Computed tomography carotid wall plaque characterization using a combination of discrete wavelet transform and texture features: A pilot study.

In 30% of stroke victims, the cause of stroke has been found to be the stenosis caused by plaques in the carotid artery. Early detection of plaque and subsequent classification of the same into symptomatic and asymptomatic can help the clinicians to choose only those patients who are at a higher risk of stroke for risky surgeries and stenosis treatments. Therefore, in this work, we have proposed a non-invasive computer-aided diagnostic technique to classify the detected plaque into the two classes. Computed tomography (CT) images of the carotid artery images were used to extract Local Binary Pattern (LBP) features and wavelet energy features. Significant features were then used to train and test several supervised learning algorithm based classifiers. The Support Vector Machine (SVM) classifier with various kernel configurations was evaluated using LBP and wavelet features. The SVM classifier presented the highest accuracy of 88%, sensitivity of 90.2%, and specificity of 86.5% for radial basis function (RBF) kernel function. The CT images of the carotid artery provide unique 3D images of the artery and plaque that could be used for calculating percentage of stenosis. Our proposed technique enables automatic classification of plaque into asymptomatic and symptomatic with high accuracy, and hence, it can be used for deciding the course of treatment. We have also proposed a single-valued integrated index (Atheromatic Index) using the significant features which can provide a more objective and faster prediction of the class.

Carotid artery wall thickness measured using CT: inter- and intraobserver agreement analysis.

SUMMARY: The purpose of this work was to compare inter- and intraobserver agreement in the analysis of CAWT by using MDCTA. The CAWT in 35 patients was quantified by 4 observers. Bland-Altman statistics were used to measure the agreement between observers. The results of our study demonstrated that the CAWT measured by using MDCTA shows a good reproducibility between observers by considering inter- and intraobserver agreement.

Carotid plaque enhancement and symptom correlations: an evaluation by using multidetector row CT angiography.

BACKGROUND AND PURPOSE: The identification of plaque characteristics that determine its vulnerability is extremely important. The purpose of this work was to evaluate CPE after administration of contrast material and to assess whether there is a statistical association between CPE and cerebrovascular symptoms. MATERIALS AND METHODS: Ninety-seven consecutive patients (69 men, 28 women; mean age, 62 years; age range, 39-82 years), studied by using an MDCT scanner, were retrospectively analyzed. Examinations were performed before and after administration of contrast medium. Plaque enhancement was analyzed, and the obtained data were compared with the patient's symptoms. Patients were classified as symptomatic (TIA or stroke with a temporal window of 6 months) or asymptomatic according to neurologic assessment and the TOAST criteria. The ROC curve and Az were calculated, and multiple logistic regression analysis was performed. RESULTS: Thirty-nine patients were excluded because they had calcified plaques (40.2%). CPE was observed in 74% of the remaining 58 patients. A statistically significant difference was observed between symptomatic and asymptomatic patients for the presence of CPE (P = .0013; OR = 7.5). Moreover, we observed that CPE was higher in fatty plaques (P = .035) than in mixed ones and more frequent in the former (P = .0119). The ROC curve demonstrated that a threshold of 15 HU is associated with a specificity and sensitivity of 83.33% and 76.47%, respectively. Multiple logistic regression showed that CPE and symptoms are associated (P = .0315). CONCLUSIONS: The results of our study suggest that for noncalcified carotid plaques, the presence of CPE is associated with cerebrovascular symptoms. Fatty plaques are more likely to have CPE compared with mixed plaques.

Carotid artery wall thickness and leukoaraiosis: preliminary results using multidetector row CT angiography.

BACKGROUND AND PURPOSE: LA is a condition caused by chronic cerebral ischemia and it represents an independent risk for stroke. The purpose of this work was to determine whether CAWT studied by using MDCTA is correlated with LA and its severity. MATERIALS AND METHODS: Ninety-eight patients ≥60 years of age were retrospectively studied by using multidetector row CT. Supra-aortic vessel analysis and brain CT were performed in the same procedure. In each patient, CAWT was measured with an internal digital caliper, and the presence and severity of LA were assessed. Correlation coefficients by using Spearman statistics and ROC curves were calculated. A P value < .05 was considered statistically significant. RESULTS: Measurements of the distal common CAWT ranged from 0.5 to 1.53 mm. A correlation between LA and increased CAWT was observed (Pearson correlation, 0.33; P < .001). On the basis of a threshold of 0.9 mm, an important statistical association between increased CAWT and LA (P < .0001) was found. With the same threshold, ROC curve analysis indicated a sensitivity of 55% and a specificity of 75% for LA. CONCLUSIONS: The results of this study show a statistically significant correlation between increased CAWT and LA (and its severity).

