Bilateral lesions of the globus pallidus in a young woman.

We report a case of stroke due to cocaine abuse in a 30-year-old woman. The initial examinations pointing to this diagnosis were CT and MRI. Magnetic Resonance Imaging revealed bilateral globus pallidus infarction characterized by restricted Diffusion with low ADC values. There was also a partial hemorrhagic component confirmed on T2* sequence. After gadolinium injection there was a ring enhancement consistent with a blood brain barrier leakage. Similar lesions have been described in post hypoxic-anoxic injuries such as following cardiac arrest, severe blood loss and CO intoxication.

Arabin cervical pessary in women at high risk of preterm birth: a magnetic resonance imaging observational follow-up study.

OBJECTIVE: To help elucidate the mechanism of action of the Arabin cervical pessary in pregnancies at high risk for preterm delivery. METHODS: Cervical length and uterocervical angle were evaluated in relation to gestational age in 198 pregnancies not at high risk for preterm birth that underwent clinical fetal magnetic resonance imaging (MRI). Additionally, in 73 singleton pregnancies at high risk for preterm birth, an Arabin cervical pessary was placed at 14-33 weeks' gestation. We performed MRI of the cervix immediately before and after placement and at monthly follow-up until removal of the pessary. In a subgroup of 54 pregnancies with a short cervix and pessary placement at 17-31 weeks' gestation, the uterocervical angle and cervical length at follow-up were compared with the preplacement values. RESULTS: In pregnancies not at high risk for preterm birth, the uterocervical angle did not vary, but cervical length showed a significant decrease with gestational age (r = -0.15, P < 0.05). Among the high-risk patients, the cervical pessary was successfully placed at first attempt in 60 (82.2%) and by the second attempt in 66 (90.4%), remaining well positioned until removal. In five patients we failed to place the pessary after two attempts, in one patient the pessary dislodged during follow-up and in one case the pessary was partly placed in the external cervical canal and triggered labor the next day. Among the subgroup of 54 patients, the median uterocervical angle immediately after pessary placement was significantly more acute than that prior to placement in the 46 (85.2%) who delivered after 34 weeks (132° vs 146°, P < 0.01), but was unchanged in the eight patients who delivered before 34 weeks (143° vs 152°, P > 0.05). CONCLUSION: In patients at high risk for preterm delivery, correct placement of the Arabin cervical pessary should be checked immediately; this can be performed quickly and easily using MRI. This study provides some evidence that, in singleton pregnancies with a short cervix, a cervical pessary delays birth through a mechanical effect on the uterocervical angle.

Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: a prospective study.

OBJECTIVES: To compare prospectively maternal acceptance of fetal and neonatal virtuopsy with that of conventional autopsy and to determine the confidence with which magnetic resonance (MR) virtuopsy can be used to diagnose normality/abnormality of various fetal anatomical structures. METHODS: MR and/or computed tomography virtuopsy and conventional autopsy were offered to 96 women (102 fetuses/neonates) following termination of pregnancy (TOP), intrauterine fetal death (IUFD) or neonatal death. Multivariable logistic regression analysis was used to investigate the effect on maternal acceptance of virtuopsy and/or conventional autopsy of the age of the mother, gestational age at TOP or delivery after IUFD, order of pregnancy, parity, religion, type of caregiver obtaining consent and reason for death. When parents consented to both MR virtuopsy and conventional autopsy of fetuses ≥ 20 weeks of gestation or neonates, the confidence with which MR virtuopsy could be used to diagnose normality/abnormality of various anatomical structures was determined on a scale in which conventional autopsy was considered gold standard. On autopsy we classified fetuses/neonates as having either 'normal' or 'abnormal' anatomical structures; these groups were analyzed separately. At virtuopsy, we indicated confidence of diagnosis of normality/abnormality of every anatomical structure in each of these two groups defined at autopsy, using a scale from 0 (definitely abnormal) to 100 (definitely normal). RESULTS: Of the 96 women, 99% (n = 95) consented to virtuopsy and 61.5% (n = 59) to both conventional autopsy and virtuopsy; i.e. 36 (37.5%) consented to virtuopsy alone. Maternal acceptance of conventional autopsy was independently positively related to singleton pregnancy, non-Moslem mother, earlier gestation at TOP or delivery afer IUFD and a maternal-fetal medicine specialist obtaining consent. Thirty-three fetuses ≥ 20 weeks of gestation had both conventional autopsy and MR virtuopsy, of which 19 had a full autopsy including the brain. In fetuses with normal anatomical structures at conventional autopsy, MR virtuopsy was associated with high diagnostic confidence (scores > 80) for the brain, skeleton, thoracic organs except the heart, abdominal organs except the pancreas, ureters, bladder and genitals. In fetuses with abnormal anatomical structures at autopsy, MR virtuopsy detected the anomalies with high confidence (scores < 20) for these same anatomical structures. However, in three cases, virtuopsy diagnosed brain anomalies additional to those observed at conventional autopsy. CONCLUSION: MR virtuopsy is accepted by nearly all mothers while conventional autopsy is accepted by about two-thirds of mothers, in whom refusal depends mainly on factors over which we have no control. Although conventional autopsy remains the gold standard, the high acceptance of virtuopsy makes it an acceptable alternative when the former is declined.

