Академический Документы
Профессиональный Документы
Культура Документы
O Hlnon et coll
1997 BOSNIAK MA. Diagnosis and management of patients with complicated cystic M Bosniak
lesions of the kidney. AJR 1997
Introduction de la catgorie IIF (Follow-up)
2000 Curry NS, Cochran ST, Bissada NK (2000) Cystic renal masses: accurate Bosniak
classification requires adequate renal CT. AJR 2000
Validation du systme de Bosniak
2003 ISRAEL GM, BOSNIAK MA. Follow-up CT of moderately complex cystic lesions of the
kidney (Bosniak category IIF). AJR 2003
Validation de la catgorie IIF
2004 ISRAEL GM, HINDMAN N, BOSNIAK MA. Evaluation of cystic renal masses: comparison
of CT and MR imaging by using the Bosniak classification. Radiology 2004
Extension lIRM du domaine dapplication de la classification
Reclassement possible en IRM de lsions sousclasses en TDM
Classification de Bosniak
Objectif
Distinguer les kystes chirurgicaux (III et IV)
des kystes non-chirurgicaux (I, II et IIf)
Scanner
Type III rehaussement - ou douteux
Conduite tenir
IRM (Sq. dyn, Gd fatsat++)
Si Gd+ reclassement en III chir.
Les masses kystiques mal classes
Reclassement IRM: 10% (7/69)
Catgorie IIF en III et III en IV : 2/3 des cas
Impact prise en charge
From: ISRAEL GM, HINDMAN N, BOSNIAK MA. Evaluation of cystic renal masses: comparison
of CT and MR imaging by using the Bosniak classification system. Radiology 2004
Les masses kystiques mal classes
Lsions IIF ou III sousclasses
IIF III
From: ISRAEL GM et al. Radiology 2004 III-IV
Les masses kystiques mal classes
Lsions IIF ou III sousclasses
III IV
From: ISRAEL GM et al. Radiology 2004
Les masses kystiques mal classes T2
Limites de lIRM
Tum. Kyst. hmorragiques: hypersignaux T1
T1
Dgradation de lHb : susceptibilit magntique
Rehaussement masqu
Valeur du T2 (htrognit de signal
Confrontation IRM / TDM
T1 Gado.
EG T1 fat sat EG T1 fat sat Gd+ EG T1 fat sat Gd+ soustrac ADC map
Lecture
Agrandissement(x2-4)
ROI adapte
Moyens de dtection
Graisse macroscopique
IRM= techniqe de
substitution
Protocole standard
Coupes fines 5mm
SE T1 et SE T1 + Sat. graisse
EG T1 apne sans et avec fatsat
Lecture
Franc hypersignal T1
Chute du signal en fatsat
<=> tissu adipeux rtropritonal T1 T1 FS
Lava-Flex
Squence 3D T1 multi-phasique
muticontraste (Water, Fat, IP-OP)
FAT ONLY
Angiomyolipomes: squence IPOP
70 masses dont 23 AML*
Dg dAML si india ink en opposition de phase
artefact linterface lsion - parenchyme rnal
The use of opposed-phase chemical shift MRI in the
diagnosis of renal angiomyolipomas.
Israel GM, AJR 2005.
Out:
T: 290
R: 670
Index:51%
Histo: AML
Kim JK, Radiology 2006
Index IS > 25%
Se : 96% Sp : 93% Clichs Pr N. Grenier
VPP : 93% VPN : 96%
* C. Couvidat, D. Eiss, S. Merran, A. Vieillefond, J-M. Correas, O. Hlnon. Papillary renal cell
carcinoma: spectrum of imaging findings with pathologic correlation. RSNA 2007
** Papillary renal carcinoma : Diagnostic approach by chemical shift gradient-echo and echo-planar MR
imaging. K Yoshimitsu & coll, Journal of Magnetic Resonance Imaging (2006) 23 : 339-344
Squences de Diffusion
Tumeur papillaire
Courtesy C ROY
Courtesy C ROY
Oncocytome
Adnome 30
oncocytaire
5 30
IRM et diagnostic dextension
Performances comparables au scanner
Information complmentaires
Extension veineuse (pT3b)
Extension transcapsulaire (pT3a)
Conclusion
Diagnostic des tumeurs kystiques
Le systme de Bosniak est applicable
Rle de lIRM dans les types IIF et III
Sequence axiale T1 et T1 FS
Sequence T1 IP OP