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Resume Les douleurs abdominales aigues sont frequentes lors de la grossesse et resultent de multiples etiologies. Devant un examen clinique souvent difficile, l’imagerie a une place importante dans la demarche diagnostique. Cependant, le choix de la modalite d’exploration, echographie, scanner, IRM, est rendu delicat du fait de la grossesse. L’evaluation du rapport benefice/risque de chaque examen apparait essentielle en particulier en raison de l’irradiation fœtale. L’objectif de cette mise au point est de decrire les modalites d’exploration des etiologies les plus frequentes de douleurs abdominales aigues chez la femme enceinte, en dehors de la pathologie obstetricale, ainsi que certaines pathologies plus rares a ne pas meconnaitre dans ce contexte.

ImportancePreoperative mapping of deep pelvic endometriosis (DPE) is crucial as surgery can be complex and the quality of preoperative information is key.ObjectiveTo evaluate the Deep Pelvic Endometriosis Index (dPEI) magnetic resonance imaging (MRI) score in a multicenter cohort.Design, Setting, and ParticipantsIn this cohort study, the surgical databases of 7 French referral centers were retrospectively queried for women who underwent surgery and preoperative MRI for DPE between January 1, 2019, and December 31, 2020. Data were analyzed in October 2022.InterventionMagnetic resonance imaging scans were reviewed using a dedicated lexicon and classified according to the dPEI score.Main outcomes and measuresOperating time, hospital stay, Clavien-Dindo–graded postoperative complications, and presence of de novo voiding dysfunction.ResultsThe final cohort consisted of 605 women (mean age, 33.3; 95% CI, 32.7-33.8 years). A mild dPEI score was reported in 61.2% (370) of the women, moderate in 25.8% (156), and severe in 13.1% (79). Central endometriosis was described in 93.2% (564) of the women and lateral endometriosis in 31.2% (189). Lateral endometriosis was more frequent in severe (98.7%) vs moderate (48.7%) disease and in moderate vs mild (6.7%) disease according to the dPEI (P P P P = .004). They were also more likely to experience postoperative voiding dysfunction (OR, 3.5; 95% CI, 1.6-7.6; P = .001). Interobserver agreement between senior and junior readers was good (κ = 0.76; 95% CI, 0.65-0.86).Conclusions and RelevanceThe findings of this study suggest the ability of the dPEI to predict operating time, hospital stay, postoperative complications, and de novo postoperative voiding dysfunction in a multicenter cohort. The dPEI may help clinicians to better anticipate the extent of DPE and improve clinical management and patient counseling.

Immunotherapy has dramatically improved the prognosis of patients with metastatic melanoma (MM). Yet, there is a lack of biomarkers to predict whether a patient will benefit from immunotherapy. Our aim was to create radiomics models on pretreatment computed tomography (CT) to predict overall survival (OS) and treatment response in patients with MM treated with anti-PD-1 immunotherapy.We performed a monocentric retrospective analysis of 503 metastatic lesions in 71 patients with 46 radiomics features extracted following lesion segmentation. Predictive accuracies for OS 1 year versus 1 year and treatment response versus no response was compared for five feature selection methods (sequential forward selection, recursive, Boruta, relief, random forest) and four classifiers (support vector machine (SVM), random forest, K-nearest neighbor, logistic regression (LR)) used with or without SMOTE data augmentation. A fivefold cross-validation was performed at the patient level, with a tumour-based classification.The highest accuracy level for OS predictions was obtained with 3D lesions (0.91) without clinical data integration when combining Boruta feature selection and the LR classifier, The highest accuracy for treatment response prediction was obtained with 3D lesions (0.88) without clinical data integration when combining Boruta feature selection, the LR classifier and SMOTE data augmentation. The accuracy was significantly higher concerning OS prediction with 3D segmentation (0.91 vs 0.86) while clinical data integration led to improved accuracy notably in 2D lesions (0.76 vs 0.87) regarding treatment response prediction. Skewness was the only feature found to be an independent predictor of OS (HR (CI 95%) 1.34, p-value 0.001).This is the first study to investigate CT texture parameter selection and classification methods for predicting MM prognosis with treatment by immunotherapy. Combining pretreatment CT radiomics features from a single tumor with data selection and classifiers may accurately predict OS and treatment response in MM treated with anti-PD-1.

