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Diffusion-weighted MR imaging of liver pathology: principles and clinical applications Due to ongoing technological advances, the range of clinical applications for diffusion-weighted MR imaging has expanded to now include abdominal pathology. Current applications for liver pathology include two main directions. First, oncologic imaging with detection, characterization and follow-up of lesions. Second, evaluation of diffuse liver diseases, including hepatic fibrosis. The diagnostic impact and role of diffusion-weighted MR imaging remain under investigation, but appear promising. Because of its short acquisition time, sensitivity, and additional information it provides, diffusion-weighted MR imaging should be included in routine liver imaging protocols.

Cystic lesions of the pancreas, with an estimated prevalence of 20%, frequently are incidental findings at imaging on asymptomatic patients. Pseudocysts, typically in a setting of pancreatitis, should first be excluded. Characterization of cystic tumors is more complicated. Still, it is important to differentiate between benign and malignant lesions. Multi-detector row CT and MRI allow characterization of such lesions in over 75% of cases. Indeterminate lesions should undergo endoscopic US with biopsy/aspiration and fluid analysis, especially for mucin producing tumors (rounded with thick enhancing wall). When imaging fails to fully characterize a lesion, follow-up may be proposed for lesions less than 3 cm in size, that are either unilocular with thin nonenhancing wall (simple cyst) or lobulated multilocular with thin nonenhancing wall (serous cystadenoma, isolated side branch IPMTP). Follow-up imaging shows that these tumors usually show very little change over time. Management is based on comparing estimated patient survival without treatment to surgical risks (morbidity, mortality, functional sequelae from the procedure).

Intracranial metastases account for up to 35% of intracranial tumors in adult. They can involve any part of the central nervous system: brain, meninges and cranial nerves. Any systemic tumor can metastasize to the brain; the most common primaries include lung, breast and melanoma. Imaging plays a major role in the evaluation and management of patients with metastatic brain tumors. This article discusses optimal CT and MR imaging protocols and describes imaging features and distinguishing characteristics of cerebral and meningeal metastases.

Digestive haemorrhage following supramesocolic abdominal surgery (cephalic duodenopancreatectomy, cholecystectomy, total oesogastrectomy) is a rare but serious complication, which can be life-threatening. Improvement in scanning techniques has made it possible to modify the diagnostic strategy and improve the therapeutic management of the patients. The aim of this iconographic review is to recall the causes of digestive haemorrhage following supramesocolic surgery and to illustrate the dominant role of tomodensitometry in diagnosing it and in planning and controlling the efficacy of endovascular treatment.

Between 1970 and 1986, 166 patients with T1 or T2 epidermoid carcinomas of the mobile tongue were treated by iridium 192 implantation (70 T1N0, 83 T2N0, 13 T1-2 N1-3). Five-year actuarial survival was 52% for T1N0, 44% for T2aN0, and 8% for or T1-2 N1-3. Cause specific survivals were 90%, 71%, and 46%, respectively. Local control was 87% for both T1N0 and T2N0, and 69% for T1-2 N1-3. Seven of 23 failures were salvaged by surgery, increasing local control to 96% for T1 and 90% for T2. Thirty-six patients developed a minor or moderate necrosis (16% T1, 28% T2). Half of these involved bone but only five required surgical intervention. Both local control (LC) and necrosis (nec) increased with increasing dose but improvement beyond 65 Gy is minimal (less than or equal to 60 Gy: LC = 78% nec = 13%; 65 Gy: LC = 90% nec = 29%; greater than or equal to 70 Gy: LC = 94% nec = 23%). For N0 patients, neck management consisted of surveillance (n = 78), elective neck dissection followed with external irradiation for pathologically positive nodes (n = 72), or irradiation (n = 3). Clinically positive nodes (13 patients) were managed by either neck dissection followed by external irradiation if pathologically positive (n = 10) or irradiation alone (n = 3). Regional control was 79% for N0 patients, improving to 88% after surgical salvage, and was 9/13 for N1-3 patients. We recommend that T1 and T2 carcinomas of the mobile tongue be treated by iridium 192 implantation to deliver 65 Gy. Mandibular necrosis should be reduced by using an intra-oral lead-lined dental mold.