Role and application of hysterosalpingography and Fallopian tube recanalization.

AIM: The prevalence of infertility in the United States is 15-20% and this condition represents an important medical problem. The purpose of this work was to evaluate therapeutical efficacy of 2 consecutive hysterosalpingography (HSG) followed each other after 4 week compared with the fallopian tube recanalization (FTR). METHODS: Two groups of 80 patients paired for mean age and age range (age range, 23-37 years; mean age, 30 years), were assessed for pregnancy rate (two-year follow-up) by using two consecutive HSG in one group and HSG and tube recanalization in the second group. Pain perception and dose delivered were assessed. Statistical analysis was performed to evaluate significant differences between the two approaches. RESULTS: Pregnancy rate after TFR was 51% whereas pregnancy rate after two consecutive HSG was 31.3% (P= 0.016; OR 2.31) and all the pregnancies were observed in those women that showed a positive variation in second HSG with a pregnancy rate of 47% (P=0.776; OR=1.18). In one case a serious complication was observed (1.25%): a tubal perforation. Minor bleeding sometimes lasted for as long as 48 h but never required any medical treatment. Pain assessment and dose delivered were statistically different by using these two methods (P= 0.027 and P<0.001, respectively) CONCLUSION: Therapeutical efficacy of two consecutive HSG followed each other after four week compared with the FTR are similar when the second HSG shows the presence of Fallopian tube patency.

Study of endoleaks after endovascular repair by using MDCTA.

PURPOSE: Our purpose was to investigate the multi-detector-row CT angiography (MDCTA) application in endoleak detection. METHODS: Fifty-nine patients that underwent endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm with endoluminal stent graft were retrospectively studied. MDCTA scans were obtained after administration of 110-130 mL of contrast material using a 4-6 mL/sec flow rate. We made unenhanced, arterial (15-20 sec) and delayed (100 sec) acquisitions. For each patient four MDCTA datasets (pre-EVAR, 1, 6, and 12 months follow-up) were obtained. Each examination was studied by two observers. Kappa value was calculated in order to evaluate inter-observer agreement. RESULTS: Twenty-one endoleaks were detected in eighteen patients. Fifteen and eighteen endoleaks were detected by using biphasic arterial CT and biphasic delayed CT respectively (sensitivity of 71.4% and 85.7% respectively). We observed a positive correlation between the presence of endoleak and the increasement in aneurysm size. Interobserver agreement was 88.1% and kappa value was 0.685. CONCLUSIONS: Biphasic CT for endoleak detection is significantly superior to arterial and delayed phases respectively. We observed a good interobserver agreement.

Correlation between kinking and coiling of the carotid arteries as assessed using MDCTA with symptoms and degree of stenosis.

AIM: To evaluate whether the presence of kinking and coiling of the carotid arteries is associated with symptoms and an increased degree of carotid artery stenosis. MATERIALS AND METHODS: One hundred and fifty-three consecutive patients examined using multidetector-row computed tomography angiography (MDCTA) were studied retrospectively. The arterial phase was obtained by injecting 4-6ml/s of contrast material. A total of 306 carotid arteries were assessed for the presence of tortuosity. The degree of carotid artery stenosis was measured according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Logistic regression analysis was performed to determine whether an independent association existed between the presence of vessel tortuosity, symptoms, and the degree of carotid artery stenosis. RESULTS: Kinking was detected on 37 occasions (12.1%) and coiling on 20 occasions (6.5%). Using Yates's corrected chi-square test, an association between kinking and symptoms (p=0.002) was observed, but not between coiling and symptoms (p=0.31). Logistic regression confirmed that the strongest association was present between stenosis degree and symptoms (p=0.001), but kinking (p=0.009) and age (p=0.001) were also significantly associated with symptoms. A Mann-Whitney test did not demonstrate correlation between coiling (p=0.16) or kinking (p=0.22) and increased degree of carotid artery stenosis. CONCLUSION: The results suggest that kinking may be associated with symptoms, whereas coiling does not appear to be associated with symptoms. The degree of carotid artery stenosis severity is not related to the presence of vessel tortuosity.

