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Summary Purpose The goal of this data challenge was to create a structured dynamic with the following objectives: (1) teach radiologists the new rules of General Data Protection Regulation (GDPR), while building a large multicentric prospective database of ultrasound, computed tomography (CT) and MRI patient images; (2) build a network including radiologists, researchers, start-ups, large companies, and students from engineering schools, and; (3) provide all French stakeholders working together during 5 data challenges with a secured framework, offering a realistic picture of the benefits and concerns in October 2018. Materials and methods Relevant clinical questions were chosen by the Societe Francaise de Radiologie. The challenge was designed to respect all French ethical and data protection constraints. Multidisciplinary teams with at least one radiologist, one engineering student, and a company and/or research lab were gathered using different networks, and clinical databases were created accordingly. Results Five challenges were launched: detection of meniscal tears on MRI, segmentation of renal cortex on CT, detection and characterization of liver lesions on ultrasound, detection of breast lesions on MRI, and characterization of thyroid cartilage lesions on CT. A total of 5,170 images within 4 months were provided for the challenge by 46 radiology services. Twenty-six multidisciplinary teams with 181 contestants worked for one month on the challenges. Three challenges, meniscal tears, renal cortex, and liver lesions, resulted in an accuracy > 90%. The fourth challenge (breast) reached 82% and the lastone (thyroid) 70%. Conclusion Theses five challenges were able to gather a large community of radiologists, engineers, researchers, and companies in a very short period of time. The accurate results of three of the five modalities suggest that artificial intelligence is a promising tool in these radiology modalities.

A 32-year global ensemble reforecast dataset has recently been developed at Meteo-France that is approximatively consistent with the operational global ensemble forecast system (called PEARP). Unlike at ECMWF or NCEP, Meteo-France does not possess a reanalysis of its own operational forecast system. Then, the initial atmospheric state and boundary conditions of the reforecasts are from the ECMWF ERA-interim reanalysis. This article presents a sensitivity study of the reforecasts to the method of land-surface initialization. To this end, two sets of short-range hindcasts using different land-surface initialization approaches are compared. The first set is initiliazed from interpolated ERA-interim land-surface fields based on a transfer function. The second set is initialized from offline simulations of the Meteo-France land-surface model (SURFEX) driven by the 3-hourly near-surface atmospheric fields of the ERA-interim reanalysis. Each set is run from 18UTC initial conditions and up to +108h. Because better results are overall found using offline SURFEX simulations, this latter approach was chosen to perform an ensemble reforecast dataset. Then, this ensemble reforecast database will be used to build a climatology of the operational ensemble prediction system of Meteo-France , which will, in turn, help better estimate forecast systematic errors and, more importantly, improve the forecast of rare extreme weather events.

This study investigates the impact of a calibration technique using estimated global model error variances on the performance of short-range ensemble forecasts. The calibration technique is rather simple as it consists of adding a random white noise of zero mean and variance equal to estimated model error variances. Two calibrated ensemble forecasts are generated, one using a homogeneous calibration factor and another one using a heterogeneous calibration factor. Based on probabilistic scores, the qualities of these two ensemble forecasts are evaluated against a non-calibrated ensemble and the operational ensemble prediction system of Meteo-France. The results show that this calibration technique significantly improves the reliability and, to a less extent, the resolution of ensemble forecasts. Better reliability results are found using a spatially heterogeneous calibration factor instead of using the homogeneous calibration factor at forecast ranges beyond 48 and 72 h.

A methodology for estimating model error statistics is proposed. Its application to the global operational model ARPEGE of Meteo-France provides valuable insights into the spatio-temporal dynamics of model error variances. In particular larger model errors are found in the midlatitude storm tracks (high cyclonic activity) for dynamical variables such as 500 hPa geopotential height and the 850 hPa wind speed. The average model errors over both hemispheres show a linear growth until they reach saturation. Model errors are also shown to grow more rapidly than predictability errors; this leads to a crossover time beyond which model error contribution to forecast error starts to play the dominant role. Moreover, model errors saturate more rapidly than predictability errors. On the other hand, spectral analysis shows an upscale energy transfer and a faster growth at synoptic scales for both model errors and predictability errors. This indicates that, for dynamical variables, the growth of both errors is most likely driven by baroclinic instability. The results found in this study could provide valuable information for a future implementation of a stochastic physics approach to account for model errors in the operational ensemble prediction system.