IntroductionDuring pregnancy, maternal obesity increases the risk of fetal abnormalities. Despite advances in ultrasound imaging, the assessment of fetal anatomy is less thorough among these women. Currently, the construction of ultrasound images uses a conventional ultrasound propagation velocity (1540 m/s), which does not correspond to the slower speed of propagation in fat tissue.The main objective of this randomised study is to compare the completeness of fetal ultrasonography according to whether the operator could choose the ultrasound velocity (1420, 1480 or 1540 m/s) or was required to apply the 1540 m/s velocity.Methods and analysisThis randomised trial is an impact study to compare a diagnostic innovation with the reference technique. The trial inclusion criteria require that a pregnant woman with obesity be undergoing a fetal morphology examination by ultrasound from 20+0 to 25+0 gestational weeks.Randomisation will allocate women into two groups. The first will be the ‘modulable speed’ group, in which operators can choose the speed of ultrasound propagation to be considered for the morphological analysis: 1420, 1480 or 1540 m/s. In the second ‘conventional speed’ group, operators will perform the morphological examination with the ultrasound speed fixed at 1540 m/s. The adjudication committee, two independent experts, will validate the completeness of each examination and the quality of the images.Ethics and disseminationThis research protocol does not change the standard management. The only possible impact is an improvement of the ultrasound examination by improving the quality of the image and the completeness of morphological examination. The Agence du Médicament et produits de santé approved this study (2018-A03478-47). The anonymised data will be available on request from the principal investigator. Results will be reported in peer-reviewed journals and at scientific meetings.Trial registration numberClinicalTrials.gov (http://www.clinicaltrials.gov) Registry (NCT04212234).

Understanding and simulating the soil organic matter had become a key challenge to better predict the landscape dynamic and its evolution. Although numerical modelling developments already integrate soil organic matter to improve agricultural practices at field or plot scales, additional work needs to be carried out to describe the landscape evolution over hundreds to thousands of years.We aim to identify and quantify the processes associated to organic matter cycle that take part in landscape long-term evolution. We complete a reference sediment transport model designed for large scale evolution by adding some physical considerations relative to organic matter behaviour. The main developments concern: Organic matter productivity and its export to soils Organic matter evolution and degradation along soil profile and during transport Rock and regolith compartments with different lithologies and compositions Weathering and erosion In this presentation, we explore the strengths and limits of this model designed to address a wide variety of questions in various settings. We also discuss the results and assess the validity of this approach considering availability of long-term sedimentary records.

Resume La tumeur de la granulosa est connue pour ses manifestations hyperoestrogeniques mais peut secreter de la testosterone dans de tres rares cas. Nous rapportons ici un cas de tumeur de la granulosa androgenosecretante chez une patiente de 47 ans.

