[Impact of whole body magnetic resonance imaging (MRI) in the management of melanoma patients, in comparison with positron emission tomography/computed tomography (TEP/CT) and CT]. / Apport de l'imagerie en résonance magnétique (IRM) du corps entier dans la prise en charge du mélanome : comparaison avec la tomoscintigraphie par émission de positons couplée à la tomodensitométrie (TEP-TDM) et à la TDM seule.

BACKGROUND: PET/CT has proven extremely useful in the management of melanoma patients, with great sensitivity (Se), but it tends to give false-positive results. Whole-body MRI (wb-MRI) is a new method that has made considerable progress. STUDY AIMS: The aim of this study was to assess the Se and specificity (Sp) of wb-MRI with a diffusion sequence for detecting melanoma metastasis compared to PET/CT. METHODS: This was a prospective study, including patients at any AJCC (American Joint Committee on Cancer) stage of melanoma. PET/CT, wb-MRI and CT, including the brain, were performed on the same day. For each of the three exams, the number of lesions per patient was counted. The treatments proposed by the doctor immediately after PET/CT and then MRI were compared. RESULTS: Forty patients were included and a total of 72 metastases were noted. CT detected 53 of these metastases (Se 80%, Sp 95%), while PET/CT detected 53 metastases, with four false-positive (Se 74%, Sp 89%) and Wb-MRI detected 59, with two false-positive (Se 83%, Sp 96%). The sensitivity of MRI was distinctly superior to PET/CT for both hepatic and pulmonary lesions. The treatment proposed after PET/CT and MRI differed in three cases: one patient was falsely reclassified by MRI (AJCC IV instead of IIB) while two others were falsely reclassified by PET/CT (AJCC IV instead of IB and IIIC). Exclusively whole-body scan influenced the treatment of four patients (10%). CONCLUSION: Wb-MRI with diffusion sequence, which is less costly than PET/CT and is also non-radioactive, could play an important role in the detection of metastases in melanoma patients.

Benign intraductal papillary-mucinous neoplasm of the pancreas associated with spontaneous pancreaticogastric and pancreaticoduodenal fistulas.

Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.

[Liver calcifications in adults: the KUB stars are too frequently neglected in the CT era]. / Calcifications hépatiques de l'adulte: les stars de l'ASP trop souvent négligées à l'ère du scanner.

Liver calcifications have been extensively described on plain radiographs, either from KUB or angiography examinations. On the other hand, their characteristics are seldom reported on cross-sectional imaging: they are frequently considered as non-specific compared to multiple other imaging features. However, clinical practice demonstrates that in specific situations (such as parasitic infections and calcified metastases), the presence of calcifications may be a determining factor in avoiding misdiagnosis with potential deleterious effects to the patient. Both CT and US can detect a large number of "benign" calcifications without associated focal lesion and knowledge of their imaging features is useful to avoid unnecessary additional imaging work-up. A review of the literature and a series of 100 cases of liver calcifications on CT are presented to review the imaging features of calcified liver lesions and isolated liver calcifications without associated focal lesion.

[Radiofrequency ablation for palliation of soft tissue tumor pain]. / La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles.

PURPOSE: To assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain. MATERIALS AND METHODS: Retrospective study of 12 patients receiving palliative treatment for soft tissue tumors (5 primary tumors including 4 sarcomas and 1 PEComa and 7 metastatic tumors) with pain refractory to standard management. RF ablation was performed under CT or ultrasound guidance. RESULTS: The efficacy was determined by using pain scores and treatment regimen modifications after RF ablation. Response was graded as absent, partial or complete. Short term symptomatic relief was observed in 100% of cases, with complete response in 43% of cases ; Mid term and long term symptomatic relief was observed in 70% and 83% of cases respectively. We also observed dosage reduction for narcotics with corresponding reduction in related side-effects and functional improvement in some patients. A single case of complication with serosanguinous collection within a region of necrosis was observed. CONCLUSION: Radiofrequency ablation for palliation of soft tissue tumor pain may be a useful complement to standard management. It results in symptomatic improvement with few complications.

[Impact of PACS implementation in a university center on radiology practice profile]. / Changements des pratiques radiologiques induites par l'implantation d'un réseau images en milieu hospitalo-universitaire.

