RESUMEN
PURPOSE: We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. METHODS: A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges. RESULTS: The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people. CONCLUSION: A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas.
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Pérdida Auditiva Sensorineural/etiología , Imagen por Resonancia Magnética/economía , Imagen por Resonancia Magnética/métodos , Neuroma Acústico/complicaciones , Neuroma Acústico/diagnóstico por imagen , Adulto , Análisis Costo-Beneficio , Árboles de Decisión , Femenino , Humanos , Masculino , Neuroma Acústico/epidemiología , Prevalencia , Sensibilidad y EspecificidadAsunto(s)
Pérdida Auditiva Sensorineural/diagnóstico , Imagen por Resonancia Magnética/métodos , Neuroma Acústico/diagnóstico , Intensificación de Imagen Radiográfica , Medios de Contraste/efectos adversos , Medicina Basada en la Evidencia , Femenino , Gadolinio/efectos adversos , Humanos , Masculino , Tamizaje Masivo/métodos , Medición de Riesgo , Sensibilidad y EspecificidadRESUMEN
Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis typically affecting multiple organ systems. We report 2 patients who presented with homonymous hemianopia and were ultimately diagnosed with biopsy-confirmed ECD. We review the spectrum of ECD and its treatment as well as histopathological and immunohistochemical differentiation from other histiocytic disorders.
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Enfermedad de Erdheim-Chester/complicaciones , Hemianopsia/etiología , Adulto , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Encéfalo/metabolismo , Encéfalo/patología , Proteínas de la Matriz Extracelular/metabolismo , Femenino , Hemianopsia/diagnóstico , Humanos , Receptores de Hialuranos/metabolismo , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Campos Visuales/fisiologíaAsunto(s)
Diagnóstico por Imagen/métodos , Aumento de la Imagen , Acúfeno/diagnóstico , Medios de Contraste , Medicina Basada en la Evidencia , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Otoscopía/métodos , Rol , Sensibilidad y Especificidad , Acúfeno/etiología , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Doppler/métodosRESUMEN
Differentiating between Coats disease and retinoblastoma can be challenging. Magnetic resonance imaging typically is obtained when retinoblastoma is suspected to evaluate for a mass or optic nerve infiltration, the latter appearing as an enhancing lesion. We report a case of optic nerve enhancement observed in the setting of an acute secondary glaucoma in a patient with unilateral Coats retinopathy. Given the gravity of the decision to recommend enucleation on the basis of clinical findings consistent with retinoblastoma, physicians must be aware of the possibility of optic nerve enhancement in the setting of inflammation and raised intraocular pressure.
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Glaucoma/patología , Imagen por Resonancia Magnética/métodos , Nervio Óptico/patología , Neovascularización Retiniana/patología , Telangiectasia/patología , Enfermedad Aguda , Preescolar , Diagnóstico Diferencial , Gadolinio , Glaucoma/etiología , Humanos , Presión Intraocular , Imagen por Resonancia Magnética/normas , Masculino , Neoplasias de la Retina/patología , Neovascularización Retiniana/complicaciones , Retinoblastoma/patología , Telangiectasia/complicacionesRESUMEN
PURPOSE: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-described clinical condition with consistent radiographic findings. The purpose of this report was to review these findings in an attempt to offer important diagnostic, prognostic, and therapeutic information associated with BRONJ. MATERIALS AND METHODS: The findings of studies assessing the radiographic landmarks on plain films, intraoral films, orthopantograph, computed tomography, magnetic resonance imaging, and nuclear bone scans in patients with BRONJ were analyzed. RESULTS: The radiographic findings in patients with BRONJ include osteosclerosis, osteolysis, dense woven bone, a thickened lamina dura, subperiosteal bone deposition, and failure of postsurgical remodeling. CONCLUSIONS: Consistent imaging findings are noted in the BRONJ patient. Imaging is an essential part of the clinical assessment of the BRONJ patient and might be an additional tool for tracking the progression of the disease.
