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ABSTRACT: Diagnosis of pigmented skin tumors is often difficult. The aim of the present study is to evaluate high frequency ultrasound and Doppler ultrasound in the localization and the characterization of these tumors.
One hundred and seventy six pigmented skin tumors including melanocytic and non melanocytic, benign and malignant lesions have been examined before resection using high frequency ultrasound (20MHz probe) and Doppler ultrasound (13MHz probe-Doppler frequency: 7MHz). Imaging data have been correlated with histological data, available in all cases.
Tumors seen at ultrasound were hypoechoic lesions, some of which, particularly malignant melanocytic tumors were vascularized. Precise ultrasonographic location of the tumor was correlated to its histological location: epidermis for purely epidermal proliferations (seborrheic keratoses), superficial dermis for dermal proliferations originating from epidermis (benign dermal nevi, melanomas during vertical growth phase, basal cell carcinomas), middle and deep dermis for dermal proliferations originating from dermis (fibrous histiocytomas, angiomas).
Ultrasound may help in assessing positive and differential diagnosis of pigmented skin tumors as it precises, before histological examination, the exact location of the lesion within the different skin layers and its origin. As far as malignant melanocytic tumors are concerned, high frequency ultrasound and Doppler ultrasound appear promising in diagnosis algorithm and pronosic of these lesions.
Journal de Radiologie 06/2001; 82(5):563-71. · 0.42 Impact Factor
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ABSTRACT: The purpose of this study was to prospectively determine any differences in vascular and liver enhancement between patients with cirrhosis and patients without cirrhosis during both the arterial and portal venous phases on dual-phase helical CT.
Fifty-eight patients with histologically proven cirrhosis (group 1) and 88 without cirrhosis (group 2 = normal findings on CT, group 3 = metastases, group 4 = other liver diseases) underwent dual-phase helical CT of the liver. Attenuation values of liver and vessels were measured on unenhanced scans and on scans obtained during the arterial and portal venous phases. The mean enhancement values per time interval (5 sec) were determined. Results were analyzed taking into account various intrinsic patient parameters.
We found no statistically significant difference in terms of mean vascular enhancement and mean liver enhancement during the arterial imaging phase for each time interval among all the groups. The mean peak enhancement and mean liver enhancement during the portal venous phase were significantly lower in group 1 than in other groups. Time to peak enhancement was significantly delayed in group 1.
In spite of the hepatic arterial buffer response, mean liver enhancement during the arterial phase was not significantly different in patients with cirrhosis compared with patients without cirrhosis. Although portal vein enhancement did not differ significantly, enhancement of cirrhotic liver was significantly lower during the portal venous phase and delayed, presumably because of decreased peripheral portal perfusion. The contrast injection protocol may be tailored to optimize conspicuity of hypovascular tumor.
American Journal of Roentgenology 12/1999; 173(5):1193-7. · 2.78 Impact Factor
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ABSTRACT: We report a case of abdominal wall metastases which occurred after diagnostic laparoscopy in a 64-year-old man presenting with gallbladder carcinoma and peritoneal carcinomatosis. CT showed enhancing masses along the laparoscopic tracts, suggesting metastatic seeding at the time of the surgery. This unusual complication fuels the current debate regarding indications of laparoscopic surgery in patients with malignancy.
Journal de Radiologie 05/1999; 80(4):388-90. · 0.42 Impact Factor
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ABSTRACT: Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage.
European Radiology 02/1999; 9(3):454-6. · 3.22 Impact Factor
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Journal de Radiologie 02/1999; 80(1):57-9. · 0.42 Impact Factor
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ABSTRACT: Imaging plays an important role in evaluating fortuitously discovered adrenal masses. These unanticipated masses (incidentalomas) are usually discovered at CT examinations. Although most incidentally discovered adrenal tumors are non-hyperfunctioning adenomas, they must be distinguished from primary or secondary malignant lesions. Recent studies have established that both unenhanced CT scans and chemical shift MR imaging can accurately differentiate benign adenomas from nonadenomatous masses by features that reflect the large amount of lipid found in most adenomas and absent in most nonadenomas. We review here the current imaging issues concerning adrenal incidentalomas including diagnostic approaches and management.
