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Introduction La nephrectomie partielle (NP) apres embolisation des vaisseaux tumoraux en salle hybride (NPESH) combine l’embolisation des vaisseaux tumoraux et l’enucleation de la tumeur sous coelioscopie dans un meme temps operatoire. L’objectif de cette etude etait d’evaluer l’impact de l’utilisation d’une salle hybride sur la prise en charge des patients traites par chirurgie pour une tumeur localisee du rein. Materiel et methodes Nous avons etudie, via la base de donnees uroCCR, tous les patients consecutifs pris en charge par nephrectomie partielle, dans un centre universitaire pour une tumeur du rein. Pendant la periode 1, de 2011 a mai 2015, les patients ont ete traites par nephrectomie partielle coelioscopique (NPC) ou ouverte (NPCO) classique. Pendant la periode 2, de mai 2015 a mai 2019, les patients ont ete traites par NPESH. Nous avons recueilli les caracteristiques des patients, des tumeurs, les donnees peroperatoires et postoperatoires. Ces donnees ont ete comparees par des tests de Student et du Khi2. Resultats Quatre-vingt-sept NP ont ete realisees pendant la periode 1 et 137 pendant la periode 2. Le score ASA des patients de la periode 2 etait plus eleve (p < 0,0001). La complexite tumorale et la taille tumorale mediane etaient similaires dans les deux groupes (p = 0,852 et p = 0,48). Le taux de complications pour les periodes 1 et 2 etait de 55,2 % et 33,6 % (p = 0,002). Les complications etaient moins severes dans le groupe 2 (p = 0,012). La duree mediane d’hospitalisation etait de 8 et 4 jours pour les periodes 1 et 2 (p < 0,0001). Les marges chirurgicales positives etaient de 2 (2,3 %) et 6 (4,6 %) pour les periodes 1 et 2 (p = 0,713). Discussion L’utilisation de la salle hybride a permis le developpement de la NPESH qui est une technique fiable. Elle semble etre une alternative interessante a la nephrectomie partielle standard en permettant de limiter, le taux de complication et la duree de sejour. Summary Introduction Partial nephrectomy (NP) after embolization of tumor vessels (NPESH) in a hybrid room combines embolization of tumor vessels and enucleation of the tumor under laparoscopy in the same operative time. The purpose of this study was to assess the impact of the use of NPESH in the management of patients treated with surgery for a localized kidney tumor. Material and methods Using the uroCCR database, we included all consecutive patients operated in a university hospital for localized kidney tumor. From 2011 to May 2015, patients were treated by Standard Partial Nephrectomy (NPS) Laparoscopic or Open and from May 2015 to May 2019 by NPESH. We evaluated characteristics of patients, tumors, perioperative data and complications. These data were compared by Student and Khi2 tests. Results 87 NPS were performed during Period 1 and 137 NPS were performed during period 2. The ASA score of patients undergoing NPESH was higher than NPS (P < 0.0001). The tumor complexity and median tumor size were similar in the two groups (P = 0.852 and P = 0.48). The complication rate for NPS and NPESH was 55.2% and 33.6% (P = 0.002). There were less severe complications in the NEPSH group (P = 0.012). The median length of stay was 8 and 4 days for the NPS and NPESH groups (P < 0.0001). Positive surgical margins were 2 (2.3%) and 6 (4.6%) for the NPS and NPESH group (P = 0.713). Discussion NPESH is an efficient technique compared to NPS. It seems to be an interesting alternative to limit renal ischemia, complication rate and length of stay for the management of localized kidney tumors.

Partial nephrectomy is the treatment of choice for small localized renal tumors. In case of doubt, a biopsy can confirm the diagnosis. The aim of this study was to evaluate the impact of a delayed time to partial nephrectomy on cancer development.Our single center study enrolled localized renal tumor patients who underwent a partial nephrectomy between 2015 and 2020; the collected data were included in the uroCCR prospective database. The histopathological stage of the tumors and the recurrence rate in patients treated with surgery90 days after diagnosis were investigated. The impact a preoperative biopsy on was also explored. Statistical significance was tested using Student's t-test and Chi-squared test (SPSS software).The cohort consisted of 179 patients, among which 41 (23 %) received a preoperative biopsy. 89 patients (50 %) were treated surgically3 months after diagnosis. The median time to nephrectomy was 86 days (13-1 037). A delayed time to surgery did not lead to significantly higher recurrence rates (P=0.66). Preoperative biopsy led to a doubling time to surgery (P0.001) but was neither correlated to a more severe tumor stage (P=0.944) nor to a higher recurrence rate (P=0.08). Tumor growth was not significantly different with or without the presence of a biopsy (P=0.122).Our data evidence that a substantial delayed time to partial nephrectomy does not result in a negative impact on cancer prognosis in localized renal tumor patients.

The 3D Navigo™ system is a magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion device for prostate targeted biopsies (TB). Our aim was to evaluate the clinically significant prostate cancer (CSC) detection rate of TB using the 3D Navigo™ system. Patients who underwent TB with the 3D Navigo™ system in our center between June 2014 and May 2018 were prospectively included, excluding those who have previously received treatment for prostate cancer. A 3-Tesla MRI imaging was performed before biopsies; findings were reported according to the Prostate Imaging Reporting and Data System version 2 (PIRADS). CSC was defined by an ISUP score ≥ 2. 304 patients underwent TB. Median age was 66 years (51–84). Median PSA was 7.75 ng/ml (0.6–70.0). Median prostate volume was 45.0 ml (15.9–221.7). PCa and CSC were found in 70.4% (214/304) and 47.7% (145/304) of the patients, respectively. The proportion of patients diagnosed with CSC among those with PCa was 67.8% (145/214). There was a significant risk of having a CSC in case of PIRADS score ≥ 4 and 5 (OR 5.0, 95% CI [2.7–9.2], P

Laparoscopic Partial Nephrectomy (LPN) after intra-arterial Embolization of renal tumors (LPNE) in a hybrid operating room allows renal tumor enucleation without dissection and clamping of the renal pedicle. The purpose was to assess the potential negative impact of embolization on the renal function. This prospective monocentric study included all patients treated with LPNE between May 2015 and June 2019. Clinical data was collected and incorporated into the UroCCR database (NCT03293563). Glomerular Filtration Rate (GFR) and Computed Tomography Renal Volume (CTRV) were compared before and after 6 months following LPNE. The mean post-operative GFR was 86.6 mL/min (SD 22.9). The mean GFR loss was 9.4% (SD 15.1) and the median renal parenchyma loss was 21 mL (SD 20.6). Using a threshold of 25% GFR loss, age was the only significant predictive factor of renal function impairment according to bivariate (59.5 vs 69.3 years, p = 0.017) and multivariable analysis (OR 1.075, CI 1–1.2], p = 0.05). Significant renal function impairment was not correlated with the renal parenchymal volume loss (OR 0.987, CI [0.95–1.02], p = 0.435). Renal function impairment after LPNE seems to be comparable to other techniques of partial nephrectomy.

