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Digestive haemorrhage following supramesocolic abdominal surgery (cephalic duodenopancreatectomy, cholecystectomy, total oesogastrectomy) is a rare but serious complication, which can be life-threatening. Improvement in scanning techniques has made it possible to modify the diagnostic strategy and improve the therapeutic management of the patients. The aim of this iconographic review is to recall the causes of digestive haemorrhage following supramesocolic surgery and to illustrate the dominant role of tomodensitometry in diagnosing it and in planning and controlling the efficacy of endovascular treatment., (Copyright © 2011 Éditions Françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Due to ongoing technological advances, the range of clinical applications for diffusion-weighted MR imaging has expanded to now include abdominal pathology. Current applications for liver pathology include two main directions. First, oncologic imaging with detection, characterization and follow-up of lesions. Second, evaluation of diffuse liver diseases, including hepatic fibrosis. The diagnostic impact and role of diffusion-weighted MR imaging remain under investigation, but appear promising. Because of its short acquisition time, sensitivity, and additional information it provides, diffusion-weighted MR imaging should be included in routine liver imaging protocols.

Surgery for the treatment of colorectal diseases has been evolving rapidly recently. In addition to classical surgical procedures (colectomy, abdominoperineal resection), new surgical procedures include coloproctectomy with creation of an ileoanal anastomosis and ileal pouch, pelvic reconstructions (omentoplasty, placement of myocutaneous flaps) and creation of different colic anastomoses after anterior rectal resection. Even if computed tomography and fluoroscopic contrast examinations are still commonly used to assess postoperative changes and complications, especially infections, pelvic magnetic resonance imaging is useful to depict postoperative changes, detect complications such as fistulas and tumor recurrence in patients who have undergone surgery for primary or recurrent rectal disease. The main surgical techniques, their respective indications and postsurgical imaging features will be discussed. The main complications and imaging work-up will also be reviewed.

Purpose: To retrospectively quantify the incidence of redundant publication in the journal Radiology and to compare the present study findings with those published for other journals and medical specialties., Materials and Methods: Two readers estimated the incidence of the redundant publication of original articles in Radiology in the year 2001. Original research articles published in 2001 were analyzed by searching MEDLINE on the PubMed server to identify articles that may have represented a duplication of the original Radiology article. MEDLINE was searched between January 1999 and December 2003 by using the surname and initial(s) of the first author. Potentially redundant articles were identified after similarities in titles and abstracts were analyzed. The full versions of all potentially redundant articles and of the corresponding index articles were then retrieved from the library. The potentially redundant article was then compared with the index article. Criteria for redundant publication were as follows: Compared with the index article, the potentially duplicate article had (a) a similar hypothesis, (b) a similar number of subjects, (c) similar results, (d) at least one author in common, and (e) no or little new information., Results: In 2001, 362 original research articles were published in Radiology. Two instances of redundant publication were found among these articles, and both were considered to be partially redundant publications due to series expansions (ie, increased numbers of study subjects) of 50% and 52%., Conclusion: Redundant publication appears to be less frequent in Radiology than in the other journals and specialties for which redundant publication information has been reported., ((c) RSNA, 2008.)

Cystic lesions of the pancreas, with an estimated prevalence of 20%, frequently are incidental findings at imaging on asymptomatic patients. Pseudocysts, typically in a setting of pancreatitis, should first be excluded. Characterization of cystic tumors is more complicated. Still, it is important to differentiate between benign and malignant lesions. Multi-detector row CT and MRI allow characterization of such lesions in over 75% of cases. Indeterminate lesions should undergo endoscopic US with biopsy/aspiration and fluid analysis, especially for mucin producing tumors (rounded with thick enhancing wall). When imaging fails to fully characterize a lesion, follow-up may be proposed for lesions less than 3 cm in size, that are either unilocular with thin nonenhancing wall (simple cyst) or lobulated multilocular with thin nonenhancing wall (serous cystadenoma, isolated side branch IPMTP). Follow-up imaging shows that these tumors usually show very little change over time. Management is based on comparing estimated patient survival without treatment to surgical risks (morbidity, mortality, functional sequelae from the procedure).