Associations between carotid artery wall thickness and cardiovascular risk factors using multidetector CT.

BACKGROUND AND PURPOSE: It has been demonstrated that the increase in CAWT is associated with an increased risk of stroke and its severity. The aim of this study was to determine whether CAWT evaluated by MDCTA is associated with the following cardiovascular risk factors: hypertension, diabetes mellitus, dyslipidemia, and smoking. MATERIALS AND METHODS: This was a retrospective study. One hundred sixty-eight patients (120 men; mean age, 68.96 years ± 11.2 years SD) were analyzed by using a multidetector row CT scanner. In each patient, CAWT was measured by using an internal digital caliper. Continuous data were described as the mean value ± SD and were compared by using the Student t test. We performed simple logistic regressions to evaluate the association between CAWT and the following: hypertension, diabetes mellitus, dyslipidemia, and smoking. A P value < .05 indicated statistical significance. RESULTS: The distal common CAWT varied from 0.5 to 1.5 mm. We observed that hypertension and diabetes mellitus were associated with increased (>1 mm) CAWT (P = .0041 and P = .0172, respectively). There was no significant association between increased CAWT and dyslipidemia or smoking. CONCLUSIONS: In our selected group, the results of this work show that an increased CAWT is associated with the cardiovascular risk determinants hypertension and diabetes. Further studies are necessary to evaluate whether it is possible to apply our observations to the general population.

Superior mesenteric artery spontaneous and isolated dissection diagnosed by using MDCTA.

We report the case of a 49-year-old man admitted to our Institute because he suffered acute abdominal pain induced by eating. Sonography don't revealed pathological findings. Then underwent a multi-detector row computed tomography angiography (MDCTA) that revealed an intimal flap separating true and false lumens that was located 2 cm from the origin of the superior mesenteric artery (SMA) and with an extension of 8 cm. Since the dissection was limited without occlusion of the SMA and the mesenteric marginal artery served as a collateral vessel on the distal side of the SMA, the treatment has been conservative. Improved CT technology facilitates the diagnosis of superior mesenteric artery dissection. Prompt diagnosis and treatment result in the lowest mortality rate and minimize the prevalence of intestinal infarction. Only 107 cases (including the present case) of isolated spontaneous SMA dissection without associated aortic dissection were identified from the literature.

Assessment of intracranial arterial stenosis with multidetector row CT angiography: a postprocessing techniques comparison.

BACKGROUND AND PURPOSE: It was demonstrated the some patients with stroke have intracranial stenosis of 50% or greater and the identification of intracranial arterial stenosis is extremely important in order to plan a correct therapeutical approach. The aim of this study was to assess the image quality and intertechnique agreement of various postprocessing methods in the detection of intracranial arterial stenosis. MATERIAL AND METHODS: Eighty-five patients who were studied by using a multidetector row CT scanner were retrospectively analyzed. A total of 2040 segments were examined in the 85 subjects. Intracranial vasculature was assessed by using MPR, CPR, MIP, and VR techniques. Two radiologists reviewed the CT images independently. Cohen weighted kappa statistic was applied to calculate interobserver agreement and for image accuracy for each reconstruction method. Sensitivity, specificity, PPV, and NPV were also calculated by using the consensus read as the reference. RESULTS: Two hundred fifteen (10.5%) stenosed artery segments were identified by the observers in consensus. The best intermethod kappa values between observers 1 and 2 were obtained by VR and MIP (kappa values of 0.878 and 0.861, respectively), whereas MPR provided the lowest value (kappa value of 0.282). VR showed a sensitivity for detecting stenosed segments of 88.8% and 91.6% for observers 1 and 2, respectively. The highest positive predictive value was also obtained by VR at 95% and 99% for observers 1 and 2, respectively. Image accuracy obtained by using VR was the highest among all reconstruction methods in both observers (185/255 and 177/255 for observers 1 and 2, respectively). CONCLUSIONS: The results of our study suggest that VR and MIP techniques provide the best interobserver and intertechnique concordance in the analysis of intravascular cranial stenosis.

Imaging of the endoleak after endovascular aneurysm repair procedure by using multidetector computer tomography angiography.

