Ultrasonography of the brachial plexus, normal appearance and practical applications.

Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots are accurately identified due to the shape (a single tubercle) of the transverse process of C7 in the paravertebral space, and the superficial position of C5 in the interscalene groove. The téléphérique technique allows the roots, trunks and cords to be followed easily into the supraclavicular fossa. In just a few years, ultrasound imaging of the plexus has become a routine anesthesia examination for guiding nerve blocks. In trained hands, it also provides information in thoracic outlet syndromes, traumatic conditions (particularly for postganglionic lesions) and tumoral diseases. Even if MRI remains the standard examination in these indications, ultrasound, with its higher definition and dynamic character, is an excellent additional method which is still under-exploited.

Infections of the spinal column--spondylodiscitis.

Infectious spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebral bodies due to the introduction of a pyogen, usually by the haematogenous route. Plain film radiography (which is usually normal in the early stages) shows blurring of the vertebral endplates and a loss of disc height that progresses quickly. MRI is the examination of choice, as it detects oedema within the trabecular bone very early, before the onset of destruction. Injection of a contrast medium with fat signal saturation improves detection and visualisation of the spread of infection in the soft tissue and epidural space. Imaging can also be used to guide a needle aspiration to investigate the infective agent.

Effect of 12 months treatment with chondroitin sulfate on cartilage volume in knee osteoarthritis patients: a randomized, double-blind, placebo-controlled pilot study using MRI.

This pilot study aimed to evaluate the correlation between clinical symptoms and cartilage volume through MRI in patients with knee osteoarthritis after 48 weeks of treatment with Structum®. Multicenter, double-blind, placebo-controlled, parallel-group study. Symptomatic knee osteoarthritis patients aged 50-75 years received either Structum® (500 mg twice daily; N = 22) or placebo (N = 21) during 48 weeks. Inclusion criteria were global pain in the target knee ≥30 mm (VAS 0-100) and radiological Kellgren-Lawrence grade 2 or 3. Clinical assessments included Lequesne index and VAS for pain on motion, at baseline, 24 and 48 weeks, and MRI at baseline and at 24 and 48 weeks. Global and compartments cartilage volume, joint cartilage abnormalities, meniscal lesions, ligaments abnormalities, synovitis, synovial effusion, osteophytes, subchondral cysts, popliteal cysts and subchondral oedema were quantified. The quantitative and qualitative reproducibility of MRI was tested by the Spearman correlation coefficient and kappa coefficients, respectively. Treatments were compared by an analysis of covariance with baseline value as covariate. Groups were comparable at baseline for demographics, disease characteristics, and cartilage volumes. A significant inter-readers correlation was seen for the assessment of cartilage volumes, number of cysts, and osteophytes (correlation coefficients from 0.951 to 0.980 within investigator and from 0.714 to 0.957). After 48 weeks, symptoms improved in both groups. The total cartilage volume increased in the Structum® group (+180 mm(3) + SD) which opposed to a loss in the placebo (-46 mm(3) + SD; NS). No statistically significant differences between groups were observed for the other MRI parameters. No correlations were evidenced between key MRI parameters changes and symptoms. The difference in the evolution of cartilage volume between the two groups could reflect a structure modifying effect of Structum®. This pilot study confirms the usefulness of quantitative and qualitative MRI as a sensitive tool to assess a structure modifying drugs in knee osteoarthritis.

[The chronically limping child]. / Boiterie chronique de l'enfant.

Chronic limping in children usually indicates the presence of an underlying organic lesion. Clinical evaluation establishes the site and type of limping. It may suggest a neurological or mechanical lesion or locoregional etiology at the level of the hip or pelvis. Plain radiographs and ultrasound are firstline imaging techniques. The diagnosis may be delayed either due to ignorance of age-specific entities or false positive or negative results on plain films and ultrasound. MRI now plays a major role for diagnosis. Multiple potential underlying etiologies including trauma, infections, arthritides or tumors are best evaluated with MRI. The MRI examination should not be limited only to the hip joint.

