[Assessing and predicting recovery from a coma following traumatic brain injury: contribution of neuroradiological data]. / Apport de la neuroradiologie à l'évaluation et au pronostic de l'éveil des comas traumatiques.

OBJECTIVE: Literature review concerning the contribution of neurological imaging to the assessment of traumatic lesions and the prognosis of traumatic coma. MATERIAL AND METHODS: Interrogation of scientific databases Medline, Embase and Current Contents via key-words. One hundred and seventy-one articles were picked up out of which 67 were analysed according to the French ANAES' rules. Results and discussion are drawn from the literature data and the author's experience. RESULTS AND DISCUSSION: In the acute stage the diagnosis approach prevails the prognostic dimension, is confused by secondary complications. Computerized-Tomography (CT) remains the best imaging modality, allowing a quick diagnosis of most of injuries, especially those which require an emergency treatment. But its predictive value in coma outcome is low. Although magnetic resonance imagery (MRI) is more sensitive, it does not at the acute stage lead to therapeutic modifications, increases the costs and is thus not necessary. MRI angiography may show cranial vessel injury which need specific therapeutic procedures. In the subacute or chronic stage after a severe head injury, CT is useful for the follow up and may provide some prognostic informations. But MRI with classical sequences has a higher sensitive and predictive power. Diffusion weighted imaging has not so far made the proof of it's predictive value. Proton MR spectroscopy seems to be able to provide data correlated with neurological outcome (NAA/Cr), but is not of routine use. Single-photon emission tomography is also useful to assess brain injury sequelae in the chronic stage; positron-emission tomography still remains a research technology. These 2 modalities have not yet a prognostic value. CONCLUSION: In the acute stage CT remains the best imaging modality. In the subacute and chronic stage MRI has the highest predictive power. Special sequences raise new hopes. Single-photon emission tomography and positron-emission tomography have not yet a prognostic value.

[Intradiploic epidermoid cyst: diagnosis by ultrasonography and MRI]. / Kyste épidermoïde intradiploïque: diagnostic par échographie et IRM.

Epidermoïd cysts are well documented. Whenever possible, surgery is always necessary. Intradiploic epidermoïd cyst are uncommon, especially in the occipital bone. Ultrasonography (US) may be useful and used instead of radiographs. As demonstrated in intracranial forms, diffusion-weighted MR Imaging (MRI) sequence can be useful for the diagnosis of epidermoid tumors and postoperative assessment of residual tumor. We propose to illustrate the usefulness of US and MRI in depicting an intradiploic epidermoïd cyst in a 27-year-old woman.

[Paradoxical embolism: an unusual cause of cerebral ischemia]. / Embolie paradoxale: une cause inhabituelle d'ischémie cérébrale.

Paradoxical embolism (PE) is an uncommonly diagnosed cause of unexplained ischemic cerebral event. Its diagnosis is based on established criteria and the failure to identify an arterial or cardiac embolic source. The association between patent foramen ovale (PFO) and cryptogenic stroke has repeatedly been demonstrated in clinical studies. Transesophageal contrast echocardiography is the best diagnostic test. Surgical or endovascular PFO closure is recommended for the long-term prevention of PE.

[Giant hydropic fibroma: a case report]. / Fibrome hydropique géant: à propos d'un cas.

Hydropic degeneration of a uterine leiomyoma is common. Giant forms are uncommon. Positive diagnosis may be challenging because the differential diagnosis includes other rare uterine tumors such as leiomyosarcoma. Uterine localization, the leiomyoma volume, margins with adjacent structures are best evaluated at MRI. Final diagnosis requires gross and microscopic examination. We describe such a diagnostic challenge in a 46-year-old woman with a giant hydropic leiomyoma.

[Plasmacytoma and AIDS: unusual duodenal localization]. / Plasmocytome et SIDA: une localisation duodénale inhabituelle.

We report an uncommon presentation of plasmocytoma in an AIDS patient. AIDS is associated with an increased risk of neoplasms. The incidence of Plasma Cell tumors in HIV-positive patients is greater than in non-infected patients. Multiple factors contribute to B cell neoplasms development.

