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The purpose of this study was to evaluate the relationship between liver spontaneous attenuation (LSA) on computed tomography (CT) reflecting the degree of steatosis, and the severity of acute pancreatitis (AP).All consecutive patients admitted from December 2014 to September 2020 for an episode of AP were retrospectively reviewed. LSA was evaluated on early CT examination and all abdominal CT examinations were reviewed by two abdominal radiologists. Severity of AP was categorized using Atlanta classification and CT severity index. Univariable and multivariable statistical analyses were performed.A total of 467 patients were included. There were 297 men and 170 women, with a mean age of 57 ± 19 (SD) years (range: 18-98 years). Among them, 236 patients (51%) had acute biliary pancreatitis, 134 (29%) had acute alcoholic pancreatitis and 97 (20%) had AP due to other etiologies. A total of 44 (9%) patients had severe AP and 423 (91%) had non severe AP. Median LSA was significantly lower in patients with severe AP (36 Hounsfield units [HU]; interquartile range [IQR]:18; 54) than in patients with non-severe AP (45 HU; IQR: 35; 51) (P0.001). In patients with alcoholic AP, median LSA was significantly lower in patients with severe AP (29 HU; IQR: 3; 43) than in those with non-severe AP (42 HU; IQR: 27; 50) (P = 0.022). At multivariable analysis, the third and fourth quartiles of liver spontaneous attenuation values (i.e.,45 HU/30 HU and30 HU) were independently associated with severe AP (OR, 3.23; 95% CI: 1.33-51.2; P = 0.038 and OR, 8.82; 95% CI: 1.91-69.7; P = 0.014; respectively).LSA on CT is associated with clinical severity of AP and may be used as an additional marker of disease severity.

The purpose of this study was to identify computed tomography (CT) features associated with early recurrence of sigmoid volvulus (SV) after a first uncomplicated episode and to develop a score for early SV recurrence risk stratification.A total of 95 patients (59 men, 36 women; mean age, 72 ± 15 [SD] years; age range: 57-87 years) who underwent abdominal CT examination for a first uncomplicated SV episode from January 1Early SV recurrence occurred in 53 patients (56%). At multivariable analysis, left lateral section volume150 cmA simple CT score allows stratification of early SV recurrence after a first episode and helps to select patient who would not benefit from prophylactic colonic surgery because of a low SV recurrence risk.

Background The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE. Purpose To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China. Material and Methods Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama’s classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion. Results Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher’s exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ2 = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P, publishedVersion

Purpose To describe the computed tomography (CT) and magnetic resonance imaging (MRI) features of severe acute alcoholic hepatitis (SAAH) and estimate the capabilities of CT and MRI in differentiating SAAH from alcoholic cirrhosis and non-alcoholic steato-hepatitis (NASH) cirrhosis. Materials and methods Fifty patients with pathologically proven SAAH (SAAH group) who underwent CT or MRI examinations up to 30 days before or 15 days after liver biopsy between January 2008 and June 2018 were retrospectively included. There were 31 men and 29 women with a mean age of 52 ± 9 (SD) years (range: 33–67 years). Imaging features of the SAAH group were compared to those obtained in two control groups including 62 patients with alcoholic cirrhosis without acute alcoholic hepatitis (control group 1) and 19 patients with NASH cirrhosis (control group 2) by two independent radiologists blinded to the final diagnosis. Univariate analyses were performed to compare imaging characteristics between the three groups, followed by diagnostic performance analysis for the diagnosis of SAAH of the main CT features. Results Heterogeneous steatosis was significantly more frequent in SAAH group than in the control groups (41/50; 82% vs. 7/62; 10% and 1/19; 5% in control groups 1 and 2, respectively for reader 1 and 34/50; 68% vs. 8/62; 13% and 1/19; 5% in control groups 1 and 2, respectively for reader 2; both P = 0.01). Transient perfusion disorders were more frequent in SAAH group than in the control groups (35/50; 70% vs. 12/62; 21% and 5/19; 26% in control groups 1 and 2, respectively for reader 1 and 39/50; 78% vs. 14/62; 23% and 13/19; 6% in control groups 1 and 2, respectively for reader 2; both P = 0.01). The combination of these two findings yielded 100% specificity (45/45; 95% CI: 92–100) for readers 1 and 2 for the diagnosis of SAAH vs. alcoholic cirrhosis and NASH cirrhosis. Conclusion The imaging features of SAAH are specific and mainly associate transient heterogeneous steatosis and liver perfusion disorders. CT/MRI may be useful to differentiate SAAH from alcoholic cirrhosis and NASH cirrhosis.

PURPOSE To identify variables associated with inconclusive ultrasound examination and the need for further abdominopelvic computed tomography (CT) examination for the diagnosis of acute appendicitis. MATERIALS AND METHODS A total of 105 adult patients with acute appendicitis were included. There were 55 patients (38 men, 17 women; mean age, 23±9 [SD] years; range: 15-58 years) with a diagnosis of acute appendicitis using ultrasound alone and 50 patients (30 men, 20 women; mean age, 31±14 [SD] years; range: 16-83 years) who required further CT. Demographic, clinical, and biological criteria and appendix location were compared between the two groups to search for variables associated with the need of further CT. RESULTS Patients who required further CT were older (31.1±14 [SD] years) and had a greater body mass index (BMI) (26.7±4.3 [SD]kg/m2) than those who did not require CT (23±9 [SD] years and 22.9±3.4 [SD]kg/m2), respectively (P

