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Arteria Carótida Interna , Progresión de la Enfermedad , Mucormicosis , Arteria Oftálmica , Neuropatía Óptica Isquémica , Humanos , Persona de Mediana Edad , Enfermedad Aguda , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Arteria Oftálmica/diagnóstico por imagen , Arteria Oftálmica/patología , Neuropatía Óptica Isquémica/diagnóstico , Neuropatía Óptica Isquémica/etiología , Trombosis/diagnóstico , Trombosis/diagnóstico por imagen , Trombosis/complicacionesRESUMEN
Anomalous aortic origin of the coronary arteries are congenital anomalies with many anatomical forms. Due to the varying risk of sudden death, these abnormalities must be classified accurately. There are still questions about the mechanism and individual risk of sudden death, the natural history of these abnormalities and the benefits of a surgical correction. Large-scale observational registries may provide more evidence-based data to practitioners caring for the patients concerned. The ANOCOR registry, the largest in size published to date, enrolled 472 patients (mean age 63 years) with 496 coronary abnormalities. The angiographic representation (with invasive coronary angiography or coronary CT angiography) according to the coronary artery and initial ectopic course could be specified with the identification of two main phenotypes: the circumflex artery (n = 235) with a retroaortic course in 97% of cases and the right coronary artery (n = 165) with an interarterial course in 89.7% of cases. Two left coronary anatomical forms have been confused by non-expert cardiologists: those with a retropulmonary or interarterial course. Sudden death related to coronary anomaly was a very rare mode of presentation (3 patients or 0.6% of the cohort) in this population with very few young patients < 35 years (11 cases or 2.3% of the cohort).
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Anomalías de los Vasos Coronarios , Humanos , Persona de Mediana Edad , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Muerte Súbita , Sistema de Registros , Tomografía Computarizada por Rayos XRESUMEN
We report serial magnetic resonance imaging (MRI) findings and follow-up in a case of human African trypanosomiasis (HAT) presenting with limited lesions followed by early and complete resolution. We searched the literature for documented cases and reviewed MRI findings before treatment. A 30-year-old Lebanese man, who had lived in Gabon for six years, presented with a two-year history of rash, anorexia, weight loss, arthralgia, paresthesia, and hypersomnia. Previously, the patient had received corticosteroid therapy for unconfirmed ANCA-associated vasculitis. Physical examination revealed a painless chancre on the left arm located at the site of an old insect bite, enlarged cervical, axillar and inguinal lymph nodes, hepatosplenomegaly and impaired concentration. Blood analysis showed an elevated protein level (90g/L) with hypoalbuminemia (24.2g/L) and elevated IgM (26.4g/L). Bone marrow aspirate and biopsy failed to detect any parasite. Polymerase chain reaction tests on blood and cerebrospinal fluid were positive for Trypanosoma. Serology tests confirmed the diagnosis of HAT due to Trypanosoma brucei gambiense infection. 3T MRI showed lesions in the hypothalamus and basal ganglia, the internal capsule, and the mesencephalon bilaterally. Follow-up MRI showed interval progression of the abnormalities. Treatment with melarsoprol was followed by clinical improvement with regression of the lesions on the three-month MRI, then total resolution at the 10-month follow-up. This case highlights a pattern of mild MRI lesions in T. brucei gambiense HAT with a total and rapid resolution under treatment. The literature review (16 HAT cases with sufficient radiological data, included ours) revealed an MRI pattern of brain lesion distribution that could be helpful for diagnosis and orienting biological tests.
