Mardi 3 octobre 2 03 /10 /Oct 20:16

 

 

 

Keywords:

 NMR spectroscopy, Fat, Lipid, Body

SRM, Spectroscopie par Résonance magnétique , Suppression de graisse .

 

http://www.clinicalimaging.org/article/PIIS0899707102004916/abstract


a Department of Radiology, Wake Forest University, Bowman-Gray Medical Center, Winston-Salem, NC 27157, USA
 * Tel.: +1-336-716-6255; fax: +1-336-716-2029 

doi: 10.1016/S0899-7071(02)00491-6

© 2003 Elsevier Science Inc. All rights reserved.

Abstract
The presence or absence of fat in lesions can have important diagnostic implications.

Current MR techniques for the evaluation of fat within lesions in the body rely on indirect imaging methods.

The goal of this study was to develop a rapid clinically practical proton spectroscopy procedure for the direct observation of a localized fat–water signal within the body.

The technique developed reliably determined fat–water ratios in phantoms and from lesions in vivo in 6 s with single voxel sizes as small as 0.125 cc.

 

Keywords: NMR spectroscopy, Fat, Lipid, Body


a Department of Radiology, Wake Forest University, Bowman-Gray Medical Center, Winston-Salem, NC 27157, USA
 * Tel.: +1-336-716-6255; fax: +1-336-716-2029 

doi: 10.1016/S0899-7071(02)00491-6

© 2003 Elsevier Science Inc. All rights reserved.

 

 

 http://irmresonance.over-blog.com/

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Mardi 3 octobre 2 03 /10 /Oct 20:01

In-phase/Out-of-phase MRI, IP/OP Sequences .

DIXON Method,

Fat-Water separation .


 

 

 

LIVER

 

ADRENAL

 1  : http://www.annals.org/cgi/content/full/130/9/759

Imaging Procedures Adrenocortical
space


Diagnosis of adrenal neoplasms depends on the identification of an adrenal mass on computed tomography (CT) or magnetic resonance imaging (MRI). Both normal and abnormal adrenal glands are readily visible on CT because of the surrounding adipose tissue in the retroperitoneum (125).

Computed tomography provides information about size, homogeneity, presence of calcifications, areas of necrosis, and extent of local invasion, making it helpful in decisions about the potential malignancy and resectability of the neoplasm.

Adrenal masses as small as 10 mm can be reliably detected by CT (126, 127), although the relative lack of retroperitoneal fat in children might decrease the sensitivity of the test in this population (128).

Adrenal CT is 70% to 80% sensitive in detecting aldosterone-producing adenomas. In one large series (111), mean tumor size was 1.8 cm, but 20% of these tumors were smaller than 1 cm. Adrenal incidentalomas are also common in older adults; thus, adrenal CT is considered adjunctive and is usually not used to direct adrenalectomy without other confirmatory data.

Whether MRI will prove superior to CT in diagnosing and differentiating among adrenal masses remains to be seen. Magnetic resonance imaging can show the invasion of an adrenocortical carcinoma into blood vessels, particularly the inferior vena cava and the adrenal and renal veins, in which tumor thrombi may occasionally be identified (125). It can also distinguish fairly accurately among primary malignant adrenocortical tumors, nonfunctioning adenomas, and pheochromocytomas by comparing the ratio of the signal intensity of each type of adrenal mass to that of the liver (128). Primary malignant adrenocortical lesions have intermediate-to-high signal intensity on T2-weighted images, nonfunctional adenomas have low signal intensity, and pheochromocytomas have extremely high signal intensity. In-phase out-of-phase MRI is emerging as a reliable method for distinguishing between adrenal incidentalomas and metastases (68, 129, 130) and proved useful in identifying an aldosterone-producing adenoma in a patient with hyperaldosteronism and bilateral nodules (125) (Figure 5).

Other imaging methods, such as iodocholesterol scanning, venography, and arteriography, are rarely indicated (115, 128, 131), but recent data show that selenocholesterol scanning may prove useful in assessing malignancy (95).



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Figure 5. Computed tomography (CT) and magnetic resonance imaging (MRI)

of aldosterone-secreting adenomas. Top.

Adrenal CT of a 61-year-old woman with primary hyperaldosteronism and bilateral adrenal nodules (arrows) did not identify an increased lipid content in either adenoma.

Middle.

 In-phase MRI also failed to differentiate between the two sides.

Bottom. A loss of signal content of the functional aldosteronoma was shown by out-of-phase MRI.

Venous sampling and surgery confirmed a right aldosteronoma. (Courtesy of J.L. Doppman).

 

 

 

 

 

 

 

 

 

 

Adrenal venous sampling remains the gold standard for the differential diagnosis of primary aldosteronism, especially because it has recently become clear that many tests used in the subtype evaluation of this condition provide variable and often inconclusive results (132). Comparison of aldosterone-to-cortisol ratios in the adrenal veins and the inferior vena cava allows detection of unilateral or bilateral sources of aldosterone hypersecretion. Although the cut-off for lateralization is controversial, ratios of 5:1 and 10:1 have been advocated (132, 133).



