Search

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

International audience; PurposeTo localize the brain structures involved in blepharospasm.Materials and methodsThis is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma.ResultsSix patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy.ConclusionAccording to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network – cortex-thalamus-globus pallidus-cortex – and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.; ObjectifLocaliser les structures cérébrales atteintes dans le blépharospasme.Matériel et méthodeÉtude rétrospective, consécutive, des IRM craniocérébrales portant sur les patients atteints de blépharospasme secondaire et ayant dans leurs antécédents immédiats un accident vasculaire cérébral ou un traumatisme crânien.RésultatsSix patients répartis en 4 patients atteints d’AVC avec des lésions ischémiques ou hémorragiques des thalamus et des noyaux caudés et 2 victimes de TC ayant des lésions contusives séquellaires de la lame quadrigéminée et atrophie du cortex frontal et cérébelleux.ConclusionEn reprenant la littérature, les lésions cérébrales corrélées au blépharospasme atteignent principalement le thalamus, la tête du noyau caudé, le striatum, le pallidum, la capsule interne, le cortex cérébral et cérébelleux. Cette étude démontre que le blépharospasme est corrélé à une lésion sur le trajet d’un réseau nerveux complexe, cortico-thalamo-pallido-cortical et ne correspond pas à une lésion neurologique unique. Ce réseau est en connexion avec les voies ascendantes et descendantes, sensitivo-motrices et les noyaux de la coordination des mouvements.

Summary Purpose To localize the brain structures involved in blepharospasm. Materials and methods This is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma. Results Six patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy. Conclusion According to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network – cortex-thalamus-globus pallidus-cortex – and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.

To localize the brain structures involved in blepharospasm.This is a retrospective consecutive series of brain MRI's of patients with secondary blepharospasm whose immediate past medical history included cerebrovascular accident or head trauma.Six patients, including 4 with CVA with ischemic or hemorrhagic lesions of the thalamus and caudate nuclei and 2 with head trauma with contusive sequellae to the tectal plate and frontal cortical and cerebellar atrophy.According to the literature, brain lesions associated with blepharospasm involve mainly the thalamus, head of the caudate nucleus, corpus striatum, globus pallidus, internal capsule, cerebral cortex and cerebellum. This study demonstrates that blepharospasm is associated with a lesion of a complex neural network - cortex-thalamus-globus pallidus-cortex - and does not correspond to a single, unique lesion. This network is connected with ascending and descending sensory-motor pathways and motor nuclei.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

In most cases, treatment of life-threatening hemoptysis requires systemic arterial embolization, bronchial or not. Knowledge of the normal and pathological features of this systemic arterial network as depicted on multidetector row CTA, is an essential key because this examination has become the main imaging study prior to any interventional procedure. This article will review the indications for chest CTA, technical considerations and protocol in the evaluation of the systemic pulmonary circulation, as well as the imaging features of this circulation with emphasis on the normal and pathological imaging features to better correlate with the clinical presentation.

OBJECTIVE. MDCT has improved the management of hemoptysis by providing more precise depiction of bronchial and nonbronchial systemic arteries than conventional CT. The purpose of this article is to review the role of MDCT in the identification of the bleeding site and the vessels causing hemoptysis.CONCLUSION. Identification of the origin of the involved systemic arteries (bronchial and nonbronchial) or involved pulmonary artery on MDCT enables the interventional radiologist to treat them, especially in elderly patients with a tortuous aorta and atheroma.

