Endovascular treatment of haemoptysis: medium and long-term assessment

PURPOSE

To assess the short, medium and long-term results of bronchial artery embolisation (BAE) and identify the factors favouring the recurrence of haemoptysis.

PATIENTS AND METHODS

This is a retrospective study, between January 2001 and June 2010, comprising 53 consecutive patients with BAE. The mean age was 53.8 years. There were 15 women (28.30%) and 38 men (71.69%).

RESULTS

The aetiologies of haemoptysis were dominated by the residual signs of pulmonary tuberculosis: 18 cases (33.96%), bronchial dilations: 12 cases (22.64%) and aspergilloma: five cases (9.43%). The bronchial arteriography showed signs of bronchial hypervascularisation in 92.45% of the cases. Forty-six patients had a first embolisation (86.79%) with immediate efficacy in 84.90% of the cases (n=45). This efficacy was noted after more than 3 years in 60.08% of the cases. Short (< 30 days) and medium-term (> 30 days and < 3 years) recurrence of haemoptysis were noted in 17.39% and 8.69% of the cases respectively. A statistically significant correlation between aspergilloma and the immediate recurrence was found (P=0.013). The risk of medium and long-term recurrence (> 3 years) was correlated with age. The survival without recurrence was statistically higher when the age was less than 60 years (P=0.0041).

CONCLUSION

BAE is an effective treatment. Aspergilloma is a major risk factor in the recurrence of haemoptysis. Repeated embolisation may be proposed for these patients.

Giant cells tumor recurrence at the third lumbar vertebra

Giant cell tumors (GCT) of the spine are rare. We report a case of (GCT) of the third lumbar vertebra revealed by left lumbar radiculopathic thigh pain in a 47 year old man. Imaging showed an osteolytic process invading the vertebral body, the posterior arch and compressing the dural sac left side. Neurological decompression was first performed including stabilization by an instrumented postero-lateral graft. A surgical biopsy was obtained at the same time to confirm the diagnosis. A secondary L2-L4 tumor curettage and graft procedure did not prevent, 5 years later, tumor recurrence. We believe that the simple tumor curettage is insufficient to prevent giant cell tumors recurrence.

[Lesions classified ACR3 with the breast cancer screening mammography program of the Ariana area: features and problems encountered]

OBJECTIVE

This retrospective work is related to ACR3 mammograms of the program "Feasibility of breast cancer screening by mammography in Ariana Governorate" in order to evaluate the efficiency and short-term quality control of these probably benign lesions.

MATERIALS AND METHODS

Mammograms classified ACR3 raised the indication of further examination, futher mammogram (profile, expanded or compression). The monitoring and control period are explained to the patient by the radiologist.

RESULTS

6.6% mammograms were classified as ACR 3 with 71.3% under the age of 50 years. Breast is very dense in 20.5% of cases, and transparent in 6% of cases. Further exams has been performed in 94. 5% of cases with a profile in 52% of cases, enlarged in 22.1%, compression in 24.9% and ultrasound in 82.5%. The surveillance protocol was insufficient for 126 women lost to the 1st control, 32 women lost for the 2nd control and 19 women were lost to the 3rd control. After two years monitoring, 219 women were reclassified as ACR2 with a negative test. In 2 patients, we found an invasive ductal carcinoma at 4 months control.

CONCLUSION

ACR 3 mammograms are the most important operator dependent category. The diagnosis of probably benign lesion dependant of the analysis of images and requires a great experience of the radiologist and a comprehensive complementary examination. In this study, this assessment was often heavy in relation to the frequency of dense breasts itself in connection with the young age of patients. In addition, for this particular category, the need of training is important and in terms of public health cost, the management of ACR3 mammograms increases difficulties and cost of screening.

