Definitive radiotherapy for T3 squamous cell carcinoma of the glottic larynx.

PURPOSE: To report the results of radiotherapy alone for stage T3 squamous cell carcinoma of the true vocal cord and compare these data with those obtained with other treatment modalities. METHODS AND MATERIALS: Seventy-five patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated with curative intent with radiotherapy alone (73 patients) or followed by a planned neck dissection (two patients) at the University of Florida between September 1966 and August 1994. No patient received adjuvant chemotherapy. All patients were monitored for at least 2 years and 85% had a minimum follow-up duration of 5 years. No patient was lost to follow-up evaluation. RESULTS: The 5-year local control and ultimate local control rates were 63% and 86%, respectively. The volume of the primary tumor (which was calculated on pretreatment computed tomographic [CT] scans in 38 patients) was inversely related to local control with larynx preservation: < or = 3.5 cm3, 20 of 23 (87%) versus greater than 3.5 cm3, four of 14 (29%) (P = .0005). There was no apparent relationship between local control after radiotherapy as a function of whether the vocal cord regained mobility or remained fixed during or shortly after completion of treatment. The 5-year absolute and cause-specific survival rates were 54% and 78%, respectively. Multivariate analysis showed that pretreatment tracheostomy was significantly related to diminished cause-specific survival (P = .0345). CONCLUSION: Radiotherapy alone results in long-term local-regional control and survival rates that are comparable to those obtained with surgery. It is unclear whether induction or concomitant chemotherapy is associated with improved local-regional control and survival compared with radiotherapy alone.

Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma.

PURPOSE: To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT). MATERIALS AND METHODS: Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years. Local recurrence and treatment complications resulting in permanent loss of laryngeal function were documented. Tumor volume was calculated using a computer digitizer, and pre-epiglottic space (PES) spread was estimated. The data were analyzed using a combination of Fisher's exact test, logistic regression modeling, and multivariate analyses. Five-year local control rates were calculated using the product-limit method. RESULTS: Local control rates were inversely and roughly linearly related to tumor volume, although there seemed to be a threshold volume at which primary site prognosis diminished. Local control was 89% in tumors less than 6 cm3 and 52% when volumes were > or =6 cm3 (P = .0012). The likelihood of maintaining laryngeal function also varied with tumor volume: 89% for tumors less than 6 cm3 and 40% for tumors > or =6 cm3 (P = .00004). Pre-epiglottic space involvement by tumor of > or =25% was associated with a reduced chance of saving the larynx (P = .0076). Multivariate analyses revealed that only tumor volume independently altered these end points. CONCLUSION: Pretreatment CT measurements of tumor volume permits stratification of patients with supraglottic SCC treated with RT alone (which allows preservation of laryngeal function) into groups in which local control is more likely and less likely. Pre-epiglottic space spread is not a contraindication to using RT as the primary treatment for supraglottic SCC.

Acute Invasive Fungal Rhinosinusitis: A Comprehensive Update of CT Findings and Design of an Effective Diagnostic Imaging Model.

BACKGROUND AND PURPOSE: Acute invasive fungal rhinosinusitis carries a high mortality rate. An easy-to-use and accurate predictive imaging model is currently lacking. We assessed the performance of various CT findings for the identification of acute invasive fungal rhinosinusitis and synthesized a simple and robust diagnostic model to serve as an easily applicable screening tool for at-risk patients. MATERIALS AND METHODS: Two blinded neuroradiologists retrospectively graded 23 prespecified imaging abnormalities in the craniofacial region on craniofacial CT examinations from 42 patients with pathology-proven acute invasive fungal rhinosinusitis and 42 control patients proved negative for acute invasive fungal rhinosinusitis from the same high-risk population. A third blinded neuroradiologist decided discrepancies. Specificity, sensitivity, positive predictive value, and negative predictive value were determined for all individual variables. The 23 variables were evaluated for intercorrelations and univariate correlations and were interrogated by using stepwise linear regression. RESULTS: Given the low predictive value of any individual variable, a 7-variable model (periantral fat, bone dehiscence, orbital invasion, septal ulceration, pterygopalatine fossa, nasolacrimal duct, and lacrimal sac) was synthesized on the basis of multivariate analysis. The presence of abnormality involving a single variable in the model has an 87% positive predictive value, 95% negative predictive value, 95% sensitivity, and 86% specificity (R(2) = 0.661). A positive outcome in any 2 of the model variables predicted acute invasive fungal rhinosinusitis with 100% specificity and 100% positive predictive value. CONCLUSIONS: Our 7-variable CT-based model provides an easily applicable and robust screening tool to triage patients at risk for acute invasive fungal rhinosinusitis into a disease-positive or -negative category with a high degree of confidence.

