ABSTRACT
PURPOSE: To qualitatively and quantitatively compare unenhanced ultra-low-dose chest computed tomography (ULD-CT) acquired at 80kVp and 135kVp. MATERIALS AND METHODS: Fifty-one patients referred for unenhanced chest CT were prospectively included. There were 29 men and 22 women, with a mean age of 64.7±11.6 (SD) years (range: 35-91 years) and a mean body mass index of 26.2±6.3 (SD) (range: 17-54.9). All patients underwent two different ULD-CT protocols (80kVp-40mA and 135kVp-10mA). Image quality of both ULD-CT examinations using a 5-level scale as well as assessability of 6 predetermined lung parenchyma lesions were blindly evaluated by three radiologists and compared using a logistic regression model. Image noise of the two protocols was compared with Wilcoxon signed-rank test. RESULTS: The mean dose-length product at 80kVp and at 135kVp were 14.7±1.8 (SD) mGy.cm and 15.6±1.9 (SD) mGy.cm, respectively (P<0.001). Image noise was significantly lower at 135kVp (58.9±12.4) than at 80kVp (74.7±14.5) (P<0.001). For all readers and for all examinations, the 135kVp protocol yielded better image quality than 80kVp protocol, with a mean qualitative score of 4.5±0.7 versus 3.9±0.8 (P<0.001). The 135kVp protocol was significantly more often of diagnostic quality than the 80kvp protocol (92.3% versus 77.8%, respectively) (P<0.001) and was less prone to image quality deterioration in obese patients. Parenchymal lesions were never better depicted on the 80kVp protocol than with the 135kVp protocol. CONCLUSION: Unenhanced chest ULD-CT should be acquired at a high kilovoltage and low current, such as 135kVp-10mA, over a low kilovoltage and high current protocol.
Subject(s)
Lung Diseases/diagnostic imaging , Radiation Dosage , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Clinical Protocols , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To determine the optimal monochromatic energy level for lung parenchyma analysis in spectral CT. METHODS: All 50 examinations (58% men, 64.8±16yo) from an IRB-approved prospective study on single-source dual energy chest CT were retrospectively included and analyzed. Monochromatic images in lung window reconstructed every 5keV from 40 to 140keV were independently assessed by two chest radiologists. Based on the overall image quality and the depiction/conspicuity of parenchymal lesions, each reader had to designate for every patient the keV level providing the best diagnostic and image quality. RESULTS: 72% of the examinations exhibited parenchymal lesions. Reader 1 picked the 55keV monochromatic reconstruction in 52% of cases, 50 in 30% and 60 in 18%. Reader 2 chose 50keV in 52% cases, 55 in 40%, 60 in 6% and 40 in 2%. The 50 and 55keV levels were chosen by at least one reader in 64% and 76% of all patients, respectively. Merging 50 and 55keV into one category results in an optimal setting selected by reader 1 in 82% of patients and by reader 2 in 92%, with a 74% concomitant agreement. CONCLUSION: The best image quality for lung parenchyma in spectral CT is obtained with the 50-55keV monochromatic reconstructions.
Subject(s)
Lung/diagnostic imaging , Radiography, Dual-Energy Scanned Projection/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Retrospective StudiesABSTRACT
Technological improvements, with iterative reconstruction at the foreground, have lowered the radiation dose of a chest CT close to that of a PA and lateral chest x-ray. This ultra-low dose chest CT (ULD-CT) has an image quality that is degraded on purpose, yet remains diagnostic in many clinical indications. Thus, its effectiveness is already validated for the detection and the monitoring of solid parenchymal nodules, for the diagnosis and monitoring of infectious lung diseases and for the screening of pleural lesions secondary to asbestos exposure. Its limitations are the analysis of the mediastinal structures, the severe obesity (BMI>35) and the detection of interstitial lesions. If it can replace the standard chest CT in these indications, all the more in situations where radiation dose is a major problem (young patients, repeated exams, screening), it progressively emerges as a first line alternative for chest radiograph, providing more data at a similar radiation cost.
