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Clinicians use brain magnetic resonance imaging (MRI) to discuss neurodevelopmental prognosis with parents of neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH).To investigate how clinicians and parents discuss these MRI results in the context of HIE and TH and how these discussions could be facilitated and more meaningful for parents.Mixed-methods surveys with open-ended and closed-ended questions were completed by two independent groups. (1) Clinicians responded to clinical vignettes of neonates with HIE treated with TH with various types of clinical features, evolution and extent of brain injury and questions about how they discuss brain MRI results in this context. (2) Parents of children with HIE treated with TH responded to questions about the discussion of MRI that they had while still in the neonatal intensive care unit and were asked to place it in perspective with the outcomes of their child when he/she reached at least 2 years of age. Open-ended responses were analyzed using a thematic analysis approach. Closed-ended responses are presented descriptively.Clinicians reported uncertainty, lack of confidence, and limitations when discussing brain MRI results in the context of HIE and TH. Brain MRI results were "usually" (53%) used in the prognostication discussion. When dealing with day-2 brain MRIs performed during TH, most clinicians (40%) assumed that the results of these early MRIs were only "sometimes" accurate and only used them "sometimes" (33%) to discuss prognosis; a majority of them (66%) would "always" repeat imaging at a later time-point to discuss prognosis. Parents also struggled with this uncertainty, but did not discuss limitations of MRI as often. Parents raised the importance of the setting where the discussion took place and the importance to inform them as quickly as possible. Clinicians identified strategies to improve these discussions, including interdisciplinary approach, formal training, and standardized approach to report brain MRI. Parents highlighted the importance of communication skills, the stress, the hope surrounding their situation, and the need to receive answers as soon as possible. The importance of showing the pictures or making representative drawing of the injury, but also highlighting the not-injured brain, was also highlighted by parents.Discussing brain MRI results for neonates with HIE treated with TH are challenging tasks for clinicians and daunting moments for parents.

Local pleural anesthesia during percutaneous lung interventions is an important part of the procedure that has not been standardized in the literature. Significant pain can be experienced during lung biopsies, which may affect the outcome of intervention. We describe a step-by-step method of anesthesia targeting the most sensitive anatomical structure involved: the parietal pleura.

Among the various imaging modalities available, CT has remained over time the core imaging technique for the evaluation of respiratory disorders. The recent advent of dual-source CT offers innovative approaches to investigate thoracic diseases, based on the use of one or two tubes as well as single or dual energy to scan the entire thorax. Two major options can be used in clinical practice with promising results. Dual source, single-energy scanning allows scanning of the entire thorax with ultra-high temporal resolution which opens the field of integrated cardiothoracic imaging without ECG gating as well as optimized evaluation of pediatric and adult patients with limited ability to cooperate. Dual-source, dual-energy acquisitions represent another very innovative means of investigating respiratory disorders, adding tissue characterization and functional analysis to morphological evaluation. The purpose of this review article is to provide results on preliminary experiences with the above-mentioned scanning conditions with dual-source CT and to envisage potential forthcoming applications in the field of thoracic imaging.

Objectifs Definir le kilovoltage optimal pour l’etude angioscano-graphique des arteres pulmonaires peripheriques. Materiels et methodes La qualite image au niveau des arteres pulmonaires de 4e, 5e et 6e ordre a ete comparee a 80 kV et 140 kV chez chacun des 40 patients a circulation arterielle pulmonaire morphologiquement et fonctionnellement normale, ayant beneficie d’une angioscanographie double source en double energie (tube A : 140 kV ; 50 mAs ; tube B : 80 kV ; 330 mAs). Resultats Le niveau moyen du rehaussement densitometrique est significativement superieur a 80 kV par rapport a 140 kV au niveau des arteres de 4e (589,7 ± 170,4 UH vs 327,9 ± 89,9 UH), 5e (561,8 ± 152,8 UH vs 314,7 ± 81,7 UH) et 6e ordre (505,2 ± 137,7 UH vs 281,1 ± 81,8 UH) (p Conclusion L’angioscanographie a 80 kV ameliore significativement l’analysabilite des arteres pulmonaires peripheriques.

