RESUMO
BACKGROUND AND PURPOSE: To compare diagnostic performances for cholesteatoma diagnosis of incremental MRI protocols including non-echo planar diffusion-weighted imaging (DWI) performed on 3T and 1.5T scanners. MATERIALS AND METHODS: Thirty-nine patients with suspected cholesteatoma underwent 3T and 1.5T non-echo planar DWI and additional unenhanced T1-, delayed gadolinium-enhanced T1- and high-resolution T2-weighted standard acquisitions. Patients either underwent surgical tympanoplasty (n=21) or close clinicoradiological follow-up (n=18). Four radiologists independently and prospectively interpreted two incremental MRI protocols, differing in the magnetic field strength of the diffusion-weighted acquisition and comprising the three standard sequences. At each step, diagnostic performances were expressed as sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Forty middle ear lesions including 21 cholesteatomas were identified. Univariate and multivariate analysis did not demonstrate significant reader, sequence addition or DWI magnetic field effect on diagnostic performances. Concerning non-echo planar DWI alone, sensitivity, specificity, positive predictive value, negative predictive value and accuracy ranged between 90.5-100%, 68.4-100%, 76.9-100%, 90.0-100% and 82.5-95.0, respectively. CONCLUSION: Non-echo planar DWI for cholesteatoma diagnosis can be performed on 1.5T or 3T scanners indifferently. High sensitivity and negative predictive value and relatively lower specificity and positive predictive value are achieved by a single non-echo planar DWI protocol.
Assuntos
Colesteatoma da Orelha Média/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem Ecoplanar/métodos , Imagem Multimodal/métodos , Reconhecimento Automatizado de Padrão/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Gadolínio , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Here we report a case of pseudotumoral recurrence of allergic fungal sinusitis with involvement of the skull base that was successfully treated with systemic corticosteroids and itraconazole without surgery. This report discusses the sometimes misleading radiological and clinical features as well as the diagnostic and therapeutic challenges of a condition that should be recognized by ENT specialists, neurosurgeons, ophtalmologists and radiologists.
Assuntos
Aspergilose/diagnóstico , Aspergilose/terapia , Aspergillus fumigatus , Rinite Alérgica Perene/microbiologia , Sinusite/microbiologia , Base do Crânio/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Rinite Alérgica , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/terapia , Sinusite/diagnóstico , Sinusite/terapiaRESUMO
OBJECTIVE: To compare the prevalence of cardiovascular risk factors (CVRF) in patients with superior vestibular neuritis (SVN) versus the general French population, and to examine the possibility of vascular etiology in acute superior vestibular deficit. MATERIAL AND METHODS: A single-center retrospective study compared the prevalence of hypercholesterolemia, hypertension, diabetes, smoking, cardiovascular disease and atrial fibrillation between patients with SVN and the French general population. Inclusion criteria comprised: rotatory vertigo lasting several days, without hearing impairment or neurological signs, with anterior and lateral semicircular canal involvement on video-Head-Impulse-Test (vHIT). A senior radiologist analyzed superior vestibular nerve and inner ear structure enhancement on cerebellopontine MRI. RESULTS: One hundred and eighteen cases of SVN were included from May 2016 to February 2020. Statistical analyses concerned 106 cases. The SVN population had significantly less hypercholesterolemia (RR=0.40) than the general French population. There was no significant difference concerning other CVRFs. Superior vestibular nerve enhancement was observed on 84% of MRIs. CONCLUSION: Prevalence of CVRF was not higher in patients with SVN than in the general population. The present study highlighted involvement of the superior vestibular nerve more than of the anterior vestibular artery in SVN.