The aim of our study was to evaluate the feasibility, safety, and potential role of the contrast agent gadoterate meglumine for digital subtraction angiography as a single diagnostic procedure or before percutaneous transluminal angioplasty of malfunctioning native dialysis fistulas.Over a 20-month period, 23 patients (15 women, eight men) with an age range of 42-87 years (mean, 63 years) having end-stage renal insufficiency and with recent hemodialysis fistula surgical placement underwent gadoterate-enhanced digital subtraction angiography with a digital 1024 x 1024 matrix. Opacification was performed on the forearm, arm, and chest with the patient in the supine position using an injection (retrograde, n = 14; anterograde, n = 8; arterial, n = 1) of gadoterate meglumine into the perianastomotic fistula segment at a rate of 3 mL/sec for a total volume ranging from 24 to 32 mL. Percutaneous transluminal angioplasty was performed in three patients and required an additional 8 mL per procedure. Examinations were compared using a 3-step confidence scale and a two-radiologist agreement (Cohen's kappa statistic) for diagnostic and opacification quality. Tolerability was evaluated on the basis of serum creatinine levels and the development of complications.No impairment of renal function was found in the 15 patients who were not treated with hemodialysis. Serum creatinine level change varied from -11.9% to 11.6%. All studies were of diagnostic quality. The presence of stenosis (n = 14) or thrombosis (n = 3) in arteriovenous fistulas was shown with good interobserver agreement (kappa = 0.71-0.80) in relation to opacification quality (kappa = 0.59-0.84). No pain, neurologic complications, or allergiclike reactions occurred. Three percutaneous transluminal angioplasty procedures (brachiocephalic, n = 2; radiocephalic, n = 1) were successfully performed.Gadoterate-enhanced digital subtraction angiography is an effective and safe method to assess causes of malfunction of hemodialysis fistulas. It can also be used to plan and perform percutaneous transluminal angioplasty.

La vessie est un muscle creux qui recueille l’urine provenant des deux reins. Viscere pelvien le plus anterieur, la vessie est situee immediatement en arriere de la symphyse pubienne dont elle est protegee par un coussin graisseux amortisseur. La forme de ce reservoir varie en fonction de son remplissage: on parle de vessie vide et de vessie pleine (maximum 700 mL). A l’etat vide, elle prend la forme d’une cupule a concavite superieure, strictement pelvienne, alors qu’en repletion elle devient plus globuleuse et abdomino-pelvienne.

OBJECTIVE. The purpose of this study was to evaluate the efficacy and safety of selective arterial embolization to control severe postpartum hemorrhage.MATERIALS AND METHODS. Twenty-five women with intractable postpartum hemorrhage underwent uterine embolization in our institution during a 6-year period.RESULTS. Angiography revealed arterial extravasation in 13 patients (52%). Sixty-nine arteries were embolized. External bleeding resolved immediately or was markedly decreased in 24 women. In one patient, embolization failed to control the bleeding, and surgical treatment was required. No major complication of embolization therapy was observed. Ten women were followed up for an average of 2 years. Menstruation resumed in all patients, and one woman became pregnant.CONCLUSION. Embolization of acute postpartum hemorrhage is a safe and effective alternative to hysterectomy.

Helical CT scan (HCT), a noninvasive method, can detect pulmonary arteriovenous malformations (PAVMs). Its sensitivity is superior to that of global digitalized angiography, but patients receive a significant dose of radiation during diagnostic HCT. We compared HCT to contrast-enhanced pulmonary magnetic resonance angiography (CEMRA), a new noninvasive radiation-free method, in the diagnosis of PAVMs.Five consecutive patients with PAVMs underwent HCT, CEMRA, and pulmonary artery digital subtraction angiography (PADSA). CEMRA was performed during the pulmonary arterial phase of an IV bolus of gadolinium. PADSA was performed during the embolization procedure. All images were examined for PAVMs. The site and size of aneurysms were specified, as well as the diameter of the vascular pedicles.Thirty PAVMs were detected by CEMRA and 38 by HCT. All 20 PAVMs at least 5 mm in diameter and 10 of the 18 PAVMs5 mm in diameter identified on HCT were also identified by CEMRA. Whatever the site, all PAVMs with a feeding artery diameter of at least 3 mm (ie, PAVMs with clinical consequences) were detected by CEMRA. No false-positive results were obtained with CEMRA. CEMRA therefore had a sensitivity of 78% and a specificity of 100%.CEMRA, a nonionizing and noninvasive procedure, has high sensitivity and specificity for the diagnosis of clinically relevant PAVMs.

