[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases.

OBJECTIVE: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. MATERIAL AND METHODS: Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. RESULTS: Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. CONCLUSION: This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.

Diagnostic approach to mediastinal masses.

Mediastinal masses represent a vast group of tumours and pseudo-tumours which can involve the various compartments of the mediastinum. The authors propose a radiologic diagnostic approach starting from the plain thoracic radiograph with study of the mediastinal lines and oesophageal transit and going on to the classifications made possible by modern CT and MR imaging. The proposed diagnostic procedure is based on nine mediastinal lines and two 'threads of Ariadne' which are the compartments where the masses are located and their behaviour at CT (densitometry before and after administration of an iodinated bolus) and at MRI (T1, T2, gadolinium-enhanced T1-weighted sequences). The definitive aetiological diagnosis may be established by surgery, but also in certain cases by percutaneous needle biopsy.

Imaging of hyperparathyroidism: US, CT, MRI and MIBI scintigraphy.

Hyperparathyroidism is a rare condition although recently the incidence has increased, particularly the asymptomatic form, as a result of routine serum calcium measurements. A definitive diagnosis can be made using modern bio-assays giving direct measurements of parathormone (PTH). Various methods are currently available for pre-operative localisation of pathological parathyroid glands. Ultrasound is sufficient prior to the initial surgery. However, if primary surgical exploration fails to localise the parathyroid glands then the surgeon faces a more complex problem and requires precise localisation prior to repeat surgery to reduce operating time and risk. No radiological method is available to localise pathological glands in 100% of cases. The surgeon is usually satisfied when two different methods are positive and in concordance. The non-invasive methods such as ultrasound, CT, MRI and scintigraphy are initially performed and if the result remains equivocal then more invasive methods such as arterial or venous sampling are undertaken. Our preliminary results in secondary hyperparathyroidism, before repeat surgery, indicate that associated and complementary tests, morphological and functional, MRI (fat-sat, T1, gadolinium) and MIBI scintigraphy, have greater efficacy.

Catheterization of the Medullary Cavity of Long Bones.

Vascular catheterization techniques were used in bones to allow access to the entire medullary cavity through a minimal percutaneous approach. The study was carried out on human and animal anatomical specimens and in living sheep. After oblique penetration at an angle of approximately 40û to the surface of the cortical bone, we attempted to pass in the bone shaft using various types of guides and catheters. Different types of instrumentation currently available were compared for ease of advancement in the shaft and quantity of bone marrow that could be aspirated. Once the metaphysis was reached, a variety of techniques were studied to penetrate the cancellous bone and to introduce a catheter. A percutaneous approach to any part of a long bone through a cortical pathway from a remote entry site is feasible in certain diagnostic or therapeutic indications, when direct approach to pathological sites in long bones is dangerous or impossible.

MR imaging in hemophilic arthropathy.

20 children with hemophilia were examined with Magnetic Resonance Imaging (MRI) to determine if MRI could be used to assess hemophilic arthropathy, especially in the early stages. 28 joints of the appendicular skeleton were imaged, including 17 knees, 10 ankles and 1 elbow. The results were compared to clinical and plain radiographic assessments and to the surgical findings when synovectomy was performed. MRI is able to evaluate the components of hemophilic arthropathy such as fluid effussion, synovial hypertrophy, the status of the articular cartilage, and bony lesions. These lesions can be discovered at an early stage when plain radiographs are still normal. MRI seems to be useful for the selection of patients needing early treatment of hemophilic arthropathy and in monitoring response to therapy.

[Enterovenous fistula. An unusual complication of Crohn disease]. / La fistule entéro-veineuse. Une complication exceptionnelle de la maladie de Crohn.

We report a case of enterovenous fistula in a young 22-year-old patient with Crohn's disease associated with jaundice. Ultrasound and computed tomography showed stationary gaz and barium in the liver. Pathological examination showed a fistula between the lumen of the inflamed segment of the ileum and the superior mesenteric venous system. This unusual finding in Crohn's disease may be a severe complication.

[Treatment of hemorrhages by rupture of cardio-tuberous varices with transjugular intrahepatic portasystemic shunt]. / Traitement des hémorragies par rupture de varices cardio-tubérositaires par anastomose porto-systémique intra-hépatique par voie trans-jugulaire.

Twelve consecutive patients admitted for bleeding from ruptured gastric varices were treated with transjugular intrahepatic portosystemic shunts and followed for a mean of 6 +/- 3 months (range: 8-293 days). The shunt was performed successfully in all 12 patients. The shunt occluded in 3 patients (respectively 19, 101 and 103 days after insertion) of whom one remained asymptomatic and two experienced rebleeding. Four patients presented with acute encephalopathy, spontaneously in two and after rebleeding in two. Three patients died, two after rebleeding and one of septic shock secondary to pneumonia. Overall, 9 patients survived a mean of 211 +/- 92 days with no rebleeding, 8 of whom have not yet experienced any complications. These results suggest that transjugular intrahepatic portosystemic shunts could be useful in treating hemorrhages from ruptured gastric varices and in preventing their recurrence.

[Percutaneous transluminal endarterectomy of femoro-popliteal atheromatous lesions. Technique. Indications. Results after 6 months]. / Athérectomie transluminale percutanée des lésions athéromateuses fémoro-poplitéees. Technique. Indications. Résultats à 6 mois.

Percutaneous atherectomy was performed in 25 patients with 30 symptomatic femoro-popliteal stenosis. INITIAL RESULTS: 23 patients were successfully treated with disappearance of claudication and a mean 0.35 increase in the ankle-arm-index. Two early thrombosis occurred. Angiographic analysis: residual stenosis lower than 30% in 25 lesions; no dissection or embolization; effective treatment of eccentered and calcified lesions; no significant dissection after additional angioplasty. RESULTS AT 6 MONTHS FOLLOW-UP: (17 patients, 19 lesions): stable improvement in 14 patients; 2 restenosis; 1 new disease. Atherectomy restores a large lumen with minimal wall trauma, thus perhaps decreasing the restenosis rate.

[Adverse effects of contrast media: results of a 6 months study]. / Effets indésirables des produits de contraste: bilan de 6 mois de suivi.

The use of iodinated contrast agents is associated with adverse drug reactions (ADRs) (mainly allergic). Data from the literature suggest a frequency of ADRs ranging from 5 to 8 per cent for the whole group of iodinated contrast agents. The present systematic prospective study performed over a period of six months investigated ADRs in a Radiology Department of the University Hospital in Toulouse. After 1480 injections of iodinated contrast agents, only five ADRs (i.e. 0.34 per cent) were observed. However, the frequency remained higher in patients with a history of allergy (1.5 per cent). The low frequency of ADRs can be explained both by the use of mainly low osmolality contrast agents (75 per cent) and by systematic preventive management of risk (detailed questionnaire, choice of the contrast agent according to risk).