Difference of anterior and posterior orbital development in patients with congenital microphthalmia: a retrospective cohort study from China.

AIM: To evaluate volume differences between anterior and posterior orbit and demographic characteristics of Chinese patients with congenital microphthalmia. METHODS: A retrospective cohort study, involving 169 unilateral congenital microphthalmia patients aged between 1 and 57 years old was conducted. Three-dimensional images of the orbit were generated from past CT scans, and digital orbital volume comprehensive measurement was done. The measured data included orbital volume (OBV), posterior orbital volume (POV), orbital width (OBW), orbital height (OBH), orbital depth (OBD), and posterior orbital area ratio. RESULTS: Significant differences were observed among OBV, POV, OBW, OBH, and OBD of the affected and unaffected eyes in different age-based groups (all P<0.001). Among them, OBH had the greatest different. The mean microphthalmic to contralateral ratio (MCR) of OBV, POV, OBW, and OBH continuously increased from 1 to 3 years old, whereas the MCR of POV decreased from 3 to 17 years old. The MCR of OBD was not found to be correlated to age. There was no significant difference between OBV, POV, OBW, and OBH in ages from 13 years old to adulthood (all P>0.05). The difference in posterior orbital area ratio between the affected and unaffected groups was not statistically significant (P>0.05). CONCLUSION: OBH is maximally affected, whereas OBD is minimally affected by microphthalmia. Posterior orbital retardation began 2y prior to orbital retardation and occurred at 3 years old in the affected eye, suggesting that intervention therapy should be done before the age of 4.

Investigation of inner ear anatomy in mouse using X-ray phase contrast tomography.

A thorough understanding of inner ear anatomy is important for investigators. However, investigation of the mouse inner ear is difficult due to the limitations of imaging techniques. X-ray phase contrast tomography increases contrast 100-1,000 times compared with conventional X-ray imaging. This study aimed to investigate inner ear anatomy in a fresh post-mortem mouse using X-ray phase contrast tomography and to provide a comprehensive atlas of microstructures with less tissue deformation. All experiments were performed in accordance with our institution's guidelines on the care and use of laboratory animals. A fresh mouse cadaver was scanned immediately after sacrifice using an inline phase contrast tomography system. Slice images were reconstructed using a filtered back-projection (FBP) algorithm. Standardized axial and coronal planes were adjusted with a multi-planar reconstruction method. Some three-dimensional (3D) objects were reconstructed by surface rendering. The characteristic features of microstructures, including otoconia masses of the saccular and utricular maculae, superior and inferior macula cribrosae, single canal, modiolus, and osseous spiral lamina, were described in detail. Spatial positions and relationships of the vestibular structures were exhibited in 3D views. This study investigated mouse inner ear anatomy and provided a standardized presentation of microstructures. In particular, otoconia masses were visualized in their natural status without contrast for the first time. The comprehensive anatomy atlas presented in this study provides an excellent reference for morphology studies of the inner ear.

Congenital Monocular Strabismus Fixus.

PURPOSE: To investigate the clinical characteristics and magnetic resonance imaging (MRI) findings of the extraocular muscle and ocular motor nerves in congenital monocular strabismus fixus. METHODS: The retrospective observational case series of three patients with congenital monocular strabismus fixus were reviewed between January 1, 2006, and December 31, 2016. Ophthalmologic examination and thin-sectioned MRI of the ocular motor nerve and the orbit were performed on the three patients. RESULTS: Three patients presented with unilateral non-progressive strabismus fixus with marked limitations of movement in all directions since birth. Of the three patients, one presented with esotropia, one with a large degree of exotropia and hypertropia, and one with an almost normal primary position. All three patients had normal ocular motor nerves, but adherences among the extraocular muscles, posterior Tenon's capsule, and the globe within the muscle cone on MRI. Two patients underwent strabismus surgery, but there were no postoperative improvements in the primary position and eye movements. CONCLUSIONS: Extensive adherences among the extraocular muscles, posterior Tenon's capsule, and globe may partially explain the cause of congenital monocular strabismus fixus and why strabismus surgery was ineffective. The findings further highlight the importance of MRI in detecting and characterizing atypical forms of strabismus. [J Pediatr Ophthalmol Strabismus. 2018;55(6):363-368.].

