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Centre d’Imagerie Médicale Pyramides

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75001 PARIS


françaises et internationales

1. Added value of one-view breast tomosynthesis combined with digital mammography according to reader experience. Thomassin-Naggara I(1), Perrot N(2), Dechoux S(3), Ribeiro C(4), Chopier J(5), de Bazelaire C(6). Eur J Radiol. 2015 Feb;84(2):235-41.
PURPOSE: To retrospectively evaluate the added value of one-view breast tomosynthesis in adjunct with mammography to characterize breast lesions. MATERIALS AND METHODS: Our institutional ethics committees approved the study and granted a waiver of informed consent. One hundred fifty-five women (mean age, 51.3 years, range: 24-92 years) who systematically underwent mammography and breast tomosynthesis with subsequent percutaneous biopsy were analyzed. Four radiologists (two seniors, R1 and R2, and two juniors, R3 and R4 with 30, 10, 3 and 1 years of experience in breast imaging, respectively) independently reviewed exams in two steps: mammography alone and tomosynthesis in adjunct with mammography. The lesions in the cohort included 39.3% (61/155) cancers, 2.5% (4/155) high-risk lesions and 58.1% (90/155) benign lesions. A receiver operating characteristic (ROC) curve analysis was performed to compare the results of the two readings.
RESULTS: There was almost perfect agreement irrespective of reader experience for the reading of the mammography in adjunct with tomosynthesis, whereas agreement was poor between junior and senior readers for the reading of mammography alone. Area under the ROC (Az) values for the tomosynthesis in adjunct with mammography were significantly better than Az values for mammography alone for all readers except the most experienced, for whom only a tendency was noted. The proportion of cancers undiagnosed by mammography alone that were well diagnosed by tomosynthesis in adjunct with mammography was 6.5% (4/61), 13.1% (8/61), 27.8% (17/61) and 26.2% (16/61) for Readers 1, 2, 3 and 4, respectively. The proportion of false positive cases induced by the addition of breast tomosynthesis to mammography was 2.1% (2/94), 2.1% (2/94), 9.5% (9/94) and 12.7% (12/94) for Readers 1, 2, 3 and 4, respectively.
CONCLUSION: Adding breast tomosynthesis to mammography improved sensitivity and negative predictive value for all readers except for the most experienced one, in whom only a tendency for improvement was noted.
2. US-guided core needle biopsy: false-negatives. How to reduce them? Perrot N(1), Jalaguier-Coudray A, Frey I, Thomassin-Naggara I, Chopier J. Eur J Radiol. 2013 Mar;82(3):424-6.
3. Breast MRI: Artefacts and pitfalls Salem C(1), Chopier J, Perrot N, Darai E, Thomassin-Naggara I. J Radiol. 2011 Dec;92(12):1053-9.
Multiple artefacts and pitfalls may occur with breast MRI. Artefacts are secondary to the MR technique itself while pitfalls often are the result of human error. The most common artefacts include motion, pulsation, chemical shift and magnetic susceptibility. The most common pitfalls include improper contrast injection, poor patient positioning, improper placement of the ROI and improper characterization of physiological and iatrogenic contrast enhancement. The identification of these artefacts and pitfalls on breast MR images may reduce their impact or even eliminate them. The use of optimized protocols is necessary. It is important to explain to patients the sequence of the examination, ensure proper placement of the breasts in the coil and optimize the contrast injection. The ROI should always be placed over the most suspicious region of the lesion. Finally, it is recommended to perform the MRI during the second week of the menstrual cycle and to discontinue the use of HRT 2 months prior to scanning when possible.
4. Characterization of complex adnexal masses: value of adding perfusion- and diffusion-weighted MR imaging to conventional MR imaging. Thomassin-Naggara I(1), Toussaint I, Perrot N, Rouzier R, Cuenod CA, Bazot M, Daraï E. Radiology. 2011 Mar;258(3):793-803.
PURPOSE: To retrospectively determine the value of adding perfusion-weighted (PW) and diffusion-weighted (DW) sequences to a conventional magnetic resonance (MR) imaging protocol to differentiate benign from malignant tumors. MATERIALS AND METHODS: The institutional ethics committee approved this retrospective study and waived the requirement to obtain informed consent. MR images in 87 women (age range, 25-87 years) who underwent imaging before surgery for complex adnexal masses-excluding endometriomas and cystic teratomas-were analyzed. Conventional morphologic, perfusion, and diffusion MR criteria of malignancy were recorded. Three independent observers reviewed images in four steps: conventional MR images alone, conventional MR images and PW images combined, conventional MR images and DW images combined, and conventional, PW, and DW MR images combined. Receiver operating characteristic curve analysis was performed to compare the results of the readings. A recursive partitioning model was built to establish a multivariate decision tree.
