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Approximately half of head and neck carcinomas arise from the oral cavity. Imaging plays an essential role in the preoperative evaluation of oral cavity carcinomas. MR imaging is particularly advantageous in the evaluation of the oral cavity, with better depiction of the anatomy in this region and reduction of dental artifacts compared with CT. MR is also the preferred imaging modality for the evaluation of bone marrow invasion and perineural tumor spread, which are findings critical for treatment planning. Advanced MR imaging techniques may potentially better delineate true tumor extent, determine lymph node metastases, and predict treatment response.

This single-institution phase II study was performed to estimate the response rate to lapatinib in neurofibromatosis type 2 (NF2) patients with progressive vestibular schwannoma (VS). Twenty-one eligible patients were enrolled. Brain and spine MRIs, including 3-dimensional volumetric tumor analysis, and audiograms were performed once at baseline and again every 12 weeks. The primary response end point was evaluable in 17 patients and defined as ≥15% decrease in VS volume. Hearing was evaluable as a secondary end point in 13 patients, with responses defined as an improvement in the pure tone average of at least 10 dB or a statistically significant increase in word recognition scores. Four of 17 evaluable patients experienced an objective volumetric response (23.5%; 95% confidence interval [CI], 10%–47%), with median time to response of 4.5 months (range, 3–12). In responders, reduction in VS volumes ranged from −15.7% to −23.9%. Four of 13 patients evaluable for hearing met hearing criteria for response (30.8%; 95% CI, 13%–58%). One sustained response exceeded 9 months in duration. Median time to overall progression (ie, volumetric progression or hearing loss) was 14 months. The estimated overall progression-free survival and volumetric progression-free survival at 12 months were 64.2% (95% CI, 36.9%–82.1%) and 70.6% (95% CI, 43.1%–86.6%), respectively. Toxicity was generally minor, and no permanent dose modifications were required. Lapatinib carries minor toxicity and has objective activity in NF2 patients with progressive VS, including volumetric and hearing responses. Future studies could explore combination therapy with other molecular targeted agents such as bevacizumab.

With the availability of high-resolution computed tomography (CT), a great deal of attention has been paid to the anatomy of the paranasal sinuses. But while investigators have focused on the osteomeatal complex and its relation to chronic rhinosinusitis, there has been little discussion of the superior turbinate. Although a few anatomic studies have tried to quantify pneumatization of the superior turbinate, the prevalence of this finding on radiography is not well addressed in the literature. We prospectively studied 100 consecutively presenting patients who underwent coronal CT of the paranasal sinuses (200 sides) for the evaluation of symptoms of chronic rhinosinusitis at an academic tertiary referral center to determine the prevalence of pneumatization of the superior turbinate. We found evidence of pneumatization in 44 of the 200 sides, for a prevalence of 22%. In all, pneumatized superior turbinates were found in 27 patients (27%)—bilaterally in 17 (17%) and unilaterally in 10 (10%).

A 30-year-old woman with myopia (−8 diopters) developed binocular horizontal diplopia over a year. She had chronic migraine and no other symptoms. Ocular motility showed a comitant esotropia (20 diopters), and 2-diopter right hypertropia. MRI (figures 1 and 2) showed features of heavy eye syndrome,1 which is associated with superotemporal prolapse of the posterior globe, degeneration of lateral rectus–superior rectus band, and displacement of the lateral rectus downward.2 The abduction failure may be confused with a sixth nerve palsy. Our patient was treated with prisms with partial success, which along with strabismus correction are the treatment options.

Objective The preferential delayed enhancement of the perilymphatic space enables detection of the non-enhancing endolymphatic hydrops present in patients with Meniere's disease. The aim of this study was to evaluate the diagnostic utility of delayed postcontrast 3D FLAIR images and a color map of fused postcontrast FLAIR and constructive interference steady state (CISS) images in the identification of endolymphatic hydrops in patients with clinically diagnosed Meniere's disease. Study design Case control, blinded study. Setting Tertiary referral center. Patients Ten patients with Meniere's disease and five volunteer controls. Intervention Diagnostic. Main outcome measure Two neuroradiologists blinded to the clinical history independently evaluated for the presence of endolymphatic hydrops on the images of both inner ears for test and control subjects. Both the standard gray-scale FLAIR images and the fused color map images were independently reviewed. Results The gray-scale 3D FLAIR images demonstrated 68.2% sensitivity and 97.4% specificity, and the fused color map images demonstrated 85.0% sensitivity and 88.9% specificity in the identification of endolymphatic hydrops in Meniere's disease. There was significant correlation between the gray-scale 3D FLAIR images and fused color map images with the categorization of involvement (p = 0.002). Inter-evaluator reliability was excellent (kappa = 0.83 for gray-scale images, kappa = 0.81 for fused color map). Conclusion Delayed 3D FLAIR and fused 3D FLAIR-CISS color map images of the inner ears after intravenous contrast administration are potentially useful diagnostic tools in the evaluation of patients with suspected Meniere's disease.