Cervical lymph node metastases: oncologic imaging and diagnosis.

Cervical metastatic disease is an issue of paramount importance in the diagnosis and management of head and neck malignancies. The frequency of cervical metastases from squamous cell carcinoma of the upper aerodigestive tract varies mainly with the site of the primary. In general, the presence of histologically confirmed metastases halves the five year survival for any given primary. With improvements in treatment and the resultant prolonged survival, the incidence of distant metastases from head and neck cancer has risen. The imaging of metastatic cervical neck nodes by CT has made a major impact on clinical assessment of nodal involvement. The treatment issues related to the presence and extent of cervical metastases will be discussed in light of the ability of CT scans to stage the neck.

Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis.

PURPOSE: To analyze the pretreatment imaging findings and outcome of patients with perineural spread of squamous or basal cell carcinoma of the face and scalp treated with radiotherapy, to determine whether CT (computed tomography) or MR (magnetic resonance) imaging can be effectively used to identify patients who would benefit from aggressive treatment, and to characterize the imaging features associated with cure. METHODS: Thirty-five patients had perineural spread of squamous and basal cell carcinoma along the divisions of the trigeminal and/or facial nerves based on clinical findings and/or histopathological proof. Perineural extension seen on imaging was divided into three zones of involvement. The volume of perineural disease was graded semiquanitatively. All patients received radiotherapy with curative intent. RESULTS: Eighteen of the 35 patients had imaging evidence of perineural spread of tumor, and the remaining 17 were imaging negative for perineural spread. The absolute 5-year survival of the imaging positive group was 50% compared with 86% in the imaging-negative group (p = 0.048). CONCLUSIONS: Imaging can be used to identify patients with advanced perineural spread who warrant aggressive radiotherapy. Imaging evidence of perineural invasion worsens prognosis; however, low-volume and peripheral perineural disease is radiocurable. Greater perineural tumor volume with more central disease was associated with an unfavorable outcome.

Malignant tumors of the nasal cavity and ethmoid and sphenoid sinuses.

Between October 1964 and December 1983, 48 patients with malignant tumors of the nasal cavity (31), ethmoid sinus (13), or sphenoid sinus (4) were treated with curative intent by radiation therapy. There were 21 squamous cell carcinomas, 14 minor salivary gland tumors (adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma), 3 malignant melanomas, 2 soft tissue sarcomas, and 8 esthesioneuroblastomas. Forty-two patients were treated with irradiation alone and six with planned combined irradiation and surgery. The 10-year actuarial local control rate for Stage I (limited to site of origin; 7 patients) was 100%; for Stage II (extension to adjacent sites, e.g., adjacent sinuses, orbit, pterygomaxillary fossa, nasopharynx; 19 patients) was 53%; and for Stage III (destruction of skull base or pterygoid plates, or intracranial extension; 22 patients) was 30%. Of 24 failures at the primary site, 10 occurred greater than 24 months after completion of irradiation. With the exception of adenoid cystic carcinoma (17% local control at 15 years), the ultimate local control rates for all histologies were in the range of 40% to 60%. Of 7 patients with documented intracranial extension, 3 (43%) remained free from local recurrence 3.5, 4, and 9 years after treatment. The 5-, 10-, 15-, and 20-year uncorrected actuarial survival rates for all 48 patients were 52%, 30%, 22%, and 22%, respectively. Continuous disease-free survival according to stage at 10 years was 86% for Stage I, 42% for Stage II, and 22% for Stage III. The single failure in a patient with Stage I disease was a lymph node metastasis that was successfully managed by radical neck dissection. The orbit was grossly invaded by tumor prior to treatment in 22 patients (46%). Sixteen (33%) of 48 patients developed unilateral blindness secondary to radiation retinopathy or optic neuropathy; in the majority of these patients the complication was anticipated because the ipsilateral eye was irradiated to a high dose. Four patients (8%) unexpectedly developed bilateral blindness 17, 35, 46, and 90 months following treatment owing to optic nerve injury. A discussion of possible means of avoiding this latter, unacceptable complication is included.