Subject(s)
Lung Diseases/diagnosis , Mass Screening/trends , Radiography, Thoracic/trends , Tomography, X-Ray Computed/trends , Humans , Mass Screening/methods , Radiation Dosage , Radiography, Thoracic/methods , Radiography, Thoracic/statistics & numerical data , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/statistics & numerical data , X-RaysABSTRACT
Type B aortic dissections are serious diseases with a 60 to 80 % 5-year survival rate. Although typically managed with a medical treatment, surgery may be necessary in the acute/subacute or the chronic phase if significant complications are encountered. For these patients, CT angiography is the first-line imaging modality, used for indicating and preparing the surgical procedure as well as for follow-up. Physicians in charge of these patients should be familiar with the key reading points. Visceral malperfusion is the most common acute complication, while aneurysmal dilatation of the false lumen is the most common chronic complication, with surgical management generally indicated when the axial diameter of the aorta exceeds 55mm. Endovascular treatment tends to replace open surgery: it requires precise measurements and identification of the entry tear (contribution of 4D-MRA).
Subject(s)
Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Dissection/diagnostic imaging , Preoperative Period , Aged , Aged, 80 and over , Aortic Dissection/surgery , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortography , Computed Tomography Angiography , Endovascular Procedures , Female , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , Postoperative PeriodABSTRACT
OBJECTIVE: Dual-energy (DE) brings numerous significant improvements in pulmonary CT angiography (CTPA), but is associated with a 15-50% increase in radiation dose that prevents its widespread use. We hypothesize that thanks to iterative reconstruction (IR), single source DE-CTPA acquired at the same radiation dose that a single-energy examination will maintain an equivalent quantitative and qualitative image quality, allowing a more extensive use of the DE technique in the clinical routine. MATERIAL AND METHODS: Fifty patients (58% men, mean age 64.8yo ± 16.2, mean BMI 25.6 ± 4.5) were prospectively included and underwent single source DE-CTPA with acquisition parameters (275 mA fixed tube current, 50% IR) tweaked to target a radiation dose similar to a 100 kV single-energy CTPA (SE-CTPA), i.e., a DLP of 260 mGy cm. Thirty patients (47% men, 64.4yo ± 18.6, BMI 26.2 ± 4.6) from a previous prospective study on DE-CTPA (375 mA fixed tube current, reconstruction with filtered-back projection) were used as the reference group. Thirty-five consecutive patients (57% men, 65.8yo ± 15.5, BMI 25.7 ± 4.4) who underwent SE-CTPA on the same scanner (automated tube current modulation, 50% IR) served as a comparison. Subjective image quality was scored by two radiologists using a 5-level scale and compared with a Kruskal-Wallis nonparametric test. Density measurements on the 65 keV monochromatic reconstructions were used to calculate signal-to-noise (SNR) and contrast-to-noise (CNR) ratios that were compared using a Student's t test. Correlations between image quality, SNR, CNR and BMI were sought using a Pearson's test. p<0.05 was considered significant. RESULTS: All examinations were of diagnostic quality (score ≥ 3). In comparison with the reference DE-CTPA and the SE-CTPA protocols, the DE-IR group exhibited a non-inferior image quality (p=0.95 and p=0.21, respectively) and a significantly lower mean image noise (p<0.01 and p=0.01) thus slightly improving the SNR (p=0.09 and p=0.47) and the CNR (p=0.12 and p=0.51). There was a strong negative relationship between BMI and SNR/CNR (ρ=-0.59 and -0.55 respectively), but only a moderate negative relationship between BMI and image quality (ρ=-0.27). CONCLUSION: With iterative reconstruction, objective and subjective image quality of single source DE-CTPA are preserved even though the radiation dose is lowered to that of a single-energy examination, overcoming a major limitation of the DE technique and allowing a widespread use in the clinical routine.
Subject(s)
Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Radiation Dosage , Radiographic Image Interpretation, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Reproducibility of ResultsABSTRACT
Catheter ablation of arrhythmogenic triggers has been validated for the treatment of atrial fibrillation that is refractory to anti-arrhythmic medication. Imaging plays an important role in guiding the procedure as well as in planning and follow-up. The goal of pre-procedural imaging is to obtain a detailed anatomical description of the pulmonary veins, to eliminate a thrombus of the left atrium and to define the prognostic factors. MDCT angiography effectively and simply meets nearly all of these needs. Thus, a precise description of the left atrium anatomy before the procedure is a key factor to success and left atrium volume is a reliable prognostic factor of recurrence. Radiologists should be aware of early and late complications, sometimes severe such as pulmonary vein stenosis, cardiac tamponade or atrial-esophageal fistula, whose positive diagnosis is based on imaging.
Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Catheter Ablation , Multidetector Computed Tomography , Angiography/methods , Humans , Imaging, Three-Dimensional , Postoperative Care , Preoperative CareABSTRACT
Thanks to a simultaneous acquisition at high and low kilovoltage, dual energy computed tomography (DECT) can achieve material-based decomposition (iodine, water, calcium, etc.) and reconstruct images at different energy levels (40 to 140keV). Post-processing uses this potential to maximise iodine detection, which elicits demonstrated added value for chest imaging in acute and chronic embolic diseases (increases the quality of the examination and identifies perfusion defects), follow-up of aortic endografts and detection of contrast uptake in oncology. In CT angiography, these unique features are taken advantage of to reduce the iodine load by more than half. This review article aims to set out the physical basis for the technology, the acquisition and post-processing protocols used, its proven advantages in chest pathologies, and to present future developments.
Subject(s)
Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Radiography, Dual-Energy Scanned Projection/methods , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Angiography/methods , Angiography/trends , Forecasting , Humans , Radiography, Dual-Energy Scanned Projection/trends , Radiography, Thoracic/trends , Tomography, X-Ray Computed/trendsABSTRACT
Since the late 1980s, lung transplantation has emerged as a valid treatment option for some patients with advanced non-neoplastic lung disease. Long-term survival of lung transplant recipients, however, is lower than that of patients with other types of transplantation, because of numerous specific postoperative complications. Thanks to X-ray and CT, radiologists can guide clinicians, helped in this diagnostic approach by the time between the date of injury and date of transplantation. We will detail in this pictorial review the immediate and late surgical complications, the immunological complications, the infectious complications and other late complications.
Subject(s)
Lung Transplantation/adverse effects , Adolescent , Adult , Aged , Diagnostic Imaging , Female , Graft Rejection/diagnostic imaging , Graft Rejection/etiology , Humans , Infections/diagnostic imaging , Infections/etiology , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Tomography, X-Ray Computed , Young AdultABSTRACT
The epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) erlotinib improves survival of lung cancer as second- or third-line therapy. However, after an initial response, most patients will recur, particularly within the central nervous system. The present study reports the case of a 27-yr-old nonsmoking male presenting with a metastatic lung adenocarcinoma with EGFR exon 19 deletion, associated with sensitivity to EGFR-TKI. Gefitinib, followed by chemotherapy and finally erlotinib resulted in prolonged disease control, until multiple liver metastases were detected. After stopping EGFR-TKI, brain metastases with carcinomatous meningitis were diagnosed. A secondary T790M mutation, associated with resistance to EGFR-TKI, was found on the liver biopsy but not in the cerebrospinal fluid. Erlotinib was reintroduced and allowed a quick neurological improvement, even though the extra-cranial disease remained resistant to erlotinib. The present report underscores the interest of molecular monitoring in lung cancer. Persistent cerebral tyrosine kinase inhibitor sensitivity should be considered in patients presenting with an early central nervous system relapse after stopping epidermal growth factor receptor tyrosine kinase inhibitor, even with a T790M-resistant mutation in noncerebral metastases. Questions remain concerning the selection of sub-clones during epidermal growth factor receptor tyrosine kinase inhibitor therapy, which could differ according to metastatic sites, especially in the central nervous system.
