Objectives
To develop technical guidelines for magnetic resonance imaging aimed at characterising renal masses (multiparametric magnetic resonance imaging, mpMRI) and at imaging the bladder and upper ...urinary tract (magnetic resonance urography, MRU).
Methods
The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Two separate questionnaires were issued for renal mpMRI and for MRU. Consensus was strictly defined using a priori criteria.
Results
Forty-two expert uroradiologists completed both survey rounds with no attrition between the rounds. Fifty-six of 84 (67%) statements of the mpMRI questionnaire and 44/71 (62%) statements of the MRU questionnaire reached final consensus. For mpMRI, there was consensus that no injection of furosemide was needed and that the imaging protocol should include T2-weighted imaging, dual chemical shift imaging, diffusion-weighted imaging (use of multiple
b
-values; maximal
b
-value, 1000 s/mm
2
) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic) contrast-enhanced imaging; late imaging (more than 10 min after injection) was judged optional. For MRU, the patients should void their bladder before the examination. The protocol must include T2-weighted imaging, anatomical fast T1/T2-weighted imaging, diffusion-weighted imaging (use of multiple
b
-values; maximal
b
-value, 1000 s/mm
2
) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic, excretory) contrast-enhanced imaging. An intravenous injection of furosemide is mandatory before the injection of contrast medium. Heavily T2-weighted cholangiopancreatography-like imaging was judged optional.
Conclusion
This expert-based consensus conference provides recommendations to standardise magnetic resonance imaging of kidneys, ureter and bladder.
Key Points
• Multiparametric magnetic resonance imaging (mpMRI) aims at characterising renal masses; magnetic resonance urography (MRU) aims at imaging the urinary bladder and the collecting systems.
• For mpMRI, no injection of furosemide is needed.
• For MRU, an intravenous injection of furosemide is mandatory before the injection of contrast medium; heavily T2-weighted cholangiopancreatography-like imaging is optional.
Objectives
To develop technical guidelines for computed tomography urography.
Methods
The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi ...survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria.
Results
Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist’s request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations.
Conclusion
This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography.
Key Points
•
To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium.
•
Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging.
•
The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.
A domino SNAr‐ihDA/rDA reaction was developed from rarely exploited 3‐fluoro‐1,2,4‐triazines with bifunctional alkyne tethered nucleophiles to construct various fused non‐aromatic/heteroaromatic ...bicycles in yields ranging from 56 to 99%, notably within the family of valuable spirooxindole derivatives. In this study, the challenging enantioselective phase‐transfer catalyzed arylation of a sulfonyl‐triazine was also demonstrated with up to 66% ee. In both racemic and asymmetric processes, the nature of the leaving group at C3 was key to successfully achieve these sequences.
Imaging of pelvic organ prolapse Lapray, Jean-François
Maġallat al-ṭibbiyat al-lubnāniyyat,
2013 Jan-Mar, Volume:
61, Issue:
1
Journal Article
Peer reviewed
Colpocystodefecography (CCD) and dynamic MRI with defecography (MRId) allow an alternation between filling and emptying the hollow organs and the maximum abdominal strain offered by the defecation. ...When applied in imaging these two principles reveal the masked or underestimated prolapses at the time of the physical examination. A rigorous application of the technique guarantees almost equivalent results from the two examinations. The CCD provides voiding views and improved analysis of the anorectal pathology (intussusception, anismus) but involves radiation and a more invasive examination. MRId has the advantage of providing continuous visibility of the peritoneal compartment, and a multiplanar representation, enabling an examination of the morphology of the pelvic organs and of the supporting structures, with the disadvantage of still necessitating a supine examination, resulting sometimes in an incomplete or impossible evacuation. The normal and abnormal results (cystoptosis, vaginal vault prolapse, enterocele, anorectal intussuception, rectocele, descending perineum, urinary and fecal incontinence) and the respective advantages and limits of the various imaging methods are detailed. Dynamic perineal and introital ultrasound remains more limited in the appreciation of posterior colpoceles and especially in anorectal disorders, than CCD or MRId. Endoanal ultrasound is the first line morphological evaluation of the anal sphincter. Transvaginal and introital ultrasound can detect some complications of suburethral tapes and meshes. Morphological and dynamic imaging are essential complementary tools to the physical examination, especially when a precise anatomic assessment is required to understand the functional complaint or when a reintervention is needed.
