RESUMO
Sphenoorbital meningiomas are a challenge to access and reconstruct. Although there is much neurosurgical literature on resection of such tumors, there is little discussion on the best methods for the reconstruction of consequent defects, which are often extensive due to large areas of hyperostosis requiring resection. We performed a retrospective analysis of patients who underwent resection and reconstruction of a sphenoorbital meningioma by the senior authors (C.S. and D.A.S.) between 2010 and 2020. Surgical access in all cases included an orbitozygomatic osteotomy. The study cohort consisted of 23 patients (20 female, 3 male) with an average age of 50 (range: 37-72) years at the time of surgery. Most patients had progressive proptosis before the ablative operation. Orbital reconstruction was with a combined titanium-Medpor implant in 18 patients, split calvarial bone graft in 3 patients, and a Medpor implant in 2 patients. Calvarial reconstruction was performed with titanium mesh in 21 patients, split calvarial bone graft and titanium mesh in 1 patient, and craniotomy bone and titanium plate in 1 patient. Reoperation was required in 7 patients due to hypoglobus or enophthalmos (N=2), orbital implant malposition (N=1), abscess (N=1), pain (N=1), intracranial fat graft modification (N=1), and soft tissue deformities (N=2). Our experience demonstrates that sphenoorbital meningiomas can require broad areas of resection of the skull base and calvarium and necessitate comprehensive reconstruction of the anterior cranial fossa, orbital walls, and cranium. Collaboration between craniofacial surgeons and neurosurgeons can achieve optimal results.
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Neoplasias Meníngeas , Meningioma , Neoplasias da Base do Crânio , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Meningioma/cirurgia , Meningioma/patologia , Estudos Retrospectivos , Titânio , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/patologia , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/patologia , Resultado do TratamentoRESUMO
Background There are multiple tools available to visualize the retinal and choroidal vasculature of the posterior globe. However, there are currently no reliable in vivo imaging techniques that can visualize the entire retrobulbar course of the retinal and ciliary vessels. Purpose To identify and characterize the central retinal artery (CRA) using cone-beam CT (CBCT) images obtained as part of diagnostic cerebral angiography. Materials and Methods In this retrospective study, patients with catheter DSA performed between October 2019 and October 2020 were included if CBCT angiography included the orbit in the field of view. The CBCT angiography data sets were postprocessed with a small field-of-view volume centered in the posterior globe to a maximum resolution of 0.2 mm. The following were evaluated: CRA origin, CRA course, CRA point of penetration into the optic nerve sheath, bifurcation of the CRA at the papilla, visualization of anatomic variants, and visualization of the central retinal vein. Descriptive statistical analysis was performed. Results Twenty-one patients with 24 visualized orbits were included in the analysis (mean age, 55 years ± 15; 14 women). Indications for angiography were as follows: diagnostic angiography (n = 8), aneurysm treatment (n = 6), or other (n = 7). The CRA was identified in all orbits; the origin, course, point of penetration of the CRA into the optic nerve sheath, and termination in the papilla were visualized in all orbits. The average length of the intraneural segment was 10.6 mm (range, 7-18 mm). The central retinal vein was identified in six of 24 orbits. Conclusion Cone-beam CT, performed during diagnostic angiography, consistently demonstrated the in vivo central retinal artery, demonstrating excellent potential for multiple diagnostic and therapeutic applications. © RSNA, 2021 Online supplemental material is available for this article.
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Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Tomografia Computadorizada de Feixe Cônico , Artéria Retiniana/diagnóstico por imagem , Angiografia Digital , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Diffuse leukoencephalopathy and juxtacortical and/or callosal microhemorrhages were brain imaging features in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy. Herein, the authors report brain imaging features in 11 critically ill patients with COVID-19 with persistently diminished mental status who underwent MRI between April 5 and April 25, 2020. These imaging features include (a) confluent T2 hyperintensity and mild restricted diffusion in bilateral supratentorial deep and subcortical white matter (in 10 of 11 patients) and (b) multiple punctate microhemorrhages in juxtacortical and callosal white matter (in seven of 11 patients). The authors also discuss potential pathogeneses.