Rapid proton fat–water spectroscopy for the characterization of non-CNS lesions in vivo

 
            http://www.clinicalimaging.org/article/PIIS0899707102004916/abstract
           

 

Gerard Riedy  Corresponding Author Information Send E-mail to Author*
Received 5 April 2002; accepted 10 May 2002.

 

            Abstract
The presence or absence of fat in lesions can have important diagnostic implications.

Current MR techniques for the evaluation of fat within lesions in the body rely on indirect imaging methods.

The goal of this study was to develop a rapid clinically practical proton spectroscopy procedure for the direct observation of a localized fat–water signal within the body.

 The technique developed reliably determined fat–water ratios in phantoms and from lesions in vivo in 6 s with single voxel sizes as small as 0.125 cc.                          

Keywords: NMR spectroscopy, Fat, Lipid, Body, SRM


a Department of Radiology, Wake Forest University, Bowman-Gray Medical Center, Winston-Salem, NC 27157, USA
 

  Communication

Fat and water separation

 in balanced steady-state free precession

using the

Dixon method

Teng-Yi Huang 1 2, Hsiao-Wen Chung 1 2 *, Fu-Nien Wang 1, Cheng-Wen Ko 1 3, Cheng-Yu Chen 2
1Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
2Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, R.O.C
3Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
email: Hsiao-Wen Chung (chung@cc.ee.ntu.edu.tw)

*Correspondence to Hsiao-Wen Chung, Department of Electrical Engineering, National Taiwan University, Rm. 238, No. 1, Sec. 4, Roosevelt Road, Taipei, Taiwan 10764, R.O.C

Funded by:
 National Science Council; Grant Number: NSC-91-2213-E-002-078
 National Center for Research Resource; Grant Number: P41RR14075
 Mental Illness and Neuroscience Discovery (MIND) Institute
 Ministry of Education
 National Science Council

Keywords
fat-water separation • Dixon method • in-phase and out-of-phase images • steady-state free precession • frequency offset

Abstract

In this work the feasibility of separating fat and water signals using the balanced steady-state free precession (SSFP) technique is demonstrated.

 The technique is based on the observation (Scheffler and Hennig, Magnetic Resonance in Medicine 2003;49:395-397)

that at the nominal values of

TE = TR/2 in SSFP imaging,

phase coherence can be achieved at essentially only two orientations (0° and 180°)

relative to the RF pulses in the rotating frame,

under the assumption of TR << T2, and independently of the SSFP angle.

 

This property allows

in-phase and

 out-of-phase SSFP images

 to be obtained by proper choices of the center frequency offset,

 and thus allows the Dixon subtraction method

 to be utilized for effective fat-water separation.

 The TR and frequency offset for optimal fat-water separation are derived from theories.

 Experimental results from healthy subjects, using a 3.0 Tesla system, show that nearly complete fat suppression can be accomplished. Magn Reson Med 51:243-247, 2004. © 2004 Wiley-Liss, Inc.


Received: 28 April 2003; Revised: 26 June 2003; Accepted: 26 September 2003

Digital Object Identifier (DOI)

10.1002/mrm.10686  About DOI

     

 

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Mardi 3 octobre 2 03 /10 /Oct 09:21

 

 

.

5e Congrès Société française de médecine vasculaire (SFMV)

 

21-23 septembre 2006, Versailles

Accident ischémique transitoire

5 % de récidive dans les 48 heures

Déficit neurologique aigu d'origine vasculaire avec imagerie normale, l'accident ischémique transitoire est une véritable urgence médicale, du fait du risque élevé de récidive : 5 % se produisent dans les 48 heures, 10 % dans le mois et 25 % dans les 3 mois qui suivent.

Cliquez pour voir l'image dans sa taille originale
L'idéal est d'adresser le patient dans une unité spécialisée(Photo S Toubon/"le Quotidien")

L'ACCIDENT ischémique transitoire (AIT) se manifeste par l'apparition brutale de troubles neurologiques comme des difficultés à bouger un bras, une jambe ou tout un côté du corps, la perte de la vue d'un œil, l'impossibilité à parler ou de trouver ses mots. Il multiplie par 50 le risque d'accident vasculaire cérébral (AVC). « Le risque d'infarctus cérébral est encore plus important pour les AIT se répétant et dont la durée s'allonge » insiste le Dr Woimant. Sachant que les AVC sont plus fréquents (130 000/an en France) que les infarctus du myocarde (120 000), qu'ils sont la première cause de handicap acquis chez l'adulte, la seconde cause de démence après la maladie d'Alzheimer et la troisième cause de décès, on comprend tout l'intérêt de prendre en charge une personne victime d'AIT avant la survenue d'un AVC.


