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Longitudinal shortening is traditionally considered the predominant part of global right ventricular (RV) systolic function. Less attention has been paid to transverse contraction. The aim of this study was to evaluate RV transverse motion by cardiovascular magnetic resonance (CMR) in a large cohort of patients and to assess its relationship with RV ejection fraction (RVEF).We retrospectively analyzed the CMR scans of 300 patients referred to our center in 2010. RVEF was determined from short axis sequences using the volumetric method. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and mid-level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) as a longitudinal reference.Our population was divided into 2 groups according to RVEF. 250 patients had a preserved RVEF (40%) and 50 had a RV dysfunction (RVEF ≤ 40%). Transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p.0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0.79, 0.82 and 0.72, with the highest specificity and sensitivity respectively of 88% and 68% for FMDC (threshold at 20%) for predicting RV dysfunction. FMDC had an excellent negative predictive value of 93%.RV fractional diameter changes, especially at the mid-level, appear to be accurate for semi-quantitative assessment of RV function by CMR. A cut-off of 20% for FMDC differentiates patients with a low (EF≤40%) or a preserved RVEF.

Frequency and epidemiology of primary epiploic appendagitis on CT in adults with abdominal pain Purpose: Advances inmedical imaging have improved the presurgical diagnosis of isolatedepiploic appendagitis. The authors assess its relative frequencyand define its main epidemiological criteria. Patientsand methods: Study of an adult population presenting with abdominalpain and evaluated by CT over a 3 year period. Evaluation for thepresence of an isolated fat density paracolic mass with hyperdenseperiphery. A review of the literature was performed as well. Results: Thefrequency of epiploic appendagitis is estimated at 1.3% andits incidence at 8.8 cases/million/year.The typical patient profile is a young to middle aged male presentingwith left flank and lower quadrant pain. Obesity, GI symptoms, fever,and leukocytosis are characteristically absent while elevation ofthe CRP is typical. CT shows the lesion along the anterolateralmargin of the descending or sigmoid colon. Spontaneous resolutionusually occurs within 8 days. Conclusion: Ourresults confirm epidemiological data from the literature. Knowledgeof the imaging features of epiploic appendagitis will ensure conservativepatients management and avoid unnecessary surgery.

Summary Introduction In 2008 the national ranking examination (NRE) will include a test on critical reading of scientific articles. This decision has provoked controversy about whether reproducible correction is possible. The aim of our study was to assess the consistency of grading between this two-part test (critical analysis and summarizing, analyzed separately), and the more classic tests. Methods Eight graders, all instructors at the Tours Medical School, corrected papers for each of the 3 tests. Papers for the critical reading test came from medical school final examinations and for the standard test from a practice examination. The instructors worked in pairs: each pair read 30 papers for each test, and both members separately graded each paper. The final grade was the mean of the two grades. The consistency of grading between the 4 pairs was estimated by Kendall's coefficient of concordance. Results Kendall's coefficients of concordance were estimated at 0.94 (95% CI = [0.86; 0.97]) for the standard test, at 0.92 (95% CI = [0.81;0.97]) for the critical analysis test, and at 0.75 (95% CI = [0.62; 0.84]) for the summaries. Pairwise comparisons estimated the difference in concordance between the standard test and the summary at 0.18 (95% CI = [0.08; 0.32]) and that between the standard and critical reading test at 0.01 (95% CI= [-0.07; 0.12]). Finally the difference in concordance between the 2 new tests — summary and critical reading — was estimated at -0.17 (95% CI = [-0.32; -0.04]). Conclusion The focus should be on the difficulty of reproducible correction of the summaries, to set up methods for appropriate correction and adequate grading. The elaboration of detailed scoring templates, including numerous items and specifying in which part of the summary each item must be placed, should help to improve the reproducibility of this test's correction.

Authors report a case of a 77 years old man who developed a small bowel mesenteric hematoma as consequence of an unusual complication from a long term oral anticoagulation treatment. Computed tomoangiography helpfully suggests diagnosis of a mesenteric hematoma and refuts an organic cause as vascular anomalies, by an equivalent method to conventional angiography, noninvasely. In our case report, patient's deterioration justified an emergency surgery corroborating medical imager findings. Authors review the rare cases previously reported.