Assuntos
Encéfalo , Hemorragia Cerebral , Infecções por Coronavirus , Leucoencefalopatias , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , COVID-19 , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Hemorragia Cerebral/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/patologia , Encefalite/diagnóstico por imagem , Encefalite/patologia , Encefalite/virologia , Feminino , Humanos , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/patologia , Leucoencefalopatias/virologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , Estudos Retrospectivos , SARS-CoV-2RESUMO
Facial transplant (FT) is a viable option for patients with severe craniomaxillofacial deformities. Transplant imaging requires coordination between radiologists and surgeons and an understanding of the merits and limitations of imaging modalities. Digital subtraction angiography and CT angiography are critical to mapping vascular anatomy, while volume-rendered CT allows evaluation of osseous defects and landmarks used for surgical cutting guides. This article highlights the components of successful FT imaging at two institutions and in two index cases. A deliberate stepwise approach to performance and interpretation of preoperative FT imaging, which consists of the modalities and protocols described here, is essential to seamless integration of the multidisciplinary FT team. ©RSNA, 2019 See discussion on this article by Lincoln .
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Angiografia Digital/métodos , Angiografia por Tomografia Computadorizada/métodos , Face/diagnóstico por imagem , Transplante de Face , Cuidados Pré-Operatórios/métodos , Adulto , Queimaduras/diagnóstico por imagem , Queimaduras/cirurgia , Anormalidades Craniofaciais/diagnóstico por imagem , Anormalidades Craniofaciais/cirurgia , Ossos Faciais/diagnóstico por imagem , Traumatismos Faciais/diagnóstico por imagem , Traumatismos Faciais/cirurgia , Humanos , Imageamento Tridimensional , Masculino , Seleção de Pacientes , Flebografia/métodos , Adulto JovemRESUMO
INTRODUCTION: Epidermal growth factor receptors EGFR and ErbB2 are overexpressed in schwannomas and meningiomas. Preclinical and clinical data indicate that lapatinib, an EGFR/ErbB2 inhibitor, has antitumor activity against vestibular schwannomas in neurofibromatosis type 2 (NF2) patients. Its antitumor activity against meningiomas, however, is unknown. METHODS: We conducted a retrospective review of patients with NF2 and progressive vestibular schwannomas treated on a phase 2 clinical trial with lapatinib (NCT00973739). We included patients with at least one volumetrically measurable meningioma (> 0.5 cm3) who received at least five 28-day courses of treatment. Patients received lapatinib 1500 mg daily. Meningioma response was assessed using 3-dimensional MRI volumetrics. Progressive meningioma growth and response were defined as + 20 and - 20% change in tumor volume from baseline, respectively. Off-treatment was defined as any period > 5 months without lapatinib. RESULTS: Eight patients (ages: 20-58 years) who met criteria had 17 evaluable meningiomas with a combined volume of 61.35 cc at baseline, 61.17 cc during treatment, and 108.86 cc (+ 77.44% change) off-treatment, p = 0.0033. Median time on-treatment and off-treatment was 15.5 and 16.7 months, respectively. On-treatment mean and median annualized growth rates were 10.67 and 1.32%, respectively. Off-treatment mean and median annualized growth rates were 20.05 and 10.42%, respectively. The best volumetric response was - 26.1% after 23 months on lapatinib. Two tumors increased > 20% volumetrically on-treatment, compared to eight tumors off-treatment. CONCLUSIONS: These data suggest that lapatinib may have growth-inhibitory effects on meningiomas in NF2 patients, and support prospective studies of lapatinib for NF2 patients with progressive meningiomas.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Meníngeas/tratamento farmacológico , Meningioma/tratamento farmacológico , Neurofibromatose 2/tratamento farmacológico , Quinazolinas/uso terapêutico , Adulto , Feminino , Humanos , Imageamento Tridimensional , Lapatinib , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neurofibromatose 2/complicações , Neurofibromatose 2/diagnóstico por imagem , Neuroma Acústico/complicações , Neuroma Acústico/tratamento farmacológico , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: This article explores recent developments in PET and MRI, separately or combined, for assessing metastatic lymph nodes in patients with head and neck cancer. CONCLUSION: The synergistic role of PET and MRI for imaging metastatic lymph nodes has not been fully explored. To facilitate the understanding of the areas that need further investigation, we discuss potential mechanisms and evidence reported so far, as well as future directions and challenges for continued development and clinical research.