PURPOSE To evaluate the reliability of pelvimetric measurements performed using stereoradiographic imaging (SRI), and to assess maternal and fetal radiation doses compared to low-dose computer tomography (CT) pelvimetry. MATERIALS AND METHODS Thirty-five pregnant women (mean age, 29.6±5.5 [SD] years; range: 20-41 years) were prospectively included. All women underwent simultaneous frontal and lateral low-dose SRI and low-dose CT examination of the pelvis. Pelvimetry measurements were obtained from both examinations and radiation doses obtained with the two techniques were compared. RESULTS SRI-CT correlation (Pearson coefficient correlation [r]; mean bias [mb]) was strong for transverse inlet diameter (r=0.92; mb=-0.09cm), anteroposterior diameter of the pelvic inlet (r=0.92; mb = 0.47cm), maximal transverse diameter (r=0.9; mb=0.21cm), sacrum length (r=0.9; mb=0.09cm). Correlation was good. Correlation was good for the sacrum depth (r=0.75; mb=0.06cm) and Magnin's index (r=0.7; mb=0.5cm). Correlation was moderate for anteroposterior diameter of pelvic outlet (r=0.6; mb=0.52cm). The fetal dose was 13.1 times lower using SRI (87±26μGy) than CT (1140±220μGy, P

The purpose of the study was to evaluate if IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes. All patients presented with anticoagulation-related spontaneous IP hematoma or RS hematoma and who underwent contrast-enhanced CT exploration, with injection of a contrast material, from January 2012 to January 2015 in our institution were included in this study. Considering the retrospective nature of our study, our institutional review board judged our study to be exempted from ethical approval and no patient consent was required. Computed tomography (CT) images were retrospectively analyzed blindly of the evolution and treatment of hematomas. The type of muscle involved; the presence of contrast extravasation after contrast injection; the volume of the hematoma, as well as, clinical and biological results (hemoglobin value g/dL); and for each patient, the type of anticoagulation used, patient’s treatment and outcomes were noted. The analyses were conducted using R 3.1.0. All statistical tests were 2-sided, and probability values

Goals To evaluate the contribution of multiphase whole-body CT angiography (CTA) for identifying the contra-indications to multiorgan retrieval (MOR) and improving the preoperative organ harvesting strategy. Patients and methods One hundred and eleven consecutive patients who were clinically brain dead underwent multiphase whole-body CTA to confirm the diagnosis of brain death and for assessment of MOR. The CTA protocol included volumetric acquisitions of the brain and abdominopelvic cavity without IV administration of iodinated contrast material, then images of the thorax-abdomen-pelvis 25 s after IV contrast administration, of the brain at 60 s and finally an abdominopelvic CT acquisition at 90 s. The diagnosis of brain death was based on well-established criteria. The assessment of thorax, abdomen and pelvis was based on a systematic checklist. Post-processing imaging techniques were used in all patients. Results No organs were retrieved from 21 patients due to patient refusal (19%). Twenty-two potential MOR were denied because of general contra-indications including 12/22 (54%) based on CTA criteria alone. Finally, 68 patients were eligible for MOR and 160 organs were harvested. The exclusion of specific organs was based on CTA alone for 2/16 livers, 4/70 kidneys and 5/55 lungs. Fifty hearts and 58 pancreases were not harvested, none based on CTA results alone. Hepatic abnormalities and vascular anatomical variants were identified in 10% of patients. At least one renal artery variant was found in 28% of patients, 13% presented with a double renal vein and 8% with a hepato-mesenteric artery. Conclusion Multiphase whole-body CTA for MOR is based on the simultaneous association of cerebral CTA to determine brain death with CTA of the thorax, abdomen and pelvis. This rapid, standardized and easily accessible procedure has no harmful effects on harvested kidneys. It makes it possible to select the donors and the organs to be harvested and allows the retrieving surgeon to identify and anticipate technical difficulties.

In patients undergoing computed tomography (CT)-guided microwave ablation (MWA) for renal tumors, we developed a CT-guided anterior paravertebral block (PVB) associated with anesthesia of the kidney capsule and inhalation of an equimolar mixture of oxygen and nitrous oxide (EMONO). The primary objectives were to describe our technique and to study its efficacy in terms of procedural success. The secondary objective was to study the tolerance by evaluating patient pain scores and the number of complications. Patients suffering from renal carcinoma classified T1a and considered to be poor candidates for surgery were included in this prospective, single-center pilot study. They underwent MWA under CT-guided loco-regional anesthesia: an anterior variant of the PVB at the level of T10, ipsilateral to the renal MWA associated with anesthesia of the kidney capsule and EMONO. Technical success was defined as total thermal ablation without additional sedation and no side effect during the procedure. Maximal pain score during the procedure was assessed using a visual analog score. Four patients were included. All procedures were technical success. No side effects were reported, either due to the procedure or anesthesia. The maximal pain score recorded immediately after procedure was 2 ± 2.4 on the visual analog score. MWA of the kidney is feasible under CT-guided anterior paravertebral block. PVB is well tolerated and can be associated with anesthesia of the kidney capsule and EMONO. This new technique may be an alternative to general anesthetic or conscious sedation in clinical practice.

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To correlate the appearance of alveolar echinococcosis (AE) hepatic lesions in magnetic resonance imaging (MRI) as defined by Kodama, to the metabolic activity visualized in 18-fluoro-deoxyglucose positron emission tomography combined with computed tomography (PET/CT).Forty-two patients diagnosed with AE and who underwent both MRI and PET/CT were included. The forty-two hepatic lesions were divided into five types according to Kodama's classification by three independent readers blinded with regard to the PET/CT information. Concerning PET/CT, two independent readers, unaware of the MRI information, considered the results as positive when an increased FDG-uptake was observed at 1 or 3 h after FDG-injection, and as negative when no increased uptake was noted. Inter-observer agreement was assessed by using κ statistics.Forty-two lesions were counted and the mean diameter of overall evaluated lesions was 6.3 cm. One lesion (2.4%) was categorized as type 1, 11 (26.2%) as type 2, 24 (57.1%) as type 3, 3 (7.1%) as type 4, and 3 (7.1%) as type 5. The inter-observer analysis found a κ coefficient of 0.96. All type-1, 90.9% of type-2 and 87.5% of type-3 lesions showed an increased FDG-uptake on PET/CT images. All non-microcystic AE liver lesions (types 4 and 5) showed no abnormal increased FDG-uptake on PET/CT images. The inter-observer analysis at 1 and 3 h found a κ coefficient of 0.95 and 0.92, respectively.In patients with AE liver lesions, the absence of microcysts on MRI is strongly correlated to a metabolically inactive disease.