Wurtzite GaN epilayers, grown on the c-plane of sapphire substrate, have been irradiated with swift heavy ions at different energies and fluences, and thereafter studied by Raman scattering spectroscopy, UV–visible spectroscopy and transmission electron microscopy. Raman spectra show strong structural modifications in the GaN layer. Indeed, in addition to the broadening of the allowed modes, a large continuum and three new modes at approximately 200 cm−1, 300 cm−1 and 670 cm−1 appear after irradiation attributed to disorder-activated Raman scattering. In this case, spectra are driven by the phonon density of states of the material due to the loss of translation symmetry of the lattice induced by defects. It was shown qualitatively that both electronic excitations and elastic collisions play an important role in the disorder induced by irradiation. UV–visible spectra reveal an absorption band at 2.8 eV which is linked to the new mode at 300 cm−1 observed in irradiated Raman spectra and comes from Ga-vacancies. These color centers are produced by elastic collisions (without any visible effect of electronic excitations).

The second phase of the Global Land–Atmosphere Coupling Experiment (GLACE-2) is a multi-institutional numerical modeling experiment focused on quantifying, for boreal summer, the subseasonal (out to two months) forecast skill for precipitation and air temperature that can be derived from the realistic initialization of land surface states, notably soil moisture. An overview of the experiment and model behavior at the global scale is described here, along with a determination and characterization of multimodel “consensus” skill. The models show modest but significant skill in predicting air temperatures, especially where the rain gauge network is dense. Given that precipitation is the chief driver of soil moisture, and thereby assuming that rain gauge density is a reasonable proxy for the adequacy of the observational network contributing to soil moisture initialization, this result indeed highlights the potential contribution of enhanced observations to prediction. Land-derived precipitation forecast skill is much weaker than that for air temperature. The skill for predicting air temperature, and to some extent precipitation, increases with the magnitude of the initial soil moisture anomaly. GLACE-2 results are examined further to provide insight into the asymmetric impacts of wet and dry soil moisture initialization on skill.

Resume Objectifs Evaluer le role de l’IRM dans l’exploration d’un ecoulement mamelonnaire pathologique lorsque la mammographie et l’echographie sont normales, et la place de l’IRM dans la conduite a tenir a savoir surveillance ou intervention chirurgicale. Patientes et methodes Notre etude prospective porte sur 50 patientes consecutives presentant un ecoulement non physiologique ayant eu une mammographie couplee a une echographie qui se sont revelees normales. L’IRM mammaire a ete realisee de facon standard dans les 16 premiers cas, puis a comporte une « ducto-IRM » avec fusion d’images a la console dans les 34 cas suivants. Resultats Dans les 25 cas de lesions a risque et malignes, l’IRM a montre une prise de contraste dans 22 cas et a ete negative dans trois cas. Dans les 25 cas sans lesion pathologique (disparition de l’ecoulement/mastopathie non proliferative banale a l’intervention), l’IRM a ete negative dans 22 cas et faussement positive dans trois cas. Conclusion Dans cette indication l’IRM a de tres bonnes sensibilites VPP et VPN. Une IRM negative nous parait justifier une surveillance clinique et non un geste chirurgical.

RADIOLOGIE ET IMAGERIE MEDICALE : Genito-urinaire - Gyneco-obstetricale - Mammaire - 34-835-A-10

Breast constitutional density may be altered and increased (acquired density) by hormonal interventions such as hormone replacement therapy (HRT). The effects of endogenous (steroids, prolactin, insulin-like factors...) and exogenous (HRT, levonorgestrel IUD, tibolone, tamoxifen, SERMs) hormones will be reviewed. Continuous combined estrogen-progestin preparations are most likely to cause an increase in density. Estrogen alone and tibolone are less likely to cause an increase in density. The sensitivity and specificity of mammography are decreased, with increased risk of interval carcinoma and rate of short interval follow-up from false positive results. The issue with regards to interruption of the hormonal therapy prior to mammography, and the duration of the interruption, are discussed.