Objective: Our purpose was to examine the computed tomographic findings in 13 patients with acute deep venous thrombosis (DVT) of central veins of the neck, chest, and abdomen in whom major perivenous inflammatory changes were noted., Methods: During a 10-year period, 13 patients with acute DVT of 21 central veins and marked perivenous inflammatory changes on computed tomography were identified. Computed tomography images were assessed for location of DVT and pattern of perivenous changes., Results: The perivenous changes took the form of a rounded or lobulated perivenous bulky mass (massive pattern or tumorlike) in 5 patients and of infiltrative changes in the other 8 patients. Direct visualization of the thrombotic vein was possible in 8 patients. Follow-up examinations (range, 6-36 months; mean, 15 months) demonstrated resolution of perivenous inflammatory changes with anticoagulation therapy in all cases., Conclusion: Perivenous inflammatory changes around the thrombotic vein presented as a rounded or lobulated perivenous bulky mass that may mimic a tumor or as infiltrative perivenous changes.

Purpose: The quality of magnetic resonance cholangiopancreatography (MRCP) images is frequently degraded by high signal from the gastrointestinal tract on heavily T2W images. The purpose of this study is to evaluate pineapple juice (PJ) as an oral negative contrast agent in MRCP., Materials and Methods: Results from MRCP in 50 patients with PJ and 50 patients with paramagnetic contrast (ferumoxsil-Lumirem) were compared. Reviewers were blinded to the type of contrast agent. Exam quality was recorded with regards to signal suppression in the stomach, duodenum and proximal small bowel and with regards to pancreatic duct and biliary ducts visualization. In vitro, the signal characteristics of several commercially available brands of PJ were assessed using T1W, T2W and MRCP sequences. Signal intensity was correlated with the manganese concentration measured using atomic absorption spectrometry. Finally, the reviewers compared the taste of PJ and ferumoxsil., Results: On MRCP sequences, results were similar with regards to signal suppression in the stomach, duodenum and proximal small bowel with PJ and ferumoxsil. Visualization of the pancreatic duct, intrahgepatic bile ducts and CBD was similar with PJ and ferumoxsil. The signal intensity of commercially available brands of PJ on T2W and MRCP sequences correlated well with the measured manganese concentration on spectroscopy. Variations in manganese concentration were observed, with values ranging from 3.65 to 27.24 mg/L. The reviewers noted that PJ tasted "good" or "very good" and that ferumoxsil tasted "bad" or "very bad"., Conclusion: Ingestion of PJ provides effective signal suppression in the GI tract on MRCP, similar to paramagnetic contrast agents. Because manganese concentration is highly variable in commercially available PJ brands, a brand with high manganese concentration should be selected.

Objective: The abdominal and retroperitoneal lymphatic system is characterized by numerous anatomic variations. Our objective is to review MR lymphographic features of normal anatomy and abnormal conditions., Conclusion: MR lymphography is a noninvasive technique that is well suited for the examination of abdominal and retroperitoneal lymphatic vessels.

The imaging features of infectious and non-infectious pathologies in HIV patients with AIDS (less than 200 CD4/mm3) are illustrated. Opportunistic infections, tumors and vascular pathologies have variable appearances based on the degree of immunosuppression and patient compliance with opportunistic infection prophylaxis. Because of advances in retroviral treatments and wider use of anti-infectious prophylaxis, thoracic pathologies in AIDS patients are less frequent but must nonetheless be recognized, and diagnosis should be suggested in patients with unknown serologic status.

