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In this open prospective trial, 53 patients with acute pain from osteoporotic vertebral fracture related to osteoporosis or malignancy underwent vertebral augmentation with a new bisphenol-a-glycidyl dimethacrylate (bis-GMA) resin (Cortoss, Orthovita, Malvern, Pa, USA). Treatment consisted of up to 8 ml of Cortoss injected into a given vertebra. The procedure encompassed single and multiple injections (including the contralateral hemivertebra, to a maximum of 3 vertebral levels). Follow-up was at 4 and 8 days and at 1, 3, and 6 months. The primary efficacy end point was patient-rated pain using a 100-point visual analog scale (VAS, with 100 as severest pain) on day 4 following treatment; secondary end points were analgesic use and quality-of-life and disability scores from the Oswestry Disability Index (ODI) and a short-form 12-item questionnaire (SF-12). The present report contains interim results collected up to the 1-month post-treatment time point. At baseline, the group’s mean VAS score was 69, indicating moderate to severe pain; at day 4, 32 of 53 patients (60.4%) reported a 30% or greater reduction in baseline pain accompanied by a VAS pain score less than 50 (mean 38.1). Pain reduction was maintained at 1 month (mean VAS 31.3). The average ODI score at baseline was 55, suggesting significant disability among participants prior to Cortoss treatment. Following treatment, the ODI scores were significantly reduced from these baseline levels (day 8, 47.4; 1 month, 33.6). Further, SF-12 physical and mental component scores at 1 month after treatment increased from baseline by 26% and 11%, respectively; while analgesic use decreased concomitantly, primarily among patients with underlying osteoporosis. A total of 20 adverse events were deemed to be device-related. The most frequent clinically significant adverse events attributed to Cortoss were leakage of Cortoss from within the vertebral body at placement (12%), back pain (7%), and unspecified pain (7%). These results indicate that vertebral augmentation with Cortoss rapidly reduces pain, decreases disability, and improves physical functioning in patients with painful vertebral compression fractures.

Nerve entrapment at the foot and ankle involves thin and complex anatomic structures and is underdiagnosed because clinical symptoms and electrophysiologic findings may not contribute to the diagnosis. Nerve entrapment can be secondary to acute trauma or repetitive microtrauma. The latter often results from intensive sports-related activity, inappropriate footwear, or internal foot derangement. Various lesions that occur in fibro-osseous tunnels can cause nerve compression (eg, ganglion cysts, varicosities, bone and joint abnormalities, tumors, tenosynovitis, supernumerary or hypertrophic muscles). Accurate nerve examination must be performed, particularly in patients with atypical ankle pain, to detect focal tenderness or paresthesia. Ultrasonography is useful in this setting because it yields both clinical and morphologic findings. High-resolution magnetic resonance imaging provides accurate delineation of the nervous system anatomy. Furthermore, technologic developments in the field of radiology are making it possible to obtain clearer, more accurate images. Radiologists must be aware of the main nerve entrapment syndromes at the foot and ankle and be able to perform accurate nerve examinations with different imaging modalities in patients with foot and ankle pain.

To describe the magnetic resonance (MRI) imaging findings of the feet in patients with early rheumatoid arthritis (RA), and to compare MRI appearance of the feet with that of the hands.Thirty consecutive patients (18 women, 12 men; age range 19-64 yrs) with early RA underwent MRI of hands and feet. Axial fat suppressed gadolinium enhanced T1 weighted spin-echo and gadolinium enhanced 3-dimensional gradient-echo (FLASH) images were obtained.In the hands, MRI findings suggested active synovitis of the wrist and metacarpophalangeal (MCP) joints in 28 (93%) and 27 (90%) patients, respectively. In the feet, active synovitis was observed in 29 (97%) patients. Bone erosions were seen in the wrist joints in 24 (80%) patients. Observers found as many bony changes in the MCP as in the metatarsophalangeal joints [23 (77%) patients]. MRI detected tenosynovitis in 16 (53%) patients in the hands, and in 18 (60%) patients in the feet. Bursitis located between or beneath the metatarsal heads was a common MRI finding [19 (63%) patients].Additional MRI of the feet may be useful when evaluation of the hands does not help identify early RA.

To compare the dynamic modifications of the thoracic outlet in asymptomatic volunteers and symptomatic patients and assess the presence and location of vasculonervous compressions in these two populations.Thirty-five healthy volunteers and 54 patients with clinical symptoms of thoracic outlet syndrome (TOS) underwent magnetic resonance (MR) imaging of the thoracic outlets with their arms alongside their bodies and after a postural maneuver. Measurements were obtained at the interscalene triangle (thickness of anterior scalene muscle, interscalene angle), at the costoclavicular space (minimum costoclavicular distance, distance between inferior border of subclavius muscle and the anterior chest wall, maximum thickness of subclavius muscle, angle between first rib shaft and horizontal), and at the retropectoralis minor space (distance between posterior border of pectoralis minor muscle and posterior lining of axilla at the passage of the axillary vessels, thickness of pectoralis minor muscle). The presence and location of vasculonervous compressions were also assessed. Group data were analyzed with the Student t test.Patients with TOS had a smaller costoclavicular distance after the postural maneuver (P.001), a thicker subclavius muscle in both arm positions (P.001), and a wider retropectoralis minor space after the postural maneuver (P.001) than did volunteers. Venous compressions after the postural maneuver were observed in 47% of volunteers and 63% of patients at the prescalene space, in 54% of volunteers and 61% of patients at the costoclavicular space, and in 27% of volunteers and 30% of patients at the retropectoralis minor space. Arterial and nervous compressions, respectively, were seen in 72% and 7% of patients. No arterial or nervous compression was seen in volunteers. Except for venous thrombosis, vasculonervous compressions were demonstrated only with arm elevation. Only three thoracic outlet measurements differed significantly in both populations.MR imaging appeared helpful in demonstrating the location and cause of arterial or nervous compressions.

