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Senechal Q, Echegut P, Bravetti M, Florin M, Jarboui L, Bouaboua M, Teriitehau C, Feignoux J, Legou F, Pessis E. Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale Follow-Up. Front Cardiovasc Med 2021; 8:751178. [PMID: 34869656 PMCID: PMC8635860 DOI: 10.3389/fcvm.2021.751178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose: To evaluate medium-term clinical outcomes of transcatheter embolization and stenting in women with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs. Materials and Methods: The study population included 327 consecutively recruited patients referred to the interventional radiology unit from January 2014 to December 2019 due to chronic pelvic congestion (91; 27.83%), lower limb varices (15; 4.59%), or a combination of both the symptoms (221; 67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (250; 78%), the right ovarian vein (85; 26%), the left internal iliac vein (222; 68%), and the right internal iliac vein (185; 57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients was suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx®). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May–Thurner syndrome angioplasty (14%) with a stent placement. Results: The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 288 (82%) patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre- to 2.0 (±2.4) postembolization (p < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 266/288 (92.36%) patients with improved quality of life in 276/288 (95.8%) patients. There were 16 minor and 4 major adverse events reported on the follow-up. Conclusion: Pelvic vein embolization (Onyx®) is an effective and safe procedure with high clinical success and quality of life improvement rates.
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Affiliation(s)
| | | | | | - Marie Florin
- Centre Cardiologique du Nord, Saint-Denis, France
| | | | | | | | | | | | - Eric Pessis
- Centre Cardiologique du Nord, Saint-Denis, France
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Do HH, Nguyen MD, Bui VG, Drapé JL, Pessis E, Henri G, Feydy A, Campagna R. Preoperative ultrasonography and magnetic resonance imaging evaluation of the position of the neurovascular bundle for Dupuytren's disease of the fifth digit. Clin Ter 2021; 172:322-328. [PMID: 34247215 DOI: 10.7417/ct.2021.2336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Dupuytren's contracture (DC) is a fibrosing disor-der that produces pathological subcutaneous nodules and cords in the normal fascia. The isolated occurrence of Dupuytren's disease of the fifth digit is uncommon. This study is aimed to describe the imaging features of an isolated digital cord of the small finger and its relationship with the neurovascular bundle. Methods A total of 13 hands in 13 patients who were clinically diagnosed with an isolated occurrence of Dupuytren's disease of the small finger were included between October 2008 and October 2013. Two independent radiologists used ultrasound and magnetic reso-nance imaging (MRI) to record size, signal or echogenicity, contrast enhancement or hyperemia, calcification, and anatomical features of the cord and its relationship with the neurovascular bundle. Results We found that ultrasound and MRI were accurate for the detection of the cords and neurovascular bundles in the small finger. The intermodality agreement between MRI and ultrasound was 100% for the detection of 6 spiraling bundles containing 13 isolated cords (46.2%). Among the subjects examined, 100% of the hands had ab-ductor digiti minimi (ADM) area involvement, and the distal insertion of the cord was on the ulnar side of the base of the middle phalanx. On MRI, all of the cords showed predominantly low signal intensity on both T1- and T2-weighted images. On ultrasound, the ulnar cord showed a hyperechoic or isoechoic appearance in 69.3% of hands and a hypoechoic appearance in 30.7% of hands. Conclusions The spiraling of the bundle in the isolated occurrence of Dupuytren's disease at the small finger is a frequent occurrence. MRI and ultrasound are good imaging modalities for the evaluation of the relationship between the neurovascular bundle and the isolated cord.
