Ultrasonographic anatomy of the long thoracic nerve: A reappraisal using high frequency (24-MHz) probe.

PURPOSE: The purpose of this study was to analyze the potential of ultrasound with a high frequency probe (24-MHz) in the assessment of the long thoracic nerve (LTN) and describe ultrasonographic landmarks that can be used for standardization. MATERIAL AND METHODS: Ultrasonography analysis of the LTN was done on 2 LTNs in a cadaver specimen and then on 30 LTNs in 15 healthy volunteers (12 men, 3 women; mean age, 28.8±3.8 [SD] years; age range: 24-39 years) by two independent radiologists (R1 and R2) using a 24-MHz probe. Interrater agreement was assessed using Kappa test (K) and intraclass correlation coefficient (ICC). RESULTS: In the cadaver, dissection confirmed that the India ink was injected near the LTN in the middle scalene muscle. In volunteers, visibility of the LTN above the clavicle was highly reproducible for the branches arising from C5 (R1: 87% [26/30]; R2: 90% [27/30]; K=0.83) and from C6 (R1: 100% [30/30]; R2: 97% [29/30]; K=0.94). Where the nerve emerged from the middle scalene muscle, the mean diameter was 0.85±0.24 (SD) mm (range: 0.4-1.6mm) for R1 and 0.9±0.23 (SD) mm (range: 0.4-1.7mm) for R2 (ICC: 0.96; 95% CI: 0.92-0.98%). Along the thoracic wall, where LTN run along the lateral thoracic artery, the mean diameter was 0.83±0.19 (SD) mm (range: 0.5-1.27mm) for R1 and 0.89±0.21 (SD) mm (range: 0.6-1.2mm) for R2 (ICC: 0.86; 95% CI: 0.72-0.93%). CONCLUSION: The LTN can be analyzed with ultrasound using high-frequency probe by using the C5 and C6 roots, the middle scalene muscle above the clavicle and the lateral thoracic artery on the chest wall as landmarks.

Ultrasonography study of the suprascapular nerve.

PURPOSE: The aim of the study was to evaluate the assessability of the suprascapular nerve (SSN) by ultrasonography in cadavers and healthy volunteers. MATERIALS AND METHODS: With ultrasonography guidance, needles were placed at origin of the SSN of four cadavers and evaluated by dissection. Two blinded radiologists performed 60 ultrasonography scans in 30 healthy volunteers to study the entire SSN at five anatomical landmarks. RESULTS: Dissection revealed that the needles were correctly located at the nerve's origin. There were no significant differences between the two radiologists' measurements of nerve size and depth. The interobserver correlation for the description of the nerve at the five predefined anatomical landmarks was very good (ICC=0.7-1). CONCLUSION: Five anatomical landmarks were used to analyze the SSN with ultrasonography. Its supraclavicular portion was easier to describe than its scapular portion; a segment of the SSN was not visible between these two portions.

Imaging of meniscus and ligament injuries of the knee.

Magnetic resonance imaging has now an indisputable role for the diagnosis of meniscus and ligament injuries of the knee. Some technical advances have improved the diagnostic capabilities of magnetic resonance imaging so that diagnoses, which may change the therapeutic approach, such as a partial tear of the anterior cruciate ligament or confirmation of unstable meniscal injuries, are now made easier. This article describes the essential about magnetic resonance imaging technique and pathological results for the menisci, collateral ligaments and damage to the central pivot of the cruciate knee ligaments.

Bone abnormalities of the knee: MRI features.

The knee is one of the most studied anatomical structures by magnetic resonance imaging (MRI). Bone abnormalities are very frequently detected, whether or not related to the symptoms for which imaging was indicated. The aim of this pictorial study is to review the most commonly observed bone abnormalities of the knee, bearing in mind that the interpretation of MR images should always take into consideration both clinical and laboratory data, as well as the results of conventional X-ray imaging.

Tumors and pseudotumors of the hand: The role of imaging.

The assessment of a swelling or mass of the wrist or the hand is commonly performed by radiologists. Because cysts on the wrist are, by far, the most frequent pathology. Diagnosis is usually based on standard radiography and ultrasound alone. Additional imaging techniques, and in particular MR imaging, are necessary to assess tumors, although malignant tumors of the hand are rare. Some benign cysts have pathognomonic characteristics visible on imaging. By understanding them, treatment planning may be improved.

Ultrasonography of the brachial plexus, normal appearance and practical applications.

Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots are accurately identified due to the shape (a single tubercle) of the transverse process of C7 in the paravertebral space, and the superficial position of C5 in the interscalene groove. The téléphérique technique allows the roots, trunks and cords to be followed easily into the supraclavicular fossa. In just a few years, ultrasound imaging of the plexus has become a routine anesthesia examination for guiding nerve blocks. In trained hands, it also provides information in thoracic outlet syndromes, traumatic conditions (particularly for postganglionic lesions) and tumoral diseases. Even if MRI remains the standard examination in these indications, ultrasound, with its higher definition and dynamic character, is an excellent additional method which is still under-exploited.

[Value of radiographic evaluation of the second metacarpal in the determination of bone age]. / Apport de la radiographie du second métacarpien pour la détermination de l'âge osseux.

PURPOSE: Age determination based on bone maturate evaluation is routinely used in forensic science and anthropology. The aim of this study was to purpose a quantitative method of age determination on the second metacarpal in a population of children and adolescents by measurements of the epiphyso-metaphysal ratio (REM) (epiphysal diameter divided by metaphysal diameter) and the cortical index (IC). MATERIAL: and methods. We evaluated the REM and the IC on 417 hand radiographs of 2 from aged 20-year-old children. RESULTS: The correlation between REM and age for males (R2=0.62; p<0.001) and females (R2=0.68; p<0.001) was a good and significant. The correlation between IC and age for males (R2=0.34; p<0.001) and females (R2=0.30; p<0.001) was also significant but poor. CONCLUSION: Measurement of IC should not be used for age assessment. Measurement of REM is simple, reproducible and poor X-ray exposing technique. It should be very useful for age determination.