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Torticollis in children must always instigate a search for trauma. Many other etiologies can be found. The authors report a case of postmedicinal atlantoaxial rotatory pseudoluxation (AARP) occurring in a child. This child had fallen down in the morning with head trauma followed by headache. Clinically, a stiff neck with an irreducible right rotation of his neck, and an osteotendinous hyperreflexia were noted. There was a C1-C2 rotatory dislocation with no traumatic lesion on the cervical CT scan. After a few hours, the torticollis spontaneously reduced and then reappeared on the left side. This clinical fluctuation and the absorption of metoclopramide (Primperan) started in the morning for acute gastroenteritis provided the diagnosis of AARP. This entity was confirmed by the good clinical and radiological follow-up and was caused by the substantial ligament laxity of the craniovertebral junction encountered in children. The analysis of medical imaging and the systematic search for a medicinal cause helped make the right diagnosis.

Torticollis in children must always instigate a search for trauma. Many other etiologies can be found. The authors report a case of postmedicinal atlantoaxial rotatory pseudoluxation (AARP) occurring in a child. This child had fallen down in the morning with head trauma followed by headache. Clinically, a stiff neck with an irreducible right rotation of his neck, and an osteotendinous hyperreflexia were noted. There was a C1-C2 rotatory dislocation with no traumatic lesion on the cervical CT scan. After a few hours, the torticollis spontaneously reduced and then reappeared on the left side. This clinical fluctuation and the absorption of metoclopramide (Primpéran) started in the morning for acute gastroenteritis provided the diagnosis of AARP. This entity was confirmed by the good clinical and radiological follow-up and was caused by the substantial ligament laxity of the craniovertebral junction encountered in children. The analysis of medical imaging and the systematic search for a medicinal cause helped make the right diagnosis.

Rathke's cleft cysts are non neoplastic lesions of the sellar area that seldom are symptomatic. Their incidence has been underestimated before magnetic resonance imaging (MRI). The aim of this work was to assess the value of MRI in the diagnosis and differential diagnosis of Rathke's cleft cyst based on a retrospective review of 12 cases and a review of the literature.We retrospectively reviewed the MRI features of 12 patients with Rathke's cleft cyst collected over 4.5 years. Patients included ten females and two males (mean age: 39 years). The most common presentation was the association of dysmenorrhea and pituitary dysfunction. MRI examinations were performed using a 1.5 Tesla system, T1 and T2 weighted sequences performed before and after Gd- DTPA injection. Signal intensity, shape, size and location of the lesion were analyzed.In all cases, MRI examination showed a cystic lesion of variable size and signal intensity. The cyst was purely intrasellar in nine cases and a suprasellar extension was noted in three cases. Five patients underwent surgery providing pathological confirmation, four underwent routine follow-up and three were lost of follow-up.We conclude that MRI is an efficient tool for diagnosis, allowing appropriate medical decision making.

We prospectively evaluated 30 patients with CNS cavernous angioma with a high field (1.5T) magnetic resonance imager. In all patients the MRI protocol included: gradient echo T1*-weighted imaging, spin echo T2*-weighted imaging and gradient echo T2*-weighted imaging. We evaluated each case for the number of lesions detected on each sequence. Gradient echo T2*-weighted imaging with a long TE (TE: 35ms) was the most sensitive sequence for the detection of cavernous angiomas allowing detection of small lesions that were not identified on the other sequences.

The neurocysticercosis is an infestation of the central nervous system by larvae of Taenia solium. The disease is endemic in a few countries of Latin America, Asia, and Africa and is becoming increasingly prevalent in the United States and Europe. The immigration of individuals from endemic areas and the tourism in these areas require a good knowledge of this disease. A retrospective study evaluating the neurocysticercosis lesions with MR and CT is proposed. Parenchymal, subarachnoid and intraventricular cysts are evaluated. We were able to recognise four CT and MR stages. MR was useful in detecting the cysts of neurocycticercosis in the first stage but was inferior in the detection of parenchymal calcifications.