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Affiliation(s)
- H H Do
- Department of Radiology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - M D Nguyen
- Department of Radiology, Pham Ngoc Thach Uni-versity of Medicine, Ho Chi Minh City, Viet Nam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - V G Bui
- Department of Radiology, Vietnam National Cancer Hospital, Hanoi, Vietnam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - J L Drapé
- Department of Radiology B, Cochin Hospital, Paris, France
| | - E Pessis
- Department of Radiology B, Cochin Hospital, Paris, France
| | - G Henri
- Department of Radiology B, Cochin Hospital, Paris, France
| | - A Feydy
- Department of Radiology B, Cochin Hospital, Paris, France
| | - R Campagna
- Department of Radiology B, Cochin Hospital, Paris, Fran
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Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, André M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. Correction to: National dose reference levels in computed tomography–guided interventional procedures—a proposal. Eur Radiol 2020; 30:6384-6386. [DOI: 10.1007/s00330-020-06948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Greffier J, Ferretti G, Rousseau J, Andreani O, Alonso E, Rauch A, Gillet R, Le Roy J, Cabrol-Faivre L, Douane F, David A, Henry S, Jacques T, Stefanovic X, Decoux E, Lafay F, Pilleul F, Couzon F, Boutet C, Woerly B, Baur P, Sans N, Faruch M, Moussier-Lherm A, Tselikas L, Jacquier A, Bigand E, Pessis E, Teriitehau C, Magnier F, Cassagnes L, Haberlay M, Boutteau D, De Kerviler E, Majorel-Gouthain C, Defez D, Vuillod A, Rouviere O, Hennequin L, Fohlen A, Alwan R, Malakhia A, Aubry S, Dohan A, Eresue-Bony M, Gautier R, Dal R, Dabli D, Hebert T, Kovacs R, Hadid-Beurrier L, Bousson V, Potel M, Barbotteau Y, Michel C, Habib-Geryes B, André M, Arnaud T, Bestion N, Ernst O, Monfraix S, Brillet PY, Guiu B, Boussel L, Demonchy M, Beregi JP, Frandon J. National dose reference levels in computed tomography–guided interventional procedures—a proposal. Eur Radiol 2020; 30:5690-5701. [DOI: 10.1007/s00330-020-06903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
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Cholet C, Guerini H, Pessis E, Drapé JL, Campagna R. Ultrasound features of painful intraosseous migration of pectoralis major tendinous calcifications with follow-up. J Ultrasound 2019; 23:411-417. [PMID: 31228123 DOI: 10.1007/s40477-019-00395-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/14/2019] [Indexed: 11/26/2022] Open
Abstract
Calcific tendinitis is a common disorder in adults. Although rare, humerus involvement associated with pectoralis major tendon calcification migration has previously been reported in studies that focus on its CT and MRI appearance. We present four cases of intraosseous migration of pectoralis major tendon calcification and their ultrasound features. Calcification migration into osseous structures is associated with cortical erosions, intraosseous calcifications, and bone marrow edema. These findings may be misleading on MRI, where the significant bone marrow and surrounding tissue inflammation may raise concerns regarding neoplasia and lead to unnecessary invasive biopsy. In these cases, echography can be less alarming, enabling the identification of the calcification, its location in the pectoralis major tendon enthesis, and the continuity between the calcification and the typical cortical erosion. Ultrasound features may be diagnostic and might help avoid additional costly imaging studies or invasive biopsy.
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Affiliation(s)
- Clément Cholet
- Centre d'Imagerie de l'Orangerie, 10-12 rue de l'Orangerie, 94170, Le Perreux-sur-Marne, France.
| | - Henri Guerini
- Service de Radiologie B, AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Paris, France
| | - Eric Pessis
- Service de Radiologie B, AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Paris, France
| | - Jean-Luc Drapé
- Service de Radiologie B, AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Paris, France
| | - Raphaël Campagna
- Centre d'Imagerie de l'Orangerie, 10-12 rue de l'Orangerie, 94170, Le Perreux-sur-Marne, France
- Service de Radiologie B, AP-HP, Hôpitaux Universitaires Paris Centre, Groupe Hospitalier Cochin, Paris, France
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Pessis E, Sverzut JM, Campagna R, Guerini H, Feydy A, Drapé JL. Reduction of Metal Artifact with Dual-Energy CT: Virtual Monospectral Imaging with Fast Kilovoltage Switching and Metal Artifact Reduction Software. Semin Musculoskelet Radiol 2015; 19:446-55. [PMID: 26696083 DOI: 10.1055/s-0035-1569256] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Imaging of patients with metal implants is a common activity for radiologists, and overcoming metal artifacts during computed tomography (CT) is still a challenge. Virtual monochromatic spectral (VMS) imaging with dual-energy CT has been reported to reduce beam-hardening metal artifact effectively. Dual-energy CT allows the synthesis of VMS images. Monochromatic images depict how the imaged object would look if the X-ray source produced X-ray photons at only a single-energy level. For this reason, VMS imaging improve image quality by reducing beam-hardening artifacts. Additional metal artifact reduction postprocessing such as metal artifact reduction software can be applied to improve the visualization of the bone-prosthesis interface, periprosthetic areas, and soft tissue near and far from the metal implant. This article summarizes how virtual monochromatic images are synthesized from dual-energy CT, and it describes and illustrates our clinical experience with a single-source dual-energy scanner with fast kilovoltage switching to reduce beam hardening in patients with metal implants.
