Radiologist
38 years of experience

Accepting new patients
Massachusetts Eye & Ear Infirmary
243 Charles St
Boston, MA 02114
617-391-5971
Locations and availability (4)

Education ?

Medical School
Upstate Medical University Physical Medicine and Rehabilitation (1972)

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Bone Diseases
Ear Cancer (Ear Neoplasm)
Nose Cancer (Paranasal Sinus Neoplasms)
Orbital Diseases
Paranasal Sinus Diseases
Castle Connolly America's Top Doctors® (2005 - 2008, 2010 - 2014)

Affiliations ?

Dr. Curtin is affiliated with 5 hospitals.

Hospital Affilations

Score

Rankings

  • Brigham and Women's Hospital
    75 Francis St, Boston, MA 02115
    • Currently 4 of 4 crosses
    Top 25%
  • Massachusetts General Hospital
    55 Fruit St, Boston, MA 02114
    • Currently 4 of 4 crosses
    Top 25%
  • Mass Eye And Ear Infirm
  • Mass General Hospital
  • Massachusetts Eye And Ear Infirmary *
    243 Charles St, Boston, MA 02114
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Curtin has contributed to 136 publications.
    Title Posterior Semicircular Canal Dehiscence Arising from Temporal Bone Fibrous Dysplasia.
    Date March 2011
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Title Ocular Adnexal Lymphoma: Diffusion-weighted Mr Imaging for Differential Diagnosis and Therapeutic Monitoring.
    Date September 2010
    Journal Radiology
    Excerpt

    To describe the magnetic resonance (MR) imaging and diffusion-weighted (DW) imaging features of ocular adnexal lymphomas (OALs), to determine the diagnostic accuracy of apparent diffusion coefficient (ADC) for discriminating OALs from other orbital mass lesions, and to assess whether variations in ADC constitute a reliable biomarker of OAL response to therapy.

    Title Medialization of the Lamina Papyracea After Endoscopic Ethmoidectomy: Comparison of Preprocedure and Postprocedure Computed Tomographic Scans.
    Date March 2009
    Journal Journal of Computer Assisted Tomography
    Excerpt

    The purpose of this article is to report computed tomography demonstration of medial bowing of the lamina papyracea in 5 patients after internal ethmoidectomy.

    Title Anatomical Changes of the Ethmoid Cavity After Endoscopic Sinus Surgery.
    Date December 2008
    Journal The Laryngoscope
    Excerpt

    Alteration of the bony architecture of the sinus cavities has been observed in chronic sinusitis. Plasticity of the ethmoid sinus framework after endoscopic surgery, however, is a newly described entity. The objective of this study was to determine the incidence and extent of changes in ethmoid size after ethmoidectomy.

    Title Comparison of 45 Degrees Oblique Reformats with Axial Reformats in Ct Evaluation of the Vestibular Aqueduct.
    Date April 2008
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: Measurement of the vestibular aqueduct on CT scans of the temporal bone is important for the detection of large vestibular aqueduct syndrome; typically this is done in the axial plane. We sought to determine the usefulness of reformats performed in the 45 degrees oblique plane for evaluating the vestibular aqueduct. In addition, we provide reference measurements for the vestibular aqueduct in the 45 degrees oblique plane. MATERIALS AD METHODS: We selected 15 subjects referred for reasons other than sensorineural hearing loss, and without radiographic evidence of abnormality of the inner ear. Two neuroradiologists independently evaluated both axial and 45 degrees oblique images for ease in visualizing the vestibular aqueduct. Then, one of the readers (B.O.) performed reference measurements of the diameter at the mouth and midpoint of the aqueduct. RESULTS: Combining the results of both observers, we judged 82% of vestibular aqueducts as well-defined or easily traced on 45 degrees oblique views, whereas we judged only 55% as well-defined or easily traced on axial views. The difference in the degrees of visualization between the 45 degrees oblique and axial reformats was significant for observer 1 (P =.022) and observer 2 (P =.001). Intraobserver agreement about the visibility of the aqueduct was higher on the 45 degrees oblique than the axial views: (kappa = 0.682, SE = 0.171) for 45 degrees oblique reformats; (kappa = 0.480, SE = 0.145) for axial reformats. On the 45 degrees oblique reformats, the mean external aperture dimension of the vestibular aqueduct was measured as 0.616 +/- 0.133 mm, and the postisthmic segment had a mean width of 0.482 +/- 0.099 mm. CONCLUSIONS: The 45 degrees oblique plane gives a more reliable depiction of the vestibular aqueduct than the axial plane in CT evaluation of the temporal bone. This technique can be useful in cases of borderline enlargement of the vestibular aqueduct.

    Title Case Records of the Massachusetts General Hospital. Case 20-2007. An 11-year-old Boy with a Calcified Mass in the Nose.
    Date July 2007
    Journal The New England Journal of Medicine
    Title Odontogenic Orbital Inflammation: Clinical and Ct Findings--initial Observations.
    Date May 2006
    Journal Radiology
    Excerpt

    PURPOSE: To retrospectively review computed tomographic (CT) and clinical findings in patients with odontogenic orbital infection. MATERIALS AND METHODS: Approval from the institutional review board was obtained for chart and scan review, and informed consent was waived for this HIPAA-compliant study. Five patients, two male and three female (median age, 37 years; age range, 13-55 years), who had odontogenic orbital cellulitis underwent clinical evaluation, CT scanning, and treatment. CT findings, including periapical lucency suggesting abscess, sinus opacification, and the route of spread of infection, were analyzed in each patient. Imaging, clinical, and surgical findings, including the initial clinical diagnosis and the presence of a periapical abscess at surgery and at pathologic examination, were compared. RESULTS: Periapical lucency and sinus opacification were seen in all patients. The route of infection spread was through either the premalar soft tissues or the maxillary sinuses. The odontogenic origin of the orbital infection was not clinically suspected in any patients. Correct diagnosis was later made at CT in all patients. Four patients had periapical abscesses at pathologic analysis, and the fifth patient had apical periodontitis at clinical analysis and granuloma at pathologic analysis. Dental surgery was required in each of the five patients for resolution of infection; four patients underwent extraction of the infected tooth, and one patient underwent incision and drainage of a periapical abscess. CONCLUSION: Abnormal periapical lucency, widening of the periodontal ligament space, and the presence of a subperiosteal abscess suggested an odontogenic origin of orbital infection.

    Title Virtual Cisternoscopy: 3d Mri Models of the Cerebellopontine Angle for Lesions Related to the Cranial Nerves.
    Date October 2005
    Journal Skull Base : Official Journal of North American Skull Base Society ... [et Al.]
    Excerpt

    This study was conducted to show that high-resolution magnetic resonance imaging (MRI) can aid in the neurosurgical approach to lesions affecting the cranial nerves (CNs) in the cerebellopontine angle (CPA). Three patients with symptomatology related to CNs VII and VIII underwent MRI examinations performed on a 1.5-Tesla Siemens MR scanner. As part of these routine examinations, the imaging technique of constructive interference in the steady state (CISS) was used to collect a volume of data through the brainstem and internal auditory canals. This high-resolution technique acquires a three-dimensional (3D) volume of data at 0.7-mm intervals. Parameters included TR 12.3/TE 5.9, number of acquisitions of 2, a matrix of 230 x 512, bandwidth of 130 Hz per pixel, and time of 8:40. Data were transferred to a commercially available GE workstation and reconstructed into a 3D surface-rendered model. This interactive method allows the model to be visualized from any angle, including that of a standard skull base approach of suboccipital craniotomy for access to the CPA cistern. The images shown include the CPA cistern as seen from the suboccipital surgical approach. CNs V, VII, and VIII can easily be seen in relation to the pons and petrous face. The relationship between the CNs and acoustic neuromas and skull base tumors can be evaluated. Vascular structures, which are often seen in relation to CNs VII and VIII, can be viewed in a 3D format to determine the need for microvascular decompression. Direct intraoperative photographs taken through the operating microscope confirmed the anatomic accuracy of the 3D models. Imaging used for interactive neurosurgical planning must demonstrate a high degree of anatomic detail. Virtual cisternoscopy using CISS MRI technique can achieve the required resolution. Reconstruction algorithms to create surface rendering can generate images with similar 3D anatomic detail to that seen during neurosurgical approaches to the CPA cistern.

