Biomedical subjects
Publications and source records attributed to Y Miaux.
Adult brain tumors comprise a remarkably diverse group of histologic varieties; the potential of CT and MRI for diagnosing presence of tumors of the brain and evaluating their extension is well recognized. A precise radiologic diagnosis can be often made as for as extra-axial tumors are concerned. On the contrary this is often more difficult for intraparenchymal tumors.
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A case of posttraumatic compressive subarachnoid cyst of the thoracic spine studied by MR myelography, and myelo-CT is reported. This cyst was surgically confirmed and treated by shunting.
We report two cases of acrylic vertebroplasty in symptomatic cervical vertebral haemangiomas. In both cases significant improvement of symptoms was rapid. One patient was able to return to work.
Neurological complications are rare in trichinosis. We report a case with marked hypereosinophilia in which MRI showed multiple small subacute cortical infarcts with Gd-DTPA enhancement.
A failed embolisation of a spinal dural arteriovenous fistula (AVF), because a pedicular injection has not reached the initial venous compartment, must be identified immediately, to allow prompt surgery and thus avoid clinical deterioration. The purpose of our study was to determine the role of CT in confirming a complete cure just after embolisation with N-butyl cyanoacrylate (NBCA). Seven patients embolised for spinal dural AVFs with perimedullary venous drainage had an immediate postembolisation CT scan. In six patients a complete cure was achieved, with a normal postembolisation angiogram in five cases. Just after injection of NBCA, we were unable to determine on plain films whether or not the glue had reached the draining vein in six of seven cases. The postembolisation CT showed various patterns: in two cured patients, the glue was visible in the inner surface of the dura mater and therefore on the venous side. In five cases, the glue was approaching the dura mater around the cord or seemed to reach its surface: in the four patients cured, the glue column was 7-18 mm high, whereas it was less than 2 mm high in the patient with angiographic proof of recurrent fistula. The follow-up angiogram remains the only way to confirm a durable cure. We suggest that immediate postembolisation CT may help in assessing endovascular treatment of spinal dural AVFs.
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MR imaging of the brain, particularly with high field MR imagers, may demonstrate signal abnormalities consistent with deposits of iron or other paramagnetic substances in extrapyramidal disorders. The diagnosis of Parkinson's disease and progressive supranuclear palsy can be made on clinical grounds in most of the cases and MR signs are of little help in the diagnosis of these diseases. In patients with parkinsonian disorders poorly responding to therapy, MR imaging may be useful in demonstrating signal abnormalities in the putamen that may help to establish the diagnosis of striatonigral degeneration (component of multiple system atrophy) with a poorer prognosis than Parkinson's disease. Finally, MR imaging may be useful in the exclusion of other disease processes.
In a phantom and in 37 patients, a simple laser guidance system for computed tomography (CT)-guided procedures used the software program of the CT scanner and a laser beam mounted on the CT gantry without need for additional software or components. The skin entry point and angulation of the target path were determined. Then the system projected the desired needle path (including compound angulation), allowing accurate needle placement in all cases, even in small lesions.
Cerebral toxoplasmosis remains the most frequent etiology of cerebral masses in AIDS. In most cases, the disclosure of multiple enhanced masses is suggestive of diagnosis of toxoplasmosis and leads to undertake presumptive therapy. Sometimes, the pattern is less suggestive, and the possibility of primary cerebral lymphoma (PCL) is a diagnostic dilemma, because this is a short term life-threatening lesion in the absence of an undelayed fitting therapy. However, apart from the periventricular form of PCL, where directly proceeding to biopsy should be suggested, there is no distinctive pattern of PCL. The most reliable features in distinguishing between PCL and toxoplasmosis are: solitary lesion, homogeneous enhancement of a lesion whose diameter is larger than 2 cm, situation in deep periventricular white matter and limited edema and mass effect. The presence of haemorrhagic foci in the lesion, if there is no steroid therapy is rather indicative of toxoplasmosis. The lack of enhancement on enhanced CT-scan does not allow to eliminate cerebral toxoplasmosis, and indicate MR examination, or empiric antitoxoplasmic treatment. The radiologic follow-up depends on clinical response and on initial pattern. The criteria of response to antitoxoplasmic treatment are: the decrease in volume or number of lesions, the decrease of edematous reaction and mass effect (if no steroid was administered). If the lesion was initially equivocal, the lack of growth in a 8-day delay is a criterion for toxoplasmosis, just as the occurring of haemorrhage in the lesions (if there is no steroid-therapy).
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PURPOSE: To assess the CT and MR appearance of cerebral aspergillosis in patients who have undergone bone marrow transplantation. METHODS: The imaging and clinical data of five patients with cerebral aspergillosis were reviewed retrospectively and compared with autopsy findings. RESULTS: Lesions are often located in the basal ganglia and demonstrate an intermediate signal intensity within surrounding high-signal areas on long-repetition-time MR scans. The lesions were multiple in four of the five patients and more numerous on MR images than on CT scans. The lesions (which demonstrate no parenchymal enhancement) are consistent with acute infarcts as confirmed at autopsy. In the large lesions, there is early intravascular and meningeal enhancement, as expected in acute infarcts involving an appreciable portion of the territory of a cerebral artery. CONCLUSION: The diagnosis of early cerebral infarction in a patient considered at risk for invasive aspergillosis, even without overt pulmonary disease, is an indication to institute aggressive antifungal therapy.
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The main problem related to the thoracoscopic resection of lung nodules is the difficulty in locating the target nodule. Among the several methods proposed, one of the most efficient is the preoperative placement of a localization wire into the nodule while it is under computed tomography scan control. After our initial series of 22 thoracoscopic resections of lung nodules without preoperative localization, we have used the hook-wire technique in 21 patients. In our initial series, we had four failures while we have had only one in the hook-wire series. Only two minor complications related to the wire localization technique occurred: a poorly tolerated pneumothorax and an intrapulmonary hemorrhage. There was no postoperative complication. The mean duration of postoperative stay was 1 to 6 days. We conclude that the preoperative localization of lung nodules using a hook wire is a safe and accurate method before thoracoscopic resection in selected patients.