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The presence of fat within a hepatic lesion is unusual and can help to direct the radiologist's diagnosis. The aim of this iconographic review is to specify the various hepatic lesions that may contain fat and their appearance particularly on MRI. A histological correlation is also suggested for the most commonly found tumors. The identification of fat within a hepatic tumor, along with other radiological signs and reflection on the clinical and epidemiological context, can lead to a diagnosis being reached or suggested, with confirmation if necessary, by a pathological examination.

Resume La presence de graisse au sein d’une lesion hepatique n’est pas classique et peut orienter le radiologue dans sa demarche diagnostique. Le but de cette revue iconographique est de preciser les differentes lesions hepatiques susceptibles de contenir de la graisse ainsi que leur aspect en imagerie en coupes et en particulier a l’IRM. Une correlation anatomo-pathologique est egalement proposee pour les tumeurs les plus frequentes. L’identification de graisse au sein d’une tumeur hepatique, en association avec les autres signes radiologiques, ainsi que la prise en compte du contexte clinique et epidemiologique peuvent permettre de poser le diagnostic ou de l’evoquer, avec confirmation si necessaire, par l’examen histologique.

Background High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment, while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung aeration in patients with early acute respiratory distress syndrome (ARDS). Methods Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an animal laboratory. Patients were optimized under conventional “open-lung” ventilation. Lung CT was performed using an end-expiratory hold (Conv) to assess lung morphology. HFPV was applied for 1 hour to all patients before new CT scans were performed with end-expiratory (HFPV EE) and end-inspiratory (HFPV EI) holds. Lung volumes were determined after software analysis. At specified time points, blood gases and hemodynamic data were collected. Recruitment was defined as a change in non-aerated lung volumes between Conv, HFPV EE and HFPV EI. The main objective was to verify whether HFPV increases alveolar recruitment without lung hyperinflation. Correlation between pleural, upper airways and HFPV-derived pressures was assessed in an ARDS swine-based model. Results One-hour HFPV significantly improved oxygenation and hemodynamics. Lung recruitment significantly rose by 12.0% (8.5–18.0%), P = 0.05 (Conv-HFPV EE) and 12.5% (9.3–16.8%), P = 0.003 (Conv-HFPV EI). Hyperinflation tended to increase by 2.0% (0.5–2.5%), P = 0.89 (Conv-HFPV EE) and 3.0% (2.5–4.0%), P = 0.27 (Conv-HFPV EI). HFPV hyperinflation correlated with hyperinflated and normally-aerated lung volumes at baseline: r = 0.79, P = 0.05 and r = 0.79, P = 0.05, respectively (Conv-HFPV EE); and only hyperinflated lung volumes at baseline: r = 0.88, P = 0.01 (Conv-HFPV EI). HFPV CT-determined tidal volumes reached 5.7 (1.1–8.1) mL.kg-1 of ideal body weight (IBW). Correlations between pleural and HFPV-monitored pressures were acceptable and end-inspiratory pleural pressures remained below 25cmH20. Conclusions HFPV improves alveolar recruitment, gas exchanges and hemodynamics of patients with early non-focal ARDS without relevant hyperinflation. HFPV-derived pressures correlate with corresponding pleural or upper airways pressures. Trial registration ClinicalTrials.gov, NCT02510105. Registered on 1 June 2015. The trial was retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1924-6) contains supplementary material, which is available to authorized users.

Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by the association of congenital bone abnormalities and extraskeletal ossification flare-ups occurring in muscles and fasciae. Early diagnosis is important to prevent ossification flare-ups, but some atypical presentations can lead to errors in diagnosis and therefore delay. Here, we report on a case of an atypical presentation of FOP in a girl, in whom prominent transverse reductional abnormalities delayed diagnosis. The patient developed extraskeletal ossifications and progressive fibrosis that led to motor restrictions. Since early diagnosis is important, we discuss the clinical presentations of FOP and the differential diagnoses.