Unlabelled: Liver biopsy is the gold standard for assessing fibrosis but has several limitations. We evaluated a noninvasive method, so-called diffusion-weighted magnetic resonance imaging (DWMRI), which measures the apparent diffusion coefficient (ADC) of water, for the diagnosis of liver fibrosis in patients with chronic hepatitis C virus (HCV). We analyzed 20 healthy volunteers and 54 patients with chronic HCV (METAVIR: F0, n = 1; F1, n = 30; F2, n = 8; F3, n = 5; and F4, n = 10) prospectively included. Patients with moderate-to-severe fibrosis (F2-F3-F4) had hepatic ADC values lower than those without or with mild fibrosis (F0-F1; mean: 1.10 +/- 0.11 versus 1.30 +/- 0.12 x 10(-3) mm2/s) and healthy volunteers (mean: 1.44 +/- 0.02 x 10(-3) mm2/s). In discriminating patients staged F3-F4, the areas under the receiving operating characteristic curves (AUCs) were 0.92 (+/-0.04) for magnetic resonance imaging (MRI), 0.92 (+/-0.05) for elastography, 0.79 (+/-0.08) for FibroTest, 0.87 (+/-0.06) for the aspartate aminotransferase to platelets ratio index (APRI), 0.86 (+/-0.06) for the Forns index, and 0.87 (+/-0.06) for hyaluronate. In these patients, the sensitivity, specificity, positive predictive value, and negative predictive value were 87%, 87%, 72%, and 94%, respectively, with an ADC cutoff level of 1.21 x 10(-3) mm2/s. In discriminating patients staged F2-F3-F4, the AUC values were 0.79 (+/-0.07) for MRI, 0.87 (+/-0.05) for elastography, 0.68 (+/-0.09) for FibroTest, 0.81 (+/-0.06) for APRI, 0.72 (+/-0.08) for the Forns index, and 0.77 (+/-0.06) for hyaluronate., Conclusion: This preliminary study suggests that DWMRI compares favorably with other noninvasive tests for the presence of significant liver fibrosis.

Intramedullary spinal cord abscess associated with infectious spondylodiscitis is a rare entity. The case of a 66-year-old man with an intramedullary spinal cord abscess complicating thoracic spondylodiscitis is presented. The patient was unable to ambulate independently due to weakness of the legs. MR imaging showed findings suggestive of infectious spondylodiscitis at the T5-T6 level associated with epidural and intramedullary spinal cord abscesses. Biopsy of the intervertebral disc was performed and Bacteroides fragilis was isolated. Antibiotic therapy was instituted, and MR imaging of the thoracic spine was performed 6 weeks after the initiation of treatment, showing resolution of the epidural and intramedullary spinal cord abscesses.

Objective: Pelvic magnetic resonance imaging (MRI) studies are widely used to assess the rectum, anal canal, and their environment. The purpose of this article is to review the current role of MRI in the evaluation of diseases involving the ischiorectal fossa and their imaging features., Conclusions: The radiologist plays an essential role in the evaluation of some conditions typically located in this space and of other conditions that occasionally involve this area or invade the ischioanal space. The accurate assessment of these diseases that MRI provides further cements its role as the primary technique for the evaluation of pelvic pathology.

The main problem associated with rectal cancer treatment is tumor recurrence. Randomized controlled studies have shown that adjuvant preoperative radiation therapy is effective for reducing local recurrence. These studies have also demonstrated that there are groups of rectal cancer patients with differing degrees of risk for local recurrence. At one end of the spectrum is the low-risk group: patients with superficial rectal cancer, who can be treated with surgery alone. At the other end is the high-risk group: patients with a close or involved resection margin at total mesorectal excision, the very advanced tumors that require a longer course of chemotherapy and radiation therapy, and extensive surgery. Paramount for this selection and differentiated treatment is a reliable preoperative test that can be used to distinguish these groups of patients. In this review article, we will discuss the role of high-resolution phased array MRI among the other imaging modalities such as endorectal MRI, endorectal US, and CT. We will also discuss and illustrate MR imaging results in terms of T stage, circumferential resection margin, locally advanced rectal cancer, and N stage.

The purpose of this study was to report a new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy. Forty-three hepatocellular carcinomas were not visible with CT fluoroscopy. A 22-gauge Chiba end-hole needle was inserted in the approximate location of a lesion estimated on the basis of anatomical landmarks demonstrated on both previous MR and CT images. We injected 3 ml of a mixture of nonionic contrast material and saline solution. Following the first injection, contrast solution filled the hepatic lesion in 29 of 43 cases. In 8 of 43 cases, contrast solution was distributed in the normal surrounding liver. In 7 of these 8 cases, repositioning allowed us to adjust the needle in the tumor. In the other 6 of 43 cases, contrast solution spread within capsule or pseudocapsule (pattern 3). In all 6 cases, repositioning allowed to adjust the needle in the tumor. This new technique allows an accurate localization of hepatic tumors that are poorly visible with CT fluoroscopy.