[Ewing's sarcoma of the soft tissues: apropos of 3 cases and review of the literature]. / Sarcome d'Ewing des parties molles: à propos de 3 cas et revue de la littérature.

Three cases of extraosseous Ewing sarcoma are reported. This pathology of the young adult is very rare as shown by the review of the literature. Clinical or imaging (CT or MRI) findings are non-specific and diagnosis is based on histology. Nonetheless, this diagnosis should be considered in all patients with primary soft tissue tumors.

[Air in the bone? Diagnosis and treatment of a pneumatocyst of the ilium. Apropos of a case]. / De l'air dans l'os? Diagnostic et traitement d'un pneumatokyste de l'ilion. A propos d'un cas.

We present a case of symptomatic pneumatocyst of the ilium observed in a professional scuba diver exposed to pressure variations. Pneumatocysts are rare and except for one case reported in a clavicular localization, are always found in subchondral bone of the iliac or sacral side of the sacroiliac joint. Undoubtedly, air fills an intraosseous node. We report here the first case of efficient treatment achieved by filling the cyst via percutaneous access under scopic control.

[Cystic duplication of the esophagus, a rare etiology of dysphagia. Apropos of a case]. / La duplication kystique de l'oesophage, étiologie rare d'une dysphagie. A propos d'une observation.

A case of an upper oesophageal duplication in a 44 year old man was reported. Dysphagia was the only clinical signs and further examinations CT Scan, MRI performed for diagnosis. Surgical treatment (thoracotomy) was performed and postoperative complication was underlined. Cysts with oesophageal structure are unusual anomaly and surgery is difficult and dangerous.

[Role of MRI in spinal and spinal cord emergencies]. / Place de l'IRM dans l'urgence rachidienne et médullaire.

Out of 137 cases concerning the spine and spine cord, the authors demonstrate that MRI is nowadays fully integrated in urgency investigations. In all cord compression suspicions and in spine trauma investigations, it's place is found. Coil and software improvements allow to put CT and MR scanning delays on a line. This study underlines the necessity of being equipped with non magnetic life support systems allowing management of very fragile patients. In traumas, MR provides the lesion's authentification, it's type, it's unique localisation or not, and therefore an early functional prognosis. The discovery of spine cord involving lesions in neoplastic conditions allows to follow a therapeutic strateging for maintaining the motor function. In the end, the authors discuss about practical utility of MR in scuba diving decompression accidents. No lesion of the spine cord has been demonstrated in 25 patients, probably because of technical insufficiency.

[Correlations between clinical examination/MRI/arthroscopy in the acute traumatic knee]. / Corrélations examen clinique/IRM/arthroscopie dans le genou traumatique aigu.

Authors study retrospectively 81 cases of isolated recent (less than three months) knee traumas. These include clinical aspects, NMR, arthroscopy. Clinical examinations have been graded: 1. possible lesion; 2. likely lesions; 3. confirmed lesions. Clinical examinations and NMR results are compared to arthroscopy considered as reference. Clinical examination of acute traumatic knee is essential. Nevertheless, its value for detecting precise lesions is poor, except for knee locking well correlated with meniscal tears. Results show that NMR provide better results than clinical examination. NMR is reliable for detecting tears of posterior cruciate ligament, tears of posterior horn of menisci (sensibility: 93%; specificity: 80%). Its results are less effective for appreciation of lesion of anterior cruciate ligament (sensibility: 88%; specificity: 78%) because of partial tears and functional but not morphologic damage. It is the only method able to evidence osteochondral injuries and soft-tissues associated lesions in traumatic knees. Emergency NMR scans show results no differences in results compared with routine examinations. However, one should keep in mind that negative NMR cannot exclude small cartilaginous lesions and partial tears of anterior cruciate ligament. According to these results and the known qualities of NMR (non invasive), we propose that this type of investigation should be more largely included in diagnostic attitude for acute injured knee. Emergency diagnostic arthroscopy could be efficiently replaced by NMR knee examination.

[Lipoblastic meningioma. An uncommon benign tumor]. / Méningiome lipoblastique. Une tumeur bénigne surprenante.

