Comparison of MRI and computed tomography in the various stages of plasma cell disorders: correlations with biological and histological findings. Myélome-Midi-Pyrénées Group.

OBJECTIVE: Our study had a double aim: (i) to evaluate the sensitivity and the specificity of computed tomography (CT) and magnetic resonance imaging (MRI) in the different stages of plasma cell disorders, and (ii) to correlate CT and MRI with the biological, cytological and histomorphometric parameters. METHODS: Twenty-four patients with MGUS according to Kyle, 12 patients with stage 1 and 12 with stage 3 myeloma, and 30 age-matched controls underwent MRI (sagittal views of the spine and coronal views of pelvis and femurs), CT (axial views from T10 to L5, sacrum, iliac crests), a histomorphometric study, determination of plasmocyte infiltration, and measurement of paraprotein, B2-microglobulin, the ca/cr ratio and osteocalcin. RESULTS: Heterogeneous osteopenia with microlacunae seen on CT scan and diffuse decreased signal intensity which remained higher than the signal of the intervertebral disk on T1 weighted sequences (MRI) were not peculiar to myeloma. Lacunae larger than 5 mm with trabecular disruption observed on CT, diffuse decreased signal intensity lower than the disk signal, and a multinodular appearance on MRI, not seen in the controls or in patients with MGUS, were observed in all stage 3 myeloma and in 40% of stage 1 myeloma patients. MGUS and stage 1 myeloma patients with abnormal MRI had a higher monoclonal component, plasma cell percentage and hypercellular bone marrow than those with normal MRI findings. MGUS or stage 1 myeloma patients with abnormal CT had a lower trabecular bone volume than those with normal CT. CONCLUSIONS: CT and MRI both reveal specific lesions in 40% of stage 1 myeloma patients. These methods are thus complementary in bone and bone marrow studies in myeloma.

[Intramuscular hemangioma. Contribution of MRI]. / Hémangiome intramusculaire. Apport de l'IRM.

The authors report one case of a relatively common benign tumor, hemangioma, although in an uncommon location, intra-muscular. The radiological exploration, principally MR imaging has a great interest to specify the diagnosis and the regional extension. Intramuscular hemangioma appears with a relatively low signal intensity on T1-weighted images, but demonstrates a clear delineation of the extent of the lesion on T2-weighted images, because of high contrast between hemangiomas and surrounding muscle. The informations obtained with MR imaging may be valuable clinically in planning surgical resection.

[Cine-MRI of the shoulder. Normal aspects]. / Ciné-IRM de l'épaule. Aspects sémiologiques normaux.

PURPOSE: To define the normal patterns of gleno-humeral joint, with kinematic MR imaging in asymptomatic volunteers. MATERIAL AND METHOD: Twenty asymptomatic volunteers (39 shoulders) were studied with a 1.5 Tesla imager. Successive acquisitions Flash (99, 18, 15 degrees) were obtained in the axial plane, from full internal to full external rotation, at the superior, mid and inferior glenoid level. RESULTS: Free edge of the anterior labrum was noted slightly mobile, its base was always immobile. The anterior labrum exhibited modification of shape and increased signal intensity in internal rotation (54%). The posterior labrum remained motionless in 97% and neither shape or signal intensity changes were noted in internal rotation. Inferior labro-capsular ligamentous complex was visualised in all cases. The anterior capsular joint was taut in external rotation and exhibited a slack (51%) or folded (13.5%) pattern during internal rotation. CONCLUSION: Kinematic MR imaging allows a dynamic assessment of the different anatomic components which may be implicated in shoulder instability. It provides information about the labro-capsular ligamentous complex.

[Strict anteroposterior radiography of the shoulder: value of the assessment of rotator cuff tears]. / La radiographie de l'épaule de face stricte en décubitus dorsal: intérêt dans le bilan des ruptures de la coiffe des rotateurs.

