INTRODUCTION:Although glioblastoma (GBM) has a very poor prognosis, overall survival (OS) in treated patients shows great difference varying from few days to several months. Identifying factors explaining this difference would improve management of patient treatment. AIM:To determine the relevance of diffusion restriction in newly diagnosed treatment-naïve GBM patients. METHODS:Preoperative magnetic resonance scans of 33 patients with GBM were reviewed. Regions of interest including all the T2 hyperintense lesion were drawn on diffusion weighted B0 images and transferred to the apparent diffusion coefficient (ADC) map. For each patient, a histogram displaying the ADC values within in the regions of interest was generated. Volumetric parameters including tumor regions with restricted diffusion, parameters derived from histogram and mean ADC value of the tumor were calculated. Their relationship with OS was analyzed. RESULTS:Patients with mean ADC value < 1415x10-6 mm2/s had a significantly shorter OS (p=0.021). Among volumetric parameters, the percentage of volume within T2 lesion with a normalized ADC value <1.5 times that in white matter was significantly associated with OS (p=0.0045). Patients with a percentage>23.92% had a shorter OS. Among parameters derived from histogram, the 50th percentile showed a trend towards significance for OS (p=0.055) with patients living longer when having higher values of 50th percentile. A difference in OS was observed between patients according to ADC peak of histogram but this difference did not reach statistical significance (p=0.0959). CONCLUSION:Diffusion magnetic resonance imaging may provide useful information for predicting GBM prognosis.

Osteochondroma is the most common benign bone tumor, and its spinal location is well documented, although uncommon. Spinal osteochondroma most commonly arises in the cervical segment and is usually asymptomatic. Spinal location of other types of cartilaginous tumors including chondroma and chondroblastoma is extremely rare, and the available literature is restricted to case reports. Spinal involvement of chondrosarcoma is rare, accounting for less than 15% of all chondrosarcomas. It affects adults in the fifth decade of life or older, predominantly males. The most frequent symptom of spinal chondrosarcoma is pain, whereas neurologic deficit is frequent, indicating a locally advanced disease at presentation. Differentiating spinal chondrosarcoma from benign cartilaginous tumors can be challenging on both imaging and histology. MRI is the imaging modality of choice for local staging. Treatment is based on en bloc tumor removal. Overall prognosis is poor compared to appendicular skeleton chondrosarcoma and varies with tumor subtype, grade, and stage.

Aneurysmal bone cyst (ABC) is a benign tumor that can be locally aggressive with a risk of recurrence after treatment. It mainly affects children and young adults and generally occurs in long bones. The spine is involved in 8.7–19% of cases with a predilection for the posterior arch. ABC presents typically as a lytic and expansile lesion with internal bony septa. MRI is the modality of choice to show the blood-filled cavities with fluid-fluid levels and to evaluate paravertebral and spinal canal extension. Some tumors can present with similar imaging features (ABC-area changes), and histologic study is mandatory to confirm the diagnosis. Many treatment modalities are available but there is a lack of consensus regarding the management of spinal ABC.

Synovial chondrosarcoma is an extremely rare malignant tumor that arises in the joint synovium. It often occurs in preexisting synovial chondromatosis with the knee being the most frequent location. The differentiation between the two conditions can be very challenging as they share many clinical, radiological, and histological features. Therefore, diagnosis should be based on a multidisciplinary approach.

Primary spinal tumors are relatively rare, representing 11% of primary musculoskeletal tumors and about 4% of all spinal tumors. Their management depends on their local and distant spread. Whenever it is feasible, en bloc resection with clear margins is the preferred surgical approach for malignant and aggressive benign tumors in order to achieve local control of the disease. An accurate preoperative evaluation is therefore mandatory for adequate surgical planning. Because spinal tumors are very rare, the main oncologic staging systems applied to them are those originally developed for appendicular location. However, the spine presents some particularities that distinguish it from extremities, namely the proximity to the spinal cord and the concern for spinal stability. These differences limit the application of the same surgical concepts that are applied in appendicular tumors. A surgical staging system dedicated to the spine and considering these particularities is therefore necessary. Imaging plays a key role in assessing the staging of tumors. Therefore, the knowledge of the main staging systems and the contribution of the different imaging modalities is necessary for the radiologist to provide an accurate staging report.