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Affiliation(s)
- Eric Pessis
- Department of Radiology, Centre Cardiologique du Nord, Saint Denis, France
| | | | - Raphaël Campagna
- Department of Radiology B, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Henri Guerini
- Department of Radiology B, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Antoine Feydy
- Department of Radiology B, Hôpital Cochin, Université Paris Descartes, Paris, France
| | - Jean-Luc Drapé
- Department of Radiology B, Hôpital Cochin, Université Paris Descartes, Paris, France
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Guerini H, Pluot E, Pessis E, Thevenin F, Campagna R, Feydy A, Gaudin P, Drapé J. Tears at the myotendinous junction of the infraspinatus: Ultrasound findings. Diagn Interv Imaging 2015; 96:349-56. [DOI: 10.1016/j.diii.2014.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pessis E, Campagna R, Sverzut JM, Bach F, Rodallec M, Guerini H, Feydy A, Drapé JL. Virtual Monochromatic Spectral Imaging with Fast Kilovoltage Switching: Reduction of Metal Artifacts at CT. Radiographics 2013; 33:573-83. [DOI: 10.1148/rg.332125124] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Campagna R, Pessis E, Biau DJ, Guerini H, Feydy A, Thevenin FS, Pluot E, Rousseau J, Drapé JL. Is Superolateral Hoffa Fat Pad Edema a Consequence of Impingement between Lateral Femoral Condyle and Patellar Ligament? Radiology 2012; 263:469-74. [DOI: 10.1148/radiol.12111066] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Guerini H, Pessis E, Theumann N, Le Quintrec JS, Campagna R, Chevrot A, Feydy A, Drapé JL. Sonographic appearance of trigger fingers. J Ultrasound Med 2008; 27:1407-1413. [PMID: 18809950 DOI: 10.7863/jum.2008.27.10.1407] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the sonographic appearance of the first annular (A1) pulley-flexor tendon complex in patients with trigger fingers. METHODS Thirty-three trigger fingers in 33 patients were examined with a 7- to 15-MHz probe. A control group consisted of 20 patients without trigger fingers. The study included systematic measurement of the thickness of the A1 pulley and a power Doppler assessment of the pulleys, tendons, and tendon sheaths. RESULTS Thickening and hypoechogenicity of the A1 pulley were found in all patients with trigger fingers. Measurements of A1 pulley thickness were significantly different (P < .0001) between the groups without trigger fingers (mean, 0.5 mm; range, 0.4-0.6 mm) and with trigger fingers (mean, 1.8 mm; range, 1.1-2.9 mm). Hypervascularization of the A1 pulley on power Doppler imaging was found in 91% of the trigger fingers but was never found in the healthy control group. Flexor tendinosis was found in 48% of the trigger fingers; tenosynovitis was found in 55%; and both were found in 39%. In the control group, tenosynovitis and tendinosis were not found. CONCLUSIONS Thickening and hyper-vascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis.
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Affiliation(s)
- Henri Guerini
- Department of Radiology B, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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Guerini H, Feydy A, Campagna R, Thèvenin F, Fermand M, Pessis E, Chevrot A, Drapé JL. [Harmonic sonography of rotator cuff tendons: are cleavage tears visible at last?]. ACTA ACUST UNITED AC 2008; 89:333-8. [PMID: 18408632 DOI: 10.1016/s0221-0363(08)93008-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE For some, cleavage tears remain a pitfall of sonography (US). The purpose of this study is to demonstrate the visibility of intratendinous tears of the supraspinatus and infraspinatus tendons and describe their imaging features on tissue harmonic US. MATERIALS AND METHODS Prospective study of 52 patients with suspected cuff pathology who underwent US prior to CT-arthrography, CT-bursography or MR arthrography. The US examinations were performed using 7-15 MHz transducers with tissue harmonic mode (pulse subtraction). An intratendinous tear was suggested by the presence of a hypoechoic intratendinous line, extending from a partial or full thickness tear. Results from US were correlated to contrast material enhanced CT or MR findings. RESULTS Ten cases of cleavage tears were detected on US compared to 18 on arthrographic examinations. False negative results occurred in poor US candidates (n=4), excessively retracted tendons (n=2) or postsurgical cuffs (n=2). Sensitivity was 55% and specificity was 94%, with PPV of 83% and NPV of 80% for the detection of intratendinous tear. The accuracy of US was lower for intratendinous tear associated with full thickness tears (5/11) compared to intratendinous tears associated with partial thickness tears (5/6). CONCLUSION We demonstrate that cleavage tears are now visible on US using high-frequency transducers and tissue harmonic mode. However, the sensitivity remains too low, especially in patients with full thickness tear, postsurgical patients and patients that are poor candidates to US.
