Search

Age estimation is an essential element in the field of forensics and is also of judicial interest in forensic medicine of the living. Despite all the methods, age estimation is often imprecise with many biases, especially in mature individuals. The main objective of our study is to assess the correlation between age and computed tomography bone mineral density of the medial end of the clavicle. A sample of 180 chest multi-slice computed tomography scans without contrast injection performed in living individuals, with suspected respiratory infection, aged 15 to 100 years was used. Bone density measurement was performed on the medial meta-epiphyseal region of the clavicles. A significant negative correlation was found between bone density and age of individuals (p-value 0.05). The mean absolute error was calculated for men at 13.4 years and 13.1 years for women, which was associated with an absence of bias. Good precision of the estimate for both sexes was also calculated on a subgroup of individuals whose age was greater than 40 years, with average absolute errors of about 12 years, which was associated with an absence of relative error. In view of our preliminary results, the study of bone density of the medial end of the clavicle could be of interest in the estimation of age. Several studies will be necessary to evaluate the reproducibility of these results on independent bone samples and in the estimation of age in the living individual.

Objectives Idiopathic inflammatory myopathies are mainly defined by inflammatory infiltrates within the muscle (lymphocytes and macrophages). Eosinophil muscle infiltration has been described in idiopathic eosinophilic myositis (IEM) and rarely in EF. This study aimed to further delineate the nosological frame of idiopathic eosinophil muscle infiltration through the exhaustive analysis of IEM and EF patients. Methods This multicentre retrospective case series included IEM patients diagnosed between 2000 and 2022. IEM inclusion criteria were eosinophilic muscle infiltration with myositis pathological features, after the exclusion of differential diagnoses. An additional group of EF patients diagnosed between 2016 and 2022 was constituted. Inclusion criteria were an EF diagnosis and fascia thickening with inflammatory infiltrate. Results A total of 20 IEM cases and 10 EF cases were included. The median (interquartile range) age at diagnosis was 65 (49–70) years; there were 18 males. Data analysis delineated four subgroups: focal EM (FEM, n = 3), diffuse EM (DEM, n = 6), eosinophilic myofasciitis (EMF, n = 11) and EF (n = 10). FEM represented a limited and benign form of myositis. DEM cases presented objective muscle impairment with eosinophilic muscle infiltration. EMF patients presented subjective muscle impairment (myalgia, 55%), fasciitis (on histology and/or imaging), eosinophilic muscle infiltration and frequent hypereosinophilia (55%). EF patients presented myalgia (50%), muscle lesions on histology with fascia-restricted inflammatory infiltrates with (60%) or without (40%) eosinophils. Conclusions The analysis of IEM and EF patient characteristics delineates four subgroups (FEM, DEM, EMF and EF) in terms of clinical, laboratory, imaging, pathological and outcome specificities, and proposes an adapted diagnostic and care management approach.

Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Depending on the study, the prevalence of ramp lesions is inconsistent. Purpose: To describe the prevalence of ramp lesions in children and adolescents and to investigate the sensitivity of magnetic resonance imaging (MRI) for diagnosing such lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We analyzed videos from arthroscopic ACL reconstruction (ACLR) in children. During these procedures, we systematically looked for potential ramp lesions. To do so, an arthroscope was passed through the intercondylar notch to visualize the posteromedial compartment. A needle was introduced at the site of a posteromedial portal to unfold the meniscocapsular junction to reveal any hidden meniscal tear. Surgical procedures were performed by 2 senior surgeons. Videos were blindly analyzed by a third surgeon. Preoperative MRIs were screened by 2 blinded, independent senior radiologists to look specifically for ramp lesions. Results: Videos of 50 consecutive arthroscopic ACLRs concerning 32 boys and 18 girls were analyzed. Mean age at surgery was 14.2 years (range, 8.5-17.6 years). A total of 14 ramp lesions (28%) in 8 boys and 6 girls were identified. In addition, there were 22 tears of the meniscal body in 20 patients (40%). Arthroscopic and MRI findings did not correlate. Among 14 arthroscopically diagnosed ramp lesions, only 8 were detected on the MRI. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. The sensitivity of MRI was 57% and the positive predictive value was 40%. Conclusion: A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. MRI has a low sensitivity for diagnosis of ramp lesions in children. Careful exploration of the posteromedial compartment is strongly recommended. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients.

