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Objective: To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological approach. Methods: Patients with parotid gland tumors who underwent salivary glands MRI between 2008 and 2019 were retrospectively selected. MRI analysis included a qualitative assessment by two radiologists (one of which subspecialized on head and neck imaging), and texture analysis on various sequences. Diagnostic performances including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of qualitative features, radiologists’ diagnosis, and radiomic models were evaluated. Results: Final study cohort included 57 patients with 74 tumors (27 pleomorphic adenomas, 40 Warthin tumors, 8 malignant tumors). Sensitivity, specificity, and AUROC for the diagnosis of malignancy were 75%, 97% and 0.860 for non-subspecialized radiologist, 100%, 94% and 0.970 for subspecialized radiologist and 57.2%, 93.4%, and 0.927 using a MRI radiomics model obtained combining texture analysis on various MRI sequences. Sensitivity, specificity, and AUROC for the differential diagnosis between pleomorphic adenoma and Warthin tumors were 81.5%, 70%, and 0.757 for non-subspecialized radiologist, 81.5%, 95% and 0.882 for subspecialized radiologist and 70.8%, 82.5%, and 0.808 using a MRI radiomics model based on texture analysis of T2 weighted sequence. A combined radiomics model obtained with all MRI sequences yielded a sensitivity of 91.5% for the diagnosis of pleomorphic adenoma. Conclusion: MRI qualitative radiologist assessment outperforms radiomic analysis for the diagnosis of malignancy. MRI predictive radiomics models improves the diagnostic performance of non-subspecialized radiologist for the differential diagnosis between pleomorphic adenoma and Warthin tumor, achieving similar performance to the subspecialized radiologist. Advances in knowledge: Radiologists outperform radiomic analysis for the diagnosis of malignant parotid gland tumors, with some MRI qualitative features such as ill-defined margins, perineural spread, invasion of adjacent structures and enlarged lymph nodes being highly specific for malignancy. A radiomic model based on texture analysis of T2 weighted images yields higher specificity for the diagnosis of pleomorphic adenoma compared to a radiologist non-subspecialized in head and neck radiology, thus minimizing false-positive pleomorphic adenoma diagnosis rate and reducing unnecessary surgical complications.

Ingestion of caustic substances, whether accidental or for the purpose of suicide, can cause severe lesions of the lips, oral cavity, pharynx, upper gastrointestinal system, and upper airways. In particular, caustic agents could be responsible for severe esophageal injuries resulting in short- and long-term complications. Because of these important clinical implications, timely diagnosis and appropriate management are crucial. In the evaluation of esophageal injuries, thoraco-abdominal computed tomography (CT) is preferable to endoscopy as it avoids the risk of esophageal perforation and allows the evaluation of esophageal injuries as well as of the surrounding tissue. In this review, we report CT findings of esophageal injuries and possible related thoracic complications caused by caustic ingestion.

Laryngeal amyloidosis is a rare and idiopathic disease that represents about 1% of all benign laryngeal lesions. It is characterized by the extracellular deposition of an abnormal amount of non-soluble fibrillar proteins in larynx. This disease presents unspecific symptoms and laringoscopic findings that make difficult to diagnose it. Management of these lesions consists of endoscopic resection of the mass through microdirect laryngoscopy. Recurrence is possible and it can occur up to 10 years after treatment; therefore a close and long-term follow-up is requested. A 60-year-old man presented with hoarseness and dysphonia. Laryngoscopy revealed a smooth, translucent and yellowish formation involving the middle-third of the left true vocal cord. The patient was first managed conservatively with speech therapy and after 6 months the lesion was removed by endoscopic CO2 laser surgery without evidence of recurrence in 2 years of follow-up. Laryngeal amyloidosis is a rare disorder that can be mistaken for a benign vocal cord polyp, nodule, retention cyst or laringocele. CO2 laser technique represents the highly effective approach to treat these lesions. Clinicians should know this rare amyloidosis site in order to avoid a delayed diagnosis and to treat it.

Hemangiopericytoma is a soft tissue tumor with histological variability and unpredictable clinical and biological behavior. this disease is uncommon in the head and neck and the growth pattern is unspecific; thus, diagnosis is often made by exclusion. A 43-year-old woman presented with a story of recurrent epistaxis associated to a growing mass in the paranasal sinus and a paraneoplastic syndrome. the imaging revealed an hypervascular tumor in the right nasal cavity and obliteration of all the ipsilateral sinus cavities. after biopsy the lesion was removed with resolution of epistaxis and paraneoplastic syndrome. There has been no evidence of disease recurrence in 3 years of follow-up. Our experience demonstrated that surgery can be considered the treatment of choice to prevent recurrence of tumor and to treat oncogenic osteomalacia too.

