[Imaging of the painful cervical spine]. / Imagerie du rachis cervical douloureux.

Neck pain can occur in several circumstances: traumatic, spontaneous, associated or not with motion, with or without head or upper limb irradiations. Each case requires appropriate clinical examination and radiographs. CT and MRI can be used to obtain additional information. Myelography and arteriography are exceptionally used. Cervical discography and facet joint arthrography are used therapeutically. After a brief anatomical review, normal and pathological patterns will be reviewed using radiographs. Each circumstance is studied: traumatic, degenerative, inflammatory and tumoral. It is emphasized that discogenic cervico-brachial neuralgia usually has a favorable spontaneous outcome. A special chapter is dedicated to calcifying and ossifying diseases of the cervical spine. Cervico-occipital neuralgia is also discussed.

[Shoulder imaging: what is the best modality?]. / Imagerie de l'épaule: quel examen choisir?

Specific pathologies of the shoulder include instabilities in young patients and tendinopathies in older patients. The choice of imaging modality depends on the information expected from each technique. In case of instability, plain films demonstrate bone abnormalities such as Hill Sachs and/or Bankart lesions. Arthro-CT or arthro-MRI need not be in all cases but can provide additional information performed about the intraarticular structures and the glenoid labrum. The rotator cuff is initially evaluated by plain films which demonstrate anatomical conditions resulting in impingement syndrome as well as indirect signs of tendinopathy. Direct visualization of tendons may be achieved by US, arthro-CT, arthro-MRI. US is a dynamic, non invasive and accurate technique for evaluation of rotator cuff tear but is very operator-dependent. Arthro-CT is more reproductive and reveals accurately partial tear as well as anterior tears involving biceps or subscapularis tendons. MRI is very useful to visualize the rotator cuff and adjacent bony structures. Nevertheless, MRI is still limited by its cost, accessibility and variable quality.

Study of the joint space of the hip on supine and weight-bearing digital radiographs.

AIM: To compare hip joint space on supine and weight-bearing anteroposterior digital radiographs. MATERIALS AND METHODS: Fifty anteroposterior views of the hip in 25 patients were taken in supine and weight-bearing positions on a fluoroscopic unit. Two observers in a double-blind study assessed the width of the joint space on an Easy Vision unit with an indirect method of measurement (metric index). RESULTS: Inter-observer and intra-observer variabilities of the metric index were less than 4.1%. There was no significant difference of the metric index of the hip (P>0.05), between supine and weight-bearing positions. CONCLUSION: There is no significant difference of the width of the joint space of the hip between supine and weight-bearing anteroposterior radiographs. Measuring joint space loss in osteoarthritis of the hip with anteroposterior views should be done with radiographs of the hip in the supine position to improve image quality.

[Radio-anatomy of the knee]. / Radio-anatomie du genou.

The authors review the radiologic anatomy of the knee joint with particular points of interest such as the cruciate ligaments, the menisci, and the articular cartilage. All imaging modalities are shown with special attention regarding MR imaging.

[Pain in the internal knee compartment]. / Douleur du compartiment interne du genou.

The anatomical classification of the traumatic or non traumatic lesion gives a mnemotechnical list which assists in the etiological search for pain of the inner aspect of the knee: skin, sub cutaneous tissue, medial lateral ligament, meniscus, cartilage, sub chondral bone, cruciate ligaments. Each mean of imaging detect specific lesions according to its technical capabilities: standard X Ray film, arthrography, CT scanner, MRI, bone scintigraphy, and echography. In practice, strategy is adapted to the clinical presentation, traumatic or non traumatic. In emergency situations, one is looking for bone, ligamentous, and meniscus lesions. Without acute traumatism, one can discover ligamentous tear sequellae (Pelligrini Stieda's ossifications), transient osteoporosis (algodystrophy), degenerative lesions (arthrosis) of the inner compartment. Always remember "close to the knee", it is necessary to check for more serious infectious or tumoral pathology. If standard plain films remain the first means of examination, and are still useful, MRI is becoming increasingly necessary for a complete anatomical evaluation.

[Imaging]. / Imagerie.

The panoply of imaging techniques useful in podology is essentially limited to X-rays. Standard "standing" and "lying" X-rays furnish most of the required information. Arthrography is sometimes performed, in particular for trauma or tumour of the ankle. CT scan and MRI make a decisive contribution in difficult cases, notably in fractures and in small fractures without displacement. The two latter techniques are useful in tendon, ligament and muscular disorders, where echography is also informative. Rigorous analysis of radiographies and a good knowledge of foot disorders make these imaging techniques efficacious.

Image-Guided Spinal Steroid Injections.

This paper has been written to stimulate the radiologist to consider the various aspects of spinal steroid injections as therapeutic procedures. Special emphasis is placed on needle guidance, asepsis, and possible problems involved. It constitutes a highly practical and variously illustrated and informative guide for the choice of steroids and various spinal joint approaches. It details the following target areas: lumbar facet joints, cervical facet joints, costovertebral joints, C1-C2 joint, intervertebral discs, epidural space, and interspinous bursa. Safety is the key element of the above-mentioned techniques. The radiologist must pay special attention to the omnipresent risk of iatrogenic infection.