The classification of acetabular fractures remains a challenge for the junior radiologist, although he is the first line of diagnosis in Emergency Department. The advantages of three-dimensional reconstructions have yet to be evaluated on a large scale.A total of 212 fractures were classified according to Letournel and Judet by a senior orthopaedic surgeon, a senior radiologist, and a resident radiologist. The CT scans were first analysed in 2D and then a second time using 2D + 3D reconstructions of the acetabulum excluding the femoral head.3D reconstructions improved correct classification not only for the radiologist resident (+ 5%) but also for senior radiologist and orthopaedist (+ 2 and + 3%). 3D reconstructions also more significantly improved the diagnoses of complex fractures (+ 8.3%) compared to simple fractures (+ 0.4%).3D reconstructions have improved the routine diagnosis of acetabular fractures, especially for junior radiologist or in cases of complex fractures.

In forensic anthropology, age estimation is a major element in the determination of a biological profile and the identification of individuals. Thus, many anatomical structures have been studied, such as the pubic symphysis, which is a source of major interest due to its late maturation. One of the most well-known methods of assessment is the Suchey-Brooks (SB) system based on the morphological characteristics of the pubic symphysis. The aim of this study was to propose linear regression formulae in order to deduce chronological age from bone density, using both Hounsfield unit (HU), and mean bone density (mBD) values of the pubic symphysis. Moreover, we intended to test the reliability and then to explore the feasibility of using HU instead of mBD values for age estimation. We built retrospectively a reference sample of 400 pubic symphyses using computed tomography at a French hospital and a test sample of 120 pubic symphyses. Equations were created to establish linear regression models for age estimation. Inaccuracy and bias were calculated for individuals aged more or less than 40 years. We highlighted homogeneous mean absolute errors for both HU and mBD values, most of them being less than 10 years. Moreover, we reported a moderate overestimation for younger individuals and a very small underestimation for older individuals. This study proposes a correlation between the bone density and age of individuals with a valuable level of reliability. Finally, HU measurements seem to be suitable for linking bone density with the age of individuals in forensic practice.

To evaluate whether ultrasonography can be used to explore the medial and lateral ligament structures during the acute phase of a closed elbow injury.A single-center, prospective study performed between December 2019 and June 2020, including patients who suffered a radial head fracture or elbow dislocation. Two radiologists did a blinded analysis using ultrasonography of visibility, injury grade, and presence of bone avulsion for the radial collateral ligament (RCL), lateral ulnar collateral ligament (LUCL), annular ligament (AL), and anterior (MCLant) and posterior bundles (MCLpost) of the medial collateral ligament. The inter-rater agreement was calculated. The ultrasonography findings were compared with the intraoperative findings in the patients who subsequently underwent surgery.Forty patients were included (28 radial head fractures and 12 elbow dislocations). The inter-rater agreement was strong for all the study parameters (kappa between 0.65 and 1), except for the visibility of the LUCL (kappa 0.52) and the visibility and appearance of the MCLpost (kappa 0.54 and 0.47, respectively). The injured ligaments were thicker than their contralateral counterparts (p 0.05). In the 10 patients who underwent surgery, the radiological-surgical correlation was 100% for the RCL and medial ligaments and 70% for the LUCL.Ultrasonography is a reproducible examination that can be used to assess the damage to elbow ligaments during the acute phase following an injury. This examination could be incorporated into the exploration protocol for elbow injuries during the preoperative assessment and to adapt the treatment.

