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Purpose: Evaluation of CT sarcopenia as a predictor of intensive care hospitalization during SARS-COV2 infection.Materials and methods: Single-center retrospective study of patients admitted to hospital with SARS-COV2 infection. The estimation of muscle mass (skeletal muscle index (SMI)) for sarcopenia, measure-ment of muscle density for muscle quality and body adiposity, were based on CT views on the T4 and L3 levels measured at admission. Demographic data, percentage of pulmonary parenchymal involvement as well as the orientation of patients during hospitalization and the risk of hospitalization in intensive care were collected.Results: A total of 162 patients hospitalized for SARS-COV2 infection were included (92 men and 70 women, with an average age of 64.6 years and an average BMI of 27.4). The muscle area measured at the level of L3 was significantly associated with the patient's unfavorable evolution (124.4cm2 [97; 147] vs 141.5 cm2 [108; 173]) (p 1/4 0.007), as was a lowered SMI (p < 0.001) and the muscle area measured in T4 (OR 1/4 0.98 [0.97; 0.99]), (p 1/4 0.026). Finally, an abdominal visceral fat area measured at the level of L3 was also associated with a risk of hospitalization in intensive care (249.4cm2 [173; 313] vs 147.5cm2 [93.1; 228] (p < 0.001).Conclusion: This study demonstrates that thoracic and abdominal sarcopenia are independently asso-ciated with an increased risk of hospitalization in an intensive care unit, suggesting the need to assess sarcopenia on admission during SARS-COV2 infection.

Bicuspid aortic valves are associated with histopathological abnormalities of the aorta. Their diameters have been measured in several studies, but the literature concerning changes in the overall anatomy of the ascending aorta is limited. We wanted to know whether the anatomy of the valve, bicuspid or tricuspid, is associated with anatomical differences. We prospectively included patients requiring aortic valve surgery. The protocol included a chest CT scan before the operation to determine the angulations and straight lengths of aortic segments 0 and 1. All of the patients underwent surgery to assess their aortic valve morphology. We included 107 patients, 25 (23%) with bicuspid diagnostic valves and 82 (77%) with tricuspid ones. Most angulations were similar between the groups. However, the angle between the ring and the plane of the top of the commissures of the semilunar cusps was lower in bicuspid than tricuspid aortic valves. The straight lengths in the aortic root did not differ significantly, but the lengths separating these planes from the BCAT plane were consistently greater in the bicuspid group. The angle between the ring plane and the patient's vertical axis was lower in the bicuspid, the plane of the ring being verticalized in this group. In conclusion, we were able to confirm significant morphological differences in addition to the diameters. However, this study does not establish causal relationships among valve morphology, ascending aortic morphology, histology, and possibly associated pathologies. An extremely large cohort will be required indicate such causal connections. Clin. Anat. 31:693-697, 2018. © 2018 Wiley Periodicals, Inc.

Background Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and poorly understood cause of acute coronary syndrome (ACS). Clinical, angiographic features and management remain to be better defined in large cohorts. Purpose The aim of this study was to evaluate clinical, angiographic characteristics, treatment modalities and prognosis of patients with SCAD from a multicenter national registry. Methods From 2016 to 2018, SCAD patients were enrolled retrospectively and prospectively in the French multicenter regristry DISCO study in 61 cardiology interventional centers. All coronary angiograms were reviewed by 2 experienced cardiologists for diagnosis confirmation and classified according to current angiographic SCAD classification. Results A total of 373 confirmed SCAD patients were included, 45.6% prospectively, 54.4% retrospectively. Mean age was 51.5±10.3 years, with 90.6% women of whom 51.2% were postmenauposal. Ninety percent of patients had ≤2 cardiovascular risk factors, 96.2% presented with ACS, with a positive troponin in 95.4%, and ST-segment elevation in 45.0%. Precipitating emotional stress factors were reported in 46.0% and a physical trigger in 12.4%. Systemic inflammatory disease was present in 5 patients (1.4%). Peripartum SCAD accounted for only 4.4% of cases. The majority of patients (75.1%) had type 2 angiographic SCAD (diffuse long smooth tubular lesions due to intramural hematoma), with only 13.8% and 8.9% having type 1 (longitudinal filling defect) and type 3 (multiple focal tubular lesions due to intramural hematoma) respectively. Multivessel SCAD occurred in 6.2%. While 84.2% of SCAD patients were initially treated conservatively, 15.5% underwent percutaneous coronary intervention as the initial strategy and 1 patient (0.3%) required surgical implantation of a left ventricular assist device. Repeat angiogram was conducted in 288 patients (median 38 [8–70] days) showing improvement of the culprit lesion in 81.9%. At 1 year follow-up, recurrent SCAD occurred in 2.5%, major adverse cardiac events (stroke, myocardial infarction, and revascularization) in 7.7%, and all patients survived. Conclusion Our study confirms that SCAD predominantly affects early middle-aged women with few cardiovascular risk factors, with peripartum SCAD accounting for a minority of cases. Type 2 angiographic SCAD which is difficult to recognize was the most frequent angiographic appearance. This may contribute to the underestimation of SCAD in clinical practice. The majority of patients were treated conservatively with favorable outcomes. Longer-term follow-up of this large cohort and further investigations on physiopathology are warranted to improve management and risk stratification of patients. Acknowledgement/Funding Fondation Coeur et Recherche, French Coronary Atheroma and Interventional Cardiology Group, French Society of Cardiology

