Infraorbital nerve involvement on magnetic resonance imaging in European patients with IgG4-related ophthalmic disease: a specific sign.

OBJECTIVES: To measure the frequency of infraorbital nerve enlargement (IONE) on magnetic resonance imaging (MRI) in European patients suffering from an IgG4-related ophthalmic disease (IgG4-ROD) as compared to patients suffering from non-IgG4-related ophthalmic disease (non-IgG4-ROD). METHODS: From January 2006 through April 2015, 132 patients were admitted for non-lymphoma, non-thyroid-related orbital inflammation. Thirty-eight had both pre-therapeutic orbital MRI and histopathological IgG4 immunostaining. Fifteen patients were classified as cases of IgG4-ROD and 23 patients as cases of non-IgG4-ROD. Two readers performed blinded analyses of MRI images. The main criterion was the presence of an IONE, defined as the infraorbital nerve diameter being greater than the optic nerve diameter in the coronal section. RESULTS: IONE was present in 53% (8/15) of IgG4-ROD cases whereas it was never present (0/23) in cases of non-IgG4-ROD (P < 0.0001). IONE was only present in cases where, on MRI, the inflammation of the inferior quadrant was present and in direct contact with the ION canal. CONCLUSIONS: In European patients suffering from orbital inflammation, the presence of IONE on an MRI is a specific sign of IgG4-ROD. Recognition of this pattern may facilitate the accurate diagnosis for clinicians and allow for the adequate management and appropriate care of their patients. KEY POINTS: • IONE on an MRI is a specific sign of IgG4-ROD. • IONE recognition allows for a quicker diagnosis and appropriate management. • IONE appears when inflammation is in direct contact with the ION canal.

Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations.

PURPOSE: The purpose of this study was to evaluate the effectiveness of ethylene vinyl alcohol copolymer (Onyx) as a single embolic agent for percutaneous arterial treatment of hemorrhage due to uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS: Twelve women (mean age, 33 years) with metrorrhagia due to uterine AVMs who were treated by percutaneous arterial embolization using Onyx as a single embolic agent were retrospectively included. The diagnosis of uterine AVM was suggested by pelvic ultrasound and/or magnetic resonance imaging findings and further confirmed by angiography. Clinical files and angiographic examinations were reviewed for angiographic findings, technical and clinical success, procedure complication and further pregnancies. Clinical success was defined by absence of metrorrhagia at 1 month following embolization. RESULTS: Sixteen arterial embolization procedures were performed. Angiographically, 6 women had high flow AVM and 6 had low flow AVM. The rate of technical and clinical success was 92% (11/12 patients). One woman with early repeat hemorrhage underwent two embolization procedures and further hysterectomy. No severe complications were observed after embolization. Three women (3/12; 25%) became pregnant following embolization including one full term pregnancy. CONCLUSION: In women with metrorrhagia due to AVM, arterial embolization with Onyx is effective and safe. Additional research is needed to confirm the possibility of future pregnancy after Onyx embolization.

Late postpancreatectomy hemorrhage: Predictive factors of morbidity and mortality after percutaneous endovascular treatment.

PURPOSE: The objective of this study was to evaluate the effectiveness of endovascular treatment in patients presenting with late hemorrhage after pancreatectomy (LPPH). MATERIAL AND METHOD: Between 2008 and 2012, 53 percutaneous arterial procedures were performed in 42 patients with LPPH. There were 27 men and 15 women (mean age, 61.8 years±14.5 [SD]; range: 19-81 years). Clinical and technical success along with frequency of complications associated with the use of different endovascular techniques in patients with and without arterial anatomical variation were assessed. RESULTS: Clinical success was observed in 35/42 patients (85%). The technical success was 37.5% in patients with anatomical variation versus 82.8% for those with modal anatomy (P=0.003). Repeat bleeding (P=0.029), complications (P=0.013) and mortality (P=0.045) were more frequent in patients with variation of celiac artery than in those with modal anatomy. For hepatic and gastroduodenal artery stump bleeding, the rate of complications was higher (60%) in the group treated by hepatic artery embolization (P=0.028) by comparison with gastroduodenal artery stump selective embolisations or treatments by covered stent. A significant difference in mortality rate was found between patients with anatomical variations of celiac artery (36.4%) and those with normal anatomy (6.5%) (P=0.032). CONCLUSION: Percutaneous endovascular treatment is effective in patients presenting with LPPH. The presence of an anatomical variation of the celiac artery increases the rate of complications and mortality in patients with LPPH.

Development and initial evaluation of a training program for peripherally inserted central catheter (PICC) placement for radiology residents and technicians.

OBJECTIVES: The goals of this study were to develop and evaluate a joint theoretical/practical training course for radiology residents and technicians and to start a collaborative practice agreement enabling radiology technicians to perform PICC placement under the responsibility of an interventional radiologist. MATERIALS AND METHODS: A joint training session based on literature evidences and international recommendations was designed. Participants were assessed before and after training, and were also asked to evaluate the program one month after completion of the training course. Practical post-training mentoring guidelines were laid down for radiologists supervising technicians. RESULTS: From January to April 2014, 6 radiology residents and 12 radiology technicians from the two interventional radiology departments of the University hospitals in Marseille took part in the training program. For both residents and technicians, significant improvement was observed between pretraining and post-training assessment. The majority of participants were satisfied with the program. CONCLUSION: Our experience suggests that combined theoretical and practical training in PICC placement allows improving technical skill and yields high degrees of satisfaction for both radiology residents and technicians. A collaborative practice agreement is now formally established to enable radiologists to delegate PICC placement procedures to radiology technicians.

