Search

Objectives Endoscopic endonasal anterior skull base surgery has expanding use in the pediatric population, but the anatomy of pediatric patients can lead to limitations. This study aims to characterize the important anatomical implications of the pediatric skull base using computed tomography (CT) scans. Design This study is designed as retrospective analysis. Setting The study setting comprises of tertiary academic medical center. Participants In total, 506 patients aged 0 to 18 who had undergone maxillofacial and or head CTs between 2009 to 2016 were involved. Methods Measurements included piriform aperture width, nare to sella distance (NSD), sphenoid pneumatization, olfactory fossa depth, lateral lamella cribriform plate angles, and intercarotid distances (ICD) at the superior clivus and cavernous sinus. These patients were then subdivided into three age groups adjusting for sex. Analysis of covariance (ANCOVA) models were fit comparing between all age groups and by sex. Results Piriform aperture width, NSD, sphenoid sinus pneumatization as measured using lateral aeration and anterior sellar wall thickness, olfactory fossa depth, and ICD at the cavernous sinus were significantly different among all age groups (p <0.0001). Our results show that mean piriform aperture width increased with each age group. The mean olfactory fossa depth also had consistent age dependent growth. In addition, ICD at the cavernous sinus showed age dependent changes. When comparing by sexes, females consistently showed smaller measurements. Conclusion The process of skull base development is age and sex dependent. During preoperative evaluation of pediatric patients for skull base surgery piriform aperture width, sphenoid pneumatization in both the anterior posterior and lateral directions, and ICD at the cavernous sinus should be carefully reviewed. [ABSTRACT FROM AUTHOR]

Objective: To provide updated data on the incidence, types, and demographics of laryngoceles in the adult population. Methods: We searched the medical archives of our institute for computed tomography (CT) studies acquired between January 1, 2007 and December 31, 2017 in which the term "laryngocele" appeared in the radiology reports. Two of the authors reviewed relevant images for the presence, type, distribution, and laterality of true laryngoceles. Demographic and clinical data were extracted from medical records and the incidence was calculated. Results: Laryngoceles were detected in 53 out of the 79 893 patients with relevant CT data, which equates to an incidence of 151 per 2.5 million (0.06:1000) patients per year. The male:female ratio was 3:1, average age was 60 (±18) years, and incidence peaked among patients in the sixth decade of life. Nine patients (17%) had known laryngeal cancer; however, the majority of the cohort did not have follow up clinic visits. Conclusion: Our study demonstrates that the incidence of laryngoceles is much greater than previously reported. In most cases, the diagnosis of a laryngocele was an incidental radiological finding. Male gender predilection and age at presentation are in agreement with previous reports. Association of laryngoceles with laryngeal cancer could not be calculated due to low rates of follow ups. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Introduction  The risk of skull base injury during choanal atresia repair can be mitigated via thorough understanding of skull base anatomy. There is a paucity of data describing differences in skull base anatomy between patients with coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities (CHARGE) syndrome and those without. Objectives  The aim of this study was to measure nasal and skull base anatomy in patients with isolated bilateral choanal atresia (BCA), CHARGE syndrome, and other syndromic congenital anomalies. Methods  Retrospective chart review of patients with bilateral choanal atresia and computed tomography of the face between 2001 and 2019 were evaluated. Choanal width, height, mid-nasal height, and skull base slope were measured radiographically. Differences in anatomy between healthy patients, those with CHARGE syndrome, and those with other congenital anomalies were compared. Results  Twenty-one patients with BCA and relevant imaging were identified: 7 with isolated BCA, 6 with CHARGE syndrome, and 8 with other congenital anomalies. A t -test indicated insignificant difference in skull base slope, choanal height, choanal width, or mid-nasal skull base height between isolate BCA cases and patients with any congenital anomaly. When comparing CHARGE to isolated BCA cases, mid-nasal height was shorter in CHARGE patients (p  = 0.03). There were no differences in measurements between patients with congenital anomalies excluding CHARGE (p  > 0.05). Two patients in the congenital anomaly group were found to have bony skull base defects preoperatively. Conclusion  This study represents the largest description of skull base and nasal anatomy in patients with CHARGE syndrome and BCA. Surgeons should be aware of the lower skull base in CHARGE patients to avoid inadvertent skull base injury. [ABSTRACT FROM AUTHOR]