Resume Le syndrome de l’anse afferente correspond a l’obstruction de cette anse lors d’une anastomose gastro-jejunale et peut survenir de facon precoce, dite aigue, ou tardivement de facon chronique. Nous decrivons les caracteristiques radiologiques de ce syndrome (radiographie standard, transit radio-opaque œso-gastrique, tomodensitometrie et IRM).

Pancreatic injuries caused by blunt trauma are unusual but associated with a high morbidity and a high mortality because of a delay in diagnosis. Clinical and laboratory findings are non-specific. Accurate grading of blunt pancreatic injury with identification of pancreatic duct disruption helps to define practical treatment guidelines. Computed tomography does not allow direct visualization of the pancreatic duct and may result in low accuracy for the detection of ductal injury. Endoscopic retrograde pancreatography is the "gold standard" but invasive (3-5% complication rate, mainly pancreatitis) and may not be possible in up to 30% of patients, or requested after surgery. Endoscopic retrograde pancreatography may be used as a therapeutic modality (stenting of the main pancreatic duct). Magnetic resonance cholangiopancreatography is non invasive and preliminary results are promising. Magnetic resonance cholangiopancreatography detects pseudocysts, has multiplanar capability and complemented with conventional MR imaging allows evaluation of the pancreatic parenchyma.

The detection of an incidentaloma at abdominal Computed Tomography (CT), except CT features that permit a specific diagnosis (hemorrhage, myelolipoma or cyst), become a problem to differentiate adenomas from "non adenomas" (primary or secondary malignancy) incidentalomas. A density of ten Hounsfield units or less with a nonenhanced CT is a feature of benign incidentaloma (essentially lipid-rich adrenal adenomas). There are two limitations of this characterization: incidentalomas initially detected at enhanced CT and lipid-poor adrenal adenomas. The relative enhancement washout on enhanced CT, by using a threshold of 50% washout, permit then to characterized as adenomas or "non adenomas" incidentalomas on a 10-minute-delayed enhanced CT. Limitations of this characterization are only for benign pheochromocytomas and atypical adrenal cortical carcinomas.

Phase imaging assessed with a 3-dimensional analysis is particularly interesting for its capacity to detect an area with early contraction corresponding to the site of VT with accuracy and to demonstrate 1 or several areas with delayed contraction because of the loss of contractile tissue by fatty or fibrofatty replacement, as has been suggested with magnetic resonance images. We believe that this 3-dimensional Fourier analysis of SPECT ERNA should be widely used in sinus rhythm and when possible, during episodes of VT before treatment by ablation techniques or surgery.

We reported the case of a three month old child who was suspected of abuse syndrome because of a possible parietal bone fracture during radiographic investigation. At autopsy, the parietal bone abnormalities were not fractures, but proved to be unossified membranous strips. A review of the literature about normal variants of parietal suture on roentgenograms was made to avoid the diagnosis of non-accidental trauma in children, especially in live children where autopsy cannot be made.

International audience; We report a rare case of amebiasis generating 19 large liver abscesses. Such a quantity of abscesses is rare, especially when occurring in a young casual traveler without any immunodeficiency disorders. A possible co-infection was excluded. By contrast, the amebic etiology was confirmed by means of serology and real-time PCR.

Background Severe aortic stenosis (AS) leads to diffuse fibrosis in the myocardium, which could cause poor clinical outcome. Cardiovascular Magnetic Resonance (CMR) with recently T1 mapping is a promising technique to identify diffuse myocardial fibrosis. The Objective of the present study was to assess myocardial fibrosis by CMR using T1 mapping in patients with surgical AS and evaluate the evolution after aortic valve replacement (AVR). Methods

Resume La distension aigue gastrique avec necrose est une complication rare et severe survenant lors d’une anorexie, d’une boulimie ou d’une polyphagie psychiatrique. Les auteurs rapportent un cas inhabituel sans contexte psychiatrique. La necrose gastrique a ete suspectee a partir des explorations radiologiques (radiographies standard et tomodensitometrie). La reconnaissance des signes radiologiques avec une presentation clinique compatible meme sans contexte psychiatrique est importante a connaitre afin d’ameliorer le delai diagnostique et ainsi de reduire la mortalite.

