Daniel Alison

Fréquence et épidémiologiedescriptive de l’appendicite épiploïque primitive par l’exploration tomodensitométrique des douleurs abdominales de l’adulte

Frequency and epidemiology of primary epiploic appendagitis on CT in adults with abdominal pain Purpose: Advances inmedical imaging have improved the presurgical diagnosis of isolatedepiploic appendagitis. The authors assess its relative frequencyand define its main epidemiological criteria. Patientsand methods: Study of an adult population presenting with abdominalpain and evaluated by CT over a 3 year period. Evaluation for thepresence of an isolated fat density paracolic mass with hyperdenseperiphery. A review of the literature was performed as well. Results: Thefrequency of epiploic appendagitis is estimated at 1.3% andits incidence at 8.8 cases/million/year.The typical patient profile is a young to middle aged male presentingwith left flank and lower quadrant pain. Obesity, GI symptoms, fever,and leukocytosis are characteristically absent while elevation ofthe CRP is typical. CT shows the lesion along the anterolateralmargin of the descending or sigmoid colon. Spontaneous resolutionusually occurs within 8 days. Conclusion: Ourresults confirm epidemiological data from the literature. Knowledgeof the imaging features of epiploic appendagitis will ensure conservativepatients management and avoid unnecessary surgery.

Immediate and delayed tolerance of iohexol and ioxaglate in lower limb phlebography: A double-blind comparative study in humans

RATIONALE AND OBJECTIVES We compared the tolerance and efficacy of iohexol-300, a nonionic low-osmolar monomer, with those of ioxaglate-320, an ionic low-osmolar dimer, in lower limb phlebography. METHODS One hundred twenty inpatients were randomly divided into two groups in this double-blind comparative study. Two hundred milliliters of contrast medium (100 ml per leg) was injected intravenously. The immediate tolerance was classified as discomfort (i.e., sensation of warmth, pain, coldness related to the injection) and adverse events occurring up to 1 hr after administration. Delayed tolerance was followed up to 8 days after the examination. The main parameter was immediate adverse events. Image quality was assessed by a radiologist using a visual analog scale. RESULTS The number of immediate adverse events was significantly higher in the ioxaglate group (p < .02). The more frequent events were digestive disorders and skin rashes; 13 of these events were reported in the ioxaglate group, but none were reported in the iohexol group (p < .001). The other parameters were not significantly different in the two groups. CONCLUSION We found a similar efficacy and a better tolerance of iohexol-300 than ioxaglate-320 in lower limb phlebography.

Épreuve de lecture critique d'article scientifique des épreuves classantes nationales : pertinence de la correction

INTRODUCTION In 2008 the national ranking examination (NRE) will include a test on critical reading of scientific articles. This decision has provoked controversy about whether reproducible correction is possible. The aim of our study was to assess the consistency of grading between this two-part test (critical analysis and summarizing, analyzed separately), and the more classic tests. METHODS Eight graders, all instructors at the Tours Medical School, corrected papers for each of the 3 tests. Papers for the critical reading test came from medical school final examinations and for the standard test from a practice examination. The instructors worked in pairs: each pair read 30 papers for each test, and both members separately graded each paper. The final grade was the mean of the two grades. The consistency of grading between the 4 pairs was estimated by Kendalls coefficient of concordance. RESULTS Kendalls coefficients of concordance were estimated at 0.94 (95% CI=[0.86; 0.97]) for the standard test, at 0.92 (95% CI=[0.81;0.97]) for the critical analysis test, and at 0.75 (95% CI=[0.62; 0.84]) for the summaries. Pairwise comparisons estimated the difference in concordance between the standard test and the summary at 0.18 (95% CI=[0.08; 0.32]) and that between the standard and critical reading test at 0.01 (95% CI= [-0.07; 0.12]). Finally the difference in concordance between the 2 new tests - summary and critical reading - was estimated at -0.17 (95% CI=[-0.32; -0.04]). CONCLUSION The focus should be on the difficulty of reproducible correction of the summaries, to set up methods for appropriate correction and adequate grading. The elaboration of detailed scoring templates, including numerous items and specifying in which part of the summary each item must be placed, should help to improve the reproducibility of this tests correction.