Bicuspid aortic valves are associated with histopathological abnormalities of the aorta. Their diameters have been measured in several studies, but the literature concerning changes in the overall anatomy of the ascending aorta is limited. We wanted to know whether the anatomy of the valve, bicuspid or tricuspid, is associated with anatomical differences. We prospectively included patients requiring aortic valve surgery. The protocol included a chest CT scan before the operation to determine the angulations and straight lengths of aortic segments 0 and 1. All of the patients underwent surgery to assess their aortic valve morphology. We included 107 patients, 25 (23%) with bicuspid diagnostic valves and 82 (77%) with tricuspid ones. Most angulations were similar between the groups. However, the angle between the ring and the plane of the top of the commissures of the semilunar cusps was lower in bicuspid than tricuspid aortic valves. The straight lengths in the aortic root did not differ significantly, but the lengths separating these planes from the BCAT plane were consistently greater in the bicuspid group. The angle between the ring plane and the patient's vertical axis was lower in the bicuspid, the plane of the ring being verticalized in this group. In conclusion, we were able to confirm significant morphological differences in addition to the diameters. However, this study does not establish causal relationships among valve morphology, ascending aortic morphology, histology, and possibly associated pathologies. An extremely large cohort will be required indicate such causal connections. Clin. Anat. 31:693-697, 2018. © 2018 Wiley Periodicals, Inc.

Resume Objectif Evaluer la prise en charge des restenoses endostents arterielles renales. Patients et methodes Etude retrospective monocentrique de 53 restenoses et deux occlusions chez 51 patients par suivi en imagerie systematique (72,5 %) et/ou degradation de la fonction renale (5,9 %) et/ou echec tensionnel (54,9 %), 15,7 mois (5–121) apres implantation, donnant lieu a 49 recalibrations par ballon et cinq stenting complementaires. Analyse des resultats techniques, de l’effet sur la tension et la fonction renale apres les revascularisations iteratives. Resultats Permeabilite secondaire de 38 arteres (63,2 %), apres 12,4 mois (3–64) avec 14 secondes restenoses ; (33,3 %) apres redilatation au ballon, 60 % apres nouveau stenting, plus frequentes chez les fumeurs ( p = 0,02), en cas d’arteriopathie peripherique ( p = 0,02), de localisation ostiale ( p = 0,049), d’alteration de fonction renale lors du diagnostic de restenose ( p = 0,012). Apres 12,7 mois (3-64) post-revascularisation, la fonction renale etait amelioree pour 30 %, stabilisee pour 50 %. Traitement des deuxiemes restenoses : un echec (7,1 %), neuf dilatations au ballon, trois cutting balloon, un second stent. Traitement des troisiemes restenoses : 71,4 %, traitees par ballon (2), cutting balloon (2) ou stent coate (DES) (1) ; puis permeabilite a distance : 50 %. Conclusion Le traitement des restenoses iteratives par les techniques conventionnelles a une efficacite imparfaite et reste actuellement non codifie.