PURPOSE: To compare the contribution of various radiographic projections in the evaluation of impingement syndrome and rotator cuff tears. Materials and method. We realized a prospective study in 53 patients with suspected rotator cuff tear, evaluated by plain radiographs and arthrography (gold standard). 31 patients were men and 22 were women (mean age 51 years). In all patients, anteroposterior radiograph, strict anteroposterior straight-beam decubitus view and anteroposterior radiograph during Leclercq's maneuver of the affected shoulder were obtained. The population was divided into three groups: group 1: normal arthrography (n=19), group 2: isolated supraspinatus tendon tear (n=23), group 3: rupture of the supraspinatus and infraspinatus tendons (n=11). The acromio-humeral space was measured on all these views and differences between the three groups were statistically analyzed. RESULTS: There is a significant statistical difference between the height of the acromio-humeral space found in patients with isolated tear of the supraspinatus tendon and those with a tear extending to the infraspinatus tendon (p=0.0001). The ROC methodology showed a better accuracy of the strict anteroposterior straight-beam decubitus view in cases of wide ruptures of the rotator cuff, and this for a selected threshold value of 6 mm. CONCLUSION: Strict anteroposterior straight-beam decubitus view, seems to be easy to realize, cheap, reproducible and very powerful in the preoperative assessment of patients with suspected rotator cuff tendon tear. It allows an excellent visualization of the acromioclavicular joint.

[Gorham disease of the rib with osteolysis followed by bone remodeling. Study with magnetic resonance imaging]. / Maladie de Gorham costale avec ostéolyse puis réapparition osseuse. Etude en imagerie par résonance magnétique.

Gorham disease, or massive osteolysis, generally presents as osteolysis of a girdle bone. We report the case of a young adult who presented a fracture followed by destruction of the third right rib, then by regrowth eight months later.

[Multiple bronchial artery aneurysms in a patient with silicosis]. / Anévrismes multiples artériels bronchiques chez un silicotique.

We report a case of haemoptysis in a long-standing silicotic in whom arteriography revealed saccular aneurysms of the bronchial arteries. Embolisation was satisfactory in excluding the aneurysms and leading to a favourable outcome. The mechanism of the formation of these aneurysms which is extremely rare was discussed with reference to the few reports and literature.

[Results of the surgical repair of the rotator cuff. Radio-clinical correlation]. / Résultats de la chirurgie réparatrice de la coiffe des rotateurs. Corrélation radio-clinique.

INTRODUCTION: This study was undertaken to evaluate the functional results of rotator cuff tear repair. MATERIAL AND METHODS: This retrospective study concerned 108 shoulders operated with a minimal follow up of 1 year (mean 5.5 years). The average age of this masculine population was 55 years. The rotator cuff tear involved: 39 times the supra-spinatus, 59 times the supra-spinatus and infra-spinatus, 6 times the supra and infra-spinatus and the teres minor, 4 times the supra-spinatus and superior part of the sub-scapularis. All these patients were reviewed using the Constant's score. The functional results were compared with an ultrasonographic study and a radiographic protocol including 5 views. Muscle strength was measured objectively with the aid of an isokinetics testing (Cybex II). RESULTS: The results were satisfactory concerning pain (67 per cent did not suffer anymore) daily activity (78 per cent experienced a slight disability) and mobility (92 per cent of the patients had an anteflexion > 120 degrees and 82 per cent an external rotation > 40 degrees). Concerning strength, the results were variable and related to the posterior extension of the tear. Most of the patients complained of weakness (mean objective deficit of strength = 25 per cent), specially a disability during repetitive over head activities. The radiographic protocol analysed the humeral head position (16 per cent of spontaneous acromio-humeral interval narrowing on the standard X Ray and 43 per cent of dynamic narrowing on Leclercq view). The spontaneous narrowing was correlated with a severe omarthrosis and a re-rupture of the rotator cuff. All these re-ruptures involved an infraspinatus lesion. Dynamic narrowing, with an acromial interval < 7 mm, were seen in 71 per cent of the patients with posterior extension of the rotator cuff tear explaining the poor final result; the ultrasonographic assessment found a thinning (75 per cent of patient) and a heterogeneity in the infraspinatus even after repair. We found 14 re-ruptures and 6 ultrasonographic disorganised structures. DISCUSSION: A well preserved external rotation and a centred head gave good result because they were associated with the integrity of the infra-spinatus, essential to the muscular balance of the rotator cuff and necessary for the dynamic and static centering of the humeral head. In 71 per cent of the cases, the suture of the posterior cuff tear did not allow a good dynamic position of the humeral head. A spontaneous narrowing (static view) of the acromio-humeral interval was in relation with a re-rupture which evolved to omarthrosis. A dynamic narrowing with a Leclercq radiograph was associated with a functional deficit after rotator cuff repair. CONCLUSION: Humeral head stabilisation, supplied by posterior muscles of the rotator cuff, is essential in prevention of omarthrosis and in recovery of good strength. In several specific cases, we think that the transfer of an external rotator muscle, with a good humeral head stabilization action, may restore strength.