Magnetic resonance imaging in the normal fetal heart and in congenital heart disease.

OBJECTIVE: To evaluate prospectively the feasibility of magnetic resonance imaging (MRI) for assessment of the fetal heart for congenital heart disease (CHD). METHODS: This was a cross-sectional study, including 66 fetuses with a normal heart and 40 with CHD. The fetal heart was examined on MRI using axial steady-state free precession (SSFP) sequences. Regression analysis was used to investigate the effect on the ability to visualize cardiac anatomy of gestational age at examination, maternal body mass index, presence of fetal cardiac abnormality, fetal movements, fetal lie and twinning. The sensitivity and specificity of detecting cardiac defects were calculated. RESULTS: The four-chamber view was visualized in 98.1% of fetuses. The sensitivity of detecting a cardiac defect on the four-chamber view was 88% and the specificity 96%. The ability to visualize the left and right outflow tracts was only influenced by the presence of fetal movements: for the left outflow tract 94.4 vs. 50.0% visualization and for the right outflow tract 92.6 vs. 53.8% visualization without and with fetal movements, respectively. The sensitivity of detecting a cardiac defect of the left outflow tract was 63% and the specificity 100%, while sensitivity and specificity were 59 and 97%, respectively, for the right outflow tract. CONCLUSIONS: Despite the use of SSFP sequences, MRI in the fetal heart remains of limited value. It can only be used as a second-line approach for abnormalities of the four-chamber view suspected at prenatal ultrasound.

[Frontal syndrome post cerebral malaria. Case report]. / Un cas de syndrome frontal post-neuropaludisme.

Cerebral malaria is one of the most serious complications of Plasmodium falciparum infection, this protozoa of the Plasmodium family is the only known to induce cerebral malaria. This case is about a frontal lobe syndrome post cerebral malaria in a young man living in an endemic malaria area. This complication is rare and most common during childhood.

[Sciatalgy: which imaging in first intention?]. / Sciatalgie: quelle imagerie en première intention?

Lombosciatalgy is a very common pathology and accounts for one of the most important problems of the public health. Usually it is a symptom that decreases with medical treatment. MRI or CT examinations may be asked for when symptoms persist for more than 7 weeks after medical treatment, symptoms increase or if there is a manipulation or infiltration foreseen. When there is a doubt on the specific origin of the symptoms, in other words when the pathology is secondary to an inflammatory/infectious, traumatic or tumoral aetiology, X-rays are performed followed by a complementary examination by CT or MRI. A CT-scan will be performed mainly in the workup of pathology of the intervertebral disk, or in a posttraumatic setting. An MRI is advisable when there is a suspicion of a primary or secondary tumour, infection or inflammation and in stenosis of the spinal canal.

Detachable coiling for embolotherapy of high-flow pulmonary arteriovenous malformation: case report and review of the literature.

Pulmonary arteriovenous malformations (PAVMs) are very rare anomalies of the lung parenchyma. Although many patients are asymptomatic, it carries a high risk of severe cerebral complications, and rarely fatal outcome due to rupture of the malformation. There is a strong association with the Rendu-Osler-Weber disease. The patients should be treated in case of symptomatic PAVMs (paradoxical emboli), and also preventively, when the feeding artery is at least 3 mm in diameter. Embolization is a well-established treatment, which can be very challenging when dealing with very high-flow fistulas, where there is a risk of inadvertent migration of the embolization material in the left cavities of the heart and in the aorta. This report emphasizes the importance of the diagnosis and the embolization indication in pulmonary arteriovenous malformations, and the usefulness of detachable coils in case of high-flow fistulas.

[Cardiac magnetic resonance. Myth and reality]. / IRM cardiaque. Mythes et réalités.

The authors report their own experience and a review of the current literature in the field of cardiac MR (CMR). Latest technical improvements now allow obtaining both anatomical and functional imaging of the beating heart and great vessels in most pathological conditions. Established CMR indications such as cardiac tumors, pericardial diseases, operated congenital heart diseases, valvular diseases, arythmogenic right ventricular dysplasia, specific cardiomyopathies and great vessels of the thorax are reviewed and updated. Current applications in post myocardial infarction such as perfusion and viability imaging sequences are described. Moreover, CMR applications in syndrome X and myocarditis are evoked. Medical contra-indications and technical limitations of CMR are also discussed. Finally, the authors insist on the interest of a real partnership between radiologists and cardiologists for these procedures.

Cavernous haemangioma in the cavernous sinus: case report and review of the literature.