Background Cardiovascular magnetic resonance (CMR) is the gold standard to measure right ventricular ejection fraction (RVEF). Longitudinal shortening is historically known to be the predominant part of its global systolic function and less attention has been paid to the transversal contraction. The aim of this study was to evaluate RV transverse motion in a large cohort of patients referred for CMR and assess its relationship with RVEF.

To prospectively compare the renal safety of meglumine gadoterate (Gd-DOTA)-enhanced magnetic resonance imaging (MRI) to a control group (unenhanced MRI) in high-risk patients.Patients with chronic kidney disease (CKD) scheduled for MRI procedures were screened. The primary endpoint was the percentage of patients with an elevation of serum creatinine levels, measured 72 ± 24 h after the MRI procedure, by at least 25 % or 44.2 μmol/l (0.5 mg/dl) from baseline. A non-inferiority margin of the between-group difference was set at -15 % for statistical analysis of the primary endpoint. Main secondary endpoints were the variation in serum creatinine and eGFR values between baseline and 72 ± 24 h after MRI and the percentage of patients with a decrease in eGFR of at least 25 % from baseline. Patients were screened for signs of nephrogenic systemic fibrosis (NSF) at 3-month follow-up.Among the 114 evaluable patients, one (1.4 %) in the Gd-DOTA-MRI group and none in the control group met the criteria of the primary endpoint [Δ = -1.4 %, 95%CI = (-7.9 %; 6.7 %)]. Non-inferiority was therefore demonstrated (P = 0.001). No clinically significant differences were observed between groups for the secondary endpoints. No serious safety events (including NSF) were noted.Meglumine gadoterate did not affect renal function and was a safe contrast agent in patients with CKD.• Contrast-induced nephropathy (CIN) is a potential problem following gadolinium administration for MRI. • Meglumine gadoterate (Gd-DOTA) appears safe, even in patients with chronic kidney disease. • Gd-DOTA only caused a temporary creatinine level increase in 1/70 such patients. • No case or sign of NSF was detected at 3-month follow-up.

We report the case of a 41-year-old man who presented with lymphoma 2 years ago and was treated by chemotherapy. Biological findings revealed important eosinophilia, although explorations did not show any lymphoma recidivism or evidence of active infection. One month later, the patient presented with fever and clinical signs of heart failure as the onset of a central catheter infection occurred with methicillin-resistant Staphylococcus aureus bacteremia. Chest radiography revealed an enlarged cardiac shadow with a congestive vascular pattern (Figure, A). The ECG showed sinus tachycardia with incomplete left bundle-branch block (Figure, B). The echocardiogram revealed severe mitral and aortic regurgitation with apical filling of the left ventricle by a mobile structure (Figure, C). An initial diagnosis …

The aim of this study was to identify the origin of swallowing sound components by using modern techniques that can provide numeric, synchronized acoustic-radiologic data. We enrolled 15 volunteer subjects (10 men and 5 women, average age = 29.5 +/- 8 years) and used an X-ray camera connected to a video acquisition card to obtain synchronized acoustic-radiologic data (25 images/s). The subjects were asked to swallow 10 ml of a barium suspension. Each sound component was associated with a specific position of the bolus and the anatomic structure that was moving. The average duration of the pharyngeal sound was 690 +/- 162 ms. The durations of the laryngeal ascension sound and the laryngeal release sound were significantly different (72 +/- 38 ms and 106 +/- 47 ms, p0.001). The upper-sphincter opening sound was present in 100% of the recordings. Its duration was 185 +/- 103 ms and was significantly different from the two other sounds. The duration of the first interval was 108 +/- 44 ms and the duration of the second was 236 +/- 139 ms. This study allowed us to determine the origin of the three main sound components of the pharyngeal swallowing sound with respect to movements in anatomic structures and the different bolus positions.

