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Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19.Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores.We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6 kg/mLow SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.

Pre-pubertal murine models of acute colitis are lacking. Magnetic resonance colonography (MRC) is a promising minimally invasive tool to assess colitis. We aimed to: 1/ Adapt a model of acute experimental colitis to pre-pubertal rats and determine whether MRC characteristics correlate with histological inflammation. 2/ Test this model by administering a diet supplemented in transforming growth factor β2 to reverse inflammation. Twenty-four rats were randomized at weaning to one of 3 groups: Trinitrobenzene Sulfonic Acid (TNBS) group (n = 8) fed a standard diet, that received an intra-rectal 60 mg/kg dose of TNBS-ethanol; Control group (n = 8) fed standard diet, that received a dose of intra-rectal PBS; TNBS+MODULEN group (n = 8) that received a dose of TNBS and were exclusively fed MODULEN-IBD® after induction of colitis. One week after induction of colitis, rats were assessed by MRC, colon histopathology and inflammation markers (Interleukin 1β, Tumor necrosis factor α, Nitric Oxide Synthase 2 and Cyclooxygenase 2). TNBS induced typical features of acute colitis on histopathology and MRC (increased colon wall thickness, increased colon intensity on T2-weighted images, target sign, ulcers). Treatment with MODULEN-IBD® did not reduce signs of colitis on MRC. Inflammatory marker expression did not differ among study groups.

Background Body composition, currently evaluated by computed tomography scan, is related to poor evolution and severity of Crohn's disease (CD). Few MRI studies have been performed, yet it is the most commonly used imaging modality for the surveillance of the disease. Aim Evaluate the feasibility of MRI body composition measurement and compare the variation according to the activity of the disease. Methods A cohort of 132 consecutive patients was studied. The visceral adiposity index (VAI), subcutaneous adiposity index (SAI) and skeletal muscle index (SMI) were measured. Patients were divided into 2 groups according to disease activity. Sarcopenic status was defined according to the cut off value (SMI Results MRI measurements of body composition parameters were feasible and reproducible. After adjustment, sarcopenia was more common (2.07 [1.02; 4.27], p = 0.046), and the SMI (−4.90 [−9.36; −0.431], p = 0.032) was lower in active disease. The SAI was lower (−14.7 [−29.8; 0.258], p = 0.054) in active disease. The VAI tended to be higher with active disease (3.91 [−3.50; 11.9], p = 0.34), and the VAI/SAI+VAI ratio was higher (9.40 [4.72; 14.1], p Conclusion Assessment of body composition is feasible and reproducible in routine MR and parameters are related to disease activity.

Background and Aims Changes in body composition have been described in patients with Crohn's disease, but their predictive performances on disease evolution remain undefined. The aims of our study were to assess, in patients with Crohn's disease requiring abdominal computed tomography, body composition by computed tomography, and to study the outcome according to various body composition parameters at the time of the computed tomography. Methods Patients with Crohn's disease who underwent abdominal computed tomography for suspected complications were retrospectively included. The definition of adverse outcome included death or need for surgery within 6 months of the computed tomography. Skeletal muscle index and visceral and subcutaneous adiposity indexes were calculated from tissue surface areas measured at the third lumbar vertebra, divided by the height squared. Results The prevalence of underweight was 26.8% and the prevalence of sarcopenia was 33.6%. After gender adjustment, skeletal muscle index tended to be reduced in patients with adverse outcome, compared with patients without surgery or death [p = 0.07]. Moreover, subcutaneous adiposity index and visceral adiposity index were significantly lower in patients with surgery or death [p = 0.009 and p < 0.001, respectively]. These differences were almost equivalent in both genders for the subcutaneous adiposity index but were clearly stronger in men for the visceral adiposity index. Conclusions Subcutaneous and visceral adiposity indexes correlate inversely with adverse outcome in patients with Crohn's disease. Alteration of body composition assessed by computed tomography in these patients appears to be a marker of disease severity.

