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Competing Interests: L’auteur déclare organiser et participer à des conférences pour Pfizer, Lilly, Novartis, UCB, Genevrier, et être employé de Gleamer : start-up intelligence artificielle

Introduction: The prevalence of vertebral sarcoidosis is highly variable (1 to 36% of reported case series). Because of limited clinical expression, its frequency is probably underestimated. Its proper management is not clearly defined., Case Report: A 42-year-old woman who had a past medical history of cutaneous and pulmonary sarcoidosis presented with low back pain that was refractory to usual medical treatment. A diagnosis of vertebral localisation of sarcoidosis was considered on the history of proven sarcoidosis, radiological features, and the absence of evidence of an alternative diagnosis. In the absence of other clinical or biological evidence of active sarcoidosis, a simple follow-up was planned. MRI control at 1 year showed the resolution of vertebral sarcoidosis lesions., Conclusion: Spontaneous regression is a possible outcome of vertebral sarcoidosis. Initiation of a specific treatment should be discussed in the absence of other visceral involvement., (Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

In 1892, J. Wolff, an orthopedic surgeon, stated that the internal architecture and shape of a bone were related to the direction of stresses placed upon it. Conventional radiographs and MRI can demonstrate the adaptability of bones to stresses. Imaging also demonstrates that this adaptability has limitations, and that excessive stress may lead to fracture., (Copyright © 2011 Elsevier Masson SAS and Éditions françaises de radiologie. All rights reserved.)

SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis) is characterized by a great variety of radiographic findings, including sclerosing osteitis, ivory vertebra, hyperostosis with paravertebral ossification, spondylodiscitis and even vertebral compression fractures. On the other hand, the MR imaging features are quite stereotypical with presence of entesopathy at the anterior vertebral corner similar to other spondyloarthropathies. In about 15% of cases, the entesophytes are limited to the anterior vertebral corner. In all other cases, it extends to involve the adjacent vertebral endplate, the anterior vertebral cortex or the adjacent vertebral corner through the disc annulus. As such, involvement of at least two adjacent vertebrae is present in about 30% of cases. The intervertebral disc may be narrowed, and, in 10% of cases, show intense T2W signal and postcontrast enhancement, simulating infections spondylodiscitis. The pseudo-infectious appearance is further increased in about one third of cases by the presence of an enhancing mass in the adjacent soft tissues. Therefore, these lesions may sometimes be difficult to differentiate from infectious spondylodiscitis and even tumors. An important differential diagnostic feature is the presence of lesions of varying ages on adjacent vertebral segments, with presence of characteristic entesopathy of a vertebral corner.

Electroneuromyography (ENMG) is the gold standard tool in evaluating peripheral neuropathies, and it is essential to the diagnosis and the location of the involvement, as well as the assessment of the severity and the prognosis of the lesion. However, it has also limitations. It is highly examiner dependant and because it is unpleasant, the assessment of some nerves and muscles is limited. The evaluation of proximal nerve and deep muscles is difficult to perform. Magnetic resonance imaging and echography represent a fast growing field in demyelinating and motor neuropathy assessment, while these imaging procedures are now well validated in myopathies. In this article, we discuss sensitivity, specificity and prognostic data brought up by these new imaging tools compared to ENMG and the significant future prospects they offer., (Copyright 2009 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Soft tissue masses around the foot and ankle are frequent. While benign lesions are two times more frequent than malignant lesions, the latter still represent one third of all lesions. The main purpose of this article is to propose a systematic approach to the differential diagnosis of soft tissue tumors of the foot and ankle based on a combination of 5 elements: clinical history and physical examination, top 10 most frequent diagnoses, patient age, lesion location, and MRI features of the mass. Selected soft tissue tumors will be described and illustrated with emphasis on these 5 elements.

Development of drugs able to modify the natural course of osteoarthritis is a major research objective. Imaging methods are needed to evaluate the effect of new medications in the experimental and clinical settings. Conventional radiographs are the gold-standard technique for routine imaging. However, magnetic resonance imaging (MRI) has transformed hyaline cartilage imaging by providing direct visualization without exposure to radiation. In addition, MRI can provide direct cartilage volumetry and tissue characterization for research purposes, using specific sequences. MRI can also give information on the content and organization of the collagen fibril network and proteoglycan chains, as well as water content. Computed tomography, arthrography and MR-arthrography require contrast medium injection into the joint space but provide high-resolution 3D images of the hyaline and fibrous cartilage.