A 39-year-old Caucasian homeless male sought medical attention because of bilateral dental pain that had developed over several weeks. He had a 15-year history of regular hemodialysis for chronic kidney disease complicated by secondary hyperparathyroidism. Clinical examination revealed symmetrical enlargement of the mid face, which the patient said had been progressing over the last decade. Dental abscess was suspected as the cause of his pain. The patient reported a similar painful episode that occurred about a decade ago, for which a facial CT had been done, and had been reported as normal. Facial (Fig. 1) and thoracoabdominal (Fig. 2) CT scans were done.

The aim of this study was to investigate the presence of fibrocartilage within the distal posterior tibial tendon (PTT) before its division correlating with size and signal variation on MR images through a radio-anatomic and pathologic study. Eight fresh cadaveric feet underwent MR imaging were cut into 4-mm slices in the axial plane. The PTT specimens were harvested at the tendon distal portion before its division and sent to pathology. Thirty-three asymptomatic subjects underwent axial double-echo turbo-spin-echo MR imaging. Proximal and distal PTT signal and diameter were evaluated. In cadavers, every PTT flared distally. Intratendinous fibrocartilage and ossified sesamoid were found in, respectively, 87.5 and 12.5% of the cases. Distal PTT flaring was demonstrated in 100% of the asymptomatic subjects (mean diameter 8 mm). An intratendinous high signal intensity on proton-density-weighted images and sesamoid bone were evidenced in, respectively, 36 and 33% of the cases. Proximally, PTT presented a 4-mm mean diameter and was hypointense in 100% of the cases. Only one accessory navicular bone was detected. Laterally off-centered increased intratendinous signal intensity as well as PTT distal widening with otherwise normal MR imaging features are related to an intratendinous fibrocartilage.

Study design A feasibility study was performed to determine the efficacy of computer assistance in endoscopic spine surgery. Objectives To assess a new method for computer assistance based on image guidance during thoracoscopic or any endoscopic spine procedure. To evaluate the reproducibility, the sensitivity and the reliability of the technique first in vitro and second in clinical use. Summary of background data The computer-based, image-guided surgery is now a routine tool used in open spine surgery. Exposure of the anatomy of the vertebra is needed for registration. This methodology is inapplicable in endoscopic approach. Fluoroscopic-based navigation combines the technology of image-guided surgery and C-arm fluoroscopy. The navigation is based on the fluoroscopic images acquired before surgery. This technology is applicable to endoscopic surgery but the navigation is based on fluoroscopic image. The computed tomography images are not exploited. There are no published data on a technique that allows image-guided surgery based on computed tomography and magnetic resonance imaging. Method A laboratory study was performed on a thoracic human spine. One vertebra was marked on the right lateral side of the body with five titanium marks. A percutaneous reference frame was specifically designed to be placed in the pedicle of the same marked vertebrae. The reference frame acted as a 3D localizer and a registration tool. The spine model was scanned including the reference frame. A standard Stealth station treatment guidance platform (Medtronic, Sofamor Danek, Memphis, TN) was used for simulation. The registration was obtained using the reference frame. Twenty navigation procedure trials were done and the error was recorded based on the distance between the anatomical point and the corresponding virtual one. Results Registration was always possible using the stealth station and a standard spine navigational software (spine 3, Medtronic Sofamor Danek, Memphis, TN). The mean error after registration given by the computer was 0.96 mm. The mean error recorded during the navigation simulation was 1.6 mm. Conclusions This technique allows the possibility of computed tomography and magnetic resonance imaging-based, image-guided endoscopic surgery. It is probable that in the near future, as image fusion technology improves, the fluoronavigation based on fluoroscopic images would enable to navigate on multimodal images. Otherwise the technique described in this article is the only reproducible one that allows computed-tomography-based computer assistance during endoscopic procedures.

OBJECTIVE. We describe the imaging findings of an unusual type of Schmorl's node appearing as giant cystlike lesion of the vertebral bodies.CONCLUSION. Giant cystic Schmorl's nodes are unusual entities; their radiologic appearance differs dramatically from the classic description and is diagnostically challenging. However, the appearance of these nodes on conventional radiographs and especially on MR images is characteristic. Knowledge of this entity would help to eliminate unnecessary invasive diagnostic or therapeutic procedures.