Results of CT and MRI explorations in 8 patients with cerebrospinal fluid (CSF) fistulae are reported and compared with surgical findings in 7. Sensitivity of MRI (CISS and fast T2 spin-echo sequences) was excellent giving perfect correlations with surgical findings in 7/7 cases. CT and MRI were found to provide complementary information suggesting they should be used in combination as first intention explorations of suspected CSF fistulae. Computerized cisternography should be used if MRI is contraindicated or if a clinically and biologically proven CSF fistulae is not visualized by CT or MRI.

Fifty files were evaluated to determine the normal anatomy of the cranial nerves. All the cranial nerves were studied including the labyrinth, in different planes with a 3DFT-CISS imaging technique. The 3DFT-CISS is especially interesting to study cranial nerves because of the excellent contrast with CSF-fluid and the possibility of thin sections. It might be essential for the diagnosis of neuralgia and cranial nerves paralysis.

We report a firearm wound of the brain which could not be analyzed by computed tomography because of induced artifacts. MRI study was remarkably after verifying the non-ferromagnetic nature of the projectiles.

Spontaneous regression of disc herniation is well known but the mechanism is not clear. Some hypotheses have been made. We present here a large thoracic disc herniation diagnosed by MRI which completely regressed one year after a medical treatment with complete amendment of symptoms.

From July 1993 to April 1994, forty dentascans were performed at Bicetre Hospital, on an Elscint Elite Plus scanner for: chronic sinusitis (18 cases); cystic pathologies (8 cases); pre-operative assessment for dental implantation (14 cases).Dentascan images permitted a precise analysis of dentomaxillary anomalies. In all cases they demonstrated the anatomical relationships of the lesions, permitting a determination of potential complications. In chronic sinusitis dental pathology was demonstrated including peri-apical granulomas or cysts breaks or elevations of the floor of the maxillary sinus, malplaced dental filling material in the maxillary antrum and fistula tracks. Among the 14 pre-operative assessments, four cases of infectious lesions were demonstrated, thereby counter-indicating dental implantation.The dentascan appears to be very useful for dentomaxillary pathology by facilitating diagnosis and the formulation of treatment and operative strategies.

Numerous techniques have been used for imaging salivary glands including standard radiography, scintigraphy, sialography, echography, computed tomography and finally NMI. These different techniques each have their own indications or complementary role. We therefore developed a protocol for using the different imaging techniques according to the different salivary pathologies encountered. This protocol is given as an examination flow chart to be used in light of clinical findings. A large number of images selected by P. Laudenbach illustrate the typical pathologies encountered. Special emphasis is placed on sialography, an important imaging technique, unfortunately somewhat neglected.

MRI has transformed the diagnosis of cavernous hemangioma, a hamartoma that is most often located in the central nervous system. The appearance of this lesion is fairly characteristic with MRI. This technique has allowed distinguishing multiple forms. Encephalic sites are most frequent, with rare medullary sites, and double brain and cord locations are exceptional. Many cases of single or multiple brain involvement have now been reported. Series of medullary involvement are much less frequent and include few cases. Double sites in the brain and cord are exceptional. The authors present a case of cavernous hemangiomas of the central nervous system with multiple encephalic sites associated with a single medullary site confirmed by surgery.

Routine volume measurement techniques most often produce a rough approximate with poor accuracy for smaller structures. The results are generally improved by increasing the examination time, so that the technique then becomes unusable in daily practice. We propose a semiautomated volume calculation method with MRI, and its application to the surveillance of non-operated acoustic neuromas. This calculation technique, based on a threshold-setting method, allows accurately delineating the contours of the structures to be measured on each section and quickly calculating the total volume. After testing its reliability on control volumes, this techniques has been used to assess the evolutive nature of 16 acoustic neuromas with mild symptoms in 15 patients rejected for surgery. The radiological examinations were 428 days apart in average. On the basis of the obtained results, a theoretic tumor doubling time was calculated, thus allowing comparison between all patients. All controlled neuromas had a theoretic doubling time ranging from 427 to 4,884 days, corresponding to little- or non-evolutive lesions, which may be explained by the series selection bias excluding evolutive tumors referred to surgery. Owing to its rapidity and easy use, this semiautomated volume calculation technique for MRI seems to be very interesting as it allows reliably quantifying a volume variation that is usually estimated approximately.

