C Vallée

End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes.

PurposeTo investigate the frequency and distribution of end plate marrow signal intensity changes in an asymptomatic population and to correlate these findings with patient age and degenerative findings in the spine.Materials and methodsMR imaging studies of the lumbosacral (LS) spine in 59 asymptomatic subjects were retrospectively reviewed by 2 musculoskeletal radiologists to determine the presence and location of fat-like and edema-like marrow signal changes about the end plates of the L1-2 through L5-S1 levels. The presence of degenerative changes in the spine was recorded as was patient age. Descriptive statistics were utilized to determine the frequency and associations of end plate findings and degenerative changes in the spine. Interobserver variability was determined by a kappa score. Binomial probability was used to predict the prevalence of the end plate changes in a similar subject population. The Fisher exact test was performed to determine statistical significance of the relationship of end plate changes with degenerative changes in the spine, superior versus inferior location about the disc and age of the patient population.ResultsFocal fat-like signal intensity adjacent to the vertebral end-plate was noted in 15 out of 59 subjects by both readers, and involved 38 and 36 out of 590 end plates by readers 1 and 2, respectively. Focal edema-like signal intensity adjacent to the vertebral end plate was noted in 8 out of 59 subjects by both readers and involved 11 and 10 out of 590 end plates by readers 1 and 2, respectively. Either fat or edema signal intensity occurred most often at the anterior (p<.05) aspects of the mid-lumbar spine and was seen in an older sub-population of the study (p<.05).ConclusionEnd plate marrow signal intensity changes are present in the lumbar spine of some asymptomatic subjects with a characteristic location along the spine and in vertebral end plates.

Epidural lipomatosis. Interest of magnetic resonance imaging in a weight-reduction treated case.

An obese patient with bilateral sciatic pain had epidural lipomatosis on magnetic resonance examination. Treatment that used a weight-reduction program eliminated the symptoms, and after magnetic resonance imaging, revealed reduction of the lipomatosis deposits.

Foraminal epidural extra osseous cavernous hemangioma of the cervical spine: A case report

STUDY DESIGN A case report of purely epidural foraminal cervical cavernous angioma assessed by magnetic resonance imaging and diagnosed at pathologic study. OBJECTIVE To illustrate a rare cause of cervical foraminal mass mimicking a schwannoma. SUMMARY OF BACKGROUND DATA Several cases of epidural cavernous angioma have been reported. A purely epidural cavernous angioma in a cervical foramen has never been reported in the literature. METHOD A 36-year-old man sought treatment for acute weakness in his right upper limb with radicular distribution. On magnetic resonance images, the lesion appeared as a foraminal mass with no bone invasion or hematic components. It enhanced after intravenous administration of Gadolinium. Pathologic study after surgery showed a typical cavernous angioma. RESULTS The patient improved slightly after surgery. CONCLUSION Clinical and radiologic presentation could be confusing in a purely foraminal epidural cervical cavernous hemangioma. Cavernous hemangioma must be known as a differential diagnosis of a foraminal schwannoma. Diagnosis of cavernous angioma is made easily on pathologic examination.

C1-2 arthrography

ObjectiveTo describe the technique of Cl-2 arthrography and recommend it as a suitable treatment for pain due to C1-2 abnormalities.Materials and methodsOne hundred patients with the following conditions were studied: cervical pain or neuralgia without radiographie changes (group 1, n=23), osteoarthritis (group 2, n=37), rheumatoid arthritis (group 3, n=23), ankylosing spondylarthritis (group 4, n=5) and diverse conditions (group 5, n=12). The technique consists of lateral puncture of the posterior aspect of the Cl-2 joint with a 20-gauge needle under fluoroscopic control, arthrography using 1 ml contrast medium, and a 1-ml long-acting steroid injection subsequently.ResultsThe articular cavity has an anterior and a posterior recess. Sometimes the posterior recess is large. In 18% of cases the contralateral joint also opacifies.ConclusionCl-2 arthrography appears to be an efficient and safe technique for the treatment of upper cervical pain due to Cl-2 articular disorders.

CT and MRI of spinal neuroarthropathy.

OBJECTIVE The objective of this article is to describe the different stages of spinal neuroarthropathy as assessed by CT and MRI and to discuss their contribution to the management of affected patients. CONCLUSION Early-stage findings consisted of inflammatory changes involving adjacent vertebral endplates and mimicking degenerative disk disease with inflammation. Subsequently, progression of the lesions led to complete destruction of the intervertebral joint. Knowledge of the initial features of spinal neuroarthropathy may allow earlier treatment, which may improve outcomes.

