INTRODUCTION:Bladder cancer are common, and their management and prognosis depend on the stage of tumor infiltration, particularly the involvement of the muscular layer. MRI appears to be an effective tool for assessing this infiltration, but its role remains to be determined. The aim of our study was to evaluate the concordance between the VIRADS score established on MRI and the histopathological examination of TURBT samples to access the staging T of bladder cancer. METHODS:We conducted an interim analysis on patients enrolled in the prospective, single-center IRMAA study (NCT05464576). All patients underwent bladder MRI prior to surgery. The VIRADS score on MRI was blindly compared to the histopathological results of TURBT samples for tumor staging T. We secondarily evaluated the concordance between the VIRADS score and the histopathological analysis of cystectomy as well as the efficacy of neoadjuvant chemotherapy. RESULTS:A total of 85 patients were included. 109 lesions were jointly identified on MRI and TURBT, of which 11 were discordant lesions. The concordance rate is 89.91% with a Cohen's Kappa coefficient of 0.74. Sensitivity is 100%, specificity is 87.4%, positive predictive value is 66.7% and negative predictive value is 100%. CONCLUSION:MRI is a promising tool for discrimination between NMIBC and MIBC. This interim analysis allowed us to identify discordant cases in order to refine future MRI interpretations for the final analysis of the IRMAA study. LEVEL OF EVIDENCE: 2:

PURPOSE:Pelvic congestion syndrome (PCS) is a major cause of chronic pelvic pain in women of reproductive age. It is often associated with pelvic venous insufficiency and venous dilatation of the ovarian and uterine veins, resulting in a variety of symptoms exacerbated by venous hypertension. Despite its prevalence, PCS lacks standardized diagnostic and management protocols, making effective treatment challenging. The purpose of this expert consensus statement was to summarize the opinions of French radiologists and gynecologists regarding the diagnosis, imaging, treatment, and management of PCS. MATERIALS AND METHODS:A working group of 14 expert radiologists and gynecologists from various French medical centers used a Delphi panel approach with several rounds of remote and face-to-face meetings to formulate and refine expert opinions based on the current literature and clinical expertise. These opinions were categorized according to diagnostic criteria, imaging techniques, therapeutic options, and follow-up protocols. RESULTS:The group formulated 72 initial opinions, and 65 were retained after rigorous evaluation for consensus. Key diagnostic tools include Doppler ultrasound for detection of venous reflux and magnetic resonance imaging for detailed assessment of venous anatomy. Endovascular embolization was highlighted as the primary treatment approach and recommended after thorough imaging evaluation. Noninvasive treatments and multidisciplinary care were also emphasized for comprehensive management. The expert opinion also included post-treatment follow-up to assess quality of life and symptom resolution. CONCLUSION:This structured consensus approach helped develop standardized expert opinions on management of, providing clear guidelines for diagnosis, treatment, and follow-up. These guidelines should improve clinical practice and patient care in the management of PCS.

Background: Nutcracker syndrome (NCS) is defined as left renal vein (LRV) compression by the superior mesenteric artery. NCS diagnosis is rendered complex by confounding symptoms. The study objective was to perform a prospective observational analysis of the diagnostic and therapeutic criteria of the patients with suspected NCS. When NCS diagnosis was confirmed, transposition of the LRV was carried out by mini-invasive robotic surgery (MIRS). Method: All patients addressed to the vascular surgery department for suspicion of NCS between January 2022 and June 2023 were included in the study. Patients were subsequently assessed by means of a computed tomography scan, dynamic duplex ultrasound and phlebography associated with an occlusion test of the left gonadic vein (LGV). Diagnostic criteria included aorto-mesenteric angle, LGV diameter and reflux, velocity ratios and diameters and the reno-caval gradient. Result: Thirty two patients aged 37 ± 14 years had suspicion of NCS. Twenty presented an aorto-mesenteric angle below 20°, twenty three had a LGV diameter greater than 5 mm and twenty two of the latter patients also had LGV reflux. A significant reno-caval gradient greater than 5 mmHg was found in ten cases, thereby consolidating NCS diagnosis. Overall, thirteen patients neither presented NCS or pelvic varicosities; eight had pelvic congestion syndrome without NCS and were successfully treated by embolization. Eleven patients with confirmed NCS underwent LRV transposition in the inferior vena cava (IVC). Eight of the latter patients received a complementary pelvic varicosity embolization 2 days later. Two months post-operation 100% of transposed LRV were permeable as assessed by duplex ultrasound controls and all of these patients reported an improvement of symptoms. Conclusion: An innovative multidisciplinary decisional algorithm establishes certitude in NCS diagnosis which can subsequently be treated radically by MIRS.

