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Purpose The purpose of this study was to identify which combination of imaging modalities should be used to obtain the best diagnostic performance for the non-invasive diagnosis of giant cell arteritis (GCA). Materials and methods This IRB-approved prospective single-center study enrolled participants presenting with a suspected diagnosis of GCA from December 2014 to October 2017. Participants underwent high-resolution 3T magnetic resonance imaging (MRI), temporal and extra-cranial arteries ultrasound and retinal angiography (RA), prior to temporal artery biopsy (TAB). Diagnostic accuracy of each imaging modality alone, then a combination of several imaging modalities, was evaluated. Several algorithms were constructed to test optimal combinations using McNemar test. Results Forty-five participants (24 women, 21 men) with mean age of 75.4 ± 16 (SD) years (range: 59–94 years) were enrolled; of these 43/45 (96%) had ophthalmological symptoms. Diagnosis of GCA was confirmed in 25/45 (56%) patients. Sensitivity and specificity of MRI, ultrasound and RA alone were 100% (25/25; 95% CI: 86–100) and 86% (19/22; 95% CI: 65–97), 88% (22/25; 95% CI: 69–97) and 84% (16/19; 95% CI: 60–97), 94% (15/16; 95% CI: 70–100) and 74% (14/19; 95% CI: 49–91), respectively. Sensitivity, specificity, positive predictive and negative predictive values ranged from 95 to 100% (95% CI: 77–100), 67 to 100% (95% CI: 38–100), 81 to 100% (95% CI: 61–100) and 91 to 100% (95% CI: 59–100) when combining several imaging tests, respectively. The diagnostic algorithm with the overall best diagnostic performance was the one starting with MRI, followed either by ultrasound or RA, yielding 100% sensitivity (22/22; 95% CI: 85–100%) 100% (15/15; 95% CI: 78–100) and 100% accuracy (37/37; 95% CI: 91–100). Conclusion The use of MRI as the first imaging examination followed by either ultrasound or RA reaches high degrees of performance for the diagnosis of GCA and is recommended in daily practice.

Background and purpose To compare the accuracy and utility of contrast enhanced magnetic resonance angiography (MRA) (CEMRA) to Time of Flight MRA (TOF MRA) during detection and evaluation of occlusions on patients diagnosed with acute ischemic stroke (AIS). Methods This single-center study was approved by our local institutional research ethics board. From August 2014 to July 2016, 131 consecutive adult patients with confirmed AIS were included. Detection of an arterial occlusion and its characterization were evaluated independently with CEMRA or TOF MRA by two blinded neuroradiologists, then by consensus using all available MR sequences. A Cohen's Kappa coefficient (κ) and intra-class correlation coefficients (ICC) were used to compare the two techniques. Results There was substantial concordance in the detection of arterial occlusion between CEMRA and TOF MRA (κ = 0.75). TOF MRA was more likely to show an arterial occlusion than CEMRA (63 versus 52 patients respectively). There were 13 and 1 false positive arterial occlusion with TOF MRA and CEMRA respectively, and 1 false negative with TOF MRA. There was excellent concordance between the location of arterial occlusions and CEMRA and TOF MRA [κ = 0.89 (0.72–0.97)]. CEMRA was significantly more likely to allow measurement of the thrombus than was TOF MRA [38 (75%) versus 14 (22%)] (P Conclusions Our study showed that CEMRA imaging detected arterial occlusions better than TOF MRA in AIS patients and more precisely such that thrombus length and location could be known, which improves the patient's management and care.

