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To assess the performance of a "triple-low" free-breathing protocol for computed tomography pulmonary angiography (CTPA) evaluated on patients with dyspnoea and suspected pulmonary embolism and discuss its application in routine clinical practice for the study of the pulmonary parenchyma and vasculature.This study was conducted on a selected group of dyspnoeic patients referred for CTPA. The protocol was designed using fast free-breathing acquisition and a small, fixed volume (35 ml) of contrast agent in order to achieve a low-exposure dose. For each examination, radiodensity of the pulmonary trunk and ascending aorta, and the dose-length product (DLP) were recorded. A qualitative analysis was performed of pulmonary arterial enhancement and the pulmonary parenchyma.This study included 134 patients. Contrast enhancement of the pulmonary arteries (409 ± 159 HU) was systematically250 HU. The duration of acquisition ranged from 0.9 to 1.3 seconds for free-breathing imaging. The mean DLP was in the range of low-dose chest CT acquisitions (145 ± 73 mGy·cm). The analysis was deemed optimal in 90% (120/134) of cases for the pulmonary parenchyma. Sixty-nine per cent (92/134) of cases demonstrated homogeneous enhancement of the pulmonary arteries to the subsegmental level. Only 6% (8/134) of examinations were considered uninterpretable.The present "triple-low" CTPA protocol allows convenient analysis of the pulmonary parenchyma and arteries without hindrance by respiratory motion artefacts in dyspnoeic patients.

Les pneumonies infectieuses aigues constituent un veritable probleme de sante publique, car elles sont une cause majeure de morbidite et de mortalite chez l’adulte. Les donnees cliniques et radiographiques sont le plus souvent suffisantes pour faire le diagnostic de pneumonie infectieuse. Par contre, le diagnostic etiologique est plus difficile a etablir, car les agents pathogenes sont multiples et la reaction du parenchyme pulmonaire est peu variee, d’ou la faible specificite des lesions radiologiques observees en dehors de quelques cas particuliers. La comprehension des mecanismes physiopathologiques permet d’expliquer certains aspects radiologiques. De meme, la connaissance des bases anatomocliniques et radiologiques autorise la reconnaissance de trois aspects radiographiques principaux. Quant a l’appreciation des contextes epidemiologique et immunitaire, ils peuvent permettre egalement d’approcher le germe en cause.

Local, regional lymph node involvement is an essential prognostic factor and an important determinant of treatment choices for patients with retroperitoneal and pelvic cancer. Current cross-sectional imaging modalities, including computed tomography and magnetic resonance (MR) imaging, use the nonspecific criterion of size and are limited in their ability to differentiate benign from malignant lymph nodes. MR lymphography is a promising imaging modality in differentiating benign from metastatic lymph nodes and provides information on lymph node morphology and function. Ultrasmall superparamagnetic iron oxide (USPIO) particles with a long plasma circulation time are suitable as an MR contrast agent for intravenous MR lymphography. They are taken up by macrophages in normally functioning nodes and reduce the signal intensity of tissue in which they accumulate because of T2 and susceptibility effects of iron oxide. In metastatic nodes, macrophages are replaced by cancer cells, which lack reticuloendothelial activity and cannot take up USPIO. The main mechanisms that might explain a heterogeneous node appearance after USPIO injection are discussed. In published reports, USPIO has shown high degrees of sensitivity and specificity for characterizing lymph nodes in cancer patients. We review the development of USPIO compounds, their imaging characteristics, and our clinical experience.

