Several mechanisms predispose to bleeding in neoplastic disease. This is all the more serious as it often occurs on a background of medically vulnerable patients and the magnitude of the bleed may lead to hemorrhagic shock or acute respiratory distress as a result of hemoptysis. It often carries a poor prognosis, even if the acute episode has been controlled, as bleeding due to rupture of a tumor often indicates an advanced stage of the disease, and also because tumor rupture carries a risk of metastatic spread including peritoneal carcinomatosis. The risk of recurrent bleeding is also not insignificant. In most cases, endovascular hemostatic embolization is the first line palliative treatment.

Au cours des pathologies néoplasiques, plusieurs mécanismes favorisent la survenue d’une hémorragie. Elles sont d’autant plus graves qu’elles surviennent sur un terrain souvent fragilisé et leur abondance peut entraîner la survenue d’un choc hémorragique ou d’une détresse respiratoire aiguë en cas d’hémoptysie. Le pronostic reste souvent sombre, même lorsque l’épisode aigu a été contrôlé, parce que la survenue d’une hémorragie par rupture tumorale témoigne souvent d’un stade avancé de la maladie et aussi parce qu’une rupture tumorale entraîne un risque de dissémination métastatique, par exemple de carcinose péritonéale. Enfin, le risque de récidive hémorragique n’est pas négligeable. Dans la majorité des cas, l’embolisation d’hémostase par voie endovasculaire représente la technique palliative de première intention.

Les hypertensions artérielles pulmonaires (HTAP) sont classées selon la nouvelle classification de Dana Point 2008 en cinq groupes. Le diagnostic positif d’HTAP repose sur le cathétérisme cardiaque droit qui permet d’affirmer le diagnostic, de définir le niveau de sévérité de l’hypertension pulmonaire, d’orienter l’étiologie avec notamment l’élimination des cardiopathies gauches, et de réaliser un test thérapeutique en fin d’intervention. L’échocardiographie est utilisée en dépistage et pour la surveillance.

WedescribetworarecardiacfindingsonbaselineFDGPETin histologically proven aggressive large B-cell non-Hodgkin’s lymphoma (NHL). The first case is a 21-year-old woman with stage IV NHL with a superior mediastinal mass and two lung nodules on contrast-enhanced CT images. FDG PET/CT showed intense uptake in these lesions and, without contiguity, a round pathological cardiac uptake in the apical septum and the right ventricle (a, b FDG PET images; c, d fusion FDG PET/CT images; transverse and sagittal, respectively). The electrocardiogram showed negative T-waves in the septal location with left chest pain and dyspnoea. Transthoracic echocardiography confirmed the presence of a 3-cm mass near the apex with development towards the right and left ventricles, without thrombus or pericardial effusion. Cardiac MR imaging revealed a hyperintense aspect on T2-weighted sequences, isointense on T1 sequences (e cine sequence T2-/T1-weighted image; f short-axis T2-weigted black blood SPIR image). This mass had disappeared on FDG PET/CT and echocardiography performed after two and four cycles of chemotherapy. The second case is a 51-year-old man with stage III NHL on CT imaging who underwent FDG PET/CT revealing posterior parietal right auricular involvement (g transverse FDG PET image; h fusion FDG PET/CT image), confirmed on MR

PURPOSE:Radiofrequency thermal ablation (TA) of lung tumors currently is considered an alternative to surgical management for early primary lung cancers and non-surgical lung metastases. The purpose of this study was to determine the tolerability and efficacy of this treatment in 29 consecutive patients, most of which with primary lung cancers, managed in our center.MATERIALS AND METHODS:Twenty-nine patients with 32 lung tumors less than 35 mm in diameter underwent radiofrequency thermal ablation between May 2004 and July 2008. The CT examinations performed during and after the ablation were reviewed to determine lesion characteristics, complications, treatment, local recurrence rate and survival rate.RESULTS:Sixty-nine percent of our population consisted of primary lung cancer. The incidence of pneumothorax was 72% with 10% requiring drainage. The rate of complete response was 81%. The survival rate at 1 year was 79%.CONCLUSION:Radiofrequency thermal ablation of lung tumors is a minimally invasive technique with high rate of complete response. It can be considered in non-surgical patients with primary or metastatic lung tumors less than 35 mm in diameter.

