Objective. - To evaluate the long-term oncological and functional results of the ablative treatment of T1a kidney malignancies by percutaneous radio-frequency (RF). Materials and methods. - Monocentric retrospective study including all patients treated for renal cell carcinoma (RCC) T1a by radiofrequency, in our center, from 2005 to 2009. All patients had a tumor biopsy before treatment. The primary endpoint was local recurrence. A total of 44 RCCs in 41 consecutive patients were treated (1 patient had 3 synchronous tumors and 1 patient had 2 tumors). There were 26 clear cell RCCs, 13 papillary RCCs and 5 chromophobe RCCs. The median age at diagnosis was 70 years [48-82]. The median American Society of Anesthesiologists (ASA) score was 2 [1-3] and the median glomerular filtration rate (GFR) was 64 mL/min [26-109]. Furhman grade was defined for 39 tumors (Clear cell RCC and papillary RCC), of which 82% were grade 1-2. The median tumor size was 20 mm [11-40], and the median RENAL score was 4 [4-6]. Complications were assessed according to the Clavien-Dindo classification. Overall survival, recurrence-free survival and metastasis-free survival were calculated using the Kaplan-Meier method. Results. - Median follow-up was 90.5 months [17.8-145.3]. Three (7%) local recurrences were reported within a median of 26 months [12-93]. All were treated by a 2nd RF. The overall 10-year survival was 70% (95% CI [56-85]). The 10-year recurrence-free survival was 72% (95% CI [57-88]). The 10-year metastasis-free survival was 87% (95% CI [74-97]). The median GFR on the date of the last news was 51 mL/min [16-98] (P = 0.05). Post-RFA complications consisted in 5 (11.3%) Clavien-Dindo 1-2 complications. No high grade (Clavien >= 3). Conclusion. - Percutaneous radiofrequency for RCC T1a is an alternative. It appears to be safe with low morbidity, satisfaying long-term oncological and functional results, but a risk of reprocessing of 7%. (C) 2020 Elsevier Masson SAS. All rights reserved.

To evaluate the long-term oncological and functional results of the ablative treatment of T1a kidney malignancies by percutaneous radiofrequency (RF).Monocentric retrospective study including all patients treated for renal cell carcinoma (RCC) T1a by radiofrequency, in our center, from 2005 to 2009. All patients had a tumor biopsy before treatment. The primary endpoint was local recurrence. A total of 44 RCCs in 41 consecutive patients were treated (1 patient had 3 synchronous tumors and 1 patient had 2 tumors). There were 26 clear cell RCCs, 13 papillary RCCs and 5 chromophobe RCCs. The median age at diagnosis was 70 years [48-82]. The median American Society of Anesthesiologists (ASA) score was 2 [1-3] and the median glomerular filtration rate (GFR) was 64mL/min [26-109]. Furhman grade was defined for 39 tumors (Clear cell RCC and papillary RCC), of which 82% were grade 1-2. The median tumor size was 20mm [11-40], and the median RENAL score was 4 [4-6]. Complications were assessed according to the Clavien-Dindo classification. Overall survival, recurrence-free survival and metastasis-free survival were calculated using the Kaplan-Meier method.Median follow-up was 90.5 months [17.8-145.3]. Three (7%) local recurrences were reported within a median of 26 months [12-93]. All were treated by a 2nd RF. The overall 10-year survival was 70% (95% CI [56-85]). The 10-year recurrence-free survival was 72% (95% CI [57-88]). The 10-year metastasis-free survival was 87% (95% CI [74-97]). The median GFR on the date of the last news was 51mL/min [16-98] (P=0.05). Post-RFA complications consisted in 5 (11.3%) Clavien-Dindo 1-2 complications. No high grade (Clavien ≥3).Percutaneous radiofrequency for RCC T1a is an alternative. It appears to be safe with low morbidity, satisfaying long-term oncological and functional results, but a risk of reprocessing of 7%.3.