One hundred and ten patients with Stage II epidermoid carcinomas of the mobile tongue were treated by interstitial irradiation (Group I: 85 patients) or external irradiation to the primary and the regional lymphatics followed by an interstitial boost (Group II: 25 patients). The neck was managed by either an elective neck dissection (43 patients) completed by external irradiation in 13 patients with pathological specimen or close follow-up (40 patients) with therapeutic neck dissection for relapses (7 patients) in Group I. Primary local control was 88% in Group I and 36% in Group II. Regional control was 91 in Group I and 5 6 in Group II for patients whose primary tumor was controlled. Five-year absolute disease-free survival (DFS) was 42% in Group I and 24% in Group II, but there was an imbalance in the distribution of larger tumors favoring Group I. There were 30 radiation-induced complications and four patients required corrective surgery. This retrospective analysis showed better results in patients whose primary was treated by interstitial irradiation alone which has the extra advantage of preserving salivary function.

From 1970 to 1986, 117 patients with T1 (47) or T2 (70) epidermoid carcinomas of the floor of the mouth (SCC) were treated by iridium-192 implantation (192 Ir). The dose was prescribed according to the Paris System and varied over those years. Follow-up information was available on 116 patients. There were 46 T1N0, 47 T2N0, and 23 T2N1-3. Neck management varied for the 93 N0 patients consisting of surveillance (24 T1, 17 T2) or elective neck dissection (22 T1:all pN-, 30 T2: 20 pN-, 10 pN+). Cause specific survival rates were 94% for T1N0, 61.5% for T2N0, and 28% for T2N1-3 at 5 years. Primary local control was 93.5%, 74.5%, and 65%, respectively, and 98%, 79%, and 65% after salvage. Patients with gingival extension or a tumor size over 3 cm (T2b) had a local control of 50% (9/18) and 58% (15/26), respectively. Nodal control was 93.5% for Stage I, 85% for Stage II, and 48% for T2N1-3 patients. There was no difference in nodal control with regard to treatment policy for Stage I-II patients. There were few complications including three deaths: two from surgery and one from 192 Ir. Nodal status, tumor size defined as T1, T2a (less than or equal to 3 cm), T2b (greater than 3 cm), and gingival extension were the only independent prognostic factors. The management of T1N0 and T2N0 SCC by 192 Ir to a dose of 65 or 70 Gy, using the Paris System, is recommended for lesions 3 cm or less and without gingival extension.

Objectifs pedagogiques Connaitre l’aspect radiologique normal des differents types d’ileostomies. Connaitre les principales pathologies qui peuvent interesser les ileos-tomies et leur traduction en imagerie. Savoir effectuer en imagerie le diagnostic de ces complications. Messages a retenir Les differents types d’ileostomies peuvent etres identifies en imagerie. Les complications des ileostomies sont nombreuses et peuvent etre detectees. Certains aspects normaux peuvent preter a confusion avec des etats pathologiques et doivent etre connus.

Objectifs Savoir reconnaitre une dilatation anevrysmale des canaux lymphatiques en lymphographie par resonance magnetique. Savoir utiliser la lymphographie par resonance magnetique pour effectuer le bilan de ces anomalies. Savoir distinguer ces dilatations anevrysmales lymphatiques des variations anatomiques et variantes de la normale et des autres lesions kystiques retroperitoneales. Points cles Les dilatations anevrysmales des canaux lymphatiques constituent une pathologie rare mais non exceptionnelle. Ces dilatations anevrysmales des canaux lymphatiques constituent donc une des causes des formations kystiques retroperitoneales. La lymphographie par resonance magnetique constitue la modalite de reference pour effectuer le diagnostic de ces anomalies lymphatiques anevrysmales et pour les distinguer des autres anomalies kystiques du retroperitoine.