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Trypanosoma brucei gambiense , Tripanosomiasis Africana , Adulto , Animales , Humanos , Imagen por Resonancia Magnética , Masculino , Reacción en Cadena de la Polimerasa , Pruebas Serológicas , Tripanosomiasis Africana/diagnóstico por imagen , Tripanosomiasis Africana/tratamiento farmacológicoRESUMEN
We report an unusual case of a frontal partially calcified pilocytic astrocytoma (PA) (WHO grade 1) in an 18-year-old woman who presented with acute, spontaneous intracerebral hemorrhage. Histopathology revealed the PA was mixed with psammoma bodies and areas of vascular proliferation responsible for a hypervascular pattern. The patient underwent a total gross resection. MRI showed no residual tumor at the 18-month follow-up and her neurological deficits improved after rehabilitation. Only 20 cases, including ours, of hemorrhagic presentation of PA in adults have been reported to date with enough radiological data. Furthermore, hemorrhagic presentation of a calcified PA is extremely rare. To date only two other cases of calcified PA with hemorrhagic presentation have been reported, one in an adult and one in an infant as described by Shibao et al. (2012) and Kapoor et al. (2015) respectively. Endothelial proliferation may be the main cause of bleeding in these lesions. In our case, a hypervascular pattern was exhibited by histopathological findings. A diagnosis of PA should be considered, especially when calcifications are present within a hemorrhagic tumor lesion.
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Astrocitoma/cirugía , Neoplasias Encefálicas/cirugía , Hemorragia Cerebral/terapia , Neoplasia Residual/cirugía , Adolescente , Astrocitoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/etiología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Miliary tuberculosis (miliary TB) is characterized by a hematogenous spread of Mycobacterium tuberculosis. Cerebral lesions associated with miliary TB have been reported with diverse frequencies. METHODS: We retrospectively analyzed brain imaging in 34 patients presenting with proven miliary TB hospitalized in our teaching hospital between 2008 and 2014. RESULTS: Neurological symptoms were present at admission in 15 patients, emerged during treatment in six, and were never reported in 13. Twenty-one of 34 patients had cerebral involvement, of which five patients did not present with any neurological symptoms. The most common brain lesions on MRI were tuberculomas. Cerebrospinal fluid (CSF) analysis showed elevated cell count in eight patients who all had abnormal MRI results. Nine patients with normal CSF had abnormal MRI results. CSF cultures were positive in only eight patients. Paradoxical clinical worsening during TB and corticosteroid treatment was observed in six patients. CONCLUSION: Among patients presenting with miliary TB who underwent brain imaging, more than 60% demonstrated cerebral involvement. Abnormal imaging could occur without any clinical nor CSF impairment. Systematically performing brain imaging in miliary TB patients could therefore be informative.
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Imagen por Resonancia Magnética , Neuroimagen , Tomografía Computarizada por Rayos X , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/microbiología , Tuberculosis Miliar/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Lung cancer is the leading cause of cancer death worldwide. Prognosis and treatment outcomes are known to be related to the disease stage at the time of diagnosis. Therefore, an accurate assessment of the extent of disease is critical to determine the most appropriate therapy. Currently available imaging modalities for diagnosis and follow-up consist of morphological and functional imaging. Morphological investigations are mainly performed with CT-scan and in some cases with MRI. In this review, we describe the contribution of MRI in lung cancer staging focusing on solid pulmonary nodule characterization and TNM staging assessment using chest and whole-body MRI examinations, detailing in each chapter current recommendations and future developments.
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Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Imagen por Resonancia Magnética/métodos , Imagen de Difusión por Resonancia Magnética/métodos , Estudios de Seguimiento , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/terapia , Estadificación de Neoplasias/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Pronóstico , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodosRESUMEN
PURPOSE: To assess the normal values of fractional anisotropy (FA) and mean diffusivity (MD) of L4, L5 and S1 nerve roots using diffusion tensor imaging (DTI) in healthy volunteers. MATERIALS AND METHODS: 37 subjects without previous history of lumbalgia or radiculalgia were prospectively examined: 27 at 1.5T and 10 at 3T MRI. The protocol included standard anatomical sequences and a DTI acquisition. Nerve root fibers were semi automatically extracted from DTI tractography. FA and MD values were measured at 4 key portions along each L4, L5 and S1 nerve roots. RESULTS: At 1.5T MRI, FA and MD were 0.221 ± 0.011 and 460.9 ± 35.5 mm2.s-1 respectively; at 3T MRI, FA and MD were 0.216 ± 0.01 and 480.1 ± 36.1 mm2.s-1 respectively, which may be considered as normal values for mobile lumbar spine nerve roots, independently of intersomatic space level (p = 0.06) and nerve root portion (p = 0.08) or magnetic field (p = 0.06). CONCLUSION: Normal FA and MD values can be measured along lumbar mobile spine nerve roots in healthy subjects. These values were not dependent on intersomatic space level, side or anatomical portion of the nerve root or magnetic field.