Irradiation alone for supraglottic larynx carcinoma: can CT findings predict treatment results?

Between January 1982 and December 1986, 54 patients with squamous cell carcinoma of the supraglottic larynx were treated for cure with radiation therapy alone; all had a minimum 2-year follow-up. For 31 patients, high-quality pretreatment CT scans were available for review. Scans were retrospectively evaluated by a single radiologist for the percentage of preepiglottic space involvement by tumor, the percentage of paralaryngeal space involvement, and the total tumor volume in cubic centimeters (cc). Volume was measured using a computer digitizer for each CT slice showing tumor. Results showed a significant difference in local control for tumors less than 6 cc versus tumors greater than or equal to 6 cc (15/18 or 83% vs 6/13 or 46%; p = .038). This difference was independent of both T stage and primary site. For T3 lesions, there was a trend toward decreased local control with increasing percentage of preepiglottic space involvement (0-25% = 85% local control; greater than 25% = 60% local control; p = .384); in most cases, however, the amount of preepiglottic space involvement reflected tumor volume (0-25%, 8/12 or 67% of tumors were less than 6 cc; greater than 25%, 7/10 or 70% of tumors were greater than or equal to 6 cc). There was no clear association between degree of paraglottic space involvement and local control. Tumor volume did not correlate with complications of treatment. Because of the limited number of patients in the current study, conclusions should be considered preliminary. However, the data do suggest that pretreatment CT findings, particularly tumor volume, can predict the likelihood of local control with radiation therapy alone for squamous cell carcinoma of the supraglottic larynx.

Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy?

PURPOSE: To determine if pretreatment computed tomography (CT) can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy (RT). METHODS AND MATERIALS: Forty-two patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with RT alone; all had a minimum 2-year follow-up. Tumor volumes and extent were determined by consensus of two head and neck radiologists on pretreatment CT studies. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. Sclerosis of any laryngeal cartilage was recorded. The specific CT parameters assessed were correlated with local control. RESULTS: Tumor volume was a significant predictor of local control. For tumors measuring < 3.5 cm3, local control was achieved in 22 of 26 patients (85%), whereas for tumors > or = 3.5 cm3, local control was achieved in 4 of 16 patients (25%) (p = 0.0002). Sensitivity and specificity using this cutpoint were 85% and 75%, respectively. Tumor score as a measure of anatomic extent was also found to be a significant predictor of local control. The local control rate for tumors assigned a low tumor score (< or = 5) was 78% (21 of 27) compared to 33% (5 of 15) for tumors assigned a high tumor score (6, 7, or 8) (p = 0.008). A significant decrease in the local control rate was observed for cancers involving the paraglottic space at the false vocal cord level (14 of 16 [88%] vs. 12/26 [46%]) (p = 0.010), cancers involving the face of the arytenoid (15 of 18 [83%] vs. 11 of 24 [46%]) (p = 0.024), and tumors involving the interarytenoid region (25 of 36 [69%] vs. 1 of 6 [17%]; p = 0.020). There were 12 patients with sclerosis of both the ipsilateral arytenoid and the adjacent cricoid cartilage. These patients showed a significant decrease in local control (4 of 12 [33%]). CONCLUSION: Pretreatment CT can stratify patients with T3 glottic carcinoma into groups more or less likely to be locally controlled with definitive RT. The local control rate for these tumors can be improved using a CT-based tumor profile; the ideal CT profile for a radiocurable T3 glottic larynx carcinoma is volume < 3.5 cm3 and no or single laryngeal cartilage sclerosis.

Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone?

