Biomedical subjects
Publications and source records attributed to B Kastler.
The case of a young child who demonstrated extrinsic narrowing of the thoracich trachea related to a mediastinal bronchogenic cyst is reported. Diagnosis was made by magnetic resonance imaging. About this case report, the authors review the possible causes of tracheal narrowing at this age of life and suggest a simple diagnostic management protocol.
During the period 1983-1987, 53 neonates (30 boys, 23 girls, mean birth weight 1,438 +/- 317 g, mean gestational age 30 +/- 2 weeks) were found to have cystic periventricular leukomalacias (CPVL) detected by brain ultrasonography. The neuro-developmental follow-up was 3-7 years. Seventeen CPVL were isolated and CPVL were associated with minor peri-intraventricular hemorrhage (0-1 to II-II) in 36 cases. CPVL included 16 minor forms (11 normal children; 2 minor, 3 moderate sequelae), 29 moderate forms (15 normal children; 4 minor, 7 moderate, 3 major sequelae) and 8 major forms (7 major sequelae, one moderate mental retardation without motor deficit). According to reverse analysis, a normal evolution (26 cases) followed CPVL which were sometimes widely, but thinly spread over the ventricles (thickness 1/5-1/3 of the cerebral mantle); minor sequelae (6 cases) were associated with a 1/4-1/3 thickness, moderate sequelae (11 cases) with a 1/3-1/2 thickness, major sequelae (10 cases) with a 1/2-2/3 thickness of CPVL. The thickness of the lesions appeared to be more predictive of sequelae than the sagittal extent, in particular that of the posterior CPVL which played a major role in the severity of sequelae, and mainly in the presence of motor deficits.
The authors report their experience of CT and MRI imaging in the study of suprasellar pathologies. The problems concerning the differential diagnosis between meningioma developed in the suprasellar region and pituitary tumour with suprasellar extension are discussed and illustrated; the demonstration of bone abnormalities (blistering, hyperostosis) is particularly useful for the diagnosis of presellar meningioma. The CT and MRI features of craniopharyngioma are compared; CT, of course, is more reliable than MRI in detecting calcifications; with both methods it may be difficult to visualize the cystic components. Glioma of the chiasma is readily diagnosed by MRI, provided the tumour is not too large. Non-thrombosed suprasellar aneurysms have typical features at CT and MRI. Cystic lesions are easily identified by MRI. The CT and MRI images of inflammatory lesions are not very typical.
In a full-term infant who underwent surgery for type III esophageal atresia, attempts to remove the tracheal tube postoperatively failed. Bronchoscopy disclosed external compression of the trachea in the chest. Selection of the investigations most likely to provide the etiologic diagnosis was discussed. Because of the patient's poor general condition, MRI of the mediastinal area was performed first and showed an abnormal origin of the brachiocephalic trunk which was the cause of tracheal compression. No attempt at corrective surgery was made and the patient was successfully extubated at four months of age.
A thoracic intradural arachnoid cyst presenting as an intradural extramedullary mass highly suggestive of psammoma on myelogram and myelo-CT is reported in a 34-year-old female. High densities of the cyst were related to collection of contrast media within the cyst. However MR examination of the thoracic spinal cord including sagittal T1 (without and with contrast) and T2 studies failed to demonstrate the mass. Lack of MR changes were related on one hand to the small size of the cyst and to the absence of mass effect on the spinal cord, and on the other hand to a CSF-like signal of the contents of the cyst. Only combination of myelography, myelo-CT and MR allows precise diagnosis of small intradural arachnoid cyst; however MR is the method of choice for evaluation of large intradural subarachnoid cysts.
Eight infants with systemic-pulmonary Blalock-Taussig shunts were evaluated by spin-echo ECG-gated MRI. Contrary to Echocardiography, MRI using coronal oblique projections successfully visualized all palliative shunts entirely in one single plane (including one carried out on a right aberrant subclavian artery). MRI allowed assessment of size, course and patency of the shunt, including pulmonary and subclavian insertion. The proximal portion of the pulmonary and subclavian arteries were also visualized. We conclude that MRI with axial scans completed by coronal oblique planes is a promising, non invasive method for imaging the anatomical features of Blalock-Taussig shunts.
Explore the source record for details and available documents.
The authors report the case of a 3-month-old infant with a history of interventricular septal defect with pulmonary arterial hypertension. This child had pulmonary symptomatology (dyspnea, recurrent bronchitis, acute attacks of asphyxia) which it was possible to link to a retrotracheal left pulmonary artery by magnetic resonance imaging (MRI). Classical investigations (upper GI barium series and chest X-ray) were suggestive of a bronchogenic cyst type abnormal pulmonary structure. Angiography confirmed the MRI diagnosis. In this case the infant also had tracheal lesions (lower tracheal hypoplasia) which required further evaluation by fibroscopy and bronchography. Thus MRI shows itself to be a useful investigation in the study of basic vascular abnormalities.
When it occurs bilaterally, disinsertion of the quadriceps tendons may suggest quadricipital amyotrophy syndrome. Questioning and physical examination of the locomotor system usually lead to a diagnosis of mechanical lesion involving the extensor mechanism of the knee. If necessary, this diagnosis can be confirmed by ultrasonography and MRI of the knee. A search for predisposing factors may result in a specific treatment, but only surgery provides functional improvement.