Neuromas and meningiomas represent by far the most frequent tumors of the cerebellopontine cistern (respectively over 80% and over 10%). Secondary malignant tumors are exceptional.Presentation of four cases of malignant tumors of the cerebellopontine cistern, either revealing or complicating a primary tumor: a bronchial cancer, a cancer of the kidney, a medulloblastoma and a lymphoma. Patients were studied in T2- and T1-weighted high-field MRI sequences before and after gadolinium injection.The four tumors were enhanced by gadolinium and shown to invade the internal auditory canal, including one bilateral involvement. In most cases, the tumors were slightly heterogeneous and had irregular margins.These observations suggest that other diagnoses than acoustic neuroma should be taken into account.

Study of the pituitary stalk pathology about six demonstrative cases. This illustrative cases are described after review of literature, anatomy and imaging modalities. CT and MRI are very sensitive technics but not very specific.

Spinal subdural hematomas are rare. They should be considered in the diagnosis of spinal cord compression. Prompt surgical treatment, if it is performed, may lead to complete recovery of the neurological deficit. But such treatment is not always necessary because of possible spontaneous recovery. MRI appears to be the method of choice to reveal hematomas even of small size and to follow up patients after treatment.

Owing to computer programs, computed tomography allows obtaining sections of the facial structures in all spatial planes and to "pile up" all sections to reconstruct the structural unit studied. In addition, these images can be reconstructed by selecting a density threshold, for example that of dentin or of enamel, isolating those from their bony environment, and thus the patient's dental arch can be visualized as if one was manipulating a pair of dental models. The first results obtained with this technique are presented, and they seem to be highly promising.

Lumbar subdural abscesses have rarely been reported in the literature, and the complications of epidural infiltrations predominantly include arachnoiditis, meningitis and epidural abscesses. We report a case of lumbar subdural abscess confirmed by surgery, which appeared following epidural infiltration for lumbar sciatica and was examined with computed tomography and MRI. Only the latter technique alone showed the abscess, after gadolinium injection, and established its intradural site.

The authors perform a retrospective study of 65 spines examined with MRI. They specify the distribution of normal posterior epidural fat and establish the relationship between the anteroposterior thickness of epidural fat and the sagittal diameter of the spine on axial sections. On sagittal sections, the fat has a variable appearance, but a constant location along the spinal canal.

The authors report about their experience with the merits of the normal systematization of epidural fat with MRI. On sagittal sections, this fat has a variable appearance, but its location along the spinal canal is constant. On axial sections, its morphology is suggestive of the level of section: cervical, upper or lower thoracic, lumbar. Some changes in this fat are precious data to explain local hypertrophy (scoliosis) or to locate an intra- or extradural process.

132 cases of malformative syringomyelia have been studied at the C.I.E.R.M. (Interdepartmental Magnetic Resonance Center) of Bicêtre Hospital. The authors describe their technique for the exploration on the cord in case of suspected intramedullary cavitation, and emphasize the morphological and evolutive aspects of these abnormalities, whether they have been operated or not.

The authors report their experience and method for computed tomography of maxilla and mandible before endosseous implant surgery. CT defines indications of implant surgery, avoiding useless operations and sometimes allowing implant surgery that seemed impossible on standard X-rays. It provides good preoperative assessment, precising diameter and length of implant, exact location and state of anatomic structures to be avoided, quality of bone and ideal implant axis.