PURPOSE: To determine if pretreatment computed tomography findings can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone. METHODS AND MATERIALS: Twenty-nine patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with radiotherapy alone; all had a minimum 2-year follow-up. High-quality pretreatment computed tomography scans were retrospectively reviewed by a single head and neck radiologist for tumor involvement of various anatomic subsites within the larynx, and total tumor volumes were calculated for 18 of the most recent patients using a computer digitizer. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. RESULTS: A significant decrease in the local control rate was observed for cancers involving the face of the arytenoid (11 of 20 [55%] vs. 9 of 9 [100%]; p = .02), or the paraglottic space at the false vocal cord level (7 of 16 [44%] vs. 13 of 13 [100%]; p not equal to < .01). Tumors assigned a high tumor score (6, 7, or 8) had a significantly decreased rate of local control with radiation therapy when compared with tumors assigned a low tumor score (< or = 5): 1 of 7 (14%) vs. 19 of 22 (86%) (p = .01). Total tumor volume also significantly correlated with the rate of tumor control. For tumors measuring 3.5 cm3 or less, local control was achieved in 11 of 12 patients (92%), whereas for tumors greater than 3.5 cm3, local control was achieved in 2 of 6 patients (33%) (p = .02). CONCLUSION: Pretreatment computed tomography scans can contribute significantly to the treatment decision for patients with T3 glottic carcinoma and can define a subset of patients with an excellent chance of being cured with preservation of a functional larynx after treatment with radiotherapy alone.

Pre- and post-radiotherapy computed tomography in laryngeal cancer: imaging-based prediction of local failure.

PURPOSE: To determine if pre-radiotherapy (RT) and/or post-radiotherapy computed tomography (CT) can predict local failure in patients with laryngeal carcinoma treated with definitive RT. METHODS AND MATERIALS: The pre- and post-RT CT examinations of 59 patients (T3 glottic carcinoma [n = 30] and T1-T4 supraglottic carcinoma [n = 29]) were reviewed. For each patient, the first post-RT CT study between 1 and 6 months after irradiation was used. All patients were treated with definitive hyperfractionated twice-daily continuous-course irradiation to a total dose of 6,720-7,920 cGy, and followed-up clinically for at least 2 years after completion of RT. Local control was defined as absence of primary tumor recurrence and a functioning larynx. On the pre-treatment CT study, each tumor was assigned a high-or low-risk profile for local failure after RT. The post-RT CT examinations were evaluated for post-treatment changes using a three-point post-RT CT-score: 1 = expected post-RT changes; 2 = focal mass with a maximal diameter of < 1 cm and/or asymmetric obliteration of laryngeal tissue planes; 3 = focal mass with a maximal diameter of > 1 cm, or < 50% estimated tumor volume reduction. RESULTS: The local control rates at 2 years post-RT based on pre-treatment CT evaluation were 88% for low pre-treatment risk profile patients (95% CI: 66-96%) and 34% (95% CI: 19-50%) for high pre-treatment risk profile patients (risk ratio 6.583; 95% CI: 2.265-9.129;p = 0.0001). Based on post-treatment CT, the local control rates at 2 years post-RT were 94% for score 1, 67% for score 2, and 10% for score 3 (risk ratio 4.760; 95% CI: 2.278-9.950 p = 0.0001). Post-RT CT scores added significant information to the pre-treatment risk profiles on prognosis. CONCLUSIONS: Pre-treatment CT risk profiles, as well as post-RT CT evaluation can identify patients, irradiated for laryngeal carcinomas, at high risk for developing local failure. When the post-RT CT score is available, it proves to be an even better prognosticator than the pre-treatment CT-risk profile.

Radiation therapy for juvenile angiofibroma: evaluation by CT and MRI, analysis of tumor regression, and selection of patients.

PURPOSE: To provide an analysis of nine patients with juvenile angiofibroma treated with radiotherapy between June 1975 and June 1987. METHODS AND MATERIALS: All patients had a minimum 3 years of follow-up; six of the patients had greater than 5 years and four had greater than 10 years of follow-up. Two patients received radiotherapy as primary therapy, and the remaining seven patients were treated with surgery initially, followed by irradiation for recurrent disease. Characteristic computed tomography (CT), magnetic resonance (MR), and angiography findings were identified. All nine patients had nasal cavity or nasopharyngeal involvement. Eight patients had involvement of the base of the skull, and seven had intracranial extension. Tumor regression during and after treatment was estimated clinically and from available imaging studies. RESULTS: Tumor regression during treatment ranged from 25% to 100%, with most patients experiencing between 30% and 50% clinical decrease in the size of the tumor. Seven patients eventually showed complete regression by physical examination, but only two of seven patients evaluated by CT and/or MR showed complete regression. In five patients, follow-up imaging studies showed stable residual changes. Local control was achieved in all patients. No late complications were found. CONCLUSION: The initial treatment of early lesions is surgical. Low dose irradiation appears to be an effective alternative to extensive surgery in treating advanced juvenile angiofibroma. Morbidity has been minimal. Residual changes are seen in subsequent imaging studies but have remained stable with long follow-up.