Objectives To assess the diagnostic accuracy of the different computed tomography (CT) signs for differentiating between malignant and cirrhotic ascites. Materials and methods We performed a retrospective study of 102 CT scans in adults, distributed into two groups based on the cirrhotic or malignant etiology of their ascites. The CT signs studied were ascites volume and relative distribution between the greater peritoneal cavity (GPC) and the omental bursa (OB), the density of the ascites, the thickness of the gallbladder wall, the thickness of the parietal peritoneum and its degree of enhancement, and tethered-bowel sign. Results The CT signs associated with malignant ascites were: presence of fluid in the omental bursa ( P = 0.003), thickening of the peritoneum its degree of enhancement ( P = 0.005), increased density of the ascites ( P = 0.01), and loss of mobility of bowel loops in the ascites ( P = 0.001). There was no difference in gallbladder wall thickness between the two groups. Conclusion The CT scan can play a role in diagnosing malignant ascites. We confirm the usefulness of the indirect signs composed of distribution of ascites fluid, thickening and enhancement of the parietal peritoneum, and loss of mobility of the bowel loops in the ascites.

The purpose of our study was to evaluate the clinical relevance of preoperative CT in distinguishing between the two subtypes of spigelian hernia (SH).We reviewed retrospectively the CT images of 35 patients. The patients were divided into two groups on the basis of the SH subtype: interstitial SH group (n = 15) and subcutaneous SH group (n = 20). Clinical characteristics of patients and CT findings were analyzed. Bowel ischemia on surgery was also noted.Sixteen right hernias and 19 left hernias were observed. Fifteen interstitial SH (43%) and 20 subcutaneous SH (57%) were found. No type of content showed a statistically significant association with one or other subtype of SH. Nine of the 26 patients presenting with SH with SB content showed signs of SBO on CT. Closed-loop SBO on CT was present in 5 of the 26 patients with SB content. An interstitial SH was observed in all of these 5 patients (p = 0.039). Surgery was performed on 10 patients. Bowel ischemia was found on surgery in 4 patients and showed no statistically significant association with a particular subtype of SH (p = 0.6).Our study shows the importance of performing CT in SH. CT provides the diagnosis of SH, shows SH content, and demonstrates the presence of SBO or closed-loop SBO. Moreover, the distinction between the two subtypes of SH on CT appears to be of clinical relevance since closed-loop SBO is statistically associated with interstitial SH and the optimal surgical approach may differ.

Resume La tomographie par emission de positons au 18F-fluorodesoxyglucose (TEP-FDG) permet d’evaluer l’activite parasitaire dans l’echinococcose alveolaire (EA) grâce a la visualisation de la reaction immunitaire hote–parasite en peripherie des lesions. Nous avons realise une relecture retrospective des images TEP et imagerie par resonance magnetique (IRM) chez 24 patients atteints d’EA afin de confronter les resultats de l’imagerie metabolique a la classification morphologique de Kodama et al. Les patients ont beneficie d’une IRM hepatique et d’une TEP-FDG « double acquisition » (une heure et trois heures apres injection), ameliorant la sensibilite de la TEP conventionnelle dans l’EA. L’etude comparative a identifie une hyperfixation perilesionnelle chez tous les sept patients avec lesions de type 1 (lesion microkystique sans element solide) ou 2 (lesion microkystique avec element solide) et chez dix des 12 patients avec lesions de type 3 (un element solide avec kystes et microkystes). Aucune hyperfixation perilesionnelle anormale (a une heure ou a trois heures) n’a ete retrouvee chez deux des 12 patients avec lesions de type 3 et chez cinq patients avec lesions de type 4 (un element solide sans kystes), ou 5 (lesion kystique de grande taille sans element solide, ni microkystes). Notre etude demontre une correlation forte entre la presence intralesionnelle de microkystes et la captation perilesionnelle du 18F-FDG, avec 89,5 % de lesions microkystiques presentant un caractere hypermetabolique. Ainsi, ces deux aspects (morphologique et metabolique) semblent correles a l’activite parasitaire, ce qui suggere une place importante au suivi combine des patients atteints d’EA par imagerie multimodalite avec realisation d’examens d’IRM et de TEP au 18F-FDG.

Resume Objectif Evaluer la presence des corpuscules de Gamna-Gandy (CGG) en IRM chez les patients atteints de cirrhose. Patients et methodes Cent dix-sept patients consecutifs suivis en IRM pour cirrhose ont ete etudies retrospectivement. Deux groupes ont ete definis : le premier comprenait des patients presentant des CGG en IRM (n = 15), le second, des patients sans CGG (n = 102). Les deux groupes ont ete analyses a la lumiere des caracteristiques cliniques et biologiques habituels de la cirrhose, a savoir le sexe et l’âge des patients, l’etiologie de la cirrhose, le score de Child-Pugh, l’existence de varices œsophagiennes, d’une splenomegalie, d’une ascite, la reouverture des veines para-ombilicales, l’apparition d’une encephalopathie hepatique. Un Fisher's exact test et un t-test ont ete utilises pour la comparaison statistique entre les deux groupes. Resultats Les CGG etaient plus frequemment retrouves en cas de splenomegalie (p = 0,035). L’hemochromatose etait la seule etiologie de la cirrhose statistiquement liee a la presence de CGG (p = 0,006) dans notre serie. Aucun lien statistique n’etait en revanche etabli entre la presence de CGG en IRM et les autres caracteristiques de la cirrhose. Conclusion D’identification aisee sur toutes les sequences en IRM, les CGG n’apparaissent pas correles a la gravite de la cirrhose. En revanche, ils sont fortement lies a la presence d’une splenomegalie et doivent etre consideres comme le reflet d’une hypertension segmentaire splenique. Ils semblent par ailleurs tres frequents en cas d’hemochromatose.