Abdominal aortic aneurysms (AAA) are an important cause of death in elderly men. Most used treatment options are endovascular aneurysm repair (EVAR) and open surgical repair. After the endovascular stent graft placement, however, several complications may occur and an important complication of EVAR is endoleak formation which occurs in approximately one-fourth of patients. Endoleak represents a blood flow outside the stent graft lumen but within the aneurysm sac. For these reasons, unlike the minimal imaging follow-up that is typically performed after surgical repair, patients undergoing EVAR require a life-long postoperative surveillance imaging. In the last years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (multidetector CT angiography, MDCTA), CT imaging became the most commonly used examination for endoleak detection. Moreover, the volume data obtained can be further rendered to generate high quality two-dimensional (2D) and three-dimensional (3D) images, that allow a better distinction between Endoleak type II, III and IV. Purpose of this study was to review and describe MDCTA potentialities in the detection of endoleak after EVAR procedures.

Multidetector row CT of the brain and carotid artery: a correlative analysis.

AIM: To evaluate the association between types of carotid plaque, the presence of prior ischaemic events detectable with CT, and patient's symptoms. MATERIALS AND METHODS: Between January 2004 and May 2006, 112 patients were evaluated using multidetector row computed tomography angiography (MDCTA) of the carotid arteries and computed tomography (CT) of the brain. Carotid arteries were categorized by evaluating the degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, the type of plaque, and the presence of plaque ulceration. The brain was assessed via CT for the presence, type, and position of lesions. Chi-square tests, Student's t test, and simple logistic regression analysis were performed and the Cohen kappa test was applied for interobserver variability measurement. RESULTS: The Chi-square test indicated a statistically significant association between the presence of fatty plaques (p=0.005) and CT-detectable lesions in the brain (p=0.004). Moreover, the number of patients with CT-detectable brain lesions was greater in patients with >70% stenosis than in those with <70% stenosis (p=0.007). Logistic regression confirmed the association between fatty plaque and symptoms (p=0.001), between >70% stenosis and symptoms (p=0.041), and an inverse association between calcified plaque and symptoms (p=0.009). CONCLUSION: MDCTA allows adequate evaluation of the type of plaque. The results of the present study indicate that there is an association between cerebral lesions, symptoms, and fatty plaque in the carotid artery. The degree of stenosis also correlated with cerebral lesions and symptoms. According to the obtained data, the type of carotid plaque should be included among primary parameters in the classification of patients' risk class.

Multi-detector-row CT of muscles with volume rendering technique.

The aim of this paper was to analyze the concept of volume rendering (VR) technique in order to define and visualize the muscles by using multi-detector-row computed tomography (MDCT) scanner. Second, to understand the current indications for performing MDCT study of the muscles underlining radiation exposure and diagnostic efficacy. Thanks to the use of fast scanning and thin collimation, MDCT can obtain near-isotropic voxels, providing an excellent image detail. Moreover, with the use of postprocessing procedures it is possible to obtain volumetric images with an impressive visual impact (dissection-like images). With the use of correct techniques, in particular VR reconstruction, it is currently possible to define body musculature detecting pathological alterations. The aim of this review was to describe the procedure to obtain a correct visualization of the body muscles and to show volume rendered images supplied by this postprocessing technique. The authors retrospectively studied 30 patients by using a MDCT. Each time projection data were reconstructed to generate section thickness as thinnest as possible which were then reprocessed to obtain VR images. For the whole patient cohort the authors generated multiple VR reconstructed images in order to define the most efficient strategies to evaluate the different types of muscles. MDCT can provide excellent visualization of the superficial musculature, in particular it defines with accuracy normal anatomy. A correct reconstruction of projectional data is important to achieve high quality images.

Fissured fibrous cap of vulnerable carotid plaques and symptomaticity: are they correlated? Preliminary results by using multi-detector-row CT angiography.