    Title A Modeling Investigation of Articulatory Variability and Acoustic Stability During American English /r/ Production.
    Date August 2005
    Journal The Journal of the Acoustical Society of America
    Excerpt

    This paper investigates the functional relationship between articulatory variability and stability of acoustic cues during American English /r/ production. The analysis of articulatory movement data on seven subjects shows that the extent of intrasubject articulatory variability along any given articulatory direction is strongly and inversely related to a measure of acoustic stability (the extent of acoustic variation that displacing the articulators in this direction would produce). The presence and direction of this relationship is consistent with a speech motor control mechanism that uses a third formant frequency (F3) target; i.e., the final articulatory variability is lower for those articulatory directions most relevant to determining the F3 value. In contrast, no consistent relationship across speakers and phonetic contexts was found between hypothesized vocal-tract target variables and articulatory variability. Furthermore, simulations of two speakers' productions using the DIVA model of speech production, in conjunction with a novel speaker-specific vocal-tract model derived from magnetic resonance imaging data, mimic the observed range of articulatory gestures for each subject, while exhibiting the same articulatory/acoustic relations as those observed experimentally. Overall these results provide evidence for a common control scheme that utilizes an acoustic, rather than articulatory, target specification for American English /r/.

    Title Imaging-guided Biopsy.
    Date June 2005
    Journal Atlas of the Oral and Maxillofacial Surgery Clinics of North America
    Title Experimental Flat-panel High-spatial-resolution Volume Ct of the Temporal Bone.
    Date December 2004
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: A CT scanner employing a digital flat-panel detector is capable of very high spatial resolution as compared with a multi-section CT (MSCT) scanner. Our purpose was to determine how well a prototypical volume CT (VCT) scanner with a flat-panel detector system defines fine structures in temporal bone. METHODS: Four partially manipulated temporal-bone specimens were imaged by use of a prototypical cone-beam VCT scanner with a flat-panel detector system at an isometric resolution of 150 microm at the isocenter. These specimens were also depicted by state-of-the-art multisection CT (MSCT). Forty-two structures imaged by both scanners were qualitatively assessed and rated, and scores assigned to VCT findings were compared with those of MSCT. RESULTS: Qualitative assessment of anatomic structures, lesions, cochlear implants, and middle-ear hearing aids indicated that image quality was significantly better with VCT (P < .001). Structures near the spatial-resolution limit of MSCT (e.g., bony covering of the tympanic segment of the facial canal, the incudo-stapedial joint, the proximal vestibular aqueduct, the interscalar septum, and the modiolus) had higher contrast and less partial-volume effect with VCT. CONCLUSION: The flat-panel prototype provides better definition of fine osseous structures of temporal bone than that of currently available MSCT scanners. This study provides impetus for further research in increasing spatial resolution beyond that offered by the current state-of-the-art scanners.

    Title Superior Semicircular Canal Dehiscence Presenting As Conductive Hearing Loss Without Vertigo.
    Date July 2004
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology
    Excerpt

    OBJECTIVE: The objective of this study was to describe superior semicircular canal dehiscence (SSCD) presenting as otherwise unexplained conductive hearing loss without vestibular symptoms. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: The study comprised 8 patients (10 ears), 5 males and 5 females aged 27 to 59 years. All 10 ears had SSCD on high-resolution computed tomography scan of the temporal bone. DIAGNOSTIC TESTS AND RESULTS: All 10 ears had significant conductive hearing loss. The air-bone gaps were largest in the lower frequencies at 250, 500, and 1000 Hz; the mean gaps for these 3 frequencies for the 10 ears were 49, 37, and 35 dB, respectively. Bone-conduction thresholds below 2000 Hz were negative (-5 dB to -15 dB) at one or more frequencies in 8 of the 10 ears. There were no middle ear abnormalities to explain the air-bone gaps in these 10 ears. Computed tomography scan and laboratory testing indicated lack of middle ear pathology; acoustic reflexes were present, vestibular evoked myogenic potentials (VEMPs) were present with abnormally low thresholds, and umbo velocity measured by laser Doppler vibrometry was above mean normal. Middle ear exploration was negative in six ears; of these six, stapedectomy had been performed in three ears and ossiculoplasty in two ears, but the air-bone gap was unchanged postoperatively. The data are consistent with the hypothesis that the SSCD introduced a third mobile window into the inner ear, which in turn produced the conductive hearing loss by 1) shunting air-conducted sound away from the cochlea, thus elevating air-conduction thresholds; and 2) increasing the difference in impedance between the oval and round windows, thus improving thresholds for bone-conducted sound. CONCLUSION: SSCD can present with a conductive hearing loss that mimics otosclerosis and could explain some cases of persistent conductive hearing loss after uneventful stapedectomy. Audiometric testing with attention to absolute bone-conduction thresholds, acoustic reflex testing, VEMP testing, laser vibrometry of the umbo, and computed tomograph scanning can help to identify patients with SSCD presenting with conductive hearing loss without vertigo.

    Title Detection of Perineural Spread: Fat Suppression Versus No Fat Suppression.
    Date April 2004
    Journal Ajnr. American Journal of Neuroradiology
    Title Identification of Juxtaforaminal Fat Pads of the Second Division of the Trigeminal Pathway on Mri and Ct.
    Date March 2004
    Journal Ajr. American Journal of Roentgenology
    Title Ct Characteristics of Intraocular Perfluoro-n-octane.
    Date January 2004
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    Perfluoro-N-octane (PFO) is a heavy liquid that is used as an aid for complicated retinal surgical procedures. Although PFO is usually removed intraoperatively, the radiographic appearance of retained PFO may mimic an intraocular foreign body or vitreous hemorrhage. As the use of PFO in retinal procedures has become more widespread, recognition of its imaging appearance has become important in the differential diagnosis of intraocular foreign body and ocular trauma.

    Title Superior Semicircular Canal Dehiscence Syndrome and Multi-detector Row Ct.
    Date March 2003
    Journal Radiology
    Title Helical Computed Tomographic Dacryocystography with Three-dimensional Reconstruction: a New View of the Lacrimal Drainage System.
    Date June 2002
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    PURPOSE: To evaluate the utility of a new diagnostic radiologic technique for anatomic evaluation of the lacrimal outflow system in patients with epiphora and to delineate anatomic variations in the lacrimal systems of patients with both patent and obstructed systems. METHODS: This study retrospectively reviewed clinical and radiologic data in a series of 30 patients with epiphora who underwent our radiologic protocol. Imaging included fluoroscopic dacryocystography followed by helical CT dacryocystography after injection of lacrimal system contrast. Axial CT data was three-dimensionally reconstructed and rotated for viewing of images in multiple projections. Mean axial cross-sectional areas of the lacrimal sac and duct were determined. RESULTS: Sixty lacrimal systems in 30 patients were clinically and radiologically evaluated. The average mean cross-sectional area of the lacrimal sac and duct in the setting of complete obstruction was 0.153 cm2 and was statistically significantly larger (p=0.0286) when compared with average mean cross-sectional areas in unobstructed (0.045 cm2) and partially obstructed (0.052 cm2) lacrimal systems and were associated with lacrimal system dilation proximal to the level of obstruction. The difference in average mean cross-sectional area between patients with unobstructed and partially obstructed systems was not statistically significant. A number of lacrimal system abnormalities were noted in our series, including obstructions at various levels of the lacrimal outflow system, lacrimal sac masses, sinusitis, sarcoidosis, sinus carcinoma, and failed dacryocystorhinostomy. Twenty-three lacrimal systems were believed to be radiographically normal. Radiologic findings altered surgical treatment in 10 of 30 patients in this series. CONCLUSIONS: This relatively safe and well-tolerated radiologic technique provides detailed imaging of the lacrimal outflow system and surrounding structures. The information obtained from this technique may be helpful in clinical and surgical decision making.

    Title Unusual Ct Appearance in an Odontogenic Keratocyst of the Mandible: Case Report.
    Date December 2001
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    An expansile lesion in the body of the left mandible had high attenuation (225 HU) on nonenhanced CT scans. Histologic examination revealed an odontogenic keratocyst with no evidence of mineralization or calcification within the lesion. The high attenuation was considered to be due to highly concentrated protein of thick, viscous keratin in the lumen of the keratocyst.

