[Role of imaging in the pre-treatment assessment and post-treatment follow-up of sinonasal malignancies]. / Place de l'imagerie dans le bilan préthérapeutique et la surveillance post-thérapeutique des tumeurs malignes du massif facial.

Malignant sinonasal tumors are the most frequent facial malignancies in adults. Assessment of these tumors requires a multidisciplinary approach and imaging plays a major role to define the precise tumor location, volume and extension and to plan post-treatment follow-up. MRI provides superior differentiation between tumor and surrounding tissues and depiction of intracranial or perineural extension. CT is a useful complement to demonstrate bone erosion or extension into the skull base.

Postoperative abdominal bleeding.

Postoperative bleeding following abdominal surgery is relatively rare and mainly depends on the type of surgery. Although bleeding is usually controlled by simple local treatment of symptoms, specific treatment including surgery or interventional radiology is sometimes necessary. This article reviews the clinical features that must be recognized depending on the type of surgery and especially focuses on the role of the radiologist in the management of this complication.

MR assessment of the brain maturation during the perinatal period: quantitative T2 MR study in premature newborns.

The purpose of our study is to trace in vivo and during the perinatal period, the brain maturation process with exhaustive measures of the T2 relaxation time values. We also compared regional myelination progress with variations of the relaxation time values and of brain signal. T2 relaxation times were measured in 7 healthy premature newborns at the post-conceptional age of 37 weeks, using a Carr-Purcell-Meiboom-Gill sequence (echo time 60 to 150 ms), on a 2.35 Tesla Spectro-Imaging MR system. A total of 62 measures were defined for each subject within the brain stem, the basal ganglia and the hemispheric gray and white matter. The mean and standard deviation of the T2 values were calculated for each location. Regional T2 values changes and brain signal variations were studied. In comparison to the adult ones, the T2 relaxation time values of both gray and white matter were highly prolonged and a reversed ratio between gray and white matter was found. The maturational phenomena might be regionally correlated with a T2 value shortening. Significant T2 variations in the brainstem (p < 0.02), the mesencephalon (p < 0.05), the thalami (p < 0.01), the lentiform nuclei (p < 0.01) and the caudate nuclei (p < 0.02) were observed at an earlier time than they were visible on T2-weighted images. In the cerebral hemispheres, T2 values increased from the occipital white matter to parietal, temporal and frontal white matter (p < 0.05) and in the frontal and occipital areas from periventricular to subcortical white matter (p < 0.01). Maturational progress was earlier and better displayed with T2 measurements and T2 mapping. During the perinatal period, the measurements and analysis of T2 values revealed brain regional differences not discernible with T2-weighted images. It might be a more sensitive indicator for assessment of brain maturation.

Endoscopic approach of the pterygopalatine fossa: report of one case.

We report one case of schwannoma of the pterygopalatine fossa. The pre-operative management and post-operative follow-up are presented. For this uncommon localization, we propose an endoscopic approach via the nasal fossa and the maxillary sinus. The advantages and limitations of this technique are discussed.

Aspergillomas of the sphenoid sinus: a series of 10 cases treated by endoscopic sinus surgery.

We report our experience with 10 cases of sphenoidal aspergillomas treated by endoscopic sinus surgery (ESS). Chronic symptoms such as cough, post-nasal discharge, dysphonia and even facial pain can be encountered in the history. Computerised tomography and, occasionally, magnetic resonance imaging are of great help in the assessment of this disease, especially when extensive skull base involvement is present. The radiological presentation can vary from an heterogeneous to homogeneous opacity with or without bone lysis to a frank pseudotumoural appearance. Four diagnostic tools have been evaluated to confirm the diagnosis: histology, direct smear, fungal cultures, and serology for Aspergillus. ESS has been successfully carried out without morbidity in all cases. No recurrence of the disease is seen after a mean follow-up of 27 months.

[Mucocele of the sphenoid sinus]. / Les mucocéles sphénoïdales.