In order to assess the value of MR in the depiction of intracranial nerves, we retrospectively reviewed 60 patients investigated over a period of 2 years. The aim of this study was: 1) to assess the score of MR in the detection of cranial nerves III to XII; 2) to determine accurate landmarks allowing for easy detection of those cranial nerves. Cranial nerves III, V, VII, VIII are well seen (70 to 100%), very often in both axial, sagittal and coronal sections. Nerves IX to XII are correctly studied only on axial planes [81 and 83%), but it is difficult to distinguish between the vagal nerve and the glossopharyngeal and spinal nerves. Due to their oblique direction and small size, fourth and sixth nerves are rarely visualized. The more important landmarks are the chiasma, the colliculi, the Meckel's cave, the internal auditory canal, the jugular foramen, the hypoglossal canal and the different brainstem structures. We suggest the following scanning protocol: short spin echo sequences (TR = 600 ms, TE = 20 msec), 3 to 5 continuous sections, 16 to 20 cm field of vue with respectively 4 or 2 excitations, 256 x 256 matrix, with at least one acquisition plane (axial), but preferably two or three planes. Thus MR is sensitive exam in the recognition of cranial nerves, and it must be the first step exam in patients presenting with cranial nerve disease.

The epidural hematoma of the spine is a seldom disease and a neurosurgical emergency. MRI allows an early diagnosis. Only surgery can provide a good anatomical and functional prognosis.

Intradural lipoma is a rare and slow growing tumor which represents 1% of all intra-spinal tumors. This tumor is often associated with dysraphism. It can be isolated without any associated vertebral or cutaneous malformations. Its clinical evolution is extremely slow and progressive. The fatty composition of this type of tumor allows easy detection by CT as well as by MRI. MRI permits: Reliable and direct assessment (in 3 different plans) of the extension of the lesion. An excellent post operative control.

Recurrence of symptomatology after diskectomy was investigated in 37 patients by computed tomography imaging. Local complications were mainly fibrous scar tissue formation and recurrence of disk lesions. Results showed the CT scan to be the most reliable exploratory procedure available at the present time, based on the quality of images obtained after intravenous iodized contrast injection.

The advantages of a vasoconstrictor test during standard radiologic imaging of the nasal fossae are discussed. After a brief anatomic and physiologic review, results are presented of the use of a prednazoline test in 23 patients with radiologically evident nasal obstruction. Results emphasize the diagnostic value of the use of the vasoconstrictor, which enables precise study of morphology of the nasal fossae and, in certain cases, their functional exploration.

MRI is sometimes of no value in investigating a region close to a metallic foreign body. Presentation of a patient with non ferromagnetic cerebral vascular clips where MRI did not allow for the study of the chiasmatic region because of major artefacts.

Popliteal phlebography by puncture of the popliteal vein anables direct opacification to be obtained of the deep venous trunks of the knee and the thigh. This simple technique can be used for precise evaluation of valvular incompetence. Normal and pathological findings after 50 popliteal phlebographies are described.

Catheterization of the portal system by transhepatic percutaneous puncture may be difficult when atrophy of the liver, severe ascites, or thrombosis of the intrahepatic portal branches exists. It could be useful, in these cases, to employ "real time" ultrasonography to assist puncture of an intrahepatic portal branch. A case is reported in which this method was used to obtain percutaneous puncture of a left portal branch during obliteration of esophageal varices.

Many new lipid- and water-soluble contrast media can be used in sialography, the three main criteria of choice being the cost, the quality of filling, particularly of the parenchyma, and its evacuation and clinical tolerance. Duroliopaque possesses very similar physicochemical properties to those of Lipiodol UF, but a sufficiently satisfactory filling of the parenchyma is not obtained. Comparison of Lipiodol UF and Hexabrix in parotid and submaxillary contrast imaging showed good clinical tolerance for both products, but improved parenchymatous filling with Lipiodol UF. However, the more effective glandular evacuation with Hexabrix makes this the product most suitable at the present time for morphologic exploration of salivary glands.

A patient with Whipple's disease was considered as cured after treatment for two years, but relapse occurred as the neurological form. Radiographic imaging showed destructive osteoarticular lesions, with few or no symptoms, affecting the peripheral skeleton but also the sacroiliac joints. The published literature is reviewed and the different osteoarticular radiologic forms of the affection described.

