Non-branched microcysts of the pancreas on MR imaging of patients with pancreatic tumors who had pancreatectomy may predict the presence of pancreatic intraepithelial neoplasia (PanIN): a preliminary study

PURPOSE

To evaluate whether pancreatic parenchymal abnormalities on magnetic resonance imaging (MRI) are associated with pancreatic intraepithelial neoplasia (PanIN) on histology.

MATERIALS AND METHODS

Retrospective study approved by institutional review board. One hundred patients (48 men, 52 women; mean age, 53.2 ± 16.29 [SD]) underwent MRI before pancreatectomy for pancreatic tumors analyzed by two independent observers blinded to histopathological results for the presence of non-communicating microcysts and pancreatic atrophy (global or focal) beside tumors. MRI findings were compared to histopathological findings of resected specimens. Interobserver agreement was calculated. The association between parenchymal abnormalities and presence of PanIN was assessed by uni- and multivariate analyses.

RESULTS

PanIN was present in 65/100 patients (65%). The presence of microcysts on MRI had a sensitivity of 52.3% (34/65 [95%CI, 51.92-52.70%]), a specificity of 77.1% (27/35 [95%CI, 76.70-77.59]), and accuracy of 61% (61/100 95%CI [50.7-70.6]) for the diagnosis of PanIN while global atrophy had a sensitivity of 24.6% (16/6 [95%CI, 24.28-24.95]) and a specificity of 97.1% (34/35 [95%CI, 96.97-97.32%]). In multivariate analysis, the presence of microcysts (OR, 3.37 [95%CI, 1.3-8.76]) (p = 0.0127) and global atrophy (OR, 9.79 [95%CI, 1.21-79.129]) (p = 0.0324) were identified as independent predictors of the presence of PanIN. The combination of these two findings was observed in 10/65 PanIN patients and not in patients without PanIN (p = 0.013 with an OR of infinity [95%CI, 1.3-infinity]) and was not discriminant for PanIN-3 and lower grade (p = 0.22). Interobserver agreement for the presence of microcysts was excellent (kappa = 0.92), and for the presence of global atrophy, it was good (kappa = 0.73).

CONCLUSION

The presence of non-communicating microcysts on pre-operative MRI can be a significant predictor of PanIN in patients with pancreatic tumors.

KEY POINTS

• In patients with pancreatic tumors who had partial pancreatectomy, MR non-communicating pancreatic microcysts have a 52.3% sensitivity, a 77.1% specificity, and a 61% accuracy for the presence of PanIN with univariate and with an odds ratio of 3.37 with multivariate analyses. • The association of global atrophy and non-communicating microcysts increases the predictive risk of PanIN.

[Brain tumors and epilepsy: postoperative evaluation of surgical procedures]

OBJECTIVES

To study the efficacy of surgery on the postoperative control of epilepsy in patients operated for brain tumors.

METHODS

Forty patients operated for supratentoriel cerebral tumors with epilepsy, at Hotel-Dieu de France (HDF) hospital center, between 1983 and 2005, were included in this study. Clinical, paraclinical and surgical information were collected. The extent of the tumor resection was based on the postoperative MRI results.

RESULTS

The mean duration of the follow-up was 52 +/- 6 months (from 6 months to 10 years). 62.5% of our patients have had acute seizures (< 1 year) and 37% had experienced chronic seizures (> or = 1 year). The histopathologic exam revealed 2 DNET, 3 pilocytic astrocytomas, 2 diffuse astrocytomas, 6 A oligodendrogliomas, 7 B oligodendrogliomas, 7 anaplastic astrocytomas and glioblastomas and 13 meningiomas. Twenty-two patients had a complete resection, whereas the postoperative MRI of 18 patients have shown a tumoral remnant. After one year of follow-up, a complete remission was noted in 57.5% of the patients (Engel I). The prognostic factors of good outcome were: low-grade glial tumors (I +/- II), meningiomas, and complete tumor resection.

CONCLUSION

The efficacy of surgery for epilepsy associated to cerebral tumors, established by the majority of articles, matched the results obtained for the patients operated at HDF, with complete seizures control in 57.5% of patients. This control depended essentially on the extent of tumor resection and on tumor's nature.

Multiple biliary hamartomas: magnetic resonance features with histopathologic correlation

The purpose of this study was to report the magnetic resonance imaging (MRI) features of multiple biliary hamartoma (MBH) and to correlate them with histopathology. MRI features of 11 patients with MBH proven by histology were retrospectively reviewed and correlated to histopathology. MBH presented as multiple, tiny, and uniformly distributed lesions in all cases. All were hypointense on T1-weighted images and hyperintense on T2-weighted images relative to the liver parenchyma. Mural nodules were identified in 10 of 11 (91%) cases. They were isosignal on T1-weighted images, intermediate signal on T2-weighted images. Gadolinium-enhanced images showed mural nodule enhancement in 9 of 10 patients (90%) or a peripheral rim-like enhancement of the whole lesion in one case (9%). MBH were present in all liver specimens. In the six patients examined at MR cholangiography, the lesions lacked communication with the biliary tree. At histopathology, the mural nodule corresponded to an endocystic polypoid projection made of conjunctive septa. Three (27%) patients had associated focal nodular hyperplasia, and 1 (9%) had concomitant cholangiocarcinoma. MRI features allowed diagnosis of MBH with accuracy. Their recognition, especially the mural nodule, may help avoid misdiagnosis.

Hématome intracérébral spontané du sujet jeune

INTRODUCTION

Hemorrhagic stroke is uncommon in young patients. The etiologic spectrum is very wide in the literature. The purpose of this study was to determine the range of etiology in a group of patients completely investigated and to study the relation with a history of high blood pressure.