Bilateral slipped capital femoral epiphysis occuring in an adult with acromegalic gigantism

The etiology of slipped capital femoral epiphysis is still unknown. Traumatic, endocrine, toxic, and mechanical causes have all been hypothesized. It is well documented that the highest incidence occurs during the adolescent growth spurt, suggesting the role of an endocrine abnormality. We report a case that supports this hypothesis.

Isolated vertebral metastasis with a fluid-fluid level from a poorly differentiated adenocarcinoma

Fluid-fluid level in bone metastases is an extremely rare finding, with only five case reports published in the literature. Here we report a case of an atypical isolated bone metastasis presenting with a fluid-fluid level revealing lung cancer in a 47-year-old patient without history of cancer. The differential diagnosis and imaging features are discussed with reference to the relevant literature.

NR-WS-11 IRM encephalique et choc septique

Objectifs Determiner la place de l’imagerie par resonance magnetique encephalique dans le bilan lesionnel chez les patients hospitalises pour choc septique presentant des troubles neurologiques. Materiels et methodes De novembre 2003 a fevrier 2005,9 patients des 98 admis pour choc septique ont ete inclus dans cette etude prospective. Sept femmes (78 %), moyenne d’âge : 63 (61-79) ans. Il s’agit de patients consecutifs hospitalises pour prise en charge de choc septique ayant presente des complications neurologiques centrales, ces patients ont donc beneficies d’une exploration par IRM en sequence ponderee Tl echo de gradient en coupe sagittale, des sequences axiale FLAIR et en diffusion avec cartographie ADC, sequence en temps de vol angiographique et sequence post-contraste avec transfert de magnetisation. Resultats L’IRM etait normale chez deux patients, de multiples accidents vasculaires cerebraux ont ete visualises chez deux patients, chez les cinq patients restants elle objectivait des lesions de la substance blanche (leucoencephalopathie) qui etaient localisees au niveau du centre semi-ovale soit localisee soit diffuse. Ces lesions de la substance blanche etaient visualisees sous forme d’hypersignaux en FLAIR associes a des anomalies sur les sequences en diffusion ainsi que sur la cartographie ADC, sans rehaussement apres contraste. Conclusion Chez les patients en choc septique l’existence de signes neurologiques centraux incite a la realisation d’une IRM qui peut mettre en evidence des lesions precoces avec un interet pronostic.

Diametre anteroposterieur du canal lombaire normal : evaluation sur base d’IRM de sujets asymptomatiques (etude multicentrique GETROA-SIMS)

Objectifs L’etude cherche a preciser le diametre AP normal du canal lombaire. Materiels et methodes Des examens en IRM ont ete realises chez 68 sujets totalement asymptomatiques, âges de 20 a 75 ans (moy = 42), lors d’une etude multicentrique du GETROA (SIMS). Les diametres anteroposterieurs du canal osseux en L4 et du sac durai en L4-L5 ont ete mesures sur des cliches agrandis et corriges en fonction des regles d’etalonnage imprimees sur les films. Les mesures ont ete effectuees sur les coupes sagittales medianes en ponderation Tl pour le canal osseux et en T2 pour le sac durai. Une etude prealable de comparaison des mesures effectuees sur des examens IRM et TDM avait permis de preciser les reperes a utiliser en IRM (e noir a noir «). Resultats Les diametres moyens mesures sont : pour le canal osseux en L4 de 16,19 mm (± 1,89) et pour le sac durai en L4-L5 de 12,69 mm (± 2,63). Conclusion Sur base de cette etude, les dimensions normales sont de 12,4 a 20 mm pour le canal osseux en L4 et de 7,4 a 18 mm pour le sac durai en L4-L5. Ces valeurs paraissent plus basses que celles generalement admises.

Signaux pathologiques des vertebres et discopathies degeneratives

Objectif Montrer l’interet de certaines sequences dans l’exploration IRM du rachis afin d’eviter les erreurs diagnostiques. Materiels et methodes A partir d’examens de patients explores dans des contextes cliniques divers, certaines pathologies degeneratives peuvent avoir une expression IRM inquietante, tumorale ou infectieuse en particulier. La combinaison de sequences choisies, la comparaison avec les donnees des radiographies et/ou du scanner, le bon sens et le contexte clinico-biologique permettent en regle generale d’eviter d’inutiles biopsies ou de traitements lourds. Conclusion La frequente pathologie degenerative rachidienne ne doit pas en imposer pour des pathologies graves.