Objective: Our objective is to describe pouchography, CT, and MRI features of the J-shaped pouch, both normal and with pouch-related complications., Conclusion: Pouchography is performed before closure of the loop ileostomy to assess the integrity of the ileal pouch and anastomosis. CT and MRI can be performed when postoperative complications, such as small-bowel obstruction, pouchitis, leakage, abscess, intramural hematoma, desmoid tumor, or recurrent Crohn's disease, are suspected.

Diagnosis of incidental adrenal masses is a real challenge to radiologists. The most common incidental tumors of the adrenal gland are adenomas and metastases. This article presents our experience with uncommon adrenal incidentalomas. Most of the magnetic resonance imaging characteristic features are demonstrated. When possible, they are correlated with the findings at gross and microscopic analysis, to help in understanding the mechanisms by which magnetic resonance imaging may aid in the characterization of the incidental adrenal mass.

Purpose: To retrospectively compare the clinical manifestation and magnetic resonance (MR) imaging features of liver adenomatosis with pathologic findings., Materials and Methods: This study had institutional review board approval, and informed consent was waived. Twenty patients were classified on the basis of pathologic findings into three groups: those with a steatotic, those with a peliotic, and those with a mixed (steatotic and peliotic) form of liver adenomatosis. MR images were reviewed in consensus by two abdominal radiologists, and findings were compared with the pathologic classification. Statistical evaluation was performed with the Student t test., Results: All patients were women (mean age, 39 years +/- 10 [standard deviation]). Lesions of the steatotic form (n = 7) showed (a) a mean diameter of 6.3 cm +/- 1.7, (b) slightly hyperintense signal on T2-weighted images, (c) hyper- or isointense signal on T1-weighted images with a signal dropout with fat suppression sequences, and (d) moderate enhancement at the arterial phase with no delayed enhancement. Lesions of the peliotic form (n = 7) showed (a) a somewhat larger size (8.3 cm +/- 3.6), (b) markedly hyperintense signal on T2-weighted images, (c) iso- or hyperintensity on T1-weighted images with no signal dropout with fat suppression sequences, and (d) strong arterial enhancement and persistent enhancement at the portal and delayed phase. Lesions of the mixed form (n = 6) included a combination of imaging features of the steatotic and peliotic forms. Lesions, however, were significantly larger in the mixed form than in the steatotic form (10.3 cm +/- 4, P < .05)., Conclusion: There are three patterns of MR imaging features of liver adenomatosis that are associated with three pathologic forms (steatotic, peliotic, and mixed).

Magnetic resonance (MR) imaging with cholangiopancreatographic sequences plays a critical role in evaluating alterations in the biliary tract after surgical procedures such as cholecystectomy, liver transplantation, hepatic resection, and the creation of a biliary-enteric anastomosis. MR cholangiopancreatography, a rapid, noninvasive, and accurate imaging technique for the assessment of early and late complications of hepatobiliary surgery, usually enables the identification of normal and abnormal postoperative changes. In cases of complete obstruction of the bile duct, MR cholangiopancreatography allows analysis of the biliary tract above and below the level of the obstruction, a capability essential for treatment planning and one that is not provided by either endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. MR cholangiopancreatography is particularly useful for the evaluation of biliary-enteric anastomoses, for which an endoscopic approach is generally precluded. It also can help detect and localize bile duct strictures and stones and can help accurately classify bile duct injuries. It is useful for detecting bile leaks, although it generally does not directly depict the extravasation of bile. In addition to MR cholangiopancreatography, T1- and T2-weighted MR imaging may be performed to depict extrabiliary soft-tissue structures and abnormalities such as an abscess, tumor recurrence or metastasis, hematoma, or hemobilia. Mangafodipir trisodium-enhanced MR cholangiopancreatography, a recently developed technique that provides a combination of anatomic and functional information, is particularly helpful for documenting bile leaks because it allows a functional evaluation of biliary excretion and may directly depict bile leakage from injured ducts., (RSNA, 2006)

Objective: The objective of this pictorial essay is to provide a review of the diseases involving the rectal wall with an emphasis on the key clinical and radiologic differentiating features., Conclusion: A wide spectrum of disease processes can involve the rectum in adults. MRI is the technique of choice in the definitive diagnosis of these disease conditions, mainly because of its superior tissue contrast differentiation.

