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International audience; The most promising materials for applications in magnetic refrigeration exhibit a large entropy change at a first-order ferromagnetic transition. Often, it has been observed that the transformation proceeds via two bursts surrounding a regime of slow transformation. Within a simplified framework, the present article reports on a thermodynamic model able to account for this “two-steps” response. This model is confronted to magnetic and calorimetric data recorded in the magnetocaloric compound LaFe11.4Si1.31Co0.29 .

Resume Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge de la paralysie faciale peripherique a la phase aigue. Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur cette thematique. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees, puis relues par un groupe de lecture independant. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Un examen clinique ORL et neurologique complet est recommande devant tout patient se presentant pour une paralysie faciale peripherique pour confirmer le diagnostic de paralysie faciale idiopathique. Il est recommande de realiser une IRM avec injection etudiant tout le trajet du nerf facial si possible dans le premier mois. Il est recommande de realiser un ENMG pour evaluer le pronostic de recuperation. Il est recommande devant toute paralysie faciale idiopathique de debuter un traitement corticoide le plus precocement possible (idealement dans les 72 heures) a la dose de 1 mg/kg/J pendant 7 a 10 jours. Les therapies antivirales sont a associer avec un traitement corticoide en cas de paralysie severe ou precoce et en cas de PFP zosterienne. Il n’est pas recommande d’utiliser un antiviral seul. A ce jour, le benefice d’une decompression chirurgicale du nerf facial n’est pas demontre.

To compare the prevalence of cardiovascular risk factors (CVRF) in patients with superior vestibular neuritis (SVN) versus the general French population, and to examine the possibility of vascular etiology in acute superior vestibular deficit.A single-center retrospective study compared the prevalence of hypercholesterolemia, hypertension, diabetes, smoking, cardiovascular disease and atrial fibrillation between patients with SVN and the French general population. Inclusion criteria comprised: rotatory vertigo lasting several days, without hearing impairment or neurological signs, with anterior and lateral semicircular canal involvement on video-Head-Impulse-Test (vHIT). A senior radiologist analyzed superior vestibular nerve and inner ear structure enhancement on cerebellopontine MRI.One hundred and eighteen cases of SVN were included from May 2016 to February 2020. Statistical analyses concerned 106 cases. The SVN population had significantly less hypercholesterolemia (RR=0.40) than the general French population. There was no significant difference concerning other CVRFs. Superior vestibular nerve enhancement was observed on 84% of MRIs.Prevalence of CVRF was not higher in patients with SVN than in the general population. The present study highlighted involvement of the superior vestibular nerve more than of the anterior vestibular artery in SVN.

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Objective To report a case of VIIIth nerve cavernous hemangioma, a very rare differential diagnosis among the various pathologies presenting as small enhancing entities into the internal auditory canal. It is one of the most challenging when imaging is not able to differentiate it from an intrameatal vestibular schwannoma. Methods and results We report a cavernous hemangioma extruding from the internal auditory canal, diagnosed after a left translabyrinthine resection in a 45-year-old man complaining of profound sensorineural hearing loss, with no facial paresis or dizziness. The preoperative differential diagnosis of a vestibular schwannoma was impossible, due to the absence of calcifications that usually characterize temporal bone hemangiomas. Clinical presentation, radiological features and treatment considerations are discussed along with up-to-date review of pertinent literature. Conclusions When considering an apparent small intra-auditory canal schwannoma, otoneurologists should be aware of the rare possibility of a cavernous hemangioma. Early diagnosis and surgical treatment may improve the functional outcome, possibly preserving neural integrity.

Summary Background and purpose To compare diagnostic performances for cholesteatoma diagnosis of incremental MRI protocols including non-echo planar diffusion-weighted imaging (DWI) performed on 3T and 1.5T scanners. Materials and methods Thirty-nine patients with suspected cholesteatoma underwent 3T and 1.5T non-echo planar DWI and additional unenhanced T1-, delayed gadolinium-enhanced T1- and high-resolution T2-weighted standard acquisitions. Patients either underwent surgical tympanoplasty (n = 21) or close clinicoradiological follow-up (n = 18). Four radiologists independently and prospectively interpreted two incremental MRI protocols, differing in the magnetic field strength of the diffusion-weighted acquisition and comprising the three standard sequences. At each step, diagnostic performances were expressed as sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results Forty middle ear lesions including 21 cholesteatomas were identified. Univariate and multivariate analysis did not demonstrate significant reader, sequence addition or DWI magnetic field effect on diagnostic performances. Concerning non-echo planar DWI alone, sensitivity, specificity, positive predictive value, negative predictive value and accuracy ranged between 90.5–100%, 68.4–100%, 76.9–100%, 90.0–100% and 82.5–95.0, respectively. Conclusion Non-echo planar DWI for cholesteatoma diagnosis can be performed on 1.5T or 3T scanners indifferently. High sensitivity and negative predictive value and relatively lower specificity and positive predictive value are achieved by a single non-echo planar DWI protocol.

