Search

Copyright of Orthopédie Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This report describes the first case of biliary actinomycosis associated with an adenocarcinoma of the gallbladder. Actinomyces naeslundii was encountered as a pure isolate after a precise and careful identification. Although, in diagnosis, cancer and actinomycosis are often confused, the simultaneous occurrence of actinomycosis in cancer lesions can happen. This case illustrates the diagnostic challenge of actinomycosis. [ABSTRACT FROM AUTHOR]

Aliment Pharmacol Ther 2010; 32: 1135-1144 Background Serum procalcitonin level may reflect non-infectious inflammation. Aim To assess the correlation of serum procalcitonin level with clinical, biological, endoscopic and radiological markers of disease activity in inflammatory bowel diseases (IBD), and to evaluate the additional diagnostic benefit of measuring serum procalcitonin level to that of C-reactive protein (CRP) for disease activity appraisal. Methods We performed a prospective observational study. Spearman's rank correlation and receiver operating characteristic analysis were used to evaluate correlation and diagnostic accuracy respectively. Results In Crohn's disease (CD) ( n = 30), serum procalcitonin level was strongly correlated with clinical, biological, endoscopic and radiological disease activity markers. In CD, the serum procalcitonin level >0.14 μg/L demonstrated a high accuracy for detecting severe disease (Sensitivity = 100%; Specificity = 96%; AUROC = 0.963; P = 0.0001). The diagnostic accuracy of the 'serum procalcitonin level-CRP strategy' (CRP >5 mg/L and serum procalcitonin level >0.05 μg/L) was significantly superior to that of CRP alone for diagnosing severe CD (AUROC = 0.783 vs. 0.674; P = 0.01). In ulcerative colitis (UC) ( n = 27), serum procalcitonin level was correlated with CRP and with endoscopic and radiological disease activity markers. Conclusions In CD, the serum procalcitonin level was correlated with all disease activity markers and a cut-off of 0.14 μg/L could distinguish severe forms of the disease. The 'serum procalcitonin level-CRP strategy' was superior to CRP alone for diagnosing active or severe CD. [ABSTRACT FROM AUTHOR]

Introduction L’hémoptysie, expression première des pseudoanévrismes (PA) inflammatoires engage le pronostic vital. Le développement intense, voire anarchique, d’une circulation artérielle bronchique est le principal facteur physiopathologique de l’hémoptysie documenté par un suivi longitudinal scannographique thoracique. Cette hypervascularisation artérielle bronchique se développe parallèlement au PA et suit son évolution en fonction du traitement étiologique des PA. Patients et méthodes Trois observations de patients sont documentées radiologiquement par scanners successifs, scrutant le développement et l’évolution des PA pulmonaires inflammatoires sur un syndrome d’Angio-Behçet et deux syndromes de Lemierre. Ce suivi radiologique contribue à comprendre la physiopathologie des PA avec le développement anarchique et majeur de la circulation artérielle bronchique au contact des PA. Résultats Le patient n o 1 suivi pour un Behçet tripolaire va déclarer un Angio-Behçet pulmonaire avec thrombus de l’oreillette droite et deux PA proximaux de 25 mm de diamètre et deux PA distaux infracentimétriques. Ces PA apparaissent sous corticoïdes. Un traitement par Infliximab est instauré devant des hémoptysies abondantes avec développement d’une circulation artérielle bronchique anarchique. L’évolution est favorable sous ce traitement. Les patients n o 2 et n o 3 sont pris en charge pour un tableau d’angines avec thromboses veineuses, l’une jugulaire, l’autre cérébrale et coma et hémoptysies. L’imagerie suivra le développement de PA dues à des emboles septiques par Fusobacterium necrophorum . Les PA sont distaux à 15 mm de diamètre pour le plus grand. Ces PA disparaîtront sous traitement antibiotique. Discussion La disparition des formes tertiaires de Syphilis avec ses anévrismes des artères pulmonaires laisse la place aux formes pseudo anévrismales inflammatoires des artères pulmonaires liées aux infections (PA mycotiques) et à des maladies vasculaires inflammatoires (Behçet, Takayasu). Au côté des PA de Rasmussen liés à Mycobactérium tuberculosis dans des tuberculoses aiguës, des PA induites par Aspergillus dans des aspergilloses invasives, des germes banaux Staphylocoques dans les endocardites du cœur droit avec ou sans toxicamonie, des germes anaérobies F. necrophorum dans le syndrome de Lemierre, les vascularites inflammatoires sont devenues plus fréquentes dans notre pratique : l’Angio-Behçet et le Takayasu, notamment dans leur forme artérielle pulmonaire. Le traitement médical antibiotique fait régresser voir disparaître les PA mycotiques. Un traitement endovasculaire artériel bronchique peut s’avérer nécessaire et salvateur. Des biothérapies anti-inflammatoires d’action rapide (anti-TNF alpha, anti-IL6…) sont préconisées dans les vascularites du Behçet et du Takayasu. Des facteurs d’angiogenèse locaux pulmonaires sont probablement libérés suite au processus inflammatoire et/ou ischémique intenses, expliquant l’hypervascularisation artérielle bronchique visualisée dans ce travail. Conclusion Le suivi scannographique longitudinal de pseudo anévrismes pulmonaires inflammatoires à savoir deux syndromes de Lemierre et un syndrome de Behçet montre le parallélisme de développement des PA et de la circulation artérielle bronchique ainsi que leur régression jusqu’à quasi disparition sous traitement médical étiologique. Les hémoptysies sont le fait de cette abondante et anarchique circulation artérielle bronch [ABSTRACT FROM AUTHOR]