The ileocecal area is a relatively short segment of the gastrointestinal tract but may be affected by pathologic conditions that are either common throughout the gastrointestinal system or exclusive to this area. These conditions include benign and malignant tumors, inflammatory processes (appendicitis, diverticulitis, epiploic appendagitis, Crohn disease), infectious diseases, and miscellaneous conditions (cecal ischemia, typhlitis, cecal volvulus, duplication cyst). The various components of the ileocecal area (cecum, appendix, ileocecal valve, terminal ileum) are close to one another, so that these conditions may involve more than one anatomic structure, thereby creating a diagnostic dilemma. The evaluation of various parameters (eg, stratified enhancement pattern of the thickened bowel wall, degree of thickening, extent and location of bowel wall involvement, degree of fat stranding relative to the degree of wall thickening) and associated findings (lymph nodes, mesenteric stranding, abscess and sinus tracts, fatty proliferation, solid organ abnormalities) will help narrow the differential diagnosis. Multi-detector row computed tomography (CT) is considered the best imaging examination for the evaluation of the ileocecal area. Consequently, the radiologist should be familiar with the multi-detector row CT features of the spectrum of diseases affecting this area to help ensure correct diagnosis and appropriate treatment., (Copyright RSNA, 2006.)

Pelvic magnetic resonance (MR) imaging is useful for identification of postoperative changes, complications, and disease recurrence in patients who have undergone surgery for primary or recurrent anorectal disease. Commonly used interventions include treatment for anorectal carcinoma: anterior rectal resection with or without creation of different colic anastomoses and abdominoperineal excision with or without pelvic reconstruction (omentoplasty, placement of myocutaneous flaps). Other common interventions include treatment for inflammatory bowel disease (coloproctectomy with or without creation of an ileoanal anastomosis and ileal pouch) and treatment for fistulas (placement of flaps or setons). Postoperative anatomic changes and formation of scar tissue can usually be identified with consecutive MR imaging examinations. Pelvic MR imaging is an accurate technique for assessment of complications including anastomotic leakage, septic complications such as fistulas and abscesses, neoplastic recurrence, and other less common complications (perineal hernia, peritoneal pseudocyst). The sophisticated surgical procedures used in rectal surgery can alter normal anatomy and make image interpretation difficult. Thus, familiarity with the appearances of postoperative anatomic changes, complications, and tumor recurrence is essential for accurate MR imaging evaluation after surgery for anorectal disease., (Copyright RSNA, 2006.)

Solitary fibrous tumor (SFT) is commonly found on serosal surfaces, and is rarely localized in the liver. There are benign and malignant variants of hepatic SFT. We report a new case of benign SFT. Our patient, a 63-year old woman, who has been followed for 5 years for an asymptomatic liver mass, was admitted for abdominal pain. Ultrasonography (US), CT, MR Imaging and angiography showed the liver mass with typical imaging features, situated in the right hepatic lobe with blood supply from the hepatic artery. Histopathological examination demonstrated a highly vascularized tumor, composed of short spindle cells alternating with hypocellular collagenous regions, with a hemangiopericytoma-like vascular pattern. The immunohistochemical staining was positive for CD 34. Tumor resection was performed. Follow-up 8 years after the resection showed no tumor recurrence or metastasis, thus confirming the initial diagnosis of benign SFT.

Magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP) features were analyzed in the diagnosis of seven surgically resected hepatobiliary cystic tumors with reference to histopathological data. Homogeneity, size, location, signal intensity, presence or absence of septa and/or nodules and MRCP features of the lesions were studied. Histological evidence demonstrated six biliary cystadenoma (BCA) including four pseudo-ovarian stroma (POS) and one biliary cystadenocarcinoma (BCAC). Cystic lesions (3-15 cm in diameter) were homogeneous in the six BCA, heterogeneous in the one BCAC, and were located in the left and right liver, respectively. On T2-weighted images all lesions were hyperintense. On T1-weighted images hypointensity was found in three BCA (all serous fluid, including one POS), isointensity was found in the three others (two mucinous and one hemorrhagic fluid, including three POS) and in the one BCAC (containing mucinous fluid). Septas were present in all cases and nodules only in the one BCAC. On MRCP a hyperintense cystic lesion was found in all cases and a bile ducts dilatation in two BCA and the one BCAC. Gadolinium-enhanced MRI in combination with MRCP is a valuable tool for the diagnosis of BCA or BCAC. However, no specific information is gained for POS detection.