The purpose of this study was to assess the capabilities of a deep learning (DL) tool to discriminate between type 1 facioscapulo-humeral dystrophy (FSHD1) and myositis using whole-body muscle magnetic resonance imaging (MRI) examination without the need for visual grading of muscle signal changes.A total of 40 patients who underwent whole-body MRI examination that included T1-weighted and STIR sequences were included. There were 19 patients with proven FSHD1 (9 men, 10 women; mean age, 47.7 ± 18.0 [SD] years; age range: 20-72 years) and 21 patients with myositis fulfilling European Neuromuscular Centre criteria and European League Against Rheumatism and American College of Rheumatology criteria (11 men, 10 women; mean age, 59.3 ± 17.0 [SD]; age range: 19-78 years). Based on thigh, calf, and shoulder sections a supervised training of a neural network was performed and its diagnostic performance was studied using a 5-fold cross validation method and compared to the results obtained by two radiologists specialized in musculoskeletal imaging.The DL tool was able to differentiate FSHD1 from myositis with a correct classification percentage respectively of 69 % (95% CI: 39-99), 75% (95% CI: 48-100) and 77% (95% CI: 60-94) when thigh only, thigh and calf or the thigh, calf, and shoulder MR images were analyzed. The percentages of correct classification of the two radiologists for these later MR images were 38/40 (95%) and 35/40 (87.5%), respectively; with no differences with DL tool correct classification (P = 0.41 and P0.99, respectively). Among the seven patients who were misclassified by the radiologists, the DL tool correctly classified six of them.A DL tool was developed to discriminate between FSHD1 and myositis using whole-body MRI with performances equivalent to those achieved by two radiologists. This study provides a proof of concept of the effectiveness of a DL approach to distinguish between two myopathies using MRI with a small amount of data, and no prior muscle signal changes grading.

This study was conducted in order to compare the prevalence of inflammatory posterior arch abnormalities on lumbar spine MRI between axial spondyloarthritis (axSpA) patients and low back pain (LBP) patients. Patients—axSpA patients meeting the 2009 ASAS criteria and chronic LBP patients who had a lumbar spine MRI were selected. MRI—STIR and T1 sagittal images up to T8–T9 were reviewed by two experienced rheumatologists blinded to the diagnosis and clinical data to identify inflammatory posterior arch abnormalities. Analyses—The prevalence of inflammatory posterior arch abnormalities between axSpA and LBP patients was compared. Clinical data were compared in the axSpA group depending on whether or not inflammatory posterior arch abnormalities were present. Ninety-five patients were enrolled in each group. The prevalence of all inflammatory posterior arch abnormalities was the same in the axSpA and LBP groups (58% in the SpA group versus 70% in the LBP group, p = 0.1). However, differences in terms of the prevalence of costotransverse joint arthritis, pedicle oedema above L3 and transverse and spinous process oedema were observed between the two groups (axSpA 27% versus LBP 6%, p = 0.0004). Patients with inflammatory posterior arch abnormalities in the axSpA group had a longer disease duration (11 versus 8 years, p = 0.02), higher CRP levels (median 11 versus 3 mg/l, p = 0.0002) and higher prevalence of radiographic sacroiliitis (84 versus 47%, p = 0.001) compared to patients without inflammatory posterior arch abnormalities. Costotransverse arthritis, pedicle oedema and transverse process oedema are more frequent in axSpA patients than LBP patients, on lumbar spine MRI depicting TH9-S1. • MRI pedicle oedema above L3, transverse process oedema, spinous process oedema or costotransverse arthritis is more frequently observed in axial spondyloarthritis (SpA). • SpA patients with at least one MRI inflammatory lesion on the posterior arch had higher clinical activity scores and biological inflammation. • Facet joint arthritis was more common in patients with chronic low back pain.

