What type of imaging work-up will help to confirm the diagnosis of gossypiboma in the limb? Review of literature.

UNLABELLED: Gossypiboma imaging features are not well known and are often confused with soft tissue tumours. Publications on this topic mainly consist of case reports and small cohorts. Its appearance on various imaging modalities is not well defined. This led us to carry out a review of literature to determine specifically: (1) which imaging modalities should be used in cases of suspected gossypiboma, (2) what are the most common imaging findings that contribute to the diagnosis of gossypiboma. An exhaustive review of literature was carried out in June 2015 in the Medline, PubMed and Cochrane databases using the keywords "gossypiboma/textiloma/foreign body". We found 205 articles describing one or multiple cases of gossypiboma in various locations. Of these, the 32 articles that had imaging data were chosen - 16 for the limbs and 16 for other locations. The type of imaging carried out, description of the gossypiboma and circumstances of the discovery and occurrence were recorded. Descriptive statistics were generated to define the type of imaging used and the various findings. Imaging consisted of X-rays in 21/32 cases (66%), computed tomography (CT) in 14/32 cases (43%), magnetic resonance imaging (MRI) in 21/32 cases (65%) and ultrasonography in 14/32 cases (43%). On X-rays, bone involvement was found in 9/15 cases (60%); there was peripheral contrast product uptake on the CT scans in 9/14 cases (64%), a hypointense signal on T1-weighted sequences on MRI in 6/13 cases (46%) and lack of vascularisation in 8/13 cases (62%) and a acoustic shadow on ultrasonography in 9/14 cases (64%). In a patient presenting with a soft tissue lump and history of surgery, an imaging work-up including X-rays, ultrasonography and MRI must be performed. Bone involvement on X-rays, acoustic shadowing on ultrasonography and hypointense signal on T1-weighted MRI sequences with lack of vascularisation in combination with a history of surgery can bring up the possibility of gossypiboma. If there is a possibility of soft tissue tumour, the case should be discussed in a multidisciplinary meeting and a biopsy should be performed first. LEVEL OF EVIDENCE: IV - systematic analysis of published retrospective studies.

MRI quantification of diffusion and perfusion in bone marrow by intravoxel incoherent motion (IVIM) and non-negative least square (NNLS) analysis.

OBJECT: To assess the feasibility of measuring diffusion and perfusion fraction in vertebral bone marrow using the intravoxel incoherent motion (IVIM) approach and to compare two fitting methods, i.e., the non-negative least squares (NNLS) algorithm and the more commonly used Levenberg-Marquardt (LM) non-linear least squares algorithm, for the analysis of IVIM data. MATERIALS AND METHODS: MRI experiments were performed on fifteen healthy volunteers, with a diffusion-weighted echo-planar imaging (EPI) sequence at five different b-values (0, 50, 100, 200, 600 s/mm2), in combination with an STIR module to suppress the lipid signal. Diffusion signal decays in the first lumbar vertebra (L1) were fitted to a bi-exponential function using the LM algorithm and further analyzed with the NNLS algorithm to calculate the values of the apparent diffusion coefficient (ADC), pseudo-diffusion coefficient (D*) and perfusion fraction. RESULTS: The NNLS analysis revealed two diffusion components only in seven out of fifteen volunteers, with ADC=0.60±0.09 (10(-3) mm(2)/s), D*=28±9 (10(-3) mm2/s) and perfusion fraction=14%±6%. The values obtained by the LM bi-exponential fit were: ADC=0.45±0.27 (10(-3) mm2/s), D*=63±145 (10(-3) mm2/s) and perfusion fraction=27%±17%. Furthermore, the LM algorithm yielded values of perfusion fraction in cases where the decay was not bi-exponential, as assessed by NNLS analysis. CONCLUSION: The IVIM approach allows for measuring diffusion and perfusion fraction in vertebral bone marrow; its reliability can be improved by using the NNLS, which identifies the diffusion decays that display a bi-exponential behavior.

Current role of CT and whole body MRI in multiple myeloma.

