Search

Resume L’hyperplasie congenitale des surrenales est une pathologie liee a une mutation genetique responsable d’une production exageree de testosterone des la vie in utero. Nous rapportons le cas d’une patiente de 15 ans atteinte de la maladie, particulierement inobservante de son traitement de substitution hormonale, chez laquelle une « prostate » a ete mise en evidence lors d’une IRM realisee pour un bilan de douleurs pelviennes chroniques et de troubles urinaires.

Resume L’atteinte digestive est l’atteinte extragenitale la plus frequente de l’endometriose, et doit toujours etre recherchee pour orienter la chirurgie. Parmi les complications classiques de l’endometriose, la surinfection est decrite, mais rare. Nous rapportons le cas d’une patiente ayant consulte pour des ecoulements rectaux dans un contexte d’endometriose connue. L’IRM a mis en evidence des lesions d’endometriose profonde, une double atteinte digestive et un endometriome surinfecte fistulise au sigmoide.

Patients with perineal Crohn’s disease need repeated MRI. Current protocols use injection of gadolinium. Repeated injections are responsible for deposit of gadolinium in the body. Our objective is to analyze diagnostic accuracy of non-contrast enhanced sequences in MRI to assess perianal Crohn disease. METHODS: From November 2016 to November 2019, all patients evaluated by MRI for assessment of perineal fistulas in Crohn disease at Rouen University Hospital, were retrospectively included. Two groups were formed: « Acute symptoms » and « Asymptomatic patients ». MRI standard evaluation was performed, and the Van Assche MRI severity score was calculated. Five objective criteria were selected: type of fistula, position to sphincter, extension of fistula, activity signs and abscesses, to obtain a specific report. Two junior radiologists each performed two readings, blindly from the final report of examination: using non-contrast enhanced sequences only and using standard protocol with injection, and specify if there was a revision in the final diagnosis of perineal involvement between the two readings, defined by the modification of at least one of the five criteria. In contentious cases, the decision was made in consensus with an experienced senior gastro-intestinal radiologist. RESULTS: 136 perineal MRI were studied (90 patients). There was no fistula in 16,2%. Fistula were simple in 37,7% and complex in 62,3%, mainly trans-sphincteric in 69,3%, with supra-levatoric extension in 29,8%. Abscesses occurred in 31,6%. Non-contrast enhanced sequences correctly described perineal involvement in 91,9% of MRI examination and failed to do so in 8,1% IC95% [4-14%]. Statistical agreement between non-contrast enhanced sequences and standard protocol was ĸ = 0,91 IC95% [0,77-0,96] for the diagnosis of active fistula, and ĸ = 0,94 IC95% [0,85-0,98] for the abscesses. CONCLUSIONS: Non-contrast enhanced sequences on MRI are efficient for the routine assessment of perianal fistulas in CD, especially for the diagnosis of abscesses and activity signs of fistula.

Resume L’hamartome kystique retrorectal ou « tailgut cyst » est une entite rare, dont l’aspect caracteristique en IRM merite d’etre connu par tout radiologue specialise en imagerie pelvienne. Sa semeiologie, relativement proche de celle des lesions d’endometriose profonde, peut aisement mener a une erreur diagnostique pour un œil non averti. Il existe un rare risque de degenerescence carcinomateuse, justifiant, selon les centres, une exerese chirurgicale prophylactique. Nous rapportons le cas d’une patiente suivie dans le cadre d’une endometriose. Une IRM precedente avait revele des atteintes d’endometriose profonde typiques, associees a des lesions plus « atypiques ».

Derinck Jean-Paul. Paysage routier, arbres d’alignement. In: Géographes associés n°10, 1er semestre 1992. Sens et pratiques de l'environnement. Spécial Géoforum 91 . p. 95.