Hepatic intraarterial lipiodol: technique, semiologic patterns, and value for hepatic tumors.

Hepatic intraarterial lipiodol (HIAL) coupled with computed tomography (CT) was used in a homogeneous series of 138 cases. All patients received 10 ml lipiodol emulsion injected by an arterial route; there were no serious complications. Four semiologic patterns were observed. Aside from nodular regenerative hyperplasia occurring in the absence of cirrhosis, HIAL gave no false-positive indications of tumor, as demonstrated by a series of 20 patients with uncomplicated cirrhosis evaluated for over 12 months. Comparison of ultrasonography, CT, angiography, and HIAL coupled with CT for exploration of hepatomas revealed the marked superiority of HIAL/CT for both tumor detection and lesion localization (search for daughter tumors).

[Intra-abdominal hemangiopericytoma. Presentation of 5 cases and review of the literature]. / Hémangiopéricytome intra-abdominal. Présentation de 5 cas et revue de la littérature.

Intra-abdominal hemangiopericytomas are rare lesions, accounting of only 10% of all hemangiopericytomas. A total of five cases are reviewed: two malignant gastric lesions, two intraperitoneal malignancies, and one "benign" pancreatic lesion with a malignant hepatic recurrence. The images obtained by ultrasonographic and CT studies corresponded either to predominantly cystic or to solid lesions. Aside from the 50% of hemangiopericytomas that are malignant from the outset, the major problem with such lesions is the uncertain nature of their natural course.

Lymphomatous superficial lymph nodes: US detection.

Superficial adenopathy is the most frequent clinical manifestation of lymphoma, both at initial workup and later when disease recurs. Data obtained by means of physical examination and ultrasonography (US) of the cervicosupraclavicular, axillary, and inguinal regions were compared for 120 patients, 60 at the time of initial staging and 60 during follow-up for a previously treated lymphoma. Twenty-nine in the second group had recurrent disease, as confirmed with histologic examination. For all 120 patients, US revealed clinically impalpable lesions in an average of 10.8% of cases for the cervicosupraclavicular region, 17.9% for the axillary region, and 4.1% for the inguinal region. Eight of the 29 relapses were not detected at physical examination, and three were demonstrated solely with US. These findings emphasize the value of US exploration of the superficial node-bearing regions in patients with lymphoma, during both initial staging and follow-up.

Hepatic lipomas: ultrasound and computed tomographic findings.

Five cases of solitary hepatic lipoma are described. These rare tumors have ultrasound (US) and computed tomographic (CT) characteristics that suggest the diagnosis. As imaged by US, hepatic lipomas always correspond to a highly echogenic, well-limited lesion with posterior attenuation. Precontrast CT scans reveal a low-density lesion (-20 to -70 HU); following contrast material injection, the tumor density may either remain negative (pure hepatic lipoma) or become positive (limit, 40 HU) when there is an associated adenomatous component. Hepatic lipomas involve no risk of degeneration, and follow-up by US is sufficient. A case of lipoma of the falciform ligament and a case of a hepatic pseudolipoma are also described; sonograms were negative in both instances, and CT was required for diagnosis.

[The CT scan coupled to the injection of lipiodol into the hepatic artery. Preliminary trial]. / La scanographie couplée à l'injection intra-artérielle hépatique de lipiodol. Expérience préliminaire.

A preliminary study of CT findings for 13 malignant liver tumors evaluated after intra-arterial hepatic lipiodol injection is presented. Comparison with ultrasound, conventional CT before and after contrast material injection, and arteriography revealed the superiority of intra-arterial lipiodol injection coupled with CT examination for both the detection of hepatomas and disease extension workups, thanks to the detection of small multifocal lesions. There is no lipiodol uptake by the tumor in cases of metastases or cholangiocarcinoma. The same technique can be applied to non-surgery patients for therapeutic hepatic artery injections of an extemporaneous lipiodol emulsion, hydrosoluble contrast materials and oncostatic drugs. A review of over 100 cases in the Japanese literature emphasizes the efficacy of this therapeutic approach.

[Imaging of hepatoma. Review of 50 cases]. / Imagerie des hépatomes. Revue de 50 cas.

The authors present 50 cases of hepatoma involving 32 cirrhotic and 18 healthy livers. Only 6 cases were amenable to exeresis completed by peripheral (4 cases) or intra-arterial (2 cases) chemotherapy. In addition to a semeiological study, the usefulness of various imaging techniques (ultrasound, CT, angiography) is discussed. Ultrasound (50 cases), the basic examination, is often sufficient for diagnosis (28 cases of puncture under ultrasound guidance); in certain cases it suffices to rule out surgery (multiple forms, vascular involvement). CT scans (40 cases) are obtained in different manners depending on whether the aim is to detect a hepatoma not seen on sonograms (as in the case of a high alpha-foetoproteinemia) or to obtain more precise anatomical data for an already discovered lesion. At present, angiography (13 cases) appears reserved for cases in which the other two techniques do not reveal any contraindications for surgery.

[Digitalized thoracic radiography in cancerology. Present contribution apropos of 200 examinations]. / Radiographie thoracique digitalisée en cancérologie. Apport actuel à propos de 200 examens.

The authors report a double study comparing the conventional chest radiograph and digitalised images. The first study was to visualise normal mediastinal structures (the contour of the posterior mediastinum, the azygo-oesophageal recess, the bronchial sub-segments, intermediate, carina, trachea) and showed a superiority of the digitalised image. The second study was on the recognition of radiological abnormalities in lung cancer which showed no precise superiority of the digitalised image in the mediastinum (bronchial tumour, adenopathies) and a current deficiency at the pleuro-parenchymal level (pulmonary nodules, atelectasis pleural effusion). This double study presents parallel results to those obtained by the anglosaxon authors on different prototypes in whom the technology and possibilities were different. The principles, the advantages and the limits of these prototypes were described and in conclusion a chosen technique for the medium term is proposed by the authors.