Ophthalmoplegia With Isolated Extraocular Muscle Hypertrophy.

A 60-year-old man is experiencing diplopia but no problems with visual acuity, pain, or other symptoms. A magnetic resonance image of the head shows abnormal thickening and T2 hyperintensity of the right lateral rectus muscle. What is your diagnosis?

Morphological and radiological features of congenital muscular hypertrophy of the upper limb: experience from a tertiary institution.

Congenital muscular hypertrophy is a rare overgrowth disorder in the phosphatidylinositol-3-kinase related spectrum. In the past 3 years, ten patients with 11 limbs involved were treated in our centre. The aim of the study was to describe the clinical and radiological deformities of these patients. We documented the characteristic clinical morphological changes, such as hypertrophy, loss of wrist flexion, thumb hyperabduction, finger deviation and skin crease changes in the palm. Radiologically, the mean first metacarpal radial deviation angle of the affected side measured 55° (range 34 to 67) compared to the normal contralateral side 42° (range 32 to 53). The mean intermetacarpal space ratio was 1.2 (range 1.1 to 1.4) and the mean palm width ratio was 1.2 (range 1.1 to 1.3). In this study, we were able to further characterize the radiological and morphological changes of congenital muscular hypertrophy of upper limbs, which would be helpful for establishing the diagnosis and monitor treatment of this rare condition.Level of evidence: IV.

A cone-beam computed tomography study of hyoid bone position and airway volume in subjects with obstructive and nonobstructive adenotonsillar hypertrophy.

OBJECTIVES: To investigate hyoid bone position and airway volume in subjects with adenoid hypertrophy, tonsillar hypertrophy, and adenotonsillar hypertrophy compared to subjects with nonobstructive adenoids or tonsils and to assess the correlation between hyoid bone and airway parameters. MATERIALS AND METHODS: A total of 121 subjects were grouped based on adenoid or tonsillar hypertrophy into four groups, as follows: (1) control group (C-group), (2) adenoid hypertrophy group (AH-group), (3) adenotonsillar hypertrophy group (ATH-group), and (4) tonsillar hypertrophy group (TH-group). Hyoid bone position and airway volumes were measured. The Kruskal-Wallis test was used for intergroup comparison, followed by pairwise comparison using the Mann-Whitney U-test. Bivariate correlation was conducted using Spearman correlation coefficients. Multiple linear regression was performed to create a model for airway volume based on hyoid bone predictive variables. RESULTS: No significant difference was found between subjects with isolated adenoid or tonsillar hypertrophy compared to the C-group. However, the ATH-group exhibited a significantly decreased hyoid bone vertical distance (HV), total airway volume (TA volume), and retroglossal airway volume (RG volume) compared to the C-group. HV and age had a high potential in terms of explaining the RG volume, whereas the TA volume and retropalatal airway volume (RP volume) models were not as successful as the RG volume counterpart. CONCLUSIONS: Subjects in ATH-group were characterized by an elevated hyoid bone position and constricted TA volume and RG volume compared to those in the C-group. HV and age were predictor variables that best explained retroglossal airway volume.

Automatic detection of adenoid hypertrophy on cone-beam computed tomography based on deep learning.

INTRODUCTION: This study proposed an automatic diagnosis method based on deep learning for adenoid hypertrophy detection on cone-beam computed tomography. METHODS: The hierarchical masks self-attention U-net (HMSAU-Net) for segmentation of the upper airway and the 3-dimensional (3D)-ResNet for diagnosing adenoid hypertrophy were constructed on the basis of 87 cone-beam computed tomography samples. A self-attention encoder module was added to the SAU-Net to optimize upper airway segmentation precision. The hierarchical masks were introduced to ensure that the HMSAU-Net captured sufficient local semantic information. RESULTS: We used Dice to evaluate the performance of HMSAU-Net and used diagnostic method indicators to test the performance of 3D-ResNet. The average Dice value of our proposed model was 0.960, which was superior to the 3DU-Net and SAU-Net models. In the diagnostic models, 3D-ResNet10 had an excellent ability to diagnose adenoid hypertrophy automatically with a mean accuracy of 0.912, a mean sensitivity of 0.976, a mean specificity of 0.867, a mean positive predictive value of 0.837, a mean negative predictive value of 0.981, and a F1 score of 0.901. CONCLUSIONS: The value of this diagnostic system lies in that it provides a new method for the rapid and accurate early clinical diagnosis of adenoid hypertrophy in children, allows us to look at the upper airway obstruction in three-dimensional space and relieves the work pressure of imaging doctors.

Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings.

Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an unusual manifestation of immune-mediated, infectious, and neoplastic conditions. Although some cases may remain asymptomatic, HP can lead to progressive headaches, cranial nerve palsies, hydrocephalus, and other neurological complications, which makes its recognition a fundamental step for prompt treatment. Regarding the diagnosis workup, enhanced MRI is the most useful imaging method to evaluate dural thickening. This article addresses the MR imaging patterns of immune-mediated HP, including immunoglobulin G4-related disease, neurosarcoidosis, granulomatosis with polyangiitis, rheumatoid pachymeningitis, and idiopathic HP. The main infectious and neoplastic mimicking entities are also discussed with reference to conventional and advanced MR sequences.

Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective.

STUDY OBJECTIVES: Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy. METHODS: This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics. RESULTS: The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index. CONCLUSIONS: STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy. CITATION: Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.

Increased 18F-PSMA and 18F-FDG Uptake in Lipomatous Hypertrophy of the Interatrial Septum.

ABSTRACT: Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign anomaly with low prevalence. Lipomatous hypertrophy of the interatrial septum is asymptomatic in most of the cases and rarely leads to atrial arrhythmias, obstructive flow symptoms, or sudden death. It is mostly diagnosed as an incidental finding in cross-sectional imaging and echocardiography, and increased 18F-FDG uptake on LHIS has been described. We present a case of repeated increased 18F-PSMA uptake in LHIS. Although very rare, familiarity with the typical features and prevalence of LHIS in PET/CT can avoid misinterpretation for metastatic disease.

Evidence of nerve hypertrophy in patients with inclusion body myositis on lower limb MRI.

INTRODUCTION/AIMS: Inclusion body myositis (IBM) is a myopathic condition but in some patients has been associated with an axonal length-dependent polyneuropathy. In this study, we quantified the cross-sectional area of the sciatic and tibial nerves in patients with IBM comparing with Charcot-Marie-Tooth disease type 1A (CMT1A) and healthy controls using magnetic resonance neurography (MRN). METHODS: MRN of the sciatic and tibial nerves was performed at 3T using MPRAGE and Dixon acquisitions. Nerve cross-sectional area (CSA) was measured at the mid-thigh and upper third calf regions by an observer blinded to the diagnosis. Correlations were performed between these measurements and clinical data. RESULTS: A total of 20 patients with IBM, 20 CMT1A and 29 healthy controls (age- and sex-matched) were studied. Sciatic nerve CSA was significantly enlarged in patients with IBM and CMT1A compared to controls (sciatic nerve mean CSA 62.3 ± 22.9 mm2 (IBM) vs. 35.5 ± 9.9 mm2 (controls), p < 0.001; and 96.9 ± 35.5 mm2 (CMT1A) vs. 35.5 ± 9.9 mm2 (controls); p < 0.001). Tibial nerve CSA was also enlarged in IBM and CMT1 patients compared to controls. DISCUSSION: MRN reveals significant hypertrophy of the sciatic and tibial nerves in patients with IBM and CMT1A compared to controls. Further studies are needed to correlate with neurophysiological measures and assess whether this finding is useful diagnostically.

Analysis of inferior nasal turbinate volume in subjects with nasal septum deviation: a retrospective cone beam tomography study.

