Varied MR appearance of autism: fifty-three pediatric patients having the full autistic syndrome.

Fifty-three autism patients ranging in age from 2 to 22 yr with a mean age of 9 yr were evaluated by MR imaging over a 3-yr study period. Sagittal, axial, and coronal spin-echo and short TI inversion recovery scans were performed on a 0.5 Tesla (Picker Inc., Cleveland, OH) system. Results were compared to 32 control patients age range 1 to 17 yr, mean 8.5 yr. MR scans were evaluated by three neuroradiologists. Measurements of midsagittal vermian height and AP diameter were performed. Subjective estimates were made of ventricular size, amygdala size, fourth ventricular size, and vermian shape. Results were correlated with clinical presentation, course, and lab analyses by a pediatric neurologist. MR findings did not present a single pattern capable of predicting the presence or severity of autism. The constellation of MR findings in this group of 53 patients was highly variable, thus we advise caution in the interpretation of MR images in autistic patients. Autism is a heterogeneous disease entity containing different clinical subgroups, which do not manifest similar radiologic pictures.

Metastatic cervical adenopathy from tumors of unknown origin: the role of CT.

A prospective CT study of seventeen patients with metastatic cervical adenopathy from tumors at an unknown primary site, believed most likely to be in the upper aerodigestive tract, was performed. All patients had normal endoscopic examinations performed by an otolaryngologist before the CT study. CT suggested a primary site in ten cases, of which four were confirmed by surgery or biopsy. In four cases, CT did not identify a suspicious site and no primary site was identified during triple endoscopy, sometimes with blind biopsies. CT was able to suggest correct causes other than carcinoma in three cases and gave useful information about the extent of nodal disease. CT should be used as part of the routine evaluation of patients with this clinical problem. A diagnostic algorithm is suggested in which CT is integrated with modern endoscopic and aspiration cytologic techniques.

Atypical CT scans in adrenoleukodystrophy.

Computed tomography has become a valuable tool in the diagnosis of adrenoleukodystrophy because of a characteristic CT pattern of symmetrical low density areas in the parietooccipital region often with a peripheral rim of enhancement. However, a few cases have been reported that depart from this classic pattern. We have recently observed an atypical CT pattern where instead of diminished attenuation in the white matter, extensive calcifications were seen with a symmetric distribution in the parietooccipital regions. There was no associated contrast enhancement.

Epidural lipomatosis with lumbar radiculopathy: CT appearance.

Epidural lipomatosis is a relatively uncommon clinical entity in which large amounts of fat are deposited in the epidural space. In most of the previously reported cases of this entity an associated myelopathy has been reported. We describe a patient who presented with lumbar radiculopathy, which was probably caused by epidural lipomatosis.

The upper aerodigestive tract and neck: CT evaluation of recurrent tumors.

Review of CT scans and clinical records of 46 patients with known or suspected recurrent tumor of the upper aerodigestive tract and neck has afforded a new radiographic perspective on the natural history of these neoplasms. The 46 patients included a group of 34 patients with squamous cell carcinoma of the upper aerodigestive tract and a group of nine patients with nonsquamous malignancies metastatic to the neck. Recurrences were evaluated for interval to recurrence, site of recurrence, and CT impact on the clinical management of the recurrent tumor. Results of the study indicate that CT detects tumor beyond the limits of physical examination in 32% of cases and in doing so may alter radiotherapy ports or the surgical approach. CT was the only means of demonstrating recurrent squamous cell carcinoma in 27% of that patient group. Moreover, the study shows the potential of CT to reduce delay in diagnosis in both patient groups, but most dramatically in those patients with nonsquamous malignancies. Recommendations for CT follow-up in this patient population are made based on this experience.

Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part I: normal anatomy.

The retropharyngeal and cervical lymph-node-bearing areas in 30 patients were examined with computed tomography (CT) to determine the range of normal variation in these nodal groups. The data agree with those in the pathologic, anatomic, and surgical literature, and indicate that CT can very precisely determine the size and gross morphology of normal nodes in the retropharyngeal region and the neck. This should have important applications in the management of patients with head and neck cancer.

Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part II: pathology.