Spinal imaging in multiple sclerosis remains challenging because of its small size and numerous artifacts. To compare 3D Phase-Sensitive Inversion Recovery (PSIR) to a conventional dataset of 3D Short Tau Inversion Recovery (STIR) and T2-weighted imaging at 3 Tesla to detect multiple sclerosis spinal cord lesions. This prospective single-center study was approved by a national research ethics board and included 54 patients (median age 44) enrolled from December 2016 to August 2018. Two neuroradiologists individually analyzed the two datasets separately and in random order. Discrepancies were resolved by consensus with a third neuroradiologist. The primary judgment criterion was the number of spinal cord lesions. Secondary judgment criteria included location of the lesions, reader-reported confidence and conspicuity assessed with the lesion-to-cord contrast ratio (LCCR). 3D PSIR detected significantly more lesions than the conventional dataset (371 versus 173, respectively, p

To assess the diagnostic value of three 3D FLAIR sequences with differing repetition-times (TR) at 3-Tesla when detecting multiple sclerosis (MS) lesions. In this prospective study, approved by the institutional review board, 27 patients with confirmed MS were prospectively included. One radiologist performed manual segmentations of all high-signal intensity lesions using three 3D FLAIR data sets with different TR of 4800 ms (“FLAIR4800”), 8000 ms (“FLAIR8000”) and 10,000 ms (“FLAIR10,000”) and two radiologists double-checked it. The main judgment criterion was the overall number of lesions; secondary objectives were the assessment of lesion location, as well as measuring contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). A non-parametric Wilcoxon’s test was used to compare the differing FLAIR. The FLAIR8000 and FLAIR10,000 detected significantly more overall lesions per patient as compared with the FLAIR4800 [116.1 (± 61.7) (p = 0.02) and 115.8 (± 56.3) (p = 0.03) versus 99.2 (± 66.9), respectively]. The FLAIR8000 and FLAIR10,000 detected four and eight times more cortical or juxta-cortical lesions per patient as compared with FLAIR4800 [1.6 (± 2.2) (p = 0.001) and 4.1 (± 5.9) (p = 6 × 10–5) versus 0.4 (± 1.1), respectively]. CNR was significantly correlated to the TR value. It was significantly higher with FLAIR10,000 than it was with FLAIR8000 and FLAIR4800 [16.3 (± 3.5) versus 15 (± 2.4) (p = 0.01) and 12 (± 2.2) (p = 2 × 10–6), respectively] An optimized 3D FLAIR with a long TR significantly improved both overall lesion detection and CNR in MS patients as compared to a 3D FLAIR with factory settings.

BACKGROUND Although several studies have evaluated dynamic contrast-enhanced (DCE) MRI in the orbit, showing its utility when detecting and diagnosing orbital lesions, none have evaluated the pharmacokinetic models. PURPOSE To provide a quality-based pharmacokinetic model selection for characterizing orbital lesions using DCE-MRI at 3.0T. STUDY TYPE Prospective. POPULATION From December 2015 to April 2017, 151 patients with an orbital lesion underwent MRI prior to surgery, including a high temporal resolution DCE sequence, divided into one training and one test dataset with 100 and 51 patients, respectively. FIELD STRENGTH/SEQUENCE 3T/DCE. ASSESSMENT Six different pharmacokinetic models were tested. STATISTICAL TESTS Univariate and multivariate analyses were performed using Wilcoxon-2-sample tests and a logistic regression to compare parameters between malignant and benign tumors for each pharmacokinetic model for the whole cohort. Receiver operating characteristic (ROC) curve analyses were performed on the training dataset to determine area under curve (AUC) and optimal cutoff values for each pharmacokinetic model, then validated on the test dataset to calculate sensitivity, specificity, and accuracy. RESULTS Regardless of the model, tissue blood flow and tissue blood volume values were significantly higher in malignant vs. benign lesions: 103.8-195.1 vs. 65-113.8, P [

