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Scintigraphy of aggressive fibromatosis.

Thirteen patients with aggressive fibromatosis underwent skeletal scintigraphy and computed tomography as part of their preoperative staging. Bone involvement was visible on plain radiographs of three patients. For the other 10 patients, the presence or absence of bone involvement was shown best by computed tomography (CT) in five instances, and best by scintigraphy only once. The two studies were equally useful four times. Although skeletal scintigraphy has previously been found to be very accurate for the evaluation of bone involvement by soft tissue sarcomas, it was less useful in these patients with aggressive fibromatosis.

Adolescent↗

[Computerized tomography of the hand: examination technic, normal anatomy, indications].

The results of 480 computed tomograms carried out in the hand are presented. The digital slice imaging technique shows following advantages: a) Imaging of the complex carpus without superimposition giving a better understanding of carpal biomechanics. b) Anatomically exact imaging of the soft tissues determined by density analysis. In the following states relevant information can be obtained by CT of the hand: 1. Posttraumatic states of the carpus such as scaphoid non-union, lunato-malacia in stages I and II, complex fracture dislocations, and carpal instabilities; 2. cystic transformation of the bone; 3. non-idiopathic CTS; 4. clinically unequivocal soft-tissue masses. In our institution conventional tomography has been largely replaced by carpal CT within a progressive diagnostic programme. Today CT is the best method for imaging soft-tissue masses of the hand.

Carpal Bones↗

[The use of computed and magnetic resonance tomography in the diagnosis of neoplasms of the pelvic bones and sacrum].

The experience of the computed tomography (CT) application in the pelvic bones and sacrum tumors diagnosis in 46 patients was summarized. The data obtained were defined more precisely using magnet-resonance tomography (MRT). MRT in contradistinction to permits to differentiate the soft tissues and reveal the tumoral invasion of dura mater and the spinal cord substance, the spinal cord nerves affection. Using CT it is possible to estimate more accurately the bone structure and tumoral elements, containing calcium.

Bone Neoplasms↗

Changes in soft tissue profile after sagittal split ramus osteotomy and retropositioning of the mandible.

PURPOSE: The prediction of profile changes as a result of orthognathic surgery remains a problem during preoperative planning because of the different relative movements of the hard and soft tissues. This study analyzed the changes in soft tissue profile after sagittal split ramus osteotomy and mandibular setback. PATIENTS AND METHODS: Soft tissue changes relative to hard tissue references were recorded by means of computer-supported measurements of preoperative and postoperative standardized lateral skull radiographs of 60 Class III patients. RESULTS: An average backward transposition of the osseous pogonion of 7.1 mm was recorded. Relative to movements of this reference point in the sagittal plane, the soft tissue pogonion moved 83.9%, the soft tissue menton moved 98.9%, the labrale superior moved 32.0%, the stomion moved 45.2%, and the labrale inferior moved 79.6%. The same measurements were performed in the vertical plane, and changes in soft tissue references were analyzed. There was a marked difference in soft tissue changes after mandibular retropositioning when compared with results after mandibular advancement reported in the literature. CONCLUSION: It was concluded that it is of great importance to consider both the direction and the surgical method when predicting profile changes in the vertical as well as sagittal plane after orthognathic surgery.

Adult↗

Solitary fibrous tumor of the orbit.

The occurrence of solitary fibrous tumor in the orbit is rare. The following is a report on the case of a 24-year-old man presented with painless, progressive proptosis of the right eye for the duration of 1 year. Computed tomography and magnetic resonance imaging demonstrated a well-circumscribed soft tissue mass with gadolinium enhancement located in the superomedial aspect of the right orbit. The patient underwent complete tumor removal through a right fronto-orbital approach, with a pathological diagnosis of solitary fibrous tumor. Postoperatively, the patient was symptom-free. From review of the literature on orbital solitary fibrous tumor, emphasis should be placed on complete tumor resection and continuous follow-up monitoring of the tumor.

Adult↗

Anteriorly displaced temporomandibular joint articular disk. Report of a case diagnosed by computed tomography.

The diagnosis of anterior displacement of a temporomandibular joint articular disk was made with computed tomography and documented with conventional arthrography. We are reporting the case to show the potential value of computed tomography for evaluating problems of the temporomandibular joint. The patient underwent thin-section axial computed tomography with advanced software imaging techniques. The articular disk was evident on the scan. It was anterior to the condyle and inferior to the articular eminence. Further studies are planned to determine whether computed tomography can supplement or possibly supplant conventional arthrography in the diagnosis of soft-tissue disorders of the temporomandibular joint.

Adult↗

Detectability of anterior displacement of the articular disk in the temporomandibular joint on helical computed tomography: the value of open mouth position.