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Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Enfermedades Maxilomandibulares/inducido químicamente , Enfermedades Maxilomandibulares/diagnóstico por imagen , Osteonecrosis/inducido químicamente , Osteonecrosis/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Humanos , Enfermedades Maxilomandibulares/patología , Imagen por Resonancia Magnética , Osteonecrosis/patología , Tomografía de Emisión de Positrones , Radiografía Panorámica , Radiofármacos , Medronato de Tecnecio Tc 99m/análogos & derivados , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada por Rayos XRESUMEN
Tinnitus ("ringing in the ears") is a prevalent symptom in the general population, and often brings patients to medical attention. Many causes of tinnitus are evident radiographically. The most frequently-encountered causes of tinnitus are discussed, and imaging recommendations are provided.
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Imagen por Resonancia Magnética , Acúfeno/diagnóstico , Tomografía Computarizada por Rayos X , Medios de Contraste , Diagnóstico Diferencial , Humanos , Acúfeno/clasificación , Acúfeno/etiologíaRESUMEN
OBJECTIVE: To determine whether the appearance of the inner ear on T2-weighted follow-up magnetic resonance imaging correlates with hearing status after hearing-preservation surgery for vestibular schwannoma. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral medical center. PATIENTS: The study includes patients undergoing hearing-preservation surgery for vestibular schwannoma from 1998 to 2003. INTERVENTION: Diagnostic evaluation with magnetic resonance imaging and audiometric evaluation. MAIN OUTCOME MEASURES: Hearing results as reported in charts was correlated with appearance of membranous labyrinth on T2-weighted magnetic resonance images obtained at least 1 year after surgery. RESULTS: Twenty-nine patients were identified, 16 of whom satisfied the inclusion criteria. All 16 of the patients underwent middle fossa removal of vestibular schwannoma. Serviceable hearing according to American Academy of Otolaryngology-Head and Neck Surgery criteria was preserved in eight patients (50%). Of the eight patients without serviceable hearing, six had the cochlear nerve sacrificed at the time of surgery. All patients with serviceable hearing had normal appearing cochleovestibular signal on T2-weighted images, whereas six of eight patients (75%) with no hearing or poor hearing had abnormal low signal in the inner ear, suggesting inner ear ossification. The positive predictive value of a normal labyrinth for preserved hearing was 90%, whereas the negative predictive value of an abnormal labyrinth for no hearing was 100%. All but one patient who had the cochlear nerve sacrificed showed abnormal morphology of the labyrinth on T2-weighted magnetic resonance imaging. CONCLUSION: We describe the T2-weighted magnetic resonance findings after hearing-preservation surgery for acoustic tumor removal. Loss of inner ear signal on T2-weighted images correlates with loss of hearing postoperatively, whereas preserved inner ear signal correlates with hearing preservation after middle fossa surgery for vestibular schwannoma removal.
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Oído Interno/patología , Pérdida Auditiva/prevención & control , Imagen por Resonancia Magnética/métodos , Neuroma Acústico/cirugía , Procedimientos Quirúrgicos Otológicos/métodos , Umbral Auditivo , Nervio Coclear/cirugía , Neoplasias del Oído/complicaciones , Neoplasias del Oído/cirugía , Femenino , Estudios de Seguimiento , Pérdida Auditiva/etiología , Humanos , Masculino , Meningioma/complicaciones , Meningioma/cirugía , Neuroma Acústico/complicaciones , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
This article discusses the benefits and drawbacks of MR imaging and computed tomography as they relate to sinus disease.