The CT and MR imaging features of the main cardiac tumors will be reviewed. Cross-sectional imaging features may help differentiate between cardiac tumors and pseudotumoral lesions and identify malignant features. Based on clinical features, imaging findings are helpful to further characterize the nature of the lesion. CT and MR imaging can demonstrate the relationship of the tumor with adjacent anatomical structures and are invaluable in the presurgical work-up and postsurgical follow-up.

We read with great interest the commentary by RE Clough, T Schaeffter and PR Taylor about the importance of MRA in aortic dissections. Nevertheless, controversy concerning the superiority of multidetector computed tomography (MD-CT) versus MRI still exists. MRI allows swift 3 D high-resolution imaging, nevertheless, because of the closed bore design of the magnet and the need for patient monitoring devices MRI maybe less adapted than CT for unstable patients. On the other hand, despite ionizing radiation hazards and nephrotoxicity of contrast agents, MD-CT optimized the balance between spatial and temporal resolution and invasiveness, hence propelling MD-CT to become the most widely used modality in current practice, thanks to its wide availability, speed, cost-effectiveness and efficiency. Imaging of all phases of contrast enhancement has also become possible using a single bolus of contrast agent, with delayed scans to visualize the parenchyma and the late opacification of false lumen. One significant drawback of MD-CT is a radiation dose, nevertheless, it is possible to reduce the radiation rate to a minimum by adequate parameter optimization. As said by RE Clough, PR Taylor, it is true that movements of the dissected aortic intimal flap through the cardiac cycle are not clearly visualized without ECG-gating. On the other hand, CT without ECG-Gating is actually sufficient for the arch and the descending aorta, allowing a complete analysis of the thoracic and abdominal aorta in one single step. Moreover, ECG-gated CTA can accurately determine aortic distensibility. In dissection, the selection of the “correct” Stent-graft dimensions is crucial. In acute dissections, the diameter of the non-dissected aortic segment immediately proximal to the entry tear is considered the reference. Inversely, for chronic dissection (>6 months) the intima becomes fibrotic and thus cannot expand. In such cases, a tapered stent-graft may be preferable and the distal diameter is easily measured, without major aortic variation during the cardiac phase. RE Clough, PR Taylor said that “MRI generated data will allow the use of shorter endoluminal devices in patients requiring intervention”. We don't believe that short stent-graft should be used anymore for dissections in the future. It is well known that false-lumen thrombosis distal to the stent-graft, particularly in the distal descending aorta, is uncommon, longer stent-grafts than what is needed to simply cover the primary tear is the trend. As a whole, considering the excellent accuracy of the two modalities, the imaging protocols for aortic diseases should be tailored to answer specific questions, taking into consideration the accessibility and the local expertise. Magnetic Resonance Imaging for Aortic DissectionEuropean Journal of Vascular and Endovascular SurgeryVol. 39Issue 4PreviewWe would like to congratulate the authors on their review of imaging for thoracic aortic disease.1 However, we would like to comment on the section regarding dissection. Multidetector contrast-enhanced computed tomography (CT) remains the most widely available modality for imaging patients with this disease, but has some limitations which may be misleading. The images acquired are a representation of one moment in the cardiac cycle and these static images may not illustrate the complex anatomical and functional changes occurring in aortic dissection. Full-Text PDF Open Archive

Purpose. Radiofrequency thermal ablation (TA) of lung tumors currently is considered an alternative to surgical management for early primary lung cancers (1) and non-surgical lung metastases. The purpose of this study was to determine the tolerability and efficacy of this treatment in 29 consecutive patients, most of which with primary lung cancers, managed in our center.Materials and methods. Twenty-nine patients with 32 lung tumors less than 35 mm in diameter underwent radiofrequency thermal ablation between May 2004 and July 2008. The CT examinations performed during and after the ablation were reviewed to determine lesion characteristics, complications, treatment, local recurrence rate and survival rate.Results. Sixty-nine percent of our population consisted of primary lung cancer. The incidence of pneumothorax was 72% with 10% requiring drainage. The rate of complete response was 81%. The survival rate at 1 year was 79%.Conclusion. Radiofrequency thermal ablation of lung tumors is a minimally invasive technique with high rate of complete response. It can be considered in non-surgical patients with primary or metastatic lung tumors less than 35 mm in diameter.