Objectifs pedagogiques Connaitre les etiologies et mecanismes de l’hypertension portale ainsi que les differents niveau d’obstacle. Savoir identifier les voies de derivations impliquees dans l’hypertension portale et connaitre les criteres pronostiques relatifs a ces voies de derivations. Savoir orienter le diagnostic en fonction des voies de derivations sollicitees. Connaitre les autres anomalies pouvant etre liees a l’hypertension portale. Messages a retenir Les voies de derivations sont des voies d’acheminement du sang portai visant a contourner un obstacle qu’elle qu’en soit la localisation. Les principales sont : para-ombilicale, gastrique gauche, splenorenales et pararectale mais d’autres plus rares sont a connaitre. L’hypertension portale secondaire a un bloc presinusoidal infrahepatique (qu’elle soit segmentaire ou non) genere classiquement des voies de derivation porto-portes, contrairement au bloc postsinusoidal genere des voies de derivations portosystemiques. La voie de derivation splenorenale indirecte est la plus pourvoyeuse d’hemorragie cataclysmique. La voie de derivation splenorenale directe est la plus pourvoyeuse d’encephalopathie hepatique. La splenomegalie, l’ascite, l’epaississement des parois coliques, les corps de Gamna Gandy et la cholangite portale peuvent etre vus en cas d’hypertension portale.

Objectifs pedagogiques Savoir reconnaitre un reservoir en J et une anastomose ileo anale en IRM. Connaitre et savoir rechercher les signes de fistule digestive en cas de maladie inflammatoire du tube digestif. Messages a retenir Le diagnostic de maladie de Crohn (MC) est parfois fait en post operatoire d’une colectomie totale pour colite inflammatoire initialement inclassee. La presence d’une fistule digestive est un argument fort en faveur de la maladie de Crohn et permet d’orienter le diagnostic etiologique.

Objectifs Evaluer l’apport de la diffusion comparativement aux criteres morphologiques dans le diagnostic des abces hepatiques versus tumeurs necrotiques hepatiques. Materiels et methodes Vingt trois patients presentant une lesion necrotique detectee au scanner ou en echographie ont beneficie d’une IRM avec sequence ponderee en diffusion. Il s’agissait pour 13 malades d’abces hepatique et pour 10 malades d’une tumeur necrotique (carcinome hepatocellulaire, cholangiocarcinome, metastases coliques, de tumeur neuroendocrine, melanome). Les sequences de diffusion etaient realisees sur Siemens (Magnetom Symphony) avec 4 valeurs de b (bO, b200, b400, b800) ou sur General Electric (Signa Excite) avec 2 valeurs de b (bO, b600). Les criteres morphologiques des lesions necrotiques : presence de logettes, paroi epaissie nodulaire et caracteristiques de rehaussement etaient analysees. Le coefficient ADC etait mesure dans la portion necrotique de la lesion et dans le foie sous jacent. Resultats L’ADC etait en moyenne de 1,13 10−3 (DS = 0,7) pour les lesions abcedees, 2,2 10−3 (DS = 0,5) pour la portion necrotique des tumeurs. La presence de logettes et de troubles de perfusion arterielle etait evocatrice d’abces. Conclusion : La sequence de diffusion avec calcul de l’ADC permet d’apporter un argument supplementaire en faveur du diagnostic d’abces hepatique.

This is a retrospective analysis of 233 evaluable patients with stage I-II squamous cell carcinoma of the oral cavity treated by definitive branchytherapy. Minimum follow-up is 3 years. Treatment of neck was chosen by a multidisciplinary team, according to age, medical status and availability for regular follow-up. One hundred and ten patients (47%) underwent elective neck dissection (END); 28 (25%) had positive nodes and received neck irradiation post-operatively. One hundred and twenty three patients (53%) were regularly followed up only, with therapeutic neck dissection (TND) reserved for cases of node relapses. In the END group, there were 19 neck relapses (17%): 12/60 (20%) in patients with mobile tongue carcinoma and 7/50 (14%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 9/19 (47%) cases. In the TND group, there were 21 neck relapses (17%): 16/82 (20%) in patients with mobile tongue carcinoma and 5/41 (10%) in patients with floor of the mouth carcinoma. Salvage treatment was successful in 13/21 (62%) cases. Ten-year survival is 37% for the END group and 31% for the TND group. Tumour stage and infiltration into underlying tissues increased the probability of neck relapse and death. Furthermore, a multivariate analysis showed that patients treated in the TND group had a higher probability of death than patients treated in the END group (p less than 0.04).

