Successful treatment of syncope in head and neck cancer with induction chemotherapy.
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Biomedical subjects
Publications and source records attributed to Mahmood F Mafee.
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Ewing sarcoma is a malignant tumor of bone that rarely spreads to the head and neck. We describe an unusual case of metastatic Ewing sarcoma involving the calvarium mimicking olfactory neuroblastoma, an uncommon neuroectodermal tumor of the anterior skull base. Pertinent clinical, radiological, and pathologic features of these tumors are described, with particular attention to their imaging characteristics.
The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication "Rhinosinusitis: Establishing definitions for clinical research and patient care" and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.
Since the development of CT and MR imaging, significant progress has been made in ophthalmic imaging. As the technology advanced and MR imaging units improved their ability in term of spatial resolution, the role of MR imaging in ophthalmic imaging has increased accordingly. This article considers the role of MR and CT imaging in the diagnosis of selected pathologies of the eye.
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The Rhinosinusitis Initiative was developed by 5 national societies. The current guidance document is an expansion of the 2004 publication, "Rhinosinusitis: Establishing definitions for clinical research and patient care" and provides templates for clinical trials in antimicrobial, anti-inflammatory, and symptom-relieving therapies for the following: (1) acute presumed bacterial rhinosinusitis, (2) chronic rhinosinusitis (CRS) without nasal polyps, (3) CRS with nasal polyps, and (4) classic allergic fungal rhinosinusitis. In addition to the templates for clinical trials and proposed study designs, the Rhinosinusitis Initiative has developed 6 appendices, which address (1) health outcomes, (2) nasal endoscopy and staging of CRS, (3) radiologic imaging, (4) microbiology, (5) laboratory measures, and (6) biostatistical methods.
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Conventional plain-film radiography may be used as a screening method for various pathological conditions of the sinonasal cavities. However, CT scanning remains the study of choice for the imaging evaluation of acute and chronic inflammatory diseases of sinonasal cavities. MRI is superior to CT in differentiating inflammatory conditions from neoplastic processes. The most common complications of rhinosinusitis in children occur in the orbit. The information obtained from the CT scan and MRI, together with clinical findings, may be the best guidelines for clinical management and the mode of treatment. Although intracranial complications of sinusitis are relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. It is prudent to obtain MRI of the sinuses, orbits, and brain whenever extensive or multiple complications of sinusitis are suspected, in addition to CT scanning. Chronic rhinosinusitis is a clinical diagnosis, confirmed and staged with the CT scan of sinonasal cavities. Chronic inflammatory disease is often associated with mucosal thickening and sclerosis of the bone, particularly within the sinuses. Chronic extramucosal fungal sinusitis develops as a saprophytic growth in retained secretions in a sinus cavity. The imaging manifestations of chronic mycotic rhinosinusitis may be nonspecific or highly suggestive of the presence of fungal infection. The presence of diffuse increased attenuation within the paranasal sinuses and nasal cavity should be considered as chronic allergic hypersensitivity aspergillosis (chronic noninvasive aspergillosis) or chronic hyperplastic sinusitis and polyposis associated with desiccated, retained mucosal secretions. The MRI characteristics of fungal sinusitis depend on the stage of the disease.
Although the diagnosis of retinoblastoma (Rb) is made primarily by means of clinical examination, CT and MR imaging are helpful to confirm the diagnosis, determine the extent of the intraocular tumor, and exclude extraocular or intracranial involvement. They are also valuable in differentiating Rb from lesions that simulate Rb.
Schwannomas are well-circumscribed ovoid masses that most commonly present in the superior orbit. Although it may be difficult to differentiate these benign masses from other orbital tumors on radiologic imaging, the CT and, in particular, the MR imaging characteristics can sometimes point to the diagnosis of a nerve sheath tumor. A definitive diagnosis can be made through correlation with histopathologic findings, however. In most cases, schwannomas have low malignant potential, and with total excision, recurrence is rare.
Since the development of CT and MR imaging, significant progress in ophthalmic imaging has been made. As the technology advanced and MR imaging units improved their ability in terms of spatial resolution, the role of MR imaging in ophthalmic imaging has increased accordingly. This article considers the role of MR and CT imaging in the diagnosis of selected pathologies of the eye.
The appropriate diagnosis and treatment of orbital rhabdomyosarcoma requires close cooperation and communication between the radiologist, the ophthalmologist, and the medical and radiation oncologists. The clinical presentation, imaging characteristics, and staging of orbital rhabdomyosarcoma are discussed. A discussion of several important simulating lesions and their distinguishing characteristics follows.
The definitive diagnosis of medulloepitheliomas of the ciliary body and optic nerve is made by histopathologic examination. Familiarity with rare tumors aids clinicians in accurately diagnosing this rare neoplasm. CT and MR imaging findings can be helpful, especially if the mass is confined in an area of the ciliary body without involvement of the retina. The characteristic findings of cystic changes and possible calcification are suggestive of medulloepithelioma rather than melanoma. The more common and ominous retinoblastoma shares some radiologic features with medulloepithelioma, however, and is thus often a consideration. Clinical diagnosis of medulloepitheliomas of the optic nerve and central nervous system (CNS) is more challenging. The diagnosis is often made by histopathologic examination. Lastly, coexisting CNS tumors and anomalies have been reported in association with intraocular medulloepitheliomas and should be recognized.
CT and MR imaging are particularly important in the diagnostic investigation of patients with vascular disorders of the orbit. The improved image quality of CT and MR imaging, along with dynamic CT angiography, MR angiography, MR venography, and multiphase dynamic contrast CT/MR imaging, has proven useful to delineate as well as differentiate various orbital vascular lesions. This article presents the current classification of orbital vascular disorders and describes the CT/MR imaging characteristics of orbital cavernous hemangiomas and simulating lesions.
The goal of this article is to familiarize general radiologists and clinicians (particularly ophthalmologists, neuro-ophthalmologists, neurologists, and neurosurgeons) with the recent introduction of clinical MR imaging scanners operating at a magnetic field strength of 3-T and to compare them with the more common standard scanners operating at 1.5-T. In this study, MR imaging at 3-T was found to offer superior depiction of orbital and intracranial anatomy and pathologic findings. Spin echo, high spatial resolution, T2-weighted, thin-section MR imaging sequences are especially useful and sensitive at 3-T for the evaluation of orbital, ocular, and intracranial anatomy and pathologic findings. The authors din that time-of-flight (TOF) MR angiography at 3-T surpasses the best MR angiography at 1.5-T and that two-dimensional TOF venography and three-dimensional contrast MR venography at 3-T offer superior visualization of intracranial and facial veins as compared with MR venography at 1.5-T. We believe that with further quality image production and efficient coil design, 3-T MR imaging should hold the promise of playing an important role in the diagnostic imaging evaluation of ocular, orbital, and optic pathway pathologic findings.
The use of CT and MR imaging has improved the understanding of many congenital and acquired conditions in pediatric ophthalmology, resulting in more appropriate therapeutic intervention and giving insight into the pathogenesis of these conditions.
Fibro-osseous, osseous, cartilaginous, and giant cell lesions of the mandible, maxilla, and other craniofacial bones share overlapping clinical, radiologic, and pathologic features that may lead to diagnostic confusion and possible misdiagnosis. The value of combined clinical-radiologic-pathologic correlation in the diagnosis of these lesions is paramount to achieving the correct diagnosis with subsequent implementation of appropriate therapeutic intervention.
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