Resume Objectifs L’objectif de cette etude a ete d’analyser retrospectivement l’efficacite et la morbidite de l’embolisation arterielle splenique pour hypersplenisme par hypertension portale (HTP), en fonction du volume de parenchyme splenique embolise et de la nature de l’hypertension portale (HTP par bloc intrahepatique vs HTP segmentaire). Patients et methodes Dix-sept patients ayant un hypersplenisme secondaire a une HTP (bloc intrahepatique, n = 14 ; HTP segmentaire, n = 3) traites par embolisation de l’artere splenique ont ete inclus retrospectivement. L’estimation du volume splenique embolise etait effectuee par TDM un mois apres l’embolisation. Une evaluation clinique et la numeration plaquettaire etaient realisees a sept jours, un mois et six mois apres l’embolisation. Resultats Dans le groupe HTP par bloc intrahepatique, le volume moyen de parenchyme splenique embolise representait 63 % du volume splenique initial (extremes : 30 a 95 %). Le taux de plaquettes sanguin augmentait en moyenne de 232 % a six mois. Tous les patients ayant moins de 80 000 plaquettes/mL a six mois avaient un volume d’embolisation Conclusion Nos resultats montrent que l’embolisation splenique de plus de 50 % du parenchyme est efficace dans le traitement des hypersplenismes par hypertension portale, mais est associee a une morbidite non negligeable si elle depasse 70 %.

Introduction et but de l’etude L’evaluation du risque cardiovasculaire et metabolique est un des enjeux majeurs de la prise en charge hygieno-dietetique et medicamenteuse des sujets obeses. De nouveaux marqueurs radiologiques ont ete recemment developpes permettant d’affiner l’evaluation du risque par rapport aux equations classiques type Framingham. Le score calcique, les mesures de la graisse epicardique, de la graisse intra-thoracique et de la graisse intra-abdominale peuvent etre des marqueurs scannographiques de risque de survenue d’evenements cardiovasculaires chez des patients a risque intermediaire, auxquels appartiennent les patients obeses. Nous avons donc compare de maniere prospective ces 4 marqueurs dans une population d’obeses, avec ou sans syndrome metabolique. Materiel et methodes Cette etude cas/temoin, monocentrique, a debute en novembre 2014. La presence d’une cardiopathie ischemique, d’une pathologie psychiatrique severe, la grossesse et l’allaitement constituaient des criteres de non-inclusion. Tous les patients subissaient un examen clinique et un prelevement sanguin dans le cadre de leur hospitalisation de semaine pour bilan initial d’obesite dans le service de nutrition clinique du CHU de Clermont-Ferrand. Les donnees cliniques et paracliniques necessaires a l’evaluation du risque cardiovasculaire ont ete collectees. Un scanner sans injection etait realise pour la mesure du score calcique, de la graisse epicardique, intra-thoracique et intra abdominale en L3. Les volumes de graisse ont ete indexes a la surface corporelle (taille en metre2). Resultats et analyse statistique Quatre-vingt-seize patients sur les 120 prevus ont ete inclus au 1er juillet 2017. On notait une predominance feminine (77,8 %), un âge de 45,0 ± 12,8 ans et un IMC de 43,8 ± 6,1 kg/m2. Un syndrome metabolique (criteres IDF/AHA/NHLBI 2009) etait present chez 63 patients (65,6 %). Les donnees scannographiques ont ete ajustees sur l’âge, le sexe et l’IMC, du fait d’une repartition inegale entre les groupes metabolique vs non metabolique. L’analyse ne montrait pas de difference entre les patients sans et avec syndrome metabolique concernant le score calcique (respectivement 11,7 ± 38,1 et 28,8 ± 79,2 ; p = 0,84), la graisse epicardique (53,5 ± 18,7 vs 50,1 ± 20,4 ; p = 0,33), la graisse intra-thoracique (139 ± 65 vs 143 ± 69 ; p = 0,97), et la graisse abdominale (333 ± 54 vs 334 ± 49 ; p = 0,92). Seule la graisse epicardique etait correlee au score de Framingham (r = 0,52 ; p 100, retrouve chez 7 patients sur 93, etait associe a un score de Framingham plus eleve (25,5 ± 25,2 vs 7,2 ± 6,2 ; p Conclusion Dans l’obesite morbide, les marqueurs scannographiques de risque cardiovasculaire ne sont pas modifies en cas de syndrome metabolique mais la graisse epicardique non liee directement a la graisse viscerale est plus predictive du risque cardiovasculaire.