Resume Les fistules anoperineales peuvent etre primitives ou secondaires, et parmi ces dernieres, l’etiologie la plus frequente est la maladie de Crohn. Le traitement est souvent combine, medico-chirurgical. L’examen clinique est limite. Les fistules peuvent etre associees a des abces. Ainsi en pretherapeutique, il est necessaire de connaitre l’extension de la fistule en profondeur et ses rapports avec l’appareil sphincterien, l’existence de trajets accessoires ou complexes, la presence d’un abces et l’activite des lesions. L’IRM anoperineale est aujourd’hui la methode de reference pour faire le bilan precis des lesions. Elle est realisee avec une antenne de surface permettant d’obtenir des sequences dans les trois plans en ponderation T2 et T1. L’IRM peut egalement avoir une place sous traitement afin de juger de l’efficacite des biotherapies dans le cadre precis de la maladie de Crohn et son utilite dans le monitoring de la cicatrisation a long terme est en cours d’evaluation.

Resume Le cancer du canal anal est un cancer viro-induit en augmentation de type histologique essentiellement epidermoide. L’IRM du canal anal est complementaire de l’echographie endo-anale et l’examen clinique pour le staging initial du cancer anal. L’IRM est realisee avec des sequences T2 et T1 injectees dans des plans propres a l’orientation du canal anal. La classification initiale des lesions s’effectue selon le systeme TNM : le staging T repose sur le degre d’infiltration tumorale avec la mesure precise de la tumeur et la description de ses rapports avec les elements anatomiques de voisinage notamment l’envahissement des sphincters. Le staging N repose sur la visualisation d’adenopathies perirectales, iliaques internes, et inguinales. L’IRM a un interet pronostique initial mais est aussi utile pour suivre les patients apres le traitement par radio-chimiotherapie. L’interet des sequences fonctionnelles (diffusion, perfusion) dans le bilan initial et dans le suivi est encore en cours d’evaluation. Les examens de suivi afin de detecter une eventuelle recidive seront realises selon un protocole identique au bilan initial. La reponse au traitement peut-etre complete avec une diminution du volume tumoral qui perdure plusieurs mois apres l’arret des traitements.

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 ».

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Background This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel obstruction. Methods Between October 2006 and August 2009, 242 patients with uncomplicated acute adhesive small bowel obstruction were included in a randomized, controlled trial (the Adhesive Small Bowel Obstruction Study, NCT00389116 ) and allocated to a gastrografin arm or a saline solution arm. The primary end point was the need for operative intervention within 48 hours of randomization. The secondary end points were the resection rate, the time interval between the initial computed tomography and operative intervention, the time interval between oral refeeding and discharge, risk factors for the failure of nonoperative management, in-hospital mortality, duration of stay, and recurrence or death after discharge. We performed a systematic review of the literature in order to evaluate the relationship between use of gastrografin as a diagnostic/therapeutic measure, the need for operative intervention, and the duration of stay. Results In the gastrografin and saline solution arms, the rate of operative intervention was 24% and 20%, respectively, the bowel resection rate was 8% and 4%, the time interval between the initial computed tomography and operative intervention, and the time interval between oral refeeding and discharge were similar in the 2 arms. Only age was identified as a potential risk factor for the failure of nonoperative management. The in-hospital mortality was 2.5%, the duration of stay was 3.8 days for patients in the gastrografin arm and 3.5 days for those in the saline solution arm ( P = .19), and the recurrence rate of adhesive small bowel obstruction was 7%. These results and those of 10 published studies suggest that gastrografin did not decrease either the rate of operative intervention (21% in the saline solution arm vs 26% in the gastrografin arm) or the number of days from the initial computed tomography to discharge (3.5 vs 3.5; P = NS for both). Conclusion The results of the present study and those of our systematic review suggest that gastrografin administration is of no benefit in patients with adhesive small bowel obstruction.