L’IRM dans la prise en charge des lésions traumatiques du pancréas

Resume Les lesions traumatiques du pancreas sont peu frequentes mais associees a une morbidite et une mortalite importantes liees au delai du diagnostic. La clinique et la biologie sont aspecifiques. La prise en charge therapeutique adaptee a la gravite de la lesion necessite de connaitre l’integrite ou non du Wirsung. La tomodensitometrie ne permet pas une vision directe du Wirsung et est donc peu performante. La cholangiopancreatographie retrograde est le « gold standard » mais est un examen invasif (3 a 5 % de complications surtout representees par des pancreatites) et peut etre impossible a realiser dans 30 % des cas ou lorsqu’elle est demandee en post-operatoire. Toutefois la cholangiopancreatographie retrograde peut etre therapeutique avec la mise en place d’un stent. La cholangio-IRM par contre est un examen non invasif avec des resultats preliminaires prometteurs. Elle permet a la difference de la cholangiopancreatographie retrograde de visualiser les pseudokystes, de faire des reconstructions multiplanaires et d’analyser le parenchyme pancreatique lorsqu’elle est associee a une IRM conventionnelle.

Volumétrie et fraction d'éjection ventriculaires gauches et droites en IRM : critères de contourage et reproductibilité interobservateur

Resume Left and right ventricular volumetry and ejection fraction with MRI: segmentation criteria and interobserver reproducibility J Radiol 2010;91:769-78 Purpose. To propose and validate anatomical criteria for the manual segmentation of right and left ventricles on cardiac MRI, to evaluate the interobserver reproducibility and tho evaluate the ease of implementation. Materials and methods. Criteria for the segmentation and the choice of the basal slices were defined based on a review of the literature and cardiac anatomy. Cardiac volumetric measurements obtained from 20 consecutive patients using these criteria were compared to measurements obtained in reference to the orthogonal planes, and to those obtained with the classical criteria described in the literature. The interobserver reproducibility was statistically assessed for 6 observers (3 experts and 3 residents with no experience in cardiac imaging). The ease of implementation was determined by the post-processing time. Results. Using orthogonal planes as a reference, the new criteria for the selection of the basal slice resulted in improved interobserver agreement and correlation compared to the classical criteria. Interobserver agreement was excellent (intra-class coefficient > 0.93 for the left ventricle, > 0.86 for the right ventricle). The mean post-processing time was similar or inferior to results from the literature. Conclusion. The proposed criteria allow easy volumetric assessment of both ventricles, while providing reproducible measurements. Objectifs. Proposer et valider des criteres anatomiques pour le contourage manuel des ventricules droit et gauche en IRM. En evaluer la reproductibilite interobservateur. En evaluer la facilite d’application. Materiels et methodes. Des criteres de contourage et du choix des coupes basales ont ete definis en fonction d’une revue de la litterature et de l’anatomie cardiaque. Les resultats obtenus sur 20 patients consecutifs ont ete compares a ceux en reference aux plans ortho

Cardiac Magnetic Resonance Imaging and Eosinophilic Endomyocardial Fibrosis

We report the case of a 41-year-old man who presented with lymphoma 2 years ago and was treated by chemotherapy. Biological findings revealed important eosinophilia, although explorations did not show any lymphoma recidivism or evidence of active infection. One month later, the patient presented with fever and clinical signs of heart failure as the onset of a central catheter infection occurred with methicillin-resistant Staphylococcus aureus bacteremia. Chest radiography revealed an enlarged cardiac shadow with a congestive vascular pattern (Figure, A). The ECG showed sinus tachycardia with incomplete left bundle-branch block (Figure, B). The echocardiogram revealed severe mitral and aortic regurgitation with apical filling of the left ventricle by a mobile structure (Figure, C). An initial diagnosis …

Caractérisation des incidentalomes surrénaliens découverts sur tomodensitométrie, revue générale

Resume La decouverte d’un incidentalome surrenalien sur une tomodensitometrie (TDM) abdominale, en dehors de caracteristiques TDM specifiques permettant un diagnostic (hematome, myelolipome ou kyste), pose le probleme de differenciation entre un incidentalome adenomateux et celui d’un « non adenomateux » (malignite primaire ou secondaire). Une densite inferieure a 10 unites Hounsfields sur une TDM sans injection est en faveur du caractere benin (essentiellement adenomes riches en lipide). Mais il y a 2 limites a cette technique : l’incidentalome visualise sur une TDM injectee d’emblee et les adenomes pauvres en lipide. Le calcul du lavage relatif, avec une valeur seuil de lavage de 50 %, a partir d’une TDM injectee d’emblee avec un delai de 10 min apres injection permet une differenciation entre les incidentalomes adenomateux et ceux « non adenomateux ». Les limites de cette caracterisation concernent seulement les pheochromocytomes benins et les carcinomes corticosurrenaliens atypiques.