Resume Objectif Les metastases hepatiques des tumeurs endocrines responsables d’un syndrome carcinoide representent une indication potentielle d’embolisation ou chimioembolisation intra-arterielle. Le but de notre etude etait d’evaluer les resultats techniques, cliniques, morphologiques immediats et a distance de ces traitements de 1995 a 2004 dans notre centre. Patients et methode Quatorze patients (huit hommes, six femmes, d’âge moyen 60 ans – de 32 a 80 ans) affectes de metastases hepatiques de tumeurs neuroendocrines et carcinoides symptomatiques, non resecables et ne repondant pas au traitement medical ont ete inclus. Des anthracyclines en emulsion lipiodolee ont ete utilisees 12 fois et une embolisation simple a visee ischemiante par coils et gelatine dans deux cas. Huit patients ont beneficie d’une seule cure, cinq patients de deux cures et un patient de trois cures espacees de un mois chacune. Les criteres d’evaluation morphologiques et cliniques de l’OMS etaient utilises. Resultats Techniquement, l’embolisation a ete realisable dans tous les cas. A cote de symptomes transitoires et de complications mineures (quatre patients), un deces est a deplorer par insuffisance renale aigue. A un mois, l’evaluation du syndrome carcinoide montrait : six reponses cliniques completes, deux ameliorations, trois situations stables et trois evolutions ; morphologiquement : une reponse partielle, sept stabilites et quatre evolutions. Au terme du suivi, cliniquement, huit patients sont decedes en moyenne huit mois apres la premiere cure et six patients ont survecu en moyenne 21 mois apres la premiere cure. Morphologiquement, la progression tumorale etait constante chez tous les patients. Conclusion Conformement aux donnees de la litterature, embolisation et chimioembolisation hepatiques nous paraissent efficaces pour faire face, au moins temporairement, au syndrome carcinoide, compliquant les metastases hepatiques non resecables des TNE, influant qualitativement sur la survie. Nos resultats morphologiques sont en retrait par rapport a ceux publies.

Patients with HIV or AIDS frequently present with GI symptoms, sometimes due to early and diffuse atherosclerosis. We report 3 cases of HIV patients with abdominal pain due to severe splanchnic arterial stenosis. Only one patient presented typical clinical findings of mesenteric ischemic. Endovascular treatment was performed in all three cases. Good clinical outcome was immediate in 2 cases. In the third case, subsequent bowel resection was required due to irreversible ischemic injury in spite of local thrombolysis and endovascular revascularization in a patient presenting with acute severe mesenteric ischemia. In all three cases, vascular patency was demonstrated at follow-up. Mesenteric ischemia is a severe complication requiring early diagnosis in HIV patients, especially those with vascular risk factors, especially since endovascular treatment is a valid therapeutic option.

International audience; The aim of this project is to design a generic formalism for parietal and regional tracking of the left ventricle (LV) and to adapt it to 3D+t3D+t cardiac imaging modalities used in clinical routine (echocardiography, gated-SPECT, cine-MRI). The estimated displacement field must be reliable enough and insensitive to various artifacts to assess regional myocardial function in 3D from the accurate and precise computation of strain. The strain has recently proved to be of great interest for diagnosis and prognostic in cardiology, but its interpretation remains difficult because of the relative nature of the indices. The clinical objective of the 3DStrain project is to bring answers about the knowledge of normality.