[Radiological protocol of large scale mammographic screeening for breast cancer in Ariana area of Tunisia]

We present the radiological protocol of the breast cancer screening program of Ariana state in Tunisia. Specifications of this protocol are largely inspired from the french model adapted to the socioeconomic Tunisian conditions. We explain the guidelines of the mammograph specifications, quality insurance of all the process, mammography procedure, double reading, complementary views and ultrasound indications and final results management.

[Retrospective results of ultrasonographically-guided biopsy the breast cancer screening program of the Ariana area of Tunisia]

OBJECTIVE

To report the results of breast ultrasonographically-guided fine needle aspirations and needle biopsies within the breast cancer screening program of L'Ariana state in Tunisia.

MATERIAL AND METHODS

Our retrospective study include 143 patients, with mammographically detected lesions, which underwent a diagnostic percutanous ultrasonographically guided procedures. 57 patients underwent a fine needle aspiration, 25 underwent a needle biopsy and 61 patients underwent both procedures.

RESULTS

Sensitivity and specificity of fine needle aspiration are of 84.2% and 98.5%. We report 13.5% of non contributive results. The needle biopsy have a sensitivity of 97.3% and a specificity of 100% with one false negative corresponding to an atypical ductal hyperplasia at the excisional biopsy.

CONCLUSION

Fine needle aspiration is a reliable method of accurately establishing a diagnosis. Needle biopsy is recommended for a preoperative lesion characterisation before adequate treatment.

[MRI of knee tuberculous arthritis]

Tuberculous arthritis is rare and the diagnosis may be confused with inflammatory arthritis. Only few cases, explored by MRI, have been reported in the literature. We report 3 cases of tuberculous arthritis of the knee revealed by insidious pain. The abnormalities revealed by MRI suggested tuberculosis. Diagnosis was confirmed by histology.

[Ectopic thyroid]

PURPOSE OF STUDY

Ectopic thyroid is defined as thyroid tissue not located anterolaterally between the second and the fourth tracheal cartilage. This anomalous localization results from abnormal embryologic development and/or migration of the gland. The purpose of this study is to demonstrate the role of imaging in the preoperative evaluation of ectopic thyroid.

MATERIAL AND METHODS

A 13-year-old girl with no other significant medical history, consulted for dysphonia, fullness in the throat and breathing difficulties. Examination of the oral cavity and oropharynx showed a large mass attached to the base of the tongue, the mass was evaluated by ultrasanography, computed tomography, magnetic resonance imaging and scintigraphy.

RESULTS

Ultrasound sonography showed a well-defined hypoechogenic mass in the posterior end of the tongue. Scintigraphy showed hyperfixation at the base of the tongue with no fixation in the normal thyroid site. Computed tomography scan revealed a spontaneously hyperdense spherical basilingual mass with a high enhancement after contrast injection. In MRI, the mass was isointense with the muscle in T1-weighted images and hyperintense in T2 weighted images.

CONCLUSION

Ectopic thyroid must be evoked in the presence of any basilangual mass. Scintigraphy and ultrasanography are gold standard in demonstration the ectopic thyroid tissue. But computed tomography and MRI playing an increasingly important role in the diagnosis, in determination of the malignant transformation and planning the surgical approach.

Aspect en IRM du neuro-behcet

PURPOSE

Describe the patterns and location of lesions seen on MR imaging in neuro-Behçet's disease.

OBSERVATIONS

33 patients with neuro-Behçet's disease (mean age: 27 years) imaged by MRI were reviewed. Most common neurologic symptoms included headaches and pyramidal signs. MRI examinations (Siemens Magnetom Impact 1 Tesla) included the following sequences: T1wi, T2wi, Flair, MPR-3D and MRA sequences.

RESULTS

Parenchymal lesions were identified in 21 patients. Brainstem, internal capsule, cerebral white matter, basal ganglia were involved respectively in 14, 10, 7, and 5 cases. Vascular thrombosis (venous: n=7; arterial: n=1) were observed in eight. MRI was normal in four patients.