Sinonasal and temporal bone infections may extend to the skull, skull base, meninges, pericerebral spaces, brain parenchyma, dural sinuses, deep cerebral or cortical veins, intracranial arteries and cranial nerves either via contiguous or hematogeneous spread. The site of infection dictates the sites of potential complications: orbital with ethmoid sinusitis, cavernous sinus thrombophlebitis and oculomotor palsies with sphenoid sinusitis, transverse sinus thrombophlebitis with mastoiditis and superior sagittal sinus thrombophlebitis with frontal sinusitis. All may result in brain abscess. Congenital and acquired defects of the skull and meninges, with or without associated meningocele or meningoencephalocele, perilymphatic fistulas, and some anomalies of the inner ear may predispose to the intracranial extension of ENT infections.

The number of patients with cochlear implant increases each year. Most of these patients may undergo MR imaging up to 1.5 Tesla, based on safety recommendations from each of the manufacturers. All external components should be removed for the examination. For three manufacturers providing about 85 % of all implanted devices in Europe, the internal components may be left in place and covered by an external bandage. Strict protocol guidelines must be implemented, especially head positioning in the magnet and within 30 cm from the bore opening. A single manufacturer, providing about 15 % of implanted devices, recommends surgical removal of the internal magnet prior to MR imaging.

Introduction Massage of the lateral pterygoid muscle according to Cyriax's principles is an unrecognized procedure. This procedure was tried on patients presenting with temporomandibular joint dysfunction syndrome. Material and methods Fifteen patients were treated. Pain, joint clicking, measurement of mouth opening, lateral excursion and propulsion were recorded. Assessment was made before and after the massage in the same consultation. Results Joint clicking was solved in 80% and pain in 50% of the cases. Mouth opening increased by 12.8%, propulsion by 11.6% and lateral excursion by 41.3%. Discussion Massage of the lateral pterygoid muscle according to Cyriax's principles is a simple and efficient method that can be recommended for patients presenting with temporomandibular joint dysfunction syndrome. We performed a brief anatomical and radiological MRI study supporting the feasibility of lateral pterygoid muscle palpation.

Les lesions traumatiques du tube digestif et du mesentere representent 1 a 5 % des lesions des traumatismes abdominaux fermes. Ce sont des lesions souvent meconnues, de diagnostic difficile et presentant une morbi-mortalite exponentielle au retard diagnostique et therapeutique. La tomodensitometrie represente l’examen de reference pour le diagnostic et pour la decision entre prise en charge conservatrice ou chirurgicale. Cette revue de l’iconographie detaille l’ensemble des signes tomodensitometriques decrits dans les lesions traumatiques du tube digestif et du mesentere.

BACKGROUND AND PURPOSE: Hypoattenuated foci in the otic capsule are routinely identified on multidetector CT (MDCT), particularly in pediatric patients. We aimed to describe and characterize the hypoattenuated focus in the anterior otic capsule. MATERIALS AND METHODS: We first reviewed histologic sections of the temporal bone from 8-month-old fetuses to determine the nature of the hypoattenuated focus in the anterior otic capsule. A cadaver collection of skull bases from fetuses and neonates ( n = 19), infants ( n = 24), and young children ( n = 23) were then studied with MDCT to determine the developmental evolution of this hypoattenuated focus in relation to the petrous apex. We specifically looked for the hypoattenuated focus in the anterior otic capsule, the development of the petrous apex, and the presence of other hypoattenuated foci in the fissula ante fenestram and middle otic layer. RESULTS: The hypoattenuated focus in the anterior otic capsule corresponded histologically to a cancellous bone trabecula emanating from the middle otic layer and directed toward the petro-occipital fissure. At this level it was covered with a cartilaginous cap. The hypoattenuated focus was observed in all of the fetuses and in all of the postnatal subjects younger than 4 months of age and was always associated with hypoattenuated foci of the middle otic layer and the fissula ante fenestram. This hypoattenuated focus became less obvious as the petrous apex developed. CONCLUSION: The hypoattenuated focus in the anterior otic capsule should be recognized as a normal variant in pediatrics. It could represent a relic from the development of the petrous apex.

