[Cutaneous foreign body granulomas following cervico-facial arterial embolization: Three cases]. / Granulomes cutanés à corps étrangers après embolisation artérielle de la sphère cervico-faciale : trois cas.

BACKGROUND: Foreign body granuloma is an inflammatory tissue reaction to exogenous material. Classically it appears on the face after aesthetic procedures. Herein we report for the first time three cases of facial granulomatous reactions to microbeads after arterial cervico-facial embolization. PATIENTS AND METHODS: Three patients underwent embolization of the facial arteries using Embogold® microbeads in a setting of epistaxis or tumoral hemostasis. Within 10 to 45 days painful, inflammatory, subcutaneous nodules appeared on the homolateral side of the face. Histological samples showed an inflammatory response with giant cells as well as the presence of microbeads in the skin. A favorable outcome was achieved with colchicine in one patient and with surgery in another; the third patient was lost to follow-up. DISCUSSION: The embolizing microspheres produced a local inflammatory reaction, with destruction of the vascular wall and bead migration to facial tissue leading to a granulomatous reaction. The occurrence of three cases within a period of few weeks, with several different operators and batches of products, is surprising considering the long-standing use of the product. There was no common comorbidity in the patients and no suggestion of trauma. Retrospective analysis of the product batches was normal. Gold staining could play a role in severe inflammatory response to Embogold® particles. CONCLUSION: These three cases illustrate the value of discussing potential foreign body granulomatous reaction in cases of facial nodules following cervico-facial embolization. Colchicine may offer a valuable therapeutic alternative.

[Nasopharyngeal carcinoma]. / Cancer du nasopharynx.

Nasopharyngeal carcinoma is relatively common. Undifferentiated Carcinomas of Nasopharyngeal Type (UNCT) are endemic Epstein-Barr virus (EBV)-related tumors. They are mainly radiosensitive. The role of imaging is to assess locoregional extension, TNM classification and adjust the radiation fields. MRI is essential to determine the initial extension. CT is useful to confirm the presence of bone involvement and evaluate nodal status. MRI and CT are necessary for the post-treatment follow-up.

[Cervical lymph nodes]. / Adénopathies cervicales.

Imaging plays a chief role in the care and monitoring of patients in cervico-facial oncology. The radiologist must know the anatomy of different lymph nodes as well as signs of malignancy (hypertrophy, enhancement, necrosis, capsular rupture, etc.). CT is still the first-line examination because of its high reliability, its accessibility and its ability to make an assessment of the upper aero digestive ways at the same time. Ultrasound is very accuracy, and allows the realization of cytoponction, but does not provide a complete exploration of the neck. MRI does not appear to be indicated for the first intention, but the new rapid sequences (STIR, diffusion) seem interesting. The PET-CT is useful in post-therapeutic management of patients, and probably in the initial staging, but its accessibility is poor.

[Peripherally inserted central catheters (PICC): a promising technique]. / Cathéters centraux insérés par voie périphérique: une technique prometteuse.

To describe technical features and benefits from PICC lines.

Anterior and posterior hypopituitarism with pituitary stalk abnormalities.

Hypopituitarism and diabetes insipidus are often idiopathic conditions. A retrospective study of 6 cases of diabetes insipidus and 8 cases of partial or global idiopathic anterior hypopituitarism has shown that MRI is of considerable value to detect abnormalities of the pituitary stalk or hypothalamo-pituitary "relay". On the basis of MRI findings, some cases of idiopathic hypopituitarism can now be grouped together in a new entity which may be called hypopituitarism due to neonatal transection of the pituitary stalk.

[Ante- and posthypophyseal insufficiency with infundibulum abnormalities]. / Insuffisance anté-et post-hypophysaire avec anomalies de la tige pituitaire.

The hypopituitarism and the diabetes insipidus are often idiopathic. A retrospective study of 6 cases of diabetes insipidus and 8 cases of partial or total idiopathic antehypophyseal insufficiency has shown the value of MRI to demonstrate anomalies of the infundibulum or hypothalamic-hypophysis "stages". MRI allows to bring together some cases of idiopathic hypopituitarism in a new entity which is the hypopituitarism due to a newborn section of the infundibulum.