This work analyzes the distribution of coal-bearing strata in the stratigraphic framework of the Mannville Group (Lower Cretaceous, Western Canada Sedimentary Basin). In the 3rd-order depositional sequence the maximum abundance of coal layers is found in the highstand system tracts (HST), whereas in the 4th-order eustatic sequences, coal deposits distribute similarly in the highstand and transgressive system tracts (TST). These trends have been related to the variation of accommodation space in the basin, which mostly influence the occurrence of favorable conditions for organic matter preservation. Petrographic analyses permit to identify variation in the coal layers composition and to relate them with the stratigraphic dynamic of the basin. The HST is characterized by a low subsidence rate, which induces low levels of the groundwater table, favoring dry conditions in the peat. By consequence, in the HST a higher abundance of inertinite maceral group is observed than in the TST. On the other hand, the TST is characterized by higher subsidence rates, thus more stable groundwater table levels, promoting the organic matter preservation. Therefore, in the TST a higher content of vitrinite and liptinite maceral groups is observed. In correspondence of the maximum flooding surface (MFS), the peat is frequently flooded, with the consequent dilution of the organic matter with terrigeneous sediment, forming carbonaceous shales deposits. By the analysis of the organic matter composition, seven depositional environments for coal were identified, located at different distance from the coast line. Each depositional environment is characterized by a specific organo-facies association, which is the reflex of different environmental conditions in the peat, in terms of water table level, type of vegetation and hydrodynamic processes. The vertical superimposition in a coal package of different depositional environments has been related to high order climatic cyclicity (5th-order transgressive and regressive cycles), which controls the groundwater table fluctuations.

The source rock characteristics (e.g. thickness, lateral extension, richness) are known to be highly variable in both time and space. The Lower Jurassic formations of north-western Europe contain source rocks with organic-rich intervals showing different characteristics from one region to another: the Paris Basin differs from the South-East Basin of France, but organic content and hydrogen index also vary within a single basin. During the Early Jurassic, the overall depositional environment of north-western Europe corresponded to an epicontinental domain at the western extremity of the Tethys Ocean. The early transgressive phase of the Jurassic induced flooding of this European realm. Because of the evolution of the connections and threshold of the European basins and their associated sedimentary settings, this domain occupied a key position for the deposition of organic-rich layers. Using a forward modelling approach, we aim to predict the heterogeneous characteristics of such sediments. It is widely accepted that primary productivity and preservation are key factors favouring the accumulation of organic-rich layers. However, the roles of these factors remain to be assessed and the processes leading to accumulation and preservation need to be quantified. We focus on the Lower Jurassic (Hettangian to Toarcian) in France, since this provides a vast amount of data to calibrate the 100-kyr time step model in terms of an accurate framework including paleogeography, stratigraphy, lithology, palaeontology, mineralogy and geochemistry. Results show that favourable conditions for the deposition of organic-rich sediment can occur even with moderate primary productivity and without requiring anoxic conditions. These windows are firstly dependent on internal factors directly linked to the basin morphology, such as sedimentation rate, bathymetry and distance from the coastline. We do not need to evoke external factors such as oceanic anoxic events or enhancement of primary production to account for the deposition of organic-rich sediments.

La prevalence de l’obesite augmente regulierement, particulierement dans la population feminine en âge de procreer. Les foetus issus de grossesses de meres obeses voient leur risque malformatif plus eleve que dans la population generale. La performance de l’echographie dans le depistage est fortement reduite par l’obesite et proportionnellement a sa severite. Les moyens d’amelioration des performances de l’echographie dans cette situation sont, principalement, un balayage ultrasonore favorisant les fenetres acoustiques ou l’epaisseur du pannicule est la moins importante et une optimisation des reglages d’image parmi lesquels le parametre « vitesse de propagation des ultrasons » doit etre pris en compte. L’echographiste doit, par ailleurs, veiller a optimiser son ergonomie de travail afin de prevenir les troubles musculosquelettiques et veiller a informer les patientes des limites de l’examen afin de prevenir le risque medicolegal.

