A. Miquel

Increased prevalence and severity of radiographic hand osteoarthritis in patients with HIV-1 infection associated with metabolic syndrome: data from the cross-sectional METAFIB-OA study

Objective To determine radiographic hand osteoarthritis (HOA) prevalence in patients with HIV-1 infection in comparison with the general population and to address whether metabolic syndrome (MetS) may increase the risk of HOA during HIV-1 infection. Patients Patients with HIV-1 infection and MetS (International Diabetes Federation, IDF criteria) aged 45–65 years were matched by age and gender to HIV-1-infected subjects without MetS and underwent hand radiographs. Framingham OA cohort was used as general population cohort. Methods Radiographic HOA was defined as Kellgren–Lawrence (KL) score ≥2 on more than one joint. Radiographic severity was assessed by global KL score and number of OA joints. HOA prevalence was compared with that found in the Framingham study, stratified by age and sex. Logistic and linear regression models were used to determine the risk factors of HOA in patients with HIV-1 infection. Results 301 patients (88% male, mean age 53.4±5.0 years) were included, 152 with MetS and 149 without it. Overall, HOA prevalence was 55.5% and was higher for those with MetS than those without it (64.5% vs 46.3%, p=0.002). When considering men within each age group, HOA frequency was greater in patients with HIV-1 infection than the general population (all ages: 55.8% vs 38.7%; p<0.0001), due to the subgroup with MetS (64.9%; p<0.0001), as well as the subgroup without MetS, although not significant (46.6%; p=0.09). Risk of HOA was increased with MetS (OR 2.23, 95% 95% CI 1.26% to 3.96%) and age (OR 1.18, 95% CI 1.12 to 1.25). HOA severity was greater for patients with MetS than those without. HOA was not associated with previous or current exposure to protease inhibitors or HIV infection-related markers. Conclusions HOA frequency is greater in patients with HIV-1 infection, especially those with MetS, than the general population. Trial registration number NCT02353767.

CT Features of Vertebral Venous Congestion Simulating Sclerotic Metastases in Nine Patients With Thrombosis of the Superior Vena Cava

OBJECTIVE The purpose of this retrospective study is to describe the CT features of vertebral venous congestion simulating sclerotic metastases in nine patients with thrombosis of the superior vena cava. MATERIALS AND METHODS We analyzed all cases of obstruction of the superior vena cava recorded in our radiologic teaching files since 2006, to identify cases with vertebral venous congestion simulating sclerotic metastases. The following CT features were analyzed: the underlying cause, exact level, and length of the venous obstruction; the pattern of collateral venous pathways visualized as enlarged and densely opacified vascular channels; and the characteristics of the vertebral venous congestion. RESULTS Nine patients referred for CT examinations between 2006 and 2014 were included in the present study. The pathways that underwent contrast enhancement included the anterior or lateral thoracic pathways in eight patients, the mediastinal pathways in seven patients, and the azygos and vertebral pathways in nine patients. Vertebral venous congestion was observed in 30 vertebrae and was specifically noted in the vertebral body (n = 25), pedicle (n = 11), lamina (n = 3), and spinous process (n = 1). The density of vertebral bone enhancement ranged from 413 to 1480 HU. The limits were well defined in eight lesions and ill defined in 22 lesions. In 23 lesions, a vessel was noted within the vertebrae, in close contact with the vertebrae, or in both locations. CONCLUSION Development of a vertebral venous collateral system can lead to vertebral venous congestion, resulting in focal and patchy enhancement of the vertebrae, which can be mistaken for sclerotic metastases.

Is sarcoma a complication of arterial femoro-popliteal bypass?

Angiosarcoma is a rare neoplasm comprising 1 to 2% of soft tissue sarcoma. This tumor has been associated with previous irradiation, exposure to toxins and the presence of foreign bodies. A case report of an epithelioid angiosarcoma that developed at the site of an arterial femoro-popliteal bypass using autologous vein is described. The initial presentation looked like a painful popliteal cyst. Chronic fibrosis secondary to the thrombosis could play a role in the tumorogenesis of this uncommon tumor. This case illustrates that sarcoma may be a late complication of vascular bypass and may have a rheumatologic presentation.

Bone imaging findings in genetic and acquired lipodystrophic syndromes: an imaging study of 24 cases

ObjectiveTo describe the bone imaging features of lipodystrophies in the largest cohort ever published.Materials and MethodsWe retrospectively examined bone imaging data in 24 patients with lipodystrophic syndromes. Twenty-two had genetic lipodystrophy: 12/22 familial partial lipodystrophy (FPLD) and 10/22 congenital generalized lipodystrophy (CGL), 8 with AGPAT2-linked CGL1 and 2 with seipin-linked CGL2. Two patients had acquired generalized lipodystrophy (AGL) in a context of non-specific autoimmune disorders. Skeletal radiographs were available for all patients, with radiographic follow-up for two. Four patients with CGL1 underwent MRI, and two of them also underwent CT.ResultsPatients with FPLD showed non-specific degenerative radiographic abnormalities. Conversely, CGL patients showed three types of specific radiographic alterations: diffuse osteosclerosis (in 7 patients, 6 with CGL1 and 1 with CGL2), well-defined osteolytic lesions sparing the axial skeleton (7 CGL1 and 1 CGL2), and pseudo-osteopoikilosis (4 CGL1). Pseudo-osteopoikilosis was the sole bone abnormality observed in one of the two patients with AGL. Osteolytic lesions showed homogeneous low signal intensity (SI) on T1-weighted and high SI on T2-weighted MR images. Most of them were asymptomatic, although one osteolytic lesion resulted in a spontaneous knee fracture and secondary osteoarthritis in a patient with CGL1. MRI also showed diffuse fatty bone marrow alterations in patients with CGL1, with intermediate T1 and high T2 SI, notably in radiographically normal areas.ConclusionsThe three types of peculiar imaging bone abnormalities observed in generalized lipodystrophic syndromes (diffuse osteosclerosis, lytic lesions and/or pseudo-osteopoikilosis) may help clinicians with an early diagnosis in pauci-symptomatic patients.