Conversely to breast cancer, few data and guidelines are available to explore and manage benign breast disorders. Therefore, the Collège national des gynécologues et obstétriciens français (CNGOF - French College of Gynaecologists and Obstetricians) decided to establish clinical practice guidelines for benign breast tumour (BBT). CNGOF appointed a committee with responsibility for selecting experts, compiling questions and summarizing the recommendations. The summary of valid scientific data for each question analyzed by the experts included a level of evidence, based on the quality of the data available and defined accordingly rating scheme developed by the Haute Autorité de santé (French National Authority for Health).

Breast sonography is required with mammogram to explore clinical breast mass (grade B), colored unipore breast nipple discharge (grade C), or mastitis (grade C). Bi-RADS system is recommended to describe and classify breast-imaging abnormalities. For breast abscess, a percutaneous biopsy is recommended in case of mass or persistent symptoms (grade C). For mastodynia, when breast imaging is normal, no MRI neither breast biopsy is recommended (grade C). Percutaneous biopsy is recommended for BI-RADS 4-5 mass (grade B). For persistent erythematous breast nipple or atypical eczema lesion, a nipple biopsy is recommended (grade C). For distortion and asymmetry, a vacuum core needle biopsy is recommended because of the risk of underestimation by simple core needle biopsy (grade C). For BI-RADS 4-5 microcalcifications without ultrasound signal, a vacuum core needle biopsy of at least 11 gauges is recommended (grade B); in the absence of microcalcifications on radiograph carrots, additional samples are recommended (grade B). For atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, flat epithelial with atypia, radial scar, mucocele with atypia, surgical excision is commonly recommended (grade C). Expectant management is feasible after multidisciplinary concertation. For these lesions, when excision is not in sano, no new excision is recommended except for pleomorphic or with necrosis CLIS (grade C). For grade 1 phyllode tumour, in sano surgical resection is recommended; for grade 2 phyllode, 10-mm margins are recommended (grade C). For breast papillary without atypia, complete disappearance of the radiologic signal is recommended (grade C). For breast papillary with atypia, complete surgical excision is recommended (grade C).

The most important roles of ultrasound in breast imaging include the diagnosis of cysts and the characterization of masses that have been incompletely assessed by mammography. Ultrasonography techniques such as harmonic and compound imaging have recently been introduced and are more efficient than conventional imaging in terms of lesion conspicuity and the characterization of breast nodule. The BI-RADS classification is an important system for describing and classifying breast lesions. With this approach, a population of benign solid breast lesions that does not require biopsy can be accurately defined. Ultrasonography should be performed as first-line examination in juvenile, in pregnant women and in patients with inflammatory syndrome. Ultrasound can detect mammographically occult breast the way they develop.

An essential component of the Cancer Plan is to improve the conditions of disclosure of a diagnosis of cancer to the patient. Providing information to patients is the phycisian's mission. The radiologist plays a crucial role in the multi disciplinary team.

The aim of this paper is to report the mammographic predictive positive value by decade of age using the assessment categories described within the BI-RADS lexicon.

Resume Qu’elle soit evaluee qualitativement ou quantitativement, la densite mammographique constitutionnelle, qui peut subir des variations physiologiques, est desormais un facteur consensuel d’augmentation du risque relatif de cancer du sein. Le but de cette mise au point est de preciser l’impact des therapeutiques hormonales de la menopause sur la densite mammographique et les possibles consequences. Alors que ni la Tibolone, ni le Raloxifene ne semblent avoir d’effet defavorable, la prise d’un traitement hormonal substitutif œstroprogestatif peut, dans certains cas, s’accompagner d’un effet de densification susceptible de reduire la sensibilite et la specificite de la mammographie. L’adaptation du rythme des mammographies et son association avec l’examen clinique et l’echographie mammaire semblent la meilleure facon de reduire le nombre de cancers de l’intervalle dans les cas de forte densite mammographique.

Resume Durant la grossesse, la glande mammaire subit des transformations importantes et encore mal connues. Les limites de l’examen clinique et des explorations radiologiques induisent des difficultes diagnostiques. Le cancer associe a la grossesse est rare, mais il est trop souvent decouvert tardivement. Certaines lesions benignes sont specifiques a la gestation et l’allaitement notamment l’adenome lactant et la galactocele.

The near-field imaging capability of sonography equipment has recently and markedly improved. High-frequency ultrasonography can improve the specificity of clinically and mammographically detected abnormalities, and helps accurately distinguish benign solid nodules from indeterminate or malignant nodules. The aim of this distinction is to obviate surgical biopsy.