BACKGROUND AND PURPOSE: Magnetic Resonance Imaging is the modality of choice to detect spinal cord lesions in patients with Multiple Sclerosis (MS). However, this imaging is challenging. New sequences such as phase-sensitive inversion recovery have been developed to improve detection. Our aim was to compare a 3D phase-sensitive inversion recovery and a conventional imaging dataset including postcontrast T2WI and T1WI to detect MS spinal cord lesions. MATERIALS AND METHODS: This retrospective single-center study included 100 consecutive patients with MS (mean age, 41 years) from January 2015 to June 2016. One senior neuroradiologist and 1 junior radiologist blinded to clinical data checked for new spinal cord lesions, individually analyzing conventional and 3D phase-sensitive inversion recovery datasets separately, placing a 3-week delay between the 2 readings. A consensus reading was done with a third senior neuroradiologist. A Wilcoxon test was used to compare the 2 imaging datasets. Intra- and interobserver agreement was assessed by the κ coefficient. RESULTS: 3D phase-sensitive inversion recovery detected significantly more lesions than conventional imaging (480 versus 168, P < .001). Eleven patients had no detected lesions on T2WI, whereas 3D phase-sensitive inversion recovery detected at least 1 lesion. All postcontrast T1WI enhancing lesions were also visible on 3D phase-sensitive inversion recovery. The signal-to-noise ratio was significantly higher using 3D phase-sensitive inversion recovery (0.63 versus 0.46, P = .03). Mean reading confidence was significantly higher using 3D phase-sensitive inversion recovery. Inter- and intraobserver agreement was good for both datasets. CONCLUSIONS: Our study showed that 3D phase-sensitive inversion recovery significantly improved detection of cervical spinal cord lesions, including both enhancing and nonenhancing lesions in patients with MS.

Magnetic resonance imaging (MRI) is the diagnostic cornerstone for precisely identifying acute ischaemic strokes and locating vascular occlusions, especially since mechanical thrombectomy has become a reference treatment. We observed that a post-contrast three-dimensional turbo-spin-echo T1-weighted sequence showed striking post-contrast vascular hyperintensities (PCVH) in ischaemic territories. We aimed to evaluate the prevalence and the meaning of this finding. This retrospective single centre study included 130 consecutive patients admitted for acute ischaemic stroke with a 3-T MRI performed in the first 12 h of symptom onset from September 2014 through September 2016. Two neuroradiologists blinded to clinical data analysed the first MRI assessments. The association between PCVH and clinical, radiological and follow-up findings was assessed, as well as inter- and intra-observer agreements. Of 130 patients, 105 (81%) had PCVH in the ischaemic territory. PCVH were associated with the presence of thrombus on susceptibility weighted imaging (p < 0.0001) and vascular occlusions on MR angiography (p < 0.0001). All patients with a visible thrombus had PCVH closely surrounding the clot. PCVH were associated with higher initial (p < 0.01) and follow-up (p < 0.01) National Institutes of Health Stroke Scale score, and higher mRS score (p < 0.05). Thrombectomy was the reference treatment for all patients with arterial occlusions. Inter- and intra-observer agreements for the detection of PCVH were excellent (κ = 0.95 and κ = 0.91, respectively). PCVH during acute strokes are a striking sensitive and reproducible tool for diagnosing and locating vascular occlusions. It may help triage patients who can benefit from thrombectomy. • Post-contrast vascular hyperintensities (PCVH) are a sensitive MR finding in acute stroke • PCVH are strongly associated with the presence and location of arterial occlusions • Inter- and intra-observer agreements for the detection of PCVH are excellent • PCVH are visible even in the case of significant motion artefacts • PCVH may help triage patients who can benefit from mechanical thrombectomy

Objectives To evaluate repeatability of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) parameters in the orbit. Methods From December 2015 to March 2016, 22 patients were scanned twice using an IVIM sequence with 15b values (0–2,000 s/mm2) at 3.0T. Two readers independently delineated regions of interest in an orbital mass and in different intra-orbital and extra-orbital structures. Short-term test-retest repeatability and inter-observer agreement were assessed using the intra-class correlation coefficient (ICC), the coefficient of variation (CV) and Bland-Altman limits of agreements (BA-LA). Results Test-retest repeatability of IVIM parameters in the orbital mass was satisfactory for ADC and D (mean CV 12% and 14%, ICC 95% and 93%), poor for f and D*(means CV 43% and 110%, ICC 90% and 65%). Inter-observer repeatability agreement was almost perfect in the orbital mass for all the IVIM parameters (ICC = 95%, 93%, 94% and 90% for ADC, D, f and D*, respectively). Conclusions IVIM appeared to be a robust tool to measure D in orbital lesions with good repeatability, but this approach showed a poor repeatability of f and D*. Key Points • IVIM technique is feasible in the orbit. • IVIM has a good–acceptable repeatability of D (CV range 12–25 %). • IVIM interobserver repeatability agreement is excellent (ICC range 90–95 %). • f or D* provide higher test-retest and interobserver variabilities. Electronic supplementary material The online version of this article (doi:10.1007/s00330-017-4933-6) contains supplementary material, which is available to authorized users.