Clinical and histopathological features of adenomas of the ciliary pigment epithelium.

PURPOSE: Adenomas of the ciliary pigment epithelium (CPE) are rare benign tumours which have mainly to be differentiated from malignant ciliary body melanomas. Here we report on a consecutive series of patients with CPE adenomas and describe their characteristics. METHODS: The retrospective hospital-based case series study included all patients who were consecutively operated for CPE adenomas. RESULTS: Of the 110 patients treated for ciliary body tumours, five patients (4.5%) had a CPE adenoma. Mean age was 59.0 ± 9.9 years (range: 46-72 years). Mean tumour apical thickness was 6.6 ± 1.7 mm. Tumour colour was mostly homogenously brown to black, and the tumour surface was smooth. The tumour masses pushed the iris tissue forward without infiltrating iris or anterior chamber angle. Sonography revealed an irregular echogram with sharp lesion borders and signs of blood flow in Color Doppler flow imaging. Ultrasonographic biomicroscopy demonstrated medium-low internal reflectivity and acoustic attenuation. In magnetic resonance imaging (MRI), the tumours as compared to brain were hyperintense on T1-weighted images and hypointense on T2-weighted images. Tumour tissue consisted of cords and nests of pigment epithelium cells separated by septa of vascularized fibrous connective tissue, leading to a pseudo-glandular appearance. The melanin granules in the cytoplasm were large and mostly spherical in shape. In four patients, the tumours were hyperpigmented. Tumour cells were large with round or oval nuclei and clearly detectable nucleoli. CONCLUSIONS: These clinical characteristics of CPE adenomas, such as homogenous dark brown colour, smooth surface, iris dislocation and anterior chamber angle narrowing but no iris infiltration, segmental cataract, pigment dispersion, and, as compared to brain tissue, hypointensity and, as compared to extraocular muscles or lacrimal gland, hyperintensity on T2-weighted MRI images, may be helpful for the differentiation from ciliary body malignant melanomas.

Role of quantitative magnetic resonance imaging parameters in the evaluation of treatment response in malignant tumors.

OBJECTIVE: To elaborate the role of quantitative magnetic resonance imaging (MRI) parameters in the evaluation of treatment response in malignant tumors. DATA SOURCES: Data cited in this review were obtained mainly from PubMed in English from 1999 to 2014, with keywords "dynamic contrast-enhanced (DCE)-MRI," "diffusion-weighted imaging (DWI)," "microcirculation," "apparent diffusion coefficient (ADC)," "treatment response" and "oncology." STUDY SELECTION: Articles regarding principles of DCE-MRI, principles of DWI, clinical applications as well as opportunity and aspiration were identified, retrieved and reviewed. RESULTS: A significant correlation between ADC values and treatment response was reported in most DWI studies. Most quantitative DCE-MRI studies showed a significant correlation between K trans values and treatment response. However, in different tumors and studies, both high and low pretreatment ADC or K trans values were found to be associated with response rate. Both DCE-MRI and DWI demonstrated changes in their parameters hours to days after treatment, showing a decrease in K trans or an increase in ADC associated with response in most cases. CONCLUSIONS: Combinations of quantitative MRI play an important role in the evaluation of treatment response of malignant tumors and hold promise for use as a cancer treatment response biomarker. However, validation is hampered by the lack of reproducibility and standardization. MRI acquisition protocols and quantitative image analysis approaches should be properly addressed prior to further testing the clinical use of quantitative MRI parameters in the assessment of treatments.

Improved performance in differentiating benign from malignant sinonasal tumors using diffusion-weighted combined with dynamic contrast-enhanced magnetic resonance imaging.