The active debate about the processes governing the organic-rich sediment deposition generally involves the relative roles of elevated primary productivity and enhanced preservation related to anoxia. However, other less spotlighted factors could have a strong impact on such deposits, e.g., residence time into the water column (bathymetry), sedimentation rate, transport behavior of organo-mineral floccules on the sea floor. They are all strongly interrelated and may be obscured in the current conceptual models inspired from most representative modern analogues (i.e., upwelling zones and stratified basins). To improve our comprehension of organic matter distribution and heterogeneities, we conducted a sensitivity analysis on the processes involved in organic matter production and preservation that have been simulated within a 3D stratigraphic forward model. The Lower-Middle Toarcian of the Paris Basin was chosen as a case study as it represents one of the best documented example of marine organic matter accumulation. The relative influence of the critical parameters (bathymetry, diffusive transport, oxygen mixing rate and primary production) on the output parameters (Total Organic Carbon, and oxygen level), determined performing a Global Sensitivity Analysis, shows that, in the context of a shallow epicontinental basin, a moderate primary productivity (&gt, 175 gC&middot, m&minus, 2&middot, year&minus, 1) can led to local anoxia and organic matter accumulation. We argue that, regarding all the processes involved, the presence and distribution of organic-rich intervals is linked as a first-order parameter to the morphology of the basin (e.g., ramp slope, bottom topography). These interpretations are supported by very specific ranges of critical parameters that allowed to obtain output parameter values in accordance with the data. This quantitative approach and its conclusions open new perspectives about the understanding of global distribution and preservation of organic-rich sediments.

International audience; Due to the multiple controlling factors involved, it is a challenging task to identify and quantify theprocesses influencing the distribution and heterogeneity of marine organic-rich rocks. To improveour understanding of these deposits, we model their burial history and stratigraphic evolution as wellas processes linked to marine organic matter history throughout the Lower Jurassic in of the NorthernLusitanian Basin (Western Iberian Margin). This 15-Ma-long interval is modelled using 100-kyrtime steps to simulate lithologies and organic matter heterogeneity as layers with a thickness of 2–5 m, depending on the sedimentation rate in the basin. The model is calibrated by well and outcropdata which provide structural and biostratigraphic constraints, as well as information on the depositionalfacies and geochemistry of the sediments. The results show that the presence of organic-richintervals is linked to first-order variations in the basin geometry and sedimentation rates. Withoutconsidering any variation of primary productivity or oxygen content in surface sea waters, theparameters of basin geometry and sedimentation rate are sufficient to predict the main characteristicsof source rocks, i.e. their occurrence, thickness and mineralogy at the basin scale. However, to fit themeasured organic carbon contents, we need to take account of other parameters such as variations ofprimary productivity or changes in dissolved oxygen concentration.

Turbidite reservoirs frequently consist of massive sandstones with excellent reservoir properties, but showing a heterogeneity which is difficult to characterize with only well and seismic data. The physical and numerical modeling of the depositional processes is then a way to predict the heterogeneity pattern and to assist the geological interpretation. Recently, Cellular Automata (CA) modeling was adapted to simulate turbidite flow deposits. In this study, CA modeling incorporates the main submarine physical processes involved in turbulent flows, such as water entrainment, erosion, deposition and particle fall-out. These processes are developed through CA simulations, in which the cells interact by exchanging energy and flow properties. In this work, the CA modeling was applied in real oilfields of the Campos Basin (offshore Brazil), in a case where the palaeotopography played a major role on trapping of turbidite sand deposits. The sensitivity tests performed on this case study highlighted that the parameters of flow concentration, composition of the substratum and the deposition model greatly impact the simulation results. The simulation results also realistically reproduced sedimentation patterns, such as successive filling of contiguous sub-basins, increasing flow velocities in confined settings, run-up effects with lateral deposition of fines and concentration of coarser sediments in topographic lows. An important characteristic of the studied turbidite reservoirs is the presence of multiple-stacked depositional cycles. For this reason, CA code was adapted to allow the simulation of multiple flow events and, by this way, to reproduce stacked turbidite cycles. The reservoir distribution and the thicknesses of the geological model fit very well with the results of CA simulations for multiple flow events. A blind test performed thanks to the drilling of a new well in the study area also confirmed the forecast capacity of the CA modeling for both sediment distribution and thickness. The results of the simulations are consistent with the geological model of the study area, and predict reservoir distribution in locations away from the wells. These results also point to the potential of such numerical techniques in improving the prediction of the turbidite reservoir extension, especially in the case where palaeotopography controlled the turbidite sedimentation.