Purpose To determine the value of multidetector-row CT (MDCT) in the management of sigmoid volvulus. Materials and methods Twenty-three MDCT examinations showing sigmoid volvulus were retrospectively evaluated and analyzed based on the type of volvulus (mesentericoaxial versus organoaxial), degree of rotation (180 degrees or 360 degrees ), maximum diameter of the volvulized sigmoid loop and presence or absence of the northern exposure sign, signs of bowel wall ischemia, and ascitis. A statistical analysis was performed to determine the correlation between patients characteristics, CT findings, type of management, and histological findings when available. Results In our study, organoaxial volvulus occurred in older patients (p=0.047), had a higher risk of recurrence (p=0.015) and more frequently required urgent surgical management than mesentericoaxial volvulus. A higher degree of rotation was associated with a more distended volvulized sigmoid colon (p=0.033) and more frequently required surgery. Conclusion In addition to detection of volvulus and signs of bowel wall ischemic, MDCT can characterize the type of volvulus and degree of rotation, findings that may assist in determining the severity of the process and direct towards optimal management, endoscopic or surgical.

CT guided dual site infiltration in pudendal neuralgia Purpose. To assess the value of CT guided dual site infiltration in patients with pudendal neuralgia and determine prognostic factors of efficacy. Materials and methods. Retrospective review of 49 patients with suspected pudendal neuralgia who underwent one or multiple injections of local anesthetics and steroids. Patients were classified based on clinical and electrophysiological findings. Results. 70% of patients with typical symptoms of pudendal neuralgia responded favorably to the infiltrations compared to 27% of patients with atypical symptoms (p Conclusion. Infiltration is an effective treatment for patients with typical pudendal neuralgia, and should be included in the management of these patients.

International audience; We investigated a marked common bile duct wall contrast-enhancement in acute pancreatitis on CT scans as an accurate sign of biliary pancreatitis. Contrast-enhanced CT scans of 80 patients with clinically and biologically confirmed acute pancreatitis were reviewed by two gastrointestinal radiologists without knowledge of the cause of acute pancreatitis. Since this study was retrospective and then did not modify the CT examination routinely performed in acute abdomen, no institutional review board approval and informed consent was requested. A systematic measure of the difference between the CT number of common bile duct wall and the CT number of pancreatic parenchyma was performed. The "choledochal ring" sign, defined by a difference greater than 15 HU was specifically studied and compared to other factors often associated with biliary pancreatitis through univariate and multivariate analyses. Compared to other factors classically associated with acute biliary pancreatitis, the "choledochal ring" sign showed high specificity (100%) and high positive predictive value (100%). In patients with acute pancreatitis, the "choledochal ring" sign is a new and accurate finding of acute biliary pancreatitis on CT scans.

The aim of our study is to investigate the pubic tubercle as a reliable CT landmark in distinguishing the three types of groin hernia. CT scans of 42 patients with surgically confirmed groin hernia were reviewed. For each patient, both the anatomical structure within the hernia and the state of the hernia to the inferior epigastric artery were specifically recorded. Hernias were also located within a schematic construction of orthogonal lines focused on the pubic tubercle. In this construction, inguinal hernias were ventral to the X-axis while femoral hernias were dorsal to the X-axis. Among the inguinal hernias, direct inguinal hernias were located strictly lateral to the Y-axis while indirect inguinal hernias medially crossed the Y-axis. All these CT results were compared to the surgical findings. The inferior epigastric artery was visualized in 90% patients and, in these cases, the situation of the hernia to the artery on CT showed no discordance with surgical findings. Within the schematic construction of orthogonal lines focused on the pubic tubercle, 50% were considered as indirect inguinal hernias, 31% as direct inguinal hernias and 19% as femoral hernias. For each patient, the CT diagnosis was consistent with the surgical report.

Resume Objectifs Modeliser les vertebres afin d’ameliorer la connaissance radioanatomique des vertebres types et de leurs rapports, et simuler les actes de radiologie interventionnelle sous scanner. Materiels et methodes Les acquisitions ont ete realisees avec un scanner multibarrette. Nous avons developpe deux logiciels de segmentation et de visualisation sous l’environnement de programmation Delphi®. Resultats Le logiciel de segmentation a permis de definir avec une bonne resolution spatiale les differentes parties anatomiques des vertebres et des elements nobles voisins. Le logiciel de visualisation, permet de selectionner les differents volumes a mettre en evidence sur reconstructions multiplanaires et 3D. Discussion Ce logiciel permet d’ameliorer les connaissances radioanatomiques des radiologues. La possibilite d’inserer une aiguille ou un trocard dans le volume permet de s’entrainer virtuellement aux gestes de radiologie interventionnelle sous guidage TDM. Conclusion Le premier logiciel de radioanatomie « volumique » est ne. Il ouvre la voie a la simulation des actes guides par tomodensitometrie.

Resume But Evaluer la valeur de l’epine du pubis comme repere TDM pour differencier les hernies femorales et inguinales de diagnostic clinique incertain, avant leur prise en charge chirurgicale, dans le cadre d’un tableau d’engouement avec occlusion mecanique du grele. Materiel et methodes Il s’agit d’une analyse retrospective des examens TDM realises dans notre service pour occlusion mecanique du grele sur l’annee 2OO3. Douze cas de hernie de l’aine responsable d’une occlusion mecanique du grele ont ete retenus. Tous les examens TDM inclus dans l’etude ont fait l’objet d’une double lecture radiologique. Les 12 cas repondant aux criteres d’inclusion ont beneficie d’une recherche de leur compte-rendu chirurgical pour authentifier le type herniaire. Resultats Douze cas de hernie de l’aine responsable d’un syndrome occlusif ont ete diagnostiques en TDM pendant l’annee 2003 dans notre service. Huit cas correspondaient a des occlusions mecaniques sur hernie inguinale (dont 4 directes et 4 indirectes) et 4 a des occlusions mecaniques sur hernie femorale. Dans tous les cas, le diagnostic du type herniaire, evoque en TDM au moyen d’un repere orthogonal centre sur l’epine du pubis dans le plan axial, a ete confirme par la chirurgie. Conclusion L’epine du pubis constitue un excellent repere TDM pour authentifier la nature inguinale (directe ou indirecte) ou femorale d’une hernie de l’aine. L’authentification pre-chirurgicale des differentes formes herniaires est importante, puisque ces hernies justifient des abords chirurgicaux differents.