PURPOSE: To determine the impact of a joint PACS implementation at a university medical center and cancer center on the radiology practice profile. Materials and methods. In 5 radiology sections, patients, selected based on identifiable acute or chronic diseases, underwent US, CT or MRI. Data were collected on datasheets from each provider with regards to clinical history, availability of prior examinations, description of patient management during the different phases of the examination, duration of examinations, and satisfaction. Data obtained prior to PACS implementation and 6-12 months and 30-36 months after implementation were compared. RESULTS: A total of 1098 datasheets were collected. Hard copy readings rapidly decreased. Comparison with prior examinations improved (+20.6% to 25.6%) as well as frequency of post-processing (+29%). The time required for image management was much more reduced for technologists (-75%) than for physicians (-23%). PACS implementation only temporarily improved the availability of radiology reports and the distribution of work between senior and junior radiologists. User satisfaction, initially high, progressively decreased due to saturation of the archival capabilities. CONCLUSION: PACS implementation in a large university center improves the efficiency of image acquisition but does not solve some of the inefficiencies of hospital organization.

[Imaging of the postoperative biliary tract]. / Imagerie des voies biliaires opérées.

For a long time, imaging of the biliary tract after surgical procedures was performed with invasive procedures such as endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. Due to recent advances in diagnostic imaging, non-invasive techniques are now favored. While US remains the initial imaging modality, it is frequently followed by CT and/or MRCP. Image interpretation should always be performed in keeping with clinical and laboratory findings as well as the type of surgical procedure. The most appropriate imaging modality is selected based on these data. In patients with jaundice or biliary tract stenosis, MRCP, with use of an optimal technique and 3D acquisition, is the imaging modality of choice. In non-jaundiced patients with non-distended biliary tract and suspected bile leak, MRCP should be completed by the injection of a liver-specific contrast agent with biliary excretion to achieve non-invasive biliary tract opacification. In patients with malignancy, CT is preferred due to its high spatial resolution and ability to demonstrate small anastomotic tumor recurrences. CT should also be performed in patients with suspected hepatic artery or portal vein injury in addition to biliary tract injury or to detect distant complications.

[MDCT in the lateral decubitus position with Valsalva maneuver in the evaluation of abdominal wall hernias]. / Scanner multicoupe en latérocubitus avec manoeuvre de Valsalva dans l'étude des hernies de la paroi abdominale.

MDCT in the lateral decubitus position during Valsalva is sensitive in the detection of abdominal wall hernias and may increase the hernia size and possibly change its contents.

[Hepatic and extrahepatic alveolar echinococcosis: CT and MR imaging features]. / Echinococcose alvéolaire hépatique et extra-hépatique : revue iconographique en scanner et en IRM.

To illustrate the CT and MR imaging features of alveolar echinococcosis, a rare disease that is endemic in the northeast of France. Hepatic and extrahepatic manifestations are presented. Fibrous and necrotic features are demonstrated on MR. Calcifications are demonstrated on CT. Accurate imaging diagnosis will exclude tumors (cholangiocarcinoma, cystadenoma, fibrous metastases) and avoid unnecessary biopsy.

[Comparison of 2D and 3D techniques in the evaluation of global ventricular function on multidetector-row CT]. / Comparaison des méthodes 2D et 3D dans l'évaluation des fonctions ventriculaires globales en scanner multi-détecteurs.

PURPOSE: To compare two methods of post processing cardiac CT data to measure global ventricular function. Materials and methods. Retrospective study where three readers measured the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) of the right (n=22) and left (n=44) ventricles, using a 2D method (extrapolated volumetric method, EVM) and a 3D method (direct volumetric method, DVM) after cardiac CT with retrospective ECG gating. Inter- and intraobserver agreement were calculated based on the intraclass correlation coefficient (ICC) with 95% confidence interval (CI95%), and results obtained with each method were compared using the student t test for paired samples. RESULTS: Inter- and intraobserver reproducibility were very good for both methods, with ICC ranging between 0.694 and 0.992, without significant difference. For the left ventricle, EDV, ESV and EF were 16653 ml, 8351 ml and 5415% for DVM et de 20361 ml, 11558 ml and 4613% for EVM respectively. Right ventricular values were 15247 ml, 7534 ml, 5013% and 17253 ml, 9940 ml, 439% (p<0,0001). CONCLUSION: The very good inter- and intraobserver reproducibility for both methods validate their use in clinical practice. Volume measurements with DVM are always inferior to volumes with EDM, with inverse relationship for EF measurements.

Tomosynthesis in musculoskeletal pathology.