Objectifs Etudier la distribution de la perfusion pulmonaire chez les BPCO en fonction de l’etat du parenchyme pulmonaire. Materiels et methodes Trente-deux patients consecutifs (âge moyen : 54.4 ans ; consommation tabagique moyenne : 30 PA) ont ete explores en TDM double energie (tube A : 140 kV ; 50 mAs ; tube B : 80 kV ; 330 mAs ; injection de 120 mL de produit de contraste a 350 mg d’iode /mL) avec quantification lobaire automatique de la perfusion pulmonaire et des lesions d’emphyseme. Resultats En l’absence d’emphyseme (n = 9), il n’est pas observe de difference significative de perfusion entre les regions superieures et inferieures (poumon droit: 21,9 ± 3,3 % vs 22,3 ± 4,2 % ; p = 0,9) (poumon gauche: 24,4 ± 3,1 % vs 21,6 ± 2,5 % ; p = 0,20). En presence d’emphyseme (n = 23) : (a) il est observe une hypoperfusion des lobes superieurs par rapport aux lobes inferieurs chez tous les patients; (b) un gradient perfusionnel = 5 % est la valeur seuil permettant de separer les patients avec (n = 11) et sans (n = 12) differences significatives d’emphyseme entre les regions superieures et inferieures (poumon droit: p = 0,017; poumon gauche: p = 0,015). Conclusion La TDM double energie permet de demontrer des alterations perfusionnelles regionales chez les BPCO emphysemateux.

Objectifs Detailler les techniques actuelles permettant d’obtenir une imagerie morpho-fonctionnelle du thorax. Demontrer l’accessibilite de cette imagerie a toutes les categories de patients respiratoires. Synthetiser les moyens permettant d’obtenir cette imagerie a faible dose. Points cles L’imagerie cardiothoracique permet d’ameliorer l’imagerie morphologique du thorax, incluant les portions proximales et moyennes des arteres coronaires. L’imagerie cardiothoracique permet egalement d’obtenir des informations fonctionnelles objectives. L’imagerie cardiothoracique synchronisee a l’ECG n’est pas synonyme d’irradiation excessive. L’imagerie synchronisee a l’ECG est concurrencee par l’imagerie en ultra-haute resolution temporelle sans gating pour les explorations cardiothoraciques. Resume Le concept d’imagerie cardiothoracique integree a modifie l’approche TDM des maladies respiratoires, permettant d’inclure une imagerie morphologique sans artefacts cardiogeniques et une imagerie fonctionnelle a partir d’une seule et meme exploration du thorax. Cette orientation a initialement decoule de l’application au thorax d’une technologie developpee pour l’imagerie cardiaque exclusive, consistant a acquerir les donnees avec synchronisation a l’ECG. Le developpement des acquisitions en ultra-haute resolution temporelle est en passe de fournir des informations equivalentes, sans gating cardiaque et a faible dose.

Objectifs Comparer l’information diagnostique et la dose d’irradiation d’une exploration spiralee et sequentielle dans la surveillance de maladies diffuses et chroniques. Materiels et methodes Quarante-trois patients (âge moyen : 33,5 ans) ont beneficie d’un examen TDM spirale pour surveillance de mucoviscidose (n = 29) et maladie infiltrante diffuse (n = 14) avec adaptation du kilovoltage et milliamperage au poids du patient et modulation 4D du milliamperage. Pour chaque patient, l’information diagnostique et la dose d’irradiation de la TDM spiralee etaient comparees a celles d’une acquisition sequentielle virtuelle, basee sur l’analyse des coupes de 1 mm d’epaisseur tous les 10 mm de l’acquisition spiralee avec calcul automatique de la dose d’irradiation correspondante. Resultats Aucune difference n’etait observee entre TDM spiralee et sequentielle : (a) dans l’identification des lesions bronchiques et/ou pulmonaires ; (b) dans la distribution spatiale des lesions ; (c) permettant de conclure a une equivalence d’information diagnostique entre les deux series d’examens. L’irradiation delivree par l’examen sequentiel (DLP : 14,8 ± 8,4 mGy. cm) etait significativement plus faible que celle de l’examen spirale (DLP : 75,5 ± 42,8 mGy.cm) (p = 0,001). Conclusion L’importance de la reduction d’irradiation sans perte d’information diagnostique plaide pour le retour de la TDM sequentielle dans le suivi TDM des maladies diffuses et chroniques du sujet jeune.