Resume L’hemangiome, lesion hepatique non kystique la plus frequente et de decouverte fortuite dans la majorite des cas, peut dans certaines situations poser des problemes diagnostiques en imagerie. Dans cet article, nous montrerons tout d’abord que l’aspect radiologique de l’hemangiome hepatique, dans sa forme typique, apparait intimement lie aux trois sous-types histologiques connus. Puis, nous verrons que certaines atypies doivent etre connues pour etablir un diagnostic. Nous observerons egalement les interactions potentielles entre l’hemangiome, la lesion vasculaire active et le parenchyme hepatique adjacent. Enfin, nous verrons les particularites pediatriques des hemangiomes hepatiques et illustrerons le cas d’un angiosarcome hepatique.

Resume Anatomiquement simples, le septum interatrial (SIA) et le septum interventriculaire (SIV) possedent des origines embryologiques complexes. Les apports recents de la biologie moleculaire ont permis une meilleure comprehension de leur formation. Des la constitution du tube cardiaque, plusieurs aires cardiogeniques vont fournir les contingents cellulaires necessaires. L’elongation et la ballonnisation du tube cardiaque, puis son inflexion, vont esquisser les sillons separant les chambres cardiaques, en regard des futurs septums. Au pole veineux du cœur, le reseau veineux embryonnaire va partiellement involuer et participer a la formation du SIA par accolement des valves veineuses. Au niveau atrial, le septum primum croit en direction du canal atrioventriculaire. Il fusionne a sa partie caudale avec les bourrelets atrioventriculaires cloisonnant le canal atrioventriculaire, tandis que sa partie crâniale se fenestre, creant l’ostium secundum. Un repli, le septum secundum, apparait ensuite sur la paroi libre de l’atrium primitif et recouvre l’ostium secundum comme un clapet en laissant persister une communication par le foramen ovale, qui s’obliterera a la naissance. Le SIV possede trois origines embryologiques principales. Le septum primum interventriculaire, apparu durant la ballonnisation, est forme de cellules du tube cardiaque. Il donnera le septum trabeculaire et le septum d’entree. L’anneau interventriculaire, entourant le foramen interventriculaire, participe au septum d’entree et forme les voies de conduction atrioventriculaires. Les bourrelets aorticopulmonaires vont cliver les voies d’ejection en aorte et artere pulmonaire, et croitre pour donner le septum de sortie. Apres avoir fusionne avec les bourrelets atrioventriculaires, ils vont aussi participer au septum membraneux.

Resume L’encephalopathie posterieure reversible (EPR) est une maladie rare mais severe du systeme nerveux central. Son contexte de survenue et son mode d’expression sont caracterises par un grand polymorphisme clinique, rendant le diagnostic parfois difficile. L’imagerie tomodensitometrique et/ou par resonance magnetique est souvent caracteristique, ce qui permet d’evoquer le diagnostic dans un contexte clinique evocateur. Certains aspects moins typiques doivent cependant etre connus afin de ne pas meconnaitre cette affection, dont l’evolution est conditionnee par la precocite du traitement.

Fibrodysplasia ossificans progressiva (FOP) is a rare disease characterized by the association of congenital bone abnormalities and extraskeletal ossification flare-ups occurring in muscles and fasciae. Early diagnosis is important to prevent ossification flare-ups, but some atypical presentations can lead to errors in diagnosis and therefore delay. Here, we report on a case of an atypical presentation of FOP in a girl, in whom prominent transverse reductional abnormalities delayed diagnosis. The patient developed extraskeletal ossifications and progressive fibrosis that led to motor restrictions. Since early diagnosis is important, we discuss the clinical presentations of FOP and the differential diagnoses.

One per cent of cases of mechanical occlusion of the small intestine are caused by internal hernias, the rarest type being an internal hernia through the broad ligament of the uterus, and representing approximately 5% of cases. While "conventional" treatment of mechanical occlusions of the small intestine is based on laparotomy, a laparoscopic approach is feasible in nearly half of cases, with an acceptable rate of morbidity. Preoperative diagnosis has for a long time been difficult but the usefulness has recently been emphasized of computed tomography. We report the cases of two patients who presented an internal hernia of the right broad ligament diagnosed with CT who afterwards underwent laparoscopic surgery.