Objective The aims of present research were to analyze the visually guided eye movements of subjects suffering from the consequences of whiplash injury and the possibility to differentiate patients from feigning subject. We analyzed the role of video-nystagmography for clinical and forensic aspects. Methods It was a prospective case–control study. Detailed history was taken and patients were thoroughly investigated. Smooth pursuit and saccadic eye movements were assessed in 33 patients affected by imbalance following a whiplash injury. A control group of 20 subjects was also evaluated. All tests were executed in neutral neck position and after left and right trunk rotation. Results The t -test, applied to all parameters showed that difference of the parameter between the groups was not statistically significant. Conclusion The visually guided eye movement evaluation does not seem to offer a clinically relevant method to differentiate patients suffering from the effects of whiplash injury from normal subjects.

To evaluate the utility of echo-color-Doppler ultrasonography (CDU) of extracranial brain-supplying vessels in patients with peripheral vertigo of unknown origin.One-hundred-fifty-six patients (study group; 42 male and 114 female; mean age 61.86 ± 14.14) and 161 patients (control group; 80 male and 81 female; mean age 62.31 ± 13.69) were prospectively evaluated with CDU of extracranial brain-supplying vessels. Plaques in common and/or internal carotid artery (CA), arterial wall intima-media thickness (IMT) of common CA and peak systolic velocity (PSV) and resistive index (RI) of vertebral arteries (VA) were evaluated. Parametric (t-test) and non-parametric (Mann-Whitney U-test and Kolmogorov-Smirnov test) tests were applied. Logistic regression analysis was performed to provide odds ratio indicating the magnitude of risk of vertigo. Independent variables consisting of characteristics (age, sex), vascular risk factors (hypercholesterolemia, diabetes, hypertension) and CDU variables (IMT, plaque, PSV and RI of VA) were considered.Plaques were found in 31 (19.8%) patients of study group and in 43 (26.7%) patients of control group. IMT1 mm was found in 98 (62.8%) patients of study group and in 125 (77.6%) patients of control group.Statistical tests, applied to PSV and RI, showed no significant difference (p-value0.05). At logistic regression analysis, vertigo was associated with age, sex, hypercholesterolemia, diabetes, hypertension and IMT (p .01) while plaque, PSV and RI of VA were not significant factors (p .05).IMT is the only CDU variable significantly associated with vertigo, especially in the lower age-classes (35-45 and 45-55) of study group.Sommario INTRODUZIONE: Valutare l’utilità dell’eco-color Doppler (CDU) dei vasi epiaortici nei pazienti con vertigine periferica da causa sconosciuta. MATERAILI E METODI: Centocinquantasei pazienti (gruppo studio; 42 uomini e 114 donne; età media 61,86 ± 14,14) e 161 pazienti (gruppo controllo; 80 uomini e 81 donne; età media 62,31 ± 13,69) sono stati sottoposti a CDU dei vasi epiaortici. Sono stati valutati i seguenti parametri: presenza di placche ateromasiche a livello dell’arteria carotide (CA) comune e/o interna; spessore medio intimale (IMT) della CA comune; picco di velocità sistolica (PSV) e indice di resistenza (RI) a livello delle arterie vertebrali (VA).Sono stati utilizzati test parametrici (T-test) e non parametrici (Mann–Whitney U-test e Kolmogorov–Smirnov test). È stata eseguita un’analisi di regressione logistica per fornire un odds ratio indice di grandezza del rischio di vertigine. Sono state considerate variabili indipendenti (età, sesso), fattori di rischio vascolare (ipercolesterolemia, diabete, ipertensione) e variabili CDU (IMT, placche, PSV e RI). RISULTATI: Placche ed IMT1 mm sono stati trovati in 31 (19,8%) e 98 (62,8%) pazienti del gruppo di studio e in 43 (26,7%) e 125 (77,6%) pazienti del gruppo controllo. I test statistici, applicati a PSV e RI, non hanno dimostrato differenze significative (p-valore 0,05). Alla regressione logistica le vertigini sono risultate associate ad età, sesso, ipercolesterolemia, diabete, ipertensione e IMT (p 0,01), mentre placche, PSV ed RI non erano fattori significativi (p 0,05). DISCUSSIONE: IMT è la sola variabile CDU significativamente associata alla vertigine, specialmente nelle classi di età inferiore (35-45 e 45-55) del gruppo studio.

During the last 20 years, various conservative surgical techniques have been proposed to treat larynx cancer. On the basis of our various experiences and of the ultrastructural data on the tissues treated with radiowaves, we decided to also use radiosurgery in operations under direct microlaryngoscopy. We select 18 patients suffering from epidermoid carcinoma. These patients had been referred to our ENT clinic at the Polichnico of Palermo between 1999 and 2001. The authors describe the surgical procedures used and emphasize the advantages of radiosurgery in the treatment of larynx cancer.