International audience; Purpose: Psammocarcinoma (PK) is a rare disease of unknown origin. We aimed to report the characteristics, management and survival of patients operated on for PK within the French Network for Rare Peritoneal Malignancies (RENAPE) expert centers.Patients and methods: All consecutive cases of PK operated within all 26 RENAPE centers between 1997 and 2018 were retrospectively analyzed.Results: Twenty-five patients were identified. The median age was 53 years [range 17–78]. None of the patients had extra peritoneal metastases at diagnosis. A median of 6 cycles of carboplatin-based systemic chemotherapy was delivered in 52% preoperatively (n = 13) and 56% postoperatively (n = 14); associated with placlitaxel for 12 patients. All patients were operated on. The median PCI was 23 [0–33]. Eighty-four percent had a complete cytoreductive surgery through digestive (n = 7), spleen (n = 3), pancreas (n = 1) resections and/or multiple peritonectomies (n = 11). Five patients (20%) had intraperitoneal chemotherapy. Morbidity (Dindo-Clavien ≥3) was 12%. No postoperative death occurred. After a median follow-up of 42 months (range [2–194]), the median overall (OS) and progression-free (DFS) survival times were respectively 128 months and 31 months. Eighteen patients recurred (72%), mainly in the peritoneum (n = 16). Four of them (22%) were reoperated. The 5 and 10-year DFS rates were both 20.3%. The 5 and 10-year OS rates were 62% and 51.7%, respectively. A complete cytoreductive surgery was associated with a better OS and DFS in a univariate analysis.Conclusion: Complete cytoreductive surgery is the cornerstone of the PK's management as a primary treatment. Recurrence remains common and new adjuvant strategies seem needed.

In forensic anthropology, the estimation of age at death is mainly required to establish a biological profile and facilitate individual identification. The Suchey–Brooks (SB) system represents one of the most commonly used and tested methods of assessment based on the morphological characteristics of the pubic symphysis. However, this method has certain drawbacks, including frequently inaccurate estimation for older individuals. The aim of this work was to test the evolution of pubic bone mineral density (BMD) according to age, especially for individuals over 40 years old. We retrospectively studied pubic bones from males (n = 88) and females (n = 113) over 40 years of age undergoing clinical multi-slice computed tomography (MSCT) in a French hospital between November 2017 and April 2018. The results revealed a significant negative correlation between BMD and age for males (R = −0.62) and females (R = −0.55). The intra- and inter-observer reliabilities of the phase allocation were moderate for males (kappa values at 0.72 and 0.65) and strong for females (kappa values at 0.93 and 0.86). Moreover, a significant difference in BMD between stages 6-1 and 6-2 for males was observed. We hypothesize that BMD might help improve the reliability of the SB system for older individuals. In addition to the pubic bone, numerous other anatomical regions such as the area of Ward could represent interesting areas of study in order to relate bone density to age.

To evaluate the efficacy of ultrasonography-guided percutaneous treatment of de Quervain tenosynovitis with the combination of a corticosteroid injection and release of the retinaculum of the first extensor compartment tendons with a 21-gauge needle. The first part of our study consisted of ten procedures on cadaver wrists followed by dissection to analyse the effectiveness of the retinaculum release and detect any collateral damage. The second part was a prospective clinical study of 35 procedures. Outcomes were evaluated through a 6-month clinical follow-up and telephone interview at the end of the study. The following parameters were monitored over time: pain level on a visual analogue scale, the QuickDASH and the PRWE. Patient satisfaction questionnaires were also administered. No complications were found during the cadaver study. However, the release was confirmed as ‘partial’ in all wrists. In the clinical portion of this study, significant improvement was observed in 91.4 % of cases (32/35) within 1 month and the results were stable until the end of the study; all of these patients avoided surgery. The release procedure failed in three patients who eventually required surgical treatment. US-guided partial release and simultaneous corticosteroid injection for treatment of de Quervain’s disease using a 21-gauge needle is feasible in current practice, with minimal complications. • Ultrasound-guided treatment of de Quervain's disease is feasible with a 21G needle. • There was notable regression of clinical signs in 91.4 % of cases. • The procedure is very safe, no iatrogenic neurovascular or tendinous injuries occurred. • Our procedure requires only one session and 3 days away from work.