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Affiliation(s)
- H Guerini
- Service de radiologie B, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
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Abstract
Wrist imaging is currently used for diagnosis of sport injuries as part of a global strategy of rapid recovery. Standard x-rays are the first step in this procedure. Although arthrography is still the reference for the diagnosis of intrinsic ligament and cartilaginous lesions, MRI can sometimes be sufficient. Ultrasonography is a dynamic process and is accurate in detecting tendon injuries. Wrist sport injuries are frequent and often asymptomatic. Here we review the usual aspects of bone, ligament, and tendon lesions encountered in each sport, while providing advice on the most appropriate imaging for each clinical symptom.
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Affiliation(s)
- H Guerini
- Service de Radiologie B, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014 Paris.
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Abstract
Peripheral nerve entrapment syndromes involve the compression of a short segment of a nerve at a specific site, as a result of the vulnerability of that nerve as it passes through a fibroosseous tunnel or an opening in fibrous or muscular tissue. Injury of the nerve may occur as a result of compression by the overlying structures. Another mechanism of injury is traction of the nerve, with or without friction of the nerve, as it travels and sharply changes direction around critical points. Imaging can be particularly helpful for the diagnosis of these uncommon injuries. Percutaneous decompression of a ganglion cyst or perineural injection for therapeutic purposes with the aid of fluoroscopy, CT, or ultrasound guidance can be performed in specific areas.
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Affiliation(s)
- E Pessis
- Service de Radiologie, Centre Cardiologique du Nord, 32, rue des Moulins Gémeaux, 93200 Saint-Denis.
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Abstract
OBJECTIVE The purpose of this study was to describe and evaluate a simple and safe procedure for direct arthrography of and steroid injection into the pisotriquetral joint. CONCLUSION Direct pisotriquetral arthrography using a medial approach is an effective and easy-to-perform technique for injection of steroids.
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Affiliation(s)
- Eric Pessis
- Department of Radiology, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint Denis 93200, France.
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Theumann NH, Pessis E, Lecompte M, Le Viet D, Valenti P, Chevrot A, Bittoun J, Schnyder P, Resnick D, Drapé JL. MR imaging of the metacarpophalangeal joints of the fingers: evaluation of 38 patients with chronic joint disability. Skeletal Radiol 2005; 34:210-6. [PMID: 15729562 DOI: 10.1007/s00256-004-0890-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 09/07/2004] [Accepted: 12/13/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To report the MR imaging findings of painful injured metacarpophalangeal (MCP) joints of the fingers. DESIGN AND PATIENTS MR imaging of 39 injured MCP joints in 38 patients was performed after a mean delay of 8.8 months. The MR images were obtained with the fingers in extended and flexed positions using T2-weighted and T1-weighted sequences before and after intravenous injection of a gadolinium compound. Ten patients were treated surgically. Mean clinical follow-up was 1.8 years. RESULTS Tears of the collateral ligaments were the most common lesion (30/39), most being radial in location. Contrast-enhanced axial T1-weighted images with the MCP joint in a flexed position showed these lesions optimally. Ten tears were partial and 20 were complete. In 13 patients, MR images showed 17 associated lesions including injuries of the extensor hood (10/17), interosseous tendon (3/17), palmar plate (3/17), and an osteochondral lesion (1/17). Sagittal MR images were essential to highlight palmar plate tears. CONCLUSION Partial or complete tears of the collateral ligaments are prevalent MR imaging findings in patients with chronic disability resulting from injuries to the MCP joints. Although conservative treatment generally is sufficient for isolated injuries of the collateral ligaments, surgical repair is often required in cases of more extensive injuries. MR imaging may clearly delineate associated lesions of and about the MCP joints.
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Affiliation(s)
- Nicolas H Theumann
- Service de Radiologie B, CHU Cochin, AP-HP-Université Paris V, and CIERM, Hôpital de Bicêtre, Paris, France.