Background Antibody-mediated rejection (AMR) is characterized by histopathological and immunophenotypic findings such as activated endothelial cells, intravascular macrophages and evidence of capillary C4d deposition. This inflammatory reaction could be followed by diffuse fibrosis. Cardiac magnetic resonance (CMR) with recently T1 mapping is a promising technique to identify diffuse myocardial fibrosis. The purpose of this study was to assess T1 mapping in patients with AMR. Methods Two patients with clinical AMR (histopathological and immunophenotypic findings, presence of donor-specific allo antibodies and allograft dysfunction) performed a CMR study one week (for the first patient) and 3 weeks (for the second patient) after the treatment of AMR (plasmapheresis, IV Immunoglobulins and Rituximab). Images were acquired on a 1.5 Tesla scanner (Siemens) including T1 mapping using a shortened modified look-locker inversion-recovery sequence and T2 mapping in a matched mid-ventricular short axis slice using a black- blood single shot fast spin echo pulse sequence. Segmental and global T1 values were measured before and 15 minutes after administration of 0.2 mmol/kg of Gadoteric acid and compared to our cohort of 17 controls. Results Mean non contrast T1 values were significantly higher in heart transplants patients compared to controls (1100 ± 5 ms vs 947 ± 29 ms, P < 0.001). Segmental T1 values were significantly higher in the 6 regions of interest compared to controls (P < 0.001 in all segments). Mean post contrast T1 values were not significantly different in patients and controls. Mean T2 value was higher in patients compared to controls (73 ± 13 vs 50 ± 4 ms), suggesting the presence of global edema. Conclusions Heart transplant patients with clinical antibodymediated rejection show a significant increased global and segmental non contrast T1 values suggesting the presence of diffuse myocardial fibrosis. Further studies are required to confirm these data. Funding

Aneurysms of the azygos vein are often asymptomatic, detected on a chest radiograph simulating paratracheal mass. When the aneurysm is totally thrombosed, it is impossible to distinguish it from another cause of mediastinal mass. A case is presented in which partial thrombosis of the aneurysm and communication with the superior vena cava led to a diagnosis on angiography and CT.

BackgroundCardiovascular magnetic resonance (CMR) with endocardial delineation of the right ventricle is the gold standard to measure right ventricular ejection fraction (RVEF). Longitudinal shortening is historically known to be the predominant part of its global systolic function and less attention has been paid to the transversal contraction. The aim of this study was to evaluate RV transverse motion in a large cohort of patients referred for CMR and assess its relationship with RVEF.MethodWe retrospectively analyzed the CMR scans of 300 consecutive patients referred for CMR between January and December 2010. Reference RV ejection fraction was determined from short axis sequence after delineating endocardial contours. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and medial level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) in the four chambers view as a longitudinal reference.ResultsPopulation was divided into 2 groups according the RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF≤40%). Both transverse and longitudinal motions were significantly reduced in the group with RV dysfunction (p

Rationale and Objectives. We compared the tolerance and efficacy of iohexol-300, a nonionic low-osmolar monomer, with those of ioxaglate320, an ionic low-osmolar dimer, in lower limb phlebography. Methods. One hundred twenty inpatients were randomly divided into two groups in this double-blind comparative study. Two hundred milliliters of contrast medium (100 ml per leg) was injected intravenously. The immediate tolerance was classified as discomfort (i.e., sensation of warmth, pain, coldness related to the injection) and adverse events occurring up to 1 hr after administration. Delayed tolerance was followed up to 8 days after the examination. The main parameter was immediate adverse events. Image quality was assessed by a radiologist using a visual analog scale. Results. The number of immediate adverse events was significantly higher in the ioxaglate group (p < .02). The more frequent events were digestive disorders and skin rashes; 13 of these events were reported in the ioxaglate group, but none were reported in the iohexol group (p < .001). The other parameters were not significantly different in the two groups. Conclusion. We found a similar efficacy and a better tolerance of iohexol-300 than ioxaglate-320 in lower limb phlebography.

Digital ischaemia is an uncommon pathology with multiple aetiologies, many of which are poorly understood. Imaging plays an important part in diagnosing curable causes. Digital substraction angiography (DSA) remains the gold standard for the study of the pathology of digital ischaemia. However, the improved spatial resolution and 3D image-processing tools of computed tomographic angiography (CTA) have led to its more recent application in the analysis of small and distal vessels. CTA is advantageous in that it provides both luminal and soft tissue imaging. It also yields a precise anatomical depiction of the vascularisation of the hand: the structure of the palmar arch is highly variable, an understanding of which is crucial when considering the source of blood supply to the arteries of the fingers. Here, we present a retrospective study of 32 patients with typical cases of the main aetiologies of digital ischaemia, all of whom underwent DSA. Eight patients suspected of hypothenar hammer syndrome additionally underwent CTA. In this study, we promote the use of CTA as a minimally invasive technique to clearly describe the localisation and extent of vessel injury.