Resume Nous presentons le cas d′une patiente de 42 ans adressee pour prise en charge d′une occlusion intestinale par invagination intestinale ileo-ileale. Cette invagination est secondaire a une tumeur bien limitee, developpee dans la paroi digestive. L′etude anatomopathologique demontre qu′il s′agit d′une tumeur stromale gastro-intestinale ou GIST. Les aspects radiologique, macroscopique, microscopique et immunohistochimique de la tumeur sont decrits et commentes.

Resume Introduction Le syndrome de Cogan correspond a l’association d’une keratite interstitielle non syphilitique et d’une atteinte audio-vestibulaire a type de maladie de Meniere. Observation Un syndrome de Cogan a ete revele par une diarrhee glairo-sanglante chez une femme âgee de 21 ans ayant pour principal antecedent une maladie de Hirschsprung. L’IRM cerebrale a permis de mettre en evidence une nevrite bilaterale d’allure virale de la VIIIe paire crânienne, encore jamais decrite dans la litterature. L’evolution des atteintes visuelle et auditive fut favorable sous corticotherapie. Conclusion Le diagnostic precoce du syndrome de Cogan peut permettre une regression des symptomes visuels et surtout audio-vestibulaires sous corticotherapie.

Resume Objectif. – Determiner l’interet de la quantification tomodensitometrique du volume pulmonaire lese lors de l’evaluation de la severite des patients souffrant de contusions pulmonaires (CP). Type d’etude. – Etude d’observation retrospective. Patients et methodes. – Les dossiers de 49 patients victimes de traumatisme thoracique avec CP ont ete revus. Recueil des donnees clinicobiologiques dont l’index d’oxygenation (PaO2/FIO2), et des traitements a visee respiratoire appliques pendant les 5 premiers jours d’hospitalisation : pression expiratoire positive (PEP) et monoxyde d’azote (NO). Le volume pulmonaire lese (CP et atelectasie) a ete quantifie sur le scanner thoracique initial par une double lecture, par 2 radiologues experimentes independants. Une correlation significative a ete recherchee entre le volume pulmonaire non fonctionnel initial, le rapport PaO2/FIO2 et les modalites de traitement. Resultats. – Une atteinte parenchymateuse pulmonaire, superieure a 37,75 % du volume pulmonaire total a ete associee a la vingt-quatrieme heure, a un rapport PaO2/FIO2 6 cmH2O et/ou de l’administration de NO. Conclusion. – La quantification tomodensitometrique du volume pulmonaire lese ou non fonctionnel apparait etre un critere de gravite des CP. Le scanner thoracique initial donne une information pronostique supplementaire parmi d’autres parametres lors du bilan des traumatismes thoraciques avec atteinte parenchymateuse.

The analysis of the FOXL2 gene (3q23) in a series of two families and two sporadic cases affected with Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES) is presented. This study detected two novel FOXL2 mutations (missence and nonsens mutations) and confirmed the recurrence of a previously described duplication. Magnetic Resonance Imaging (MRI) of the orbit, in one family, showed absence or hypotrophy of the eyelid superior levator muscle suggesting a possible role of FOXL2 in the development of this extra-ocular muscle.

Three-dimensional CT scan imaging obtained by using helicoidal CT scan provides the basis for an endoscopic exam said to be virtual since no invasive procedure is actually performed. Compared to optical endoscopy this easily accessible exam offers additional information especially for the analysis of the infraglottic and tracheal areas, which are two anatomically rigid segments. This property facilitates their three-dimensional reconstruction. Our study encompassed 6 patients presenting with a stenosis of the laryngotracheal tract. In 5 of them it was possible to correlate optical and virtual endoscopic imaging. Coupling both exams significantly improved the diagnostic investigation and facilitated the management of the disease. However, the real contribution of virtual endoscopy to the exploration of tumoral conditions still remains to be determined given the low degree of tissue resolution. As a consequence parietal and extraparietal lesional spreading is more accurately assessed by axial scan imaging.

International audience; Recently, several methods have been proposed for describing plane, non-algebraic curves in a projectively invariant fashion. These curve representations are invariant under changes in viewpoint and therefore ideally suited for recognition. We report the results of a study where the strengths and weaknesses of a number of semi-local methods are compared on the basis of the same images and edge data. All the methods define a distinguished or canonical projective frame for the curve segment which is used for projective normalisation. In this canonical frame the curve has a viewpoint invariant signature. Measurements on the signature are invariants. All the methods presented are designed to work on real images where extracted data will not be ideal, and parts of curves will be missing because of poor contrast or occlusion. We compare the stability and discrimination of the signatures and invariants over a number of example curves and viewpoints. The paper concludes with a discussion of how the various methods can be integrated within a recognition system.