[Magnetic resonance imaging in osteoid osteoma]. / Imagerie par résonance magnétique des ostéomes ostéoïdes.

The purpose of this study was to determine magnetic resonance imaging (MRI) features of osteoid osteomas and to evaluate the place of MRI in the diagnostic workup of suspected osteoid osteoma by comparing its diagnostic value with that of computed tomography (CT). Nine patients with radioclinical features highly suggestive of osteoid osteoma were investigated using bone scintigraphy, CT scan and MRI. MRI sequences were weighted for T1 (TR: 500 ms-TE: 34 ms), T2 (TR:2000 ms-TE:50-100 ms) and T1 after intravenous injection of gadolinium-DTPA contrast material. The appearance of the nidus and surrounding area were analyzed, as well as the accompanying inflammatory reaction involving the bone marrow, soft tissues or synovium. All patients had surgical treatment. Clinical recovery was achieved in every case. Histological studies confirmed the diagnosis of osteoid osteoma in 7 patients. In two cases, histological confirmation was not obtained and the exact nature of the lesion therefore remained in doubt, although clinical and scintigraphic findings as well as the subsequent course were consistent with the diagnosis of osteoid osteoma. In 5 cases, MRI proved inferior to CT scan for detecting the nidus. MRI disclosed edema of the bone marrow not seen on CT scan sections in 5 cases, edema of the soft tissues in three cases, and synovitis with joint effusion in one patient with an epiphyseal osteoid osteoma. At present, MRI plays only an ancillary role in the diagnosis of osteoid osteoma, which rests on the concomitant use of bone scintigraphy and CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous extraction of an osteoid osteoma of the lumbar spine under CT guidance.

We report one case of percutaneous extraction of an osteoid osteoma of the lumbar spine under CT guidance. We describe the procedure of nidus extraction. This technique allows precise removal of the nidus with pathologic verification after extraction.

Osteoid osteoma: percutaneous resection with CT guidance.

In 24 patients with presumed osteoid osteoma in the appendicular skeleton (n = 23) and lumbar spine (n = 1), percutaneous resection with a drill system and computed tomographic (CT) guidance was performed. In the procedure, a 7-mm-diameter toothed drill inserted over a guide wire is used to remove the nidus. Twenty-three patients were successfully treated. Histologic confirmation of osteoid osteoma was obtained in 19 cases. In one patient, open surgery with bone grafting and osteosynthesis was necessary because of inadvertent extensive bone resection resulting from damage to the drill. All patients have remained free of pain and recurrence for 3-24 months. Although the procedure was effective in all patients, the 7-mm diameter of the toothed drill may cause difficulty in small bones or even danger in areas such as the posterior vertebral arch. In locations such as the tubular bones of the lower extremity and the femoral neck, however, this technique is feasible and may become the treatment of choice for osteoid osteoma.

Kinematic MR imaging of the shoulder: normal patterns.

OBJECTIVE: We performed this study to define the normal patterns of the glenohumeral joint with kinematic MR imaging in healthy volunteers. SUBJECTS AND METHODS: Twenty healthy volunteers (39 shoulders) were studied with a 1.5-T imager. Successive fast low-angle shot images (75/11 [TR/TE], 15 degrees flip angle) were obtained in the axial plane from full internal to full external rotation at the superior, middle, and inferior glenoid levels. RESULTS: The free margin of the anterior labrum was seen to be slightly mobile and its base was always fixed. The anterior labrum showed changes in shape and signal intensity during internal rotation (54%). The posterior labrum remained motionless in 97% of patients and no shape or signal-intensity changes were noted during internal rotation. The anterior joint capsule was taut during external and internal rotation, exhibited a slack pattern in 51% of patients, and a folded pattern in 14% of patients. CONCLUSION: Kinematic MR imaging, which permits dynamic evaluation of the various anatomic components that may be involved in shoulder instability, also provides information on the labrocapsular ligamentous complex.

CT and MRI of massive osteolysis of Gorham.

Massive osteolysis of Gorham is a clinical, radiographic, and histologic entity characterized by histologically benign vascular proliferation involving bone associated with extensive osteolysis. We present CT and MRI findings of the disease and serial radiography following the progressing bone destruction.

Percutaneous resection of osteoid osteoma under CT guidance in eight children.