Introduction Comparaison des logiciels commerciaux Emory Toolbox (ECTB), Quantitative Gated Spect (QGS), Corridor 4DM et Myometrix utilises pour l’evaluation des parametres quantitatifs de la fonction ventriculaire gauche (FVG) en scintigraphie myocardique sur camera CZT (CZT-SPECT) comparativement a l’IRM, prise comme reference. Patients et methodes Quarante-huit patients ayant presente un SCA ST+ ont ete inclus. A 6 semaines, une echocardiographie (ETT), une CZT-SPECT et une IRM ont ete realisees. La fraction d’ejection ventriculaire gauche (FEVG), les volumes tele-diastolique (VTD) et tele-systolique (VTS) ont ete mesures par les 3 techniques et selon les 4 logiciels scintigraphiques. La concordance des parametres evalues par les differents logiciels, l’ETT et par l’IRM a ete calculee par coefficient de Lin ( ρ ). La concordance par classe (dysfonction VG severe FEVG 50 %) et l’impact de l’etendue de la necrose sur la concordance des parametres de FVG ont ete evalues. Resultats La concordance des mesures des FEVG, des VTS et VTD en CZT-SPECT avec celle de l’IRM etait bonne quel que soit le logiciel utilise, au moins equivalente a celle de l’ETT. Les mesures de Myometrix ( ρ FEVG : 0,825 ; ρ VTS : 0,903 ; ρ VTD : 0,679) et QGS ( ρ FEVG : 0,799 ; ρ VTS : 0,889 ; ρ VTD : 0,701) semblaient les plus proches de celles de l’IRM. Les necroses de plus de 3 segments sur 17 n’avaient pas d’impact negatif sur la concordance des mesures de FEVG par Myometrix et QGS avec celle de l’IRM ( ρ : 0,863 et 0,849 respectivement). La concordance par classe de dysfonction VG avec l’IRM etait moderee pour l’ensemble des logiciels scintigraphiques et l’ETT. Myometrix et QGS restaient les methodes les plus performantes (taux de cas concordants avec l’IRM 75 % et 72 % respectivement, kappa 0,66 et 0,63 respectivement). Conclusion L’evaluation des parametres quantitatifs de FVG en CZT-SPECT est fiable, Myometrix et QGS paraissant etre les logiciels les plus concordants avec l’IRM, sans lui etre substituable lors d’un suivi de la FVG. Leur concordance avec l’IRM est au moins equivalente a celle de l’ETT.

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

L’embolisation renale s’adresse a des situations tres diverses, relatives a des pathologies parenchymateuses ou vasculaires concernant aussi bien la cancerologie, la traumatologie, les complications iatrogenes, l’hypertension arterielle ou l’insuffisance renale terminale, pour des gestes programmes ou en urgence.

Presentation in several international conferences, at the stage of design and interim results of randomized trials regarding the appropriateness of percutaneous endovascular correction of renal artery stenosis has raised some questions among clinicians, including nephrologists. What lessons should get the interventional radiologist now published the first results?

The purpose was to determine the efficacy and technical particularities related to the use of Amplatzer(®) Vascular Plugs (AVP) for preoperative portal vein embolization. Between 2005 and 2009, a total of 48 type I AVP were embolized into the portal venous system of 17 patients (51-83 years) prior to extended hepatic resection where the residual liver volume (RLV) was deemed sufficient (RLV35-40% in patients with underlying hepatocellular disease,25-30% in patients with normal liver). AVP were used alone in seven patients and combined to other embolization agents in 10 patients (coils: n=5, microparticles: n=1, resorbable gel foam: n=4). The procedure was technically successful in 100% of cases with immediate success rate of 94.1% (imcomplete embolization of a segmental branch of segment VIII). The procedure was well tolerated clinically in 94.1% of cases, and in 100% of cases based on laboratory values. The rate of recanalization on follow-up CT at 5 weeks (2-22) was 11.7%. The rate of complications, major (left portal vein thrombosis following right portal vein embolization) and minor (one case of portovenous fistula), was 11.7%. The rate of RLV growth was from +13 to +285 cm(3) (mean at +122 cm(3)), or +4.98 to +78.51% (mean at +33.3%) (hepatocellular carcinoma: mean of +30.7%, metastases: mean of +19.7%). The rate of surgical candicacy was 94.1% (two patients were excluded: insufficient growth of RLV, development of peritoneal carcinomatosis). AVP appear to be reliable and effective for the preoperative embolization of the portal vein, with low morbidity and sufficient growth of RLV.

L’incertitude evolutive des SAA traites medicalement (dont les indications therapeutiques sont delicates, avec un risque operatoire eleve chez des patients souvent âges et fragiles) impose un suivi attentif par imagerie. Apres traitement chirurgical ou endovasculaire, les complications evolutives sont souvent silencieuses et les signes cliniques trop tardifs, imposant egalement un suivi systematique au long cours.

