Search

Purpose: The purpose of our study was to prospectively evaluate 3D time-of-flight (TOF) MR angiography (MRA) in the follow-up of 27 intracranial aneurysms treated with Guglielmi detachable coils (GDCs)., Method: From February 1997 to June 1998, 26 patients with 27 aneurysms were included in this prospective study. Aneurysms were located in the anterior circulation in 23 cases and in the posterior circulation in 4 cases. All patients underwent 3D TOF MRA and digital subtraction angiography (DSA) in the same week within 4 months after aneurysmal treatment with GDCs. No clinical events occurred during the follow-up. We analyzed residual flow within the coil mass and within the aneurysmal neck and the patency of the parent and adjacent arteries on MRA and DSA. MRA analysis was based upon MIPPED and source images. DSA was our gold standard., Results: In all cases, the quality of MRA was good enough to be informative. In aneurysmal analysis, the sensitivity, specificity, positive predictive value, and negative predictive value of MRA were, respectively, 80, 100, 100, and 96% to diagnose residual flow within the coil mass (one false-negative case) and 83, 100, 100, and 95.5% to diagnose residual flow within the aneurysmal neck (one false-negative case). In arterial analysis, sensitivity and positive predictive value of MRA were 89 and 100% to diagnose patency of the parent artery (three false-negative cases) and 83 and 100% to diagnose patency of adjacent arteries (seven false-negative cases)., Conclusion: In the follow-up of intracranial aneurysms treated with GDCs, 3D TOF MRA could be used as a screening test to select patients that should undergo DSA and thus could improve patient follow-up in terms of risk-benefit.

Congenital nasal pyriform aperture stenosis is a rare cause of neonatal airway obstruction. Computed tomography confirms the diagnosis and delineates the anomaly. This abnormality can be isolated or associated with abnormalities of the midface. The two options are surgical or medical treatment. The surgical treatment usually used is a surgical enlargement of the nasal pyriform aperture via a sublabial approach. We report 2 cases of congenital nasal stenosis treated successfully by an inter-maxillary disjunction followed by an expandable palatal plate. This simple and low morbidity technique allowed a durable transversal augmentation of the pyriform apertures.

Aneurysmal dilatation of a patent ductus arteriosus is a rare condition. One hundred and fifty three cases have been reported, of which 59 (39%) were operated, with an operative mortality of 16%. The authors report a case detected in a premature neonate on chest X-ray showing a mass in the mid-mediastinal region. Surgical resection was undertaken by video-thoracoscopy. Peroperative analysis of the resected specimen suggested a vascular structure and this was confirmed by histological study, which showed spontaneous aneurysm of a thrombosed patent ductus arteriosus or cystic residue of a patent ductus arteriousus. The authors underline the importance of peroperative puncture of structures of uncertain origin and the possibility of conversion of such a procedure to that of an extreme emergency.

Objectives: Assess three fat suppression sequences used to search for spinal metastases: TurboSTIR, phase contrast gradient-echo, and MISTEC-Chopper after gadolinium injection., Material and Methods: A prospective study was conducted in 10 patients with primary neoplasia. MIR sequences acquired (1 Tesla) were TurboSTIR, T1 spin-echo with and without gadolinium injection, phase contrast gradient-echo and M-Chop after gadolinium injection. Signal intensity in normal bone marrow, metastatic tissue, and subcutaneous fat as well as background noise was measured. Signal-to-noise (S/N) ratio was determined. Lesion borders, artefacts, and extent of detected lesions were determined quantitatively. Bone marrow signal intensity was also recorded., Results: S/N ratio was best with gradient-echo which identified well the borders of lesions within the hemopoietic marrow. For lesions located in high-fat marrow (as in post-radiation marrow), the high intensity signal of the lesion confounded with the fat signal. TurboSTIR gave effective fat signal suppression and was particularly useful for yellow marrow, less so for red marrow. This technique confounded cell proliferation with perilesional edema (enlarging lesion extention). In one case, this sequence did not detect a small lesion visible with the two other sequences. This sequence was sensitive to artefacts (especially vascular artefacts) which can produce false nodular images. M-Chop gave good suppression of vertebral fat tissue (better for yellow marrow) but subjective detection of lesions was more difficult., Conclusion: The phase contrast gradient-echo sequence after gadlinium injection appeared to be the best sequence excepting cases of post-trauma (radiotherapy or chemotherapy) fat transformation of the marrow where the TurboSTIR sequence could be preferred.

Each kind of superficial vascular malformation (or "angioma") has been included in a widespread classification that has been elaborated by means of a multidisciplinary approach. At present, therapeutic management of these vascular malformations often needs one or several procedures of interventional radiology. The purpose of this paper in to illustrate embolization techniques in each indication and to describe advantages and drawbacks of these different techniques.

Introduction: The aim of this work was to determine the usefulness of systematic liver sonography in patients with immature cutaneous hemangiomas., Patients and Methods: Children with immature cutaneous hemangiomas who met inclusion criteria underwent liver sonography., Results: No case of hepatic angioma was observed., Conclusions: Liver sonography is not necessary as a routine test in children with several immature angiomas. This examination could be proposed in situations other than those evaluated in this work including miliary angiomas, unusual immature angiomas, hepatomegaly, unexplained heart failure.