Subject(s)
Adenocarcinoma/pathology , Adenocarcinoma/therapy , Central Nervous System Neoplasms/secondary , Central Nervous System Neoplasms/therapy , ErbB Receptors/antagonists & inhibitors , ErbB Receptors/metabolism , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Drug Resistance, Neoplasm , Erlotinib Hydrochloride , Gefitinib , Humans , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Male , Neoplasm Metastasis , Quinazolines/administration & dosage , Recurrence , Treatment OutcomeABSTRACT
Hemostatic disorders can be found in approximately 90% of cancer patients, but clinical expression in only 15%. Hemorrhagic complications are more frequent in acute leukaemia; solid tumors are often associated with deep venous thromboses (DVP). Disseminated intravascular coagulation syndrome (DICS) can be latent or acute, and has various clinical presentations, occurring in the course of many serious conditions including cancer. Patients have higher morbidity and mortality. Irrespective of the etiology, DICS can be revealed by a wide variety of clinical manifestations, from mild biological hemostasis disorders, to intravascular or extravascular microthromboses or lethal hemorrhagic events. We report the case of a 45-year-old female with non-small-cell lung cancer with metastases at diagnosis. The patient developed and finally died of numberous thromboembolic events subsequent to DICS. This case illustrates some rather rare complications of DICS and offers the opportunity to discuss the main therapeutic goal in this situation, i.e. to modulate the disproportionate production of thrombin, inducing thromboses and/or hemorrhages by consumption of the cellular and plasmatic coagulation factors. This means a symptomatic and mostly etiologic treatment, especially chemotherapy which can in itself provoke thromboembolic events.
Subject(s)
Adenocarcinoma/complications , Carcinoma, Non-Small-Cell Lung/complications , Disseminated Intravascular Coagulation/complications , Lung Neoplasms/complications , Thromboembolism/etiology , Adenocarcinoma/diagnosis , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/mortality , Blood Coagulation Tests , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/mortality , Disseminated Intravascular Coagulation/diagnosis , Echocardiography , Female , Humans , Intracranial Thrombosis/etiology , Karnofsky Performance Status , Lung Neoplasms/diagnosis , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/mortality , Middle Aged , Pulmonary Embolism/etiology , Radiography, Abdominal , Radiography, Thoracic , Shock, Cardiogenic/etiology , Stroke/diagnostic imaging , Stroke/etiology , Tomography, X-Ray ComputedABSTRACT
Pituitary metastases are rare and generally asymptomatic. We studied 5 patients with pituitary metastases from lung cancer, illustrating the different clinical features. These metastases were in these cases symptomatic with the manifestation being diabetes insipidus or visual field defect. Histological subtypes from our five patients were as well small cell or non small cell lung cancer. After diagnosis of pituitary metastasis, prognosis seems to be linked to the histological subtype and the stage of lung cancer, rather than to the presence of such metastases.
Subject(s)
Lung Neoplasms/pathology , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/secondary , Adult , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Small Cell/pathology , Diabetes Insipidus/etiology , Humans , Male , Middle Aged , Vision Disorders/etiologyABSTRACT
Imaging of the brachial plexus and of the thoracic outlet syndrome is difficult due to the complex path of the brachial plexus and the morphological variations during the movements. This imaging includes simple radiographs, computed tomographies (CT) and myelo CT scan, magnetic resonance imaging and echo-Doppler. Pathologies of this area include congenital deformities (dysplasia of the upper RIB or of the clavicle), non-malignant or malignant tumors, muscular pathologies, and pathologies of the nerve roots or trunks.
Subject(s)
Brachial Plexus/pathology , Diagnostic Imaging , Thoracic Outlet Syndrome/diagnosis , Diagnosis, Differential , Humans , Predictive Value of TestsABSTRACT
Pathologic processes that may involve the chest wall include congenital and developmental anomalies, inflammatory and infectious diseases, and soft-tissue and bone tumors. Many of these processes have characteristic radiologic appearances that allow definitive diagnosis. Sternal deformities can be visualized at radiography and their severity quantified with computed tomography (CT). In cervical rib, CT with multiplanar reconstruction may demonstrate relevant anatomic detail and the relationship between bone deformity and arterial compression. In Poland syndrome, radiography reveals an area of hyperlucency on the affected side, whereas CT demonstrates the absence of the greater pectoral muscle and clearly depicts associated musculoskeletal anomalies. Tuberculosis typically manifests at radiography and CT as osseous and cartilaginous destruction and soft-tissue masses with calcification and rim enhancement. Aspergillosis involving the chest wall manifests as pulmonary consolidations and permeative osteolytic changes of the rib and spine at CT and as an area of increased signal intensity at T2-weighted magnetic resonance (MR) imaging. Neurogenic tumors and hemangiomas also typically have high signal intensity at T2-weighted MR imaging. Apparent mass extension or unequivocal bone destruction seen at CT or MR imaging may indicate chest wall involvement by lymphoma. Radiologically, soft-tissue sarcomas typically appear as areas of soft-tissue density or attenuation, often associated with necrotic areas of low density or attenuation. At radiography, plasmacytoma typically manifests as well-defined, "punched-out" lytic lesions with associated extrapleural soft-tissue masses. Chondrosarcoma frequently appears as a large, lobulated excrescent mass arising from a rib with scattered flocculent calcifications characteristic of its cartilaginous mix. Familiarity with these radiologic features facilitates accurate diagnosis and optimal patient treatment.