Assuntos
Doenças Cardiovasculares , Hipercolesterolemia , Neuronite Vestibular , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos Transversais , Fatores de Risco de Doenças Cardíacas , Humanos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Canais Semicirculares , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/epidemiologiaRESUMO
PURPOSE: This study aimed to evaluate the value of diffusion-weighted imaging (DWI) and gadolinium-enhanced dynamic magnetic resonance imaging (MRI) for differentiating benign and malignant parotid gland tumors, and for characterizing the various histological types (pleomorphic adenoma, and Warthin's and malignant tumors). PATIENTS AND METHODS: This retrospective study involved 60 patients with suspected parotid gland tumors (mean age: 59.4 years), and was carried out from April 2005 to February 2008. All had undergone pathological examination. All MRI examinations were performed using the Siemens Magnetom Avanto 1.5T MRI system. Non-enhanced T1-weighted (T1W), gadolinium-enhanced fat-suppressed T1W and T2-weighted (T2W) images were obtained for all 60 patients, with diffusion-weighted echoplanar imaging (DW-EPI) and apparent diffusion coefficient (ADC) evaluation in 59 patients, and gadolinium-enhanced dynamic MRI sequences in 51 patients. Interpretation was carried out by two experienced radiologists (the first evaluation used T1W, gadolinium-enhanced fat-suppressed T1W and T2W images; the second evaluation used T1W, T2W, DWI and dynamic MRI) and, for each case, the benign/malignant nature of the tumor and its histological type were determined. RESULTS: After the second reading, increases were noted in sensitivity, specificity, malignant positive predictive value (PPV) and negative predictive value (NPV), as well as in accuracy (90-100% for the first observer, and 90-97% for the second observer). Interobserver reliability also showed a significant increase from the first to the second reading (kappa=0.63 to 0.87, respectively). CONCLUSION: Gadolinium-enhanced dynamic MRI and DW-EPI with ADC evaluation improved the performance of MRI in distinguishing between benign and malignant parotid gland tumors, and characterizing the different histological types of benign tumors (pleomorphic adenoma and Warthin's), thus leading to greater consensus in interpretation of the images.
Assuntos
Algoritmos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias Parotídeas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Humans differ from other primates in their significantly lengthened growth period. The persistence of a fetal pattern of brain growth after birth is another important feature of human development. Here we present the results of an analysis of the 1.8-million-year-old Mojokerto child (Perning 1, Java), the only well preserved skull of a Homo erectus infant, by computed tomography. Comparison with a large series of extant humans and chimpanzees indicates that this individual was about 1 yr (0-1.5 yr) old at death and had an endocranial capacity at 72-84% of an average adult H. erectus. This pattern of relative brain growth resembles that of living apes, but differs from that seen in extant humans. It implies that major differences in the development of cognitive capabilities existed between H. erectus and anatomically modern humans.
Assuntos
Encéfalo/anatomia & histologia , Encéfalo/crescimento & desenvolvimento , Cognição/fisiologia , Fósseis , Hominidae/anatomia & histologia , Hominidae/crescimento & desenvolvimento , Crânio/anatomia & histologia , Envelhecimento/fisiologia , Animais , Evolução Biológica , Encéfalo/fisiologia , Educação Infantil , História Antiga , Hominidae/fisiologia , Humanos , Lactente , Crânio/crescimento & desenvolvimento , Fatores de TempoRESUMO
OBJECTIVES: Attempt to describe and analyse the radiological and nuclear medicine patterns of sinonasal sarcoidosis (SNS) still poorly reported in the literature. MATERIAL AND METHODS: Retrospective single institution study of 22 consecutive patients with symptomatic biopsy-proven SNS to evaluate the interest of CT, MRI, (67)Ga scintigraphy and (18)F-FDG PET/CT for diagnosis and therapeutic follow-up. RESULTS: Nodules of the septum and turbinates are the most suggestive CT and MRI features. Other CT features such as sinusal filling, mucosal thickening, osteosclerosis or destructive sinonasal lesions are not specific and depend on clinical context and evolutive stage of SNS. (18)F-FDG PET/CT provides complete morphofunctional mapping of active inflammatory sites related to sarcoidosis with a better diagnostic sensitivity (100%) compared to (67)Gallium scintigraphy (75%). The changes in (18)F-FDG uptake intensity could reflect the efficacy of treatment. CONCLUSION: SNS is an uncommon and probably underdiagnosed phenotype of sarcoidosis. Even if guided biopsy remains necessary for SNS confirmation, medical imaging plays an important role in diagnosis and therapeutic follow-up. CT features with nodules of the septum and/or turbinates are suggestive of SNS contrary to other nonspecific CT findings. CT imaging is directly related severity, reversibility and course of SNS and provide an original radiological staging system in order to predict patient clinical outcome. PET/CT may be used for diagnosis assessement but also to monitor treatment response in a given clinical context, in a patient with histopathologically-proven SNS. Prospective and long term studies are necessary to validate these preliminary results.
