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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.

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).

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.

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.

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.

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.

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.

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.

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: 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.

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.

Imaging studies play an increasing role in patients with an acute abdomen. Guided by main symptoms, clinical findings and examination, imaging studies can confirm or change the diagnosis and the severity of the disease, guide the medical or surgical therapeutic. The plain film of the abdomen, despite its overall low sensibility and specificity, remains the current first-line radiological test in suspected bowel obstruction and detection of free air. The ultrasound and computed tomography, with a high sensibility and specificity, are more often used in first-line or after the plain film.

Primary leiomyosarcoma of bone is a rarely reported tumor of elderly subjects. It usually shows an aggressive osteolytic pattern on plain radiographs and involves predominantly the metaphyses of long bones. We report a case of primary leiomyosarcoma of bone, which is atypical by its epiphyseal location, a non-aggressive pattern on plain radiographs and its MR imaging features.

Filter placement within the inferior vena cava is performed to prevent pulmonary embolism in patients with contraindications or failure of anticoagulant therapy. Several complications of vena cava filters have been described. However, mechanical complications related to IVC filters may not be of any clinical significance. The purpose of this pictorial essay is to present the imaging features of complications related to inferior vena cava filter placement.

Lyme disease involves multiple organ systems including in 10-15% of cases, the nervous system. Cranial neuropathies are observed in the second stage of the disease. The facial nerve is the most frequently affected nerve (20-30%). Facial nerve enhancement may be associated with cochleovestibular nerve abnormalities and can mimick an intracanalicular pseudomass. We present post-gadolinium enhancement of multiple cranial nerves associated to an intracanicular enhancement illustrated in a patient referred for a facial nerve palsy and presenting a Lyme disease. We discuss the differential diagnosis.

Encephalic diseases remain an important problem in AIDS patients despite improvement in the rate of disease spread. We provide data on the current situation and describe the clinical, pathological and imaging features commonly observed in encephalic diseases in AIDS patients.

Magnetic resonance angiography (MRA) has become a major tool in the management of vascular diseases. However, many artifacts that may lead to misinterpretations are encountered with this imaging modality. The purpose of this paper was to enumerate, explain and illustrate each kind of artifact encountered with "time of flight" or "phase contrast" imaging methods. For each artifact, we tried to provide one or several techniques to minimize its consequences.

Magnetic resonance angiography is now a technique commonly used in neurologic practice. We give a brief overview of the biophysical principles of this technique. Recent refinements and technical innovations are also noted. After some anatomic considerations about the carotid artery, we provide some data about the role of MRA in atherosclerotic and non atherosclerotic diseases (dissections, aneurysms, arteritis, post operative follow-up...) of the extra and intracranial carotid arteries. The purpose of this review is to concentrate on the role of magnetic resonance angiography in patients with various carotid artery diseases and to specify possibilities, limitations and risk of misinterpretation. Magnetic resonance angiography is a major, still evolving technique.

We report a case of wirsungorrhagia related to rupture of a pseudoaneurysm into the duct of Wirsung in a patient with chronic pancreatitis. Upper gastrointestinal endoscopy showed blood coming from the papilla of Vater suggesting wirsungorrhagia. Non-contrast computed tomography showed a spontaneous hyperdensity and arteriography showed an extravasation of contrast within a very large duct of Wirsung confirming wirsungorrhagia. Arteriography and dynamic computed tomography revealed a pseudoaneurysm from the left gastric artery. The pseudoaneurysm was successfully embolized with four steel microcoils, after super-selective catheterization of small branch of the left gastric artery, keeping gastric and liver vascularization.

We report the initial and long-term results of non surgical procedures performed for the treatment of biliary strictures in liver transplant patients. Twelve liver transplant patients with biliary strictures underwent 16 interventional radiological procedures. Initial technical success was achieved in 11 of 12 patients (91%). Within long-term, with a follow-up of 27 months, primary success rate (only one procedure) was 58% (7 of 12 patients). Three restenoses occurred. They were all treated by interventional radiological procedures. The secondary success rate (one or more procedures) was 83% (10 of 12 patients). Two complications occurred including one pancreatitis and one cholangitis. Non surgical management may be performed for patients with biliary strictures after liver transplantation.

Giant hepatic hemangiomas are rare entities. They can be symptomatic with pain and increased erythrocyte sedimentation rate. Cholestasis has already been reported. We describe a case of biliary dilatation secondary to a hemorrhagic giant hepatic hemangioma documented on CT and MRI.