This study aims to reconstruct the stratigraphic architecture of the subsurface coal bearing Mannville Group deposits (Lower Cretaceous, Western Canada Sedimentary Basin, South and Central Alberta), in order to characterize the occurrence of coal strata within this interval, by focusing on their geometry, extension and distribution. Two regional well correlation transects, calibrated by core sedimentological analysis, were established. The Mannville Group was subdivided into system tracts: a lowstand system tract (LST), which corresponds to the Lower Mannville Fm., a transgressive system tract (TST), corresponding to a backstepping phase of marine transgression, and finally, a highstand system tract (HST) that corresponds to the “undivided” Upper Mannville. The geometry, distribution and extension of the coal layers are examined within the sequential framework previously reconstructed. Four different zones where coal seams have occurred have been identified: LST-TST, early HST, middle HST and late HST. Thinner and more restricted coal layers are formed during the lowstand and transgressive system tracts and also during the late highstand system tract. Thicker, more extensive coal layers are accumulated during early highstand, as a result of the interaction with the topography, which is partly smoothed during the deposition of the Mannville Group, and the changes to the accommodation space through time.

International audience; – The recent development of unconventional resources has triggered a regain of interest for source-rocks. The presence of hydrocarbons in these unconventional systems is generally associated with organic-rich sediments. This study aims at better understanding the factors controlling the accumulation of marine organic matter at basin scale, using a process-based approach. This work focuses on the Montney, Doig and Halfway Formations (Lower and Middle Triassic, Alberta and British Columbia, Canada). Recent studies show that the Triassic strata of the Western Canada sedimentary basin can be considered as a transitional period between the Paleozoic passive margin and the Jurassic foreland basin. Based on a 3D regional stratigraphic architecture and on a description of the organic rich interval distribution, a process-based numerical model (DionisosFlow and DORS) has been used to simulate the stratigraphic evolution of the Montney, Doig and Halfway Formations and reproduce the organic distribution in these formations. This modeling approach allowed us to test different scenarios of primary productivity and basin restriction and discuss the regional controls on organic matter accumulation such as dynamic of anoxia or dilution of organic matter by detrital sediments. The reconstruction of the stratigraphic architecture emphasizes a major drop of the water discharge in the basin. In the absence of any evidence supporting a link with a climate change, the drop in water discharge suggests a major modification of the drainage area of the basin, potentially associated with the early stage of the cordilleran orogeny and foreland basin evolution. The numerical simulation also shows that the primary productivity rates in the Montney and Doig Formations are characteristic of a coastal area and that a basin restriction is required to account for the level of anoxia observed in the studied Formations. Lastly, this study investigates the regional controls on organic matter accumulation and emphasizes the impact of regional paleogeographic and geodynamic evolution on the dynamic of anoxia and on the dilution. Keywords: source rocks / stratigraphic modeling / organic matter / sedimentary fluxes / primary productivity / basin anoxia Résumé – Facteurs de contrôles sur la formation des roches mères : apport d'une modélisation stratigraphique 3D des formations du Trias du bassin ouest canadien. Le développement récent des hydrocarbures non conventionnels a suscité un regain d'intérêt pour les roches mères. La présence d'hydrocarbures dans ces systèmes non conventionnels est souvent associée à des dépôts riches en matière organique primaire. Cette étude vise à mieux comprendre les facteurs contrôlant l'accumulation de la matière organique en domaine marin à grande échelle, en utilisant une approche basée sur les processus. Ce travail se focalise sur les Formations de Montney, Doig et Halfway (Trias inférieur et moyen, Alberta et Colombie Britannique, Canada). Des études récentes montrent que le Trias du bassin ouest canadien peut être considéré comme une période de transition entre une marge passive au Paléozoïque et un bassin d'avant pays au Jurassique. En s'appuyant sur l'architecture stratigraphique régionale de cet intervalle et sur la description de ses niveaux riches en matière organique, une modélisation numérique des processus sédimentaires This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (DionisosFlow et DORS) a été réalisée afin de simuler l'évolution stratigraphique des formations de Montney, Doig et Halfway et de reproduire la distribution de la matière organique dans les formations étudiées. Cette modélisation a permis de tester différents scénarios de productivité primaire et de restriction de bassin et discuter l'influence relative sur l'accumulation de matière organique des facteurs de contrôle régionaux tels que la dynamique de l'anoxie et la dilution de la fraction organique par du matériel détritique. Afin de respecter les observations, il a été nécessaire d'introduire une chute majeure des flux d'eau dans le bassin entre le Trias inférieur et moyen. En l'absence d'évidences d'un changement climatique dans cette zone pendant cette période, cette chute des flux d'eau suggère une modification majeure des aires de drainage du bassin, potentiellement liée aux premiers stades de l'orogenèse de la cordillère canadienne et aux prémices de la formation du bassin d'avant pays. La simulation numérique permet aussi de montrer que les taux de production organique dans les formations de Montney et Doig sont caractéristiques de zone côtière et qu'une restriction du bassin est nécessaire pour induire des niveaux anoxiques dans les formations étudiées. Enfin, cette étude permet de souligner les contrôles régionaux sur l'accumulation de la matière organique et met en avant l'impact de la paléogéographie et de l'évolution géodynamique sur la dilution et l'évolution de l'anoxie.

