Post-pneumonectomy evaluation of the chest: a prospective comparative study of MRI with CT.

A comparative study of 11 pneumonectomized patients was undertaken in order to evaluate the respective advantages and drawbacks of MRI and CT in post-operative follow-up. Nine patients were healthy at the time of the study and two presented with tumor recurrence. MR examination included 500/40 ms axial, and frontal 800/40-80 ms or 1300/60-120 ms nongated spin echo sequences. MRI was slightly more efficient in identifying vascular stump and main nodal stations, and detected better than CT tumoral and metastatic spread in cancer recurrences. It was as informative as CT in evaluating postpneumonectomy space and bronchial stump. It was noncontributory in the detection of calcifications. Although clips were visible with MRI, their location was less definite than with CT, a potential pitfall when radiotherapy is planned.

Contribution of computed tomography in six sacrococcygeal chordomas.

Six sacrococcygeal chordomas were studied with CT at the Institut Gustave-Roussy. Only one was examined at the time of the initial diagnosis and CT made a valuable contribution to this. In other cases, CT determined the possibility of initial surgical excision and the field of radiotherapy and helped make a reliable diagnosis of local recurrences. CT seems to be the best examination to use for the early diagnosis of chordomas and recurrences, which will perhaps help improve the prognosis of this serious disease.

MRI in the pre-operative assessment of tracheal cylindroma. Case report.

Compared with malignant neoplasms of the chest, benign tumours are quite rare; cylindroma (or salivary gland adenoma) is exceptional. The apparent histological benignancy belies its high potential for invasiveness. This can, in some cases, lead to extensive, non-conservative surgery. By a different approach in the imaging of the chest, Magnetic Resonance Imaging in this condition may provide an accurate pre-operative assessment. We present a case in which MRI provided the information necessary for the surgical approach, and describe its accuracy and the results obtained.

[An MRI study of the normal pelvis in the immediate postpartum period]. / Etude IRM du pelvis normal en post-partum immédiat.

PURPOSE: To describe the MR findings of the pelvis in the early post-partum period, after vaginal delivery or cesarean section. MATERIALS AND METHODS: Fifteen asymptomatic patients were imaged using a 1.5 Tesla MR unit between 1 and 7 days following delivery. Eight patients had a vaginal delivery, and seven patients had a cesarean section. RESULTS: The following items were evaluated: uterus size, architecture, and contents; uterine and abdominal wall scars; parametrium; peritoneal cavity; ovarian veins. CONCLUSION: MRI provided a good evaluation of the pelvic changes related to pregnancy and delivery. Knowledge of the normal findings should improve diagnosis of early post-partum complications.

[Bronchial anastomotic complications after pulmonary transplantation. X-ray computed tomographic evaluation]. / Complications anastomotiques bronchiques après transplantation pulmonaire. Evaluation tomodensitométrique.

PURPOSE: To determine the sensitivity and specificity of CT in depicting bronchial anastomotic complications after lung transplantation. MATERIALS AND METHODS: A retrospective, blinded review of 105 CT scans obtained after single (n = 17) or double (n = 10) lung transplantation in 27 patients was done by two radiologists in consensus. CT images, were analyzed with respect to the status of bronchial anastomoses, with three possible answers given to the readers: normal, dehiscence, or stenosis. CT features were correlated to bronchoscopic and follow-up findings, which were considered as standard of reference. RESULTS: CT had a 60% sensitivity and 98% specificity for the diagnosis of bronchial dehiscence, and 40% and 99% for the diagnosis of anastomotic stenosis. One case of bronchial disruption was diagnosed on CT scan only and subsequently confirmed by repeated bronchoscopy. CONCLUSION: In our study, CT has a low sensitivity but a high specificity in the detection of bronchial anastomotic complications after lung transplantation. However, CT remains useful in some cases, as it can show complications not seen bronchoscopically.

MR appearance of the normal chest after pneumonectomy.

Magnetic resonance (MR) imaging of the chest was performed in nine patients who had undergone pneumonectomy, to evaluate postoperative chest anatomical changes. The main criterion of selection in this study was the absence of cancer recurrence at the time of the study and 6 months later (normal clinical, fiberoptical and cytological data and normal laboratory values). All the MR studies were compared with chest CT performed within 15 days after MR imaging. Postpneumonectomy space revealed in all cases a heterogeneous signal both on T1- and T2-weighted spin-echo sequences. Vascular and bronchial stumps were clearly delineated and surrounded by low signal areas, considered to be postoperative scars. Spatial involvement was well understood with frontal and axial views. Calcifications were poorly identified. Surgical clips were easily detected, but they were difficult to locate accurately. No adverse effects was reported, either in patients with or without surgical clips.

