Background: Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. Methods: Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. Results: Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and h...

/pdf/medullary-thyroid-cancer-management-guidelines-of-the-59581m0st9.pdf

Medullary thyroid cancer: management guidelines of the American Thyroid Association.

PURPOSE: To compare multi–detector row computed tomographic (CT) angiography and digital subtraction angiography (DSA) prior to revascularization in patients with symptomatic peripheral arterial disease for the purpose of assessing recommendations for additional imaging and physician confidence ratings for chosen therapy. MATERIALS AND METHODS: In a randomized controlled trial, 73 patients were assigned to CT angiography, and 72 were assigned to DSA. Physician confidence in the treatment decision was measured as a continuous outcome on a scale of 0–10 (uncertain to certain) and as a dichotomous outcome (further imaging recommended, yes or no). Mean confidence scores and additional imaging recommendations were compared between CT and DSA groups in an intention-to-diagnose-and-treat analysis. To detect trends in confidence, confidence scores were plotted over time, and multiple linear regression analysis was performed. To detect trends in additional imaging recommendations, logistic regression analysis was ...

Peripheral arterial disease: therapeutic confidence of CT versus digital subtraction angiography and effects on additional imaging recommendations.

Magnetic Resonance Imaging of the Functional Anatomy of the Inferior Rectus Muscle in Superior Oblique Muscle Palsy

With the introduction of multi-detector row computed tomography (MDCT), scan speed and image quality has improved considerably. Since the longitudinal coverage is no longer a limitation, multi-detector row computed tomography angiography (MDCTA) is increasingly used to depict the peripheral arterial runoff. Hence, it is important to know the advantages and limitations of this new non-invasive alternative for the reference test, digital subtraction angiography. Optimization of the acquisition parameters and the contrast delivery is important to achieve a reliable enhancement of the entire arterial runoff in patients with peripheral arterial disease (PAD) using fast CT scanners. The purpose of this review is to discuss the different scanning and injection protocols using 4-, 16-, and 64-detector row CT scanners, to propose effective methods to evaluate and to present large data sets, to discuss its clinical value and major limitations, and to review the literature on the validity, reliability, and cost-effectiveness of multi-detector row CT in the evaluation of PAD.

/pdf/multi-detector-row-computed-tomography-angiography-of-4yvt4wtz3a.pdf

Multi-detector row computed tomography angiography of peripheral arterial disease.

BACKGROUND Liver embolisation is one of the treatment options available for patients diagnosed with neuro-endocrine neoplasms (NEN). It is still uncertain whether the benefits of the various types of embolisation treatments truly outweigh the complications in NENs. This systematic review assesses the available data relating to liver embolisation in patients with NENs. METHODS Eligible studies (identified using MEDLINE-PubMed) were those reporting data on NEN patients who had undergone any type of liver embolisation. The primary end points were best radiological response and symptomatic response; secondary end-points included progression-free survival (PFS), overall survival (OS) and toxicity. RESULTS Of 598 studies screened, 101 were eligible: 16 were prospective (15.8%). The eligible studies included a total of 5,545 NEN patients, with a median of 39 patients per study (range 5-214). Pooled rate of partial response was 36.6% (38.9% achieved stable disease) and 55.2% of patients had a symptomatic response to therapy when pooled data were analysed. The median PFS and OS were 18.4 months (95% CI 15.5-21.2) and 40.7 months (95% CI 35.2-46.2) respectively. The most common toxicities were found to be abdominal pain (48.8%) and nausea (48.1%). Outcome did not significantly vary depending on the type of embolisation performed. CONCLUSION Liver embolisation provides adequate symptom relief for patients with carcinoid syndrome and is also able to reach partial response in a significant proportion of patients and a reasonable PFS. Quality of studies was limited, highlighting the need of further prospective studies to confirm the most suitable form of liver embolisation in NENs.

Liver Embolisation for Patients with Neuroendocrine Neoplasms: Systematic Review.

But. Evaluer l'angio-TDM spiralee (ASCT) et deux techniques d'angio-IRM (ARM) en pathologie atheromateuse aorto-iliaque par rapport a l'arteriographie. Patients et methodes. L'aorte abdominale et les axes iliaques de vingt-deux patients arteritiques (quatre bilans preoperatoires d'anevrisme et dix-huit arteriopathies obstructives) ont ete explores par quatre techniques : aorto-arteriographie (methode de reference), ARM 2D temps de vol (ARM 2D TOF), ARM 3D avec injection de Gadolinium (ARM 3D Gd) et ASCT. L'interpretation s'est faite a la fois sur les coupes axiales (ARM 2D TOF et ASCT) et sur des representations MIP (apres soustraction des mesures avant et apres injection de Gadolinium pour l'ARM 3D Gd). Resultats. La sensibilite, la specificite et la fiabilite pour la mise en evidence des stenoses significatives (superieures a 50 %) et des occlusions etaient respectivement : 38 %, 89 %, 77 % pour l'ARM 2D TOF ; 75 %, 71 %, 72 % en ARM 3D Gd et 95%, 90 %, 92 % en ASCT. En excluant les arteres iliaques internes, elles devenaient 54%, 96 %, 88 % en ARM 2D TOF ; 96 %, 80 %, 83 % en ARM 3D Gd et 92 %, 93 %, 95 % en ASCT. Conclusion. L'ARM 3D Gd, technique encore tres perfectible, apparait bien superieure a l'ARM 2D TOF pour la detection des stenoses significatives et des occlusions aorto-iliaques. Ses performances approchent celles de l'ASCT si l'on exclut les arteres iliaques internes, alors qu'elle a l'avantage de s'affranchir du probleme des calcifications parietales.

