Bone age estimation based on multislice computed tomography study of the scapula

Progress in medical imaging has opened new areas of research in forensic anthropology, especially in the context of the study of bone age assessment. The study of bone age has become a useful tool for age estimation at death or age of young adult migrants in an anthropological context. We retrospectively evaluated multislice computed tomography (MSCT) explorations focused on scapulae of 232 individuals (123 males; 109 females) aged between 8 and 30 years old. Computed tomography (CT) scans were viewed in axial and multiplanar reconstructed images using OsiriX 5.9 (64 bit)®. The ossification centers of the scapula studied were as follows: acromial, sub-coracoid, glenoid, coracoid, coracoid apex, and inferior angle epiphyses. Fusion status was scored based on a five-stage system (stage 1: no ossification, stage 2: visualization of an ossification center, stage 3: partial ossification, stage 4: full ossification associated to an epiphyseal scar, and stage 5: full ossification without epiphyseal scar). Intra-observer variability was excellent, and inter-observer variability was good, demonstrating the reliability of this MSCT staging system. The fusion of scapular ossification centers was statistically associated with age (p  0.05). In conclusion, MSCT of the scapula is an efficient method for age assessment, which is complementary to preexisting methods particularly for specifying the 18-year threshold. Further studies with larger groups are needed to support our results

An unusual intracardiac foreign body following penetrating thoracic injury

Foreign bodies in the heart after thoracic trauma may result in fatal outcome. We report a pendant inside the pericardium after penetrating injury that did not cause major cardiac injury with a favorable outcome

Blended learning of radiology improves medical students’ performance, satisfaction, and engagement

Purpose To evaluate the impact of blended learning using a combination of educational resources (flipped classroom and short videos) on medical students’ (MSs) for radiology learning. Material and methods A cohort of 353 MSs from 2015 to 2018 was prospectively evaluated. MSs were assigned to four groups (high, high-intermediate, low-intermediate, and low achievers) based on their results to a 20-MCQs performance evaluation referred to as the pretest. MSs had then free access to a self-paced course totalizing 61 videos based on abdominal imaging over a period of 3 months. Performance was evaluated using the change between posttest (the same 20 MCQs as pretest) and pretest results. Satisfaction was measured using a satisfaction survey with directed and spontaneous feedbacks. Engagement was graded according to audience retention and attendance on a web content management system. Results Performance change between pre and posttest was significantly different between the four categories (ANOVA, P = 10−9): low pretest achievers demonstrated the highest improvement (mean ± SD, + 11.3 ± 22.8 points) while high pretest achievers showed a decrease in their posttest score (mean ± SD, − 3.6 ± 19 points). Directed feedback collected from 73.3% of participants showed a 99% of overall satisfaction. Spontaneous feedback showed that the concept of “pleasure in learning” was the most cited advantage, followed by “flexibility.” Engagement increased over years and the number of views increased of 2.47-fold in 2 years. Conclusion Learning formats including new pedagogical concepts as blended learning, and current technologies allow improvement in medical student’s performance, satisfaction, and engagement

L'imagerie moderne post-mortem sans et avec produit de contraste : diverses applications archéologiques et thanatologiques