Objectifs L’ischemie distale des doigts et de la main est une pathologie peu frequente (incidence estimee a 6 pour 1 million d’habitants). Elle est cependant importante a connaitre en raison de l’orientation etiologique suggeree par les examens radiologiques et de ses consequences therapeutiques. Quatre grandes etiologies se distinguent : le syndrome du marteau hypothenar par occlusion d’un anevrysme de l’artere ulnaire developpee apres des microtraumatismes repetes (contexte professionnel) ; les arterites : maladie de Buerger ou arterite juvenile tabagique ; L’atteinte auto-immune telle celle de la sclerodermie, la maladie de Raynaud ; les malformations arterio-veineuses dont la thrombose aigue peut etre revelatrice ; les embolies arterielles. Materiels et methodes Notre etude, retrospective, reprend l’ensemble des patients ayant consulte au CHU de Tours pour une ischemie digitale depuis 2006. Vingt six patients âges de 30 a 80 ans ont beneficie d’une arteriographie diagnostique. Un angioscanner a ete realise chez huit patients suspects de syndrome du marteau hypothenar. Resultats Nous rapportons l’etude arteriographique, doppler et angioscanographique de 8 patients suspects de syndromes du marteau, ainsi que les arteriographies des 18 autres patients (3 origines emboliques, 1 malformation arterio-veineuse thrombosee, 13 arterites distales, 1 angiographie normale). Conclusion Cette etude retrospective permet de faire le point sur les differentes etiologies a evoquer devant une ischemie digitale, de connaitre les criteres diagnostiques a l’arteriographie et de distinguer par angioscanner les syndromes du marteau hypothenar.

Objectifs Proposer et valider des criteres anatomiques pour le contourage manuel des ventricules. En evaluer la reproductibilite inter-observateur. En evaluer la facilite d’application. Materiels et methodes Des criteres de contourage et du choix des coupes basales ont ete definis en fonction d’une revue de la litterature et de l’anatomie cardiaque. Les resultats obtenus sur 20 patients consecutifs ont ete compares a ceux en reference aux plans orthogonaux et par application des criteres classiques. Les volumes d’ejection droit et gauche ont ete compares pour evaluer la coherence des resultats. La reproductibilite inter-observateur a ete statistiquement evaluee pour 6 observateurs (3 experts et 3 juniors). La facilite d’application a ete evaluee par le temps de post-traitement. Resultats Les criteres proposes sont valides par rapport aux plans orthogonaux. Les resultats sont coherents, contrairement a ceux obtenus par les criteres classiques. La reproductibilite est excellente (coefficient de correlation intraclasse > 0,93 pour le VG et > 0,86 pour le VD). Les temps moyens de post-traitement etaient comparables ou inferieurs a ceux de la litterature. Conclusion Les criteres proposes permettent d’obtenir facilement des mesures reproductibles et coherentes de volumetrie et de fraction d’ejection ventriculaires.

Objectifs pedagogiques Connaitre la place de l’IRM dans la detection et la caracterisation des thrombi intraventriculaires gauches. Connaitre les differentes sequences a realiser et leur interet respectif. Decrire les aspects semiologiques des thrombi intraventriculaires gauches. Montrer l’interet de l’IRM pour le diagnostic etiologique des thrombi intraventriculaires gauches. Connaitre les principaux diagnostics differentiels. Messages a retenir L’IRM est un examen sensible et specifique pour la detection des thrombi intraventriculaires, notamment grâce a l’analyse des sequences apres injection. Elle permet egalement une bonne caracterisation topographique et morphologique de ces lesions. Elle permet de faire un diagnostic etiologique precis allant des causes frequentes ischemiques aux causes plus rares de dyskinesie ventriculaire (fibrose sous-endocardique, non compaction ventriculaire).

Objectifs pedagogiques Connaitre les actualites professionnelles en imagerie cardiaque. Acquerir des connaissances nouvelles en IRM cardiaque.