Avis neurologique le jour même
Les experts sollicités par la Haute Autorité de Santé recommandent de considérer l'AIT comme une véritable urgence diagnostique et thérapeutique. C'est pourquoi, devant toute suspicion d'AIT, un avis neurologique s'impose le jour même. Lorsque c'est possible, l'idéal est d'envoyer son patient dans une unité spécialisée. « C'est même indispensable en cas d'AIT récidivants et récents ou d'AIT survenant sous traitement », poursuit le Dr Woimant. Ces unités sont au nombre de quarante en France : il en faudrait au moins 150 pour répondre aux besoins actuels, et le ministère travaille actuellement sur la création de nouvelles unités.
« Pour éliminer une hémorragie cérébrale - une contre-indication au traitement antithrombotique - et d'autres diagnostics, une IRM (ou, à défaut, un scanner) s'impose en urgence. Pour trouver la cause de l'AIT (artérielle, cardiaque ou hématologique), le bilan comprend, en outre, un Doppler des artères cervicales et transcrâniennes, un ECG, si besoin complété d'une échographie cardiaque, et un bilan hématologique : hémogramme, VS, CRP, ionogramme sanguin, glycémie, créatininémie, TP et TCA. Selon les résultats du bilan, une intervention chirurgicale peut être programmée en urgence en cas de sténose d'une carotide. Un traitement anti-arythmique est prescrit en cas d'arythmie par fibrillation auriculaire. Et lorsque le bilan ne retrouve rien de particulier, on donne de l'aspirine à petite dose (75 à 150 mg), sans oublier, bien sûr, la prise en charge des facteurs de risque artériels : diabète, hypercholestérolémie, hypertension artérielle, sédentarité, obésité, tabagisme, etc.


Trop d'AIT passés inaperçus
En France, l'âge moyen de survenue de l'AVC est de 73 ans, mais un quart d'entre eux touche des moins de 65 ans. Parmi les survivants, deux tiers vont garder des séquelles physiques ou cognitives entravant leur autonomie dans 40 % des cas. Or, lorsqu'on interroge des patients hospitalisés pour un accident vasculaire constitué, jusqu'à 30 % relatent un épisode faisant penser à un AIT dans les jours ou les semaines qui ont précédé. Si ce signal avait été reconnu à temps, l'AVC aurait peut-être pu être évité : c'est pourquoi la Société française neuro-vasculaire (1) a déjà envoyé plus de 70 000 affiches et brochures d'informations à l'attention des généralistes, afin qu'ils sensibilisent leurs patients au problème. « Par ailleurs, après un accident constitué, le fait d'avoir été pris en charge en urgence dans une unité neuro-vasculaire réduit de 30 % les risques de dépendance et de mortalité, avec un bénéfice qui perdure 10 ans » , insiste le Dr Woimant.

>Dr NATHALIE SZAPIRO

D'après un entretien avec le Dr France Woimant, hôpital Lariboisière de Paris et présidente de la Société française neuro-vasculaire.
(1) Pour plus d'informations : www.sfnv-France.com

L’IRM, un examen clé

Autrefois défini par des symptômes durant moins de 24 heures, l’AIT repose aujourd’hui sur des critères d’imagerie. «On le définit comme un épisode bref de dysfonction neurologique due à une ischémie focale cérébrale ou rétinienne, dont les symptômes cliniques durent typiquement moins d’une heure, sans preuve d’infarctus aigu», explique le Dr Woimant. Pour vérifier l’absence d’infarctus justement et ainsi faire la différence avec un AVC, l’IRM avec séquence de diffusion est l’examen recommandé en première intention. Si elle n’est pas réalisable, un scanner cérébral sans injection de produit de contraste est alors préconisé.

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Par SPINNEUR - Publié dans : CNS/SNC/BRAIN/CERVEAU.
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Lundi 2 octobre 1 02 /10 /Oct 22:05

 

AUNTMINNIE

.


  Ependymome du foramen de Luschka .

CLICK TO ENLARGE CLICK TO ENLARGE CLICK TO ENLARGE

Findings:  A mass appears to be compressing and shifting the pons and fourth ventricle to the left and also pushing the cerebellum posteriorly.

Therefore this most likely is in the right cerebellopontine angle.

The mass is fairly well circumscribed with mild heterogenous contrast enhancement.


Differential Diagnosis:  The differential diagnosis includes both tumors in the cerebellopontine angle (CPA) and posterior fossa tumors in children because the exact location of the tumor is difficult to definitively determine,

The differential diagnosis includes both tumors in the cerebellopontine angle (CPA) and posterior fossa tumors in children because the exact location of the tumor is difficult to definitively determine,

but is most likely in the CPA. 

