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Background: The prognosis of Sezary syndrome (SS) and mycosis fungoides (MF) depends on lymph node (LN) involvement. The usefulness of LN image-guided core-needle biopsies (CNBs), instead of surgical sampling, has been poorly evaluated. Objectives: To determine the prognostic value of LN CNB in MF/SS. Methods: A retrospective search was conducted to identify all LN biopsy specimens of MF/SS between 2008 and 2019. Biopsies were staged according to the International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer (ISCL/EORTC) criteria. We performed immunolabelling and determined the tumour clone frequency (TCF) by high-throughput sequencing of the T-cell receptor beta locus. Results: We included 119 consecutive biopsies from 100 patients, 45 with MF and 55 with SS. N1, N2 and N3 stages were diagnosed in 34 (29%), 26 (22%) and 59 (49%) cases, respectively. The TCF, Ki67 index, and percentage of cells positive for thymocyte selection-associated high mobility group box protein (TOX), programmed cell death protein 1 (PD1), killer cell immunoglobulin-like receptor 3DL2 (KIR3DL2) and cluster of differentiation (CD)30 were all positively correlated with the N stage. Median overall survival (OS) for N1/N2 vs. N3 patients was 42 months (range 26–not reached) vs. 14 months (range 5–30), respectively (p 75 years, LN short-axis diameter >15 mm, N3 stage, presence of large-cell transformation, TOX >60%, PD1 >25%, Ki67 >30%, KIR3DL2 >15%, CD30 >10% and TCF >25% were identified as adverse prognostic factors. In multivariate analyses, only an age >75 years and Ki67 index >30% were associated with reduced OS. We developed a new prognostic index associating the N stage and the Ki67 index, which better discriminates N3 patients with poor prognosis. Conclusions: CNB allows an objective assessment of the LN involvement in MF/SS, relevant for staging and prognosis.

Objectives Environmental contamination by patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through respiratory droplets suggests that surfaces and equipment could be a medium of transmission. We aimed to assess the surface and equipment contamination by SARS-COV-2 of an emergency department (ED) during the coronavirus infectious disease-2019 (COVID-19) outbreak. Methods We performed multiple samples from different sites in ED patients care and non-patient care areas with sterile premoistened swabs and used real-time reverse transcriptase polymerase chain reaction (RT-PCR) to detect the presence of SARS-CoV-2 ribonucleic acid (RNA). We also sampled the personal protective equipment (PPE) from health care workers (HCWs). Results Among the 192 total samples, 10 (5.2%) were positive. In patient care areas, 5/46 (10.9%) of the surfaces directly in contact with COVID-19 patients revealed the presence of SARS-CoV-2 RNA, and 4/56 (7.1%) of the surfaces that were not directly in contact with COVID-19 patients were positive. SARS-CoV-2 RNA was present only in the patients’ examination and monitoring rooms. Before decontamination SARS-CoV-2 RNA was present on the saturation clip, the scuff for blood pressure measurement, the stretcher, the plastic screens between patients and the floor. After decontamination, SARS-CoV-2 RNA remained on the scuff, the stretcher and the trolleys. All samples from non-patient care areas or staff working rooms were negative. Only one sample from the PPE of the HCWs was positive. Conclusions Our findings suggest that surfaces and equipment contamination by SARS-CoV-2 RNA in an ED during the COVID-19 outbreak is low and concerns exclusively patients’ examination and monitoring rooms, preserving non-patient care areas.

Purpose The purpose of this study was to determine the efficacy of salvage cryotherapy for intra-prostatic and local extraprostatic recurrences after curative treatment of prostate adenocarcinoma. Material and method Twenty-eight men (mean age, 69 ± 6 [SD] years; range: 51–82 years) treated with cryoablation for prostatic (N = 21) or extraprostatic (N = 7) recurrent prostate cancer after radiotherapy with or without associated prostatectomy were included. Technical success, complication and recurrences were reported. Biological recurrence was defined as an elevation ≥ 2 ng/mL of prostate specific antigen (PSA) serum level after the treatment. Results The mean follow-up was 18 months. Among the 21 patients with intraprostatic recurrence, 14 had successful cryotherapy with a mean decrease in serum prostate-specific antigen (PSA) levels of − 5.7 ± 2.6 (SD) ng/mL (range: − 2.1 to − 16.9 ng/mL). Four patients (19%) had early progression and three patients (14%) had delayed biological recurrence (mean time: 15 months). Among the 7 patients with extraprostatic recurrence, 2/7 (291%) had successful cryotherapy with a decrease in PSA serum level of − 2.7 ± 1.6 (SD) ng/mL (range: − 0.5–− 5.5 ng/mL) and 4/7 (57%) had early biological recurrence after cryotherapy that required androgen deprivation therapy, whereas 1/7 (4%) was lost to follow-up. No major complications were observed for both intra- and extraprostatic recurrence. Conclusion Salvage cryoablation of locally recurrent prostate cancer after curative treatment is feasible and safe when the half prostate is treated. It could delay initiation of androgen deprivation therapy in these patients.