Journal de Radiologie 10/1998; 79(9):837-48. · 0.42 Impact Factor
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ABSTRACT: The technical choice in imaging the adrenal gland will depend on several factors discussed in the review. CT and MRI are achieving increasingly high accuracy in the investigation of patients suspected to present adrenal pathology. Scintigraphy evaluates functional patterns of both adrenal cortex and medulla, depending on the radiopharmaceutical that is used. Non invasive characterization of adrenal lesions is very important in cases of incidental discovery of adrenal masses. This review concentrates on new techniques for evaluating the incidentally discovered adrenal masses and differentiating between adrenal adenomas and metastases.
La Revue du praticien 05/1998; 48(7):718-23.
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ABSTRACT: The purpose of the present study is to asses the value of high frequency ultrasonography (20 MHz), a new noninvasive imaging technique, in cutaneous tumors. Cutaneous tumors are clinically varied and their diagnosis is still based on histopathological analysis. 140 cutaneous tumors have been examined with US and imaging findings have been compared to the results of clinical and histological examinations. This study shows that high frequency ultrasonography, even though it cannot replace pathological analysis, may help the dermatologist in the positive diagnosis of some cutaneous tumors and in accessing the location and the in depth-extension of the lesions in the different layers of the skin.
Journal de Radiologie 05/1998; 79(4):313-7. · 0.42 Impact Factor
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P Legmann,
O Vignaux,
B Dousset,
A J Baraza,
L Palazzo,
I Dumontier,
J Coste,
A Louvel,
G Roseau,
D Couturier, A Bonnin
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ABSTRACT: The purpose of this study was to compare dual-phase helical CT and endosonography for the diagnosis and staging of pancreatic tumors.
Thirty patients with suspected pancreatic tumors underwent endosonography and dual-phase helical CT. A pathologic diagnosis was obtained in all cases with surgery (n = 23) or biopsy (n = 7), resulting in 27 neoplasms. Dual-phase helical CT and endosonographic findings were correlated with surgical and pathologic findings to determine diagnosis and resectability of pancreatic tumors.
Overall diagnostic sensitivity was 92% for dual-phase helical CT and 100% for endosonography (p = .45). Overall accuracy for staging of pancreatic tumors was 93% for both dual-phase helical CT and endosonography. Overall accuracy for predicting resectability was 90% for both dual-phase helical CT and endosonography. Accuracy of predicting unresectability was 100% for dual-phase helical CT and 86% for endosonography (p > .80). Differences were not considered statistically significant.
Dual-phase helical CT and endoscopic sonography do not differ significantly for diagnosis and assessment of resectability of pancreatic tumors.
American Journal of Roentgenology 05/1998; 170(5):1315-22. · 2.78 Impact Factor
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ABSTRACT: Surgical treatment for primary hyperparathyroidism (HPT) is effective in 90% of cases. Recurrent or persistent HPT occurs in 10% of cases. Parathyroid imaging is indicated to confirm and locate an abnormal gland before reoperation. The aim of this study was to evaluate whether the combination of 99Tcm sestamibi scintigraphy, MRI and venous blood sampling (VBS) improved the overall sensitivity for abnormal parathyroid gland detection. 18 patients with recurrent or persistent HPT underwent sestamibi scintigraphy (n = 18), MRI (T1 weighted and STIR sequences) (n = 18) and venous blood sampling (n = 12) at different sites (internal jugular veins, innominate veins, and superior vena cava). All patients underwent surgical exploration. MRI yielded positive results in 15 cases (sensitivity 88%), sestamibi scintigraphy in 14 cases (83%) and VBS in 10 cases out of 12 (83%). Combined results of MRI, sestamibi and VBS yielded positive results in 16 cases (94%). The combination of MRI, sestamibi scintigraphy and VBS improved accuracy in detecting abnormal parathyroid glands before reoperation.
British Journal of Radiology 06/1997; 70(833):459-64. · 1.31 Impact Factor
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La Presse Médicale 01/1997; 25(40):2050. · 0.67 Impact Factor
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ABSTRACT: The authors develop and compare contrast material injection protocols suitable for hepatic helical computed tomography.
One hundred twenty-one patients who underwent contrast-enhanced computed tomography (CT) of the liver with spiral CT imaging were evaluated for enhancement of the liver parenchyma and for post-enhancement attenuation of the aorta and portal vein with iohexol. Patients were assigned randomly to five protocols with different flow rates, volume of contrast material, and scan delays.