The presence of spontaneous portosystemic shunts increases the risk of complications after transjugular intrahepatic portosystemic shunt (TIPS) placement.

PURPOSE: The goal of this study was to identify clinical and imaging variables that are associated with an unfavorable outcome during the 30 days following transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIAL AND METHODS: Fifty-four consecutive patients with liver cirrhosis (Child-Pugh 6-13, Model for End-stage Liver Disease 7-26) underwent TIPS placement for refractory ascites (n=25), recurrent or uncontrolled variceal bleeding (n=23) or both (n=6). Clinical, biological and imaging variables including type of stent (covered n=40; bare-stent n=14), presence of spontaneous portosystemic shunt (n=31), and variations in portosystemic pressure gradient were recorded. Early severe complication was defined as the occurrence of overt hepatic encephalopathy or death within the 30days following TIPS placement. RESULTS: Sixteen patients (30%) presented with early severe complication after TIPS placement. Child-Pugh score was independently associated with complication (HR=1.52, P<0.001). Among the imaging variables, opacification of spontaneous portosystemic shunt during TIPS placement but before its creation was associated with an increased risk of early complication (P=0.04). The other imaging variables were not associated with occurrence of complication. CONCLUSION: Identification of spontaneous portosystemic shunt during TIPS placement reflects the presence of varices and is associated with an increased risk of early severe complication.

Pelvic trauma and vascular emergencies.

Pelvic ring injuries carry a high mortality rate, the main cause of which, in the first 24hours, is exsanguination. Injured patients are managed by a multidisciplinary damage-control strategy. Unstable patients should have instrumentalized hemostasis without delay. Arterial embolization is an effective way of achieving this and justifies this approach being permanently available in level 1 trauma-centers. After CT assessment of injuries, stable patients can undergo arterial embolization if active arterial bleeding or vascular damage is present. The embolization methods (selective or unselective) and agents used depend on the patient's hemodynamic stage and assessment of the injury whenever possible.

'Peripheric' pancreatic cysts: performance of CT scan, MRI and endoscopy according to final pathological examination.

OBJECTIVE: To assess the accuracy of pre-operative staging in patients with peripheral pancreatic cystic neoplasms (pPCNs). METHODS: From 2005 to 2011, 148 patients underwent a pancreatectomy for pPCNs. The pre-operative examination methods of computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) were compared for their ability to predict the suggested diagnosis accurately, and the definitive diagnosis was affirmed by pathological examination. RESULTS: A mural nodule was detected in 34 patients (23%): only 1 patient (3%) had an invasive pPCN at the final histological examination. A biopsy was performed in 79 patients (53%) during EUS: in 55 patients (70%), the biopsy could not conclude a diagnosis; the biopsy provided the correct and wrong diagnosis in 19 patients (24%) and 5 patients (6%), respectively. A correct diagnosis was affirmed by CT, EUS and pancreatic MRI in 60 (41%), 103 (74%) and 80 (86%) patients (when comparing EUS and MRI; P = 0.03), respectively. The positive predictive values (PPVs) of CT, EUS and MRI were 70%, 75% and 87%, respectively. CONCLUSIONS: Pancreatic MRI appears to be the most appropriate examination to diagnose pPCNs accurately. EUS alone had a poor PPV. Mural nodules in a PCN should not be considered an indisputable sign of pPCN invasiveness.

[Vascular ischemic lesions of the kidney in multiple trauma patients: incidence and management, a report of 7 cases]. / Lésions vasculaires ischémiques rénales chez le polytraumatisé: incidence et prise en charge à propos de 7 cas.

AIMS: Study the incidence, type and outcome of traumatic ischemic arterial lesions of the kidney in multiple trauma patients. MATERIALS AND METHODS: Retrospective study of 500 multiple trauma patients who underwent whole body 64 slice CT Scan (mean age 34 years old, sex ratio 4M/1W, mean ISS 29). RESULTS: There were seven cases of vascular lesions of the left kidney 1.4% of patients (men, median age 25 years old, mean ISS43.9). These were closed traumas with sudden deceleration and dissection of the renal artery trunk in three cases and injury to its branches in four cases with preserved excretion. Three patients died of associated injuries, including one patient who received a stent on D0. One patient underwent a nephrectomy and the three other patients were not treated which did not affect renal function or pressure (follow-up 19 months). CONCLUSION: We found a high incidence of traumatic renal dissection in multiple trauma patients. Multidetector scan appears to provide the best results for the diagnosis of these lesions as well as the many associated lesions resulting in a very poor prognosis for these patients. Treatment is not well defined and management of these lesions is often of secondary importance because of the severity of associated injuries.