PURPOSE: Carotid artery plaque with a disrupted fibrous cap is characterized by a higher tendency to rupture, resulting in a higher rate of transitory ischemic attack and stroke. The purpose of our study was to evaluate whether there is a statistically significant correlation between the presence of fissured fibrous cap (FFC) (assessed by using multi-detector-row CT angiography (MDCTA)) and ipsilateral symptomaticity. MATERIAL AND METHODS: 147 patients (105 males, 42 females; mean age 63 years, range 37-84) with a stenosis of at least 50% or a plaque alteration at sonography were retrospectively studied, yielding a total of 294 carotid arteries, by using a multi-detector-row CT (MDCT) scanner. A search for detection of FFC and a correlation with previously registered data about patients' symptomaticity by using statistical assessment were performed. Each examination was assessed independently by two readers and interobserver agreement was calculated. RESULTS: Among the 147 patients included in the study group, 15 were excluded because of inadequate quality images. In the 132 remaining patients, for a total of 264 carotids assessed, 30 FFCs were detected by using MDCTA and overall there were 36 symptomatic patients (12 ipsilateral symptomatic patients with FFC). A statistical correlation between the presence of FFC and symptomaticity (p = 0.0032) was found. The kappa value between readers was 0.781. CONCLUSIONS: MDCT may depict FFC and the results of our study suggest that FFC may be used as an indicator for prediction of potential cerebrovascular pathology. The interobserver agreement obtained was good.

Diagnostic sensitivity of multidetector-row spiral computed tomography angiography in the evaluation of type-II endoleaks and their source: comparison between axial scans and reformatting techniques.

BACKGROUND: After endovascular stent-graft placement, several complications may occur. Retrograde filling of the aneurysm (type-II endoleak) is the most common. PURPOSE: To evaluate the accuracy, image quality, and interobserver agreement of multidetector-row spiral computed tomography angiography (MDCTA) in the diagnosis of type-II endoleak, by using various types of reformatting techniques in comparison to regular axial images. MATERIAL AND METHODS: Twenty-four patients who had had endovascular repair of an infrarenal abdominal aortic aneurysm with stent graft were retrospectively studied. In 12 of 24 patients, a type-II endoleak was found. CT scans were obtained after intravenous administration of 130 ml of nonionic contrast material using a 4-6-ml/s flow rate. All patients were investigated with axial scans, multiplanar reconstruction (MPR), maximum intensity projection (MIP), shaded-surface display (SSD), and volume-rendering (VR) techniques. For each patient and for each reconstruction method, the image quality of the scans was scored as 0 for bad quality, 1 for poor quality, 2 for good quality, and 3 for excellent quality images. Two radiologists reviewed the CT images independently. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each reconstruction method, with the axial images as the reference method. Interobserver agreement and kappa value were also recorded. RESULTS: MPR showed the highest sensitivity (83% and 67% for observers 1 and 2, respectively), PPV (91% and 80% for observers 1 and 2, respectively), and NPV (85% and 71% for observers 1 and 2, respectively), whereas VR showed the highest specificity (92% for both observer 1 and 2). CONCLUSION: Reformatting techniques provide good-quality images; nevertheless, their efficacy in the study of type-II endoleak was found to be suboptimal in comparison to regular axial images. The MPR technique is probably the best choice in conjunction with axial images.

Osteoma of the mandible: case report and application of multi-detector-row CT rendering technique.

Osteoma is an uncommon benign slow growing neoplasm of the bone, characterized by proliferation of osteoblasts forming bone trabeculas in a connective tissue stroma. After paranasal sinus, mandible is its second most frequent location. The osteoma can be central, peripheral or of extraskeletal type. Peripheral osteomas are quite uncommon. This fact suggests that peripheral osteoma of the mandible may be traumatically damaged, mostly because of muscle traction. This paper reports a case of peripheral osteoma located in the mandible. The patient underwent a multi-detector-row computed tomography (MDCT) in order to plan corrective surgery. MDCT images were post-processed with volume rendering techniques.

Differences between MIP and MPR techniques in the carotid artery stenosis degree measurement. Evaluation using multi-detector-row CT angiograph.