AIM To assess the feasibility of SPECT-computed tomography (CT) in rats with trinitrobenzene sulfonic acid (TNBS)-induced acute colitis and confront it with model inflammatory characteristics. METHODS Colitis was induced in Sprague-Dawley rats by intrarectal injection of TNBS (n = 10) while controls received vehicle (n = 10). SPECT-CT with intravenous injection of 10 MBq of 67Ga-Citrate was performed at day 2. SPECT-CT criteria were colon wall thickness and maximal wall signal intensity. Laboratory parameters were assessed: colon weight:length ratio, colon cyclooxygenase-2 expression by western blot and histological inflammatory score. RESULTS Colon weight/length ratio, colon COX-2 expression and histological inflammatory score were significantly higher in the TNBS group than in the control group (P = 0.0296, P < 0.0001, P = 0.0007 respectively). Pixel max tend to be higher in the TNBS group than in the control group but did not reach statistical significance (P = 0.0662). Maximal thickness is significantly increased in the TNBS group compared to the control group (P = 0.0016) while colon diameter is not (P = 0.1904). Maximal thickness and colon diameter were correlated to colon COX-2 expression (P = 0.0093, P = 0.009 respectively) while pixel max was not (P = 0.22). Maximal thickness was significantly increased when inflammation was histologically observed (P = 0.0043) while pixel max and colon diameter did not (P = 0.2452, P = 0.3541, respectively). CONCLUSION SPECT-CT is feasible and easily distinguished control from colitic rats.

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RADIOLOGIE ET IMAGERIE MEDICALE : Abdominale - Digestive - Epreuve corrigee par l'auteur. Disponible en ligne depuis le 08/06/2018

Early imaging features after sleeve gastrectomy Purpose. Sleeve gastrectomy is a new bariatric surgical procedure with promising early results and low morbidity and mortality. We have evaluated the early imaging findings and value of upper GI study (UGI) and CT. Patients and methods. Twenty five patients (mean age = 38.9 years, mean BMI=51.5 kg/m2) following sleeve gastrectomy for morbid obesity underwent UGI at day 1. CT was immediately performed in patients with suspected leak or as a follow-up examinations in patients with suspected complication. The different imaging features observed were recorded. Results. UGI demonstrated 13 normal examinations (52%), an abnormal appearance in 11 cases (44%) with opacification of a lateral pouch, and one complication (leak confirmed on CT). Two patients underweent CT (day 3 and day 15) for suspected complication, with demonstration of leak in both cases. Conclusion. An abnormal appearance after sleeve gastrectomy is frequently observed on UGI. Routine UGI at day 1 is useful to detect large leaks. CT with oral contrast should be performed in all patients with imaging or clinical suspicion of leak.

Aim Faecal incontinence (FI) requires careful assessment of its aetiology to determine the most effective treatment. The aims of this study were to evaluate MRI defaecography in FI and to compare it with clinical examination combined with rigid rectoscopy in assessing the pelvic floor in patients with FI. Method Consecutive patients with FI referred over a 3-year period to our tertiary centre for MRI defaecography were retrospectively studied. MRI images of the pelvic floor were compared with clinical examination and anuscopy and rectoscopy. Results Seventy-four female patients [mean age 60.5 (30.0–81.0) years] were recruited. MRI defaecography showed conditions which often overlapped, including internal intussusception in 19 (25.7%) and pelvic floor descent in 24 (32.4%). There was average agreement between MRI and clinical examination for a significant anterior rectocoele (κ = 0.40) and poor agreement between MRI and anuscopy/rectoscopy for intra-rectal (κ = 0.06) and intra-anal intussusception (κ = 0.11). Conclusion Other than for anterior rectocoele, there is poor correlation between MRI defaecography and clinical examination with rigid rectoscopy. MRI can detect a variety of abnormal static and dynamic pelvic disorders. This includes enterocoele, which could result in a modification of the surgical approach to intussusception and anterior rectocoele.

AIM To evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission. METHODS All patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses. RESULTS Forty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission. CONCLUSION Deep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

Un patient de 63 ans, hemophile, presente depuis deux jours des douleurs abdominales violentes mal systematisees. Parmi ses principaux antecedents, on note un hematome du psoas un an auparavant et une hepatite C posttransfusionnelle bien controlee par un traitement antiviral. A l’examen clinique, le patient est apyretique, l’abdomen est douloureux dans son ensemble sans defense ni contracture, il n’y a pas de trouble du transit. Le bilan biologique est en faveur d’une deglobulisation aigue avec une hemoglobine a 7,9 g/dl. Il existe une discrete hyperleucocytose a 16 Giga/l. Le bilan hepatique est normal et la C Reactive Protein est a 47 mg/l. Un examen TDM abdomino-pelvien est demande. Celui-ci est realise (General Electric Lightspeed 16) sans puis avec injection de produit de contraste (Xenetix 350, GuerbetFrance) aux temps arteriel et portal (fig. 1 et 2).

