Radiology Quiz Case 2.

JAMA otolaryngology-- head & neck surgery 04/2013; 139(4):421-422. DOI: 10.1001/jamaoto.2013.147a
Source: PubMed
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    ABSTRACT: Computed tomographic (CT) imaging of stapes prostheses is inaccurate. Clinical situations arise in which it would be helpful to determine the depth of penetration of a stapes prosthesis into the vestibule. The accuracy of CT imaging for this purpose has not been defined. This study was aimed to determine the accuracy of CT imaging to predict the depth of intrusion of stapes prostheses into the vestibule. The measurement of stapes prostheses by CT scan was compared with physical measurements in 8 cadaveric temporal bones. The depth of intrusion into the vestibule of the piston was underestimated in specimens with the fluoroplastic piston by a mean of 0.5 mm when compared with the measurements obtained in the temporal bones. The depth of penetration of the stainless steel implant was overestimated by 0.5 mm when compared with that in the temporal bone. The type of implant must be taken into consideration when estimating the depth of penetration into the vestibule using CT scanning because the imaging characteristics of the implanted materials differ. The position of fluoroplastic pistons cannot be accurately measured in the vestibule. Metallic implants are well visualized, and measurements exceeding 2.2 mm increase the suspicion of otolithic impingement. Special reconstructions along the length of the piston may be more accurate in estimating the position of stapes implants.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 08/2008; 29(5):586-92. DOI:10.1097/MAO.0b013e3181758e96 · 1.60 Impact Factor
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    ABSTRACT: ObjectivesMagnetic resonance (MR) imaging may provide some information as to the extent and tissue characteristics of a cancerous mass, but the imaging features of lesions in the floor of the mouth have not been sufficiently clarified. MR imaging features of tumescent lesions in this region were characterized, and the differential diagnoses are discussed. MethodsMR images of 12 patients with tumescent lesions in the floor of the mouth (three patients with squamous cell carcinoma, two with adenoid cystic carcinoma, one with hemangioma, one with schwannoma, one with lipoma, and four with ranula) were reviewed. The literature on the imaging features of tumescent disease in the floor of the mouth was searched using the Medline database. ResultsSix types of tumescent lesions in the floor of the mouth are presented. The differential diagnosis through a review of the references is discussed. Malignant tumors were demonstrated as ill-defined masses. MR images were good at showing the internal structures, such as fluid, hemorrhage, fat, nerves, calculus (phlebolith), cholesterol, and keratin, as different signal intensities. Therefore, MR images gave clues for the differential diagnosis. ConclusionMR images presented the distinctive features or the extent of the lesions and were therefore considered useful for a more accurate diagnosis prior to treatment.
    Oral Radiology 06/2006; 22(1):18-26. DOI:10.1007/s11282-006-0040-0 · 0.15 Impact Factor
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    ABSTRACT: A 32-year-old pregnant woman developed a progressive right sixth cranial nerve palsy as an isolated finding. Brain MRI disclosed a discrete lobulated lesion centered in the right Meckel's cave with intermediate signal on T1, high signal on T2, and diffusion characteristics similar to those of cerebrospinal fluid on apparent diffusion coefficient mapping. The initial radiologic diagnosis was schwannoma or meningioma. No intervention occurred. Shortly after cesarean delivery, the abduction deficit began to lessen spontaneously. One month later, the abduction deficit had further improved; 7 months later it had completely resolved. Repeat MRI after delivery failed to disclose the lesion, which was now interpreted as consistent with an arachnoid cyst arising within Meckel's cave. Twenty-one similar cases of Meckel's cave arachnoid cyst or meningocele have been reported, 7 found incidentally and 14 causing symptoms, 2 of which produced ipsilateral sixth cranial nerve palsies. All previously reported symptomatic patients were treated surgically. This is the first report of an arachnoid cyst arising from Meckel's cave in pregnancy and having spontaneous resolution.
    Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 10/2008; 28(3):186-91. DOI:10.1097/WNO.0b013e318183be6c · 1.81 Impact Factor