Breast cancer is the most frequent feminine cancer in France and its incidence increases steadily. The time of access to medical care is an indicator of the quality of the treatments recommended by the Plan Cancer 2009-2013, as it influences the diagnosis and reduces psychological morbidity during the pre-diagnosis phase. The one-day diagnosis is a recently initiated concept, which offers to get the results of the biopsy on the day it is performed and facilitates the setting-up of therapeutic care with the surgeon met during the one-day medical consultations. The aim of this study is to evaluate the satisfaction of patients who benefited from a one-day breast lesion diagnosis, as well as confirm the decrease of time of access to medical treatment.This is an observational, non-interventional and single-centre study based on 27 patients who benefited from one-day breast lesions diagnosis over two years. The patients were only included who had a classified lesion ACR 4 or 5 and visible in the ultrasound. We analyzed the histological concordance between the biopsy and the definitive histology, the time of access to medical care, and the therapeutic treatments We analyzed the psychological impact of such an organization by sending to the patients a questionnaire including the Psychological Consequence Questionnaire (PCQ) and the Breast Cancer Anxiety Indicator (BCA) allowing to estimate the anxiety generated by the pre-diagnostic phase, the DC-Sat allowing to estimate the satisfaction of the consultation of announcement, as well as the same day diagnosis benefit.The patients were 59.8 years old in average [33-87]. The average time between the date of the mammography and the one-day diagnosis consultation (including the biopsy) was 15.0 days [0-60]. Fifty-seven percent of the patients considered this time as short. The average time between the biopsy date and the start of the treatment was 15.9 days [4-30]. The one-day diagnosis took an average of 1.6 days [1-5]. The results of the PCQ showed an important emotional impact during the diagnosis phase, and the average BCA score reached an average of 3.9 on a scale of 5. However, the patients were very satisfied with the diagnosis consultation with an average of 8.7 on a scale of 10, and 95% think the one-day diagnosis is beneficial to the patients.This study shows that the one-day breast-damage diagnosis enables to improve the time of access to care, and meets the current recommendations. Even though faster access to treatment does not reduce the psychological morbidity of awaiting diagnosis, the patients express their satisfaction and find the rapidity of the pre-diagnosis phase beneficial.In view of this study, the one-day breast-damage diagnosis appears to be a quality feature in the process of access to care and treatment of the patients.

The kidney is the most commonly injured genitourinary organ. The diagnosis and treatment depend on the mechanism of injury (blunt or penetrating trauma), the clinical presentation, and the extent of the lesions. Knowledge of the different appearances of the posttraumatic kidney on imaging studies is essential for prompt and effective treatment of patients. This pictorial essay reviews the imaging evaluation and principal imaging findings associated with blunt and penetrating renal trauma. The role of computed tomography is emphasized because it is a very sensitive, specific, and accurate modality in detecting the presence or absence of injury and defining its extent.

Background: Controversies surrounding medical treatment in patients with unresectable hepatocellular carcinoma continue to persist. Aim: To perform a meta-analysis of therapeutic modalities which had been evaluated in two or more randomized trials. Methods: Fifty-two randomized trials were studied; only 30 were included. This overview identified seven therapeutic modalities which had been evaluated in two or more trials: adriamycin, 5-fluorouracil, interferon, percutaneous ethanol injection, transarterial chemotherapy, the combination of lipiodol with transarterial chemotherapy, and tamoxifen. Results: Comparisons of survival between control groups showed substantial heterogeneity. There was no survival benefit at 1 year with adriamycin (mean difference 4%), 5-fluorouracil (mean difference −3%), percutaneous ethanol injection (mean difference 6%) or transarterial chemotherapy (mean difference −2%). For interferon, the survival benefit was significant with the Der Simonian & Laird method (mean difference 9%, 95% CI = 1–18%, P = 0.04) but not with the Peto et al. method (2.4 mean odds ratio, 95% CI = O.9–6.8). The meta-analysis of tamoxifen showed a borderline survival benefit (mean difference 25%, 95% CI = 0–49%, P = 0.05). However, in sensitivity analyses, the survival benefit of tamoxifen was no longer significant. Conclusions: No treatment has clearly proven efficacy in survival. 5-Fluorouracil, adriamycin and transarterial chemotherapy were not associated with survival benefit at 1 year. The number of randomized controlled trials was insufficient to enable a conclusion to be reached for interferon and percutaneous ethanol injection. Controversy persists concerning tamoxifen efficacy. Interferon and tamoxifen require new randomized controlled trials on a larger population of patients.

The purpose of this article is to review the diagnostic work-up of renal failure, acute or chronic. The role of the radiologist is to exclude the presence of a curable etiology such as urinary tract obstruction or vascular thrombosis. Renal ultrasound with Doppler imaging is the imaging modality of choice for this indication, and the use of a contrast agent is useful to evaluate renal perfusion. Non-contrast CT remains valuable for the diagnosis of some urinary tract pathologies. Finally, MRI is the most comprehensive imaging modality for the evaluation of the urinary tract, but performed as a second line modality mainly for practical reasons but also due to the non-negligible risk of nephrogenic systemic fibrosis secondary to the intravenous administration of gadolinium based contrast agent.

