Jean Michel Bartoli

Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non-compaction

AIMS To describe a method for measuring trabeculated left ventricular (LV) mass using cardiac magnetic resonance imaging and to assess its value in the diagnosis of left ventricular non-compaction (LVNC). METHODS AND RESULTS Between January 2003 and 2008, we prospectively included 16 patients with LVNC. During the mean period, we included 16 patients with dilated cardiomyopathy (DCM), 16 patients with hypertrophic cardiomyopathy (HCM), and 16 control subjects. Left ventricular volumes, LV ejection fraction, and trabeculated LV mass were measured in the four different populations. The percentage of trabeculated LV mass was almost three times higher in the patients with LVNC (32 +/- 10%), compared with those with DCM (11 +/- 4%, P < 0.0001), HCM (12 +/- 4%, P < 0.0001), and controls (12 +/- 5%, P < 0.0001). A value of trabeculated LV mass above 20% of the global mass of the LV predicted the diagnosis of LVNC with a sensitivity of 93.7% [95% confidence interval (CI), 71.6-98.8%] and a specificity of 93.7% (95% CI, 83.1-97.8%; kappa = 0.84). CONCLUSION The method described is reproducible and provides an assessment of the global amount of LV trabeculation. A trabeculated LV mass above 20% of the global LV mass is highly sensitive and specific for the diagnosis of LVNC.

Results of endovascular treatment in cases of abnormal placentation with post‐partum hemorrhage

Aim:  The purpose of this study was to evaluate the clinical success of selective arterial embolization in cases of post‐partum hemorrhage due to abnormal placentation.

Cathéters centraux insérés par voie périphérique : une technique prometteuse

Peripherally inserted central catheters (PICC): a promising technique To describe technical features and benefits from PICC lines.

Sonographic diagnosis of a cervical vagal schwannoma

This case report illustrates the role of high‐resolution sonography in the preoperative assessment of a schwannoma of the vagus nerve in the neck. Sonography identified the tumor in the right carotid space and determined its origin from the right vagus nerve, facilitating the surgeons approach to preserve nerve function.

Variations anatomiques des voies biliaires en cholangio-IRM: faisabilité et intérêt chirurgical.

Resume But de l’etude evaluer la performance de la cholangio-IRM dans la recherche de variations anatomiques « potentiellement dangereuses » au cours des actes de chirurgie. Materiel et methode analyse retrospective realisee a partir de 45 cholangio-IRM indiquees pour l’exploration de pathologies benignes (n = 19) et malignes (n = 26). La population comportait 29 hommes et 16 femmes, d’une moyenne d’age de 57 ans. Les examens ont ete lus et interpretes par deux radiologues de maniere independante. Resultats des variantes anatomiques ont ete observees chez 9 patients (20 %), 6 interessant la convergence biliaire et 4 le canal cystique (un patient presentait 2 variantes associees). Les variantes anatomiques interessaient le canal lateral droit : 1 (2,2 %) glissement a gauche du canal lateral s’abouchant dans le canal hepatique gauche ; 2 (4,4 %) trifurcations et 3 (6,6 %) abouchements distaux du canal lateral. Pour le canal cystique ont ete observes 2 canaux avec abouchement distaux soit 7,44 %, et 3 insertions du canal cystique sur le bord gauche de la voie biliaire principale, soit 11,1 %. La concordance interobservateur a ete de 100 % pour l’identification des variantes anatomiques. Conclusion notre serie confirme l’interet de la cholangio-IRM dans l’exploration atraumatique des voies biliaires dans le bilan pre-operatoire afin de detecter des variations anatomiques pouvant compliquer l’acte operatoire.

Bilateral Iliac Vein Thrombosis After Seat Belt-Related Trauma Revealing Hypoplasia of the Inferior Vena Cava A Case Report

Hypoplasia of the inferior vena cava can be revealed by a deep venous thrombosis of the lower limbs. Associated precipitating factors or clotting defects leading to thrombosis are frequently observed. A case of bilateral iliac veins thrombosis occurring after a motor vehicle accident with seat belt injury is reported, revealing hypoplasia of the inferior vena cava. This young man was totally asymptomatic up to the crash, and did not have coagulation abnormalities. The patient had a very good outcome after anticoagulant treatment with complete regression of venous thromboses. Hypoplasia of the inferior vena cava was a predisposing anatomic abnor mality that led to thrombosis, but seat belt trauma was probably the precipitating factor. This observation should be kept in mind in the evaluation of a deep venous lower limb thrombosis.