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Imagen por Resonancia Magnética , Enfermedades de los Senos Paranasales/diagnóstico , Senos Paranasales/patología , Tomografía Computarizada por Rayos X , Humanos , Procesamiento de Imagen Asistido por Computador , Micosis/diagnóstico , Micosis/diagnóstico por imagen , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Rinitis/diagnóstico , Rinitis/diagnóstico por imagen , Sinusitis/diagnóstico , Sinusitis/diagnóstico por imagenRESUMEN
BACKGROUND: Understanding the anatomy of the ethmoid roof is critical to safe surgical outcomes. Normative data regarding the height and slope of this region have been somewhat limited, derived primarily from cadaveric coronal computed tomography (CT) studies. With triplanar imaging programs, precise multidimensional measurements of the ethmoid roof are now possible. We present a radioanatomic study to characterize normative sagittal and coronal dimensions of the ethmoid roof. METHODS: Bilateral measurements were taken in 100 consecutive sinus CT scans using ThinClient 3D software. In the sagittal plane, the height of the ethmoid roof was measured in quadrants at five equidistant points between the frontal beak and sphenoid face, referencing the nasal floor. In the coronal plane, the ethmoid roof was measured at three points at the level of the anterior ethmoid artery and at two points at the junction of the posterior ethmoid and sphenoid sinuses. RESULTS: When examined sagittally, the right side showed significantly lower skull base heights in the anterior ethmoid compared with the left side (59.0 mm versus 59.8 mm, p = 0.017; 53.7 mm versus 54.5 mm, p = 0.0004). Coronal measurements of the anterior ethmoid roof showed similar significant differences. The anterior ethmoid roof had greater asymmetries of height compared with the posterior ethmoid roof, which was fairly constant. CONCLUSION: This study provides numerical correlates to accepted concepts regarding the shape and slope of the ethmoid roof. Differences in height of the skull base between right and left sides, especially in the anterior ethmoid sinus, may be an important surgical consideration. The posterior ethmoid roof appears to be relatively constant and should serve as a reliable surgical landmark.
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Hueso Etmoides/anatomía & histología , Hueso Etmoides/diagnóstico por imagen , Adulto , Humanos , Imagenología Tridimensional , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Valores de Referencia , Programas Informáticos , Tomografía Computarizada por Rayos XRESUMEN
Clinical assessment of olfactory dysfunction can be challenging. Because olfactory disturbances comprise most chemosensory abnormalities with imaging findings, this article focuses on the imaging of smell disorders. This article reviews the normal imaging appearance of the olfactory apparatus, discusses the respective roles of CT and MRI, provides illustrative imaging of typical pathologic lesions, and discusses a clinically based imaging strategy.
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Células Quimiorreceptoras/patología , Trastornos del Olfato/diagnóstico , Trastornos del Olfato/fisiopatología , Bulbo Olfatorio , Humanos , Imagen por Resonancia Magnética , Bulbo Olfatorio/diagnóstico por imagen , Bulbo Olfatorio/patología , Bulbo Olfatorio/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: Schwannomas are benign, slow-growing tumors that arise from nerves. Those originating from the sympathetic cervical chain are rare. We describe our experience with the clinical presentation, surgical management, and outcomes of patients with this pathology. STUDY DESIGN: Retrospective chart review of a case series in a tertiary referral center. METHODS: Four cases of cervical sympathetic chain schwannomas were reviewed. Patients presented with either an asymptomatic neck mass discovered on routine physical examination (1 patient), an enlarging neck mass (2), or an acute onset of a Horner's syndrome (1). All patients underwent preoperative imaging (magnetic resonance imaging, computed tomography, or both). RESULTS: The location and soft-tissue characteristics of the mass, along with displacement of the carotid sheath vessels, were typical of a cervical sympathetic chain schwannoma. All patients underwent surgical excision of the mass. Postoperative Horner's syndrome was encountered in all patients. First bite syndrome was encountered in two patients. CONCLUSIONS: Cervical sympathetic chain schwannomas are rare tumors. Preoperative imaging characteristics facilitate the diagnosis. First bite syndrome can occur and may be debilitating postoperatively. Long-term prognosis is excellent.