OBJECTIVE. The purpose of this report is to describe the normal MR anatomy of the thoracic outlet and its modification after postural maneuvers using an anatomic-MR imaging correlation. CONCLUSION. MR imaging appears to be a useful technique to study the thoracic outlet and its contents because of its excellent soft-tissue depiction and its multiplanar capabilities. T1-weighted images obtained in the sagittal plane clearly depicted the different compartments of the cervicothoracic-brachial junction. Hyperabduction maneuvers may have potential applications in the assessment of the thoracic outlet syndrome by showing the location of compression.

Bone texture analysis might provide information about bone structure in a noninvasive manner. In a prospective case–control cross-sectional study we investigated the value of computed tomography (CT) image analysis of the distal radius in the assessment of osteoporosis. Twenty patients suffering from postmenopausal osteoporosis were studied and compared with 21 age-matched controls. Eight slices were selected in each patient: four consecutive coronal slices and four consecutive cross-sectional slices. Bone texture analysis was performed using statistical, fractal and structural methods leading to the measurement of 32 features. Structural variables derived from histomorphometric parameters were measured after segmentation from a binary or a skeletonized image. Bone mineral density was measured by dual-energy X-ray absorptiometry both at the lumbar spine and the femoral neck. Eight of the 9 statistical features were significantly different in osteoporotic women as compared with controls (coronal slices, p < 0.05). Seven structural variables were statistically different between the two groups on coronal slices (p < 0.05): valley surface area, bone volume/tissue volume, trabecular partition, Euler’s number, trabecular bone pattern factor, node-to-node strut count and terminus-to-terminus strut count. The most significant results on coronal slices (p < 0.01) concerned 4 structural features: trabecular partition, Euler’s number, trabecular bone pattern factor and terminus-to-terminus strut count. Three features were statistically different (p < 0.01) between the two groups on cross-sectional slices (skeletonization from gray levels). A few features yielded by texture analysis were correlated with both lumbar spine and femoral neck bone mineral density, but the level of these correlations was weak (r < 0.5). In conclusion, CT image analysis of the distal radius is a useful tool for characterizing bone texture alterations in osteoporotic women. These findings are in keeping with microarchitectural osteoporosis-related changes diagnosed on bone biopsies.

Fat suppression is commonly used in magnetic resonance (MR) imaging to suppress the signal from adipose tissue or detect adipose tissue. Fat suppression can be achieved with three methods: fat saturation, inversion-recovery imaging, and opposed-phase imaging. Selection of a fat suppression technique should depend on the purpose of the fat suppression (contrast enhancement vs tissue characterization) and the amount of fat in the tissue being studied. Fat saturation is recommended for suppression of signal from large amounts of fat and reliable acquisition of contrast material-enhanced images. The main drawbacks of this technique are sensitivity to magnetic field nonuniformity, misregistration artifacts, and unreliability when used with low-field-strength magnets. Inversion-recovery imaging allows homogeneous and global fat suppression and can be used with low-field-strength magnets. However, this technique is not specific for fat, and the signal intensity of tissue with a long T1 and tissue with a short T1 may be ambiguous. Opposed-phase imaging is a fast and readily available technique. This method is recommended for demonstration of lesions that contain small amounts of fat. The main drawback of opposed-phase imaging is unreliability in the detection of small tumors embedded in fatty tissue.

Objectifs pedagogiques Connaitre la clinique de la nevralgie pudendale. Preciser l’anatomie et la radio-anatomie de ce nerf. Exposer les principes de prise en charge de la nevralgie pudendale. Messages a retenir La nevralgie du nerf pudendal est une etiologie frequente des douleurs pelviennes chroniques qui doit etre bien connue. Le diagnostic est clinique. L’imagerie peut avoir un role diagnostique et therapeutique en particulier lors des infiltrations sur le trajet du nerf. La chirurgie est le traitement de reference en cas d’echec des traitements medicaux.

The ligaments of the wrist have been demonstrated with magnetic resonance (MR) imaging by many authors. Distinction has been made between the extrinsic, or radiocarpal and ulnocarpal, ligaments and the intrinsic, or intercarpal, ligaments. The stability of the wrist depends on numerous ligaments: The volar ligaments are important stabilizers of the wrist, whereas the dorsal ligaments are less crucial for wrist stability. An MR imaging protocol that demonstrates these structures with high resolution has been developed. Cadaveric wrists are imaged with a spoiled gradient-recalled-echo volume-acquisition technique with fat suppression after three-compartment enhancement with a contrast agent containing gadolinium. The specimens are then sectioned, and the anatomic and pathologic findings are correlated with the findings on the MR images. The extrinsic and intrinsic ligaments of the wrist are clearly demonstrated with this technique. This protocol was designed for anatomic study and promotes understanding of the anatomy and biomechanics of the wrist; it is not intended for clinical use.

Purpose The purpose of this study was to describe the MR appearance of the acetabular labrum in asymptomatic hips on high resolution MRI. Method Fifty-two hips in 46 asymptomatic volunteers with an age range of 15-85 years were evaluated with coronal and axial T1-weighted and T2-weighted sequences. The shape, margin, size, and signal intensity of the acetabular labrum were analyzed. Results The labrum was absent in its anterosuperior aspect in five hips (10%). Intralabral regions of intermediate of high signal intensity were detected in 30 hips (58%) imaged with T1-weighted and proton density-weighted sequences. Intralabral linear hyperintense foci reaching the articular surface and consistent with a labral tear were detected in four labra on T2-weighted images. Intralabral microcysts were seen in three labra. Conclusion The MR appearance of the hip labrum is varied in asymptomatic volunteers. Intralabral increased signal intensity and absent anterosuperior labra are especially frequent and may represent asymptomatic lesions or normal variations.