The aim of this study was to compare muscle biopsy findings, as well as clinical and analytical features, with those of magnetic resonance imaging (MRI) studies of muscle in patients with dermatomyositis.All patients from the Longitudinal Myopathy Cohort of the Hospital Clínic de Barcelona were prospectively included in the study from 2009 to 2016. MRI images of muscle and fascial oedema were compared with muscle pathology results using both quantitative and semi-quantitative scores.We found a statistically significant association between the inflammatory infiltrate and both muscle (r2=0.54, p=0.001) and fascial oedema (r2=0.54, p0.001). In addition, muscle oedema was significantly associated with punched-out vacuoles (p=0.04) and muscle enzymes in serum (r2=0.34, p=0.01 for CK and r2=0.22, p0.05 for aldolase). The number of treatment drugs received at the time of MRI was inversely associated with the number of muscle inflammatory cells in the biopsy and with both muscle and fascial oedema (all p0.05).Key MRI findings correlate with the main features of dermatomyositis muscle biopsy results, suggesting that MRI findings could be used as a surrogate marker of disease activity.

Data regarding sexual dimorphism in children are sparse with contradictory results. Recently, geometric morphometric analysis has shown that the pubis and ilium have both sexual shape dimorphism and shape differences that increase during ontogeny, but little is known about the entire pelvic (os coxae) bone shape in very young children. The goal of this study was to show pelvic bone age-related and sex-related shape changes using 3D geometric morphometric analysis in very young children. Geometric morphometric analysis was carried out on CT scans of the pelvic bone of 96 children aged from 3 to 24 months. Eleven landmarks were defined on the left pelvic bone. Geometric morphometric analyses were carried out to identify trends in bone shape in sex-based and age-based subgroups. Age-related differences in shape were statistically significant (Goodall's F = 3.68; p < 0.001) but there were no sex-related differences in shape (Goodall's F = 1.95; p = 0.065). Overall, the superior part of the pelvic bone becomes narrower with age. This study has shown that geometric morphometric analysis of the pelvic bone is feasible in very young children and revealed changes in shape with age but not differences with sex.

Objective Evaluate the diagnostic value of cone beam computed tomography (CBCT) for scaphoid and wrist fractures that are missed on standard radiographs. Materials and methods Between September 2014 and October 2015, we prospectively enrolled 49 patients with a clinically suspected scaphoid fracture following an acute injury but had normal radiographs. Each patients underwent radiographs, CBCT and (magnetic resonance imaging) MRI within 7 days of the initial injury event. Both exam were evaluated independently by two radiologists. Results For scaphoid cortical fractures CBCT sensitivity is 100% (95% CI: 75%–100%), specificity 97% (95% CI: 83%–100%). CBCT diagnosed all 24 corticals wrist fractures, corresponding to a sensitivity of 100% (95% CI: 83%–100%), specificity of 95% (95% CI: 75%–100%). Kappa agreement rate between the two radiologists was K = 0.95 (95% CI: 0.85–1) for scaphoid fractures and K = 0.87 (95% CI: 0.73–1) for wrist fractures. Conclusions CBCT is superior to radiographs for diagnosing occult cortical fractures. Because of its low radiation dose, we believe that CBCT can be used in current practice as a replacement or supplement to radiographs to detect these fractures and optimize the cost-effectiveness ratio by limiting the number of needless immobilizations.

Decision trees provide an alternative to multivariate discriminant analysis, which is still the most commonly used in anthropometric studies. Our study analyzed the metric characterization of a recent virtual sample of 113 coxal bones using decision trees for sex determination. From 17 osteometric type I landmarks, a dataset was built with five classic distances traditionally reported in the literature and six new distances selected using the two-step ratio method. A ten-fold cross-validation was performed, and a decision tree was established on two subsamples (training and test sets). The decision tree established on the training set included three nodes and its application to the test set correctly classified 92% of individuals. This percentage was similar to the data of the literature. The usefulness of decision trees has been demonstrated in numerous fields. They have been already used in sex determination, body mass prediction, and ancestry estimation. This study shows another use of decision trees enabling simple and accurate sex determination.