RESULTS: There was almost perfect agreement for lesion characterization regardless of the reader experiment or step considered (κ = 0.811-0.929). Area under the receiver operating characteristic curve values were higher for conventional and DW images combined, conventional and PW images combined, and conventional, DW, and PW images combined compared with conventional MR images alone (P < .05). For all readers, the accuracy of conventional, PW, and DW imaging combined was higher than that of conventional MR imaging alone for benign masses (P < .01) but not for malignant masses (P = .24). The addition of both PW and DW images led to a correct change in the diagnosis in 19% (11 of 57 patients), 23% (13 of 57 patients), and 24% (14 of 57 patients) of cases for readers 1, 2, and 3, respectively, with no incorrect changes. Conventional, PW, and DW MR imaging criteria were combined to generate a decision tree giving an accuracy of 95%.
CONCLUSION: The addition of PW and DW sequences to a conventional MR imaging protocol improved the diagnostic accuracy in the characterization of complex adnexal masses.
5. Long-term results of hysteroscopic myomectomy in 235 patients. Polena V(1), Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S. Eur J Obstet Gynecol Reprod Biol. 2007 Feb;130(2):232-7. Epub 2006 Mar 10.
OBJECTIVE: To assess the efficacy of transcervical resection of submucous fibroids according to type and size.
MATERIALS AND METHODS: Retrospective follow-up of 235 women with submucous fibroids at outpatient hysteroscopy who underwent a hysteroscopic transcervical resection. The main indications were the abnormal uterine bleeding and fertility problems. Thirty-seven percent of patients had an associated endometrial ablation and 32% had a polyp resection. Fifty-one percent of women were menopausal. In cases of incomplete resection a repeat procedure was offered. RESULTS: Intra-operative complications were rare (2.6%) and there was no major complication. Eighty-four percent of cases were followed-up. The median follow-up was 40 months (range 18-66 months). The procedure was classed as a success in 94.4% of patients. Among the cases that were classed as a failure, four patients had a repeated hysteroscopic procedure, three patients had a subsequent hysterectomy and four patients presented with abnormal uterine bleeding at follow-up.
CONCLUSION: The hysteroscopic transcervical resection of submucous fibroids is a safe and highly effective long-term therapy for carefully selected women presenting with abnormal uterine bleeding and fertility problems. It produces satisfactory long-term results with few complications.
6. Preeclampsia and antiphospholipid syndrome. Uterine artery Doppler evaluation. Carbillon L(1), Uzan M, Kettaneh A, Letellier E, Stirnemann J, Perrot N, Tigaizin A, Fain O. Rev Med Interne. 2006 Feb;27(2):111-6. Epub 2005 Nov 22.
INTRODUCTION: Women with persistently high resistance in uterine arteries have an increased risk of the subsequent development of preeclampsia. Doppler investigation provides a non-invasive method for the study of the uteroplacental blood flow. In pregnant women the antiphospholipid syndrome is associated to an increased risk of preeclampsia and complications related to uteroplacental insufficiency, and the role of uterine artery Doppler is discussed. CURRENT KNOWLEDGE AND KEY POINTS: In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. In women with preeclampsia or related complications, the abnormal persistence of high resistance to flow in the uterine arteries correlates with maternal and neonatal outcome. In one study including patients with antiphospholipid syndrome, a high resistance index in the uterine arteries at 22-24 weeks gestation strongly predicted the subsequent development of preeclampsia. In another study including patients with lupus anticoagulant, persistent bilateral notches at 22-24 weeks gestation may identify preeclampsia and fetal growth restriction with a high sensitivity, specificity, positive and negative predictive value. The treatment may improve the uteroplacental blood flow and is a possible confounding factor which needs further evaluation. FUTURE PROSPECTS AND PROJECTS; In patients with antiphospholipid antibodies a higher impedance has been observed in the uterine artery, suggesting a possible vascular dysfunction precluding to impaired trophoblastic invasion and placental thrombosis, as probable mechanisms in the complications. If confirmed, these findings might have important implications for the management of these patients.
7. Doppler and immunohistochemical evaluation of decidual spiral arteries in early pregnancy. Carbillon L(1), Ziol M, Challier JC, Perrot N, Uzan M, Prevot S, Uzan S. Gynecol Obstet Invest. 2005;59(1):24-8. Epub 2004 Sep 1.