The diagnostic value of ultrasound for musculoskeletal pathology is well recognized. Ultrasound offers a low-cost, nonionizing, readily available imaging technique for the evaluation of tendons, muscles, soft-tissue masses, cysts, and other fluid collections. These advantages also make ultrasound a valuable tool for guiding a variety of musculoskeletal interventions. Its real-time capabilities permit continuous monitoring of the needle position relative to the target lesion and to surrounding structures such as vessels. Ultrasound can be regarded as the OfluoroscopyO for soft tissues. Ultrasound therefore can be used to localize and characterize the lesion, monitor the needle position during the procedure, document the efficacy of the drainage or the technique, and be used for follow-up imaging. Procedures that can be performed under ultrasound guidance include aspiration of fluid for analysis, injection of medication (steroids), decompression of cyst, bursitis or joint, abscess and hematoma drainage, treatment of calcific tendinitis, biopsy, and foreign body retrieval.

Objective. To assess the radiographic features of erosive arthropathy of the hands occurring in patients undergoing hemodialysis, and its relationship with metabolic abnormalities. Patients and design. A retrospective study of hand radiographs of 80 patients on maintenance hemodialysis was performed with the aim of detecting erosive arthropathy. Results and conclusions. Ten patients showed erosive arthropathy of the hands with a predilection for distal interphalangeal joints. The first joint abnormality was joint space narrowing with or without erosion. The mean duration of hemodialysis was 5 years (range 1–15 years). The development of arthropathy could not be related to a metabolic factor. The pathogenesis of arthropathy of the hands is possibly multifactorial, accounting for the disparate descriptions of the radiographic features in the literature.

Objectifs pedagogiques Le but de cette presentation est de rappeler : - la semiologie classique des infections musculo-squelettiques au rachis et au squelette appendiculaire - la semiologie plus atypique a connaitre : semiologie tres precoce, condensation osseuse ou destruction inhabituelle, atteinte excentree, topographies rares - les indications respectives des differentes techniques d’imagerie - les complications a connaitre - les elements importants a indiquer dans le compte rendu car influencant la prise en charge therapeutique des patients. Resume Le developpement des traitements immuno-suppresseurs et des gestes interventionnels expliquent en partie la recrudescence des infections osteo-articulaires dans nos pays. L’infection aigue constitue une veritable urgence therapeutique car le pronostic fonctionnel est en jeu. Les atteintes sub-aigues et chroniques presentent une semiologie radiologique bien differente. Cette presentation a pour but de rappeler les bases indispensables a connaitre pour permettre une prise en charge therapeutique optimale des patients.

Objectifs Cette presentation didactique a pour but d’illustrer l’imagerie des metastases osseuses peripheriques. Materiels et methodes A partir de la base de donnees de l’etablissement nous avons selectionne de facon retrospective les examens d’imagerie conventionnelle effectues a la recherche de metastases osseuses peripheriques. Dans certains cas nous avons realise la correlation avec l’imagerie en coupe. La presentation est faite sur format informatique de type Powerpoint permettant une interactivite. Resultats Au moyen de cas cliniques ce travail illustre les aspects les plus frequents des metastases osseuses peripheriques, la semiologie atypique (metastase corticale, acrometastase), les aspects post-therapeutiques (radiotherapie, chimiotherapie) et quelques diagnostics differentiels (osteomyelite, tumeur osseuse primitive). De plus les rappels epidemiologiques et etiopathologiques sont egalement abordes. Conclusion La radiographie standard associee a la scintigraphie reste pour le moment le couple diagnostique pour la detection des metastases osseuses. L’analyse rigoureuse des cliches standard permet non seulement le plus souvent le diagnostic, mais apporte aussi des arguments sur l’origine, le risque de complication et l’evolutivite des lesions.

A young girl had a large isolated and localized multicystic lesion of the right humerus, which was revealed by a pathological fracture. MRI and bone biopsy showed liquid-filled bone cysts. The final diagnosis was localized cystic lymphangiomatosis.

The objective of this study was to assess the contribution of magnetic resonance (MR) imaging in the diagnosis and surgical planning of five cases of synovial haemangioma of the knee. The clinical, radiological and arthroscopic features of five pathologically proven synovial haemangiomas of the knee were retrospectively reviewed. A diagnostic delay, on average of 8 years, had occurred in four of the cases. Plain films were unremarkable, except for one case with arthropathy mimicking haemophilia, Arteriography, performed in three patients, was normal in one. CT, performed in three patients, showed the lesion, but the extent of the latter was better demonstrated with MR imaging. Synovial haemangiomas had a high signal intensity on T2-weighted images, without any extensive mass effect. Fibrofatty septa within the lesion were observed in three cases and muscular and/or fatty invasion in two. Arthroscopy allowed diagnosis of the lesion in two cases, but showed only non-specific synovitis in another two. This study emphasizes the valuable contribution of MR imaging in the diagnosis and surgical planning of synovial haemangiomas.