CT imaging features of colitis in neutropenic patients Colitis in neutropenic patients presents with non-specific clinical findings including abdominal pain, fever, diarrhea and abnormal liver function tests. Four diagnoses are relatively more frequent: neutropenic enterocolitis, pseudomembranous colitis, intestinal GVHD and CMV colitis. Knowledge of their respective imaging features combined with epidemiological data frequently leads to the correct diagnosis. The purpose of this paper is to illustrate the imaging features of colitis in neutropenic patients.

Purpose. To review the histological features of 26 circumscribed liver lesions associated with liver capsule retraction and discuss the differential diagnosis while evaluating for the presence of fibrous stromal reaction. Materials and methods. Retrospective study performed between January 2005 and June 2008 including 26 patients: 18 males and 6 females, without history of cancer, aged between 42 and 82 years (mean age: 64.5 years), presenting with liver capsule retraction adjacent to a circumscribed liver lesion detected on CT or MRI. A single lesion was present in 17 patients, and multiple lesions were present in 9 patients. All liver lesions were biopsied with semi-quantitative evaluation of fibrous stromal reaction. Results. Twenty-one patients had benign or malignant liver tumors and 5 patients had confluent hepatic fibrosis. Twenty of 21 liver tumors were malignant (95.2%): 3 intra-hepatic cholangiocarcinoma, 17 cases of metastatic disease including colorectal carcinoma (n=8), bronchogenic carcinoma (n=1), pancreatic carcinoma (n=4), esophageal carcinoma (n=1), breast carcinoma (n=1), gallbladder carcinoma (1) and endocrine neoplasm of the pancreas (n=1), and 1 case of liver sclerosing angioma (n=1). There was no case of hepatoma. Excluding the 5 cases of confluent hepatic fibrosis, fibrous stromal reaction was present in 15 of 21 cases. Conclusion. The presence of capsular retraction next to a circumscribed liver lesion, while non-specific, is suspicious. In keeping with previous reports, metastases were frequently the cause and intrahepatic cholangiocarcinoma was the most frequent primary tumor. In patients with chronic hepatocellular disease, confluent fibrosis was a frequent etiology. The fibrous component of the underlying malignant lesion along with its subcapsular location appear to be determining factors in the development of capsular retraction.

In most cases, fibrolamellar hepatocellular carcinoma has specific and distinctive histopathological features that distinguish it from hepatocellular carcinoma. Magnetic resonance imaging can provide characteristic features to obtain a diagnosis of this entity. We report a case of fibrolamellar hepatocellular carcinoma with a radiological-pathological correlation in a 37 year-old man with chronic viral hepatitis B without cirrhosis who underwent right hepatectomy.

En analysant la pratique professionnelle, selon une methode elaboree et validee, l’Evaluation des Pratiques Professionnelles vise a ameliorer la qualite de la prise en charge des patients grâce a la mise en œuvre et au suivi d’actions d’amelioration des pratiques. Nous rapportons les resultats obtenus dans le cadre d’une autoevaluation participative a type d’audit general des pratiques, realise pour structurer et formaliser la demarche qualite d’un service de radiologie vasculaire. Les objectifs de cet audit etaient de determiner un etat de base, de mettre en evidence les eventuels dysfonctionnements, de degager les pistes d’amelioration et le degre de priorite des actions a mettre en œuvre. Il visait aussi a favoriser une prise de conscience de l’ensemble des professionnels du service de la necessite d’instaurer et de s’impliquer dans l’evaluation continue des pratiques.

Resume L’observation d’une tumeur carcinoide du canal hepatique commun documentee par TDM et IRM est rapportee. Apres une revue des differents diagnostics possibles, les auteurs demontrent que la semeiologie TDM et IRM classique peut orienter le diagnostic vers cette pathologie rare dans cette localisation inhabituelle.

