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PubMed2005

Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection.

CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.

Abscess↗

PubMed2001

Significance of the soft tissue profile on facial esthetics.

The soft tissue profile has been studied extensively in orthodontics, primarily from lateral cephalometric radiographs, under the assumption that the form of the soft tissue outline largely determines the esthetics of the whole face. The purpose of this study was to assess the relative contribution of the shape of the soft tissue profile outline on the attractiveness of the face, as seen from the profile view. Pretreatment color profile facial photographs of 20 female patients were used. The photographs were scanned, and the soft tissue outlines were digitized. The average outline of the 20 original photographs was then calculated and used as a template for modifying the photographs with computer warping methods. This resulted in 20 warped photographs, all with the same soft tissue outline. Three additional photographs were constructed with 1 face-the composite average of the 20 original photographs-and 3 hairstyles from 3 of the original pictures. The photographs were printed and presented to 10 laypersons and 10 orthodontists for scoring. Scoring was performed on 2 occasions separated by at least 1 week. On the first occasion, the original photographs of 10 of the patients and the warped photographs of the other 10 patients were shown. At the next session, the remaining 10 original and 10 warped photographs were shown. The 3 composite photographs were interspersed with the 20 pictures shown to the judges in each scoring session. Judges were asked to score facial attractiveness on a scale of 0 to 10. The judges were unaware of both the computer modification of the photographs and the purpose of the study. Good agreement was noted between the judges, although the orthodontists tended to be more influenced by the profile outline than did the laypersons. The 3 averaged composite photographs were consistently given the highest scores. The modified photographs were given higher scores than their original counterparts, showing that facial attractiveness is influenced by soft tissue outline form. However, the score improvement was not sufficient to reach the level of the composite images, especially for faces initially judged as being unattractive. This shows that factors other than profile outline shape may be more influential in facial esthetics.

Adolescent↗

PubMed1992

Block-surface staining for differentiation of starch and cell walls in wheat endosperm.

A staining technique for differentiating starch granules and cell walls was developed for computer-assisted studies of starch granule distribution in cells of wheat (Triticum aestivum L.) caryopses. Blocks of embedded caryopses were sectioned, exposing the endosperm tissue, and stained with iodine potassium iodide (IKI) and Calcofluor White. Excessive tissue hydration during staining was avoided by using stains prepared in 80% ethanol and using short staining times. The IKI quenched background fluorescence which facilitated the use of higher concentrations of Calcofluor White. Cell wall definition was improved with the IKI-Calcofluor staining combination compared to Calcofluor alone. The high contrast between darkly stained starch granules and fluorescent cell walls permitted computer assisted analysis of data from selected hard and soft wheat varieties. The ratio of starch granule area to cell area was similar for both wheat classes. The starch granule sizes ranged from 2.1 microns 3 to 22,000 microns 3 with approximately 90% of the granules measuring less than 752 microns 3 (ca. 11 microns in diameter). Hard wheat samples had a greater number of small starch granules and a lower mean starch granule area compared to the soft wheat varieties tested. The starch size distribution curve was bimodal for both the hard and soft wheat varieties. Three-dimensional starch size distribution was measured for four cells near the central cheek region of a single caryopsis. The percentage of small granules was higher at the ends than at the mid-section of the cells.

Cell Wall↗

PubMedDate not supplied

Computed tomography of prostatic and bladder rhabdomyosarcomas.

Rhabdomyosarcoma represents the most common soft tissue sarcoma in children. The CT findings in five patients with pelvic rhabdomyosarcoma are reported. In the three male patients the primary tumor originated in the prostate gland whereas in the two female patients the bladder was the primary site. The CT findings in the prostatic tumors included an enlarged, inhomogeneous prostatic mass with invasion of the perirectal fat. In two of these patients there was thickening of the levator ani muscle and one showed tumor invasion through the ischiorectal fossa and sciatic and obturator foramina into the pelvic musculature and bone. In the two patients with bladder tumors, one showed a large mass adjacent to the lateral aspect of the bladder and ascites, suggesting an ovarian primary tumor. The other patient with sarcoma botryoides (a subtype of rhabdomyosarcoma) had a diffusely thickened bladder. Two patients have had a follow-up CT demonstrating tumor regression posttherapy. The characteristically large size of these masses and propensity for local invasion in a young patient are typical features of pelvic rhabdomyosarcoma.