OBJECTIVE: The purpose of this study was to establish the diagnostic reliability of anterior displacement of the articular disk in the temporomandibular joint on helical computed tomography. STUDY DESIGN: Ninety-four consecutive patients were examined through use of both computed tomography and magnetic resonance imaging. On axial computed tomography, anterior disk displacement was defined as the presence of an area of soft tissue density that was semilunar in shape and located in front of the mandibular condyle. RESULTS: With magnetic resonance imaging taken as the diagnostic gold standard in evaluation of articular disk position, the sensitivity, specificity, and accuracy for computed tomography were 91%, 100%, and 97%, respectively, in the closed mouth position and 96%, 99%, and 98%, respectively, in the open mouth position. CONCLUSIONS: The detectability on axial helical computed tomography of anterior displacement of the articular disk in the temporomandibular joint in the open mouth position was almost equal to that on magnetic resonance imaging. It is recommended that the open mouth position be added when helical computed tomography is used to evaluate patients with temporomandibular joint disease.

Absorptiometry, Photon↗

Elastofibroma dorsi: CT and MR imaging findings.

Elastofibroma dorsi is a benign fibroelastic tumor of unknown etiology that arises bilaterally or unilaterally at the lower subscapular level. It can be easily diagnosed on computed tomography or magnetic resonance images and should not be mistaken for a malignant tumor.

Aged↗

Volume measurements of normal orbital structures by computed tomographic analysis.

Computed tomographic digital data and special off-line computer graphic analysis were used to measure volumes of normal orbital soft tissue, extraocular muscle, orbital fat, and total bony orbit in vivo in 29 patients (58 orbits). The upper limits of normal for adult bony orbit, soft tissue exclusive of the globe, orbital fat, and muscle are 30.1 cm3, 20.0 cm3, 14.4 cm3, and 6.5 cm3, respectively. There are small differences in men as a group compared with women but minimal difference between right and left orbits in the same person. The accuracy of the techniques was established at 7%-8% for these orbit structural volumes in physical phantoms and in simulated silicone orbit phantoms in dry skulls. Mean values and upper limits of normal for volumes were determined in adult orbital structures for future comparison with changes due to endocrine ophthalmopathy, trauma, and congenital deformity.

Adult↗

CD-based image archival and management on a hybrid radiology intranet.

This article describes the design and implementation of a low-cost image archival and management solution on a radiology network consisting of UNIX, IBM personal computer-compatible (IBM, Purchase, NY) and Macintosh (Apple Computer, Cupertino, CA) workstations. The picture archiving and communications system (PACS) is modular, scaleable and conforms to the Digital Imaging and Communications in Medicine (DICOM) 3.0 standard for image transfer, storage and retrieval. Image data is made available on soft-copy reporting workstations by a work-flow management scheme and on desktop computers through a World Wide Web (WWW) interface. Data archival is based on recordable compact disc (CD) technology and is automated. The project has allowed the radiology department to eliminate the use of film in magnetic resonance (MR) imaging, computed tomography (CT) and ultrasonography.

Compact Disks↗

Extraosseous Ewing's sarcoma. Computed tomography evaluation before and after chemotherapy.

Fourteen patients with extraosseous Ewing's sarcoma were evaluated by computed tomography (CT) and conventional radiography. The sites of involvement were in the lower extremities (six cases), the chest wall (four), pelvis (two), and the paravertebral region (two). In seven cases, the initial contrast-enhanced CT disclosed a necrotic soft tissue mass in four, two of them with peripheral enhancement. In three cases, the mass was homogeneous and did not enhance. CT enabled us to detect the size of the mass, the integrity of adjacent bone and medullary cavity, and to determine the presence or absence of metastases. CT was useful for evaluation of the patients' tumor response to treatment. In three of four patients treated with chemotherapy, CT showed evidence of a dramatic initial response. In one patient who was resistant to chemotherapy, surgical methods were required.

Adolescent↗

Orbit deformities in craniofacial neurofibromatosis type 1.

BACKGROUND AND PURPOSE: The possible relationship of orbit deformities in neurofibromatosis type 1 (NF1) to plexiform neurofibromas (PNFs) have not been fully elucidated. Our purpose was to review orbital changes in patients with craniofacial NF1. METHODS: We retrospectively reviewed CT and MR imaging abnormalities of the orbit in 31 patients (18 male, 13 female; mean age, 14 years; age range 1-40 years) with craniofacial NF1. RESULTS: Orbital abnormalities were documented in 24 patients. Six had optic nerve gliomas with enlarged optic canals. Twenty had PNFs in the orbit or contiguous to the anterior skull. The posterior orbit was distorted by encroachment from an expanded middle cranial fossa in 13 patients, and 18 had enlargement of the orbital rim. Other changes included focal decalcification or remodeling of orbital walls adjacent to PNFs in 18 patients and enlargement of cranial foramina resulting from tumor infiltration of sensory nerves in 16. These orbital deformities were sometimes progressive and always associated with orbital infiltration by PNFs. CONCLUSION: In our patients with craniofacial neurofibromatosis, bony orbital deformity occurred frequently and always with an optic nerve glioma or orbital PNF. PNFs were associated with orbital-bone changes in four patterns: expansion of the middle cranial fossa into the posterior orbit, enlargement of the orbital rim, bone erosion and decalcification by contiguous tumor, and enlargement of the cranial foramina. Orbital changes support the concept of secondary dysplasia, in which interaction of PNFs with the developing skull is a major component of the multifaceted craniofacial changes possible with NF1.