Resume L’etude a compare les proprietes mecaniques de l’os trabeculaire humain cryoconserve avec une nouvelle allogreffe issue de tissu humain traitee par Osteopure™. Nous avons utilise une procedure de test par compression, non destructive, sur trois faces orthogonales (70 echantillons 10x10x10 mm provenant de tetes femorales humaines). Les tests mecaniques ont ete appliques sur les echantillons frais et apres la procedure de nettoyage Osteopure™ et de sterilisation. Des tests destructifs ont finalement ete appliques suivant la direction axiale et les resultats compares a ceux d’un groupe controle (31 echantillons). Les courbes contrainte-deformation obtenues pour les echantillons traites ne differaient pas significativement de celles observees pour des echantillons cryoconserves humains. Les modules de Young obtenus, aussi bien pour les procedures non-destructives (os frais, degraisse et apres sterilisation) que destructives (os frais et apres sterilisation) n’ont pas ete significativement differents (respectivement 183 ± 71, 192 ± 96, 202 ± 92 et 325 ± 200, 311 ± 92 MPa). La force maximale de rupture etait de 6,62 ± 3,58 MPa pour les os traites par Osteopure™ et de 9,94 ± 2,74 MPa pour les os cryoconserves. Les proprietes mecaniques de l’os cryoconserve ne sont pas significativement modifiees par le traitement Osteopure™ en particulier en ce qui concerne le module de Young, autorisant un bon comportement mecanique et fonctionnel du greffon.

Resume Les techniques therapeutiques endovasculaires percutanees sont en constante evolution : les progres technologiques incessants et une evaluation devenue tres rigoureuse de leurs resultats permettent de voir certaines indications se confirmer et d’autres emerger. Apres avoir presente des principes generaux, nous decrirons les techniques de revascularisation percutanees, en decrivant les procedures et le materiel, les resultats et les indications pour le traitement des stenoses et des occlusions, puis nous aborderons le chapitre des embolisations, a visee hemostatique, de devascularisation tumorale, pour traiter des malformations vasculaires ou assurer des hemodetournements. Seront ensuite envisages le traitement des anevrismes par endopontages, les filtres caves, les chambres implantables, la recuperation de corps etrangers endovasculaires, les shunts portocaves percutanes et le traitement des faux anevrismes postcatheterisme par compression echoguidee.

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The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For the RLN other arterial sources were arteries arising from the aortic arch in 1 specimen, the subclavian artery in 3 specimens, the first intercostal artery in 1 specimen, and the inferior thyroid artery in all specimens. For the VN other arterial sources were arteries arising from the aortic arch in 2 specimens and the inferior thyroid artery in 1 specimen. For both the VN and RLN the veins were located under the pleura and directed towards the internal thoracic vein anteriorly and the thoracic intercostal veins posteriorly. In conclusion, the inferior thyroid artery at the thoracic inlet for the RLN and the anterior bronchoesophageal artery are the more consistent vessels supplying the VN and RLN. Vascular damage occurring during mediastinal lymph node excision to the VN and RLN, especially in the subaortic region, may explain postoperative vocal fold paralysis.

a lipomatose est une complication rare de la corticotherapie au long cours. Les localisations preferentielles sont le mediastin, la region retrooculaire et l’espace epidural rachidien. Dans ce dernier cas, les symptomes sont peu specifiques. Un tableau de compression medullaire aigue peut parfois survenir en cas de tassement vertebral associe, comme nous l’illustrons dans cette observation.

Une prise de Gadolinium permettait de prevoir constament un effet favorable des anti-inflammatories.

Dynamic MRI of the pelvis was performed in 16 young nulliparous, normally continent women. The examinations were performed in the dorsal decubitus position. Using Turbo-Flash scans (acquisition time: 2.1 sec), sagittal images were obtained at rest and with maximal pelvic straining. The sacral promontory-subpubic (PSP) and the subpubic-subsacral axes (SPSS) measured respectively 80.5 degrees and 30 degrees in relation to the horizontal plane, without a statistically significant difference between rest and straining. A marked deformation of the posterior wall of the bladder was observed in 13 cases and the bladder neck was frontally deformed in 10 cases. With straining, the base of the bladder did not descend beyond 15 mm below the SPSS, and the cervix stayed at least 14 mm above the SPSS. These were established as the normal criteria for pelvic assessment. 20 multiparous patients (mean age 65 years), referred for urinary stress incontinence and/or prolapse, were investigated using the criteria previously established. The PSP, SPSS, and vaginal angle measured 80.95 degrees, 30.57 degrees, and 69.69 degrees respectively in relation to the horizontal. No statistically significant difference was detected between straining and rest conditions. The angle of the uterus in relation to the horizontal was 57.36 degrees at rest and 65.90 degrees in straining with a difference that was statistically significant. In six patients, the base of the bladder descended more than 1.5 cm while straining and in seven patients the cervix descended at least 1.4 cm below the SPSS while straining, both statistically significant differences. Overall, between our control and study populations, there were no significant differences between PSP and SPSS measured on straining and at rest. However, differences were detected in the vaginal angle, bladder-base position, and cervical position. These results suggest the potential substitution of MRI for colpocystography.