International audience; We report on the progress towards an all epitaxial oxide layer technology on silicon substrates for epitaxial piezoelectric microelectromechanical systems. (101)-oriented epitaxial tetragonal BaTiO3 (BTO) thin films were deposited at two different oxygen pressures, 5.10 2 mbar and 5.10 3 mbar, on SrRuO3/Yttria-stabilized zirconia (YSZ) buffered silicon substrates by pulsed laser deposition. The YSZ layer full (001) orientation allowed the further growth of a fully (110)-oriented conductive SrRuO3 electrode as shown by X-ray diffraction. The tetragonal structure of the BTO films, which is a prerequisite for the piezoelectric effect, was identified by Raman spectroscopy. In the BTO film deposited at 5.10 2 mbar strain was mostly localized inside the BTO grains whereas at 5.10 3 mbar, it was localized at the grain boundaries. The BTO/SRO/YSZ layers were finally deposited on Si microcantilevers at an O2 pressure of 5.10 3 mbar. The strain level was low enough to evaluate the BTO Young modulus. Transmission electron microscopy (TEM) was used to investigate the epitaxial quality of the layers and their epitaxial relationship on plain silicon wafers as well as on released microcantilevers, thanks to Focused-Ion-Beam TEM lamella preparation.

[1] The goal of this study is to produce a new soil moisture analysis for subseasonal forecasting. An accurate soil moisture initialization is today widely recognized as having a great potential to increase summertime subseasonal forecasting skill. In this study, soil moisture initial conditions are generated using the Precipitation Assimilation Reanalysis (PAR) technique. This technique consists mainly of nudging precipitation in a coupled land-atmosphere model by adjusting the vertical air humidity profile based on the difference between model and observed precipitation rates in a continuous assimilation period of a few months. The effect of the PAR technique on the model soil moisture estimates is evaluated using (1) a benchmark in global soil moisture analysis produced by the Global Soil Wetness Project Phase 2 (GSWP-2) and (2) in-situ observations from the state of Illinois. Using PAR, we find that the coupled land-atmosphere FSU/COAPS model reproduces with a reasonable accuracy the seasonal cycle and the temporal variability of monthly soil moisture anomalies produced by GSWP-2 across most of the globe. The temporal structure of monthly soil moisture anomalies match also fairly well with in-situ observations from the Illinois state deep into the soil. Finally, overall the PAR technique shows better results than the NCEP/DOE Reanalysis 2. Therefore, in this study we have developed a new soil moisture analysis product that (1) is physically consistent with the atmospheric physics of the coupled land-atmosphere FSU/COAPS model, (2) is globally comparable with GSWP-2 and (3) better fits in-situ observed soil moisture characteristics than R2 over Illinois.

Les masses kystiques a l’echographie sont extremement frequentes. Nous proposons une revue iconographique de leurs differents aspects, avec application de la classification BI-RADS [1] et determination de la conduite a tenir. L’enjeu est d’eviter un geste interventionnel quand le kyste est simple ou e de ne pas meconnaitre un cancer devant un amas de microkystes ou une masse complexe (fig. 1).

To determine the role of MRI in the evaluation and management of patients with suspicious nipple discharge and normal mammographic and US evaluation.A total of 50 patients with suspicious nipple discharge and normal mammographic and US evaluation prospectively underwent MRI. The first 16 patients underwent routine breast MRI, while MR-ductography with image fusion at the console was added for the last 34 patients.In 22 of 25 high-risk and malignant lesions, MRI showed enhancement whereas it was normal in three cases. In 25 benign cases (resolution of discharge/benign non-proliferative breast disease), MRI was negative in 22 cases and falsely positive in three cases.In this clinical setting, MRI shows excellent sensitivity, PPV and NPV. A negative result on MRI would support clinical follow-up as opposed to surgery.

[1] The second phase of the Global Land-Atmosphere Coupling Experiment (GLACE-2) is aimed at quantifying, with a suite of long-range forecast systems, the degree to which realistic land surface initialization contributes to the skill of subseasonal precipitation and air temperature forecasts. Results, which focus here on North America, show significant contributions to temperature prediction skill out to two months across large portions of the continent. For precipitation forecasts, contributions to skill are much weaker but are still significant out to 45 days in some locations. Skill levels increase markedly when calculations are conditioned on the magnitude of the initial soil moisture anomaly.