Adult↗

PubMed2003

Using a human visual system model to optimize soft-copy mammography display: influence of display phosphor.

RATIONALE AND OBJECTIVES: The authors developed an efficient method for optimizing cathode ray tube performance for soft-copy digital mammography displays, based on correlation between the performance of human observers and the performance of a mathematical computer model of the human visual system. The authors measured radiologist performance on soft-copy display monitors with different phosphors and used these results to validate the human visual performance model. MATERIALS AND METHODS: Six radiologists viewed a series of 250 mammographic images with microcalcifications of different contrast levels. They viewed images on two soft-copy display monitors with phosphor luminescence-one with P45 and the other with P104. The same images were analyzed with the JNDmetrix Visual Discrimination Model, which is based on psychophysical just-noticeable difference measurement principles and on frequency-channel vision-modeling principles. Receiver operating characteristic curves were generated for the human and model observers' performances, and results were compared statistically. RESULTS: Both human and model performance (area under the receiver operating characteristic curve) was better overall with the P45 than with the P104 monitor, especially for microcalcifications in the midlevel contrast range. There was high correlation between the human and model observers. CONCLUSION: The results indicate that the type of phosphor in a display monitor can influence observer performance significantly and that a model based on characteristics of the human visual system can be used to predict human observer performance accurately.

Breast Neoplasms↗

PubMed1987

Volumetric rendering techniques: applications for three-dimensional imaging of the hip.

Volumetric rendering is a new approach to three-dimensional (3D) imaging that overcomes many of the drawbacks of currently available surface-rendering systems. Its application on the Pixar Imaging System in two cases of acetabular fracture was assessed to illustrate the features of the technique. The fast-computing architecture and large memory of this system allow rapid generation of a series of high-quality 3D images in each plane of rotation (x or spinal axis, z or somersaulting axis) that can be viewed as independent static images or as an animated real-time video loop. Editing to remove the normal contralateral hemipelvis enhances appreciation of acetabular abnormalities. Every pixel of computed tomographic data is preserved, allowing representation of both soft tissue and bone as translucent overlap. The presentation of data also allows detection of subtle abnormalities and features and minimizes the artifact generation common in surface-rendered images.

Computers↗

PubMed1985

Intraabdominal panniculitis: clinical, radiographic, and CT features.

Intraabdominal panniculitis, also known as lipodystrophy, is an inflammatory condition of adipose tissue that may result in development of large masses containing necrotic fat (nodular intraabdominal panniculitis). Symptoms are secondary to inflammation or mass effect on adjacent organs. Barium studies may show nonspecific inflammatory changes and displacement of bowel loops. Computed tomography (CT) demonstrates inhomogeneous masses containing fat and soft tissue density. The diagnosis of intraabdominal panniculitis has seldom been made prospectively. However, the CT findings are characteristic and can aid in the evaluation and management of patients with this disease.

Adipose Tissue↗

PubMed1985

Simultaneous dual isotope studies in the diagnosis of infection.

A simultaneous dual isotope technique incorporating computer subtraction for the diagnosis of bone, joint, or soft-tissue infection using [67Ga]citrate and [99mTc]MDP or sulfur colloid is described. Comparison of this technique with visual congruence or noncongruence of the two radionuclide images in 41 patients shows that the two techniques have identical sensitivity (93%) and specificity (92%) but the computer technique gave additional information in 17% of all cases (44% of abnormals) concerning the anatomic location of the infective focus which aided in the subsequent surgical management of the patient.

Adolescent↗

PubMed1989

[Diseases of the aerodigestive tract and of the soft tissues of the neck. Comparison of MRI and CT].