Clinical and radiographic findings were retrospectively reviewed in a multicentric survey of 58 patients with histologically proven pigmented villonodular synovitis (PVNS) of the hip. The most common clinical features were mechanical pain (47 cases) and limitation of joint motion (47 cases). On plain films, a classic form with large and multiple lucencies was found in 36 cases, followed by an osteoarthritis-like form (9 cases), an arthritis-like form (8 cases), normal radiographic appearance (3 cases), osteonecrosis of the femoral head (one case) and joint destruction with acetabular protrusion (one case). Bilateral involvement of the hips was probable in two patients. In contrast to the knee, the hip showed a high prevalence of bony lesions and joint space narrowing. Although an uncommon disease, PVNS of the hip has to be considered when arthritis is associated with uncharacteristic clinical or radiographic findings.

Musculoskeletal disorders are among the most common problems affecting the elderly. The resulting loss of mobility and physical independence can be particularly devastating in this population. The aim of this article is to present some of the most frequent musculoskeletal disorders of the elderly, such as fractures, osteoporosis, osteoarthritis, microcrystal disorders, infections, and tumors.

Abstract 3921 Background. Osteolytic disease is a major complication of multiple myeloma (MM) that may lead to devastating skeletal-related events (SREs). 70% of patients have osteolytic lesions at diagnosis, and up to 90% develop lytic lesions during the course of their disease. Furthermore, almost 15% of patients present with diffuse osteopenia at diagnosis. Various imaging techniques have been performed for the diagnosis and follow-up of bone disease in MM, however, conventional radiography (CR) remains the gold standard. CR has several limitations. One is that CR reveals lytic disease when more than 30% of the trabecular bone has been lost. Thus, some patients may have a suboptimal assessment of generalized osteopenia. Another limitation is that CR cannot be used for the assessment of response to therapy because the lytic bone lesions seldom show evidence of healing. On the other hand new vertebral fractures do not always indicate disease progression and may occur due to ongoing bone loss or reduction of tumor mass that supports the bony cortex. Other limitations include lack of accurate visualization of some areas, observer dependency, lengthy period on the examination table, and poor tolerance by patients with severe pain and extended lytic disease. The EOS System is a new 2D and 3D imaging system for musculo-skeletal physiology and pathology assessment with low radiation dose and standing position. We hypothesized that EOS would not be inferior to CR in terms of routine imaging and diagnosis of bone lytic lesions of patients with MM, but would improve on the quality of life during the procedure of the imaging for the frail patients with MM. Methods and Materials. Fifty six consecutive patients with symptomatic MM (at diagnostic and at first relapse) were included in this prospective study. Each patient provided informed consent. All patients underwent an EOS® examination (frontal and lateral views from skull to knees) and radiographs (axial skeleton: skull, spine, pelvis, femurs, humeri, ribs, as per International Myeloma Working Group guidelines) the same day, prior to start any treatment. Each imaging modality was read in random order by 2 reviewers independently for the detection of bone lesions (osteolytic lesions, vertebral collapses). Whole-body MRI was performed in case of disagreement between the 2 imaging modalities. Radiation dose and technical comfort were also assessed. The length of time of either exam was measured and the patients had to fill in a quality of life questionnaire aimed at comparing the roughness of the 2 techniques. Our study received prior approval from our Ethics Committee. Results. The median age was 62 (range, 32–90), gender ratio was 30 male / 26 female. CR and EOS® diagnosed 467 and 451 bone lytic lesions, respectively. There was no significant difference between the 2 imaging techniques, as 445 out of 473 bone lesions were detected by both the EOS®system and the CR. The median length of time to perform the CR exam was 6 to 8 times longer than EOS® technique. The average radiation dose with the EOS®system was 7.8 times less than with CR. The majority of the patients found the EOS®system examination to be more comfortable than the multiple radiographic incidences. The main limitation to EOS® technique was in patients with high BMI greater than 30, in whom CR remains the most sensitive technique. Furthermore, EOS® system was not able to differentiate old versus novel lytic lesions, as expected with standard radiographs. Finally, EOS presented with the same difficulty to count the number of lytic lesions per patient, as for the CR technique. Conclusion. EOS® system is a new low-dose radiation device which allows a quicker scan of the whole body. In this preliminary study performed in patients with MM, this technique allowed detection of bone lesions with better comfort for the patients as compared to CR. This is of paramount importance in patients with MM that often presented with altered health status and bone pain that hampered the ability to perform CR with optimal conditions. Disclosures: Facon: Celgene: Consultancy, Honoraria; Janssen-Cilag: Consultancy, Honoraria.