To present our experience with emergency or programmed embolization of angiomyolipomas.The retrospective study 1999-2000 included a total of 20 patients with AML, five of whom had hypothyroidism. Group I emergency embolization: 11 patients age being 61.4 ± 15.6 years and the size of AML 8.2 ± 2.8 cm presented retroperitoneal hemorrhage from spontaneous rupture. Two had a hemorrhagic shock. A transfusion of 3.4 blood units per patient was performed for five patients. A clinical and radiological follow-up was done by scanning during the first week and in one month. Group II preventive embolization: nine patients, with age between 58.3 ± 15.2 years and tumor size 5.2 ± 2.2 cm, all asymptomatic. All successfully received a unilateral preventive embolization. A scan was performed one month later.Group I: the embolization was effective in 100% of patients. No intraoperative incident was reported. After one month, the reduction in tumor volume was 40%. At eight months, a patient underwent nephrectomy because of a new fracture, and another a second embolization after 14 months. The technical result was maintained in 83% of cases after 18 months. Two patients developed HTA after embolization controlled by a single treatment, and five had limited renal ischemic sequels. Group II: no intraoperative incidents and no postoperatively complications have been reported. One month after embolization, the reduction in tumor volume was 23%. After 24 months, patients remained completely asymptomatic, no spontaneous bleeding has been reported, no surgery has been performed, and no HTA has been described. Only one re-embolization was done at 20 months (artery duplicity). Limited renal ischemic sequels were reported for one patient but no renal failure.The required embolization became the method of choice in emergency with excellent results and few complications at distance. Programmed embolization effectively prevented the risk of bleeding, without impact on the renal function, with a low economic cost compared to hospitalization and emergency care. The significance of the observed AML--hypothyroidism association in our series requires a confrontation with more important cohorts.

La morbidite de l’angioplastie de l’artere renale (ATPR) reste consequente: 14% en moyenne (12–36%) dans la revue de la Society of Interventional Radiology (SIR) (2 994 revascularisations d’artere renale (AR) dont 980 stentings, chez 2474 patients) (1), en excluant les complications dites radiologiques /techniques (evenements per procedure sans consequence clinique mais majorant la duree du geste ou son cout). Les hematomes ou lesions au point de ponction necessitant chirurgie, transfusion sanguine et/ou hospitalisation prolongee sont les complications les plus frequentes (5 % des procedures); la mortalite globale a 30 jours s’eleve a 1 %, et les complications graves (occlusion d’une AR principale, perte d’un rein, perforation de l’AR, chirurgie de sauvetage de l’AR) surviennent pour moins de 4% des gestes.

To describe the imaging work-up and management of type III endoleaks detected after covered stent-graft treatment of descending thoracic aortic aneurysms.Retrospective study of circumstances surrounding the diagnosis, management and outcome type III endoleaks occuring in 3 of 18 patients following covered stent-graft treatment of descending thoracic aortic aneurysms between April 1998 and July 2005. The endoleaks were detected at a mean follow-up of 22 months (19-24 months) after stent-graft placement.The type III endoleaks were detected on scheduled follow-up CT examinations in asymptomatic patients. Endovascular management was proposed at a mean interval time of 4.4 months (1 week - 11 months) after diagnosis of the endoleak, and was successful in all 3 cases. One patient died 1 month after endovascular repeai of the leak, 1 patient required surgical management at 14 months for new recurrence, and 1 patient had a favorable outcome at 2 months.Follow-up of patients after covered stent-graft treatment of descending thoracic aortic aneurysms is required. Prompt endovascular repair of delayed complications may be possible, but surgical management may become necessary.

Usually atherosclerotic in origin, aneurysms of the abdominal aorta (AAA) tend to involve the infrarenal aorta. Their biphasic exponential growth pattern, initially slow then accelerated, results in a risk of rupture. Surgical management is recommended for aneurysm diameters of 45-50mm or for growth rates more than 5mm in 6 Months. Imaging is useful for detection and follow-up of nonsurgical aneurysms, presurgical evaluation of aneurysms, and postsurgical follow-up. Frequently asymptomatic, AAA frequently is an incidental finding at the time of abdominal US. The size of the aneurysm sac, the presence of a neck and the size of the iliac arteries are assessed at the time of initial US detection. US is sufficient for follow-up of small aneurysms. Cross sectional imaging evaluation is necessary when surgery is contemplated. Readily available, multidetector row CT scanners with advanced image post-processing capabilities provide all the necessary information prior to surgical or endovascular management: evaluation of the aneurysm sac and neck, iliac and visceral arteries, and adjacent organs. Angiography with graduated catheters remains sometimes indicated. MR angiography provides results similar to CT but is less readily available and is usually reserved for patients with contraindication to iodinated contrast material. While follow-up imaging after surgical management is seldom performed, it is mandatory after endovascular management and includes KUB, Doppler US and CT or MR angiography.