Objectifs Caracteriser par imagerie morphologique et metabolique un cas d’adenome de l’oreille moyenne (AOM) chez un patient presentant un nodule meso-tympanique suspect de paragangliome (PGL) a l’imagerie conventionnelle. Compte tenu de sa rarete, il n’y a pas de donnees definitives concernant le phenotype d’imagerie fonctionnelle. Materiels et methodes Un patient presente des acouphenes gauches, sans vertige, evoluant depuis plusieurs annees. L’otoscopie montre un tympan gauche mat. La TDM met en evidence un nodule tympanique gauche de 10 × 12 mm associe a une otite sereuse. L’IRM confirme un nodule au contact du nerf de Jacobson en isosignal T1, hypersignal T2 et hypersignal T1 apres injection de gadolinium, pattern compatible avec un PGL. Seule la captation lente du contraste en angioIRM (sequences en echo de gradient rapide) est atypique. Au bilan d’imagerie metabolique on trouve une hyperfixation lesionnelle tres intense du 111In-pentetreotide a la SRS, une fixation moderee du 18F-FDG (SUVmax : 3,5) et une fixation minime de la 18F-FDOPA (SUVmax a 10 min : 1,43 et a 30 min : 0,97 a 30 min) a la TEP/TDM. Resultats Apres chirurgie, l’anatomopathologie montre des cellules sans mitoses ni atypie, avec agencement glandulaire. L’IHC est positive pour la chromogranine, synaptophysine et pankeratine. Le diagnostic retenu est celui d’AOM. Les AOM, aussi appeles tumeurs carcinoides de l’oreille moyenne (OM), sont des tumeurs rares. Elles sont issues du tissu glandulaire de la muqueuse de l’OM et ont des caracteristiques histologiques et immunohistologiques similaires a celles des tumeurs carcinoides pulmonaires ou gastro-intestinales. Elles expriment frequemment la chromogranine, la synaptophysine ou la vimentine et dans certains cas la somatostatine. Le diagnostic differentiel radiologique des AOM avec les PGL est difficile et repose sur l’angioIRM ou l’angiographie car les AOM sont moins vascularises. Conclusions L’expression des recepteurs de la somatostatine semble etre la caracteristique preponderante des AOM. Au contraire, le metabolisme amine est faible, contrairement aux PGLs. En consequence, devant la suspicion de paragangliome tympanique, l’absence d’hyperfixation significative de la 18F-FDOPA doit faire evoquer ce diagnostic differentiel.

Objectifs L’objectif de ce travail etait d’etudier la cinetique de fixation de la 18F-FDOPA dans les paragangliomes de la tete et du cou (PGLs-TC) avant et apres traitement par chirurgie ou radiotherapie (RT). Les recommandations europeennes suggerent en cas de PGLs la realisation d’une acquisition TEP entre 30 et 60 min apres l’injection de la 18F-FDOPA. Il a ete demontre que dans certaines pathologies comme le cancer medullaire de la thyroide (CMT) des acquisitions precoces etaient plus sensibles. Une seule etude comprenant principalement des pheochromocytomes s’est interessee a la cinetique de la fixation de la 18F-FDOPA dans les PGLs, montrant une captation intense et precoce. Les auteurs notent toutefois une fixation significativement moins intense des PGLs-TC par rapport aux pheochromocytomes. Materiels et methodes Vingt patients avec PGLs-TC explores par TEP/TDM a la 18F-FDOPA avec acquisitions precoce (5–30 min apres injection), standard (35–70 min apres injection) et tardive (75–100 min apres injection) ont ete inclus. Sept patients n’etaient pas encore traites. Huit et 5 patients etaient en recidive locale apres chirurgie ou radiotherapie externe ou metabolique. Seul un patient etait porteur d’une mutation SDHC. Pour chaque patient des 3 groupes, une ROI a ete placee manuellement sur la lesion fixant et au versant controlateral afin d’estimer la SUVmax tumorale (T), le bruit de fond (NT) et leur rapport (T/NT) aux 3 temps de l’examen. Les differents examens ont ete compares par le t-test de Student pour echantillons apparies ou non apparies. Resultats Le groupe des recidives apres RT presente aux 3 temps de l’examen une SUVmax T et un T/NT globalement inferieur a ceux des autres groupes. La SUVmax T diminue au cours du temps avec des valeurs moyennes superieures a 10 pour tous les groupes. Pour le T/NT, on observe une tendance globale a l’augmentation au cours du temps liee a la diminution progressive du NT. La valeur de SUVmax T/NT la plus basse est de 1,9 pour un patient du groupe non traite au temps precoce, temoignant d’un bon contraste dans les images. Conclusions Les PGLs-TC montrent une decroissance de la SUVmax T et une augmentation du T/NT dans le temps. L’acquisition precoce permettrait de detecter un eventuel CMT associe dans le cadre d’une NEM2a et de ne pas meconnaitre un petit residu tumoral post-RT. L’acquisition tardive pourrait etre utile dans les cas douteux infracentimetriques et faiblement fixants.