Quickly progressive amyotrophy of the thigh: An unusual cause of rapid chondrolysis of the knee.

While rapidly destructive OA is more recognized in hip, we report the case of a 50-year-old woman who presented a rapid chondrolysis in the patellofemoral joint in a context of rapid loss of muscular strength. She had arthralgia, myalgia and proximal muscular deficit of the limbs. Creatine phospho kinase level was elevated and electromyogram exam showed a myogenic syndrome. Neither immune nor visceral disease was highlighted. As we suspected a polymyositis, we started corticosteroids and physiotherapy, then methotrexate and intravenous immunoglobulin. Concomitantly to the worsening of the muscular deficit and atrophy of hamstrings, she developed a persistent and disabling knee pain. Initial radiographs and magnetic resonance imaging (MRI) showed only a patellofemoral dysplasia and tiny cartilage damages. Because of aggravation of myalgia, we treated by mycophenolate mofetyl then rituximab. One year later, the knee remained painful and swollen. MRI showed signs of advanced osteoarthritis including an important loss of cartilage with an atrophy of hamstrings. Several articular corticosteroids injections were done. In the same time, the evolution of the muscular disease was unusual. Another histological analysis of muscle has highlighted a genetic myopathy due to mutation of calpain. Immunosuppressive treatments were stopped and a total joint replacement was performed. We show for the first time a case of rapid chondrolysis of patellofemoral joint related to a severe genetic myopathy.

Imagerie du rachis lombaire opéré

Imaging of the postsurgical spine Some early complications (hematoma, spondylodiscitis, pseudomeningocele) can occur with all types of surgery while late complications vary with the type of surgery. After discectomy, postsurgical changes (osseous and ligamentous defects, scar tissue, granulation tissue) should be distinguished from postsurgical complications or recurrent disease (recurrent disc herniation, arachnoiditis, spondylodiscitis). Following spinal decompression and fusion procedures, standard radiographs and CT can confirm the adequate position of the fusion devices, the presence of fusion, and the development of late osseous complications: pseudarthrosis, instability and recurrent stenosis.

Imagerie moderne des atteintes périphériques dans la spondylarthrite ankylosante.

Cross-sectional imaging of peripheral involvement in ankylosing spondylitis Ankylosing spondylitis is the most common spondyloarthropathy. It is characterized by enthesopathy (inflammation at the insertion of ligaments, tendons or fascia to bone). The os calcis is most frequently involved. Additional peripheral manifestations include synovitis and dactylitis. Unlike radiographs that demonstrate late manifestations of the disease, ultrasound and MRI demonstrate early inflammatory changes of bones and soft tissues. Multiple sites of involvement may also be detected on a single examination. Both imaging modalities facilitate early diagnosis, a crucial element for patient management. Both modalities may also monitor lesion regression during treatment.

Imagerie de l’entorse latérale de cheville

Resume Les radiographies standards sont parfois insuffisantes dans l’exploration d’une entorse cheville. Le but de ce travail est d’illustrer comment a l’aide de l’imagerie comme l’echographie dynamique, l’arthroscanner et l’IRM on peut apporter un diagnostic precis, utile pour le medecin du sport ou le chirurgien.

Stratégie d’imagerie chez un patient suspect d’hyperparathyroïdie primaire

Resume L’hyperparathyroidie est une maladie rare dont le traitement est chirurgical. La strategie d’exploration ne fait pas l’objet d’un consensus. Pour certains, le diagnostic est essentiellement biologique et la chirurgie exploratrice des parathyroides peut etre faite en premiere intention. Ce n’est qu’en cas d’echec, devant la possibilite d’une ectopie parathyroidienne que l’imagerie est utile. Pour d’autres, l’imagerie est systematique. Le couple echographie et scintigraphie de soustraction au Tc Sestamibi est la base du diagnostic. Ce n’est qu’en cas de discordance que les autres examens comme la TDM ou l’IRM sont indiques. Une bonne connaissance de l’anatomie et des variantes embryologiques, ainsi que des performances des differents examens est indispensable afin de proposer dans chaque cas la meilleure strategie d’exploration.

L’imagerie des adenomes parathyroidiens

Objectifs Faire un rappel embryologique du developpement des parathyroides permettant de reperer les sites eventuels d’ectopie, de preciser le role de l’imagerie et les differentes modalites diagnostiques des adenomes parathyroidiens. Materiels et methodes Revue retrospective des examens radiologiques incluant l’echographie et pour certains le scanner et l’IRM d’une dizaine de patients presentant une hyperparathyroidie et suivis au Kremlin-Bicetre. Resultats Aucun adenome ectopique n’a ete detecte ni meconnu, un cas de multiples adenomes cervicaux et le reste des adenomes solitaires, en majorite operes sous anesthesie locale. Conclusion Les adenomes parathyroidiens primitifs ou secondaires sont la cause frequente d’hyperparafhyroidie. Ils peuvent etre multiples ou ectopiques. L’imagerie joue un role primordial dans le diagnostic pre-operatoire et l’approche chirurgicale.