Breast constitutional density may be altered and increased (acquired density) by hormonal interventions such as hormone replacement therapy (HRT). The effects of endogenous (steroids, prolactin, insulin-like factors...) and exogenous (HRT, levonorgestrel IUD, tibolone, tamoxifen, SERMs) hormones will be reviewed. Continuous combined estrogen-progestin preparations are most likely to cause an increase in density. Estrogen alone and tibolone are less likely to cause an increase in density. The sensitivity and specificity of mammography are decreased, with increased risk of interval carcinoma and rate of short interval follow-up from false positive results. The issue with regards to interruption of the hormonal therapy prior to mammography, and the duration of the interruption, are discussed.

The most important roles of ultrasound in breast imaging include the diagnosis of cysts and the characterization of masses that have been incompletely assessed by mammography. Ultrasonography techniques such as harmonic and compound imaging have recently been introduced and are more efficient than conventional imaging in terms of lesion conspicuity and the characterization of breast nodule. The BI-RADS classification is an important system for describing and classifying breast lesions. With this approach, a population of benign solid breast lesions that does not require biopsy can be accurately defined. Ultrasonography should be performed as first-line examination in juvenile, in pregnant women and in patients with inflammatory syndrome. Ultrasound can detect mammographically occult breast the way they develop.

An essential component of the Cancer Plan is to improve the conditions of disclosure of a diagnosis of cancer to the patient. Providing information to patients is the phycisian's mission. The radiologist plays a crucial role in the multi disciplinary team.

[1] The simulated soil moisture from the Florida State University (FSU) climate model coupled to the National Center for Atmospheric Research community land model (CLM2) is evaluated using two reanalyses (the European Centre for Medium-Range Weather Forecasts 40-year Reanalysis (ERA40) and the National Centers for Environmental Prediction/Department of Energy Reanalysis 2 (R2)) and in situ observations in Illinois and China from the Global Soil Moisture Data Bank. While the soil moisture was prescribed in the previous FSU climate model, the implementation of the CLM2 within the FSU model (hereafter FSU-CLM) provides a prognostic soil moisture (both soil liquid water and soil ice) in 10 vertical layers. For the first layer (∼0–10 cm) the comparison of the soil moisture annual cycle between the FSU-CLM and the two reanalyses shows that in the Northern Hemisphere (NH) the FSU-CLM and the ERA40 are in phase but they are out of phase with the R2. While a parameterization of the soil ice process is included in both the FSU-CLM and ERA40, it is not included in the R2. In this study, we found that the soil ice plays a key role in determining the soil moisture variation over the NH. The two reanalyses and the FSU-CLM are also compared with in situ observations. The FSU-CLM turns out to follow the annual cycle of the in situ observations better than both reanalyses.

Le code RULE a permis de poser et de resoudre la plupart des problemes peses par la programmation de l'idee du sous-assemblage. La simplicite de la notion de reglette etait necessaire pour reduire l'effort de programmation et surtout de maintenance. Des situations a grand nombre de variables ont permis de s'assurer de la stabilite des algorithmes mis en jeu.

The aim of this paper is to report the mammographic predictive positive value by decade of age using the assessment categories described within the BI-RADS lexicon.

Whether qualitative-classified or quantitative-measured, mammographic density, which changes according to physiological variations, is nowadays commonly recognized as a factor increasing the relative risk of breast cancer. The present review aims at clarifying the impact of menopausal hormonal therapies on mammographic density. Neither Tibolone nor Raloxifene seem to have any negative impact on mammographic density. In some instances, oestrogens-progestin hormonal replacement therapies may increase mammographic density and thus reduce sensitivity and specificity of screening mammograms. Shorter intervals between mammographies combined with additional physical examination and breast ultrasonography appear to be the best way to reduce interval cancers.

The near-field imaging capability of sonography equipment has recently and markedly improved. High-frequency ultrasonography can improve the specificity of clinically and mammographically detected abnormalities, and helps accurately distinguish benign solid nodules from indeterminate or malignant nodules. The aim of this distinction is to obviate surgical biopsy.