(IF 1.54; Q2); International audience; The Cellular Automata for Turbidite systems (CATS) model is intended to simulate the fine architecture and facies distribution of turbidite reservoirs with a multi-event and process-based approach. The main processes of low-density turbulent turbidity flow are modeled: downslope sediment-laden flow, entrainment of ambient water, erosion and deposition of several distinct lithologies. This numerical model, derived from (Salles, 2006; Salles et al., 2007), proposes a new approach based on the Rouse concentration profile to consider the flow capacity to carry the sediment load in suspension. In CATS, the flow distribution on a given topography is modeled with local rules between neighboring cells (cellular automata) based on potential and kinetic energy balance and diffusion concepts. Input parameters are the initial flow parameters and a 3D topography at depositional time. An overview of CATS capabilities in different contexts is presented and discussed.

International audience; Submarine canyons are the main conduits for sediment transfer from continental shelves to deep abyssal plains. A large number of bathymetric and seismic surveys provide detailed information on their morphology and structure, shedding light on the mechanisms involved in their formation. However, because of the difficulty in deploying instruments in deep marine environments, little is known about the processes by which turbidity currents erode and incise the canyon floors. In this study, we use a micro-scale tank experiment to investigate the incision of a mobile sediment bed by a gravity current. We inject a brine at the top of a ramp covered with low-density plastic sediments. Conditions for channel formation are investigated through systematic exploration of the slope vs. discharge phase space. Measurements of the sediment bed topography and the gravity-current velocity profile allow us to characterize the channel incision dynamics. A channel forms when the bed shear stress exceeds the sediment critical shear stress. In this case, a channel starts forming near the upstream end of the incline and propagates down-slope while slowly deepening. After a transient state of about 1-2 hours, the channel reaches steady state. Experimental results suggest that the slope controls the rate of erosion and the speed of channel incision, while the brine discharge controls the channel geometry. The erosional morphologies created by our experimental gravity currents show strong analogies with the axial incision of canyons, the primary mechanism by which canyons connected to continental shelves or large rivers evolve.