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Técnicas de Imagen Sincronizada Cardíacas , Miocarditis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Enfermedad Aguda , Adulto , Biomarcadores/sangre , Medios de Contraste , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Humanos , Yopamidol/análogos & derivados , Imagen por Resonancia Magnética , Masculino , Interpretación de Imagen Radiográfica Asistida por ComputadorRESUMEN
PURPOSE: To measure the fractional anisotropy (FA) and the mean diffusivity (MD) values of L4, L5 and S1 nerve roots using diffusion tensor imaging (DTI) and to correlate them with four different clinical patterns. PATIENTS AND METHODS: Fifty-six human participants were prospectively included and divided between four groups: healthy subjects, patients with clinical symptomatic nerve root pain with and without anatomical discoradicular conflict and patients with incidental anatomical discoradicular conflict seen on magnetic resonance imaging (MRI). MRI protocol included anatomical sequences (sagittal T1- and T2-weighted, axial T2-weighted) and a 25 directions DTI sequence. FA and MD values were measured in consensus by two readers and compared between the four groups. RESULTS: Mean FA and MD values were significantly different for patients with clinically symptomatic nerve root pain (n=27) both with (n=16) (FA=0.187±0.015; MD=510±40) and without (n=11) (FA=0.193±0.011; MD=490±30.5) anatomical discoradicular conflict compared to healthy subjects (n=29) (FA=0.221±0.011; MD=460.9±35.5) including 2 subjects with incidental anatomical discoradicular conflict (FA=0.211±0.013; MD=450.8±41.2) on MRI (P=0.003). CONCLUSION: Measurement of FA and MD values of L4, L5 and S1 nerve roots using DTI could be useful in lumbar nerve root pain assessment. Further studies with different image processing methods are needed.
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Imagen de Difusión por Resonancia Magnética/métodos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/patología , Síndromes de Compresión Nerviosa/diagnóstico , Sacro/patología , Raíces Nerviosas Espinales/patología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Imagen Eco-Planar/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND PURPOSE: Neurologic complications in infective endocarditis are frequent and affect patient prognosis negatively. Additionally, detection of asymptomatic lesions by MR imaging could help early management of this condition. The objective of our study was to describe MR imaging characteristics of cerebral lesions in a neurologically asymptomatic population with infective endocarditis. MATERIALS AND METHODS: One hundred nine patients at the acute phase of a definite or possible infective endocarditis according to the Duke modified criteria and without neurologic manifestations according to the NIHSS were prospectively included. Each patient underwent cerebral MR imaging and MRA within 7 days of admission. RESULTS: MR imaging showed abnormalities in 78 patients (71.5%). Acute ischemic lesions (40 patients, 37%) and cerebral microbleeds (62 patients, 57%) were the most frequent lesions. Eight patients had an acute SAH, 3 patients had brain microabscesses, 3 had a small cortical hemorrhage, and 3 had a mycotic aneurysm. Acute ischemic lesions mostly appeared as multiple small infarcts disseminated in watershed territories (25/40, 62.5%) and as lesions of different ages (21/40, 52.5%). Cerebral microbleeds were preferentially distributed in cortical areas (362/539 cerebral microbleeds, 67%). No significant correlation was found among lesions, in particular between acute ischemia and cerebral microbleeds. CONCLUSIONS: Occult cerebral lesions, in particular cerebral microbleeds and acute ischemic lesions, are frequent in infective endocarditis. The MR imaging pattern of acute small infarcts of different ages predominating in watershed territories and cortical cerebral microbleeds may represent a surrogate imaging marker of infective endocarditis.