Few studies have been conducted to determine sex differences in the immature coxal bone and the results were often contradictory. The authors studied sexual dimorphic differences of the pubis using geometric morphometric analysis of five osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 188 children (95 boys, 93 girls) living in the region of Toulouse, southwestern France, ranging in age from 1 to 18 years old. They used geometric morphometric methodology first to test sexual dimorphism in size (centroid size) and shape (Procrustes residuals) and second to examine patterns of shape change with age (development) and size change with age (growth). Based on statistical significance test results, the pubic shape became sexually dimorphic at 13 years old, although visible shape differences were observed as early as 9 years old. This work showed that the trajectories of pubis shape (development) and size (growth) differed throughout ontogeny and between sexes.

To describe the pathological appearance of the anterolateral ligament (ALL) on US and MRI in knees with an anterior cruciate ligament (ACL) tear. This prospective study included 30 patients who had a suspected acute ACL tear. Their injured and contralateral knees were evaluated with radiography, US and MRI. Two radiologists evaluated the ALL on the MRI and US examinations. Agreement between these examiners’ findings was evaluated with Cohen’s kappa. On US examination, the ALL was found to be injured in 63% of cases (19/30; k = 0.93). The enthesis was found to be torn in 50% of cases (15/30; k = 1), with the tear located at the tibial attachment in all instances. On the MRI exam, the ALL was found to be injured in 53% of cases (16/30; k = 0.93). The enthesis was found to be torn in 13% of cases (4/30; k = 0.76), with the tear located at the tibial attachment in all instances (k = 0.93). ALL injuries that occur with ACL tears are located at the tibial enthesis. They are often associated with bone avulsion at the enthesis and are better viewed on US. • ALL injuries often occur in combination with ACL tears. • ALL injuries can be assessed with ultrasonography and MRI. • ALL injuries associated with ACL tears are located at the tibial enthesis.

OBJECTIVES: Acromioclavicular joint injuries are typically diagnosed by clinical and radiographic assessment with the Rockwood classification, which is crucial for treatment planning. The purpose of this study was to describe how the ultrasound findings of acromioclavicular joint injury compare with radiography and MRI findings. METHODS: Forty-seven patients with suspected unilateral acromioclavicular joint injury after acute trauma were enrolled in this prospective study. All patients underwent digital radiography, ultrasound and 3T MRI. A modified Rockwood classification was used to evaluate the coracoclavicular ligaments. The classifications of acromioclavicular joint injuries diagnosed with radiography, ultrasound and MRI were compared. MRI was used as the gold standard. RESULTS: The agreement between the ultrasound and MRI findings was very good, with a correlation coefficient of 0.83 (95 % CI: 0.72-0.90; p < 0.0001). Ultrasound detected coracoclavicular ligament injuries with a sensitivity of 88.9 %, specificity of 90.0 %, positive predictive value of 92.3 % and negative predictive value of 85.7 %. The agreement between the ultrasound and radiography findings was poor, with a correlation coefficient of 0.69 (95 % CI: 0.51-0.82; p < 0.0001). CONCLUSION: Ultrasound is an effective examination for the diagnostic work-up of lesions of the coracoclavicular ligaments in the acute phase of an acromioclavicular injury. KEY POINTS: • Ultrasound is appropriate for acute acromioclavicular trauma due to its accessibility. • Ultrasound contributes to the diagnostic work-up of acute lesions of the coracoclavicular ligaments. • Ultrasound is appropriate in patients likely to benefit from surgical treatment. • Ultrasound could be a supplement to standard radiography in acute acromioclavicular trauma.

