Imaging of the windows of the temporal bone.

Imaging of the window of the temporal bone has became an important tool in the analysis of hearing loss, vertigo, tinnitus in a context of trauma, malformation, otosclerosis, and chronic otitis media. A good knowledge of the anatomy and a good technical procedure are necessary for making an efficient diagnosis. The increased thickness of the footplate may be delineated in otosclerosis, chronic otitis media, malformation, when it is measured at 0.7 mm or more in horizontal computed tomography (CT) sections. The traumatic displacement of the stapes, particularly within the labyrinths, is easily diagnosed in horizontal CT section. Imaging of the round window is now very important for the detection of otosclerotic foci, congenital stenosis, and perilymphatic fistula with or without fracture. Magnetic resonance imaging (MRI) with the high-resolution T2 plays an important role in the detection of a small amount of fluid in the round window recess, confirming the traumatic perilymphatic fistula without fracture.

Is there still a place for angiography in the management of renal mass lesions?

In recent years, the development of noninvasive imaging modalities for exploration of the kidney has markedly reduced the use of angiography in the evaluation of renal masses. Presently, it is not required in routine practice to evaluate renal masses. Ultrasound is the most efficient procedure in detecting renal tumor. It is acknowledged that arteriography has a limited diagnostic and staging value compared with CT and MRI for the assessment of renal cell carcinomas (RCC). Most urologists recommend partial nephrectomy or tumor enucleation in an effort to preserve as much as possible functioning renal tissue. In such cases a preoperative map of the renal vasculature is not needed. Information on the main renal artery(ies) and segmental renal arteries can be provided with spiral CT or dynamic MR angiography. Arteriography remains useful in exceptional situations. Interventional arteriography is becoming an important part. It is indicated by means of selective embolization for the treatment of potentially bleeding tumor (i.e. angiomyolipoma) or in emergency in cases of acute hemorrhage. Less frequently, it may be proposed as a palliative procedure for inoperable patients with huge renal tumor. Two other indications of interventional arteriography are acknowledged. Some urologists request preoperative embolization of the tumor-harboring kidney to decrease/avoid extensive blood loss during surgery and/or to facilitate surgery with huge renal tumors when the renal vessels are difficult to reach. The complications of nephron-sparing surgery (partial nephrectomy or tumor enucleation) related to bleeding or arteriovenous fistulas may be cured by arterial embolization.

[Imaging of tumors and pseudotumors of the ear]. / Imagerie des tumeurs et pseudo-tumeurs de l'oreille.

CT and MRI are in most of the cases associated in imaging of tumours and pseudo-tumours of the temporal bone. The tumours of the external auditory meatus particularly the malignant ones are rare. It is of a great interest to delineate a possible extension to the chorda tympani. Secondary cholesteatoma are the most frequent pseudo-tumours of the middle ear: CT and MRI evaluate very well their extension particularly in the giant forms. Others tumours like tuberculosis, histiocytosis, primitive cholesteatoma, tympanic body++ tumours may be diagnosed by imaging as well as the neuroma of the facial nerve, the meningioma or some rarer lesions as the adenoma, or the carcinoid tumour of the middle ear. The adenoma of the endolymphatic sac is the only true tumour of the membranous labyrinth whose diagnosis is nicely made by MRI. The primitive cholesteatoma, the neuroma of the facial nerve may reach the labyrinthine bone and are easily diagnosed by imaging which generally speaking is very good in evaluating the kind of pathology of each cavities, delineating the extension of the lesions and orientating the surgical procedures.

Cervical Chymopapain Chemonucleolysis.

Cervical chemonucleolysis probably represents the treatment of choice in case of a C6-C7 radiculalgia. This technique must be performed by specialists, given the particular anatomy which is in front of the cervical disk, within the soft tissues. For the future it is necessary to delete the manufacturer's restrictions concerning chymopapain use at the cervical level.

[Imaging of renal graft lymphomas. Apropos of 5 cases]. / Imagerie des lymphomes du rein greffé. A propos de 5 observations.

The occurrence of non-hodgkin's lymphoma is a classical complication after transplantation. The frequent localization near the graft is well established. We report 5 cases of lymphoma, arising from the renal graft, from a series of 648 transplantations (0.77%). The lesions appear as soft tissue masses, iso or hypoechoic with ultrasonography, soft tissue attenuation with CT and low attenuation after contrast medium. With MRI, we note isosignal in T1 and hyposignal in T2 weighted sequences. The involvement of renal parenchyma (n = 3) and the inclusion of the vessels in the masses (n = 2) are frequent. Excretory tract compression leading to obstruction is often associated (n = 3).