Sinonasal and temporal bone infections may extend to the skull, skull base, meninges, pericerebral spaces, brain parenchyma, dural sinuses, deep cerebral or cortical veins, intracranial arteries and cranial nerves either via contiguous or hematogeneous spread. The site of infection dictates the sites of potential complications: orbital with ethmoid sinusitis, cavernous sinus thrombophlebitis and oculomotor palsies with sphenoid sinusitis, transverse sinus thrombophlebitis with mastoiditis and superior sagittal sinus thrombophlebitis with frontal sinusitis. All may result in brain abscess. Congenital and acquired defects of the skull and meninges, with or without associated meningocele or meningoencephalocele, perilymphatic fistulas, and some anomalies of the inner ear may predispose to the intracranial extension of ENT infections.

The number of patients with cochlear implant increases each year. Most of these patients may undergo MR imaging up to 1.5 Tesla, based on safety recommendations from each of the manufacturers. All external components should be removed for the examination. For three manufacturers providing about 85 % of all implanted devices in Europe, the internal components may be left in place and covered by an external bandage. Strict protocol guidelines must be implemented, especially head positioning in the magnet and within 30 cm from the bore opening. A single manufacturer, providing about 15 % of implanted devices, recommends surgical removal of the internal magnet prior to MR imaging.

International audience; Branchio-oculo-facial syndrome (BOFS) is an autosomal-dominant condition characterized by three main features, respectively: branchial defects, ocular anomalies, and craniofacial defects including cleft lip and/or palate (CL/P). We report on one family with three affected, and two sporadic cases that have been found to carry missense mutations in the newly reported BOFS gene: TFAP2A. This report confirms the involvement of this transcription factor in this developmental syndrome with clinical variability. Moreover, we present CT scan temporal bone anomalies in the familial cases, related to branchial arch defects, highlighting the importance of radiological investigations for differential diagnosis.

SUMMARY: A retrospective study was conducted on a cohort of 15 patients who underwent surgery because cholesteatoma or abscess was suspected. All patients had MR imaging prior to surgery with diffusion-weighted images (DWI) from which the apparent diffusion coefficient (ADC) value was calculated. Using this technique, we were able to determine 3 distinct ADC value ranges corresponding to the 3 groups of lesions found at surgery (pure cholesteatoma, cholesteatoma with infection, and abscess or infection). This needs to be confirmed by further studies with a wider range of patients.

This study aimed at evaluating the performance of Cine-MRI to assess swallowing in patients previously treated for head and neck cancer.10 healthy control subjects and a cohort of 10 patients with 8 partial glossectomies, 1 total laryngectomy and 1 glossolaryngectomy underwent imaging from October 2005 to February 2007. The MRI examinations were performed on a 1.5 Tesla system (Siemens Avanto), with True-Fisp sequences (TR = 170 ms, TE = 1 ms, slice thickness = 10 mm) at a rate of 8 pictures per second, during dry swallowing.Results are relevant for real-time spatial resolution from lips to larynx and dynamic motions analyses of tongue, velum, posterior pharyngeal wall and larynx during dry swallowing. Oro-pharyngo-laryngeal occlusion deficiency induces aspiration in case of partial glossectomy. Total laryngectomy modifies tongue, velum and pharynx landmarks.Cine-MRI i) provides functional insight from the oral cavity to the larynx, ii) gives accurate informations about impairments due to the pathology and its treatment, iii) completes others investigations like fiberoptic endoscopy or transit time, iiii) allows a precise analysis of the muscular movements involved in the deficient swallowing mechanism, in order to optimize rehabilitative strategies and results.