Un homme de 45 ans est hospitalise aux urgences chirurgicales pour douleurs abdominales evoluant depuis 72 heures. Il a comme antecedent une appendicectomie, il y a 16 ans. Initialement diffuses, les douleurs siegent de maniere elective en fosse iliaque droite. La palpation abdominale trouve une defense sans contracture. Le patient est apyretique et ne presente pas d’autre signe fonctionnel. Biologiquement, il existe un syndrome inflammatoire avec une CRP (C Reactive Proteine) a 300 et une polynucleose neutrophile a 12 000 elements/ml. Un examen tomodensitometrique abdomino pelvien (General Electric Lightspeed 16) sans et avec injection de produit de contraste avec etude au temps portal est realise (fig. 1a, 1b et 1c) . Il met en evidence une volumineuse masse du bas-fond caecal. Celle-ci est heterogene, associant une partie tissulaire a centre necrotique et une partie plus homogene hypodense, bien limitee de type kystique dont la paroi se rehausse apres injection. Il n’y a pas de calcification intratumorale ou capsulaire. Il existe une discrete infiltration de la graisse mesenterique peri lesionnelle sans epanchement intraperitoneal. Devant ces anomalies, une exploration chirurgicale est decidee. Elle met en evidence une masse suspecte du caecum a laquelle est accolee une collection d’aspect colloide. Le peritoine parietal est infiltre dans toute la gouttiere parieto-colique droite. L’examen anatomopathologique confirme le diagnostic de mucocele et retrouve une lesion maligne de type adenocarcinome mucineux du grele distal au contact de la valvule de Bauhin (fig. 2) . Cette mucocele serait secondaire a l’envahissement tumoral du moignon appendiculaire restant apres l’appendicectomie (fig. 3 et 4) . Il n’a pas ete visualise de cellule epitheliale suspecte au sein de la mucocele.

Un patient de 63 ans, hemophile, presente depuis deux jours des douleurs abdominales violentes mal systematisees. Parmi ses principaux antecedents, on note un hematome du psoas un an auparavant et une hepatite C posttransfusionnelle bien controlee par un traitement antiviral. A l’examen clinique, le patient est apyretique, l’abdomen est douloureux dans son ensemble sans defense ni contracture, il n’y a pas de trouble du transit. Le bilan biologique est en faveur d’une deglobulisation aigue avec une hemoglobine a 7,9 g/dl. Il existe une discrete hyperleucocytose a 16 Giga/l. Le bilan hepatique est normal et la C Reactive Protein est a 47 mg/l. Un examen TDM abdomino-pelvien est demande. Celui-ci est realise (General Electric Lightspeed 16) sans puis avec injection de produit de contraste (Xenetix 350, GuerbetFrance) aux temps arteriel et portal (fig. 1 et 2).

Delayed transpyloric impaction is a very rare complication of esophageal metallic stent placement. Authors report different endoscopic removal techniques, but none of these has been validated yet because of their variable success, time-consuming nature, and risk of perforation and hemorrhage. We report that a "wait-and-see" approach is a safe and effective policy in patients with permeable transpyloric impacted esophageal stents.

Magnetic resonance colonography (MRC) has been recently developed to assess bowel inflammation in inflammatory bowel disease (IBD) patients. Evaluating animal models of inflammation with MRC may be important in new drug-screening processes. The aim of this study was to assess the feasibility of MRC in colitic rats and confront it with model characteristics.Colitis was induced by rectal injection of trinitrobenzene-sulfonic acid (TNBS) in 13 rats while six rats received the vehicle. MRC was performed at day 2. Colon inflammation and production of inflammatory mediators were evaluated. Image quality was assessed by wall and motion artifacts. MRC criteria were bowel wall thickness, wall signal intensity on T2-weighted (T2w) and T1w images, the appearance of a target sign pattern, and irregular patterns of mucosal surface.MRC quality was good or excellent in 16/21 examinations with no difference between groups. Colitis rats were significantly different from controls in terms of wall thickness (P = 0.004), the appearance of a target sign pattern (P = 0.02), irregular patterns of mucosal surface (P = 0.01), and hyperintensity on T1w images (P = 0.03). All MRC criteria except maximal bowel wall thickness were associated with colon weight:length ratio and inflammatory biomarkers (all P0.05). Minimal bowel wall thickness and wall signal intensity on T2w images were associated with histological score (P0.05).MRC is feasible and reliable in rats with TNBS-induced colitis. MRC criteria including colon wall thickness, wall signal intensity on T2w images, hyperintensity in T1w sequence, and the appearance of a target sign pattern may be potential targets for new IBD drugs.

