Laurence Monnier-Cholley

MR Lymphography of Abdominal and Retroperitoneal Lymphatic Vessels

OBJECTIVE The abdominal and retroperitoneal lymphatic system is characterized by numerous anatomic variations. Our objective is to review MR lymphographic features of normal anatomy and abnormal conditions. CONCLUSION MR lymphography is a noninvasive technique that is well suited for the examination of abdominal and retroperitoneal lymphatic vessels.

Long-term follow-up after neoplastic seeding complicating percutaneous ethanol injection for treatment of hepatocellular carcinoma.

We describe a case of subcutaneous metastasis along the needle track after percutaneous ethanol injection (PEI) for treatment of hepatocellular carcinoma. After surgical resection and extrabeam radiation therapy the patient is alive without evidence of recurrence five years after PEI. One should pay attention to the abdominal wall around the needle track in interpreting CT or MR images of patients with previous PEI.

Utilisation du jus d’ananas en tant qu’agent de contraste négatif en cholangiopancréatographie par résonance magnétique

Resume Objectifs La qualite des examens de cholangiopancreatographie par resonance magnetique (CPRM) est frequemment degradee par le signal eleve du contenu digestif sur les sequences fortement ponderees en T2. L’objectif de cette etude est d’evaluer les resultats obtenus par l’ingestion de jus d’ananas en tant qu’agent de contraste negatif en CPRM. Materiels et methodes Nous avons compare les resultats de la CPRM de 50 patients ayant ingere du jus d’ananas et de 50 patients ayant ingere un produit de contraste paramagnetique (ferumoxsil-Lumirem ® ). Les observateurs ne connaissaient pas la nature du produit de contraste ingere. La qualite des examens a ete analysee en terme de suppression du signal au sein de l’estomac, du cadre duodenal et du grele proximal et en terme de visualisation du canal pancreatique, des voies biliaires intrahepatiques et de la voie biliaire principale. In vitro, nous avons analyse l’intensite du signal de differents jus d’ananas disponibles sur le marche, en se servant de sequences ponderees en T1, de sequences ponderees en T2 et de sequences de CPRM. L’intensite du signal a ete correlee avec la concentration de manganese mesuree par spectrometrie d’emission atomique. Finalement, les observateurs ont compare les gouts respectifs du jus d’ananas et du ferumoxsil. Resultats Sur les sequences de CPRM, les resultats etaient equivalents en terme de suppression de signal de l’estomac, du cadre duodenal et du grele proximal apres ingestion de jus d’ananas ou de ferumoxsil. La visualisation du canal de Wirsung, des voies biliaires intrahepatiques et de la voie biliaire principale etait equivalente apres ingestion d’ananas ou de ferumoxsil. L’intensite du signal des differents jus d’ananas sur les sequences ponderees en T2 et sur les sequences de CPRM etait bien correlee avec la concentration de manganese mesuree pour chacun des jus par spectrometrie. D’importantes variations de la concentration de manganese ont ete observees entre les differents jus d’ananas testes. La concentration de manganese variait entre 3,65 et 27,24 mg/L. Les observateurs ont considere que le jus d’ananas avait un « bon » ou un « tres bon » gout alors que le ferumoxsil avait un « mauvais » ou « tres mauvais » gout. Conclusion L’ingestion de jus d’ananas permet d’obtenir une diminution efficace du signal du tractus digestif en CPRM d’une facon comparable a celle qui est obtenue avec les produits de contraste paramagnetiques. Comme la concentration de manganese est largement variable dans les differents jus d’ananas disponibles dans le commerce, un jus d’ananas a haute concentration de manganese doit etre selectionne.

Diffuse cavernous hemangioma of the rectosigmoid colon : Imaging findings

Diffuse cavernous hemangioma of the rectosigmoid colon (DCHR) is an uncommon disease that affects mainly young adults. As the main symptom is non-specific chronic rectal bleeding, the clinical diagnosis is difficult and often delayed. In this essay, we illustrate the imaging features of DCHR, including plain radiograph, barium enema, CT and MR study, and echoendoscopy. Pitfalls in diagnosis and the role of imaging study in the diagnosis, in the preoperative staging, and in the follow-up of the patients are defined.

Imagerie des pathologies thoraciques chez le patient VIH au stade sida

The imaging features of infectious and non-infectious pathologies in HIV patients with AIDS (less than 200 CD4/mm3) are illustrated. Opportunistic infections, tumors and vascular pathologies have variable appearances based on the degree of immunosuppression and patient compliance with opportunistic infection prophylaxis. Because of advances in retroviral treatments and wider use of anti-infectious prophylaxis, thoracic pathologies in AIDS patients are less frequent but must nonetheless be recognized, and diagnosis should be suggested in patients with unknown serologic status.

Redundant Publication in the Journal Radiology

PURPOSE To retrospectively quantify the incidence of redundant publication in the journal Radiology and to compare the present study findings with those published for other journals and medical specialties. MATERIALS AND METHODS Two readers estimated the incidence of the redundant publication of original articles in Radiology in the year 2001. Original research articles published in 2001 were analyzed by searching MEDLINE on the PubMed server to identify articles that may have represented a duplication of the original Radiology article. MEDLINE was searched between January 1999 and December 2003 by using the surname and initial(s) of the first author. Potentially redundant articles were identified after similarities in titles and abstracts were analyzed. The full versions of all potentially redundant articles and of the corresponding index articles were then retrieved from the library. The potentially redundant article was then compared with the index article. Criteria for redundant publication were as follows: Compared with the index article, the potentially duplicate article had (a) a similar hypothesis, (b) a similar number of subjects, (c) similar results, (d) at least one author in common, and (e) no or little new information. RESULTS In 2001, 362 original research articles were published in Radiology. Two instances of redundant publication were found among these articles, and both were considered to be partially redundant publications due to series expansions (ie, increased numbers of study subjects) of 50% and 52%. CONCLUSION Redundant publication appears to be less frequent in Radiology than in the other journals and specialties for which redundant publication information has been reported.