Mean parenchymal contrast enhancement was statistically significantly higher with protocol 5 (biphasic injection of 100 mL of iohexol 300 (g/100 mL) at a flow rate of 1.5 mL/second followed by 25 mL at 2 mL/second; total iodine load = 37.5 g, with a scan delay of 70 seconds). The highest aortic enhancement and the second highest portal vein enhancement were obtained with this protocol.
The authors suggest an easily tolerated injection protocol able to ensure high parenchymal liver enhancement and satisfactory aortic and portal vein enhancement. This protocol includes a long scan delay (70 seconds), biphasic low flow injection rate, and a relatively low iodine load.
Investigative Radiology 09/1996; 31(8):467-71. · 4.59 Impact Factor
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ABSTRACT: Direct visualization of pituitary parenchyma and lesions has been made possible by progress in imaging. CT scan and magnetic resonance imaging, which has become the imaging method of choice in pituitary diseases, allow detection of 2 to 3 mm pituitary microadenomas, with a sensitivity of 60 and 85% respectively. The ability to establish the extent of the tumor using these techniques has made them indispensable to preoperative assessment of macroadenomas. Nevertheless, cavernous sinus involvement is often difficult to evaluate, and the smallest adenomas still escape detection.
La Revue du praticien 07/1996; 46(12):1504-8.
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ABSTRACT: The purpose of this study was to prospectively evaluate spiral CT with maximum-intensity projection in the diagnosis of hepatic artery thrombosis in patients with liver transplants.
Thirty liver transplant recipients (19 men, 11 women; mean age, 49 years) underwent Doppler sonography and spiral CT with maximum-intensity projection to evaluate both hepatic parenchyma and hepatic vessels. In five cases, these examinations were followed by angiography for suspected hepatic artery thrombosis.
Among the 30 patients, results of both Doppler sonography and spiral CT were abnormal in five patients. In all five patients, Doppler sonography revealed an absence of intrahepatic arterial signal (sensitivity, 100%). Spiral CT showed the hepatic artery to be patent from its origin to the anastomosis and then occluded distally in four patients and showed occlusion of the entire hepatic artery in one patient (sensitivity, 100%). Aortography and/or selective arteriography of the celiac axis confirmed the diagnosis of hepatic artery thrombosis in all five cases. The other 25 patients had a normal clinical outcome, 24 with normal findings on Doppler sonograms (specificity, 96%), and 23 with normal findings on spiral CT. Two patients had false-positive CT studies because of technical failures (specificity, 92%).
Spiral CT with maximum-intensity projection is highly accurate in identifying hepatic artery thrombosis after liver transplantation.
American Journal of Roentgenology 02/1995; 164(1):97-101. · 2.78 Impact Factor
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ABSTRACT: To assess methods of imaging postoperative changes in the eyeball by performing in vitro and in vivo studies of the main solid and fluid materials used in the treatment of cataract and retinal detachment.
The samples were analyzed in vitro with computed tomography (CT) and magnetic resonance (MR) imaging performed at 0.5 T. In vivo studies were performed in seven patients who underwent lens implantation (n = 1), scleral buckling with hydrogel or silicone (n = 6), and retinopexy with gas or silicone oil (n = 6). The attenuation and signal intensity of the materials were compared with values for anatomic structures.
Lens implants were difficult to visualize. Each scleral buckling and retinopexy material was easily differentiated from the others and from anatomic structures at both CT and MR imaging.
Postoperative CT or MR imaging may be useful after retinal detachment surgery, particularly when ultrasound is not reliable after intravitreous gas-fluid interchange.
Radiology 06/1994; 191(2):433-9. · 5.73 Impact Factor
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ABSTRACT: Spontaneous unilateral adrenal haematoma is a very rare condition. We report 10 such cases in which the pathological examination confirmed the diagnosis and for which computed tomography (CT) (n = 10) and magnetic resonance imaging (MRI) (n = 5) were performed. The diagnosis of this condition was difficult because there was no specific clinical setting nor any specific functional disorder. CT most often revealed a large mass (> 4 cm) of one of the adrenal glands, most often displaying soft-tissue attenuation and thus not specific. However, MRI suggested the diagnosis, showing foci of hypersignal on T1-weighted images and heterogeneous masses on T2-weighted images, predominantly displaying hypersignal and not enhancing, after Gd-DTPA dynamic perfusion study. Pathologic examination of the surgical specimen confirmed either idiopathic haematoma (n = 5) or haematoma possibly associated with a small benign tumour (n = 5). The diagnosis of adrenal haematoma must be considered when an unilateral isolated large adrenal mass is discovered in an asymptomatic patient. MRI with Gd-DTPA dynamic perfusion study has to be performed and one may suggest waiting and repeat imaging (so as to follow decrease in size or signal changes) in order to avoid surgery.