Objectifs Aide a l’apprentissage de la semiologie radiologique thoracique. Materiels et methodes Il s’agit d’un cours didactique sur CD-Rom a l’intention des etudiants en medecine de 3 e annee. Il a pour but de permettre a l’etudiant de connaitre la technique, les criteres de qualite, la radio-anatomie et les principaux syndromes de la radiologie thoracique de facon plus ludique. La radiographie de thorax est l’examen le plus prescrit et tous les medecins en formation et quelle que soit leur future specialite seront amenes a analyser des radiographies du thorax. Or c’est aussi un examen difficile a interpreter et une analyse didactique est indispensable. Resultats Ce cours sur Powerpoint permet d’acquerir une demarche d’interpretation, de comprendre et d’analyser la radio-anatomie du thorax sur des cliches et non pas sur des dessins. Il illustre egalement les grands syndromes pathologiques et se termine par un quiz pour permettre a l’etudiant de s’evaluer. Conclusion Le developpement des outils informatiques et l’evolution des techniques nous incite egalement a modifier nos methodes de pedagogie. Ce CD-Rom est destine aux jeunes etudiants, mais il permet egalement aux plus anciens de reviser de facon plus rapide.

Objectifs Fournir aux radiologues en formation un kit electronique sur les tumeurs hepatiques. Materiels et methodes Etude retrospective a partir d’une banque de donnees compilee entre 1998 et 2005 au CHU de Tours sur l’imagerie CT, IRM et echographie sans et avec contraste de tous les types de tumeurs hepatiques frequentes et rares, benignes ou malignes. Resultats Poster electronique sur une base Powerpoint avec de nombreux liens permettant de se reporter a des images, a des textes ou a des references bibliographiques. Conclusion L’evolution technologique constante et l’apparition de nouveaux outils diagnostiques (scanners multicoupes, IRM, echographie de contraste) obligent a disposer de nouveaux outils pedagogiques pour maitriser la semiologie des tumeurs hepatiques.

Objectifs L’imagerie en coupe des urgences abdominales permet souvent d’orienter l’indication operatoire, notamment en fonction de la localisation des epanchements. Il s’agit ici de reprendre l’anatomie du peritoine de maniere didactique pour en simplifier l’interpretation. Materiels et methodes II s’agit d’une synthese des donnees embryologiques et anatomiques concernant les feuillets peritoneaux et les differents espaces qu’ils delimitent. Ces donnees sont rapportees a l’imagerie en coupe, notamment au scanner. Resultats La cavite abdominale peut etre divisee en deux entites volumiques chacune sous-divisee en region : la cavite peritoneale contenant les visceres et son pendant extraperitoneal contenant les vaisseaux. Ce poster didactique permet de reviser l’anatomie du peritoine afin de mieux comprendre la diffusion des epanchements intra-abdominaux dont la localisation precise est importante a connaitre, notamment pour les indications chirurgicales. Conclusion La topographie intra ou extra-peritoneale des epanchements liquidiens et gazeux est une information capitale pour elucider le mecanisme de leur formation et de leur diffusion. Cette presentation didactique permet d’en reviser les bases.

Objectifs Decrire de maniere retrospective, les anomalies individualisees a la cholangiowirsungo-IRM dans la prise en charge des pancreatites aigues d’etiologie dite indeterminee au terme des premieres investigations clinique, biologique et d’imagerie. Materiels et methodes Nous avons pu inclure 36 patients sur 24 mois. La cholangiowirsungo IRM etait effectuee dans un delai de 4 a 6 semaines et sa technique etait composee de 3 Sequences Single Shot MRCP paralleles en coronal strict, coronal oblique anterieur droit, et coronal oblique anterieur gauche. Tous les examens ont ete interpretes par le meme radiologue, senior specialise et experimente en imagerie digestive. Resultats Au total 21 etiologies possibles ont ete individualisees : 19 cholangiowirsungo-IRM ont oriente en faveur d’une etiologie et un examen a identifie deux etiologies possibles. Neuf examens etaient en faveur d’une pancreatite chronique, 9 en faveur d’une TIPMP et 3 en faveur d’une etiologie obstructive tumorale differente de la TIPMP. Deux CWIRM ont identifie un pancreas divisum. Conclusion Au terme de l’etude, 21 explorations par IRM ont pu mettre en evidence une anomalie retenue comme etiologie de pancreatite aigue par le clinicien prenant en charge le patient.