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Abstract
The aim of the current study was to test a protocol of quantification of phalangeal three-dimensional (3D) rotations during flexion of three-joint digits. Three-dimensional-specific software was developed to analyze CT reconstruction images. A protocol was carried out with six fresh-frozen upper limbs from human cadavers free from any visible pathology (three females, three males). CT millimetric slices were done for reconstruction of hand bone units. Orthonormal coordinate systems of inertia were calculated for each unit. Three-dimensional phalangeal rotations were estimated between two static positions (fingers in extension and in a fist position). Results were displayed for the joints of each three-joint finger with calculation of 3D rotations. Mean longitudinal axial rotations of metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints ranged from 14 degrees pronation to 19 degrees supination. The index finger was in a global pronation position (4/6 specimens). The fourth and fifth fingers were in a global supination position in every case. The third finger was in a more variable global rotation (pronation in 2/6 specimens). MCP, PIP and DIP flexion angles ranged respectively from 71 degrees to 89 degrees, 65 degrees to 87 degrees, and 41degrees to 77 degrees. Lateral angles ranged from 19 degrees (ulnar angulation) to 23 degrees (radial angulation). The study of phalangeal rotations was possible in spite of a heavy protocol. This protocol could be partially automatated to speed up the analyses. Longitudinal axial rotations could be analyzed, in addition to flexion/extension or abduction/adduction rotations. CT scan reconstructions would be helpful for investigating pathological fingers. Abnormal rotations of digits could be quantified more precisely than during a current clinical examination of the hand.
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Affiliation(s)
- R Degeorges
- Laboratoire de Biomécanique, Ecole Nationale Supérieure des Arts et Métiers (ENSAM), CNRS, 75013 Paris, France.
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Pessis E, Drapé JL, Ravaud P, Chevrot A, Dougados M, Ayral X. Assessment of progression in knee osteoarthritis: results of a 1 year study comparing arthroscopy and MRI. Osteoarthritis Cartilage 2003; 11:361-9. [PMID: 12744942 DOI: 10.1016/s1063-4584(03)00049-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objectives of this study were to determine the sensitivity to change of magnetic resonance imaging (MRI) quantification of chondropathy after 1 year in osteoarthritis of the medial tibiofemoral compartment and to assess the predictive value of subchondral bone marrow edema and bone abnormalities on progression of chondropathy. DESIGN Twenty patients with symptomatic knee osteoarthritis of the medial compartment underwent a prospective, longitudinal study. All patients were evaluated the same day at entry and after 1 year by plain weight-bearing radiographs, MRI with a three-dimensional gradient-echo sequence, using a 0.2-T dedicated MR unit, and arthroscopy. The medial tibiofemoral chondropathy was quantified blindly with MRI and arthroscopy using the French Society of Arthroscopy (SFA) score. Presence of subchondral bone marrow edema and bone abnormalities on initial MRI was recorded in order to evaluate their influence on both unchanged and worsened chondropathy after 1 year. RESULTS After 1 year, no statistically significant changes were observed with plain radiographs and arthroscopy. At variance, a statistically significant worsening of chondropathy was found with MRI using the SFA-MR score (P=0.01). SFA-MR score was the most responsive outcome. Absence of subchondral bone abnormalities and bone marrow edema on initial MR assessment predicted absence of worsening of chondropathy after 1 year. CONCLUSION MRI appears promising for evaluating progression of knee osteoarthritis.
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Affiliation(s)
- E Pessis
- Department of Radiology B, Hôpital Cochin-27, AP-HP, Université Paris V, rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France.
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Kamate C, Baloul S, Grootenboer S, Pessis E, Chevrot A, Tulliez M, Marchiol C, Viguier M, Fradelizi D. Inflammation and cancer, the mastocytoma P815 tumor model revisited: triggering of macrophage activation in vivo with pro-tumorigenic consequences. Int J Cancer 2002; 100:571-9. [PMID: 12124807 DOI: 10.1002/ijc.10519] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Subcutaneous in vivo injections of cells of the mastocytoma line P815 in syngenic DBA/2 mice induce locally fast growing solid tumors. These have been used extensively as a cancer model to analyze and manipulate the relationship between tumor cells and host's immune defenses. We report that progression of P815 tumors in vivo was accompanied by a burst (Days 5-7) of local inflammatory cells recruitment and angiogenesis observed histologically, corroborated in vivo by MRI with gadolinium, overtranscription of macrophage activation marker genes, secretion of TNF-alpha by regional lymph node cells and concomitant systemic inflammation. No substantial overtranscriptions of either VEGF or IL-10 or TGF-beta genes were observed. Induction of COX-2 gene was a late event. To establish a possible relationship between the tumor-induced local, regional and systemic increase of pro-inflammatory mediators and progression of tumors in vivo, we carried out experiments deliberately modulating the inflammatory status of the recipient animals. Pretreatment of recipient animals by i.p. injection of thioglycolate accelerated P815 tumor growth. At the opposite, treatment of mice with either a COX-1 + COX-2 inhibitor (aspirin, 1 mg/day/mouse) or a specific COX-2 inhibitor (celecoxib, 0.13 mg/day/mouse) for 2 weeks after injection of tumor cells, significantly reduced the size and growth rate of tumors compared to control mice. Experiments carried out in vitro indicated that peritoneal macrophages from untreated animals were strongly activated by live P815 cells and by P815 membrane preparations. The tumor-induced inflammatory reaction could establish a local micro environment favoring tumor progression. The P815 tumor model might be helpful to recognize important factors controlling host/tumor relationship.
