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Lymphatic dissemination is thought to be a rare event in breast sarcomas. The decision to perform axillary clearance is challenging. In our prospective cohort, we aimed to evaluate the frequency and factors determining lymph node (LN) involvement in breast sarcomas, with the aim of proposing a decision tree/algorithm for the realization of LN clearance in breast sarcomas.Fourty-five women were surgically treated for breast sarcomas from 1982 to 2020. Angiosarcomas and other sarcomas were compared in terms of LN involvement, recurrence, and mortality.Twenty-three patients underwent axillary lymphadenectomy. Initial LN involvement was diagnosed in one case of D2-40 positive, primary angiosarcoma for which preoperative imaging detected a suspicious LN confirmed by preoperative histology. Among the 22 patients who had no initial axillary lymphadenectomy, two patients with D2-40 positive angiosarcoma had recurrent cancer in LN (internal mammary group in 1 and homolateral axilla in 1). The average follow-up in the overall population was 6.2 years (±8.3). The cohort's overall recurrence rate was 33% (15/45) and the time of recurrence after initial surgery was on average 2.4 years (±3.1). For the three patients with LN metastases, time to recurrence after surgery was 3.7 years (±4.5). There was no significant difference in the overall recurrence rate depending on whether or not lymphadenectomy was initially performed (respectively 26% vs 41% OR=1.11, P=0.29).Systematic axillary clearance leads to overtreatment in breast sarcomas. A decision tree, including radiological examination of the axilla, histological type of sarcoma, and D2-40 positivity, could be a decision aid in the choice of axillary clearance. more...

International audience; Background: Identifying the 30% of adhesive small bowel obstructions (aSBO) for which conservative management will require surgery is essential. The association between the previously described radiological score and failure of the conservative management of aSBO remains to be confirmed in a large prospective multicentric cohort. Our aim was to assess the risk factors of failure of the conservative management of aSBO considering the radiological score.Material and methods: This prospective observational study took place in 15 French centers over 3 months. Consecutive patients experiencing aSBO with no early surgery were included. The six radiological features from the Angers radiological computed tomography (CT) score were noted (beak sign, closed loop, focal or diffuse intraperitoneal liquid, focal or diffuse mesenteric haziness, focal or diffuse mesenteric liquid, and diameter of the most dilated small bowel loop > 40 mm).Results: Two hundred and seventy nine patients with aSBO were screened. Sixty patients (21.5%) underwent early surgery, and 219 (78.5%) had primary conservative management. In the end, 218 patients were included in the analysis of the risk factors for conservative treatment failure. Among them, 162 (74.3%) had had successful management while for 56 (25.7%) management had failed. In multivariate analysis, a history of surgery was not a significant risk factor for the failure of conservative treatment (OR = 0.11; 95%CI = 0-1.23). A previous episode of aSBO was protective against the failure of conservative treatment (OR = 0.36; 95%CI = 0.15-0.85) and an Angers CT score ≥ 5 as the only individual risk factor (OR = 2.39; 95%CI = 1.01-5.69).Conclusion: The radiological score of aSBO is a promising tool in improving the management of aSBO patients. A first episode of aSBO and/or a radiological score ≥5 should lead physicians to consider early surgical management. more...

Pathological complete response (pCR) after neoadjuvant systemic treatment (NST) is an important prognostic factor in HER2-positive breast cancer. The majority of HER2-positive breast cancers are amplified at the HER2 gene locus, several genes are co-amplified with HER2, and a subset of them are co-expressed. The STARD3 gene belongs to the HER2 amplicon, and its role as a predictive marker was never addressed. The objective of this study was to investigate the predictive value of STARD3 protein expression on NST pathological response in HER2-positive breast cancer. In addition, we studied the prognostic value of this marker. Methods. We conducted a retrospective study between 2007 and 2020 on 112 patients with non-metastatic HER2-positive breast cancer treated by NST and then by surgery. We developed an immunohistochemistry assay for STARD3 expression and subcellular localization and determined a score for STARD3-positivity. As STARD3 is an endosomal protein, its expression was considered positive if the intracellular signal pattern was granular. Results: In this series, pCR was achieved in half of the patients. STARD3 was positive in 86.6% of cases and was significantly associated with pCR in univariate analysis (p = 0.013) and after adjustment on other known pathological parameters (p = 0.044). Performances on pCR prediction showed high sensitivity (96%) and negative predictive value (87%), while specificity was 23% and positive predictive value was 56%. Overall, specific, relapse-free, and distant metastasis-free survivals were similar among STARD3 positive and negative groups, independently of other prognosis factors. Conclusion: NST is an opportunity for HER2-positive cancers. In this series of over a hundred HER2-positive and non-metastatic patients, a STARD3-negative score was associated with the absence of pathological complete response. This study suggests that determining STARD3 overexpression status on initial biopsies of HER2-positive tumors is an added value for the management of a subset of patients with high probability of no pathological response. more...