From 1961 to 1974, 245 patients with unilateral "operable" breast cancer (25% T1, 56% T2, 19% T3) were treated with breast conservation and irradiation at the Gustave Roussy Institute (1961-1969) or at the Henri Mondor Hospital (1970-1974). The minimum follow-up is 15 years. Most patients with T greater than 3 cm underwent radiation therapy with the tumor in place, while the greater part of patients with T less than 3 cm received radiation therapy after tumorectomy. The breast and draining lymph node areas received widefield telecobalt irradiation to 45 Gy. The dose to the tumor site was boosted using iridium-192 implantation. Additional irradiation was given to the internal mammary and lower axillary nodes using an electron beam. The 15 years NED survival rate was 63%, 51% and 26% for T1, T2 and T3 tumors, respectively. The NED survival for T less than or equal to 1 cm was 86%. The local recurrence rate was 8, 12 and 19% for T1, T2 and T3 tumors, respectively. Of the patients with local recurrence, 85% underwent surgical salvage. Complications were rare. Cosmetic results were satisfactory in most patients including the T3 group. The proportion of breasts conserved among patients living NED at 15 years, was 97, 88 and 93% for T1, T2 and T3 tumors, respectively. In 1980, after almost 20 years experience using breast conserving techniques, we modified our treatment policies in close collaboration with our surgical team, hel cbye extending the indications for tumorectomy and associating routine surgical exploration of the lower axilla.

Objectifs Savoir qu’il existe deux types de cholangites : la cholangite sclerosante primitive (CSP) et les cholangites secondaires. Connaitre les differentes causes des cholangites secondaires. Connaitre la semiologie d’une cholangite en cholangio-pancreato-IRM. Points cles La CPRM est un examen non invasif et reproductible permettant le diagnostic et la surveillance des CSP. Une cholangite doit etre evoquee devant des anomalies des voies biliaires a type de stenoses etagees et d’irregularites parietales. Le diagnostic etiologique peut etre approche par CPRM.

Objectifs Connaitre la gamme diagnostique des masses mesenteriques. Identifier les diagnostics differentiels. Determiner la prise en charge therapeutique. Points cles Les masses mesenteriques sont rares et decouvertes au decours d’un scanner abdominal. L’imagerie permet d’affirmer l’origine mesenterique de la masse et son caractere kystique, solide ou graisseux. Les diagnostics differentiels sont les atteintes infectieuse, vasculaire ou inflammatoire du mesentere. La prise en charge therapeutique necessite en general une preuve his-tologique. Resume La gamme diagnostique des masses mesenteriques depend du caractere solide, kystique ou graisseux de la lesion. Les tumeurs solides primitives concernent essentiellement les tumeurs desmoides, et plus rarement les tumeurs stromales, les tumeurs de Castelmann et les neurofibromes. Les tumeurs solides secondaires concernent les lymphomes et les metastases de tumeur carcinoide. Les tumeurs kystiques les plus frequentes sont les lymphangiomes kystiques. Il peut egalement s’agir de duplications digestives, de kystes enteriques et de teratome kystique. Les tumeurs graisseuses sont dominees par les lipomes et les liposarcomes. Le principal diagnostic differentiel est la panniculite mesenterique (ou mesenterite sclerosante) qui est une atteinte inflammatoire du mesentere probablement d’origine auto-immune. Une preuve histologique par ponction percutanee ou chirurgie est en general necessaire a la prise en charge therapeutique.