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Affiliation(s)
- Caroline Kamate
- Département d'Immunologie, Institut Cochin, INSERM-CNRS-Université Paris V, Hôpital Cochin, Paris, France
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Hilliquin P, Pessis E, Coste section sign J, Mauget D, Azria A, Chevrot A, Menkès CJ, Kahan A. Quantitative assessment of joint space width with an electronic caliper. Osteoarthritis Cartilage 2002; 10:542-6. [PMID: 12127834 DOI: 10.1053/joca.2002.0809] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED The progression of joint space narrowing (JSN) is considered to be the best available marker of osteoarthritis (OA) progression. Several techniques have been proposed for the measurement of joint space at its narrowest point in OA of the hips and knees. OBJECTIVE To evaluate the properties of the technique using an electronic caliper for the measurement of JSN in OA patients. DESIGN We used an electronic caliper to measure joint space width (JSW) for hips on 100 plain radiographs. JSW was measured in the vertical position at the center of the femoral head. Femoral head diameter was also determined to correct for variations due to differences in magnification of digitized X-rays. All films were read twice by each of two rheumatologists (one junior, one senior) and two radiologists (one junior, one senior). Intraclass correlation coefficients and their 95% confidence intervals were calculated. RESULTS Detailed results are given for right hips (38 with OA, 18 inflammatory, 44 normal); very similar results were obtained for left hips. For JSW, the intraclass correlation coefficient was between 0.96 and 0.99 for intraobserver reliability. The level of reliability was similar for analysis of the diameter of the femoral head (R:0.84 to 0.98) and for the ratio of these two measurements (0.96 to 0.99). The most reliable measurements were those made by the senior radiologist, followed by those made by the two rheumatologists. In assessments of interobserver reliability for the measurement of JSW, R varied from 0.91 to 0.96 for the first reading and from 0.88 to 0.96 for the second reading. For the measurement of femoral head diameter, R varied from 0.86 to 0.96 for the first reading and from 0.74 to 0.96 for the second reading. CONCLUSION The electronic caliper technique is an accurate method for measuring JSW in the hip. This technique seems to be reproducible, is simple, and could be used for routine evaluation. Further validation is required, with the measurement of serial X-rays from the same patients.
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Affiliation(s)
- P Hilliquin
- Service de Rhumatologie, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.
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Chevrot A, Chevrot AL, Drape J, Godefroy D, Chevrot A, Dupont AM, Gires F, Chemla N, Pessis E, Sarazin L, Minoui A. Image-Guided Spinal Steroid Injections. Semin Musculoskelet Radiol 2001; 1:221-230. [PMID: 11387070 DOI: 10.1055/s-2008-1080142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper has been written to stimulate the radiologist to consider the various aspects of spinal steroid injections as therapeutic procedures. Special emphasis is placed on needle guidance, asepsis, and possible problems involved. It constitutes a highly practical and variously illustrated and informative guide for the choice of steroids and various spinal joint approaches. It details the following target areas: lumbar facet joints, cervical facet joints, costovertebral joints, C1-C2 joint, intervertebral discs, epidural space, and interspinous bursa. Safety is the key element of the above-mentioned techniques. The radiologist must pay special attention to the omnipresent risk of iatrogenic infection.