Assuntos
Fluordesoxiglucose F18 , Radioisótopos de Gálio , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Doenças Nasais/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Tomografia por Emissão de Pósitrons , Cintilografia , Sarcoidose/diagnóstico , Tomografia Computadorizada Espiral , Tomografia Computadorizada por Raios X , Adulto , Idoso , Glicemia/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Deformidades Adquiridas Nasais/diagnóstico , Prognóstico , Recidiva , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND PURPOSE: Middle ear adenomatous tumors (MEAT) are rare tumors which can be begin or malignant and can present a neuroendocrine differentiation. Their radiological aspect is very similar to glomus tympanicum (GT) which are the most common tumoral lesions of the middle ear. We present several radiological and clinical findings that could help radiologists to accurately identify MEAT. MATERIAL AND METHODS: We retrospectively reviewed the radiological and clinical findings of three patients with MEAT and of eight patients with GT. Diagnostic was obtained after surgical resection in all cases. All patients had high resolution CT and MR of the middle ear associated with a subtracted digital carotid angiography. Tumor location, size, extension, signal intensity, and enhancement were analysed. From the medical records of the patients, clinical manifestations (hearing loss, tinnitus), evolution length and recurrences were noted. RESULTS: MEAT and GT appeared as tissular lesion with significant enhancement on CT and MR. A vascular blush was present on angiography in all cases of GT and absent from all cases of MEAT. A close relationship between the tumor and the Jacobson's nerve or its branches was identified in all cases of GT. Pulsatile tinnitus was present in all patients with GT and absent in all patients with MEAT. CONCLUSION: A middle ear tissular lesion clearly separated from the Jacobson nerve or its branches, showing significant enhancement after contrast medium injection but with a normal angiography, should make one suspicious for MEAT.
Assuntos
Tumor Adenomatoide/diagnóstico , Neoplasias da Orelha/diagnóstico , Orelha Média/patologia , Tumor de Glomo Timpânico/diagnóstico , Tumor Adenomatoide/diagnóstico por imagem , Tumor Adenomatoide/patologia , Adulto , Angiografia Digital , Artérias Carótidas/patologia , Diagnóstico Diferencial , Neoplasias da Orelha/diagnóstico por imagem , Neoplasias da Orelha/patologia , Orelha Média/diagnóstico por imagem , Glomo Timpânico/diagnóstico por imagem , Glomo Timpânico/patologia , Tumor de Glomo Timpânico/diagnóstico por imagem , Tumor de Glomo Timpânico/patologia , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fotomicrografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.
Assuntos
Paralisia de Bell/diagnóstico , Paralisia de Bell/terapia , Doença Aguda , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Antivirais/uso terapêutico , Paralisia de Bell/tratamento farmacológico , Meios de Contraste , Descompressão Cirúrgica , Esquema de Medicação , Quimioterapia Combinada/métodos , Nervo Facial/diagnóstico por imagem , Paralisia Facial/diagnóstico , França , Gadolínio , Herpes Zoster da Orelha Externa/tratamento farmacológico , Humanos , Oxigenoterapia Hiperbárica , Imageamento por Ressonância Magnética , Exame Neurológico , Otolaringologia , Modalidades de Fisioterapia , Prognóstico , Recuperação de Função Fisiológica , Sociedades MédicasRESUMO
Branchio-oculo-facial syndrome (BOFS) is an autosomal-dominant condition characterized by three main features, respectively: branchial defects, ocular anomalies, and craniofacial defects including cleft lip and/or palate (CL/P). We report on one family with three affected, and two sporadic cases that have been found to carry missense mutations in the newly reported BOFS gene: TFAP2A. This report confirms the involvement of this transcription factor in this developmental syndrome with clinical variability. Moreover, we present CT scan temporal bone anomalies in the familial cases, related to branchial arch defects, highlighting the importance of radiological investigations for differential diagnosis.
