BIRADS ultrasonography.

The fourth edition of the BIRADS mammography appeared in 2003 and is now associated with the first editions of the BIRADS ultrasound and MRI. BIRADS is a system of assistance to the drafting of the reports more and more used in the world and soon directly implemented on mammography and ultrasound units. The categories of evaluation of the BIRADS allow a clear synthesis of the descriptive data resulting from the use of the lexicon and invite the radiologist to a reasoned, objective and less intuitive step. They give an action to be taken and responsibility to the radiologist and the referring physicians in the assumption of the patients.

[Presentation of the French translation of the Breast Imaging Reporting System and Data System (BI-RADS)]. / Présentation de la traduction française du BI-RADS (Breast Imaging Reporting System and Data System).

BI-RADS is a system of assistance to the drafting of the reports more and more used in the world and soon directly implemented on mammography and ultrasound units. The categories of evaluation of the BI-RADS allow a clear synthesis of the descriptive data resulting from the use of the lexicon and invite the radiologist to a reasoned, objective and less intuitive step. They give an action to be taken and responsibility to the radiologist and the referring physicians in the assumption of the patients. The 4th edition of the BI-RADS mammography appeared in 2003, and is now associated with the first editions of the BI-RADS ultrasound and MRI.

MR imaging of renal transplant rejection.

The results of 62 consecutive MR examinations were correlated with the subsequent clinical course and histologic results. Twenty-six cases of rejection showed a marked diminution of cortico-medullary differentiation (CMD). The renal parenchymal vascular pattern and visibility of renal sinus fat were not markedly altered in rejection and there was no difference between normal and rejected allograft shape. The ability of MR imaging to diagnose renal transplant rejection is only based on CMD, which, however, is non-specific. In 2 cases of severe acute rejection, T2 weighted images showed an abnormal signal intensity of the cortex due to renal infarction. Our preliminary results in 8 patients with Gd-DOTA injection showed 2 cases with necrosis seen as areas with absent contrast enhancement. This technique seems to be promising in the detection of perfusion defects.

[Spontaneous urine extravasation during intravenous urography. Apropos of 21 cases. Review of the literature]. / Extravasation spontanée d'urine au cours de l'urographie intra-veineuse. A propos de 21 cas. Revue de la littérature.

Twenty one cases of spontaneous urine extravasation during an intravenous urography have been analysed in order to determinate the radiological signs and the causes of this rare phenomenon. Related to the increased pressure of the excretory tract, these extravasations usually disappear without complications. No specific treatment is required except the treatment of the obstacle due generally to calculi. No infection nor development of retroperitoneal fibrosis nor sinusal lipomatosis were observed in the patients we studied.

[Spontaneous urine extravasation during intravenous urography. Apropos of 21 cases. Review of the literature]. / Extravasation spontanée d'urine au cours de l'urographie intraveineuse. A propos de 21 cas. Revue de la littérature.

Twenty one cases of spontaneous urine extravasation during an intravenous urography have been analysed in order to determinate the radiological signs and the causes of this rare phenomenon. Related to the increased pressure of the excretory tract, these extravasations usually disappear without complications. No specific treatment is required except the treatment of the obstacle due generally to calculi. No infection nor development of retroperitoneal fibrosis nor sinusal lipomatosis were observed in the patients we studied.

[Extracorporeal lithotripsy of urinary calculi. Results and radiologic criteria of effectiveness. Apropos of 700 cases]. / Lithotritie extra-corporelle des calculs urinaires. Résultats et critères radiologiques d'efficacité. A propos de 700 cas.

The results of extracorporeal shock wave lithotrity (Dornier lithotriptor) for 700 cases of urinary calculi have been reviewed and correlated with the radiological features of the calculi in order to define some predictive radiological criteria of effectiveness. The calculi were broken up in 74.5% of all cases, complete destruction (no residual fragment) was achieved in 34.5% and partial destruction in 40% of cases. The rate of failure (failure to break up or scatter the calculus) is 8.9%. Complications were observed in 2.6% of all cases, a second session of lithotrity or a surgical operation was required in 4.8% of cases (evolution lost to follow-up: 9.2%). The comparison of these results with the radiological data obtained before lithotrity allows distinguishing 2 categories of calculi: 1) Calculi with a favorable prognosis: single, smaller than 1 cm, pyelic, not very opaque and heterogeneous, located in normal-sized cavities; 2) calculi with a poor prognosis: multiple, larger than 2 cm, lower calyceal or ureteral, very opaque and homogeneous, located within dilated cavities.