Between February 1988 and July 1989, the authors used magnetic resonance imaging (MRI) to study 54 newborn infants aged between 2 and 35 days and suspected of congenital heart disease. All children also underwent echocardiography and 7 angiography during the neonatal period (13% of children studied). MRI was well tolerated and there were no adverse events. MRI proved to be complementary to echocardiography in several lesions affecting the great vessels of the base and the left atrial region. Agreement between angiography and MRI results was very good, with MRI being more useful in one case. MRI enables full and non-invasive postoperative follow-up. In conclusion, despite the great heterogenicity of the cardiac malformations studied and which requires a degree of caution, the authors feel that MRI is a second line investigation after echocardiography. It may limit the indications of angiography. Its own indications are the retrocardiac region, the main arteriovenous vessels of the base and postoperative follow-up in congenital heart disease. The development of techniques such as angio RM will further modify data in the future.
MR findings are reported in three patients presenting mannosidosis. Among a family of 8 children, 4 presented typical clinical and biological abnormalities related to mannosidosis. Brain MR examinations including sagittal T1 and axial T2 sections were obtained in three patients of this family (one 25-year-old male, one 34-year-old female, and one 35-year-old female). MR scans demonstrate seven types of modifications: (1) brachycephaly, (2) thick calvaria, (3) verticalization of the chiasmatic sulcus, (4) poor pneumatization of the sphenoid body, (5) partial empty sella turcica (6) cerebellar atrophy, and (7) white matter signal modifications. High signal abnormalities involving the parieto-occipital white matter are identified on axial T2-weighted scans in the three patients and are probably related to demyelination and associated gliosis as described previously by several authors on specimens.
The authors report coarctation of the abdominal aorta in an infant aged three months. A complete study of the lesion was made by magnetic resonance imaging (MRI), which confirmed involvement of the renal and iliac arteries, dilatation of the celiac trunk and of the superior mesenteric artery, and the absence of visualization of the inferior mesenteric artery. MRI is seen to be a valuable tool for monitoring this type of anomaly and allows angiography to be avoided.
The use of nuclear magnetic resonance in this study allowed complete and accurate pre- and postoperative follow-up on three newborn infants with pulmonary atresia and interventricular communication or extreme tetralogy of Fallot who had undergone systemic-pulmonary palliative surgical correction of the Blalock-Taussig type. The morphological and functional appearance of the surgical correction was well assessed and regular monitoring was possible of the permeability and calibre of the anastomosis and condition and progression of the pulmonary pathway. Nuclear magnetic resonance proved to be a promising means of examination in the postoperative follow-up of congenital cardiopathies.
The authors report a case where the diagnosis of complete pericardial agenesis was made by magnetic resonance imaging (MRI). This anomaly is rare, often asymptomatic (two-thirds of the cases) and its diagnosis may be evoked on a chest X-Ray and sonocardiography. MRI confirms the initial clinical impression and, besides, enables to completely rule out associated cardiac or pulmonary pathologies.
The authors report the case of a 34 weeks premature infant presenting a transpositions of the large vessels, who underwent a Rashkind during the neonatal period, a Senning procedure at three months, and was explored and followed-up by magnetic resonance imaging (MRI). The images obtained are of good quality, permitting a precise diagnosis of transposition of the large vessels and visualization of an inter-ventricular communication (IVC) which were missed on ultrasonography. The MRI shows complete images of the Senning correction and permits a non-invasive post-operative monitoring of this correction. MIR is therefore an interesting second intention examination which may effectively complement ultrasonography and limit the indications of angiography.
The aim of this study was to evaluate potential indications of Magnetic Resonance Imaging (MRI) in the diagnostic workup of congenital heart disease in the newborn in comparison with two other means of investigation: Doppler-echocardiography and angiography. The imaging permitted to make the diagnosis in the 10 cases. MRI was superior than echocardiography in one newborn with a double aortic arch. MRI detected small muscular ventricular septum defects in two newborns with transposition of the great vessels. There was good agreement between MRI and angiographic images. Neither age nor prematurity proved to pose a limit on the diagnosis of MRI. MRI proved to be a good investigative tool which should be used after echocardiography, eventually making it possible to avoid angiography.
Seventeen patients underwent MRI spin-echo imaging (Magniscan 5000) 7 to 21 days after acute myocardial infarction (10 anterior, 7 inferior--average 13.1 +/- 3.7 days). The success rate of visualisation of AMI evaluated independently by a qualitative score (from 0 to 4) based on the brilliance of the myocardial signal after taking steps to eliminate the brillance of pericardial fat and subendocardial flow signals, was 3.1 +/- 0.87 in anterior AMI (10 out of 10) and 1.28 +/- 1.25 (4 out of 7) in inferior AMI (p less than 0.007). The diagnostic sensitivity was increased when images of the third echo were used (13 out of 17) compared to those of the second echo (8 out of 17, p less than 0.016). The value of the 3rd echo is explained and emphasised. Abnormal intramyocardial signals were not recorded in a control group of 10 patients under similar conditions of multi-echo imaging. Finally, significant correlations were observed between peak CPK concentrations and the MRI score (r = 0.62; p less than 0.01) and between peak CPK and the number of sections in which the hyperbrilliant signal was observed (r = 0.74; p less than 0.001): this may open the day to quantification of myocardial necrosis by MRI.
The authors report a case of double aortic arch in the newborn (age: 1 month) explored with magnetic resonance imaging. MRI offers a non invasive and non ionizing examination very well-tolerated by the patient if a correct methodology is used (total acquisition time 40 mn). The quality of the images is sufficient for diagnosis and presurgical evaluation: the diameter, the permeability and the relationship with the surrounding organs of the respective aortic arches were well demonstrated with this technique. The contributions of MRI with respect to 2-D echocardiography and angiography as well as the future possible totally non invasive evaluation of this cardiac anomaly is discussed.