La Presse Médicale 06/1994; 23(22):1023-6. · 0.67 Impact Factor
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ABSTRACT: Spontaneous necrosis of a corticotroph adenoma is rare and is a very unlikely way of curing Cushing's disease. We report hereafter a case where magnetic resonance imaging of the pituitary provided clear evidence of the event. Successive and timely pituitary magnetic resonance imaging in this patient showed first a typical microadenoma as a well-limited mass with a low signal intensity before the necrosis, then a bright signal before gadolinium injection in the T1-weighted image at the time of the event and, finally, the aspect of an empty sella turcica with a small arachnoidocele 1 year later. The necrosis of a corticotroph adenoma is more frequent in macro- than in microadenomas, and is usually heralded by headache and visual disturbances. In this case, pituitary necrosis was entirely asymptomatic, and cured the patient as well as the surgeon's knife would have. Nevertheless, this exceptional occurrence does not rule out the possibility of a recurrence.
European Journal of Endocrinology 06/1994; 130(5):469-71. · 3.42 Impact Factor
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ABSTRACT: After removal, the maxilla and the mandible are placed on a standard radiologic cassette and a X-ray is performed with a low energy beam. Different views can be obtained if required. These radiographic images provide a complete, permanent and detailed record of dental anatomy and restorations, for comparison with antemortem radiographies. Two examples are provided. Moreover, this technique enables the determination of the dental age of children.
Journal de Radiologie 01/1994; 74(12):671-4. · 0.42 Impact Factor
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ABSTRACT: CT plays an important role in the screening of complications of acute hemorrhagic pancreatitis. There are three classifications at present, one based on a bioclinical score (Ranson) and the other two consisting of gradual stages of severity and resorting to CT imaging (Balthazar and Hill). The authors report about a study on 34 cases of acute pancreatitis, including 10 that became complicated, to which they applied a new classification including the existence of glandular necrosis, the number of extrapancreatic streaks, related to Ranson's bioclinical score. This classification makes it possible to classify acute pancreatitis into three stages: a mild stage with a favorable outcome, a medium stage requiring close surveillance, and stage 3 involving a high (75%) risk of severe complications.
Journal de Radiologie 12/1993; 74(11):569-74. · 0.42 Impact Factor
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ABSTRACT: The vast majority of patients with Cushing's disease have a corticotroph adenoma, the selective removal of which, through the transsphenoidal route, has the potential to offer a definitive and complete cure. This study was designed to compare the diagnostic accuracy of computerized tomography (CT) and magnetic resonance imaging (MRI) to identify the presence, evaluate the size, and assess the topographic characteristics of pituitary corticotroph adenomas.
Forty-two patients with Cushing's disease were included in this prospective study, of whom 16 were subsequently explored transsphenoidally. Computerized tomography used a CE 12,000 CGR apparatus with 1.5-mm coronal slices and a 2-mm interslice gap. Magnetic resonance imaging used an MR Max 0.5T GE apparatus; adjacent 3-mm slices were obtained with a T1-weighted gradient echo before and after gadolinium injection.
Lesions compatible with an adenoma were identified in 29 patients by MRI and in 21 patients by CT (69 vs 50%, P < 0.02). Seven macroadenomas were identified as well by the two methods. Eight of the 22 microadenomas detected by MRI were not identified by CT. Evidence for intracavernous tumour extension was found in nine patients: it was more frequently detected by MRI (8 patients) than by CT (4 patients). Fourteen patients with positive MRI had a pituitary examination: in one case the adenoma could not be reached because of purely suprasellar location; of the other 13 all were found by the surgeon and the surgical outcome was successful in 12 cases.
MRI is superior to CT for the examination of the pituitary gland in patients with Cushing's disease.
Clinical Endocrinology 09/1993; 39(3):307-13. · 3.17 Impact Factor