We report a cavernous haemangioma in the left cavernous sinus. This lesions very rarely occurs in this site and is difficult to diagnose correctly preoperatively. CT, angiography and MRI permit differentiation of the cavernous haemangioma from other tumours in this region and thereby contribute to a better surgical approach. The radiological features of cavernous haemangioma reported in the literature are summarised.

[Ganglion cyst of the cervical spine causing radiculopathy]. / Le kyste ganglionnaire de la colonne cervicale responsable d'une radiculopathie.

A case of ganglion cyst of the cervical spine causing radiculopathy is presented. This epidural mass is rare at the cervical level. Computed tomography suggests the diagnosis by the postero-lateral position of the mass close to facet joint. The trilobed configuration and the tissue characterisation of the cyst are well documented on MRI.

[Diagnosis of infraclinical lesions of the breast with dynamic MRI: results of a prospective and multicenter study]. / Diagnostic des lésions infracliniques du sein par IRM dynamique: résultats d'une étude prospective et multicentrique.

AIM: To determine the accuracy of dynamic contrast-enhanced subfraction MRI to diagnose nonpalpable breast lesions in a prospective multicenter study. MATERIAL AND METHODS: From June to November 1994, 72 patients had a surgical biopsy for a nonpalpable breast lesion and a preoperative dynamic MR after an informed consent was obtained. MR examinations were performed on 0.5, 1 and 1.5T MR unit. Each center underwent dynamic sequences either in spin or gradient echo in T1 weighted images obtained in less than two minutes before and after injection of Gadolinium-DOTA. The presence/absence of contrast enhancement within two minutes after injection of Gadolinium were considered as positive/negative findings respectively. RESULTS: These 72 women had mammographic (n = 80) or ultrasonographic lesions (n = 2). Mammograms showed mass (n = 23), asymmetrical density (n = 2), architectural distorsion (n = 8), clustered microcalcifications (n = 47) or was normal (n = 2). Dynamic Breast MR imaging showed early contrast enhancement in 44 malignant lesions (sensitivity: 89.8%) and 13 benign lesions (specificity: 60.6%). Five intraductal carcinoma of comedo (n = 1) or non-comedo (n = 4) type did not demonstrate any early contrast enhancement. CONCLUSION: This prospective mulcentric study confirms the high sensitivity of dynamic breast MRI whatever the type of MR unit or sequences.

[Radiography profile in forced plantar flexion for studying unsteady feet]. / La radiographie de profil en flexion plantaire forcée pour l'étude du pied instable.

We have studied the interest of an original radiological incidence ("Plantar hyperflexion") allowing to demonstrate a possible hyperlaxity of medio-tarsal joints. We discovered a significant difference of mobility between patients with unstable feet and the control group. The existence of a medio-tarsal hyperlaxity should be taken into account before starting any treatment.

[Alternate red nucleus syndrome (Claude variant). Apropos of a case report]. / Syndrome alterne du noyau rouge (variante de Claude). A propos d'une observation.

The authors describe a case of Claude's syndrome corresponding to a third cranial nerve palsy with contralateral cerebellar ataxia, due to a red nucleus softening. They review the different varieties of red nucleus syndromes and their usual causes.

Prediction of splenic volume by a simple CT measurement: a statistical study.

The width, thickness, and areas of the spleen were obtained by abdominal computed tomography on 50 patients. Several simple linear equations were used to predict the splenic volume and were correlated with a previously published method for volume estimation based on summing areas of multiple contiguous scans. This was used as a standard and demonstrated an excellent linear correlation (r = 0.95) with an estimate based on a product of length and maximal width. Correlation was even better (r = 0.991) with an estimate based on length, maximal width, and thickness.

[Correlation between standard radiology and computed tomography in the demonstration of mediastinal lines]. / Corrélation radiologie standard et tomographie computée dans la démonstration des lignes médiastinales.

The mediastinal lines correspond to the contours of the middle and upper mediastinum, and represent the edges of a dense, pleural covered structure marginated by the air within the lung. The mediastinal lines derive their names from the adjacent organs: 1) The posterior mediastinal junction line (where both lungs meet posteriorly, just before the vertebral column). 2) The anterior mediastinal junction line (where both lungs meet anteriorly, behind the sternum). 3) The right paratracheal stripe (where the right lung meets the trachea). 4) The esophageal-pleural stripe (which disappears at the level of the arch of the Azygos vein that divides the right lung from the esophagus. 5) The Azygos-pleural line (where the arch of the Azygos vein meets the right lung). 6) The esophageal-pleural line (where the right esophageal wall meets the right lung). 7) The para-aortic line (that is the most constant). 8) and 9) The left and right paraspinous lines (whereof the right is the most often visible). The absence of one of the mediastinal lines is sometimes insignificant, since it can be caused by anatomical variations or by the conditions of the picture. C.T. explains the formation's mechanism of these mediastinal lines, explains the anatomic reasons for their possible absence or displacement and often provides us with their etiology. C.T. offers a simple, reliable and atraumatic method in cases of displaced or vanished mediastinal lines, and should replace standard tomography of the mediastinum.