Tomosynthesis is an imaging technique that uses standard X-ray equipment with digital flat panel detectors to create tomographic images from very low-dose projections obtained at different angles. These images are parallel to the plane of the detector. Filtered back-projection or iterative reconstruction algorithms can be used to produce them. Iterative reconstruction used with a metal artifact reduction algorithm reduces metal artifacts, and therefore, improve image quality and in-depth spatial resolution. The radiation dose is lower compared to that of computed tomography and is two to three times the dose of a standard radiography. Tomosynthesis is intended for the analysis of high-contrast structures and especially for bones. It is superior to projection radiography when bone superimpositions are important or when metal structures hide regions of interest. The high in-plane resolution and its ability to perform exams in weight-bearing positioning are some of the main advantages of this technique. The impossible production of perpendicular multiplanar reconstruction and a limited contrast resolution are its main limitations. Tomosynthesis must be considered as an extension or an addition to standard radiography, as it can be performed in the same diagnostic step. The purpose of this article was to describe the principles, advantages and limitations, and current and future applications in musculoskeletal pathology of tomosynthesis.

[CT enteroclysis: a pictorial essay]. / L'enteroscanner: revue iconographique.

The objective of the CT-enteroclysis is to distend the entire small intestine equally and sufficiently using a nasojejunal probe and an enteroclysis catheter for administration of a neutral opacifying agent. Today this is the best radiological method available to explore the small intestine because of its good spatial resolution and the rapidity of the exam. It is a high-performance exam when searching for transmural and extramural pathologies, in particular small tumoral lesions. It remains less effective in the exploration of anomalies of the lumen's mucosal lining, contrary to videocapsule endoscopy and the double-balloon enteroscope. It has been recognized that the CT-enteroclysis is a high-performance examination that should replace the small-bowel follow-through exam. However, there are undeniable disadvantages: higher does of radiation, patient discomfort during placement of the enteroclysis catheter, false-positive results, long interpretation time, and the impossibility of exploring the endoluminal aspect of the intestinal mucosal lining. All radiologists should therefore become familiar with the problems involved with this exam and its signs and patterns, which are illustrated in this pictorial review.

[New possibilities to study biliary tree and gallbladder: functional magnetic resonance cholangiography contrast-enhanced with mangafodipir trisodium (Mn DPDP)]. / Les nouvelles possibilités d'exploration des voies biliaires en IRM: de l'imagerie morphologique à l'imagerie fonctionnelle avec perfusion de Mangafodipir Trisodium (Mn DPDP).

Mangafodipir trisodium (Teslascan) is a hepatobiliary contrast agent that provides noninvasive opacification of the bile ducts. Using this contrast medium combined with a T1-weighted gradient echo enhanced sequence provides functional imaging of the bile ducts. Second-intention MRI was obtained after the usual morphological study of the bile ducts using heavily T2-weighted sequences (SS-FSE Te eff long and SS FSE Te eff short). This method can detect many biliary duct anomalies: biliary leakage in the postoperative context, mapping of bile ducts and the gallbladder in the search for anatomical variants, analysis of biliodigestive or biliobiliary anastomoses, or a dynamic study of bile secretion and excretion. Opacification of the bile ducts has only been possible until now with invasive tests aggravated by a certain co-morbidity rate and their functional study using biliary scintigraphy limited by mediocre spatial resolution. This new possibility provides access not only to morphological imaging, but also to functional imaging with excellent spatial resolution.

[Liver and focal liver contrast: radiologic-pathologic correlation]. / Foie et contraste des lésions focales: corrélation radio-histologique.

Knowledge of the histological features of different components of a liver lesion greatly assists radiologists because it provides understanding of the correspondingimaging features. The imaging characteristics of lesions depend on variations of the extracellular architecture, mainly surrounding stromal tissue. Until histological imaging techniques become available, cellular analysis relies on optical microscopy and immunohistochemistry. Recent advances in imaging techniques now provide additional information on lesions due to improved spatial, temporal and contrast resolution. Correct interpretation of these imaging features should improve diagnosis.

[A rare tracheal tumour: solitary fibroma]. / Une cause exceptionnelle de tumeur trachéale: la tumeur fibreuse solitaire.