Radiation therapy of the neck or axillary areas for cancer may result in delayed brachial plexus palsy. Differential diagnosis between radiation and tumor brachial plexopathy is difficult. We report the case of a 38-year-old woman, treated by radiation therapy for osteosarcoma of the humeral head 22 years before, who exhibited a rapidly progressive incomplete hand palsy. EMG study revealed a conduction block at the level of the lateral cord. In this case, MRI could not distinguish between a delayed radiation injury and tumor infiltration. The diagnosis was clarified with an ultrasonographic examination. Neurolysis and epineurotomy of the median trunk in the brachial and axillary areas were performed. Histological examination confirmed radiation-induced nerve injury. The characteristics of this uncommon form are reviewed with regard to the previously reported descriptions.

Objective: Monitor a reproducible analysis method based on a simple algorithm., Diagnosis of Rheumatologic Disease in Wrists: The first step is to examine the joint space. When the space is preserved, diagnosis may be established on the presence of bony defects, demineralization or erosions., Diagnosis of Rheumatologic Disease in Fingers: The first step is to determine whether the patient has degenerative or inflammatory joint disease involving the joint space or bone disease where bony lesions predominate.

Since the advent of new imaging methods (CT, MRI), plain radiographs still play a central role in the evaluation of the non-traumatic painful hip. In rheumatologic practice, standing antero-posterior views of the pelvis, bilateral antero-posterior views of the hips and bilateral lateral view of Lequesne should be performed. This first radiographic evaluation can be completed by a CT arthrogram in the first stage of osteoarthritis or by MRI in synovitis and epiphyseal disorders involving the femoral head (osteonecrosis, transient osteoporosis, subchondral fracture). The physician must be aware of the performance of each imaging in order to use the appropriate radiological exam in each situation.

The authors describe the indications for radiologic explorations in case of traumatic as well as non-traumatic conditions. In case of trauma of the wrist, the radiologic exploration looks for a fracture, a dislocation or a ligament injury. Initially, postero-antérior and lateral views must be completed with an antero-posterior view, a scaphoid incidence and an oblique view. This initial examination can be completed secondarily by specific views for the carpal bones, dynamic X-Rays, CT scan or arthro CT scan. In non-traumatic cases, radiologic explorations look for osteo-articular or soft tissue abnormalities specific of a inflammatory or degenerative disease. The initial incidence is a postero-anterior view of both hands. It can be completed secondarly by other explorations (other X-Rays, Ultra-sound, CT scan or MRI).

Purpose: To assess the value of imaging in the differential diagnosis of erosive intervertebral osteochondrosis (EIVO) versus infectious discitis (ID)., Materials and Methods: Twelve cases of EIVO and 30 cases of ID were reviewed to define the usefull signs for differential diagnosis on plain films, CT, and MR., Results: No single sign is sufficient, but the association of several signs is suggestive of EIVO: discal vacuum phenomenom, well-defined sclerosis and erosions of vertebral endplates, high signal strip surrounding low signal of vertebral endplates on T1-weighted images., Conclusion: Imaging is helpful in difficult differential diagnosis of EIVO versus ID.

Cysts of the glenoid labrum are ganglia cysts extending near the glenohumeral joint with frequent clinical signs and symptoms of a compression of the subscapularis nerve. They are detected through MR examination. They are frequently associated to instability of the glenohumeral joint.

The authors emphasize the misleading images of lumbar myelography encountered in common vertebral diseases: disk disease, posterior interapophyseal joint diseases, degenerative and narrow spinal canal, in which dynamic views in the upright position represent the most original contribution of lumbosacral myelography as compared to new techniques. The authors also describe the postoperative appearances observed on lumbosacral myelography and some rarer diseases which must not be missed, such as epidural arachnoid cysts and epidural lipomatosis.

