Intérêt de l’entéro-IRM dans la maladie de Crohn

Thanks to recent technical developments, small bowel MRI has become an indisputable imaging technique in exploring small bowel Crohn’s disease. It is non-radiant and offers excellent tissue resolution and improved spatial resolution providing a mapping of small bowel lesions and a reliable assessment of the inflammatory activity of the disease; key information for therapeutic care. It requires digestive filling, either by enteroclysis or oral ingestion; the latter is privileged mainly due to its level of tolerance. Acquisitions are performed in coronal and axial planes, with T1- and T2-weighted sequences, with a gadolinium intravenous injection. The main signs to analyse are mural findings (thickening and contrast enhancement) and extra mural findings (comb sign, fistula, abscesses). Small bowel MRI is increasingly important and complementary to other techniques because it recognizes percutaneous and peridigestive abnomalies, fundamental to this pathology, not seen by capsule video and endoscopic explorations, which, on the other hand, provide a better analysis of mucosal abnomalies.     

Intérêt pronostique de l’infiltration du chorion dans les tumeurs vésicales pT1

IntroductionThe aim of our study was to evaluate the prognostic impact of tumor infiltration depth of the lamina propria and invasion or non-invasion of the muscularis mucosa of pT1 bladder tumors, studying recurrence and progression rate, overall survival, disease-free survival and progression-free survival.Patients and methodsAll slides were reviewed to determine the presence or absence of muscularis mucosa, invasion above (pT1a) or below (pT1b) the muscularis mucosa, and the invasion depth of the lamina propria (pT1m: a single focus of lamina propria invasion ≤0.5 mm, pT1e: single focus >0.5 mm of lamina propria invasion or multiple micro-invasive area).ResultsDepending on the invasion of the muscularis mucosa, the rate of recurrence and progression was more frequent in pT1b tumors in comparison to patients classified pT1a, with a recurrence rate of 84.6% (p = 0.0012) and a progression rate of 38.5% (p = 0.003). Depending on the degree of invasion of the lamina propria, the rate of recurrence and progression was more frequent for pT1e tumors in comparison to pT1m, with a recurrence rate of 57.2% (p = 0.05) and a progression rate of 17.9% (p = 0.11). Disease-free survival was 70.3 months for pT1a tumors against 53.6 months for pT1b tumors (p = 0.046), and it was 61.7 months for pT1e tumors against 55.5 months for pT1m tumors (p = 0.85).ConclusionThe classification of bladder tumors based on the invasion of the lamina propria has proved its efficiency through the recurrence rate and the progression rate among our patients.