For lymph node (LN) pathological analyses, whole excision has long been recommended for detection of lymphoma, although complications such as infection, hypertrophic scar, lymphorrhoea and lymphoedema may occur1. For the patients, surgical LN excision requires general anesthesia during a surgery stay, with high cost for public health insurance, for private health insurance, and out of pocket. The development of percutaneous image-guided core-needle biopsy (CNB) to replace surgical LN excision has made short-time intervention using advanced medical technology a valuable opportunity. Image-guided CNB enables a precise selection of the biopsy site, based on the size and the depth of the abnormal LN, and imaging characteristics2. This article is protected by copyright. All rights reserved.

Initial histopathological analysis of a pulmonary lesion is mandatory whenever a lung cancer is suspected in order to determine the optimal diagnostic strategy. Adequate material must be obtained for a definite histological diagnosis (preferable to a cytological one) and in some cases (mainly in adenocarcinoma) molecular analysis. The two main methods to obtain adequate biopsy samples are flexible bronchoscopy and computed tomography (CT)-guided lung biopsy. Flexible bronchoscopy is a valuable method for proximal tumors. On the other hand, CT-guided lung biopsy is more accurate for peripheral tumors. CT-guided lung biopsy is a reliable procedure that conveys a 90% sensitivity for the diagnosis of lung cancer. When performed in a secured environment after contraindications evaluation, its severe complications rate is low, mainly consisting of pneumothorax requiring chest tube placement and hemoptysis.

Objectifs La strategie de prise en charge des oncocytomes reste heterogene de par la crainte d’une croissance tumorale alterant le parenchyme renal restant et de la meconnaissance d’une tumeur mixte. L’objectif de ce travail etait d’evaluer les strategies de prise en charge et l’evolution clinique et radiologique d’une cohorte d’oncocytomes biopsies. Methodes Nous avons revu retrospectivement tous les dossiers de biopsies renales realisees dans deux centres universitaires francais entre 2009 et 2019. Tous les cas d’oncocytomes identifies sur la biopsie renale ont ete extraits. Les donnees suivantes ont ete analysees : âge de la population, terrain genetique, taille de la tumeur sur imagerie et modalites de prise en charge de l’oncocytome. Resultats Cinquante-deux patients ont ete identifies, âge moyen au diagnostic 63 ans, dont un syndrome de Birt–Hogg–Dube. Au total, 18 patients ont ete traites d’emblee (12 par chirurgie partielle et 6 par traitement ablatif percutanee) et 34 n’ont pas eu de traitement actif immediat (25 surveilles et 9 abstentions therapeutiques). La croissance tumorale de l’oncocytome a pu etre evaluee en moyenne a 2 mm par an. La correspondance histologique des biopsies des oncocytomes par rapport a la piece definitive etait de 79 % (1 cellule claire grade 2 et 2 tumeurs hybrides retrouvees). Chez les 25 patients ayant eu une surveillance initiale 5 ont finalement subi un traitement actif (3 cryotherapies, 1 nephrectomie partielle et 1 nephrectomie elargie) motive a chaque fois par croissance tumorale (moyenne 5,2 mm/an). Conclusion Dans notre cohorte, la croissance tumorale etait faible et la surveillance le traitement de choix, cette attitude therapeutique etant adaptee en fonction de la croissance tumorale (plus de 5 mm par an dans notre cohorte) et du terrain particulier (âge jeune, forme familiale connue) faisant craindre une tumeur mixte.

Background Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator’s instruments, meaning the position and progression of the instruments are visualised in real time on the patient’s images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. Methods/design This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. Discussion This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. Trial registration ClinicalTrials.gov identifier: NCT01896219. Registered on 5 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2049-6) contains supplementary material, which is available to authorized users.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

The term “second look” lesions in MRI refers to lesions detected by MRI that were not initially seen on mammography or ultrasound. The objectives of our study were to analyse the displacement of targets between MRI and ultrasound; to define discriminating BIRADS morphological criteria to predict benign or malignant character and better establish the indications of second look ultrasound and biopsy; and to analyse the agreement between ultrasound and MRI in terms of morphological criteria. A retrospective and monocentric review was performed of the records of consecutive patients with breast abnormalities (mass or non-mass) initially detected by MRI that were not initially seen on mammography or ultrasound. All patients with abnormalities found during the performance of second look ultrasound and biopsied were included in the study. All lesions were documented using the BIRADS lexicon for MRI and ultrasound. Of 100 included patients, 108 lesions were detected by MRI, found via second look ultrasound and biopsied between January 2008 and 2010. All of the included patients were followed-up for a variable period, from 2 to 5 years. Eighty-two upon 108 biopsied lesions (76%) were benign and 26/108 lesions (24%) were malignant. This study confirmed the switch from procubitus to decubitus essentially displaces the tumour in the antero-posterior direction. It showed that the risk factors were not reliable criteria for establishing an indication for second look ultrasound. This study also showed that circumscribed contours and a progressive enhancement curve (type I) for masses on MRI had the strongest negative predictive value of greater than 0.85. In ultrasound, the round or oval shape, circumscribed contours and the parallel orientation to the skin favoured benignity with a NPV of greater than 0.85. For masses, the study showed that the agreement in interpretation of the benign versus suspicious morphological criteria between the MRI and the ultrasound was very weak for the shape (Kappa=0.09) and weak for the contours (Kappa=0.23). Finally, the MRI overestimated the size of the targets compared to ultrasound (Student t-test, p=0.0001). The performance of second look ultrasound has to be performed after the detection of an abdnormality on MRI even for lesion classified BIRADS 3. The biopsy indications must be wide with insertion of a clip and a control MRI. Only this control allows to stop the investigation if the biopsied lesion is benign.