 Considerations would include:

  • Ependymoma:  Originating from a rest of ependymal cells located in the foramen of Luschka. (The actual diagnosis in this case)
  • Medulloblastoma: Usually more midline and stronger enhancement than this tumor.
  • Brainstem Glioma: Originates in brainstem and this tumor is more in the CPA.
  • Juvenile Pilocystic Astrocytoma: Usually more cystic and in cerebellar hemisphere
  • Meningioma: Has stronger enhancement than this tumor and rarely seen in children
  • Acoustic Schwannoma: Usually involves the internal auditory canal and this tumor does not.
  • Epidermoid Cyst: Usually has no enhancement and this mass does.
Diagnosis:  Ependymoma

 

Ependymomas are glial tumors that arise from ependymal cells within the CNS. The World Health Organization (WHO) classification for these tumors includes 4 divisions: (1) ependymoma (with cellular, papillary, and clear cell variants), (2) anaplastic ependymoma, (3) myxopapillary ependymoma, and (4) subependymoma. Intracranial ependymomas usually arise from the roof of the fourth ventricle in children. While spinal ependymomas usually present in adults as intramedullary masses arising from the central canal or exophytic masses at the conus and cauda equina.

Intracranial ependymomas represent 6-9% of primary CNS neoplasms and generally present in young children with a mean age of 4 years. These tumors account for 30% of primary CNS neoplasms in children younger than 3 years. Spinal ependymomas are more rare than intracranial types. Most are of the myxopapillary type related to the conus or filum terminale and present in patients aged 20-40 years. Intramedullary ependymomas have been associated with neurofibromatosis type 1. Currently, the 5-year survival rate for patients with intracranial ependymomas is approximately 50%.

The clinical history associated with ependymomas varies depending upon the age of the patient and the location of the lesion. For children with masses in the fourth ventricle, a history of progressive lethargy and headache may be elicited. Supratentorial ependymomas may be associated with increased intracranial pressure manifested as headache, nausea, vomiting, and cognitive impairment.

Ependymomas have some characteristic features on CT scan and MRI that help narrow the differential diagnosis.

  • Intracranial ependymoma:
  • Intracranial ependymomas are typically isodense on unenhanced CT scans with minimal to moderate enhancement upon contrast administration. Calcification can be noted on unenhanced CT scans in approximately one half of cases. Cyst formation is common in these tumors. Foraminal spread can be observed in posterior fossa lesions through the foramina of Luschka and Magendie and thus can present as a tumor in the cerebellopontine angle. On pre-contrast and post-contrast MRI, tumors often appear heterogeneous secondary to necrosis, hemorrhage, and calcification. Variable signal intensity is noted on T1- and T2-weighted images.
  •  
  • Spinal ependymoma:
  • In general, most intramedullary tumors are isointense or slightly hypointense to the surrounding spinal cord on T1-weighted images. Often, only subtle spinal cord enlargement is evident. T2-weighted images are more sensitive because most tumors are hyperintense to the spinal cord on these pulse sequences. Nearly all intramedullary neoplasms enhance on T1-weighted contrast examinations. Ependymomas usually demonstrate uniform contrast enhancement and are located symmetrically within the spinal cord. Polar cysts are identified in the majority of cases, particularly in the setting of cervical or cervicothoracic tumors. Heterogeneous enhancement from intratumoral cysts or necrosis also can be observed.

Medical management of patients with ependymomas includes adjuvant therapy (ie, conventional radiation therapy, radiosurgery, chemotherapy), steroids for treatment of peritumoral edema, and anticonvulsants in patients with supratentorial ependymoma. The extent of tumor resection is the most important prognostic factor associated with long-term survival for patients with nonmalignant forms of ependymoma, regardless of location. Children with posterior fossa lesions usually undergo surgery via a midline suboccipital approach.

References:

  1. Applegate GL, Marymont MH: Intracranial ependymomas: a review. Cancer Invest 1998; 16(8):

 

 

 

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Lundi 2 octobre 1 02 /10 /Oct 21:18

 

 

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Par SPINNEUR - Publié dans : irm resonance magnétique
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Lundi 2 octobre 1 02 /10 /Oct 21:11

 

Diagnostic Imaging Online
septembre 15, 2006

Dismissed U.K. whistleblower fires back

The bitter feud between a trauma radiologist and senior management at a top London teaching hospital shows no signs of easing.

Dr. Otto Chan was fired from his job as a consultant radiologist at Barts and the London NHS Trust in June. Chan claims he was dismissed because he threatened to go public with allegations that the hospital was not reading all x-rays. The hospital said he was fired for gross misconduct. An appeal is pending.

The trouble started in 2002, according to Chan. One day he noticed that boxes of unread x-ray films that had accumulated over two years and had been strewn in the hospital corridors were missing. Each packet contained from one to eight images. He later found the boxes hidden in a locked room in anticipation of a government inspection.

"None of the CT scans, angiograms, or x-rays was read for two years," Chan said.

He reported the incident to the hospital, which then asked him to oversee the problem. He agreed to read all the films, which took him seven months at a cost of about $18,000, he said. By 2004, a second backlog of another 15,000 packets of film had accumulated. This time, the hospital refused his request to report all the films.

"These patients had fractures and cancers. Many patients had operations canceled because the hospital couldn't find the results of their x-rays," he said.