L'architecture, les mecanismes de la statique et de la dynamique du pelvis rendent difficiles les indications therapeutiques en cas d'incontinence urinaire et/ou de prolapsus, soulignant l'interet de bilans precis statiques et dynamiques, en particulier chez les patientes multi-operees ou les modifications anatomiques sont nombreuses. A cote de ses performances purement morphologiques, l'IRM, en utilisant des sequences rapides, est surement un examen d'avenir dans l'expertise des desequilibres de la statique pelvienne. Si la realisation de l'exploration en decubitus dorsal est un inconvenient de depart a ce jour incontournable, l'absence d'opacification pelvienne instrumentale rend l'IRM beaucoup plus physiologique que le colpocystogramme. Apres avoir etabli des criteres de normalite, nous avons tente chez des patientes affectees d'une incontinence et/ou d'un prolapsus de mettre en evidence des criteres predictifs pour une decision therapeutique. Les limites que nous avons rencontrees sont peut etre a rapporter a la population (heterogeneite et importance des antecedents). L'impossibilite de visualiser avec precision le col vesical et la filiere ano-rectale, contrairement a l'avis d'auteurs anterieurs, [6] constitute egalement un handicap. La substitution de l'IRM au colpocystogramme nous apparait donc aujourd'hui prematuree. Mais la technique, tres evolutive, est susceptible d'amendements rapides, notamment par la majoration de la resolution spatiale. Sa place dans les bilans de routine devra surement etre rediscutee bientot.

Magnetic resonance imaging (MRI) allows accurate assessment of Crohn's disease (CD), but requires gadolinium injection. Diffusion-weighted (DW)-MRI yields comparable performances in small bowel CD. We compared the accuracy of DW-MR enterocolonography (MREC) and the magnetic resonance index of activity (MaRIA), and performed an external validation of the Clermont score in assessing inflammation in CD.This was an observational prospective study of a single-center cohort. A total of 130 CD patients underwent consecutively MREC with gadolinium injection and DWI sequences between July 2011 and December 2012.Of the 848 evaluated segments (small bowel=352, colon/rectum=496), 175 (20.6%) were active (small bowel=111, colon/rectum=64) defined as MaRIA ≥7. Using a receiver operating characteristic (ROC) curve, we determined an apparent coefficient of diffusion (ADC) threshold of 1.9 × 10(-3) mm(2)/s that yielded a sensitivity and a specificity in discriminating active from nonactive CD of 96.9% and 98.1%, respectively, for the colon/rectum, and 85.9% and 81.6%, respectively, for the ileum. ADC was better correlated to MaRIA ≥7 than related contrast enhancement obtained with injected sequences (P0.001). The Clermont score (=1.646 × bowel thickness-1.321 × ADC+5.613 × edema+8.306 × ulceration+5.039) was highly correlated with the MaRIA (rho=0.99) in ileal CD but not in colonic CD (rho0.80). Interobserver agreement was high with regard to ADC measurement (correlation0.9, P0.001, and concordance0.9, P0001).DW-MREC is a reliable tool to assess inflammation in colonic (ADC) and ileal (Clermont score) CD and its use in daily practice would avoid gadolinium injection.

The ovaries can be affected by a vast variety of tumours, which may be benign or malignant, solid or cystic. Although ultrasonography is often the first examination performed in the evaluation of gynaecological conditions, magnetic resonance imaging is nowadays the most accurate imaging technique in the characterization of ovarian masses. Once the ovarian origin of a pelvic mass has been determined, the detection of any fibrous component within the lesion significantly reduces the spectrum of aetiologies that should be considered. Fibrotic tissue usually displays marked low-signal intensity on T2-weighted sequences at MRI, and enhancement is mostly moderate after intravenous administration of gadolinium chelates. This review aims to provide the main diagnoses to consider at MRI whenever an ovarian tumour, both purely solid or solid and cystic, contains a fibrous component, even if minimally abundant. The corresponding key imaging features are provided.