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Neoplasias de Cabeça e Pescoço/patologia , Metástase Linfática/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Imagem Multimodal , Tomografia por Emissão de Pósitrons/métodos , Meios de Contraste , Humanos , Compostos RadiofarmacêuticosRESUMO
Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
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Vértebras Cervicais/diagnóstico por imagem , Ecocardiografia Transesofagiana , Hiperostose Esquelética Difusa Idiopática/complicações , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Osteófito/complicações , Osteófito/diagnóstico por imagem , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Sequential computed tomography (CT) technique remains the most common protocol for CT evaluation of the head despite nearly universal adoption of continuous technique for all other body parts. This may be attributable to the belief by radiologists that this technique is superior to helical scanning uniquely for this indication. This study attempts to clarify the issue. METHODS: A phantom evaluation and a prospective randomized clinical image quality trial were performed comparing sequential and helical technique using the most current generation 128-row detector CT scanner. RESULTS: Phantom evaluation demonstrated equivalence between the 2 techniques for low-contrast resolution and line pair spatial discrimination. Continuous scanning provided the highest contrast-to-noise ratio. There was no significant difference between the 2 techniques regarding image quality except for cortical visualization at the cerebral hemispheres, which was subtly but significantly superior for sequential technique. CONCLUSIONS: Head CT image quality for sequential and continuous techniques are virtually equivalent.
Assuntos
Cabeça/diagnóstico por imagem , Imagens de Fantasmas , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Humanos , Estudos Prospectivos , Tomógrafos Computadorizados , Tomografia Computadorizada EspiralRESUMO
BACKGROUND: Orbital decompression is frequently performed in the management of patients with sight-threatening and disfiguring Graves' ophthalmopathy. The quantitative measurements of the change in orbital volume after orbital decompression procedures are not definitively known. Furthermore, the quantitative effect of septal deviation on volume change has not been previously analyzed. OBJECTIVES: To provide quantitative measurement of orbital volume change after medial and inferior endoscopic decompression and describe a straightforward method of measuring this change using open-source technologies. A secondary objective was to assess the effect of septal deviation on orbital volume change. METHODS: A retrospective review was performed on all patients undergoing medial and inferior endoscopic orbital decompression for Graves' ophthalmopathy at a tertiary care academic medical center. Pre-operative and post-operative orbital volumes were calculated from computed tomography (CT) data using a semi-automated segmenting technique and Osirix™, an open-source DICOM reader. Data were collected for pre-operative and post-operative orbital volumes, degree of septal deviation, time to follow-up scan, and individual patient Hertel scores. RESULTS: Nine patients (12 orbits) were imaged before and after decompression. Mean pre-operative orbital volume was 26.99 cm(3) (SD=2.86 cm(3)). Mean post-operative volume was 33.07 cm(3) (SD=3.96 cm(3)). The mean change in volume was 6.08 cm(3) (SD=2.31 cm(3)). The mean change in Hertel score was 4.83 (SD=0.75). Regression analysis of change in volume versus follow-up time to imaging indicates that follow-up time to imaging has little effect on change in volume (R=-0.2), and overall mean maximal septal deviation toward the operative side was -0.5mm. Negative values were attributed to deviation away form the operative site. A significant correlation was demonstrated between change in orbital volume and septal deviation distance site (R=0.66), as well as between change in orbital volume and septal deviation angle (R=0.67). Greater volume changes were associated with greater degree of septal deviation away from the surgical site, whereas smaller volume changes were associated with greater degree of septal deviation toward the surgical site. CONCLUSION: A straightforward, semi-automated segmenting technique for measuring change in volume following endoscopic orbital decompression is described. This method proved useful in determining that a mean increase of approximately 6 cm in volume was achieved in this group of patients undergoing medial and inferior orbital decompression. Septal deviation appears to have an effect on the surgical outcome and should be considered during operative planning.
Assuntos
Descompressão Cirúrgica , Endoscopia , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/cirurgia , Órbita/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Septo Nasal/diagnóstico por imagem , Órbita/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada EspiralRESUMO
OBJECTIVE: Traditional fat-suppressed T1-weighted spin-echo or turbo spin-echo (TSE) sequences (T1-weighted images) may be degraded by motion and pulsation artifacts in head-and-neck studies. Our purpose is to evaluate the role of a fat-suppressed T1-weighted 3D radial gradient-recalled echo sequence (radial-volumetric interpolated breath-hold examination [VIBE]) in the head and neck as compared with standard contrast-enhanced fat-suppressed T1-weighted images. MATERIALS AND METHODS: We retrospectively evaluated 21 patients (age range, 9-67 years) who underwent head-and-neck MRI at 1.5 T. Both contrast-enhanced radial-VIBE and conventional fat-suppressed TSE contrast-enhanced T1-weighted imaging were performed. Two radiologists evaluated multiple parameters of image quality, graded on a 5-point scale. Mixed-model analysis of variance and interobserver variability assessment were performed. RESULTS: The following parameters were scored as significantly better for the contrast-enhanced radial-VIBE sequence than for conventional contrast-enhanced T1-weighted imaging: overall image quality (p < 0.0001), degree of fat suppression (p = 0.006), mucosal enhancement (p = 0.004), muscle edge clarity (p = 0.049), vessel clarity (p < 0.0001), respiratory motion artifact (p = 0.002), pulsation artifact (p < 0.0001), and lesion edge sharpness (p = 0.004). Interobserver agreement in qualitative evaluation of the two sequences showed fair-to-good agreement for the following variables: overall image quality (intraclass correlation coefficient [ICC], 0.779), degree of fat suppression (ICC, 0.716), mucosal enhancement (ICC, 0.693), muscle edge clarity (ICC, 0.675), respiratory motion artifact (ICC, 0.516), lesion enhancement (ICC, 0.410), and lesion edge sharpness (ICC, 0.538). Excellent agreement was shown for vessel clarity (ICC, 0.846) and pulsation artifact (ICC, 0.808). CONCLUSION: The radial-VIBE sequence is a viable motion-robust improvement on the conventional fat-suppressed T1-weighted sequence.