Objectives: The aim of this study was to identify the prognostic value of pre-operative imaging to predict post-transplantation survival in critically ill cirrhotic patients with severe acute-on-chronic liver failure (ACLF). Methods: Patients with grade 3 ACLF who underwent liver transplantation between January 2010 and January 2020 and with available contrast-enhanced abdominal computed tomography (CT) performed less than 3 months before LT were retrospectively included (n = 82). Primary endpoint was 1-year mortality. Imaging parameters (sarcopenia, liver morphology and volumetry, and signs of portal hypertension) were screened and tested to build a prognostic score. Results: In the multivariate analysis, three independent CT-derived prognostic factors were found: splenomegaly (p = 0.021; HR = 5.6 (1.29-24.1)), liver atrophy (p = 0.05; HR = 2.93 (1.01-10.64)), and vena cava diameter ratio (p < 0.0001; HR = 12.7 (3.4-92)). A simple prognostic score was proposed, based on the presence of splenomegaly (5 points), liver atrophy (5 points), and vena cava diameter ratio < 0.2 (12 points). A cutoff at 10 points distinguished a high-risk group (score > 10) from a low-risk group (score ≤ 10) with 1-year survival of 27% vs. 67% respectively (p < 0.001). It was found to be an independent predictive factor in association with the Transplantation for ACLF3 Model (TAM) score. Conclusion: Pre-transplantation contrast-enhanced abdominal CT has a significant impact on selection of patients in ACLF3 in order to predict 1-year survival after LT. Key points: • Splenomegaly, liver atrophy, and vena cava diameter ratio are independent CT-derived prognostic factors after transplantation for severe acute-on-chronic liver failure. • A simple CT-based prognostic score is an independent predictive factor, complementary to clinical and biological parameters. • The use of the CT-derived score allows stratification based on 1-year mortality for patients with otherwise uncertain prognosis with clinical and biological parameters alone. Keywords: Acute-on-chronic liver failure; Liver transplantation; Tomography. more...

Background:To prospectively evaluate the post-therapeutic aspects of the anal canal on MRI using diffusion tensor imaging (DTI) with tractography in healed perianal fistula.Methods:From September 2019 to August 2021, we included 21 patients referred for follow-up MRI of post-therapeutic anal fistulas. All patients were imaged at 3T including an additional DTI sequence. Our cohort was divided between normal and abnormal sphincters based on T2-weighted images. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were measured for four different muscular components. For the qualitative data, interobserver concordance was determined using quadratic Cohen weighted kappa statistics. For quantitative data we used the Mann-Whitney test for two independent groups and Kruskall-Wallis for several independent groups, with a significance level pResults:The quality score of the 3D representation was satisfying with a substantial interobserver concordance. On the 3D color coded representation, we did not observe any disruption of fibers in the abnormal group. The circular configuration of the internal sphincter and puborectalis was clearly demonstrated. In both groups, there was no significant different between internal sphincter and puborectalis/external sphincters, (ADC values (p=0.38 and p=0.24; FA values (p=0.73 and p=0.27), respectively. Similarly, there was no statistically significant difference in terms of DTI values between the normal and abnormal segments.Conclusion:In healed perianal fistula, minor sequalae (on T2-weighted images) did not appear to modify the DTI parameters or the 3D tractography. However, further studies with larger cohorts are required to confirm the potential clinical impact of this new noninvasive imaging method. Trial registration : This study was approved by the National Ethical Committee (CPP 19 04) and the Institutional Review Board of the US National Library of Medicine -ClinicalTrials.gov Identifier : NCT03881436 ; first posted registration date : 19/03/2019 more...