BACKGROUND: Differentiating benign from malignant sinonsal lesions is essential for treatment planning as well as determining the patient's prognosis, but the differentiation is often difficult in clinical practice. The study aimed to determine whether the combination of diffusion-weighted (DW) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can improve the performance in differentiating benign from malignant sinonasal tumors. METHODS: This retrospective study included 197 consecutive patients with sinonasal tumors (116 malignant tumors and 81 benign tumors). All patients underwent both DW and DCE-MRI in a 3-T magnetic resonance scanner. Two different settings of b values (0,700 and 0,1000 s/mm 2 ) and two different strategies of region of interest (ROI) including whole slice (WS) and partial slice (PS) were used to calculate apparent diffusion coefficients (ADCs). A DW parameter with WS ADCs b0,1000 and two DCE-MRI parameters (time intensity curve [TIC] and time to peak enhancement [Tpeak]) were finally combined to use in differentiating the benign from the malignant tumors in this study. RESULTS: The mean ADCs of malignant sinonasal tumors (WS ADCs b0,1000 = 1.084 × 10-3 mm 2 /s) were significantly lower than those of benign tumors (WS ADCs b0,1000 = 1.617 × 10-3 mm 2 /s, P < 0.001). The accuracy using WS ADCs b0,1000 alone was 83.7% in differentiating the benign from the malignant tumors (85.3% sensitivity, 81.2% specificity, 86.4% positive predictive value [PPV], and 79.5% negative predictive value [NPV]). The accuracy using DCE with Tpeak and TIC alone was 72.1% (69.1% sensitivity, 74.1% specificity, 77.5% PPV, and 65.1% NPV). Using DW-MRI parameter was superior than using DCE parameters in differentiation between benign and malignant sinonasal tumors (P < 0.001). The accuracy was 87.3% (90.5% sensitivity, 82.7% specificity, 88.2% PPV, and 85.9% NPV) using DW-MRI combined with DCE-MRI, which was superior than that using DCE-MRI alone or using DW-MRI alone (both P < 0.001) in differentiating the benign from the malignant tumors. CONCLUSIONS: Diffusion-weighted combined with DCE-MRI can improve imaging performance in differentiating benign from malignant sinonasal tumors, which has the potential to improve diagnostic accuracy and to provide added value in the management for these tumors.

Clinical characteristics of pulsatile tinnitus caused by sigmoid sinus diverticulum and wall dehiscence: a study of 54 patients.

CONCLUSIONS: CT angiography (CTA) and digital subtraction angiography (DSA) are valuable tools in imaging work-ups for the diagnosis of sigmoid sinus diverticulum (SSD) and sigmoid sinus wall dehiscence (SSWD). The development of pulsatile tinnitus (PT) resulting from SSD and SSWD may be associated with the dominance of venous systems. OBJECTIVE: Our goal was to evaluate the clinical characteristics of PT caused by SSD and SSWD. METHODS: This was a retrospective chart review undertaken in a tertiary academic referral center. Fifty-four patients with PT due to SSD and SSWD were recruited. Hospital files of these patients were assessed. Data included medical history, physical examinations, auxiliary examinations, and radiographic findings of CTA and DSA. RESULTS: The study population comprised 51 females and 3 males. Most patients with PT caused by SSD and SSWD were middle-aged women. All had normal otoscopy results. Anomalies occurred in or adjacent to the region of the transverse-sigmoid sinus junction in 52 patients. Half of the patients (27/54) presented abnormal results of examination of blood lipids. There were 57.41% (31/54) cases with ipsilateral dominance of the venous system, 9.26% (5/54) cases with contralateral dominance, and 33.33% (18/54) cases with co-dominance of the venous system.

[Value of temporal bone dual phase contrast enhancement computed tomography in diagnosing causes of pulsatile tinnitus].