The purpose of this study was to determine the following: whether the arterial supply of a normal appendix is visible with Doppler sonography; whether the physiologic vasodilatation that accompanies childhood appendicitis is visible; what Doppler patterns appear once necrosis of the appendix has occurred; what Doppler shifts are visible with chronic, recurrent appendicitis; and whether other conditions in the right lower quadrant can mimic the Doppler sonographic patterns of appendicitis.Twenty-five fasting patients without abdominal pain or intestinal disease and 45 patients (1-25 years old; mean, 8 years old) with right lower quadrant pain and suspected appendicitis were examined sonographically, using 5- and 7-MHz linear, color, and pulsed Doppler transducers. Arterial signals were sought within the appendix and neighboring tissues, counted, and classified as sparse (1-2), moderate (3-4), or abundant (4). The resistive index (RI) was measured. Thirty patients who underwent surgery were retained for surgical and pathologic correlation, and only they formed the appendicitis study.A normal appendix was found in 10 patients. Doppler shifts were sparse, and diastolic flow was low or absent (RI, 0.85-1). Acute uncomplicated appendicitis was found in 13 patients, who had abundant color Doppler signals throughout most of the appendix, with high diastolic flow (RI, 0.40-0.77; mean, 0.54). Acute necrotic appendicitis with perforation was found in 11 children, eight of whom showed no signals in the necrotic area at the tip. Few or no signals were seen in the remainder of the appendix (RI, 0.33-0.90; mean, 0.54). In two patients, signals were abundant in the tissues surrounding the appendix. Recurrent or chronic appendicitis was found in three patients, previously diagnosed as having Crohn's disease, psychosomatic illness, or nonspecific abdominal pain. The appendix had Doppler signals confined to the tip (RI, 0.63-0.83; mean, 0.75). Other diagnoses were found in three patients, in whom the appendix was not seen. There were abundant color signals in the intestinal wall and adjacent tissues in the right lower quadrant. Two patients had Crohn's disease, and the third had an unsuspected early pregnancy. The appendix was normal in all.Acute appendicitis is accompanied by inflammatory hypervascularity reflected as an increased number of color signals and higher diastolic Doppler shifts as compared with those found in normal persons. No Doppler shifts are identified in areas of appendiceal ischemia. Other acute inflammation in the right lower quadrant also produces numerous Doppler shifts with high diastolic flow, as does ovulation. Care must be taken to identify the source of these Doppler signals. The changing vascularity of healing, recurrent, and chronic appendicitis promises to further our understanding of the pathogenesis and evolution of this disease.

Resume Introduction Le pronostic de l’anorexie mentale (AM) est severe (deces dans 2 a 5 % des cas). L’AM entretient des liens etroits avec des acces de boulimie. Observation Une femme anorexique mentale de 25 ans a ete hospitalisee pour syndrome occlusif avec vomissements, la presence d’une contracture abdominale, l’absence de bruits hydroaeriques et un arret des matieres et des gaz. La biologie etait normale. Le scanner abdominal mettait en evidence une volumineuse distension gastrique. Le diagnostic de syndrome occlusif fonctionnel etait retenu. Sous traitement medical et surveillance en reanimation, la distension gastrique s’est resolue progressivement. Discussion Les periodes de restriction alimentaire de l’AM sont entrecoupees d’acces boulimiques a l’origine de complications digestives parfois severes. Les anomalies de la motilite gastrique peuvent aboutir a des distensions majeures de l’estomac avec risque de perforation. La survenue de douleurs abdominales en cas d’AM au decours d’un acces boulimique doit faire evoquer le diagnostic de distension gastrique aigue avec risque majeur de perforation.