Article originalÉpreuve de lecture critique d'article scientifique des épreuves classantes nationales : pertinence de la correctionCorrecting the critical reading test of the national ranking examination

INTRODUCTION In 2008 the national ranking examination (NRE) will include a test on critical reading of scientific articles. This decision has provoked controversy about whether reproducible correction is possible. The aim of our study was to assess the consistency of grading between this two-part test (critical analysis and summarizing, analyzed separately), and the more classic tests. METHODS Eight graders, all instructors at the Tours Medical School, corrected papers for each of the 3 tests. Papers for the critical reading test came from medical school final examinations and for the standard test from a practice examination. The instructors worked in pairs: each pair read 30 papers for each test, and both members separately graded each paper. The final grade was the mean of the two grades. The consistency of grading between the 4 pairs was estimated by Kendalls coefficient of concordance. RESULTS Kendalls coefficients of concordance were estimated at 0.94 (95% CI=[0.86; 0.97]) for the standard test, at 0.92 (95% CI=[0.81;0.97]) for the critical analysis test, and at 0.75 (95% CI=[0.62; 0.84]) for the summaries. Pairwise comparisons estimated the difference in concordance between the standard test and the summary at 0.18 (95% CI=[0.08; 0.32]) and that between the standard and critical reading test at 0.01 (95% CI= [-0.07; 0.12]). Finally the difference in concordance between the 2 new tests - summary and critical reading - was estimated at -0.17 (95% CI=[-0.32; -0.04]). CONCLUSION The focus should be on the difficulty of reproducible correction of the summaries, to set up methods for appropriate correction and adequate grading. The elaboration of detailed scoring templates, including numerous items and specifying in which part of the summary each item must be placed, should help to improve the reproducibility of this tests correction.

Nécrose gastrique sur distension aiguë sans contexte psychiatrique

Resume La distension aigue gastrique avec necrose est une complication rare et severe survenant lors d’une anorexie, d’une boulimie ou d’une polyphagie psychiatrique. Les auteurs rapportent un cas inhabituel sans contexte psychiatrique. La necrose gastrique a ete suspectee a partir des explorations radiologiques (radiographies standard et tomodensitometrie). La reconnaissance des signes radiologiques avec une presentation clinique compatible meme sans contexte psychiatrique est importante a connaitre afin d’ameliorer le delai diagnostique et ainsi de reduire la mortalite.

Cardiac magnetic resonance T1 mapping pre and post contrast in heart transplant patients with clinical antibody-mediated rejection: a preliminary experience

Background Antibody-mediated rejection (AMR) is characterized by histopathological and immunophenotypic findings such as activated endothelial cells, intravascular macrophages and evidence of capillary C4d deposition. This inflammatory reaction could be followed by diffuse fibrosis. Cardiac magnetic resonance (CMR) with recently T1 mapping is a promising technique to identify diffuse myocardial fibrosis. The purpose of this study was to assess T1 mapping in patients with AMR. Methods Two patients with clinical AMR (histopathological and immunophenotypic findings, presence of donor-specific allo antibodies and allograft dysfunction) performed a CMR study one week (for the first patient) and 3 weeks (for the second patient) after the treatment of AMR (plasmapheresis, IV Immunoglobulins and Rituximab). Images were acquired on a 1.5 Tesla scanner (Siemens) including T1 mapping using a shortened modified look-locker inversion-recovery sequence and T2 mapping in a matched mid-ventricular short axis slice using a black- blood single shot fast spin echo pulse sequence. Segmental and global T1 values were measured before and 15 minutes after administration of 0.2 mmol/kg of Gadoteric acid and compared to our cohort of 17 controls. Results Mean non contrast T1 values were significantly higher in heart transplants patients compared to controls (1100 ± 5 ms vs 947 ± 29 ms, P < 0.001). Segmental T1 values were significantly higher in the 6 regions of interest compared to controls (P < 0.001 in all segments). Mean post contrast T1 values were not significantly different in patients and controls. Mean T2 value was higher in patients compared to controls (73 ± 13 vs 50 ± 4 ms), suggesting the presence of global edema. Conclusions Heart transplant patients with clinical antibodymediated rejection show a significant increased global and segmental non contrast T1 values suggesting the presence of diffuse myocardial fibrosis. Further studies are required to confirm these data. Funding