Objectifs Decrire l’anatomie normale de la traversee cervico-thoraco-brachiale en IRM et en TDM. Decrire les modifications dynamiques des differents compartiments de la traversee cervico-thoraco-brachiale. Presenter les variations anatomiques possiblement a l’origine de compressions vasculaires et nerveuses. Messages a retenir La traversee cervico-thoraco-brachiale comprend trois compartiments : le triangle interscalenique, la pince costo-claviculaire et le tunnel sous-pectoral. Le scanner et l’IRM permettent d’apprehender l’anatomie de cette region anatomique. Lors de l’elevation du membre superieur il existe un retrecissement de la pince costo-claviculaire et du tunnel sous-pectoral. Des compressions des structures vasculo-nerveuses (arteres sous-cla-viere et axillaire et plexus brachial) peuvent survenir au sein des compartiments de la traversee cervico-thoraco-brachiale. Resume La traversee cervico-thoraco-brachiale est constituee par l’ensemble des espaces anatomiques que franchissent les elements vasculaires ou nerveux depuis la berge mediale du defile inter-scalenique, jusqu’au bord inferieur du tendon distal du muscle grand pectoral. Les trois sites de compression potentielle successivement empruntes par le pedicule vasculo-nerveux sont : le defile inter-scalenique, la pince costo-claviculaire et le tunnel sous-pectoral. A l’elevation du membre superieur, il existe un retrecissement de la pince costo-claviculaire et du tunnel sous-pectoral. Le scanner et l’IRM permettent une etude morphologique et dynamique de cette region anatomique, et peuvent preciser la topographie et les causes des compressions vasculo-nerveuses.

Objectifs Savoir reconnaitre une spondylodiscite debutante. Connaitre les formes inhabituelles d’infection rachidienne. Reconnaitre les principaux diagnostics differentiels. Messages a retenir Certains signes sont utiles pour differencier une tuberculose d’une infection a germes pyogenes. Les anomalies de signal du disque peuvent etre absentes, focales ou excentrees en cas de spondylodiscite debutante. Penser aux arthrites zygapophysaires. Penser a rechercher un autre foyer ou une extension de l’infection a distance. Resume En cas de spondylodiscite debutante, les anomalies de signal du disque peuvent manquer. L’IRM peut etre negative dans les 2-4 premiers jours. Certaines presentations peuvent etre inhabituelles ou trompeuses en imagerie (germes particuliers, spondylites, arthrites zygapophysaires, atteinte de l’arc posterieur, nourrisson). Dans les diagnostics differentiels, on citera notamment les affections microcristallines et rhumatismales et les pathologies traumatiques et micro-traumatiques.

Objectifs Demontrer que l’echographie peut permettre une etude precise du nerf phrenique dans son trajet cervical. Materiels et methodes La premiere partie de ce travail a comporte une etude sur cadavres (etude echographique, coupes anatomiques, dissections, etude anatomo-pathologique). Elle a ete suivie d’une etude echographique sur 20 volontaires (40 nerfs phreniques) realisee par deux radiologues en consensus. La localisation, le trajet et les rapports du nerf phrenique avec les structures adjacentes ont ete analyses. Resultats Le trajet precis du nerf phrenique pouvait etre identifie dans tous les cas. Certains reperes anatomiques utiles pour la detection de ce nerf ont pu etre definis (notamment les arteres cervicales transverse et ascendante). Certaines variations anatomiques ont egalement pu etre observees. Conclusion Le trajet cervical du nerf phrenique peut etre identifie en echographie. La connaissance precise de la localisation du nerf, qui peut presenter des variations inter-individuelles, pourrait avoir des applications utiles en clinique.

Objectifs pedagogiques Connaitre les aspects radiographiques de l’osteogenese imparfaite (OI). Savoir faire le diagnostic differentiel entre maltraitance et OI. Connaitre les aspects radiographiques sous traitement par biphosphonates. Messages a retenir Le diagnostic d’OI doit etre evoque des qu’une fragilite osseuse est suspectee. Il peut se poser chez le jeune enfant un probleme de diagnostic differentiel avec une maltraitance. Le bilan radiographique complet du squelette permet d’evoquer le diagnostic. Le traitement par biphosphonates est tres efficace chez les enfants presentant une forme moderee ou severe d’OI.

Objectifs Le but de ce travail etait de demontrer que l’echographie pouvait permettre une etude precise du nerf fibulaire superficiel a la jambe. Materiels et methodes La premiere partie de ce travail a comporte une etude sur cadavres (echographies, dissections, coupes, etude ana-tomo-pathologique). Elle a ete suivie d’une etude echographique sur 30 volontaires (60 nerfs) par deux radiologues en consensus. La localisation, le trajet et les rapports du nerf fibulaire superficiel avec les structures adjacentes ont ete analyses. Resultats Le nerf fibulaire superficiel pouvait etre etudie en echo-graphie dans son ensemble. Le niveau de l’emergence proximale du nerf entre les muscles long fibulaire et long extenseur des orteils et le niveau auquel il traversait le fascia crural pour devenir sous-cutanes etaient extremement variables. Le nerf etait localise dans le compartiment anterieur de la jambe dans 26,6% des cas et se divisait avant de traverser le fascia crural dans 6,6% des cas. Conclusion Le nerf fibulaire superficiel peut etre parfaitement etudie en echographie. La connaissance de sa localisation precise, qui peut presenter des variations inter-individuelles, pourrait avoir des applications cliniques tres utiles.

Objectifs pedagogiques Promouvoir les nouvelles techniques d’imagerie fonctionnelle en pathologies osteo-articulaires : IRM de diffusion et a ultrashort TE. Imagerie moleculaire de l’infection osseuse. Apport du post-traitement 3D et 4D en scanographie.