Unlabelled: Percutaneous ablation using acetic acid is an attractive method because of its low morbidity and low number of sessions required to induce complete tumor necrosis. Moreover, the real-time fluoroscopy CT scan could improve the technique by improving distribution of the necrotizing agent within the tumor., Aim: To determine the feasibility and the long-term results of the acetic acid percutaneous injection under CT fluoroscopy guidance in a series of cirrhotic patients with small hepatocellular carcinoma in a single French center., Methods: One hundred and two patients with hepatocellular carcinoma were evaluated for treatment between 1999 and 2000. The selection criteria for fluoroscopy CT scan-directed percutaneous acetic acid ablation were: 1) one to three nodules<5 centimeters; 2) Child-Pugh class<13; 3) prothrombin index > 40% and platelet count > 50000 per mm(3) and 4) contraindication to both resection and liver transplantation. Post treatment follow-up included ultrasonography, magnetic resonance and alphafetoprotein levels every 3 months. Recurrence and survival rates were estimated using the Kaplan-Meier method., Results: Forty-nine patients (48%) could benefit from a curative treatment, most of them (37/49) being eligible for fluoroscopy CT scan-directed percutaneous acetic acid. The mean follow up was 24.4 +/- 2.7 months. Complete tumor necrosis was achieved in 28 patients (76%) after a mean of 1.6 sessions. In these 28 patients, the recurrence rates were 34% and 48% and survival rates were 76% and 70%, at 24 and 36 months, respectively. No serious complications occurred during or after the treatment., Conclusions: Percutaneous ablation using acetic acid using CT fluoroscopy guidance may be considered as a short term efficient, low risk treatment and can be applied even in patients with ascites or severe hemostatic abnormalities. However, the high rate of recurrence and the early occurrence of multifocal hepatocellular carcinoma underline the limits of this method as well as of all other percutaneous strategies.

Objectives: To evaluate MR imaging in detecting and characterizing secondary reactive synovitis and correlate the results with arthroscopy., Materials and Methods: Retrospective study of 10 patients referred for MR imaging and arthroscopy of the knee or shoulder. The diagnosis of reactive synovitis was confirmed by arthroscopy and pathological examination. Synovial thickening was graded at MRI as follows. Grade 0: normal; grade 1: diffuse synovial thickening; grade 2: nodular synovial hypertrophy; grade 3: pseudotumoral synovial mass., Results: Synovitis was described at MRI in 8 cases. There were 2 false negative results on MR imaging for the knee. Synovitis was secondary to knee trauma and rotator cuff tear or surgery of the shoulder. On arthroscopy, all synovial lesions were detected and confirmed at pathology. Synovitis was not detected at MRI (grade 0) in 20% of cases. Synovitis appeared diffuse (grade 1) in 30%, nodular (grade 2) in 30% and pseudotumoral (grade 3) in 20%. Bony erosions were adjacent to synovial thickening in 5 cases., Conclusion: Reactive synovitis can occur after trauma. MR imaging is useful in detecting and evaluating secondary reactive synovitis. Arthroscopy and synovial biopsy are necessary to exclude infectious or tumoral synovitis.

Iatrogenic drug disorders should be considered when presented with a number of imaging findings mainly involving the nervous, musculoskeletal, gastrointestinal or genitourinary system. Care should be used when differentiating between imaging findings related to the underlying pathology and imaging findings related to drug-related complications: examples include the impact of steroid therapy on bones and the impact of triple-drug anti-HIV therapy and its impact of fatty tissue. Knowledge of the necessary imaging surveillance protocol is implied.