Background: Metal-on-metal (MoM) hip prostheses were shown to have high failure rates including the formation of periprosthetic cystic masses called periprosthetic pseudotumor collections (PPCs).Purpose: To compare MRI prevalence and size of PPCs in patients after bilateral total-hip-replacement (THR) in which at least one hip was replaced by a MoM prosthesis.Material and Methods: All sequential MRI examinations of patients with bilateral THR in which at least one is MoM (2010-2013) were retrospectively evaluated. MRIs were analyzed separately by two readers for the presence and size of PPCs. These were compared between MoM and non-MoM implants and between patients with unilateral or bilateral-MoM prostheses. Blood metal ion levels were also compared.Results: Seventy hips of 35 patients (male:female ratio, 9:26; mean age, 64 years; age range, 35-82 years) were assessed. Sixteen patients (45%) underwent bilateral MoM-THRs and 19 (55%) had one MoM and the other non-MoM, yielding 51 MoM THRs and 19 non-MoM THRs. Twenty-eight PPCs were detected in 19 patients (54%): 26 in MoM THRs (51%) and two in non-MoM THRs (10.5%, P = 0.00009). The mean PPC volume in the MoM implants (107 mm(3)) was higher than that of the non-MoM implants (18 mm(3), P = 0.49). Cobalt/chromium blood levels were 78 µg/L/25 µg/L for bilateral MoM THRs and 21 µg/L/10 µg/L for unilateral MoM implants (P = 0.1 and 0.16, respectively).Conclusion: PPCs are more prevalent in MoM THRs compared to non-MoM THRs. Larger PPC volumes and higher blood metal ion levels were detected in patients with bilateral MoM THRs compared to unilateral MoM THRs (P > 0.05). [ABSTRACT FROM AUTHOR]

The article describes the case of a 53-year-old woman with Burkitt lymphoma of the thyroid gland. Case highlights include a contrast-enhanced computed tomography scan of the patient's neck obtained from an outside facility, Hashimoto thyroiditis shown by fine-needle aspiration cytology, and the rapid growth of her thyroid on a background of Hashimoto thyroiditis.

OBJECTIVE. The purpose of this study was to show, by use of a phantom, that magnetic eyelashes worn in the MRI environment can cause substantial artifact and that detachment of the eyelashes from the phantom can occur. CONCLUSION. A new cosmetic product, magnetic eyelashes, should be of interest and concern to radiologists and technologists working in the MRI environment. We strongly recommend inserting a line about magnetic eyelashes on the MRI safety questionnaire and adding stops in the screening system to prevent the entry of anyone with these lashes, including staff, into the MRI scanner room.

Objective: The purpose of this study is to characterize sacroiliac joints (SIJs) findings at CT of patients with diffuse idiopathic skeletal hyperostosis (DISH), a condition characterized (using the Resnick classification criteria) by ossification of at least four contiguous vertebrae in the thoracic spine and preserved disk space, but without radiographic evidence of intraarticular SIJ abnormalities., Materials and Methods: Pelvic CT examinations of 104 patients with DISH (fulfilling the Resnick criteria on spinal CT) and 106 age- and sex-matched control subjects whose entire spine lacked CT evidence of DISH (total, 149 men and 61 women; mean [± SD] age, 72.3 ± 8.7 years) were retrospectively evaluated for the presence of intra- and extraarticular bridging osteophytes, spurs, subchondral cystlike changes, erosions, and sclerosis of SIJs. Excluded were patients with known ankylosing spondylitis or inflammatory-related diseases. Data were analyzed using multivariate ANOVA to examine the degree of difference between patients with DISH and control subjects. Logistic regression analysis was used to generate odds ratios to examine their discriminatory ability. ROC analysis was then applied to examine the sensitivity and specificity of the results., Results: The frequency of anterior bridging, posterior bridging, entheseal bridging, and joint ankylosis was significantly higher among patients with DISH compared with control subjects (48% vs 9%, 20% vs 1%, 34% vs 4%, and 23% vs 0%, respectively; p < 0.001 for all comparisons)., Conclusion: Intraarticular ankylosis seen at CT, an entity not included in the Resnick classification criteria, is common among patients with DISH, which implies that the radiologic classification criteria for DISH need to be revised.

Objective: American College of Radiology and Society of Breast Imaging guidelines call for routine breast MRI screening only for women with the highest risk profiles for development of breast cancer, suggesting that screening of women at lower risk might result in an increased frequency of false-positive biopsy results. The purpose of this study was to test this assumption by comparing MRI-guided biopsy outcomes of lesions detected at MRI screening of women with a personal history of breast cancer with outcomes among women with genetic or familial high risk., Materials and Methods: Outcomes of 130 MRI-guided biopsies were analyzed. One group consisted of women with hereditary (genetic or familial) risk, and the other group consisted of women with a personal history of breast cancer. Biopsies were performed with a 9-gauge vacuum-assisted device or surgically after MRI localization., Results: Of 130 MRI-guided biopsies, 20 (15%) yielded malignant histologic findings, 14 (11%) yielded high-risk lesions, and 96 (74%) had benign findings. There was a slightly higher malignancy rate for the personal-risk group (19%) compared with the hereditary-risk group (13.5%). There also was a slightly higher combined rate of malignancy and high-risk lesions (34% vs 22%) with no statistically significant difference (p < 0.25, p < 0.12). Patients in the hereditary-risk group were younger (44 ± 1.2 vs 54 ± 1.7 years; p < 0.001) than those in the personal-risk group., Conclusion: Our preliminary data show no difference between the two risk groups with respect to probability of an MRI-guided biopsy result of malignancy, calling into question the proposed assumption. Further prospective studies of the role of MRI screening combined with MRI-guided biopsy when required for patients with previously treated localized breast cancer may be indicated.