Background Data comparing percutaneous ablation (PCA) and surgical resection (SR) for an isolated local recurrence (LR) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are lacking. Objective To examine the outcomes between PCA and SR for an isolated LR following PN for RCC. Design, setting, and participants Patients who underwent PN for RCC and developed an LR between 2013 and 2019 were included. An LR was defined as the appearance of a mass in contact with the resection bed or the development of a tumor in the same region of the homolateral kidney as the original site. Intervention PCA or SR. Outcome measurements and statistical analysis To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. Oncological outcomes, complications, and renal function were evaluated between groups using logistic, linear, and Cox proportional hazard regression models. Results and limitations A total of 81 patients with an isolated LR were included (PCA: 42; SR: 39). The median follow-up was 23 mo. After adjustment, excellent balance was achieved for the majority of propensity score variables. In IPTW analysis, PCA was associated with a lower risk of postoperative complications (odds ratio = 0.22; p = 0.006) and a smaller change in eGFR (beta = −16.18; p = 0.001). There were no significant differences in the risk of disease recurrence (hazard ratio [HR] = 0.72; p = 0.61), new LR (HR = 1.51; p = 0.59), and distant metastasis (HR = 0.19; p = 0.09). Limitations include the sample size and unmeasured confounding factors. Conclusions Our results suggest that PCA provides comparable oncological outcomes to repeat surgery with fewer complications and better renal function preservation for the management of an LR after PN. Patient summary This report shows that percutaneous ablation can be used for treating a local recurrence of renal cell carcinoma after partial nephrectomy, without significantly compromising cancer control.

Purpose The main objective was to evaluate types and predictive factors of incidental findings (IFs) on multidetector computed tomographies (MDCTs) performed for an emergency department (ED). The secondary aim was to analyze additional investigations, their benefits, side effects, costs and the final diagnoses. Method One thousand consecutive patients over 18 years old who underwent an MDCT in the ED of our institution from January 2011 to November 2011 were retrospectively included, accounting for 300 head MDCTs and 700 other MDCTs. The following criteria were collected in patient electronic medical records: IFs (divided into low and high clinical significance), body areas covered, availability of a prior imaging, radiologist’s experience and subspecialty, additional investigations, their outcomes and costs. Results Among the 1000 included patients, 232 had at least one IF and 122 had at least one IF of high clinical significance (IFCS). There were 340 IFs and 150 IFCSs. A significant association with the presence of at least one IF was noted for older patients, less-experienced radiologists, no subspecialty of the radiologist, the abdominopelvic area, and the absence of prior imaging. Eighteen IFs generated additional investigations in our institution, including five invasive samplings and three surgical operations, with two diagnoses of malignancy (a gastrointestinal stromal tumor and a Bosniak IV cystic renal lesion). One benign iatrogenic complication occurred. Total cost of these investigations was €41,247 (with an average of €2292 per IF investigated). Conclusion IFs on emergency MDCTs were frequent, rarely severe, rarely iatrogenic and relatively expensive.

To evaluate and compare pathological characteristics of renal cysts Bosniak IIF, III and IV in light of recent histological classification. The French research network for kidney cancer UroCCR conducted a multicentre study on patients treated surgically for a renal cyst between 2007 and 2016. Independent radiological and centralized pathological reviews were performed for every patient. Pathological characteristics were compared to the Bosniak classification. Of a total 216 patients included, 175 (81.0%) tumours (90.9% of Bosniak IV, 69.8% of Bosniak III) were malignant or had a low malignant potential, with 60% of clear cell renal cell carcinoma (CCRCC), 24% of papillary RCC (PRCC) and 6.9% of multilocular cystic renal tumour of low malignant potential (MCRTLMP). Malignancies were mostly of low pT stage (86.4% of pT1–2), and low ISUP grade (68.0% of 1–2). Bosniak III cysts had a lower rate of CCRCC (46.7 vs. 67.3%), higher rate of PRCC (30 vs. 20.9%) and MCRTLMP (18.3 vs. 0.9%) compared to Bosniak IV (p

Objectifs Decrite pour la premiere fois en 1996, la nephrectomie laparoscopique pour reins polykystiques est maintenant couramment utilisee par plusieurs unites de transplantation. Cependant l’extraction de ces reins de haut volume est un defi qui n’a pas ete resolu de maniere adequate. Nous avons experimente une technique de fragmentation manuelle intracorporelle au sein d’un sac d’isolation au cours de la cœlioscopie manuellement assistee. Methodes Tous les patients atteints de polykystose renale et qui ont necessite une nephrectomie ont ete inclus de maniere prospective dans l’etude de janvier 2018 a mai 2021. La nephrectomie a ete realisee par laparoscopie manuellement assistee a l’aide du systeme laparoscopique GelPort®, positionne a travers une incision de Pfannenstiel de 8 cm. Trois ou quatre trocarts supplementaires et une optique de 0° ou 30° de dix millimetres ont ete utilises. Le rein a ensuite ete place dans un sac d’isolation Vi-Drape® (45 cm × 45 cm) avant d’etre morcele a la main en intracorporel puis extrait au travers de l’ecarteur Alexis du GelPort®. Resultats Vingt-trois nephrectomies (9 reins gauches, 14 reins droits) ont ete realisees. Les indications operatoires etaient les suivantes : prise en charge pre-transplantation, infection kystique recurrente, douleur, prolapsus genital, polyglobulie et presence d’une lesion suspecte de malignite chez respectivement 12, 5, 2, 1, 1 et 2 patients. L’âge, l’IMC, le volume renal median des patients etaient respectivement de 55 ans (47–74), 25,03 kg.m-2 (18,04–34,88) et 1520 cc (588–4627). Les temps operatoires, de mise au sac, de fragmentation medians etaient respectivement de 147 min (89–306), 4,00 min (1,87–16,43), 1,15 min (0,16–4,65). Aucun drainage n’etait necessaire, avec une perte mediane d’hemoglobine de 0,1 g/dl (−1–3,9). 12 patients (52 %) ont presente des complications postoperatoires, dont 2 de grade III, 1 de grade IV. La duree mediane du sejour etait de 3 jours (2–15). Conclusion La fragmentation manuelle intra-corporelle de volumineux reins polykystiques dans un sac d’isolation pendant la nephrectomie cœlioscopique manuellement assistee permet d’extraire facilement d’enormes reins polykystiques avec un dommage minimal a la paroi abdominale et un risque minimal de dissemination bacterienne ou oncologique.

