MDCT arthrography assessment of the severity of cartilage damage and scapholunate dissociation in regard to specific-component tears of the scapholunate interosseous ligament.

PURPOSE: To evaluate the distribution and severity of cartilage damage and scapholunate dissociation assessed on multi-detector computer tomography (MDCT) arthrography in a sample of patients with scapholunate interosseous ligament (SLIL) injury, in regard to component-specific tears. METHODS: We retrospectively included 37 patients with SLIL tears and 34 patients without SLIL tears who served as controls, all patients had undergone MDCT arthrography. Morphology of SLIL dorsal and volar components was graded as: normal, partial, or complete tear. Cartilage damage was assessed in 14 distinct regions of the wrist using a semiquantitative modified scoring system. Staging of scapholunate advanced collapse (SLAC) for each patient was based on the distribution of cartilage damage seen on MDCT arthrography. Scapholunate dissociation was measured for each patient at the tenth of a millimeter. The Student's t-test (p) and the Wilcoxon Rank-Sum test (P) were used to compare the different groups. RESULTS: The cartilage damage scores obtained were greater in patients with complete SLIL dorsal component tear than in other patients (p = 0.0019 and P = 0.0018). Scapholunate dissociation was greater in these patients (p = 0.0003 and P = 0.0013). Scapholunate dissociation was also greater in patients with SLAC wrist (p = 0.0004 and P = 0.0012), with a cut-off value of 3.7 mm for diagnosing SLAC (sensitivity 83.3 % and specificity 89.5 %). CONCLUSION: MDCT arthrography assessment shows that the severity of cartilage damage and scapholunate dissociation is greater when the dorsal component of the SLIL is completely ruptured.

MRI characteristics of carotid bulb atypical fibromuscular dysplasia in black stroke patients.

BACKGROUND AND PURPOSE: In black stroke patients, a particular form of fibromuscular dysplasia (FMD), called atypical FMD (aFMD), is involved in stroke mechanism. The high rate of stroke recurrence under medical treatment leads to propose surgery in such patients. Regarding its location level on the carotid bulb, aFMD is often confused with atherosclerosis or free-floating thrombus. Nowadays, only histology can confirm the diagnosis. MRI of aFMD has never been assessed. MATERIALS AND METHODS: The constitution of a black patient's cohort with aFMD-related ischemic stroke is currently in progress in the French West Indies, Martinique. In patients scheduled for surgery, MRI of the carotid bifurcation was analyzed preoperatively, with subsequent histological examination of the excised specimen. The first four black stroke patients with MRI and histological findings are described. RESULTS: On imaging, aFMD lesion was homogeneous with isosignal on T2-weighted sequences and slight hypersignal on T1-weighted sequences with mild gadolinium enhancement of the inner layer. Histological findings confirmed the aFMD mainly located in the intima. CONCLUSIONS: aFMD generates a particular MRI pattern in our four patients, which could increase the diagnosis accuracy. Carotid bulb lesion in black stroke patients should suggest aFMD and MRI analysis may contribute to rule out differential diagnoses.