OBJECTIVE: To evaluate the value of temporal bone dual phase contrast enhancement computed tomography (DPCT) in diagnosing the causes of pulsatile tinnitus (PT). METHODS: We retrospectively analyzed the DPCT findings of 157 patients with unilateral PT. Temporal bone High-resolution CT (HRCT) was performed in 71 patients, magnetic resonance imaging (MRI) in 80 and digital subtraction angiography (DSA) in 89. RESULTS: In 71 patients with both DPCT and HRCT scan, a total of 68 causes were found. The accuracy of DPCT was 100% it was significant higher than that of HRCT (77.9%). In 80 patients with both DPCT and MRI, 83 causes were known. The accuracy of DPCT (94.0%) was significantly higher than that of MRI (8.4%). In 89 patients with both DPCT and DSA scan, 99 causes were identified. The accuracy of DPCT was 91.9% and it was significantly higher than that of DSA (15.2%). CONCLUSION: DPCT may be an ideal imaging modality for diagnosing the causes of PT.

[Role of computed tomographic angiography in the evaluations of dural arteriovenous fistulas with pulsatile tinnitus as initial symptom].

OBJECTIVE: To evaluate the sensitivity and specificity of computed tomographic angiography ( CTA) for dural arteriovenous fistulas ( DAVFs) in patients presenting with pulsatile tinnitus( PT). METHODS: The clinical and imaging data were collected for all patients undergoing CTA for PT from 2008 to 2012. Nine PT patients with DAVFs confirmed by digital subtraction angiography ( DSA) and 9 age and gender-matched control PT patients without DAVFs were selected. The CTA images were blindly analyzed by two experienced neuroradiologists for the following signs: asymmetric venous collaterals in extracranial space , asymmetric attenuation of internal jugular vein ( IJV) , asymmetric external carotid artery( ECA) branches, "shaggy" appearance of dural venous sinus, multiple transcalvarial channels, enlarged foramen spinosum, asymmetric cavernous sinus and enlarged cortical veins. RESULTS: The sensitivities of the following DAVFs signs were quite different: asymmetric attenuation of IJV ( 89% ) , asymmetric venous collaterals ( 89%) , asymmetric ECA branches ( 78%) , shaggy dural venous sinus ( 67%) , multiple transcalvarial channels (67%), enlarged foramen spinosum (56%), stenosis of venous sinus (33%) and asymmetric cavernous sinus ( 2 2 % ) . The presence of asymmetric attenuation of IJV , asymmetric ECA branches, shaggy dural venous sinus, multiple transcalvarial channels and asymmetric cavernous sinus all demonstrated a highly specificity of 100% while the presence of asymmetric venous collaterals and enlarged foramen spinosum had a specificity of 89% . The presence of stenosis of venous sinus revealed a specificity of 78%. Enlarged cortical veins were all absent. CONCLUSION: CTA may be used as a screening examination for DA VFs in PT patients. The presence of asymmetric venous collaterals, asymmetric attenuation of UV,asymmetric ECA branches, shaggy dural venous sinus and multiple transcalvarial channels has a high sensitivity and specificity for diagnosis. Enlarged ECA branches usually serve as DA VFs feeders.Meanwhile, DA VF should be considered in PT patients when multiple transcalvarial channels and enlarged foramen spinosum are detected on high-resolution CT of temporal bone.

Magnetic resonance imaging findings in sporadic Möbius syndrome.

BACKGROUND: Although neuroradiological findings of Möbius syndrome have been reported as a result of brain and brainstem abnormalities, magnetic resonance imaging (MRI) now permits the direct imaging of the cranial nerve (CN) and branches in the orbits. This study presents the MRI findings in patients with sporadic Möbius syndrome. METHODS: Prospectively, CNs were imaged in the cistern using head coils and three dimensional fast imaging employing steady-state acquisition (3D-FIESTA), yielding a 0.5 mm(2) resolution in planes of 0.8 mm thickness in seven patients with sporadic Möbius syndrome. The cavernous and intraorbital segment of the CN and the extraocular muscles (EOMs) were imaged with T1 weighting in all patients. The cavernous segment was imaged in coronal planes, while the intraorbit in quasicoronal planes were imaged using surface coils. Intraorbital resolution was 0.16 mm(2) within 2.0 mm thick planes. RESULTS: In the seven patients, the CN were absent or showed hypoplasia in the cistern, cavernous sinus, and orbit. Abducens (CN VI) and facial (CN VII) nerves were absent on the affected sides. Unilateral CN IX (glossopharyngeal nerve) in two cases displayed dysplasia. Branches from the inferior division of CN III were observed to innervate the lateral rectus (LR) bilaterally in three cases and unilaterally in one case, and had intimate continuity with the LR muscle in two cases bilaterally and two cases unilaterally. Hypoplasia of EOMs was shown in five cases. Dysplasia of the medulla on the left side was found in one patient. CONCLUSIONS: Direct imaging of CNs and EOMs by MRI is useful in diagnosis of Möbius syndrome. It can directly demonstrate the abnormalities of the CN and orbital structures. The absence or hypoplasia of CN VI and CN VII may be the most common radiologic features in sporadic Möbius syndrome, and hypoplasia of CN IX may be an associated feature. The abnormality of EOMs and aberrant innervations in the orbit should be observed, and may be important for the study of the etiology.