Objective: To determine whether quantitative whole-brain MR diffusion histograms in patients with MS differ from those of normal control subjects. Background: MRI detects macroscopic cerebral lesions in MS, but the white matter lesion burden on MRI correlates imperfectly to clinical disability. Previous reports have further suggested abnormalities in white matter of MS patients with no visible lesions on conventional MRI. Methods: A total of 25 subjects (13 with MS [9 relapsing–remitting, 4 secondary progressive] and 12 healthy control subjects) underwent diffusion-weighted echoplanar MRI encompassing the entire brain. The average apparent diffusion coefficient (ADC ave , or diffusion trace) was calculated on a pixel-by-pixel basis after segmentation of intracranial space from calvarium and extracranial soft tissues. Whole-brain ADC ave histograms were calculated and plotted for statistical comparison. Results: Mean whole-brain MR ADC ave in MS patients was elevated and histograms were shifted to higher values compared with normal control subjects. Mean whole-brain ADC ave of secondary progressive patients was shifted to higher values compared with relapsing–remitting patients. Whole-brain ADC ave histograms of relapsing–remitting patients showed no significant difference from normal control subjects. Conclusion: Whole-brain MR diffusion histograms may quantitate overall cerebral lesion load in patients with MS and may be able to discern differences between clinical subgroups.

There are a multitude of tumors that may spread to the extra-axial compartment (i.e., meninges, skull base, and calvarium). The role of imaging in the search for metastases is to detect the full extent of and to correctly localize the disease. This unit presents basic protocols for imaging extra-axial metastatic tumors. Specific modifications are discussed where necessary. The sequences described in this unit are based on a 1.5 T scanner (Echospeed GE Medical Systems, Milwaukee, Wisconsin), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

This unit presents the preferred protocol for imaging the brain following the institution of chemotherapy, radiation therapy, or surgery for brain tumors and specific modifications are discussed where necessary. The sequences described in this unit are based on a 1.5 T scanner (Echospeed GE Medical Systems), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

The majority of primary brain tumors in adults are found in the supratentorial compartment, while tumors in pediatric patients are usually infratentorial in location. This unit presents basic protocols for imaging all types of primary intra-axial brain tumors, whether infiltrative (i.e., astrocytoma, oligodendroglioma, lymphoma) or circumscribed (i.e., ganglioglioma, cystic astrocytoma). Specific modifications are discussed where necessary. The sequences described in this unit are based on a 1.5 T scanner (Echospeed GE Medical Systems), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

Extra-axial tumors most commonly arise from the meninges, calvarium, or skull base. Localization of a lesion as extra-axial or extra-cerebral in origin has significant clinical importance in terms of treatment planning and predicting prognosis. High-resolution fat-suppressed imaging is crucial for specific evaluation of the skull base, and correlation with computed tomography (CT) is often helpful in these cases. This unit presents basic MRI protocols for imaging extra-axial tumors in specific locations; sequence modifications are discussed where necessary. The sequences described in this unit are based on a 1.5 T scanner (GE Medical Systems), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

The role of MRI imaging in the metastatic work-up is to detect the spread of tumor to the brain parenchyma, and define the location. Intravenous contrast (gadolinium-DTPA) provides the greatest sensitivity for detecting brain lesions and is almost always indicated except when there is no intravenous access. This unit presents a Basic Protocol for imaging intra-axial brain metastases and specific modifications are discussed for the case of metastatic brain tumors demonstrating evidence of hemorrhage. The sequences described in this unit are based on 1.5 T scanner (Echospeed GE Medical Systems, Milwaukee, Wisconsin), but can be expected to be equally applicable to other field strengths and scanners from other manufacturers.

Objective To discuss the computed tomographic (CT) and clinical findings of those entities that may present as recurrent deep neck infections. Patients and Methods Twelve patients with recurrent deep neck infections and CT scans were retrospectively identified since 1990. Their CT scans and medical histories were reviewed. The diagnosis was pathologically confirmed in all cases. Results The CT scans revealed an abscess or a localized infected cyst in the deep soft tissues of the neck, with varying degrees of associated inflammatory change in the adjacent soft tissues. The diagnoses in these cases included 1 first branchial cleft cyst, 3 second branchial cleft cysts, 1 third branchial cleft cyst, 2 fourth branchial cleft cysts, 2 infected lymphangiomas, 2 thyroglossal duct cysts, and 1 cervical thymic cyst. Conclusions Most deep neck infections are the result of suppurative adenitis. The location of the primary focus is usually from the mucosa of the upper aerodigestive tract or from an odontogenic source. Less common causes are perforations due to a foreign body, thrombophlebitis of the internal jugular vein, or osteomyelitis of the spine. Recurrences in these situations are unusual. Less commonly, congenital lesions can present as deep neck infections, and recurrences are common. Our cases suggest that the recurrence of a deep neck infection should alert the physician to the possibility of an underlying congenital lesion and that CT is helpful in the early recognition of these lesions.