To describe imaging features suggestive of retrograde perineural spread in progressive facial palsy without known tumoral origin. Two reports of perineural infiltration by salivary malignant tumors were diagnosed on abnormal enhancement of the facial nerve associated with an abnormal nerve enlargement (1/2). These unsuspected tumors were located in parotid gland (1/2) and the sub-maxillary gland (1/2). ENT tumors (especially adenoid cystic carcinomas) should be carefully searched in case of perineural spread, as these tumors may be misdiagnosed due to their size, location and signal. Therefore, imaging studies of facial palsy should include temporal bone, skull base, parotid gland, submaxillary gland and sub cutaneous areas of the face. A sub-maxillary gland tumor should be searched in case of facial palsy associated with glossodynia.

After a brief review of the pertinent anatomy of joint compartments and main ligaments of the wrist, the authors present the technique of wrist arthrography and CT arthrography. They discuss the normal and pathological patterns. The main indications are the chronic painful wrist and posttraumatic wrist. Imaging can reveal ligament defects (particularly scapholunate ligament, or lunotriquetral ligament), triangular fibrocartilage tears, capsular defects, cartilage thinning, foreign bodies, synovial ganglia or synovitis of the wrist.

More than 50% of patients with acquired immunodeficiency syndrome (AIDS) present a lesion affecting parotid gland, lymph nodes, paranasal sinuses, pharyngo-larynx or temporal bone. In about 20% out of cases affected patients present different head and neck lesions at the time of evaluation. Most often, clinical examination and endoscopy are sufficient to perform diagnosis and to manage the disease. Imaging studies (CT or MRI) are indicated when the nature of the disease is unknown or when a map of the process is mandatory for therapeutic approach. Some imaging features are strongly suggestive of HIV infection: parotid cysts associated with hyperplasia of the nasopharynx and cervical lymph nodes enlargement; labyrinthitis and multinevritis; and head and neck squamous cell carcinomas in non alcoolo-tobacco addicted patients. Such diseases suggest the need for knowledge of the patient's seropositivity status.

A case of symptomatic giant hemangioma of the liver with fever, anemia, and increased erythrocyte sedimentation rate is reported. Spontaneous hyperdense areas at CT, and high signal-intensity areas at T1-weighted MR images were demonstrated within the hemangioma. Marked hemorrhagic zones demonstrated at pathologic examination may explain these uncommon clinical and imaging features.

Peritoneal mesothelioma is a rare, either benign or malignant tumor of the peritoneum. We retrospectively analyzed the imaging features of six malignant and three benign peritoneal mesothelioma. Asbestos exposure was proven in three of the six malignant cases and in none of the three benign cases. Ascites was found in seven patients (78%), peritoneal masses in eight patients (88%), small peritoneal nodules in six patients (66%), parietal peritoneal thickening in six patients (66%), thickened mesentery in five patients (55%) and pleural plaques as well as nodules in one patient. These imaging features support the diagnosis of peritoneal mesothelioma but do not allow differentiation between benign and malignant forms of peritoneal mesothelioma.

Renal vein thrombosis was observed in a patient with acute ulcerative colitis complicated by retroperitoneal perforation. Retroperitoneal inflammation related to colonic perforation may constitute a predisposing factor for local thrombosis in combination with coagulation disorders (protein S deficiency).

Two cases of cerebral arteritis related to varicella-zoster virus in seropositive patients are presented. Diagnosis of arteritis was made by conventional angiography. However, 3D Time of Flight MR Angiography demonstrated an excellent sensitivity in detection of cerebral arterial stenosis located at the skull base.

Extra-adrenal pheochromocytoma are extremely uncommon tumors. They demonstrate abdominal (97% of the cases), thoracic, vesical or cervical localizations. We report the case of a hepatic pheochromocytoma in a young patient with a post history of labile arterial hypertension. Ultrasonography, computed tomography and magnetic resonance imaging features were similar to those of adrenal pheochromocytoma. The presence of neuroendocrine cells was supported by immunohistochemical criteria. Histological observation showed a lack of local extension. In addition, four years after surgery, there was no apparent clinical syndrome suggesting tumor recurrence or metastasis occurrence. These observations supports the diagnosis of non malignant, primary hepatic pheochromocytoma. To our knowledge, this is the first radiologic description of this kind of tumor.

The pulmonary hernia is a rare entity defined by protrusion of pulmonary tissue through an abnormal weakness of the thoracic wall. We describe a case of spontaneous pulmonary hernia associated with osseous sternocostal abnormalities in a patient with a Recklinghausen disease.

