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Purpose: To evaluate the risk of radiofrequency ablation treatment failure for hepatocellular carcinomas (HCC) next to large vessels., Materials and Methods: Between May 2000 and October 2002, from a total of 83 patients treated by radiofrequency ablation for HCC in a single center, 13 patients with tumoror=3 mm in diameter (Group A) were matched with 13 patients with similar size tumors located away from large vessels (Group B). Immediate response and recurrence rate were evaluated on CT., Results: After mean follow-up interval of 39+/-16.5 months for Group A and 39+/-14 months for Group B, local recurrence rates were 7/12 versus 1/12 respectively (p=0.03). For Group A, 6/7 local recurrences clearly contacted a large vessel., Conclusion: The cooling effect from flowing blood in large vessels markedly increases the rate of local failure of radiofrequency ablation for small HCC located near large vessels.

Susceptibility Weighted Imaging (SWI) is a new MR imaging technique using the BOLD effect (Blood Oxygen Level Dependent) and the differences of susceptibility between tissues. It is a 3D gradient echo, fully velocity compensated sequence. The echo time is chosen to maximize the signal cancellation in veins and a specific post-processing is applied using the phase images as a complementary source of contrast. It is very useful for the visualization of veins either normal or abnormal. It shows hemorrhage, even of small quantity, better than conventional gradient echo sequences. Its use is still limited by a long acquisition time and some remaining artifacts.

The realization of radiological examinations in the elderly population must be adjusted to the needs of patients that usually have health problems and very little patience. Its organization must be thought as a whole: appointment, reception of an awaited patient, human accompaniment allowing good cooperation, nursing support, and prompt availability of reports. Adapted equipment facilitates the examination: stretchers to raise and carry invalid patients, digital radiography. Structural linking of radiology and geriatric units with a departmental support avoids the isolation of medical and ancillary staff, reinforce the bonds with geriatricians and facilitates the access to CT before any contrast-enhanced (barium, iodinated) examination. Teleradiology is a complementary tool of making the medical support available and reinforce the interactivity with geriatricians. The simplicity of the questions in current geriatrics makes it possible to use teleradiology in daily practice.

We report a case of cavitation of the mesenteric lymph nodes, an uncommon complication of celiac diseases. Computerized tomography is the method of choice for diagnosis and follow up after gluten free diet.

Xanthogranulomatous cholecystitis (XGC) is a benign chronic inflammation of the gallbladder, rarely described in the radiologic literature. Like xanthogranulomatous pyelonephritis, it can clinically and radiologically mimic carcinoma. This unusual entity is characterized morphologically by a broad spectrum of xanthogranulomatous changes seen from a small limited focus within yellow nodule in the gallbladder wall, to diffuse involvement of the entire gallbladder with extension of the fibrosis into surrounding tissues. It is clear that recurrent inflammation and calculi are important for the pathogenesis, which is not well understood. The clinical presentation and radiologic findings of XGC are non specific. Irregular thickening of the gallbladder wall and local extension of the process can mimic carcinoma. Diagnosis of XGC is always established by histological examination, characterized by the infiltration of round cells, lipid laden histocytes and multinucleated giant cells in the muscle layer. We report a case of 76-year-old woman who had an episode of epigastric and right upper quadrant pain, 4 months before admission. Physical examination demonstrated a palpable mass in gallbladder region. Echography and computed tomography showed a large gallbladder, a thickened wall and an infiltration of the adjacent liver. The relatively well defined gallbladder internal border and the absence of biliary tract's dilatation allowed us to suggest the diagnosis of XGC, which was confirmed intraoperatively by frozen section histology. Once the diagnosis was established, cholecystectomy was performed. Occasionally, the inflammatory reaction is so severe that a subtotal cholecystectomy is required. Postoperative recovery was, as usually, uneventful. Although a rare entity, XGC should be considered in the differential diagnosis of complex right upper quadrant masses, as well as neoplastic gallbladder disease.

Imaging procedures offer an important contribution to the syndrome of the abused child that F.N. Silverman himself proposes to call the Ambroise Tardieu syndrome. First they disclose and analyse the lesions which may involve bones, encephalon or spinal cord, viscera, soft tissues. Then they must answer four questions: Traumatic lesion or normal variant? If traumatic, are there arguments pointing to abuse, for instance multiple bone lesions of different ages and more specifically fractures of ribs, clavicle, spine, pelvis, phalanxes? Is there a possibility of a general disease explaining such traumatic lesions? Etiologies are revised including sensibility deficits. Finally are the bad treatments inflicted with an intention of hurting, injuring or destroying? The answer results of a discussion with clinicians and social interveners but some lesions, as phalanx fractures, may be determining. In this situation that involves the vital prognosis and may induce severe sequellae the imaging strategy, fully described, is of paramount importance.

Problems encountered during pre-operative embolization in 21 patients with spinal affections could be differentiated as a function of the 3 main regions affected: cervical, dorsolumbar, and lumbosacral. The distinction between the totally different problems raised was based on histologic and angiographic studies of the vascularization of the spinal cord and vertebral column. Whenever possible, and particularly when it can be complete, embolization markedly facilitates the surgical procedure.

The authors have studied retrospectively 32 children with malignant bone tumor. All patients underwent conventional arteriography just before surgery. Distal foci of hypervascularisation and venous thrombosis, not seen at CT, may alter surgical treatment. When large extension to soft tissues is present, the arteriography remains unchallenged to evaluate the venous involvement.

CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intraarticular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

Findings on arthrography of posterior lumbar spine joints in 55 patients were compared with those reported in the literature. Two major degenerative lesions of these joints, diverticula and cysts, can provoke back pain and symptomatic nerve compression. Whereas diagnosis of a cyst is dependent mainly on computed tomography imaging, that of a diverticulum is ensured by arthrography, an investigation which also has a therapeutic aim since it allows infiltrations to be performed.

Historical aspects and anatomophysiologic features of posterior lumbar vertebral joints are summarized and results of arthrography of 55 joints presented, together with a simple, original method for performing this examination. Normal anatomic appearances condition understanding of principal lesions encountered, particularly with respect to compression of adjacent nerve structures.

We describe five cases of painful periosteal reaction occurring in children. The initial radiographic appearance of stress fracture may be troublesome since the new bone formation may be confused with malignant bone lesion. Because of the importance of making a correct diagnosis multiple imaging techniques will often be employed. We discuss the radiographic signs and their usefulness in the differential diagnostic of periosteal reaction.