    Title Anomalous Facial Nerve Canal with Cochlear Malformations.
    Date July 2001
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: Anteromedial "migration" of the first segment of the facial nerve canal has been previously identified in a patient with a non-Mondini-type cochlear malformation. In this study, several patients with the same facial nerve canal anomaly were reviewed to assess for the association and type of cochlear malformation. METHODS: CT scans of the temporal bone of 15 patients with anteromedial migration of the first segment of the facial nerve canal were collected from routine departmental examinations. In seven patients, the anomalous course was bilateral, for a total of 22 cases. The migration was graded relative to normal as either mild/moderate or pronounced. The cochlea in each of these cases was examined for the presence and size of the basilar, second, and apical turns. The turns were either absent, small, normal, or enlarged. The CT scans of five patients with eight Mondini malformations were examined for comparison. RESULTS: The degree of the facial nerve migration was pronounced in nine cases and mild/moderate in 13. All 22 of these cases had associated cochlear abnormalities of the non-Mondini variety. These included common cavity anomalies with lack of definition between the cochlea and vestibule (five cases), cochleae with enlarged basilar turns and absent second or third turns (five cases), and cochleae with small or normal basilar turns with small or absent second or third turns (12 cases). None of the patients with Mondini-type cochlear malformations had anteromedial migration of the facial nerve canal. CONCLUSION: Anteromedial migration of the facial nerve canal occurs in association with some cochlear malformations. It did not occur in association with the Mondini malformations. A cochlea with a Mondini malformation, being similar in size to a normal cochlea, may physically prohibit such a deviation in course.

    Title Magnetic Resonance Imaging of Primary Anterior Visual Pathway Tumors.
    Date March 2001
    Journal International Ophthalmology Clinics
    Title Persistent Stapedial Artery: Ct Findings.
    Date January 2001
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    CT of a patient with conductive hearing loss showed a small vascular structure leaving the carotid canal and passing through the stapes to join the facial nerve canal. The small bony channel paralleled the anterior tympanic segment of the facial nerve, continuing beyond the geniculate ganglion into the middle cranial fossa. Otoendoscopic photography documented the presence of a persistent stapedial artery.

    Title Lymph Node Pathology. Benign Proliferative, Lymphoma, and Metastatic Disease.
    Date November 2000
    Journal Radiologic Clinics of North America
    Excerpt

    The evaluation of cervical lymph nodes is one of the main indications for performing CT and MR imaging of the neck. Imaging may be done for evaluation of an unknown neck mass, but more commonly the neck is imaged to evaluate potential metastasis from a known mucosal malignancy. CT and MR imaging characteristics of both malignant and nonmalignant nodal diseases are reviewed and the differential diagnosis of nodal pathologies for specific imaging findings are discussed. A recently proposed imaging-based nodal classification for metastatic nodal diseases from head and neck cancer is also described.

    Title The New Imaging-based Classification for Describing the Location of Lymph Nodes in the Neck with Particular Regard to Cervical Lymph Nodes in Relation to Cancer of the Larynx.
    Date September 2000
    Journal Orl; Journal for Oto-rhino-laryngology and Its Related Specialties
    Excerpt

    For over five decades, the principle landmarks used in cervical nodal classification were clinical and defined either by palpation or found at the operative table. However during the past two decades, sectional imaging has consistently improved its quality and resolution and it has been shown that imaging can identify deep structures and adenopathy not amenable to palpation. Such disease can alter planned operative or radiation fields. In the April 1999 issue of the Archives of Otolaryngology-Head Neck Surgery, for the first time an imaging-based classification was published that gave precise anatomic landmarks for use in classifying metastatic cervical adenopathy. This classification was developed in consultation with head and neck surgeons so that the nodal levels classified by this imaging-based system would correspond closely with the nodal levels determined by utilizing the most commonly employed clinically-based classifications. This article describes this imaging-based classification and demonstrates its use with axial diagrams.

    Title An Unusual Pterygopalatine Meningocele Associated with Neurofibromatosis Type 1. Case Report.
    Date September 2000
    Journal Journal of Neurosurgery
    Excerpt

    The authors describe an unusual meningocele of the lateral wall of the cavernous sinus and the anterior skull base in a young patient with typical stigmata of neurofibromatosis Type 1 (NF1). This lesion was discovered during evaluation for recurrent meningitis. It represented an anterior continuation of Meckel's cave into a large cerebrospinal fluid space within the lateral wall of the cavernous sinus, extending extracranially through an enlarged superior orbital fissure into the pterygopalatine fossa adjacent to the nasal cavity. It was successfully obliterated, via an intradural middle fossa approach, with fat packing and fenestration into the subarachnoid space. This meningocele most likely represents a variant of cranial nerve dural ectasia occasionally seen in individuals with NF1. It has as its basis the same mesodermal defect responsible for the more common sphenoid wing dysplasia and spinal dural ectasias identified with this condition. Involvement of the trigeminal nerve with expansion of the lateral wall of cavernous sinus has not been reported previously. The authors surmise, however, that it may be present in some cases of orbital meningocele associated with sphenoid wing dysplasia.

    Title Mucocele of the Infratemporal Fossa As an Unusual Complication of Midfacial Fracture.
    Date June 2000
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title Otosclerosis: Computed Tomography and Magnetic Resonance Findings.
    Date May 2000
    Journal American Journal of Otolaryngology
    Title Dedifferentiated Chondrosarcoma of the Larynx.
    Date April 2000
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    A 74-year-old man with a history of a chondroid lesion of the larynx noted an enlarging neck mass. Axial CT showed a large expansile lesion arising from the left thyroid cartilage. Multiple rings and arcs with relatively intact cortex indicated a chondroid lesion. Irregularity of the anterolateral margin abutted a prominent soft-tissue component. The specimen obtained from fine needle aspiration was suggestive of a malignant fibrous histiocytoma. After further resection, the final diagnosis was dedifferentiated chondrosarcoma. A new soft-tissue component or rapid growth of the mass can be indicative of a diagnosis of dedifferentiated chondrosarcoma.

    Title Imaging-based Nodal Classification for Evaluation of Neck Metastatic Adenopathy.
    Date March 2000
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    OBJECTIVE: This study was undertaken to create an imaging-based classification for the lymph nodes of the neck that will be readily accepted by clinicians, result in consistent nodal classification, and be easily used by radiologists. SUBJECTS AND METHODS: Over an 18-month period, the necks of 50 patients with cervical lymphadenopathy were scanned with CT, MR imaging, or both. Imaging anatomic landmarks were sought that would create a nodal classification of these necks similar to the clinically based nodal classifications of the American Joint Committee on Cancer and the American Academy of Otolaryngology-Head and Neck Surgery. Each nodal level was defined to ensure consistent nodal classification and eliminate areas of confusion existing in the clinically based classifications. RESULTS: Necks were classified using the imaging-based classification and then compared with the classification of the same necks using the most common clinically based classifications. The imaging-based nodal classifications of the superficial nodes were the same as the clinically based classifications; however, the deep nodes of eight patients were found only by imaging. The anatomic precision and the level definition afforded by sectional imaging allowed the radiologists to use the imaging-based classification in a consistent manner. CONCLUSION: This imaging-based classification has been endorsed by clinicians who specialize in head and neck cancer. The boundaries of the nodal levels were easily discerned by radiologists and yielded consistent nodal classifications. The reproducibility of this classification will allow it to become an essential component of future classifications of metastatic neck disease.

    Title A Multidisciplinary Approach to Atypical Lacrimal Obstruction in Childhood.
    Date September 1999
    Journal Ophthalmic Plastic and Reconstructive Surgery
    Excerpt

    PURPOSE: This study explores the diagnosis and management of unusual anomalies involving the canaliculi, nasolacrimal duct, nasal cavity, and sinuses in childhood. METHODS: A case series of eight children with lacrimal outflow anomalies ranging from distal nasolacrimal duct cyst formation to persistent dacryocystitis following failed probing or silicone intubation were reviewed retrospectively. Diagnostic studies including intranasal endoscopy and preoperative or intraoperative dacryocystography (DCG) were of value. RESULTS: Treatment modalities included endoscopically guided resection of lacrimal cyst mucosa, endoscopic dacryocystorhinostomy (DCR), and monocanalicular or bicanalicular intubation of the lacrimal outflow system. In our series, endoscopic surgery was well tolerated by all patients with improvement in symptoms. CONCLUSIONS: This initial experience suggests that endoscopic techniques may be useful in the management of atypical lacrimal outflow obstruction in childhood.