The diagnosis of localized osteolysis (synonym: bone cyst, defect) must be analytical. The site, size, and shape of the defect, its limits, assessed according to the Lodwick classification, reflect the activity of the lesion, the type of any periosteal reaction and the presence of a soft tissue mass are analysed successively. Based on these criteria and the clinical and laboratory characteristics, the image can be classified as quiescent or active, allowing guidance of management.

Interrogation of patients still painful after lumbar intervertebral disk surgery provides with a series of informations each of them having only an indicative value, while they altogether compound a score helping assess the presence or the absence of a recurring disk herniation.

Cervical myelography is obtained after injection of contrast medium into the lumbar subarachnoid space through a lumbar puncture. The patient is prone with a large radiolucent block under the pelvis so that the site of lumbar puncture is at a higher level than that of the cervical spine lordosis. Lumbar contrast is injected gently so that the contrast fluid slides along the ventral aspect of the dural sac and immediately reaches the cervical subarachnoid space. Then AP and lateral (with a horizontal X-ray beam) views are obtained. The patient has to remain firmly immobilized during the whole procedure to avoid blending of the contrast medium with CSF. This procedure is safe and allows cervical myelography to reach the same quality as that obtained through cervical puncture.

Calcific deposit within soft tissues is frequently a clue for diagnosis. The radiological analysis of a calcific deposit within soft tissues includes the following aspects: the basic structure of the calcification, the grade of differentiation of the calcification, the site of the calcification, the number of calcific deposits, the shape of the calcification, the changes in the adjacent non-calcified soft tissues and in the adjacent bone, the course of the clinical signs, the course of the radiological abnormalities.

The discovery of an image of central bone calcification raises the differential diagnosis of bone infarction and chondroma. The matrix of chondroma is characteristic of cartilage. It produces typical cartilaginous calcifications: rings, arcs, coarse, irregular grains, moth-eaten appearance. These calcifications are predominantly observed in the centre of the image. They are situated in a bone defect, often multilocular, sometimes accompanied by multiple scratch marks of the cortical endosteum. In contrast, infarction is characterized by the presence of a serpiginous calcified border at the interface between live bone and dead bone. In the centre, the bony trabeculae are still visible on CT sections, in contrast with chondroma. On MRI, chondromas present a heterogeneous lobular appearance on T2-weighted sequences (checkerboard appearance) due to alternating zones of high signal intensity cartilaginous matrix and low signal intensity calcified or ossified fibrous septa. On MRI, bone infarction is characterized by a continuous peripheral line with a marked low signal intensity.

The authors present a case of a 39 years old patient who had a herniation pit of the left femoral neck, 5 years ago. This lesion disappeared spontaneously. To our knowledge, no report of healing of a herniation pit has been previously described.

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy.

This is a review article on fibrous dysplasia of bone. All aspects of this condition including, macroscopic and histologic findings, lesion distribution, clinical, radiological and biological findings as well as evolution and treatment are discussed. A classification of skeletal lesions based on then appearance on plains films and computed tomography is proposed; 3 radiological types are differentiated: non-expanding bone lesions, expanding lesions with a thick periosteal reaction and expanding lesions with a thin periosteal shell. Main features of osteofibrous dysplasia are also discussed.

The spinal vacuum phenomenon is a collection of gas within the disk space, the vertebral body, the apophyseal joint or the spinal canal. The intradiscal vacuum phenomenon is frequently observed in degenerative disk disease and crystal-induced diskopathy. This has obvious significance to the radiologist, who, on observing a narrowed disk space or collapsed vertebral body, might otherwise consider infectious or neoplastic spondylitis, a likely possibility. The presence of vacuum phenomenon militates against the diagnosis of infection or tumor.

Degenerative vertebral dislocations (laterolisthesis) are responsible for progressive transverse intervertebral shift. These changes appear like a translation of the lateral edge of a vertebra compared to that of the underlying vertebra and are easily diagnosed. Vertebral dislocations can be secondary to active lumbar scoliosis or unilateral or asymmetrical degenerative spondylolisthesis. In every case, the appearance of laterolisthesis is reflected by the onset or aggravation of scoliosis which may become self-perpetuating. This lesion is secondary to osteoarthritic disruption of the integrity of the intervertebral disk and ligaments. Open and closed patterns have been described depending on the side of the associated disk opening. The onset of a rotatory dislocation reflects the progressive evolution of the deformity, which may require medical treatment, or surgical reduction and fixation by vertebral arthrodesis.