Squamous cell carcinoma of the pharyngeal wall treated with irradiation.

This is an analysis of 74 patients with 75 squamous cell carcinomas of the pharyngeal wall treated with radical irradiation at the University of Florida between October 1964 and December 1984. All patients have a 2-year follow-up and 69% have a minimum 5-year follow-up. All patients were treated with continuous-course irradiation: 56 with once-a-day fractionation and 18 with twice-a-day fractionation. Patients treated with the split-course technique are not included in this series. Sixty-three patients were treated with external beam irradiation alone; 11 patients underwent an interstitial implant to the primary lesion following external beam irradiation. The local control rates with irradiation are as follows: T1, 3/4; T2, 12/21; T3, 12/27; and T4, 2/10. Only two patients were salvaged by operation for a local recurrence following irradiation. There was an improvement in the rate of local control with the use of twice-a-day fractionation and a decrease in the rate of local control with the combination of external beam irradiation and interstitial implant, compared with external beam irradiation alone. The 5-year determinate survival rates by AJCC stage are as follows: I, no data; II, 4/9; III, 3/16; and IV, 1/18.

Preoperative evaluation of the thoracic aorta using MRI and angiography.

The ability of ECG-gated magnetic resonance imaging (MRI) to evaluate disease of the thoracic aorta compared with angiography was prospectively assessed in 28 patients. MRI identified abnormalities in all patients, with confirmation at operation in 22 (79%) and by angiography alone in all 28. In 20 of the patients, MRI correctly diagnosed 20 of 21 aneurysms of the thoracic aorta (6 dissecting, 4 saccular, 10 fusiform), but 1 surgically proven fusiform aneurysm was categorized as an enlarged aortic dissection based on both MRI and angiographic findings. One dissection and 1 fusiform aneurysm were shown by MRI only. Coarctation of the aorta was identified in 4 patients. Ascending aortic enlargement and left ventricular hypertrophy were identified by MRI in 4 patients with aortic stenosis. In 7 patients (25%), MRI provided additional important information not shown by angiography and in 1 patient, the MRI findings resulted in a change in the surgical approach. In 14 of 28 patients (50%), angiography was necessary for definitive preoperative evaluation of the aortic valve, the coronary arteries, or the brachiocephalic vessels. MRI was a useful noninvasive supplement to angiography for the preoperative assessment of thoracic aortic disease.

Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings.

PURPOSE: Our goal was to illustrate the relevance of periantral soft-tissue infiltration to the early diagnosis of invasive fungal sinusitis and to describe variations in the appearance of normal periantral soft tissues. METHODS: We reviewed two cases of pathologically proved invasive maxillary fungal sinusitis in which the sole imaging finding suggestive of invasive disease was periantral soft-tissue infiltration. Variations in the CT appearance of normal periantral soft tissues were studied in 112 patients by assessing the appearance of the fat planes along the anterior and posterior bony antral walls and by noting the presence of infraorbital and distal internal maxillary artery branch vessels within the anterior and posterior periantral fat planes, respectively. RESULTS: None of the 112 patients had findings that suggested, or that could mimic, soft-tissue infiltration in the anterior periantral soft tissues. In only one (1%) of the 112 patients was there a loss of visibility of the posterior periantral fat plane that was not clearly attributable to the otherwise normal-appearing posterior periantral soft tissues. CONCLUSION: Infiltration of the periantral fat planes may represent the earliest imaging evidence of invasive fungal disease. When encountered as the sole radiologic finding, periantral soft-tissue infiltration should suggest the possibility of invasive fungal sinusitis in the appropriate clinical setting.

Wegener granulomatosis of the eustachian tube and skull base mimicking a malignant tumor.

Wegener granulomatosis is a well-studied yet sometimes difficult-to-diagnose systemic vasculitis. Early treatment with immunosuppressants is the therapy of choice and usually controls the disease. Two cases of Wegener granulomatosis are presented, both with symptoms and imaging findings suggestive of a malignant tumor of the nasopharynx or skull base. The focus of upper respiratory involvement in each case was the eustachian tube.