Radiation-induced bile duct strictures are rare since bile ducts are considered to be resistant in radiation injury. We report a case of bile duct stenosis where evidence is presented that bile duct stricture was the result of radiation injury and which illustrates the major contribution of magnetic res-onance cholangiography in biliary tract disease evaluation.

International audience; Several imaging modalities are available ranging from fluoroscopic techniques to ultrasonography and MRI for the evaluation of patients with pelvic floors disorders. High-resolution ultrasonography and MRI not only provide superior delineation of the pelvic floor anatomy but also reveal pathology and functional changes. This article focuses on standard imaging procedures including defecography, ultrasonography, and MRI and discusses its use in clinical practice by illustrating both normal and abnormal patterns.

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MR Colonography is a new non invasive technique for colonic imaging. The first studies in man appeared in 1997-1998. MR Colonography requires an endoluminal contrast and combines volumetric acquisition with sophisticated image post-processing referred as virtual endoscopy. New technical developments such as fecal tagging were recently introduced. MR Colonography now enters into a phase of clinical evaluation. This article describes the available technique as well as pitfalls and artifacts with regard to our own experience.

Multifocal liver hemangioendothelioma is a rare tumor occurring in children less than 6-months-old. It can be life threatening during the first year of life because of possible hemorrhage or high output heart failure. Slow and often spontaneous recovery is the rule. The association of ultrasound and contrast-enhanced dynamic MR seems sufficient to establish the diagnosis.

Focal nodular hyperplasia of the liver is a benign neoplasm. The pathogenesis is unknown, but it was hypothesized that focal nodular hyperplasia may be a response to a vascular abnormality. We report on a case of focal nodular hyperplasia that developed in a young patient 1 year after a blunt hepatic injury.

BACKGROUND: Magnetic resonance colonography (MRC) has been developed to assess inflammatory bowel diseases. We aimed to assess the feasibility of MRC in rats with TNBS-induced chronic colitis and to confront imaging results with fibrosis and stenosing features of the model. MATERIALS AND METHODS: Chronic colitis was induced in 12 rats by weekly intra-rectal injection of increasing doses of TNBS for 6 weeks, while 8 control rats received the vehicle. At week 7, MRC was performed. Fibrosis scores were assessed and fibrosis mediators measured. RESULTS: Chronic colitis was associated with significant body weight loss (p

We report the case of a 77-year-old woman presenting with a jejunal intussusception as the primary symtom of metastatic renal cell carcinoma. Both lesions were demonstrated by abdominal CT which detected also pancreatic metastasis. This case emphasizes the significance of CT to diagnose intussusception and to characterize its cause.

Renal infarction is a rare and often difficult diagnosis. The objective of this study was to demonstrate that contrast-enhanced spiral CT in patients presenting features of renal colic, can establish the diagnosis by confirming the presence of infarction of the renal parenchyma.Over a 10-month period, the authors proposed the following decision flow-chart for all patients admitted with clinical features of renal colic: plain abdominal x-ray and first-line renal ultrasound, which, in the absence of a diagnosis (stones or dilatation of cavities), were completed by unenhanced spiral CT scan. When these examinations were normal, contrast-enhanced spiral CT scan was then performed.300 patients were included in this study, and CT was performed in 40 cases. This management allowed the diagnosis of infarction of the renal parenchyma in three patients, who are described here. When unenhanced CT sections do not reveal any abnormality, contrast-enhanced sections are essential to visualize the infarcted zone, seen as a triangular low density lesion with clearly defined margins and a vascular topography.Contrast-enhanced spiral CT should now be considered to be the reference examination for the assessment of non-documented renal colic. This recent imaging modality should allow the diagnosis of a greater number of infarctions of the renal parenchyma, which formerly remained undiagnosed.

