[The diagnosis of recent scaphoid fractures: review of the literature]. / Le diagnostic des fractures récentes du scaphoïde: revue de la littérature.

Fractures of the scaphoid are the most common carpal fractures. A review of the literature indicates that the prevalence of the fracture in the case of clinical suspicion is less than 50%. A quality X-ray examination remains essential as an initial diagnostic tool in the evaluation of scaphoid fractures. Its sensitivity varies from 59 to 79%. Patients with negative X-rays present with about 18.7% of scaphoid fractures; 5% of bruised scaphoid; 13% of radius fractures and 7% of miscellaneous bone lesions. If not treated promptly, a scaphoid fracture may be compounded by non-union with associated risk factors such as avascular necrosis and osteoarthritis. Considering these risks, patients with suspected scaphoid fracture with normal X-rays, routinely undergo wrist immobilization until imaging confirms or denies the presence of fracture. Consequently, more than half of the patients undergo wrist immobilization needlessly. This may have a negative impact on their professional life and personal activities while representing a high medical cost. MRI is the imaging technique of choice for suspicious or negatice X-rays. MDCT is less costly than MRI or bone scan, readily available and highly effective for trauma patients but is lacks accuracy and should be used with caution in this indication.

[Technical considerations for injection of a mixture of iodinated contrast material and Artirem for combined CT and MR arthrography]. / Détermination des conditions d'utilisation d'un mélange contenant un produit de contraste iodé et de l'Artirem en vue de la réalisation combinée d'une arthro-IRM et d'un arthroscanner.

PURPOSE: To determine the influence of 4 independent parameters on signal intensity and density measurements after injection of an arthrography-specific form of gadoterate meglumine and an iodinated contrast material for combined MR and CT arthrography. The parameters included: 1) variations of gadolinium and iodinated contrast agents within the mixture, 2) variations of concentration of the iodinated contrast agent, 3) variation of temperature of the mixture, 4) the type of MR pulse sequence acquired. MATERIALS AND METHODS: The study was performed on a CT using a phantom containing 47 different syringes. Ten separate mixtures of gadolinium and iodinated contrast agents were obtained, each with a 10% change in the respective proportion of each contrast agent. This was repeated 4 times for 4 iodinated contrast agents of different iodine concentration. Two control syringes, 4 mixtures containing 50% normal saline and 50% iodinated contrast material (one for each of the 4 concentrations of iodinated contrast material) and one with a mixture of 50% of normal saline and gadolinium contrast agent. For the MR acquisition, the syringes were separated into 4 groups for 4 phantoms. On a 1.5 T MR unit, SE T1W, FSE T2W, PD and 3D FIESTA sequences were acquired. All acquisitions were repeated 2 times, and a 3 different temperatures. RESULTS: The progressive increase in the proportion of gadolinium contrast in the solution was associated with a non-linear increase of signal on T1W, 3D FIESTA, and PD images. The signal intensity reached a plateau at concentrations between 40-60%. Signal variations on the 3D FIESTA sequence were significant. On T2W images, there was an increase of measured signal intensity at low gadolinium concentrations. On CT, there was a linear relationship between density measurements and dilution of gadolinium. The progressive increase of the concentration of the iodinated contrast was associated with increased signal loss on MR and progressive increase of density values on CT. Temperature variations were associated with signal intensity changes on T2W and FIESTA images, but not on T1W images. CONCLUSION: At 1.5 T, a mixture of 50% iodinated contrast and 50% gadolinium contrast corresponded to an acceptable compromise for combined acquisition of MR and CT arthrography.

[Neurogenic muscle hypertrophy: imaging features in three cases and review of the literature]. / Hypertrophie musculaire neurogène: à propos de trois cas, imagerie et revue de la littérature.

OBJECTIVE: To review the literature on well-documented cases of neurogenic muscle hypertrophy in order to define significant features of this disease. PATIENTS AND METHODS: The PUBMED and SCIENCE DIRECT web-sites were used to conduct an inventory of all reported cases of this disease. We entered the key-words "hypertrophy", "muscle" and "neurogenic", and found 48 articles, describing 129 cases. Our criteria of inclusion included hypertrophy of one or several muscles of a lower limb, previous realization of at least one imaging study (CT or MRI) and electromyography of lower limbs; criterion of exclusion was hypertrophy related to hereditary or acquired polyneuropathies. Twenty-five cases were retained for investigation along with 3 recent cases observed in our department. RESULTS: Results show that neurogenic muscle hypertrophy is usually presents with painful enlargement of a calf in a male, aged 32 to 60 years, with previous history of low back pain and sciatica, 68% of the time due to disk herniation or lumbar stenosis. Other clinical findings may include radiation therapy or trauma. CONCLUSION: The symptoms of neurogenic muscle hypertrophy may lead to MRI examination before electromyography. This disease should be included in the differential diagnosis.