We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion ( at 6 months of anticoagulation).During a median follow-up of 41 months, recurrent VTE occurred in 67 out of 371 patients (6.8 events per 100 person-years). In main multivariate analysis, the hazard ratio for recurrence was 3.65 (95% CI 1.33-9.99) for age 50-65 years, 4.70 (95% CI 1.78-12.40) for age >65 years, 2.06 (95% CI 1.14-3.72) for patients with pulmonary vascular obstruction index (PVOI) ≥5% at 6 months and 2.38 (95% CI 1.15-4.89) for patients with antiphospholipid antibodies. When considering that PVOI at 6 months would not be available in practice, PVOI ≥40% at pulmonary embolism diagnosis (present in 40% of patients) was also associated with a 2-fold increased risk of recurrence.After a first unprovoked pulmonary embolism, age, PVOI at pulmonary embolism diagnosis or after 6 months of anticoagulation and antiphospholipid antibodies were found to be independent predictors for recurrence.

Suicide is the eighth cause of mortality in France and the leading cause in people aged between 25 and 34 years. The most common methods of suicide are hanging, self-poisoning with medicines and firearms. Postmortem computed tomography (CT) is a useful adjunct to autopsy to confirm suicide and exclude other causes of death. At autopsy, fractures of the hyoid bone or thyroid cartilage, or both, are found in more than 50% of suicidal hangings. Cervical vertebra fractures are rare and only seen in suicide victims jumping from a great height. Three-dimensional reconstructions from CT data are useful to visualize the ligature mark on the neck. In suicides by firearm, postmortem CT shows entry and exit wounds, parenchymal lesions along the bullet path, as well as projectiles in case of penetrating trauma. However, in the chest and abdomen it is more difficult to identify the path of the projectile. Postmortem CT also shows specific features of suicide by drowning or stabbing, but its use is limited in cases of self-poisoning. The use of postmortem CT is also limited by decomposition and change of body position. This article presents the imaging features seen on postmortem CT according to the method of suicide.

Objectives: The goal of this ex vivo study was to determine if Dual-Energy Computed Tomography (DECT) can discriminate ferromagnetic bullets from non-ferromagnetic bullets. Methods: Twelve different bullets, placed in the center of the scanner on a gelatin phantom, underwent DECT evaluation. These projectiles were both ancient bullets from the 19Th century (eg. 8mm 1890 ECP) and recent bullets from the late 20th century (eg. 9mm Lüger; 7.92mm Mauser; 7mm sport carabin). Two independent radiologists who were blinded to the properties of bullets performed all measurement on an external workstation with extended CT scale. Regions of interest (ROI) were placed in the core of each projectile. From these data, a dual-energy index (DEI) was calculated. A bootstrap method with a p value of less than 0.05 was used to demote statistical significance. Results: Five bullets were ferromagnetic and seven were non-ferromagnetic. The DEI calculated were significantly (p<0.05) different between the ferromagnetic and nonferromagnetic projectiles. There were no significant difference (p>0.05) for intrareader and interreader agreement analysis. Conclusion: Dual-energy CT, despite several limitations, could be a valid method to differentiate ferromagnetic from non-ferromagnetic bullets in an ex-vivo environment with extended CT-scale. This approach could contribute to MR safety but further studies are necessary before using dual-energy CT as a routine technique for screening gunshots victims.

Objective Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis. Methods The data were from the DESIR cohort of 688 patients aged 18–50 years with inflammatory low back pain for ⩾3 months but &lt;3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher's exact test) or the Mann–Whitney test. Results LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019). Conclusion In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.

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Objective To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain. Methods Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (&lt;40° vs ⩾40°), lumbosacral angle (&lt;15° vs ⩾15°) and lumbar lordosis (LL, &lt;50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher's exact) and the Mann–Whitney test. With Bonferroni’s correction, P &lt; 0.001 indicated significant differences. Results Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL &lt; 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL. Conclusion Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.

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ObjectivesTo assess the impact of spinal angles on clinical and imaging features of suspicion of axial spondyloarthritis (axSpA).MethodsThe DESIR cohort is a prospective longitudinal cohort study of adults aged 18–50 with inflammatory back pain (IBP) ≥3 months, ≤3 years. Baseline lateral lumbar radiography of patients included in DESIR cohort were read by two central blinded fellow readers (and a rheumatologist spine specialist in case of discrepancy) for Sacral Horizontal Angle (SHA), Lumbosacral angle (LSA) and total Lordotic Angle (TLA) measures. On the basis of literature, patients were classified depending on whether they had TLA more or less than 50°, SHA more or less than 40° or LSA more or less than 15°. Associations between angles and baseline clinical variables, presence of X-Rays (New York) and MRI (ASAS and MORPHO proposal definition) sacroiliitis, presence of spinal signs of spondyloarthritis (mSASSS, BASRI-total, SPARCC scores), presence of spinal degenerative MRI signs on X-rays (yes or no) and MRI (presence of Modic abnormalities, Pfirrmann score, Canal stenosis, Extrusion, High intensity zone Facet osteoarthritis) according to central reading (two readers) and axSpA diagnostic confidence (according to local clinician's confidence on a 0–10 visual analog scale) were assessed by univariate analysis using the chi-square test (or Fisher's exact test where appropriate) and the Mann-Whitney test. Adjustment for multiple testing was performed according to Bonferroni method.ResultsOf 708 patients, data were available for 677, 675 and 672 for SHA, LSA and TLA, measures with a mean value of 39.2°, 14.5° and 51.5° respectively. Clinical features and diagnostic confidence did not differ between the SHA, LSA and TLA groups. More sacroiliitis imaging, according to ASAS (41.4% versus 32.0%) and MORPHO definition (48.6% versus 39.3%), were reported in TLA<50° group but the differences did not reach statistical significance. Radiological scores were low with a mean value of 0.49 (±1.83), 0.30 (±0.78) and 4.9 (±9.0) for mSASSS, BASRI-total and SPARCC score, respectively, and no inter-group difference was found. In L5S1, more grade 3 and 4 Pfirrmann class and MODIC discopathy (types 1 and 2) were observed for SHA <40°, and TLA <50° (p<0.001) whereas the difference did not reach the significance level for LSA<15° (p=0.05) (table).ConclusionsLumbar spine morphology is not associated with any clinical variable, presence on X-Rays or MRI of spinal signs of spondyloarthritis or sacroiliitis. At the L5S1 level, a more horizontal SHA and a reduction of TLA is associated with more degenerative radiological lumbar spine manifestations.Disclosure of InterestNone declared