Purpose In order to limit ischemia and operative bleeding during and after partial nephrectomy we developed a clampless laparoscopic technique, in a hybrid operating room, immediately after super-selective arterial embolization of the renal tumor. We evaluated feasibility and morbidity of this new approach of zero ischemia in partial nephrectomy. Methods We included prospectively 50 consecutive patients treated in a hybrid operating room by this new technique for a localized renal tumor in a university hospital between May 2015 and January 2017. We evaluated perioperative data, postoperative complications, surgical margin and modification of renal function one month after surgery. Renal tumor complexity was evaluated by the R.E.N.A.L. score. Results We included 30 (60%) men and 20 (40%) women with a median age of 61 years (32–84) and a median BMI of 26.85 kg/m2 (20.1–46.4). Tumors were at low, median and high complexity in respectively 11 (22%), 32 (64%) and 7 (14%) cases. Median endovascular and surgical procedures durations were 43 min (16–120) and 80 min (32–150). Median blood loss was 100 mL (10–850). Two Clavien II complications occurred. Median length of hospital stay was 3 days (2–7). Renal function was not modified one month after partial nephrectomy. Median tumor size was 3 cm (1.2–8). Forty tumors (80%) were malignant and surgical margins were positive in one (2%). Conclusions Clampless laparoscopic partial nephrectomy in a hybrid operating room without pedicular dissection after previous tumoral embolization is a technically safe and carcinologically efficient mini-invasive alternative for the management of localized renal tumors.

Resume L’objectif de notre etude etait d’evaluer les index de performance du scanner post-mortem sans injection dans la detection des lesions thoraciques apres mort violente. Materiel et methode Nous avons recueilli retrospectivement un echantillon de 67 corps decedes de mort violente avec lesions thoraciques, et qui ont eu un scanner non injecte, analyse en temps reel et suivi d’une autopsie. Une confrontation scanner–autopsie constituait le gold standard de notre etude. Les donnees ont ete recueillies par organe : cœur, pericarde, aorte, poumons, plevre, os et diaphragme avec calcul d’index de performance classique. Resultats Les lesions pleurales (59/67), et osseuses (55/67) vues au scanner etaient toutes vues a l’autopsie et confirmees en consensus lors du staff mensuel (sensibilite et specificite de 100 %). Dix-sept sur 67 lesions diaphragmatiques etaient detectees au scanner, et 18 en autopsie et confirmees par le staff, soit une sensibilite de 94 % avec une specificite de 98 %. Quarante sur 67 contusions pulmonaires etaient vues au scanner avec deux faux positifs et un faux negatif, avec sensibilite du scanner de 95 %, specificite de 96 % et une accuracy de 95 %. Quatorze sur 67 lesions aortiques ont ete detectees au scanner contre 19 lesions retenues par le staff apres l’autopsie (sensibilite 74 %, specificite 85 %, accuracy 82 %). Pour les lesions pericardiques, 19/67 etaient vues au scanner et 20 a l’autopsie et confirmees par le staff (sensibilite 80 %, specificite 94 %, accuracy 85 %) ; 10/67 lesions cardiaques etaient vues au scanner, et 15 etaient retenues lors du staff de confrontation (sensibilite 57 %, specificite 94 %, accuracy 81 %). Conclusion La performance du scanner post-mortem non injecte etait bonne pour la detection des lesions pleuropulmonaires, osseuses et diaphragmatiques mais moindre pour les lesions cardiaques et aortiques pour lesquelles le recours aux signes indirects etait imperatif.

Resume Objectifs Valider la performance du scanner corps entier dans le bilan morphologique avant prelevement multi-organes (PMO) chez des sujets en etat de mort encephalique. Evaluer son impact sur la duree de prise en charge des prelevements. Materiels et methodes Cinquante et un patients en etat de mort encephalique etaient inclus successivement, de facon prospective et monocentrique (mars 2011–mars 2013). Le protocole d’acquisition comportait la confirmation du diagnostic de mort encephalique par angioscanner cerebral, et un seul passage thoraco-abdomino-pelvien au temps portal. Les anomalies morphologiques thoraco-abdomino-pelviennes (lesions focales ou diffuses, hepatopathie type steatose), les variantes anatomiques vasculaires etaient analysees. La reference diagnostique etait l’aspect macroscopique et/ou l’analyse anatomopathologique sur biopsies. Une premiere lecture etait realisee par un radiologue senior, une deuxieme en cas de discordance radio-chirurgicale. La duree de la prise en charge etait evaluee. Resultats Le scanner a modifie le PMO dans 21 cas : 3 annulations, 10 poursuites apres anatomopathologie, 8 greffons recuses. Quatre-vingt-quinze pour cent des variantes anatomiques vasculaires sont visibles. La concordance radio-chirurgicale sur la steatose hepatique est de 80 %. Le gain de temps sur la prise en charge est de 2 h 30. Conclusion Le scanner corps entier permet une selection fiable des potentiels greffons et diminue le temps de prise en charge, sous reserve d’un protocole optimise.

Objectifs Evaluer la precision diagnostique de la tomodensitometrie (TDM) dans l’evaluation du stade t3a du carcinome renal a cellules claires (CRCC). Methodes La TDM preoperatoire de 96 patients inclus de maniere prospective (base de donnees UROCCR) a ete relue a posteriori par deux radiologues, en aveugle, en se focalisant sur l’evaluation d’un envahissement du tissu adipeux perirenal et/ou du tissu adipeux hilaire et/ou d’un thrombus macroscopique dans la veine renale ou dans l’une de ses branches afin d’etablir le stade ct3a. Le caractere positif des marges tumorales et la presence de neovaisseaux peritumoraux ont egalement ete evaluees, ainsi que l’influence du rehaussement (aspect œdematie et/ou inflammatoire) de la graisse perirenale dans l’analyse de la graisse peritumorale. L’ensemble des patients inclus presentaient 100 CRCC confirmes a l’analyse histo-cyto-pathologique. Resultats La sensibilite du diagnostic scanographique d’un envahissement du tissu adipeux perirenal et/ou du tissu adipeux hilaire et/ou d’un thrombus de la veine renale etait de 77 %, 86 % et 86 % et la specificite etait de 72 %, 88 % et 97 % respectivement. La sensibilite et la specificite du diagnostic scanographique des tumeurs de stade t3a etaient respectivement de 72 % et 70 % [score κ = 0,38 (0,29–0,47)]. Parmi les 38 (16 %) tumeurs pt3, 6 (16 %) etaient sous-evaluees : la presence de neovaisseaux ou une tumeur aux contours irreguliers n’etaient pas des criteres augmentant de maniere significative la precision du diagnostic d’envahissement local. Parmi les 62 tumeurs limitees au rein, 17 (27 %) etaient surevaluees en stade ct3 et parmi ces 17 cas de faux positifs, la graisse perirenale presentait un rehaussement dans 14 cas ( Fig. 1 , Fig. 2 , Fig. 3 , Fig. 4 , Tableau 1 , Tableau 2 ). Conclusion La tomodensitometrie fournit de bons resultats en ce qui concerne l’analyse de la graisse perihilaire renale, d’un thrombus veineux et des tumeurs limitees au rein. L’evaluation de la graisse perirenale reste une tâche difficile, avec des facteurs de confusion, conduisant a un diagnostic scanographique plus difficile du stade t3a.