Early experimental studies have shown that it is possible to obtain vascular obliteration and clot formation using monopolar direct current electrocoagulation. There is a major risk of rupture of blood vessels if alternating current is used. Using a co-axial bipolar electrode and high frequency alternating current it was possible to obtain valid, reproducible, and safe vascular obliteration in the distal digestive tract arteries in dogs. The obliteration is due to lesions of the intima and the formation of a clot in situ.

Correlations between ultrasonographic and clinical and histological findings were studied in 74 patients presenting with echogenic gallbladder sludge. The majority of patients in whom bile examinations had been performed had either pus, blood, biliary sediment, or microcalculi in the bile, but precise identification of the nature of the sludge does not appear to be possible on ultrasonography. Calculi were present in the gallbladder in 39 p. cent of these patients, only 9 p. cent demonstrating the presence of sludge without established liver or biliary lesions. This ultrasonographic image appears, therefore, to be a clinically significant valid finding.

Diagnosis of a vertebral artery loop in the transverse canal, suggested by a CT scan image, is dependent mainly on results of angiography (preferably computer assisted and by the venous route). This lesion is a differential diagnosis of a neuroma, when the cervical intervertebral foramen is enlarged.

Results of diagnostic ultrasonography in 29 patients with pancreatic duct dilatation were able to define the value of this procedure in the diagnosis of chronic pancreatitis and particularly cancer of the pancreas. Dilatation of the duct may in fact be the only ultrasonographic sign of a pancreatic lesion. It is now possible to study the pancreatic duct by ultrasonography, and this method of exploration should be employed whenever the pancreas has to be investigated.

The authors report ten cases of intra-arachnoid metastases affecting the spinal cord and its roots. These cases illustrate all the myelographic appearances seen: multiple nodular appearances, striated appearance related to thickening of the roots, failure to visualise one or more root sheaths, filling defect of varying regularity preferentially seen in the dural cul-de-sac, but also in the terminal part of the cord associated with varying degrees of block. Myelographic technique is essential of they are to be visualised: water soluble opaque agents and tomography, if possible by complex scanning alone ensure accurate analysis of the roots. This type of involvement raises a pathogenic problem regarding the exact mechanism of such metastases. The prognosis is very poor despite treatment based upon radiotherapy and chemotherapy.

Changes in CT scan and NMR imaging findings are reported in a patient with cerebral radiation lesions affecting first the left and then the right frontal cerebral cortex. This case is exceptional since voluntarily and by necessity the radiation dose for an inextirpable frontal sinus tumor had been very high. As a result of this radiotherapy, a survival of about 10 years was obtained under good conditions, with cerebral lesions provoking relatively moderate functional consequences.

Nine cases of recurrent petrous cholesteatomas have been studied by a 1,5 T MR unit. Gadolinium was injected in 1 case. In all cases, comparison between MR, CT and clinical findings were made. MR allows for accurate topographic study and assessment of cholesteatomas extension, in particular in the posterior fossa and skull base. Relationships with the internal carotid artery and the jugular vein are clearly depicted.

A study was conducted in dogs to evaluate the effect on the organism of a new embolisation material: carnauba wax micropellets. The ultimate objective was to study the possible use of micropellets containing an active product for therapy in situ. Renal embolisation was performed by selective or highly selective arterial catheterisation in dogs. Pathological examination demonstrated that only mild foreign body reactions occurred at the embolisation site. Overall tolerance was good. The micropellets were shown to possess some biodegradation properties and to be susceptible to deformation. An attempt is made to define the ideal micropellet from the point of view of size, kinetic features, and biodegradation properties.

A 32-year-old woman presented with a chondromyxoid fibroma of the right temporomandibular joint. The tumor is rarely observed but this case emphasizes the need for complete radiological investigation of this joint in patients with clinical symptoms localized to this region.

Of four adult patients with the trichorhinophalangeal syndrome, 3 were from one family, one had associated major femoral trochlear dysplasia and bilateral mandibular condyle dysplasia, and another a bilateral coxa plana.