Imagerie par résonance magnétique de diffusion (IRMD) en pathologie hépatique: principe et applications cliniques.

Diffusion-weighted MR imaging of liver pathology: principles and clinical applications Due to ongoing technological advances, the range of clinical applications for diffusion-weighted MR imaging has expanded to now include abdominal pathology. Current applications for liver pathology include two main directions. First, oncologic imaging with detection, characterization and follow-up of lesions. Second, evaluation of diffuse liver diseases, including hepatic fibrosis. The diagnostic impact and role of diffusion-weighted MR imaging remain under investigation, but appear promising. Because of its short acquisition time, sensitivity, and additional information it provides, diffusion-weighted MR imaging should be included in routine liver imaging protocols.

Magnetic resonance imaging of the ischiorectal fossa : Spectrum of disease

Objective: Pelvic magnetic resonance imaging (MRI) studies are widely used to assess the rectum, anal canal, and their environment. The purpose of this article is to review the current role of MRI in the evaluation of diseases involving the ischiorectal fossa and their imaging features. Conclusions: The radiologist plays an essential role in the evaluation of some conditions typically located in this space and of other conditions that occasionally involve this area or invade the ischioanal space. The accurate assessment of these diseases that MRI provides further cements its role as the primary technique for the evaluation of pelvic pathology.

Noncontrast Magnetic Resonance Lymphography

BACKGROUND Different imaging techniques have been used for the investigation of the lymphatic channels and lymph glands. Noncontrast magnetic resonance (MR) lymphography has significant advantages in comparison with other imaging modalities. METHODS Noncontrast MR lymphography uses very heavily T2-weighted fast spin echo sequences which obtain a nearly complete signal loss in tissue background and specific display of lymphatic vessels with a long T2 relaxation time. The raw data can be processed with different algorithms such as maximum intensity projection algorithm to obtain an anatomic representation. RESULTS Standard T2-weighted MR images easily demonstrate the location of edema. It appears as subcutaneous infiltration of soft tissue with a classical honeycomb pattern. True collection around the muscular area may be demonstrated in case of severe lymphedema. Lymph nodes may be normal in size, number, and signal intensity; in other cases, lymph nodes may be smaller in size or number of lymph nodes may be restricted. MR lymphography allows a classification of lymphedema in aplasia (no collecting vessels demonstrated); hypoplasia (a small number of lymphatic vessels), and numerical hyperplasia or hyperplasia (with an increased number of lymphatic vessels of greater and abnormal diameter). CONCLUSION Noncontrast MR lymphography is a unique noninvasive imaging modality for the diagnosis of lymphedema. It can be used for positive diagnosis, differential diagnosis, and specific evaluation of lymphedema severity. It may also be used for follow-up evaluation after treatment.

Post-mortem CT scan with contrast injection and chest compression to diagnose pulmonary embolism

Dear Editor, Post-mortem examination relying on medical autopsy is the standard of reference in clinical medicine. Unfortunately, medical autopsy rate has declined worldwide in the few last decades for many reasons, the most frequent being family refusal. Post-mortem imaging using CT scan (virtopsy) is emerging as an alternative to conventional autopsy. However, virtopsy is performed without contrast injection because of blood flow cessation making pulmonary embolism diagnosis impossible [1]. Recently, protocols derived from forensic medicine allowing vascular opacification have been reported [2]. However they require cannulation of femoral vessels and the connection to a modified heart–lung machine [3]. This approach is rather cumbersome and not routinely feasible. We recently diagnosed pulmonary embolism immediately after death using CT scan imaging with peripheral contrast injection followed by chest compressions to restore partial blood flow [4]. This prompted us to implement a protocol of contrast injection for post-mortem imaging. In cases of sudden death in the ICU and after family consent, virtopsy is performed at the radiology department of our hospital as soon as possible. For the purpose of the procedure, central or peripheral venous catheters inserted before death are not removed. The procedure is as follows: first an unenhanced contrast medium CT scan from head to pelvis is performed; thereafter the contrast medium (2 mL/kg) is injected manually via the venous catheter. A chest CT scan is then performed after one or two rounds of 20 chest compressions (as required to restore partial blood flow). This procedure has been approved by the institutional review board of our hospital. From February to August 2014, 16 ICU patients who died unexpectedly (median age 60.5 [34; 88], 13 male (81 %), median SAPS II at admission 59 [29; 112], having echographic signs of acute cor pulmonale immediately before death 6/16) were subjected to post-mortem CT scans with contrast injection. The median delay between death and examination was 68.5 min [0; 206]. In all cases, the procedure described above allowed a high quality opacification of the right ventricle and pulmonary arteries up to subsegmental division (Fig. 1a), independently of venous catheter location (central or peripheral). Pulmonary embolism diagnosis was retained relying on post-mortem CT scan in three out of