OBJECTIVE: The purpose of this study was to estimate spiral artery subchorionic flow at 8-11 gestational weeks (GW) by Doppler ultrasound and then to analyze these vessels in the decidua basalis using histologic, morphometric and immunohistochemical analyses.
METHODS: Subchorionic spiral arteries were evaluated in 5 women scheduled for aspiration at 8-11 GW. Flow velocity waveforms were sought using color and pulsed Doppler, and the diastolic/systolic (D/S) index was calculated. Transcervical biopsy specimens and aspiration products were thoroughly examined to investigate the structure of the spiral artery at the implantation site using cytotrophoblastic and arterial smooth muscle cell immunohistochemical markers (anti-cytokeratin 7 and anti-actin monoclonal antibodies). Spiral artery cross-sectional inner areas were measured and compared with the D/S index in each case.
RESULTS: Low-impedance pulsatile flow could be detected below the trophoblastic ring in all cases. Complete obstruction of a spiral artery lumen was never observed and cytotrophoblastic cells were incorporated into the vessel wall starting from the perivascular cuff. CONCLUSION: Both techniques evidenced that decidual spiral arteries in the placental bed are not completely obstructed at 8-11 GW.
8. Prospective evaluation of uterine artery flow velocity waveforms at 12-14 and 22-24 weeks of gestation in relation to pregnancy outcome and birth weight. Carbillon L(1), Uzan M, Largillière C, Perrot N, Tigaizin A, Paries J, Pharizien I, Uzan S. Fetal Diagn Ther. 2004 Jul-Aug;19(4):381-4.
OBJECTIVE: Uterine artery flow velocity was prospectively assessed using Doppler ultrasound at 12-14 and 22-24 weeks of gestation in the prediction of subsequent complications related to uteroplacental insufficiency: preeclampsia, pregnancy-induced hypertension, fetal growth restriction, fetal death and placental abruption, and to elucidate its relationship with birth weight. METHODS: Uterine artery Doppler assessment was obtained during routine ultrasound screening in 263 unselected women. Flow velocity waveforms were coded according to the number of notches present at each scanning, respectively: none (0, 0), uni-/bilateral notches that disappeared (1, 0) or (2, 0), uni-/bilateral notches that persisted unilaterally (1, 1) or (2, 1), and persistent bilateral notches (2, 2).
RESULTS: Complete outcome data was obtained for 243 (92.4%) women. Of these women, 55 (22.6%) and 84 (34.6%) women had uni- and bilateral notches, respectively, at 12-14 weeks' gestation; 14 (5.8%) and 21 (8.6%) patients had uni- and bilateral notches, respectively, at 22-24 weeks' gestation. Analysis of complication rates for the four groups showed that they increased with notch persistence (5.7, 13.5, 57.1 and 76.2%), while the corresponding mean birth weight declined (3,273, 3,180, 2,698 and 2,418 g).
CONCLUSION: The absence or early disappearance of uterine artery notches is associated with fewer complications related to uteroplacental insufficiency and normal birth weight, whereas their late and partial disappearance or bilateral persistence tends to compromise the prognosis.
9. Contribution of ultrasonography in the diagnosis of ectopic pregnancy. Ardaens Y(1), Guérin B, Perrot N, Legoeff F. J Gynecol Obstet Biol Reprod (Paris). 2003 Nov;32(7 Suppl):S28-38.
High-resolution endovaginal sonography has considerably improved ectopic pregnancy imaging. In conjunction with serum hCG measurements, it allows early detection of ectopic pregnancy (EP) and has significantly reduced the morbidity and the mortality of this disease. The major sonographic finding is the uterine vacuity, the diagnosis of ectopic pregnancy is quite sure in case of absence of intra-uterine pregnancy (IUP) associated with serum hCG above 1500 mUi/ml. Conversely, the presence of IUP excludes practically the diagnosis of EP, but IUP must be distinguished from a pseudosac. The visualization of an ectopic sac that contains an embryo or a yolk sac clearly allows the diagnosis of EP, but its sensitivity is only 25%. The most common sonographic finding is a hematosalpinx, which looks like an echogenic adnexal mass, next to the ovary containing the corpus luteum. Color Doppler is useful to enhance ectopic trophoblastic flow, but it is only a complementary technique of endovaginal sonography. Finally, if the first sonography is inconclusive, a follow-up examination must be performed 2 or 4 days later.