To assess the value of CT for diagnosis and follow-up of AFS. Evaluation of characteristic CT features of AFS.Retrospective review of 12 cases of AFS presenting with all published diagnostic criteria (1) chronic rhinosinusitis refractory to standard management (2) CT features of chronic sinusitis (3) anatomopathologic, immunoallergologic, biochemical and mycologic criteria. CT findings were correlated with surgical findings and reviewed by one ENT and two radiologists to assess the diagnostic value of different CT features, alone or in association.AFS was isolated in 6 cases, and associated with allergic bronchopulmonary aspergillosis (ABPA) in 6 cases. CT showed pan- or polysinusitis, unilateral or bilateral, with mucosal thickening, sinus opacification frequently heterogeneous, bony changes, fluid trapping, and with pseudotumoral appearance in 3 cases.CT findings alone are not specific or pathognomonic but may suggest AFS in the correct clinical or immunoallergologic setting. It may alert the physician to the need for complementary work-up, exclude the presence of associated lung disease, and better adapt treatment and follow-up.

The literature suggests that the lateral pterygoid muscle is not palpable using an oral approach. The authors palpate the lateral pterygoid muscle during clinical examination and for the treatment of temporomandibular joint disorders. The authors present an MRI demonstration showing how palpation is achieved.

To identify the anterior ethmoidal artery (AEA) of a skull specimen on CT prior to transnasal endoscopic surgical management of anterior epistaxis.From a medial canthotomy approach, the AEA was located and a marker placed on 9 skull specimens (18 AEA). CT with 2D reformations was then performed. The AEA were then dissected using an endoscopic anterior ethmoidectomy approach. The presence of AEA procidence was recorded.Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA procidence: 1) presence of an ethmoid bulla above the AEA canal 2) AEA canal located below (not within) the ethmoid roof, anterior to the bulla.High resolution CT depiction of the AEA provides information regarding its accessibility for endoscopic ligation in patients with severe anterior epistaxis as an alternative to external ligation while demonstrating the upper limit of the anterior ethmoid.

Massage of the lateral pterygoid muscle according to Cyriax's principles is an unrecognized procedure. This procedure was tried on patients presenting with temporomandibular joint dysfunction syndrome.Fifteen patients were treated. Pain, joint clicking, measurement of mouth opening, lateral excursion and propulsion were recorded. Assessment was made before and after the massage in the same consultation.Joint clicking was solved in 80% and pain in 50% of the cases. Mouth opening increased by 12.8%, propulsion by 11.6% and lateral excursion by 41.3%.Massage of the lateral pterygoid muscle according to Cyriax's principles is a simple and efficient method that can be recommended for patients presenting with temporomandibular joint dysfunction syndrome. We performed a brief anatomical and radiological MRI study supporting the feasibility of lateral pterygoid muscle palpation.

High-resolution CT scans are able to determine with accuracy the location of the anterior ethmoidal artery in relation to the roof of the ethmoid. This investigation should greatly help functional endoscopic sinus surgery to avoid accidental injury of the artery and to coagulate the vessel in cases of severe epistaxis.This was a radio-anatomical study of the anterior ethmoid artery in order to assess the course of the artery prior to endoscopic cauterization.Eighteen ethmoid sinuses (nine heads) were dissected and high-resolution CT scans were performed in axial, coronal and sagittal planes.All anterior ethmoidal arteries were identifiable. The arteries were included in the roof of the ethmoid in eight cases. In three cases the arteries were prominent under the roof. In seven cases the dissection found the arteries distant from the roof. This anatomical feature was associated with pneumatization of the floor of the orbit. The correlation between CT scan and dissection was very satisfactory.

Objectifs Evaluer les performances diagnostiques et la reproductibilite inter-observateur de la TEP/TDM a la 18F-FDopa et de l’imagerie morphologique en coupes pour la detection des recidives post-therapeutiques des PGLs de la tete et du cou. Patients et methodes Nous avons etudie retrospectivement une serie de 15 patients porteurs de 17 PGLs de la tete et du cou deja traites par chirurgie, radiotherapie externe ou metabolique et presentant une suspicion clinique de recidive. Une evaluation par TEP/TDM a la 18F-FDopa et IRM ou TDM a ete realisee. Les examens ont ete relus independamment par trois medecins de chaque specialite. Les performances des deux modalites d’imagerie ont ete evaluees en fonction des donnees anatomopathologiques en cas de reprise chirurgicale possible ou du suivi clinique et d’imagerie. Resultats L’analyse des performances diagnostiques a montre une meilleure sensibilite de la TEP/TDM a la 18F-FDopa par rapport a l’imagerie en coupes (respectivement, 100 % contre 72,7 %). La specificite etait de 100 % pour les deux modalites d’imagerie. La reproductibilite inter-observateur etait meilleure pour l’imagerie metabolique. Ces differences de sensibilite et de reproductibilite inter-observateurs sont probablement liees a la presence de remaniements post-therapeutiques. En effet, la TEP/TDM a la 18F-FDopa est peu soumise a ces modifications et s’avere d’interpretation plus aisee. Conclusion Pour la detection des PGLs de la tete et du cou recidivants apres traitement, la TEP/TDM a la 18F-FDopa semble etre l’examen de premier choix permettant de guider les explorations morphologiques qui restent neanmoins indispensables pour la prise en charge therapeutique optimale du patient. Le developpement actuel des machines hybrides TEP/IRM se revelerait particulierement interessant dans cette indication.

