Bruno Kastler

Injection of alcohol into bone metastases under CT guidance

Objective Percutaneous injection of ethanol was evaluated in terminally ill cancer patients with painful osteolytic bone metastases treated previously without success by radiation or chemotherapy and conventional pain therapy. Methods and Materials Twenty-five patients with 27 bone metastases in various locations underwent one to three instillations of 3–25 ml ethanol (95%) under CT guidance, which allowed precise needle positioning and control of the diffusion of alcohol thus minimizing the complications. Results Within 24 to 48 h 74% of the cases experienced a reduction of analgesic needs. Conclusion Percutaneous ethanol injection under CT guidance is useful in reducing pain and in improving the quality of life of patients with advanced stages of cancer and painful bone metastases.

Fetal shoulder measurements with MRI.

Objective We studied the ability of MRI to predict fetal shoulder width (FSW). Materials and Methods In 30 patients referred for MR pelvimetry, measurement of FSW was performed and compared with caliper measurements at term. We report here the feasibility of a method using axial and coronal MR images oriented to the fetal body axes. Results Shoulder width by MRI (mean = 12.76 ± 1.42 cm) correlated significantly with postnatal orthopedic caliper measurements (mean = 12.99 ± 1.37 cm; r = 0.955, SEE = 4.29 mm, p = 0.00001) and with birth weight (r = 0.63, p = 0.0005). Mean paired differences showed a statistically significant 2.3 ± 4.2 mm underestimation of FSW by MRI (p = 0.01). This reasonably quick nonionizing technique seems to have the potential for evaluating shoulder dystocia and deserves further evaluation.

Splenic abscesses in typhoid fever: US and CT studies.

Salmonella typhi splenic abscesses (SA) are traditionally considered to be a rare complication of typhoid fever (TF). Our prospective study in an extensive series of patients was aimed at demonstrating that the incidence of SA was usually underestimated. Four hundred patients were systematically examined by abdominal ultrasound (US) at the time of proven biological diagnosis of TF, which was the 2nd week of admission. Twenty patients with persistent or recurrent symptoms (despite adequate treatment) or with acute lower thoracic pain were followed by US and CT. In eight patients both imaging modalities revealed anomalies compatible with SA.

A Compact Laser Beam Guidance System for Interventional Ct

Objective We propose a simple, compact, and accurate light guidance system for interventional CT. Materials and Methods The system using intersecting laser beams is mounted on the CT gantry and ensures precise needle guidance even when the gantry is tilted. The device does not require additional software/hardware. Results Phantom simulations and clinical experiments have demonstrated an accuracy of ± 1° and ± 1 mm. Conclusion The laser guidance system for CT makes the intervention safer, faster, and more accurate.

MR diagnosis of subdiaphragmatic anomalous pulmonary venous drainage in a newborn.

Our report describes a case of infradiaphragmatic total anomalous pulmonary venous return diagnosed by MR in a newborn with an interruption of the aortic arch with ventricular septum defect and anomalous pulmonary venous drainage. The severity of the congenital cardiopathy did not permit surgical treatment and the infant died soon after. Pathology confirmed the MR findings. Magnetic resonance not only complements echocardiography but also can be used for patients in intensive care and can in our case avoid angiography.

Evaluation of Blalock-Taussig shunts in Newborns : value of oblique MRI planes

Eight infants with systemic-pulmonary Blalock-Taussig shunts were evaluated by spin-echo ECG-gated MRI. Contrary to Echocardiography, MRI using coronal oblique projections successfully visualized all palliative shunts entirely in one single plane (including one carried out on a right aberrant subclavian artery). MRI allowed assessment of size, course and patency of the shunt, including pulmonary and subclavian insertion. The proximal portion of the pulmonary and subclavian arteries were also visualized. We conclude that MRI with axial scans completed by coronal oblique planes is a promising, non invasive method for imaging the anatomical features of Blalock-Taussig shunts.

Potential role of MR imaging in the diagnostic management of Ebstein anomaly in a newborn

A case of Ebstein anomaly in a 2-day-old newborn is presented. The complementary roles of two-dimensional Doppler echocardiography and magnetic resonance imaging in managing this cardiac malformation are emphasized.

Detection and quantification of recent myocardial infarction: Diagnostic value of multiecho multislice spin echo imaging

Thirty-four patients with documented transmural MI were studied with gated three echo, multislice MR imaging. In 12 patients MRI MI size was compared with CK release measurement, Tl-201 SPECT defect, and with Tc-99m LVEF. Infarct was visualised in 29/34 patients on 3rd echo images (18/34 on 2nd and 6/34 on 1st echo images). Mean MR infarct size (planimetered from 3rd echo images): 33.1 +/- 9% overestimated the SPECT defect (mean value of 23.8 +/- 15%). However, the overall correlation between MRI and Tl-201 sizing was significant: r = 0.82; p less than 0.001; SEE = 5.5%. The correlation with LVEF also appeared significant: r = -0.61; p less than 0.038.