Comparaison de 3 séquences de diffusion en IRM 3T dans le diagnostic des lésions ischémiques cérébrales aiguës

L'objectif de notre étude était de comparer 3 séquences de diffusion b1000 3 et 6 directions (b1000 3dir, b1000 6dir) et b2000 6 directions (b2000 6dir) pour la détection des lésions ischémiques récentes en IRM 3T. Trente-neuf patients consécutifs suspects d'accident ischémique aigu (21 AIT<48h et 18 AIC<4h30) ont été explorés par ces 3 séquences de diffusion d'une durée effective de 65s; 107s et 123s. Une analyse qualitative visuelle a été réalisée par 3 lecteurs évaluant le nombre, la localisation des lésions ischémiques, la présence d'artéfacts et la confiance d'interprétation de chaque séquence. Les résultats ont montré que la séquence de diffusion b2000 6dir a permis une augmentation de la détection des lésions ischémiques aiguës de petites tailles en ou au niveau du tronc cérébral. Ces résultats pourraient s'expliquer par une augmentation du contraste entre les lésions ischémiques et le tissu sain et par l'augmentation du volume des lésions visibles en b2000 6dir.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Premier cas décrit d’un homme porteur d’un syndrome de Klinefelter et d’une ostéopathie striée avec sclérose de la base du crâne

National audienceL’ostéopathie striée avec sclérose de la base du crâne est une pathologie rare liée au chromosome X. Il s’agit d’une pathologie fréquemment symptomatique chez les sujets féminins et fréquemment létale chez les sujets de sexe masculin et donc considérée comme dominante liée à l’X. Nous décrivons ici le cas d’un patient masculin adulte, présentant des signes cliniques et radiologiques similaires à ceux habituellement décrits chez les patients de sexe féminin. Le diagnostic a été confirmé par l’identification d’une mutation dans le gène AMER1. La présence d’os longs striés et le phénotype particulier du patient a également conduit au diagnostic de syndrome de Klinefelter homogène, expliquant probablement le phénotype non létal et plutôt modéré comparé aux rares patients masculins déjà rapportés

Primary anterior cruciate ligament repair: magnetic resonance imaging characterisation of reparable lesions and correlation with arthroscopy

International audienceObjectives A recent treatment algorithm suggests that proximal anterior cruciate ligament (ACL) tears with good-to-excellent tissue quality are amenable to primary repair. Our primary objective was to assess the ability of MRI to determine the exact tear location and tissue quality, using arthroscopy as a reference standard. Methods In an initial sample of 71 patients with prior ACL surgery (repair or reconstruction), the diagnostic accuracy of MRI was assessed using arthroscopy as a reference standard. Each native ACL tear was graded according to Sherman's arthroscopic classifications during the surgical procedure. MRI scans were retrospectively reviewed for grading, blinded to arthroscopic findings and in consensus by two musculoskeletal radiologists. Tear location and tissue quality were graded using the MRI Sherman tear location (MSTL), MRI Sherman tissue quality (MSTQ) and simplified MRI Sherman tissue quality (S-MSTQ) classifications. Intra- and inter-observer agreement was assessed on a second sample of 77 patients. MRI classification accuracy was compared by McNemar's tests. Intra- and inter-observer agreement was assessed using Cohen's kappa coefficient. Results Regarding tear location, diagnostic accuracy was 70% (50/71) based on the MSTL classification. Diagnostic accuracy for tissue quality was 52% (15/29) based on the MSTQ classification and 90% (26/29) for the S-MSTQ classification (p = 0.003). Inter-observer agreement was good for MSTL (kappa = 0.78) and moderate-to-good for the MSTQ and S-MSTQ classifications (kappa = 0.44 and 0.63 respectively). Conclusions MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears

First case of osteopathia striata with cranial sclerosis in an adult male with Klinefelter syndrome

International audienceOsteopathia striata with cranial sclerosis is a rare X-linked disorder. It is often lethal in male patients, and is considered X-linked dominant since affected females exhibit clinical signs, although milder than males. We describe here an adult male patient, with clinical and radiological signs similar to those described in female patients. Diagnosis was confirmed by the identification of an AMER1 mutation. The presence of long bones striation and the clinical phenotype of the patient also led to the diagnosis of non-mosaic Klinefelter syndrome, probably explaining the non-lethal and even rather minor phenotype compared to the rare affected males already described

Spinal cord involvement in posterior reversible encephalopathy syndrome (PRES)

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Improving detection of ischemic lesions at 3Tesla with optimized diffusion-weighted magnetic resonance imaging

International audienceBACKGROUND AND PURPOSE: This study compared three different combinations of DWI parameters: three and six diffusion imaging directions (3dir and 6dir, respectively) using b=1000 or 2000s/mm(2) (b1000 or b2000, respectively) to improve detection of recent ischemic lesions at 3Tesla (3T). MATERIALS AND METHODS: A total of 47 consecutive patients underwent three DWI scans: 3dir b1000; 6dir b1000; and 6dir b2000. Qualitative visual analysis was performed by three readers based on evaluation of the number of lesions, presence of artifacts and diagnostic confidence. Interobserver agreement, sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: Forty-five lesions were detected by 3dir b1000, 52 by 6dir b1000 and 56 by 6dir b2000 in 30 patients. The additional lesions identified by 6dir b2000 were either small or located in the posterior fossa. Sensitivity with 6dir b2000 was significantly higher than with 3dir b1000 (98.1% vs 77.4%; P<0.05). CONCLUSION: At 3T, 6dir b2000 DWI detected more acute ischemic lesions than 3dir b1000, particularly small lesions and those located in the brain stem

Extensive basal ganglia edema caused by a traumatic carotid-cavernous fistula: a rare presentation related to a basal vein of Rosenthal anatomical variation

International audienceThe authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis, dysarthria, and a comatose state caused by right orbital trauma from a thin metal rod. Brain MRI showed a right CCF and vasogenic edema of the right side of the brainstem, right temporal lobe, and basal ganglia. Digital subtraction angiography confirmed a high-flow direct CCF and revealed a hypoplastic second segment of the BVR responsible for the hypertension in inferior striate veins and venous congestion. Endovascular treatment was performed on an emergency basis. One month after treatment, the patient's symptoms and MRI signal abnormalities almost totally disappeared. Basal ganglia and brainstem venous congestion may occur in traumatic CCF in cases of a hypoplastic or agenetic second segment of the BVR and may provoke emergency treatment