Purpose Screening for cardiac iron overload is generally done by magnetic resonance imaging (MRI) and demonstrated by a shortening of the myocardial T2* below 20 ms at 1.5 Tesla. This measurement was validated with a specific sequence and the CMRTools ® calculation software (reference technique). The objective of this study was to validate the use of sequences and software programs that are available in routine clinical practice to screen for iron overload. Material and methods First, a phantom of 11 tubes with a T2* between 4 and 33 ms was tested at three sites that had MRI machines of different brands. Second, the myocardial T2* values of 75 patients were measured in routine clinical practice using two methods. The first method used the reference sequence specially installed in the machines associated with the CMRTool software. The second method used the standard acquisition sequences available in the machines followed by calculation on a computer spreadsheet. Results In the phantom, the mean of the differences in T2* between each machine was 0.6 ms. Thirteen patients had a lowered T2* value with the reference technique. Three cases were poorly classified using the routine technique and corresponded with false positives of low overload (T2* between 18 and 20 ms). Conclusion Screening for myocardial iron overload can be done by MRI by using sequences and calculation software available in routine clinical practice during the same examination as the one for the evaluation of hepatic iron overload.

CT-guided transparietal lung biopsy in imaging makes it possible to find the pathogenic agent in half of all fungal infections and most bacterial infections (sensitivity=55%, specificity=100%). Performance is decreased in consolidations (50% of infections) compared to masses. Complications, pneumothorax, alveolar bleeding and hemoptysis are generally benign and rarely (

Core needle biopsy is increasingly replacing excisional lymph node biopsy in the diagnosis and subclassification of malignant lymphomas, with obvious advantages in terms of morbidity and costs. This technique has radically altered the diagnostic strategy of enlarged lymph nodes at our institution, avoiding unnecessary nodal excisions. It represents a viable alternative as long as the number and size of cores for morphologic and molecular studies are not compromised. This quick and safe technique can be applied to the initial diagnostic evaluation of malignant lymphomas as well as the reassessment of previously diagnosed malignant lymphomas at time of progression or recurrence.

Objectifs En cas de recidive locale post-radiotherapie (RLPR), la place des traitements ablatifs comme la cryotherapie reste peu evaluee. L’objectif de cette etude etait de decrire les resultats operatoires et oncologiques a court terme de la cryotherapie en cas de RLPR. Methodes Tous les patients traites par cryotherapie prostatique totale ou focale pour une recidive locale apres radiotherapie ou curietherapie pour cancer de la prostate entre 2011 et 2016 dans un centre ont ete inclus retrospectivement. Toutes les RLPR ont ete confirmees par mesure du PSA, biopsies prostatiques, IRM et PET a la choline. L’evaluation etait clinicobiologique a M1, M3, M6 et 1 an. Les criteres de jugement de l’efficacite du traitement etaient le PSA, l’introduction d’une hormonotherapie et la progression clinique. Resultats Dix-neuf hommes de 70 ans en moyenne ont ete inclus : 16 (84,2 %) traite par radiotherapie, 3 (15,8 %) par curietherapie. Le delai moyen de prise en charge apres traitement initial etait de 93,83 mois. Le PSA median avant cryotherapie etait de 5,27 ng/mL. Le PSA median a 1, 3, 6, 12 mois post-cryotherapie etait respectivement de 2, 0,63, 1,24 et 2,32 ng/mL. La duree moyenne d’hospitalisation etait de 1,58 jours. Quatre patients (21 %) ont presente une complication Clavien 2 (RAU) lors de l’hospitalisation. A un an, il existait 3 complications tardives (16 %) (2 incontinences urinaires severes, 1 stenose uretrale). Quatre patients (21 %) presentaient des signes irritatifs invalidants a 1 an. Le taux de recidive biologique et d’evolution clinique a 1 an etait de 15,8 % (3 patients) et 26,3 % (5 patients), respectivement. Au total, 8 patients (42 %) ont ete mis sous hormonotherapie depuis la cryotherapie. Conclusion La cryotherapie prostatique est faisable, avec des resultats operatoires satisfaisants mais au prix d’un taux significatif de complications tardives. Le taux de complications semble inferieur pour les cryotherapies focales par rapport aux totales. Plus d’un patient sur deux n’ont pas presente de reprise evolutive a 1 an.

