S. Novellas

MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis

OBJECTIVE MRI was the first imaging technique to permit the visualization of the uterine junctional zone and remains the imaging method of choice to evaluate it and its associated pathology. CONCLUSION Adenomyosis can be diagnosed using MRI with a diagnostic accuracy of 85%. The most important MR finding in making the diagnosis is thickness of the junctional zone exceeding 12 mm. The principal limitation of MRI is the absence of a definable junctional zone on imaging, which occurs in 20% of premenopausal women.

CT-Guided Percutaneous Catheter Drainage of Acute Infectious Necrotizing Pancreatitis: Assessment of Effectiveness and Safety

OBJECTIVE The purpose of this study is to assess retrospectively the effectiveness and safety of CT-guided percutaneous drainage and to determine the factors influencing clinical success and mortality in patients with infectious necrotizing pancreatitis. MATERIALS AND METHODS From April 1997 to December 2005, 48 consecutive patients (33 men and 15 women; median age, 58.5 years) with proven infectious necrotizing pancreatitis underwent percutaneous catheter drainage via CT guidance. Evaluated factors included clinical, biologic, and radiologic scores; drainage and catheter characteristics; and complications. Clinical success was defined as control of sepsis without requirement for surgery. Univariate analysis was performed to determine factors that could have affected the clinical success and the mortality rates. RESULTS Clinical success was achieved in 31 of 48 patients (64.6%) and was significantly associated with Ranson score (p = 0.01) and with the delay between admission and the beginning of the drainage (p = 0.005), with a calculated threshold delay of 18 days (p = 0.001). The global mortality rate (14/48 [29%]) was also influenced by the Ranson score (p = 01) and the delay of drainage (p = 0.04) with the same threshold delay (p = 0.01). Only two major nonlethal procedure-related complications were observed. CONCLUSION Percutaneous catheter drainage is a safe and effective technique to treat acute infectious necrotizing pancreatitis.

Obstetrical prognosis and pregnancy outcome following pelvic arterial embolisation for post-partum hemorrhage

Post-partum hemorrhage is an obstetrical emergency. Pelvic artery embolisation offers an alternative to surgical intervention and increases the rate of conservative treatment. The objective of this review was to study the scientific literature on obstetrical outcomes following uterine-sparing arterial embolisation performed for post-partum hemorrhage in a prior pregnancy. A Medline and Sciencedirect search were performed in order to review all the French and English reports about pregnancy following pelvic arteries embolisation for post-partum hemorrhage. Nineteen articles were identified and 13 were selected for inclusion. We have included the fertility follow-up of a total of 168 women who underwent pelvic arteries embolisation for post-partum hemorrhage. We highlight the clinical success of embolisation in 154 of the 168 patients (92%). Following the embolisation procedures, 7 hysterectomies were required and 4 patients died. Two of the 4 deaths occurred in women who were transferred from an outlying institution to a tertiary referral center. In this population, 45 pregnancies were described. Among these pregnancies, 32 resulted in live births (71%), 8 were miscarriages (18%) and 5 patients carried out voluntary termination of pregnancy (11%). The cesarean section rate was 62%. Post-partum hemorrhage occurred in 6 cases leading to 2 hysterectomies. In conclusion, pelvic arterial embolisation offers a safe and conservative alternative to surgical interventions for post-partum hemorrhage in well-selected patients desiring to preserve future fertility.

MR Cholangiopancreatography Features of the Biliary Tree After Liver Transplantation

OBJECTIVE Our objective was to show the usefulness of MR cholangiopancreatography in assessing biliary complications after liver transplantation. CONCLUSION MR cholangiopancreatography is the best noninvasive tool for the diagnosis and assessment of biliary complications.

The value of pelvic MRI in the diagnosis of posterior cul-de-sac obliteration in cases of deep pelvic endometriosis.

OBJECTIVE The objective of our study was to define relevant MRI signs allowing preoperative diagnosis of posterior cul-de-sac obliteration in patients with deep pelvic endometriosis. MATERIALS AND METHODS This retrospective study included patients who underwent pelvic MRI completed by a laparoscopic examination. Three radiologists performed the MRI review blinded and recorded the following signs: sign 1, retroflexed uterus; sign 2, retrouterine mass; sign 3, displacement of intraperitoneal fluid; sign 4, elevation of the fornix; and sign 5, adherence of bowel loops. Laparoscopic results provided the criterion standard for diagnosis of posterior cul-de-sac obliteration. The performance of MRI was evaluated by calculating the average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI results of the two more experienced radiologists for each sign and for combinations of signs. Interobserver agreement for each sign and impression for posterior cul-de-sac obliteration were calculated for all radiologists. RESULTS Sixty-three patients were included in the study. Posterior cul-de-sac obliteration was diagnosed in 43 patients at laparoscopy. The mean sensitivity, specificity, and accuracy of each sign and impression of posterior cul-de-sac obliteration were, respectively, as follows: sign 1, 24.4%, 77.5%, 41.3%; sign 2, 97.1%, 83.7%, 92.8%; sign 3, 95.0%, 88.7%, 93.1%; sign 4, 30.2%, 97.5%, 51.6%; sign 5, 83.7%, 91.2%, 86.1%; and impression of posterior cul-de-sac obliteration, 91.9%, 91.2%, 91.7%. Interobserver concordance varied from 0.26 to 0.81 with best results obtained with the combination of signs 2, 3, and 5. Best concordances for junior radiologist evaluations were obtained with assessment of sign 3. CONCLUSION MRI allows posterior cul-de-sac obliteration diagnosis. Pelvic fluid displacement may be the sign with greatest utility when considering both diagnostic accuracy and interobserver agreement.