PURPOSE:To report oncological outcomes of patients with prostate cancer undergoing active surveillance according to SURACAP criteria. METHODS:This multicentric study included patients who were initially treated with active surveillance for localized prostate cancer according to the SURACAP criteria. The duration of active surveillance as well as the causes of discontinuing the protocol and the definitive pathological results of patients who further underwent radical prostatectomy were retrospectively evaluated. The predictors of discontinuing active surveillance were assessed using a univariable Cox Model. In addition, the predictive value of initial MRI was assessed for patients who performed such imagery. RESULTS:Between 2007 and 2013, 80 patients were included, with a median age of 64 years [47-74]. Median follow-up was 52.9 months [24-108]. At 5 years follow-up, 43.4% patients were still under surveillance. Among patients that underwent surgery, 17.8% had an extra-capsular extension. The risk of discontinuing was not significantly greater for patients with tumor size of 2 or 3mm versus 1mm (HR=0.9 [0.46-1.75], P=0.763), 2 positives cores versus 1 (HR=0.98 [0.48-2.02], P=0.967), T2a vs. T1c stage (HR=2.18 [0.77-6.18], P=0.133), increased PSA level (HR=1 [0.96-1.15], P=0.975) or the patient's age (HR=1 [0.93-1.16], P=0.966). Among the 50 patients who performed initial MRI, the results of such imagery was not significantly associated to the risk of discontinuing active surveillance MRI (HR=1.49 [0.63-3.52], P=0.36). CONCLUSION:Although this study reveals a high rate of release from active surveillance at 5 years, the rate of extra-capsular tumors reported in the group of patients that underwent surgery is among the lowest in literature. LEVEL OF EVIDENCE:4.

Évaluer les résultats carcinologiques, la morbidité du traitement ablatif de 48 tumeurs malignes du rein, prouvées histologiquement, par radiofréquence (RFA) percutanée guidée par tomodensitométrie, ainsi que l’évolution la fonction rénale. Quarante-huit tumeurs rénales, préalablement biopsiées chez 43 patients (âge médian : 70 ans) ont été traités consécutivement par radiofréquence percutanée de mai 2005 à novembre 2009 dans notre centre. La taille moyenne des tumeurs traitées était de 22,1 ± 5,62 mm. Le suivi reposait sur l’imagerie (TDM ou IRM) et créatininémie à 1 mois, 3 mois, 6 mois, 1 an puis tous les ans. Le succès était défini par un rehaussement de moins de 10 UH de la zone traitée sur l’uro-TDM. Le suivi médian a été de 71 mois (12–106). Le nombre moyen de séance par patient était de 1,03. Le taux de succès global était de 97,1 %. Les 19 biopsies à 1 an après la RFA ont mis en évidence de la fibrose sans tissu tumoral. Deux patients ont eu une récidive locale à 3 ans, 2 patients ont eu une évolution de leur maladie en dehors du site traité et 4 patients ont développé des nouvelles localisations. La survie globale était de 95 %. Quatre patients sont décédés au cours du suivi, dont un des suites de l’évolution de son carcinome rénal. Six complications ont été colligées, cinq gradées Clavien 1–2 et un décès chez un patient traité par antiangiogénique pour une maladie métastatique. Dans cette étude le traitement des tumeurs malignes du rein, histologiquement prouvées, par RFA percutanée a été peu morbide et a permis un contrôle carcinologique satisfaisant et une préservation de la fonction rénale. Cependant un suivi plus long est nécessaire avant de proposer la RFA dans des indications électives.

A 56 year-old woman, without antecedents, was examined for chronic lumbago. The X-rays of the lumbar vertebrae were normal. A CT scan and then an MRI were carried out. The lumbar spine CT scan (Fig. 1) revealed a median posterior corporeal lesion on L5 of 36 mm in diameter. It was compressed, irregular and had several lytic zones. In MRI, the lesion (Fig. 2) was in hypersignal T2, hyposignal T1, non-enhanced. It complied with the cortex of the posterior vertebral wall, the posterior vertebral arc, the epidural space and the soft peri-vertebral tissue. The most likely diagnosis was that of a benign tumour deriving cells from the notochord (BNCT). Considering their rarity and the difficult differential diagnosis with a chordoma, in particular, a vertebral biopsy under fluoroscopic guide was carried out with a Larédo-Hamzé coaxial tocard. The histological examination (Fig. 3) of the biopsy samples revealed, within the spongy tissue, in the intertrabecular tissue, a replacement of the haematopoietic tissue by pseudo-lipomateous tissue made of vacuolised cells with weakly eosinophilic cytoplasm. Cytonuclear atypy or myxoid stroma was not noted. The trabeculae in contact were slightly sclerotic; the limits of the lesion were distinct. The immunochemical techniques (Fig. 4) revealed diffuse positivity of the pseudolipoblastic cells with anti-AE1/AE3 antibodies, protein S100 and vimentin. The anatomopathological examination confirmed the diagnosis of BNCT. Monitoring through imaging was proposed.