CONTEXTE La radiopelvimétrie permet d’évaluer les dimensions du bassin osseux maternel. Elle a pour principale indication la présentation en siège (PS) du fœtus en fin de grossesse, afin de discuter de la voie d’accouchement. Actuellement, la radiopelvimétrie est réalisée par une acquisition scanographique faible dose. Les mesures obtenues sont comparées aux dimensions du fœtus afin d’éliminer un risque de disproportion fœtopelvienne qui contre-indiquerait un accouchement par voie basse. La réalisation d’une tentative de version par manœuvre externe (VME) est préconisée après 36 semaines d’aménorrhée (SA) pour obtenir une présentation céphalique. Cependant, le taux de succès de la VME est faible, et, même en cas de VME réussie, l’accouchement par voie basse d’un foetus en présentation céphalique n’est pas une règle.OBJECTIF Devant les risques d’échec de la VME et les risques de morbi-mortalité d’un accouchement d’un fœtus en PS, il est important d’identifier les facteurs pouvant influencer la réussite de la VME et d’un accouchement par voie basse. L’accouchement par voie basse est réalisé quasi exclusivement en décubitus dorsal avec flexion des hanches à 90°. Les pelvimétries réalisées par TDM faible dose ne permettent qu’une évaluation en décubitus dorsal strict. Le système EOS® autorise la prise de clichés dans des positions physiologiques et permet des acquisitions dans une position plus proche de celle adoptée lors de l’accouchement (position assise), tout en diminuant l’irradiation comparativement au scanner faible dose et en fournissant des données radiologiques équivalentes. Il apparaît aussi possible d’étudier la dynamique du bassin maternel après changement de position (debout puis assise). Ces informations pourraient être une aide à la prédiction de la réussitede la VME et d’un accouchement par voie vaginale.MÉTHODE L’étude pelviEOS, débutée en janvier 2022, avec une durée d’étude estimée jusqu’en février 2024, a pour but d’évaluer la dynamique du bassin osseux maternel. La réalisation d’un pelvi-TDM est remplacée par une pelvimétrie avec le système EOS® en position debout et assise chez les femmes présentant un fœtus en siège à partir de 36+0SA, et avant tentative de VME.RÉSULTATS Les résultats intermédiaires seront produits en fin d’année 2022, avant les résultats globaux ultimes de fin d’étude (2024).CONCLUSION Cette étude a pour but d’apporter des informations supplémentaires sur la prédiction de la réussite d’un accouchement par voie basse d’un fœtus en PS et le succès d’une VME grâce à d’éventuels facteurs pronostiques. Elle pourrait également permettre d’élargir le champ d’application du système EOS® et modifier les habitudes en réalisant les pelvimétries par système EOS® au lieu d’un pelviscanner, en diminuant l’irradiation.

