Distal coil embolization of the superior rectal arteries for disabling chronic bleeding due to haemorrhoidal disease is safe and effective in patients untreatable by surgery.

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Image-guided thermal ablation is a well-established locoregional technique for the treatment of hepatocellular carcinoma (HCC). HCC surveillance programs have led to an increase in the number of patients diagnosed at an early stage of the disease who are eligible for thermal ablation. Tumor response is assessed on imaging and requires extensive follow-up; thus, radiologists play a key role in defining the technical success and efficacy of treatment as well as identifying progressive disease. Although they are rare, complications, such as secondary infections, must also be identified. Several contrast-enhanced imaging techniques can be used at different postprocedural timepoints but magnetic resonance imaging (MRI) and computed tomography (CT), which allow both liver-centered and whole-body imaging are the cornerstones of follow-up. This review describes the imaging features of HCC following thermal ablation. After describing the basic technical elements of follow-up imaging, imaging findings are divided into three groups: normal and expected features (the good), abnormal features, uncontrolled disease, and complications (the bad), and atypical or rare presentations (the ugly). J. Magn. Reson. Imaging 2016;44:1070-1090.

We conducted a prospective study to evaluate a new hemorrhoidal bleeding score (HBS). Methods: All consecutive patients who had consulted between May 1, 2016, and June 30, 2017 for bleeding hemorrhoidal disease were prospectively assessed at a proctological department. The study was conducted in two stages. A first stage assessed the validity of the score on a prospective patient cohort. A second stage assessed the interobserver reproducibility of the score on another prospective cohort. Results: One hundred consecutive patients were studied (57 men, mean age 49.70 years). A positive association between HBS and surgery indication was found (p<0.001). A cutoff value of the score of 5 ( 5 vs. > 5) separated patients from surgical to medical-instrumental treatment with a sensitivity and specificity of 75.00% and 81.25% respectively. In the multivariate analysis, only HBS was significantly associated with the operative decision (OR: 12.22). Prolapse was no longer significantly associated with the surgical indication. After a mean follow-up after treatment of 7 months, HBS improved statistically significantly (p<0.0001). For the reproducibility of the score, an additional 30 consecutive patients (13 men, mean age 53.14 years) were enrolled with an excellent agreement between two proctologists (kappa= 0.983). Conclusion: HBS is sensitive, specific and reproducible. It can assess the severity of hemorrhoidal bleeding. It can discriminate between the most severe surgery-indicated patients, and does so in a more efficient way than the Goligher's prolapse score. It also allows to quantify the extent of change in hemorrhoidal bleeding after treatment.

Je remercie le Pr Vilgrain d'avoir accepté de présider ce travail de thèse. Votre bienveillance et vos conseils m'auront permis de m'élever. Je vous remercie d'avoir créé et d'entretenir dans votre service cette ambiance unique, donnant l'envie et le courage de faire, et de bien le faire. Je remercie le Pr de Kerviler d'avoir accepté de juger ce travail de thèse. Je vous remercie de me faire confiance et de me donner l'opportunité de travailler à vos côtés. Cela fait bien trop longtemps que j'attends. Je remercie le Pr De Baere d'avoir accepté de juger ce travail de thèse. Je vous remercie d'inspirer ma génération de radiologues interventionnels. Je remercie le Pr Luciani d'avoir accepté de juger ce travail de thèse. Votre regard et votre expertise sur ces sujets me sont chers. Je remercie mon directeur de m'avoir constamment accompagné et soutenu dans ce projet. Je te remercie surtout d'être bien plus qu'un directeur à mes yeux. Je remercie les différents maîtres, qui année après année ont modelé ma pensée et mon raisonnement : Foucauld, Laure, Sophie, Anne-Laure, Onorina, Bertrand et Jean-Noel. Je remercie l'équipe d'anatomo-pathologie de Foch de m'avoir montré à quel point le diagnostic était primitif en radiologie, et bien sûr pour tout le reste. Je remercie tous les radiologues interventionnels qui ont, si patiemment, accompagnés mes très lents gestes : Kim, Philippe C, Nourrezzamene, Tolis, Mohammed, Carmella, Galadec, Philippe B et Felipe. Je serai un peu de vous tous. Je remercie la fraternité Beaujon de m'avoir accueilli, intégré, fêté, sorti, réintégré et refêté.

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