Introduction Differencier persistance de vascularisation fœtale (PVF) et decollement de retine (DR) peut etre difficile cliniquement et en echographie mode B, mais est indispensable en raison de l’impact pronostic et de la prise en charge radicalement differente. Objectif Evaluer l’apport du Doppler pulse quantitatif pour differencier PVF et DR. Materiel et methodes Nous avons inclus 66 enfants (âge median 6 mois) avec une suspicion clinique de DR ou de PVF posterieure entre janvier 2005 et octobre 2018 dans cette etude retrospective bicentrique. Tous les enfants ont eu une echographie conventionnelle et Doppler sous anesthesie generale, avec une analyse qualitative et quantitative de la vascularisation, notamment de la vitesse systolique maximale, de la vitesse tele-diastolique et de l’index de resistance. Le diagnostic de reference repose sur les observations peroperatoires, ou une analyse complete du dossier medical pour les enfants n’ayant pas ete operes. Un test de Mann–Whitney a ete utilise pour comparer le Doppler quantitatif chez les enfants ayant un DR versus une PVF. Resultats L’index de resistance etait significativement plus eleve chez les enfants avec une PVF que chez ceux presentant un DR : 1 (IQR 0) versus 0,6 (IQR 0,1), p Conclusion L’etude du Doppler quantitatif est tres utile pour differencier PVF et DR, et peut aider a ameliorer la prise en charge des enfants concernes.

Multinodular and vacuolating neuronal tumor of the cerebrum is a rare supratentorial brain tumor described for the first time in 2013. Here, we report 11 cases of infratentorial lesions showing similar striking imaging features consisting of a cluster of low T1-weighted imaging and high T2-FLAIR signal intensity nodules, which we referred to as multinodular and vacuolating posterior fossa lesions of unknown significance. No relationship was found between the location of the lesion and clinical symptoms. A T2-FLAIR hypointense central dot sign was present in images of 9/11 (82%) patients. Cortical involvement was present in 2/11 (18%) of patients. Only 1 nodule of 1 multinodular and vacuolating posterior fossa lesion of unknown significance showed enhancement on postcontrast T1WI. DWI, SWI, MRS, and PWI showed no malignant pattern. Lesions did not change in size or signal during a median follow-up of 3 years, suggesting that multinodular and vacuolating posterior fossa lesions of unknown significance are benign malformative lesions that do not require surgical intervention or removal.

Introduction: Malignant middle cerebral artery infarction (MMI) is a severe complication of ischaemic stroke (IS), with a mortality rate up to 80%. Diffusion-weighted imaging (DWI) lesion volume larger than 82 millilitres on cerebral MRI performed within the six first hours is known to be predictive of MMI. These patients, with “malignant profile”, were mostly excluded of endovascular therapy (EVT) randomised trials. The aim of our study was to evaluate whether successful reperfusion after EVT in patients presenting IS with large DWI lesion decreased occurrence of malignant stroke. Methods: We analysed data collected between 2014 and 2018, in a monocentric prospective IS patients registry treated with EVT. Patients were selected if they had a malignant profile and could be eligible to a craniectomy. Thus, selected patients were less than 65-years old, with a severe stroke defined by National Institutes of Health Stroke Scale (NIHSS) score > 15 and with DWI lesion larger than 82ml. We compared patients with successful recanalization (defined by Thrombolysis in Cerebral Ischemia (TICI) 2b or 3) and poor recanalization (TICI 0, 1 or 2A). Primary end point was malignant stroke rate. Secondary end points were craniectomy, haemorrhagic complications, 90-days all-cause mortality rates and 90-days favourable outcome (defined by modified Rankin Scale 0-2). Results: From 2014 to 2018, 66 patients were selected. MMI occurred in 27 patients (42%), and 22 (33%) had effectively craniectomy. Successful recanalization was observed for 46 patients (69.7%). MMI occurrence was significantly lower in the latter patients compared to the poor recanalization group (14/44(31.8%) vs 13/20(65.0%); OR=0.25 (0.08-0.77), p = 0.015). Less craniectomies were performed in the successful recanalization group (12/46 (26.1%) vs 10/20 (50.0%); OR=0.35 (011-1.06), p=0.063).There was no significant difference in symptomatic intracranial haemorrhage rate; in 90-days favourable outcome and all causes mortality rate between the two groups. Conclusion: Successful recanalization performed in IS patients with large DWI lesion decreases the occurrence of malignant strokes and the need for craniectomy procedure. Further data with a larger sample or from randomized studies are needed.

