[Pulmonary lymphangioleiomyomatosis in a menopaused woman]. / Lymphangioléiomyomatose pulmonaire chez une femme ménopausée.

We report an unusual case of pulmonary lymphangioleiomyomatosis in a menopaused woman who had been taking estrogen hormone replacement therapy for several years. The characteristic feature of this uncommon disease is a proliferation of non-tumoral abnormal smooth muscle cells within the alveolar walls, and around the bronchi, lymph nodes and blood vessels. About twenty cases of pulmonary lymphangioleiomyomatosis have been described in menopaused women, who generally were taking estrogen hormone replacement therapy. This subpopulation does not appear to present any particular clinical, functional or radiographic features.

[Magnetic resonance angiography of the cervical and superior mediastinal veins]. / Angiographie par résonance magnétique des veines cervicales et du médiastin supérieur.

PURPOSE: To evaluate magnetic resonance venography (MRV) in the detection of cervical/mediastinal venous thrombosis (CMVT). METHODS: MR venograms were performed in 20 patients suspected for CMVT. 2D-TOF MR venography was used for all studies. MR and conventional venographic/surgical data were collected prospectively and analyzed in a blinded manner comparatively to other corroborative studies: venography (n = 8), color-Doppler studies (n = 15), CT (n = 12), and/or surgery (n = 6). RESULTS: MRV was 100% sensitive and 100% specific in the diagnosis of venous thrombosis (VT) of the cervical/mediastinal veins, present in fourteen patients, and 93% accurate in grading the extension of CMVT. MR images showed a greater number of collateral vessels than detected by contrast venography in case of complete cervical/mediastinal venous thrombosis. CONCLUSION: The positive diagnosis and extent of CMVT can be accurately diagnosed by a non-invasive method such as MRV.

Abdominal aortic aneurysms: assessment with gadolinium-enhanced time-of-flight coronal MR angiography (MRA).

A prospective study was performed to evaluate the efficacy of a gadolinium-chelate-enhanced MR angiography (MRA) using a coronal acquisition in the preoperative assessment of aneurysms of the abdominal aorta (AAA). Twenty patients with AAA were explored with MR using a two-dimensional (2D) time-of-flight MRA technique with a coronal acquisition, before and after intravenous administration of 0.1 mmol/kg of a gadolinium-chelate. Gadolinium-chelate-enhanced MRA with a coronal acquisition decreased deleterious saturation effects within aorta and iliac arteries in 16 of 20 patients (80%) and improved the overall quality of the images of the upper and lower parts of the AAA (i.e. extent of the aneurysm). Furthermore, gadolinium-chelate-enhanced MRA with a coronal acquisition allowed a better differentiation between slow flow and mural thrombus. Gadolinium-chelate-enhanced MRA had a sensitivity of 100% and a specificity of 96% for evaluation of renal artery involvement, and a sensitivity of 93% and a specificity of 100% for iliac artery involvement. The results of this study show that gadolinium-chelate-enhanced MRA obtained with a coronal acquisition is efficacious for the preoperative assessment of AAA.

Pulmonary MR angiography at 1.0 T: early results with k-space segmented and post-contrast TurboFLASH two-dimensional time-of-flight sequences.

PURPOSE: To evaluate the combined performance of two time-of-flight methods in imaging the pulmonary arteries. MATERIALS AND METHODS: This study was prospectively conducted in 28 patients suspected for pulmonary embolism (PE). Sixteen patients were free of pulmonary vascular disease, and 12 had pulmonary vascular disease as demonstrated by pulmonary angiography. To reduce artifacts caused by cardiac and respiratory motion, MR images were acquired in all subjects using bi-dimensional (2D), gradient-recalled echo (GRE), breath-hold techniques. Sagittal thin (6-mm) sections obtained with ECG gating, k-space segmentation and incremented flip-angles (TONE), and coronal thick (15-mm) sections obtained after a unique injection of Gadolinium chelate were used. RESULTS: High quality images were obtained in all 16 (100%) subjects free of pulmonary disease with both techniques, and in 10 and 12 (87% and 100%) patients suspected for pulmonary artery disease with sagittal and coronal Gd-enhanced MRA, respectively. In patients free of pulmonary disease, TONE images exhibited distal pulmonary arteries with 2.1 subsegmental divisions on average, whereas Gd-enhanced TurboFLASH images were the most accurate to identify proximal pulmonary arteries within the mediastinum, even if only 0.8 subsegmental divisions were seen on average. A correct diagnosis of pulmonary embolism was obtained in all cases but one, with use of both MRA techniques, with an overall accuracy of 86%. CONCLUSION: The association of segmented sagittal GRE images and coronal first-pass Gd-enhanced GRE images can provide information upon normal and diseased pulmonary arteries within the mediastinum until subsegmental pulmonary branches, even in patients with short-breathing. Further studies of patients with various pulmonary artery diseases will confirm whether this technique makes pulmonary MRA feasible in clinical routine situations.