INTRODUCTION: Solitary fibromas are rare anatomo-pathological entities, described initially in the pleural cavity. The mesenchymal origin of these tumours explains their widespread distribution. CASE REPORT: The authors report a case of solitary fibroma of the trachea in a woman of 30 years of age, presenting as acute respiratory distress and preceded by a 2 year history of episodes of dyspnoea diagnosed as unstable asthma. CT and MRI imaging showed evidence of a localised tracheal tumour without mediastinal infiltration. The images and macroscopic appearances were non-specific. Bronchoscopic resection of the tumour gave immediate relief of the symptoms. Histology, which was positive for anti-CD34 antibodies and negative for epithelial, muscular and neurological markers, led to a diagnosis of solitary fibroma with no evidence of malignancy. CONCLUSION: To our knowledge, this observation is the first description of a primary solitary fibroma localised to the trachea. The clinical and radiological features are no different from those of other tracheal tumours. After excision, the prognosis is good but long-term follow-up is necessary on account of the risk of local recurrence or metastasis.

[Biliary colic: imaging diagnosis]. / La douleur biliaire: comment la reconnaître? Comment l'explorer?

Biliary colic is the most common clinical presentation of symptomatic gallstone disease, whatever its localisation (cholelithiasis or choledocolithiasis). The pain of biliary colic is unfortunately called "colic", a word suggesting paroxystic bouts and usually described as localised in the right upper quadrant. In fact, biliary pain is most frequently epigastric in location, usually starts abruptly to generally persists without fluctuation and resolve gradually over two to four hours. Biliary lithiasis has a high prevalence in the population, especially in elderly women but only 20% of the patients are symptomatic and among them, only 10 to 20% experience severe pain. Misdiagnosis is frequent with potential disastrous implications, especially with other causes of epigastric pain (atypical myocardial ischemia, perforated ulcer, etc.). Non invasive imaging of the biliary tract is now generally easy to obtain; abdominal ultrasound for gallbladder stones and magnetic resonance cholangiography for the main bile duct and the intrahepatic bile ducts. But, for gallbladder stones, the greatest care must be taken by the radiologist to link up the symptomatology and the cholelithiasis. Precise description of the abdominal pain (nature, intensity, location, duration, irradiation...) is needed and must be searched by the radiologist to prevent misdiagnosis.

[Pulmonary artery sarcoma during postpartum: CT findings]. / Sarcome de l'artère pulmonaire dans le post-partum: aspects scanographiques.

We report the case of a 28 year-old female, who gave birth seven weeks previously, presenting with a pulmonary artery leiomyosarcoma discovered on a thoracic CT performed for clinical suspicion of pulmonary embolism. This case presents two major points of interest: on the first hand, it is a particular context (young post-partum patient), with classic symptoms of routine pulmonary embolism. On the other hand, the exam clearly demonstrates tumor enhancement, which is characteristic but rarely described.

Multimodality evaluation of musculoskeletal sarcoidosis: Imaging findings and literature review.

Whilst the detailed X-ray features of thoracic manifestations of sarcoidosis are now clearly defined and known by most radiologists, the same does not apply to osteoarticular and muscular features of the disease, which may however raise major diagnostic problems, either because they are the presenting features of the disease (7% of cases) or because they develop during its course. The bony lesions of sarcoid dactylitis (classical Perthes-Jüngling disease) are very characteristic and well known. Many other presentations of bone and bone marrow sarcoidosis may however raise major diagnostic difficulties, particularly uni- or multifocal osteolytic and sclerotic forms of the disease. The articular manifestations of sarcoidosis are difficult to distinguish from those of the other inflammatory and degenerative arthropathies. The muscular lesions in sarcoidosis are generally clinically silent and therefore often missed. MRI has shown them to be very common in active sarcoidosis. Acute forms carry a good prognosis whereas chronic lesions are a presenting feature of multi-organ sarcoidosis. Finally, clinicians should always think about the possibility of an iatrogenic origin for musculoskeletal abnormalities seen in sarcoidosis, particularly those related to corticosteroid therapy.

[Contribution of EKG-gated multislice CT in the diagnosis of arrhythmogenic right ventricle dysplasia: report of two selected cases]. / Apport du scanner volumique avec synchronisation ECG dans le diagnostic de cardiomyopathie arythmogène du ventricule droit: à propos de deux cas choisis.

Arrhythmogenic cardiomyopathy of the right ventricle is characterized by replacement of right myocardial cells by fibro-fatty tissue and arrhythmias. The authors present two cases where EKG gated multislice CT was valuable. In one case, comprehensive evaluation of extensive ventricular dysplasia complicated by intraventricular thrombus was achieved whereas accurate evaluation of the ventricular wall process was possible in another case.