Recurrent parotid adenocarcinoma occurring within the cerebellopontine angle.

A patient presented 3 1/2 years after resection of a malignant parotid tumor with a new cerebellopontine angle mass. The presence of multiple punctate calcifications and loss of T2 signal were helpful in correctly identifying the lesion as mucinous adenocarcinoma.

Leiomyosarcoma of the larynx presenting as a laryngopyocele.

An 87-year-old man had an 8-month history of hoarseness, respiratory distress, and dysphagia. Physical examination, including direct laryngoscopy, revealed a mass on the right anterolateral side of the neck and a submucosal mass of the supraglottic larynx. A contrast-enhanced CT scan showed a more superior cystic mass, a laryngopyocele resulting from a more inferior, solid-appearing and obstructing mass at the level of the true vocal cord. The obstructing mass was also entirely submucosal at direct laryngoscopy; however, a biopsy specimen revealed a malignant tumor. Subsequent total laryngectomy and pathologic review showed it to be a leiomyosarcoma.

Rhabdomyoma of the pharyngeal musculature extending into the prestyloid parapharyngeal space.

A 66-year-old woman reported fullness in the right ear for 6 months before admission. A submucosal mass shown by MR imaging and CT to arise in the prestyloid parapharyngeal space was the cause of her symptoms. Histologically, the mass proved to be a rhabdomyoma, a rare benign neoplasm, that arose from the muscular wall of the pharynx.

The developing anterior skull base: CT appearance from birth to 2 years of age.

PURPOSE: To describe the normal CT appearance of the developing anterior skull base in children 24 months of age and younger. METHODS: A retrospective review of the CT examinations of a healthy population of 61 subjects newborn through 24 months of age was performed. Two investigators independently reviewed the examinations, making measurements and observations regarding the length of the skull base, ossification pattern, and development of the crista galli, perpendicular plate of the ethmoid bone, and fovea ethmoidalis. RESULTS: At birth, the anterior skull base is largely cartilaginous. Ossification begins in the roof of the ethmoidal labyrinth laterally and spreads toward the midline. By 6 months of age, 50% of the anterior skull base has completely ossified. This percentage steadily increases over the first 2 years of life, and by 24 months, 84% of the anterior skull base is completely ossified, with a cartilaginous gap anteriorly in the region of the foramen cecum, the residual unossified portion. Ossification of the crista galli and perpendicular plate of the ethmoid bone begins around 2 months of age, shows a steady increase in ossification to 14 months of age, then increases little to 24 months of age. The fovea ethmoidalis begins development by 6 months of age, with the anterior portion the most developed in 82% of the population. CONCLUSION: The timing and pattern of ossification we observed differ somewhat from that reported in prior radiologic and anatomic studies, with the earliest bony bridging of the ethmoidal complex to the crista galli seen as early as 2 months of age. Development of the anterior skull base follows a predictable and orderly pattern that is important for understanding how to avoid errors in interpreting CT examinations through this region.

Arytenoid cartilage sclerosis: normal variations and clinical significance.

PURPOSE: Our purpose was to determine the variation in location, distribution, and sex predilection of arytenoid cartilage sclerosis in a population of patients without laryngeal cancer as an aid to understanding the significance of this entity when seen in patients with laryngeal cancer. METHODS: One hundred CT examinations of patients of different ages and with no history of laryngeal cancer or radiation therapy were evaluated for the presence of arytenoid cartilage sclerosis. The arytenoid cartilage was subdivided into three regions: superior process, body, and vocal process. Each region was assessed on each side separately on bone window scans. RESULTS: Arytenoid cartilage sclerosis was seen in 16% (n = 16) of the patients. Sclerosis was most common in the body (n = 12) and least common in the true vocal process (n = 2); the left side was the preferred location for all three regions. In 50% of the patients, at least two regions were affected. Eighty-one percent of sclerotic arytenoid cartilage was seen in women. CONCLUSION: Knowledge of the frequency and distribution of arytenoid cartilage sclerosis as a normal variant can aid in determining the risk of arytenoid cartilage involvement in patients with laryngeal cancer.