Objectifs pedagogiques Reviser les indications du coroscanner. Connaitre les parametres techniques d’acquisition. Savoir choisir et utiliser les differents modes de reconstruction. Reviser les prerequis anatomiques a la realisation des reconstructions et de l’interpretation. Connaitre les limites techniques et d’interpretation. Connaitre les principes de redaction du compte-rendu. Messages a retenir Les radiologues doivent connaitre l’impact clinique et maitriser la realisation technique de l’examen. La bonne connaissance des parametres d’acquisition ainsi que des modalites de reconstruction et de traitement des images est indispensable. L’anatomie des coronaires doit etre acquise. La redaction du compte-rendu doit integrer les limites techniques et d’interpretation.

Objectifs Reviser les indications du coroscanner. Connaitre les parametres techniques d’acquisition. Savoir choisir et utiliser les differents modes de reconstruction. Reviser les prerequis anatomiques a la realisation des reconstructions et de l’interpretation. Connaitre les limites techniques et d’interpretation. Connaitre les principes de redaction du compte-rendu. Messages a retenir Les radiologues doivent connaitre l’impact clinique et maitriser la realisation technique de l’examen. La bonne connaissance des parametres d’acquisition ainsi que des modalites de reconstruction et de traitement des images est indispensable. L’anatomie des coronaires doit etre acquise. La redaction du compte-rendu doit integrer les limites techniques et d’interpretation.

Objectifs Connaitre les differentes sequences pour l’exploration d’une masse cardiaque. Connaitre l’arbre diagnostique a utiliser devant une suspicion de masse cardiaque. Connaitre l’aspect des principales masses cardiaques. Points cles Les thrombus sont l’etiologie la plus frequente des masses cardiaques. Les thrombus ne surviennent pas sans une cause favorisante. Le rehaussement d’une masse cardiaque doit etre interprete aux vues des sequences cinetiques. Les lesions inferieures a un centimetres sont tres delicates a caracteriser. Resume Au travers de la SFICV, un groupe de travail national a collige les dossiers radiologiques de patients explores pour suspicion de masse cardiaque. Ces masses cardiaques peuvent etre separees en trois groupes : les variantes du normal, les thrombus et les tumeurs. Les lesions les plus frequentes sont representees par les thrombus qui peuvent prendre des aspects tres variables en fonction de leur cause. Le rehaussement tardif est le signe majeur discriminant pour le diagnostic de tumeurs. La prise de contraste doit etre interpretee au vu des sequences cinetiques pour eviter les erreurs diagnostiques. Ce groupe de travail a regroupe de nombreux CHU francais et va permettre la realisation d’un ouvrage.

Objectifs Principes de realisation et informations apportees par l’IRM cardiaque dans la pathologie ischemique myocardique. Illustration des signes pathologiques par des dossiers cliniques. Materiels et methodes Mise au point sur les principes de realisation de l’IRM dans l’ischemie myocardique : sequences utilisees, determination des plans de coupe, apport de l’etude de la fonction VG, etude du rehaussement tardif et confrontation avec les donnees cliniques, para-cliniques et celles de la coronarographie. Resultats Dans l’infarctus aigu ou subaigu, l’IRM myocardique permet d’evaluer le retentissement fonctionnel global ou segmentaire, la zone peri lesionnel (œdeme tissulaire), la topographie et extension de la necrose tissulaire, reperfusee ou non (« no-reflow » tissulaire), ainsi qu’une eventuelle ischemie residuelle associee (stress). Dans l’exploration de l’infarctus chronique, on explore le retentissement fonctionnel a distance (remodelage), la topographie et l’extension de la sequelle post-IDM, ainsi que la viabilite residuelle. Conclusion L’IRM permet une evaluation morpho-fonctionnelle et une caracterisation des lesions d’ischemie myocardique tant dans le post-infarctus immediat que chronique.