Otosclerosis is a primitive osteodystrophia of the labyrinthine bone. Its diagnosis must be confirmed by a CT scan in order to eliminate the other causes that may lead to conductive hearing loss with an absence of stapedial reflex: fixation of the head of the malleus to the lateral wall of the tympanic cavity, absence of the long process of the incus or stapes, gusher syndrome, primary cholesteatoma, or tympanic facial nerve neuroma blocking the stapes. Particular problems in otosclerosis must be clarified: an extension to the round window (poor postoperative results), and extension to the tympanic cavity blocking the malleus and/or the incus, the labyrinthine lumen, or the internal auditory meatus (very rare). The position of the tympanic facial nerve canal and associated abnormalities must be assessed: stapedial artery, malformations of the ossicles and/or the labyrinth, and chronic otitis media. MRI is indicated in extension to the labyrinthine lumen, the internal auditory meatus, and in postoperative complications with labyrinthitis. MRI can also evaluate the active otosclerotic focus (gadolinium enhancement).

Cogan's syndrome is defined by the combination of non syphilitic interstitial keratitis and inner ear dysfunction, similar to Meniere's disease.Cogan's syndrome was revealed by haemorrhagic glaireous diarrhoea in a 21 year-old woman whose medical history included Hirschsprung's disease. Cerebral MRI revealed viral-like bilateral neuritis of the eighth cranial nerve, never described in the literature before. The auditory and visual disorders regressed after treatment with corticosteroids.The early diagnosis of Cogan's syndrome permits the cure of the visual and auditory and notably inner ear symptoms with corticosteroid therapy.

Imaging of the temporal bone must be integrated into the clinical context because the information provided by otologists is of great interest. The temporal bone contains three cavities: two are filled with air (external ear and middle ear) and one contains fluid (inner ear, or labyrinth, connected to the brain by the eighth cranial nerve). The aims of imaging are, in all pathologies, to avoid surprises during surgery of the middle ear and to provide information about the morphology of the cavities, in particular the inner ear and internal auditory meatus. The procedures for analyzing the different structures of the temporal bone on diagnostic images are the same, and regard both the content and the walls of the cavities.

To evaluate computed tomography quantification of injured pulmonary volume after thoracic trauma and its relevance for severity grade of patients with lung contusion.Retrospective study in a major French Level I university trauma center.Clinical and biological data including oxygenation index (PaO2/FIO2) and therapeutics modalities during the first 5 days: positive end expiratory pressure (Peep) and nitric oxide (NO), were collected on 49 patients with lung contusion resulting from thoracic trauma. Injured pulmonary volume was evaluated on initial thoracic tomodensitometry by 2 senior radiologists. The correlation between oxygenation index, therapeutics modalities and initial injured pulmonary volume was assessed for signification.Injured pulmonary volume larger than 37.75% of total lung volume is associated with both hypoxemia at the twenty-fourth hour (PaO2/FIO2300), and need for Peep6 cm H2O and /or ongoing NO administration on day 5.Injured parenchymal pulmonary volume evaluation on initial tomodensitometry seems to be an important indicator of lung contusion severity. Thoracic computed tomography provides additional prognostic information in the initial evaluation of thoracic trauma with parenchymal injury.

The analysis of the FOXL2 gene (3q23) in a series of two families and two sporadic cases affected with Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome (BPES) is presented. This study detected two novel FOXL2 mutations (missence and nonsens mutations) and confirmed the recurrence of a previously described duplication. Magnetic Resonance Imaging (MRI) of the orbit, in one family, showed absence or hypotrophy of the eyelid superior levator muscle suggesting a possible role of FOXL2 in the development of this extra-ocular muscle.