Objectifs L’embolisation selective des vaisseaux tumoraux avant nephrectomie partielle permet une enucleation de la tumeur renale sans clampage du pedicule renal. Cependant, l’utilisation de produit de contraste et le risque d’embolisation de parenchyme renal sain pourraient provoquer une deterioration de la fonction renale. L’objectif de cette etude etait d’evaluer le retentissement de l’embolisation des vaisseaux tumoraux sur la fonction renale. Methodes Nous avons inclus dans la base de donnees prospectives uroCCR tous les patients operes d’une nephrectomie partielle apres embolisation selective des vaisseaux tumoraux en salle hybride pour une tumeur du rein localisee entre mai 2015 et mai 2019 dans un centre unique. Une diminution superieure a 25 % du debit de filtration glomerulaire (DFG) selon la formule MDRD a 6 mois de l’intervention etait consideree comme majeure. Nous avons utilise des donnees de volumetrie renale sur scanner avant chirurgie et a 6 mois de la chirurgie, pour quantifier le pourcentage de perte de parenchyme renal sain. Resultats Nous avons inclus 93 patients dont l’âge moyen etait 60,4 (± 12) ans et 4 (4,3 %) avait une insuffisance renale preoperatoire. La taille tumorale moyenne etait 3,4 (± 1,6) cm et 30 (32,3) patients avaient un stade pT1b-2. A 6 mois, le DFG moyen etait diminue de 9,4 % (± 15), 10 (9 %) patients avaient une perte majeure de fonction renale, un (1 %) patient presentait une nouvelle insuffisance renale et la perte moyenne de parenchyme renal sain etait de 21 (± 20,6) mL. Le nombre d’arteres embolises et la quantite de produit de contraste utilisee n’etaient pas des facteurs associes a une perte significative de fonction renale. Seul l’âge etait un facteur significativement associe a une perte majeure de fonction renale (p = 0,017) ( Tableau 1 ). Conclusion Les variations de fonction renale apres embolisation puis enucleation tumorale sans clampage du pedicule renal sont similaires a celles rapportees dans la litterature pour les autres techniques. L’âge du patient est le principal facteur de deterioration de la fonction renale postoperatoire.

Resume Les ruptures isthmiques aortiques doivent etre systematiquement recherchees lors des traumatismes thoraciques a haute cinetique. Cette pathologie est grave et met en jeu le pronostic vital du patient. Elle necessite un diagnostic rapide tout en evitant les pieges diagnostiques. L’angioscanner est l’examen de reference. Les principaux signes scanographiques de rupture de l’aorte thoracique sont l’hematome aortique parietal, le flap intimal, le pseudo-anevrisme et l’extravasation de produit de contraste. Il existe trois types de lesions : la lesion intimale, la lesion sous-adventitielle ou pseudo-anevrismale et la rupture complete avec lesion des trois tuniques, qu’il est important de grader pour une meilleure prise en charge therapeutique. Les principaux pieges diagnostiques du scanner sont la presence d’un diverticule ductal et d’une dilatation post-isthmique fusiforme. Les associations lesionnelles ne doivent pas etre meconnues. Les plus frequentes sont la rupture de la racine de l’aorte et la rupture de l’aorte thoracique dans le hiatus diaphragmatique.

Currently, post-mortem computed tomography (PMCT) has become an accessible and contemporary tool for forensic investigations. In the case of burn victims, it provides specific semiologies requiring a prudent understanding to differentiate between the normal post-mortem changes from heat-related changes. The aim of this pictorial essay is to provide to the radiologist the keys to establish complete and focused reports in cases of PMCT of burn victims. Thus, the radiologist must discern all the contextual divergences with the forensic history, and must be able to report all the relevant elements to answer to the forensic pathologist the following questions: Are there tomographic features that could help to identify the victim? Is there evidence of remains of biological fluids in liquid form available for toxicological analysis and DNA sampling? Is there another obvious cause of death than heat-related lesions, especially metallic foreign bodies of ballistic origin? Finally, what are the characteristic burn-related injuries seen on the corpse that should be sought during the autopsy? • CT is highly useful to find features permitting the identification of a severely burned body. • PMCT is a major asset in gunshot injuries to depict ballistic foreign bodies in the burned cadavers. • CT is able to recognise accessible blood for tests versus heat clot (air-crescent sign). • Heat-related fractures are easily differentiated from traumatic fractures. • Epidural collections with a subdural appearance are typical heat-related head lesions.