[Imaging features of pubalgia]. / Imagerie des pubalgies.

Pubalgia is a generic term used to describe groin pain due to a multitude of different etiologies such as skeletal (microtraumatic pubic symphysis arthropathy), muscular (adductor or rectus abdominis disorders), or abdominal wall (inguinal hernia) disorders. Diagnosis relies mainly on MRI for musculoskeletal disorders and ultrasound for abdominal wall disorders.

[Evolution of the pelvis and hip throughout history: from primates to modern man]. / Évolution du bassin et de la hanche « à travers les âges ¼: des primates à l'homme moderne.

The evolution to a bipedal mode of locomotion was accompanied by a verticalization of the spine and a modification in the shape of the pelvis: horizontal curvature and sagittal rotation. Phylogenesis meets ontogenesis: flat bones in fetuses similar to the monkey, australopithecus features at birth and "human-like" features by 7 or 8years of age. These anatomical modifications explain the characteristics of human bipedalism: stable, economical, with hip and knee extension in the standing position with little lateral motion. Some pathologies induce a regression to a more archaic mode of bipedal locomotion.

[Cross-sectional imaging of peripheral involvement in psoriatic arthritis]. / Nouvelle imagerie des atteintes périphériques du rhumatisme psoriasique.

The purpose of this article is to: 1) describe the main plain film, ultrasound and MR imaging features of peripheral involvement in psoriatic arthritis, 2) describe the advantages of ultrasound and MRI at the early stages of the disease; 3) describe how to use MRI and ultrasound in order to assess response to tumor necrosis factor-alpha blocker therapy.

[Pelvic and spinal MR follow-up of multiple myeloma patients after high-dose chemotherapy and autologous peripheral blood stem cell transplant]. / Suivi par IRM pelvi-rachidienne d'une cohorte de patients atteints de myélome multiple, traités par chimiothérapie à haute dose et autogreffe de cellules souches périphériques.

PURPOSE: To evaluate the changes of bone marrow lesions on pelvic and spinal MR in patients with multiple myeloma after high-dose chemotherapy and autologous peripheral blood stem cell transplant. PATIENTS AND METHODS: Pelvic and spinal MR examinations were obtained at presentation (myeloma diagnosis) and 1 year after transplant in 20 patients that were part of a group of 39 patients enrolled in a prospective study. The type of marrow replacement (classified in stages with stage 0: normal; stage 1: salt and pepper; stage 2: focal infiltration; stage 3: diffuse infiltration), the number and size of marrow lesions and the number of vertebral compression fractures were recorded. We have compared the findings prior to and following transplant, with correlation to the response to treatment and the use of biphosphonates. RESULTS: The type of marrow replacement was improved following transplant in 65% of patients (not statistically significant). The number and size of nodules > 20 mm showed significant reduction (p = 0.0224 and p = 0.0237 respectively). Lesions on MR improved in 50% of patients with good response and 75% of patients with poor response to treatment. Patients receiving biphosphonates showed more vertebral compression fractures. CONCLUSION: The evolution of marrow replacing lesions on MR is discordant compared to the biological and clinical response to treatment. Pelvic and spinal MR evaluation at the time of diagnosis does not appear to be a good predictive factor of response to treatment. Biphosphonates do not appear to prevent new vertebral compression fractures. Pelvic and spinal MR provides interesting data in the follow-up of patients with myeloma following autologous transplant, especially in the local evolution of marrow replacing lesions, but our results do not justify its use in routine clinical practice.

[High resolution MR imaging of the skin: normal imaging features]. / IRM haute résolution de la peau: aspects normaux.