Sphenoid sinus mucoceles are pseudocystic expansile slow-growing processes that arise within the sphenoid sinus. A dynamic process of bone resorption and erosion results in a pseudo-tumoral development. Clinical features and potential risks are related to mass effect with compression of the optic nerves and intracranial extension of the process. CT and MRI allow diagnosis and distinguish mucoceles from skull base tumors or inflammatory diseases. Endonasal endoscopic approach is adapted to the treatment of sphenoid mucoceles and allows marsupialization of the mucoceles.

[Paranasal sinuses and facial imaging: exploratory strategies]. / L'imagerie des sinus de la face et du massif facial: stratégies d'exploration.

Advances in radiological and endoscopic imaging allow more accurate location and spread of nasosinusal diseases. These developments have led to a better understanding of sinusal anatomy and to widespread of surgical techniques as endoscopic sinus surgery. CT becomes the primary imaging modality for assessment of chronic rhinosinusitis and complex traumatic injury. Associated to CT, MRI is used to distinguish between inflammatory and neoplastic pathology and to assess lesions involving the skull base or intracranial structures. However, optimization of technical parameters according to the pathology is necessary.

[Luxation of a hypoplastic posterior arch of the atlas. Report of a case]. / Luxation sur hypoplasie d'un hémi-arc postérieur de l'atlas. A propos d'un cas.

A rare case of sagittal dislocation of the hypoplastic right semi-posterior arch of the atlas, complicating a cervical trauma, is described. The authors specify its radiographic and CT appearance. This is a congenital abnormality discovered accidentally, for which no specific surgical treatment was implemented.

[X-ray computed tomographic study of the ethmoid and middle meatus. I. radioanatomy (coronal plane)]. / Exploration tomodensitométrique de l'ethmoïde et du méat moyen. I. Radio-anatomie (incidence coronale).

The advance of endoscopic endonasal surgery allows limited surgical resection in chronic rhinosinusitis. An accurate topographic evaluation of diseases and individual morphologic variation are necessary for this functional surgery. The preoperative radiological investigations require a precise knowledge of ethmoid and osteo-meatal unit anatomy. Thin sections by high resolution CT were performed in coronal plane. The anatomical land marks and the ethmoidal bony roots, which allow a study of the osteo-meatal unit and ethmoid air cells system, are showed. Like endoscopic view, coronal slices better display the different grooves for paranasal sinus draining and their relations with the ethmoid.

[X-ray computed tomographic study of the ethmoid and middle meatus. II. Radio-anatomy (axial incidence) and morphological variations]. / Exploration tomodensitométrique de l'ethmoïde et du méat moyen. II. Radio-anatomie (incidence axiale) et variations morphologiques.

Chronic rhinosinusitis endoscopic surgery needs an accurate evaluation of diseases and paranasal sinus anatomic variations. High resolution CT by thin section (2 mm) allow this pre-operative assessment. An anatomical study of the ethmoid air cell system is always possible in axial plane. The bidimensional CT exploration (axial and coronal plane) displays the anatomic variations of ostiomeatal unit, that have been reported to predispose sinusitis. They are nasal septal deviation, pneumatization and paradoxical curvature of the middle turbinate, pneumatization of unciform process, Haller's cells, prominent agger nasi cell and ethmoid bulla. The endoscopic endonasal surgery landmarks, the individual morphologic variations, the topographic relations to the orbit and to the brain are also well shown by CT.

[MRI in infectious and spontaneous tumoral epidural hemorrhagic pathology]. / IRM et pathologie épidurale tumorale infectieuse et hémorragique spontanée.