MRI can assess local and locoregional spread of a newly diagnosed prostate cancer by detecting extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node invasion. Endorectal MRI remains the only accurate means to assess local extension. Pelvic MRI with surface coils and the use of superparamagnetic particules provide the sensitivity and the specificity which have never been obtained by the sole measurement of node size of the lymphatic chains draining the prostate gland. With the endorectal coil, only direct signs of extracapsular extension have been maintained and indirect signs have been discarded, giving their too low specificity. Early SVI can only be consistently detected if result of TRUS guided biopsies show involvement of the prostate base. With the pelvic phased array coil, superparamagnetic particules show that metastatic lymph nodes have a specific MR signal which can be detected in normal size nodes. Indications of imaging relies on results of parametrers available before MR imaging. More important than PSA level and Gleason score on biopsies is the so called quantitative histology, represented by the number of sextants involved by tumor and the amount of cancer (measured in mm of tumor) present on biopsies which determine a risk of extraprostatic spread. Of the risk of extraprostatic spread depends indication of MR, which is most probably unnecessary in patients at low risk (20%) of extraprostatic extension.

Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. The management of this complication is contentious; therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and issue guidelines. A comprehensive literature search was carried out. The resulting report was discussed at the 8th European Symposium on Urogenital Radiology in Genoa, Italy. Automated power injection may result in extravasation of large volumes and may or can lead to severe tissue damage. Infants, young children and unconscious and debilitated patients are particularly at risk of extravasation during contrast media injection. Fortunately, most extravasations result in minimal swelling or erythema, with no long-term sequelae; however, severe skin necrosis and ulceration may occur. Large volumes of high osmolar contrast media are known to induce significant tissue damage. Compartment syndrome may be seen associated with extravasation of large volumes. Conservative management is often adequate, but in serious cases the advice of a plastic surgeon is recommended. Based on the review simple guidelines for prophylaxis and management of contrast medium extravasation injuries are proposed.

Magnetic resonance contrast agents have demonstrated their clinical usefulness in a variety of organs for improved detection of various neoplastic, inflammatory and functional abnormalities. Gadolinium chelates are the most widely used. They are extracellular, non-specific contrast agents. Their use in many clinical indications is justified because, in conjunction with improved imaging techniques, these safe and image-enhancing contrast agents add morphologic and functional information compared with unenhanced MR images. This article describes the commercially available compounds, and summarizes their approval status on the international market regarding indications and doses. Their mechanisms of action, biodistributions, toxicities and tolerance profiles in normal and high-risk patient populations are described. Additionally, this article reviews the specific recommendations by the manufacturers for patients at risk. Finally, their main clinical applications are reviewed.

We report a case of benign colonic tubular adenoma arising in a 36-year-old female at the site of ureterosigmoidostomy performed 25 years before. The tumor was revealed by recurrent episodes of pyelonephritis; hydronephrosis was present. On colonic enema, the tumor appeared lobulated, 4 cm in diameter. CT scan showed a multiloculated mass, which enhanced after injection. Pathology revealed a tubular adenoma of the colon with cystic dilatation of glandular structures. The role of imaging studies in the follow-up of patients after ureterosigmoidostomy is discussed.

An unusual case of spontaneous intraperitoneal rupture of the ureter was observed in adult with acute renal pain. Diagnosis was best established with CT rather than intravenous urography. CT demonstrated ureteral leakage with the contrast medium extravasating into the peritoneal cavity. The patient was initially managed successfully by endourology. Secondary stenosis of the ureter required surgery for partial resection of the distal ureter.

We report a case of subacute bowel obstruction due to a compression of the rectosigmoid junction by a chronically distended bladder, occurring in a 91-year-old male suffering from a long-standing diabetes mellitus and a prostatic adenoma. Radiographic, water-soluble contrast enema and pelvic CT features are reported.