Objectifs Le systeme 3D Navigo™ permet la realisation de biopsies de prostate ciblees (BPC) par fusion d’images echographie-IRM. L’objectif de cette etude etait d’evaluer le taux de detection du cancer de prostate (CaP) cliniquement significatif (CSC) par BPC utilisant le systeme 3D Navigo™. Methodes Nous avons prospectivement inclus tous les patients ayant eu des BPC utilisant le systeme 3D Navigo™ entre juin 2014 et mai 2018 dans notre centre. Une IRM multiparametrique (IRMmp) 3 Tesla etait systematiquement realisee au prealable. Les lectures des IRMmp et des histologies (biopsies et prostatectomies) ont ete realisees en simple aveugle. Un CSC etait defini sur les biopsies par : un score ISUP ≥ 2 et/ou une longueur tumorale > 3 mm, et/ou une extension extra-prostatique et/ou ≥ 3 biopsies positives. Un CSC sur piece de prostatectomie radicale (PR) etait defini par : un score ISUP ≥ 2 et/ou un stade ≥ pT3. Resultats Au total, 317 patients ont eu des BPC. L’âge, le PSA et le volume prostatique medians etaient respectivement de 67 (51–84) ans, 7,62 (0,6–70) ng/mL, et 44,2 (12,1–221,7) mL. Des lesions PIRADS = 3, 4 et 5 etaient retrouvees chez respectivement 37, 157 et 100 patients. Le nombre median de carottes par patient etait de 9, avec un taux median de biopsies positives de 26 %. Un CaP etait retrouve chez 72,8 % des patients. Le taux de CSC etait de 62,6 %. Une correlation existait entre le score PIRADS et le taux de detection de CSC (r = 0,4, p Il existait une forte correlation entre les scores ISUP des BPC et des pieces operatoires des PR (r = 0,608, p Conclusion Les BPC avec le systeme 3D Navigo™ permettent de detecter efficacement la presence d’un cancer de prostate chez 72 % des patients avec un taux de CSC de 86 %. Il existait 12 % CSC non identifiees par les BPC justifiant la realisation de biopsies systematisees complementaires.

Objectifs L’objectif de cette etude etait de tester un algorithme pratique base sur l’IRM multiparametrique afin de determiner le type histologique des tumeurs renales. Methodes Cette etude retrospective a inclus 40 patients presentant une tumeur renale avec resultat histologique et une IRM preoperatoire. Deux radiologues ont evalue independamment chaque critere d’apres l’algorithme (T2, T1 dixon in-out, diffusion et sequences post-gadolinium) en retenant un type tumoral comme hypothese diagnostique. Quelques criteres ont ete ajoutes (2 quantitatifs) : T2 ratio (ratio signal tumeur/rein normal) et un pourcentage de rehaussement de la tumeur a la phase corticomedullaire. Test du kappa, representations graphiques d’analyse en concordance multiple et analyses en regression logistique ont permis de determiner les correlations inter-observateur et tenter d’identifier des modeles tumoraux et d’eventuels criteres plus utiles ou non. Resultats La correlation entre l’hypothese selon l’algorithme ( Tableau 1 ) et le resultat anatomopathologique etait modeste pour les deux lecteurs (65,9 et 58,5 %). De plus, l’algorithme montre une performance egalement moderee dans une conclusion dichotomique benin-malin (sensibilite de 80–85,5 % et specificite de 50–75 %). Seulement deux modeles IRM semblaient reellement specifiques et diametralement oppose, representant p-RCC (papillaire) et c-RCC (carcinome a cellules claires) ( Fig. 1 ). L’analyse des deux criteres quantitatifs ajoutes a l’etude initiale a montre des performances inferieures a celles attendues. Par ailleurs, l’analyse du dephasage n’etait pas determinante pour plusieurs raisons : mauvaise correlation inter-observateur, jamais preponderant dans les analyses en regression lineaire logistique et a distance de l’ensemble des criteres sur les representations graphiques selon les analyses en concordance multiples. Conclusion Tel que presente, cet algorithme montre une performance moderee dans l’identification IRM des sous-types histologiques des tumeurs renales, insuffisante pour remplacer la biopsie en pratique quotidienne.

Introduction The diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection. Aim We present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below. Methods A 26‐year‐old male drug addict presented with glans pain 4 days after self‐injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis. Results After 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28‐day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications. Conclusions To date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy. Brecheteau F, Grison P, Abraham P, Lebdai S, Kemgang S, Souday V, Nedelcu C, Culty T, Larre S, Azzouzi AR, and Bigot P. Successful medical treatment of glans ischemia after voluntary buprenorphine injection. J Sex Med 2013;10:2866–2870.

International audience

Purpose The aim of this study was to assess the performances of unenhanced post-mortem computed tomography (CT) to detect thoracic injuries in violent death. Materials and methods Retrospectively, we conducted a review of unenhanced CT scans of 67 victims of violent deaths with thoracic injuries and compared CT findings with the results of clinical autopsy. Our gold standard was a comparison of CT scans with autopsy discussed in a monthly forensic radiology multidisciplinary team meeting (MDTM). The data were collected by organ system: heart, pericardium, aorta, lungs, pleura, bone, and diaphragm and performance indices (sensitivity, specificity, accuracy) were calculated. Results Pleural (59/67) and bone (55/67) injuries detected on CT were also found at autopsy and confirmed by the MDTM (sensitivity and specificity 100%). Seventeen out of 67 diaphragmatic lesions were visible on CT. Eighteen out of 67 were confirmed during MDTM after autopsy, yielding overall sensitivity of 94% and specificity of 98%. Forty out of 67 lung contusions were found on CT with two false positives and one false negative yielding 95% sensitivity for CT with a specificity of 96%, and accuracy of 95%. Fourteen out of 67 aortic injuries were found on CT compared to 19 confirmed during MDTM (sensitivity 74%, specificity 85%, accuracy 82%). In terms of pericardial lesions, 19/67 were found on CT and 20 on autopsy and confirmed during MDTM (sensitivity 80%, specificity 94%, accuracy 85%). Ten out of 10/67 cardiac lesions were visible on CT imaging and 15 found on autopsy and confirmed during MDTM (sensitivity 57%, specificity 94%, accuracy 81%). Conclusion Unenhanced post-mortem CT performs well to detect pleural, pulmonary, bone and diaphragmatic injuries but less well to identify cardiac and aortic injuries, for which the use of indirect signs is essential.

The management of metastatic renal cell carcinoma (mRCC) has been transformed by the use of targeted therapies, ablative therapies and improved surgical techniques. The objective of this study was to identify therapeutic strategies that resulted in complete remission (CR) and to assess survival of patients in CR. In a prospective database, we included all patients treated for mRCC at a university hospital between 2007 and 2015. CR was defined as the absence of metastasis after a full-body computed tomographic scan. We treated 77 patients with mRCC and experienced a CR in 22 (29 %) patients. Patients in CR had, respectively, synchronous and metachronous metastases in 7 (32 %) and 15 (68 %) cases and unique and multiple metastases in 4 (18 %) and 18 (82 %) cases. All patients were treated with cytoreductive nephrectomy and 21 (96 %) had metastasectomy or percutaneous ablation of their metastases. One patient had a CR after systemic treatment with sunitinib. After a median (range) follow-up since metastatic diagnosis of 35 (1–89) months, 12 patients (55 %) had disease recurrence. The median (range) duration of CR before recurrence was 14 (1–39) months. After recurrence, a new CR was obtained in 7 patients (58 %). At the end of follow-up, 16 patients (73 %) were still in CR, 5 (23 %) were undergoing medical treatment, and 1 patient died during the postoperative course. In the era of targeted-therapies, CRs were obtained with multimodal treatment of metastatic kidney cancer. All patients in CR had a nephrectomy and almost all of them had multiple metastasectomies.