CONCLUSION

This study shows the value of MR imaging for the exploration of parenchymal lesions of neuro-Behçet's and confirms the frequency of brainstem involvement.

[Eagle's syndrome]

OBJECTIVES

Elongated styloid process also known as Eagle's syndrome is an entity that may be the source of craniofacial and cervical pain. It is frequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of oropharyngeal and maxillofacial diseases. From four observations of Eagle's syndrome, we recall the clinical and radiological findings of this affection.

MATERIAL AND METHODS

Retrospective analysis of four patients examined during a 2-year period. These patients presented cervical pain associated with headache, vertigo, otalgia and dysphagia. All patients were explored by conventional radiographs and three-dimensional computer tomography reconstruction.

RESULTS

Digital palpation of the fossa reproduced and exacerbated the pain. Neck radiographic examination showed a bilateral elongation of the styloid process in both cases. The cervical scanner showed a bilateral elongation of the styloid process in all cases.

CONCLUSION

Eagle's syndrome is a frequent entity that remains vaguely known by physicians. Three-dimensional computer tomography is useful for the diagnosis of this entity.

[Transverse fracture of the sacrum: value of imaging. A case report]

Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.

L’imagerie dans la mucormycose rhinocérébrale

PURPOSE

Rhinocerebal mucormycosis is a rare life threatening fungal infection observed in immunocompromised patients. We report six cases of patients with rhinocerebral mucormycosis confirmed histologically. Our study confirms the necessity of early diagnosis when clinical and CT findings are suggestive.

MATERIALS AND METHODS

This is a retrospective study including 6 diabetic patients (3 women and 3 men) aged from 28 and 63 years. Five patients had ethmoiditis evolving for a few days (3 to 5 days), and one patient was in an ketoacidotic coma and had a severe infectious syndrome with purulent rhinorrhea evolving for 4 days. All of our patients underwent computed tomography (CT) scan of the paranasal sinuses. MRI was performed in two patients with neurological findings.

RESULTS

Unilateral ethmoido-maxillary sinusitis was noted in 5 cases. Only one case of pansinusitis was found. All patients presented orbital involvement. Cerebral involvement was noted in 4 cases (cerebral venous thrombosis: 2 cases; abscess: 2 cases; cerebral ischemia: 2 cases). The diagnosis of mucormycosis was based on endonasal biopsy. When available, MRI allowed a more precise evaluation of the orbital and cerebral extension.

CONCLUSION

Mucormycosis is an opportunist mycosis due to mucoralis fungus. It is very invasive with a highly aggressive potential in diabetic or immunocompromised patients. Imaging study particularly CT scan, plays an important role in diagnosis especially to evaluate cerebral extension.

[Double location of breast and spine tuberculosis. A case report]

We describe the case of a 38-year-old woman with breast tuberculosis associated with a second localization in the lumber spine. These features simulated breast cancer with vertebral metastasis. Clinical and imaging findings are described herein.

[Abdominal polyarteritis nodosa: angiographic features]

PURPOSE

Polyarteritis nodosa (PAN) is a systemic vasculitis of small and medium size arteries. The purpose of this study is to evaluate imaging findings, especially angiographic features, of 17 patients with abdominal involvement from polyarteritis nodosa.

PATIENTS AND METHODS

We reviewed the medical records and imaging findings of 17 patients with PAN involving the abdomen. All patients underwent digital subtraction angiography of the renal or visceral arteries completed by a post-angiographic KUB. Abdominal CT scan was available in three patients. All patients underwent muscle biopsy. A surgical biopsy of the gallbladder was obtained in one patient.

RESULTS

Multiple small aneurysms involving small and medium sized arteries were detected at angiography in 12 patients. CT showed a renal subcapsular hematoma in two patients and acute pancreatitis in one patient.

CONCLUSION

Involvement of gastrointestinal and renal arteries is frequent in polyarteritis nodosa. The diagnosis of PAN should be considered when multiple small-sized aneurysms are present at angiography even if biopsy is negative.