The increased incidence of detection of small renal tumours, less than or equal to 3 cm in diameter, is related to the generalization and improvement of radiological techniques. Many asymptomatic renal tumours are discovered by ultrasonography and computed tomography. Medical imaging is now able to identify simple cysts (morphological characters, absence of blood supply), angiomyolipomas (demonstration of the fatty contingent) and other solid renal tumours (tumour enhancement on computed tomography). Plain, followed by postcontrast CT looking for contrast enhancement of the lesions is the examination of choice in this context. MRI with Gadolinium injection looking for neoplastic enhancement can be useful in doubtful cases. Medical imaging is able to reliably demonstrate the vascular nature of solid lesions, but cannot distinguish between renal cancer, oncocytoma or another benign solid tumour. Medical imaging allows precise preoperative mapping when partial nephrectomy is envisaged.

PURPOSE: To evaluate treatment of osteoid osteoma with computed tomography (CT)-guided percutaneous excision and immediate follow-up scintigraphy. MATERIALS AND METHODS: Sixteen consecutive adolescent and adult patients underwent CT-guided percutaneous excision of a nidus with 14-gauge biopsy cutting needles, with local anesthesia. After the presence of nidus was confirmed at immediate follow-up scintigraphy, curettage of the bored cavity was performed to remove any residual fragments of the nidus. Scintigraphic and histologic findings were correlated. RESULTS: The nidus was removed successfully in 14 of the 16 patients, with no complications (mean follow-up, 15 months; range, 3-25 months). In five of the 14 patients, immediate follow-up scintigraphy showed incomplete resection of the nidus and immediate second resection was successful. Surgical resection was necessary in two of the 16 patients. CONCLUSION: CT-guided percutaneous excision with immediate follow-up scintigraphy was safe and effective for lo...

Sclerosing mesenteritis is an uncommon condition of unknown etiology. It is likely to be the fibrous evolution of mesenteric panniculitis. It often has an indolent course but may be complicated by progressive bowel obstruction. The treatment of the symptomatic forms is not well established. The observations of two women (20 and 65 years old) with a relentless downhill course of biopsy-proved sclerosing mesenteritis are described. A treatment regimen with corticosteroid therapy (initially 1 mg/kg/day) and colchicine (1 mg/day) led, in both cases, to a rapid improvement. Abdominal computer tomography showed reduction in the tumor size. The combination of corticosteroids and colchicine is helpful in the management of symptomatic sclerosing mesenteritis. Follow-up with abdominal computed tomography is useful in evaluating the therapeutic impact.

The purpose of this paper is to describe the general principle of MRI, emphasising the practical conduct of the examination which consists of three main phases. The authors define the concepts of relaxation time and T1 and T2, essential parameters for the understanding of MRI. They simply explain how to recognise a predominance of T1- or T2-weighting on MRI images. They review the principal artefacts which must be recognised in order to avoid erroneous interpretation of the images. Lastly, they define the value of MRI in clinical urology, renal pathology, especially neoplastic, and prostatic and bladder disease.

We know that the contrast of MR images can be better than that of CT scans. In the spin echo mode, sequences with long TR and long TE provide great contrast, while, conversely, sequences with short TR and TE produce images with a greater anatomical fidelity. This dual performance, a notion that had never been expressed as explicitly in imaging, has led to distinguishing between the roles of MRI for detection and tissue characterization (diagnosis and nature). While the choice of an appropriate sequence for characterization has apparently been made immediately with a modulation of T2 weighting, the selection of a detection sequence is less easy. The number of parameters involved (signal-to-noise and contrast-to-noise ratios, spatial resolution, artifacts, imaging time) and the compromise arrangements needed to take them into account explain the lack of consensus as to the optimal sequence for detection. Instead of becoming simpler with time, the issue is increasingly complex, as now fast imaging has been developed in addition to conventional spin echo imaging, and may even supersede it.

The effectiveness of renal transplantation has been considerably improved by the use of cyclosporine as an antirejection agent. However, because of those very same immunosuppressive properties, this substance may lead to several infectious or tumoral complications that raise complex therapeutic problems. This article reports about one case of immunoblastic lymphoma discovered in a patient who received renal transplantation and who had been treated with cyclosporine for two years.