Resume Objectifs Presenter et illustrer les principales applications de la quantification de flux par contraste de phase en imagerie cardiovasculaire. Conclusion Les sequences de velocimetrie par contraste de phase permettent une etude precise, fiable, reproductible et non invasive des flux sanguins ; donnees parfois non accessibles aux autres techniques d’investigations. Les informations hemodynamiques ainsi obtenues sont complementaires des images IRM angiographiques. Les applications cliniques apparaissent variees, permettant tout d’abord une meilleure comprehension physiopathologique mais participant egalement a la strategie therapeutique et a la surveillance apres traitement chirurgical ou endovasculaire.

Points essentiels Les syndromes aortiques constituent une grande urgence diagnostique et therapeutique du fait de la morbi-mortalite elevee des maladies aigues de l’aorte. La modalite d’imagerie mise en œuvre doit permettre de faire le diagnostic ou d’eliminer la presence d’un syndrome aortique aigu, mais egalement identifier les signes de gravite de l’atteinte aortique . La tomodensitometrie, l’echographie transœsophagienne et l’imagerie par resonance magnetique ont des valeurs de sensibilite et specificite excellentes et a peu pres equivalentes pour le diagnostic des maladies aigues de l’aorte. La tomodensitometrie a l’avantage d’identifier les atteintes des collaterales et notamment des branches viscerales de l’aorte abdominale (diagnostic des malperfusions). En pratique clinique , c’est la tomodensitometrie qui est l’examen diagnostic le plus souvent realise, suivi par l’echographie transœsophagienne. Lorsqu’une modalite d’imagerie est negative et que la suspicion clinique est forte de syndrome aortique aigu, une deuxieme modalite d’imagerie doit etre realisee sans delai.

Dose delivery during CT coronary angiography with retrospective ECG gating is high especially due to the important slice overlapping. Optimization of the acquisition parameters is necessary to reduce patient exposure. First, the height of the scan field should be limited to the heart. Both kV and mA should be adjusted based on patient morphology. ECG gated exposure modulation with mA reduction during systole, a technique most applicable for patients with slow and regular heart rate, can result in a dose reduction up to 50%. The use of prospective ECG gating can also reduce patient dose. This technique also requires patients with slow and regular heart rate.

Gas containing lesions of the lung can be differentiated into cystic and cavitary lesions based on their imaging characteristics, which is helpful for differential diagnosis. The imaging features include number, size, thickness and smoothness of the walls, content, lesion distribution and occasional associated lesions. Some imaging features have characteristic diagnostic implications: mural nodule and meniscus sign. Cysts are characterized by thin and regular walls, less than 2 mm in thickness. The differential diagnosis includes: histiocytosis X, lymphangioleiomyomatosis, cystic metastases, septic emboli, pulmonary sequestration. Emphysema, honeycombing and cystic bronchiectases should also be considered. Cavitary lesion have thicker walls. The most frequent etiologies include abscess, cavitary tumors, mycobacterial infections and fungal infections.

Background Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing hemoptysis of pulmonary arterial origin. Methods We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with hemoptysis of pulmonary arterial origin. Results Of 272 patients who were referred for severe hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive hemoptysis (n = 1). Conclusions MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe hemoptysis of pulmonary arterial origin.

A 49-year-old woman was treated for right kidney stones using flexible ureteroscopy and laser lithotripsy. She was readmitted 2 weeks after the treatment with complaints of walking difficulties. On neurologic examination, it was found that she had a bilateral proprioceptive dysfunction. Spinal MRI revealed an intramedullary lesion at the T10-T11 level consistent with an intramedullary cavernoma. The final diagnosis was a spinal compression consecutive to the cavernoma bleeding associated with the prolonged lithotomy position. Symptoms have not been reversible and the patient continued to have walking difficulties. We report for the first time a major complication that arises as a result of using flexible ureteroscopy for treating kidney stones.

To investigate feasibility, safety, and efficacy of salvage radical prostatectomy (RP) for recurrent prostate cancer (PCa) after focal treatment with TOOKAD® Soluble vascular-targeted photodynamic therapy (VTP). Nineteen patients underwent RP after biopsy-proven PCa post-focal VTP. We reported: operation time, blood loss, transfusion, complications, urethral catheterization time, functional outcomes, and short-term oncologic outcomes. Median age was 64 years (58–70). Median PSA before VTP was 6.30 ng/ml (3.20–9.80). Median delay between VTP and RP was 17 months (8–48). Median blood loss was 400 ml (100–1,000). Median operation time was 150 min (90–210), median urethral catheterization time was 7 days (5–18), and median hospital stay was 7 days (4–21). There was no perioperative mortality. Three patients had related per-operative complications: one pelvic hematoma (150 cc) (Clavien IIIa), one per-operative transfusion (900 cc hemorrhage) (Clavien II), and one superficial wound infection (Clavien I). After a median follow-up of 10 months (1–46), 13 were completely continent (68 %), five needed ≤1 pad/day, and one needed 3 pads/day (Clavien I). Severe erectile dysfunction was observed before and after RP (respectively 8 and 18). Ten patients regained potency with appropriate treatment. Median postoperative PSA was 0.02 ng/ml (

International audience; PURPOSE: Extent of lung contusion on initial computed tomography (CT) scan predicts the occurrence of acute respiratory distress syndrome (ARDS) in blunt chest trauma patients. We hypothesized that lung ultrasonography (LUS) on admission could also predict subsequent ARDS. METHODS: Forty-five blunt trauma patients were prospectively studied. Clinical examination, chest radiography, and LUS were performed on arrival at the emergency room. Lung contusion extent was quantified using a LUS score and compared to CT scan measurements. The ability of the LUS score to predict ARDS was tested using the area under the receiver operating characteristic curve (AUC-ROC). The diagnostic accuracy of LUS was compared to that of combined clinical examination and chest radiography for pneumothorax, lung contusion, and hemothorax, with thoracic CT scan as reference. RESULTS: Lung contusion extent assessed by LUS on admission was predictive of the occurrence of ARDS within 72 h (AUC-ROC = 0.78 [95 % CI 0.64-0.92]). The extent of lung contusion on LUS correlated well with CT scan measurements (Spearman's coefficient = 0.82). A LUS score of 6 out of 16 was the best threshold to predict ARDS, with a 58 % [95 % CI 36-77] sensitivity and a 96 % [95 % CI 76-100] specificity. The diagnostic accuracy of LUS was higher than that of combined clinical examination and chest radiography: (AUC-ROC) 0.81 [95 % CI 0.50-1.00] vs. 0.74 [0.48-1.00] (p = 0.24) for pneumothorax, 0.88 [0.76-1.00] vs. 0.69 [0.47-0.92] (p < 0.05) for lung contusion, and 0.84 [0.59-1.00] vs. 0.73 [0.51-0.94] (p < 0.05) for hemothorax. CONCLUSIONS: LUS on admission identifies patients at risk of developing ARDS after blunt trauma. In addition, LUS allows rapid and accurate diagnosis of common traumatic thoracic injuries.

