[A glomus tumor of the toe: a pediatric case report]. / Une tumeur glomique de l'orteil : une observation pédiatrique.

SUMMARY: A glomus tumour of the third toe is quite rare in children. The authors report a clinical observation based on a misdiagnosis due to insufficient investigations, which led to a mistaken referral to a pediatric psychiatrist. Preoperative diagnosis requires a targeted MRI. Complete resection of the tumor results in an immediate resolution of the pain.

[Different methods for assessing quality in health sector]. / Les différents modes de reconnaissance de la qualité en santé.

AN OBLIGATION: The "management" of quality is an integral part of "medical" management today. The health centers and professionals have to prove their value and know-how through distinct signs of recognition. A METHOD FOR ASSESSING QUALITY: This paper defines the method of assessment of quality and specifies the typology of the persons, organisms, supervisors and clients of the French health system who have a personal or collective interest in judging the quality of health services. DIFFERENT POSSIBILITIES: Numerous existing methods for assessing quality are presented together with their use, implementation and the use made by the actors and consumers of the health system. Some of these assessment methods are formal, others informal, some are mandatory, others optional; some concern the general population, others the professionals. Although know-how is essential in health, making it known is strategic today.

[Preoperative management of hip osteochondritis: comparison of MRI and arthrography with abduction views]. / Bilan préopératoire des ostéochondrites de hanches: comparaison de l'arthrographie et de l'IRM avec des clichés en abduction.

PURPOSE: Comparison between conventional arthrography and MRI in the preoperative work up of Legg-Calvé-Perthes disease. MATERIAL: ans methods. We studied 17 children (18 hips) who had arthrography and MRI (open-magnet configuration) the same day. Coronal and sagittal T1 weighted were realised with the hip in neutral position. Additional coronal T1 weighted with abduction of the hip were obtained. Two readers analysed individually MRI and arthrographic findings: shape of femoral head, index of Heyman (antero-external covering), came effect, recentering of femoral head and quality of examimation. RESULTS: No statistical difference between MRI and arthrography could be noted-exception made for the index of Heyman. CONCLUSION: MRI can replace arthrography in Legg-Calvé-Perthes disease.

[Imaging of the hip in healthy children in MRI: evaluation of the acetabular coverage]. / Imagerie de la hanche de l'enfant sain en IRM: évaluation de la couverture cotyloïdienne.

PURPOSE: To define with MR imaging a reference value for acetabular coverage on coronal and sagittal images for a population of healthy children. MATERIALS AND METHODS: 36 children (72 hips) where prospectively studied over 1 year. T1-weighted spin-echo images in both coronal and sagittal planes were obtained. Slice thickness was 4 mm. Measurement of acetabular coverage (AHI: Acetabular-Head Index) was made in both planes with two different landmarks: bone and cartilage. Study of the evolution with age was made. RESULTS: The acetabular coverage is symmetrical and decreases with age. Its measurement is reproducible. CONCLUSION: This study shows that measurement of acetabular coverage (AHI) is easily obtained at MR imaging and is reproducible. We suggest 83 (mean 1SD) as the inferior limit for AHI based on cartilage measurements. We introduce sagittal values, never published. We believe that MR, by its ability to demonstrate the cartilaginous surfaces, will play a major role in the true understanding of the anatomical relationship between the femoral head and the acetabulum.

[Why quality management is imposed in radiology?]. / Pourquoi le management de la qualite s'impose en imagerie medicale?

Quality management plays an important role in the French health care system, especially in radiology. The purpose of this article is to review the reasons of this evolution. Radiologists, technicians and hospital managers must be familiar with these concepts and implement them in their units.

Ultrasound assessment of the acetabulum in the infant hip.

One hundred and fifty infant hips were studied using simultaneous ultrasonography and radiography. The reliability of measurement was found to be similar for alpha angle and d/D ratio. However, the acetabular index correlated much better with the d/D ratio than with the alpha angle. In fact, in hips where the d/D ratio exceeded 56%, radiographs could be dispensed with. Besides, the use of a sector scanner or a linear-array tranducer was found to make no significant difference to the correlation between the acetabular index and the d/D ratio. Sonographic assessment of acetabular development in the infant should permit a reduction in the number of radiographs required during screening and follow-up.

Intraosseous cyst injection.

Unicameral and aneurysmal bone cysts are benign lesions, but they often require treatment to prevent pathologic fractures. Percutaneous therapeutic techniques have been developed because they are less aggressive than surgery. A radio-orthopedic consensus is required to choose a percutaneous method rather than a surgical procedure, especially in children.

Experimental evaluation of a percutaneous injectable biomaterial used in radio-interventional bone-filling procedures.