SummaryBackground Whether diffusion-weighted imaging (DWI)-MRI is of value in detecting and assessing inflammation of ileal Crohn's disease (CD) remains poorly investigated. Aim To compare DWI-MR enterography (MRE) with conventional MRE in estimating inflammation in small bowel CD, to determine an apparent diffusion coefficient (ADC) threshold to differentiate active from non-active lesions and to assess inter-observer agreement. Methods Thirty-one CD patients from the Clermont-Ferrand IBD unit with ileal involvement were consecutively and prospectively included between April and June 2011. All patients underwent DWI-MRI to detect the digestive segment with the most severe lesions, which was then used to calculate the ADC. Qualitative and quantitative results were compared with conventional MRE including MaRIA (Magnetic Resonance Index of Activity) score calculation and independent activity predictors (wall thickening, oedema, ulcers). Each examination was interpreted independently by two radiologists blinded for clinical assessment. Results Seventeen patients (54.8%) had active CD as defined by the MaRIA score ≥7. DWI hyperintensity was highly correlated with disease activity evaluated using conventional MRE (P = 0.001). Qualitative analysis of DW sequences determined sensitivity, specificity, positive predictive value and negative predictive value as 100%, 92.9%, 94.4% and 100% respectively. Quantitative analysis using a cut-off of 1.6 × 10−3 mm²/s for ADC yielded sensitivity and specificity values of, respectively, 82.4% and 100%. Inter-observer agreement was high with regard to DWI hyperintensity (κ = 0.69, accuracy rate = 85.7%) and ADC (correlation = 0.74, P

Finite element modelling of the human lumbar vertebral column employs data-processing procedures for study of the linear and nonlinear elasticity of materials such as are currently used in mechanics or in civil engineering. Thanks to developments in computer science, requiring a close collaboration between doctors and engineers, we put forward in this preliminary study a linear computerised model of the lumbar column comprising 4824 meshes and 6813 nodes. By reducing the simplificatory hypotheses and integrating new parameters, this model as developed is capable of important clinical applications in surgery and ergonomics.

Resume Les hemarthroses spontanees recidivantes du genou sont frequentes et une etiologie est souvent retrouvee. A l’inverse les hemarthroses sur prothese sont rares et leur etiologie reste souvent inconnue. Nous rapportons une observation d’hemarthroses recidivantes sur prothese de genou implantee 6 ans auparavant, induite par une simple hypervascularisation periarticulaire, qui a beneficie d’un traitement endovasculaire par embolisation.

Posterior reversible encephalopathy syndrome (PRES) is a rare but severe condition of the central nervous system. It develops in a variety of clinical settings and it has diverse patterns of expression, which can sometimes make diagnosis difficult. Characteristic features are often demonstrated on computed tomography imaging and/or magnetic resonance imaging, meaning that when there is a suspicious clinical picture, this diagnosis should suggest itself. However, clinicians should be aware of some of the less typical features in order to more fully understand this condition, in which early treatment is key to good clinical progress.

Although anatomically simple structures, the atrial septum and the ventricular septum have complex embryological origins. Recent findings in molecular biology allowed better comprehension of their formation. As soon as the heart tube is formed, cells migrate from several cardiogenic fields to take part in the septation. Elongation, ballooning, and later inflexion of the heart tube create chamber separating grooves, facing the future septa. The systemic venous tributaries conflate at the venous pole of the heart; it will partially involute while contributing to the atrial septum. The primary atrial septum grows from the atrial roof towards the atrioventricular canal. It fuses there with the atrioventricular cushions, while its upper margin breaks down to form the ostium secundum. Then a deep fold develops from the atrial roof and partly covers the ostium secundum, leaving a flap-like interatrial communication through the oval foramen. It will close at birth. The interventricular septum has three embryological origins. The ventricular septum primum, created during the ballooning process, origins from the primary heart tube. It will form the trabecular septum and the inlet septum. The interventricular ring, surrounding the interventricular foramen, will participate in the inlet septum and also form the atrioventricular conduction axis. The outflow cushions will separate the outflow tract in the aorta and pulmonary artery, and grow to create the outlet septum. After merging with the atrioventricular cushions, they will also be part of the membranous septum.

In haematology units, acute abdominal symptoms are common and often challenging for the clinician in charge. Two haematological conditions that may induce specific diagnoses are of particular concern: neutropenia and haematopoietic stem cell transplantation. Clinical and biological manifestations, including abdominal pain, fever, diarrhoea, hepatic cytolysis, or cholestasis are often non-specific. Computed tomography is often the primary imaging screening technique performed in such patients, as it is widely available, performs well for this indication, and may demonstrate evocative findings. The aim of this review is to provide the spectrum of specific diagnoses encountered and the corresponding key CT features in patients presenting with acute abdominal disorders following neutropenia and/or haematopoietic stem cell transplantation.