International audience; Background: Cerebral small-vessel disease (CSVD) is a chronic disease accounting for one-third of strokes and the second etiology of dementia. Despite sustained immunovirological control, CSVD prevalence is doubled in middle-aged persons living with HIV (PLHIVs), even after adjustment for traditional cardiovascular risk factors. We aimed to investigate whether exposure to any antiretroviral drug class could be associated with an increasing risk of CSVD.Methods: The MicroBREAK-2 case-control study (NCT02210130) enrolled PLHIVs aged 50 years and older, treated with combined antiretroviral therapy for ≥5 years, with plasma HIV load controlled for ≥12 months. Cases were PLHIVs with radiologically defined CSVD, and controls were CSVD-free PLHIVs matched for age (±5 years), sex, and year of HIV diagnosis (±5 years). Multivariable conditional logistic regression analyses focused on cumulative exposure to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and/or exposure to integrase inhibitors (yes or no), adjusted for hypertension, CD4 nadir, current CD4/CD8 ratio, and HIV transmission group.Results: Between May 2014 and April 2017, 77 cases and 77 controls (85.7% males) were recruited. PLHIVs' median age was 57.6 years, and median HIV diagnosis year was 1992. The increasing risk of CSVD was not associated with exposure to any ART class.Conclusion: No deleterious effect of ART class exposure on the risk of CSVD was found for middle-aged treated PLHIVs.

We read with much interest the article by Dr Morales and colleagues published in the May 2018 issue of American Journal of Neuroradiology [1][1] in which they showed that T1-weighted dynamic contrast-enhanced (DCE) MR imaging might help differentiate atypical hemangiomas from metastatic vertebral

BACKGROUND AND PURPOSE: MR imaging is the key examination in the follow-up of patients with MS, by identification of new high-signal T2 brain lesions. However, identifying new lesions when scrolling through 2 follow-up MR images can be difficult and time-consuming. Our aim was to compare an automated coregistration-fusion reading approach with the standard approach by identifying new high-signal T2 brain lesions in patients with multiple sclerosis during follow-up MR imaging. MATERIALS AND METHODS: This prospective monocenter study included 94 patients (mean age, 38.9 years) treated for MS with dimethyl fumarate from January 2014 to August 2016. One senior neuroradiologist and 1 junior radiologist checked for new high-signal T2 brain lesions, independently analyzing blinded image datasets with automated coregistration-fusion or the standard scroll-through approach with a 3-week delay between the 2 readings. A consensus reading with a second senior neuroradiologist served as a criterion standard for analyses. A Poisson regression and logistic and γ regressions were used to compare the 2 methods. Intra- and interobserver agreement was assessed by the κ coefficient. RESULTS: There were significantly more new high-signal T2 lesions per patient detected with the coregistration-fusion method (7 versus 4, P < .001). The coregistration-fusion method detected significantly more patients with at least 1 new high-signal T2 lesion (59% versus 46%, P = .02) and was associated with significantly faster overall reading time (86 seconds faster, P < .001) and higher reader confidence (91% versus 40%, P < 1 × 10(−4)). Inter- and intraobserver agreement was excellent for counting new high-signal T2 lesions. CONCLUSIONS: Our study showed that an automated coregistration-fusion method was more sensitive for detecting new high-signal T2 lesions in patients with MS and reducing reading time. This method could help to improve follow-up care.