Objectifs Decrire, expliquer les differents types de volvulus digestifs. Illustrer leur aspect radiologique en insistant sur la TDM. Discuter la place de l’imagerie dans leur diagnostic positif, etiologique et leurs complications. Points cles Les volvulus peuvent interesser la quasi-totalite des organes du tube digestif. L’imagerie joue un role important permettant un diagnostic precoce. L’ASP permet de suspecter ou d’affirmer le volvulus notamment celui du sigmoide. Le scanner multicoupe joue un role primordial dans : le diagnostic topographique precis du volvulus, son mecanisme, l’association eventuelle d’anomalie congenitale, la recherche des signes de souffrances.

Objectifs Savoir reconnaitre les vaisseaux lymphatiques a l’etage sousmesocolique, a l’etage susmesocolique et au niveau du retroperitoine. Connaitre les principales variations anatomiques et les variantes dela normale. Savoir utiliser la lymphographie par resonance magnetique en pathologie lymphatique. Points cles A l’etage sousmesocolique, il est generalement possible d’identifier les canaux lymphatiques de drainage de l’intestin grele et du colon. A l’etage susmesocolique, on identifie regulierement les canaux lymphatiques hepatiques, pancreatiques et spleniques. On identifie dans tous les cas les collecteurs lymphatiques retroperitoneaux, notamment au niveau de la confluence retroperitoneale superieure. Il existe une tres grande variabilite individuelle pour le nombre, l’apparence et le calibre des canaux lymphatiques abdominaux et retroperitoneaux. La lymphographie par resonance magnetique peut etre utilisee pour l’exploration de pathologies lymphatiques.

Objectifs Connaitre la presentation clinique du syndrome de Fitz-Hugh-Curtis. Reconnaitre les signes tomodensitometriques observes lors de ce syndrome. Determiner la place du scanner dans l’exploration des douleurs febriles de l’hypocondre droit. Points cles Le syndrome de Fitz-Hugh-Curtis se presente generalement par une douleur febrile de l’hypocondre droit. Le rehaussement capsulaire hepatique au temps arteriel de l’injection avec troubles de perfusion adjacents constitue un signe evocateur du syndrome de Fitz-Hugh-Curtis. Les signes de salpingites peuvent etre absents.

Objectifs Connaitre les differentes techniques chirurgicales utilisees pour le traitement de la maladie de Crohn. Reconnaitre les aspects normaux et pathologiques de l’imagerie post-operatoire de la maladie de Crohn. Evaluer la place de l’entero-IRM dans les recidives post chirurgicales particulierement chez les patients peu symptomatiques. Points cles Il est primordial de reconnaitre le site de l’anastomose afin de localiser d’eventuelles recidives. Les recidives les plus frequentes se situent en amont de l’anastomose sous forme de stenose. Les atteintes courtes sont mieux caracterisables en entero-IRM.

Objectifs pedagogiques Connaitre les principales sequences utilisees en lymphographie par resonance magnetique. Connaitre l’anatomie des vaisseaux lymphatiques de l’abdomen et du retroperitoine. Connaitre les variations anatomiques et variantes de la normale. Savoir utiliser la lymphographie par resonance magnetique en pathologie lymphatique. Messages a retenir Les lymphatiques peuvent etre analyses sur des sequences bidimensionnelles tres ponderees en T2. L’analyse des lymphatiques abdominaux est optimale en se servant de sequences tridimensionnelles tres ponderees en T2. Il existe une tres grande variabilite d’un individu a l’autre pour le nombre, l’apparence et le calibre des canaux lymphatiques abdominaux et retroperitoneaux. La lymphographie par resonance magnetique peut etre utilisee pour l’exploration de pathologies lymphatiques telles que les lymphangiectasies, la lymphangiomyomatose, les dilatations lymphatiques congenitales ou acquises, les anomalies lymphatiques post-chirurgicales.