    Title Benign Expansile Lesions of the Sphenoid Sinus: Differentiation from Normal Asymmetry of the Lateral Recesses.
    Date June 1999
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: There is a wide range of normal variation is sphenoid sinus development, especially in the size of the lateral recesses. The purpose of this study was to determine imaging characteristics that may help differentiate between opacification of a developmentally asymmetric lateral recess and a true expansile lesion of the sphenoid sinus. METHODS: Coronal CT was performed in seven patients with expansile or erosive benign lesions of the sphenoid sinus, and results were compared to a control population of 72 subjects with unopacified sphenoid sinuses. The degree of asymmetry of lateral recess development was assessed with particular attention to the separation of vidian's canal and the foramen rotundum (vidian-rotundum distance). The images were also examined for evidence of: erosion, defined as loss of the normal thin bony margin on at least two contiguous sections; apparent thinning of the sinus wall, defined as a focal apparent decrease in thickness again on at least two contiguous sections; and for vidian's canal or foramen rotundum rim erosion or flattening. RESULTS: Of the seven patients with expansile lesions, vidian's canal margin erosion was present in seven, unequivocal sinus expansion in three, wall erosion in three, wall thinning in three, erosion of the foramen rotundum in two, and flattening in the foramen rotundum in four. Forty-one of the 72 controls had lateral recess formation, 28 of which were asymmetric. The distance between vidian's canal and the foramen rotundum (vidian-rotundum distance) relied on the presence or absence of pneumatization, with a significantly larger distance in the presence of greater wing pneumatization. Examination of 24 controls revealed apparent thinning of the sinus wall, typically at the carotid groove, but no flattening, thinning, or erosion of the vidian canal or of the foramen rotundum. CONCLUSION: Examination of controls and patients with expansile or erosive lesions of the sphenoid sinus revealed side-to-side asymmetry in the development of the sinus and lateral recess, making subtle expansion difficult to assess. Furthermore, variability in the vidian-rotundum distance correlated with degree of pneumatization, and did not necessarily reflect expansion. Thus, in the absence of gross sinus wall erosion, flattening or erosion of the rims of vidian's canal or the foramen rotundum provides the most specific evidence of an expansile or erosive process within the sinus.

    Title Atrophy of the Posterior Cricoarytenoid Muscle As an Indicator of Recurrent Laryngeal Nerve Palsy.
    Date June 1999
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: The posterior cricoarytenoid (PCA) muscle is one of the intrinsic muscles of the larynx innervated by the recurrent laryngeal nerve. As such, recurrent laryngeal nerve palsy should not only result in paralysis of the true vocal cord or thyroarytenoid muscle but also in a similar change in the PCA muscle. The ability of CT and MR imaging to depict denervation atrophy in the PCA muscle in patients with recurrent laryngeal nerve palsy was evaluated. METHODS: Two investigators reviewed the CT and/or MR studies of 20 patients with a clinical history of vocal cord paralysis. The appearance of the PCA muscle was given a rating of 0, 1, 2, 3, or 4, with 0 being definitely normal and 4 being definitely abnormal or atrophic. Each study was also reviewed for the presence or absence of other features of vocal cord paralysis: thyroarytenoid muscle atrophy, anteromedial deviation of the arytenoid cartilage, an enlarged piriform sinus and laryngeal ventricle, and a paramedian cord. RESULTS: Atrophy of the PCA muscle was shown unequivocally in 65% of the cases and was most likely present in an additional 20%. The frequency with which other features of vocal cord paralysis were seen was as follows: thyroarytenoid atrophy, 95%; anteromedial deviation of the arytenoid cartilage, 70%; enlarged piriform sinus, 100%; enlarged laryngeal ventricle, 90%; and a paramedian cord, 100%. CONCLUSION: Atrophy of the PCA muscle may be commonly documented on CT and MR studies in patients with recurrent laryngeal nerve palsy and vocal cord paralysis, and therefore should be part of the constellation of imaging features of vocal cord paralysis. This finding is particularly useful when other imaging findings of vocal cord paralysis are absent or equivocal.

    Title An Imaging-based Classification for the Cervical Nodes Designed As an Adjunct to Recent Clinically Based Nodal Classifications.
    Date April 1999
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Over the past 18 years, numerous classifications have been proposed to distinguish among the diverse nodal levels. Some classifications have used surgical landmarks, others physical assessment criteria. These classifications do not agree precisely and exhibit sufficient variation that competent physicians could arrive at slightly different staging of the patient's nodal disease. In the past 2 decades, computed tomography and magnetic resonance imaging have offered progressively more refined anatomical precision, reproducibility, and visualization of deep, clinically inaccessible structures. Because the majority of patients with head and neck malignancies presently undergo sectional imaging prior to treatment planning, we felt a need to integrate anatomical imaging criteria with the 2 most commonly used nodal classifications: those of the American Joint Committee on Cancer and those of the American Academy of Otolaryngology-Head and Neck Surgery. The imaging-based nodal classification proposed herein has been developed in consultation with surgeons interested in such classifications in the hope that the resultant classification would find ready acceptance by both clinicians and imagers. It is our desire that the best attributes of imaging, combined with those of the physical assessment, can result in a better and more consistently reproducible nodal staging than is possible by either

    Title Parotid Pleomorphic Adenomas: Delayed Ct Enhancement.
    Date March 1999
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    BACKGROUND AND PURPOSE: Weak or absent CT enhancement in pleomorphic adenomas of the parotid gland has been observed immediately after i.v. contrast administration. This feature can result in poor lesion conspicuity relative to both normal parotid tissue and other parotid abnormalities. The purpose of this study was to document the delayed CT enhancement characteristics of parotid pleomorphic adenomas and to preliminarily compare these results with the enhancement characteristics of other parotid gland tumors. METHODS: Preoperative CT scans from 18 pathologically proved parotid gland neoplasms were reviewed retrospectively. Lesions included eight pleomorphic adenomas, four Warthin's tumors, two squamous cell carcinomas, two mucoepidermoid cancers, one acinic cell carcinoma, and one melanoma metastasis. In all cases, axial CT was performed after the administration of 100 to 150 mL of i.v. contrast material, followed by delayed (average, 24 minutes; range, 13 to 34 minutes) coronal CT scanning. The mean normalized Hounsfield unit (HU) attenuation of each lesion was computed by drawing a region of interest around the entire mass and dividing the resulting HU value by that of the contralateral uninvolved parotid gland. RESULTS: For all eight pleomorphic adenomas, the degree of contrast enhancement increased and became progressively more uniform with time. Mean normalized axial lesion enhancement averaged 1.20 +/- 0.35 at 8 minutes, compared with 2.30 +/- 0.66 on the coronal scans at 24 minutes. For the 10 nonpleomorphic adenomas, no significant change was found in either the degree or pattern of contrast enhancement between the immediate and delayed CT scans. In these tumors, peak enhancement was reached early, during axial scanning. CONCLUSION: Delayed CT contrast enhancement is observed in parotid pleomorphic adenomas, increasing in both degree and homogeneity with time. This feature may be useful in selecting an appropriate contrast delay when scanning possible pleomorphic adenomas to improve lesion conspicuity and, potentially, to better distinguish these tumors from other parotid abnormalities.

    Title Cervical Ectopic Thyroid.
    Date February 1999
    Journal American Journal of Otolaryngology
    Title Diffuse Neurofibroma of the Orbit Associated with Temporal Meningocele and Neurofibromatosis-1.
    Date February 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Extension to the Orbit from Paraorbital Disease. The Sinuses.
    Date January 1999
    Journal Radiologic Clinics of North America
    Excerpt

    Disease of the sinuses frequently involves the orbit. Infection, mucocele, and tumor of the sinuses originally may present with orbital findings. Imaging attempts to evaluate the interface between sinus and orbit. Imaging findings reflect the integrity of the sinus mucosa, the thin bony wall, and the more resistant fibrous periorbita. Both CT and MR imaging play a role in this evaluation.