Study design This was a single center, retrospective observational study. Objective to investigate—in a cancer population—the prevalence and hallmarks of intravertebral enhancement (IVE) detected on contrast-enhanced CT. Summary of background data Intravertebral enhancements secondary to iodinated contrast stagnation have been described. Cancer patients have an increased risk of perivertebral venous thrombosis or stenosis secondary to several risk factors (cancer or drug induced hypercoagulability, deterioration of venous flow linked to catheter insertion, prolonged immobilization). In case of a high density lesion identified on CT, the diagnostic choice between metastasis and contrast media within bone marrow vessels may be an issue, especially as oncologic follow-up CT scans are usually performed with contrast medium injection. Methods 2572 contrast-enhanced body CT scans performed in cancer patients over 3 months in the medical imaging department of a university hospital were retrospectively reviewed. IVE was sought when paravertebral venous collateral circulation was detected and bone metastasis ruled out and classified as linear or nodular. Their locations within vertebra, their relation to the injection side and the predominant collateral venous network side were evaluated. Results Sixty-seven (2.8%) patients had a collateral paravertebral venous system and among them 21 had IVE (37%). There were 208 IVE locations involving 75 vertebrae. 199 IVE were linear-shaped (95.7%) and 9 nodular-shaped (4.3%). 80.8% were located between C6 and T4. 88.9% were localized in the vertebral body. 73.1% were located medially or ipsilateral to the injection side. Conclusion Intravertebral enhancement is found in 37% of the patients with paraspinal collateral venous circulation when a CT scan is performed for cancer. The ipsilateral or medial position of the IVE relative to the injection side and the side of the dominant perivertebral venous system, and the possibility of connecting the IVE to a paravertebral vein may be in favor of vascular opacification.

A 57-year-old white woman, with history of hydatidiform mole 2 years earlier, was evaluated at our stroke center for the acute onset of intense cephalgia, vomiting, and aphasia. Recent medical history was significant for a vertebrobasilar transient ischemic attack 1 month earlier with a negative etiologic evaluation and negative vessel imaging and transesophageal echocardiography (TEE). A treatment by aspirin 160 mg was then started. On admission, neurological examination revealed a global aphasia and right homonymous hemianopsia. The National Institutes of Health Stroke Scale score was 8. She had no fever. Cardiovascular examination revealed a systolic murmur. Pulmonary auscultation was normal. A computed tomographic brain scan showed a left lobar temporal intracerebral hematoma with a subarachnoid hemorrhage in the ipsilateral sylvian fissure. Cerebral angiography and arteriography showed no vascular abnormality. Brain MRI showed a hemorrhagic infarction in the left middle cerebral artery territory and revealed several subacute infarctions in other vascular territories (Figure 1). Magnetic resonance angiography was normal. Coagulation tests involving fibrinogen, prothrombin time, activated partial thromboplastin time were normal. …

The authors studied sexually dimorphic differences in coxal shape using geometric morphometric analysis of 15 osteometric landmarks recorded by multislice computed tomography (MSCT), based on three-dimensional reconstructions of 65 Caucasian adults. Geometric morphometric analysis, principal component analysis, canonical variates analysis, and other discriminant analysis (Goodall’s F-test and Mahalanobis distance) were performed for the three separate bones of the left innominate (pubis, ilium, and ischium), the modified pubis (pubis and ischiopubic ramus), the modified ilium (ilium and ischial spine), three bone complexes (ischiopubic, iliopubic, and ilio-ischial), and the complete innominate. A cross-validation test was also performed. All areas studied were dimorphic, but results for sexual dimorphism in decreasing order were as follows: the modified pubis, followed by the ischiopubic complex, the iliopubic complex and the complete innominate, the pubis, the modified ilium, the ilio-ischial complex, the ilium, and finally the ischium. These results show the potential of this approach for future anthropological research.