[Magnetic resonance imaging findings of orbital disease in neurofibromatosis type 1 patients].

OBJECTIVE: To explore the magnetic resonance imaging (MRI) features of neurofibromatosis type 1 (NF1) with orbital involvement. METHODS: We retrospectively reviewed the MRI findings of orbital abnormalities in 80 NF1 patients (86 orbits). The diagnosis was confirmed by the updated National Institute of Health (NIH) criteria. All of them underwent MRI scans of orbit or brain while 71 patients had contrast enhancement. RESULTS: The orbital abnormalities were documented in 80 patients. And 79 cases (85 orbits) had plexiform neurofibroma in orbit and/or adjacent regions. The orbital involvements extended to superficial temporal fossa (n = 61), infratemporal fossa (n = 31), cavernous sinus (n = 61) and pterygopalatine fossa (n = 51). There was mild-to-moderate enhancement in 71 orbits on contrast-enhanced MRI examinations. There were localized defects of orbital walls because of sphenoid bone dysplasia of greater wing (n = 79), sphenoid bone dysplasia of lesser wing (n = 72), augmentation (glaucoma) of eyeballs (n = 32) and optic nerve gliomas (n = 5). And 53 cases had hyperintense lesions on T2-weighted brain images. CONCLUSION: Orbital involvement is common for NF1. And MRI is a useful tool of evaluating the extent of involvements and other abnormalities in the NF1 patients.

Characteristic findings of malignant melanoma in the sinonasal cavity on magnetic resonance imaging.

BACKGROUND: Malignant sinonasal melanoma (MSM) is a rare tumor with a perplexing signal intensity due to variable histopathologic components. This study was undertaken to delineate its MR imaging features. METHODS: MR imaging findings of 10 patients (6 women and 4 men, mean age 61.3 years old) with pathologically confirmed MSM were retrospectively reviewed. The location, size, signal intensity, enhancement, and internal imaging characteristics of all tumors were evaluated. Signal intensity and degree of enhancement was graded in comparison with the gray matter and adjacent muscle uptake, respectively. RESULTS: There were 8 tumors that were pathologically confirmed to contain melanin. Compared to gray matter of the brain, 7 of them demonstrated hyperintensity on T1WI and 6 (6/7) showed hypointensity on T2WI. There was multiple linear, dark-signal intensity on T2WI within the mass in 9 of the 10 patients' tumors. Evaluated with gadolinium-enhanced imaging, all 10 patients showed moderate enhancement within the areas that were isointense in the lesion on pregadolinium T1WI. Moreover, some parts which displayed hyperintensity on T1WI within the tumors of 7 patients showed mild enhancement that was similar to muscle on a time-intensity curve (TIC). CONCLUSIONS: MSM shows characteristic MR signal intensity (hyperintensity on T1WI and the linear, low-signal intensity on T2WI), which may provide valuable information for clinical diagnosis. Together with conventional MRI, TIC may be useful for indicating pleomorphic patterns of MSM.

[Age-related changes of normal adult inferior rectus muscle:analysis with dynamic contrast-enhanced magnetic resonance imaging].