INTRODUCTION:Diagnosis and treatment of displaced humerus lateral condylar fracture is well codified with open reduction and pinning. For non-displaced or minimally displaced lateral condylar (NMDLC) fractures, diagnosis can be challenging because of cartilaginous structures none visualized on radiographs. AIM:To determine the usefulness of MRI in evaluating articular extension of NMDLC fracture. METHODS:We reviewed consecutive NMDLC fractures during 6 years including children younger than 15 years old with displacement lesser than 2 mm (Rigault type I) at initial radiographs divided in two groups: only line fracture was viewed (R1a), displacement gap lesser than 2 mm (R1b). After elbow cast immobilization, children have got MRI. Surgery was performed in complete articular fractures. All children were seen after 1 mouth then at 6 month for elbow evaluation. RESULTS:Thirty-one fracture, including twenty-two (70.97%) boys. Average age was 6.24 years (3 to 11). Fifteen fractures was classified R1a and sixteen R1b .According to MRI, seven fractures (22,6%) were metaphyseal Gp1, eleven (35,5%) were metaphyso-epiphyseal with an intact hinge cartilage Gp2 ,nine (29%) were complete Salter IV Gp3 and MRI reveals a supracondylar fractures in four cases. Fracture was metaphyseal more often in R1a group (40.0%) compared to R1b (6.3%). Gp3 group was significantly higher in R1b (50.0%) compared to R1a group (6.7%). For the sixteen R1b cases, eight presented articular cartilage involvement on MRI (Gp3) with concordant operative findings. CONCLUSION:MRI is effective in assessing epiphyseal extension fracture providing accurate information for appropriate treatment.

Synovial metastasis and synovial lymphoma are extremely rare and mainly reported in case reports. Clinical presentation and imaging features are nonspecific, and diagnosis is based on histological findings. Lung cancer is the most frequent primary tumor in synovial metastases, and the knee is the main location. Most cases of synovial lymphoma were reported in Non-Hodgkin lymphoma.

The relationship between corpus callosum and schizophrenia is elusive. Neuropsychiatric symptoms in Mild encephalitis with reversible splenial lesion (MERS) such as delirium, and negativism, suggest a link between corpus callosum and psychiatric disturbances.Here in, we report catatonia as an initial symptom of MERS in a schizophrenic patient.The aim of this study is to discuss the likely causal relationship between catatonic syndrome and MERS.To the best of our knowledge, the catatonia was not reported before as a prodromal symptom of MERS. We therefore report this case in order to enlarge the spectrum of MERS symptoms in psychiatric patients and discuss the relationship between catatonia and splenium lesions.

Spinal tuberculosis remains frequent in low- and middle-income countries, with an increased incidence of infections having been recently observed in developed countries. It represents 25–60% of all musculoskeletal tuberculosis. Tuberculous spondylodiscitis (also called Pott disease), isolated tuberculous vertebral osteomyelitis and primitive neural arch tuberculosis are the three main anatomico-radiological patterns. Magnetic resonance imaging is the gold standard imaging technique for the assessment of spinal tuberculosis, allowing an early and precise diagnosis. In the absence of early and adequate treatment, the disease may progress, leading to spinal deformities and/or neurological impairment. The diagnosis is usually straightforward when the patient already has existing extraskeletal tuberculosis. Otherwise, spinal tuberculosis is typically confirmed by bacteriological and/or histopathological tests.

Paget's disease of bone (PDB) is a focal disorder of accelerated skeletal remodelling that is uncommon in patients under the age of 40 years; it is more prevalent in older individuals. We report two cases of PDB diagnosed in early adulthood at the Mohamed Kassab Institute of Orthopedics, La Manouba, Tunisia. The first case was a 35-year-old male patient who presented in 2011 with a seven-month history of hip pain. The second case was a 39-year-old female patient who presented 2014 with chronic lower back pain. The PDB diagnosis was confirmed with clinical, biological and radiological investigations. Both patients were doing well on follow-up. Some previous cases have been reported in the literature, differing from the presented cases in some aspects; data of PDB features at differing ages is still insufficient. Early recognition of this clinical entity in young patients is important as early treatment can affect the progression of the disease.

Triki, Wafa; Belem, Ali; Labbene, Emna; Riahi, Hend; Chelli-Bouaziz, Mouna Author Information

Salmonella osteomyelitis is uncommon and generally associated with sickle cell disease. Vertebral location is extremely rare and has mainly been reported in case reports. Magnetic resonance imaging (MRI) is the modality of choice for assessing discovertebral and soft tissue abnormalities. Imaging features are similar to other spondylodiscitis. Bacteria isolation is necessary for definitive diagnosis and antibiotic susceptibility testing, allowing adequate medical treatment.