The effectiveness of renal transplantation has been considerably improved by the use of cyclosporine as an antirejection agent. However, because of those very same immunosuppressive properties, this substance may lead to several infectious or tumoral complications that raise complex therapeutic problems. This article reports about one case of immunoblastic lymphoma discovered in a patient who received renal transplantation and who had been treated with cyclosporine for two years.

Among all noninvasive techniques, high-resolution ultrasonography used alone has rarely been used for the diagnosis of thrombosis in the calf. Nineteen patients with suspected AVT were examined with ultrasonography and phlebography during 4 months. For each patient, a sonogram and a phlebogram were taken within less than 24 hours and interpreted independently. The sonographic exploration with a high-resolution (5 MHz) transducer covers all deep trunks and muscular veins (soleus or gastrocnemius muscles). The positivity criterion is the persistence of a hypoechogenic endoluminal image under moderate compression. According to the phlebographic data, 65% of the patients present with thrombosis. Ultrasonography has a sensitivity of 95% and a specificity of 99% for the study of the deep trunks. Ultrasonography screens more thromboses than phlebography (23 cases versus 17). On a whole, ultrasonography seems to be more sensitive than phlebography for the diagnosis of recent sural thrombosis.

This article is a review of the current commercial MR contrast media (gadolinium chelates) and of the products that are not yet on the market and are under trial in man (super-magnetic iron oxides, manganese compounds) or only in animals (ferric chelate, liposomes containing gadolinium compounds, gadolinium chelate/human serum albumin compounds, hepatic asialoglycoprotein receptors).

The artificial urinary sphincters are implanted to treat some urinary incontinence. Abdominal plain films allow the checking of the function of the cuff; the diameter of the pressure regulating balloon can be appreciated by ultrasound or plain film. The main complications (bending of the tubules, leak, urethral erosion, rupture of the cuff) and their radiological diagnosis are described.

The low osmolality iodinated contrast agents (ICA), ionic or non ionic are now suggested too replace the usual high osmolality ICA. The main arguments are the better clinical tolerance and a lower renal toxicity. Recent experimental studies have clearly demonstrated that the low osmolality ICA presents a lower renal toxicity. On the rat, we have confirmed that the in vivo renal toxicity of low osmolality ICA, is lower than the high osmolality ICA toxicity. It is clearly demonstrated on man than the enzyme urinary excretion and proteinuria are little or not modified by the low osmolality ICA, but both are increased by high osmolality ICA. These changes are found with a normal glomerular filtration flow. No difference are noted in the creatinine concentration and clearance follow-up. However it is possible that the necessary population of patient to get statistically significative differences between both agents can be superior to the number of patients studied. In clinical practice, we think, that low osmolality ICA must be used for patients presenting one or several risk factors of acute renal failure.

The protal system of 45 normal patients have been retrospectively studied on spin echo MRI sequences (interleaved cuts): multiple artifacts have been evaluated and 24% of them were visualized at the portal system level. Thus, partial volume effect responsible for almost 25% of the artifacts is not always easily seen on a single sequence. Respiratory and aortic artifacts can deteriorate the visualization of the vascular lumen but cannot be confused with a thrombosis. Well-known artifacts, as slice entry phenomenon and even echo rephasing, represent more than 60% of the artifacts: they are readily recognized when they are typical and indicate flowing blood. On the contrary, an other artifact, representing less than 5% of the total and seen at the level of the left portal vein, simulates a thrombus, on T2 weighed images. We conclude that the frequency and polymorphism of the artifacts are limiting factors of MRI value in the diagnosis of portal vein thrombosis.

This observation illustrates the use of CT in the diagnosis of rectosigmoid hemangiomas and the assessment of their extension. The CT appearance of hemangiomas is very specific and therefore allows confirming a diagnosis that is often difficult to make with other radiological techniques and with endoscopy: phleboliths within the thickened rectal wall are a characteristic sign. CT is primarily required when radical surgery is contemplated due to disabling repeated proctorrhagia: it provides a better delineation of trans- and extraparietal hemangioma extension, knowing that adhesion (...).