Purpose: To compare and quantify, by means of receiver operating characteristic (ROC) and localization ROC analyses, the performance of radiologists, pulmonologists, and anesthesiologists (residents and staff) in the detection of missed lung cancer., Materials and Methods: The study was approved by the institutional review board, and informed consent was not required or obtained for review of radiographs. A set of 60 posteroanterior chest radiographs was presented to 36 observers: 12 radiologists, 12 pulmonologists, and 12 anesthesiologists. Each of these three observer categories included six residents and six staff. Thirty of the radiographs each depicted one lung cancer that was overlooked at prospective image interpretation; the other 30 were normal radiographs matched for age and smoking history. Observers were asked to rate their degree of suspicion concerning the presence of lung cancer by using a visual analog scale and to point out the zone of suspicion on a schematic of the lung. These data were used to generate combined ROC-localization ROC curves and to assess performance. Intraobserver consistency was evaluated by using intraclass correlation coefficients and weighted kappa statistics., Results: Areas under the ROC curves indicated better performance for radiologists and pulmonologists compared with anesthesiologists (P < .002) and for staff compared with residents (P < .022). Performance was lower for all categories of observers when localization ROC curves were used. Radiologists and staff pulmonologists showed a higher degree of confidence in the assessment of normality than did other categories of physicians. Intraobserver consistency was poor., Conclusion: Experienced readers showed better ability to distinguish normality from abnormality. Combined ROC and localization ROC analyses gave a more reliable quantification of observer performance than did ROC analysis alone., ((c) RSNA, 2004.)

Intramural hematoma of the colon is a rare complication of blunt abdominal trauma. We report the case of a 32-year-old man who presented with abdominal pain related to blunt trauma. The initial diagnosis of post-traumatic intramural hematoma of the colon was performed at CT scan and proven at colonoscopy. Although the majority of cases warrant surgery, conservative therapy was proposed in the present case with spontaneous resolution of the hematoma demonstrated by CT scan.

Purpose: A French multicenter registry was set up to confirm the safety and efficacy of large calibrated tris-acryl gelatin microspheres for embolization of symptomatic fibroids., Methods: Technical recommendations included embolization using large microspheres (>500 microm) with no secondary embolization agent. Postprocedural pain, clinical improvement and adverse events were prospectively evaluated during a follow-up period of at least 6 months., Results: Eighty-five women complaining of fibroid-related symptoms entered the study. In seven women, a secondary embolization agent was used in addition to microspheres. Complete resolution of menorrhagia was achieved in 84% of women at 24 months and significant uterine and fibroid volume reductions were noted after 6 months (37% and 73%, respectively). Three women experienced definitive amenorrhea (4%) and two women required hysteroscopic resection of a fibroid. Eight women were treated by hysterectomy because of treatment failure. In seven of these women, treatment failure was explained by an additional cause of symptoms including diffuse adenomyosis, endometrial hyperplasia or ovarian artery supply to the fibroids., Conclusion: Limited uterine artery embolization using large microspheres has good clinical success rate with low postprocedural pain and complications. Women can expect excellent midterm results with a high level of symptom control and significant fibroid volume reduction. Confidence in the end-point recommended here may require the experience of several cases.

Purpose: To determine the rate at which original studies that were presented orally at the 1995 Radiological Society of North America (RSNA) Scientific Assembly were published in Medline-indexed journals and to identify factors predictive of publication., Materials and Methods: The 1995 RSNA Scientific Program was jointly reviewed by two readers. A total of 1,897 abstracts were included in the study. A Medline search of articles published between 1996 and 2000 was then conducted to identify articles written by the first, second, and/or last authors of all abstracts published in the 1995 RSNA Scientific Program. The year of publication, journal, country origin of the abstract, subspecialty, and nature of the research (ie, human, animal, or technical) were recorded. Publication rates were compared by using multiple logistic regression analysis., Results: Six hundred thirty-five abstracts were expanded into manuscripts that were subsequently published in Medline-indexed journals; thus, the publication rate was 33%. A study was published less than 3 years after the 1995 scientific assembly in 595 (94%) cases. Genitourinary radiology and chest radiology studies had the highest publication rates (46% and 48%, respectively; P <.01), whereas physics studies had the lowest (24%, P <.001). Technical studies (24%, P <.001) were less likely than human studies (36%, P <.001) to be published. The publication rate also differed substantially according to the country origin of the abstract. The articles were published in a total of 109 journals and chiefly in Radiology (211 cases, 33% of published studies)., Conclusion: One-third of original studies presented orally at the 1995 scientific assembly were subsequently published in Medline-indexed journals. More articles were published in Radiology than in any other identified journal., (Copyright RSNA, 2004)

We report two cases of acute aortic thrombosis in cancer patients. Aortic thrombosis is rare in the absence of atherosclerosis, dissection, or aneurysm. On the one hand, hypercoagulable state related to cancer is a well-known risk factor for venous thrombosis. On the other hand, arterial thrombosis has been rarely reported in cancer patients. Recognition of aortic thrombosis is important because it is a dangerous condition; furthermore, it exposes at the patient to complications such as peripheral embolism. In addition, anticoagulation can result in resolution of thrombosis.