Objectifs pedagogiques Reconnaitre rapidement les images pieges en coloscopie virtuelle. Connaitre leurs risques : faux positifs (coloscopies de controle inutiles) et faux negatifs (echec du depistage). Savoir manipuler les differents types de reconstructions (2D MPR, 3D endoluminale) pour caracteriser les differentes images pieges frequemment rencontrees. Messages a retenir La vue 3D endoluminale est la vue de base d’interpretation de la coloscopie virtuelle et est a l’origine de nombreuses images pieges. Les images pieges peuvent etre regroupees en 3 types : dues au patient (diverticule, spasme, valvule ileo-cœcale, compression extrinseque, protheses), dues a la preparation colique (selles liquides, selles dures, mucosites, diverticules remplis), dues a l’acquisition (durcissement, sonde rectale). L’etude avec les differentes reconstructions permet le plus souvent de statuer sur l’origine de l’image. Le CAD (logiciel d’auto detection des polypes) peut etre pris en defaut par certaines images pieges et necessite une analyse avec les differentes reconstructions.

Objectifs Connaitre les grands cadres cliniques des suppurations ano-perineales et la place de l’IRM. Connaitre la technique de realisation d’une IRM ano-perineale. Savoir interpreter une IRM ano-perineale. Connaitre la classification anatomique des fistules en IRM. Connaitre les elements du score d’activite des suppurations ano-perineales en IRM. Messages a retenir L’IRM est l’examen cle pour le bilan des suppurations ano-perineales notamment dans le cadre de la maladie de Crohn. Une cartographie precise des lesions peut etre faite. Elle permet le diagnostic d’abces profond et evalue l’activite des trajets fistuleux identifies. Resume Le bilan morphologique des suppurations ano-perineales representees principalement par les atteintes ano-perineales de la maladie de Crohn repose aujourd’hui sur l’IRM. Elle a une place importante lorsqu’un traitement par anti-TNF est discute chez les patients ayant une atteinte severe de maladie de Crohn. Elle est realisee avec une antenne de surface, des sequences en T2 dans les 3 plans et en Tl avec injection. Elle permet le diagnostic precis des fistules et des abces. Une classification des fistules par rapport aux sphincters (inter/trans/extra-sphincteriennes) doit etre donnee. Le caractere actif d’une fistule (hypersignal T2 et prise de contraste) est important pour preciser le degre d’inflammation.

This study evaluates the endosonographic patterns of the anal sphincter after sphincteroplasty to define specific postoperative findings and to identify factors related to clinical outcome after sphincter repair.Thirty-one incontinent patients (29 women, two men; mean age = 57 years) who underwent surgical repair for an external sphincter defect were studied postoperatively by endosonography. Twenty patients were found to improve after surgery.Postoperative endosonograms showed specific images: direct visualization of the surgical process was represented by the "overlapping sign" in 17 cases and the "end-to-end suture" in four cases. These echographically favorable cases were associated with improvement after surgery in 18 of 21 patients (p0.005). Persistent defects were reduced in five patients and unchanged in five other patients and were associated with poor outcome in eight of 10 patients (p0.005).Postoperative endosonography of the external anal sphincter presented some specific endosonographic aspects. The association between anal endosonographic findings and clinical outcome suggests the use of this procedure to assess patients following sphincteroplasty.

The aim of this study was to compare the prevalence of anal sphincter defects on anal sonography of incontinent and continent patients.Four hundred sixty-eight consecutive subjects who underwent anal sonography were studied. The prevalence of anal sphincter defects was calculated in 335 incontinent patients, 115 continent patients, and 18 asymptomatic female volunteers. All subjects answered a questionnaire about childbirth and proctologic surgery.The prevalence of anal sphincter defects revealed on sonography was 65% in the 335 incontinent patients. The prevalence of anal sphincter defects in incontinent patients was 88% in patients with a history of childbirth and proctologic surgery and 62% with childbirth alone. The prevalence of anal sphincter defects revealed on sonography was 43% in continent patients and 22% in asymptomatic volunteers. The prevalence of anal sphincter defects in continent patients with a history of childbirth and proctologic surgery was 92% and was 41% with childbirth alone. We found no difference in the prevalence of sphincter defects according to the age and sex of patients.Anal sonography can be used to identify sphincter defects in approximately two thirds of incontinent patients. Prevalence is greater in patients with a history of proctologic surgery. Because of the presence of sphincter defects in continent patients and in asymptomatic volunteers, caution should be used in attributing incontinence to anal sphincter defects alone.