OBJECTIVE: To explore the age-related changes of blood supply and extracellular space volume in normal adult inferior rectus muscle, evaluate the microcirculation in extraocular muscle and offer important information for the diagnosis and treatment of extraocular muscle disorders. METHODS: A total of 250 patients undergoing nose-sinus dynamic contrast-enhanced magnetic resonance imaging were studied. Five groups were divided according to age (20 - 30 yr old, 30 - 40 yr old, 40 - 50 yr old, 50 - 60 yr old and over 60 yr old). The technique of 3DFSPGR (3-dimensional fast spoiled gradient-recalled) was used in dynamic contrast-enhanced imaging scanning 4 minutes and 59 seconds and acquiring 12 phases. Time-intensity curves of orbital layer, global layer of inferior rectus muscle and temporal muscle ipsilaterally were drawn on post-process work station. From the curves, the values of SIpre, SImax and SIphase12 were obtained and then SIpeak (peak signal intensity), Tpeak (time of peak enhancement) and WR (washout ratio) computed. The data were analyzed statistically. RESULTS: SIpeak of orbital layer in all groups was as follows: 404.7 ± 12.7, 395.1 ± 15.9, 367.3 ± 5.1, 307.0 ± 12.4 and 265.3 ± 6.2 respectively. Tpeak: (85.2 ± 1.0) s, (93.2 ± 8.1) s, (106.8 ± 4.6), (122.8 ± 8.6) s and (133.0 ± 0.8) s respectively. WR: (9.25 ± 0.50)%, (8.25 ± 0.50)%, (7.50 ± 0.58)%, (4.75 ± 1.26)% and (3.50 ± 1.73)% respectively. SIpeak of global layer in all groups was as follows:261.9 ± 2.1, 256.6 ± 1.1, 243.8 ± 3.3, 225.4 ± 4.9 and 219.8 ± 5.3 respectively. Tpeak: (157.8 ± 1.7) s, (166.5 ± 4.5) s, (173.2 ± 7.2) s, (192.8 ± 9.1) s and (200.5 ± 2.4) s respectively. WR: (7.25 ± 0.50)%, (6.27 ± 0.00)%, (4.50 ± 0.58)%, (3.75 ± 0.50)% and (2.25 ± 1.50)% respectively. SIpeak, Tpeak and WR of temporal muscle in all groups showed no statistical significance (P > 0.05). Tpeak increased while SIpeak and WR decreased with age. Furthermore the changes of Tpeak of orbital layer were more sensitive. CONCLUSION: Dynamic contrast-enhanced magnetic resonance imaging can non-invasively reflect the age-related changes of blood supply and extracellular space volume in normal adult inferior rectus muscle so as to offer important information for the diagnosis and treatment of extraocular muscle disorders.

Detection of 100% oxygen induced changes in retina using magnetic resonance imaging: a human study.

BACKGROUND: Inner retinal oxygenation response (ΔPO(2)) is a worldwide study focus. However, the relevant reports on its radiological measurements are limited. In this study, magnetic resonance imaging (MRI), employing T1 weighted image (T1WI), was used to detect changes in ΔPO(2) following 100% oxygen inhalation in human subjects. METHODS: MRI was performed on a 1.5-T GE scanner system. After obtaining ophthalmologic data, eleven healthy individuals were given room air and 100% oxygen inhalation in order with different intervals. The MRI T1WI data were collected for 50 minutes. Data were analyzed with NIH IMAGE software. RESULTS: ΔPO(2) was not panretinally uniform, and changes in oxygenation response were spatially inhomogeneous. During the initial phase (before 5 minutes) of 100% oxygen inhalation, preretinal vitreous water signals in the region of papilla optica increased rapidly. On the contrary, in other regions signals declined. In a later period (35 minutes), ΔPO(2) was panretinally fluctuated and increased slowly and attained homeostasis. After hyperoxia (45 minutes), delayed-enhancement of preretinal vitreous water signals in regions other than the papilla optica occurred, and then dropped down. There was no significant difference (P > 0.05) at any consecutive time point during and after hyperoixa. CONCLUSIONS: These results reveal that hyperoxia can induce region-specific signal changes in preretinal vitreous water. Regulatory activity of the retinal vessel network may be the mechanism during 100% oxygen inhalation. Moreover, MRI is a valuable tool for investigating ΔPO(2) and exploring the mechanism of retinal oxygenation response physiologically or pathologically in vivo.