PURPOSE: To describe the qualitative and quantitative MR imaging features of normal skin. MATERIALS AND METHODS: Thirty-one normal subjects underwent MR evaluation on a 1.5 Tesla magnet using a dedicated coil. Several skin sites were evaluated (back at the scapular level, posterior calf and inferior heel). Two pulse sequences were acquired: a SE T1W and a gradient-echo sequence (FIESTA). Qualitative and quantitative analysis was performed for all three sites. RESULTS: In normal subjects, the different skin layers (callus, epidermis, dermis, hypodermis and pilosebaceous follicles) can be separated and measured on MR. Epidermis and hypodermis are hyperintense whereas dermis is hypointense. Our results confirm the presence of qualitative and quantitative variations between different skin regions. In some cases, a differentiation between papillary and reticular dermis can be achieved. Pilosebaceous follicles and the deep vascular network were clearly depicted on the FIESTA sequence. Measurements for each skin layer were compared based on sex, site and MR pulse sequence. CONCLUSION: MRI provides evaluation of the different skin layers, epidermis, dermis, and hypodermis, and their different components.

[Elbow: plain radiographs]. / Coude: radiographies standard.

Plain radiographs usually allow accurate diagnosis. In this paper, the main radiographic projections will be reviewed along with their normal imaging features. In spite of significant advances in imaging of the elbow (multiplanar capabilities of MRI, volumetric CT imaging), conventional radiographs of the elbow remain a firstline imaging technique in the evaluation of disorders of the elbow.

[Shoulder radiography: useful radiographic views in current practice]. / Radiographies de l'épaule: les incidences utiles en pratique courante.

The purposes of this paper are: 1) to review the different radiographic projections commonly used to explore shoulder pathology; 2) to propose a practical approach for radiographic evaluation of the shoulder, adapted to the main clinical situations; 3) to recognize the different imaging features of the most frequent shoulder diseases.

[Shoulder pain: image guided management]. / Douleur de l'épaule: apport de la radiologie interventionnelle.

Different interventional radiology techniques used in the management of the painful shoulder will be reviewed in this article. The etiology of shoulder pain is variable, and several image guided procedures are available, from simple to more complex. US and fluoroscopy guided intra-articular and bursal infiltration techniques will be described. Percutaneous needle removal of calcific deposits and capsular distension/infiltration of adhesive capsulitis will be discussed. Cysts in the spinoglenoid or suprascapular notch may cause impingement of the suprascapular nerve and may be aspirated under US guidance. Finally, percutaneous radio-frequency treatment of symptomatic bone metastases under CT guidance may at times be performed. Musculoskeletal radiologists should be familiar with this spectrum of image guided interventional procedures.

[Imaging of traumatic injuries of the shoulder]. / Imagerie des traumatismes de l'épaule.

The goals of this article are: 1) to review the different radiographic projections commonly used at the time of initial imaging evaluation of patients presenting with traumatic injuries of the shoulder; 2) to review the indications and findings of cross-sectional imaging modalities in the assessment of shoulder trauma; 3) to recognize the main anatomical lesions secondary to traumatic injuries of the shoulder.

[Ultrasonography of the tendons: from image to pathology]. / Ecografía tendinosa: de la imagen a la patología.

Radiology allows to define etiologies of tendon injuries and authorize a most suitable treatment. For that reason, the use of the sonography has been developed from several years and has four main purposes to define the type of injury and to orient the treatment: to confirm the real existence of the tendon tear, to need the exact location the same one, to determine the gravity of the lesion, and finally, to evaluate its acute or chronic character. In this paper, we will try to define the normal pattern of the tendon and describe the more frequent lesions of the shoulder or the ankle: complete or partial tear, tendinopathy, dislocation and enthesopathy.

[Use of SSFSE sequence for cine-MRI of the cervical spine in professional front-line rugby players]. / Utilisation de la séquence SSFSE pour la Ciné-IRM du rachis cervical du rugbyman professionnel de première ligne.