This observation illustrates how difficult it is to interpret the intravascular signal observed with MRI in cases of portal hypertension. A signal occupying the entire lumen of the portal trunk and branches can be seen, which is constantly observed in the axial as well as coronal planes in the 3 series studied. It is hypointense relative to the liver on T1-weighted images, hyperintense on T2-weighted images: this appearance therefore perfectly mimicks portal thrombosis. Ultrasound combined with pulsed Doppler demonstrates the stagnant blood within the patent portal system. This kind of artifact, which is produced by a very slow flow or even by the standstill of flow, is much more difficult to recognize than the common flow artifacts; the criteria put forward by various authors to distinguish between artifacts and thrombosis are of no avail in this case. Examinations must able to confirm or rule out portal thrombosis in the case of portal hypertension with deceleration of flow. In practice, ultrasound studies, combined with pulsed Doppler in the best cases, is therefore indicated as a first-intension technique.

Objectifs To compare the performance of Sinerem®-enhanced MRI with unenhanced MRI for nodal staging. Materiels et methodes 271 patients (mean age 61) with prostate (116), uterus (109), bladder (49) cancers and ambiguous clinical nodal status, were enrolled. MRI (1T/1.5T) was performed before and 24-36 hours after Sinerem® (slow IV infusion, 2,6 mg Fe/kg), maximum 2 weeks before lymphadenectomy. Imaging was standardized (axial Tl/PD-w, axial and para-sagittal T2*-wGRE sequences, 5 mm-slice thickness, 0.5 mm-interslice gap). Three off-site blinded readings were performed. Resultats Histopathology showed metastatic nodes for 68 patients (26.6 %), with 328 nodes individually correlated between MRI and histopathology (17.5% metastatic). Pre+post-Sinerem® sensitivity was higher than pre-contrast sensitivity, highly significantly for 2 readers (> 22 %, p Conclusion In pelvic cancer patients with ambiguous nodal status, Sinerem®-enhanced MRI demonstrates higher sensitivity than unenhanced MRI for diagnosing lymph node metastases, with similar high specificity and higher NPV. This may contribute to better patient management. Post-Sinerem® images are sufficient for nodal assessment.

Objectifs Identifier les caracteristiques, les comportements de sante, les criteres de choix de l’hopital et attentes de cette population. Definir a partir de ce profil particulier comment ameliorer la prise en charge des patientes pour les soignants. L’objectif final est de donner aux femmes une reponse adaptee a leurs attentes tout en les fidelisant et de mieux repondre au depistage organise du cancer du sein. Materiels et methodes La methode utilisee est le questionnaire. Plusieurs items ont ete retenus : âge, situation familiale, milieu socioculturel, comportements par rapport a leur sante, criteres de choix et appreciation du service. Resultats Les resultats montrent une population de proximite, heterogene. On peut cependant individualiser deux types de patientes. La femme plutot fataliste a plus de 65 ans et a une vision plus pragmatique de sa sante. Elle a une tres grande confiance dans le systeme de sante hospitalier. La femme plus maitresse de son destin est plus jeune, encore en activite. Elle se fait suivre regulierement et a realise un nombre important de mammographies. Elle a aussi confiance dans le systeme hospitalier mais a une relation plus exigeante et plus critique. Conclusion A partir de ces resultats, des recommandations sont editees.

Resume Les objectifs du suivi post-therapeutique des tumeurs de vessie sont 1) de rechercher une recidive loco-regionale ou a distance, 2) de verifier la permeabilite du montage chirurgical apres cystectomie et 3) de detecter des complications precoces (fuites) ou tardives (stenoses). L’echographie est realisee en premiere intention pour le controle de lesions benignes resequees (recherche de polypes recidivants) tandis que TDM et plus rarement IRM sont realisees pour detecter une eventuelle recidive locale, parietale, ganglionnaire, voire metastatique de tumeur maligne. Le controle des voies urinaires reposait classiquement sur l’UIV qui tend a etre remplacee par l’uroscanner, la connaissance precise du montage chirurgical etant indispensable pour l’interpretation des images.

When confronted with rectorrhagia in a young patient, combining a straight abdominal examination with a barium enema investigation may reveal the presence of phleboliths, atypical by their large number and central localization, and orientate towards the rare diagnosis of a colorectal hemangioma.