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Encefalopatías/epidemiología , Encefalopatías/patología , Encéfalo/patología , Endocarditis/epidemiología , Endocarditis/patología , Imagen por Resonancia Magnética/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Comorbilidad , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Cerebral complications are well-identified causes of morbidity and mortality in patients with infective endocarditis (IE). Few studies have analysed the impact of brain magnetic resonance imaging (MRI) in IE patients with neurological manifestations. OBJECTIVES: The aims of this study were to assess the MRI contribution to the management of patients with IE neurological manifestations and to compare cerebral CT and MRI findings. MATERIAL AND METHODS: Patients with definite or probable IE and neurological manifestations were prospectively enrolled from 2005 to 2008, in a university hospital (Bichat Claude Bernard Hospital, Paris). Clinical and radiological characteristics and echocardiographic findings were systematically recorded. Brain MRI with angiography was performed and compared to available CT scans. The contribution of MRI results to cerebral involvement staging and to therapeutic plans was evaluated. RESULTS: Thirty patients, 37-89 years old, were included. Nineteen suffered from pre-existing heart disease. Blood cultures were positive in 29 cases and the main micro-organisms were streptococci (n = 14) and staphylococci (n = 13). The IE was mainly located on mitral (n = 15) and aortic valves (n = 13). Neurological events were strokes (n = 12), meningitis (n = 5), seizures (n = 1), impaired consciousness (n = 11) and severe headache (n = 1). MRI findings included ischaemic lesions (n = 25), haemorrhagic lesions (n = 2), subarachnoid haemorrhage (n = 5), brain abscess (n = 6), mycotic aneurysm (n = 7), vascular occlusion (n = 3) and cerebral microbleeds (n = 17). In 19/30 cases, neurological manifestations were observed before the diagnosis of IE. MRI was more sensitive than CT scan in detecting both clinically symptomatic cerebral lesions (100 and 81%, respectively) and additional asymptomatic lesions (50 and 23%, respectively). Therapeutic plans were modified according to MRI results in 27% of patients: antibiotherapy regimen modifications in 7% (switch for molecules with high cerebral diffusion) and surgical plan modifications in 20% (indication of valvular replacement due to the embolic nature of the vegetations revealed by MRI or postponement of surgery due to haemorrhagic lesions). None of the 16/30 (51%) operated-on patients experienced postoperative neurological worsening. In-hospital death occurred in 4 patients. CONCLUSION: In patients with IE neurological manifestations, MRI revealed a broader involvement of the brain (type and number of lesions) than indicated by clinical signs and/or CT scan. With a better disease staging of neurological manifestations, MRI brain imaging may help in patient management and the decision-making process especially for cardiac surgery indication and timing of valve replacement.
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Encefalopatías/diagnóstico , Encéfalo/irrigación sanguínea , Encéfalo/patología , Angiografía Cerebral/métodos , Arterias Cerebrales/patología , Imagen de Difusión por Resonancia Magnética , Endocarditis Bacteriana/complicaciones , Angiografía por Resonancia Magnética , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Encefalopatías/etiología , Encefalopatías/mortalidad , Encefalopatías/patología , Encefalopatías/terapia , Arterias Cerebrales/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/etiología , Ecocardiografía , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/terapia , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Paris , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: Retroperitoneal fibrosis (RPF) is a rare disease with an expanding etiologic spectrum. We aimed to analyze non-invasive diagnosis strategy, associated disorders, monitoring, treatment and prognosis. METHODS: Retrospective cohort study in a single tertiary center. RESULTS: Eighteen RPF cases (11 males) followed between 1996 and 2009 were reviewed. Blood CRP level was high in all cases before treatment. CT scan, associated or not with MRI or 18-FDG PET-scan, confirmed the diagnosis in 15 patients. Histological analysis of a surgical biopsy specimen was performed in only three cases. Ten patients suffered retroperitoneal fibrosis secondary to systemic vasculitis (granulomatosis with polyangeitis, n=1, Takayasu aortitis, n=2), systemic fibrosis with Riedel thyroiditis (n=1) and atheromatous periaortitis (n=6). Fifteen patients were treated with corticosteroids with a mean treatment duration of 60 months (12-228). Dependency to corticosteroids was recorded in ten patients. Patients with fibrosis related to vasculitis were younger, had a higher CRP level, more frequent corticosteroid dependency and a higher relapse rate. Relapses were successfully treated with steroids. Immunosuppressive treatment was only prescribed in the setting of systemic vasculitis. No patient died, after a 6±2 years follow-up. Late relapses could occur, sometimes years after steroid therapy cessation. CONCLUSION: In our study, RPF occurred as a secondary disorder in 60% of the cases. Disease extension, relapse rate and treatment response varied according to the underlying cause of RPF, pleading for an extensive and systematic initial assessment. Since no death or end-stage renal insufficiency was observed, RPF might be considered as a steroid-sensitive and benign disorder.