Several studies have served to underline the interest of MRI in the diagnosis and assessment of epidural abscess and malignant extradural spinal tumors. In our work, one of the quantitatively greatest published to this day, 64 patients presenting epidural pathology were evaluated by means of MRI. All the explorations were brought about through weighted multiplaned sequences T1, T2 and gadolinium injection. The pathological spectrum encountered is comprised of: metastatic extradural spinal tumors (58%), primary extradural spinal tumors (7%), epidural localizations of hematological diseases (9%), epidural abscess (25%), and one case of epidural hematoma. Assessment was brought to bear upon behavior in relation to type of sequence, spread of disease, medullary effects, type of enhancement following gadolinium injection. Degree of correlation with clinical data and surgical findings was also appraised. As concerns tumourous epidural pathology, positive diagnosis due to a lesion hinges upon the T1 and T2 sequences. Gadolinium's contribution is restricted to analysis of perivertebral and vertebral spreading; it also facilitates recognition of the spinal cord in circumferential epiduritis. So much said, gadolinium appears to be essential in frequently less compressive forms of infectious epiduritis; it plays a pronounced role in both follow-up of their evolution and recognition of acute epidural hematoma.

[Adamantinoma of the tibia. X-ray computed tomographic and MRI study. Apropos of a case]. / Adamantinome du tibia. Etude tomodensitométrique et par IRM. A propos d'un cas.

Adamantinoma of the long bones in a very rare tumor that mainly affects the tibia. Its diagnosis is difficult both radiologically, as the lesion appears as a poorly specific metaphyseal lacuna with or without periosteal reaction, and histologically. Its prognosis used to be guarded because of recurrence and of possible metastatic diffusion, but it has been considerably improved by wide resection with reconstruction. On the occasion of a new case, the authors describe the appearance observed with MRI and the merits of this examination for the preoperative assessment.

[X-ray computed tomographic study of the ethmoid bone and middle meatus. III. Application to chronic infectious sinus pathology]. / Exploration tomodensitométrique de l'ethmoïde et du méat moyen. III. Application à la pathologie infectieuse sinusienne chronique.

As nasal endoscopy, high resolution CT is a part of the chronic rhinosinusitis pre-operative assessment. It shows, thanks to a precise and anatomical study of the ethmoid and sinusal draining, the extension of the diseases and the local morphological variations which predispose to chronic diseases. The main aspects of chronic sinusitis, nasal polyposis and fungal maxillary sinus diseases are reported. The frequency of individual morphological variations and the mucosal changes due to a nasal cycle require a great care in the interpretation of the diseases.

[Congenital arteriovenous malformation of the internal iliac artery discovered during pregnancy]. / Malformation artérioveineuse congénitale de l'artère iliaque interne découverte au cours de la grossesse.

We report a case found at the start of labour because of the presence of a "tumour praevia". Ultrasound, Doppler and tomodensitometric examination carried out after caesarean section confirmed the vascular origin of this lesion. Arteriography made it possible to decide the pattern of this arteriovenous malformation which was occurring in several branches of the left internal iliac artery. It was not possible to obliterate it completely by selective arterial embolisation, so it was removed surgically a few months later. Little is known about the complications that occur because of these arteriovenous malformations in pregnancy and during delivery. There is the theoretical risk that spontaneous rupture will occur in pregnancy but this does not justify terminating the pregnancy. It is better to carry out caesarean section because the tumour can obstruct delivery and may rupture as well as causing delay in labour. The treatment for these lesions is sometimes difficult and complex and one has to decide whether to preserve the uterus or not. Selective embolisation and pre-operative embolisation followed by surgical removal of dysplasic tissue are the therapies of choice.

[Imaging aspects of primary cerebral lymphoma]. / Aspects par imagerie des lymphomes cérébraux primitifs.

Th CT and MRI appearance of 196 lymphomatous histologically proved lesions were rewied in 127 patients. A post contrast study was performed in all patients studied with CT; 118 lesions were also assessed before an iodine contrast injection. 40 lesions were both studied with CT and MRI, and 12 only with MRI. There is a single lesion in 86% of the cases with a supratentorial location in 87%. The lesion size is over 1 cm in 90% and 87% of the lesions appear with regular and sharp demarcation. A mild edema is associated in 86%. Most of the lesions display an infiltrative pattern with a soft mass effect on the surrounding cerebral parenchyma. The basal ganglion, corpus callosum and trigone location, or an infiltration of the periventricular ependyma, or a mirror pattern, appear strongly suggestive for a lesion of lymphomatous origin. The CT post contrast enhancement of the lesion is present in 99% and homogeneous in 82%.