Objectifs La cryotherapie per cutanee pourrait etre une alternative therapeutique a la nephrectomie partielle qui est le traitement de reference des tumeurs renales de moins de 4 cm. L’objectif de cette etude etait de comparer les resultats oncologiques de la cryotherapie par rapport a la tumorectomie robot assistee pour le traitement des tumeurs renales de stade T1. Methodes Les patients traites par tumorectomie robot vs cryotherapie pour tumeur renale maligne dans 4 centres entre 2009 et 2016 ont ete inclus retrospectivement. Les deux groupes furent appareilles un pour un sur le stade tumoral radiologique et le score RENAL (package Matchit, R software version 3.2.2). Tous les patients du groupe cryo ont ete biopsies. Les caracteristiques des patients avant et apres match ainsi que les resultats oncologiques ont ete compares entre les deux groupes. Une regression de Cox ajustee sur l’âge, le type de traitement, le type histologique et les marges a ete conduite pour identifier les facteurs associes a la recidive locale. Les marges positives etaient definies histologiquement dans le groupe robot et radiologiquement dans le groupe cryo. Resultats Au total, 647 patients ont ete identifies, 470 robots et 177 cryo. Apres appariement, on ne retrouvait pas de difference significative entre les deux groupes (177 robot et 177 cryo) pour le stade tumoral, le score RENAL, la taille tumorale (27,6 vs 25,9, p = 0,07), et le sexe. L’âge des patients du groupe cryo restait significativement superieur (69,9 vs 59,8 ans, p p = 0,03). La survie sans recidive a 5 ans etait de 85 % dans le groupe cryo vs 95 % dans le groupe robot ( log rank p = 0,02, Fig. 1 ). En analyse multivariee, seule la presence de marges positives etait significativement associee a la recidive locale ( p Conclusion Le taux de recidive locale apres cryotherapie etait significativement plus eleve qu’apres tumorectomie robot pour tumeur renale de stade T1. La realisation d’un traitement incomplet etait le principal critere associe a la recidive. Le taux de recidive pourrait etre surestime dans le groupe cryo en raison d’un suivi radiologique plus strict.

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.

Background Diagnosis of melanoma metastasis is often based on a combination of clinical and radiological examinations in patients with a past history of melanoma. Chemotherapeutic treatment is often proposed without histological proof of the metastatic status. Objective The aim of this study was to investigate a cohort of melanoma patients with invasive diagnostic procedures (IDPs) for pathological confirmation of metastasis in case of suspicious visceral lesions. Methods A total of 109 melanoma patients with IDPs for suspicious visceral lesion(s) were included. Data about primary melanoma, IDPs characteristics, pathological result and therapeutic consequence were collected. Patients with AJCC Stage I–III melanoma at the time of the IDP were statistically analysed for various characteristics according to the final diagnosis yielded by the IDP. Results A total of 64 diagnostic surgical resections, 38 CT-guided core-needle biopsies, 15 ultrasound-guided core-needle biopsies, 6 surgical biopsies and 6 per-endoscopic biopsies were performed. Main target organs were the lungs (43.5%), breasts (8.5%) and liver (8%). IDPs were well tolerated and provided adequate samples for reliable diagnoses. Among the 105 IDPs in stage I–III patients, 56 melanoma metastases (53%), 25 benign lesions (24%) and 23 other cancers (22%) were found. One IDP was not informative. Multivariate analysis showed that nodular type of the primary melanoma, time-lag between primary melanoma and IDP over 12 months and the presence of suspicious lesions outside the organ biopsied were significantly associated with melanoma metastasis diagnosis. Conclusion Suspected melanoma metastasis was ruled out for benign lesion or second cancer in nearly half of the stage I–III patients having undergone an IDP, therefore modifying the medical treatment.

Background Data on factors influencing inclusion of Hodgkin's lymphoma (HL) patients in randomized clinical trials (RCT) are limited and, for the present study they were analyzed in a RCT for III/IV HL. Patients and methods All patients with stage III/IV HL referred to the Saint-Louis Hospital between January 2003 and May 2007 were studied. A Groupe d'Etudes des Lymphomes de l'Adulte/European Organisation for Research and Treatment of Cancer RCT, to compare ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) with increased-dose BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone), was open for recruitment. Noninclusion criteria and physician's reasons for non-recruitment were prospectively recorded. The reasons for patient's refusal were collected retrospectively. Logistic regression analyses were carried out in order to identify factors predicting inclusion. Results A total of 102 patients were diagnosed, among whom 51% were included. Seven patients were ineligible, 22 refused to participate, and 21 were not enrolled due to the physician's decision. Main reasons for patients’ refusal were standard treatment preference and concerns about experimental arm toxicity, mainly infertility risk. Conditions that could hamper accurate follow-up and toxicity concerns accounted for most of the physicians’ reasons. Adverse prognostic factors [B symptoms (odds ratio, OR = 5.35) and international prognostic score ≥3 (OR = 2.69)] were independently associated with inclusion. Conclusion Despite an attractive protocol, only 51% of patients were included. It highlights concerns about selection of patients and the difficulty to obtain informed consent with better prognostic profile patients.