Subject(s)
Magnetic Resonance Imaging , Thoracic Diseases/diagnosis , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aspergillosis/diagnosis , Aspergillosis/diagnostic imaging , Bone Neoplasms/diagnosis , Bone Neoplasms/diagnostic imaging , Cervical Rib Syndrome/diagnosis , Cervical Rib Syndrome/diagnostic imaging , Chondrosarcoma/diagnosis , Chondrosarcoma/diagnostic imaging , Female , Hemangioma/diagnosis , Hemangioma/diagnostic imaging , Humans , Image Processing, Computer-Assisted/methods , Lymphoma/diagnosis , Lymphoma/diagnostic imaging , Male , Middle Aged , Pectoralis Muscles/abnormalities , Plasmacytoma/diagnosis , Plasmacytoma/diagnostic imaging , Poland Syndrome/diagnosis , Poland Syndrome/diagnostic imaging , Sarcoma/diagnosis , Sarcoma/diagnostic imaging , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/diagnostic imaging , Sternum/diagnostic imaging , Sternum/pathology , Thoracic Diseases/congenital , Thoracic Diseases/diagnostic imaging , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed/methods , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/diagnostic imaging , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/diagnostic imagingABSTRACT
In this work the imagery of non-small cell primary bronchial cancers are reviewed. The standard chest x-ray of the thorax remains irreplaceable for the early detection of these pathologies. On the other hand, progress in imagery has propelled thoracic computed tomographic scanning to the pole position for assessing the local and regional extension of the disease as well as for distance spread of these cancers. The latest developments with spiral CT have again improved the performance of CT scanning. Magnetic resonance imaging has a few precisely defined roles in assessing the extension of bronchopulmonary cancers. In particular with involvement of the apices, the chest wall and in the extension into the cardiovascular system. In this article the emphasis is on the illustration of non-small cell bronchial cancers on computed tomography and on magnetic resonance imaging.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Lung Neoplasms/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Adenocarcinoma, Bronchiolo-Alveolar/diagnosis , Adenocarcinoma, Bronchiolo-Alveolar/diagnostic imaging , Angiography , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Diagnosis, Differential , Humans , Lung Neoplasms/diagnostic imaging , Pancoast Syndrome/diagnosis , Pancoast Syndrome/diagnostic imaging , Radiography, ThoracicABSTRACT
Reduction of pain without systematic side effects can be achieved in advanced stages of cancer with precise percutaneous techniques guided with computed tomography (CT). CT guidance allows exact needle positioning, reducing complications and improving the results. Regional analgesia with neurolytic block (neurolysis) is achieved by injection of alcohol or phenol and involves intentional destruction of a nerve or nerves to interrupt nociceptive pathways for weeks or months. Percutaneous alcoholization of bone metastasis is indicated in patients with painful, severe, osteolytic bone metastasis if conventional anticancer therapy is ineffective and high doses of opiates are necessary to control pain and when rapid pain relief is necessary. Bone packing with acrylic glue (methyl methacrylate) is used to prevent pathologic fractures and pain in patients with vertebral body tumors and acetabular metastasis. With these techniques, the radiologist is able to play an active role in pain management and in improving the quality of life of patients with malignancies.