[MRI in the diagnosis of Rathke's cleft cyst]

PURPOSE

Rathke's cleft cysts are non neoplastic lesions of the sellar area that seldom are symptomatic. Their incidence has been underestimated before magnetic resonance imaging (MRI). The aim of this work was to assess the value of MRI in the diagnosis and differential diagnosis of Rathke's cleft cyst based on a retrospective review of 12 cases and a review of the literature.

PATIENTS AND METHODS

We retrospectively reviewed the MRI features of 12 patients with Rathke's cleft cyst collected over 4.5 years. Patients included ten females and two males (mean age: 39 years). The most common presentation was the association of dysmenorrhea and pituitary dysfunction. MRI examinations were performed using a 1.5 Tesla system, T1 and T2 weighted sequences performed before and after Gd- DTPA injection. Signal intensity, shape, size and location of the lesion were analyzed.

RESULTS

In all cases, MRI examination showed a cystic lesion of variable size and signal intensity. The cyst was purely intrasellar in nine cases and a suprasellar extension was noted in three cases. Five patients underwent surgery providing pathological confirmation, four underwent routine follow-up and three were lost of follow-up.

CONCLUSION

We conclude that MRI is an efficient tool for diagnosis, allowing appropriate medical decision making.

[MRI of cerebral cortical dysgenesis]

PURPOSE

Cortical cerebral dysgenesis is a heterogeneous disorder of cortical development and organization. It is well known by neuropathologists and is becoming more important in the clinical setting, mainly due to MRI. Our purpose is to report the MRI features of cortical dysplasia in 30 patients and to propose a simple classification with review of the literature.

PATIENTS AND METHODS

It is a retrospective study of the MRI features of 30 cases of cortical dysgenesis. All patients were evaluated by electroencephalography and brain MRI using T1 and T2 weighted, inversion recovery T1 weighted, FLAIR and MPR 3D sequences with multiplanar reformations.

RESULTS

Twenty-nine patients were referred to the neurology department because of refractory epilepsy and one patient for mental retardation. Our patients were distributed in 4 groups: diffuse forms represented by agyria-pachygyria (4 cases), polymicrogyria (one case), and nodular heterotopias (5 cases), local bilateral forms represented by bilateral polymicrogyria (11 cases), unilateral forms represented by hemi-megalencephaly (one case), and focal cortical forms found in eight cases.

CONCLUSION

Neuroblast migration disorders are better known, mainly due to high resolution MRI techniques that by the quality of multiplanar study and a better differentiation between gray and white matter, allow a more precise diagnosis.

[Value of imaging in GAPO syndrome]

GAPO syndrome is a rare genetic disorder. The term GAPO is the acronym for the manifestations: Growth retardation, Alopecia, Pseudoanodontia and Optic atrophy. We report the case of a 12 year-old boy with GAPO syndrome. Physical examination was remarkable for: dilated scalp veins with two flaccid masses of the vertex and the right mastoid area that was pulsatile with an audible bruit. Brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and cerebral angiography showed very prominent cortical veins, hypoplasia of the left transverse sinus, agenesis of the left jugular vein and left sigmoid sinus with 2 enlarged emissary veins underlying the palpable scalp masses. We suggest that brain MRI and MRA should be performed in patients with GAPO syndrome to detect anomalies of the intracranial venous circulation.

[Carotid body tumors: contribution of the various imaging techniques. A report of six cases]

INTRODUCTION

Carotid body tumors are rare hypervascular lesions arising from neural crest paraganglion cells.

MATERIALS AND METHODS

We retrospectively analyzed the imaging features of six patients with carotid body tumors to precise their imaging characteristics in order to find specific signs and elaborate a strategy for diagnosis.

RESULTS

Imaging features detect the vascular nature of these tumors of the carotid space causing characteristic widening of the carotid bifurcation. Two patients had multiple (two or more) localizations and one had a family history of glomus tumor.