Introduction La maladie de Behçet est une vascularite systémique d’étiologie inconnue. L’angiobehçet affecte principalement le système veineux et les manifestations artérielles sont rares mais graves, se traduisant le plus souvent par des anévrysmes, parfois des occlusions artérielles. Nous en rapportons une nouvelle observation. Observation Les antécédents du patient, âgé de 54 ans, étaient marqués par une tuberculose pulmonaire à l’âge de 6 ans, et une énucléation de l’œil gauche suite à un décollement de rétine. Il était connu pour un engaînement péri-bronchovasculaire lobaire moyen depuis 10 ans avec calcifications, considéré comme une maladie du hile droite post tuberculeuse. En janvier 2012, des hémoptysies de moyenne abondance avaient conduit à une artério-embolisation. En août 2012, étaient constatés une augmentation des hémoptysies, un amaigrissement, et une augmentation de la taille de la lésion hilaire, accompagnée d’un thrombus flottant de 75 mm de la veine cave inférieure (VCI). Une tomodensitométrie en émission de positons avait montré une hyperfixation de la lésion pulmonaire droite. En octobre 2012, survenait une thrombose étendue de la VCI, à la veine cave supérieure et aux veines fémorales. Une anticoagulation était débutée. Le patient fut hospitalisé dans notre service en janvier 2013 pour de nouvelles hémoptysies. Cliniquement, outre une dyspnée stade III et l’absence de trouble neurologique, était notée une aphtose bipolaire avec cicatrices génitales. Celle-ci apparaissait récidivante depuis plusieurs années. La tomodensitométrie montrait une stabilité des lésions pulmonaires, une régression partielle de la thrombose et de l’aspect inflammatoire du réseau veineux. Après relecture de l’ensemble des imageries, la lésion pulmonaire correspondait à un anévrisme de l’artère pulmonaire droite. Le diagnostic de maladie de Behçet était posé. Il n’y avait pas d’anomalie à l’examen ophtalmologique, l’IRM cérébrale était normale. À noter un haplotype HLA B51. La prise en charge a consisté en une corticothérapie à 500 mg/j pendant 3 jours puis un relais per os, et des bolus de cyclophosphamide 600 mg/m 2 à j1, j14, j28, puis tous les 21 jours pour un total de six cures sous couvert d’un traitement par rifinah. La taille de l’anévrysme diminuait significativement, passant de 36 × 32 mm à 23,5 × 19 mm en 1 mois, une régression complète étant notée à la fin des cycles de cyclophosphamide qui était relayé par du mycophénolate mofetil. Cependant, le patient présentait en août 2013 une hémoptysie massive entraînant son décès. Conclusion Ce cas clinique illustre le pronostic péjoratif des anévrysmes pulmonaires dans la maladie de Behçet, malgré une régression morphologique totale de l’anévrysme sous traitement, laissant présager des lésions de la paroi vasculaire irréversibles. Il montre aussi que la maladie de Behçet est encore sous diagnostiquée, l’aphtose pourtant évidente ayant été négligée de même que les thromboses veineuses. [ABSTRACT FROM AUTHOR]