Purpose. - To analyze the changes in vicinal kidney parenchyma after percutaneous RFA.Materials et methods. - Twenty-four CT-guided RFA procedures were performed on six pigs using 2 cm LeVeen coaxial needles. We studied volume, morphology, cavitation and enhancement of the ablation zones (AZ) before and after the procedure on contrast-injected CT-scans. The kidneys were removed four weeks later and studied in the path lab.Results. - All the procedures were successfully completed. Four weeks later, the CT-scans showed AZ that were either clearly circumscribed or with unclear borders, heterogenous areas associating necrosis and infarct tissue and mesenchyma showing a process of apoptosis around the edges. A treatment considered as incomplete on the CT-scan (presenting as an enhancement) was always associated with necrosis on the histology slides, although the necrotic areas behaved in various different ways on the CT-scan after injection of contrast medium: an enhancement of more than 10 MU did not mean that no necrotic tissue was present.Conclusion. - RFA causes heterogenous tissue changes, associating necrotic and ischemic zones and an apoptotic reaction. The mechanisms of these changes and their therapeutic significance should be studied. CT-scans performed immediately after RFA procedure and one month later are not predictive of the efficacy of the treatment because an enhancement of the AZ does not mean that it is not necrotic. The value of a CT-scan performed one month after the procedure is debatable, because the tissue remodeling that occurs in the kidneys is not definitive at this time-point. (C) 2012 Elsevier Masson SAS. All rights reserved.

Angiomyolipoma is the most frequent benign renal solid tumor. Because of the lack of fat component on the CT scan, diagnosis of this tumor is hard and can require percutaneous biopsy of unknown renal tumor. The follow-up of the poor fat CT scan component AML (PFCT AML) is uncertain.Five hundred percutaneous renal biopsy under tomodenstitometry have been realised between 1998 and 2008. There was 41 PFCT AML on the 500 biopsy. By definition, a PFCT AML is an AML where the diagnosis is done on a percutaneous biopsy but where there was no fat component on the first CT scan. We studied and compared clinical, tomodensitometric and histologic parameters of these 41 patients (mean age: 56, 9±11.04; sexe rate M/F: 6/35) where renal AML was diagnosed on percutaneous renal biopsy but without fat component on CT scan. Average size was 26.44±14.68mm. We phone-called 16 patients for the long-term follow-up. Average follow-up was 41±28.3 months. For four patients on 16, initial diagnosis was done in front of local symptoms, for one of the 16 diagnosis was done in front of general symptoms, for one of the diagnosis was done during Bourneville tuberous sclerosis evolution and 10 of the 16 was done fortuitously.After review of the initial CT scan, fat density was found on 24% of them. Ten percent was epithelioid angiomyolipoma. Four renal biopsy on 41 (10%) was epithelioid AML. No epithelioid AML had fat component after the second look of the CT scan. Among the 16 patients who were phone-called, three (19%) underwent a complication. Two had abdominal pain and was treated medically. Initial sizes were 26 and 30mm. Only one patient must be operated by radical nephrectomy for acute hemorrhage. Initial size was 45mm. No neoplasic degeneration was identified for those 16 patients.In our study, the PFCT AML rate was 8.2%. In 25% cases, CT scan read-through shown a fat component and could help for the diagnosis. PFCT AML evolution seems to be the same as a classic AML. Conservative treatment had a good covering because there was no death and no malignant evolution. However, we found 10% of epithelioid angiomyolipoma in which malignant risk is high. PFCT AML diagnosed on renal percutaneous biopsy of unknown renal tumor requires the same management than the classic AML.

Confrontation imagerie-anatomopathologie sur la viabilité tissulaire centrale et périphérique et l’homogénéité de la cicatrice après radiofréquence rénale. Vingt quatre procédures de radiofréquence rénale étaient réalisées sur 6 porcs anesthésiés avec des aiguilles coaxiales de Leveen 2 cm, sous guidage tomodensitométrique. Le protocole de chauffe suivait les recommandations du constructeur. Un scanner était réalisé avant et après la procédure, et avant l’explantation des reins (à 4 semaines). Les scanners étaient injectés avec prises de densité séquentielles sur la cicatrice. Les reins expiantés étaient étudiés en anatomopafhologie. On retenait comme complication l’abcès d’une cicatrice et un décès pendant l’anesthésie. On étudiait 4 lésions aiguës. Les 19 lésions chroniques étaient hétérogènes et associaient des zones centrales de nécrose et d’ischémie, et en périphérie des zones apop-totiques et mésenchymateuses. La majorité des lésions ne présentait pas de rehaussement avec une nécrose en anatomopathologie. Un rehaussement (> 10 UH) n’était pas toujours associé à l’absence de nécrose. Le contrôle scanner post-radiofréquence surévaluait la taille de la zone traitée. La radiofréquence induisait toujours une destruction cellulaire centrale dont le résultat anatomopathologique apparaissait hétérogène mais sans parenchyme rénal viable 4 semaines après traitement. Un rehaussement tissulaire en tomodensitomé-trie ne signifiait pas un échec de traitement.