Interventional radiology is beginning to be used in bone pathology. An injectable biomaterial Ethibloc*, composed of alcohol and a vegetal protein (zein), has been successfully used for percutaneous treatment of benign bone lesions. The reasons for this success remained unknown and needed to be understood. In this study, using a rabbit model, an evaluation was made of bone formation and tissue reaction during the first weeks after the injection of this biomaterial. Ethibloc* was injected percutaneously into bone defects in rabbit distal femurs. Three time intervals were studied: 2, 4 and 8 wks. The three control groups constituted unfilled, polymethylmethacrylate (PMMA), and alcohol. Undecalcified bone technique was used for a qualitative analysis and histomorphometric evaluation. A low bone formation was found which was less than in the control groups (PMMA and unfilled). The "Ethibloc group" was characterized by an early inflammatory reaction. Good clinical results obtained with Ethibloc* probably arose, after an initial vascular thrombosis, from a secondary bone reaction and spontaneous osteogenesis obtained after the disappearance of vascular or hyperpression reaction.

[Psychological behavior of patients in MRI: analysis, proposals for improvement and contribution of open magnet equipment]. / Le comportement psychologique des patients en IRM: analyse, propositions d'amélioration et apport de l'appareillage à aimant ouvert.

Many patients report anxiety during MR imaging. Anxiety is due to immobility, coil noise, high temperature, duration of the examination and shape of the system. On basis of a prospective series of 250 patients undergoing MR studies, we have analysed mechanisms and reasons of anxiety. Psychological strategies are useful to reduce anxiety and improve patients' cooperation and relaxation. The easiest and most effective way is to inform the distressed patient. Information about the MRI examination must be clear and simple. Open field magnets improve comfort and global conditions of the examination realisation. Psychological consequences are less important. Open field MR systems reduce claustrophobia induced by MR imaging.

[Structural MRI study of the Achilles tendon. Correlation with microanatomy and histology]. / Etude structurale du tendon d'achille en IRM. Corrélation avec la microanatomie et l'histologie.

On T1 and T2 weighted MR Imaging, normal Achilles tendon is generally described as a homogeneous low signal structure. However, punctuate and/or short linear high signal foci are often seen, especially on the anterior part of axial sections. These images are not artifacts. The aim of this study was to correlate MR images of 20 normal Achilles tendons with micro-anatomic and histologic studies of 2 cadaver tendons. Intratendinous vessels were found in connective tissue septa called mesotenon. Foci of high signals result from this mesotenon. On T1 weighted images, a normal Achilles tendon can present high signal images without any disease process.

Osteomesopyknosis: report of a new case with bone histology.

A new case of osteomesopyknosis, a rare autosomal dominant axial osteosclerosis is reported, with 4 affected members of the same family. Biochemical investigations, bone mineral content (BMC) measurement, 99mTc HMDP bone scan and microscopy of iliac crest bone and femoral head have been performed on 1 subject. A marked increase of BMC was found, without abnormality of biochemical data. Microscopy of bone showed an increase of trabecular thickness, and a low rate of bone turnover. No abnormality of mineralization was found on microradiographs.

Artifacts in magnetic resonance imaging of the spine after surgery with or without implant.

Magnetic resonance (MR) imaging is often disturbed after spine surgical procedures with or without an implant. Artifacts are induced by ferromagnetic or nonferromagnetic implants and devices and by small metallic particles left by surgical instruments. All metallic artifacts can affect the quality and usefulness of postoperative spine MR examinations. The physical effects caused by the introduction of metal or other conductive materials into a magnetic field and their consequences are presented. The application to postoperative spine MR examinations and solutions to reduce artifacts are discussed.

[Role and place of MRI in the diagnosis of aseptic osteonecrosis of the femoral head. Apropos of 58 pathologic hips]. / Apport et place de l'IRM dans le diagnostic de l'ostéonécrose aseptique de la tête fémorale. A propos de 58 hanches pathologiques.

The early diagnosis of aseptic osteonecrosis of the femoral head has always been difficult. By studying 58 cases, the authors have demonstrated the diagnostic superiority of magnetic resonance imaging. As in the literature, we found aseptic osteonecrosis of the femoral head with no clinical sign, neither radiographic nor scintigraphic, by positive magnetic, resonance imaging. Moreover, it enables the simultaneous study of both hips. It gives with precision the age and extent of the necrosed fragment and enables an absolute differential diagnosis with hip algodystrophy. Magnetic resonance imaging is therefore the second and only examination to be carried out after the standard radiography. The couple, radiography and magnetic resonance imaging, gives all the necessary information for the diagnosis and classification of the aseptic osteonecrosis of the femoral head and Te 99m bone scintigraphy and scanner, whose value was limited, can thus be avoided.

The supernumerary muscles of the leg: a report of two cases.

Two cases of supernumerary muscles of the leg reported, which were both inserted on the sides of the calcaneus. The accessory soleus m., adductor of the fore-foot, is a variation of the triceps surae which through hypertrophy on the medial side of the leg can become particularly problematic in athletes. The fourth peroneal m. abductor of the fore-foot, is considered to increase the stability of the ankle and is asymptomatic.