Objectifs Les liens entre symptomes fonctionnels ano-rectaux et anomalies defecographiques sont discutes. Cette etude compare les anomalies mises en evidence en defecographie dans deux populations masculine et feminine, appariees pour l’âge et les symptomes. Materiels et methodes Soixante-six hommes consecutifs (âge moyen = 55,4 ans) se plaignant de constipation (n = 46), d’incontinence anale (n = 18) ou de douleur pelvienne (n = 37) ont eu une defecographie avec opacification du grele a la recherche d’un trouble de la statique pelvienne. Ils etaient compares a 198 femmes appariees pour l’âge et les symptomes, etudiees dans les memes conditions techniques. Resultats La defecographie etait normale chez 22,7 % des hommes contre 5,5 % des femmes (p Conclusion Dans le sexe masculin, la prevalence plus faible des rectoceles, enteroceles et perinees descendus souligne les difficultes d’interpretation de la defecographie et la complexite des liens entre plaintes fonctionnelles anoperineales et anomalies morphologiques et dynamiques.

Objectifs Nous nous sommes interesses a l’apport du scanner multidetecteur dans l’analyse endoluminale des protheses œsophagiennes. Materiels et methodes Six patients (4 hommes - âge moyen = 65 ans) porteurs de protheses œsophagiennes palliatives pour cancer stenosant de l’œsophage ont ete etudies en scanner (GE-LightSpeedl6) et en endoscopie devant une suspicion clinique de recidive endoluminale. Une helice thoracique (1,25 mm-phase arterielle) puis abdominale etaient realisees et les images analysees, en 15 minutes, sur console Advantage Windows-4,1 (reconstructions MPR-MIP et endoscopie virtuelle). La permeabilite prothetique etait analysee en 2D/3D. Resultats Trois patients avaient une double prothese. Chez quatre patients, un obstacle a la partie terminale de la prothese etait retrouve. Un patient presentait une repousse tumorale au dessus de sa prothese ainsi qu’une compression tracheale bien visualisee en endoscopie virtuelle de la trachee, realisee dans le meme temps. Un patient avait une prothese permeable. L’endoscopie a confirme secondairement ces donnees et permis la pose d’une seconde prothese chez une patiente. Le bilan d’extension realise dans le meme temps a mis en evidence des metastases chez 2 patients. Conclusion L’analyse en scanner mutidetecteur des protheses œsophagiennes est faisable, apportant en un temps court, avec un grand confort pour le patient, une information endoluminale de qualite associee au bilan d’extension.

Objectifs Analyser la faisabilite de la colo-IRM dans les poussees severes de rectocolite hemorragique (RCH) et evaluer la concordance avec l’endoscopie realisee en urgence. Materiels et methodes Dix-huit patients presentant une RCH en poussee grave ont beneficie en aveugle d’une colo-IRM et d’une endoscopie sans anesthesie a la recherche de signe de gravite. La colo-IRM consistait en un remplissage hydrique colique suivi de sequences type BFFE, T2 ± fat sat et Tl sans et avec injection. Le cadre colique a ete divise en 6 segments. La qualite de la distension a ete notee. La presence de lesions inflammatoires, leur etendue et l’existence d’eventuels signes de gravite ont ete analyses en endoscopie et en IRM. La concordance par segment et par patient selon la presence ou non de lesions severes a ete calculee. Resultats La qualite de distension des 108 segments analyses en colo-IRM etait satisfaisante. L’endoscopie a etudie 36 segments (rectum et sigmoide). La concordance pour le diagnostic de lesions severes etait excellente pour le rectum (k = 0,85) et bonne pour le sigmoide (k = 0,64). L’IRM en explorant l’ensemble du colon retrouvait des signes de gravite chez tous les patients qui en presentaient en endoscopie et permettait d’en mettre en evidence plus haut situes chez 4 patients. Des anomalies peridigestives etaient presentes en IRM dans 12% des cas. Conclusion La colo-IRM est un examen facilement realisable dont les resultats sont significativement correles a ceux de la rectosigmoi-doscopie dans les poussees severes de RCH. Elle permet de rechercher des signes de gravite sur l’ensemble du cadre colique difficile a explorer totalement par endoscopie dans cette situation.