Chan threatened to go public with the problem. But shortly thereafter, in January 2005, the hospital suspended the radiologist on charges that included racism, bullying, and harassment. Chan said he was targeted because he was a whistleblower.

He challenged the suspension, and the hospital appointed an internal investigation. In April 2006, after 15 months of review and at a cost of nearly $3 million, the panel found no truth to any of the charges, Chan said.

"The panel said I was deficient with managers. Well, you can imagine that I was fiercely deficient with managers. When they tried to tell me not to report films, I told them where to go," he said.

Two months later Chan was fired.

Although the panel's findings are confidential, Chan said it had recommended reinstating him. In a written statement released by the hospital, however, medical director Dr. Charles Gutteridge said the panel concluded that there were grounds for dismissal.

"The decision to dismiss him was only taken after a 19-month investigation, which included a formal hearing by an independent panel comprising a senior barrister, a representative from the doctor's medical royal college, and an independent member," said Gutteridge's statement.

Because the investigation is continuing, the hospital would not grant requests to speak with several individuals, including a radiologist who Chan said was responsible for hiding the films, a human resources official who Chan said fabricated the charges against him, hospital CEO Paul White, and Gutteridge.

In an e-mail, Ray Dunne, senior press officer for the hospital, disputed British press accounts of the saga. He wrote that Chan was dismissed because of his behavior toward clinical colleagues and it had nothing to do with any concerns he may have had about x-rays.

Dunne also wrote that the x-rays didn't go unchecked, that clinicians had examined and acted on the x-rays but that the radiologist shortage caused delays in obtaining formal radiology reports. It's a well-known problem across all U.K. hospitals, he noted.

Dunne did not dispute the general outline of events given by Chan or the figures that Chan provided.

In his statement, Gutteridge said that the reporting delays affected only low-risk x-rays -- films previously examined and acted upon by clinicians, including radiologists, but awaiting formal reports.

"We reviewed our procedures in 2004 and found that in some cases formal reports were not needed. We have since revised our reporting practices and increased the number of staff available to report on x-rays. All relevant x-rays are now reported on within appropriate timeframes," he said.

In a July 10 article, the Daily Mirror reported that at least 375 nurses, 152 doctors, and 35 other clinical staff are suspended at a cost of hundreds of million dollars a year. Many healthcare workers say the NHS Trust uses this tactic to get whistleblowers to keep quiet, according to the article.

In a Sept. 1 article, the Mirror detailed a list of problems at the hospital caused by what physicians say is management's focus on numbers rather than patients. Problems reported include potential spinal injuries not investigated because not enough radiologists were on duty and one interventional radiologist on duty where there would normally be five.

The paper reported that Chan criticized hospital management for allowing all but six radiologists to leave on vacation in August. He said their interest in saving money rather than lives could prove fatal in the event of a terrorist attack. The London NHS Trust was the hospital that treated most of the victims of the subway bombings in July 2005 and is also likely to be the location for imaging services at the 2012 Olympics.

For more information from the Diagnostic Imaging archives:

Whistleblower alleges Medicare fraud at Florida imaging centers

I just hate to hear that lonesome whistle blow

Watch their tongues to see if they're lying


-- By C. P. Kaiser

Par SPINNEUR - Publié dans : MALPRACTICE JURIDIQUE MEDICAL LAW
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Lundi 2 octobre 1 02 /10 /Oct 21:09

 

 MR BIOPTY 

.

/R E P E A T/ - Media invitation -

On the eve of Breast Cancer Awareness Month

    FIRST DEDICATED BREAST MAGNETIC RESONANCE IMAGING (MRI)
UNIT IN CANADA TO BE HOISTED INTO PLACE BY CRANE
.
MONTREAL, Sept. 21 /CNW Telbec/ - Just a few days prior to the official
start of Breast Cancer Awareness Month, Ville Marie Medical and Women's Health
Centre will install, in spectacular fashion, Canada's first dedicated breast
magnetic resonance imaging (MRI) unit with biopsy capability.
At 12:30 p.m. this Friday, September 22, the extremely sensitive device -
which will enhance the clinic's breast cancer detection and diagnosis
capabilities - will be hoisted to the ninth floor of the clinic by a giant
crane.
Dr. Nathalie Duchesne, MD. FRCP (c), a radiologist of international
renown and Director of the Ville Marie Magnetic Resonance Imaging Centre, will
be on hand for interviews. She will be accompanied by colleagues from her
interdisciplinary team of surgeons, oncologists and breast pathologists.
The 5,454-kilogram (12,000-pound) load will be lifted from the rear
parking lot of the Ville Marie Medical and Women's Health Centre at 1538
Sherbrooke Street West (southeast corner of the Sherbrooke-Guy intersection).
The MRI unit will then be coupled to a Sentinel table. The latter is an
innovative product developed in Toronto that merges MRI with ultrasound to
provide biopsy capability.