The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan.

Une varicocele testiculaire est une dilatation du plexus pampiniforme. Elle s’etend parfois jusqu’aux veines intra testiculaires (fig. 1).

In most cases, treatment of life-threatening hemoptysis requires systemic arterial embolization, bronchial or not. Knowledge of the normal and pathological features of this systemic arterial network as depicted on multidetector row CTA, is an essential key because this examination has become the main imaging study prior to any interventional procedure. This article will review the indications for chest CTA, technical considerations and protocol in the evaluation of the systemic pulmonary circulation, as well as the imaging features of this circulation with emphasis on the normal and pathological imaging features to better correlate with the clinical presentation.

Evaluate the feasibility of the virtual pleuroscopy (VP) in the detection of the pleural plaques.Twenty consecutive patients, having asbestos exposure, explored by unenhanced multidetector CT-scan (Siemens, Sensation 16). The imaging parameters were as follows: beam width, 12 mm; beam pitch, 1; and reconstruction thickness, 1mm every 0.8mm at 120 kV and 180 mA. The image display used a surface-rendering algorithm and produced perspective red-scale images with a matrix of 512 x 512. Each VP image simulated a coned-down view, with a variable cone angle to explore the diaphragmatic pleura. The camera was placed 1 to 2 cm above the diaphragmatic dome. Four views are studied by diaphragm: crâniocaudal, lateral tangential, anterior and posterior. The observed virtual pleura aspect was classified in 5 groups (gr): gr 1: Rib band, gr 2: lobulated pleural thickening, gr 3: spicular, gr 4: plaques and gr 5: nodules. The results were compared to the other MDCT images using multiplanar reformatting.The visualization of each diaphragm was optimal (35/40; 87.5%), limited (3/40; round atelectasis and asbestosis) or impossible (2/40; asbestosis). The classifications of the studied 38 diaphragmatic pleura were: gr 1 (n=15), gr 2 (n=5), gr 3 (n=11), gr 4 (n=7), gr 5 (n=0). The MDCT analysis showed normal pleura for both gr 1 and gr 2, a confirmed or beginning of fibrosis for gr 3 and confirmed the presence of pleural plaques on the diaphragmatic pleura in all cases of gr 4.The virtual pleuroscopy is a reality. It is a feasible technique. Other studies are necessary to confirm these preliminary results.

We describe a case of digital glomus tumor diagnosed by MRI and three-dimensional contrast MR angiography (MRA). Images provided the formal definitive diagnosis and the precise localization of the tumor, guiding the necessary surgical resection. It is possible that noninvasive MRA could replace conventional arteriography for the evaluation of patients with clinical suspicion of glomus tumor.

Persistent sciatic artery is a rare congenital malformation due to the lack of regression of the dorsal arterial axis of the embryo that can be revealed by serious complications. We report a case of bilateral persistent sciatic artery revealed by subacute distal ischemia. This case illustrates the possibility of false negative imaging and the importance of ruling out this diagnosis in case of recurrent and apparently idiopathic distal embolism.

Chronic descending aortic pseudoaneurysm generally result from traumatic and can spontaneously progress to rupture. We report the case of a 70-year-old patient presenting a chronic pseudoaneurysm of the thoracic aorta treated by endovascular stent-grafting. The patient underwent imaging evaluation for endoluminal repair: thoracic aorta was evaluated by contrast-enhanced CT scan and supra-aortic and iliac vessels were evaluated by MRI-imaging. Stent-graft was deployed under fluoroscopic guidance across the aneurysmal defect. The left sub-clavian artery was covered, but no ischemic symptoms appeared and transposition of the left sub-clavian artery was not necessary. Clinical and radiological follow-up at 6 and 30 months showed total exclusion and thrombosis of the pseudoaneurysm. Chronic pseudoaneurysm of the thoracic aorta do benefit from endoluminal repair, which is adapted to patients with high surgical risk.

