Computed tomographic analysis of frontal sinus drainage pathway variations and frontal rhinosinusitis.

OBJECTIVE: The objective of this study was to radiologically determine frontal sinus drainage pathway variations with respect to superior attachment of uncinate process (SAUP) and their effect on prevalence of frontal rhinosinusitis. DESIGN: This was a retrospective cohort study. METHODS: Computed tomography scans of the 919 frontal sinus sides of 460 patients (252 female, 208 male; mean age, 35.1 ± 10.5 years) who were candidates for endoscopic sinus surgery were evaluated retrospectively between August 2012 and January 2013 by 3 radiologists to determine the SAUP types and the presence of frontal rhinosinusitis. RESULTS: The frontal sinus outflow tract was localized medial to the SAUP in 651 frontal sinus sides and lateral to the SAUP in 268 sides. We determined 3 types (types 7, 8, and 9) of SAUP in addition to 6 types defined in literature. The most common type of SAUP was type 3 (n = 332, 36.1%) followed by type 2 (n = 256, 27.8%) and type 7 (n = 160, 17.4%). Of the evaluated sides, 316 (34.3%) had frontal rhinosinusitis. Frontal rhinosinusitis was more common in the sides where the frontal sinus outflow tract was localized medial to the SAUP than those localized lateral (37.2% vs 27.6%, P = 0.006). CONCLUSIONS: Endoscopic approach to frontal recess usually requires uncinectomy, and it is necessary to know SAUP to prevent postoperative retained superior portion of the uncinate process. The location of frontal sinus outflow tract on the SAUP affects the prevalence of frontal rhinosinusitis as well. Frontal rhinosinusitis is significantly more common when the frontal sinus outflow tract was localized medial rather than lateral to the SAUP. LEVEL OF EVIDENCE: 2b.

Sonographic appearance of the normal appendix in children.

PURPOSE: To determine the visualization rate of the appendix in children without appendicitis and investigate factors affecting it. METHODS: Between January 2010 and April 2010, 205 consecutive children (103 boys and 102 girls; mean age: 9 years) without clinical signs of appendicitis were examined by ultrasound (US). The location of appendix was determined. The outer appendiceal diameter with and without compression was measured and the content of the lumen and mural vascularity on color Doppler was determined. The appendix diameter was correlated with age, weight, and height using Pearson correlation. For age, weight, and height, children with a visualized appendix were compared with those in whom the appendix was not visualized using Student's t test. RESULTS: The appendix was visualized in 142 of 205 (69.3%) children. The mean diameters of the appendices without and with compression were 4.2 ± 0.9 mm and 3.5 ± 0.8 mm, respectively, with 53.5% of the appendices in the mid-pelvic location. Appendiceal lumen was empty in 35.2% of children. Only one appendix showed mural vascularity on color Doppler. There was no correlation between the diameter (compressed or noncompressed) of the appendix and age, weight, or height. Mean ± SD age, weight, and height of the children with a visualized appendix (8.6 ± 0.3 years, 29.9 ± 0.9 kg, 127.7 ± 1.7 cm, respectively) were significantly lower than those in children with a nonvisualized appendix (9.8 ± 0.4 years, 36.0 ± 1.8 kg, 134.7 ± 2.5 cm, respectively) (p < 0.05 for all three parameters). CONCLUSION: In the majority of the children, the appendix can be visualized with US. Age, weight, and height affect the visualization rate of the normal appendix.

Cardiac T2* MRI assessment in patients with thalassaemia major and its effect on the preference of chelation therapy.

The aim of the study is to assess the relationship between T2* magnetic resonance imaging (MRI) values and age, serum ferritin level, left ventricular ejection fraction (LVEF), splenectomy status, and to identify appropriate modifications to chelation therapy based on T2* MRI results of children with thalassaemia major. Sixty-four patients with thalassaemia major (37 girls/27 boys) older than 8 years of age were enrolled in the study. Based on the first T2* MRI, the patients' myocardial iron depositions were classified into three groups: T2* MRI <10 ms (high risk group), T2* MRI 10-20 ms (medium-risk group) and T2* MRI >20 ms (low-risk group). There was no significant relationship between T2* MRI value and ages, serum ferritin levels and splenectomy status of thalassaemia major patients. The mean LVEFs were 60, 75, and 72.5 % in the high-, medium-, and low-risk groups, respectively (P = 0.006). The mean cardiac iron concentrations calculated from the T2* MRI values were 4.96 ± 1.93, 1.65 ± 0.37, and 0.81 ± 0.27 mg/g in the high-, medium-, and low-risk groups, respectively. Chelation therapies were re-designed in 24 (37.5 %) patients according to cardiac risk as assessed by cardiac T2* MRI. In conclusion, until recently, T2* MRI has been employed to demonstrate cardiac siderosis without a direct relationship with the markers used in follow-up of patients with thalassaemia. However, modifications of chelation therapies could reliably be planned according to severity of iron load displayed by T2* MRI.