MR features of the levator ani muscle in the immediate postpartum following cesarean delivery

Introduction and hypothesisWe wanted to show that at the time of cesarean delivery, the active process of labor itself was sufficient to create early alterations of the pelvic floor musculature as detectable via magnetic resonance imaging (MRI).MethodsThirty primipara patients underwent pelvic MRI between the second and third day after cesarean delivery. Ten patients had a cesarean without labor while 20 patients underwent urgent cesarean delivery after the onset of labor.ResultsPatients undergoing active labor during cesarean had 2.7 times more abnormalities than the patients with cesareans without labor. The abnormalities the most frequently found were a hypersignal in the puborectalis (p = .004), a hypersignal in the iliococcygeus (p = .064) and a defect in the orientation of this same muscular bundle (p = .049).ConclusionThis preliminary study suggests that active labor during the time of a cesarean induces early lesions of the pelvic muscular floor.

Imagerie des pseudo-tumeurs inflammatoires hépatiques

Resume Objectif Decrire les caracteristiques en imagerie des pseudo-tumeurs inflammatoires hepatiques. Introduction Les pseudo-tumeurs inflammatoires sont des lesions benignes rares pouvant mimer en imagerie l’aspect d’une atteinte neoplasique. Leur diagnostic est le plus souvent redresse par l’etude histologique de la piece chirurgicale motivee par une semeiologie radiologique suspecte et atypique. Materiel et Methode Etude retrospective entre 1998 et 2006 de pseudo-tumeurs inflammatoires hepatiques prouvees histologiquement. Les techniques radiologiques employees comportaient l’echographie, l’echographie de contraste, le scanner helicoidal et l’imagerie par resonance magnetique (IRM). Resultats 7 lesions (Taille moyenne : 61,4 mm) etaient identifiees chez 6 patients (Âge moyen : 66 ans). Les examens cliniques et biologiques etaient aspecifiques. Nous disposions de 5 echographies dont 1 avec contraste, 5 tomodensitometries et 3 IRM. En echographie, toutes les tumeurs etaient hypoechogenes sans rehaussement apres injection de Levovist®. En scanner, elles etaient principalement hypodenses avant injection. Le rehaussement apres injection intraveineuse d’iode etait inconstant, tardif et modere. En IRM, les lesions etaient iso ou discretement hyperintenses en T2, iso ou hypointenses en T1 avec un discret rehaussement peripherique au temps tardif. Conclusion Ce diagnostic differentiel doit etre connu des radiologues et peut etre evoque dans un contexte inflammatoire chronique avec une masse hepatique ne presentant pas les caracteristiques d’une tumeur hepatique specifique mais celles d’une lesion partiellement fibreuse avec prise de contraste tardive.

Anévrisme de l'artère splénique: diagnostic et thérapeutique endovasculaire

Splenic artery aneurysm: diagnosis and endovascular therapy Splenic artery aneurysms are now diagnosed more frequently thanks to the increase and improvement in different imaging techniques. In case of rupture they are potentially life threatening and thus in certain cases may require appropriate preventive treatment. This treatment should be offered to patients with suspected pseudoaneurysms, with an aneurysm larger than 20mm in diameter, or which is progressing. The development of interventional endovascular radiology has provided new therapeutic options for the management of aneurysms, by excluding the sac from the arterial circulation with coil embolisation or with a covered stent. The success rate of these treatments is between 75 and 100% with significantly less morbidity and mortality than with surgical techniques.

Pathologie du ligament rond : à propos de deux cas

e ligament falciforme est constitué par le repliement de deux feuillets péritonéaux délimitant un espace contenant le ligament rond, involution de la veine ombilicale, de la graisse et des structures vasculaires principalement veineuses. En 1987, Meyers a décrit les possibilités d’extension de processus infectieux ou tumoraux le long des différents ligaments hépatiques, l’atteinte isolée du ligament rond apparaissant exceptionnelle (1). Nous rapportons l’aspect en échographie et en tomodensitométrie de deux nouveaux cas d’extension septique et tumorale le long de ce ligament.

Endométriose pelvienne profonde en IRM

Deep pelvic endometriosis: MR features Endometriosis is a frequent pathology of adult women. Clinical examination and US are poorly sensitive for detection of deep pelvic implants and MR is superior for presurgical mapping of disease extent. This is important to optimize complete surgical excision, the only proven treatment to achieve symptomatic relief. The purpose of this pictorial essay is to describe the imaging features of deep pelvic endometriosis and the technical means to optimize its detection.