CT and MRT are compared with each other in examinations of the aerodigestive tract in 250 patients. MRT was found to be the method of highest sensitivity and specificity after intravenous administration of the contrast medium Gd-DTPA. Magnetic resonance tomography was found to be clearly superior to computed tomography on account of the 3-dimensional imaging possibilities, improved contrasting of soft parts, and freedom from artifacts. In space-occupying growths of the nasopharynx, oropharynx and hypopharynx, the primary use of MRT must be considered mandatory in diagnostic strategy planning. CT occupies the second rank and can be used for optimised visualisation of small osseous lesions and for digital subtraction angiography (DSA). The latter plays an important role in the analysis of selective vascular supply and in diagnosis before intraarterial chemotherapy. In respect of processed in the soft tissues of the neck, pathological lesions of the lymph nodes, vessels, soft parts and cervical processes are differentiated (n = 139). For the diagnosis of the entire neck region, magnetic resonance tomography with the additional use of the contrast medium Gd-DTPA proves to be the method with the highest rate of accuracy. In processes of the soft tissues, sonography can also be employed as a primary diagnostic tool. However, in certain localisations and lesions this method can only be used with certain restrictions. According to the present state of the art, computed tomography must be considered as a secondary procedure in the diagnosis of the neck region.

Head↗

PubMed1989

Renal vein leiomyosarcoma: a case report and literature review.

A case of leiomyosarcoma of the renal vein occurring in a 48-year-old woman is reported, and the literature is reviewed. Ultrasonography (US) revealed a rounded uniform echogenic mass in the renal hilus. Computed tomography (CT) showed a well-demarcated, uniform, soft tissue density mass. Both US and CT were useful to detect the renal mass in the present case, and may be useful for staging of renal vein leiomyosarcoma. However, these imaging procedures did not reveal diagnostic features of leiomyosarcoma.

Female↗

PubMed1985

Magnetic resonance imaging: application in musculoskeletal infection.

Forty-two patients with clinically suspected osteomyelitis were examined using magnetic resonance imaging (MRI). Twenty-seven patients (64%) had previous surgery or fracture, and 15 (36%) were referred for differentiation of acute osteomyelitis from bone tumors or other pathologic conditions. MRI was compared with computed tomography in 12 cases and with 111In-labeled leukocytes scans in 22. With MRI, 92% of proved infections were detected, and bone and soft-tissue changes were more evident than with routine radiographs, tomography, or computed tomography. In patients with negative cultures and no previous surgery or fracture, it was difficult for MRI to differentiate operative changes from infection. In these patients, 111In-labeled leukocyte images were more specific than MRI.

Adolescent↗

PubMed1998

Infectious mediastinitis after cardiac operations: computed tomographic findings.

BACKGROUND: Infectious mediastinitis after cardiac operations is of great concern to cardiac surgeons because of its poor prognosis. Prompt surgical interventions such as debridement and irrigation are the key to treatment of infectious mediastinitis. METHODS: We surveyed retrospectively the cases of 722 consecutive cardiac surgery patients at our hospital. Mediastinitis developed in 21 patients after the cardiac operation. We performed computed tomography in 11 of these patients before resternotomy and in 10 patients as the control 2 to 3 weeks after the cardiac operation. RESULTS: Mediastinal soft tissue swelling was seen in 7 patients, bilateral pleural effusion was found in 9 patients, sternal dehiscence or sternal erosion was observed in 8 patients, and subcutaneous fluid accumulation was found in 7 of the mediastinitis group. Unilateral pleural effusion was seen in 6 and bilateral effusion in 1, and mediastinal soft tissue swelling was seen in 1 patient of the control group. CONCLUSIONS: Our study showed that mediastinal soft tissue mass combined with bilateral pleural effusion can be a characteristic computed tomography finding in poststernotomy infectious mediastinitis, and that chest computed tomography is more sensitive to detecting sternal dehiscence, sternal erosion, and subcutaneous fluid accumulation.

Bacterial Infections↗

PubMed2006

Virtopsy hemorrhage of the posterior cricoarytenoid muscle by blunt force to the neck in postmortem multislice computed tomography and magnetic resonance imaging.