Les malformations arterio-veineuses pulmonaires (MAVP) constituent la principale indication d’embolisation dans le territoire arteriel pulmonaire.

A cote du priapisme a bas debit, consequence d’un obstacle au retour veineux d’origine hematologique, iatrogene ou secondaire a un traumatisme medullaire, qui est douloureux et constitue une urgence urologique car il expose a une ischemie caverneuse, le priapisme a haut debit, lie a une augmentation prolongee et non regulee du flux arteriel, est beaucoup moins frequent. Non douloureux et n’evoluant pas vers l’ischemie, il est en regle secondaire a un traumatisme perineal ou penien direct, et doit etre evoque dans ce contexte devant des anomalies cliniques: penis moins rigide que dans les priapismes veino-occlusifs, non douloureux, avec souvent une bonne tolerance des symptomes expliquant des delais parfois prolonges avant consultation, signe de la «compression perineale»: detumescence partielle ou complete lors de la compression digitale du perinee. La ponction-lavage des corps caverneux etait classiquement realisee afin de distinguer priapismes a bas ou haut debit, retrouvant dans le dernier cas sang rouge rutilant et niveau d’oxygene arteriel. Elle n’est aujourd’hui necessaire que lorsque le diagnostic de priapisme a haut debit est incertain (absence d’etiologie traumatique evidente, erection douloureuse, recurrence de la symptomatologie, facteur(s) de risque pour un priapisme veino-occlusif). L’echographie- Doppler permet aussi d’affirmer le priapisme a haut debit et de localiser certaines fistules.

Opto-electronic systems utilising measurement of displacement of skin markers allows study of movement in the living subject. The authors have used this method in a kinematic study of the thoracic and lumbar spine measuring the displacement of skin markers placed over the spinous processes. It was possible to approach the physiological state of these complex movements once the apparatus had been calibrated to the correct level, and the error margins minimised. Repeated measurements confirmed the reliability of this method even if movement of the skin with respect to the bony reference points introduced some margin of error. Three dimensional displacement of the vertebrae were measured during voluntary movements of the spine demonstrating the complex geometry. Since opto-electronics are non-invasive they constitute an important advance in the study of the kinematics of the spine.

The infratemporal fossa and its contents (particularly the pterygoid muscles) is a region difficult to explore, in spite of its importance in odontostomatological pathology. In order to reduce the indications that justify examination by computed tomography and magnetic resonance imaging, for reasons of economy of health, the authors describe by application of orientated anatomical slices the way in which ultrasonography can be performed. Only the posterior approach between the mandible laterally and the mastoid process medially provided consistently adequate exploration of the infratemporal fossa and the pterygoid muscles.

Colitis in neutropenic patients presents with non-specific clinical findings including abdominal pain, fever, diarrhea and abnormal liver function tests. Four diagnoses are relatively more frequent: neutropenic enterocolitis, pseudomembranous colitis, intestinal GVHD and CMV colitis. Knowledge of their respective imaging features combined with epidemiological data frequently leads to the correct diagnosis. The purpose of this paper is to illustrate the imaging features of colitis in neutropenic patients.

According to the ultrasound and MRI findings, supported by planned dissections, the female perineum is organised around the musculofascial system converging towards the fibrous structure of the central perineal tendon (CPT). Behind the CPT the fascial layers form part of a fibrous assembly extending from the ventral surface of the sacrum to the anal complex, prolonging the direction of the sacral concavity downwards and forwards. On the other hand, in front of the CPT the fasciae fuse to form two aponeurotic bands circumscribing the urogenital fossa. The fascial system is reinforced cranially by the structures of the hypogastric sheath and the uterosacral ligaments. The weak point of the urogenital fossa is partly filled by the urethral-clitoridal-vulvar complex. The perineum so formed plays a cardinal role in stabilising the pelvic viscera. Stress is placed on the firmness of the posterior perineum, a key element in pelvic stability. The posterior perineum is often involved in pathological conditions and a good acquaintance with these structures is essential in defining therapeutic indications.