Radiology of bone lacunae can help differentiate between smouldering and symptomatic myeloma. CT seems to be more apt for this purpose than a standard X-ray but appropriate principles must be applied when performing and reading it. Lesions visible in an MRI above all allow myelomas to be monitored during treatment. Because of the radiation dose, whole body CT must be performed with a slice thickness of 2mm, increments of 1.5 and intensity of 40mAs. It should be read associating the reading of the axial slices with reading the mean coronal and sagittal projections of a thickness of 2cm. Whole body MRI must associate T1-weighted sagittal, STIR coronal and b-800 diffusion-weighted axial sequences. Changes in the disease correlate with changes in the diffusion, STIR and T1-weighted images interpreted together. While whole body CT has a place in clinical routine, the indication for whole body MRI still needs to be clarified and has yet to take its place in research protocols.

Is a breast MRI possible and indicated in case of suspicion of breast cancer during lactation?

The paper tries to answer two questions: the safety of the injection of gadolinium during breastfeeding; the value of a breast MRI in the nursing mother if breast cancer is suspected. Recent Anglo-Saxon publications are in favour of continued breastfeeding following the injection of gadolinium. In fact, only a minute quantity of contrast product passes into the mother's milk, much less than the threshold recommended in paediatrics in the infant. However, a suspension of lactation for 24h after the injection of gadolinium chelate is still recommended in France. The literature is poor as regards the contribution of the MRI during lactation, although the data indicates that the MRI is contributory, in spite of the physiological changes in the breast during this period. In fact, all of the lesions have been visualised and correctly classified according to the BI-RADS classification by the ACR(1). However, the semiology is specific and has to be known.

Imaging of snapping phenomena.

Snapping phenomena result from the sudden impingement between anatomical and/or heterotopical structures with subsequent abrupt movement and noise. Snaps are variously perceived by patients, from mild discomfort to significant pain requiring surgical management. Identifying the precise cause of snaps may be challenging when no abnormality is encountered on routinely performed static examinations. In this regard, dynamic imaging techniques have been developed over time, with various degrees of success. This review encompasses the main features of each imaging technique and proposes an overview of the main snapping phenomena in the musculoskeletal system.

Is MRI useful to assess labral reduction following acute anterior shoulder dislocation?

INTRODUCTION: Better knowledge of the anatomical lesions following primary anterior dislocation of the shoulder could help to resolve the issue of the recommended position of immobilization. The aim of this study was to describe such early lesions and to evaluate labral reducibility in both external and internal rotation of the arm. PATIENTS AND METHODS: Fifteen shoulders were investigated by MRI without intra-articular injection. The 15 patients (14 men and one woman) had a mean age of 28 years (range: 17-42 years). Labral lesions were classified on a system based on Gleyze and Habermeyer's endoscopic assessment and reducibility was assessed on Itoi's criteria. RESULTS: Constant hemarthrosis allowed an arthrogram type effect. The Hill-Sachs lesion was small in five cases, medium in eight cases and large in two. There were seven labral lesions of type I, seven of type II and one of type III. External rotation (mean: 30.6 degrees; range: 15 degrees-65 degrees), reduced the labrum in six cases (40%). DISCUSSION: The present study failed to confirm the constant reduction of the labrum reported by Itoi, perhaps because external rotation was less than that obtained in his study (m=52 degrees; range: 35 degrees-81 degrees). Reduction was partly due to posterior migration of the hemarthrosis obtained by external rotation. CONCLUSION: MRI assessment of labral reducibility after primary anterior shoulder dislocation may be considered for patients at high risk of recurrence, in order to decide the ideal position of immobilization. LEVEL OF EVIDENCE: Level IV. Retrospective diagnostic study.

["Méta-analyse": a web-based tool for research and analysis of radiology papers]. / "Méta-analyse" : un outil de recherche et d'analyse d'articles de radiologie sur le web.

Finding articles providing answers to specific clinical questions is greatly facilitated by the availability of indexed Medline abstracts using the Pubmed search engine. Nonetheless, the large number of references sometimes requires a time-consuming review of multiple abstracts. In order to streamline the search process, we have created a tool facilitating the search and review of these abstracts. We present here this tool named "Méta-analyse".