A SSFSE sequence is proposed in the sagittal plane for a cine-MRI of the cervical spine in front-line rugby players. Thus one can complete the static study and improve the detection of canal stenosis and the prevention of spinal cord injuries.

[Ultrasound features of entesopathy in patients with psoriatic dactylitis]. / Signes échographiques d'enthésopathies au cours des dactylites psoriasiques.

PURPOSE: To describe the sonographic features of entesopathy in patients with psoriatic dactylitis. Materials and methods. Clinical, radiographic and sonographic evaluation of 120 hand joints with clinical abnormality including 20 fingers in 17 patients with rheumatoid arthritis (RA) and 20 fingers in 17 patients with psoriatic arthritis (PA). RESULTS: Forty cases of dactylitis. In patients with RA: 29 cases of synovitis, 15 cases of tenosynovitis, and 2 cases of tendinitis; in patients with PA: 21 cases of synovitis and 3 cases of tenosynovitis. Bone erosions were present in RA patients whereas erosions with bone production were present in PA patients. A total of 60% of RA and PA patients showed erosions on conventional radiographs. Features suggesting entesopathy were present in PA patients only: specific changes of P3, capsular hyperostosis and periarticular periostitis. CONCLUSION: Based on evaluation of PA patients, it seems that sonographic features suggesting entesopathy in patients with dactylitis may be present.

[Febrile osseous pain in children with sickle cell disease: MRI findings]. / Douleurs osseuses fébriles chez l'enfant drépanocytaire: apport de l'IRM.

PURPOSE: The aim of this study was to report the MRI findings that can suggest a vaso-occlusive crisis in cases of febrile osseous pain in children suffering from sickle cell disease. MATERIALS AND METHODS: MRI (T1 and T2 weighted sequences and T1 weighted sequence with fat saturation before and after gadolinium injection) was performed in 10 children with sickle cell disease, presenting with febrile osseous pain. The diagnosis of vaso-occlusive crisis was made after fast improvement due to symptomatic treatment and negative bacteriological result. RESULTS: MRI was abnormal in all cases. A multifocal localisation was found in 2 cases. Bone marrow abnormalities were constant. In 10 cases, high T1 and T2 signal and metaphyso-diaphysial lesions were noted. Heterogeneous medullar enhancement with "ink stain" feature was constant. Early periosteal abnormalities were noted in 8 cases with inflammatory or stratified features. Cortical thinning was found in 1 case. Soft tissue abnormalities were observed in 5 cases with inflammatory features in 4. CONCLUSION: Multifocal synchronous localisation, medullar abnormalities resulting from hemoglobin degradation, heterogeneous enhancement, early periosteal abnormalities and associated soft tissues swelling are MRI findings suggesting acute vaso-occlusive disease.

[Unusual association of chylopericardium and aortic hypoplasia in a neonate]. / Association inhabituelle chez un nouveau-né d'un chylopéricarde et d'une hypoplasie aortique.

We report the case of a neonate with two very rare anomalies: primary chylopericardium and diffuse hypoplasia of the thoraco-abdominal aorta. The presentation on the 16th post-natal day was with dyspnoea and refusal to feed. The initial clinical examination revealed hepatomegaly and weak femoral pulses. 2D ultrasound gave a diagnosis of a large compressive pericardial effusion combined with moderate hypoplasia of the aortic isthmus. Emergency pericardial drainage removed 80ml of chylous liquid. Following prolonged parenteral nutrition, the pericardial effusion stabilised. A mechanism of diffuse vascular disease affecting the aorta and the lymphatic system is suggested.

[Necrolytic cutaneous erythema and pancreatic tumour: the glucagonoma]. / Erythème nécrolytique migrateur et tumeur pancréatique: le glucagonome.

Glucagonoma is a rare neuroendocrine neoplasm. Characteristics are clinical (necrolytic migratory erythema, weight loss), biological (diabetes) and radiological (pancreatic tumor). The Authors report a case of glucagonoma that also secreted insulin.