Background: Testicular tumors have been reported in boys and adolescents with congenital adrenal hyperplasia (CAH) inadequately controlled by hormonal therapy., Case Reports: Two adolescents were treated for CAH due to 21-hydroxylase deficiency. They developed hyperplastic nodular testes at the age of 16 and 17 years, respectively. CAH in both was inadequately controlled as confirmed by hormonal studies. The tumors regressed after adequate steroid therapy in the first patient but persisted in the second patient despite normalization of 17-OH progesterone and plasma renin activity., Conclusion: Testicular ultrasonography should be systematic in all male patients with CAH since radiological findings are earlier than clinical manifestations. The ACTH-dependent tumors require intensification of hormonal therapy in order to obtain tumoral regression and to prevent infertility.

The vascular complications of peritonsillar phlegmons have become exceptional. On the basis of a recent case, the authors sum up the criteria of severity, including: white puncture sample, paralysis of the 9th, 10th, 11th, 12th cranial nerves and of the cervical sympathetic nerve. Computed tomography allows not only refining the topographic diagnosis, but even sometimes diagnosing a pseudoaneurysm before it is fissured. At this stage, intraoperative radiology may probably prevent the unavoidable secondary rupture. If it cannot be used, preventive ligation must be proposed. In the absence of cataclysmic hemorrhage, this easier procedure usually does not cause any irreversible neurological deficit. If performed in emergency, it may entail a major risk, not only a neurological risk, but a vital risk as well.

A familial observation of Reinhardt-Pfeiffer type mesomelic chondrodysplasia spanning three generations is reported. This case clearly shows that expression of the disease can vary widely within a given family. One member affected as a fetus had a severe form suggesting Langer mesomelic dwarfism syndrome, whereas his mother was free of clinical symptoms and his maternal aunt had a typical form of Reinhardt-Pfeiffer syndrome. Clinical manifestations in the other affected family members were perfectly consistent with dyschondrosteosis syndrome. The very broad spectrum of clinical patterns in this family suggests that there may be connections between the various types of mesomelic dysplasia. Establishing clear-cut distinctions between these entities, although useful in practice, may not accurately reflect molecular anomalies. Furthermore, the family member affected as a fetus also had Turner syndrome, which may have contributed to the severity of his condition. The possibility of identifying severe mesomelic dysplasias antenatally by ultrasonography should be pointed out.

Radiologic images suggestive of chondroma may be observed in polyostotic or mono-osteotic fibrous dysplasia and were detected in 11 out of 27 patients with the polyostotic form and 1 out of 7 with the mono-osteotic form. Histology in some cases showed cartilaginous tissue foci suggestive of an isolated chondroma or Ollier's disease. Pathogenicity of these cartilaginous lesions and relations between Ollier's chondrodysplasia and fibrous dysplasia are discussed.

Ultrasonography has profoundly modified the diagnostic conditions of polycystic renal dysplasia in children. Non-palpable forms, which were previously most frequently missed, can now be detected during the antenatal period. In infants, ultrasonography generally provides a definite diagnosis, which can be confirmed by aspiration-opacification of the cysts. On the basis of a series of 40 cases and a review of the literature, the authors discuss the therapeutic implications of these new data. Surgery remains essential in cases of palpable polycystic renal dysplasia, especially when it is complicated. However, in the sub-clinical forms, as the risks of malignant degeneration and the incidence of post-operative complications are minimal in the one case and undefinable in the other, surgical excision is possible but not essential.

The practice of systematic X ray screening for congenital dislocation of the hip leads to the discovery of a somewhat rare anomaly: the calcification of the vestigial segment of the umbilical artery. The authors describe 6 cases of this peculiar condition of which the diagnosis is easy and does not necessitate any complementary investigation. This finding has no pathological significance; this condition must be considered as a normal variant.

Intravenous numeric angiography is a new method of medical imaging for investigation of possible renovascular causes of arterial hypertension. A non-invasive examination, it is less costly than conventional renal arteriography and can be performed in outpatients. Satisfactory images of the renal arteries were obtained in 80 p. cent of 200 hypertensive patients, and the presence of lesions was confirmed in 47 cases.

The authors describe a case of osteoid osteoma developing in the lower femoral epiphysis of a 9-year-old child. It was close to the growth plate and was recognised with the aid of digital angiography and tomo-densitometry. It was removed by a surgical approach across the growth plate.

In the most common clinical expression of infantile polycystic disease, the kidneys are greatly enlarged in the neonatal period. When the child gets older the kidneys become smaller. In this case report, both kidneys kept growing after birth causing abdominal distention and respiratory distress. The differential diagnosis was a bilateral massive nephroblastomatosis, but the renal pathology showed characteristic features of infantile polycystic disease.

Two cases of tuberculous meningitis showed that there is a delay between the C.T. images and the clinical signs. The computed tomography which was still normal one and two months after the first clinical signs did not permit an early diagnosis of the tuberculous meningitis. It did not give either, at least in the beginning, a good appreciation of the results of the treatment, since most of the C.T. images appeared and/or increased while the patient's conditions had already been improving under treatment for several days or weeks. In a long range, however, the C.T. images usually disappear.

The authors in a first part of their contribution indicate the various types of imaging investigations which can be used by the radiologist: Conventional radiographs og the thorax; Conventional complementary examinations: esophagogram, conventional tomography, tracheo-bronchography, angiography, pulmonary scintigraphies; Modern complementary investigations: CT echography, digitalized angiography, magnetic resonance imaging. In the second part of this article the authors explain which are the most appropriate procedures for every type of tracheal and/or bronchial malformation.