Nocardiosis is an uncommon infection, which is exceptionally present as a postoperative event. A case of postoperative pulmonary and cerebro-meningeal infection caused by Nocardia otitidiscaviarum after a leg amputation in a diabetic patient is reported. Diagnosis has been delayed and the clinical, radiological and microbiological causes of this delay are assessed from a quality of care management point of view. Recommendations are proposed regarding physicians' role and optimized microbiological procedures for recognition of slowly growing nocardial strains.

Resume Les lymphomes de l'appareil urogenital sont des tumeurs rares dont le diagnostic est important car ils relevent d'un traitement medical specialise. Les localisations les plus frequentes sont le rein (nodule unique ou multiple) et le testicule, les autres etant exceptionnelles. L'important est d'avoir un diagnostic immunohistologique precis qui, associe a un bilan d'extension, permet de guider les options therapeutiques. Celles-ci reposent le plus souvent sur de la chimiotherapie (associee a une immunotherapie dans les lymphomes B) dont l'intensite et le nombre de cycles dependent des facteurs pronostiques initiaux.

It is now accepted that MR imaging does not present any biological risk for humans, even in cases of repeated exposure. However, several of the MR components (magnetic field, gradients, RF pulses, electrodes...) may cause some inconveniences to patients, most of them being reversible. However, severe accidents have been reported. Even though screening of patients for MR imaging eligibility is performed to identify patients with contra-indications to MRI, the lack of vigilance or the ignorance of certain basic safety requirements could lead to serious adverse effects, including death. The goal of this article is to review the various accidents reported with MRI, to explain their mechanism, and to describe means of prevention.

There are several imaging techniques, each with advantages and limitations. Standard or computed radiography is always useful. CT diagnosis of an enlarged lymph node is easy but it is very difficult to conclude about its reactive or metastatic nature: subtle signs can help. MRI has similar pitfalls but sometimes it may be possible to identify fibrotic scarred nodes. US with Doppler can evaluate the abnormal angioarchitecture of a metastatic lymph node. Sentinel lymph nodes are easily identified by nuclear medicine. CT-PET provides morphologic and metabolic information which increases the diagnostic accuracy. Imaging work-up strategies for selected malignancies are discussed.

OBJECTIVE: To investigate the effect of an exercise training program on lipid profile in correlation with DHEA level and body weight and body composition in type 2 diabetic men. DESIGN: Longitudinal, controlled clinical intervention study with exercise training consisting of an 8 week supervised program of aerobic exercise (75% VO2 peak, 45 min), twice a week and intermittent exercise, once a week, on a bicyle ergometer. SUBJECTS: Sixteen men (age 45.4±7.2 y (mean±s.d.), HbA1c 8.15±1.7%, body mass index (BMI) 29.6±4.6 kg/m2) were randomly divided into two groups: trained group (n=8) and control group (n=8). MEASUREMENTS: Lipid, apo- and lipoprotein and DHEA concentrations. Cross-sectional areas of subcutaneous and visceral adipose tissue and mid-thigh muscle by magnetic resonance imaging. RESULTS: Training decreased visceral (153.25±38.55 vs 84.20±21.30 cm2, P

Although central nervous system involvement in disseminated aspergillosis is known to occur in immunocompromised patients, particularly after bone marrow transplantation, localized involvement of the spinal cord is exceedingly rare. In this report we present and illustrate detailed imaging findings of central nervous system invasion by Aspergillus fumigatus in a 30-year-old woman, with emphasis on the spinal cord involvement.

Primary malignant melanoma of the esophagus is a rare but aggressive tumor that accounts for less than 0.1-0.2% of all esophageal malignancies. The aim of this study was to report a case of primary malignant melanoma of the esophagus in a 72-year-old woman. The diagnosis was histologically proven, but the patient died despite extensive surgical resection.

Disorders of the choroid plexus, a central nervous system structure, are rare, but can pose diagnostic difficulties. The purpose of this review is to illustrate the computed tomography and magnetic resonance imaging findings of a wide spectrum of lesions that affect the choroid plexus. The areas covered include (1) neoplasms (papilloma, leukaemia, meningioma, lymphoma and metastases); (2) infections (bacterial, fungal and viral); (3) cysts; (4) haemorrhage; (5) congenital abnormalities (Sturge-Weber syndrome, Klippel-Trenaunay-Weber syndrome and vascular malformations); and (6) non-infectious inflammatory disorders (xanthogranulomas, inflammatory pseudotumour, neurosarcoidosis, rheumatoid nodule and villous hypertrophy). Few of the patterns of choroid plexus involvement are specific for a particular pathological process.Guermazi, A. (2000) Clinical Radiology 55, 503–516.

Resume But de l'etude : Le but de ce travail est de presenter une synthese des differents progres realises dans le domaine des ponctions abdominales guidees par scanner. Ces ameliorations permettent d'augmenter la rentabilite des ponctions et de diminuer le nombre de complications. Les principales ameliorations concernent les techniques de guidage avec en particulier l'apparition de scanners ultra-rapides, les systemes de biopsies automatiques qui permettent d'augmenter la taille des prelevements et d'ameliorer leur qualite, et les nombreux artifices techniques permettant un acces plus facile de la lesion a biopsier, en mobilisant le patient et/ou en deplacant certaines structures anatomiques. De plus, une meilleure prise en charge des prelevements effectues passe par une etroite collaboration avec l'anatomopathologiste. Cette etude se termine par une synthese des complications des biopsies guidees par scanner, qui sont rarement observees.