We report the US and MRI appearance in a patient with a giant lactating adenoma detected during pregnancy and followed-up for 12 months postpartum. The different imaging features of lactating adenomas are discussed, especially at US and MRI. We discuss also the role of core biopsy in diagnosing pregnancy associated breast masses.

Mammography must be performed before restauring RHT. We discuss the radiological contrindications before RHT, and the predictive positive value of malignancy for stellate lesions, round opacities, diffuse microcalcifications, cluster of microcalcifications. Ultrasonography is essential for differentiating benign from malignant lesions. Diagnosis strategy (clinical follow-up, fine needle aspiration, biopsy, surgery) depends also on personal and familial history.

Objectifs Connaitre les particularites de la pathologie mammaire par rapport a la femme adulte. Savoir interpreter les aspects echographiques specifique, a un jeune âge. Donner la strategie diagnostique devant une masse mammaire. Messages a retenir Le developpement du sein est le premier signe de la puberte. L’examen clinique est primordial. L’echographie est realisee en premiere intention. L’adenofibrome est la tumeur benigne la plus frequente. Resume Moins de 5% des jeunes filles ont une masse palpable correspondant a un adenofibrome, une mastopathie fibro-kystique de plus en plus souvent, un kyste retro-areolaire. Certaines tumeurs benignes sont tres rares : adenome pur, neurinome, angiome... Le cancer est exceptionnel avec des formes specifiques avant l’âge de 20 ans. Devant un nodule palpable

Objectifs Connaitre la technique des prelevements par macrobiopsies sur table dediee. Se conforter aux criteres de qualite dans la realisation des macrobiopsies stereotaxiques. Connaitre les indications validees. Savoir correler les aspects radio-histologiques. Messages a retenir Le guidage stereotaxique est choisi en cas de microcalcifications, masse non visible ou non accessible en echographie. Au moins 12 prelevements sont necessaires. La macrobiopsie sous-estime dans moins de 10% une composante invasive dans un carcinome canalaire in situ. Des prelevements positifs permettent de proposer une prise en charge oncologique adaptee. Resume Les procedures de qualite doivent etre strictes lors de la realisation des examens : concordance de la cible avec l’anomalie en imagerie, echantillons suffisants, verification de la diminution du nombre de calcifications ou de la disparition de la cible en fin de prelevement, analyse de la concordance entre anatomopathologie et aspect en imagerie. Des lesions atypiques sur les echantillons impliquent une chirurgie secondaire. Les prelevements par macrobiopsies sont fiables avec des resultats en termes de sensibilite et specificite identiques a ceux de la biopsie chirurgicale.

Resume Les signes cliniques et radiologiques peuvent orienter d’emblee vesr la benignite d’un syndrome inflammatoire mammaire. Nous decrirons les signes de l’infection de la plaque areolo-mamelonnaire, des mastites dermatologiques, des abces mammaires, des kystes infectes, des poussees de cytosteatonecrose, des etiologies plus rares. Les aspects trompeurs et les pieges diagnostiques seront evoques. Nous discuterons la conduite a tenir immediate et le probleme de l’evolution sous traitement medical.

A 14-year-old girl consulted for multiple breast nodules which were found to result from Cowden's disease, also called multiple hamartomatosis. Mammography and sonography examinations were completed with nuclear magnetic resonance imaging after injection of paramagnetic contrast product. Cowden's disease is a rare condition resulting in the development of tumors in genodermatous tissue; The cause remains unknown. In cases involving the breast, cutaneous lesions are markers of precancerous development since cancer occurs in 28 to 30% of these cases.

Resection of the pancreas remains the only treatment modality offering any possibility of cure. It can now be practised with an acceptably low mortality and morbidity since recent advances in operative and perioperative management have lessened its risk. The Whipple procedure is the most common surgical procedure for pancreatic resection, but in recent years, several new operations have been developed. This constant evolution presents a challenge to the radiologist involved in postoperative evaluation. Each examination must be tailored to the specific operation.

Non puerperal abscess associated with periductal mastitis assumes increasing importance. US is an excellent tool for detection of an abscess cavity, which many have a variety of scanographic findings. Mammography may be difficult to perform properly because of pain and edema of the breast.