    Title Detection of Perineural Spread: Fat is a Friend.
    Date January 1999
    Journal Ajnr. American Journal of Neuroradiology
    Title Vertigo Produced by Petrous Extension of a Radiation-induced Fibrosarcoma of the Anterior Skull Base.
    Date November 1998
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title A Hairy Polyp Presenting As a Middle Ear Mass in a Pediatric Patient.
    Date October 1998
    Journal American Journal of Otolaryngology
    Title A Duplicated Tympanic Facial Nerve and Congenital Stapes Fixation: an Intraoperative and Radiographic Correlation.
    Date October 1998
    Journal American Journal of Otolaryngology
    Title Imaging of the Skull Base.
    Date October 1998
    Journal Radiologic Clinics of North America
    Excerpt

    Skull-base imaging has been a key factor in the advancement of skull-base surgery. The analysis of MR imaging or CT of the skull base emphasizes important landmarks, which are key to surgical planning. Although the definitive diagnosis usually is done by biopsy, the radiologist can limit the list of possibilities of the identity of a skull base lesion. The apparent site of origin is a key factor. Separation of cystic abnormalities from more solid enhancing abnormalities also is critical.

    Title Thyroid Gland After Total Laryngectomy: Ct Appearance.
    Date May 1998
    Journal Radiology
    Excerpt

    PURPOSE: To determine the computed tomographic (CT) appearance of the normal thyroid gland after total laryngectomy, because the high attenuation (or heterogeneous attenuation) of thyroid parenchyma was misinterpreted as tumor on several CT studies. MATERIALS AND METHODS: A search of computerized clinical files compiled from January 1996 through August 1997 yielded data on 24 patients who had undergone laryngectomy and subsequent CT of the neck. From these 24 patients, CT findings were available in 21. Because one patient had undergone total thyroidectomy and was excluded from the study, a retrospective review was performed in the remaining 20 patients. RESULTS: In 14 patients, unilateral thyroid tissue was present; in the other six there was bilateral thyroid tissue not connected by an isthmus. Thus, there were 26 remaining thyroid lobes, of which six were round and 20 were oval or lobular. Nineteen lobes showed homogeneously high attenuation (including one scanned without use of contrast material), six showed heterogeneous high attenuation or contained areas of hyperlucency, and one was obscured by streak artifact. CONCLUSION: Thyroid tissue can appear as unilateral or bilateral asymmetric masses on neck CT scans after laryngectomy. Gland tissue can show homogeneously or heterogeneously high attenuation. Familiarity with the varied postoperative appearance of normal thyroid gland can prevent its misdiagnosis as tumor.

    Title Dental Bur Fragments Causing Metal Artifacts on Mr Images.
    Date May 1998
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    PURPOSE: Our purpose was to define the role of dental bur fragments in producing metal artifacts on MR images. METHODS: Dental prosthetic reconstructions were made for two dogs. The two lower second premolars were prepared for full-cast crowns by using a diamond bur. The crown margin was placed subgingivally on the right side (1 mm below the free gingival margin) and at the same level as the free gingival margin on the left side. After 1 week, full-cast crowns were cemented in place. MR imaging was performed 7 days later. RESULTS: Metal artifacts appeared in both second premolar regions of the mandible on MR images, with the right side, in which the crown margin was positioned subgingivally, displaying a larger signal distortion than the left side. After removal of the crown, the artifact remained on the right. On histopathologic examination, bur fragments were detected in the gingiva, more on the right than on the left. X-ray fluorescent element analysis showed iron in the gingival tissue containing bur fragments. CONCLUSION: Distortion of MR images was considered to be attributable in part to the damage of the gingiva and in part to the presence of dental bur fragments.

    Title Comparison of Ct and Mr Imaging in Staging of Neck Metastases.
    Date April 1998
    Journal Radiology
    Excerpt

    PURPOSE: To compare the abilities of magnetic resonance (MR) imaging and computed tomography (CT) in detection of lymph node metastasis from head and neck squamous cell carcinoma. MATERIALS AND METHODS: MR imaging and CT were performed with standard protocols in patients with known carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Histopathologic examination was performed to validate imaging findings. Between 1991 and 1994, 213 patients undergoing 311 neck dissections were accrued at three institutions. RESULTS: For the upper jugular and spinal accessory regions, the areas under the receiver operating characteristic curves for combined information on size and internal abnormality were 0.80 for CT and 0.75 for MR imaging. Sensitivities, specificities, negative predictive values (NPVs), and positive predictive values (PPVs) were calculated for various size criteria with and without internal abnormality information. With use of a 1-cm size or an internal abnormality to indicate a positive node, CT had an NPV of 84% and a PPV of 50%, and MR imaging had an NPV of 79% and a PPV of 52%. CT achieved an NPV of 90%, correlating with a PPV of 44%, with use of 5-mm size as an indicator of a positive node. CONCLUSION: CT performed slightly better than MR imaging for all interpretative criteria. However, a high NPV was achieved only when a low size criterion was used and was therefore associated with a relatively low PPV.

    Title Larynx.
    Date March 1998
    Journal Neuroimaging Clinics of North America
    Excerpt

    The complex anatomy of the larynx, best conceptualized as a set of mucosal folds draped over a cartilaginous skeleton, has developed as a consequence of its many upper airway functions. Despite its deep location in the neck, much of the mucosal surface of the larynx is amenable to direct laryngoscopic inspection. The role of the radiologist in laryngeal imaging, therefore, is not primarily to diagnose disease, but to aid in both surgical staging and in the evaluation of potential clinical "blind spots." In this article, the normal anatomy of the larynx is reviewed, with special attention to important surgical and functional structures.

    Title Rule out Eighth Nerve Tumor: Contrast-enhanced T1-weighted or High-resolution T2-weighted Mr?
    Date February 1998
    Journal Ajnr. American Journal of Neuroradiology
    Title A Re-evaluation of Imaging Criteria to Assess Aggressive Masticator Space Tumors.
    Date August 1997
    Journal Head & Neck
    Excerpt

    PURPOSE: To evaluate the correlation between the gross imaging evidence of an aggressive masticator space (MS) tumor and the presence of such a MS malignancy. MATERIALS AND METHODS: Thirty patients were identified retrospectively who had a malignancy that either arose in or metastasized to the MS, had pathologic verification of the diagnosis, and had magnetic resonance (MR) and/or computed tomographic (CT) images. Specifically evaluated was the presence or absence of gross imaging evidence of mandibular erosion and the integrity of the medial MS fascia as evaluated by a smooth margin between this fascia and the parapharyngeal space fat. RESULTS: Of the 30 tumors, 28 were high-grade malignancies and 2 were histiocytoses. Of these, 5 had mandibular erosion and violation of the MS fascia, 19 had bone erosion with an intact fascia, 4 had neither bone erosion nor fascial violation (3 of these patients were under the age of 20 years), and 2 had fascial violation with no bone erosion. CONCLUSIONS: In 76.7% of patients with a malignancy arising in the MS, on imaging the medial MS fascia was grossly intact. There were 4 patients with MS malignancy and neither violation of the medial MS fascia nor mandibular bone erosion. Thus, these imaging findings may not be good criteria to evaluate the presence of a high-grade MS malignancy, especially if the patient is under the age of 20 years, in which age group MS sarcomas are more likely to arise.

    Title Odontogenic Keratocyst in a Young Child.
    Date March 1997
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title T2-weighted Mr Characteristics of Internal Auditory Canal Masses.
    Date January 1997
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    PURPOSE: To determine whether masses of the internal auditory canal are hypointense relative to cerebrospinal fluid, and therefore visible, on fast spin-echo T2-weighted MR images. METHODS: Forty-six patients had 50 masses of the internal auditory canal, identified initially on contrast-enhanced MR images, that were evaluated retrospectively for signal intensity of the mass with respect to cerebrospinal fluid and for visibility of the neural elements within the internal auditory canal on T2-weighted images. RESULTS: Forty-seven of 50 masses were clearly identified on T2-weighted images. Three small abnormalities (2 to 4 mm) were not seen with confidence on T2-weighted images. However, on close inspection of these three masses, the small abnormality on contrast-enhanced MR images corresponded to a hypointense focus on T2-weighted images. All 50 masses were hypointense relative to cerebrospinal fluid on T2-weighted images. CONCLUSION: All masses of the internal auditory canal in this study were hypointense relative to cerebrospinal fluid on T-2 weighted images, and were therefore visible.