Primary hepatic pheochromocytoma.

Pheochromocytomas are uncommon tumors that represent a potentially curable cause of hypertension. They are usually located in the adrenal glands, but 10% arise from extra-adrenal sites, located along the paravertebral sympathetic chains. We report a case of primary hepatic pheochromocytoma responsible for a severe hypertension in a 24-year-old man. Echotomography showed a lightly heterogeneous mass located in the segment 8 of the liver. Iodine 131-metaiodobenzylguanidine scintigraphy showed a large hepatic concentration of the tracer and no other localization. This tumor appeared highly vascularized on enhanced CT scan and on aortic angiography. Magnetic resonance imaging revealed a hepatic tumor with a high signal intensity on T2-weighted images and with a signal isointense to the liver on T1-weighted images. The hepatic venous sampling contained the highest catecholamine level, whereas the adrenal venous sampling was normal. After surgical resection of the hepatic tumor, the tension level and catecholamines plasmatic level normalized. No recurrent symptoms appeared during a 3-year follow-up.

Early discovery of a traumatic carotid-cavernous sinus fistula by jugular venous oxygen saturation monitoring. Case report.

This report describes the early diagnosis, due to an acute increase of jugular venous oxygen saturation occurring 20 hours after trauma, of a traumatic carotid-cavernous sinus fistula after severe head injury. Hyperemia in severe head injury should be treated only after an intracerebral arteriovenous communication has been excluded.

[Desmoid tumor in Gardner syndrome. Apropos of a case evaluated with echography, CT and MRI]. / Tumeur desmoïde dans le cadre du syndrome de Gardner. A propos d'un cas évalué en échographie, TDM et IRM.

A case of desmoid abdominal tumor is reported. This is a rare benign tumor often found in association with Gardner's syndrome. The radiological features with ultrasonography, computed tomography and magnetic resonance imaging are presented. These explorations illustrate the infiltrating characteristics and the high potentially recurrence rate of desmoid tumor.

Cervical nucleolysis: indications, technique, results. 190 patients.

For many years now percutaneous techniques have proved effective in the curative treatment of lumbar disc herniation, mostly in young subjects. This technique, however, is seldom indicated, let alone performed, in the cervical spine for a variety of reasons: a) the neck contains several closely arranged structures such as the vasculo-nervous bundles, the airway-digestive tract and the cervical spine around the spinal cord; b) the disc is approached by the anterior route, in contrast with the lumbo-sacral spine where the approach is posterolateral; c) the manufacturers insist on restrictions in the use of chymopapain in view of the potential risk of spinal cord damage, either by possible breaks in the meninges of by accidental diffusion of the enzyme into perimedullary epidural structures which support a particularly developed venous plexus; d) legal protection may be denied to operators who perform cervical chemonucleolysis, since the product has not yet been officially authorized, in France and perhaps elsewhere*, for treatment of cervical disc herniation. Several years of experience in the practice of cervical nucleolysis have convinced the authors that this method is remarkably effective and can be used in the treatment of cervicobrachial neuralgia (CBN) occurring in young subjects. Radiculalgia is essentially due to a disc fragment being positioned within the vertebral canal or a foramen, thereby compressing the nerve roots. During several years microsurgery of the disc has been effective in the treatment of refractory radiculalgia, and to compete with this procedure familiar to neurosurgeons cervical nucleolysis must convincingly demonstrate that its therapeutic value is at least as good as that of surgery. Finally, the vast majority of cervical disc herniations is made up of free disc fragments located within the meshes of the posterior longitudinal ligament of the spine (transligamentous fragment). Cervical nucleolysis was introduced in France by Bonafe and Lazorthes made enthusiastic by their first studies, and the idea of this procedure, developed by a radio-neurosurgical team, has gradually been gaining ground. The decision to intervene is made when the radiculalgia is recurrent or resistant to a well-conducted medical treatment of several weeks duration. Therefore all disc herniations that would have been treated surgically can be treated by injection of an enzyme. This point is very important, and in fact the well-codified and effective surgical procedure has progressively been abandoned by the operators, in view of the simplicity of nucleolysis and the rapid pain relief it procures.(ABSTRACT TRUNCATED AT 400 WORDS)

MRI of aggressive meningiomas.