[Evaluation of CT guided cervical epidural injections in patients with mechanical cervicobrachial neuralgia]. / Evaluation des infiltrations épidurales cervicales sous contrôle tomodensitométrique dans le traitement des névralgies cervico-brachiales mécaniques.

PURPOSE: Prospective study evaluating the efficacy and tolerability of CT guided cervical epidural injections for mechanical cervicobrachial neuralgia. MATERIALS AND METHODS: Between July 2003 and August 2004, 34 patients (16 females, 18 males) with mean age of 44.5 years were enrolled. Enrollment criteria included mechanical cervicobrachial neuralgia of more than 1 month's duration, refractory to medical management, with good correlation between clinical and imaging findings. An evaluation using the Neck Pain Disability Score (NPDS) and associated Secondary criteria was performed by a single observer at day 0, day 30 and day 90. The injections were performed under CT guidance. RESULTS: The symptomatic efficacy of CT guided injections at 3 months was 45% using the NPDS, 47.1% using an analog pain scale, and 58.8% as graded by patients (effective/very effective). Tolerability was excellent (55.9%), moderate (41.2%) and poor (2.9%). CONCLUSION: CT guided cervical epidural injections appear effective and well-tolerated. A blinded randomized study could validate its value. However, a study comparing steroids and placebo raises ethical concerns.

[Computerizing the radiological sign]. / L'informatisation du signe radiologique.

The goal of this article is to present to the radiologist the different theories of the sign and their consequences for sign representation in computer systems. All the theories of the sign are presented, but the most relevant are highlighted in order to explain the great modeling systems currently in use (such as DICOM-SR or the UMLS). The constructivist approach of the notion of disease, the semiosis process, which starting from signs produces new signs, and the structuralist analysis of sign through language are emphasized. The purpose of this analysis is to end up with a consensual representation of the sign that can be understood by human beings and processed by machines. Such a representation, also known as an ontology, is based on a semantic organization of language, thus allowing medicine to become a truly scientific discipline. It aims at disambiguating the symbols given to machines, which will help us in our reasoning.

[Synovial biopsy under US guidance: technical considerations and results]. / Technique et évaluation du guidage échographique pour la réalisation de biopsies synoviales.

PURPOSE: To describe and assess ultrasound (US) guided biopsy of peripheral joint synovial membrane. METHOD: Between January 2002 and January 2005, 83 patients have undergone biopsies of synovial membrane performed under ultrasonographic guidance, as a diagnostic procedure for monoarthritis of unknown etiology. After synovial thickening was confirmed by US examination, the optimal approach to the joint was decided in accordance with maximal synovial thickening localization and adjacent anatomic structures. The absence of complications related to the biopsy was verified by continuous ultrasonographic scanning during and immediately after the procedure. The procedure was rated as successful if synovial tissue was identified by histologic examination of the biopsy specimen. Success rate of the procedure was compared to the fluoroscopic guided biopsy success rate that was formely published in medical literature. RESULTS: Synovial tissue was obtained in 78 cases (94%) (shoulder (100%), elbow (75%), wrist (85.7%), hip (88.2%), knee (97%), ankle (100%). No complication occurred. CONCLUSION: US guided biopsy of peripheral joint synovial membrane is a safe and effective technique that has multiple advantages compared to fluoroscopic guided procedure.

[Diffusion weighted MRI of spine tumors]. / Evaluation de la diffusion dans la pathologie tumorale rachidienne.