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Ganglios Simpáticos/patología , Neurilemoma/patología , Neoplasias del Sistema Nervioso Periférico/patología , Neoplasias del Sistema Nervioso Periférico/cirugía , Anciano , Biopsia con Aguja , Estudios de Seguimiento , Ganglios Simpáticos/cirugía , Ganglionectomía/métodos , Síndrome de Horner/diagnóstico , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neurilemoma/cirugía , Cuidados Preoperatorios , Estudios Retrospectivos , Medición de Riesgo , Muestreo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: Several previous studies have shown that muscle appearance on magnetic resonance is a sensitive indicator of muscle denervation. Previous attempts at determining preoperative indicators of final facial function after acoustic neuroma removal has been mostly unsuccessful. The goal of this study was to determine if the appearance of the facial muscles on preoperative imaging is predictive of final facial function after surgical removal of vestibular schwannomas. STUDY DESIGN: We conducted a retrospective chart and magnetic resonance review. SETTING: This study was conducted at a tertiary referral center. PATIENTS: We included all patients who underwent vestibular schwannoma removal between January 1, 1997, and December 31, 2001, with available preoperative magnetic resonance images and a minimum of 12 months follow up. INTERVENTIONS: We used translabyrinthine, middle fossa, and suboccipital approaches for tumor removal. A neuroradiologist, blinded to preoperative or final facial function after tumor removal, retrospectively reviewed preoperative magnetic resonance images. MAIN OUTCOMES MEASURES: Facial muscles were evaluated on magnetic resonance and classified as symmetric or asymmetric. Facial function was graded using the House-Brackmann scale. Preoperative facial function was noted on the preoperative physical examination. Final function was determined at least 12 months postoperatively. RESULTS: A total of 247 patients underwent tumor removal during the study period. One hundred thirty-two patients had adequate preoperative magnetic resonance images. Patients with preoperative facial muscle asymmetry seen on preoperative magnetic resonance indicating muscle atrophy had significantly worse final facial function, regardless of tumor size. CONCLUSION: The preoperative appearance of facial muscles provides valuable insight into the physiology of the facial nerve in the presence of vestibular schwannomas. Patients with pre-operative facial muscle symmetry have significantly better facial function than those with atrophy.
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Músculos Faciales/patología , Nervio Facial/fisiopatología , Imagen por Resonancia Magnética , Neuroma Acústico/cirugía , Complicaciones Posoperatorias/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Músculos Faciales/inervación , Músculos Faciales/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Pronóstico , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To report the magnetic resonance appearance of hypotonus maculopathy. DESIGN: Observational case report. METHODS: A 48-year-old man with a long history of glaucoma and subsequent trabeculectomy in the right eye developed hypotonus maculopathy. Visual acuity continued to decrease in both eyes of a relatively young individual with severe primary open angle glaucoma. A magnetic resonance image was requested to look for a compressive optic neuropathy. RESULTS: Magnetic resonance imaging showed an abnormal plaquelike thickening of the macula and flattening of the posterior globe. CONCLUSION: To our knowledge, this is the first case report of the magnetic resonance appearance of hypotonus maculopathy.
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Enfermedades de la Coroides/diagnóstico , Presión Intraocular , Mácula Lútea/patología , Hipotensión Ocular/diagnóstico , Enfermedades de la Retina/diagnóstico , Glaucoma de Ángulo Abierto/cirugía , Humanos , Mácula Lútea/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Trabeculectomía , UltrasonografíaRESUMEN
OBJECTIVES/HYPOTHESIS: Successful unilateral or minimal-access parathyroid exploration and reoperative surgery of the parathyroid glands requires accurate preoperative localization of parathyroid disease. Although ultrasound and nuclear imaging techniques have an established role in this regard, the use of computed tomography (CT) for parathyroid exploration is not well understood. The purpose of the present study was to better define the diagnostic utility of CT in preoperative localization of the abnormal gland in surgery for hyperparathyroidism. STUDY DESIGN: Retrospective cohort study. METHODS: All parathyroid explorations performed at Oregon Health and Science University (Portland, OR) between 2000 and 2002 were reviewed. The study group was limited to patients with hyperparathyroidism in whom localization failed preoperatively using ultrasound and/or sestamibi scanning and subsequent investigation using CT imaging was performed. Operative, pathological, and imaging reports were then analyzed to assess the accuracy of CT imaging for localizing parathyroid disease. RESULTS: Twenty-two patients with hyperparathyroidism were investigated preoperatively using CT imaging. Parathyroid exploration was successful in all but one patient, leaving 21 patients in all in the cohort. The majority of cases (67%) were reoperative, and all patients had previously undergone inconclusive ultrasound and/or sestamibi scanning. Computed tomography correctly localized parathyroid disease in 18 (86%) of the 21 patients who underwent successful extirpation of parathyroid disease and was able to identify abnormal glands with equal utility in the neck and the chest. CONCLUSION: When ultrasound or sestamibi are unsuccessful, CT imaging can provide valuable preoperative localizing information before surgery for hyperparathyroidism, particularly in patients with recurrent or persistent disease.
