Jacques Pringot

Defecography: I. Description of a new procedure and results in normal patients

To solve frequently encountered clinical problems in the anorectal area, we have developed a simplified dynamic method of defecography. A radiopaque substance, the consistency of normal stools, is introduced into the rectum and the patient is then seated on a specially designed seat composed of superposed air chambers which, for technical reasons, are filled with water. The movements induced by evacuation of the rectum are recorded using 100-mm ampliphotography.After recording findings in 56 normal patients, we are able to define 5 criteria for “normal”: increase in anorectal angulation, obliteration of the impression of the puborectal muscle, wide opening of the anal canal, total evacuation of the rectal contents, and normal resistance of the pelvic floor. The mean value of the anorectal angle (ARA) was 91.96° (±1.52 SEM) at rest and 136.76° (±1.51 SEM) during straining. The increase of ARA during straining is 44.8°.

Defecography: II. Contribution to the diagnosis of defecation disorders

Our simple method of defecography has proved to be more sensitive than clinical evaluation in the detection and description of defecation disorders. Among the different types of disorders, described on the basis of 144 abnormal defecograms, the most common are rectal intussusception (RI), intraanal rectal intussusception (IRI), external manually (EMRP) or spontaneously (ESRP) reducible prolapses, rectocele, and accentuation of the impression of the puborectalis sling (AIPR).Study of the mean values of the anorectal angle (ARA) (normal mean value=92° at rest) reveals an increase (p<0.05) in the ARA in IRI and ESRP and a decrease (p<0.05 at rest,p<0.001 at strain) in AIPR. The most striking observation is a highly significant increase (p<0.001) in the ARA associated with incontinence.

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

The sonographic studies of 72 patients with pathologically proven Hodgkins or non-Hodgkins hepatic lymphoma were retrospectively reviewed. Sixty-eight patients (94%) had secondary hepatic lymphoma (nine of them had AIDS-related lymphoma) and four patients (6%) had primary lymphoma of the liver. Forty-six of 72 patients (64%) had diffuse hepatic involvement, and 26 of 72 patients (36%) had focal liver lesions as demonstrated by sonography. Four patterns of disease were identified: (a) hepatomegaly was depicted by sonography in 26 of the 59 patients with secondary hepatic lymphoma not related to AIDS, in two of the nine patients with AIDS-related secondary hepatic lymphoma, and in one of the four patients with primary hepatic lymphoma; (b) multiple rounded well-delineated hypoechoic liver lesions were found in 22 of the 68 patients with secondary hepatic lymphoma; (c) a large heterogeneous echoic mass, which was an evocating clue to the diagnosis of primary lymphoma of the liver, was found in the four patients with primary lymphoma of the liver; and (d) an absence of sonographic abnormalities was found in 20 of the 59 patients with secondary lymphoma not related to AIDS. Liver involvement with lymphoma should be considered in any patient who develops multiple homogeneous hypoechoic liver masses, even in the absence of known underlying lymphomatous disease.

Focal Nodular Hyperplasia in Association With Spontaneous Intrahepatic Portosystemic Venous Shunt

We report a case of focal nodular hyperplasia in an adolescent with a spontaneous intrahepatic portosystemic venous shunt. Diagnosis was established by duplex and color Doppler ultrasound, computed tomography, magnetic resonance imaging, and histology. This association further supports the hypothesis that focal nodular hyperplasia is a response to a preexisting vascular abnormality.

Primary lymphoma of the liver: MR findings

Primary lymphoma of the liver is a rare disease. The MR appearances of three cases of pathologically confirmed primary non-Hodgkins lymphoma of the liver are presented. All three lymphomatous lesions appeared as unique well demarcated focal liver lesions on MR images. On T1-weighted images, two lesions were hypointense and one slightly hyperintense to the liver. On T2-weighted images, the three lesions were slightly heterogeneous and hyperintense. Lobulation, which was better seen on T2-weighted images, was noticed in one lesion. One lesion was studied after gadopentetate dimeglumine injection and showed marked and heterogeneous enhancement.

Capsule and mosaic pattern of hepatocellular carcinoma: correlation between CT and MR imaging.

Computed tomography (CT) was compared with magnetic resonance (MR) imaging in depicting the capsule and the mosaic pattern of hepatocellular carcinoma in 34 patients. The kappa statistic was used to compare results from both modalities. For the detection of the capsule, there was a substantial agreement beyond chance between late enhanced CT (more than 5 min after dynamic CT) and MR imaging (kappa=0.76). Late enhanced CT and MR imaging had almost perfect agreement for the demonstration of the mosaic pattern (kappa=0.85). These agreements were better than the agreements between unenhanced CT and MR imaging or between early enhanced CT and MR imaging. These results suggest that late enhanced CT compares favorably with MR imaging in depicting the capsule and the mosaic pattern of hepatocellular carcinoma.

Magnetic resonance imaging of lower abdominal and pelvic lesions: assessment of oral magnetic particles as an intestinal contrast agent.

To determine the value of oral magnetic particles (OMP) as a superparamagnetic MR contrast agent for the gastrointestinal tract in lower abdominal and pelvic lesions, 30 patients underwent spin-echo imaging before and after ingestion of OMP at a dose of approximately 80 mg of iron in 800 ml water. The preparation was divided into four portions and taken by the patient over a 2-h period. Two readers independently reviewed the MR images. The contrast material was well tolerated and the distribution of the contrast material was good to excellent in the proximal and pelvic small bowel, but was not sufficient in the colon with the dose and timing used in the study. Postcontrast images showed a significantly better delineation of the lesions, the small bowel, and the paraaortic region, but no significant improvement in the delineation of the colon, the iliac vessels area, the bladder or genital tract. Compared with precontrast images, confidence in defining or excluding disease on postcontrast images was better, equal or worse in 40, 60 and 0% of cases, respectively (P less than 0.001) with a substantial agreement between readers (kappa = 0.71). OMP produced susceptibility artefacts of significant intensity in only one case. These results indicate that OMP may be useful in the delineation of lower abdominal and pelvic lesions at MR imaging. Marking of the colon by a contrast agent might improve the results.