The cochlear implant is an implanted auditory prosthesis that can restore severe and profound hearing loss. About 20% of patients with congenital sensorineural hearing loss have a malformation of the inner ear. These abnormalities must be investigated before a cochlear implant because they can lead to intra and postoperative complications and/or anomalies. Most labyrinthine malformations are well known; some are less frequent and can be underdiagnosed at the preoperative computed tomography. This report presents the case of bilateral cochlear-facial dehiscence, bony dehiscence between the facial nerve labyrinthine segment, and cochlear basal turn. In our 56-year-old patient, this malformation was misdiagnosed before the cochlear implant and revealed afterward because of abnormal facial nerve stimulation during intraoperative electrophysiological checking.

Purpose Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. Materials and Methods Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. Results Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% ( n = 6) had grade 3 complications, and 5.4% ( n = 3) had CDC major complications. Conclusion This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. Level of Evidence 3 Retrospective cohort study. Graphic Abstract

Excellent outcomes of angioplasty/stenting for the post-thrombotic syndrome (PTS) have been reported, notably regarding objective criteria in the vast French SFICV cohort. Differences may exist between patient-reported and objective outcomes. We investigated this possibility by using validated scales because significative correlations are discordant in the literature between patency and patient-reported characteristics. Patient-reported outcomes seem to be a more consistent tool than radiologic patency for the diagnosis and follow-up of patients displaying PTS. We retrospectively reviewed the Villalta scale and 20-item ChronIc Venous dIsease quality-of-life Questionnaire (CIVIQ-20) scores recorded after endovascular stenting for PTS at 14 centres in France in 2009–2019. We also collected patency rates, pre-operative post-thrombotic lesion severity, and the extent of stenting. We performed multivariate analyses to identify factors independently associated with improvements in each of the two scores. The 539 patients, including 324 women and 235 men, had a mean age of 44.7 years. The mean Villalta scale improvement was 7.0 ± 4.7 (p < 0.0001) and correlated with the thrombosis sequelae grade and time from thrombosis to stenting. The CIVIQ-20 score was available for 298 patients; the mean improvement was 19.2 ± 14.8 (p < 0.0001) and correlated with bilateral stenting, single thrombosis recurrence, and single stented segment. The objective gains demonstrated in earlier work after stenting were accompanied by patient-reported improvements. The factors associated with these improvements differed between the Villalta scale and the CIVIQ-20 score. These results proved that clinical follow-up with validated scores is gainful in patients treated for PTS thanks to a mini-invasive procedure.

The complete change in our medico-surgical team redefined the management of deep venous disorders not previously undertaken in our tertiary center. The objective of this study was to conduct an observational retrospective analysis of the different diagnostic and therapeutic criteria of patients referred for suspected nutcracker syndrome (NCS). Transposition of the left renal vein (LRV) with minimally invasive robotic surgery (MIR) was performed when the diagnosis was confirmed.

It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021–October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.

No guidelines for the treatment of Kommerell diverticulum (KD) have been established. Endovascular treatment with arch vessel reconstruction of 4 patients with a right-sided aortic arch and aberrant left subclavian artery are presented herein. A 39-year-old woman and 47-year-old man experienced dyspnea and retrosternal pain. The first patient concomitantly underwent left subclavian transposition and thoracic endovascular aortic repair (TEVAR). The second patient underwent bilateral carotid-subclavian bypass grafting, followed by TEVAR and KD embolization. The 2 other patients were 72- and 75-year old men who presented with KD and type B dissection, in which these conditions were characterized by acute thoracic pain in the former patient and were noted on incidental body scan for prostatic adenocarcinoma in the latter. The third patient underwent carotid-subclavian bypass grafting, followed by TEVAR and subclavian plugs, and in the fourth patient, regular follow-up with antihypertensive therapy was scheduled. After a mean follow-up period of 12 months, all patients were alive.