Objectifs Evaluer l’apport des sequences IRM dynamiques dans la caracterisation des stenoses de la maladie de Crohn. Materiels et methodes Une entero-IRM a 1,5 Tesla comportant des sequences conventionnelle et dynamique en ponderation T2, et des sequences T1 sans et avec injection de produit de contraste, dans des plans coronaux et axiaux, a ete realisee chez 30 patients (16 femmes, âge moyen 36 ans) apres absorption de 1,5 litre de PEG. Les anomalies parietales, extra-parietales et les complications ont ete analysees et confrontees aux donnees cliniques. Resultats L’entero-IRM a mis en evidence : 1) le caractere inflammatoire intestinal sous la forme d’un epaississement de la paroi accompagne d’une prise de contraste pathologique de la muqueuse, 2) une fibrose parietale provoquant un retrecissement luminal precede d’une dilatation pre-stenotique, 3) des atteintes extra-parietales et des complications. Les sequences dynamiques ont donnes des informations fonctionnelles sur les stenoses visualisees en differenciant les stenoses peu serrees et peu symptomatiques (n = 21) des stenoses symptomatiques (n = 9). Conclusion Les sequences dynamiques ameliorent l’evaluation morphologique de la maladie de Crohn en precisant le caractere symptomatique ou non des stenoses orientant ainsi vers la prise en charge chirurgicale ou non des patients.

Objectifs Notre objectif etait d’analyser les variations de l’origine geographique des articles publies dans la revue Radiology entre 1990 et 2005. Materiels et methodes L’ensemble des articles originaux, en excluant les revues, les editoriaux et les lettres, publies de 1990 a 2005 dans la revue Radiology ont ete analyses pour determiner l’origine geographique de l’article. Les resultats ont ete analyses en fonction du nombre absolu de papiers publies par pays. Resultats Le nombre d’articles en provenance des Etats-Unis d’Amerique et du Canada a ete divise par deux lors de ces quinze dernieres annees. D’autres pays ont au contraire connu une augmentation du nombre d’articles publies, tels que l’Allemagne et la Coree qui ont triple leur nombre de publications. L’augmentation du nombre de publications a ete tres marquee pour deux pays, la Chine et la Confederation Helvetique (facteur 10). La France a eu une publication relativement constante sur ces quinze dernieres annees. Pour les publications francaises, il existait d’importantes variations en fonction de la sous-specialite radiologique, les radiologies thoracique, neurologique, musculosquelettique et gastro-intestinale etant plus souvent representees. Conclusion I1 existe d’importantes disparites du nombre de publications dans la revue Radiology en fonction de l’origine geographique sur ces quinze dernieres annees.

Objectifs pedagogiques Revoir les possibilites techniques de realisation d’une entero-IRM. Connaitre les indications actuelles et futures. Decrire l’imagerie des principales pathologies rencontrees. Proposer un compte-rendu type. Messages a retenir Proposer un protocole standard de realisation d’une entero-IRM en discutant de l’interet de l’enteroclyse ou non, du choix d’agents de contraste negatif ou positif absorbes par voie orale, et des sequences indispensables et optionnelles a realiser. La grande indication actuelle de l’entero-IRM est la maladie de Crohn pour realiser un bilan exhaustif des lesions au moment du diagnostic de la maladie. La semiologie radiologique comprend l’analyse morphologique de l’atteinte des couches parietales et des anomalies extra-parietales. Les principales donnees devant etre mentionnees dans un compterendu type sont discutees.