PURPOSE: To evaluate the contribution of diffusion weighted MR imaging in malignant spine pathology. Materials and methods. Between February 2004 and January 2005, 49 patients (43 to 86 years old) were included. Three groups were made: osteoporotic collapses (n = 13), malignant collapses (n = 15) and malignant spine lesions (n = 21). The MRI (Symphony 1.5T) allowed SENSE imaging. After conventional MRI examination (T1, T2 fat sat, T1 with Gadolinium), all patients underwent diffusion weighted imaging (Spin Echo) with variable b values: 0, 250, 500, 750 and 1000. The diffusion sequence lasted 2 min 29 s. The Apparent Diffusion Coefficient (ADC) was calculated automatically. The analysis was qualitative (signal study b = 1,000 mm2/s) and quantitative (ADC measurement). RESULTS: The image quality was good except for some cervical examinations. Qualitative analysis did not show a difference between benign and malignant lesions. Quantitative results are: malignant spine lesion (mean ADC = 0.826 10-3 s/mm2), malignant spinal collapses (mean ADC = 0.912 10-3 s/mm2) and benign spinal collapses (mean ADC = 1.497 10-3 s/mm2). There was overlapping results between benign and malignant lesion. The statistical study showed a significant difference (t test with p < 1/10 000). For an ADC threshold value of 1.089 (malignant lesion ADC < 1.089), ROC curve showed a specificity = 80% and a sensitivity = 83.3%. CONCLUSION: Performing diffusion weighted imaging of the spine is easy with new MR technology. The ADC measurement of spine lesion provides important additional information, but does not serve as a substitute for the routine MRI sequences. In the future, it could become an important point in this difficult diagnosis.

[Vertebral trabecular network analysis on CT images]. / Analyse de la trame osseuse vertébrale sur coupes scanographiques.

PURPOSE: Comparing texture analysis, density measurement and visual quantification of trabecular network on spine CT images, to better evaluate bone architecture in osteoporosis. METHOD AND MATERIALS: Seventeen patients, aged 19 to 84 years, were included. One patient presented osteoporotic fractures. High resolution computed tomographic (HR-CT) images of the third lumbar vertebra were acquired using a Somatom 4 plus CT (Siemens) in a strict axial orientation with FOV of 12 cm and slice thickness of 1 mm. The size of the Region Of Interest was 1,6 cm(2). Three analyses were performed on this ROI: Density (in Hounsfield Unity), texture analysis (run length) and features inspired from bone histomorphometry (Bone Volume/Tissue Volume). RESULTS: Density measurement, run length methods and BV/TV provided consistent results with regards to age. Indeed density, run length and BV/TV results were lower for older patients with more advanced bone trabeculra alterations. CONCLUSION: Only BV/TV and run length parameters seemed to show additional information on trabecular network architecture. The contribution of these two measurements to diagnose and classify osteoporosis will be the goal of a clinical study.

[Periosteal hemangioma of the distal humeral: case report and review of the literature]. / Hémangiome sous périosté de l'extrémité inférieure de l'humérus. Description d'un cas et revue de la littérature.

The authors report a case of periosteal cavernous hemangioma of the distal humeral. They describe the imaging findings of hemangiomas of long tubular bones and discuss their differential diagnosis.

Monitoring incident report in the healthcare process to improve quality in hospitals.

Healthcare organizations are facing growing pressures to adopt intelligent technology to promote quality and safety care in public and private hospitals. In 2000, the Institute of Medicine report also indicated that an estimated 44,000 to 98,000 Americans die annually as a result of preventable medical errors and it appears that information management in hospitals can help the organization to improve the quality level. This paper aims to present an experience in the management of events not compliant with the best practice by monitoring these events in a hospital. We used ISO standard to implement general quality process and quality management. This project consists in proposing the possibility of declaring different dysfunctions and incidents by a simple form integrated into the intranet services of the hospital for the medical, nursing and administrative staff. This should lead to quality management of the medical units.

[Evaluation of the efficacy of CT guided thoracic sympatholysis to treat palmar hyperhidrosis]. / Evaluation de l'efficacité thérapeutique de la sympatholyse thoracique dans l'hyperhidrose palmaire sous contrôle tomodensitométrique.

PURPOSE AND METHOD: Palmar hyperhidrosis is a pathological condition characterized by overperspiration caused by any stress or emotion. We have evaluated the results of 101 CT guided sympatholysis procedures performed on 50 patients suffering from primary palmar hyperhydrosis. RESULTS: Mean follow up was 50 Months (6 Months to 8 Years) for 87 procedures with immediate good results in 46 patients. Using actuarial analysis, 62% of patients had persistent good results after 50 Months. Complications included one case of small pneumothorax requiring no treatment and one case of vagal syndrome. Pain or thoracic discomfort was reported by 14 patients and was relieved by aspirin within 24 hours. Six patients developed a Horner's syndrome that resolved within a few weeks and six other patients developed moderate compensatory overperspiration over the face, thorax or contralateral arm. CONCLUSION: Based on our results, CT guided sympatholysis provides results similar to endoscopic thoracic sympathectomy and is associated with fewer risks.