Les auteurs rapportent le cas d’un patient de 31 ans qui évacue un calcul contenant un coil en platine, dans un tableau de colique néphrétique non compliquée. Cinq ans auparavant ce patient avait subi une néphrolithoto-mie percutanée. Une hématurie persistante avait cédé grâce à l’embolisation artérielle d’une branche polaire inférieure. Le coil évacué avait été déployé trop distalement et s’était enroulé dans le faux anévrysnie. Différen-tes hypothèses sont développées pour tenter d’expliquer le processus physiopathologique.

Authors report a case of a 31 years old patient who eliminate a urinary stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was successfully managed with angioembolization of a lower polar artery branch. One of the coils was deployed too distally. It was not efficient, it rolled itself up in the pseudoaneurysm cavity. Different physio pathological hypothesis are developed to explain this expulsion.

Rapporter la technique et le bénéfice de la mise en place de cathéters centraux insérés par voie périphérique (PICCs) Deux cent dix-sept PICCs ont été mis en place pour alimentation parentérale (129), chimiothérapie (75) ou antibiothérapie (13). La ponction veineuse était réalisée sous échographie et le positionnement distal du PICC au niveau de la veine cave supérieure contrôlé sous fluoroscopie sans injection de produit de contraste. Tous les PICCs ont pu être insérés avec succès au niveau de la veine basilique (153), de la veine brachiale (48) ou de la veine céphalique (16). La durée d’utilisation moyenne du PICC était de 16 jours (1 à 96 jours). Le taux de complications infectieuses était de 2,7 % (6/217). Douze cathéters (5,5 %) ont été retirés prématurément : 7 par retrait accidentel dû au patient et 5 pour thrombose veineuse périphérique. Aucune complication majeure n’a été notée Les PICCs représentent une alternative simple, sûre et efficace au placement de voies veineuses centrales conventionnelles. Contrairement à ces dernières, ils peuvent être gérés à domicile. Ce type de cathéter largement utilisé en Amérique du Nord devrait, dans les années futures, devenir une activité quotidienne non négligeable des centres de radiologie interventionnelle.

Diagnostic d’une masse tissulaire du rein : donner les principaux groupes anatomo-pathologiques et leur fréquence. Donner une approche diagnostique d’une masse tissulaire rénale en échographie, TDM et IRM. Préciser la stratégie pré-thérapeutique en imagerie en fonction du terrain et du type de lésion rénale.

Réaliser un Atlas de l’imagerie TDM des tumeurs et masses rénales de l’adulte. CD-Rom destiné aux radiologues en cours de formation mais aussi à ceux, plus confirmés, qui désirent approfondir leurs connaissances grâce à la description de l’ensemble des formes typiques, ou atypiques, des principales masses rénales ainsi que des tumeurs rares. A partir du recueil d’une collection de masses rénales explorées par URO TDM : Corrélation anatomo-pathologique (biopsies percutanées et étude des pièces opératoires) et le cas échéant avec d’autres techniques d’imagerie : échographie, IRM, Artériographie. L’analyse sémiologique de chaque tumeur et de ses différentes présentations TDM est accessible par deux types d’entrée : d’une part, description de l’ensemble des variétés anatomo-pathologiques : lésions kystiques et solides, bénignes et malignes, uniques et multiples. D’autre part, approche didactique et pratique : découverte d’une lésion rénale : orientation diagnostique et conduite à tenir en fonction de sa présentation échographique ou scanographique. Atlas de sémiologie TDM, à visée didactique, de la pathologie tumorale rénale. Corrélation radio-anatomo-pathologique (généralisation des biopsies). Approche pratique.

The diagnosis of arterio-ureteric fistula must be considered in the case of sudden onset of abundant or intermittent haematuria occurring in a particular context (history of aorto-iliac vascular surgery, prolonged ureteric stenting, ilio-pelvic radiotherapy). Emergency treatment must control bleeding. Endovascular stenting may be a useful technique, followed by reconstructive surgery with vascular bypass graft and treatment of the ureteric lesion.