L'angioscanner post-mortem (ATDMPM) est une technique en plein essor. Notre travail a consisté en l'application des protocoles d'ATDMPM sur plusieurs types de populations. D'abord, nous avons acquis une expérience, notamment concernant les décès par chute d'un lieu élevé. Puis, nous avons eu la chance de travailler sur une collection rare de cœurs archéologiques momifiés et très bien conservés, datant entre le XVème et le XVIIème siècle. Les résultats radiologiques, autopsiques et histologiques concordaient. Nous avons également étudié une momie artificielle bretonne bien conservée du XVIIème siècle, qui avait comme particularité un arbre aortique abdominal et iliaque intact, permettant de réaliser la première angiographie post-mortem d'une momie de plus de 350 ans. Enfin, nous avons tenté d'adapter le protocole adulte de l'ATDMPM aux enfants en utilisant le modèle porcin. Dans un premier temps, nous avons testé une modification des moyens d'injection, en remplaçant les canules chirurgicales par des introducteurs radiologiques. Forts de ces résultats, nous avons réalisé des ATDMPM sur un modèle porcin. Nous avons utilisé deux machines différentes. L'opacification vasculaire globale a été satisfaisante pour l'ensemble des groupes. La réalisation des ATDMPM avec la machine Virtangio(r) s'est révélée très difficile en raison du seuil limite de pression. Les tests de corrélation ont mis en évidence une relation significative entre les caractères anthropométriques des porcs, les paramètres d'injection et le pourcentage de segments opacifiés. Notre travail confirme ainsi la complémentarité entre les techniques classiques d'investigations post-mortem et l'imagerie moderne, avec ou sans injection de produit de contraste. Il permet également d'entrevoir un futur riche de recherche et d'interdisciplinarité dans les domaines de recherche archéologique, anthropobiologique, médico-légale et radiologique.Post-mortem Computed Tomography Angiography (PMCTA) is a growing technique. Our work consisted in the application of the protocols of PMCTA on several types of populations. First, we gained experience regarding deaths in a context of great height falls. Then, we had the chance to work a rare collection of mummified archaeological hearts and very well preserved, dating between the XVth and XVIIth centuries. We also studied a well-preserved artificial mummy from French Brittany dating from the XVIIth century, characterized by an intact abdominal aortic and iliac tree. We applied the first PMCTA of a mummy of more than 350 years. Finally, we tried to adapt the adult protocol of PMCTA to children, using a porcine model. First, we tested a modification of the injection procedure by replacing the surgical cannulas by radiological introducers. Based on these results, we carried out a series of PMCTAs on pigs. We used two different machines. Overall vascular opacification was satisfactory for all groups. The realization of the MPMCTA with the Virtangio(r) machine proved very complex due to the upper limit of pressure. Spearman correlation tests showed a significant relationship between anthropometric characteristics of pigs, injection parameters and percentage of opacified segments. A higher percentage of opacification is obtained for individuals of smaller weights, with comparatively smaller quantities of contrast agent injected. Our work confirms the complementarities between classical techniques of post-mortem investigations and modern imaging, with or without injection of contrast media. It also allows us to foresee a rich future of research and interdisciplinarity in the fields of archaeological, anthropobiological, medico-legal and radiological researches

Post-mortem modern imaging with and without contrast agent : diverse archaelogical and forensic applications