In eight children with suspected osteoid osteoma, a percutaneous resection under CT guidance was performed. The specific drill resection system we currently use includes a 7-mm-diameter toothed drill. Osteoid osteomas were located in the appendicular skeleton in seven children and in the spine (second lumbar vertebral body) in one. All eight patients were successfully treated with complete relief of pain. There was no recurrence of symptoms during a follow-up period of 8-35 months. CT guidance was accurate enough to allow a focal bone excision, and no subsequent bone repair was needed. Histological confirmation was obtained in all cases. This simple and safe technique, when feasible, seems to be an effective means of treatment of osteoid osteoma in children.

Osteoid osteoma: CT-guided percutaneous resection and follow-up in 38 patients.

PURPOSE: To reevaluate at medium term the results of computed tomography (CT)-guided percutaneous resection of osteoid osteomas. MATERIALS AND METHODS: Thirty-eight patients who had undergone treatment by means of this technique were reexamined with a mean follow-up of 3.7 years. The short- and medium-term clinical course and histologic features of the resection specimens were analyzed. RESULTS: The bone fragment could be analyzed in all cases, and the diagnosis of osteoid osteoma was confirmed in 28 patients (74%). A different diagnosis was made in six patients: mucoid cyst, subchondral arthritic geode, fibrous dysplastic lesion, focal osteochondritis, or focal chronic osteomyelitis. Cure was obtained in 32 patients (84%), whatever the cause. Complications, generally minor and transient, were observed in nine patients (24%). The most severe complications were two femoral fractures and one focal chronic osteomyelitis due to Staphylococcus aureus infection. CONCLUSION: The results of this study confirm the efficacy of percutaneous resection of osteoid osteomas and the possibility of using this method for successful treatment of other small bone lesions.

[Magnetic resonance imaging in the bone sites of malignant non-Hodgkin's lymphoma. Apropos of 16 cases]. / Imagerie par résonance magnétique dans les localisations osseuses des lymphomes malins non Hodgkiniens. A propos de seize observations.

The primordial role of MRI in the staging of primary or secondary bone tumors has been clearly established. The authors report a study of 16 patients with NHL with suspected bone involvement, investigated by conventional radiography, bone scan, CT, bone marrow biopsy and MRI. The authors believe that, in the future, MRI will have an important role in the staging and follow-up of treatment of bone lymphomas. Better than any other techniques, MRI provides a precise assessment of tumor extension. It also represents a valuable method for monitoring patients during treatment by visualising the course of the disease.

Osteoid osteoma: MR imaging versus CT.

PURPOSE: To compare the performance of computed tomography (CT) and magnetic resonance (MR) imaging in diagnosis of osteoid osteoma. MATERIALS AND METHODS: Nineteen patients with histologically proved osteoid osteoma underwent CT and MR imaging before excision of the lesion. CT and MR images were compared regarding lesion conspicuity and detection of marrow, soft-tissue, and/or synovial changes adjacent to the primary lesion. RESULTS: CT was more accurate than MR imaging in detection of the osteoid osteoma nidus in 63% of cases. MR imaging was better than CT in showing intramedullary and soft-tissue changes in all cases. This may produce a misleading aggressive appearance on MR images. There was a statistically significant correlation between presence or absence of marrow or soft-tissue changes and treatment with antiinflammatory medications (P < .05). CONCLUSION: CT remains the best imaging modality for diagnosis of osteoid osteoma. MR images should not be interpreted without reference to plain radiographs and CT scans if serious errors in diagnosis are to be avoided.

Inoperable pulmonary aspergilloma: percutaneous CT-guided injection with glycerin and amphotericin B paste in 15 cases.

Fifteen patients with active inoperable pulmonary aspergilloma underwent percutaneous injection of a special therapeutic paste of glycerin and amphotericin B. This paste was warmed just prior to injection, and filling of the lesional cavity was achieved in one session if it was possible to obtain anaerobic conditions for destruction of the aspergilloma. Injection was performed with computed tomographic guidance with use of an 18-gauge flexible needle and with administration of anti-coughing analgesia. Follow-up was continued for 7 months on average. Filling of the lesion cavities required three sessions on average because of cough or bronchospasm. In 12 cases the aspergilloma regressed within 3 months and results at serology became negative. In three cases, there was no change in the cavity, but hemoptysis did not recur. Results in this series confirm the feasibility and efficacy of this palliative treatment.