In forensic autopsies, one of the most important and common signs of violence to the neck is hemorrhages of the soft tissues. The Institute of Forensic Medicine in Bern evaluates the usefulness of postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) of forensic cases prior to autopsy. The aim of this study was to prove the sensitivity of postmortem MSCT and MRI in the detection of hemorrhages of the neck muscles. A full body scan prior to and a detailed scan of the explanted larynx after autopsy were performed. MSCT detected multiple fractures of the larynx. Detailed MRI was able to demonstrate the hemorrhage of the left posterior cricoarytenoid muscle. The minor hemorrhage of the right posterior cricoarytenoid muscle could not be detected with certainty. Although more experience is required, we conclude that combined MRI and MSCT examination is a useful tool for documentation and examination of neck muscle hemorrhages in forensic cases.

Asphyxia↗

PubMed1998

Elastofibroma dorsi: MR and CT findings.

Elastofibroma dorsi is a benign, pseudotumoral soft tissue lesion of the periscapular area. The characteristical findings in magnetic resonance images and computed tomography usually allow the diagnosis and prevent radical surgery. We report the MR and CT findings of elastofibroma dorsi in four women presenting as an elongated soft tissue mass intermingled with fat, between the ribs and the serratus muscle, deep to the inferior angle of the scapula.

Adult↗

PubMed2006

[Pelvic and perineal trauma. Diagnosis and interventional radiotherapy].

The integration of multislice CT (MSCT) in the imaging of emergency trauma has led to a paradigm shift in trauma management. In case of hemodynamically instable patients, initial imaging is limited to a small set of standardized radiographs. Computed tomography is the imaging modality of choice for further diagnostic work-up. Consequently it should be used at an early stage and in a less restricted manner for complete assessment of the pelvic injury and to determine therapeutic management. The MSCT allows full assessment of bone, parenchymal, and vascular injuries in a single examination in the shortest time possible. High-resolution 3D imaging provides additional options. There is increasing support for primary use of MSCT in critically ill patients due to the comprehensive imaging it allows while maintaining a fast scan time. The potential and limitations of diagnostic imaging in pelvic ring fracture and associated injuries are explained. Indications for vascular interventions in arterial bleeding are discussed.

Acetabulum↗

PubMed2006

[The application of radiological imaging in the forensic pathology about cervical part].

Multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) are useful to analyze cervical injury. Especially in injury of skeleton and soft tissue, it has equal value with conventional autopsy. Even they can reparation some shortcoming consisted in the cervical part autopsy. In some difficult postmortem examination of decomposed, charred or highly infectious cadavers and in some religion country, they should be a useful alternative way to examine injury in cervical part of cadaver such as mechanical asphyxia, whiplash injury, vertebra injury, or vascular injury.

Asphyxia↗

PubMed2001

Unilateral proptosis with thyrotoxicosis resulting from solitary retroorbital soft tissue metastasis from follicular carcinoma thyroid.

Unilateral proptosis can be of neoplastic origin, even if the results of thyroid function tests suggest hyperthyroid disease, and it needs proper investigation with a computed tomographic scan of the orbit. The authors present a case of left-sided proptosis resulting from a metastasis in the retroorbital soft tissue from follicular carcinoma of the thyroid. A nodular goiter involving the left lobe and isthmus was found. The initial thyroid function test values suggested hyperthyroid disease and the patient had clinical signs of toxicity. A computed tomographic scan of the orbit revealed a left-sided retroorbital soft tissue mass, part of which was resected and found be to a metastasis from follicular carcinoma of thyroid. Total thyroidectomy was performed and the patient was treated with I-131 after operation. The proptosis resolved with I-131 treatment.

Carcinoma, Papillary, Follicular↗

PubMed1995

The role of plain radiography, computed tomography, and magnetic resonance imaging in sarcoma evaluation.

Imaging plays an important role in the diagnosis, staging, treatment planning, and post-treatment monitoring of bone and soft-tissue sarcomas. Plain radiography should be the initial imaging undertaken for patients who present with pain or a mass that may represent a musculoskeletal tumor. This is especially true of bony lesions, in which plain radiography remains the most specific noninvasive means of determining the aggressiveness of a lesion and establishing a working differential diagnosis.

Bone Neoplasms↗