While breast hematomas are common, their imaging features are often underrecognized or mistaken for other conditions. Diagnosis of acute hematomas is generally easy when associated with a recent history of breast trauma, surgery, or percutaneous biopsy. However, minor trauma might not always be remembered, and breast hematoma might have longlasting imaging manifestations when associated with fat necrosis. Also, because of the increasing use of breast MRI and FDG-PET/CT, breast hematomas are increasingly detected as incidentalomas and may mimic malignancies. Conversely, breast hematomas may also be associated with authentic malignant processes. In this pictorial review, we present the natural history of breast hematomas, their various imaging features, as well as their differential diagnoses, highlighting the situations requiring histopathological correlation. more...

OBJECTIVE: Preoperative diagnosis of phyllodes tumor (PT) is challenging, core-needle biopsy (CNB) has a significant rate of understaging, resulting in suboptimal surgical planification. We hypothesized that the association of imaging data to CNB would improve preoperative diagnostic accuracy compared to biopsy alone. METHODS: In this retrospective pilot study, we included 59 phyllodes tumor with available preoperative imaging, CNB and surgical specimen pathology. RESULTS: Two ultrasound features: tumor heterogeneity and tumor shape were associated with tumor grade, independently of CNB results. Using a machine learning classifier, the association of ultrasound features with CNB results improved accuracy of preoperative tumor classification up to 84%. CONCLUSION: An integrative approach of preoperative diagnosis, associating ultrasound features and CNB, improves preoperative diagnosis and could thus optimize surgical planification. more...

Reports of acute pulmonary embolism associated with coronavirus disease 2019 (COVID-19) have emerged in the literature. For example, Chen et al (1) described 25 pulmonary CT angiographic examinations from 1008 patients with COVID-19; 10 were positive for pulmonary embolism, mostly as segmental or subsegmental acute pulmonary embolism. In addition, d-dimer levels have been reported as elevated in patients with COVID-19 (2,3), with the suggestion of an independent association between the severity of the disease and the level of d-dimer (4). The purpose of this report is to describe the rate of pulmonary embolus in patients classified as having COVID-19 infection who underwent chest CT at a tertiary referral center. more...

Background There are conflicting data regarding the diagnostic performance of chest CT for COVID-19 pneumonia. Disease extent at CT has been reported to influence prognosis. Purpose To create a large publicly available data set and assess the diagnostic and prognostic value of CT in COVID-19 pneumonia. Materials and Methods This multicenter, observational, retrospective cohort study involved 20 French university hospitals. Eligible patients presented at the emergency departments of the hospitals involved between March 1 and April 30th, 2020, and underwent both thoracic CT and reverse transcription-polymerase chain reaction (RT-PCR) testing for suspected COVID-19 pneumonia. CT images were read blinded to initial reports, RT-PCR, demographic characteristics, clinical symptoms, and outcome. Readers classified CT scans as either positive or negative for COVID-19 based on criteria published by the French Society of Radiology. Multivariable logistic regression was used to develop a model predicting severe outcome (intubation or death) at 1-month follow-up in patients positive for both RT-PCR and CT, using clinical and radiologic features. Results Among 10 930 patients screened for eligibility, 10 735 (median age, 65 years; interquartile range, 51-77 years; 6147 men) were included and 6448 (60%) had a positive RT-PCR result. With RT-PCR as reference, the sensitivity and specificity of CT were 80.2% (95% CI: 79.3, 81.2) and 79.7% (95% CI: 78.5, 80.9), respectively, with strong agreement between junior and senior radiologists (Gwet AC1 coefficient, 0.79). Of all the variables analyzed, the extent of pneumonia at CT (odds ratio, 3.25; 95% CI: 2.71, 3.89) was the best predictor of severe outcome at 1 month. A score based solely on clinical variables predicted a severe outcome with an area under the curve of 0.64 (95% CI: 0.62, 0.66), improving to 0.69 (95% CI: 0.6, 0.71) when it also included the extent of pneumonia and coronary calcium score at CT. Conclusion Using predefined criteria, CT reading is not influenced by reader's experience and helps predict the outcome at 1 month. ClinicalTrials.gov identifier: NCT04355507 Published under a CC BY 4.0 license. more...