PURPOSE To assess the clinical relevance of gadolinium-enhanced MR angiography (Gd-MRA) as the first-line angiographic examination for planning lower limb revascularization in patients at high risk of complications after contrast arteriography (CA). METHOD Forty-five consecutive patients at high risk of post-CA complications because of chronic renal insufficiency, diabetes mellitus, advanced age, or the need for brachial artery catheterization or graft puncture had Gd-MRA as first-line angiography before a surgical or endovascular procedure for lower limb ischemia. RESULTS After Gd-MRA, 59 procedures were performed, including 38 surgical reconstructions, 17 endovascular procedures, and four amputations. Complementary CA was only required in seven patients for whom a below-knee bypass was planned. Cumulative patency rates at 1 and 24 months were, respectively, 91% and 91% for suprainguinal bypasses, 100% and 92% for infrainguinal above-knee bypasses, 80% and 57% for below-knee bypasses, and 92% and 76% for iliofemoral angioplasties. After 24 months of follow-up, limb salvage, amputation, and mortality rates were, respectively, 86%, 3.5%, and 7% for stage II ischemia and 48%, 11%, and 30% for stages III and IV. CONCLUSION Gd-MRA can be proposed for first-line preoperative imaging in the management of lower limb ischemia for patients at high risk and permits the selective use of CA as a second-line examination if a below-knee bypass is required.

Indications for sialography have became rare and radiologists are less and less experienced for salivary gland cannulation. MR Sialography allows opacification of salivary ducts without any cannulation and could replace residual indications for sialography. The purpose of this paper is to review the principle of the technique, the normal and pathologic aspects of MR Sialography and to emphasize advantages and limitations compared to other techniques.

The causal effect of cannabis, associated or not with smoking, in juvenile thromboangiitis disorders such as Leo Buerger disease, has been suggested. We describe here a case of a 30-year-old woman who smoked cannabis and developed intermittent claudication of the lower limbs. Female sex and proximal localization of the lesions (external iliac artery) are not usually described in "cannabis arteritis". Cannabis would be involved not only in the pathogenesis of juvenile obstructive arteriopathy, but also in the development of atheromatous lesions in the young subject.

Radiological explorations of the thorax raise a certain number of risks for the mother and infant which should be well recognized by the pneumologist. Irradiation is the major risk and can be evaluated in comparison with other risks of radiation. We recall the dosimetric system based on the effective dose expressed in Sievert (Sv). The risks of irradiation are described. The dangers related to contrast agents are discussed. Each type of thoracic imaging is then considered from the standpoint of the technique, risks involved and means of radioprotection. Precise indications for each technique are given in detail for pregnant women. We review rapidly the physiological and pathological signs and symptoms observed during pregnancy and propose a practical attitude for ordering radiographic explorations.

To describe the radiographic and CT findings of primary AIDS-related lymphoma (ARL) of the lung (ARLL), and to evaluate percutaneous transthoracic needle biopsy (PTNB) in the diagnosis of primary ARLL.Seven chest radiographs and seven CT scans of HIV-infected patients with histologically proved primary pulmonary non-Hodgkin's lymphoma (PPL) were reviewed at our institution. All of the patients had fibroscopy with BAL. The diagnosis of PPL was established histologically by means of PTNB (n = 4), open-lung biopsy (n = 2), or autopsy (n = 1).All but one patient had multiple peripheral well-defined nodules of various sizes on the chest X-ray film and CT scan. One patient had a subpleural parenchymal infiltrate and another had a main peripheral mass with spontaneous cavitation. Hilar/mediastinal adenopathies and pericardial/pleural effusion were never associated with the parenchymal abnormalities. Fibroscopy with BAL was always negative. PTNB, done in six cases, was diagnostic in four cases and suggested primary ARLL in two cases. No complications occurred during these procedures.After excluding infectious causes, multiple peripheral nodules and/or masses without hilar or mediastinal adenopathies and without pleural effusion are suggestive of primary pulmonary ARL. A specific diagnosis can be obtained by means of PTNB.