Closed loop obstruction occurs when a segment of bowel is incarcerated at two contiguous points. The diagnosis is based on multiple transitional zones. The incarcerated loops appear in U or C form or present a radial layout around the location of the obstruction. It's very important to specify the type of obstruction because, in patients with simple bowel obstruction, a conservative approach is often advised. On the other hand, a closed loop obstruction immediately requires a surgical approach because of its high morbidity and the risk of death in case of a late diagnosis., (Copyright © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Background: Radiofrequency ablation has became a validated therapeutic technique for symptomatic drug refractory atrial fibrillation (AF). Cardiac computed tomography (CT) is used to evaluate left atrial (LA) anatomy in order to improve AF ablation. The analysis of noncardiac structures during cardiac CT may identify clinically significant incidental findings (IFs). The objective of this study was to determine the prevalence of IF in patients undergoing AF catheter ablation., Methods: Between February 2008 and March 2010, all patients planned for a first procedure of AF or LA tachycardia (LAT) ablation underwent a cardiac CT scan and were retrospectively included in this study. Extracardiac IFs were considered to be present if an abnormality was identified without previous clinical suspicion or known disease., Results: Two hundred and fifty patients (55.2 ± 9.6 years of age, 82.4% men) were enrolled (133 paroxysmal, 43 persistent, 58 permanent AF, and 16 LAT). Fifty-eight patients (23.2%) had a total of 76 IFs. Patients with IF were significantly older (59.5 ± 8.2 vs 53.8 ± 9.7 years old, P < 0.001). No relationship existed between the type of arrhythmia and IF existence. The majority of IFs were pulmonary (50%), with 15.8% of pulmonary emphysema. Two cases of lung cancer and of pulmonary fibrosis, 15 mediastinal adenopathies, and three congenital coronary arteries anomalies were found., Conclusions: Cardiac CT scan is a useful tool to evaluate LA morphology before AF ablation. However, as a considerable prevalence of IF was found in our study, extracardiac structures should be routinely analyzed to detect unknown conditions, which could require specific management., (©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.)

Background: PET/CT has proven extremely useful in the management of melanoma patients, with great sensitivity (Se), but it tends to give false-positive results. Whole-body MRI (wb-MRI) is a new method that has made considerable progress., Study Aims: The aim of this study was to assess the Se and specificity (Sp) of wb-MRI with a diffusion sequence for detecting melanoma metastasis compared to PET/CT., Methods: This was a prospective study, including patients at any AJCC (American Joint Committee on Cancer) stage of melanoma. PET/CT, wb-MRI and CT, including the brain, were performed on the same day. For each of the three exams, the number of lesions per patient was counted. The treatments proposed by the doctor immediately after PET/CT and then MRI were compared., Results: Forty patients were included and a total of 72 metastases were noted. CT detected 53 of these metastases (Se 80%, Sp 95%), while PET/CT detected 53 metastases, with four false-positive (Se 74%, Sp 89%) and Wb-MRI detected 59, with two false-positive (Se 83%, Sp 96%). The sensitivity of MRI was distinctly superior to PET/CT for both hepatic and pulmonary lesions. The treatment proposed after PET/CT and MRI differed in three cases: one patient was falsely reclassified by MRI (AJCC IV instead of IIB) while two others were falsely reclassified by PET/CT (AJCC IV instead of IB and IIIC). Exclusively whole-body scan influenced the treatment of four patients (10%)., Conclusion: Wb-MRI with diffusion sequence, which is less costly than PET/CT and is also non-radioactive, could play an important role in the detection of metastases in melanoma patients., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Chemical peritonitis occurs following intraperitoneal rupture of a mature ovarian dermoid. Rupture may be acute and spontaneous, typically during pregnancy, or iatrogenic. Low grade ruptures lead to parasitic peritoneal dermoid cysts, usually involving the greater omentum, cul-de-sac of Douglas and perihepatic region. Radiologists should be familiar with their appearance to correctly diagnose the condition and not mistake the disease for peritoneal carcinomatosis., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)