Scapholunate instability is challenging to diagnose and to treat. If left untreated, it contributes to the development of wrist osteoarthritis. In the static stage, diagnosis is obvious when a careful radiographic analysis is performed, but the choice of surgical treatment is not as straightforward. In the dynamic stage, diagnosis is harder to make solely based on static imaging methods (radiographs, CT or MR arthrogram), which means exploratory arthroscopy may be required prior to surgical treatment. Despite it is an invasive procedure, arthroscopy is considered by many surgical teams, as the gold standard to explore the scapholunate joint space. Dynamic imaging, such as the four-dimensional computed tomography (4DCT), can analyze changes in the carpal joint spaces during wrist movements. Given our prospective study’s findings, 4DCT appeared as a quantitative multiparametric and reproductible relevant tool for the diagnosis and prognosis of suspected scapholunate instability, including for patients with questionable radiography findings. Abnormal kinematic parameters values seem to be indicative of significant biomechanical changes in the dissociated wrists. Moreover, 4DCT analysis demonstrated correspondence with the arthroscopic dynamic analysis of the scapholunate joint space. Several ligamentoplasty techniques have been described to treat chronic reducible scapholunate instability without chondral lesions. Their common objective is to correct radiological anomalies in order to prevent risk of osteoarthritis. These procedures have served as the basis for several clinical studies and while all the latter share similar good clinical results, the radiographic aspect varies widely, with frequently the recurrence of radiological anomalies. Thus, we described the scapholunate intercarpal ligamentoplasty (SLIC) which uses a free Palmaris Longus graft to reconstruct the scapholunate complex. At short to mid-term follow-up, we report satisfactory clinical and radiological results, and no osteoarthritis wrist case. In a cadaver study, we reported the 4DCT evaluation of that ligamentoplasty and provided additional evidence of its effectiveness in reducing scapholunate instability and restoring scapholunate joint stability. Finally, we designed a device for guiding wrist movements in order to increase the reproducibility and homogeneity of the movement during dynamic imaging acquisition., L'instabilité scapho-lunaire est difficile à diagnostiquer et à traiter. En l’absence de traitement, elle évolue vers l'arthrose du poignet. Au stade statique, le diagnostic est évident lorsqu'une analyse radiographique minutieuse est effectuée, mais le choix du traitement chirurgical n'est pas aussi simple. Au stade dynamique, le diagnostic est plus difficile à poser sur la base unique de méthodes d'imagerie statiques (radiographies, tomodensitométrie ou IRM), ce qui justifie qu'une arthroscopie exploratoire puisse être nécessaire avant le traitement chirurgical. Bien qu'il s'agisse d'une procédure invasive, l'arthroscopie est considérée par de nombreuses équipes chirurgicales comme le gold standard pour explorer l'espace articulaire scapho-lunaire. L'imagerie dynamique, telle que le scanner dynamique quatre dimensions (4DCT), peut analyser les modifications des espaces articulaires du carpe lors des mouvements du poignet. Au vu des résultats de notre étude prospective, le 4DCT est apparu comme un outil pertinent multiparamétrique quantitatif et reproductible pour le diagnostic et le pronostic de l'instabilité scapho-lunaire suspectée, y compris pour les patients présentant des résultats radiographiques douteux. Les valeurs anormales des paramètres cinématiques semblent indiquer des changements biomécaniques significatifs dans les poignets dissociés. De plus, l'analyse 4DCT a démontré une correspondance avec l'analyse dynamique arthroscopique de l'espace articulaire scapho-lunaire. Plusieurs techniques de ligamentoplastie ont été décrites pour traiter l'instabilité scapho-lunaire réductible, chronique et sans lésions chondrales. Leur objectif commun est de corriger les anomalies radiologiques afin de prévenir des risques d'arthrose. Ces procédures ont servi de base à plusieurs études cliniques, et si ces dernières partagent de bons résultats cliniques similaires, l'aspect radiographique est très variable, où la récidive des anomalies radiologiques est fréquente. Ainsi, nous avons mis au point la ligamentoplastie scapho-lunaire et inter-carpienne (SLIC) qui utilise un transplant libre de Palmaris Longus pour reconstruire le complexe scapho-lunaire. Avec un suivi à court et moyen terme, nous rapportons des résultats cliniques et radiologiques satisfaisants, et aucun cas d’arthrose. Dans une étude cadavérique, nous avons évalué en 4DCT cette ligamentoplastie et fourni des preuves supplémentaires de son efficacité dans la réduction de l'instabilité scapho-lunaire et la restauration de la stabilité articulaire de ce couple. Enfin, nous avons conçu un dispositif de guidage des mouvements du poignet, afin d'augmenter la reproductibilité et l'homogénéité du mouvement lors de l’acquisition d'imageries dynamiques.