[Diffuse nasal polyposis and comorbidity: study of 65 cases treated by endonasal endoscopic surgery]. / Polypose naso-sinusienne diffuse et co-morbidité. A propos de 65 cas traités par chirurgie endonasale.

INTRODUCTION: Nasal polyposis is an inflammatory disorder which pathophysiology remains unclear. Several clinical associations are described according to co-morbidities (asthma, allergy...). OBJECTIVE: To analyze the efficacy of a standardized surgical procedure in 65 patients with nasal polyposis, enrolled in three categories according to the presence of co-morbidities (asthma, allergy...). STUDY DESIGN: Open prospective study of non-randomized cases from a single institution. METHODS: An inception cohort of 65 consecutive patients with nasal polyposis observed from January 1994 to December 1997. The same surgical procedure was performed in all patients. At the end of the study, an evaluation was performed to collect all the information concerning nasal and bronchial symptoms, asthma conditions, and medical treatment. RESULTS: 60 patients have finally completed the study. Polyposis was isolated in 29 patients, asthma was present in 21 patients, associated with aspirin intolerance in 10 patients (ASA Triad). Nasal obstruction and olfactory dysfunction was improved in 37 and 42 patients, respectively (p<0.0001), without a statistical significance between all groups. After surgery, topical treatment with steroids and local recurrences were more frequently observed in the ASA Triad group without statistical significance. CONCLUSION: Nasal polyposis appears to be less controlled in the ASA Triad group compared to isolated nasal polyposis, although such conclusion is not statistically significant.

[Nasosinusal schwannoma. Apropos of 2 cases. Value of nasal endoscopy for diagnosis and treatment]. / Les schwannomes naso-sinusiens. A propos de deux cas. Intérêt de l'endoscopie nasale pour le diagnostic et le traitement.

Two cases of paranasal schwannomas are reported. These tumors are rare. Its symptomatology is no specific explaining the late diagnosis. The contribution of radiology and endoscopy for this pathology is analysed. Ct scan and MRI state precisely the extension and the relations of the tumor. Endoscopy improves the endonasal exam pre and post operative and may be an option for the surgical treatment of these tumors. In connection with that we present an original approach of the pterygopalatine fossa under endoscopic control via the middle meatus.

[Unilateral choanal atresia and paranasal sinus growth]. / Atrésie choanale unilatérale et croissance sinusienne.

Mechanisms regulating sinus growth are poorly understood. We report a series of six cases of unilateral choanal atresia and discuss the role of nasal ventilation on sinus growth. The presence and the size of the sinus cavities are the main parameters. Our preliminary results suggest that sinus growth is independent of nasal ventilation.

[Radiology and pathologies of the paranasal cavities]. / Radiologie et pathologie rhinosinusienne.

The radiologic exploration of the paranasal cavities are one of the main exams when ENT is dealing with a sinus pathology. CT scan, MRI, angiography of the paranasal cavities are now easily available to explore the different pathologies including infection, chronic rhinosinusitis or tumors. The authors report their experiences with these exams, to suggest guidelines and recommendations to obtain the best radiologic management of the sinus pathologies.

[Adenoid cystic carcinoma (CAC) of the naso-sinonasal cavities: report of 5 cases, review of the literature]. / Carcinome adénoïde kystique (CAK) des cavités naso-sinusiennes: à propos de 5 nouveaux cas, revue de la littérature.

Adenoid cystic carcinoma is a rare tumour which mainly affects the major and accessory salivary glands. We report 5 new cases affecting the nose and sinuses, and based on these review the literature to determine how this disorder can be better treated, given the significant morbidity and mortality of the condition.