Indagini radiologiche preoperatorie in chirurgia vascolare

La patologia vascolare si avvale di indagini mediante tecniche d’immagine poco o affatto invasive. Gli apparecchi ecoDoppler di ultima generazione migliorati dai mezzi di contrasto ecografici, la risonanza magnetica a banda larga e gli scanner multidetettori sono sufficientemente performanti per poter limitare il ricorso all’angiografia. La scelta dell’esame e condizionata dalla sua affidabilita, dall’indicazione clinica, dalle controindicazioni proprie di ciascun paziente e dal livello tecnico disponibile. L’ecoDoppler viene utilizzato in prima istanza, completato da una RM o da uno scanner a seconda della situazione clinica. In caso di dubbio l’angiografia resta l’ultima spiaggia, ma diventa preponderante soprattutto come guida del trattamento endovascolare. Resta da definire il ruolo della tomografia a emissione di positroni (PET) .

Potential value of T1 mapping in cardiac MR assessment of hypertrophic cardiomyopathy and dilated cardiomyopathy patients: preliminary results

Summary The purpose of this study is to assess the potential value of T1 mapping in assessing fibrosis in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) in comparison to late contrast enhanced imaging using cardiac MR. Background Myocardial fibrosis causes 1) increased stiffness and induces pathological signaling in cardiomyocytes resulting in progressive cardiac failure, 2)impairs mechanoelectric coupling of cardiomyocytes and increases the risk of arrhythmias. T1 mapping allow to quantify the total amount of myocardial extracellular volume and to subsequently define the amount of myocardial fibrosis. Quantification of fibrosis in dilated and hypertrophic cardiomyopathies and it’s link to delayed myocardial enhancement is unclear. Methods

New insight of CMR in the diagnosis of left ventricular non-compaction: measurement of trabeculated left ventricular mass

Methods Between January 2003 and 2008, we prospectively included 16 patients with LVNC. During the mean period we included 16 patients with dilated cardiomyopathy (DCM), 16 patients with hypertrophic cardiomyopathy (HCM), and 16 control subjects. All patients underwent a 1.5 T CMR with SSFP cine sequences, the following parameters were used: TR/TE = 40 ms/1.8 ms, slice thickness = 6 mm, no gap between slice, flip angle = 65°, matrix = 148 × 256, field of view = 350 × 350 mm, temporal resolution = 35 ms, retrospective gating for the Siemens scan; and TR/TE = 3.5/1.5 ms, slice thickness = 6 mm, no gap between slice, flip angle = 60°, matrix = 148 × 256, field of view = 350 × 350 mm, temporal resolution = 35 ms, retrospective gating for the Philips scan. LV volumes, LV ejection fraction and trabeculated LV mass were measured (Figure 1). Figure 1: Illustration of the described method for measuring the global and trabeculated LV masses in patients with LVNC, DCM, HCM and controls. Row A shows the short axis end-diastolic cine images used for measurement without contouring. Row B shows inclusion of papillary muscles but exclusion of LV trabeculation for the measurements of the compacted LV mass. Row C shows inclusion of papillary muscles and trabeculation for the measurements of global LV mass.

Radioanatomie des veines des membres inferieurs et de la confluence iliocave

Objectifs Connaitre l’anatomie des differents reseaux veineux pelviens et des membres inferieurs. Connaitre les principales variantes anatomiques. Connaitre les modalites d’exploration et leurs resultats normaux. Points cles L’echo-Doppler est l’examen de reference pour l’exploration des veines des membres inferieurs. Le scanner avec injection de produit de contraste analyse precisement la confluence iliocave et son environnement. L’examen est bilateral et comparatif. Resume L’exploration des veines des membres inferieurs est une demande tres frequente, qu’elle soit realisee dans le cadre d’une atteinte thromboembolique ou d’une insuffisance veineuse. L’anatomie du reseau veineux doit etre parfaitement connue ainsi que ses variantes. L’echo-Doppler est l’examen de premiere intention permettant une analyse morphologique et fonctionnelle complete, mais parfois insuffisante sur le pelvis. Le scanner permet une bonne exploration de la confluence iliocave et de son environnement, au prix d’une irradiation non negligeable. La phlebographie permet une cartographie complete mais ses indications se rarefient. L’IRM n’a pas de reelles indications actuellement.