The authors have attempted to establish by MRI morphological criteria for the so-called "aggressive" intracranial meningiomas. The MRI features of 20 meningiomas histologically aggressive (numerous mitoses and small necrotic foci) or malignant (same plus invasion of the subjacent brain tissue) were compared with those of a control population of 26 patients with benign meningioma. The site of the tumour and its histological type had little predictive value, but there was a remarkably high proportion of male patients in the group with aggressive meningioma (9/20 versus 2/26). More than other varieties, aggressive meningiomas frequently emitted, on both T1- and T2-weighted sequences, a heterogeneous signal due to a necrotic focus (P less than 0.01). The high-intensity signal observed on T2-weighted sequences (11/20) was suggestive of syncitial or angioblastic meningioma. Cystic meningiomas were present in virtually equal proportions (3/20 versus 3/26) in the two populations and could raise problems concerning the diagnosis of nature, especially when intraventricular. Gadolinium injection provided further evidence of aggressiveness, such as irregular tumour outline or even contrast enhancement of brain tissue in malignant cases (3/4), but enhancement of the dura mater was equally frequent in both groups (P greater than 0.2). Massive peritumoral oedema was significantly more frequent in aggressive melanomas (P less than 0.01).

[Detection of recent myocardial infarction by spin-echo MRI. Value of the third echo]. / Détection de l'infarctus myocardique récent par l'IRM en écho de spin. Intérêt du troisième écho.

Seventeen patients underwent MRI spin-echo imaging (Magniscan 5000) 7 to 21 days after acute myocardial infarction (10 anterior, 7 inferior--average 13.1 +/- 3.7 days). The success rate of visualisation of AMI evaluated independently by a qualitative score (from 0 to 4) based on the brilliance of the myocardial signal after taking steps to eliminate the brillance of pericardial fat and subendocardial flow signals, was 3.1 +/- 0.87 in anterior AMI (10 out of 10) and 1.28 +/- 1.25 (4 out of 7) in inferior AMI (p less than 0.007). The diagnostic sensitivity was increased when images of the third echo were used (13 out of 17) compared to those of the second echo (8 out of 17, p less than 0.016). The value of the 3rd echo is explained and emphasised. Abnormal intramyocardial signals were not recorded in a control group of 10 patients under similar conditions of multi-echo imaging. Finally, significant correlations were observed between peak CPK concentrations and the MRI score (r = 0.62; p less than 0.01) and between peak CPK and the number of sections in which the hyperbrilliant signal was observed (r = 0.74; p less than 0.001): this may open the day to quantification of myocardial necrosis by MRI.

[Chordoma of the base of skull in children. Apropos of a case]. / Chordome de la base du crâne chez l'enfant. A propos d'un cas.

Chordoma of base of skull is a rare tumor in children. The case reported was atypical by its slow course, the initial clinical signs resulting from the development of the tumoral process in the posterior fossa at the level of the petrous and pontocerebellar angle. Neuro-ophthalmologic manifestations appeared at a late stage only.

[Pheochromocytoma of the organ of Zuckerkandl]. / Phéochromocytome de l'organe de Zuckerkandl.

The authors report the case of a pheochromocytoma of the organ of Zuckerkandl in a 46 year old man. The clinical presentation was severe paroxysmal hypertension; the tumour was located by arteriography, CT scanning, and by scintigraphy with iodine labelled benzylguanidine. The blood pressure returned to normal after surgery. The embryological, anatomical and physiological features of the organ of Zuckerkandl are reviewed: the authors discuss briefly the modern methods of diagnosis and localisation of the tumour.

Soft cervical disc herniations.

The authors report their findings in a series of 51 patients suffering from typical cervical radiculopathy. With the aid of the CT scanner and intravenous injection of a contrast medium, the quality and resolution of the resulting images allowed neurosurgical intervention in 42 patients in whom the symptomatology alone was not sufficiently informative to allow successful treatment. In most cases the CT images allowed an accurate diagnosis and revealed a free fragment that had torn the common posterior vertebra ligament.

[A case of pheochromocytoma with cardiac localization. Review of the literature]. / Un cas de phéochromocytome à localisation cardiaque. Revue de la littérature.

In a 26-year old man who died post-operatively, post-mortem examination revealed the presence of a phaeochromocytoma located in the atrio-ventricular sulcus and involving the trunk and bifurcation branches of the left coronary artery. Pre-operative investigations, including whole-body computerized tomography, and exploratory laparotomy had failed to detect the tumour. In contrast with the case reported here, the 4 other cases previously published concerned intrapericardial phaeochromocytomas in contact with the posterior wall of the left atrium.