[Study of variations in adult sphenoid sinus by multislice spiral computed tomography].

OBJECTIVE: Explore the anatomic variations of adult sphenoid sinus and delineate the precise relationship between sphenoid sinus and adjacent structures. METHODS: Using multi planner reformation (MPR), the images of 260 spiral computed tomography (CT) scans were reviewed through a doctor station. RESULTS: The sphenoid was divided into 6 types: no development, conchal, pre-sellar, half-sellar, full-sellar and post-sellar. The prevalence was 0.19%, 1.54%, 8.08%, 22.88%, 20.58% and 46.73% respectively. And there was no difference between left and right. The prevalence of accessory septa or bone spur inside sphenoid sinus was 51.5%. With the gasification spreading, the prevalence was rising. And there was statistical significance among them. The dorsum sella was divided into three types: I, II, III. And its prevalence was 48.08%, 25.19% and 26.73% respectively. The difference of sphenoethmoid distribution among the various type sinus had no statistical significance. The prevalence of vidian canal and foramen rotundum protrusion was 39.2% and 15.8% respectively. And all occurred in pterygoid process cells. Internal carotid artery (ICA) was divided into 4 types. And the prevalence of type 0 to 3 was 13.5%, 50.0%, 26.9% and 9.6% respectively. With the gasification spreading, the prevalence of types 2, 3 was rising. And there were statistical significance among them. The prevalence of type 0 to 4 CNII was 4.4%, 19.2%, 26.0%, 29.0% and 21.4% respectively. With the gasification spreading, the prevalence of type 3, 4 CNII was rising. And the difference had statistical significance. CONCLUSION: MPR and multislice spiral CT can facilitate a precise study of anatomic variations in adult sphenoid sinus and delineate the relationships between sphenoid sinus and adjacent structures. Caution must be exercised during sphenoid and trans-sphenoid surgery to minimize the risk of inadvertently injuring the adjacent structures.

[Comparison of sensitivity of audiological tests to identify otitis media with effusion in newborn infants].

OBJECTIVE: To investigate the sensitive factors which were used in routine audiological tests to find out otitis media with effusion (OME) in newborn infants. METHODS: Subjects of this study were 48 infants, including 31 males and 17 females, who failed in the universal newborn hearing screening. The age ranged from 1.5 to 12 months with the average age of 4.3 months. All subjects accepted temporal bone CT and routine audiological assessments, including air-conduction and bone-conduction auditory brainstem response (ABR), 40 Hz-auditory event related potential (40 Hz-AERP), distortion-product otoacoustic emission (DPOAE), acoustic reflex, tympanometries using 226 Hz and 1000 Hz probe tone. Nine factors were statistically analyzed using Kappa test, Univariate chi(2) test and multivariate condition Logistic stepwise regression analysis, which included the results of acoustic immittance, the air-conduction and bone-conduction ABR thresholds, the difference between air-conduction and bone-conduction ABR thresholds, the latency of ABR wave I, duration between ABR wave I and V, 40 Hz-AERP thresholds, amplitudes and thresholds of DPOAE, and acoustic reflex thresholds (ART). RESULTS: Seventy-seven ears were diagnosed with OME, and 19 ears were normal. CT scan of temporal bone was set as a comparative standard. Kappa test indicated that the results of tympanometry with 1000 Hz probe tone (Kappa = 0.745, P < 0.001), the air-conduction ABR threshold (Kappa = 0.453, P < 0.001), the latency of ABR wave I (Kappa = 0.430, P < 0.001), the threshold of 40 Hz-AERP (Kappa = 0.582, P < 0.001), and DPOAE (Kappa = 0.495, P < 0.001) had agreement with the results of temporal bone CT on evaluating the function of middle ear. Univariate analysis indicated that sensitive factors of middle ear function in newborn infants were tympanometry with 1000 Hz probe tone (P < 0.001), ART (P < 0.001), the air-conduction ABR threshold (P < 0.001), the difference between air-conduction and bone-conduction ABR thresholds (P < 0.001), the latency of ABR wave I (P < 0.001), the threshold of 40 Hz-AERP (P < 0.001) and DPOAE (P < 0.001). And multivariate conditional Logistic stepwise regression model showed that tympanometry with 1000 Hz probe tone (P < 0.001) and 40 Hz-AERP threshold (P = 0.004) can be substituted into Logistic stepwise regression equation. CONCLUSIONS: Tympanometry with 1000 Hz probe tone and are sensitive factors to find out OME in newborn infants. The air conduction ABR threshold, ABR wave I latency, 40 Hz-AERP threshold and DPOAE could reflect the middle ear function of newborn infants effectively.