Introduction Le but de ce travail etait d’integrer les variations dynamiques de l’orientation pelvienne lors de la mesure tomodensitometrique de la position des implants d’une prothese totale de hanche. Materiel et Methode Cinquante-cinq PTH instables (33 luxations posterieures et 22 anterieures) et 59 PTH stables ont ete analysees. Une radiographie de bassin de profil en charge avec calcul de la version pelvienne etait realisee (ligne centre des tetes, centre de S1/verticale). Une coupe « habituelle » etait realisee, puis sur le scoutview une coupe perpendiculaire a l’axe pelvien « coupe anatomique », enfin cette coupe etait modifiee de la valeur de la version pelvienne : anteversion « fonctionnelle » simulant le passage en orthostatisme. L’anteversion du pivot femoral etait mesuree. Resultats Les parametres « anteversion habituelle », « anatomique » et « fonctionnelle » avaient une influence significative sur la survenue et le sens des luxations, pas le pivot femoral. Pour les instabilites posterieures, 8 cupules etaient anteversees de moins de 20° et deux cupules retroversees selon la coupe « habituelle », la coupe « anatomique » montrait 18 cupules avec une anteversion inferieure a 15° et 7 cupules retroversees, retablissant la realite dans 50 % des cas. L’anteversion « anatomique » traduit l’anteversion du bassin (retroversion de la cupule) lors de l’orthostatisme. Pour les instabilites anterieures, la coupe « fonctionnelle » montrait 16 cupules anteversees de plus de 30°, pour seulement 11 sur la coupe « habituelle ». La coupe « fonctionnelle » traduit la retroversion moins frequente (8 % des sujets sains) du bassin (hyperanteversion de la cupule) lors de l’orthostatisme. La mesure « fonctionnelle » des 59 PTH stables revelait 12 fois une anteversion excessive (>30°). Discussion L’orthostatisme fait varier la position du bassin de 18 a 30° (92 % des sujets s’anteversent). La coupe « habituelle » rend peu compte des positions de la cupule. La mesure « anatomique » est utile lors des luxations posterieures et la mesure « fonctionnelle » lors des luxations anterieures. Douze des 35 cupules (PTH stables) avec anteversions « habituelles » normales etaient trop anteversees selon la coupe « fonctionnelle ». Sur 55 PTH instables, une tomodensitometrie normale aurait meconnu 5 retroversions, 10 anteversions insuffisantes, et 5 hyperanteversions (36 % des cas). Conclusion Ce protocole permet de comprendre les malpositions prothetiques a l’origine des episodes d’instabilite pour des implants qui apparaissent bien positionnes sur des coupes tomodensitometriques standard.

Objectifs Determiner les signes IRM differenciant un TVNT poro-tique et malin. Materiels et methodes Etude multicentrique prospective de 78 patients explores en IRM pour TVNT avec suivi a un an obtenu pour le diagnostic final : 37 benins et 41 malins. Plus de 50 variables ont ete recueillies independamment par deux lecteurs. Ont ete etudiees : la reproductibilite intra et inter-observateur et la performance diagnostique de chaque variable dont la reproductibilite inter-observateur etait superieure a 0,8. Resultats Signes discriminatifs pour le diagnostic de TVNT malins : presence d’une lyse (VVP 70 %), hyposignal diffus T1 (VVP 80 %), masse intracanalaire (VVP 79 %), masse paravertebrale (VVP 71 %), convexite mur posterieur (VVP 86 %), aspect heterogene de la prise de contraste (VVP 67 %), evidement du corps vertebral (VVP 82 %), hypersignal nodulaire ou diffus (VVP 66 %) et a distance du plateau (VVP 66 %). Presence de nodule sur le reste du rachis (Sp 90 %) ; signes discriminatifs pour le diagnostic de TVNT benins : hyposignal T1 partiel ou absent (VVP 81 %), presence d’un recul du mur posterieur (VVP 68 %), presence d’une corticale fracturee ou normal (VVP 87 %). Les anomalies du pedicule ne sont pas discriminatifs d’un diagnostic (malins (39 cas), benins (21 cas)). Conclusion L’IRM est un examen discriminant pour differencier un TVNT porotique vs malin.

Objectifs Etudier en tenseur de diffusion les valeurs de fraction d’anisotropie (FA) et de coefficient apparent de diffusion (ADC) de sujets sains ou atteints d’affections musculaires. A notre connaissance, ce type d’etude n’a jamais ete realise. Materiels et methodes Quatorze patients (8 myosites a inclusion, 3 polymyosites, 1 dermatomyosite, 2 myopathies facio-scapulo-humerales avec atteinte du quadriceps femoral) et 7 volontaires sains ont beneficie d’une IRM de la cuisse droite (ponderation T1, STIR et tenseur de diffusion). La FA et l’ADC ont ete calcules pour chaque composant du muscle quadriceps femoral par positionnement de plusieurs ROI et par tractographie. Resultats Une difference de l’ADC a ete observee chez les volontaires sains en fonction de l’âge et du sexe. En cas de degenerescence graisseuse musculaire marquee, les fibres tractees etaient moins nombreuses et plus courtes : la realisation des mesures de FA et d’ADC via cette technique n’apparait donc pas pertinente. Les valeurs de FA et d’ADC obtenues par ROI etaient par contre differentes (ADC diminue) de celles des temoins. Conclusion L’etude en tenseur de diffusion autorise une approche originale de la microarchitecture musculaire.

