein, the VPI was 0.48 +/- 0.31 (mean +/- SD). Marked pulsatility of venous flow (VPI > 0.5) was found in 12 of 23 subjects. We found an inverse correlation between the VPI and the subjects' body mass index (r = -.76; p < .001). Portal vein pulsatility decreased significantly during sitting (p < .05) and deep inspiration (p < .01). The portal VPI was correlated with caliber variation of the inferior vena cava (r = .59; p < .05). In the portal venous system, antegrade flow peak velocities occurred most often during the third quarter of the cardiac cycle, particularly in the splenic vein. CONCLUSION: Doppler sonography shows pulsatile portal venous flow in healthy adults, especially in thin subjects. This pulsatility has an inverse correlation to body mass. The finding of a pulsatile portal vein needs to be interpreted in clinical context and does not necessarily imply dysfunction of the right side of the heart.