To assess the results of endovascular treatment in a large population of patients suffering from post-thrombotic syndrome (PTS) due to iliocaval occlusive disease. In this retrospective multi-center study, 698 patients treated by stenting for PTS in 15 French centers were analyzed. Primary, primary assisted, and secondary patency rates were assessed, and clinical efficacy was evaluated using Villalta and Chronic Venous Insufficiency Questionnaire in 20 questions (CIVIQ-20) scores. Outcomes were compared against pre-operative CT-based severity of the post-thrombotic lesions in the thigh (4 grades). Technical success, defined as successful recanalization and stent deployment restoring rapid anterograde flow in the targeted vessel, was obtained in 668 (95.7%) patients with a complication rate of 3.9%. After a mean follow-up of 21.0 months, primary patency, primary assisted patency, and secondary patency were achieved in 537 (80.4%), 566 (84.7%), and 616 (92.2%) of the 668 patients, respectively. Venous patency was strongly correlated to the grade of post-thrombotic changes in the thigh, with secondary patency rates of 96.0%, 92.9%, 88.4%, and 78.9%, respectively, for grades 0 to 3 (p = .0008). The mean improvements of Villalta and CIVIQ-20 scores were 7.0 ± 4.7 points (p < .0001) and 19.1 ± 14.8 points (p < .0001), respectively. Endovascular stenting as a treatment option for PTS due to chronic iliocaval venous occlusion generates a high technical success, low morbidity, high midterm patency rate, and clinical improvement. Venous patency was strongly correlated to the severity of post-thrombotic lesions in the thigh.

Background. & mdash; In recent years, transcatheter aortic valve implantation (TAVI) without predilation (direct TAVI) has become the preferred method for implanting TAVI prostheses. Appropriate patient selection is important to avoid suboptimal outcomes and associated complications. Aim. & mdash; To evaluate whether aortic valve calcification measured with computed tomography predicts suboptimal results from direct TAVI with a self-expanding prosthesis.Methods. - Single-centre retrospective analysis of patients who received a CoreValveTM prosthesis (Medtronic, Minneapolis, MN, USA) in a direct TAVI procedure between January 2018 and March 2019. Aortic valve calcification assessment (aortic valve calcium score, calcium volume and calcium mass) was calculated from the computed tomography scan before TAVI. Procedural characteristics, need for postdilation and complications were analysed. Results. - Of 168 included patients, 18 were postdilated. Aortic valve calcium score (4259 vs. 2578; P < 0.001), calcium volume (1184 vs. 647 mm3; P < 0.001) and calcium mass (642 vs. 368 mg; P < 0.001) were higher in patients needing postdilation. Aortic valve calcium score (odds ratio 9.73; P = 0.004), calcium volume (odds ratio 8.48; P = 0.006) and calcium mass (odds ratio 6.21; P = 0.006) were independent predictors of suboptimal direct TAVI outcomes. Conclusion. - A high aortic valvular calcium score, assessed by computed tomography scan, is an independent predictor of suboptimal prosthesis implantation outcomes in direct TAVI. (c) 2022 Elsevier Masson SAS. All rights reserved.

La consultation de radiologie interventionnelle fait partie du parcours de soins du patient en radiologie interventionnelle. Sa conduite et son organisation obéissent à des recommandations présentées dans cet article et reprenant les points suivants : qui la réalise ; comment informe-t-on le patient ; comment doivent être organisés les locaux et la gestion documentaire ; comment le patient doit-il recevoir l’information ; quels doivent être les éléments du dossier de consultation du patient ; et quels documents doivent être générés et archivés dans le dossier patient informatisé de l’établissement (lettre de consultation, les documents d’information et consentement).

We report the case of a 14-year-old man who arrived at the emergency department affected by a high-flow priapism due to a traumatic left arterial-sinusoidal fistula. After clinical examination, a colour Doppler ultrasound of the penis was performed which showed a left arterial-sinusoidal fistula measuring 7×16×30mm, with high-speed and turbulent flow. The fistula was successfully treated by three highly selective endovascular embolizations and at the 20days follow-up, clinical examination resulted normal.