BackgroundIn patients with lymphoma, tissue for histology can be obtained through image-guided techniques or by surgery. The aim of this study was to assess the efficacy of surgical endoscopic techniques in obtaining adequate tissue specimens.MethodsNinety-two patients with suspected or confirmed lymphoma were referred for a surgical biopsy of a deeply located intrathoracic or intra-abdominal mass or lymph node. The 86 patients who had surgery using a surgical endoscopic technique were included in this study. There were 54 men and 32 women, of mean age 34 (range 15–78) years. Most were selected directly for surgery while five previously had a failed computed tomography-guided biopsy. A total of 89 procedures were performed in 86 patients: laparoscopy (15 patients), thoracoscopy (61) and mediastinoscopy (13).ResultsNo patient died. One intraoperative complication occurred during thoracoscopy (1 per cent). Two postoperative complications were noted (2 per cent). Three patients required conversion to open surgery (3 per cent). Adequate tissue for histology was obtained by surgical endoscopic procedures in 87 per cent. Twelve of 13 mediastinoscopies were successful. After thoracoscopy, the success rate was 92 per cent but only nine of 15 laparoscopies were considered successful.ConclusionIn patients with lymphoma, surgical endoscopic techniques have a high diagnostic yield and a low morbidity rate. Barring exceptional circumstances these should be favoured rather than conventional open surgery.

New contrast agents are being developed by drug companies to better image the liver magnetic resonance imaging (MRI). They can be divided into hepatobiliary agents (Gd-EOB-DTPA, Gd-BOPTA, Mangafodipir) and nanoparticulate agents directed to the reticulo-endothelial system (ferumoxides, SHU 555A). After intravenous injection, all these agents concentrate in the liver and induce profound signal changes. Particulate agents induce predominantly a darkening of the liver parenchyma, while hepatobiliary agents induce a brightening. In both cases, liver-lesion conspicuity is enhanced, leading to a better visualization of the lesion. After a description of the principal pharmacokinetic characteristics of the compounds, this review paper summarizes the utility of the agents in the detection and characterization of focal liver diseases.

SummaryMore and more pulmonary nodules are currently approached via thoracoscopy. We have evaluated the results and the morbidity of a consecutive series of 120 patients operated on by a single surgeon. Patients and methods. One hundred and twenty-two nodules have been resected in 120 patients. The average size of these nodules was 16 mm (3–30 mm). A pre-operative localization technique was used in 61 patients (50%). The procedures were as follows: biopsy (6 cases), wedge-resection (110 cases). A video-assisted lobectomy was performed in 26 cases. Results. The mortality rate was 0.8% (one case of ARDS in the post-operative course of a video-assisted lobectomy). Intra-operative morbidity rate was 1.6% (2 cases of haemorrhage requiring a thoracotomy) and the postoperative morbidity rate was 5%. Six procedures were converted to thoracotomy (5%). The nodules were localized in all cases but 2 (1.6%). The mean post-operative stay was 4.6 days in the whole series and 3.2 days in the series of patients with a sim...

Microcirculation imaging in breast cancer involves studying tissue enhancement after contrast injection, which is used to calculate perfusion and permeability. The magnitude of enhancement reflects blood and interstitial volumes. This technique has benefitted from advances in MRI, which allow large volumes to be acquired with a good compromise between temporal and spatial resolution. Software has also advanced enabling microcirculation maps to be calculated and heterogeneity to be analyzed. If permeability is increased and interstitial volume is reduced, the microcirculation imaging suggests a suspicious aggressive lesion and can be used for early assessment of neoadjuvant therapies by demonstrating restoration of normal functional indices, which precede morphological changes.

The aim of the study was to determine the role of pre-operative magnetic resonance imaging (MRI), with and without contrast enhancement, in patients with penile carcinoma. Nine patients with a penile cancer were studied. The staging of the tumours was performed by clinical examination, MRI and surgery, according to the TNM classification. Six patients had primary tumours, of clinical stage T1 (n = 1) and T2 (n = 5). Three other patients had been previously treated and presented with a local recurrence of clinical stage T2. Surface-coil MRI was performed at 0.5 T with T1 weighted sequences before and after gadolinium-DOTA, and T2 weighted sequences. MRI results were compared with the clinical and surgical findings. T1 weighted sequences did not clearly demonstrate the margins of the tumours. T2 weighted sequences were the more useful in five patients, whereas contrast enhanced T1 weighted sequences allowed better delineation of the lesions in only three patients. Therefore, an imaging protocol should include spin echo T2 weighted sequences. Clinical examination correctly staged six of nine tumours; MRI, seven of nine tumours and the combination of both examinations, eight of nine tumours. MRI provided good evaluation of tumoral invasion into the penile shaft.