Once the equipment is installed, Ville Marie Magnetic Resonance Imaging
Centre will become an international centre of excellence affiliated with the
German company Siemens, the Canadian firm Sentinel and the American company
SenoRx, a manufacturer of biopsy tools. 
As a result, radiologists from the
world over will come to Montréal to attend training and knowledge-upgrading
sessions.
<<
DATEBOOK
WHAT:     Interviews and hoisting by crane of Canada's first dedicated
breast magnetic resonance imaging (MRI) unit with biopsy
capability
WHEN:     Friday, September 22, 12:30 p.m.
WHERE:    Rear parking lot, Ville Marie Medical and Women's Health
Centre, 1538 Sherbrooke Street West
WHO:      Dr. Nathalie Duchesne, internationally renowned radiologist
>>

For further information: André Bouthillier, François-Olivier Gagnon,
(514) 732-4114, (514) 895-0127; Source: Breast-dedicated MRI Center


BREAST-DEDICATED MRI CENTER - Renseignements sur cet organisme

                                 


 
Communiqués de presse
Communiqués de presse

(2)
Archives photo
Archives photo

Attention News Editors:

/R E P E A T/ - Media invitation - On the eve of Breast Cancer Awareness Month

    FIRST DEDICATED BREAST MAGNETIC RESONANCE IMAGING (MRI)
                                    Source: Breast-dedicated MRI Center
                                    

 

 

Archives photo
Archives photo
Par SPINNEUR - Publié dans : SEIN . BREAST
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Lundi 2 octobre 1 02 /10 /Oct 20:57

 

 

Un chirurgien, ses parents et deux piqûres de curare
Jean-Paul Gournier, accusé de double meurtre, est renvoyé aux assises.
Par Olivier BERTRAND
QUOTIDIEN : Jeudi 21 septembre 2006 - 06:00
Saint-Priest-en-Jarez (Loire) envoyé spécial
 
Jean-Paul Gournier n'a été placé sous contrôle judiciaire que trois mois, au printemps 2001. Il n'a jamais fait le moindre jour de détention préventive. Pourtant, dans six mois, ce chirurgien stéphanois risquera la perpétuité devant la cour d'assises de la Loire, pour «empoisonnement sur ascendants légitimes». On l'accuse d'avoir tué ses parents, par injection d'un dérivé de curare, afin d'hériter d'eux plus vite. Il nie.
 
Bonbonne. Le mardi 30 novembre 1999, les pompiers découvrent chez eux André Gournier, 75 ans, dans son canapé, et, à côté dans un fauteuil, Geneviève, 82 ans. Tous deux décédés. La télévision est allumée, le gaz ouvert, mais la bonbonne vide. Un fer à repasser, branché, a brûlé un rideau. Des expertises montreront qu'ils sont morts la veille, d'une injection massive d'atracurium, produit curarisant qu'utilisent les anesthésistes. Aucune seringue ne se trouve dans la pièce.
 
Leur fils, Jean-Paul, 40 ans à l'époque, est alors entendu. Chirurgien cardio-vasculaire à Saint-Etienne, Montbrison et Lyon, il explique aux enquêteurs qu'il est venu la veille voir ses parents. Il vit à cinq cents mètres de chez eux. «J'étais inquiet , raconte-t-il à Libération . Papa était très fatigué et maman semblait comme en état d'ébriété, alors qu'elle ne buvait pas. Je voulais leur faire une prise de sang, car je craignais une intoxication alimentaire ou médicamenteuse.» Le lundi soir, il aurait attendu que le père rentre de son bridge, et aurait fait les prélèvements, avant de quitter ses parents vers 20 heures.
La justice s'étonnera que le chirurgien n'ait pas fait analyser immédiatement les flacons, qu'il remet aux enquêteurs dès le lendemain. «Mais s'il avait tué ses parents, pourquoi les aurait-il conservés et donnés à la justice, puisqu'ils le désignent comme  suspect ?» répond François Saint-Pierre, son avocat.
Le chirurgien dit qu'il a d'abord cru au suicide de ses parents. Dans le cahier de compte qu'il tenait quotidiennement, le père aurait «tiré un trait» sous la date du 15 novembre. Avec sa femme, ils ont effectué une donation à leurs six petits-enfants et leur ont envoyé une lettre, cinq jours avant leur mort. Le courrier, un peu solennel, détaille la donation. Un post-scriptum ajoute : «Cette lettre n'est peut-être pas explicite pour les plus jeunes d'entre vous mais, dans le temps et avec les explications de vos parents, vous serez à même de nous comprendre.» 
Les parents se déchiraient depuis une trentaine d'années. Ils s'étaient connus à Dakar, où la mère exerçait comme infirmière. Le père contrôlait des bateaux pour Veritas. En 1960, ils avaient laissé les fastes de la colonisation pour s'installer au fin fond de la Loire, où le père est devenu directeur d'entreprises. «J'ai vécu dans un vrai cocon», raconte Jean-Paul Gournier. En 1974, une nièce s'installe chez eux. Elle a 16 ans, s'appelle Evelyne. Le père aurait eu une liaison avec elle. «Papa avait un grand défaut, soupire Jean-Paul Gournier. Il était très coureur.» 
«Putaille». Les trente années suivantes auraient, selon le fils, ressemblé au Chat , ce film de Pierre Granier-Deferre où Simone Signoret et Jean Gabin se déchirent. La mère reproche au père de le tromper, puis en a confirmation par un détective.
 