10. Uteroplacental haemodynamics and uterine artery Doppler practice at 12 weeks gestation. Carbillon L(1), Largillière C, Perrot N, Tigaizin A, Cynober E, Uzan M. Gynecol Obstet Fertil. 2003 Apr;31(4):378-81.
Last years, feasibility and possible interest of uterine artery Doppler during the third month of gestation were confirmed. Doppler flow velocity waveforms can be obtained and assessed in both uterine arteries using abdominal ultrasonography at 12-14 weeks' gestation. The no notch group (one third of women) has a low risk for hypertension, intra-uterine growth restriction, abruptio placentae. The "protecting" effect of the absence of uterine artery notch is as high as this physiological change occurs earlier.
11. Various Doppler sonographic appearances and challenges in prenatal diagnosis of vasa praevia. Seince N(1), Carbillon L, Perrot N, Uzan M. J Clin Ultrasound. 2002 Sep;30(7):450-4.
Rupture of vasa praevia is associated with a high rate of fetal or neonatal mortality. Since the recent development of color and spectral Doppler sonography, prenatal diagnosis of vasa praevia has been increasing but is not yet consistent. We report 2 cases that were diagnosed prenatally, enabling cesarean section to be performed under optimal conditions to prevent complications. A better knowledge of the characteristic Doppler sonographic appearances and the risk factors associated with vasa praevia could greatly facilitate the prenatal diagnosis of this condition and hence the fetal prognosis.
12. Menorrhagia after age 40. Contribution of ultrasonic examination. Perrot N(1), Mergui JL, Frey I, Uzan M. Gynecol Obstet Fertil. 2002 Jun;30(6):523-31.
Menorrhagia after age 40 can have functional, general, local, or organic reasons. The most frequent are: submucous myomas, adenomyosis, polyps. Submucous myomas: a transvaginal scan (TVUS) specifies the type of myoma according to its situation within the uterine cavity: intracavitary myoma or submucous. A transvaginal scan is performed to assess myomas before operative HSC. There are three criteria to check: myomas diameter must be less than 5 cm; 5 mm or more of normal myometrium should be present between myoma and external wall; the myoma must not be in contiguity with a subserosal myoma. Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. Pathology may be proximal or distal, focal or diffuse. Transvaginal US shows: cystic dilatation of heterotopic glands, heterogeneity of the myometrial echotexture, antero-posterior asymmetry of the uterus. TVUS has a sensitivity of 62 to 89% and a specificity of 89 to 96%. Polyps are most often hyperechoic: this makes the diagnosis more difficult in luteal phase; Power Doppler shows the vascular central pedicle. TVUS has a sensitivity of 75%. The polyps smaller than 3 mm are not visible in a reliable way without the help of a contrast media in the cavity.
13. Intervillous and spiral artery flows in normal pregnancies between 5 and 10 weeks of amenorrhea using color Doppler ultrasonography. Alouini S(1), Carbillon L, Perrot N, Uzan S, Uzan M. Fetal Diagn Ther. 2002 May-Jun;17(3):163-6.
OBJECTIVE: The aim of our study was to investigate early placental circulation development and spiral and uterine artery flows in normal 1st-trimester pregnancies. METHODS: A prospective study of intervillous and spiral artery flows in 49 normal pregnancies (5-10 weeks of amenorrhea) was performed. Transvaginal color and pulsed-wave Doppler techniques (6-MHz probe) were used as routine ultrasound scanning modalities before pregnancy termination for psychosocial reasons. RESULTS: In all pregnancies, between 5 and 10 weeks, continuous nonpulsatile intervillous flow (mean V(max) 3.55 cm/s) and spiral artery flow (mean peak systolic velocity 16.2 cm/s, mean diastolic index D/S 0.49 +/- 0.089) were detected. In the 47 women in whom the uterine artery flow was measured, the mean peak systolic velocity was 67.5 cm/s, the mean diastolic index was 0.12, and bilateral notching was observed.
CONCLUSIONS: In all cases, between 5 and 10 weeks, slow and continuous nonpulsatile intrachorionic flow could be detected, whereas pulsatile flow was detected in spiral arteries. The true nature of this early intervillous circulation remains to be determined.
14. Assessment of Fallopian tube patency by HyCoSy: comparison of a positive contrast agent with saline solution. Boudghène FP(1), Bazot M, Robert Y, Perrot N, Rocourt N, Antoine JM, Morris H, Leroy JL, Uzan S, Bigot JM. Ultrasound Obstet Gynecol. 2001 Nov;18(5):525-30.