Technical aspects of 3D contrast-enhanced magnetic resonance angiography are exposed, detailing more particularly the pulse sequence used and the mode of injection of contrast agent. Then, various vascular territories are analyzed, and illustrated using various examples of main pathologies observed in routine clinical practice: abdominal aorta, renal arteries, pelvic and mesenteric vessels, and peripheral arteries.

Objectifs Savoir quand explorer la vascularisation systemique pulmonaire (VSP). Savoir comment le faire. Savoir ou chercher les images de cette VSP. Savoir distinguer une VSP normale d’une VSP pathologique. Savoir integrer les images observees dans le contexte pour en tirer une conduite therapeutique. Points cles La VSP physiologique est representee pas les arteres bronchiques (AB), normalement de petite taille et non visible au niveau des hiles. Leur capacite d’adaptation a l’ischemie pulmonaire est enorme et rapide, avec hypertrophie et apparition de shunts systemo-pulmonaires dans de nombreux cas ; elles sont alors visibles au niveau des hiles. Le shunt est rarement visible. En pathologie, d’autres arteres systemiques, fonction du type et de la localisation de la pathologie, peuvent s’hypertrophier. L’embolisation de cette VSP est, en urgence, le traitement de choix des hemoptysies graves ou menacantes ; un transfert des coupes natives en cas de transfert du patient est capital. Resume Indication : Toute hemoptysie menacante (> 50 ml) conduit a explorer la vascularisation systemique pulmonaire (VSP), en urgence(> 200 ml ; intolerance). Technique : angioscanner volumique (base du cou au tronc cœliaque), au temps aortique. Lecture dynamique en MIP (3 mm), en fenetre mediastinale elargie (50-200/500UH), apres avoir explore le parenchyme (etiologie ; localisation du saignement). Tout transfert du patient imposant l’envoi d’un CD des images natives. Resultat : On cherche les arteres bronchiques (AB) en position normale (paroi anterieure et laterale droite de l’AoT descendante, de son origine au plan inferieur a la bronche souche gauche). Elles sont de petit calibre et non visibles ou non decelables jusqu’aux hiles. A l’etat pathologique, elles s’hypertrophient (= 1,5 mm) et sont visibles au minimum jusqu’aux hiles. Tout vaisseau pathologique dans le mediastin est suivi jusqu’a son origine, decelant des AB de naissance atypique (arc aortique, AoT basse) ou ectopique (TSA, arteres thoraciques internes (ATI)). Une VSP non bronchique, ne passant pas par les hiles, est recherchee en zone pathologique : TSA, ATI, arteres intercostales, du ligament triangulaire, diaphragmatiques… Integration : Les constatations seront rapprochees du contexte pour decider d’une arterio-embolisation, notamment, tout contexte de necrose fera eliminer une atteinte arterielle pulmonaire.

For a 72-year-old patient with chronic renal failure, and a renal artery stenosis, we used gadolinium as a contrast agent to perform a digital subtraction arteriography and subsequent arterial angioplasty. Ten ml of gadolinium were used for the arteriography, and during a second procedure 40 ml for the angioplasty, giving high quality images. Renal function remained stable after the procedure, while blood pressure was easier to control.

Report about one case of rare tumor of the muscles (myxoma of the psoas muscles). Ultrasonographic, tomographic and arteriographic appearance.