[Endoscopic transpterygoid intervention of meningoencephalocele within lateral recess of sphenoid].

OBJECTIVE: To report the results of endoscopic transpterygoid intervention of nine patients with meningoencephalocele and cerebrospinal fluid (CSF) leaks within lateral recess of sphenoid sinus (LRSS). The diagnosis, operative techniques and their related problems were discussed. METHODS: Nine hospitalized patients with meningoencephalocele and CSF leaks within lateral recess of sphenoid sinus (LRSS) were included in this paper. Six were male and 3 were female, aged from 27 to 56 years old. Two patients had the histories of endoscopic repair. The preoperative orientation of CSF leaks and meningoencephalocele depended on CT scan and MR cisternography. Endoscopic transpterygoid intervention and the repair of skull base defects were undertaken under general anesthesia. RESULTS: All the operations were successful. One patient had a postoperative intracranial hypertension and Hydrocephalus. Two patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia. One of them had a xerophthalmia. All the symptoms above mentioned relieved gradually 6 months after operation. No recurrence was found during follow -up for 6 to 58 months (mean 25. 6 months). CONCLUSIONS: Endoscopic transpterygoid intervention for meningoencephalocele and CSF leaks within LRSS is a minimally invasive technique and a straightforward approach.

[Spiral computed tomographic analysis of frontal recess regions].

OBJECTIVE: The purpose of the study was to determine the prevalence of frontal recess cells in Chinese patients who did not have frontal sinus disease related symptoms. METHODS: Forty-nine Chinese patients without frontal sinus disease symptoms were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were evaluated using a standard triplanar reconstruction protocol on a computer workstation. RESULTS: The prevalence of agge rnasi cell was 94% (92/98). Sixty-four uncinate processes (65%, 64/98) had one superior attachment for each uncinate process, the other thirty-four uncinate processes (35%, 34/98) had two superior attachments for each uncinate process. The uncinate process' single superior attachment into the surrounding structures was identified to have the following distribution: 53% (52/98) to the lamina papyracea, 9% (9/98) to the middle turbinate, 3% (3/98) to the skull base. Most of the uncinate process' two superior attachments were either into the lamina papyracea and the skull base (24%, 23/98) or into the lamina papyracea and the middle turbinate (10%, 10/98). Only one uncinate process (1%) superiorly attached to the skull base and the middle turbinate. The prevalence of recessus terminalis was 87% (85/98). Of all the frontal cells identified in 32 sides (33%) of frontal recesses, the prevalence of type I, type II, type II and type IV cells were 23% (23 sides), 2% (2 sides), 7% (7 sides) and 0% (0 side) respectively. Supra bullar cell, frontal bullar cell and interfrontal septal cell were identified in 30 sides (31%), 7 sides (7%) and 7 patients (14%) respectively. CONCLUSIONS: The result characterized normal frontal recess pneumatization in Chinese. That, together with the variations of the uncinate process' superior attachment emphasized the roles of agger nasi cell and the uncinate process in endoscopic frontal sinus surgery.