Prostate imaging: Contribution of PET PSMA and MRI.

Prostate cancer is the most common malignant tumour and represents the third cause of cancer-mortality in men. The management of prostate cancer has dramatically changed over the last decades, mainly due to improvement of diagnostic modalities and development of new therapeutic strategies. Imaging plays a key role in all the steps of prostate cancer management. In recent years, magnetic resonance imaging (MRI) and positron-emission tomography (PET) - computed tomography (CT) have emerged as two major tools for the detection of prostate cancer, tumour staging and treatment choice. Both MRI and PET-CT - using choline or prostate-specific membrane antigen (PSMA) as radiotracer - have become mandatory. This article presents the contribution of the latest advances in these two imaging techniques of prostate cancer and their future developments.

[Magnetic resonance imaging in Cushing disease. Prediction of surgical results]. / Imagerie par résonance magnétique dans la maladie de Cushing. Prédiction des résultats opératoires.

OBJECTIVES: The purpose of the study is to determine if pituitary Magnetic Resonance Imaging (MRI) can predict the outcome of transsphenoidal surgery in patients with Cushing's disease. METHODS: Fifty four patients were divided in three groups according to MRI findings: those with a well circumscribed focal lesion clearly separated from the cavernous sinus (group 1, n = 24), those with adenomas in close contact with the cavernous sinus (group 2, n = 18), and those with no identified lesion (group 3, n = 12). RESULTS: The adenoma is found on the predicted side in 97,6% of the cases with positive MRI. A histologically proven adenoma is found in 96, 100 and 33% of the cases in groups 1, 2 and 3, with successful outcome in 91, 94 and 58% of the patients respectively. In group 2, surgery failed in a patient in whom tumoral tissue surrounded the internal carotid artery, but succeeded in two other cases in whom a MRI involvement of the cavernous sinus was suspected. CONCLUSION: We confirm the excellent localization value of MRI. Failure due to cavernous sinus involvement can be predicted only when MRI shows that the adenomatous tissue surrounds the carotid artery. In cases of negative MRI, the outcome is less favorable.

[Imaging of pituitary adenoma]. / Imagerie des adénomes hypophysaires.

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.

Silent necrosis of a pituitary corticotroph adenoma revealed by timely magnetic resonance imaging: a cause of spontaneous remission of Cushing's disease.

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.

Functioning ectopic supradiaphragmatic pituitary adenomas.

Pituitary adenomas arising far from the pituitary gland occur rarely as a result of defects in embryological migration. Likewise, there have been reports of isolated suprasellar adenomas (clinically nonfunctioning), presumably derived from cells of the pars tuberalis. In this report, we present four cases of functional pituitary adenomas (three adrenocorticotrophic hormone, one prolactin) confined to the supradiaphragmatic region. In each case, the tumors were initially treated unsuccessfully by operations via the transsphenoidal route because of expected intrasellar processes with suprasellar extension.

[CD4 TIL (Tumor Infiltrating Lymphocytes) induce complete response in patients treated with IL-2 (Interleukin-2). Preliminary study]. / Les TIL (Tumor Infiltrating Lymphocytes) CD4 induisent des résponses complètes chez des patients traités par IL-2 (Interleukin-2). Etude préliminaire.

This study analyzed clinical response induced by TIL in patients with renal cell carcinoma previously treated by interleukin-2. Six patients (4 men, 2 women, mean age 44.3 years) with measurable metastatic localizations have been treated by TIL reinjection (0.02 to 7.6 x 10(10) cells). TIL phenotype was a combination of CD4 and CD8 in 3 patients, predominantly CD4 in two patients and predominantly CD8 in one patient. Previous treatment by interleukin-2 induced one partial response, 2 stabilizations of the disease and 3 tumoral progressions. TIL led to an amelioration for 4 patients: 2 were in complete response, 2 were stabilized and 2 had tumoral progression and decreased. This study shows that CD4 TIL may improve an initially response induced by IL-2 therapy.

Comparison of computerized tomography and magnetic resonance imaging for the examination of the pituitary gland in patients with Cushing's disease.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: MRI is superior to CT for the examination of the pituitary gland in patients with Cushing's disease.