Forty-one patients were examined (39 prospectively and 2 retrospectively) with computed tomography (CT) to determine its value in staging cervical and retropharyngeal nodal metastases. Precise surgical confirmation of CT findings was available in 25 patients. CT correctly increased the stage of the disease in six necks, and showed extranodal extent more precisely than the clinical examination in six others. The clinical evaluation proved superior to CT at predicting the extent of extranodal disease in two patients. Both CT and the clinical examination failed to detect microscopic tumor in normal-size nodes in two patients and falsely predicted tumor in enlarged nodes in one. CT offers information important for management and prognosis that is not available from the clinical examination in patients who have already been treated for cancer of the neck, and in patients with extranodal spread or retropharyngeal adenopathy. In the untreated neck CT will increase the stage of the disease from N0 to N1 about 5% of the time. Simple criteria for integrating CT into current clinical-diagnostic staging systems based on this and other experience are presented.

Efficacy of nonionic low-osmolar gadodiamide injection in animals with intracranial mass lesions.

Gadodiamide injection is a nonionic, low-osmolar formulation of a paramagnetic metal chelate complex consisting of gadodiamide and caldiamide sodium. The efficacy of gadodiamide injection as a magnetic resonance (MR) imaging enhancement medium was evaluated by imaging intracranial 9L-glioma lesions induced in rats and naturally occurring lesions in dogs. T1- and T2-weighted spin-echo images were obtained before and after administration of gadodiamide injection at doses of 0.1 and 0.2 mmol/kg. On the precontrast T1-weighted images, the intracranial lesions were not well seen, appearing isointense to normal brain parenchyma. Although the presence of disease was shown unequivocally on the T2-weighted images, the margins of the masses could not be delineated. Postcontrast T1-weighted images were characterized by marked enhancement of the tumor, with no change in signal intensity in the surrounding edematous brain tissue. Gadodiamide injection was efficacious in identifying areas of blood-brain barrier breakdown associated with intracranial masses.

CT of the oropharynx, tongue base, and floor of the mouth: normal anatomy and range of variations, and applications in staging carcinoma.

CT scans of 35 patients were obtained during rapid drip infusion of contrast material to determine the range of normal variation in the structures of the oropharynx and the floor of the mouth. Superficial structures such as the tonsillar pillars and lingual and faucial tonsils vary so much in appearance that they are not useful indicators in the detection of subtle lesions; in fact, they are potential sources of "pseudomasses." Asymmetric obliteration of the parapharyngeal space is useful for the detection of subtle lesions of the upper tonsillar fossae; however, confident diagnosis in regard to the lower oropharynx depends on visualization of a mass lesion or loss of the more constant planes in the floor of the mouth and the tongue base. CT findings added unique and valuable information in eight of 12 cases of carcinoma, confirmed the clinical impression of the extent of the lesion in four cases, and were potentially misleading in one case. CT is a valuable adjunct to the detection and staging of an oropharyngeal malignancy.

Disk fragment migration.

This report analyzes the most frequently observed migration paths of disk fragments in 47 patients who had extruded or sequestered disks. Observations are based principally on magnetic resonance (MR) images. When disk fragments moved in a superior (42%) or inferior (40%) direction from the donor disk, the displaced disk components were most frequently (94%) dislodged into the right or left half of the anterior epidural space (AES) and rarely straddled the midline. To explain this phenomenon, the authors investigated the anatomy of the AES by dissecting four cadaver specimens and reviewing 300 MR images of the spine. They conclude that the migrating path of a disk fragment is determined by the anatomy of the AES, a fairly well-defined space delimited posteriorly by the posterior longitudinal ligament and by membranes laterally attached to it. It consists of two compartments separated by a sagitally aligned septum. During migration, sequestered disk fragments usually stay in these compartments.

Branchial cleft anomalies and their mimics: computed tomographic evaluation.

A review was made of the clinical records and radiographic examinations of 38 patients with neck lesions clinically suspected of being branchial cleft anomalies. The impact of computed tomography in this sometimes confusing clinical picture was assessed and CT criteria for diagnosing branchial cleft anomalies (BCAs) and differentiating them from their mimics were identified. Seventeen branchial cleft anomalies (four of the first branchial cleft and 13 of the second branchial cleft) and 21 BCA mimics were evaluated. A definitive CT diagnosis of second branchial cleft cysts based on characteristic morphology, location, and displacement of surrounding structures was possible in 80% of cases. CT was found to be the best radiographic examination in making a definitive diagnosis of BCA if a neck mass was present. CT-derived information, by providing additional preoperative data on the extent and type of neck lesion, frequently altered the course of patient management.