CONCLUSION

MRI with MRA is considered as the gold standard imaging technique for the evaluation of glomus tumors as it allows a multiplanar approach which is important in the preoperative study.

[Pelvic ganglioneuroma. Case report]

Ganglioneuroma is a neurogenic tumor originating from autonomic ganglia. It most commonly occurs in patients younger than 20 years with a slight predominance of females. The pelvic localization is rare. Imaging can lead to diagnosis but it is not specific. The diagnosis can only be confirmed by the pathologic study. The authors report one case of pelvic ganglioneuroma diagnosed in an 11-year-old child who also had hypertension and renal failure.

[Diabetic fibrous mastopathy]

Diabetic fibrous mastopathy was first described in 1984. This mastopathy usually occurs in patients with autoimmune disorders and often occurs in patients with insulin-dependent diabetes. Little is known about this benign condition. Clinically and radiologically, this entity may simulate malignancy. The presence of an underlying auto-immune disorder or diabetes may suggest the correct diagnosis. The authors report two cases of fibrous mastopathy and suggest that core biopsy could replace surgical biopsy for diagnosis.

[MRI symptomatology of non-tumoral myelopathies]

We present a retrospective study in order to analyze the abnormalities noted on MRI in 27 cases of myelopathy excluding tumors, explored between 1994 and 1996. The different lesions were: Multiple Sclerosis (n = 11), Spondylotic myelopathy (n = 3), Neurosarcoidosis (n = 4), CMV Myelitis (n = 1), Radiation Myelopathy (n = 1), Spinal Dural Arteriovenous Fistula (n = 1), Intramedullary Cysticercosis (n = 1), Infarct (n = 5). The exams have been made on 1.5 Tesla Magnetom Vision Siemens or GE Signa machine. All patients have had axial and sagittal views with coronal complementary study in 4 cases. Sequences were Spin echo pT1 (TR: 560, TE: 12), Fast Spin echo pT2 (TR: 3 500, TE: 99 or 128), and gradient echo pT2 (TR: 700, TE: 22, Angle: 25 degrees). Intravenous injection of Gadolinium has been made in 16 cases (0.1 mmol/kg). We have studied the presence or not of a signal abnormality in pT1 and/or in pT2, of enhancement, and its topography (cervical, thoracic, lumbar). We classified lesions in central and/or peripheral and according, to their topography in anterior, posterior or lateral type. The form has been classified in four types (nodular, triangular, "pen like", plage). Extension in transversal (superior or inferior to half medullary surface) and cranio-caudal directions (inferior to one vertebrae, between one and two vertebrae, superior to two vertebrae) has been also classified. Others intra or perimedullar and encephalic abnormalities have been noted. We analyzed the results for each pathology and underline the essential diagnosis criteria noted (low cranio-caudal and transversal extension with frequent triangular form of Multiple Sclerosis lesions, frequent suggestive abnormalities of the encephale (82%) in Multiple Sclerosis, intra and perimedullar enhancement with deformations of the surface of the spinal cord in Sarcoidosis' lesions, extended dorsolumbar "pen like" lesions with inconstant enhancement of infarcts, focal plage lesions centered on degenerative changes of the spinal canal in spondylotic myelopathy, bony lipomatous involution in front of intramedullary radiation plage lesion...) and also review the literature and confront their results to it. We insist on the difficulties in classifying myelopathy (radio-clinical terminology discordances, identical signal abnormalities frequently caused by different illness, necessity to compare to pathologic results). We propose a MRI study protocol that should interest the whole spinal cord and comport T1 weighted without and after gadolinium sequences, T2 weighted sequences (with always a gradient echo type). 2 or better 3 different plans should be made. A complementary study of the brain by MRI is often useful. Clinical study, biology, evolution, MRI and when possible pathology all are necessary to better understand myelopathy's mechanisms.