[Management system for patients requiring stereotactic macrobiopsies of the breast: report on 100 patients]. / Mise en place de la prise en charge des macrobiopsies stéréotaxiques mammaires: évaluation sur 100 patientes.

PURPOSE: The authors describe and evaluate the management system for patients requiring large core vacuum-assisted biopsies at a dedicated breast center. This process includes mandatory review of all requests by a multidisciplinary team. MATERIAL: and method. Patients were provided questionnaires to evaluate their degree of satisfaction with the management process. Results from biopsy and surgery were retrospectively reviewed. RESULTS: From the 100 patients included in the study (106 macrobiopsies), 95,28% of biopsies were informative. The degree of correlation between the histological diagnosis from biopsy and surgery was 86,95% for the 46 operated cases. The degree of acceptability by patients as well as medical and non-medical staff was satisfactory. CONCLUSION: The original feature of this process is the retrospective review of all charts after the histological results becomes available for final validation of the biopsy results and management. The results of the biopsy and the post biopsy management are provided by the initial referring physician, allowing optimal patient care and follow-up.

Tracing computerized incidents to manage and improve quality health care in hospitals.

The promotion of quality and safety care in public and private Hospitals has become a crucial stake. To succeed in this, a quality process is necessary for quality management. To set it up, it is necessary to have different piloting tools. Data collection of effective information is one of these tools. It is necessary to be able to process the data quickly in order to answer the various demands rapidly. This project consists in proposing the possibility of declaring different dysfunctions and incidents by a simple formula integrated into the intranet services of the hospital for the medical, nursing and administrative staff. This should lead to quality management of the medical units.

[CD-ROM burning of CT scan images: initial experience]. / Mise en place d'un système de gravure d'examens scanographiques sur cédérom.

OBJECTIVES: To evaluate the cost, the functionment and the impact of the installation of a CD-ROM burning system of CT scan images. MATERIALS AND METHODS: An automated CD-ROM burning system (e-patient*, TSI, Paris, France) allows to burn CDs for CT scan examinations containing more than 4 films. During a 3 month period, we have delivered for each examination a CD-ROM including images with a Dicom viewer and a selection of interesting images printed on one film. The system has been evaluated by the technologists, the radiologists and the referring physicians by means of a questionnaire. The costs and the technical problems have also been studied. RESULTS: The benefits of our system are the increase of the diagnostic performances of the referring physicians who use the DICOM format and a reduction of the printing costs. All referring physicians pointed out major changes in their daily work including difficulties to visualize images in relation with a lack of computer infrastructure and the impossibility of simultaneous analysis of several examinations. Technologists encountered technical problems to bum examinations and radiologists had to do extra work to related to image selection. CONCLUSION: The installation of an automated burning system requires the creation of a dedicated team to train all the users and adapt the presentation of results to the clinical constraints (i.e. performing and printing an image selection). This system will not replace the hospital network but will be complementary.

[Pain management with nerve root block under ct and neurostimulator guidance]. / Traitement de la douleur par infiltrations nerveuses sous contrôle tomodensitométrique et neurostimulateur.

PURPOSE: To evaluate the efficacy of nerve roots block under CT and neurostimulator guidance for the management of pain. MATERIAL: and method. Nerve root blocks were performed in 27 patients (pudendal nerve, intercostal nerve, ilio-hypogastric nerve, thoracic and lumbar sympatholysis). These were performed with corticosteroids (Altim((R))) (20 patients) or phenol (7 patients). RESULTS: Seventeen patients (63%) had pain reduction during at least 15 days. The pain relief was longer with phenol. Complications appeared in the 3 lumbar sympatholysis (inguinal pain) and one of the thoracic sympatholysis (Claude Bernard Horner syndrome). CONCLUSION: The nerve root blocks seem to have some efficacy and a further evaluation is necessary to assess their impact on the ability of patients to return to work and their need for pain medication. When performing these procedures, one must be careful to avoid potential complications and verify that the procedure is needed.