Background: This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. Methods: A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43–59%) and 100% (95% CI: 99–100%) for US, 83% (95% CI: 72–91%) and 85% (95% CI: 72–92%) for MRI, and 49% (95% CI: 39–59%) and 94% (95% CI: 91–96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. Conclusions: In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases. more...

Resume La chirurgie conservatrice du cancer du sein ne permet pas toujours d’obtenir un resultat esthetique satisfaisant. En remodelant et en adaptant immediatement le volume du sein traite, la chirurgie oncoplastique permet de combiner securite oncologique et resultat esthetique optimal. Ce type de chirurgie necessite un bilan preoperatoire particulierement precis, afin d’obtenir des marges saines et eviter une reprise chirurgicale souvent compliquee. Dans cet article, nous exposerons les elements essentiels du bilan preoperatoire radiologique a fournir au chirurgien. more...

Background: Coronavirus 2019 (COVID-19) in the post-operative period is challenging. Its clinical manifestations may have similarities to other septic, thoracic, or gastrointestinal post-surgical complications. Additionally, the post-operative period may be a time of increased risk for severe manifestations of COVID-19. We sought to evaluate the frequency of COVID-19 in a cohort of patients who had recently had operations who were undergoing imaging for acute symptoms and the role of chest computed tomography (CT) in this setting. Patients and Methods: We included all patients who had chest CT for acute symptoms in the 15 days after a surgical procedure between March 1 and 31, 2020. Results: Of 46 patients with acute post-operative symptoms requiring chest imaging, eight (17%) were ultimately diagnosed with COVID-19. Among them, five (62%) required mechanical ventilation and two (25%) died. All had abnormal chest CT with typical findings of COVID-19 in 87%. Computed tomography provided an alternate diagnosis in 53% of patients who did not have COVID-19. The average time between a COVID-19-positive chest CT and the polymerase chain reaction (PCR) confirmation was 1.2 days (range, 0-4 days). Conclusion: COVID-19 is a serious post-operative condition associated with significant morbidity and mortality. Chest CT provides prompt diagnosis of COVID-19. In centers with a high prevalence of COVID-19, chest acquisition should be included in CT scans done for acute post-operative symptoms. more...

The Cowden Syndrome A 32-year-old woman presented with a right breast mass and multiple oral mucosal papillomas. Genetic testing showed a PTEN mutation, and a diagnosis of the Cowden syndrome was made. more...

Background uPA and PAI-1 are breast cancer biomarkers that evaluate the benefit of chemotherapy (CT) for HER2-negative, estrogen receptor-positive, low or intermediate grade patients. Our objectives were to observe clinical routine use of uPA/PAI-1 and to build a new therapeutic decision tree integrating uPA/PAI-1. Methods We observed the concordance between CT indications proposed by a canonical decision tree representative of French practices (not including uPA/PAI-1) and actual CT prescriptions decided by a medical board which included uPA/PAI-1. We used a method of machine learning for the analysis of concordant and non-concordant CT prescriptions to generate a novel scheme for CT indications. Results We observed a concordance rate of 71% between indications proposed by the canonical decision tree and actual prescriptions. Discrepancies were due to CT contraindications, high tumor grade and uPA/PAI-1 level. Altogether, uPA/PAI-1 were a decisive factor for the final decision in 17% of cases by avoiding CT prescription in two-thirds of cases and inducing CT in other cases. Remarkably, we noted that in routine practice, elevated uPA/PAI-1 levels seem not to be considered as a sufficient indication for CT for N≤3, Ki 67≤30% tumors, but are considered in association with at least one additional marker such as Ki 67>14%, vascular invasion and ER-H score Conclusions This study highlights that in the routine clinical practice uPA/PAI-1 are never used as the sole indication for CT. Combined with other routinely used biomarkers, uPA/PAI-1 present an added value to orientate the therapeutic choice. more...

