[Virtual endoscopic navigation and body transparency based on computed tomography. A step towards in vivo imaging]. / Navigation endoscopique et transparences corporelles par scanner à RX, une étape en imagerie in vivo.

Progress in HR-CTdata processing has led to lower X-ray exposure and to better diagnostic performance. We describe 19 adult patients (among 5000) examined by HR CT with 64 detectors, acquisition and exposure protocols in mSv, spiral, 0.6-mm slices, 5To PACS. After the two usual processing steps (60 gray values, 5122 and 10242 matrices, dedicated workstations for coronaroscopy and virtual coloscopy, 2D multiplanar reformation, surfacic, 3D volumes with dissection and navigation), a third original data processing step on additional workstations was added. Variable matrix extrapolated images, flexible colored curves (different from anatomical conventions), lighting (sources) and transparencies (unavailable with traditional endoscopy) were used. The digital film is a 16-minute "journey "consisting of 19 endo-body navigations in 5 regions, from the head to the bronchi, from the heart to the coronary arteries, and from the digestive tract to the abdomen and pelvis. One possible application is post-operative verification of an aortic graft. The movie is illustrated here with ten plates. This new approach is cost-effective and beneficial for the patient, in terms of early diagnosis and therapeutic follow-up. Ethical issues are also examined.

[Dynamic study of the female levator ani muscle using MRI 3D vectorial modeling]. / Examen dynamique du muscle élévateur de l'anus de la femme par modélisation vectorielle 3D IRM: étude préliminaire.

UNLABELLED: The levator ani muscle has a major role in the female pelvic floor, and is involved in the pathophysiology of pelvic prolapse and stress urinary incontinence. We conducted an anatomical and morphological study of this muscle using dynamic 3D vectorial reconstruction MRI, in order to analyze the contraction of two major components of the levator ani: the iliococcygeus and pubococcygeus. MATERIALS AND METHODS: Three volunteer healthy continent nulliparous women aged from 19 to 22 underwent dynamic pelvic MRI. Coronal T2-weighted pelvic images were obtained in the supine position, at rest, holding back, and during Valsalva stress effort. 3D vectorial models were reconstructed by manual segmentation of the source images, and were set up on bony anatomic marks. Iliococcygeus and pubococcygeus volumes were measured in the three positions. Volumetrics, displacement and dynamic morphing changes were analyzed with 3D vectorial animation software. RESULTS: The urogenital hiatus extended more holding back (mean +4.31 mm) than on effort (mean +2.78 mm). The iliococcygeus lowered (mean -3.95 mm) and deviated outward (mean +3.01 mm). DISCUSSION: The basic tone of the iliococcygeus muscle gives it a dome shape, and its reflex contraction against abdominal strain ensures anal and urinary continence The levator ani is more than a pelvic diaphragm: it is a truly dynamic pelvic floor. Its points of support on the stiff osseous frame allow it to retain the pelvic organs. The levator ani muscle seems to prevent anal prolapse during stress strain.

[Boxing: traumatology and prevention]. / La boxe, sport de combat, de la traumatologie à la prévention.

In 1986, a surgeon who, as an amateur boxer himself was concerned with boxers' health, approached a pioneering Parisian neuroimaging unit. Thus began a study in close cooperation with the French Boxing Federation, spanning 25 years. In a first series of 52 volunteer boxers (13 amateurs and 39 professionals), during which MRI gradually replaced computed tomography, ten risk factors were identified, which notably included boxing style: only one of 40 "stylists" with a good boxing technique had cortical atrophy (4.5 %), compared to 15 % of "sloggers". Changes to the French Boxing Federation rules placed the accent on medical prevention. The second series, of 247 boxers (81 amateurs and 266 professionals), showed a clear improvement, as lesions were suspected in 14 individuals, of which only 4 (1.35 %) were probably due to boxing. The third and fourth series were part of a protocol called "Brain-Boxing-Ageing", which included 76 boxers (11 having suffered KOs) and 120 MRI scans, with reproducible CT and MRI acquisitions (9 sequences with 1.5 T then 3 T, and CT). MRI anomalies secondary to boxing were found in 11 % of amateurs and 38 % of professionals (atrophy, high vascular T2 signal areas, 2 cases of post-KO subdural bleeding). CT revealed sinus damage in 13 % of the amateurs and 19 % of the professionals. The risk of acute and chronic facial and brain damage was underline, along with detailed precautionary measures (organization of bouts, role of the referee and ringside doctor, and application of French Boxing Federation rules).

[Imaging the brain, from the cell to the organ]. / Imagerie de l'encéphale, de la cellule a l'organe.