La femme de ménage affirme que la patronne disait, quand le mari sortait : «Il va voir la putaille.» Et qu'elle criait parfois : «Je vais le tuer.» Des amies de Geneviève confirment que celle-ci parlait souvent de tuer son mari. L'une d'elles précise : «Elle avait ajouté qu'elle savait comment le faire proprement. Qu'elle saurait faire disparaître les traces.» 
Pour François Saint-Pierre, le mobile de la mère est plus fort que celui du fils. Jean-Paul Gournier est soupçonné d'avoir tué ses parents car sa «situation patrimoniale» était «irrémédiablement compromise», selon une expertise. Le chirurgien était à découvert de 177 000 francs et sa mère lui avait prêté 400 000 francs. «Je fais un chiffre d'affaires de 450 000 ou 500 000 euros par an, réplique Jean-Paul Gournier. Qu'est-ce que j'en avais à foutre de 177 000 francs. Je venais de créer une société. C'est une horreur d'imaginer que j'ai tué mes parents pour cela.» 
Paralysie. Plusieurs expertises nuisent au chirurgien. Aucune ne prouve qu'il a tué, mais toutes concluent que la mère ne pouvait s'injecter l'atracurium, faire disparaître la seringue, puis revenir s'asseoir. Par voie intraveineuse, le produit aurait provoqué la mort en quelques dizaines de secondes, avec un début de paralysie avant la fin de l'injection. Selon François Saint-Pierre, les experts surévaluent les doses ; une injection par voie sous-cutanée reste possible, la mort, dans ce cas, laissant quelques dizaines de minutes de répit. La mère pouvait alors jeter la seringue dans la cheminée.
Le 31 août 2001, un premier juge a signé un avis de fin d'instruction. «Il m'a serré la main en me disant qu'il me croyait innocent», affirme Jean-Paul Gournier. Mais il a été remplacé et son successeur a tout repris à zéro. Le chirurgien raconte qu'il a «eu l'impression de (se) retrouver dans la Vérité, de Clouzot». Un film où Brigitte Bardot répond devant les assises du meurtre de son amant, sans convaincre les magistrats, aveuglés parce qu'elle dégage. Le rendez-vous aux assises est prévu pour mars ou avril 2007.
 
Phoenix

inpensable
C inpensable d'accuser un fils d'avoir tué ses parent pour une raison aussi légère !Seul un monstre en serait capable et je pense pa kun om ki travail ds la médecine soi de ceu la!... Vendredi 22 Septembre 2006 - 00:41

 

 

 

 

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Par SPINNEUR - Publié dans : MALPRACTICE JURIDIQUE MEDICAL LAW
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Lundi 2 octobre 1 02 /10 /Oct 20:45

 

 


 

 In-phase/ Out-of-phase MRI ,

 DIXON Method, 
FAT-WATER SEPARATION

 

 

 

 Adrenal

 Adenoma

 MRI

 IRM , Surrénales , adénome , Résonance magnétique .


Adrenal Adenoma IP/ OP Study .

 

T1 in Phase

In-Phase T1 Weighted

 

 

 

 

 

 

 

T1 out-of-Phase

Out-of-Phase T1 Weighted

Dark-Ink  

Intensity Drop-out with OP T1w

( due to INTRACYTOPLASMIC FAT )  

 

Imaging Procedures
space

Diagnosis of adrenal neoplasms depends on the identification of an adrenal mass on computed tomography (CT) or magnetic resonance imaging (MRI). Both normal and abnormal adrenal glands are readily visible on CT because of the surrounding adipose tissue in the retroperitoneum (125). Computed tomography provides information about size, homogeneity, presence of calcifications, areas of necrosis, and extent of local invasion, making it helpful in decisions about the potential malignancy and resectability of the neoplasm. Adrenal masses as small as 10 mm can be reliably detected by CT (126, 127), although the relative lack of retroperitoneal fat in children might decrease the sensitivity of the test in this population (128).

Adrenal CT is 70% to 80% sensitive in detecting aldosterone-producing adenomas. In one large series (111), mean tumor size was 1.8 cm, but 20% of these tumors were smaller than 1 cm. Adrenal incidentalomas are also common in older adults; thus, adrenal CT is considered adjunctive and is usually not used to direct adrenalectomy without other confirmatory data.