Resume Objectif Le but de ce travail est de decrire le feces sign et de definir sa valeur comme critere de non severite dans l’occlusion du grele sur bride ou adherences peritoneales. Materiels et methodes Nous avons analyse retrospectivement les occlusions du grele sur bride ou adherences peritoneales diagnostiquees en TDM entre janvier 2001 et decembre 2002. Tous les examens dans lesquels figurait un feces sign ont ete inclus dans l’etude. Le dossier clinique de chaque patient selectionne a ete ressorti et etudie. Resultats Vingt patients ont ete inclus dans cette etude. Douze patients ont beneficie d’un traitement conservateur efficace avec aspiration nasogastrique. Aucune complication ischemique digestive n’a ete retrouvee au decours des 6 laparotomies realisees en urgence et des 3 realisees de facon differee. A chaque fois, le traitement a consiste en une adhesiolyse et aucune resection intestinale n’a ete necessaire. Conclusion Recemment decrit dans la litterature radiologique, le feces sign peut etre considere comme le premier critere positif de non gravite d’une occlusion du grele sur bride ou adherences peritoneales.

CERVOXY ACL CLIN; International audience

ObjectivesTo demonstrate the reliability of the EOS imaging system in measuring the internal diameters of the bony pelvis.Materials and methodsA prospective study comparing the results of the pelvimetry of 18 dry pelvises carried out on the EOS imaging system to measurements taken manually and using the two current gold standard CT methods. Pelvimetric measurements of each pelvic bone were obtained using four methods and compared: direct manual measurements, spiral and sequential CT pelvimetry, and 2D-3D low-dose biplanar X-rays. The various obstetric diameters were measured to the millimetre and compared.ResultsThere was no significant difference in the different diameters assessed, with the exception of the interspinous diameter. There was a highly significant correlation (P

The authors report the case of a 46-year-old woman with large bowel obstruction secondary to lumbar hernia following latissimus dorsi flap. Diagnosis was made by CT. This paper describes the CT features of this rare pathology. A brief review of the literature is also presented.

Purpose To study the possible relationship between mesenteric panniculitis (MP) visible on computed tomography (CT) and the presence of an underlying neoplastic disease. Patients and methods A retrospective analysis of 158 patients with CT examinations that revealed the presence of MP was performed. CT images were analyzed by two different radiologists using morphological criteria validated in the radiological literature. The presence, frequency and type of neoplastic lesions associated with MP were assessed. Results MP was asymptomatic in 96/158 patients (61%). Fat halo sign and pseudocapsule were visible on CT in 89/158 (56%) and 93/158 (59%) patients, respectively. Underlying neoplastic disease was present in 88/158 patients (56%). The neoplastic diseases most often associated with MP were lymphoma (28%), melanoma (18%), colorectal cancer (15%) and prostate cancer (13%). Conclusion MP has typical CT appearance and is associated with underlying neoplastic disease in 56% of patients. Such levels of association might suggest that MP may be considered as a paraneoplastic condition. Hence, incidental depiction of MP on CT in a patient without known neoplastic disease should incite radiologists to further scrutinize CT examination for presence of synchronous neoplastic lesions.

The increasing use of computed tomography in evaluating patients with acute abdominal pain has revolutionized the diagnosis of small bowel obstruction in adults. Computed tomography is incontestably the most useful and powerful tool to make positive, topographic, and etiologic diagnoses of small bowel obstruction. Good knowledge of some key signs and rigorous analysis of computed tomographic images by radiologists should lead to improved diagnosis and appropriate treatment.

We report a case of surgically confirmed strangulation of small bowel through a defect in the greater omentum. Computed tomography demonstrated the presence and the location of this very unusual internal abdominal hernia. Those findings are presented.

Objectifs Analyser la valeur du scanner pour le diagnostic differentiel d’un bezoard et d’un small bowel feces (SBF) sign dans le cadre des occlusions du grele. Materiels et methodes Vingt sept examens TDM realises pour occlusion du grele (8 patients avec un bezoard confirme chirurgicalement et 19 patients avec un SBF sign et pas de bezoard a la chirurgie) ont ete analyses retrospectivement par 2 radiologues specialises. Les criteres TDM etudies etaient la forme (bien definie ou amorphe), la longueur (courte, 10 cm) et le site de la lesion, la presence d’une coque lesionnelle et une image similaire dans l’estomac. Un fat-density floating fibers (FFF) sign, correspondant a la visualisation de fibres de densite graisseuse au sein de la lumiere intestinale etait notee. Un Fischer's exact test a ete utilise pour la comparaison statistique. Resultats Les 8 bezoards et les 19 SBF sign ont tous ete identifies comme une image lesionnelle intraluminale, contenant du gaz, situee immediatement en amont du site de l’occlusion. Les bezoards ont montre une plus forte incidence de coque lesionnelle (p = 0,002), d’image similaire dans l’estomac (p = 0,011) et de FFF sign (p Conclusion Bien que certains criteres se recoupent, la decouverte TDM au cours d’une occlusion du grele d’une masse intraluminale de contours bien definis contenant du gaz, presentant une coque lesionnelle, une image similaire dans l’estomac et un FFF sign est typique d’un bezoard ; une masse intraluminale amorphe et isolee contenant du gaz est typique d’un SBF.