[Cushing syndrome during pregnancy. New diagnostic methods used in 3 cases of adrenal cortex carcinoma]. / Syndrome de Cushing pendant la grossesse. Nouvelles méthodes diagnostiques appliquées à 3 cas de carcinome du cortex surrénalien.

Cushing's syndrome during pregnancy is most often caused by an adrenal cortical tumour; it is a rare event which bears poor foetal and maternal prognoses. We report 3 cases of adrenal cortex carcinoma diagnosed during pregnancy (after 24, 27 and 28 weeks respectively of amenorrhea) and revealed by local tumoral signs in 2 cases and by pulmonary embolism in the third. Because hair growth was moderate and weight gain as well as high blood pressure had mistakenly been attributed to the pregnant state, these clinical features of hypercortisolism has only lately been related to tumoral secretion. The hypercortisolic state was firmly established by comparing the patients' urinary cortisol levels (677, 941 and 2,167 micrograms/day) and 20-hour salivary cortisol levels (9.9, 15 and 25.3 micrograms/ml) with values obtained in women at the same stage (88 +/- 11.4 micrograms/day and 2.31 +/- 0.25 micrograms/ml). The aetiological diagnosis was made by the finding of a highly increased salivary testosterone levels (50, 34 and 95 pg/ml; normal = 8.6 +/- 4 pg/ml), and by magnetic resonance imaging which showed unilateral adrenal masses of 3, 8 and 20 cm in diameter respectively. These 3 cases illustrate the difficulty of the clinical diagnosis of hypercortisolism during pregnancy. Assessment of the unbound steroids and magnetic resonance imaging are the most useful methods for an early diagnosis, thus preventing the severe complications which may otherwise reveal this rare pathological condition.

[Role of MRI in the diagnosis of endocrine tumors of the pancreas]. / Place de l'IRM dans le diagnostic des tumeurs endocrines du pancréas.

Eight patients affected with endocrine tumor of the pancreas were examined, within the same period of time, by MRI and CT. Results from those two examinations were similar for the detection of the primary tumor (succeeding to visualize the lesion 5 times out of 8) and the evaluation of locoregional and vascular extension. No tumor smaller than 3 cm was diagnosed by MRI. Most of cases the pancreatic tumor appeared as hypointense in T1 and hyperintense in T2 sequences. MRI was a little more efficient than CT for the detection of liver metastases. MRI seems to be an interesting method for the follow-up of those patients needing a regular and prolonged surveillance after primary tumor ablation.

Subcapsular hepatic necrosis in liver transplantation: CT appearance.

Eleven cases of subcapsular hepatic necrosis were found in 47 hepatic transplantation patients who underwent CT examination between the second and 14th postoperative day. CT examinations of all 11 cases showed nonenhancing hypodense subcapsular areas with irregular contours in the liver. Major vessels were free of obstruction. Anatomic correlation, possible in one case, confirmed the diagnosis. Size disproportion between the graft and the recipient abdominal cavity reduced hepatic blood flow and caused abnormal pressure points. One or both of these factors could result in ischemia in subcapsular areas and explain the subcapsular necrosis. Although it has good prognosis without treatment, subcapsular hepatic necrosis is important to recognize to avoid confusion with liver necrosis after vascular thrombosis.

[Retrorectal tumor in adults. Combination of computed tomography and endorectal echography]. / Tumeur rétrorectale de l'adulte. Intérêt de l'association tomodensitométrie et échographie endorectale.

A retrorectal tumor was identified by presacral palpation in a 41-year old woman. Combined preoperative computed tomography and intrarectal ultrasound accurately delineated regional and local spread, respectively. This combined approach confirmed diagnosis and provided guidance for total ablation of a mature cystic teratoma.

[Computed tomography in the exploration of the adrenal gland]. / La place de l'examen tomodensitométrique dans l'exploration des surrénales.

After reviewing their normal procedure (protocole) in studying the suprarenals, the authors will now present their results: --normal anatomy, --normal variants and pit falls, --pathological aspects: masses and other causes. Anyway, computed scanning of the suprarenals should be associated to clinical and biological signs.