L'angioscanner post-mortem (ATDMPM) est une technique en plein essor. Notre travail a consisté en l'application des protocoles d'ATDMPM sur plusieurs types de populations. D'abord, nous avons acquis une expérience, notamment concernant les décès par chute d'un lieu élevé. Puis, nous avons eu la chance de travailler sur une collection rare de cœurs archéologiques momifiés et très bien conservés, datant entre le XVème et le XVIIème siècle. Les résultats radiologiques, autopsiques et histologiques concordaient. Nous avons également étudié une momie artificielle bretonne bien conservée du XVIIème siècle, qui avait comme particularité un arbre aortique abdominal et iliaque intact, permettant de réaliser la première angiographie post-mortem d'une momie de plus de 350 ans. Enfin, nous avons tenté d'adapter le protocole adulte de l'ATDMPM aux enfants en utilisant le modèle porcin. Dans un premier temps, nous avons testé une modification des moyens d'injection, en remplaçant les canules chirurgicales par des introducteurs radiologiques. Forts de ces résultats, nous avons réalisé des ATDMPM sur un modèle porcin. Nous avons utilisé deux machines différentes. L'opacification vasculaire globale a été satisfaisante pour l'ensemble des groupes. La réalisation des ATDMPM avec la machine Virtangio(r) s'est révélée très difficile en raison du seuil limite de pression. Les tests de corrélation ont mis en évidence une relation significative entre les caractères anthropométriques des porcs, les paramètres d'injection et le pourcentage de segments opacifiés. Notre travail confirme ainsi la complémentarité entre les techniques classiques d'investigations post-mortem et l'imagerie moderne, avec ou sans injection de produit de contraste. Il permet également d'entrevoir un futur riche de recherche et d'interdisciplinarité dans les domaines de recherche archéologique, anthropobiologique, médico-légale et radiologique.Post-mortem Computed Tomography Angiography (PMCTA) is a growing technique. Our work consisted in the application of the protocols of PMCTA on several types of populations. First, we gained experience regarding deaths in a context of great height falls. Then, we had the chance to work a rare collection of mummified archaeological hearts and very well preserved, dating between the XVth and XVIIth centuries. We also studied a well-preserved artificial mummy from French Brittany dating from the XVIIth century, characterized by an intact abdominal aortic and iliac tree. We applied the first PMCTA of a mummy of more than 350 years. Finally, we tried to adapt the adult protocol of PMCTA to children, using a porcine model. First, we tested a modification of the injection procedure by replacing the surgical cannulas by radiological introducers. Based on these results, we carried out a series of PMCTAs on pigs. We used two different machines. Overall vascular opacification was satisfactory for all groups. The realization of the MPMCTA with the Virtangio(r) machine proved very complex due to the upper limit of pressure. Spearman correlation tests showed a significant relationship between anthropometric characteristics of pigs, injection parameters and percentage of opacified segments. A higher percentage of opacification is obtained for individuals of smaller weights, with comparatively smaller quantities of contrast agent injected. Our work confirms the complementarities between classical techniques of post-mortem investigations and modern imaging, with or without injection of contrast media. It also allows us to foresee a rich future of research and interdisciplinarity in the fields of archaeological, anthropobiological, medico-legal and radiological researches

Une vision simplifiée de la vascularisation artérielle hépatique (à propos d'une série de 2035 patients)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Other non-surgical treatments for liver cancer

Interventional radiology plays a major role in the modern management of liver cancers, in primary hepatic malignancies or metastases and in palliative or curative situations. Radiological treatments are divided in two categories based on their approach: endovascular treatment and direct transcapsular access.Endovascular treatments include mainly three applications: transarterial chemoembolization (TACE), transarterial radioembolization (TARE) and portal vein embolization (PVE). TACE and TARE share an endovascular arterial approach, consisting of a selective catheterization of the hepatic artery or its branches. Subsequently, either a chemotherapy (TACE) or radioembolic (TARE) agent is injected in the target vessel to act on the tumor. PVE raises the volume of the future liver remnant in extended hepatectomy by embolizing a portal vein territory which results in hepatic regeneration.Direct transcapsular access treatments involve mainly three techniques: radiofrequency thermal ablation (RFA), microwave thermal ablation (MWA) and percutaneous ethanol injection (PEI). RFA and MWA procedures are almost identical, their clinical applications are similar. A probe is deployed directly into the tumor to generate heat and coagulation necrosis. PEI has known implications based on the chemical toxicity of intra-tumoral injection with highly concentrated alcohol by a thin needle

Avec ou sans hypothèse ? Qu'attendre de la paléoépidémiologie ? Exemple à partir de l'étude d'un couvent breton des ordres mendiants

International audienc

Interpretation of 2-[F-18]FDG PET/CT in Hodgkin lymphoma patients treated with immune checkpoint inhibitors

International audienceThe development of immunotherapy has revolutionized cancer treatment, improving the outcome and survival of many patients. Immune checkpoint inhibitors (ICIs), the most common form of immunotherapy, use antibodies to restore T-cells' anti-tumor activity. Immune checkpoint inhibitors are gaining ground in the therapeutic strategy across various cancers. Although widely used in solid tumors, ICIs have shown remarkable efficacy in patients with Hodgkin lymphoma. 2-[F-18]Fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/CT is the gold standard to stage and monitor responses in Hodgkin lymphoma. This article reviewed the use of 2-[F-18]FDG-PET/CT in patients with Hodgkin lymphoma treated with ICI, focusing on image interpretation for response monitoring and detecting adverse events