Objectifs On definit par « publication redondante » (egalement appelee reiteree, en double, dupliquee) la publication par les memes auteurs d’un article reprenant tout ou partie d’un article deja publie. L’objectif de ce travail etait d’evaluer le taux de redondance dans la revue Radiology et de le comparer aux taux de redondance d’autres revues. Materiels et methodes Deux observateurs ont analyse le taux de redondance dans la revue Radiology en 2001. Nous avons analyse l’ensemble des articles originaux a l’aide de la banque de donnees Medline sur le serveur PubMed afin d’identifier les articles qui avaient pu etre a l’origine de publications redondantes. Medline a ete analyse de 1999 a 2003 par une recherche sur le nom du premier auteur. Les articles redondants ont ete reclasses comme redondants (articles quasiment identiques), partiellement redondants (similitudes importantes entre les articles) et fragmentes (donnees artificiellement separees dans plusieurs papiers). Resultats Trois cent soixante deux articles originaux ont ete publies en 2001 dans Radiology. Nous n’avons trouve aucun cas de redondance complete. Deux articles ont ete consideres comme partiellement redondants. Nous n’avons pas trouve de cas d’articles fragmentes. Conclusion Le taux de redondance est moins frequent dans la revue Radiology que dans d’autres revues.

Objectifs Notre objectif etait d’etudier la faisabilite d’un protocole d’IRM dynamique pour l’analyse des pneumopathies infiltratives diffuses chroniques (PID). Materiels et methodes Vingt-quatre patients (âge moyen : 51,2 ans) etaient explores pour une PID, active ou non cliniquement (n = 14), une masse tumorale (n = 9) ou une fibrose mediastinale (n = 1). Les patients etaient etudies en TDM-HR et en IRM dynamique apres injection de 20 ml de chelate de gadolinium a 5 ml/s par injecteur automatique. Les artefacts et la qualite des images etaient analyses. Les parametres cinetiques (rehaussement maximal, rehaussement relatif maximal (RMR), pente de rehaussement, aire sous la courbe) etaient calcules pour la fonction d’entree vasculaire, pour les zones presumees saines, les infiltrations et les condensations pulmonaires des PID et pour les poumons normaux des autres patients, utilises comme temoins. Resultats Les artefacts, principalement respiratoires et vasculaires, genaient peu l’interpretation. La fonction d’entree vasculaire variait selon les patients et etait correlee a l’indice de masse corporelle (p = 0,03). Dans les PID, les parametres cinetiques differaient entre les lesions evolutives et non evolutives avec des resultats significatifs pour la caracterisation des infiltrations (RMR = 414 % contre 76 %, p = 0,02). Conclusion L’IRM dynamique est une technique prometteuse pour l’exploration des PID.

Forty-eight patients with T1 or T2 epidermoid carcinomas of the base of tongue were treated at the Henri Mondor Hospital between 1971 and 1981. Forty-one patients received moderate dose 60Co external beam irradiation (mean: 48.6 Gy) to the primary tumor and regional nodes, followed by an interstitial iridium 192 implant to the primary tumor (mean: 32 Gy). This completed the treatment for the 30 node negative patients, but those with clinically positive nodes were managed by either an additional electron beam boost to the involved nodes or a neck dissection. Seven tumors were treated exclusively by implantation to the base of tongue (mean: 63 Gy). Five-year crude disease-free survival is 50% with 35% of patients dying of recurrent disease. Definitive local control for T1 lesions is 85% (11/13) and for T2 is 71% (25/35). A dose response effect was observed with local control of 79% (26/33) obtained with a combined dose greater than or equal to 75 Gy, but only 50% (4/8) for less than or equal to 70 Gy. For N0 patients definitive regional control is 97% and for N1-3 is 89%. Minor or moderate soft tissue ulceration was observed in 12 patients, including 3 cases that progressed to osteonecrosis. None required surgical intervention. No correlation exists between necrosis and tumor size or total dose.