Assuntos
Síndrome Brânquio-Otorrenal/genética , Osso Temporal/anormalidades , Fator de Transcrição AP-2/genética , Sequência de Aminoácidos , Sequência de Bases , Síndrome Brânquio-Otorrenal/complicações , Criança , Análise Mutacional de DNA , Feminino , Humanos , Masculino , Dados de Sequência Molecular , Linhagem , Fator de Transcrição AP-2/fisiologiaRESUMO
OBJECTIVES: The purpose of this study was to investigate the correlation between hearing loss and inner ear enhancement in patients suffering from leptomeningeal carcinomatosis (LC) involving the internal acoustic canal (IAC). Previous studies have only reported an association between IAC enhancement and sensorineural deafness. MATERIAL AND METHODS: In a prospective study conducted from 2005 to 2007, 14 patients with LC involving the IAC underwent high-resolution MRI and otolaryngology examination. MRI images were analyzed by two experienced radiologists who were blinded to audiologic investigation results. RESULTS: Three (21%) patients had IAC and inner ear enhancement on gadolinium-weighted MRI. All three had a sensorineural hearing loss. Eleven (79%) patients had IAC enhancement without inner ear enhancement. Nine of these 11 patients were free of sensorineural hearing loss. Only two of them had sensorineural deafness. CONCLUSION: These findings are suggestive of a relation between hearing loss and inner ear enhancement in leptomeningeal carcinomatosis, as previously reported for bacterial meningitis. However, further investigations, including radiopathological correlation and a larger number of patients, are warranted to confirm these preliminary results.
Assuntos
Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Imageamento por Ressonância Magnética , Carcinomatose Meníngea/complicações , Carcinomatose Meníngea/fisiopatologia , Vestíbulo do Labirinto/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Audiometria/métodos , Feminino , Perda Auditiva Neurossensorial/patologia , Humanos , Aumento da Imagem , Masculino , Carcinomatose Meníngea/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Vestíbulo do Labirinto/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION: Massage of the lateral pterygoid muscle according to Cyriax's principles is an unrecognized procedure. This procedure was tried on patients presenting with temporomandibular joint dysfunction syndrome. MATERIAL AND METHODS: Fifteen patients were treated. Pain, joint clicking, measurement of mouth opening, lateral excursion and propulsion were recorded. Assessment was made before and after the massage in the same consultation. RESULTS: Joint clicking was solved in 80% and pain in 50% of the cases. Mouth opening increased by 12.8%, propulsion by 11.6% and lateral excursion by 41.3%. DISCUSSION: Massage of the lateral pterygoid muscle according to Cyriax's principles is a simple and efficient method that can be recommended for patients presenting with temporomandibular joint dysfunction syndrome. We performed a brief anatomical and radiological MRI study supporting the feasibility of lateral pterygoid muscle palpation.