Subject(s)
Ethanol/administration & dosage , Neoplasms/complications , Pain Management , Radiography, Interventional , Tomography, X-Ray Computed , Bone Cements/therapeutic use , Bone Neoplasms/complications , Bone Neoplasms/secondary , Bone Neoplasms/therapy , Fluoroscopy , Humans , Injections , Nerve Block/methods , Pain/etiology , Radiography, Interventional/methodsABSTRACT
Pheochromocytomas are uncommon tumors that represent a potentially curable cause of hypertension. They are usually located in the adrenal glands, but 10% arise from extra-adrenal sites, located along the paravertebral sympathetic chains. We report a case of primary hepatic pheochromocytoma responsible for a severe hypertension in a 24-year-old man. Echotomography showed a lightly heterogeneous mass located in the segment 8 of the liver. Iodine 131-metaiodobenzylguanidine scintigraphy showed a large hepatic concentration of the tracer and no other localization. This tumor appeared highly vascularized on enhanced CT scan and on aortic angiography. Magnetic resonance imaging revealed a hepatic tumor with a high signal intensity on T2-weighted images and with a signal isointense to the liver on T1-weighted images. The hepatic venous sampling contained the highest catecholamine level, whereas the adrenal venous sampling was normal. After surgical resection of the hepatic tumor, the tension level and catecholamines plasmatic level normalized. No recurrent symptoms appeared during a 3-year follow-up.
Subject(s)
Liver Neoplasms/diagnosis , Pheochromocytoma/diagnosis , 3-Iodobenzylguanidine , Adult , Aortography , Catecholamines/blood , Contrast Media , Hepatic Veins , Humans , Hypertension/diagnosis , Iodine Radioisotopes , Iodobenzenes , Magnetic Resonance Imaging , Male , Tomography, X-Ray Computed , UltrasonographyABSTRACT
The authors relate their experience with 7 cases of mediastinal goiter residual to a subtotal thyroidectomy for substernal goiter. The differential diagnosis with ordinary recurrence was based on the absence of connection with the cervical remnant. The reasons for surgical decision-making was mediastinal compression in 4 patients, hyperthyroidism in 1 patient and absent diagnosis in 1 patient; surgery was systematic in 1 asymptomatic patient. Sternal splitting incision was required in 6 patients: alone in 3, associated with cervical incision in 3 others; excision by an exclusively cervical route was possible in one patient. No malignancy was discovered. Postoperative outcome was uncomplicated in all patients. The residual goiter has the same clinical and paraclinical presentation as the ordinary intrathoracic goiter; treatment should be principally surgical for the same reasons. Nevertheless, for this mediastinal tumor, sternum-splitting incision will be required in most cases.
Subject(s)
Goiter, Substernal/surgery , Aged , Female , Goiter, Substernal/diagnostic imaging , Humans , Male , Middle Aged , Recurrence , Reoperation , Thyroidectomy , Tomography, X-Ray ComputedABSTRACT
We present two cases of bilateral, symmetrical pedicular clefts associated with dural ectasia in von Recklinghausen's disease (neurofibromatosis). In one case the pedicular cleft was at the T12 level, while in the other it was at L4, and was responsible for spondylolisthesis. Two hypotheses are advanced to explain the cleft: (1) a congenital, dysplastic osseous defect and (2) bilateral stress fractures related to thinning of the pedicle caused by dural ectasia.
Subject(s)
Dura Mater , Lumbar Vertebrae , Magnetic Resonance Imaging , Meningocele/diagnosis , Neurofibromatosis 1/diagnosis , Spinal Neoplasms/diagnosis , Spondylolisthesis/diagnosis , Thoracic Vertebrae , Tomography, X-Ray Computed , Adult , Arachnoid Cysts/diagnosis , Diagnosis, Differential , Dura Mater/pathology , Female , Humans , Lumbar Vertebrae/pathology , Meningocele/pathology , Thoracic Vertebrae/pathologyABSTRACT
The authors report their experience of CT and MRI imaging in the study of suprasellar pathologies. The problems concerning the differential diagnosis between meningioma developed in the suprasellar region and pituitary tumour with suprasellar extension are discussed and illustrated; the demonstration of bone abnormalities (blistering, hyperostosis) is particularly useful for the diagnosis of presellar meningioma. The CT and MRI features of craniopharyngioma are compared; CT, of course, is more reliable than MRI in detecting calcifications; with both methods it may be difficult to visualize the cystic components. Glioma of the chiasma is readily diagnosed by MRI, provided the tumour is not too large. Non-thrombosed suprasellar aneurysms have typical features at CT and MRI. Cystic lesions are easily identified by MRI. The CT and MRI images of inflammatory lesions are not very typical.