Three-dimensional MDCT angiography of splanchnic arteries: pearls and pitfalls.

Fast scanning along with high resolution of multidetector computed tomography (MDCT) have expanded the role of non-invasive imaging of splanchnic arteries. Advancements in both MDCT scanner technology and three-dimensional (3D) imaging software provide a unique opportunity for non-invasive investigation of splanchnic arteries. Although standard axial computed tomography (CT) images allow identification of splanchnic arteries, visualization of small or distal branches is often limited. Similarly, a comprehensive assessment of the complex anatomy of splanchnic arteries is often beyond the reach of axial images. However, the submillimeter collimation that can be achieved with MDCT scanners now allows the acquisition of true isotropic data so that a high spatial resolution is now maintained in any imaging plane and in 3D mode. This ability to visualize the complex network of splanchnic arteries using 3D rendering and multiplanar reconstruction is of major importance for an optimal analysis in many situations. The purpose of this review is to discuss and illustrate the role of 3D MDCT angiography in the detection and assessment of abnormalities of splanchnic arteries as well as the limitations of the different reconstruction techniques.

[Post-partum haemorrhage associated with genital tract lacerations: series of 44 cases]. / Hémorragie du post-partum liée à des plaies de la filière génitale: étude de 44 cas.

OBJECTIVES: Genital tract lacerations are responsible for potentially serious postpartum hemorrhage (PPH), and are often underestimated. The objective of this study was to analyze the characteristics of genital tract lacerations associated with severe PPH in a reference center. PATIENTS AND METHODS: All women transferred for treatment of PPH due to genital tract lacerations between January 2008 and April 2011 were included in this observational study. Two populations of patients with genital tract lacerations were defined : patients with "complex" lesions and patients with "simple" genital tract laceration. RESULTS: Forty-four patients were treated for PPH associated with genital tract lacerations. The average age of patients was 30.6 years (17-41 years). All the patients had a vaginal delivery, combined with an instrumental in 70.5% of cases. With the exception of one patient, all patients had a revision of the cervix and vagina before the transport in our Institution. Twenty nine patients (70.7%) had received a suture of genital tract in their maternity. In our Hospital, the patient having a "simple" genital tract lesion received in 54.5% of cases medical drugs alone against 33.3% for patients with complex genital tract lacerations. In 39.4% of cases an embolization was necessary for the group of patients with complex genital tract lacerations against 9.1% in the simple genital tract lesion group. DISCUSSION AND CONCLUSION: Genital tract lacerations are a serious cause of HDD. Their management should be multidisciplinary combining appropriate and timely decisions (resuscitation, embolization and/or surgery). The sequence of these treatments depends on the clinical condition of the patient and justifies a transfer to a referral center.

[Transfers for postpartum haemorrhage in a Reference center (Lariboisière hospital): our experience during two years (2008 and 2009)]. / État des lieux des transferts pour hémorragie de la délivrance dans un centre de référence (hôpital Lariboisière) en 2008 et 2009.

OBJECTIVES: The postpartum haemorrhage (PPH) is the main cause of maternal mortality and is responsible in France every year of a quarter of the maternal deaths. We realized a study on the transfers for postpartum haemorrhage in 2008 and 2009 in a Reference center (Lariboisière Hospital). PATIENTS AND METHODS: It is a descriptive retrospective study over a period of two years, including all the patients cared for a postpartum haemorrhage. RESULTS: Two hundred and ninety-nine patients were cared for a PPH in 2008 and 2009 at the hospital Lariboisière. For transferred patients, the average age of the patients was of 30.9 years with varying extremes from 16 to 43 years old. It was the first pregnancy for 45.4% of the patients, having given birth to singletons (90.3%) by natural way in 63.8% of the cases. The care on arrival to Lariboisière based on surveillance in recovery room in 71.4% of the cases. The rate of embolisation was 22.4% and was stable over these two periods. DISCUSSION AND CONCLUSION: A supervision in recovery room associated with measures of resuscitation and with use of prostaglandins is mostly sufficient for the most part of the care of the PPH. In case of persistent bleeding, the embolisation remains an excellent therapeutic option and a good alternative in the hysterectomy of haemostasis, which however has to keep its place in severe PPH.

[Imaging of gastrointestinal stromal tumors]. / Imagerie des tumeurs stromales digestives.