    Title Computer-assisted Intraoperative Navigation During Skull Base Surgery.
    Date December 1996
    Journal American Journal of Otolaryngology
    Excerpt

    PURPOSE: In patients with diseases of the cranial base, anatomical landmarks are often obliterated by tumor inflammatory diseases or previous surgery. The surgeon may fail to recognize important anatomical structures or tumor margins, increasing the morbidity of the surgery and downgrading the oncological outcome. MATERIALS AND METHODS: The ISG Viewing Wand is an intraoperative navigational device that uses a position-sensing articulated arm linked to a computer that allows the surgeon to correlate the anatomy of the patient with the computerized display of the reformatted images of preoperative computerized tomography or magnetic resonance. We used the ISG system in 20 patients undergoing skull base surgery for the treatment of tumor inflammatory diseases and trauma. RESULTS: The use of the ISG wand translated into a decreased need for the resection of vital structures and provided reliable mapping of the boundaries of the paranasal sinuses and tumor margins. CONCLUSION: Intraoperative navigation is a promising technology that complements the surgeon's interpretation of the surgical field. Further refinements of this technology will ease the incorporation of these intraoperative navigation systems into other surgical procedures.

    Title Chondrosarcoma of the Nasal Septum: Skull Base Imaging and Clinicopathologic Correlation.
    Date September 1996
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Chondrosarcoma arising in the head and neck and craniofacial region is an uncommon lesion. The nasal septum is a particularly rare site of origin, with approximately 30 cases previously reported in the English literature. We present six new cases of chondrosarcoma arising in the nasal septum. Each of these tumors required cranial base surgical approaches for removal. Current imaging techniques allow a very accurate diagnosis to be made before biopsy. The characteristic ring-forming calcifications seen on computed tomography scans can be correlated with the histologic pattern of calcification. Magnetic resonance imaging techniques allow precise definition of tumor extent, which is particularly important because the disease is best treated with primary surgery. Advances in imaging and surgical techniques allow a much more complete tumor removal. It is hoped that this will increase the likelihood of cure in these patients. Surgical management and indications for adjuvant therapy are discussed.

    Title Head and Neck Radiology.
    Date April 1996
    Journal Radiology
    Title The Petrous Apex.
    Date October 1995
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Petrous apex lesions are rare, but when present, they can usually be precisely defined. The key to their identity consists of answering five questions: 1) Is the abnormality arising in the petrous apex or from contiguous areas? 2) Are the bony walls of the apex and the septations in the air cells smoothly remodeled? 3) What are the MR imaging signal characteristics of the lesion? 4) Is there enhancement of the internal "matrix" of the lesion? 5) What is the relationship of the lesion to the carotid artery?

    Title Lesions of the Parapharyngeal Space. Role of Mr Imaging.
    Date October 1995
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Because the parapharyngeal space is one of the deep spaces of the upper neck, it is a difficult region to examine clinically. On each side of the head, this space is located lateral to the pharynx and medial to the ramus of the mandible, the pterygoid muscles, and the parotid gland. It is only with bimanual palpation that any small fullness within this space may be clinically appreciated. When a parapharyngeal mass is sufficiently large, it displaces the lateral pharyngeal wall and pharyngeal tonsil toward the midline and may cause lateral displacement of the parotid gland. Only when a lesion is very large does it manifest as a fullness near the angle of the mandible. Thus, clinical evaluation of the space is quite limited.

    Title Necrotizing (malignant) External Otitis: Prospective Comparison of Ct and Mr Imaging in Diagnosis and Follow-up.
    Date August 1995
    Journal Radiology
    Excerpt

    PURPOSE: To compare computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis and follow-up of necrotizing external otitis. MATERIALS AND METHODS: CT and MR imaging were performed in seven patients at diagnosis and at 6 and 12 months after initiation of therapy. Imaging findings were compared and correlated with the clinical course of the disease. RESULTS: Cortical bone erosion was best seen on CT scans (n = 5 vs n = 0 on MR images) and failed to normalize with cure. Subtemporal soft-tissue abnormalities (n = 7 with both modalities) were better appreciated with MR imaging and had low signal intensity on T1- and T2-weighted images. Soft-tissue changes improved but did not disappear completely with treatment. CONCLUSION: CT is preferred at initial diagnosis, as small cortical erosions are better seen. Either modality can be used to follow up soft-tissue evolution. MR imaging may be better for evaluation and follow-up of meningeal enhancement and changes within the osseous medullary cavity.

    Title Enlarged Anterior Chamber: Ct Finding of a Ruptured Globe.
    Date August 1995
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    A deep anterior chamber of the globe is a clinical sign of posterior scleral rupture, an ophthalmologic emergency. On axial CT, the depth of the anterior chambers of ruptured globes was greater than the depth of the anterior chambers of normal globes. The discrepancy between the depth of the two anterior chambers in any patient can also suggest posterior scleral rupture.

    Title Importance of Imaging Demonstration of Neoplastic Invasion of Laryngeal Cartilage.
    Date March 1995
    Journal Radiology
    Title Advances in Treatment of Tumors of the Cranial Base. Advances in Imaging.
    Date March 1995
    Journal Journal of Neuro-oncology
    Excerpt

    Imaging has facilitated aggressive skull base surgery by allowing precise preoperative delineation of the extent of lesions. Continued advances providing even better resolution on imaging studies may in turn facilitate the development of new surgical approaches to the skull base.

    Title Head and Neck Radiology.
    Date February 1995
    Journal Radiology
    Title Inflammatory Lesions and Tumors of the Nasal Cavities and Paranasal Sinuses with Skull Base Involvement.
    Date December 1994
    Journal Neuroimaging Clinics of North America
    Excerpt

    The size and location of these masses can be accurately assessed today with appropriate imaging studies. The radiologist, however, must pay attention to detail and carefully evaluate the margins of the lesion and note its precise size because this information determines the operation and operative approach used. In addition, by carefully analyzing the imaging characteristics, a fairly accurate preoperative diagnosis can be given that will allow treatment planning to precede until final pathologic confirmation is available.

    Title Double Mucocele of the Paranasal Sinuses.
    Date December 1994
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    We have observed two contiguous mucoceles in one patient. Based on the mucoceles' signal intensities on MR imaging, as well as their anatomic location as delineated by CT and MR, we hypothesize that the "downstream" mucocele obstructed the "upstream" sinus, leading to formation of a secondary mucocele.

    Title Fast Spin-echo Imaging of the Neck: Comparison with Conventional Spin-echo, Utility of Fat Suppression, and Evaluation of Tissue Contrast Characteristics.
    Date December 1994
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    PURPOSE: To determine whether fast spin-echo sequences could replace conventional spin-echo methods in the evaluation of head and neck neoplasms and associated adenopathy and to evaluate differences in tissue contrast characteristics between conventional spin-echo and fast spin-echo examinations of head and neck disease. METHODS: Twenty-seven patients with squamous cell carcinoma were imaged on a 1.5-T imager with both conventional spin-echo and fast spin-echo sequences with identical section thickness and position. Twenty-one of the 27 fast spin-echo studies were performed with frequency-selective fat suppression. Three radiologists independently evaluated the images using a five-point scale to compare primary lesion margin definition and conspicuity, lymph node margin definition and conspicuity, gross motion artifact, and flow artifact. Quantitative percent contrast and contrast-to-noise ratios were calculated and compared in 7 cases with fat-suppressed fast spin-echo. RESULTS: Fast spin-echo was preferred by all three readers for lesion margin conspicuity and lymph node conspicuity. Gross motion and flow artifact demonstrated trends toward reader preference for fast spin-echo. Quantitative contrast values for fast spin-echo were significantly greater than those for conventional spin-echo. CONCLUSIONS: Fast spin-echo with fat suppression can replace conventional spin-echo at a time savings of more than 50% and improves tissue contrast and the conspicuity and definition of margins for primary lesions and lymph nodes. Fat-suppression heterogeneity remains the major limitation of this technique. Thus, careful attention to fat-suppression failure and unwanted water saturation is essential.

    Title Imaging of Ossicular Prostheses.
    Date November 1994
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    The prostheses available for reconstruction of the ossicular chain have expanded to include a variety of synthetic materials. Hydroxyapatite contains the inorganic constituents found in human living bone and is currently being incorporated into many new prostheses. This study demonstrates the computed tomography and magnetic resonance image characteristics of eight middle ear prostheses, a block of dense hydroxyapatite, and a human incus. Imaging of ossicular prostheses is more informative with computed tomography.

    Title Radiology of Congenital Hearing Loss.
    Date September 1994
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Thin-section high-resolution computed tomography with "bone algorithm" remains the examination of choice for evaluation of congenital ear malformations. It furnishes the best anatomic detail for planning the surgical approach and avoiding unfortunate intraoperative events secondary to variant courses of vessels and nerves.