Often mentioned and not much documented, the lipoblastic meningioma is an unusual extra-axial benign tumor. It has spontaneously hypodensity in CT and appears with a high signal in MRI in T1-weighted sequence. Its vascularisation is rich and shows a strong contrast intake. Its resection is known as easy and its prognosis is excellent. The authors report here the observation of a 65 year old women having a lipoblastic meningioma. Literature is gone through and differential diagnoses are considered.

[Correlations between the clinical test/MRI/arthroscopy in acute knee injuries]. / Corrélations examen clinique/IRM/arthroscopie dans le genou traumatique aigu.

Authors study retrospectively 81 cases of isolated recent (less than three months) knee traumas. These include clinical aspects, NMR, arthroscopy. Clinical examinations have been graded: 1. possible lesion; 2. likely lesions; 3. confirmed lesions. Clinical examinations and NMR results are compared to arthroscopy considered as reference. Clinical examination of acute traumatic knee is essential. Nevertheless, its value for detecting precise lesions is poor, except for knee locking well correlated with meniscal tears. Results show that NMR provide better results than clinical examination. NMR is reliable for detecting tears of posterior cruciate ligament, tears of posterior horn of menisci (sensibility: 93%; specificity: 80%). Its results are less effective for appreciation of lesion of anterior cruciate ligament (sensibility: 88%; specificity: 78%) because of partial tears and functional but not morphologic damage. It is the only method able to evidence osteochondral injuries and soft-tissues associated lesions in traumatic knees. Emergency NMR scans show results no differences in results compared with routine examinations. However, one should keep in mind that negative NMR cannot exclude small cartilaginous lesions and partial tears of anterior cruciate ligament. According to these results and the known qualities of NMR (non invasive), we propose that this type of investigation should be more largely included in diagnostic attitude for acute injured knee. Emergency diagnostic arthroscopy could be efficiently replaced by NMR knee examination.

[Neurocysticercosis of spinal manifestation. Apropos of a case]. / Neurocysticercose à révélation spinale. A propos d'un cas.

A case of spinal extramedullary cysticercosis with location in basal cisterns is reported. It was revealed by a severe sciatalgia and studied with MR imaging which is precious for the diagnosis and the follow-up. Cerebral cisternal arachnoiditis is the main problem in this racemose form where long medical treatment is necessary.

[Ileocolic intussusception in adults. Apropos of a case caused by benign inflammatory polyp of the terminal ileum]. / Invagination iléo-colique de l'adulte. A propos d'un cas, secondaire à un polype inflammatoire bénin de l'iléon terminal.

A case of an adult intussusception secondary to a fibroid polyp of the terminal ileum is reported. Adult intussusceptions are observed rarely, usually caused by an organic lesion. The preoperative diagnosis is based on US patterns, target aspect and sandwich sign.

[The adipose tissue of the pelvis in imaging technics]. / Le tissu adipeux du pelvis en imagerie.

Fat is a fundamental contrast agent in pelvic imaging. The features of fat are typical on CT and MRI but vary on ultrasonography according to the physical characteristics and histology. The study of pelvic fat is of great importance in pelvic exploration because fat outlines both the normal structures and their borders. Involvement or masking of the pelvic fat is a good marker of carcinologic spread. Changes in pelvic fat may also be observe in inflammatory diseases. Specific diseases of fatty pelvic connective tissue such as lipomatosis and liposarcomas, are classically described. Teratomas with a fatty component derived from pelvic structures (ovaries) are easily diagnosed using imaging methods.

[The thorax of patients in diving accidents. Radiologic study]. / Le thorax de l'accidenté de plongée. Etude radiologique.

On the basis of a series including 185 files on diving accidents gathered between 1981 and 1988, the authors carry out a radiological study of the thoracic signs observed after drowning and lung overpressure. The typical radiological form and the various clinical forms of drowning and lung overpressure are described in this article. Emergency plain thoracic radiography in bed in the method of choice. However, the existence of many false-negative findings leads to proposing a study with computed tomography (CT) after initial treatment in order to better assess the lesions and to characterize the accident. The utility of radiology is also demonstrated for the follow-up of evolution. Lastly, the authors lay stress on the necessity to prevent such accidents, to which radiologists can contribute by detecting thoracic lesions (dystrophy and other evolutive lesions) for which diving is contraindicated.