M. Lewin

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.

MRI of Rectal Disorders

OBJECTIVE The objective of this pictorial essay is to provide a review of the diseases involving the rectal wall with an emphasis on the key clinical and radiologic differentiating features. CONCLUSION A wide spectrum of disease processes can involve the rectum in adults. MRI is the technique of choice in the definitive diagnosis of these disease conditions, mainly because of its superior tissue contrast differentiation.

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.

Epithelioid solitary fibrous tumor in the ischioanal fossa

Dear Editor: Solitary fibrous tumor (SFT) is a rare mesenchymal tumour initially described in the pleural cavity, but later reports have documented its occurrence in various extrapleural sites, including the abdomen [3, 5, 6]. The diagnosis of these tumors has generally been fraught with difficulties, because of their histologic variability. They can display storiform, hemangiopericytic, herring-bone, neural-type palisading, and diffuse sclerosing areas [4]. We describe the second case of SFT in the ischioanal fossa, characterized by epithelioid areas. To our knowledge, this feature has not been documented in this location before. A 67-year-old male, with unremarkable medical history, presented with urinary problems. Rectal examination revealed a fullness in the right side of the rectum. MRI study showed the presence of a 14×8 cm moderately circumscribed, heterogeneous solid mass, with high vascularity, and central necrosis, occurring in the right ischioanal fossa (Fig. 1). This mass was extra-peritoneal in location, with resultant superio-left displacement of the levator musculature and the rectum. The tumor was totally excised. No further therapy was given, and the patient recovered well, without evidence of recurrence as yet (6 months of follow-up). Grossly, the excised lesion was a well circumscribed, partially encapsulated, rounded mass, measuring 13×12× 8 cm. On section, the mass had multinodular, gray-whitish and firm appearance, withmyxoid and hemorrhagic changes at the center (Fig. 2). Microscopically, the tumor was characterized by prominent vascularity, with numerous small and mid-sized caliber vessels, with hyalinized wall “hemangiopericytoma-like” and significant variation in cellularity (Fig. 3). Hypercellular areas were predominant at the periphery, they displayed compact clusters of epithelioid neoplastic cells, with abundant eosinophilic cytoplasm, and distinct cell borders (Fig. 4). The nuclei were round with finely dispersed chromatin and small nucleoli. There was no nuclear atypia and mitoses were difficult to find (<1/10 HPF). Necrosis was prominent at the center, as well as myxoid degeneration. There was no storiform pattern, neuroid appearance, or diffuse sclerosing areas, even after multiple sampling of the tumor. The surgical margins were found to be clear. Immunohistochemically, tumor cells were strongly positive for vimentin, CD34 (Fig. 3, inset), BCL2 (Fig. 4, inset), and moderately for CD99 (MIC 2). Scattered cells reacted with KL1. Immunostains for EMA, actin, desmin, CD117 (c-Kit), and S100 protein, were negative. The diagnosis of epithelioid SFT, with unpredictable prognosis was made. SFT is an uncommon spindle cell neoplasm that was first described as a distinctive pleural lesion in 1931. In subsequent decades, extra-thoracic SFTs have increasingly been recognized. In this paper, we report the second case of SFT arising in the ischioanal fossa; the first was described by Dudkiewicz et al. in 2004 [2]. What makes the present lesion apparently unique, is the presence of epithelioid features. This morphologic variability may contribute to more difficulties in diagnosing these tumours, especially on percutaneous biopsy. Histologically, these tumours are characterized by a variety of growth patterns, with admixture in a various proportion of bland spindle cell cytology, alternating hyperand hypocellular areas, keloid-like hyalinisation, and a frequently prominent branching vasculature often described as N. Mourra (*) . J.-F. Flejou Department of Pathology, Hôpital St-Antoine, 184, rue du faubourg St-Antoine, 75012 Paris, France e-mail: najat.mourra@sat.ap-hop-paris.fr Tel.: +33-1-49282178 Fax: +33-1-49282878

Computed Tomography Features of Acute Thrombosis of Central Veins With Perivenous Inflammatory Changes

Objective: Our purpose was to examine the computed tomographic findings in 13 patients with acute deep venous thrombosis (DVT) of central veins of the neck, chest, and abdomen in whom major perivenous inflammatory changes were noted. Methods: During a 10-year period, 13 patients with acute DVT of 21 central veins and marked perivenous inflammatory changes on computed tomography were identified. Computed tomography images were assessed for location of DVT and pattern of perivenous changes. Results: The perivenous changes took the form of a rounded or lobulated perivenous bulky mass (massive pattern or tumorlike) in 5 patients and of infiltrative changes in the other 8 patients. Direct visualization of the thrombotic vein was possible in 8 patients. Follow-up examinations (range, 6-36 months; mean, 15 months) demonstrated resolution of perivenous inflammatory changes with anticoagulation therapy in all cases. Conclusion: Perivenous inflammatory changes around the thrombotic vein presented as a rounded or lobulated perivenous bulky mass that may mimic a tumor or as infiltrative perivenous changes.

Carcinome à cellules acineuses du pancréas, de développement essentiellement intracanalaire : à propos d’un cas

Resume Le carcinome a cellules acineuses (CCA) du pancreas represente environ 1 % des tumeurs du pancreas exocrine de l’adulte. Nous rapportons une forme rare de CCA chez un homme de 66 ans. Cette tumeur etait revelee par des douleurs epigastriques et un amaigrissement. L’examen tomodensitometrique abdominal objectivait une lesion hypodense relativement bien limitee, heterogene, au niveau de la tete du pancreas, mesurant 4,2 cm de diametre. Il existait une dilatation importante du canal de Wirsung en amont, avec un aspect de bourgeons tumoraux a l’interieur de ce canal. Le diagnostic de CCA etait porte sur la cytoponction realisee lors de l’echoendoscopie. Sur la piece de duodenopancreactectomie cephalique, le canal de Wirsung, dilate (2,5 cm de diametre), etait occupe par une tumeur bourgeonnante. L’examen histologique retrouvait un CCA, de developpement essentiellement intracanalaire (canal de Wirsung et canaux accessoires), envahissant la glande pancreatique et la paroi duodenale. Les marqueurs neuroendocrines etaient negatifs. Il s’agit, a notre connaissance, du second cas de CCA, de developpement essentiellement intracanalaire. Ces formes rares de CCA peuvent poser des problemes diagnostiques avec les tumeurs intracanalaires papillaires et mucineuses du pancreas. Dans notre observation, la cytoponction realisee sous echoendoscopie a constitue une aide precieuse au diagnostic.

Comment je fais une entéro-IRM ? Théorie et pratique

Les évolutions technologiques récentes (séquences ultrarapides sans artefacts de respiration, antenne de surface/ corps entier en réseau phasé, logiciels de reconstruction 3D) ont étendu la place de l’IRM dans l’exploration du tube digestif [1, 2]. En raison de son excellente résolution en contraste, l’entéro-IRM est devenue une technique performante pour analyser la paroi intestinale, de manière non invasive et non irradiante, notamment dans le cas de maladie de Crohn qui a été l’objet de la majorité des études. En général, la sémiologie radiologique des pathologies en IRM correspond à celle connue en TDM. Cependant, l’entéroIRM est capable de fournir en plus des informations fonctionnelles à l’aide par exemple de séquences dynamiques pondérées en T2. Les objectifs de ce cours sont de revoir les possibilités techniques de réalisation d’une entéro-IRM, de décrire l’imagerie de la maladie de Crohn, de connaître les performances et de préciser les indications actuelles et futures de l’entéro-IRM.