Assuntos
Massagem , Músculos Pterigoides/fisiopatologia , Síndrome da Disfunção da Articulação Temporomandibular/terapia , Adolescente , Adulto , Dor Facial/fisiopatologia , Dor Facial/terapia , Estudos de Viabilidade , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Côndilo Mandibular/fisiopatologia , Pessoa de Meia-Idade , Radiografia Panorâmica , Amplitude de Movimento Articular/fisiologia , Som , Síndrome da Disfunção da Articulação Temporomandibular/fisiopatologia , Adulto JovemRESUMO
A good examination in facial nerve imaging (CT or MR imaging) depends on a good knowledge of anatomy. Two clinical situations must be considered: imaging of patients with or without facial palsy. CT and MR imaging are very useful when the symptoms are atypical or progressive: MR imaging gives very good information about the facial nerve inflammation but may also discover a schwannoma, a hemangioma, a meningioma, or a primitive or secondary cholesteatoma. In malignant tumors of the parotid gland, a study of the fallopian canal must always be performed to delineate an extension in the mastoid, tympanic, or intrameatic parts. In some rare cases, a metastasis in the temporal bone may occur, especially in the region of the geniculate ganglion. Particular attention must be paid to children with facial palsy, considering the possibility of a histiocytosis or metastasis of a neuroblastoma.
Assuntos
Neoplasias dos Nervos Cranianos/patologia , Doenças do Nervo Facial/patologia , Imageamento por Ressonância Magnética , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/etiologia , Doenças do Nervo Facial/diagnóstico por imagem , Doenças do Nervo Facial/etiologia , Humanos , RadiografiaRESUMO
PURPOSE: To assess the value of CT for diagnosis and follow-up of AFS. Evaluation of characteristic CT features of AFS. METHODS: Retrospective review of 12 cases of AFS presenting with all published diagnostic criteria (1) chronic rhinosinusitis refractory to standard management (2) CT features of chronic sinusitis (3) anatomopathologic, immunoallergologic, biochemical and mycologic criteria. CT findings were correlated with surgical findings and reviewed by one ENT and two radiologists to assess the diagnostic value of different CT features, alone or in association. RESULTS: AFS was isolated in 6 cases, and associated with allergic bronchopulmonary aspergillosis (ABPA) in 6 cases. CT showed pan- or polysinusitis, unilateral or bilateral, with mucosal thickening, sinus opacification frequently heterogeneous, bony changes, fluid trapping, and with pseudotumoral appearance in 3 cases. CONCLUSION: CT findings alone are not specific or pathognomonic but may suggest AFS in the correct clinical or immunoallergologic setting. It may alert the physician to the need for complementary work-up, exclude the presence of associated lung disease, and better adapt treatment and follow-up.
Assuntos
Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose/diagnóstico por imagem , Aspergilose/imunologia , Hipersensibilidade Respiratória/etiologia , Sinusite/diagnóstico por imagem , Sinusite/microbiologia , Tomografia Computadorizada por Raios X , Adulto , Anticorpos Antifúngicos/análise , Aspergilose/complicações , Aspergillus/imunologia , Aspergillus/isolamento & purificação , Aspergillus fumigatus/imunologia , Aspergillus fumigatus/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Fungos/imunologia , Fusarium/imunologia , Fusarium/isolamento & purificação , Humanos , Imunoglobulina E/análise , Masculino , Pessoa de Meia-Idade , Teste de Radioalergoadsorção , Hipersensibilidade Respiratória/imunologia , Hipersensibilidade Respiratória/microbiologia , Estudos Retrospectivos , Sinusite/complicações , Sinusite/imunologia , Testes Cutâneos , Fatores de TempoRESUMO
PURPOSE: To identify the anterior ethmoidal artery (AEA) of a skull specimen on CT prior to transnasal endoscopic surgical management of anterior epistaxis. MATERIALS AND METHODS: From a medial canthotomy approach, the AEA was located and a marker placed on 9 skull specimens (18 AEA). CT with 2D reformations was then performed. The AEA were then dissected using an endoscopic anterior ethmoidectomy approach. The presence of AEA procidence was recorded. RESULTS: Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA procidence: 1) presence of an ethmoid bulla above the AEA canal 2) AEA canal located below (not within) the ethmoid roof, anterior to the bulla. CONCLUSION: High resolution CT depiction of the AEA provides information regarding its accessibility for endoscopic ligation in patients with severe anterior epistaxis as an alternative to external ligation while demonstrating the upper limit of the anterior ethmoid.