Objectifs Tenant compte de l’obligation morale et juridique d’information et de consentement des patients avant un examen radiologique, la SFR a elabore des fiches d’information. Le but de notre etude a ete de comparer la comprehension et la satisfaction du patient sur l’information prealable a un examen radiologique (vasculaire, tomodensitometrie avec injection intraveineuse) selon le type d’information delivree. Le deuxieme objectif etait d’evaluer la qualite du document ecrit diffuse par la SFR et son degre de comprehension et d’acceptation par le patient. Materiels et methodes Trois cents patients ont ete repartis aleatoirement en trois groupes selon la modalite d’information donnee (information habituellement donnee par le service demandeur ; remise, en sus, d’un document ecrit standardise redige par la SFR ; entretien oral la veille de l’examen). Il s’agissait d’une etude principalement qualitative (questionnaires psychologiques et entretiens semi-diriges). Resultats Vingt pour cent des patients ne desiraient aucune information (examen connu, âge, « ne veut pas savoir »). L’absence d’information a ete mal vecue. La fiche ecrite etait trop longue et complexe. Il existait des difficultes de lecture ou de langue. L’information orale avait l’avantage d’etre adaptee et permet de poser des questions. Dans tous les cas, les risques decrits etaient tres souvent oublies. Conclusion II est important de ne pas confondre information comprehensible et « couverture medico-legale ».

Objectifs L’inflammation isolee des appendices epiploiques, pathologie auparavant de decouverte chirurgicale fortuite pour suspicion d’appendicite ileo-ceacale ou sigmoidite compliquee, beneficie des progres de l’imagerie medicale pour son diagnostic, par des methodes non invasives. Les auteurs evaluent sa frequence relative. Materiels et methodes Etude d’une population adulte ayant beneficie d’un examen tomodensitometrique pour douleur abdominale, sur une periode de 3 ans. Recherche d’une masse de densite graisseuse, paracolique, isolee, associee a une couronne hyperdense qui affirme le diagnostic. Resultats La frequence de l’appendicite epiploique primitive intra-abdominale est estimee a 1,3%. Notre population concerne une majorite d’hommes, cinquantenaire en moyenne, pris en charge pour des douleurs localisees en flanc et fosse iliaque gauche. L’absence d’obesite, de symptomatologie digestive, de fievre, d’hyperleucocytose, mais une CRP anormale, predominent dans sa presentation clinique et biologique. Le scanner localise la lesion sur le colon descendant ou sigmoide. Sa resolution spontanee survient dans les 3 jours. Conclusion L’etude corrobore les donnees epidemiologiques de la litterature et confirme le caractere non exceptionnel de cette pathologie. Elle illustre l’importance de la vulgarisation semiologique pathognomonique de cette entite benigne pour son bon diagnostic, ce qui assure au patient un traitement conservateur symptomatique et lui evite ainsi une chirurgie inutile.

Free floating thrombus (FFT) is generally considered as a high risk factor of pulmonary embolism (PE) in patients with lower limb proximal deep venous thrombosis (prox.DVT). 95 in-hospital patients with angiographically established recent prox.DVT were prospectively evaluated according to the presence (Group A) or the absence (Group B) of a FFT. On day 1, venous duplex scanning (VDS). perfusion lung scan (PLS) and pulmonary angiogram (PA), if abnormal PLS, were performed. On day 10 ± 1, PLS was repeated and PA, if impairment of PLS. A 3 month clinical follow-up was scheduled. Patients were treated with APTT adjusted iv unfractionated heparin (n = 2) or sc low molecular weight heparin (n = 93) (Nadroparin 225 Axa IC units/kg/12 H). Warfarin was initiated on day 3 ± 1.5 patients were excluded at baseline for uncertain phlebographic diagnosis of FFT. Group A (n = 62) and Group B (n = 28) were well matched according to age, sex, risk factors and delay from onset of symptoms to treatment. Sensitivity and specificity of VDS for the diagnosis of FFT were respectively 68 and 86%. On admission, PE prevalence was 65% in Group A(40/62) and 50% in Group B(14/28) (ns). 2 patients were excluded of the day 10 ± 1 follow-up analysis for preventive vena cava filtering (1 major bleeding, 1 cholecystectomy): recurrent PE rate was 3.3% in Group A (2/61) and 3.7% in Group B (1/27). No symptomatic recurrent PE occurred between day 10 ± 1 and 3 month. 4 patients died after hospital discharge (no death directly related to thromboembolic disease). Thus no higher risk of PE can be seen in patients with free floating prox-DVT and anticoagulant therapy should be efficient to prevent recurrent PE in such patients.