To highlight the advantages of real time fluoroscopy guided electrode-array (EA) insertion (FGI) during cochlear implants surgery. All surgical procedures were performed in a dedicated operating room equipped with a robotic C-arm cone beam device, allowing for intraoperative real time 2D FGI and postoperative 3D imaging. Only straight EAs were used. Patients were sorted out in three groups: ANAT, with anatomical concerns; HP, with residual hearing; NPR: patients with no particular reason for FGI. In all cases the angle of EA-insertion was measured. In the HP group pre and postoperative hearing were compared. The radiation delivered to the patient was recorded. Fifty-three cochlear implantation procedures were achieved under fluoroscopy in 50 patients from November 2015 to January 2020 (HP group: n = 10; ANAT group: n = 13; NPR group: n = 27). In the ANAT group, FGI proved to be helpful in 8 cases (61.5%), successfully guiding the surgeon during EA -insertion. On average, the angle of insertion was at 424° ± 55°. In the HP group, a controlled smooth EA-insertion was carried out in all cases but one. The targeted 360° angle of insertion was always reached. Hearing preservation was possible with an eventual average drop of 30 ± 1.5 dB. In the NPR group, FGI helped control the quality of insertion in all cases and appeared very informative in five (17.8%): one EA-misrouting, three stuck EAs, and one case with hidden electrodes out of the cochlea in revision surgery. Final 3D cone beam CT scan double-checked the EA position in all adults. The radiation dose was equivalent to a bit less than four digital subtract radiographs. The FGI is a very useful adjunct in cochlear implantation in all cases of expected surgical pitfalls, in patients with residual hearing, and even in case without preoperative particular reason, with low irradiation.

INTRODUCTION:The last decade has seen a steady increase worldwide in the prevalence of end-stage renal disease (ESRD). Hemodialysis is the major modality of renal replacement therapy (RRT) in 70% to 90% of patients, who require well-functioning vascular access for this procedure. The recommended access for hemodialysis is an arteriovenous fistula or a vascular graft. However, recourse to central venous catheters remains essential for patients whose chronic renal disease is diagnosed at the end stage or in whom an arteriovenous fistula cannot be created or maintained. Tunneled dialysis catheter (TDC) exposure can induce venous stenosis and occlusions and can result in superior vena cava syndrome and/or vascular access loss. Exhaustion of conventional vascular accesses is 1 of the greatest challenges that nephrologists and patients have to face. Several unconventional salvage-therapy routes for TDC placement in patients with exhausted upper body venous access have been reported in the literature.METHODS:We report 2 new cases of intra-atrial TDC placement for patients with exhausted vascular access and perform a meta-analysis of cases from the literature.RESULTS:A total of 51 patients were included. The TDC was inserted by a cardiovascular surgeon in all cases. At the end of follow-up, 75% patients were alive. The median survival time was 25 months. Survival time of hemodialysis patients with intra-atrial TDC was lower than that observed with conventional TDC.CONCLUSIONS:This unconventional technique is safe and functional for hemodialysis patients with exhausted venous access. Atrial vascular access for TDC placement is salvage therapy and is therefore potentially lifesaving.