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Affiliation(s)
- A. Chevrot
- Service de Radiologie B, Hopital Cochin, Paris, France
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Pessis E, Chevrot A, Drapé JL, Leveque C, Sarazin L, Minoui A, Le Blevec G, Chemla N, Dupont AM, Godefroy D. Study of the joint space of the hip on supine and weight-bearing digital radiographs. Clin Radiol 1999; 54:528-32. [PMID: 10484220 DOI: 10.1016/s0009-9260(99)90850-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM To compare hip joint space on supine and weight-bearing anteroposterior digital radiographs. MATERIALS AND METHODS Fifty anteroposterior views of the hip in 25 patients were taken in supine and weight-bearing positions on a fluoroscopic unit. Two observers in a double-blind study assessed the width of the joint space on an Easy Vision unit with an indirect method of measurement (metric index). RESULTS Inter-observer and intra-observer variabilities of the metric index were less than 4.1%. There was no significant difference of the metric index of the hip (P>0.05), between supine and weight-bearing positions. CONCLUSION There is no significant difference of the width of the joint space of the hip between supine and weight-bearing anteroposterior radiographs. Measuring joint space loss in osteoarthritis of the hip with anteroposterior views should be done with radiographs of the hip in the supine position to improve image quality.
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Affiliation(s)
- E Pessis
- Department of Radiology B, Hôpital Cochin, Paris, France
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22
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Dupin N, Rubin De Cervens V, Gorin I, Calvez V, Pessis E, Grandadam M, Rabian C, Viard JP, Huraux JM, Escande JP. The influence of highly active antiretroviral therapy on AIDS-associated Kaposi's sarcoma. Br J Dermatol 1999; 140:875-81. [PMID: 10354025 DOI: 10.1046/j.1365-2133.1999.02818.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To assess the clinical and biological benefit of highly active antiretroviral therapy on AIDS-associated Kaposi's sarcoma (KS), 13 patients with AIDS-associated Kaposi's sarcoma (five pulmonary KS and eight cutaneous KS) were prospectively followed for a mean duration of 12 months. Six patients were treated with specific anti-KS chemotherapy before or simultaneously with the introduction of antiretroviral therapy. Clinical response was assessed according to the AIDS Clinical Trial Group (ACTG) criteria. CD4 cell counts, plasma HIV-1 RNA and human herpesvirus 8 (HHV-8) viraemia were measured at baseline and at different points. Among patients with pulmonary KS, we observed three complete responses (CR), one partial response (PR) and one progression. The median survival time after the diagnosis of pulmonary KS was 15 months with a median duration of the response after the discontinuation of specific chemotherapy for KS of 8 months. Among patients with cutaneous KS, we observed four CR, three PR and one stable response. A complete response was significantly associated with a reversal in HHV-8 viraemia (five of six vs. one of six; P = 0.02, Mann-Whitney test).
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Affiliation(s)
- N Dupin
- Service de Dermato-Vénéréologie, Hôpital Tarnier-Cochin, Paris, France; Laboratoire de Virologie, Groupe Hospitalier Pitié-Salpétrière, Paris, France.
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Abstract
Lumbar facet joint (LFJ) arthrography with intraarticular injections of long-acting steroids and local anesthetics is routinely used for therapeutic purposes in selected patients for relief of low back pain. The procedure may also be used for diagnostic reasons to establish the source of such pain. However, because direct access to the LFJ space is not always possible owing to degenerative changes such as osteophytes, another posterior approach has been proposed for LFJ arthrography. With the patient in the prone position, a spinal needle is inserted vertically into the inferior recess of an LFJ with fluoroscopic guidance and the patient under local anesthesia. To facilitate puncture, cushions are placed under the patient's abdomen to flatten normal lumbar lordosis, which enlarges the inferior recess of the LFJ. Use of cushions also results in a decrease in tissue thickness in the patient, thereby improving image quality and decreasing radiation exposure. LFJ arthrography can demonstrate the causative role of facet disease in abnormalities responsible for low back pain or sciatica and can be performed easily and rapidly with this direct posterior approach.