Summary— Natural regrowth of holm oak coppice (Quercus ilex L) following partial cuts. The aim of this article was to study the influence of coppice age (4 to 57 years old) and of intensities of cleaning (light and heavy) or thinning (26-78% of removed basal area) on the appearance and growth of new stump sprouts in Quercus ilex coppice. The sprout layer at soil level can be quantified by degree of closure, biomass and Quercus ilex sprout height. This layer grew regularly for the 5 years following harvest and increased in direct proportion to increase in thinning intensities; it was found to be greater for young coppice (25 years old and less) than for old coppice. Coppice functioning was then studied at the stool level. Number and growth of new sprouts inside each stool were then related to the initial characteristics of the initial stool as well as to the degree of thinning in the stool. Sprout number was proportional to number of cut shoots, while sprout growth tended to be related to percentage of shoot or basal area removed by thinning. Finally an attempt has been made to explain the functioning of the stools by separating the effects of the mean thinning intensity of each plot and of the degree of cutting for each stool. In conclusion, hypotheses have been proposed on physiological origin of the observed phenomena.

Objectifs Definir les regles de bonne pratique de l'IRM mammaire. Rappeler les conditions techniques de realisation de cet examen. Savoir decrire l’architecture lesionnelle et les caracteristiques dynamiques du rehaussement. Savoir organiser un compte-rendu et utiliser la classification Bi-Rads. Messages a retenir Une IRM mammaire doit comporter des sequences en ponderation Tl, T2, dynamiques injectees ; des techniques de soustraction d’image facilitent le reperage du rehaussement. L’analyse de l’architecture lesionnelle prime sur l’analyse des courbes. Des rehaussements glandulaires physiologiques sont possibles chez la femme non menopausee et sous traitement hormonal substitutif. Les artefacts de mouvements et la mauvaise indication de cet examen sont deleteres a son interpretation. L’interpretation doit toujours etre confrontee a l’histoire clinique et a l’imagerie conventionnelle.

Objectifs Connaitre la description BI-RADS des anomalies IRM. Connaitre les applications et limites de cette description. Savoir les signes les plus utiles a decrire. Messages a retenir Garder a l’esprit le caractere tri-dimensionnel du sein en utilisant les reconstructions 3D. Comparer les coupes injectees avec les coupes natives pour differencier un focus d’une petite masse. Analyser la forme et le contour d’une masse sur la premiere serie injectee. Resume La classification IRM est d’une utilisation plus complexe que celle de la mammographie et de l’echographie. Les types de rehaussement interne d’une masse sont aises et utiles a decrire pour evaluer le degre de suspicion, en revanche pour les rehaussements sans masse les termes de ponctue-micronodulaire-reticulaire semblent d’utilisation plus theorique que pratique. La localisation de la lesion ne peut etre correlee avec fiabilite avec la situation clinique. Les images sont decrites pour les ACR 2. Mais pour les ARC 3-4-5 « la plupart des approches sont intuitives », il est donc necessaire d’utiliser des algorithmes combinant morphologie et cinetique.

Objectifs Connaitre les indications de la cytologie, des microbiopsies et des macrobiopsies sous echographie. Connaitre leurs modalites techniques. Savoir effectuer la concordance radiohistologique. Messages a retenir Cytoponction : rares indications. Microbiopsies : en premiere intention, masses echographiques BIRADS 4 ou 5. Macrobiopsies : en seconde intention, discordance radiohistologique apres microbiopsies. Techniques fiables. Resume Cytoponction : diagnostic liquide/ solide, adenopathie. Microbiopsies : masses BIRADS 4 et 5 : forme irreguliere ; grand axe vertical ; contour non circonscrit, microlobule, indistinct, anguleux ou spicule ; halo hyperechogene peripherique ; attenuation posterieure et autres masses en fonction de l’evolutivite et du terrain, 20-30 minutes, sous anesthesie locale. macrobiopsies : indications : microbiopsies non contributives, certains papillomes solitaires, en alternative a la chirurgie pour des masses benignes, 30 a 45 minutes, sous anesthesie locale, pose de clip en post-procedure. En micro et macrobiopsies : controle dynamique de la qualite du geste, resultats histologiques fiables, peu de complication. Concordance radiohistologique : benin contributif : controle a 6 mois puis surveillance habituelle, benin non contributif : microbiopsie : macrobiopsie ou chirurgie. Macrobiopsie : chirurgie lesions a risque : chirurgie, malin : traitement.