Assuntos
Osso Etmoide/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Angiografia/métodos , Artérias/anatomia & histologia , Cadáver , Dissecação/métodos , Endoscopia/métodos , Osso Etmoide/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: This study aimed at evaluating the performance of Cine-MRI to assess swallowing in patients previously treated for head and neck cancer. MATERIALS AND METHODS: 10 healthy control subjects and a cohort of 10 patients with 8 partial glossectomies, 1 total laryngectomy and 1 glossolaryngectomy underwent imaging from October 2005 to February 2007. The MRI examinations were performed on a 1.5 Tesla system (Siemens Avanto), with True-Fisp sequences (TR = 170 ms, TE = 1 ms, slice thickness = 10 mm) at a rate of 8 pictures per second, during dry swallowing. RESULTS: Results are relevant for real-time spatial resolution from lips to larynx and dynamic motions analyses of tongue, velum, posterior pharyngeal wall and larynx during dry swallowing. Oro-pharyngo-laryngeal occlusion deficiency induces aspiration in case of partial glossectomy. Total laryngectomy modifies tongue, velum and pharynx landmarks. CONCLUSION: Cine-MRI i) provides functional insight from the oral cavity to the larynx, ii) gives accurate informations about impairments due to the pathology and its treatment, iii) completes others investigations like fiberoptic endoscopy or transit time, iiii) allows a precise analysis of the muscular movements involved in the deficient swallowing mechanism, in order to optimize rehabilitative strategies and results.
Assuntos
Cinerradiografia , Transtornos de Deglutição/diagnóstico , Imageamento por Ressonância Magnética , Adulto , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/reabilitação , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Laringectomia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Índice de Gravidade de DoençaRESUMO
CONCLUSION: High-resolution CT scans are able to determine with accuracy the location of the anterior ethmoidal artery in relation to the roof of the ethmoid. This investigation should greatly help functional endoscopic sinus surgery to avoid accidental injury of the artery and to coagulate the vessel in cases of severe epistaxis. OBJECTIVES: This was a radio-anatomical study of the anterior ethmoid artery in order to assess the course of the artery prior to endoscopic cauterization. MATERIALS AND METHODS: Eighteen ethmoid sinuses (nine heads) were dissected and high-resolution CT scans were performed in axial, coronal and sagittal planes. RESULTS: All anterior ethmoidal arteries were identifiable. The arteries were included in the roof of the ethmoid in eight cases. In three cases the arteries were prominent under the roof. In seven cases the dissection found the arteries distant from the roof. This anatomical feature was associated with pneumatization of the floor of the orbit. The correlation between CT scan and dissection was very satisfactory.
Assuntos
Seio Etmoidal/irrigação sanguínea , Tomografia Computadorizada por Raios X , Artérias/anatomia & histologia , Cauterização , Endoscopia/métodos , Humanos , Doença Iatrogênica , Complicações IntraoperatóriasRESUMO
BACKGROUND: Our aim was to confirm the usefulness of the perilymphatic signal changes on T2-weighted (T2W) gradient-echo sequence to differentiate vestibular schwannomas from internal auditory canal (IAC) meningiomas, through a compartmental analysis of inner ear fluids signal intensity. METHODS: A total of 203 patients with all criteria for typical vestibular schwannoma on T1-weighted contrast-enhanced sequences were retrospectively enrolled (190 schwannomas and 13 meningiomas). All patients underwent a T2W gradient-echo steady state free precession (SSFP) acquisition at 3T. Two radiologists analysed the signal intensity of the perilymph (cistern and cochlea) and endolymph (saccule and utricle) using a region of interest-based method for obtaining ratios between the analysed structures and the cerebrospinal fluid (CSF). RESULTS: Obstructive vestibular schwannomas showed a markedly decreased perilymphatic signal in both cistern and cochlea; the cistern/CSF ratio (Ci/CSF) was 0.62. The decrease was more moderate in IAC meningiomas (Ci/CSF = 0.81). For Ci/CSF > 0.70, the tumour was more likely a meningioma, with a 92% sensitivity and 83% specificity. No endolymphatic signal changes were observed. CONCLUSION: The pronounced decrease in perilymphatic signal on a T2W SSFP sequence in obstructive vestibular schwannoma provides a new tool to differentiate schwannomas from IAC meningiomas, which may be useful to overcome the insufficiencies of morphological analysis.