CONTEXTE: Le présent document ainsi que les constats qu&#039;il énonce ont été rédigés en soutien aux travaux du ministère de la Santé et des Services sociaux (MSSS) et de l&#039;Institut national de santé publique du Québec (INSPQ) dans le contexte de l&#039;urgence sanitaire liée à la maladie à coronavirus (COVID-19) au Québec L&#039;objectif est de réaliser une recension sommaire des données publiées et de mobiliser les savoirs clés afin d&#039;informer les décideurs publics et les professionnels de la santé et des services sociaux Vu la nature rapide de cette réponse, les constats ou les positions qui en découlent ne reposent pas sur un repérage exhaustif des données publiées, une évaluation de la qualité méthodologique des études avec une méthode systématique ou sur un processus de consultation élaboré Dans les circonstances d&#039;une telle urgence de santé publique, l&#039;INESSS reste à l&#039;affût de toutes nouvelles données susceptibles de lui faire modifier cette réponse rapide CONSTATS DE L&#039;INESSS À CE JOUR: Considérant la situation actuelle de pandémie au Québec et ailleurs dans le monde, et à la lumière des informations présentées dans cet état des connaissances sur le diagnostic moléculaire de la COVID-19, l&#039;INESSS dégage les constats suivants: -La charge virale du SARS-CoV-2 évolue dans le temps en fonction du stade de la maladie et influence le résultat du test par RT-PCR Généralement, les faux négatifs sont attribuables à une charge virale trop faible au moment du prélèvement, surtout si celui-ci a été effectué au tout début ou à la toute fin de l&#039;infection virale -Un ou plusieurs résultats négatifs n&#039;excluent pas la possibilité d&#039;une infection par le SARS-CoV-2 -Plusieurs enquêtes épidémiologiques suggèrent que des individus auraient été infectés par des personnes pré-symptomatiques, mais aussi par des asymptomatiques -Des données fragmentaires issues de différentes sources comportant plusieurs limites rapportent que la proportion d&#039;individus asymptomatiques serait importante Les chiffres disponibles varient en fonction de l&#039;épidémiologie locale, de la population à l&#039;étude et des conditions et critères d&#039;accès au test -Bien que ne faisant pas consensus, le dépistage systématique de certains groupes de personnes, comme les travailleurs de la santé et les résidents de milieux de soins de longue durée, a été recommandé par quelques organisations et experts afin de contenir la propagation de la maladie et protéger les personnes vulnérables PRÉSENTATION DE LA DEMANDE: Dans le contexte actuel de pandémie de la COVID-19, des efforts massifs sont investis dans la détection de cette maladie Dans un premier temps, le présent document traite de la détection moléculaire du virus SARS-CoV-2 par technique d&#039;amplification des acides nucléiques (TAAN), et ce, en ce qui a trait aux situations cliniques à prioriser, aux performances diagnostiques attendues et aux éléments à considérer pour en assurer la fiabilité Ce document aborde également la situation des cas asymptomatiques, notamment, leur potentiel infectieux, leur proportion et leur contribution à la chaîne de transmission et à la pertinence de les détecter, s&#039;il y a lieu MÉTHODOLOGIE: 1) Quelles sont les positions et orientations d&#039;organisations savantes et d&#039;autorités de santé en matière de priorisation de l&#039;accès aux tests de détection du SARS-CoV-2? 2) Quelle est la performance de détection du SARS-CoV-2 par RT-PCR relativement au diagnostic de la COVID-19? a) Quels sont les proportions de résultats faussement négatifs? b) Quels sont les éléments susceptibles de nuire à la fiabilité des résultats du test par RT-PCR pour la détection du SARS-CoV-2? 3) Le dépistage systématique des asymptomatiques peut-il être pertinent et si oui, dans quelles situations? a) Quel est le potentiel infectieux des asymptomatiques (et pré-symptomatiques) et ceux pré entant des formes légères de la maladie? b) Quelles sont les proportions d&#039;asymptomatiques et de cas subcliniques dans la communauté? c) Dans quels milieux ou dans quelles situations serait-il bénéfique d&#039;effectuer le dépistage systématique de la COVID-19? SOMMAIRE DES RÉSULTATS: 1 Positions et orientations de sociétés savantes et d&#039;autorités de santé concernant l&#039;utilisation du test moléculaire pour la détection du SARS-CoV-2 En date du 22 avril, vingt-et-un (21) documents en lien avec la pertinence et les critères de détection moléculaire de la COVID-19 adoptés par les autorités de santé d&#039;autres juridictions ont été recensés Les principaux renseignements extraits de ces documents sont les suivants: -Personnes devant systématiquement être testées ou testées en priorité;-Particularités pour les travailleurs de la santé;-Limites du test à considérer Ces éléments sont résumés dans les paragraphes suivants 2 Fiabilité des tests moléculaires pour la détection du SARS-CoV-2 et le diagnostic de la COVID-19 Onze (11) publications traitant de la fiabilité de la détection moléculaire du SARS-CoV-2 ont été retenues, dont : -cinq (5) présentant des proportions de faux négatifs dans le temps [Li Y ;Li D ;Long;Xie;Ai, 2020] et;-six (6) abordant certains éléments susceptibles de nuire à la qualité des résultats de la RT-PCR [Pan;Loeffelholz &amp;Tang;Lippi;Wölfel;Lo;Wikramaratna, 2020] 3 Potentiel infectieux des individus asymptomatiques et pré-symptomatiques Quinze (15) publications traitant du potentiel infectieux des asymptomatiques, pré-symptomatiques et de formes légères de la maladie ont été retenues