Background: The association of the linear dimensions of the inferior turbinate hypertrophy with nasal septal deviation has been studied recently. However, the volumetric dimensions provide a more accurate status of the turbinate hypertrophy compared to linear measurements. The aim of this study was to analyze the association of inferior nasal turbinate volume with the degree of nasal septal deviation (NSD). Methods: A retrospective evaluation of the cone beam computed tomography (CBCT) scans of 412 patients was carried out to obtain 150 scans which were included in the study. The scans were categorized into three groups. Group 1 comprised of 50 scans of patients with no inferior turbinate hypertrophy (ITH) and no nasal septal deviation. Group 2 comprised of 50 scans of patients with ITH and no NSD; whereas Group 3 included 50 scans of patients with ITH and NSD. The total turbinate volume of inferior turbinates (bilateral) were determined by using Vesalius 3D software (PS-Medtech, Amsterdam, Netherlands). Results: The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologists was 0.82. There were no significant age and gender related changes in the total turbinate volume. Patients in Group 3 had significantly higher (p = 0.001) total turbinate volume compared to Group 2 and Group 1. There was a positive and significant correlation (r = 0.52, p = 0.002) between the degree of septal deviation and total turbinate volume. When the total turbinate volume of the patients with different types of septal deviation was compared in Group 3, a statistically significant difference (p = 0.001) was observed. Regression analysis revealed that the septal deviation angle (SDA) (p = 0.001) had a relationship with total turbinate volume. From the results of the study we can conclude that the total turbinate volume is higher in patients with nasal septal deviation. It can also be concluded that the septal deviation angle has a positive correlation with total turbinate volume. The data obtained from the study can be useful in post-surgical follow up and evaluation of patients with nasal septal deviation and hypertrophied inferior nasal turbinate.

Clinical, imaging features and treatment response of idiopathic hypertrophic pachymeningitis.

BACKGROUND: Idiopathic hypertrophic pachymeningitis (IHP) is a rare inflammatory disease that causes focal or diffuse thickening of the dura mater. However, longitudinal follow up studies are still lacking for these patients. OBJECTIVE: To investigate the clinical characteristics, neuroimaging findings, treatment response and outcome of IHP. METHOD: A retrospective case series of 30 patients admitted Beijing Tiantan Hospital were screened via Hospital Information System from January 1st, 2011, to January 31st, 2021. All patients' clinical symptoms, imaging, and treatment response were collected via a standardized form. We compared the effects of high-dose and low-dose corticosteroids on headache, impaired vision, and MRI remission during acute onset. The effects of different immunosuppressants on preventing relapses were also compared. RESULTS: Headache (93.3%) and multiple cranial neuropathy (66.7%) were the most common symptoms of IHP. Cerebral spinal fluid test showed that protein levels were elevated in 17 (56.7%) patients, and white blood cells were increased in seven patients. MRI demonstrated that diffuse (60%) and focal (40%) enhancement occurred in the dura mater, especially in the tentorium cerebellum (80%). High-dose and low-dose corticosteroids reduced headache and dural enhancement during the acute phase. The high dose corticosteroid significantly relieved the headache than the low dose group (p = 0.041). Patients treated with mycophenolate mofetil and cyclophosphamide might achieve longer remission (months, p = 0.428). CONCLUSION: Headache and multiple cranial neuropathy are the most common clinical manifestations of IHP. In this study, almost all patients had a good initial response to corticosteroid therapy during the acute phase. Mycophenolate mofetil and cyclosporine may be effective for preventing relapses.

Papel de las técnicas de imagen en el diagnóstico de la hipertrofia selectiva del músculo tensor de la fascia lata / Role of imaging techniques in the diagnosis of selective hypertrophy of the tensor fascia lata

El músculo tensor de la fascia lata es una estructura muscular que forma parte de la porción lateral de la pelvis y del muslo proximal. La patología de este músculo no es bien conocida y descrita en la literatura. Por el contrario, la hipertrofia y la seudohipertrofia del músculo tensor de la fascia lata son hallazgos por imagen relativamente frecuentes que a menudo no se diagnostican y entran en un diagnóstico diferencial con patologías más complejas y peligrosas. En este artículo, nuestro objetivo es describir las características anatómicas y funcionales del músculo tensor de la fascia lata, profundizando en la descripción del músculo en radiología, su patología y un resumen de la literatura sobre el tema.(AU)