Thoracic aortic dissection: diagnosis with transesophageal echocardiography versus MR imaging.

PURPOSE: To compare transesophageal echocardiography (TEE) and magnetic resonance (MR) imaging in the diagnosis of dissection of the thoracic aorta. MATERIALS AND METHODS: Thirty-one consecutive patients with clinically suspected aortic dissection and 10 postoperative patients underwent transesophageal color Doppler echocardiography and MR imaging. Imaging results were compared at independent double-blind readings. Final diagnosis was obtained from consensual review of all corroborative studies. RESULTS: MR imaging depicted the intimal flap in 95% of aortic dissections; TEE, in 86% (P < .05). In surgical patients, the sensitivity of MR in detection of residual dissection was 100% versus 86% with TEE (P < .05). The inferior extent of the dissected lumen was seen only with MR imaging. False-positive results occurred in two cases with TEE and in one with MR imaging. CONCLUSION: MR imaging is superior to TEE in the evaluation and follow-up of dissection of the thoracic aorta. Because the availability of MR is limited, however, TEE should remain the standard modality for diagnosis.

Assessment of vascular involvement with magnetic resonance angiography (MRA) in Pancoast syndrome.

The purpose of this study was to evaluate the diagnostic value of MRA in determining vascular involvement in bronchogenic carcinoma with Pancoast syndrome. Six patients with Pancoast syndrome were investigated preoperatively by means of MRA. Following standard spin-echo MR imaging in the axial and coronal planes, two successive two-dimensional (2D) time-of-flight acquisitions were obtained in the axial plane, the first with venous, the second with arterial presaturation. MRA data were compared to angiographic data in four cases, and to surgical findings in all six cases. MRA demonstrated displacement (n = 2) and encasement (n = 2) of subclavian and/or brachiocephalic arteries, and encasement or occlusion of subclavian and/or right brachiocephalic vein (n = 3). Close correlation between MRA, angiography and surgery was obtained. These preliminary results suggest that MRA is a noninvasive diagnostic method complementary to MR imaging for detecting vascular involvement in bronchogenic carcinoma with Pancoast syndrome.

Pulmonary time-of-flight MR angiography at 1.0 T: comparison between 2D and 3D tone acquisitions.

The purpose of this study was to compare the performance of 2D vs. 3D time-of-flight (TOF) methods in imaging the normal pulmonary arteries with commercially available 1.0 T equipment. The study was conducted in 20 volunteers and 7 patients with suspected pulmonary embolism (PE). To reduce artifacts caused by cardiac and respiratory motion, MR images were acquired in volunteers using two-dimensional (2D), gradient-recalled echo (GRE), breath-hold techniques, and three-dimensional (3D) acquisitions. Sagittal thin (6-MM) segmented k-space 2D sections obtained with cardiac gating during systole (turboFLASH, TR/TE9/6 ms, 14 segments of 9 lines) and incremented flip-angles (TONE), and 50-mm 3D volume TONE acquisitions with 32 partitions (FISP, TR/TE34/10ms) were successively performed. In the second phase of the study, patients were examined only with the 3D technique. Images of volunteers were qualitatively and quantitatively analyzed. S/N ratios were statistically compared by means of the paired-sample Wilcoxon ranked-signed test, a value of p < .05 being significant. In volunteers, 3D acquisitions displayed significantly more segment-order pulmonary arteries on average than did 2d acquisitions displayed significantly more segment-order pulmonary arteries on average than did 2D acquisitions (2.95 +/- 0.64 vs. 2.2 +/- 0.85, respectively; p < .01). Moreover, the signal intensity of arteries within the lungs was less homogeneous in the 2D than in the 3D technique, with a signal intensity ratio between peripheral and proximal arteries of 63% +/- 7% and 73% +/- 2%, respectively (p < .05). In patients, no erroneous diagnoses were obtained using the 3D technique. 3D images of normal lungs provide MR angiograms of better quality than do 2D images, and require less contribution from subjects because they are performed in free breathing. Ongoing improvements in MR sequences and further studies are now necessary to assess the value of 3D TONE MRA in the diagnosis of PE.