CONTEXTE L’endométriose est une pathologie fréquente, touchant 10 % des femmes en âge de procréer et à l’origine de douleurs pelviennes chroniques. L’IRM constitue l’examen de référence pour le bilan lésionnel. La prise en charge chirurgicale de l’endométriose profonde est complexe et expose à un risque de complications postopératoires. L’efficacité du traitement médical sur les douleurs est bien établie dans la littérature et son impact sur l’évolution des lésions d’endométriose profonde est plus discuté. L’histoire naturelle de la maladie endométriosique est complexe en raison de multiples facteurs susceptibles de modifier l’évolution lésionnelle.OBJECTIF Étudier l’évolution des lésions d’endométriose au cours du temps en IRM, chez des patientes n’ayant pas bénéficié de traitement chirurgical. Analyser secondairement les facteurs influençant cette évolution, en particulier le traitement médical.MÉTHODE Étude observationnelle rétrospective monocentrique réalisée au CHU de Clermont-Ferrand entre novembre 2015 et septembre 2019, incluant des patientes présentant au moins une lésion d’endométriose profonde, non opérées et ayant eu au minimum deux IRM pelviennes avec un délai minimal de neufs mois. Les IRM ont été relues de façon indépendante et en aveugle par un radiologue junior et deux radiologues seniors spécialisés en imagerie de la femme, afin d’analyser l’évolution en taille et en nombre des lésions d’endométriose.RÉSULTATS 55 patientes ont été incluses, dont 71 % ayant initialement consulté en gynécologie pour des douleurs pelviennes, et 35 % pour infertilité. Le délai moyen entre les deux IRM était de 23 mois. Parmi les patientes incluses, 69 % bénéficiaient d’un traitement médical d’intervalle, et 31 % n’en ont pas reçu. Il n’a pas été démontré de différence significative à la progression ou à la régression en IRM des lésions d’endométriose au cours du temps, quelle que soit la localisation. Les données n’ont pas permis de conclure quant à l’influence de la prise d’un traitement hormonal. Il existait une majoration en taille des lésions d’endométriose entre la première et la seconde évaluation IRM, moins marquée chez les patientes sous traitement hormonal. Au moins une lésion d’endométriose profonde et/ou ovarienne était apparue chez six patientes lors de la seconde IRM. En parallèle nous avons observé une régression lésionnelle chez six patientes au cours de cette étude. Il existait une bonne corrélation entre l’évolution douloureuse subjective des patientes et l’évolution radiologique des lésions lors de la seconde IRM pour les atteintes d’endométriose profonde postérieure et ovarienne, sans qu’une puissance statistique suffisante n’ait été obtenue. Ces résultats étaient reproductibles puisqu’il existait une bonne concordance entre les radiologues séniors et junior concernant la détection des lésions d’endométriose, notamment profonde.CONCLUSION Cette étude n’a pas mis en évidence de différence significative concernant l’évolution en taille des lésions d’endométriose en IRM chez des patientes n’ayant pas bénéficié de traitement chirurgical, quelle que soit la localisation. La prise d’un traitement hormonal semblait être associée à une moindre progression lésionnelle, sans qu’une puissance statistique suffisante n’ait pu être obtenue.

Contexte : L’IRM est l’examen de référence dans le bilan initial du cancer de l’endomètre, permettant d’estimer le degré d’envahissement du myomètre, et contribuant à planifier le geste chirurgical. Depuis plusieurs années, les progrès techniques ont permis l’avènement de séquences T2 en 3 dimensions, d’acquisition plus rapide et permettant une reconstruction des images a posteriori dans une infinité de plans.Objectif : évaluer les performances diagnostiques de la séquence 3D-T2 versus 2D-T2 pour l’estimation du degré d’envahissement myométrial dans le bilan préopératoire du cancer de l’endomètre.Méthode : De décembre 2018 à juillet 2020, 31 patientes ont bénéficié d’une IRM pour le bilan initial d’un cancer de l’endomètre, suivie d’une prise en charge chirurgicale au CHU de Clermont-Ferrand. Le degré d’envahissement du myomètre, les dimensions tumorales et la qualité des images selon une échelle visuelle de 1 à 5 ont été analysés indépendamment et en aveugle par deux radiologues de niveau d’expérience différent. Les résultats ont été comparés à l’histologie finale considérée comme le Gold-standard.Résultats : La précision diagnostique pour l’évaluation du degré d’envahissement myométrial était identique entre les deux séquences pour le lecteur junior : 85,71%. Pour le lecteur senior, la précision était significativement inférieure (p = 0,0455) avec la séquence 3D-T2 comparativement à la séquence 2D-T2 : respectivement 82,14% et 67,86%. Concernant la mesure du grand axe tumoral, la précision diagnostique était bonne pour les deux lecteurs : 87,7 % en 2D-T2 et 90,2% en 3D-T2 pour le lecteur 1 ; 86,3% en 2D-T2 et 84,5% en 3D-T2 pour le lecteur 2. Il n’a pas été mis en évidence de relation entre les erreurs diagnostiques et la qualité des images.Conclusion : La séquence 3D-T2 présente une moins bonne précision diagnostique pour l’évaluation de l’envahissement myométrial, mais une très bonne précision pour la mesure des dimensions tumorales. Nos résultats ne permettent pas de valider l’utilisation de la séquence 3D-T2 en pratique courante mais des progrès techniques pourraient contribuer à une amélioration de ses performances diagnostiques.