The tensor fascia lata is a muscular structure that forms part of the lateral portion of the pelvis and proximal thigh. Because conditions affecting this muscle have not been widely reported and are relatively unknown, hypertrophy and pseudo-hypertrophy of the tensor fascia lata, although relatively common imaging findings, often go undiagnosed; instead, radiologists perform the differential diagnosis with more complex and more dangerous conditions. This article aims to review the anatomic and functional characteristics of the tensor fascia lata, going into detail about the radiological description of this muscle and pathological conditions that can affect it, as well as reviewing the relevant literature.(AU)

A New Approach for Evaluating Palatine Tonsillar Hypertrophy in Children Based on Ultrasound: A Pilot Study.

OBJECTIVES: To develop a novel ultrasound (US) plane to diagnose palatine tonsillar hypertrophy objectively in children. METHODS: Tonsillar ultrasonography of children (age 2-14 years) who had a clinical diagnosis of tonsillar hypertrophy or not were analyzed retrospectively. Clinical data (including gender, age, body mass index (BMI)), and volume (V) of tonsils measured by the US, were recorded. Furthermore, we found a new US plane to diagnose tonsillar hypertrophy and named it the submental oblique cross-section. In this plane, diameters of the left tonsil, right tonsil, and central oropharynx were designated as T1, T2, and O. Then, we calculated the ratio by the formula (T1 + T2)/O. RESULTS: A total of 172 cases (85 hypertrophy and 87 non-hypertrophy) were included in this study. There were no significant differences in gender (P = .844), age (P = .666), and BMI (P = .089) between the groups. In the non-hypertrophy group, the V of both sides had a positive linear correlation with age or BMI. In contrast, there was no linear correlation between ratio and age or BMI. The area under the curve (AUC) of ratio and V was 0.970 (95%CI: 0.947-0.993) and 0.835 (95%CI: 0.778-0.893) by receiver operating characteristic (ROC) analysis, respectively. The optimal cutoff value of ratio for diagnosis of tonsillar hypertrophy was 2.293 (sensitivity = 88.2%, specificity = 95.4%). CONCLUSIONS: We established a new US section to evaluate tonsillar hypertrophy. This approach could be easily acquired and provide a reference value to guide clinical practice.

Hypertrophic pachymeningitis with co-occurrence of anti-neutrophil cytoplasmic antibodies and immunoglobulin G4 seropositivity: Case report and literature review.

We report an extremely rare case of hypertrophic pachymeningitis in which a 71-year-old man presented with an intractable recurrent headache for >1 year. During this period, he became positive for immunoglobulin G4 and proteinase 3-antineutrophil cytoplasmic antibodies. Contrast-enhanced magnetic resonance imaging showed characteristic diffuse thickening of the dura. Symptoms were improved by intravenous methylprednisolone (500 mg per day for 5 days) and cyclophosphamide pulse therapy during corticosteroid withdrawal; he remained symptom-free during 1-year follow-up. This case suggests that this disease can be treated by corticosteroids combined with immunosuppressive agents.

Evaluation of the associations between maxillary sinus dimensions and adenoid hypertrophy using multislice computed tomography.

INTRODUCTION: Adenoid hypertrophy is especially common in childhood, raising the concern that such growth might affect maxillary sinus volumes during the developmental period. This study evaluated the developmental relationships between maxillary sinus volumes and adenoid hypertrophy via computed tomography. MATERIALS AND METHODS: It was examined computed tomographic images of 118 individuals: 61 boys and 57 girls. The participants were divided into a healthy control group (n = 59) and an experimental group (with adenoid hypertrophy) (n = 59). Raw data were recorded in DICOM format and analysed using the ITK-SNA algorithm; it was measured the right, left, and total maxillary sinus volumes and adenoid tissue sizes. RESULTS: It was found significant between-group differences in the three maxillary sinus volumes and adenoid tissue dimensions (linear maximum anterior and posterior depth; maximum upper and lower height, and maximum width to the right and left) (all p<0.001). On the contrary, there was no significant difference according to sex in terms of either maxillary sinus volumes or linear adenoid tissue measurements. Maxillary sinus volumes increased significantly according to age in both groups. CONCLUSION: Adenoid hypertrophy decreases the maxillary sinus volumes, regardless of sex. The impacts of adenoid growth on maxillary sinus aeration and sinus disease should be further investigated.