OBJECTIVE: To compare the efficiency of air-filled albumin microspheres (Infoson) with saline solution in determining Fallopian tube patency during hysterosalpingo contrast sonography (HyCoSy). METHODS: This was a prospective randomized multicenter study with a sequential design. Over a 10-month period, 23 patients (mean age, 33 years) referred for infertility were examined by HyCoSy (saline or Infoson) before conventional hysterosalpingography (Iopamiron 370), performed during the same session. Contrast agents were administered through a 5-F Ackrad balloon catheter inserted transcervically into the uterine cavity. HyCoSy was performed with a 7-MHz transvaginal probe using both B-mode and color Doppler, and tubal patency was demonstrated by the appearance of contrast agent in the peritoneal cavity near the ovaries. Data were registered for each patient during the examination and the results were monitored by sequential analysis.
RESULTS: Mean volumes of contrast injections were 35.3 mL of saline, 14.4 mL of Infoson, and 13.8 mL of Iopamiron 370. Infoson-enhanced HyCoSy provided a significantly larger (P = 0.006) number of correct diagnoses (20/22 Fallopian tubes) than did saline HyCoSy (12/24 Fallopian tubes), and the same number as that achieved by hysterosalpingography.
CONCLUSION: A positive ultrasound contrast agent appears to be more efficient than saline solution at determining Fallopian tube patency in infertile women by means of HyCoSy, and as efficient as an iodinated contrast agent in the same population explored by HSG. HyCoSy could be used to screen infertile women, thereby avoiding the use of iodinated contrast medium and exposure to ionizing radiation during conventional HSG in patients with patent Fallopian tubes.
15. Doppler ultrasonography and implantation: a critical review. Carbillon L(1), Perrot N, Uzan M, Uzan S. Fetal Diagn Ther. 2001 Nov-Dec;16(6):327-32.
Active perifollicular angiogenesis in ovaries and endometrium is linked with the quality of oocytes and endometrial receptivity, and consequently with the outcome of implantation. Studies evaluating ovarian velocimetry in relation to implantation and pregnancy rates bring essentially into play velocity values or non-quantitative parameters, whose reproducibility is low and which are hardly usable in daily practice. Conversely, the assessment of uterine artery flow by Doppler examination is easy and reproducible, and high impedance at the end of the follicular phase is a good predictive indicator of poor endometrial receptivity. In early pregnancy, Doppler investigation must not be used routinely because its safety is still under discussion; however, the available data show that impedance in the uterine and spiral arteries does not show any significant difference between normal and abnormal pregnancies (missed abortions or anembryonic pregnancies), and the significance of easily detectable intervillous flow is hotly debated, raising fundamental points.
16. Picture of the month. Adenomyosis: power Doppler findings. Perrot N(1), Frey I, Mergui JL, Bazot M, Uzan M, Uzan S. Ultrasound Obstet Gynecol. 2001 Feb;17(2):177-8.
17. Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients. Frey I(1), Le Breton C, Lefkopoulos A, Perrot N, Khalil A, Chopier J, Le Blanche A, Bigot JM. Eur Radiol. 1998;8(7):1187-92.
The purpose of this study was to describe magnetic resonance findings of intradural spinal canal secondaries and to select the best way of investigating this condition. Thirty patients with a known malignancy [breast carcinoma (n = 14), lung carcinoma (n = 10), other sites (n = 6)] and unexplained neurologic signs were studied with pre- and post-contrast T1-weighted images and T2-weighted images. Cerebrospinal fluid cytology was available in 16 patients and positive in 11 patients. In all the patients, post-contrast T1-weighted images demonstrated abnormal enhanced lesions. Most of them were nodular, located on the conus medullaris and the cauda equina. Few lesions appeared at the thoracic or cervical levels, as nodular or thin areas of enhancement. Pre-contrast T1-weighted sequences failed or were equivocal to detect the lesions. Eighteen of 30 patients had cerebral metastases. Fourteen had osseous metastases. In conclusion, post-contrast T1-weighted sequence is the optimal modality for the diagnostic of intradural spinal canal metastases. Axial and coronal images may be a useful adjunct to precise anatomic changes. T1-weighted and T2-weighted sequences remain necessary when further information is expected on vertebra or soft tissue.
18. Sonohysterography: a new study method of the uterine cavity: evaluation of 84 cases and comparison to hysteroscopy. Perrot N(1), Frey I, Mergui JL, Sananes S, Uzan M, Uzan S. Contracept Fertil Sex. 1997 Apr;25(4):325-9.