Patient's age no longer is a major factor when discussing the diagnosis and treatment of hepatobiliary and gastrointestinal diseases. However, discussing with the physician in charge of the patient is the only adequate way to propose the quickest, least invasive and most comfortable imaging modality that will give a proper answer to the clinical problem. Cross sectional imaging, especially ultrasound, CT and in some cases MRI, plays an important role in the diagnosis of these diseases.

Myositis ossificans circumscripta is a benign pathology of soft tissue occurring in young patients often after localized trauma. Histological and radiological appearances may mimic a malignant neoplasm, mainly sarcoma. We report a case characteristic of myositis ossificans circumscripta, to illustrate diagnostic arguments which are based on their appearance on conventional radiographs, computed tomography and magnetic resonance imaging and on their changes with time.

Objective: The purpose of our study is to evaluate the distribution of acetic acid mixed with iodinated contrast agent during percutaneous acetic acid injection on CT fluoroscopy for hepatocellular carcinoma., Conclusion: Monitoring acetic acid distribution on CT fluoroscopy can detect extratumoral diffusion and may optimize the distribution of acetic acid in hepatocellular carcinoma.

Hepatic portal vein gas has been documented in numerous conditions and is traditionally regarded as a poor prognostic sign. There are, however, several reports of portal vein gas with a benign course. We report the first case of transient hepatic portal vein gas secondary to the ingestion of a caustic substance. The literature of hepatic portal vein gas in benign disease is reviewed.

Objective: To evaluate the results of combination of D-Dimer test and simple clinical model for the diagnosis of deep vein thrombosis (DVT)., Materials and Methods: Inclusion: clinical suspicion of DVT. Non inclusion criteria were Clinical model performed by the referring physician included probability varying from high to low. D-Dimer test was performed by five different rapid techniques. Standard of reference was Doppler ultrasonography (DU) performed by a senior radiologist., Results: Eight hundred and fifty-four DU were performed on a 14 months time period, including 206 suspicion of pulmonary embolism, 109 postoperative time period, 120 non-included or excluded patients, 278 incomplete observations, 141 complete observations. DVT was present in 33 cases and absent in the other 108 cases (prevalence 23%). Sensitivity and negative predictive value of the five tests were between 82 and 97% and 90 et 97%. The most sensitive test had a specificity of 36% and a positive predictive value of 32%. Combination of clinical model and D-Dimer test did not improve the diagnostic accuracy., Conclusion: None of the test evaluated in the present study, even when combined with the clinical model results, did allow the exclusion of DVT.

We describe a case of subcutaneous metastasis along the needle track after percutaneous ethanol injection (PEI) for treatment of hepatocellular carcinoma. After surgical resection and extrabeam radiation therapy the patient is alive without evidence of recurrence five years after PEI. One should pay attention to the abdominal wall around the needle track in interpreting CT or MR images of patients with previous PEI.

A pulmonary artery pseudoaneurysm developed after placement of a Swan-Ganz catheter for liver surgery is described. This observation is unusual for two reasons. Pulmonary artery pseudoaneurysm was discovered on a simple post-operative chest radiograph. Spontaneous thrombosis and radiographic regression were observed.

Objective: The purpose of the present study was to determine the publication rate in Medline-indexed journals of papers originally presented at the Journées Françaises de Radiologie (JFR96)., Materials and Methods: Proceedings from the JFR 96 were reviewed by two observers in conference. A Medline search encompassing 1997-1999 was performed for the lead author of all abstracts of original papers. Publication year and the journal of publication were recorded., Results: 456 oral presentations were analysed, 39 papers were subsequently published corresponding to a publication rate of 8.5%. 10 papers were published in Radiology, 4 in European Radiology and 4 in the Journal de Radiologie, the other 21 in other journals. Publication rate was significantly higher for two sessions: Research session (publication rate was 22%) and Bone and Joint session (publication rate was 16%)., Conclusion: Less than 10% of abstracts presented at JFR 96 were subsequently published in Medline-indexed journals. This rate is lower than the publication rate of papers presented at other medical meetings.