La perspective d’une étude dynamique des artères des membres inférieurs en IRM grâce à la séquence ECTRICKS

PURPOSE

This article presents a new MR angiography technique, Elliptic Centric Time Resolved Imaging on Contrast KineticS (ECTRICKS), which allows dynamic evaluation of the lower limb arteries opacification when venous return prevents adequate diagnostic evaluation of calf arteries.

PATIENTS AND METHODS

Comparative examinations could be compared. Additional arteries in 59 patients using a standard MRA technique and the ECTRICKS technique.

RESULTS

A total of 33 examinations could be compared. Additional arteries could be evaluated in 10% of our patient population using the ECTRICKS technique, and in 20% for our diabetic population. Arterial evaluation was better with the ECTRICKS technique in patients with diabetes and venous insufficiency.

CONCLUSION

ECTRICKS is a good complementary sequence for evaluation the calf arteries in patients with diabetes or early venous return.

Le péritoine « témoin » de la pathologie abdomino-pelvienne

Most inflammatory, infectious or tumoral diseases of the bowel and abdominal organs may secondarily involve the peritoneum which acts as a mirror of the diseases. Multidetector CT allows breathhold acquisitions through the abdomen and pelvis providing high spatial and contrast resolution imaging at all phases of contrast distribution as well as MPR and 3D capabilities.

[Familial diffuse interstitial fibrosis of prolonged onset worsening during pregnancy]

INTRODUCTION

Familial idiopathic interstitial pulmonary fibrosis is rare. In this case report the diagnosis was confirmed histologically in four members of the same family.

CASE REPORT

A woman whose father and two paternal uncles had developed pulmonary fibrosis was hospitalised from birth on account of delayed growth and dyspnoea. At the age of one year an increase in dyspnoea and the development of hypoxaemia and diffuse interstitial shadowing led to a surgical lung biopsy. The histological diagnosis was idiopathic interstitial fibrosis. Immunosuppressive treatment for one year led to clinical improvement with relief of the hypoxaemia but persistence of the interstitial shadowing. A pneumothorax at the age of 15 required pleurectomy. The clinical state remained stable with a restrictive ventilatory defect up to the age of 26 when respiratory insufficiency developed in the course of pregnancy. The outcome following delivery was severe respiratory failure complicated by pulmonary arterial hypertension leading to death the following year.

CONCLUSIONS

This case is distinguished by a histological diagnosis in four members of a family of whom one was an infant, the prolonged stabilisation after immunosuppressive therapy and the possible role of pregnancy in the progression.

[Granulocyte sarcoma of the pancreas without extra-pancreatic location]

INTRODUCTION

Granulocyte sarcoma (GS), also known as chloroma, is a localized malignant tumor composed of myeloid cells, the diagnosis of which is difficult. The pancreatic location and recurrence, aside from any context of malignant hemopathy, are exceptional.

OBSERVATION

A 31-year-old woman developed an isolated and recurrent granulocyte sarcoma of the pancreas, without any context of a malignant hemopathy. The diagnosis retained on extemporaneous examination was an adenocarcinoma of the pancreas, because of the non-specific necrotic nature of the tumor. The immuno-histochemical exploration corrected the diagnosis. Despite local surgery, an isolated tumor recurred 6 months later. This relapse was treated with radiotherapy followed by heavy chemotherapy, identical to that applied in acute myeloblastic leukemia (AML). Ten months later, remission was stable and complete.

COMMENTS

Isolated granulocyte sarcomas located in the pancreas are exceptional and have often led to initial erroneous diagnosis. Immuno-histochemical methods are essential in order to obtain correct diagnosis. Despite the localized nature of the tumor, intensive AML-type chemotherapy is necessary.

[MRI of portal cavernoma with biliary involvement]

PURPOSE

To assess the value of MRI in the diagnosis of portal cavernoma with biliary obstruction.

MATERIAL

and methods: six patients referred for clinical suspicion of biliary obstruction and portal cavernoma were explored with MRI. all patients were explored using a signa 1.5 t GE MR unit, with high gradient field strength and torso phased array coil. Biliary ducts were explored with ss-fse sequences of MR-cholangiopancreatography (MRCP), coronal and oblique coronal 20mm thick slices. Then, coronal T2w with shorter TE eff, MR-angiography and delayed T1w sequences were performed. CT scan and sonographic examinations of the liver were performed in all patients. Two patients were operated on and 2 underwent endoscopic retrograde cholangiography.