Confirmer la faisabilité du scanner 16 détecteurs à permettre une description anatomique des veines tributaires du sinus coronaire. Evaluer son utilité pour l'intervention de resynchronisation cardiaque (atrio-biventriculaire ou triple ventriculaire). Vingt neuf patients, en insuffisance cardiaque réfractaire d'origine ischémique ou non, ont bénéficié d'un repérage des veines coronaires par coroscanner à l'aide d'un protocole orienté vers l'analyse des veines coronaires avant la mise en place des sondes de stimulation par voie endoveineuse exclusive. Le sinus coronaire et ses principales branches afférentes, leurs caractéristiques et variantes anatomiques ont été visualisés chez quasiment tous les malades. Le myocarde était analysable dans tous les cas. Vingt six patients ont été resynchronisés dont 22 avec succès : dans 97% des cas, les veines cibles avaient été décrites en coroscanner. Notre étude confirme qu'il est possible en scanner 16 détecteurs et à l'aide d'un protocole à visée veineuse coronaire, d'obtenir une cartographie précise des veines tributaires du sinus coronaire, chez des insuffisants cardiaques sévères et malgré la présence préalable de sondes chez certains d'entre eux. Le coroscanner peut faciliter l'intervention de resynchronisation : pré-sélection des veines cibles, appréciation de la viabilité myocardique sous-jacente et estimation des difficultés techniques.

Indications for and experience with placement of endovascular stent grafts in the thoracic aorta are still evolving. Recent advances in imaging technologies have drastically boosted the role of pre-procedural imaging. The accepted diagnostic gold standard, digital subtraction angiography, is now being challenged by the state-of-the-art computed tomography angiography (CTA), magnetic resonance angiography (MRA) and trans-oesophageal echocardiography (TEE). Among these, technological advancements of multidetector computed tomography (MDCT) have propelled it to being the default modality used, optimising the balance between spatial and temporal resolutions and invasiveness. MDCT angiography allows the comprehensive evaluation of thoracic lesions in terms of morphological features and extent, presence of thrombus, relationship with adjacent structures and branches as well as signs of impending or acute rupture, and is routinely used in these settings. In this article, we review the current state-of-the-art radiological imaging for thoracic endovascular aneurysm repair (TEVAR), especially focusing on the role of MDCT angiography. After analysing the technical aspects for optimised imaging protocols for thoracic aortic diseases, we discuss pre-procedural determinants of candidacy, and how to formulate interventional plans based on cross-sectional imaging.

There is a need to define the current indications for coronary CT angiography ( CCTA) even as technology continuously evolves. CCTA using 64 MDCT units has shown to be highly accurate for diagnosis of stenoses 50 % on selected populations. It is currently used for its negative predictive value ( 96- 98%). Stenosis quantification remains inferior to conventional coronary angiography with tendency to overestimate stenoses < 70%. For diagnosis of coronary artery disease, CCTA is considered based on clinical findings ( pre- test probability of coronary artery disease) and presence of myocardial ischemia on other functional studies. The main appropriate indications include: artery disease with excellent NPV and good negative likelihood ratio ( 0.05) when ECG is non- contributory, 2 consecutive troponin levels at 6 hours are negative in a patient with low risk of coronary artery disease. CCTA is indicated in patients with low to moderate risk when functional tests are non- contributory or unavailable, or ECG is noninterpretable. evaluation of some lesions prior to angioplasty and stent placement ( long segment occlusion, proximal lesions involving LAD and circumflex arteries). In selected patients, CCTA may replace coronary angiography prior to valvular surgery.