Most metabolic myopathies (like glycogenoses and mitochondrial myopathies) are related to inborn errors of muscle energy metabolism and often present clinically as exercise intolerance (inability to sustain normal exercise). We investigated whether the previously observed absence of normal exercise-induced variation in the T2 of muscle in McArdle's disease (a metabolic myopathy caused by muscle phosphorylase deficiency) was specific for this disease and whether the variations in T2 could be used for screening patients suspected of having metabolic myopathy.Exercise-induced variations in proton MR signal and in intracellular pH were studied in the forearm flexor muscles of nine healthy subjects and 49 patients with exercise intolerance due to muscle pain, suggesting a metabolic myopathy. The relative increase in T2, delta T2/T2, was measured from MR spin-echo images before and after exercise. Phosphocreatine (used as a control of the degree of exercise) and intracellular pH were measured from phosphorus-31 spectra before and during exercise. The progressive 4.5-min handgrip exercise reached maximal exertion capability at the end of exercise and decreased phosphocreatine to less than 50% of its rest value.Variations in T2 and end-exercise pH were correlated. The nine healthy subjects showed a delta T2/T2 ranging from +19% to +44% (but little T1 variation). Ten patients with McArdle's disease showed only slight delta T2/T2 (0-10%). There was no overlap with values for healthy subjects, but there was some with values for other patients. Of the 21 subjects with a delta T2/T2 less than 19%, 19 had a metabolic myopathy. The other two had a congenital neuromuscular disorder (one central core disease, one nemaline myopathy) with type I fiber predominance (type I muscle fibers are characterized by a high oxidative metabolism and a low lactic acid production).The altered increase in T2 was sensitive but not specific for McArdle's disease. However, as variations in T2 reflect variations in pH, they seem to be specific for myopathies in which there is little exercise-induced decrease in pH (some metabolic myopathies and congenital neuromuscular disorders with type I fiber predominance) among patients in whom exercise intolerance is the main symptom. Our results suggest that MR imaging might be useful as a screening test for these diseases.

BACKGROUND AND PURPOSE: Lack of cerebral circulation is an important confirmatory test for brain death (BD). Conventional angiography remains the standard imaging method, but CT angiography (CTA) is emerging as an alternative. France accepts BD diagnoses relying on a score based on lack of opacification of 7 intracerebral vessels in CTA images. The purpose of this study was to validate the efficiency of this score and to evaluate the sensitivity of a novel 4-point CTA score in confirming BD. MATERIALS AND METHODS: A prospective multicentric study was conducted during 12 months with 105 patients referred for CTA to confirm a clinical diagnosis of BD. Clinical data were recorded. CTA images were interpreted first by local radiologists at the referent center, resulting in a 7-point score based on lack of opacification of the pericallosal and cortical segments of the middle cerebral arteries (MCAs), internal cerebral veins (ICVs), and 1 great cerebral vein per patient and, second, by a consensus panel of 3 expert radiologists, blinded to the initial scores, resulting in novel 4-point scores based on the lack of opacification of the cortical segments of the MCAs and ICVs. RESULTS: Injection of contrast medium did not alter renal function. With the initial 7-point score, sensitivity was 62.8%. With the simplified 4-point score, sensitivity was 85.7% and specificity was 100%. Opacification of ICVs was absent in 98.1% of patients. CONCLUSIONS: Lack of opacification in the cortical segments of the MCAs and internal veins in CTA is efficient and reliable for confirming BD.

Renal cell carcinoma in a renal graft is a rare condition whose incidence will increase in the future. To our knowledge no standardized treatment has been established for this disease. We performed a prospective study of nephron sparing surgery for small renal cell carcinoma in renal grafts.From January 2002 to December 2006, 2,050 renal graft recipients were followed at our transplantation center. Of these patients 7 were diagnosed with histologically confirmed renal cell carcinoma in the renal graft, 5 of whom presented with T1a renal cell carcinoma and prospectively underwent nephron sparing surgery.Five patients with 15 to 30 mm (median 20) renal cell carcinoma were included in the study and were treated with nephron sparing surgery. Median operative time was 110 minutes (range 60 to 150). Blood loss was less than 200 ml in each case. All tumors were pT1aN0M0 with negative margins. No postoperative complications were observed (hemorrhage, urinary fistulas, renal failure). Preoperative immunosuppressive treatment was not modified postoperatively. At 3 months after nephron sparing surgery and at a mean of 17.4 months of followup (range 5 to 54) no significant impairment of renal function or recurrence was observed.Nephron sparing surgery is a safe and efficient procedure for the treatment of renal cell carcinoma in renal grafts, resulting in the preservation of renal function and in short-term cancer control.

We report a case of variceal changes of the azygos vein, hemiazygos vein, and paraesophageal collaterals presenting as bilateral posterior mediastinal masses in a patient with long-standing portal hypertension due to hepatosplenic schistosomiasis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. Dynamic CT allowed the diagnosis in demonstrating the vascular nature of these masses, which enhanced to the same degree as the other vessels. Noninvasive techniques, such as color Doppler sonography and MRI, may also be useful due to their multiplanar capabilities.