[Cancer of the kidney: venous staging using magnetic resonance imaging]. / Cancers du rein: bilan d'extension veineuse en imagerie par résonance magnétique.

Venous tumor invasion in 42 renal cell carcinomas was evaluated by MRI. A correct diagnosis of renal vein and inferior vena cava (IVC) involvement was made in 14 of 17 tumors: 1 false negative diagnosis of right renal vein invasion was due to a double renal vein in which the inferior vein (identified by MRI) was not involved; 2 cases of IVC involvement were understaged (1 case of suprahepatic extension) or not identified (the false negative of renal vein invasion previously described). One false positive (among 31 tumors without venous invasion) was reported in a case of a large tumor in which the compressed but free right renal vein was overevaluated by MRI.

[Comparison of MRI and CT X-ray in the evaluation of bladder cancer. Apropos of 26 cases]. / Comparaison IRM-TDM dans le bilan des cancers de vessie. A propos de 26 cas.

26 urothelial carcinomas studied with MRI and CT have been reviewed. The results are connected with surgical and histological data. The assessment of the size and number of tumoral sites is more accurate with MRI, which allows a correct assessment of bladder wall infiltration in 20 of the 22 tumors studied with T2-weighted sequences. The sensitivity of both techniques is the same for the invasion of fat (92%) and the involvement of neighboring organs (67%), although MRI seems to be more specific (85% and 95% for 77% and 89%). The results are similar for the study of lymph node invasion (71% sensitivity). The performances of MRI for the assessment of bladder cancer extension are therefore comparable to those of CT. The advantages of the former technique include the clearer visualization of the tumor itself, especially for cancers of the neck and dome of the bladder owing to exploration in several planes. In addition, it allows a reliable assessment of the degree bladder wall infiltration and differentiates tumors that are not or not very infiltrating from highly infiltrating tumors.

[Percutaneous treatment of abscess of the kidney and retroperitoneum]. / Traitement percutané des abcès du rein et du rétropéritoine.

Twenty eight abscesses or infected liquid collections located in the kidney or in the retroperitoneum were drained percutaneously. The abscesses were located in the renal parenchyma in most cases (14 cases), in the anterior pararenal space in 3 cases and in the iliopsoas muscle in 9 cases. In all cases, the drain was inserted under TV monitoring after needle puncture, which was most often guided by ultrasound. The percutaneous treatment was successful in 82% of all cases. Among the 5 unsuccessful attempts, 1 case of duodenal fistula required surgical treatment while the anterior pararenal abscess was effectively evacuated by the inserted drain, and 1 case of infected hydatid cyst was treated surgically immediately after the percutaneous needle puncture. Drainage is the first-line method for the treatment of abscesse of the kidney and retroperitoneum. It requires an appropriate technique and strict follow-up, which allow healing the lesion in most cases.

[Respiratory manifestations in hereditary angioneurotic edema]. / Manifestations respiratoires des oedèmes angioneurotiques héréditaires.

Hereditary angioneurotic oedema is an autosomal dominant state associated with a quantitative, and sometimes purely functional, deficiency of C1 esterase inhibitor (C1 INH). The clinical manifestations may begin during adulthood or childhood; they are periodical and of varying severity. Beside oedema of the skin and digestive disorders, respiratory disorders are bound to attract attention. They consist of laryngeal oedema, which may end in lethal asphyxia if tracheotomy is not performed, or, exceptionally, of pulmonary oedema requiring assisted ventilation, as in the case reported here. The diagnosis, suspected in the presence of a decrease in CH50 and C4, is confirmed by a quantitative assay of C1 INH, which is low, and/or by the Fong and Good's functional tests. The physiopathological mechanisms are complex. They involve complement activation through the classical route, and activation of the coagulation system contact phase. Patients with severe attacks now benefit from treatment with preparations of C1 INH in high concentrations. The best treatment, however, is prophylactic, using testosterone derivatives, danazol and stanozolol, which can be prescribed for long periods taking into account their usually moderate side-effects.