The prevalence of neurological complications in patients with osteoporotic vertebral collapse and the risk factors for neurological compromise were studied retrospectively in 138 inpatients. Six per cent of patients had objective neurological loss. Patients with neurological loss were more likely to have changes suggestive of malignant disease on roentgenograms, computed tomography, and magnetic resonance imaging. Diagnosis was based on magnetic resonance imaging and examination of vertebral biopsy specimens. Comparison of patients with and without neurological loss suggested that an intravertebral vacuum phenomenon and/or a cortical osteoporosis may cause fracture of the posterior wall and therefore compression of neurological structures.

Erdheim-Chester disease is an endogenous, non-genetically-determined lipidosis characterized by infiltrates of foamy, lipid-laden histiocytes and by bilateral symmetric foci of sclerosis in appendicular long bones. The clinical spectrum ranges from focal bone lesions to systemic disease with life-threatening visceral involvement. In one third of patients, roentgenograms show focal osteolysis within areas of sclerosis. Authors report a new case of Erdheim-Chester disease documented by two bone biopsies in different sites. Features in their patient included: 1) osteolysis and sclerosis of the long bones of the limbs and maxillas, with CT scan evidence of cortical rupture; 2) on magnetic resonance imaging studies, heterogeneous foci of decreased signal intensity on T1 images and heterogeneous areas of moderately increased signal intensity on T2-weighted images; 3) increased serum osteocalcin levels; 4) laboratory evidence of chronic inflammation with no extraosseous manifestations. The clinical, radiological, and pathological features of Erdheim-Chester disease are different from those of Langerhans cell histiocytosis. However, three cases of patients with both conditions have been reported in the literature, suggesting that there may be links between the two diseases.

Imaging of the knee is one of the main indications of MRI in musculo-skeletal diseases. Some of the most recent papers dealing with MR imaging of the knee are discussed in this review article. Abnormal conditions reviewed are meniscal injuries including those occurring in previously operated menisci, osteochondral fractures, osteochondritis dissecans and rheumatoid arthritis.

This study of the topographic distribution of tumoral and pseudotumoral lesions of the proximal femur shows that certain lesions have a preferential site, for example osteoid osteoma affects the internal cortex of the neck and diaphysis or the intertrochanteric zone; chondroblastoma occurs in zones of epiphyseal ossification of the head; fibrous dysplasia affects the femoral neck, while sparing the epiphyseal femoral head and trochanters. The island of osteosclerosis is situated, at least partially, in the support fan; so-called physiological cysts are situated on or above the midline of the neck and below the basicapital line. Osteolytic or mixed metastases preferentially involve Ward's triangle in the femoral neck and the intertrochanteric region. The sites of these lesions therefore appears to depend on the bony architecture which, in turn, is dependent on mechanical stresses. However, this purely morphological study fails to demonstrate whether mechanical stresses influence the development of these lesions.

The authors review the embryology of the hip joint with its pathological implications. The radioanatomy is presented in an elementary fashion, with the appearance of each component as seen on the various imaging techniques (conventional X-rays, CT scan, MRI). The authors also describe the views used in conventional radiology and the invasive techniques of arthrography and arthroscanning.

Nuclear magnetic resonance has shed new light on our understanding of osteonecrosis of the femoral head. It is at present the most sensitive and most specific imaging technique for the diagnosis of this condition. Studies involving correlations between MR images and anatomical findings have facilitated the understanding of tissue changes responsible for magnetic appearances. However, all problems are not resolved. At an early stage, fortunately almost always asymptomatic, false negative MRI or MR findings similar to those of algoneurodystrophy of the hip can be encountered. The aim of this article is to pinpoint the current status of these questions on the basis of a review of the recent literature. The contribution of MRI with injection of Gadolinium and future prospects are also discussed.

