What is the role of computed tomographic coronary angiography in diabetic patients?

UNLABELLED: All diabetes specialists are aware of the frequency and severity of coronary disease in diabetics. Non-invasive diagnostic tests perform well, but they could be better. AIM: To assess the role of computed tomographic coronary angiography in diabetics. New cardiac imaging techniques such as CT coronary angiography are promising tools for the selection of patients for conventional X-ray coronary angiography, which remains the key for diagnosis and angioplasty. The limitations of CT coronary angiography, even using the most advanced machines with a 64-slice capacity, are its resolution, the need for an iodine contrast agent and the cumulative radiation from repeated examinations. CONCLUSION: CT coronary angiography appears to have great potential for patients at risk where non-invasive tests cannot absolutely exclude coronary disease and for the follow-up of coronary bypass surgery.

[Indications for the use of an epidural blood patch in the treatment of spontaneous intracranial hypotension]. / Indication du blood-patch dans le traitement de l'hypotension intracrânienne spontanée.

We report a patient with spontaneous intracranial hypotension treated with an epidural blood patch (EBP) and discuss the indication of this procedure in the treatment of this syndrome. Once diagnosis has been established (symptoms, CSF pressure, MRI), we propose to wait no more than a week, when simple treatment options have failed, before proceeding to an EBP. We inject a minimum of 20 ml, until the appearance of pain while injecting, of autologous blood in the L3-L4 epidural space. If this technique is unsuccessful, T6 would appear to be the best level to perform an EBP because it is by far the most common location of dural leakage (cervico-dorsal junction) and because this choice is also in accordance with the fact the blood may spread over 10 vertebral segments on each side of the injection level. Spinal MRI should at best be done before the procedure but is absolutely required when the patient fails to respond to the EBP conducted in the conditions we propose.

Pontoneocerebellar hypoplasia: definition of MR features.

We report five patients with pontoneocerebellar hypoplasia. Because the issue of cerebellar malformations is a difficult subject, we tried to define criteria for diagnosis on MRI: a thin flat pons with disappearance of the anterior curve, a small cerebellum with predominant flattening of the hemispheres and shortened cerebellar fissures, in contrast to atrophy. The posterior fossa is not enlarged. We emphasize the probable late onset of the disease in fetal life because of the demonstration of the abnormalities at US during the last trimester of the pregnancy in one patient. Prenatal diagnosis is important because of possible autosomal recessive transmission.

[Proper technics and the reduction of radiation in helical computed tomography]. / Bonnes pratiques et diminution de l'irradiation en tomodensitométrie hélicoïdale.

Helical computed tomography is the main source of ionizing radiation delivery in diagnostic radiology. For each series, average radiation dose is between 20 and 30 mGy. This dose can potentially be reduced by decreasing intensity or voltage and by increasing pitch. Helical acquisition allows reformating of images with smaller increment or different obliquity, and avoids additional irradiation. Hardware and software devices designed for dose reduction must be systematically used. Users of CT systems should be aware of radiation dose delivered with CT and must carefully assess the need of each additional acquisition. Obsolete habits, as gantry tilting for lumbar CT, which increases patient exposure, must be given up. Rational use of helical CT decreases radiation exposure and gains time, whereas thoughtless use increases radiation exposure without real benefit.

[MRI in post-traumatic cerebral fat embolism]. / IRM dans l'embolie graisseuse cérébrale post-traumatique.

We report two cases of posttrauma cerebral fat embolism evaluated with MRI. Due to sensitivity, MRI is the best examination for detecting focal abnormalities of the grey or white matter. MRI helps to make the diagnosis in atypical cases and allows assessment of both extension and course of the embolism.

[Imaging of encephalic parasitic diseases]. / Imagerie des parasitoses encéphaliques.

We review the main cerebral parasitic diseases, with emphasis on the most frequently encountered in Europe.

[Disseminated tuberculosis of unusual locations]. / Tuberculose floride avec localisations rares.

We report a case of disseminated tuberculosis involving the middle ear, the central nervous system, the spine and the lung. The tuberculous epidural abscess and otomastoiditis don't have any specific imaging features. But their coexistence with an other tuberculous involvement might suggest their tuberculous nature. The epidural abscess may result from direct extension from otomastoiditis.