BACKGROUND AND PURPOSE: The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity. MATERIALS AND METHODS: From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets. RESULTS: The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others. CONCLUSIONS: Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.

Resume Le terme tumeurs orbitaires recouvre un large spectre de pathologies benignes et malignes, touchant les composants orbitaires ou developpees a leur contact. Elles sont decouvertes de maniere fortuite ou recherchees dans le bilan d’une affection generale ou devant des signes orbitaires (exophtalmie, douleurs…). Le scanner, l’IRM et l’echographie avec Doppler couleur (EDC) jouent un role qui varie en fonction de la presentation clinique et de la pathologie recherchee. Cet article, fruit d’une longue experience dans un centre referent, n’a pas la volonte d’etre exhaustif. Nous avons prefere aborder ces tumeurs sous l’angle de leur presentation usuelle, en insistant sur les causes les plus frequentes et les tableaux radiocliniques qui permettent d’y penser (exophtalmie progressive ou brutale, enfant ou adulte, lesions des glandes lacrymales, lesions periorbitaires, enophtalmie). Nous detaillerons en particulier les atteintes musculaires (maladie de Basedow, tumeurs), les lesions vasculaires (hemangiome caverneux, varices, lymphangiome kystique), les lesions de l’enfant, les hematomes orbitaires. Nous proposons des protocoles d’exploration simples et des diagnostics differentiels utiles. Les references bibliographiques permettront a ceux qui veulent aller plus loin de completer leurs connaissances dans ce domaine passionnant.

The term orbital tumor covers a wide range of benign and malignant diseases affecting specific component of the orbit or developing in contact with them. They are found incidentally or may be investigated as part of the assessment of a systemic disorder or because of orbital signs (exophthalmos, pain, etc.). Computed tomography, MRI and Color Doppler Ultrasound (CDU), play a varying role depending on the clinical presentation and the disease being investigated. This article reflects long experience in a reference center but does not claim to be exhaustive. We have chosen to consider these tumors from the perspective of their usual presentation, emphasizing the most common causes and suggestive radiological and clinical presentations (progressive or sudden-onset exophthalmos, children or adults, lacrimal gland lesions, periorbital lesions and enophthalmos). We will describe in particular muscle involvement (thyrotoxicosis and tumors), vascular lesions (cavernous sinus hemangioma, orbital varix, cystic lymphangioma), childhood lesions and orbital hematomas. We offer straightforward useful protocols for simple investigation and differential diagnosis. Readers who wish to go further to extend their knowledge in this fascinating area can refer to the references in the bibliography.

Objectifs Comparer une methode automatisee de lecture en Coregistration-Fusion (CF) avec la methode standard de detection de nouvelles lesions cerebrales en hypersignal T2 (HST2) chez des patients atteints de sclerose en plaques (SEP) au cours de leur suivi. Materiels et methodes Cette etude monocentrique approuvee par l’IRB incluait 94 patients traites par dimethyl fumarate de janvier 2014 a aout 2016. Un neuroradiologue senior et un radiologue junior ont verifie la presence de nouvelles lesions cerebrales HST2, analysant de maniere independante les ensembles d’images en aveugles avec la CF automatisee ou la methode standard de defilement manuel. Un delai de 3 semaines entre les deux lectures etait requis. Des tests de Poisson et de Wilcoxon ont ete utilises pour comparer les deux methodes. Les accords intra et inter-observateurs ont ete evalues par le coefficient Kappa. Resultats L’âge moyen des patients etait de 38,9 ans. Il y avait significativement plus de nouvelles lesions HST2 detectees avec la methode CF (712,2 versus 47,5 p Conclusion Notre etude a montre qu’une methode CF automatisee etait considerablement plus facile et plus sensible pour detecter de nouvelles lesions HST2 chez les patients atteints de SEP, ainsi que pour reduire le temps de lecture. Cette nouvelle methode pourrait considerablement ameliorer le suivi.