Introduction Une hepatomegalie avec NASH est frequente chez l'obese morbide genant la chirurgie bariatrique par coelioscopie. Le but de ce travail est d'evaluer par IRM les modifications hepatiques induites par regime PSMF (protein Sparing Modified Fasting) avant chirurgie. Materiels et methodes Trente neuf sujets ont ete inclus (20 hommes, 19 femmes), âge moyen 44,9 ans, IMC 45,4±5,6kg/m 2 . Le diagnostic de NASH a ete porte apres echographie hepatique et exclusion des autres causes. Les patients ont beneficie d'un regime PSMF de 5±1,2 jours (de 3 a 8 jours) et d'une IRM hepatique avant et apres. Les parametres hepatiques (volume total, gauche, droit, fleche hepatique, score de steatose) ont ete evalues par contourage (Osirix®) pour les volumes et par score de Dixon 3 points (DX3) pour la steatose. Resultats Aucune correlation n'a ete retrouvee entre les volumes hepatiques initiaux et l'IMC. Le volume hepatique total des diabetiques de type 2 (n=22) etait plus eleve que chez les non diabetiques (n=17) : 3 017 vs 2 459cm 3 , p=0,002 ainsi que le volume du foie gauche (1 164 vs 843cm 3 , p=0,02). Les volumes ont diminue apres regime PSMF (respectivement de 455±299, 195±224 et 260±159cm 3 pour le volume total, gauche et droit, soit – 15,8±8,2 %, – 17,4±19,5 % et – 14,2±8,3 %). La fleche hepatique a diminue de 0,8±0,6cm et le DX3 de 5,6±6,6 %. Le regime PSMF sur 5 jours a permis d'obtenir 90 % de la baisse des volumes observee. Enfin, une correlation positive a ete retrouvee entre le tour de taille initial et la variation du volume hepatique total (r=0,34 ; p=0,04) et celle du foie gauche (r=0,45 ; p=0,006) ainsi qu'entre l'IMC initial et la variation de volume du foie gauche (r=0,42 ; p=0,008). Conclusion L'IRM hepatique objective une diminution du volume hepatique apres regime PSMF chez l'obese morbide avant chirurgie bariatrique. Le foie gauche est plus sensible a cette sequence dietetique.

The aim of this study was to compare the clinical usefulness of ultrasmall superparamagnetic iron oxide (USPIO) MR contrast media (Sinerem, Guerbet Laboratories, Aulnay-sous-Bois, France) with precontrast MRI in the diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma, using histology as gold standard. Eighty-one previously untreated patients were enrolled in a multicenter phase-III clinical trial. All patients had a noncontrast MR, a Sinerem MR, and surgery within a period of 15 days. The MR exams were analyzed both on site and by two independent radiologists (centralized readers). Correlation between histology and imaging was done per lymph node groups, and per individual lymph nodes when the short axis wasor = 10 mm. For individual lymph nodes, Sinerem MR showed a high sensitivity (or = 88%) and specificity (or = 77%). For lymph node groups, the sensitivity wasor = 59% and specificityor = 81%. False-positive results were partially due to inflammatory nodes; false-negative results from the presence of undetected micrometastases. Errors of interpretation were also related to motion and/or susceptibility artifacts and problems of zone assignment. Sinerem MR had a negative predictive value (NPV)or = 90% and a positive predictive value (PPV)or = 51%. The specificity and PPV of Sinerem MR were better than those of precontrast MR. Precontrast MR showed an unexpectedly high sensitivity and NPV which were not increased with Sinerem MR. The potential contribution of Sinerem MR still remains limited by technical problems regarding motion and susceptibility artifacts and spatial resolution. It is also noteworthy that logistical problems, which could reduce the practical value of Sinerem MR, will be minimized in the future since Sinerem MR alone performed as good as the combination of precontrast and Sinerem MR.

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.

Objectifs Connaitre l’anatomie des cavites, canaux et foramens de l’os temporal, des nerfs VII, VIII, IX, X, XI, XII. Connaitre les principales techniques d’imagerie et leurs resultats dans le diagnostic des tumeurs et pseudo-tumeurs de l’os temporal. Messages a retenir Savoir reconnaitre un processus tumoral ou pseudo-tumoral de l’os temporal et de son environnement immediat, son mode d’extension, sa nature. Resume L’os temporal contient 3 cavites externe, moyenne, interne, plusieurs canaux (dont le canal facial et le meat acoustique interne) constituant en outre l’apex petreux, le foramen jugulaire. Les lesions epidermiques, meningees, paragangliomes, schwannomes, adenomes, Wegener, histiocytose, sarcoidose, lymphomes, leucoses aigues, carcinomes sont presentes en imagerie et analyses dans leur specificite.