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Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/cirugía , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cintigrafía , Estudios Retrospectivos , UltrasonografíaRESUMEN
BACKGROUND AND PURPOSE: Extension of malignant melanoma along cranial nerves is a little-known complication of malignant melanoma of the head and neck. We describe the clinical and MR imaging findings of perineural spread of malignant melanoma to cranial nerves, emphasizing that this entity occurs more commonly with desmoplastic histology and may have a long latent period following primary diagnosis. METHODS: At two institutions, we identified and retrospectively reviewed eight cases of malignant melanoma of the head and neck that had MR imaging evidence of perineural spread of disease. All patients underwent confirmatory tissue sampling. RESULTS: Seven patients had melanomas of the facial skin or lip, and one patient had a primary sinonasal lesion. By histopathology, these melanomas included five desmoplastic, two mucosal, and one poorly differentiated melanotic spindle-cell tumor. All patients developed symptomatic cranial neuropathy an average of 4.9 years from the time of initial diagnosis. MR imaging demonstrated postgadolinium enhancement of at least one branch of the trigeminal nerve in all cases and of at least one other cranial nerve in five cases. Other findings included abnormal contrast enhancement and soft tissue thickening in the cavernous sinus, Meckel's cave, and/or the cisternal segment of the trigeminal nerve. CONCLUSION: Although perineural spread of disease occurs most commonly with squamous cell carcinoma and adenoid cystic carcinoma, malignant melanoma must also be included in this differential diagnosis, particularly if the patient's pathology is known to be desmoplastic. Similarly, any patient with malignant melanoma of the head and neck who undergoes MR imaging should receive an imaging assessment focused on the likely routes of perineural spread.
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Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Melanoma/diagnóstico por imagen , Melanoma/patología , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia con Aguja Fina , Neoplasias de los Nervios Craneales/diagnóstico por imagen , Neoplasias de los Nervios Craneales/secundario , Neoplasias de los Nervios Craneales/terapia , Progresión de la Enfermedad , Susceptibilidad a Enfermedades/diagnóstico por imagen , Susceptibilidad a Enfermedades/epidemiología , Susceptibilidad a Enfermedades/patología , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Melanoma/terapia , Persona de Mediana Edad , Radiocirugia , Radioterapia , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Radiologists play an important role in the evaluation of upper neck infections. Although most oral cavity infections arise from diseased teeth, several other sources of infection need to be considered. The distinction between abscess and phlegmon is of particular importance. Cross-sectional imaging is frequently used to identify complications of the initial infection.
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Infecciones Bacterianas/diagnóstico por imagen , Boca/diagnóstico por imagen , Orofaringe/diagnóstico por imagen , Infecciones Bacterianas/etiología , Infecciones Bacterianas/terapia , Humanos , Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: Our goal was to determine whether preoperative MR imaging of facial muscles predicts facial function after facial nerve grafting. METHODS: A retrospective review of all patients undergoing facial nerve grafting between 1997 and 2001 revealed 26 patients. Twelve of the patients had adequate preoperative MR images available for review and had undergone clinical follow-up for at least 12 months. Eight had malignant parotid tumors, and four had benign skull base or parotid tumors. Preoperative facial muscle MR imaging appearance was categorized as symmetrical or asymmetrical. The asymmetrical images were further classified into mild or pronounced asymmetry. Preoperative facial function was classified by using the House-Brackmann scale. Postoperative function was graded with the May scale. RESULTS: Four patients had symmetrical facial muscles shown by preoperative MR imaging, three had mild asymmetry, and five had pronounced asymmetry. No or mild asymmetry had an 86% positive predictive value for good to excellent functional outcome. Eighty percent of patients with pronounced asymmetry experienced poor functional outcomes. Six of eight patients with malignant and perineural tumors at surgery had asymmetrical facial muscles revealed by preoperative MR imaging studies. CONCLUSION: Symmetrical or mildly asymmetrical facial muscles are predictive of good facial function after nerve grafting. Pronounced asymmetry of facial muscles on MR images is predictive of poor facial function after grafting. Asymmetric facial muscles on preoperative MR images are associated with perineural tumor spread in patients with malignant disease.