    Title Cranial Base Surgery: Results in 183 Patients.
    Date July 1994
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: To learn about the effects of cranial base surgery. DESIGN: Cohort study with a mean follow-up of 30 months. SETTING: Population-based. PATIENTS: A consecutive sample of 183 patients who underwent cranial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesions, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURES: Disease-free interval, overall survival, and rate of complications and functional status. INTERVENTION: Cranial base surgery was followed by radiotherapy (in previously untreated patients). RESULTS: After completion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One patient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of disease). Among the patients who were treated for benign neoplasm, 72% had no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumatic lesions demonstrated successful correction of their presurgical problem with skull base surgery. One patient (who had invasive aspergillosis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Karnofsky performance score was improved or unchanged after surgery in 83% of patients. The average duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively. CONCLUSIONS: Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study it was found to be beneficial in controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, and inflammatory lesions.

    Title Head and Neck Radiology.
    Date February 1994
    Journal Radiology
    Title Ameloblastoma of the Maxilla: Ct and Mr Appearance.
    Date February 1993
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    This paper describes the CT and MR appearance of an ameloblastoma that involved the maxilla, infratemporal fossa, and adjacent structures. Although not pathognomonic, the multicystic appearance of an ameloblastoma may suggest the correct diagnosis.

    Title Subperiosteal Orbital Abscess in Children: Diagnosis, Microbiology, and Management.
    Date February 1993
    Journal The Laryngoscope
    Excerpt

    A chart review was undertaken of 30 patients who were presented to Children's Hospital of Pittsburgh from 1983 to 1990 and underwent surgical management for suspected subperiosteal abscess of the orbit (SPA). All patients had preoperative computerized tomography (CT) scans. Twenty-seven of 30 CT scans were reevaluated, of which 20 (74%) demonstrated findings consistent with or suggestive of SPA. Opacified sinuses were seen in 100% of this study group. Abscess collections were found in 21 patients (70%). Predominant organisms included: Streptococcus pneumoniae (38%), Streptococcus pyogenes (33%), and Haemophilus influenzae (14%); Moraxella catarrhalis was not isolated and anaerobic bacteria were isolated from only one patient. CT scans were found to be accurate predictors of SPA in 16 (80%) of 20 patients. All patients did well following surgical intervention without visual or central nervous system sequelae. We conclude from this study that CT scans should be obtained when SPA is suspected, and antimicrobial therapy should be directed toward the bacteria isolated from these abscesses.

    Title Chronic Inflammatory Sinonasal Diseases Including Fungal Infections. The Role of Imaging.
    Date February 1993
    Journal Radiologic Clinics of North America
    Excerpt

    The computed tomographic (CT) and magnetic resonance (MR) imaging techniques used for evaluating the paranasal sinuses and nasal fossae are reviewed. A summary of the physics concepts relating to the MR signal intensities observed with sinonasal secretions is given, as is a review of normal secretions and the pathophysiologic changes in the secretions that occur with chronic infections. The imaging findings of sinonasal chronic infections, mucoceles, fungal diseases, and granulomatous diseases are then presented, and a recommended imaging protocol is given.

    Title Chordomas of the Skull Base: Mr Features.
    Date December 1992
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    PURPOSE: To characterize the MR features of skull base chordomas with regard to signal intensity, size, position, extension, and Gd-DTPA enhancement. PATIENTS AND METHODS: The MR imaging studies of 28 patients with surgically proven chordomas of the skull base were retrospectively reviewed. Twenty-two of these patients received intravenous administration of Gd-DTPA. RESULTS: On short TR/short TE images, chordomas generally had low to intermediate signal. On long TR/long TE images, chordomas generally had very high signal that was heterogeneous in 79%. After Gd-DTPA administration, all chordomas demonstrated some degree of contrast enhancement. In most cases, enhancement was demonstrated throughout most of each tumor in a heterogeneous pattern. Chordomas were associated with MR findings of displacement and encasement of vessels, and frequent extension into adjacent structures such as the cavernous sinus, sella, nasopharynx, and hypoglossal canal. CONCLUSION: The MR characterization of the position and extent of these neoplasms played an important role in determining the optimal surgical approaches for gross total tumor resection.

    Title Magnetic Resonance Imaging of the Large Vestibular Aqueduct.
    Date November 1992
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    The large vestibular aqueduct syndrome describes an abnormally large endolymphatic duct and sac with associated sensorineural hearing loss. This entity was originally reported in 1978 and has since been identified as a finding in children with progressive hearing loss. The original description of the large vestibular aqueduct employed hypocycloidal polytomography of temporal bone. Subsequent reports studied patients identified with this syndrome using computed tomographic scans. We report magnetic resonance imaging of two patients diagnosed with the large vestibular aqueduct syndrome. The magnetic resonance imaging and computed tomographic scans are compared and the significant findings on magnetic resonance imaging are reviewed. This should assist the otolaryngologist and radiologist with establishing the appropriate diagnosis.

    Title Pneumolabyrinth: a Computed Tomographic Sign of Temporal Bone Fracture.
    Date August 1992
    Journal American Journal of Otolaryngology
    Title High Signal from the Otic Labyrinth on Unenhanced Magnetic Resonance Imaging.
    Date August 1992
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    High signal from the otic labyrinth was observed on precontrast MR scan of two patients who presented with sudden hearing loss and vertigo. The authors suggest the possibility that the high signal was caused by hemorrhage but that clinical significance and therapeutic implications of this finding need further study.

    Title Variability in the Enhancement of the Normal Central Skull Base in Children.
    Date August 1992
    Journal Neuroradiology
    Excerpt

    We studied the signal and enhancement characteristics of the central skull base prospectively in 40 children aged 13 days to 8 years, on a 1.5 T MRI system. Identical standard short TR/TE spin echo sequences in the sagittal plane were performed before and after intravenous gadolinium-DTPA. The sequences used for comparison were filmed at identical window and level settings. Three independent observers assessed (1) the intensity of contrast enhancement of the basisphenoid, basiocciput and presphenoid, (2) the signal intensity of the spheno-occipital synchondrosis, (3) the degree of pneumatization of the sphenoid sinus and (4) the uniformity of signal intensity reflecting fatty replacement of the marrow of the basisphenoid, basiocciput and presphenoid. In 16% and 28% respectively of cases there was no enhancement of the basisphenoid and basiocciput after gadolinium administration; in 42% and 44% there was mild enhancement, and moderate or intense enhancement was observed in 42% and 28% of cases. Even when there was irregular fatty replacement, residual hemopoietic clements could enhance intensely. When skull base neoplasms are being investigated, the normal signal irregularity and enhancement of the central skull base in children must not be confused with pathologic invasion of the marrow.

    Title Imaging of Acoustic Neuromas.
    Date August 1992
    Journal Otolaryngologic Clinics of North America
    Excerpt

    A negative high-quality, high-resolution, contrast-enhanced MRI scan is excellent evidence that a patient does not have an AN. Most nerve sheath tumors have a characteristic appearance, and when a tumor is detected there is seldom any doubt as to the identity of the lesion. There are other causes of enhancement, however, or of high signal that can be mistaken for an AN, and these must be kept in mind when a case is considered positive. In some cases, it may be appropriate to defer surgery to clarify a questionable finding by obtaining a follow-up scan. CT is still a reliable examination. In addition to evaluating the IAC, valuable information about the architecture of the petrous bone and labyrinth is provided. Improvements in imaging technology are occurring at a rapid rate. Thinner slices and more rapid scan techniques will make MRI even more useful in evaluation of the IAC.

    Title Chondrosarcomas of the Skull Base: Mr Imaging Features.
    Date July 1992
    Journal Radiology
    Excerpt

    The magnetic resonance (MR) images from 17 patients with chondrosarcomas of the skull base were retrospectively reviewed to characterize the size, location, signal intensity, and extension of these tumors. Eleven patients with chondrosarcomas received intravenously administered gadopentetate dimeglumine. In 16 patients, computed tomographic (CT) scans were obtained to evaluate intratumorous mineralization and bone erosion. On short repetition time (TR)/echo time (TE) MR images, chondrosarcomas generally had low to intermediate signal intensity; on long TR/TE MR images, they generally had very high signal intensity. Signal heterogeneity on long TR/TE MR images was seen in 10 of 17 tumors (59%) and was caused by matrix mineralization, fibrocartilaginous elements, or both. Matrix mineralization was demonstrated with CT in seven of the 16 chondrosarcomas. Chondrosarcomas showed marked enhancement after administration of gadopentetate dimeglumine in either a heterogeneous (n = 8) or homogeneous (n = 3) pattern. The information about the size and extent of these neoplasms was important in the choice of surgical approaches for gross total resection of tumor.