The aim of our study was to compare whole-body MRI (Magnetic Resonance Imaging) with a multi-contrast protocol including a DW (Diffusion Weighted) sequence to PET-CT (Positron Emission Tomography) using (18)FDG (18F-fluoroDeoxyGlucose) for staging advanced melanoma. In a first part, we compared the respective overall accuracy of each modality. We analyzed in a second part the benefits of a DW sequence added to the standard whole-body MRI protocol. Among the population of the 35 patients who experienced the two examinations of our prospective blinded study, we were able to detect 120 lesions and 70 of them were found malignant. The sensitivity and specificity for whole-body MRI were respectively 82% and 97%, while PET-CT reached 72.8% and 92.7%. DW sequence allowed the detection of 14 supplementary malignant lesions (20%) in comparison with standard MRI protocol. Moreover, this technique has been shown to be the most accurate for detecting metastases in the liver, bone, subcutaneous and intra-peritoneal sites. Consequently, a DW sequence should be added systematically to the standard whole-body MRI oncologic protocol because of its high added-value for metastasis detection., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Objective: Magnetic resonance imaging (MRI) enables accurate assessment of inflammatory bowel diseases (IBD), but its main limitation is the need for bowel preparation. Diffusion-weighted imaging is feasible in Crohn's disease. We evaluated the accuracy of MRI in combination with diffusion-weighted imaging (DWI-MRI) without oral or rectal preparation in assessing colonic inflammation in both ulcerative colitis and Crohn's disease., Design: This was an observational study of a single-centre cohort., Patients: All patients who underwent DWI-MRI-colonography without bowel preparation between January 2008 and February 2010 in our centre were analysed., Results: Among the 96 patients (ulcerative colitis=35; Crohn's disease=61) who had DWI-MRI-colonography, 68 had concomitant endoscopy. In ulcerative colitis a segmental magnetic resonance score (MR-score-S) >1 detected endoscopic inflammation with a sensitivity and specificity of 89.47% and 86.67%, respectively (AUROC=0.920, p=0.0001). In the Crohn's disease group, a MR-score-S >2 detected endoscopic inflammation in the colon with a sensitivity and specificity of 58.33% and 84.48%, respectively (AUROC=0.779, p=0.0001). The MR-score-S demonstrated better accuracy for the detection of endoscopic inflammation in the ulcerative colitis group than in the Crohn's disease group (p=0.003). In ulcerative colitis, the proposed total magnetic resonance score (MR-score-T) correlated with the total modified Baron score (r=0.813, p=0.0001) and the Walmsley index (r=0.678, p<0.0001). In Crohn's disease, the MR-score-T correlated with the simplified endoscopic activity score for Crohn's disease (r=0.539, p=0.001) and the Crohn's disease activity index (r=0.367, p=0.004). The DWI hyperintensity was a predictor of colonic endoscopic inflammation in ulcerative colitis (OR=13.26, 95% CI 3.6 to 48.93; AUROC=0.854, p=0.0001) and Crohn's disease (OR=2.67, 95% CI 1.25 to 5.72; AUROC=0.702, p=0.0001). The accuracy of the DWI hyperintensity for detecting colonic inflammation was greater in ulcerative colitis than in Crohn's disease (p=0.004)., Conclusions: DWI-MRI-colonography without bowel preparation is a reliable tool for detecting colonic inflammation in ulcerative colitis.

Liver calcifications have been extensively described on plain radiographs, either from KUB or angiography examinations. On the other hand, their characteristics are seldom reported on cross-sectional imaging: they are frequently considered as non-specific compared to multiple other imaging features. However, clinical practice demonstrates that in specific situations (such as parasitic infections and calcified metastases), the presence of calcifications may be a determining factor in avoiding misdiagnosis with potential deleterious effects to the patient. Both CT and US can detect a large number of "benign" calcifications without associated focal lesion and knowledge of their imaging features is useful to avoid unnecessary additional imaging work-up. A review of the literature and a series of 100 cases of liver calcifications on CT are presented to review the imaging features of calcified liver lesions and isolated liver calcifications without associated focal lesion.

Lung cancer is the leading cause of cancer mortality in the world. Its incidence is still rising, especially in women, and its prognosis is poor with a 5-year survival of 15%. Since 1970, several studies on lung cancer screening have been conducted using different investigations. Screening by chest X-ray and sputum cytology does not lead to improved survival in lung cancer. Screening by CT scan has the same outcome but the detection of lung cancer, especially in its early stages, is better than with chest X-ray and sputum cytology. Fluorescence endoscopy is a valuable examination for the detection of pre-invasive bronchial lesions. Genetic studies and identification of circulating tumour cells are being developed. All these examinations are very stressful for the patients. Only few trials have studied the consequences of lung cancer screening on the quality of life. In this review, we analyze the various screening strategies, their impact on quality of life and health and their adverse effects., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine the impact of a joint PACS implementation at a university medical center and cancer center on the radiology practice profile. Materials and methods. In 5 radiology sections, patients, selected based on identifiable acute or chronic diseases, underwent US, CT or MRI. Data were collected on datasheets from each provider with regards to clinical history, availability of prior examinations, description of patient management during the different phases of the examination, duration of examinations, and satisfaction. Data obtained prior to PACS implementation and 6-12 months and 30-36 months after implementation were compared., Results: A total of 1098 datasheets were collected. Hard copy readings rapidly decreased. Comparison with prior examinations improved (+20.6% to 25.6%) as well as frequency of post-processing (+29%). The time required for image management was much more reduced for technologists (-75%) than for physicians (-23%). PACS implementation only temporarily improved the availability of radiology reports and the distribution of work between senior and junior radiologists. User satisfaction, initially high, progressively decreased due to saturation of the archival capabilities., Conclusion: PACS implementation in a large university center improves the efficiency of image acquisition but does not solve some of the inefficiencies of hospital organization.

