[Transient bone marrow edema of the hip]. / Le syndrome d'œdème médullaire de la tête fémorale.

Transient bone marrow edema of the hip is characterized by moderate homogeneous low MR signal intensity with ill-defined margins that involves at least a portion of the femoral head. Spin echo T1-weighted images are helpful to exclude other underlying diseases (tumor, infection, necrosis from systemic origin…), for which marrow edema is secondary or no epiphyseal in location. High-resolution fat-suppressed T2-weighted or proton density images allow evaluation of the articular cartilage, subchondral bone and subchondal marrow: if the articular cartilage is abnormal, the lesion is irreversible (arthrosis or necrosis); if the subchondral bone is focally interrupted and/or if the femoral is no longer spherical, the lesion is irreversible (necrosis); if a focal linear fluid collection is present under the subchondral bone, the lesion is irreversible (necrosis). Finally, subchondral changes may provide useful prognostic information: the absence of any abnormality other than marrow edema typically indicates that complete resolution is likely; the presence of a focal T2-weighted hypointense lesion immediately next to the subchondral bone suggests an irreversible lesion, especially if it is equal to or thicker than 4mm or the joint space. In some instances, prognosis cannot be reliably determined requiring the need for follow-up imaging.

[Retroperitoneal fibrosis and multiple myeloma: fortuitous association?]. / Fibrose rétropéritonéale et myélome multiple : association fortuite ?

We report a 59-year-old man presenting with retroperitoneal fibrosis (RF) associated with IgG lambda multiple myeloma. Recent clinical and immunohistochemical findings suggest that RF might be a particular expression of plasma cell/lymphoid dyscrasia, and that this association is not merely fortuitous. We review the pathophysiological evidence supporting this hypothesis.

[Plain radiography of the knee: the articular surfaces]. / Relecture des radiographies standard du genou: les surfaces articulaires.

Lateral knee radiographs allow recognition of both medial and lateral femoral and tibial surfaces, groove and anterior borders of the trochlea and lateral facet and ridge of the patella. Analysis of these lines allows detection of focal contour abnormalities, femoral trochlear dysplasia and patellar tilt. Qualitative radiological analysis of the osseous surfaces detects the particular aspect of abraded subchondral bone ("drawn with chalk"), preventing the trap of false joint spaces on non weight-bearing views. Occasionally, very subtle bone abnormalities can be recognized in cases of cartilaginous, subchondral or even meniscal lesions. However, these focal abnormalities are not constant, and their visualization is somewhat anecdotal.

[Principles of analysis for sacroiliac joints imaging]. / Principes d'interpretation de l'imagerie des articulations sacro-iliaques.

Interpretation of sacroiliac joints imaging is uneasy. Simultaneous erosions, hyperostosis, and ankylosis together make the diagnosis of inflammatory lesions. Articular abnormalities may also be induced by mechanical stress or ligament ossifications. Distribution of the lesions can help to establish a precise diagnosis. Inflammatory lesions may be located in any part of the articulation, including the posterior and inferior part. Mechanical lesions as in osteitis condensans ilii are commonly located in the anterior middle part of the joint. Ligament ossification in case of idiopathic skeletal hyperostosis is located at the margins of joint. The basic for the interpretation of sacroiliac joints is to look at high quality plain radiographs. When diagnosis is uncertain, complementary methods must be considered. CT is useful for analysis of subacute or chronic lesions and MRI is to be preferred for acute lesions, in young patients and when searching for signs of inflammatory activity in an already known chronic disease.

Bone marrow edema of the femoral head.

This article addresses the MR features of the bone marrow edema syndrome (BMES) of the femoral head with emphasis on the prevalence and clinicopathology of the disorder and description of the current concepts on diagnosis and prognosis. BMES can be observed in self resolving conditions such as transient osteoporosis of the hip, spontaneous fracture of the femoral head, or post traumatic lesions. Rapidly destructive coxarthrosis, necrosis of the femoral head as well as certain forms of spontaneous fracture of the femoral head may present a similar MR pattern, though prognosis is definitely less favourable. The challenging role of the radiologist is to recognize BMES at an early stage and to provide adequate prognosis on the lesion outcome.

Hyperfractionated accelerated radiotherapy (HART) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (NSCLC): results of a phase II study for patients ineligible for combination radiochemotherapy.

PURPOSE: To evaluate a hyperfractionated and accelerated radiotherapy (HART) protocol in patients with inoperable non-small cell lung carcinoma (NSCLC) who were ineligible for combination radiochemotherapy studies. METHODS AND MATERIALS: From February 1989 through August 1994, 23 patients ineligible for available combined modality protocols in our institution were enrolled and treated with HART, consisting of 63 Gy given in 42 fractions of 1.5 Gy each, twice daily, with a minimum time interval of 6 h between fractions, 5 days a week, over an elapsed time of 4.2 weeks, or 29 days. There was no planned interruption. RESULTS: The 1-, 2-, and 3-year survival rates were 61%, 39%, and 19%, respectively, with a median survival of 16.8 months. At the time of analysis, 4 patients are alive and 19 have died, 16 from NSCLC and 3 from cardiac disease. Overall response rate was 48%, with 22% of patients achieving a complete response and 26% a partial response. Correlation between acute response rate and survival was poor. First site of relapse was local-regional in 8 patients (35%), distant in 6 patients (26%), and local-regional and distant in 4 (17%) patients. One patient had Grade IV and 2 had Grade III esophagitis. One patient presented with chronic Grade III lung toxicity. There were no treatment-related deaths. CONCLUSION: In this group of 23 patients ineligible for radiochemotherapy, this HART regime was quite feasible and was followed by little toxicity. Results in this particularly poor prognosis NSCLC patient category should be compared to series with a similar patient profile; however, median survival is at least similar to that obtained in recent series of combination radiochemotherapy.