Age-Related Changes in the Submandibular Gland: An Imaging Study of Gland Ptosis Versus Volume.

BACKGROUND: Debate surrounding the morphological evolution of the submandibular gland (SMG) with aging, and the uncertain influence of patient demographics, has led to hesitancy about incorporating targeted interventions of the SMG into clinical practice. OBJECTIVES: The aim of this study was to determine whether SMG ptosis, hypertrophy, or both is the primary etiology behind the increase in submandibular volume with age. METHODS: MRI segmentation was used to calculate the total and inframandibular (IM) volume and height of the SMG. Adult subjects with previous MRIs of the head and neck were used for analysis. Those with pathology or artifact compromising the SMG were excluded. Subjects were divided into 4 age-defined cohorts, for clinical applicability. RESULTS: The study included 129 patients (65 females; 64 males) with a mean age of 52.3 years (range, 20-85 years). No significant change in total SMG volume was observed between the reference group and all cohorts. The IM-SMG volume of the reference cohort was 5.77 cm3. All 3 cohorts had a greater IM-SMG volume than the reference group. The 45- to 54-year cohort had a mean volume of 6.7 cm3 (P = 0.4), the 55- to 64-year cohort, 7.5 cm3 (P = 0.01), and the ≥65-year cohort, 7.2 cm3 (P = 0.01). Male sex and overweight or obese BMI were associated with significantly larger total and IM-SMG volumes. CONCLUSIONS: The novel finding of a significantly larger IM-SMG volume with no change in total volume provides evidence for SMG ptosis rather than hypertrophy as a significant contributor to age-related submandibular fullness. The lack of any significant difference in total volume or height with aging emphasizes the role of glandular descent.

Evaluation of dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging for predicting muscular hyperplasia/hypertrophy in Crohn's disease.

OBJECTIVES: The existence of smooth muscle alteration in Crohn's disease (CD) is often neglected. It has been found that muscular hyperplasia/hypertrophy rather than fibrosis was the primary component of bowel wall thickening. This study aimed to assess the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted imaging for the characterization of histopathologic tissue composition of CD, particularly smooth muscle hypertrophy, as well as inflammation and fibrosis. METHODS: The study included patients diagnosed with CD who received MRI examination 30 days before resection from August 2016 to December 2020. A semiquantitative histological grading scheme was employed to evaluate the pathological tissues. Resected sections were matched with MRI according to pathological marks. Parameters evaluated included: mural thickness, T2 ratio, apparent diffusion coefficient value; and maximum enhancement, initial slope of increase, perfusion parameters of DCE-MRI and enhancement pattern. These parameters were compared with location-matched histopathological grade. RESULTS: Ninety-one sections were enrolled in this retrospective study. When active inflammation is moderate or severe, volume transfer coefficient (Ktrans), maximum enhancement (ME) and initial slope of increase (ISI) are lower, mural thickness is higher when a certain degree of smooth muscle alteration is present. When active inflammation is absent or mild, ME, mural thickness and ISI can differentiate the presence of predominant muscular alteration. By combining ME and thickness comparisons against their cutoff values to create a combined ordinal parameter, the area under the curve value for whether significant muscular alteration coexists with moderate or severe active inflammation was found to be 0.953. CONCLUSIONS: MRI predicts the degree of inflammation, and can distinguish the degree of muscular alteration coexists with moderate or severe active inflammation with reasonable accuracy.