Assuntos
Tecido Adiposo/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Imagem Ecoplanar/métodos , Gadolínio , Neoplasias de Cabeça e Pescoço/patologia , Aumento da Imagem/métodos , Imageamento Tridimensional/métodos , Adolescente , Adulto , Idoso , Criança , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Técnica de Subtração , Adulto JovemRESUMO
Three elderly patients experienced musical hallucinations (MH) in the context of hearing loss. In at least two of the cases, the onset was sudden. All three patients had pontine T2/FLAIR hyperintense foci on MR scan after the onset of the MH.
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Alucinações/etiologia , Música , Ponte/patologia , Esquizofrenia/complicações , Esquizofrenia/patologia , Adulto , Antipsicóticos/uso terapêutico , Humanos , Masculino , Esquizofrenia/tratamento farmacológicoRESUMO
OBJECTIVE: To determine if metal reduction magnetic resonance imaging sequences and changes in implant placement minimize artifact from cochlear implants and improve visualization of intracranial structures. STUDY DESIGN: Cadaveric study. SETTING: Tertiary referral center. PATIENTS: Five cadaveric heads. INTERVENTIONS: Specimens were implanted with Advanced Bionics HiRes Ultra3D devices at nasion-external auditory canal angles of 90, 120, and 160 degrees, and distances from the external auditory canal of 9 or 12 cm. Standard brain/internal auditory canal (IAC) sequences with metal artifact reducing technique were acquired in a 1.5T scanner. MAIN OUTCOME MEASURES: The primary outcome was visibility of 14 intracranial structures graded on a 4-point scale (1, structures <50% visible; 2, >50% visible with some areas nonvisible from artifact; 3, artifact present but adequate for diagnosis; and 4, high quality). Scores were determined by experienced head and neck radiologists and compared with one-way analysis of variance. RESULTS: Imaging sequences included axial 5-mm whole-brain turbo spin echo (TSE) T2 with right to left and anterior to posterior encoding, fluid-attenuation inversion recovery high bandwidth, axial 5-mm whole-brain slice-encoding metal artifact correction (SEMAC), axial IAC constructive interference in steady state, and axial 3-mm T1 IAC with and without fat saturation. T1 IACs in axial and coronal planes were best for ipsilateral structures overall (mean [standard deviation {SD}], 3.8 [0.6] and 3.8 [0.5]). SEMAC (mean [SD], 3.5 [0.8]) was superior to TSE with anterior to posterior encoding (mean [SD], 3.5 [0.9) for ipsilateral cortex, cerebellopontine angle, and brainstem/cerebellum, and equivalent for the inner ear. Constructive interference in steady state and T1 with fat saturation were poor for all ipsilateral structures (mean, 2.8 [ p < 0.01]; mean, 3.1 [ p < 0.01]). The 120 degrees/12 cm position was overall best, although the 120 degrees/9 cm position still afforded visualization of ipsilateral structures; other angles and distances conferred slight advantages for specific structures of interest. CONCLUSIONS: SEMAC and T2 TSE with anterior to posterior encoding sequences provide artifact suppression while retaining excellent image quality. Different placement angles did not confer improvement in visualization, although placement distances provided slight advantages for some structures.