Sonohysterography versus hysteroscopy: the assessment of the uterine cavity: a series of 84 cases. We study indications, advantages, limits of a technic of investigation of uterine cavity: sonohysterography. Our results show that sonohysterography is as effective as hysteroscopy in the diagnosis of intrauterine conditions. It is painless, no time consuming. There is no adverse effects and it is helpful in the diagnosis of intrauterine abnormality as a complement of transvaginal scanning.
19. Maternal and fetal Doppler ultrasound: acquisition and perspectives. Uzan M(1), Perrot N, Breart G, Uzan S. Contracept Fertil Sex. 1997 Apr;25(4):288-92.
20. Ultrasono-hysterography: techniques and indications. Perrot N(1), Frey I, Bigot JM. J Radiol. 1996 Sep;77(9):687-90.
Sonohysterography consists in injecting a saline solution into the uterine cavity and performing transvaginal sonography. The purpose of this procedure is the pre-operative assessment of intracavitary anomalies, especially polyps, myoma, adhesions, congenital abnormalities such as septate uterus. Technical aspects are shown. This procedure is painless, atraumatic and no adverse effect is seen if the usual precautions before hysterography are taken. The right place of this exam is between hysterography and hysteroscopy, but more widespread use is required before a final opinion can be reached.
21. Color Doppler in gynecology. Perrot N(1), Uzan M. Contracept Fertil Sex. 1994 Dec;22(12):753-9.
22. The effects of tamoxifen on the endometrium. Perrot N, Guyot B, Antoine M, Uzan S. Ultrasound Obstet Gynecol. 1994 Jan 1;4(1):83-4.
23. Breast cancer: effect of tamoxifen on the mineral density of bone. Zylberberg B, Dormont D, Perrot N, Uzan S. Eur J Obstet Gynecol Reprod Biol. 1993 Dec 15;52(2):147-8.
24. Echography in gynecology. Perrot N(1), Uzan M. Contracept Fertil Sex. 1993 Oct;21(10):709-12.
25. Pelvimetry in x-ray computed tomography. Principles, technics and results. Perrot N, Lebreton C, Carette MF, Boudghene F, Bigot JM. Ann Radiol (Paris). 1987;30(6):423-4.
26. Role of echotomography in the diagnosis of obstructive jaundice. 51 cases. Metges PJ, Flageat J, Herhandez C, Perrot N, Daly JP, Dumeige F. Med Chir Dig. 1982;11(5):337-43.
27. Topic of the month: what is your diagnosis? (author's transl). Vincens C, Perrot N, Bigot JM. Ann Radiol (Paris). 1981 Nov;24(7):613-6.
28. Imaging of myomas: is preoperative MRI usefull ? Bazot M(1), Salem C, Frey I, Daraï E. Gynecol Obstet Fertil. 2002 Sep;30(9):711-6.
Leiomyomas are the most common uterine neoplasms. Leiomyomas classified as intramural, submucosal, or subserosal are usually associated with various types of degeneration. The diagnosis and the treatment of leiomyomas vary among these subtypes of leiomyomas. Magnetic resonance imaging is the most accurate imaging technique for detection, localization, and characterization of myomas. The differential diagnosis at MR imaging includes adenomyosis and solid adnexal masses. Despite its relatively high cost, MR imaging is a very useful procedure which can assist preoperative planning.
29. Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients. Le Blanche AF(1), Bazot M, Frey I, Meaume S, Piette F, Carette MF, Weill-Engerer S. Invest Radiol. 2002 Jan;37(1):35-9.
RATIONALE AND OBJECTIVES: Pneumonia is the leading cause of death after the age of 85 years. Chest radiography (CXR) requires forced inspiration for accurate assessment, but kyphosis, denutrition, muscular weakness, and neurologic disorders limit active inspiration. The aim of this study was to evaluate a new passive expansion technique, by raising the patient's arms above the head, in the radiographic diagnosis of pneumonia.
METHODS: During a 10-month period, CXR were performed in 1452 geriatric patients for pulmonary acute disorders in our geriatric university hospital. When fewer than five anterior rib segments were visible on the conventional front view, a second CXR was performed with the patient's arms being raised above the head by a radiologist. The diagnostic questions were: Are more than five anterior rib segments present? Is pneumonia visible? The chest radiographs were independently analyzed (3-step confidence scale) by two radiologists and compared by interobserver kappa-coefficients calculation.