PATIENTS AND METHODS

We reviewed study database, clinical and diagnostic records of 130 patients identified in a population based study, aged 18 to 55 years presenting with hemorrhagic stroke. There were divided into two groups: 67 patients treated at Hotel-Dieu Hospital in Beirut, Lebanon, and 63 patients reviewed at Yale New Haven Hospital, Connecticut, USA. Patients presenting with selective subarachnoidal or intraventricular hemorrhage were excluded. Diagnostic evaluation was assessed for completeness (based on prospectively articulated evidence based criteria) and for identifiable etiology of hemorrhagic stroke and its relation to high blood pressure.

RESULTS

There were 84 cases (64%) with complete diagnostic workup. The most common cause of incomplete investigations in remaining cases was death, poor neurological condition and incomplete follow up. Hematoma was superficially located (lobar) in 59.2%, deep seated (thalamo-capsulo-lenticular) in 26%, within the brain stem in 8.7% and cerebellar in 6.1%. An etiology was established in 70.4% of cases (pial AVM 16.7%, aneurysms 15.5%, hematological disorders 13%, cavernous malformations 10.7%, tumors 4.8%, bleeding within ischemic area 3.8%, vasculitis 2.3%, venous thrombosis 1.2% and venous angioma 1.2%. 29.6% of patients remained with undetermined etiology despite complete investigations. In a subgroup of 45 patients, a history of high blood pressure was found in 46.7%. In this cohort, an underlying etiology was established in 71% of cases.

CONCLUSION

Complete investigation can establish an etiology in 70% of young patients who survived hemorrhagic stroke, independently from the presence of a history of high blood pressure.

[Percutaneous renal angioplasty. Experience of the Radiodiagnostic Service of the Hotel-Dieu of France]

OBJECTIVE

We report on a series of 42 renal artery stenosis treated with percutaneous transluminal angioplasty (PTA).

MATERIALS AND METHODS

From January 1988 to June 1996, these 42 renal artery stenoses were found in 33 patients (17 males and 16 females) who had a balloon dilation (with 3 stent deployment); 9 of these lesions were bilateral and 7 on a single kidney. Initially, 32 patients had a high blood pressure and 6 a progressive renal failure. Twenty-two patients presented an atheromatous pathology, 7 a fibromuscular dysplasia. One patient had a Takayasu arteritis, and 3 others a stenosis of the renal graft artery.

RESULTS

We find a complete initial success in 86% of the patients, a partial success in 14% without any catheterization failure. Global success rate of PTA is 90% at 29 months mean follow-up. A benefit of PTA regarding blood pressure was found in 84.4% of the patients. The renal function became normal in half the patients with renal insufficiency.

CONCLUSION

PTA is an efficient treatment for renal artery stenosis. A satisfactory improvement of blood pressure and renal function is found in a high number of patients.

[Endovascular treatment of arteriovenous vertebro-vertebral fistula]

Vertebral arteriovenous fistulae are relatively rare, with limited experience in most centers. We report our experience in the treatment of a vertebral arteriovenous fistula treated by interventional method. A review of the literature is made and the etiology, presentation and treatment of this unusual lesion are discussed. The endovascular occlusion is now the treatment of choice of vertebral fistulae.

[Imaging aspect of a case of fibrodysplasia ossificans progressiva]

Fibrodysplasia ossificans progressiva is a rare congenital disease that affects children under the age of five years. Soft tissue swelling of the cervical and dorsal regions with local pain, warmth and low grade fever are the early clinical manifestations, usually associated with hallux valgus and microdactily of the fingers and toes. Calcifications of the fascias and muscles cause muscular contractures leading to progressive disability and restrictive lung disease. In the early stage, CT shows edema of the soft tissues and later on, calcifications of muscular fascia. The association of these radiographic and CT findings is specific and should avoid muscular biopsies which are known to be an aggravating factor in this disease.

Isolated brain metastases of osteosarcoma in a patient presenting with a patent foramen ovale

We report the case of a patient in whom brain MR imaging was requested for initial symptoms of intracranial hypertension. The presence of multiple intracranial hemorrhagic lesions suggested brain metastases. Body screening showed periosteal osteosarcoma of the left fibula with no lung metastases, but with a patent foramen ovale which probably allowed neoplastic cells to reach the brain without being filtered through the lungs. The conclusion of this study was that a left-right cardiac communication is to be considered in cases of isolated brain metastases from osteosarcoma.

[Percutaneous bile drainage in neoplastic obstructive pathology of the biliary tract. Experience of the Hotel-Dieu of France in 100 drainages]

Between 1981 and 1994, a 100 biliary drainages were introduced transhepatically in 71 patients with malignant biliary disease. Eighty-six endoprosthesis were inserted, 6 internal-external drainages and 8 external drainages. Our success rate in catheterization of the stenosis was 97%. The early complication rate was 17% (12/71) most often due to hemorrhage (n = 3), infection (n = 4), duodenal perforation (n = 1), biliary leak (n = 2) and death by septic shock (n = 2). Twenty-nine patients with 39 endoprosthesis had a long-term follow-up. The most common late complication observed was occlusion (15/39, 37%) and migration (1/39, 2.5%). Specific treatment of complications was carried out in 10 of the 29 patients (35%). It is concluded that patients with inoperable malignant obstruction of the bile ducts should be offered an indwelling endoprosthesis whatever their prognosis; an occluded stent can be removed or at least bypassed in nearly all patients, thereby maintaining palliation of symptoms.