Objectifs Evaluer la presence d’anomalie du pedicule dans les tassements vertebraux osteoporotiques en IRM. Materiels et methodes Etude prospective de 149 patients hospitalises pour des tassements vertebraux non traumatiques dont 138 ont ete explores par IRM (sequences T1, T1 GADO, T2FAT SAT, T2 EG) avec un diagnostic final obtenu a un an. Evaluation des anomalies de signal en IRM par deux lecteurs independants. Resultats L’anomalie du signal pediculaire a ete observee dans 70,3 % des tassements vertebraux non traumatiques sans difference significative entre les tassements malins (71 %) et les tassements osteoporotiques (58 %). Conclusion L’atteinte pediculaire est un signe frequemment retrouve dans les tassements vertebraux non traumatiques aussi bien malin que benin. Contrairement aux idees recues, cette anomalie n’est pas un element d’orientation en faveur de malignite ou de benignite.

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

Objectifs Valoriser les activites MIGAC MERRI afin de preparer les motivations du financement de ces activites dans les prochaines annees. Resume La T2A introduit une part MIGAC MERRI en plus du financement des soins par les GHS. La partie MERRI finance la recherche, l’enseignement, l’innovation et les activites dites de « reference » sur la base d’un pourcentage fixe (13,5 % pour les CHU « fort chercheur ») du financement des soins. Le CHRU de Lille a souhaite sortir de cette logique et contractualiser les activites MERRI sur leurs realites et leurs potentiels. Pour cela, il a ete demande a chaque equipe d’imagerie specialisee par organe de declarer ses activites de recherche et d’enseignement. Cette methode declarative a ete completee depuis 2006 par une evaluation des publications avec le logiciel SIGAPS. Ces premiers resultats ont permis de travailler sur les plateaux techniques dont l’imagerie est le point central. Ce travail a conduit a distinguer trois niveaux d’activite : les activites de recherche propres au service, les activites d’imagerie mobilisees par des recherches cliniques connues de l’institution et protocolisees, les activites de recherche clinique non connues de l’institution (ex : imagerie de controle dans un protocole mene par un service). Decrire precisement chaque activite a partir d’indicateurs comme le temps machine et le temps medecin a permis de valoriser en couts directs l’importance des ressources d’imagerie engagees dans ces activites.

Resume Les lesions traumatiques de la face laterale de la cheville concernent le plus souvent le ligament collateral lateral mais pas toujours. D’autres diagnostics (parfois associes a une entorse laterale) doivent etre envisages et dependent du mecanisme lesionnel rencontre. Ce dernier peut etre difficile a preciser. L’examen clinique de la cheville n’est pas toujours aise au stade aigu. Les radiographies sont parfois prises en defaut et ne permettent pas d’authentifier la lesion ligamentaire. Enfin, plus tardivement, des sequelles non negligeables peuvent etre rencontrees si la prise en charge therapeutique initiale n’est pas adaptee. A l’heure actuelle, l’echographie est un bon moyen de dresser un bilan lesionnel precis. Au cours de cet expose, nous mettrons l’accent sur 3 diagnostics principaux qu’il est important de reconnaitre : la lesion traumatique du retinaculum des tendons fibulaires, la fracture du processus lateral du talus et l’entorse du ligament bifurque. La lesion du retinaculum des tendons fibulaires favorise leur instabilite et peut se compliquer d’une fissuration tendineuse ; la fracture non diagnostiquee du processus lateral du talus peut rapidement entrainer une arthrose sous-talienne ; l’entorse du ligament bifurque s’accompagnant d’une fracture du processus antero-superieur (rostre) du calcaneus peut etre responsable d’importantes douleurs residuelles.

Objectifs La connaissance du trajet du rameau cutane palmaire du nerf median est importante avant la section du retinaculum des flechisseurs des doigts lors d’un syndrome du canal carpien. Les objectifs de cette etude etaient d’evaluer les possibilites d’individualisation en imagerie de ce rameau et de preciser en imagerie de coupe son trajet. Materiels et methodes Dissection fine de 15 faces anterieures de poignet pour mettre en evidence le trajet du rameau cutane palmaire du nerf median. Realisation de correlations anatomo-IRM de facon directe sur 5 poignets cadaveriques avec etude histologique. Realisation de correlations indirectes avec des coupes IRM et echographiques chez 30 volontaires. Resultats La visualisation du rameau cutane palmaire du nerf median etait possible en IRM et en echographie. Cette structure naissait du bord radial du nerf median dans tous les cas et cheminait entre les tendons du muscle flechisseur radial du carpe et du muscle long palmaire. Conclusion La visibilite par l’imagerie du rameau cutane palmaire est possible. Sa reconnaissance permet de limiter le risque de lesion de ce rameau nerveux lors de l’intervention chirurgicale d’un syndrome du canal carpien.