Adolescent↗

Association of verrucous carcinoma and inverted papilloma in the sinonasal tract.

It is well known that inverted papilloma (IP) is sometimes associated with malignancies; however, the association of IP with verrucous carcinoma (VC) is extremely rare. We herein report a case of IP in the nasal cavity with VC in the maxillary sinus. A 73-year-old Japanese woman presented with a 3-month history of right-sided nasal obstruction and repetitive epistaxis. A biopsy of the mass was performed and the pathological result proved to be IP. Computed tomography and magnetic resonance imaging revealed a moderately enhanced soft-tissue lesion filling the right nasal cavity and a ring-enhanced expansive lesion in the maxillary sinus. Under a tentative diagnosis of IP of the nasal cavity with maxillary empyema, she underwent right medial maxillectomy via a lateral rhinotomy approach, and a histopathological diagnosis of IP in the nasal cavity with VC in the maxillary sinus was obtained. Her postoperative clinical course was uneventful. She is currently free from symptoms, and there is no evidence of recurrence 5 months after surgery. The pathology, clinical manifestation, and treatment of VC associated with IP are reviewed from literature.

Aged↗

Assessment of tissue oxygenation.

A continuous supply of oxygen to all tissues is necessary for the efficient production of ATP, and this supply is considered sufficient when aerobic metabolism is maintained. Nonhealing wounds, necrotizing infections, radiation-induced necrosis, crush injury, decompression illness, and CO poisoning all exhibit impaired tissue oxygenation. The need for efficacy of HBO therapy in such conditions is in part determined by the prevailing state of tissue oxygen supply and demand. The methods currently available or under development for assessing the adequacy of tissue oxygenation include blood gas analysis, transcutaneous oxygen measurement, gastric tonometry, pulse oximetry, near-infrared spectroscopy, functional MR imaging, MR spectroscopy, electron paramagnetic resonance, positron emission tomography, and single photon emission computed tomography. The clinical and experimental applications of these methods are discussed and emphasis is placed on their role in hyperbaric medicine.

Animals↗

Peroneal arteriovenous fistula and pseudoaneurysm formation after blunt trauma. A case report.

A 56-year-old man sustained blunt trauma to the right calf which, 15 months later, manifested as a painful soft tissue mass with aggressive destruction of the fibula. Contrast-enhanced computed tomography and popliteal arteriography disclosed a peroneal arteriovenous fistula and pseudoaneurysm. Five years after pseudoaneurysm repair and fistula ligation, the patient was free of symptoms and had no further bone destruction.

Aneurysm↗

Computer-navigated ACL reconstruction with the OrthoPilot.

Within the minimally invasive-operation techniques, small approaches are desirable in many fields of the surgery to reduce soft-tissue trauma; however, the risk exists that the surgeon will lose the general view of the topographic structures. The remedy lies in computer navigation with the OrthoPilot. This navigation system has already been used successfully for knee endoprosthesis. A special software was developed for use of the navigation-system, OrthoPilot, for ACL reconstruction. This system is capable of determining the exact optimum position of tunnel replacement by computer navigation. This determination is made by a high-precisive infra-red camera and rigid bodies fixed onto the patient. The experience gained in performing 150 ACL reconstructions to date demonstrates the ease of handling, reduction in extra operation time to a minimum of 10-15 minutes, and only minimal trauma by fixing the rigid bodies. In all cases, an optimum position was documented for the tunnel replacement. Furthermore, no expensive pre-operation x-rays (CT scan, nuclear spin) are needed. Use of the computer-assisted navigation system demonstrated that femoral and tibial tunnel replacement can be positioned precisely. Thus, a false position of the tunnel replacement, the main cause of' transplant-failure, can be avoided. The OrthoPilot is an important support system for both less-experienced and experienced surgeons when performing surgical ACL revisions.

Anterior Cruciate Ligament↗

Periosteal ganglia: CT and MR imaging features.

The imaging features of four cases of periosteal ganglia were studied. Three lesions were located over the proximal shaft of the tibia, in proximity to the pes anserinus. The fourth lesion involved the distal shaft of the ulna. Three lesions had different degrees of external cortical erosion, scalloping, and thick spicules of periosteal bone on plain radiographs. The bone adjacent to the fourth lesion was not involved. Computed tomography (CT) showed these lesions to be sharply defined soft-tissue masses abutting the periosteum. All of the lesions had the same attenuation as fluid. Magnetic resonance (MR) imaging revealed the ganglia to be sharply defined masses that were isointense compared with neighboring muscles on T1-weighted images. There was markedly increased signal intensity compared with that of fat on T2-weighted images. The signal intensity on both types of images was homogeneous. The MR imaging features were consistent with the fluid nature of the lesions. Under the appropriate clinical circumstances, the MR imaging and CT features of periosteal ganglia are diagnostic.

Adult↗