We read with much interest the article by Chi et al[1][1] in the March 2019 issue of the American Journal of Neuroradiology , “Alterations in Blood-Brain Barrier Permeability in Patients with Systemic Lupus Erythematosus.” Reportedly, dynamic contrast-enhanced (DCE) imaging supports the

To measure the frequency of infraorbital nerve enlargement (IONE) on magnetic resonance imaging (MRI) in European patients suffering from an IgG4-related ophthalmic disease (IgG4-ROD) as compared to patients suffering from non-IgG4-related ophthalmic disease (non-IgG4-ROD). From January 2006 through April 2015, 132 patients were admitted for non-lymphoma, non-thyroid-related orbital inflammation. Thirty-eight had both pre-therapeutic orbital MRI and histopathological IgG4 immunostaining. Fifteen patients were classified as cases of IgG4-ROD and 23 patients as cases of non-IgG4-ROD. Two readers performed blinded analyses of MRI images. The main criterion was the presence of an IONE, defined as the infraorbital nerve diameter being greater than the optic nerve diameter in the coronal section. IONE was present in 53% (8/15) of IgG4-ROD cases whereas it was never present (0/23) in cases of non-IgG4-ROD (P < 0.0001). IONE was only present in cases where, on MRI, the inflammation of the inferior quadrant was present and in direct contact with the ION canal. In European patients suffering from orbital inflammation, the presence of IONE on an MRI is a specific sign of IgG4-ROD. Recognition of this pattern may facilitate the accurate diagnosis for clinicians and allow for the adequate management and appropriate care of their patients. • IONE on an MRI is a specific sign of IgG4-ROD. • IONE recognition allows for a quicker diagnosis and appropriate management. • IONE appears when inflammation is in direct contact with the ION canal.

Introduction La sclerose en plaque est une maladie inflammatoire du systeme nerveux central, caracterisee par la presence de plaques de demyelinisation. L’exploration de l’atteinte medullaire, habituellement etudiee en ponderation T2, est difficile compte tenu de la petite taille de cette structure et de nombreux artefacts. De nouvelles sequences (STIR, DIR, PSIR, MPRAGE) [1] , [2] , [3] , [4] , [5] ont montre une meilleure sensibilite de detection des lesions, dans de petites series. L’objectif de notre etude etait de comparer les performances de detection de la sequence 3D PSIR par rapport a une sequence T2. Materiel et methode Cette etude retrospective monocentrique approuvee par un comite d’ethique local a inclus 100 patients ayant beneficie d’une IRM medullaire avec des sequences T2 et 3D PSIR. Deux lecteurs (senior et junior) ont analyse les sequences en insu des informations cliniques, selon un ordre independant, aleatoire, avec lecture en consensus si discordance. Le critere de jugement principal portait sur la detection et la quantification du nombre de lesions medullaires, les criteres secondaires sur la mesure du degre de certitude et la concordance interobservateur. Les tests statistiques non parametriques de Wilcoxon et le kappa de Cohen ont ete utilises. Resultats Cent patients ont ete inclus (âge median = 41, sex-ratio = 3F/2 M). La sequence 3D PSIR etait fortement plus sensible que le sagittal T2 seul (480 plaques visualisees versus 168 respectivement, p = 6 10–13). Treize patients sans plaque decelable en T2 avaient au moins une plaque visible en 3D PSIR. Le degre de confiance etait nettement superieur avec le 3D PSIR (2,56 contre 2,21), p = 3,10–11. La concordance interobservateurs etait bonne (kappa = 0,7). Conclusion La sensibilite de detection de lesions medullaires etait significativement meilleure avec une sequence 3D PSIR comparativement a une sequence sagittale T2.