Objectifs Cette presentation didactique a pour but d’illustrer l’aspect TDM des differentes pathologies gastriques de l’adulte. Materiels et methodes L’analyse retrospective des scanners abdominaux realises dans notre service sur les annees 2004 et 2005, nous a permis d’identifier et d’illustrer la majorite des pathologies rencontrees au niveau de l’estomac. Resultats Ce poster electronique propose sous la forme d’un atlas largement illustre les aspects TDM des differentes causes de pathologie gastrique de l’adulte (cancer gastrique, linite plastique, lymphome, tumeur stromale, ulcere gastrique, gastrites, pancreas ectopique, diverticule, etc.). L’accent est mis sur les signes TDM cles permettant un diagnostic etiologique precis. Les differentes pathologies presentees sont regroupees selon leur mecanisme physiopathologique. Conclusion Compte tenu de l’avenement recent des scanners multidetecteurs, permettant des reconstructions multiplanaires de tres haute qualite, les radiologues doivent se familiariser avec l’aspect TDM des differentes pathologies gastriques. Une bonne connaissance des signes etio-pathogeniques discriminants, associee a une etude rigoureuse des images TDM, permettent le plus souvent un diagnostic performant pour une prise en charge optimale et appropriee.

Objectifs Decrire l’aspect IRM du tendon distal reinsere du biceps brachial chez des patients sans deficit clinique. Materiels et methodes Sept patients ont fait l’objet d’une exploration IRM du tendon distal du muscle biceps brachial. Tous ces patients avaient beneficie, apres rupture complete, d’une reinsertion chirurgicale de leur tendon sur la tuberosite radiale. L’evaluation clinique du membre superieur opere, effectuee par un chirurgien orthopedique, etait satisfaisante chez tous les patients. L’IRM a ete realisee a chaque fois sur une machine 3 Teslas (GE), en ponderation SE Tl et SE T2 dans le plan axial et sagittal oblique, avec un delai entre l’intervention chirurgicale et la realisation de l’IRM de 10 et 33 mois. Resultats Les resultats ont ete : tendon continu jusqu’a son insertion radiale (7), contours tendineux et fibres tendineuses reguliers (7), elargissement distal du tendon (4), hyposignal Tl et T2 (3), discrets hypersignaux lineaires intratendineux (2), signal heterogene (2). Conclusion Les signes constamment retrouves, a l’IRM 3 Teslas, pour un tendon bicipital reinsere sont : l’aspect regulier de ses contours et de ses fibres tendineuses. Le signal du tendon est variable et sa terminaison peut presenter un evasement sans caractere pathologique. C’est la premiere fois qu’une telle investigation avec correlation clinique est effectuee.

Objectifs Evaluer les signes TDM de la sclerose peritoneale encapsulante (EPS) chez les patients en dialyse peritoneale (DP) en tant que facteurs pronostiques de l’evolution vers l’abdominal cocoon (AC). Materiels et methodes Les donnees cliniques et TDM de 90 patients en DP ont ete retrospectivement analysees. En fonction de leur symptomatologie, les patients etaient classes en 3 groupes (asymptomatique, modere, severe). Ces resultats cliniques etaient confrontes aux signes TDM de l’EPS (epaississement peritoneal, calcifications peritoneales, presence de collections liquidiennes, feces sign, signes d’occlusion mecanique du grele, anses agglutinees, pseudo-sac, signes d’ischemie ou de necrose intestinale). Un AC etait defini en TDM par la presence conjointe d’anses agglutinees et d’un pseudo-sac. En fonction du type de donnees analysees, un Fischer exact test ou un t-test etait utilise pour l’etude statistique. Resultats L’AC n’etait present que chez les patients symptomatiques (p = 0,041). En revanche, la survenue d’un AC n’etait pas correlee a la severite des symptomes (p = 0,16). Parmi les signes TDM etudies, la presence de collections liquidiennes (p = 0,11), d’anses agglutinees (p = 0,0001), d’un pseudo-sac (p = 0,0001), d’un feces sign (p = 0,002) et de signes d’occlusion mecanique du grele (p = 0,0001), montraient un lien statistique avec la survenue d’un AC. De plus, l’association en TDM de collections liquidiennes, d’un feces sign et de signes d’occlusion mecanique du grele etait extremement sensible et specifique de la survenue d’un AC (Se = 67%, Sp = 100%, VPP = 100%, VPN = 96%). Conclusion Un examen TDM doit etre realise chez tout patient symptomatique en DP. En effet, la presence associee de collections liquidiennes, d’un feces sign et de signes d’occlusion mecanique du grele permet de predire la survenue d’un AC, qui constitue un motif d’arret de la DP.

Objectifs Savoir reconnaitre les stenoses du grele en echo mode B. Connaitre les modalites d’injection du Sono Vue. Utilisation des logiciels de quantification faiblement reproductible. Messages a retenir Importance de l’exploration morphologique avec une sonde haute frequence pour reconnaitre les lesions du grele et du mesentere. Necessite d’injecter un flacon entier de Sonovue par boucle (destruction rapide par les sondes haute frequence). Distinguer une stenose inflammatoire d’une stenose fibreuse. Quantifier le rehaussement parietal. Resume L’echographie en mode B permet de faire un bilan morphologique satisfaisant des lesions du grele dues a la maladie de Crohn ; le Doppler permet d’approcher le degre d’inflammation. L’echographie de contraste permet d’approcher la quantification de l’inflammation et de distinguer les stenoses inflammatoires des stenose fibreuses (d’apres une serie preliminaire de 13 patients operes). Elle semble une technique prometteuse du suivi des patients traites par anti TNF alpha. Par contre, elle reste inferieure a l’entero IRM pour faire une cartographie des lesions et deceler toutes les complcations.