[Value and results of radioguided deep spinal biopsy]. / Intérêt et résultats de la biopsie osseuse profonde rachidienne radioguidée.

MATERIAL AND METHODS. 76 percutaneous vertebral biopsies were performed with fluoroscopic guidance at the Radiology B Service, Hôpital Cochin in Paris, from November 1991 to March 1994. There were 12 cervical, 23 thoracic, 45 lumbar and sacral biopsies. There were 71 patients (28 women and 43 men), aged 22 to 88 years old (mean age 55.9). The needle used was either a trophine needle (Mazabraud) or a cutting needle (Surcut) or both. We have been doing vertebral percutaneous biopsies for 20 years in our radiology Service, and we published a review of 100 cases in 1983. The aim of this second review is to actualize the technique and the results. RESULTS. An accurate diagnosis was made in 80% of all cases. Diagnosis were: malignancy (34 cases), infection (21 cases), benign compression fracture (10 cases), miscellaneous (11 cases). There were two complications, one at the cervical spine (aggravation of a cervical cord compression) and one at the thoracic spine (pneumothorax). CONCLUSION. Percutaneous vertebral biopsy under fluoroscopic guidance is a safe and reliable method of obtaining a diagnosis in different spine lesions, avoiding thus, in most cases, a surgical procedure.

[MRI of the knee. Value of delayed sequences after intravenous injection of gadolinium]. / IRM du genou. Intérêt de séquences retardées après injection intraveineuse de gadolinium.

A prospective study of delayed sequences after intravenous injection of gadolinium for knee MRI shows the similar results as from the literature: enhancement of synovial fluid after 30 minutes. Sixteen patients were studied mainly with gradient echo. This phenomenon improves the visualisation of the intraarticular structures like meniscus, cruciate ligaments, or cartilage. This study leads to use this technique in case of difficulties like postoperative intraarticular lesions.

[Chemolysis of intravertebral disk hernia and spinal syndrome]. / Hernie intra-spongieuse, nucléolyse et syndrome rachidien.

The authors report a 31 year old patient who underwent L5-S1 chemonucleolysis. The prenucleolysis discogram disclosed intravertebral discal displacement. Severe spinal symptoms and development of geodes in the endplates adjacent to the treated disk occurred after the procedure. This case suggests that intraosseous discal displacement may be a risk factor for postchymopapain nucleolysis discitis and may contraindicate chemonucleolysis.

Magnetic resonance imaging assessment of sacroiliac joint involvement in Gaucher's disease.

A young woman with Gaucher's disease experienced acute pain in her right sacroiliac (SI) joint. Although pelvic radiographs and computed tomographic scan showed no significant change in the right SI joint, magnetic resonance imaging demonstrated an area of high signal intensity in the iliac part of the right SI joint, and a periosseous collection of blood. This skeletal location is rarely reported in Gaucher's disease; the mechanism of bone crisis is still controversial and our case suggests the occurrence of a bone infarct.

[Radiologic anatomy of the wrist]. / Anatomie radiologique du poignet.

Wrist imaging still relies first on plain X-Ray films, MRI allows excellent appreciation of the sculture of bones, ligaments, tendons and even nerves. C.T. is essentially useful in traumatology, while Wrist arthrography can be useful for detection of small ligament lesions.

[Anulography]. / L'annulographie.

Despite new imaging modalities such as MRI, the discography remains useful, particularly as the first step of chemonucleolysis. The anulography corresponds to a technical error due to the wrong position of the needle during the procedure. We have noticed 32 anulographies on 1226 discographies done in our department, between 1985 and 1989. The anulography exhibits a typical pattern that must be diagnosed; if not, that can lead to a diagnosis mistake or a wrong therapeutic attitude. The needle of discography must then be repositioned.

[The dural sheath in the sitting and standing position during saccoradiculography. Apropos of 150 cases]. / Etude du fourreau dural en position assise et debout au cours de la saccoradiculographie. A propos de 150 cas.

Lateral images were studied in the sitting and standing positions during a continuous series of 150 radiculographies, in patients presenting with a symptomatology suggestive of herniated disk or lumbar stenosis. In 67% of cases the dural sac was abnormally reduced at the level of the inter-somatic spaces, due to disk protrusion or intracanalar protrusion of posterior soft tissues. In 23% of cases, an absolute canalar stenosis with anterior-posterior decrease to less than 10 mn in the standing position existed. This was due in 65% of cases to an isolated or predominant posterior impression, the latter appearing in the standing position in only 55% of cases. Saccoradiculography is the only procedure allowing study of the dural cul-de-sac in the standing position. It should be carried out if a narrow lumbar canal is suspected clinically, even if investigations in the lying position, such as CT scan or MR imaging show normal canalar dimensions.