P. Taourel

Sonographic assessment of the normal and abnormal bowel wall in nondiverticular ileitis and colitis.

Abstract.Background: To assess the value of high resolution sonography (HRS) in identifying normal and inflammatory bowel wall in nondiverticular ileitis and colitis by using a segment-by-segment analysis. Methods: Thirty-five HRS were performed in patients with nondiverticular inflammatory bowel disease, without knowledge of clinical, endoscopic, and radiologic data. HRS evaluated separately five intestinal segments (terminal ileum, cecum/ascending colon, transverse, descending colon, and sigmoid colon) and was considered positive for inflammation when wall thickness during compression exceeded 3 mm. We compared HRS findings with results of endoscopy or enteroclysis performed within 8 days of HRS; endoscopic and radiologic results were classified into two subgroups: mild inflammatory lesions and frank inflammatory lesions. Results: Segment-by-segment analysis resulted in an accuracy of 81%, a sensitivity of 70%, and a specificity of 93%. Sensitivity was significantly lower for mild lesions (52%) than for frank lesions (87%, p < .001). Of the 32 patients having an inflammatory bowel condition, 29 (91%) had at least one segment correctly identified as inflammatory by HRS. Conclusion: Even if relatively insensitive for minor lesions, HRS is a promising, minimally invasive method for assessing normal and inflammatory bowel wall in nondiverticular ileitis and colitis.

Acute abdomen of unknown origin: Impact of CT on diagnosis and management

A prospective study was performed including 40 patients with an acute abdominal syndrome presenting difficulties in defining the etiology. All patients underwent an emergency computed tomographic (CT) scan. The CT scan made the syndromes diagnosis in 95% of cases and it permitted the detection of a lesion in 57.5% of cases. The diagnostic impact of CT scan was significant (p<0.01). The value and the specific contribution of CT in various diseases were analyzed. CT allowed appropriate therapeutic decisions in 95% of cases where clinical examination performance was positive in only 60% of cases. We had two negative CT results leading to an inappropriate therapeutic decision; it consisted of two cases of undiagnosed appendicitis. CT modified the primary therapeutic strategy in 30% of cases and avoided seven laparotomies.

Helical CT of large bowel obstruction.

Although large bowel obstruction (LBO) is four to five times less common than small bowel obstruction (SBO), it is a frequent problem and accounts for approximately 2–4% of surgical admissions for acute abdominal conditions. Because of significant limitations in the clinical and initial radiologic evaluations, with the development of computed tomography (CT) for examination of the acute abdomen, the role of CT in the diagnosis and assessment of bowel obstruction has expanded. This role has been stressed mainly for the diagnosis and management of SBOs [1–5]. As with SBO, the ideal method for evaluating patients with suspected LBO should be relatively noninvasive and capable of answering the following questions defined by Mondor et al. [6]:

Corrélations anatomopathologiques : IRM des tumeurs ovariennes primitives

MR Imaging of primary ovarian tumors with pathologic correlation Ovarian tumors are classified based on the cell of origin into epithelial tumors, germ cell tumors and sex cord-stromal tumors. This pictorial essay illustrates the MR imaging features of the main ovarian tumors with pathologic correlation. These key features are helpful to suggest a specific diagnosis or narrow the differential diagnosis, in order to optimize the surgical approach.

Pearls and pitfalls in breast MRI

At our academic institution, we have noticed repeated examples of both false-positive and false-negative MR diagnoses in breast cancer. The most common diagnostic errors in interpreting MRI of the breast are discussed in this review and experience-based advice is provided to avoid similar mistakes. The most common reasons for false-positive diagnoses are misinterpretation of artefacts, confusion between normal enhancing structures and tumours and, above all, insufficient use of the American College of Radiology breast imaging reporting and data system lexicon, whereas false-negative diagnoses are made as a result of missed tiny enhancement, a background-enhancing breast, or enhancement interpreted as benign rather than malignant.