Objectifs Analyser la valeur du scanner pour le diagnostic differentiel des occlusions du grele sur bride et sur adherences peritoneales. Materiels et methodes Soixante-sept examens TDM realises pour occlusions du grele sur bride ou adherences peritoneales prouvees chirurgicalement ont ete etudies retrospectivement. Les resultats TDM etaient compares entre les 2 groupes au vu de criteres evocateurs d’occlusion simple (zone transitionnelle unique et brutale, signe du bec, fat notch sign), de criteres evocateurs d’une occlusion a anse fermee (double signe du bec, repartition en C des anses, distribution radiaire des vaisseaux mesenteriques), du site de l’occlusion dans la cavite abdominopelvienne et de la presence d’un feces sign et d’un whirl sign. Un Fisher-exact test a ete utilise pour la comparaison statistique. Resultats Les criteres d’anse fermee et de whirl sign etaient retrouves dans les seuls cas d’occlusion du grele sur bride. Comparees aux occlusions du grele sur adherences peritoneales, les occlusions du grele sur bride montraient un nombre significativement plus eleve de signe du bec (p = 0,.0001) et de fat notch sign (p = 0,0001). Le feces sign etait plus frequemment present en cas d’occlusion sur adherences peritoneales (p = 0,014). L’ischemie (p = 0,011) et la necrose intestinale (p = 0,049) etaient des criteres plus frequents en cas d’occlusion sur bride que sur adherences peritoneales. La situation pelvienne de l’occlusion du grele etait en faveur d’une cause adherentielle (p = 0,039) et un plus haut taux de perforation chirurgicale etait associe aux cas d’occlusions sur adherences peritoneales (p = 0,031). Conclusion Le scanner est utile pour distinguer les occlusions du grele sur bride des occlusions du grele sur adherences peritoneales. En cas d’occlusion simple, la mise en evidence d’un signe du bec ou d’un fat notch sign offre une bonne sensibilite et une excellente specificite pour le diagnostic d’occlusion sur bride.

Objectifs Evaluer l’interet du scanner multidetecteur dans le diagnostic positif et le diagnostic de gravite des volvulus du colon sigmoide. Materiels et methodes Vingt-trois examens TDM de volvulus du sigmoide ont ete etudies retrospectivement et analyses en fonction de leur type (mesenterico-axial ou organo-axial), de leur degre de rotation (180 ou 360 degres), de la presence ou non d’un Northern exposure sign, du diametre maximal de l’anse volvulee, de la presence ou non de signes parietaux de souffrance ischemique et de l’existence d’un epanchement intraperitoneal. Une etude statistique a ete conduite afin de determiner la correlation entre les caracteristiques de la population, la semiologie tomodensitometrique, le type de prise en charge decide et les resultats histologiques le cas echeant. Resultats Dans notre etude, le volvulus de type organo-axial survient dans une population plus âgee (p = 0,047), presente un risque de recidive plus eleve (p = 0,015) et necessite un recours plus frequent a la chirurgie de premiere intention que le volvulus mesenterico-axial. Un degre de rotation eleve est lie a une distension plus importante de l’anse volvulee (p = 0,033) et entraine un recours plus frequent a une sanction chirurgicale. Conclusion Au-dela du diagnostic positif de volvulus du sigmoide et de la recherche de signes de souffrance ischemique digestive, l’examen TDM permet d’analyser le type du volvulus et son degre de rotation, elements qui semblent conditionner la gravite du processus et peuvent orienter vers une prise en charge optimale, endoscopique ou chirurgicale.

Objectifs pedagogiques Connaitre les elements pertinents du diagnostic des tumeurs biliaires. Savoir qu’il existe des lesions simulant le cancer. Savoir faire le bilan pretherapeutique des tumeurs biliaires. Connaitre la place actuelle de la radiologie interventionnelle en pathologie tumorale biliaire.

Objectifs Connaitre la semiologie des atteintes ligamentaires du genou dans les differents types d’entorse (benignes-graves) et comprendre le mecanisme physio-pathologique en cause. Connaitre la caracterisation des lesions meniscales et cartilagineuses avec l’apport significatif des coupes fines (tous les types lesionnels) et surtout des sequences isotropiques 3 D inframillimetriques avec la mise en evidence des chondropathies. Messages a retenir L’IRM 3 T en routine (haute resolution) des lesions menisco-ligamentaires du genou, etablit le diagnostic de certitude, definit le pronostic en particulier chez le sujet jeune (pratique sportive) et determine la meilleure attitude therapeutique. Resume Les correlations avec l’arthroscopie demontrent une excellente fiabilite de l'IRM 3 T en routine, en coupes de 2 mm pour tous les types de lesions meniscales, radiaires, verticales instables et multi-planaires (FLAP TEAR) ou degeneratives (fente avec kyste). Experience a propos de 1200 patients, 200 correlations radio-chirurgicales. Les contusions des ligaments lateraux sont demontrees comme les atteintes du croise anterieur dans les trois plans de l’espace avec le classique modele des points d’angles. Le diagnostic de rupture complete – incomplete est beaucoup plus precis qu’a 1,5 T (croise anterieur). Enfin, l’analyse du cartilage est optimisee avec tous ses grades lesionnels (sequences 3D isotropiques inframillimetriques).

Objectifs Etudier la presence d’un fort rehaussement de la paroi du bas choledoque comme signe specifique de l’origine biliaire d’une pancreatite aigue. Materiels et methodes Les examens TDM avec injection de produit de contraste de 80 patients ayant presente une pancreatite aigue prouvee cliniquement et biologiquement ont ete retrospectivement analyses par 2 radiologues specialistes non avertis de la cause de la pancreatite aigue. Du fait de la nature retrospective de l’etude et de l’absence de modification du protocole scanographique pancreatique utilise en routine, aucune demande d’approbation du comite d’ethique ni aucun consentement eclaire des patients n’a ete requis. Un calcul systematique de la difference de densite du rehaussement de la paroi du bas choledoque et de celui du parenchyme de la tete du pancreas a ete realise. Le « choledocal ring sign », defini comme une difference de densite superieure a 15 UR a ete specifiquement etudie et compare au travers d’analyses univariees et multivariees aux autres facteurs frequemment associes aux pancreatites aigues d’origine biliaire. Resultats Compare aux autres facteurs classiquement associes a la pancreatite aigue d’origine biliaire, le « choledocal ring sign », tel que precedemment defini, possede une specificite (100 %) et une valeur predictive positive (100 %) extremement importantes. Conclusion Dans le cadre d’une etude scanographique, le « choledocal ring sign » apparait comme un nouveau signe extremement specifique de l’origine biliaire d’une pancreatite aigue.

