[Imaging in the screening and diagnosis of hepatocellular carcinoma in cirrhosis liver in Tunisia. A series of 30 cases]. / L'imagerie dans le dépistage et le diagnostic du carcinome hépatocellulaire sur foie de cirrhose en Tunisie. A propos de 30 cas.

UNLABELLED: The aim of our study is to expose a practical screening and diagnosis strategy of HCC occuring in cirrhosis liver, which is nowadays a health public matter in Tunisia. METHODS: HCC routine screening in cirrhosis liver has been conducted every 6 months using a combination of abdominal sonography and serum alpha-foetoprotein levels. PCUS, CT scan or MRI have been performed each time a focal liver lesion was discovered in US, or in case of elevated serum alpha-foetoprotein levels. 30 cases of HCC were identified. RESULTS: US has shown a unique nodule in 46% of the cases, multiple nodules in 50% of them. No lesion has been discovered in 4% of the cases. Nodule size ranged from 8 to 140 mm. Heterogenous hyperechoic pattern was the most frequent one (41%). Hypervascular doppler feature was authentified in 20% of the cases. Serum alpha-foetoprotein levels had respectively a sensitivity and a specificity of 14% and 44% in lesions inferior to 3 cm, 62% and 80% in lesions superior to 3 cm. Typical arterial enhancement of HCC was depicted in 1 case for PCUS, in 76% for CT scan and 60% for MRI. CONCLUSION: Combination of abdominal sonography and serum alpha-foetoprotein levels practiced every 6 months represent a good compromise between cost and effectiveness. Second intention imaging is based on CT scan in Tunisia because of its availability compared to MRI. PCUS is becoming in the near future the best modality for lesion caracterization thanks to its safety and relative inexpensiveness.

[Meningioma of the jugular foramen with a large cervical extension]. / Meningiome du foramen jugulaire à large extension cervicale.

Meningioma rarely gives an extra cranial extension. The authors report a case of meningioma of the jugular foramen reaching the left side of the neck. Epidemiological and clinical aspects of meningiomas of the neck are presented. The pathogenesis of this ectopic meningioma is discussed. We stress the contribution of imaging to evoke the diagnosis, determine the exact extent of the tumor, guide biopsies and allow post-therapeutic surveillance. Histological diagnosis of meningiomas of the neck is difficult since it can mimic more commonly encountered neck tumours. Difficulties of surgical techniques used to manage the tumor are also reported.

[Parotid haemangioma: MR imaging findings in 3 cases]. / Hémangiome parotidien: aspects IRM. A propos de trois cas.

OBJECTIVE: Parotid gland hemangioma is uncommon in infancy and childhood and even rarer in adulthood. The clinical presentation, supported by imaging findings provides the diagnosis. The aim of this work is to discuss the different clinical and radiological aspects of this lesion with a special emphasis on MRI findings. METHODS: Three patients with unilateral hemangioma are presented. Radiological investigations including ultrasound and magnetic resonance imaging (1 Tesla) were performed. RESULTS: Sonographic studies showed a lobulated mass with intermediate echogenicity, enlarging most or all of the visualized parotid gland. Correlative MR images in all cases showed a well-defined mass with an intermediate signal on T1-weighted images. On T2-weighted images, all masses appeared bright, heterogeneous with low signals within the masses consistent with flow voids representing blood vessels. Phleboliths were present in one case. CONCLUSION: MRI is the investigation of choice allowing an accurate diagnosis and avoiding invasive procedures including biopsy.

[Idiopathic granulomatous hypophysitis: clinical apppearance and imaging]. / Hypophysite granulomateuse idiopathique: aspects cliniques et radiologiques.

Idiopathic granulomatous hypophysitis is a chronic inflammation of the pituitary gland. It is a rare occurrence and is diagnosed only on pathologic examination. We report a case of a 23-year-old female patient presenting with polyuria and polydipsia associated with a pituitary failure and hyperprolactinemia. MRI study showed a space occupying lesion of the pituitary gland with a marked enhancement after gadolinium injection. Pituitary biopsy was consistent with the diagnosis of idiopathic granulomatous hypophysitis. The aim of this work is to discuss the different clinical and radiological aspects of the disease with a special emphasis on differential diagnosis.