Eight cases of spinal sarcoma complicating Paget's disease seen in different centers were reviewed. Clinical and radiological features of this condition were determined on the basis of these 8 cases and of 51 previously published cases. In the current series as well as in previous reports, most cases involved the lumbar and sacral spine and manifested as low back pain with sciatica and early development of neurological deficits. Roentgenographic diagnosis proved difficult because of the anatomic complexity of the spine and architectural changes characteristic of the pagetic bone. The most common radiological features was a mixed pattern with both sclerosis and central osteolysis. Computed tomography performed in one patient of current series disclosed osteolysis of the sacrum (not visible on plain roentgenograms) with tumor spread to adjacent soft tissues. Features shared by spinal and nonspinal sarcomas complicating Paget's disease include advanced mean age of patients, predominance of osteogenic sarcomas among histologic forms, increased risk of sarcoma in polyostotic Paget's disease, and a very grim prognosis. Development of a neurological deficit in a patient with Paget's disease is an unusual occurrence which should suggest sarcomatous transformation. Roentgenographic changes are difficult to identify on plain films of the spine and consequently CT scan studies are warranted whenever a sarcoma is suspected.

The understanding of carpal instability and their radiological signs are based on a knowledge of the anatomy and complex physiology of the wrist. This article successively deals with the physiological anatomy, radiological technique, normal static and dynamic radiological features, radiographic signs of various types of instability and therapeutic principles.

We report a case of chondrosarcoma of the femoral neck wrongly considered as a normal variant during a long time due to the initial aspect on the plain films and its location. Precise radiological criteria must allow the differential diagnosis and will be detailed.

The authors report a case of insufficiency fracture of the sacrum in an 81-year old woman. The fracture was related to disjunction of the pubic symphysis consecutive to curettage of the pubic bones for septic osteitis developed after vulvectomy for cancer. The diagnosis was suspected on the results of bone scintigraphy and was confirmed by computerized tomography with frontal sections and contrast inversion, showing the characteristic H-shaped fracture.

From a serie of ten cases of compressive vertebral hemangiomas (H.V.C.), the interest of different imaging methods was evaluated. CT scan and M.R.I. were the best imaging modalities in most cases. A CT guided biopsy was necessary in three cases to differentiate from metastasis. Angiography permitted to establish the vascular patterns and to evaluate the usefulness of embolization performed in six cases.

This paper describes a specific prone oblique view very helpful to thoracic vertebral bone biopsy under fluoroscopic control. In this position the costal head and neck axis gives the direction of the procedure. A puncture between two ribs following this direction easily avoids both the pleura and spinal canal. This thoracic biopsy of the vertebral body and disc under fluroscopic control becomes a reliable diagnostic tool.

We are reporting 4 cases of unnoticed sacral fractures in osteoporotic women. Their mean age was 73 years. Only in one case the fracture was seen on a standard X-Ray. On the other hand, hyperfixation with isotopes on the sacrum formed a very characteristic H-shaped image. In two of these patients, the sacral fracture was confirmed by tomodensitometry, but this examination was unavailing in the third patient. In the 4th case, hyperfixation of the isotope was not significant. Only a guided bone biopsy and the favorable evolution of the disease enabled the diagnosis of sacral fracture.

Percutaneous vertebral trephine biopsy is a valuable investigation. A new type of trephine needle for vertebral biopsy is described in this paper. This trephine needle is introduced on the thin needle used for local anesthesia, following a procedure similar to vascular catheterism. Thus, the same puncture is used for local anesthesia and bone biopsy. Therefore, local anesthesia is more effective and the biopsy procedure is much safer, particularly at the thoracic level where vital organs are very close to the spine. A very practical handle design for advancing the trephine needle on the guide wire makes the biopsy procedure easy and precise. This trephine needle enhance indications of this potentially valuable procedure.

The significance of a gas shadow, known as an intra-somatic space, seen in cases of vertebral compression is discussed in relation to two cases with histological confirmation by means of trocar aspiration biopsy of the vertebra. The presence of this image is in favour of a neoplastic or infectious aetiology; however, in view of the limited experience, histological confirmation by aspiration biopsy of the vertebra is indicated in the presence of one or more reasons for suspecting a neoplastic aetiology. The most satisfactory pathophysiological hypothesis to explain the appearance of an intra-somatic space is that this image generally appears in cases of osteoporotic vertebral compression complicated by a certain degree of osseous ischaemia.