Hepatic pseudolesion around the falciform ligament: prevalence on CT examination.

BACKGROUND: The purpose of this study was to determine the prevalence of hepatic pseudolesions seen around the falciform ligament on computed tomography (CT) of the abdomen obtained with intravenous administration of contrast material. METHODS: We first retrospectively reviewed the CT scans of six patients in whom hepatic pseudolesions were seen around the falciform ligament. The abdominal CT scans of 587 patients were then prospectively analyzed for the presence of hepatic pseudolesions around the falciform ligament to determine the prevalence of this finding on CT examinations. RESULTS: CT scans in the first six patients showed two types of hepatic pseudolesion around the falciform ligament. In three patients, hepatic pseudolesions were focal spared areas in fatty liver. In three patients, hepatic pseudolesions were developed in nonfatty liver. Prospectively, hepatic pseudolesions were found on five of 587 CT examinations (prevalence = 1%). A single hepatic pseudolesion was found in segment 4 on two examinations. Two hepatic pseudolesions (one in segment 4 and one in segment 3) were found together on three CT examinations. CONCLUSION: Hepatic pseudolesions around the falciform ligament are seldom seen on CT scan. However, recognition of these pseudolesions is crucial because they may be interpreted as true tumors.

Study of three radio-induced malignant fibrohistiocytomas of bone.

Malignant fibrohistiocytoma (MFH) is one of the most frequent malignant tumours of soft tissues [6]. Its classification as a bone tumour, however, is relatively recent [1]. In addition to primary MFH in bone, the entity has been observed to occur as a secondary phenomenon, some cases having complicated pre-existing infarcts of bone [4]. This paper reports three cases of MFH of bone developing as a consequence of previous radiation therapy.

Benign giant-cell tumours of bone with pulmonary metastases and favourable prognosis. Report on two cases and review of the literature.

This paper reports two giant-cell tumours of bone of low-grade malignancy, both complicated by the development of pulmonary metastases in which the histological appearances were identical to those of the primary neoplasm. Ten similar cases in the literature are reviewed.

Radiological study of two disseminated malignant non-Hodgkin lymphomas affecting only the bones in children.

Malignant non-Hodgkin lymphomas are a neoplastic proliferation of lymphoid cells whose clinical manifestations are extremely variable. All tissues can be affected. There may be localization in lymphoid organs (Waldeyer's ring, spleen, digestive tract), other localizations (lungs, pleura, liver, bone marrow, central nervous system), and unusual localizations. Although bone marrow is often affected, bone involvement is very rare in the early stages of the disease. This report concerns the radiological study of two disseminated malignant non-Hodgkin lymphomas affecting only the bone in children.

CT demonstration of the 1996 AJCC-UICC regional lymph node classification for lung cancer staging.

The new international lymph node classification adopted by the American Joint Committee on Cancer (AJCC) and the Union Internationale Contre le Cancer (UICC) is described and illustrated with computed tomography (CT). Anatomic landmarks for 14 hilar, intrapulmonary, and mediastinal lymph node stations are designated. Main differences between the new international classification and the American Thoracic Society (ATS) one are emphasized. In particular, mediastinal pleural reflection is now used to differentiate N2 from N1 nodes. The ATS 10L (left peribronchial nodes) and 10R (right tracheobronchial nodes) stations are now replaced by the AJCC-UICC station 10 (hilar nodes) and the AJCC-UICC station 4 (lower paratracheal, including azygos, nodes), respectively. This very important difference from the ATS classification helps classify the 4 lower paratracheal nodes as N2 nodes, even though the pleural reflection is not seen with CT. The 5 AJCC-UICC nodes are renamed subaortic nodes instead of aortopulmonary ATS nodes. Paraortic nodes, which previously were classified as 5 ATS nodes, are now included with the 6 AJCC-UICC nodes (now renamed paraaortic nodes instead of anterior mediastinal ATS nodes). This change helps accurate labeling because the border between 5 and 6 ATS nodes was not always clear on CT scans. Radiologists should be familiar with this new classification to be able to more accurately compare the lung cancer staging done in different institutions around the world.