Arthroscopic knee surgery is a widely performed and relatively safe technique with few complications. We report a case of a young girl with a previously undescribed complication of arthroscopy consisting of the association of deep venous thrombosis and concomitant pseudoaneurysm of the popliteal artery.

The broad category of non-Hodgkin's lymphoma includes a large variety of different diseases including indolent as well as aggressive lymphomas. Mucosa-associated lymphoid tissue (MALT) lymphoma arises in the extranodal mucosal lymphoid tissue and has only been recognised as a distinct entity in recent years. It affects one or several extranodal structures such as the stomach, the lung, the eye and salivary glands. The lymphoma is generally of low grade and has indolent course. The aim of this article is to exemplify the most common radiological patterns of MALT lymphoma.

Fanconi's anaemia is a severe refractory anaemia, associated with congenital malformations in approximately two-thirds of cases. Although these malformations may involve every organ system, suggestive dysmorphic features include growth retardation, radial ray deformities and urinary malformations. These malformations are not specific for Fanconi's anaemia, but should be recognized during pregnancy, or later in childhood, and suggest the possibility of inherited haematopoiesis disorders.

The purpose of this review is to illustrate the wide range of radiological abnormalities in myelofibrosis. Myelofibrosis, also called myeloid metaplasia, is a myeloproliferative disorder of unknown etiology. The common imaging findings in patients with myelofibrosis are osteosclerosis, hepatosplenomegaly, and lymphadenopathies. In addition, extramedullary hematopoiesis may develop in multiple sites such as chest, abdomen, pelvis, and central nervous system, simulating malignant disease. Selected plain-film, CT, and MR images in patients with myelofibrosis are shown as pictorial essay to allow ready recognition of the most common imaging abnormalities of the disease.

Our purpose is to report our clinical experience with patients who underwent endovascular treatment with Wallstents for subacute or chronic benign obstruction of the superior vena cava (SVC).Twelve patients who were an average of 54 +/- 12 years old were referred for treatment of severe SVC syndrome related to implanted central venous catheters (n = 8), postradiation fibrosis (n = 2), a permanent pacemaker (n = 1), or a benign tumor (n = 1). Symptoms were present for an average of 16 weeks (range, 4-48 weeks) before treatment. Diagnosis of SVC obstruction was confirmed with helical CT and pretherapeutic phlebography. Four patients had Stanford's type II stenosis; two, type III; and six, type IV. The mean clinical and radiologic follow-up intervals were 11 months (range, 1-36 months) and 7 months (range, 1 week to 32 months), respectively.Recanalization was successful in all patients. Fifteen stents were implanted in the 12 patients. Stents were placed after percutaneous balloon angioplasty in nine patients, and primary stent placement was attempted in three patients. We immediately achieved a satisfactory SVC diameter in all patients, whose symptoms were relieved completely within 1 week of stent placement. No technical or clinical complications occurred. SVC syndrome recurred in one patient 2 months after stent placement and was treated by placing a second stent.Endovascular treatment with stent placement should be considered relevant and safe for refractory benign SVC syndrome. However, a larger series and a longer follow-up period are needed to define the role of stent placement for this syndrome.

The purpose of this study was to assess the findings on chest high resolution computed tomography (HRCT) in patients with primary humoral immunodeficiency. HRCT was prospectively and consecutively performed in 19 patients with primary humoral immunodeficiency, aged 15-64 years (mean 36), and in 15 healthy subjects. HRCT results were correlated with clinical and biological data. Bronchial lesions were observed in 11 patients (58%), consisting either of bronchial wall thickening in eight or bronchiectasis in eight; both were present in five patients. Lobar and/or segmental collapses were found in seven patients (37%), scars in eight patients (42%), interstitial lesions in six patients (32%), and lobular air-trapping in two patients (11%). Parenchymal collapses were correlated with the annual frequency of infections (p = 0.03) and with the IgA level (p = 0.01). Scars were correlated with the annual frequency of infections (p = 0.04). No correlation was found between bronchial wall thickening or bronchiectasis and the data analysed. In conclusion, HRCT is a useful method to demonstrate lung disease in primary humoral immunodeficiencies, with special emphasis on bronchial changes and interstitial lesions.

A patient treated with fluoxetin for a manic depressive disorder developed pulmonary inflammatory nodules with noncaseating giant cell granulomas, interstitial pneumonia and non-necrotizing vasculitis, whilst remaining asymptomatic. A progressive resolution of pulmonary nodules occurred after withdrawal of the offending agent, and the chest radiograph returned to normal in 9 months. The diagnosis was assessed by an open lung biopsy.

Richter syndrome is the transformation of chronic lymphocytic leukemia (CLL) into large cell lymphoma. Besides the involvement of lymph nodes, liver, and spleen, bone lesions occur infrequently. We report one case of a patient with a paraspinous mass and destruction of the vertebra by large cell transformation of CLL seen on CT and MRI. There was nothing specific about the clinical presentation, imaging characteristics, and histopathological pattern of bone biopsy that would allow for confident differentiation from infectious spondylitis.