To assess the role of colour Doppler flow imaging (CDFI) in the diagnosis and management of lacrimal fossa lesions. Institutional ethical committee approval was obtained. Fifty-one patients with 62 lacrimal fossa lesions were retrospectively included from 2003–2015. All patients underwent conventional ultrasonography and CDFI, with a qualitative and quantitative analysis of the vascularization. All patients had lacrimal gland surgery. Definitive diagnosis was based on pathological examination. The study included 47 non-epithelial lesions (NEL) and 15 epithelial lesions (EL), with 24 (39 %) malignant lesions and 38 (61 %) benign lesions. NEL were significantly more likely to present with septa (p

Introduction La carotidynie est une entite rare caracterisee par une cervicalgie lateralisee isolee, permanente. Le diagnostic est radiologique. Nous rapportons une serie de 4 patients avec un suivi clinicoradiologique. Observation Ces 4 patients nous ont ete adresses en consultation ou hospitalisation pour une suspicion de dissection arterielle cervicale devant un tableau clinique identique : une douleur cervicale lateralisee permanente, spontanee et exacerbee par les mouvements cervicaux et a la palpation sans contexte infectieux ou traumatique. L’examen neurologique etait sans particularite. L’IRM cervicale en coupe axiale T1 et T2 FAT SAT sans et avec injection de gadolinium et l’angioscannner des troncs supra-aortiques retrouvaient un epaississement parietal avec une prise de contraste de la carotide commune et/ou de la partie proximale de la carotide interne, sans stenose arterielle ni atherome significatif ni signe de dissection. Chez un patient, la prise de contraste s’etendait aux tissus mous avoisinants. Chez 2 patients, on retrouvait la presence d’adenopathies cervicales. L’echo-Doppler arteriel des troncs supra-aortiques montrait un epaississement parietal de l’ensemble des tuniques arterielles. L’evolution clinique et radiologique (echo-Doppler et IRM) etait favorable avec un traitement par corticoides ou anti-inflammatoires non steroidiens. Discussion La carotidynie, entite controversee, n’est pas incluse dans la derniere classification des cephalees de l’International Headache Society. Cependant, nos observations et les donnees recentes de la litterature permettent d’individualiser un profil clinicoradiologique distinct des principaux diagnostics differentiels. Son existence a l’etat isole ou en tant que manifestation d’une pathologie systemique reste discutee. Conclusion La carotidynie est une cause de cervicalgie lateralisee. Nous proposons de realiser 2 examens radiologiques par echo-Doppler des vaisseaux du cou et IRM cervicale ou angioscanner des troncs supra-aortiques. Informations complementaires Cette observation n’a pas beneficie de financement public ou prive.

OBJECTIVES: To evaluate the incidence of non-functioning posterior communicating arteries (PCoA) of the circle of Willis in patients presenting with idiopathic sudden sensorineural hearing loss (SSHL). BACKGROUND: Pathogenesis of SSHL remains unclear despite several theories. A strong association between non-functioning PCoA of the circle of Willis and SSHL has been recently suggested, supporting the theory of vascular disorders. SETTING: Tertiary referral center. PATIENTS AND METHODS: Ultrasonographic Doppler flow measurements of the vertebrobasilar system were performed prospectively in 27 consecutive patients with idiopathic SSHL and in 27 healthy subjects. RESULTS: A non-functioning PCoA was found in 4 patients with idiopathic SSHL and in 4 cases in the control group. CONCLUSION: The results of our study did not show any association between non-functioning PCoA of the circle of Willis and idiopathic SSHL, contrasting with previous data. We do not recommend adding routine transcranial Doppler ultrasonography in the test-battery for SSHL.

Summary: A 71-year-old female patient presented with a wide-necked carotid cavernous aneurysm for which stent and coil placement was planned. Arterial tortuosity required direct puncture of the common carotid artery for access. The procedure was performed while the patient was receiving antiplatelet and anticoagulative therapy. To avoid potentially hazardous and prolonged carotid compression, a closure device (Angio-Seal) was used at the end of the procedure. The postoperative period was clinically uneventful. Sonographic and angiographic follow-up of the carotid artery were performed.