Objectifs Mettre au point les sequences d’IRM cutanee a 3 Tesla. Decrire la radioanatomie cutanee a 3 Tesla. Discuter les avantages par rapport a un systeme a 1,5 Tesla. Materiels et methodes Grâce a l’utilisation d’une antenne superficielle dediee, nous avons adapte et optimise les sequences FIESTA et SETl pour l’IRM a 3 Tesla. Nous avons ensuite realise chez 15 volontaires sains une etude descriptive de la radioanatomie cutanee en sequence FIESTA et SETl sur differents sites: le visage, l’avant-bras, le dos, le mollet. Resultats L’utilisation d’un haut champ (3T) permet, grâce a meilleur rapport signal sur bruit, de realiser des images d’IRM cutanee avec une resolution spatiale jamais atteinte auparavant, dans des temps de sequence acceptables. Les problemes d’artefacts ont ete resolus: chez tous les sujets, et pour tous les sites, l’IRM a 3 Tesla a permis d’analyser precisement l’epiderme, le derme et l’hypoderme. Conclusion L’IRM cutanee est une methode d’imagerie recente. Grâce au champ a 3 Tesla, la qualite des images a progresse et permet d’envisager de vastes perspectives dans l’etude de 1’hydratation, du vieillissement ou des maladies cutanees.

Objectifs II n’existe pas actuellement de consensus, dans les plaies des doigts, sur la necessite de la reparation de l’artere digitale en plus de la suture du nerf. L’imagerie des arteres digitales ne peut etre effectuee en routine par des methodes invasives (TDM, angiographie) et est difficile a l’IRM. Ce travail montre l’interet de l’echo-Doppler dans l’evaluation de l’influence sur la recuperation nerveuse de la permeabilite des arteres digitales. Materiels et methodes Une etude retrospective sur la reinnervation des nerfs collateraux apres section d’un nerf digital palmaire a ete realisee chez 35 patients avec un recul minimum de 3 ans (total de 40 nerfs leses). L’analyse de la permeabilite des arteres etait realisee par echo-Doppler ; l’analyse de la qualite de la recuperation nerveuse par un chirurgien orthopediste specialise dans la microchirurgie de la main. Resultats La qualite de l’exploration Doppler etait bonne dans 100 % des cas. Vingt-cinq nerfs etaient associes a une artere permeable et 15 a une artere non permeable. Le resultat fonctionnel etait evalue par le test de Weber (8,84 mm versus 13,47 mm en cas d’artere non permeable) et l’existence d’un intolerance au froid (16 % versus 86,7 %). Conclusion Ce travail montre l’interet de la reparation systematique de l’artere digitale palmaire en plus de la reparation du nerf digital, ainsi que l’utilite pour le chirurgien de l’echo-Doppler, methode d’imagerie simple, non invasive et fiable dans l’exploration de la vascularisation des doigts.

Objectifs Realiser un logiciel permettant l’etude volumique de la radioanatomie des vertebres et des actes peri-rachidiens sous guidage TDM. Materiels et methodes Nous avons modelise, sur la base d’acquisitions tomodensitometriques volumiques, 10 vertebres types, et pour chacune un geste sous guidage TDM. Nous avons ensuite developpe un logiciel de visualisation permettant de realiser une etude volumique des vertebres et des gestes idealement simules. Resultats Au travers de ce logiciel, la radio-anatomie des vertebres types est etudiee de maniere didactique et interactive, en reconstruction multiplanaire et en 3D. Les actes simules constituent les « fondamentaux » des gestes rachidiens et perirachidiens sous guidage TDM, et sont illustres par des fiches de synthese. Conclusion Les « vertebres types » proposees dans ce logiciel correspondent a l’essence de la radio-anatomie vertebrale. L’apport didactique des gestes modelises en 3D est renforce caractere analytique et volumique de leur etude.

Objectifs Rapporter un cas rare de gastrite hypertrophique de l’enfant. Preciser l’apport de l’echographie haute resolution dans la demarche diagnostique. Materiels et methodes Enfant de 6 ans refere pour bilan de douleurs abdominales persistantes depuis 10 jours, avec hyperthermie et quelques vomissements. La biologie revele une hypoprotidemie avec hypoalbuminemie, sans autre anomalie, ni proteinurie. Une echographie abdomino-pelvienne est alors realisee, confrontee ensuite a un examen TDM abdominal, a un TOGD, et au resultat de l’endoscopie digestive haute. Resultats L’echographie montre un epaississement parietal gastrique important, constitue de l’alternance de cinq couches hyper/hypoechogenes, avec plis muqueux geants se projetant dans la lumiere gastrique, compatible avec une gastrite hypertrophique (maladie de Menetrier). La TDM et le TOGD sont concordants. Le diagnostic est confirme par l’endoscopie digestive haute. Conclusion L’echographie haute resolution est performante pour l’analyse de la paroi gastrique. Elle a permis le diagnostic de gastrite hypertrophique de l’enfant et devrait se substituer dans cette indication a la TDM et au TOGD.

Objectifs Montrer l’interet de l’echographie de contraste dans le suivi des patients greffes renaux. Materiels et methodes Un partenariat etroit existe au CHU de Besancon entre les services de radiologie et de nephrologie. Entre 500 et 600 echo-Dopplers annuels sont realises dans le cadre du suivi des patients greffes renaux. L’echographie de contraste (Sonovue ® , Bracco Imaging SpA, Italie) est utilisee en routine en cas de resultat pathologique. Resultats Ce travail illustre l’apport de l’echographie de contraste dans les processus pathologiques du greffon renal : rejet aigu, subaigu et chronique, atteinte infectieuse, collections perigreffon, anomalie du pedicule vasculaire du greffon. L’utilisation courante de l’echographie de contraste couplee a l’analyse fine echo-Doppler du greffon renal est souvent suffisante dans le cadre du bilan d’imagerie. Cela permet de diminuer l’utilisation d’autres methodes d’imagerie plus invasive dont notamment le scanner avec injection de produit de contraste iode. Conclusion L’echographie de contraste apparait comme un outil indispensable dans le bilan d’imagerie des pathologies du greffon renal a la fois pour l’apport diagnostique par rapport a l’echo-Doppler seul et aussi par son innocuite chez des patients dont on cherche a preserver la fonction renale.