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ABSTRACT: INTRODUCTION: This study focuses on the feasibility and diagnostic accuracy of MR of the larynx performed with surface coils after endoscopic laser resection (ELR) for glottic cancer. METHODS: Thirty-one MR examinations of the larynx performed with surface coils on average 12 months after ELR were retrospectively reviewed. Image quality was assessed for each acquired sequence (score 1-3). All the postoperative focal lesions detected at the excision site were analysed by assessing the following: contrast/noise ratio (CNR) normalized on lateral cricoarytenoid muscle; lesion morphology (nodular/elongated) and enhancement after contrast agent administration; apparent diffusion coefficient (ADC) on diffusion-weighted sequences (DWI). RESULTS: The image quality was highest for axial and coronal T2 sequences (2.39 and 2.58, respectively), and lower for the other sequences (1.66-1.72). However, in most sequences (86-100 %) the quality was considered acceptable. Among 35 focal lesions, nine were histologically proven recurrences, 26 were classified as benign focal lesions (BFL) on the basis of the subsequent follow-up. All recurrences had an intermediate T2 signal (0 < cnr0), mostly (4/5) nodular shape, intense enhancement and high ADC. The combination of T2-weighted and DWI provided the highest accuracy in the differential diagnosis between recurrences and BFL. CONCLUSION: MR with surface coils is feasible and can be considered an effective tool in the follow-up after ELR for glottic cancer.
Neuroradiology 12/2012; · 2.82 Impact Factor
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ABSTRACT: Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess. The clinical presentation is widely variable, and often early symptoms do not reflect the disease severity. The complication risk depends on the extent and anatomical site: diseases that transgress fascial boundaries and spread along vertically oriented spaces (parapharyngeal, retropharyngeal, and paravertebral space) have a higher risk of complications and require a more aggressive treatment compared with those confined within a nonvertically oriented space (peritonsillar, sublingual, submandibular, parotid, and masticator space). Imaging has 5 crucial roles: (1) confirm the suspected clinical diagnosis, (2) define the precise extent of the disease, (3) identify complications, (4) distinguish between drainable abscesses and cellulitis, and (5) monitor deep neck space infection progression. Ultrasonography is the gold standard to differentiate abscesses from cellulitis, for the diagnosis of lymphadenitis. and to identify internal jugular thrombophlebitis in the infrahyoid neck. However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation of superficial lesions and to image-guided aspiration or drainage. Computed tomography (CT) combines fast image acquisition and precise anatomical information without field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and multicompartment lesions and for the identification of mediastinal and intracranial complications. Contrast agent administration enhances the capability to differentiate fluid collections from cellulitis and allows the detection of vascular complications. Magnetic resonance imaging is more time-consuming than CT, limiting its use to selected indications. It is the technique of choice for assessing the epidural space involvement in pre- and paravertebral space infections and complements CT in the evaluation of the infections reaching the skull base.
Seminars in ultrasound, CT, and MR. 10/2012; 33(5):432-42.
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ABSTRACT: Magnetic resonance imaging (MRI) features of a surgical splenorenal shunt in a 28-year-old girl are described. The woman underwent color doppler ultrasonography during follow up for the shunt, which was inconclusive. MR was used to investigate the function of the shunt. Velocity and flow direction in splanchnic vessels and in the shunt were evaluated using cine fast phase-contrast sequences. MR findings could be of help in the evaluation of patients undergoing surgical shunts during follow up.
Magnetic Resonance Imaging 03/2012; 30(5):731-3. · 1.99 Impact Factor
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ABSTRACT: The complex regional anatomy of the nose and paranasal sinuses makes the interpretation of imaging studies of these structures intimidating to many radiologists. This paper aims to provide a key to interpretation by presenting a simplified approach to the functional anatomy of the paranasal sinuses and their most common (and most relevant) variants. This knowledge is basic for the full understanding of chronic rhinosinusitis and its computed tomography (CT) patterns. As fungal infections may be observed in the setting of chronic rhinosinusitis, these are also discussed. Chronic sinus inflammation produces bone changes, clearly depicted on CT images. Finally, clues to suspecting neoplastic lesions underlying inflammatory sinus conditions are provided.
Insights into imaging. 07/2010; 1(3):155-166.
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ABSTRACT: Treatment monitoring of paranasal tumors is crucial, given the high rate of local and regional relapses that impairs the overall prognosis of patients. Magnetic resonance imaging (MRI) is the technique of choice to detect changes in the submucosa and deep spaces of the suprahyoid neck, inaccessible at clinical and endoscopic assessment. Correct interpretation of MRI requires detailed knowledge of the treatment applied and of the changes treatments are supposed to produce on macroscopic anatomy and tissue signals. Once such background of information is obtained, detection of recurrences is a less challenging task.
Cancer Imaging 01/2010; 10:183-93. · 1.50 Impact Factor
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Circulation 08/2008; 118(3):e63-4. · 14.74 Impact Factor
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ABSTRACT: Endonasal surgery is currently extending its application beyond inflammatory sinonasal lesions to successfully treat both benign and malignant neoplasms. This progression has been possible by the detailed information provided by imaging techniques (CT, MRI and PET). Inflammatory diseases are the "domain" of CT. CT provides excellent details about the thin bony sinonasal walls separating the ethmoid from the anterior skull base and the orbit. Benign and malignant neoplasms are the "domain" of MRI because the tumor is more easily separated from adjacent structures, the periosteal linings (periorbita, dura mater) and perineural spread can be accurately shown. Whereas MRI precisely assess pre-treatment tumor extent, early submucosal local recurrences are difficult to demonstrate because of post-treatment changes of the anatomy and of the signal of treated tissues. Though diffusion-weighted imaging and dynamic contrast-enhanced techniques are promising developments, PET-CT may overcome the limits of morphological MRI.
European Journal of Radiology 07/2008; 66(3):372-86. · 2.61 Impact Factor
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ABSTRACT: The impressive development of endonasal surgical techniques during the last two decades has been made possible by the detailed
pre-operative information provided by computed tomography (CT) and magnetic resonance imaging (MRI). For each imaging technique,
specific fields of clinical application have been described in the medical literature [1]. As CT supplies excellent details about the thin bony sinonasal walls, it reveals the precise individual anatomy of the
nose and paranasal sinuses. It is on the basis of this internal map that endonasal surgery for rhinosinusitis is planned. Therefore, inflammatory diseases belong to the domain of CT, whereas
benign and malignant neoplasms are covered by the MRI. The main advantages of MRI are that it more precisely distinguishes
tumor signal from adjacent structures, more accurately demonstrates two critical periosteal linings (periorbita, dura mater),
and allows the early detection of perineural spread of disease. In addition, as endonasal surgeons are confronted with new
challenges, such as endoscopic craniofacial resection, radiologists must be able to provide answers to questions regarding
the precise grading of the intracranial neoplastic extent [2].
12/2007: pages 176-185;