Ruptured abdominal aortic aneurysm is the major surgical emergency in the retroperitoneal compartment. Rupture of an abdominal aortic aneurysm is always fatal without urgent operative repair. Computed tomography is the reference standard for the diagnosis of ruptured abdominal aortic aneurysm in hemodynamically stable patients. At CT, the diagnosis is based on the combination of abdominal aortic aneurysm and extraluminal retroperitoneal blood. Retroperitoneal hemorrhage usually demonstrates both isodense and hyperdense areas. In most cases hemorrhage is located in psoas compartments and perirenal space. In the case of ruptured abdominal aortic aneurysm other findings may be demonstrated such as focal interruption of the aortic wall and active extravasation of contrast media in the retroperitoneal compartments. Inflammatory abdominal aortic aneurysm, that may present as acute abdominal pain, should be recognized and differentiated from ruptured abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm is characterized by a fibrotic process around the abdominal aorta that may entrap adjacent structures such as ureters, duodenum and inferior vena cava. Aortic dissection, mycotic aneurysm, and inferior vena cava thrombosis are less common. Complications occurring after emergency aneurysm replacement are also considered.

The diagnosis of acute pancreatitis is based on clinical examination and basic laboratory tests. The main role of sonography in acute pancreatitis is to evaluate gallstones and small fluid collections. However, sonography is frequently difficult due to intestinal ileus related to pancreatitis. CT is indicated early in the clinical course of acute severe pancreatitis when the diagnosis is uncertain or when complications such as abscess, hemorrhage, or necrosis, are suspected. In addition, CT may be used to assess the prognosis and follow-up of patients.

Interventional radiology used in acute abdominal diseases has demonstrated its efficacy in most emergency cases especially in patients at high risk for surgery. Percutaneous drainage is a reference standard for abscesses located within the abdomen and pelvis with high success rates of up to 80%. The diagnosis and treatment of gastrointestinal hemorrhage have changed over the past two decades, with decreased diagnostic examinations and advances in pharmacologic therapy and improved endoscopic techniques. On the other hand, embolization techniques and new procedures such as trans jugular intra hepatic porto systemic shunt have been developed. Arterial embolisation in many situations such as blunt or direct trauma, obstetric or post operative hemorrhage, can be used as an effective easy and relatively safe technique with high success rates to stop bleeding and save the organ. Percutaneous drainage and angiographic techniques adapted to biliary and urinary tree have also been developed as well as endoscopic procedures, allowing treatment of stenoses by balloon dilatation, or plastic or metal prostheses. Indications, technical aspects, complications and limits of these various procedures are presented.

Radiologic evaluation of abdominal trauma must provide a quick and accurate assessment of the lesions in order to improve the management of the patient. The technique used varies depending on the mechanism of the trauma (blunt trauma or stab wounds) and the hemodynamic status. Radiologic evaluation is usually performed in blunt trauma whereas stab wound trauma is usually explored surgically. The various techniques available are standard radiographs, ultrasonography, computed tomography and arteriography. The role of magnetic resonance imaging in the immediate evaluation is still not well defined. It appears to be a useful method in the delayed evaluation of diaphragmatic trauma. Computed tomography is the method most commonly performed in trauma patients. This technique is accurate and allows correct assessment of the lesions. The disadvantages are the radiation induced and the need for a hemodynamically stable patient. The aim of the radiologic evaluation is to provide the clinicians with an accurate description of the lesions. It can help in the management of the patient usually in association with clinical and laboratory data. It can also guide interventional procedures (drainage, embolization...). Finally, it allows radiographic follow-up when conservative treatment is performed.

Intraperitoneal vascular lesions constitute severe causes of acute abdomen. These disorders include ischemia and infarction of colon and small bowel and abdominal hemorrhage. In case of intestinal ischemia, the radiologic procedures are performed in order to establish the diagnostic, identify the site of ischemia, and detect the etiology of ischemia. Plain radiography of the abdomen, ultrasonography, CT scan and angiography may be performed. In case of intestinal hemorrhage, angiography may be performed when endoscopy fails to establish the diagnosis. Embolization can be performed in selected cases.

Infectious disease is a common cause of acute abdomen. The diagnosis is based on clinical examination and basic laboratory tests. However, medical imaging routinely performed according to the clinical findings is frequently useful. Hepatic and splenic abscesses are correctly demonstrated by ultrasonography and computed tomography. Ultrasonography is the reference standard for the diagnosis of acute cholecystitis. The US examination is also performed for the diagnosis of appendicitis and its complications. Ultrasonography and barium enerna are commonly performed for the evaluation of signoid diverticulitis. Computed tomography is the reference standard to determine medical or surgical procedures.

Emergency pelvic imaging is currently based on transabdominal and transvaginal sonography. Life threatening emergencies such as ectopic pregnancy and annexial torsion can be diagnosed by these technics. Doppler imaging (pulsed Doppler and color encoded) improve the diagnostic efficacy in an emergency context. Evaluation of pelvic inflammatory disease, cyst bleeding and placental disruption in best obtained by US because of its simplicity, safety and low cost.