RESULTS: One hundred three patients (97 female, 6 male), representing 7% of the examined population, with an average age of 86.5 years (range, 70-104 years) were included. An additional anterior rib segment was visible on the front CXR when the arms were raised above the head (P < 0.001). Pneumonia was diagnosed in 59 patients with high agreement (kappa = 0.84) by the passive expansion technique, whereas the pneumonia infiltrate was visible in only 44 patients with considerably lower agreement (kappa = 0.36) when the arms were positioned along the trunk (P < 0.03).
CONCLUSIONS: Raising the arms above the head optimizes the quality of CXR and increases the detection of pneumonia in the geriatric patient. New ergonomics and adequate contention are required.
30. Intradural extramedullary spinal canal secondary neoplasms: MR findings in 30 patients. Frey I(1), Le Breton C, Lefkopoulos A, Perrot N, Khalil A, Chopier J, Le Blanche A, Bigot JM. Eur Radiol. 1998;8(7):1187-92.
The purpose of this study was to describe magnetic resonance findings of intradural spinal canal secondaries and to select the best way of investigating this condition. Thirty patients with a known malignancy [breast carcinoma (n = 14), lung carcinoma (n = 10), other sites (n = 6)] and unexplained neurologic signs were studied with pre- and post-contrast T1-weighted images and T2-weighted images. Cerebrospinal fluid cytology was available in 16 patients and positive in 11 patients. In all the patients, post-contrast T1-weighted images demonstrated abnormal enhanced lesions. Most of them were nodular, located on the conus medullaris and the cauda equina. Few lesions appeared at the thoracic or cervical levels, as nodular or thin areas of enhancement. Pre-contrast T1-weighted sequences failed or were equivocal to detect the lesions. Eighteen of 30 patients had cerebral metastases. Fourteen had osseous metastases. In conclusion, post-contrast T1-weighted sequence is the optimal modality for the diagnostic of intradural spinal canal metastases. Axial and coronal images may be a useful adjunct to precise anatomic changes. T1-weighted and T2-weighted sequences remain necessary when further information is expected on vertebra or soft tissue.
31. Fetal toxicity of valsartan and possible reversible adverse side effects. Berkane N(1), Carlier P, Verstraete L, Mathieu E, Heim N, Uzan S. Birth Defects Res A Clin Mol Teratol. 2004 Aug;70(8):547-9.
BACKGROUND: Published cases suggest that the use of angiotensin II receptor antagonists is fetotoxic during the third trimester, but not in early pregnancy. CASE: We report a case in which the adverse fetal effect of angiotensin II receptor antagonist treatment was reversed. A woman with chronic hypertension was treated with valsartan until gestation week (GW) 20, when a complete anhydramnios was observed. Six days after interruption of the treatment, amniotic fluid reappeared. It reached a normal level at GW 23.5. The plasmatic creatinine level and the renal ultrasound examination were within normal limits at the six-month follow-up.
CONCLUSIONS: Whereas angiotensin-II-receptor antagonist generates a severe renal toxicity, this case suggests that, at least in the first half of pregnancy, these effects can be reversed.
32. Detection of hepatitis C virus RNA (HCV RNA) in amniotic fluid: a prospective study. Delamare C(1), Carbonne B, Heim N, Berkane N, Petit JC, Uzan S, Grangé JD. J Hepatol. 1999 Sep;31(3):416-20.
BACKGROUND/AIMS: Mother-to-infant transmission of hepatitis C virus (HCV) has been reported, but the transmission route is unknown. The aim of our study was to detect HCV RNA in amniotic fluid of pregnant women seropositive for HCV. METHODS: Twenty-two HCV seropositive women were included in the study (median age: 39 years). An amniocentesis was performed in all patients during the 4th month of pregnancy. Sixteen women also tested positive for HCV RNA in serum. The range of HCV RNA titers was 0.3 to 15.1x10(6) Eq/ml (Quantiplex HCV RNA 2.0 Assay, Chiron Diagnostics). Of these 16 viremic patients, four had an anterior placenta, ten had a posterior placenta and the position of the placenta was not determined in two cases. PCR (Amplicor HCV, Roche Diagnostics) was used to detect HCV RNA in the amniotic fluid. We also studied 11 HCV seronegative women as a control group.