Role of CT in the acute nontraumatic abdomen

The diagnostic workup of the acute abdomen always begins with a precise clinical history, a complete physical examination, and careful reading of plain films. Commonly performed additional imaging studies include contrast examination and, more recently, ultrasound. CT offers the advantage of allowing a comprehensive diagnostic evaluation of both solid and hollow viscera in neoplastic as well as in inflammatory and vascular disorders.

Le péritoine acteur de la pathologie abdominale

Resume Le peritoine : acteur de la pathologie abdominale. Le peritoine est un acteur a part entiere de la pathologie abdominale puisque : • des orifices au sein des mesos peuvent etre a l’origine de hernies internes ; • des anomalies de developpement du peritoine peuvent entrainer des anomalies de position, mais surtout de fixation des anses digestives a l’origine de volvulus ; • des tumeurs diffuses ou localisees du peritoine peuvent se developper de facon primitive ou secondaire ; • des atteintes infectieuses, inflammatoires ou ischemiques primitives du peritoine peuvent etre a l’origine de syndromes douloureux abdominaux aigus ou subaigus et/ou de syndrome septique, ou de la constitution d’epanchement cloisonne par defaut de reabsorption du liquide peritoneal. Cette mise au point a un double objectif : d’une part illustrer l’apport de l’imagerie dans le diagnostic de ces differentes affections, et d’autre part, donner quelques regles permettant de les mettre en evidence ou de les caracteriser.

Apport de l’IRM dans le diagnostic et le bilan d’extension des cancers lobulaires infiltrants

Purpose To assess the use of breast MRI for the diagnosis and staging of invasive lobular carcinoma and its impact on surgical management.PURPOSE: To assess the use of breast MRI for the diagnosis and staging of invasive lobular carcinoma and its impact on surgical management. MATERIALS AND METHODS: Retrospective study of 35 invasive lobular carcinoma, histologically diagnosed in 34 patients who underwent clinical exam, mammography, ultrasonography and magnetic resonance imaging. RESULTS: Enhancement at MRI was seen for all 35 cancers. It was focal for 24 patients, regional for 10 and diffuse for 1. The kinetic of the enhancement was characteristic of malignancy for 33 patients. For 11 patients the MRI staging was positive, finding 8 news cancers. For 3 patients MRI lead to biopsy of benign lesions but improved the surgical management in the 8 cases of new cancers: wider excision for 3 cases, planned breast conservation converted to mastectomy in 3 cases and excision of contralateral lesion in 2 cases. CONCLUSION: Breast MRI is useful in diagnosis, staging and surgical management of invasive lobular breast carcinoma.

SénologieApport de l’IRM dans le diagnostic et le bilan d’extension des cancers lobulaires infiltrantsBreast MRI in invasive lobular carcinoma: diagnosis and staging

Purpose To assess the use of breast MRI for the diagnosis and staging of invasive lobular carcinoma and its impact on surgical management.PURPOSE: To assess the use of breast MRI for the diagnosis and staging of invasive lobular carcinoma and its impact on surgical management. MATERIALS AND METHODS: Retrospective study of 35 invasive lobular carcinoma, histologically diagnosed in 34 patients who underwent clinical exam, mammography, ultrasonography and magnetic resonance imaging. RESULTS: Enhancement at MRI was seen for all 35 cancers. It was focal for 24 patients, regional for 10 and diffuse for 1. The kinetic of the enhancement was characteristic of malignancy for 33 patients. For 11 patients the MRI staging was positive, finding 8 news cancers. For 3 patients MRI lead to biopsy of benign lesions but improved the surgical management in the 8 cases of new cancers: wider excision for 3 cases, planned breast conservation converted to mastectomy in 3 cases and excision of contralateral lesion in 2 cases. CONCLUSION: Breast MRI is useful in diagnosis, staging and surgical management of invasive lobular breast carcinoma.

Doppler study of fasting and postprandial resistance indices in the superior mesenteric artery in healthy subjects and patients with cirrhosis

We assessed the resistance index (RI) in the superior mesenteric artery under fasting and postprandial conditions in healthy subjects and in patients with cirrhosis to determine whether the amount of change in the RI reflects the presence or severity of liver dysfunction.