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Affiliation(s)
- L Sarazin
- Department of Radiology, Hôpital Cochin, Paris, France
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Abstract
PURPOSE To determine the validity and the reliability of T1-weighted three-dimensional gradient-echo magnetic resonance (MR) imaging for quantification of articular cartilage abnormalities of osteoarthritic knees. MATERIALS AND METHODS Forty-three patients (mean age, 63 years) with knee osteoarthritis (American College of Rheumatology criteria) of the medial tibiofemoral compartment underwent a prospective, cross-sectional study. Knees were examined with a T1-weighted three-dimensional gradient-echo sequence (1.4-mm contiguous sections), with use of a 0.2-T dedicated MR unit, before arthroscopic exploration. The tibiofemoral articular cartilage abnormalities were quantified blindly on both the MR and arthroscopic images with the French Society of Arthroscopy (SFA) score (0-100) and grading scheme (five grades). RESULTS There was a statistically significant correlation between the SFA-arthroscopic score and the SFA-MR score (r = .83) and between the SFA-arthroscopic grade and the SFA-MR grade (weighted kappa = 0.84). The deepest cartilage lesions graded with arthroscopy and MR imaging showed correlation in the medial femoral condyle (weighted kappa = 0.83) and in the medial tibial plateau (weighted kappa = 0.84). The intraobserver reliability of the SFA-MR score was higher (r = .94) than the interobserver reliability (r = .80). CONCLUSION Quantification of chondropathy with MR imaging is feasible and well correlated with anatomic cartilage breakdown.
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Affiliation(s)
- J L Drapé
- Department of Radiology, Hôpital Cochin, Paris, France
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Feydy A, Drapé J, Beret E, Sarazin L, Pessis E, Minoui A, Chevrot A. Longitudinal stress fractures of the tibia: comparative study of CT and MR imaging. Eur Radiol 1998; 8:598-602. [PMID: 9569330 DOI: 10.1007/s003300050442] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to compare the performance of CT and MRI in the diagnosis of longitudinal stress fracture of the tibia (LSFT). A retrospective study of imaging findings was performed in 15 patients with LSFT. The CT and MR images were compared for detection of fracture line, callus, bone marrow edema, and soft tissues changes. The CT and MRI techniques allowed the detection of the fracture line in 82 and 73 % of cases, respectively. The callus was always visualized with CT or MRI. The MRI technique had a markedly higher sensitivity than CT in the detection of bone marrow edema (73 vs 18 %) and soft tissue lesions (87 vs 9 %). This may cause a misleading aggressive appearance on MRI. Computed tomography remains the best imaging modality for diagnosis of LSFT. However, MRI findings should be known to obviate the performance of CT or bone biopsy.
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Affiliation(s)
- A Feydy
- Service de Radiologie B, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, F-75 679 Paris Cedex 14, France
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Drapé JL, Pessis E, Sarazin L, Minoui A, Godefroy D, Chevrot A. [MRI and articular cartilage]. J Radiol 1998; 79:391-402. [PMID: 9757267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although plain films are fundamental for routine imaging of degenerative chondral lesions, MRI is a promising tool of investigation for the articular cartilage. Its modalities are still imprecise and debated, but, because of its noninvasiveness, it is destined to be preferred over arthroCT. The small size of the cartilage requires thin slices of less than 3-mm thick. The various features of normal cartilage images must be well known. They depend on acquisition parameters, zonal structure of the cartilage and numerous artifacts (partial volume average, chemical shift, magnetic susceptibility, truncation, "magic angle"). Fast SE images provide a good compromise between contrast and the signal-to-noise ratio. T2-weighted images take advantage of an arthrographic effect in case of joint effusion. 3D GE images allow a more accurate evaluation with 1-mm thick slices. In all sequences, adding of a fat-suppression presaturation increases contrast between the cartilage and the surrounding structures. The diagnostic accuracies of the different sequences and of MR arthrography are discussed. Quantitative measurements of cartilage thickness and volume remain the topic of clinical research.
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Affiliation(s)
- J L Drapé
- Service de Radiologie B, Hôpital Cochin, Paris
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27
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Affiliation(s)
- G de Pinieux
- Groupe Hospitalier Cochin, Port-Royal, Paris, France
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Chevrot A, Drapé JL, Godefroy D, Dupont AM, Pessis E, Sarazin L, Minoui A. [Imaging]. Rev Prat 1997; 47:20-4. [PMID: 9035538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The panoply of imaging techniques useful in podology is essentially limited to X-rays. Standard "standing" and "lying" X-rays furnish most of the required information. Arthrography is sometimes performed, in particular for trauma or tumour of the ankle. CT scan and MRI make a decisive contribution in difficult cases, notably in fractures and in small fractures without displacement. The two latter techniques are useful in tendon, ligament and muscular disorders, where echography is also informative. Rigorous analysis of radiographies and a good knowledge of foot disorders make these imaging techniques efficacious.
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Affiliation(s)
- A Chevrot
- Service de radiologie B Hôpital Cochin, Paris
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