AIM: Stroke is the third leading cause of mortality in the world and the stenosis degree is considered a fundamental parameter for the definition of the therapeutic approach. With the development of Multi-Detector-Row CT (MDCTA) scanner, computed tomography has become a widely used imaging technique for categorizing carotid artery stenosis degree. The purpose of this paper is to compare two CT post-processing procedures, maximum intensity projection (MIP) and multi planar reconstruction (MPR) in order to evaluate their sensitivity and inter-technique agreement. METHODS: For the purpose 45 patients (35 males and 10 females), that underwent MDCTA for carotid artery evaluation, have been retrospectively evaluated. Data set were processed with the study group's workstations, by using MPR and MIP algorithms. Each patient was assessed for stenosis degree by using North American Symptomatic Carotid Endarterectomy Trial method. Statistic analysis was performed to determine the sensitivity of the used procedure. The Cohen kappa test was applied to assess the level of intra-observer agreement. Image quality was also evaluated. RESULTS: MPR sensitivity was 87.8% (95% confidence interval [CI] 81-94.5%) and MIP sensitivity was 91.1% (95% CI 85.2-97%). Agreement in MPR was 0.792 with a standard error (SE) of 0.066, and agreement in MIP was 0.836, with a SE of 0.072. CONCLUSION: Results of the study indicate the MIP algorithm is more sensitive than MPR. Best intra-observer agreement and image quality results were also observed in the MIP. Data suggest also that MIP should be the post-processing procedure to be utilized in the evaluation of carotid artery stenosis degree, when using MDCTA. Presence of big calcified plaque can determine difficulties in MIP evaluation of stenosis degree.

Accessory renal artery stenosis and hypertension: are these correlated? Evaluation using multidetector-row computed tomographic angiography.

BACKGROUND: Renal artery stenosis may produce hypertension, and this condition is referred to as renovascular hypertension (RVH). PURPOSE: To evaluate, by using multidetector-row spiral computed tomographic angiography (MDCTA), whether a relationship between accessory renal artery stenosis and hypertension may be hypothesized. MATERIAL AND METHODS: 214 patients (142 males, 72 females; mean age 66 years) who had previously undergone an MDCTA to study the abdominal vasculature were retrospectively studied. Patients with renal artery stenosis (RAS) were excluded from this analysis. The patients were studied by means of a four-detector-row CT, and scans were obtained after intravenous bolus administration of 110-140 ml of a nonionic contrast material with a 3-6 ml/s flow rate. As a second step, by means of statistical analysis, hypertension data were compared with findings of accessory artery stenosis. Two radiologists first independently reviewed the MDCTA images and then, in case of disagreement, in consensus. Interobserver agreement was calculated for all measurements. RESULTS: The overall number of detected accessory renal arteries was 74 in 56 of the 214 patients. Accessory renal artery stenosis was detected in 21 of the 56 patients. There was a difference in the prevalence of hypertension between patients with (n = 21) and without (n = 35) accessory renal artery stenosis (P = 0.0187). Interobserver agreement was good (kappa value 0.733). CONCLUSION: Any statistical association between the presence of accessory renal artery stenosis and hypertension could not be disclosed. However, accessory renal artery stenosis, detected by MDCTA, is an important pathological sign that the radiologist has to assess in the light of its possible association with hypertension.

Multidetector row CT angiography in the evaluation of the hepatic artery and its anatomical variants.

A detailed study of the hepatic arteries is mandatory for several pathological conditions affecting the liver. Multidetector-row CT angiography (MDCTA), using fast patient imaging and thin collimation, generates near-isotropic voxels, producing excellent image quality and detail. In particular pre-surgical planning for patients undergoing hepatic surgery (tumour resection, transplantation) or selective chemotherapy infusion, requires a complete detailed assessment of hepatic vessel anatomy. The purpose of this article is to review the normal hepatic artery anatomy and its variants according to the Michels Classification, describing the post-processing techniques that can be employed to achieve the best results.

Carcinoma cuniculatum of the larynx: a rare clinicopathological entity.

OBJECTIVE: Carcinoma cuniculatum is a rare variant of low-grade squamous cell carcinoma. We report the second case of carcinoma cuniculatum of the larynx in the literature. METHOD: Case report and review of the world literature concerning carcinoma cuniculatum of the larynx and upper aerodigestive tract. RESULTS: A histologically proven carcinoma cuniculatum of the larynx is reported in a 72-year-old man. The patient underwent a supracricoid laryngectomy with crico-hyoidopexy, and was free of disease at 70 months after surgery. We emphasise the clinical presentation, histology and therapeutic approach of this rare tumour. CONCLUSION: To our knowledge this is the second report in the world literature of carcinoma cuniculatum of the larynx. Carcinoma cuniculatum of the larynx must be considered as a distinct 'clinicopathological entity' and close cooperation between the clinician and the pathologist is essential for the correct diagnosis of these tumour as regards to the correct classification and therapy.