From 1970 to 1979, a group of 50 patients was treated for squamous cell carcinoma of the penis by interstitial irradiation using an afterloading technique and iridium 192 wires. The group included 9 patients with T1 tumors, 27 with T2 tumors, and 14 with T3 tumors. Forty-five patients presented with no metastatic inguinal nodes (N0), 3 patients with N1 nodes, and 2 patients had N3 nodes. After treatment, 11 patients (1 T1, 6 T2 and 4T3) developed local recurrences; 10 of these 11 patients underwent penile amputation which controlled the tumor in 7 of the patients. One patient refused amputation. Three patients developed post-therapeutic necrosis which necessitated partial amputation in 2 cases. Eight patients developed post-therapeutic urethral stenosis, which required surgical treatment in three of the cases. Overall, at their last follow-up examinations, 74% of the patients were free of disease with conservation of penile morphology and function. Most patients without metastatic nodes (37/45) at diagnosis did not receive prophylatic treatment of the groin. Two of these patients developed delayed metastatic nodes; one was successfully salvaged. All 5 patients presenting with metastatic nodes at diagnosis died, four with uncontrolled regional disease. Twenty-one percent of the patients died of their disease. We advocate interstitial irradiation using iridium 192 wires for the treatment of non-infiltrating or moderately infiltrating squamous cell carcinoma of the penis in which the largest dimension does not exceed 4 cm. Pre-implant circumcision and regular long-term follow-up are necessary. More extensive tumors are better managed surgically. When regular follow-up can be assured, it is reasonable to forgo prophylactic treatment of the inguinal nodes in patients presenting without groin metastasis.

From January 1970 to November 1982, 70 patients with carcinoma of the pinna were treated by interstitial irradiation. An afterloading technique with Iridium 192 wires was used. One patient recurred and had a total pinnectomy followed by 60 Gy external radiation. This patient was alive without evidence of disease at 134 months. Three patients who had tumors greater than 4 cm in size at presentation developed late necrosis which required subsequent total pinnectomy. Cosmetic results were assessed in 55 patients and were good with few late sequelae (in 78% of cases (3646) when the tumor measured less than 4 cm, but only in 19 when the tumor measured more than 4 cm). We advocate interstitial Iridium 192 irradiation for treatment of pinna tumors smaller than 4 cm. None of 39 patients with squamous cell carcinoma had biopsy proven cervical lymph node metastasis at the time of diagnosis. Four patients with squamous cell carcinoma (439: 10%) later developed a regional nodal metastasis after treatment of the pinna. All four relapsed in the parotid region and were managed by partial parotidectomy and neck dissection followed by external irradiation. One of these four patients died from uncontrolled cervical node disease. In our opinion, when regular follow-up is dependable, it is reasonable to save treatment of the cervical nodes for those patients who relapse with involved metastatic cervical nodes.

The 5 year results of radical radiation therapy in operable, infiltrating breast cancer (T1, T2, T3; NO, N1a, N1b) in 177 patients are presented. The treatment protocol included a pre-radiotherapy tumorectomy for T1 and certain T2 tumors (those less than 3cm diameter). Patients with larger tumors were treated by radiotherapy alone. The treatment technique incorporated both conventional fractionated radiotherapy (60 Co and electrons) and endocurietherapy (192 Ir). At 5 years, the uncorrected, disease-free survival rates were 84 % for T1, 79% for T2 and 56% for T3: loco-regional persistent or recurrent disease was seen in 4.5 % of patients with Tl disease, 7.5 % of those with T2, and 23 % of T3 patients; 16 mastectomies had been performed. Of the patients with T1 and T2 disease, 95 % had retained their breast and the esthetic result was judged to be good in 75 %. We recommend this technique of radical radiotherapy in early breast cancer because of this high rate of tumor control, associated with a low rate of normal tissue damage and survival figures comparable to those achieved by radical surgery.

From July 1971 to December 1981, 33 selected patients with T1, T2 tumors of the tonsillar region were treated according to the following protocol: 1. Telecobalt therapy to the primary site and to neck nodes to a dose of 45 Gy. 2. Brachytherapy to the primary site to a dose of 30 Gy using iridium 192. 3. Boost dose to involved neck nodes with electrons, or radical neck dissection, whether N1, N2, or N3. The actuarial disease-free survival was 76% when all patient groups were included and 80% for the NO patients. The local control rate was 100%. Disease control in the neck was 94% overall and 100% for the NO group. These results favor the use of this protocol for superficial, minimally infiltrating tumors less than 4 cm in diameter, without obvious extension to the base of the tongue or retromolar trigone.