RESULTS: In the viremic group (n = 16), HCV RNA was detected once in amniotic fluid. The positive specimen was collected from a patient with an HCV RNA serum value equal to 1.1x10(6) Eq/ml. The placenta was in an anterior position. A PCR inhibitor was detected in one case. No HCV RNA was detected in the amniotic fluid of six seropositive non-viremic patients, nor in the control group. Serum HCV RNA was negative in the ten children tested. The woman whose amniotic fluid contained HCV RNA was the mother of one of them.
CONCLUSIONS: HCV RNA detection in amniotic fluid is rarely positive. The anterior position of the placenta in the only positive detection cannot rule out contamination of the amniotic fluid during the transplacental amniocentesis.
33. Unexpected inherited chromosomal translocation during prenatal diagnosis for maternal age: risk for a nondetectable karyotype imbalance in offspring. Siffroi JP(1), Heim N, Benzacken B, Franco JC, Le Bourhis C. Fetal Diagn Ther. 1998 Sep-Oct;13(5):271-5.
An unexpected t(1;19) translocation is described in a fetus. Inherited from the mother, this translocation was found during the course of a normal prenatal diagnosis made for maternal age. The very short length of chromosomal translocated segments and their labelling pattern made high-resolution cytogenetic methods and fluorescence in situ hybridization techniques necessary for the correct identification of this karyotype rearrangement, both in mother and fetus. Different modes of meiotic segregation, leading to potential erroneous prenatal diagnoses, are discussed.
34. Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women. Goffinet F(1), Paris J, Heim N, Nisand I, Breart G. Eur J Obstet Gynecol Reprod Biol. 1997 Jan;71(1):11-9.
OBJECTIVE: To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry.
STUDY DESIGN: Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression.
RESULTS: 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA.
CONCLUSION: Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.
35. Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: counting the layers of the dividing membrane. Vayssière CF(1), Heim N, Camus EP, Hillion YE, Nisand IF. Am J Obstet Gynecol. 1996 Dec;175(6):1529-33.
OBJECTIVE: Our aim was to determine whether chorionicity in twin gestations can be diagnosed by use of high-frequency ultrasonography to count the layers of intraamniotic membrane.
STUDY DESIGN: This prospective study of 66 twin pregnancies between 13 and 38 weeks' gestation used transabdominal ultrasonography at 10 MHz. The pregnancy was classified as monochorionic when two layers were counted and as dichorionic when three or four layers were counted. The findings of the examiner, who had no other information about chorionicity, were compared with those of the histopathologic examination of the placenta.
RESULTS: Ultrasonography allowed chorionicity to be determined correctly in 60 of 63 cases (95%; 100% in the second trimester and 92% in the third. The predictive value for dichorionicity was 100% (48/48) and the sensitivity 94% (48/51). The 12 monochorionic diamniotic pregnancies in which the membrane was visualized were all correctly diagnosed. In a thirteenth case, with severe oligohydramnios, the membrane could not be seen. Two patients were lost to follow-up. In 95% of the cases (63/66) only one examination was required to diagnose chorionicity. Intraobserver variability was 0% (0/26). Interobserver variability, tested by photographs, was 3% (2/65).
CONCLUSIONS: This technique should be the first-line method for determining chorionicity in the second and third trimesters because it is the most effective. Its excellent reproducibility may be attributable to the use of high-frequency ultrasonography.
36. Comparative value of transverse abdominal diameter and fetal abdominal perimeter. 3844 biometric examinations. Grangé G(1), Favre R, Goffinet F, Heim N, Peterschmitt C, Kohler A, Gutedel A, Nisand I. J Gynecol Obstet Biol Reprod (Paris). 1995;24(8):843-9.
OBJECTIVE: Assess charts of abdominal size as they are used in a routine ultrasound screening, on a non selected population with 5 operators, to compare the interest of transverse abdominal diameter (TAD) with abdominal circumference (AC).
METHOD: Retrospective study, in the department of Antenatal Diagnosis of the Centre Médico-Chirurgical et Obstétrical between September 1991 and August 1994. MAIN OUTCOME MEASURES: Abdominal biometry and gestational age to characterize the prenatal trophicity. Neonatal weight and gestational age at birth to characterize neonatal trophicity.
RESULTS: Between 32 and 36 weeks, the TAD charts detected only one SGA (small for gestational age) out of 10. However, the AC sensitivity was 54.5% with a specificity of 94%. In the same period, the TAD charts suspect LGA (large for gestational age) for one exam out of two. The charts of AC have about the same performance to detect LGA and SGA.
CONCLUSION: For a routine ultrasound screening between 32 and 36 weeks gestational age, the AC charts have to be preferred to TAD charts.


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