History An otherwise healthy 18-year-old man was admitted to the emergency department with a closed displaced fracture of the left femoral shaft ( Fig 1 ) after a high-velocity motorbike accident. At admission, other physical examination findings were unremarkable. Initial unenhanced and contrast material-enhanced (120 mL of Iomeron 400; Bracco Imaging, Milan, Italy) computed tomography (CT) was performed in the arterial and venous phases from the head to the knees. No abnormalities were noted in the brain or chest at initial CT. [Figure: see text] Within a few hours, the patient developed sudden mental confusion and severe hypoxemia, with rapidly worsening tachypnea and perturbed arterial blood gas with low partial pressure of oxygen (61 mmHg [8.1 kPa]; normal range, 75-100 mmHg [10.0-13.3 kPa]) and low partial pressure of carbon dioxide (32 mmHg [4.3 kPa]; normal range, 38-42 mmHg [5.1-5.6 kPa]). A second contrast-enhanced chest CT examination and initial brain magnetic resonance (MR) imaging were performed. Femoral fracture was stabilized with external fixation, and the patient was admitted to the intensive care unit, with progressive neurologic recovery at day 3 and respiratory improvement at day 4. Treatment included intubation with mechanical ventilation and intravenous administration of steroids and noradrenaline. Afterward, the femoral fracture was stabilized with an intramedullary nail. The patient made a full neurologic recovery 1 month after the accident. more...

The goal of this study was to evaluate different fat-suppressed fluid-sensitive sequences in association with different metal artifacts reduction techniques (MARS) to determine which combination allows better fat suppression around metallic hip implants. An experimental study using an MRI fat–water phantom quantitatively evaluated contrast shift induced by metallic hip implant for different fat-suppression techniques and MARS. Then a clinical study with patients addressed to MRI unit for painful hip prosthesis compared these techniques in terms of fat suppression quality and diagnosis confidence. Among sequences without MARS, both T2 Dixon and short tau inversion recuperation (STIR) had significantly lower contrast shift (p more...

Breast background parenchymal enhancement (BPE) is an increasingly studied MRI parameter that reflects the microvasculature of normal breast tissue, which has been shown to change during neoadjuvant chemotherapy (NAC) for breast cancer. We aimed at evaluating the BPE in patients undergoing NAC and its prognostic value to predict recurrence. MRI BPE was visually and quantitatively evaluated before and after NAC in a retrospective cohort of 102 women with unilateral biopsy-proven invasive breast cancer. Pre-therapeutic BPE was not predictive of pathological response or recurrence. Quantitative post-therapeutic BPE was significantly decreased compared to pre-therapeutic value. Post-therapeutic quantitative BPE significantly predicted recurrence (HR = 6.38 (0.71, 12.06), p more...

Purpose To determine if the obliteration of a cervical space, the paraspinal fat pad (PFP), can be used as an indicator at computed tomography (CT) of an injury of cervical spine posterior ligamentous complex (PLC). Materials and Methods This retrospective study was approved by the institutional board review; written informed consent was obtained from healthy subjects and was waived for patients. First, PFP appearance was evaluated in an anatomic specimen and in 10 healthy subjects on spine CT scans by three radiologists (readers 1, 2, and 3) working in consensus. Then, in 85 patients with suspicion of cervical spine trauma following high-velocity trauma, readers 2 and 3 reviewed in consensus the cervical spine CT (reference for fracture and luxation) and 1.5-T magnetic resonance images (T1, T2, and short inversion time inversion-recovery sequences; reference for ligament and disk injuries and contusion or occult fracture) for traumatic injuries. CT appearance of PFP was independently analyzed by readers 1 and 2, and interobserver agreement (weighted kappa) was calculated. Relationships between PFP changes and injuries and descriptive analysis were calculated by using logistic regression and Fisher test, respectively. Results The PFP could be identified as a well-circumscribed fatty area between cervical spine and posterior muscles. Interobserver agreement was 0.76. An abnormal PFP was associated with PLC (P.001) and arch (P = .006) injuries but not with body (P = .056), longitudinal ligaments (P = .412), or disk (P = .665) injuries. Sensitivity, specificity, positive predictive value, and negative predictive value for PLC injuries were 55% (11 of 20), 97% (38 of 39), 92% (11 of 12), and 81% (38 of 47), respectively. Conclusion PFP changes on CT scans are significantly associated with injuries of PLC in patients with spine cervical trauma. more...