[CT evaluation of total HIP prosthesis infection]. / Evaluation des infections de prothèses totales de hanches au scanner.

PURPOSE: To evaluate the ability of CT imaging to detect infectious lesions in total hip prosthesis. PATIENTS AND METHODS: CT was performed in 17 cases of suspected total hip prosthesis infection. Images were reviewed to evaluate for the presence of soft tissue abscess, hip joint effusion or fistula and peri-prosthetic lucency or erosion at bone window setting. The feasibility of CT imaging is assessed with regards to metallic artifacts. RESULTS: Infection was confirmed in 10 hips. A soft tissue abscess was present in 8 of these cases, in association to a joint effusion, presumably septic, in 7 cases. A fistula was identified in 8 cases. A peri-prosthetic lucency was present in 10 cases, 7 of which with infection, and erosions were noted in 4 patients, 2 of which with infection. Metallic artifacts reduced image quality but did not prevent detection of soft tissue abscesses. CONCLUSION: CT is useful for detection of soft tissue abscesses in patients with infected hip prosthesis. CT is useful for surgical planning or follow-up of patients treated conservatively.

MRI of intramedullary cavernous haemangiomas.

We reviewed 11 cases of intramedullary cavernous haemangiomas (IMCH) studied by MRI, to assess its diagnostic value in these lesions. Follow-up MRI was obtained in five patients 7 days-2 years following the initial study. In one case a postoperative examination was obtained. The diagnosis was pathologically proven in ten cases, and supported in the last by a family and personal history of cavernous haemangiomas. A reticulate appearance with areas of mixed signal intensity in both T1- and T2-weighted images was the most common finding. Homogeneous high, low or intermediate signal intensity was each found in one case. Two small lesions gave low signal. A rim of low signal was less common than in cerebral cavernous haemangiomas. In one case, the brain showed more than 20 lesions with the MRI appearances of cavernous haemangiomas. In two of five patients, serial preoperative MRI showed progressive disappearance of high-signal areas on both T1- and T2-weighted images. To find a haemorrhagic intramedullary lesion on MRI is not rare. Although the appearances are not pathognomonic, an IMCH can be suggested. We suggest that the following characteristics may help: (1) a personal and/or family history of cavernous haemangiomas; (2) typical MRI appearances of mixed acute, subacute and chronic haemorrhage; (3) a tendency for signal intensity to decrease on follow-up; (4) normal spinal angiography; and (5) associated brain lesions.

Interest of TOF PET for clinical applications.

The interest of PET is now well established in medical research. Recently PET has proved to be also useful in the clinical domain e.g. for the diagnosis of epilepsy, myocardial disease etc... Its use has been so far limited by the cost of the radionuclide production and the cost of the PET itself. However, inexpensive, compact cyclotrons and centralized distribution of F18 are beginning to facilitate the availability of radionuclides. Thanks to its performances in terms of high random rate, sensitivity gain, random reduction, TOF is becoming practical for clinical use, especially with new types of architecture allowing the reduction of the cost of the detection head, so far the main obstacle to the use of TOF PET in clinical domain.

Adenoid cystic carcinoma of the head and neck: evaluation with MR imaging and clinical-pathologic correlation in 27 patients.

Twenty-seven adenoid cystic carcinomas (ACCs) of the head and neck in 27 patients were evaluated in a retrospective study based on findings at magnetic resonance (MR) imaging and pathologic and clinical examination. Clinical follow-up was obtained over a mean period of 6.3 years (range of follow-up, 3 months to 17 years); all patients underwent one to seven MR examinations. On T2-weighted images, lesions with low signal intensity corresponded to highly cellular tumors (solid subtype) with a poor prognosis; lesions with high signal intensity corresponded to less cellular tumors (cribriform or tubular subtype) with a better prognosis. MR images were not specific in differentiation of ACCs from other types of tumors; this result underscores the need for biopsy to ensure correct diagnosis. Local, intracranial, osseous, and perineural invasion was depicted, but because of its lack of specificity, MR imaging caused overdiagnosis of tumor extension, particularly perineural spread and bone abnormalities.