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Fibrosis Retroperitoneal/diagnóstico , Fibrosis Retroperitoneal/terapia , Centros Médicos Académicos , Adulto , Anciano , Diagnóstico Diferencial , Diagnóstico por Imagen , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Persona de Mediana Edad , Fibrosis Retroperitoneal/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Fatigue is a prominent feature of systemic lupus erythematosus (SLE), usually ascribed to various factors, such as muscle or joint involvement, anaemia or depression. The Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoantibody-mediated disorder of neuro-muscular transmission. We report on a well-defined LEMS associated with thymus hyperplasia in a SLE patient. An African 41 years-old SLE patient presented with persisting fatigue, myalgia and dyspnea, abolished reflexes and a bilateral ptosis. Neuromuscular electrodiagnostic study showed a clear-cut potentiation that was typical of a pre-synaptic neuromuscular junction disease. Anti-calcium gated channels antibodies were disclosed in serum and a diagnosis of LEMS was made. A total body CT-scan revealed an antero-superior mediastinal mass, compatible with thymoma. The tumour was surgically removed with a final diagnosis of follicular thymic hyperplasia. In conclusion, our observation provides a new example of entangled organ-specific and systemic autoimmunity in the context of thymus pathology. Potentiation study during electromyography should be performed systematically to rule out LEMS in patients with SLE and muscle weakness.
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Síndrome Miasténico de Lambert-Eaton/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Hiperplasia del Timo/complicaciones , Adulto , Fatiga/diagnóstico , Fatiga/etiología , Humanos , Síndrome Miasténico de Lambert-Eaton/diagnóstico , Masculino , Mauritania , Timoma/diagnóstico , Timoma/cirugía , Hiperplasia del Timo/diagnóstico , Neoplasias del Timo/diagnóstico , Neoplasias del Timo/cirugía , Tomografía Computarizada por Rayos X , Imagen de Cuerpo EnteroRESUMEN
Cardiac MRI in patients with acute coronary syndrome with elevated troponin levels but normal coronarography can now routinely be performed on most MR units. MRI plays an important role in this clinical setting by its ability to detect myocardial infarction in patients with normal coronarography or suggest a different, potentially severe, alternate diagnosis such as myocarditis or takotsubo cardiomyopathy.
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Síndrome Coronario Agudo/diagnóstico , Aumento de la Imagen , Imagen por Resonancia Magnética , Síndrome Coronario Agudo/diagnóstico por imagen , Adulto , Angiografía Coronaria , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Factores de TiempoRESUMEN
PURPOSE: To use diffusion weighted MR imaging (DWI), a technique routinely used in patients with stroke, for diagnosis of myocardial infarction (MI). MATERIALS AND METHODS: A breath hold ECG gated DWI sequence (b = 300 sec/mm2) was developped and applied to 7 patients with recent MI (3-15 days), 3 patients with chronic MI (> 6 months) and 4 patients with valvular heart disease without MI (control cases). DWI data were correlated to T2W, first pass perfusion and delayed enhancement data. RESULTS: In all patients with recent MI, DWI showed an area of increased signal with reduction of ADC relative to normal myocardium. Hyperintense lesion on DWI corresponded to areas of delayed enhancement. The diffusion images were normal in patients with chronic MI or no MI. CONCLUSION: Even though no animal model or other reference method is available, these preliminary results indicate that DWI could assist clinicians in detecting recent MI.