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Implante Coclear , Implantes Cocleares , Humanos , Artefatos , Imãs , Imageamento por Ressonância Magnética/métodos , CadáverRESUMO
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Neoplasias de Cabeça e Pescoço , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/terapia , Recidiva Local de Neoplasia/patologia , Prognóstico , Sociedades Médicas , Estados UnidosRESUMO
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Assuntos
Zumbido , Doenças Vasculares , Malformações Vasculares , Humanos , Diagnóstico por Imagem/métodos , Sociedades Médicas , Zumbido/diagnóstico por imagem , Estados UnidosRESUMO
BACKGROUND: Previous studies suggest that semicircular canal dehiscences (SCDs) have a developmental origin. OBJECTIVE: We hypothesized that if SCDs originate during development, incidence of radiographic SCDs in young children will be higher than in adults. MATERIALS AND METHODS: Thirty-four temporal bone HRCTs of children younger than 2 years and 40 temporal bone HRCTs of patients older than 18 years were reformatted and re-evaluated for presence of SCD or canal thinning. Results were compared with indications for HRCT and clinical information. RESULTS: SCDs were detected in 27.3% of children younger than 2 years of age (superior, 13.8%; posterior, 20%) and in 3% of adults (P < 0.004). Of children with one radiographic dehiscence, 55.6% had multiple and 44% had bilateral SCDs on HRCT. No lateral canal SCDs were present. Thinning of bone overlying the semicircular canals was found in 44% of children younger than 2 years and 2.5% of adults (P < 0.0001). CONCLUSION: SCDs are more common on HRCTs of very young children. This supports the hypothesis that SCDs originate from discontinuation of bone deposition/maturation. However, SCDs on imaging do not necessarily correlate with canal dehiscence syndrome and should therefore be interpreted carefully.
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Doenças do Labirinto/diagnóstico por imagem , Doenças do Labirinto/epidemiologia , Canais Semicirculares/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Intensificação de Imagem Radiográfica/métodos , Medição de RiscoRESUMO
Many different benign and malignant processes affect the central skull base and petrous apices. Clinical evaluation and tissue sampling are difficult because of its deep location, leaving imaging assessment the primary means for lesion evaluation. Skull base lesions demonstrate a variety of confusing appearances on imaging, creating diagnostic dilemmas. It is important to be familiar with imaging appearances of common mimickers of malignant neoplasm in the skull base. This article familiarizes readers with imaging characteristics of various anatomic variants and benign pathologies that mimic malignant neoplasms, in hopes of increasing confidence of diagnosis, decreasing unnecessary procedures, and allaying patient fear.
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Neoplasias da Base do Crânio , Humanos , Imageamento por Ressonância Magnética , Osso Petroso/patologia , Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios XRESUMO
Pre- and postoperative imaging is increasingly used in plastic and reconstructive surgery for the evaluation of bony and soft tissue anatomy. Imaging plays an important role in preoperative planning. In the postoperative setting, imaging is used for the assessment of surgical positioning, bone healing and fusion, and for the assessment of early or delayed surgical complications. This article will focus on imaging performed for surgical reconstruction of the face, including orthognathic surgery, facial feminization procedures for gender dysphoria, and face transplantation.
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Transplante de Face , Procedimentos de Cirurgia Plástica , Diagnóstico por Imagem , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/cirurgia , Feminização/cirurgia , Humanos , MasculinoRESUMO
This article presents guidelines for initial imaging utilization in patients presenting with sinonasal disease, including acute rhinosinusitis without and with suspected orbital and intracranial complications, chronic rhinosinusitis, suspected invasive fungal sinusitis, suspected sinonasal mass, and suspected cerebrospinal fluid leak. CT and MRI are the primary imaging modalities used to evaluate patients with sinonasal disease. Given its detailed depiction of bony anatomy, CT can accurately demonstrate the presence of sinonasal disease, bony erosions, and anatomic variants, and is essential for surgical planning. Given its superior soft tissue contrast, MRI can accurately identify clinically suspected intracranial and intraorbital complications, delineate soft tissue extension of tumor and distinguish mass from obstructed secretions.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Sinusite , Sociedades Médicas , Humanos , Imageamento por Ressonância Magnética/métodos , Sinusite/diagnóstico por imagem , Estados UnidosRESUMO
Cranial neuropathy can result from pathology affecting the nerve fibers at any point and requires imaging of the entire course of the nerve from its nucleus to the end organ in order to identify a cause. MRI with and without intravenous contrast is often the modality of choice with CT playing a complementary role. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Assuntos
Doenças dos Nervos Cranianos , Humanos , Doenças dos Nervos Cranianos/diagnóstico por imagem , Revisão por Pares , Análise de SistemasRESUMO
Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.