Duplicated gallbladder is a rare congenital anomaly that require special attentions due to its clinical, surgical and diagnostic difficulties. We present a case of a 39-year-old female patient with a duplicated gallbladder who presented with an acute biliary pancreatitis, a case to our knowledge is the first in the literature. A double gallbladder in an abdominal ultrasonography was doubtful, thus a computed tomography scan, a magnetic resonance cholangiopancreatography and an endoscopic retrograde cholangiopancreatography were done that confirmed the double gallbladder. A laparoscopic cholecystectomy with an intraoperative cholangiography was performed safely two months after the acute attack. The histopathological report revealed a Y-shaped type 1 double gallbladder according to the Harlaftis et al. classification. more...

Olfactory bulb (OB) volume evaluation by magnetic resonance imaging (MRI) has been demonstrated to be related to olfactory dysfunction in many different diseases. Olfactory dysfunction is often overlooked in Bardet-Biedl syndrome (BBS) patients and is rarely objectively evaluated by MRI. We present a series of 20 BBS patients with olfactory dysfunction. The OB was evaluated separately and blindly by two radiologists (SR and SM) with 3 Tesla MRI imaging comparatively to 12 normal control subjects by global visual evaluation and by quantitative measurement of OB volume. In the 12 control cases OB visual evaluation was considered as normal in all cases for radiologist (SR) and in 10 cases for radiologist (SM). In the 20 BBS patients, OB visual evaluation was considered as abnormal in 18 cases for SR and in all cases for SM. OB volumetric evaluation for SR and SM in BBS patients was able to provide significant correlation between BBS and olfactory dysfunction. This study indicates that OB volume evaluation by MRI imaging like structural MRI scan for gray matter modifications demonstrates that olfactory dysfunction in BBS patients is a constant and cardinal symptom integrated in a genetical syndrome with peripheral and central olfactory structure alterations. more...

This case report aims to illustrate the clinical usefulness of diffusion-weighted imaging for diagnosis of bilateral adrenal ischemia during pregnancy. We also provide a retrospective analysis of adrenal gland diffusion data in a control group of 12 pregnant women with no adrenal dysfunction, to assess the normal range of apparent diffusion coefficient of adrenal gland during pregnancy. more...

Background Breast fibromatosis is a rare disease characterized by monoclonal fibroblast proliferation. It has no ability to metastasize but has a high local recurrence rate and often infiltrates surrounding tissues. Surgical treatment is the reference, but recently, new targeted therapies have emerged. We report an original case of a patient with breast fibromatosis who received exclusive medical treatment. Our aim was to analyze these treatments based on the clinical and radiological outcome, iatrogenic effects, and pharmacological action. Case presentation We report the case of a 19-year-old woman who developed a desmoid-type fibromatosis of the lower inner quadrant of the right breast, measuring 50 × 25 mm (i.e., a volume of 27.4 cm3). Initial surgery was not possible because of potential esthetic and functional prejudice. Thus, she had an exclusive medical treatment including several lines: NSAIDs with tamoxifen and triptorelin, followed by sorafenib, then interferon α2b, and finally sunitinib. With tyrosine-kinase inhibitors (TKIs) (sunitinib), a significant partial response was observed (57% reduction of the maximal tumoral volume). For each treatment, we provided the clinical and radiological outcome in association with known pharmacological action. Conclusions TKI had been an interesting alternative option to initial surgery, providing at least a partial response and potentially allowing less mutilating surgery. However, no pharmacological mechanism can unequivocally explain TKI efficacy. In general, breast fibromatosis should be treated along with oncologist and interventional radiologists in a trans-disciplinary modality, thus offering an adapted treatment for this particular desmoid-type fibromatosis localization. more...

This article reviews and explains the basic physical principles of metal-induced MRI artifacts, describes simple ways to reduce them, and presents specific reduction solutions. Artifacts include signal loss, pile-up artifacts, geometric distortion, and failure of fat suppression. Their nature and origins are reviewed and explained though schematic representations that ease the understanding. Then, optimization of simple acquisition parameters is detailed. Lastly, dedicated sequences and options specifically developed to reduce metal artifacts (VAT, SEMAC, and MAVRIC) are explained. more...

Cortical necrosis;Renal insufficiency;ComputedtomographyBilateral renal cortical necrosis is a rare but classic cause of acute renal failure occurringfollowing a state of shock. It results in major irreversible renal impairment. A unilateralform isunusual, so thata particular mechanism suspected allows renal function tobe preserved. The aim of thisoriginal observation is to discuss pathogenic hypothesisand present a recently observed case. more...