Objectifs pedagogiques Connaitre les lesions intra-parotidiennes non chirurgicales. Illustrer la place de l’imagerie dans le diagnostic de lesions rares. Messages a retenir Evoquer un certain nombre de lesions parotidiennes evite des parotidectomies inutiles : angiomes veineux, neurinome du nerf facial, lesions infectieuses, kystes lympho-epitheliaux, ganglions simples ou hyperplasiques et lymphome.

Objectifs pedagogiques Connaitre la radio anatomie des canaux salivaires sublinguaux et submandibulaires et la pathologie canalaire de ces glandes. Messages a retenir La pathologie canalaire submandibulaire et sublinguale est dominee par les lithiases avec place preponderante de l’exploration echographique. En cas d’examen non contributif, le TDM remplace les cliches conventionnels. Le developpement de techniques conservatrices (extraction endobuccale ou endoscopique et techniques de LEC) impose un bilan precis.

Objectifs pedagogiques Connaitre la semiologie radiologique (echographie, IRM) d’un adenome pleomorphe et d’une tumeur de Warthin. Connaitre la correlation histopathologique. Messages a retenir Penser a completer l’echographie par un mode doppler couleur devant toute lesion pseudo-kystique de la parotide, a la recherche d’une vascularisation tumorale. Se mefier d’evoquer systematiquement un adenome pleomorphe devant une lesion en hypersignal T2 sur une sequence avec saturation de la graisse. Interet de la diffusion en pratique quotidienne pour le diagnostic d’adenome pleomorphe.

Objectifs pedagogiques Connaitre la gamme des lesions « kystiques de la parotide ». Adapter les techniques d’exploration a ce lesions kystiques. Messages a retenir Gamme diagnostique des lesions kystiques parotidiennes differente des lesions tissulaires (indications moins larges de parotidectomie) : serologie VIH, exploration canalaire, cytologie a destinee bacteriologique a envisager. La presentation echographique pseudokystique des lymphomes et de certaines lesions malignes doit etre envisagee : IRM (gadolinium et diffusion) et cytologie.

Objectifs Comparer l’analyse morphologique a l’analyse fonctionnelle (perfusion et diffusion) pour differencier une tumeur benigne (notamment de Warthin) d’une tumeur maligne. Materiels et methodes Etude prospective monocentrique (juin 2003-janvier2009) de masses salivaires operees (60 lesions parotidiennes, 3 submandibulaires) avec confrontation anatomopathologique. Quarante six lesions ont eu une sequence de diffusion dont 34 une sequence de perfusion. Resultats Quatre types de courbe dynamique de rehaussement (A, B, C, D) selon le pic de rehaussement et % de lavage : diagnostic d’une tumeur benigne (Whartin) avec sensibilite de 92% (85%), specificite 60% (79%). Difference significative (non significative) entre adenome pleomorphe et tumeur maligne (tumeur de Warthin et tumeur maligne). L’etude du coefficient de diffusion apparent (CDA) permet, avec une limite a 1,3 10_3 mm2/sec, le diagnostic de tumeur benigne (sensibilite : 65%, specificite : 86%) avec difference significative entre adenome pleomorphe et tumeur maligne sans difference entre tumeur de Warthin et tumeur maligne. L’association des 2 techniques n’ameliore pas les resultats. Conclusion Interet des sequences de diffusion pour le diagnostic d’une tumeur benigne mais faible sensibilite ; interet de la perfusion pour le diagnostic de tumeur de Warthin (mais faible specificite), qui ne semble cependant pas superieur a l’etude morphologique.

Objectifs pedagogiques Connaitre la radio anatomie des canaux salivaires parotidiens et les causes de parotidite canalaire. Messages a retenir Les parotidites canalaires ont une etiologie lithiasique dominante diagnostiquee en TDM, une frequence non negligeable de stenoses (eventuellement associees aux lithiases), de megacanaux, polypes et corps etrangers justifie une exploration canalaire (sialo IRM ou sialographie) en vue d’une prise en charge conservatrice endoscopique.