Évaluation comparative de l'angio-TDM spiralée, de l'angio-IRM 2D temps de vol et 3d gadolinium en pathologie athéromateuse aorto-iliaque

We report functionally successful hepatic and left adrenal embolization with particles to treat Cushing's syndrome associated with a medullary thyroid carcinoma.

Embolization of hepatic and adrenal metastasis to treat Cushing's syndrome associated with medullary thyroid carcinoma: a case report.

The utility of the inferior oblique m. radioanatomical study by a FLASH 3D sequence in magnetic resonance imaging (MRI). Twenty eyes (ten healthy volunteers aged 21–32 years, without any history of significant ocular pathology) were explored by MRI (1 Tesla; cranial coil) and comparisons were made between spin echo (SE) T1 sequence (through the neuro-ocular and coronal planes; thickness of slices = 3 mm) and a gradient echo FLASH 3D sequence (thickness of slices = 1 mm). This enabled a mm by mm reformation of the inferior oblique m. through the frontal-oblique plane, made possible by new SE T1 sequences through the same plane. Position, height, and signal of the m. were estimated. The mean frontal angle formed by the muscle and the sagittal axis measured 29° for the right eye and 27° for the left eye. The muscle was always identifiable in the reformation despite its thin dimensions: 1.9 mm (1.5–2.8) on the right and 2 mm (1.7–2.5) on the left, in low signal silhouetted by the high signal of orbital fat. Thus, thanks to mm by mm reconstructions using FLASH 3D sequence, a good radioanatomic study of the inferior oblique m. by MRI is possible. This could be useful particularly for the strabismus of children.

Study of the inferior oblique muscle of the eye by MRI.

The purpose was to illustrate that single or multirow spiral CT angiography has become the main modality for the examination of the abdominal aorta. Our multidisciplinary group investigates weekly 15 abdominal aortas, with a single slice spiral CT since 1995, and a 4 row detector spiral CT since 1999. CT scans protocols and parameters optimization for the 2 CT systems are described. Indications and results of CT to investigate the various abdominal aortic diseases are illustrated and discussed: aneurisms (pretherapeutic staging, selection of indications of endovascular stent-grafting); obstructive aorto-arteriopathies (pretherapeutic staging, follow up after endovascular revascularization); dissection (diagnosis, pretherapeutic staging, follow up); inflammatory diseases; normal patterns and principal complications after surgery. Situations where multislice CT is superior to single slice CT and compared advantages of MRI are discussed. CT is at the present time the main technique to image abdominal aorta. Multislice CT is especially interesting to explore the whole aorta, poly traumatisms, and to plan and follow up endovascular treatments.

Angioscanner hélicoïdal de l’aorte abdominale

ne nouvelle génération de scanographes hélicoïdaux est désormais à notre disposition. Ces machines autorisent, par la rapidité des acquisitions et l’étendue des volumes explorés, la couverture angioscanographique de la totalité de certains organes et de grandes longueurs de segments artériels en phase artérielle vraie, bouleversant la qualité des explorations et en conséquence les indications radiologiques. La diminution des temps d’acquisition permet d’accéder à une résolution temporelle suffisante pour un examen morphologique de l’aorte thoracique ascendante, mais aussi du cœur. Des procédés associés de synchronisation à l’électrocardiogramme peuvent encore diminuer les artefacts de mouvement. La diminution de l’épaisseur des coupes majore la résolution spatiale et diminue les effets de volume partiel, optimisant la définition anatomique, mais aussi la qualité des reconstructions, en particulier tri-dimensionnelles et notamment des techniques de rendu de volume. Le scanner hélicoïdal constitue ainsi désormais la technique usuelle de premier recours pour l ‘exploration de l’aorte abdominale. Nous allons successivement passer en revue les modalités techniques d’exploration de l’aorte par TDM, ses résultats et ses indications, et tenter d’en préciser la place actuelle par rapport à l’IRM.

vasculaire - Angioscanner hélicoïdal de l’aorte abdominale

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