Acute aortic syndrome is an emergency that requires prompt diagnosis and treatment because of its high morbidity and mortality rates. The chosen imaging modality should allow to diagnose or eliminate the presence of an acute aortic syndrome but also identify signs of severity of the aortic disease. Computed tomography, transesophageal echocardiography and MRI have high sensitivity and specificity values and roughly equivalent for the diagnosis of acute aortic syndromes. Computed tomography has the advantage of identifying involvement of aortic collaterals including visceral branches of the abdominal aorta. In clinical practice, Computed tomography is the diagnostic modality the most often performed, followed by trans esophageal echocardiography. If a high clinical suspicion exists for acute aortic syndrome but initial aortic imaging is negative, a second imaging study should be obtained without delay.

Hemoptysis of pulmonary arterial origin is a diagnostic challenge in patients admitted to a respiratory ICU (RICU) for treatment of hemoptysis. Its early accurate recognition and treatment reduce morbidity and prevent mortality. Multidetector row CT angiography (MDCTA) is an accurate method for imaging the systemic vascular network. Our aim was to assess the MDCTA signs and role in managing hemoptysis of pulmonary arterial origin.We performed a retrospective clinical and radiologic analysis of all consecutive patients who were referred for severe hemoptysis to our RICU and were treated by endovascular means between January 2004 and December 2006. We reviewed all of those cases with hemoptysis of pulmonary arterial origin.Of 272 patients who were referred for severe hemoptysis to the RICU, 189 patients were treated by endovascular means. Thirteen patients (nine men, four women; mean age, 45 years) had hemoptysis of pulmonary arterial origin. Signs of pulmonary arterial hemoptysis seen on MDCTA were of the following three types: pseudoaneurysm (n = 5); aneurysm of the pulmonary artery (n = 3); or the presence of a pulmonary artery in the inner wall of a cavity (n = 5). Hypertrophy of the bronchial arteries seen on MDCTA associated with any of these signs predicted the necessity to treat both the bronchial and pulmonary arteries. Pulmonary artery vasoocclusion was performed as a first treatment in eight patients with such an association (n = 1) or without such an association (n = 7) along with bronchial artery embolization. The remaining five patients were treated with systemic artery embolization, followed by surgery (n = 1), pulmonary artery vasoocclusion (n = 3), and death from massive hemoptysis (n = 1).MDCTA performed prior to endovascular treatment allows the correct identification and early appropriate management of severe hemoptysis of pulmonary arterial origin.

We report the case of a 24-year-old patient with known scimitar syndrome presenting with hemoptysis. Multidetector CT angiography showed the scimitar vein draining the right lung to the inferior vena cava associated with right lower lobe bronchopulmonary sequestration. The presence of hemoptysis associated with scimitar syndrome is likely secondary to an anomalous systemic arterial blood supply. We treated this patient successfully with transcatheter occlusion of the anomalous feeding arterial vessels.

Objectifs pedagogiques Reconnaitre les aspects scanographiques typiques evocateurs de BOOP, et les contextes cliniques et pathologiques favorisants. Savoir y penser face a une semiologie scanographique atypique. Messages a retenir La BOOP est une entite pathologique d’etiolo-gie et de symptomatologie variables, et d’aspects radiologiques polymorphes. L’aspect typique au scanner est celui d’opacites alveolaires peripheriques en motte, bilaterales et migratrices, et le signe du halo inverse.

Objectifs pedagogiques Reconnaitre les differents aspects angiographiques des metrorragies tardives post interruption de grossesse et discuter la relation entre retention trophoblastique et MAV uterine. Connaitre l’interet de l’embolisation arterielle dans la prise en charge therapeutique. Messages a retenir Dans le cadre des metrorragies tardives apres interruption de grossesse, l’arteriographique montre le residu trophoblastique avec retour veineux precoce pouvant aller jusqu’a la MAV constituee. Elle est le premier temps de l’embolisation arterielle qui permet le plus souvent la resolution des metrorragies.

Objectifs pedagogiques Connaitre les donnees anatomiques incontournables de l’hippocampe. Savoir realiser une exploration IRM de l’hippocampe en pratique courante. Reconnaitre les principales anomalies hippocampiques en IRM 1,5 tesla. Messages a retenir L’IRM 1,5 tesla permet la detection de la plupart des lesions hippocampiques. Des sequences simples suffisent pour detecter, caracteriser les anomalies hippocampiques et faire le bilan d’extension au sein du systeme limbique et par extension a l’ensemble du parenchyme cerebral.

Objectifs Decrire les differentes indications de coroscanner apres une coronarographie. Materiels et methodes Etude retrospective, descriptive, portant sur 40 patients colliges du 31/07/06 au 03/03/09, ayant beneficie d’un coroscanner apres une coronarographie dans notre centre. Nous avons ainsi repertorie les differentes indications de coroscanner post coronarographie. Resultats Les indications de coroscanner etaient les suivantes : stenose jugee non significative (n = 7) ; pontages inexplorables (n = 3) ; exploration incomplete du tronc commun (n = 8), ou de coronaires (n = 5) ; suspicion de dissection (n = 7) ; suspicion de spasmes (n = 2), variation anatomique de trajet (n = 1), fistule arterio-veineuse (n = 1), fracture de stent (n = 1), coronaire droite de cafheterisme selectif irrealisable du fait d’un anevrisme de l’aorte ascendante (n = 1), autres lesions (n = 4). Dans la majorite des indications (n = 37), le coroscanner a repondu a la question posee. Conclusion Le coroscanner est tres utile en post coronarographie, avec un large champ d’indications pour lesquelles il apporte des informations complementaires importantes dans la prise en charge du patient.