RESUMO
Otosclerosis is a primitive osteodystrophia of the labyrinthine bone. Its diagnosis must be confirmed by a CT scan in order to eliminate the other causes that may lead to conductive hearing loss with an absence of stapedial reflex: fixation of the head of the malleus to the lateral wall of the tympanic cavity, absence of the long process of the incus or stapes, gusher syndrome, primary cholesteatoma, or tympanic facial nerve neuroma blocking the stapes. Particular problems in otosclerosis must be clarified: an extension to the round window (poor postoperative results), and extension to the tympanic cavity blocking the malleus and/or the incus, the labyrinthine lumen, or the internal auditory meatus (very rare). The position of the tympanic facial nerve canal and associated abnormalities must be assessed: stapedial artery, malformations of the ossicles and/or the labyrinth, and chronic otitis media. MRI is indicated in extension to the labyrinthine lumen, the internal auditory meatus, and in postoperative complications with labyrinthitis. MRI can also evaluate the active otosclerotic focus (gadolinium enhancement).
Assuntos
Imageamento por Ressonância Magnética , Otosclerose/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Diagnóstico Diferencial , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Otosclerose/complicações , Otosclerose/diagnóstico por imagem , Otosclerose/cirurgia , Complicações Pós-Operatórias/diagnóstico , PrognósticoRESUMO
INTRODUCTION: Cogan's syndrome is defined by the combination of non syphilitic interstitial keratitis and inner ear dysfunction, similar to Meniere's disease. OBSERVATION: Cogan's syndrome was revealed by haemorrhagic glaireous diarrhoea in a 21 year-old woman whose medical history included Hirschsprung's disease. Cerebral MRI revealed viral-like bilateral neuritis of the eighth cranial nerve, never described in the literature before. The auditory and visual disorders regressed after treatment with corticosteroids. CONCLUSION: The early diagnosis of Cogan's syndrome permits the cure of the visual and auditory and notably inner ear symptoms with corticosteroid therapy.
Assuntos
Nervo Coclear , Diarreia/etiologia , Perda Auditiva Bilateral/complicações , Ceratite/complicações , Doenças do Labirinto/complicações , Doenças do Nervo Vestibulococlear/diagnóstico , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Audiometria , Diagnóstico Diferencial , Feminino , Perda Auditiva Bilateral/tratamento farmacológico , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Doenças do Labirinto/diagnóstico , Doenças do Labirinto/tratamento farmacológico , Imageamento por Ressonância Magnética , Doença de Meniere/diagnóstico , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Prognóstico , Síndrome , Fatores de Tempo , Resultado do Tratamento , Doenças do Nervo Vestibulococlear/complicações , Doenças do Nervo Vestibulococlear/tratamento farmacológicoRESUMO
OBJECTIVE: To report a case of VIIIth nerve cavernous hemangioma, a very rare differential diagnosis among the various pathologies presenting as small enhancing entities into the internal auditory canal. It is one of the most challenging when imaging is not able to differentiate it from an intrameatal vestibular schwannoma. METHODS AND RESULTS: We report a cavernous hemangioma extruding from the internal auditory canal, diagnosed after a left translabyrinthine resection in a 45-year-old man complaining of profound sensorineural hearing loss, with no facial paresis or dizziness. The preoperative differential diagnosis of a vestibular schwannoma was impossible, due to the absence of calcifications that usually characterize temporal bone hemangiomas. Clinical presentation, radiological features and treatment considerations are discussed along with up-to-date review of pertinent literature. CONCLUSIONS: When considering an apparent small intra-auditory canal schwannoma, otoneurologists should be aware of the rare possibility of a cavernous hemangioma. Early diagnosis and surgical treatment may improve the functional outcome, possibly preserving neural integrity.