Whether MRI will prove superior to CT in diagnosing and differentiating among adrenal masses remains to be seen. Magnetic resonance imaging can show the invasion of an adrenocortical carcinoma into blood vessels, particularly the inferior vena cava and the adrenal and renal veins, in which tumor thrombi may occasionally be identified (125). It can also distinguish fairly accurately among primary malignant adrenocortical tumors, nonfunctioning adenomas, and pheochromocytomas by comparing the ratio of the signal intensity of each type of adrenal mass to that of the liver (128). Primary malignant adrenocortical lesions have intermediate-to-high signal intensity on T2-weighted images, nonfunctional adenomas have low signal intensity, and pheochromocytomas have extremely high signal intensity. In-phase out-of-phase MRI is emerging as a reliable method for distinguishing between adrenal incidentalomas and metastases (68, 129, 130) and proved useful in identifying an aldosterone-producing adenoma in a patient with hyperaldosteronism and bilateral nodules (125) (Figure 5). Other imaging methods, such as iodocholesterol scanning, venography, and arteriography, are rarely indicated (115, 128, 131), but recent data show that selenocholesterol scanning may prove useful in assessing malignancy (95).


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Figure 5. Computed tomography (CT) and magnetic resonance imaging (MRI) of aldosterone-secreting adenomas. Top. Adrenal CT of a 61-year-old woman with primary hyperaldosteronism and bilateral adrenal nodules (arrows) did not identify an increased lipid content in either adenoma. Middle. In-phase MRI also failed to differentiate between the two sides. Bottom. A loss of signal content of the functional aldosteronoma was shown by out-of-phase MRI. Venous sampling and surgery confirmed a right aldosteronoma. (Courtesy of J.L. Doppman).

 

 

Adrenal venous sampling remains the gold standard for the differential diagnosis of primary aldosteronism, especially because it has recently become clear that many tests used in the subtype evaluation of this condition provide variable and often inconclusive results (132). Comparison of aldosterone-to-cortisol ratios in the adrenal veins and the inferior vena cava allows detection of unilateral or bilateral sources of aldosterone hypersecretion. Although the cut-off for lateralization is controversial, ratios of 5:1 and 10:1 have been advocated (132, 133). extract of :

  ANNALS OF INTERNAL MEDICINE 

 
http://www.annals.org/cgi/content/full/130/9/759

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http://irmresonance.over-blog.com/


 


 

 

Par SPINNEUR - Publié dans : RENAL & ADRENAL MRI
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Lundi 2 octobre 1 02 /10 /Oct 20:32

 

DOI: 10.1148/rg.244035723

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RadioGraphics 2004;24:999-1008
©
RSNA, 2004

EDUCATION EXHIBIT

Imaging Appearances of Lateral Ankle Ligament Reconstruction1

Alexander J. Chien, MD, Jon A. Jacobson, MD, David A. Jamadar, MB,BS, FRCS, FRCR, Monica Kalume Brigido, MD, John E. Femino, MD and Curtis W. Hayes, MD

1 From the Department of Radiology, Pomona Valley Hospital and Medical Center, Pomona, Calif (A.J.C.); the Departments of Radiology (J.A.J., D.A.J., M.K.B.) and Orthopaedic Surgery (J.E.F.), University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910G, Ann Arbor, MI 48109-0329; and the Department of Radiology, Medical College of Virginia/Virginia Commonwealth University, Richmond, Virginia (C.W.H.). Received September 4, 2004; revision requested December 11 and received February 23, 2004; accepted March 8. Address correspondence to J.A.J. (e-mail: jjacobsn@umich.edu).

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Six patients were retrospectively identified as having undergone lateral ligament reconstruction surgery. The surgical procedures were categorized into four groups: direct lateral ligament repair, peroneus brevis tendon rerouting, peroneus brevis tendon loop, and peroneus brevis tendon split and rerouting. At radiography and magnetic resonance (MR) imaging, the presence of one or more suture anchors in the region of the anterior talofibular ligament indicates direct ligament repair, whereas a fibular tunnel indicates peroneus brevis tendon rerouting or loop. Both ultrasonography (US) and MR imaging demonstrate rerouted tendons as part of lateral ankle reconstruction; however, MR imaging can also depict the rerouted tendon within an osseous tunnel if present, especially if T1-weighted sequences are used. Artifact from suture material may obscure the tendon at MR imaging but not at US. With both modalities, the integrity of the rerouted peroneus brevis tendon is best evaluated by following the tendon proximally from its distal attachment site, which typically remains unchanged. The rerouted tendon or portion of the tendon can then be traced proximally to its reattachment site. Familiarity with the surgical procedures most commonly used for lateral ankle ligament reconstruction, and with the imaging features of these procedures, is essential for avoiding diagnostic pitfalls and ensuring accurate assessment of the ligament reconstruction.

© RSNA, 2004

Index Terms: Ankle, anatomy, 46.92 • Ankle, MR, 46.1214 • Ligaments, 46.486

 

 

 

 


 

Par SPINNEUR - Publié dans : CHEVILLE . ANKLE .PIED FOOT .
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