RESULTS

Three different types of biliary involvement were found: in 3 cases findings that mimic cholangiocarcinoma spreading along the common bile duct and in 3 other cases multiple smooth extrinsic impressions along the common bile duct; in one patient MRCP demonstrated an irregular narrowing of the common bile duct mimicking chronic cholangitis. In all cases, the bile duct varices appeared of low T2W signal; in three cases, fibrosis was identified on delayed sequences.

CONCLUSION

MRCP and MR-angiography can be proposed as a first imaging study in patients with portal cavernoma and cholestasis or bile duct dilatation.

[Fibrous tissue(s): a key for lesion characterization in digestive diseases]

Fibrosis is one of the hallmarks of inflammatory and repair processes in pathology. Various exogenous and endogenous stimuli, including tumor development, can induce inflammatory reactions. During the post-equilibrium phase after IV injection of non specific contrast media, CT and/or MR allow the study of these inflammatory answers to tumoral or infectious processes. Delayed enhancement of collagenic fibrous tissue during the late post-equilibrium phase is an essential complementary data in the characterization of many liver lesions: cirrhosis, cholangiocarcinoma, focal nodular hyperplasia, fibrous metastasis. but also for the differential diagnosis of pancreatic diseases (groove pancreatitis vs ductal adenocarcinoma) or of gastro-intestinal diseases (gastric adenocarcinoma vs lymphoma, mechanical complication vs inflammatory bouts of ileal Crohn's disease).

[Pneumobilia and MRCP: value of sagittal view]

Pneumobilia can lead to artifacts at MRCP obtained from thick coronal and coronal oblique slabs. Axial and sagittal images can both show gas bubbles in bile ducts but sagittal images depict more easily the presence of an air-fluid level.

Dynamic MR imaging of bladder haemangioma

Haemangioma is a rare benign mesenchymal tumour of the bladder. We report a case of bladder haemangioma and describe the enhancement kinetics observed on MR images after gadolinium bolus administration, which is similar to that reported in liver haemangioma.

[Incremental lower extremity CT venography, a simplified approach for the diagnosis of phlebitis in patients with pulmonary embolism]

PURPOSE

To demonstrate that incremental CT venography, performed at the time of CT pulmonary angiography, can easily diagnose deep venous thrombosis. Materials and Methods. Retrospective analysis of 152 combined incremental CT venography and CT pulmonary angiography. Results were compared to Doppler US examinations in 18 cases.

RESULTS

61% of venous thrombosis was found on incremental CT examination in case of pulmonary embolism. In 5 cases, isolated venous thrombosis was found without pulmonary embolism. The CT diagnosis of DVT was confirmed by US; CT appeared more accurate than US in the calf.

CONCLUSION

CT venography combined with CT pulmonary angiography is a useful tool in order to obtain a comprehensive evaluation for thrombo-embolic disease.

[Imaging of the intrahepatic biliary tree with thick slice MR cholangiography]

PURPOSE

To assess the value of single shot fast spin echo MR sequence (SS-FSE) in the evaluation of the normal and pathologic intrahepatic biliary tree.

MATERIAL AND METHODS

418 consecutive patients (457 examinations) referred for clinical and/or biological suspicion of biliary obstruction underwent MR cholangiopancreatography (MRCP). All patients were imaged with a Signa 1.5 T GE MR unit, with High Gradient Field Strength and Torso Phased Array Coil. Biliary ducts were imaged with SS-FSE sequence, coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Total acquisition time was 1 second. Source images were reviewed by two radiologists blinded to clinical information. In case of disagreement, a third radiologist's opinion was requested. In all cases, MRCP results were compared with direct biliary tract evaluation, other imaging studies and clinical and biological follow-up.

RESULTS

In all cases, MRCP produced high quality images. Numerous branch of division were observed although the peripheral intrahepatic ducts were well seen in more than 90% in an area 2 cm below the capsule. The number of division was statistically higher when mechanical obstruction was present. Intrahepatic calculi or peripheral cholangiocarcinoma were well detect by MRCP. For the detection of cholangitis, MRCP sensitivity was 87.5% but the positive predictive value was only 57.7% because of a high number of false positive. The diagnosis of primary sclerosing cholangitis must be made only on strict criteria and slightly dilated peripheral bile ducts unconnected to the central ducts in several hepatic segments were a characteristic MR sign of primary sclerosing cholangitis.

CONCLUSION

MRCP can be proposed as a first intention imaging technique for the evaluation of intrahepatic ducts.