Objectifs pedagogiques Montrer comment deceler les principales pathologies de l’os temporal qui touchent la chaine ossiculaire. Montrer les particularites semiologiques sur le scanner haute resolution (CT-HR) en 2D de chaque pathologie. Messages a retenir Le CT-HR permet de deceler des luxations, des fractures, des malformations, des lyses osseuses de la chaine ossiculaire. L’analyse des images 2D dans des plans specifiques aux structures en question est indispensable pour la description diagnostique et pronostique des pathologies.

Objectifs pedagogiques Connaitre la classification chirurgicale des bicuspidies et ses aspects en scanner multidetecteur. Savoir eviter le piege diagnostique des BA a trois cuspides. Messages a retenir Avec des techniques de reconstruction raffinees et la comprehension de la classification chirurgicale des BA, le scanner cardiaque avec gating permet une analyse correcte de la valve aortique.

Objectifs Savoir optimiser les parametres d’acquisition et d’injection de produit de contraste. Savoir adapter le protocole face aux conditions particulieres : stenoses ou thromboses etagees, troubles trophiques, pathologie anevris-mal aortique et/ou poplite. Connaitre les differents modes de reconstructions. Messages a retenir Le temps de progression du produit de contraste est variable selon la situation clinique : augmente en cas de stenoses ou thrombose etagees, de pathologie anevrismale, raccourci en cas de troubles trophiques distaux. On doit prendre garde, notamment avec les appareils 64 barrettes, a ne pas depasser la progression du produit de contraste lors de l’acquisition. Resume L’acquisition doit durer environs 40 secondes ; ceci necessite le ralentissement du temps de rotation (0,5 a 0,75 s) et du deplacement de table ; ceci doit etre adapte a la situation clinique. Une injection de 120-140 ml de produit de contraste a 3-3,5 ml/s permet d’obtenir une phase de plateau de rehaussement suffisamment longue tout le long de l’acquisition. Une seconde acquisition centree sur les jambes peut etre enchainee rapidement en cas d’absence d’opacifica-tion du reseau jambier. Les reconstructions de type angiographique donnent une vision globale de l’arbre vasculaire ; elles doivent etre completees par l’analyse des coupes axiales transverses et des reconstructions en mode 2D curviligne automatisees.

Objectifs pedagogiques Savoir evoquer le diagnostic d’hypertension arterielle pulmonaire post-embolique (HTAP-PE) devant un tableau clinique peu evocateur. Reconnaitre les signes CT directs et indirects d’HTAP-PE. Messages a retenir Le signe direct de l’embolie pulmonaire chronique est la mise en evidence du tractus fibreux intra-arteriel pulmonaire definitif. Les signes indirects pertinents de l’embolie pulmonaire chronique sont : l’aspect en mosaique du parenchyme pulmonaire associe a une disparite de calibre des arteres pulmonaires entre les territoires ischemies et les territoires vascularises, les sequelles d’infarctus pulmonaire dans les territoires ischemies y compris des bronchomegalies ; il s’y associe une augmentation de calibre des arteres pulmonaires proximales, une augmentation de taille des cavites cardiaques droites, une dilatation des arteres bronchiques. Les signes indirects de l’embolie pulmonaire chronique sont en rapport avec l’HTAP.

Objectifs Connaitre les principales complications hemorragiques de la pancreatite. Connaitre les indications et la semiologie du scanner multidetecteur dans cette pathologie. Souligner l’interet du traitement endovasculaire de ces lesions. Points cles Les complications hemorragiques de la pancreatite aigue ou chronique sont rares mais leur taux de mortalite est eleve. Les lesions arterielles sont souvent des pseudo-anevrysmes des branches du tronc cœliaque ou de l’artere mesenterique superieure. Le scanner multidetecteur fait le diagnostic d’hemorragie intra-kystique ou intra-peritoneale et permet l’analyse precise des pseudo-anevrysmes. Le traitement endovasculaire est le traitement de choix de ces lesions.

Objectifs Revoir l’aspect normal des sinus veineux et veines cerebrales sur different protocoles scanographiques (sans injection, angioscanner veineux) et sur les sequences IRM habituelles. Connaitre l’aspect pathologique et les sequences IRM cles en fonction de l’âge du thrombus. Savoir les avantages, les limites et les pieges diagnostiques de l’angioscanner veineux (ASV) et de l’ARM (3D contraste de phase, 2D TOF, ARM veineux avec Gadolinium) : que choisir ? Points cles Il n’existe pas pour le moment une strategie consensuelle pour le diagnostic du la thrombophlebite. En ASV analyser tres attentivement le veines corticales au contact de la voute. En 2DTOF attention aux artefacts de flux, completer si necessaire par ARM veineuse avec Gadolinium. En ARM veineuse avec Gadolinium attention aux thrombus anciens rehausses et aux hypoplasies des sinus.

Objectifs Evaluation de l’efficacite de l’embolisation des arteres uterines immediatement apres une cesarienne pour placenta accreta ou percreta. Materiels et methodes Dans une etude retrospective, nous avons recense 12 patientes avec suspicion d’anomalie de la placentation ayant beneficie d’une embolisation preventive des arteres uterines. Le diagnostic d’anomalie de la placentation etait base sur les donnees cliniques, l’echographie (l2/l2) et l’IRM (6/12). La cesarienne etait pratiquee en salle de radiologie interventionnelle. L’embolisation des arteres uterines etait realisee au decours immediat de la cesarienne. Resultats L’embolisation des arteres uterines etait efficace sur l’hemostase pour 9 patientes sur 12. Trois hysterectomies d’hemostase ont ete realisees : deux pour hemorragie massive secondaire, une suite a un echec de l’embolisation en raison de la dissection d’une artere uterine lors du catheterisme. Le placenta etait laisse en place dans 5 cas, l’embolisation etait efficace dans ces 5 cas. Les suites operatoires ont ete marquees par un cas de necrose uterine necessitant une hysterectomie 6 semaines apres l’embolisation. Une patiente avait un placenta percreta avec envahissement du mur vesical posterieur requerant une hysterectomie avec cystectomie partielle trois mois plus tard. Conclusion L’embolisation des arteres uterines est efficace pour prevenir l’hemorragie du post-partum en cas de placenta accreta. Elle diminue de maniere significative le taux d’hysterectomie.

Objectifs Rappeler la technique de la lymphographie. Rappeler les indications passees et actuelles de la lymphographie notamment comme methode therapeutique pour les fistules lymphatiques. Connaitre la physiopathologie et le traitement des fistules lymphatiques. Points cles L’interet de la lymphographie persiste chez les patients avec une fistule lymphatique, notamment a l’etage thoracique. La methode a un double but : traiter l’ecoulement et orienter une eventuelle future chirurgie si l’ecoulement persiste.