For a long time, imaging of the biliary tract after surgical procedures was performed with invasive procedures such as endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. Due to recent advances in diagnostic imaging, non-invasive techniques are now favored. While US remains the initial imaging modality, it is frequently followed by CT and/or MRCP. Image interpretation should always be performed in keeping with clinical and laboratory findings as well as the type of surgical procedure. The most appropriate imaging modality is selected based on these data. In patients with jaundice or biliary tract stenosis, MRCP, with use of an optimal technique and 3D acquisition, is the imaging modality of choice. In non-jaundiced patients with non-distended biliary tract and suspected bile leak, MRCP should be completed by the injection of a liver-specific contrast agent with biliary excretion to achieve non-invasive biliary tract opacification. In patients with malignancy, CT is preferred due to its high spatial resolution and ability to demonstrate small anastomotic tumor recurrences. CT should also be performed in patients with suspected hepatic artery or portal vein injury in addition to biliary tract injury or to detect distant complications.

Purpose: To compare two methods of post processing cardiac CT data to measure global ventricular function. Materials and methods. Retrospective study where three readers measured the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) of the right (n=22) and left (n=44) ventricles, using a 2D method (extrapolated volumetric method, EVM) and a 3D method (direct volumetric method, DVM) after cardiac CT with retrospective ECG gating. Inter- and intraobserver agreement were calculated based on the intraclass correlation coefficient (ICC) with 95% confidence interval (CI95%), and results obtained with each method were compared using the student t test for paired samples., Results: Inter- and intraobserver reproducibility were very good for both methods, with ICC ranging between 0.694 and 0.992, without significant difference. For the left ventricle, EDV, ESV and EF were 16653 ml, 8351 ml and 5415% for DVM et de 20361 ml, 11558 ml and 4613% for EVM respectively. Right ventricular values were 15247 ml, 7534 ml, 5013% and 17253 ml, 9940 ml, 439% (p<0,0001)., Conclusion: The very good inter- and intraobserver reproducibility for both methods validate their use in clinical practice. Volume measurements with DVM are always inferior to volumes with EDM, with inverse relationship for EF measurements.

MDCT in the lateral decubitus position during Valsalva is sensitive in the detection of abdominal wall hernias and may increase the hernia size and possibly change its contents.

To illustrate the CT and MR imaging features of alveolar echinococcosis, a rare disease that is endemic in the northeast of France. Hepatic and extrahepatic manifestations are presented. Fibrous and necrotic features are demonstrated on MR. Calcifications are demonstrated on CT. Accurate imaging diagnosis will exclude tumors (cholangiocarcinoma, cystadenoma, fibrous metastases) and avoid unnecessary biopsy.

Knowledge of the histological features of different components of a liver lesion greatly assists radiologists because it provides understanding of the correspondingimaging features. The imaging characteristics of lesions depend on variations of the extracellular architecture, mainly surrounding stromal tissue. Until histological imaging techniques become available, cellular analysis relies on optical microscopy and immunohistochemistry. Recent advances in imaging techniques now provide additional information on lesions due to improved spatial, temporal and contrast resolution. Correct interpretation of these imaging features should improve diagnosis.

Mangafodipir trisodium (Teslascan) is a hepatobiliary contrast agent that provides noninvasive opacification of the bile ducts. Using this contrast medium combined with a T1-weighted gradient echo enhanced sequence provides functional imaging of the bile ducts. Second-intention MRI was obtained after the usual morphological study of the bile ducts using heavily T2-weighted sequences (SS-FSE Te eff long and SS FSE Te eff short). This method can detect many biliary duct anomalies: biliary leakage in the postoperative context, mapping of bile ducts and the gallbladder in the search for anatomical variants, analysis of biliodigestive or biliobiliary anastomoses, or a dynamic study of bile secretion and excretion. Opacification of the bile ducts has only been possible until now with invasive tests aggravated by a certain co-morbidity rate and their functional study using biliary scintigraphy limited by mediocre spatial resolution. This new possibility provides access not only to morphological imaging, but also to functional imaging with excellent spatial resolution.