Gastrointestinal stromal tumors (GIST) arising from interstitial cells of Cajal, represent the first type of solid tumor, which is very sensitive to a specific molecularly targeted tyrosine kinase receptor blocker (i. e., imatinib). On CT, which is considered as the reference technique, GISTs typically present as large, well-delineated, heterogeneous and sometimes exophytic masses. In contrast with the absence of lymph node involvement, hepatic metastasis as well as mesenteric involvement can be observed. MR-enteroclysis is indicated to investigate the local extent of the disease in specific cases whereas MR imaging is used to detect hepatic metastasis. Because of a specific treatment, contrast-enhanced imaging is needed for the follow-up of treated tumors. Evaluation of tumor response to treatment is best assessed with CT which still remains the reference imaging technique whereas FDG-PET imaging is used in specific cases.

[Percutaneous abdominopelvic interventional procedures using real-time CT fluoroscopy guidance at 21 mAs: an analysis of 99 consecutive cases]. / Procédures interventionnelles percutanées abdominales et pelviennes sous contrôle TDM à l'aide d'un système de guidage fluoroscopique intégré à 21 mA: analyse de 99 cas.

PURPOSE: The purpose of our study was to retrospectively evaluate the efficacy, the limitations and the complications of real-time CT fluoroscopy (Carevision) as an adjunct to CT guidance for percutaneous abdominopelvic interventional procedures. Materials and methods. During a 28 month period, 99 patients (55 men, 44 women) with a mean age of 59 years had percutaneous abdominopelvic interventional procedure under CT guidance using CT fluoroscopy. Sixty-four patients had a percutaneous drainage of an abdominopelvic fluid collection with a Seldinger technique using an 8.5- to 14-F drainage catheter and 35 patients had a percutaneous biopsy using an 18-G automatic core biopsy needle. RESULTS: In all cases, the quality of the real-time CT fluoroscopic images allowed to securely monitor needle advancement towards the target lesion and to confirm correct position of the needle tip. The diameters of target lesions ranged from 1.5 to 10 cm, with a mean value of 4.75 cm. No immediate complications were observed. The real-time CT fluoroscopy times ranged from 25 to 242 sec, with a mean time of 117 sec. All percutaneous procedures (100%) were successfully performed. CONCLUSION: Our initial clinical experience suggests that real-time CT fluoroscopy allows to perform effective and secure percutaneous abdominopelvic interventional procedures. However, because of substantial radiation exposure, its use has to be limited to specific et selected cases.

[Gastrointestinal stromal tumors: role of computed tomography before and after treatment]. / Tumeurs stromales digestives: rôle de la tomodensitometrie avant et apres traitement.

Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. They are generally located in the stomach or the small bowel and the potential for becoming malignant varies. Due to their expression of c-kit protein, a positive diagnosis as well as a specific targeted treatment by molecular biology (imatinib) are available. Computed tomography is the best imaging method for diagnosis, staging and follow-up of GIST. They appear as a well-defined exophytic mass with heterogeneous enhancement after intravenous injection of iodinated contrast material. They may contain areas of necrosis and/or haemorrhage and enlarged lymph nodes are exceedingly rare. Most common metastatic sites are the liver and mesentery. Large tumour size and liver or mesenteric metastases are computed tomography criteria for a high malignant potential. After treatment, decrease in tumour size, number and density of lesions and the disappearance of enhancing nodules suggest a positive response to imatinib therapy, whereas a new enhancing nodule within a mass is the usual pattern of recurrence. Positron emission tomography may be useful in specific cases when clinical data are inconsistent with computed tomography criteria.

[Percutaneous drainage of abdomino-pelvic collections. Indications, techniques, and results]. / Drainage percutané des collections abdomino-pelviennes extra-parenchymateuses.

Extra-parenchymal collections in the abdomen and pelvis are a not infrequent occurrence in gastrointestinal pathologies. Twenty years of experience have proved percutaneous drainage to be a safe and effective therapeutic modality. Several studies have demonstrated the efficacy of radio-guided percutaneous drainage which can serve as a substitute for open surgical drainage in 70% of cases. This therapeutic modality should be considered for every case of abdomino-pelvic collection.

[Endovascular stent grafting for chronic proximal thoracic aortic pseudoaneurysm]. / Faux anévrysme chronique de l'aorte thoracique descendante proximale: traitement endovasculaire percutané.

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.