Parkinsonism and dilatation of the perivascular spaces (état criblé) of the striatum: a clinical, magnetic resonance imaging, and pathological study

Two men, 89 and 83 years of age, presented with predominantly axial parkinsonian signs. In both cases, magnetic resonance imaging of the brain showed numerous small foci, delineating the striatum. The lesions had the same signal as cerebral spinal fluid in both T1 and T2 sequences. Postmortem examination of the brain showed numerous lacunes due to dilatation of the perivascular spaces, frequently associated with alterations of the surrounding brain parenchyma. Typical changes of Parkinson's disease were associated in one case. Such vascular changes may produce, or modify, a parkinsonian syndrome.

[Hypoxic cerebral lesions. X-ray computed tomography and MRI aspects. Apropos of 20 cases. Selective vulnerability of the striatopallidum]

Brain lesions following hypoxic-ischaemic injuries are known from autopsy studies, but their appearance in live patients has been only occasionally described, and only sporadic reports have been published on their CT and MRI images. Over a 2-year period (1991-93) we studied the clinical, MRI and CT features in 20 patients shortly after a severe hypoxia. Clinical examination showed motor extrapyramidal signs in 13 cases and coma in 7 cases. MR with inversion recovery (IR) and T2-weighted spin echo (SE) sequences was performed in 17 patients and CT in 15. Bilateral lesions were found in 11 cases, but in 13 of them CT was normal. Radiological lesions were always symmetrical and bilateral, located in the pallidum in 10 cases, the striatum in 4 cases and the thalamus in 2 cases. Additional white matter lesions were present in only 4 MRI examinations. No relationship was found between the mechanism of hypoxia and the severity of clinical signs. The course of the clinical signs was correlated with the presence of radiological lesions. In comatous patients there was a relation between parkinsonism and abnormalities of basal ganglia. None of the patients who had perinatal asphyxia had radiological lesions. The presence of pallidal or striatal confirmed the hypoxic origin of neurological symptoms, especially in patients with parkinsonism. MRI, particularly in IR sequences, makes it possible to detect small lesions in basal ganglia after hypoxic injuries.

[Solid breast nodules: reliability of ultrasonographic and cytological studies]

The authors evaluated the usefulness of US study and US guided fine-needle aspiration cytology (FNAC) in 144 solid breast lesions. US studies was performed with a 10-MHz transducer. Homogenous hypoechogenicity, elongation along the general orientation of the breast tissue plane, regular margins, and intensification of posterior echoes were considered as benign signs. US guided FNAC was performed when lesions were depicted at US. The smears were performed immediately by the cytologist who was present during the procedure. US signs and FNAC diagnoses were compared with surgical/core biopsy diagnoses or negative imaging follow-up. The sensitivity of US was 93%, specificity 75%, accuracy 81%. Among 41 malignant lesions the cytologic findings were malignant (n = 26) or suspicious (n = 7) with 1 false positive and 2 false negative. Inadequate samplings were less frequent last year study (13.5%). The sensitivity of cytologic diagnosis was 94%, specificity 85%, and accuracy 88%. US study and FNAC could be helpful in evaluating solid breast lesions. A better accuracy may be obtained if FNAC is associated with core biopsy.

Axial motor disturbances after hypoxic lesions of the globus pallidus

Four subjects aged between 29 and 60 years were examined because of axial motor impairment after hypoxic brain injury. Magnetic resonance imaging revealed circumscribed lesions of the globus pallidus in every case. The association of freezing of the gait, speech disorders, axial bradykinesia, and postural disturbances, with no rigidity or tremor and little or no distal akinesia, suggests a role of the globus pallidus in controlling axial motion.

Contribution of oral magnetic particles in MR imaging of the abdomen with spin-echo and gradient-echo sequences

An open phase III clinical trial of the oral contrast agent OMP (oral magnetic particles) was performed in 35 patients undergoing abdominal magnetic resonance (MR) imaging at 1.5 T with axial spin-echo and gradient-echo sequences. The diagnostic efficacy of OMP was examined by comparing pre-and postcontrast images. Bowel loops and abdominal organs were more easily recognizable after OMP ingestion, and the general quality of the images was improved because of fewer bowel-related artifacts. The diagnostic value of the postcontrast abdominal MR examination was superior or equal to that of the precontrast study, and additional information was obtained in 44% of the cases. Postcontrast gradient-echo sequences increased confidence in the MR examination in 18% of cases. OMP was well tolerated and increased the quality and amount of diagnostic information acquired during the examination. Gradient-echo imaging was found to be a useful complement, but the need for a reduction in susceptibility artifacts was apparent and indicates that a decrease in TE or the use of rapid spin-echo sequences might be advantageous.

[Intradural metastases of visceral cancers. MRI aspects. Apropos of 2 cases]

The authors report two cases of intradural metastasis: a man with bronchopulmonary cancer suffering from left L5 sciatic pain and a woman with breast cancer whose examination shows motor weakness of both legs. CT was negative in the first case. Gadolinium injection on T1 sequence shows in the first case small nodular lesions along the roots of cauda equina and in the second case linear enhancements around the spine, at different levels. These aspects are the most frequently reported. MRI is an innocuous and the most sensitive technic for such lesions. An early diagnosis improves the functional prognosis. Despite of radiotherapy and chemotherapy, vital prognosis remains bad because of widespread of the intradural lesions and their frequent association with cerebral metastasis.

[Subperiosteal chondroma. Diagnostic contribution of x-ray computed tomography. Apropos of 2 cases]

Results of CT scan exploration are reported in two cases of subperiosteal chondroma, one in a 4 year old child affecting the anterior tibial tuberosity the other in a 9 year old child involving the upper end of humerus. Data from CT scan imaging were undoubtedly superior to those of conventional radiography and appear to be characteristic of this benign cartilaginous tumor, greatly facilitating correlation between clinical, radiological and pathologic findings. The scanner should allow certain situations to be dedramatized and the surgical attitude adapted when the functional prognosis is involved.

[Synovial cysts of unusual localization. 2 cases and review of the literature]

Two patients with true synovial cysts in atypical sites (internal compartment of knee and inguinal hollow) were investigated by radioarthrography, ultrasound and computed tomography imaging. The cyst in the hip region originated from a dilated serous bursa of the iliopsoas muscle that did not communicate or was no longer in communication with the joint. In contrast, the cyst of the knee appeared to be a lateral synovial capsule hernia. Positive diagnosis in both cases was dependent on combined ultrasound-CT scan imaging, this eliminating a tumor (sarcoma) of soft tissues. However, affirmation of the synovial origin (mesothelial covering of the wall) of the lesion was obtained by histology only, this allowing differentiation from a "capsular" (fibrous wall) cyst, which probably provokes similar ultrasound and CT scan images.