Objective: To study the correlation between genital phenotype and cystic fibrosis genotype in men lacking at least one vas deferens.
Design: Prospective study.
Setting: Institut Rhônalpin pour la ...Reproduction Humaine, Lyon-Bron, France.
Patient(s): Forty-seven infertile men lacking at least one vas deferens.
Intervention(s): All patients were screened for the 13 most common
CFTR gene mutations and for the 5-thymidine variant of intron 8. Renal, scrotal, and transrectal ultrasonography were systematically performed.
Main Outcome Measure(s): Epididymal and seminal vesicular abnormalities and testicular volume were compared among men with two, one, or no
CFTR gene mutation, with or without the 5T allele.
Results: Seminal vesicles and the symmetry of epididymal and vesicular abnormalities did not differ between patients with and those without the
CFTR gene mutation. Epididymal abnormalities were more frequent in men without the mutation. Testicular volumes were significantly lower in men without the mutation and those with the 5T allele only.
Conclusion: Men with the
CFTR mutation, the 5T allele only, and those without CFTR mutation have few differences in genital phenotype. Low testicular volume is observed in men without the
CFTR mutation and those with the 5T allele only.
INDICATIONS FOR IMAGING: Apart from ultrasound assessment of post-voiding residual urine, radiological examinations are not recommended for the initial work-up of non-neurological female urinary ...incontinence. CYSTOGRAPHY: Cystography is not recommended as a first-line examination to evaluate uncomplicated stress, urge or mixed urinary incontinence. Cystography may be recommended in the case of complex, complicated or relapsing urinary incontinence, discordance between clinical findings and urodynamic assessment or in the presence of associated prolapse, in which case colpocystodefecography or even dynamic MRI should be preferred. URINARY TRACT ULTRASOUND: Ultrasound is not recommended for the initial work-up of pure stress urinary incontinence or genital prolapse Ultrasound without forced diuresis and after a spontaneous void, is recommended for the assessment of post-voiding residual urine and to assess complicated suburethral tape. Ultrasound is an optional examination in the case of complex or relapsing urinary incontinence, discordance between clinical findings and urodynamic assessment or in the presence of prolapse. PELVIC MRI: Dynamic MRI is not currently recommended for the initial work-up of urinary incontinence.
Flow inside centrifugal turbomachines is always turbulent and presents unsteady flow characteristics due to the interaction between fixed and rotating parts. Moreover, during off-peak running, the ...flow angle/blade profile mismatch causes large local speed fluctuations which accentuate and amplify turbulence and unsteady flow levels particularly in rotor-stator interaction zones. Measurements of typical turbulence parameters within the rotor are only possible by means of such techniques as the laser velocimeter. A comparative analysis of flow in two pump scale models is presented in this paper. Each pump comprises both a smooth and bladed nozzle, and averaged and fluctuating speed vector and turbulence values are presented and analysed.
L'art de l'argumentation ne cède pas ses droits en situation de guerre. Au contraire, la préparation des conflits, la conduite des opérations et la reconstruction de la paix sont d'intenses moments ...de persuasion, de négociation et de confrontation dans lesquels l'art oratoire occupe toute sa place. Fruit d'une collaboration active entre historiens et juristes, cet ouvrage propose une réflexion novatrice sur les usages et les fonctions du discours en situation de conflit armé. Les articles réunis ici transportent le lecteur des plaines du Péloponnèse et de l'Italie romaine au Tribunal international de La Haye, en passant par les guerres d'Attila et de Bourgogne, par les conflits religieux et ceux de la monarchie absolue, ou encore par la guerre de Sécession et les deux conflits mondiaux. S'y révèlent les modalités et les enjeux de la parole en guerre : qu'elle s'efforce de justifier ou de contester l'engagement, la violence ou les buts de guerres ; de convaincre les autorités politiques et l'opinion publique d'entrer dans le conflit ou les combattants de sacrifier leur vie ; qu'elle implore le pardon ou réclame des réparations ; qu'elle cherche à s'emparer de la gloire d'une victoire ou à repousser la honte d'une défaite.
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