Brain imaging has progressed over the centuries, from prehistory (surgical and sculptural empiricism), through the Middle Ages (dissection and drawings), the Renaissance (printing) and the 18th century (Spallanzani and ultrasounds), to the 19th century and the discovery of piezoelectricity by the Curie brothers and X-rays by Röntgen in 1895. The head had finally become transparent! The microscope was used by Ramon Y Cajal for histological and neuropathological brain studies. Marie Curie's discovery of radioisotopes paved the way for advances in in vivo neurophysiology. In the 20th century, technical progress accelerated with the advent of computed tomography. Injected contrast products were initially negative (air for ventriculography and pneumo-encephalography), and subsequently positive (intraventricular then intraarterial iodine, cerebral arteriography, increasingly hyperselective). Neurology and neurosurgery were followed by neuroradiology, stereotaxy, and interventional neuroradiology. G.N. Hounsfield's EMI CT scanner replaced silver salts crystals with computed pixels and voxels. Magnetic resonance imaging (MRI, 1981), which dispenses with the need for X-rays, is evolving at the same pace as computer science itself (Moore's Law) in the form of nanometric biophotonics for example. Diffusion MRI is providing precious information on neuroanatomy (axonal organization of the white matter and neuro-tractography, vascular anatomy), neurochemistry (MRS) and neurophysiology. Functional MRI of sensory activation and resting connectivity, the substrate of thought, is giving fascinating results. Functional stereotactic neurosurgery (for epilepsy, abnormal movements, etc.), stereotactic radiosurgery and endovascular interventional neuroradiology are among the latest approaches.

[Computed tomography and cranial paleoanthropology]. / Scanner à rayons X et paléoanthropologie crânienne.

Since its invention in 1972, computed tomography (C.T.) has significantly evolved. With the advent of multi-slice detectors (500 times more sensitive than conventional radiography) and high-powered computer programs, medical applications have also improved. CT is now contributing to paleoanthropological research. Its non-destructive nature is the biggest advantage for studying fossil skulls. The second advantage is the possibility of image analysis, storage, and transmission. Potential disadvantages include the possible loss of files and the need to keep up with rapid technological advances. Our experience since the late 1970s, and a recent PhD thesis, led us to describe routine applications of this method. The main contributions of CT to cranial paleoanthropology are five-fold: --Numerical anatomy with rapid acquisition and high spatial resolution (helicoidal and multidetector CT) offering digital storage and stereolithography (3D printing). --Numerical biometry (2D and 3D) can be used to create "normograms" such as the 3D craniofacial reference model used in maxillofacial surgery. --Numerical analysis offers thorough characterization of the specimen and its state of conservation and/or restoration. --From "surrealism" to virtual imaging, anatomical structures can be reconstructed, providing access to hidden or dangerous zones. --The time dimension (4D imaging) confers movement and the possibility for endoscopic simulation and internal navigation (see Iconography). New technical developments will focus on data processing and networking. It remains our duty to deal respectfully with human fossils.

[The visual pathways, from anatomical MRI to physiological with (f)MRI and tractography with diffusion tensor MRI (DTMRI)]. / Les voies de la vision, de l'IRM anatomique à la physiologie (IRM(f)) et IRM en tenseur de diffusion (IRMTD) ou tractographie.

Advances in MRI technology have led to a better knowledge of visual pathways (1984-2004), with a new descriptive anatomy and functional model. The authors first describe the technical development of MRI over the last thirty years, then describe and illustrate the new descriptive anatomy. Cephalic MRI reveals brain structures that were previously invisible, on different encephalic planes, in the optic pathways, horizontally from the cornea to the calcarin fissure (neuro-ocular plane (NOP), oblique trans-hemispheric neuro-ocular (OTNOP) and neuro-opto-tractal planes (NOTP)), in their orthogonal orientation upon the oculomotor pathways: head and axonal optic nerve pack (visual deutoneurons in their meninges), optic tracts, lateral geniculate bodies, optic radiations and the calcarian fissure. Comparative anatomy with the rhesus macaque is mentioned. Functional neuroanatomy (physiology) benefits from cine-MRI for ocular motricity (OD MRI), growth by the observation of myelinization in children, blood and CSF circulation by MR angiography, local blood volumes by perfusion imaging, neuronal quantification with inflammation or myelin regeneration by spectroscopy (MRS), brain mapping by functional MR ((f)MRI) measuring local CBF enhancement by paradigmatic stimulations. The recent functional imaging method, tractography (or diffusion tensor MRI (DTMRI)), using diffusion MRI techniques, natural vector calculations with diffusion tensor and software power for morphological and statistical directional results, represents the direction of projection, association and commissural white matter tracts. Normal examples are shown and some common clinical consequences are discussed.

Resolution of homonymous visual field loss documented with functional magnetic resonance and diffusion tensor imaging.

A 68-year-old man developed right homonymous hemianopic paracentral scotomas from acute infarction of the left extrastriate area. He was studied over the ensuing 12 months with visual fields, conventional MRI, functional MRI (fMRI), and diffusion tensor imaging (DTI). As the visual field defect became smaller, fMRI demonstrated progressively larger areas of cortical activation. DTI initially showed that the lesioned posterior optic radiations were completely interrupted. This interruption lessened in time and had disappeared by one year after onset. fMRI and DTI are innovative measures to follow functional and structural recovery in the central nervous system. This is the first reported application of these imaging techniques to acute cerebral visual field disorders.