    Title Cystic Temporofacial Rhabdomyosarcoma with Subarachnoid Communication.
    Date June 1992
    Journal Ajnr. American Journal of Neuroradiology
    Title Duplication Anomaly of the Internal Auditory Canal.
    Date December 1991
    Journal Ajnr. American Journal of Neuroradiology
    Title Computerized Tomography and Magnetic Resonance Imaging Following Cranial Base Surgery.
    Date October 1991
    Journal The Laryngoscope
    Excerpt

    The computed tomography scans and magnetic resonance imaging films of 57 patients who underwent anterior or anterolateral cranial base surgery from January 1987 to August 1989 were retrospectively reviewed to ascertain the significance of early and late postoperative intracranial imaging changes. Extra-axial changes (air, blood, cerebrospinal fluid collection) were found in 96% of patients; axial changes (brain edema, contusion) were seen in 30% of patients in the first postoperative period (72 hours). Subsequently, extra-axial changes began to resolve but axial changes became more prevalent. After 6 months, only axial changes persisted (encephalomalacia). It was encouraging to find a low correlation of imaging abnormalities with clinically significant findings.

    Title The Role of Preoperative Ct Scans in Staging External Auditory Meatus Carcinoma: Radiologic-pathologic Correlation Study.
    Date October 1991
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Survival is related to the pathologic extent of tumor in external auditory meatus (EAM) carcinoma. This study assesses the validity of preoperative CT scans in staging EAM carcinoma. The accuracy of staging EAM carcinoma with preoperative CT scans was evaluated by comparing radiography and histopathology. Patients who received preoperative CT scan were selected from a retrospective series of 35 temporal bone resections for EAM squamous cell carcinoma. The CT scans were systematically reviewed for tumor involvement in 12 anatomic areas. The histopathology slides for the corresponding patients were reviewed according to the same criteria. CT scan findings accurately diagnosed the extent of tumor involvement identified during histopathologic examination. These tumors demonstrated the capacity to spread along existing anatomic pathways as well as direct bone erosion. We conclude that preoperative CT scans accurately stage EAM squamous cell carcinoma.

    Title Dehiscent Temporomandibular Joint.
    Date July 1991
    Journal Radiology
    Excerpt

    The appearance of an acute effusion in a well-pneumatized temporal bone directs attention to the nasopharynx and skull base. Two patients are described in whom dehiscence of the temporomandibular joint allowed herniation of the contents of the joint posteromedically, where they obstructed the middle ear entrance of the eustachian tube, the protympanum. This is, to the authors' knowledge, a previously unreported cause of an acute middle ear and mastoid effusion.

    Title Imaging of the Larynx and Cervical Trachea.
    Date June 1991
    Journal Current Opinion in Radiology
    Excerpt

    Few new concepts have been introduced recently into the literature on imaging of the larynx and cervical trachea. Instead, the applications of recent technical advances have been further investigated. Most of the interest was directed at imaging of laryngeal cancer using CT and MR imaging. Several papers addressed ways in which imaging makes an impact on case management by detecting tumor extension not obvious to the clinician who uses a mirror or endoscope to directly visualize the larynx.

    Title Sphenochoanal Polyps: Evaluation with Ct and Mr Imaging.
    Date January 1991
    Journal Radiology
    Excerpt

    A sphenochoanal polyp is a solitary mass of low attenuation on computed tomographic (CT) scans that arises from the sphenoid sinus and extends through the sphenoid ostium, across the sphenoethmoid recess, and into the choana (the boundary between the nasal cavity and nasopharynx). More often, however, a choanal polyp is an antrochoanal polyp, which arises from the maxillary antrum, protrudes through the middle meatus, extends into the nasal cavity, and continues back to the choana. Contiguous axial or coronal magnetic resonance and CT images help clearly differentiate the rare sphenochoanal polyp from the more common antrochoanal polyp. The sinus of origin is important to identify, as the surgical approach depends on the target sinus.

    Title Benign Erosion of Laryngeal Cartilage: Report of Two Cases.
    Date January 1991
    Journal Ajnr. American Journal of Neuroradiology
    Title Magnetic Resonance Imaging of the Paranasal Sinuses.
    Date December 1990
    Journal Topics in Magnetic Resonance Imaging : Tmri
    Excerpt

    MRI has been very helpful in evaluating tumors in the paranasal sinuses. MRI can differentiate retained secretions from tumors. The multiplanar capabilities of MRI are also very helpful in identifying tumor margins. Although a specific diagnosis can be suggested in most cases, demonstration of the extent of the disease and specifically the relationship to key surgical landmarks is more important. Structures of thin cortical bone are better seen with CT than MRI. For several reasons, CT is still the examination of choice for evaluation of the osteomeatal complex and inflammatory disease of the sinuses.

    Title Hypointense Paranasal Sinus Foci: Differential Diagnosis with Mr Imaging and Relation to Ct Findings.
    Date September 1990
    Journal Radiology
    Excerpt

    Despite the plethora of information provided by magnetic resonance (MR) imaging that allows differentiation of some substances that are indistinguishable at computed tomography (CT), there are diagnostic problems. In particular, there are several quite disparate substances that all appear as either low signal intensity or signal void on T1-weighted images and even lower signal intensity or signal void on T2-weighted images. These substances include air, desiccated secretion, mycetomas, acute hemorrhage, calcium, bone, and enamel. When they are surrounded by material that has long T1 and T2 relaxation times, a not uncommon MR appearance in the sinonasal cavities, they may be impossible to differentiate from one another. The current explanations for the low signal intensities are presented, the similarities in the MR appearance are illustrated, and the use of CT to resolve diagnostic problems is discussed. CT appears to be the best modality for initially examining patients with suspected routine inflammatory disease or fungal infection.

    Title The Effect of Clinical History on Chest Radiograph Interpretations in a Pacs Environment.
    Date July 1990
    Journal Investigative Radiology
    Excerpt

    The effect that accompanying patient information has on diagnostic accuracy in radiologic interpretation has been studied by many researchers but remains a matter of contention. Experiments in the past emphasized the chest film because this procedure is the one done most frequently in radiology. However, with the increasing importance of digital imaging, the role of patient history in these procedures should be assessed. The use of a model computerized patient history in the interpretation of digitized chest images that were displayed on a high-resolution workstation was studied. Two hundred forty-seven selected posteroanterior chest images that indicated disease and that indicated no disease were interpreted in random sequence by five board-certified radiologists, with and without accompanying patient histories. Readers were prompted by the response forms to evaluate images for the possible occurrence of interstitial diseases, nodules, or pneumothorax. No significant differences (P = .05) in the detection of these abnormalities were noted between case readings with and without history for any of the radiologists or for the group as a whole. However, this methodology reflects a direct interpretation approach. The results of this study may not necessarily be applicable to individual prompts, different imaging procedures, or other abnormalities.

    Title Osteogenesis Imperfecta Tarda: Appearance of the Temporal Bones at Ct.
    Date April 1990
    Journal Radiology
    Excerpt

    The computed tomographic findings in the temporal bone of two patients with osteogenesis imperfecta tarda are described. One of the patients had bilateral facial nerve paresis, and both patients presented with hearing loss.

    Title Congenital Anomalies of the Temporal Bone.
    Date April 1990
    Journal Seminars in Ultrasound, Ct, and Mr
    Excerpt

    Inner ear anomalies are a rare but important cause of sensorineural hearing loss. Combined external and middle ear anomalies are more common, causing conductive hearing loss and cosmetic deformity. The course of the facial nerve canal is altered in many temporal bone anomalies. Its location is of great importance when surgical therapy is anticipated. Vascular anomalies and bone dysplasias occasionally affect the temporal bone. High resolution CT, using thin sections and edge enhancement techniques, is capable of demonstrating the finer bony details of these temporal bone anomalies.

    Title Malignant External Otitis: Utility of Ct in Diagnosis and Follow-up.
    Date February 1990
    Journal Radiology
    Excerpt

    Malignant external otitis is a severe bacterial infection of the bone and soft tissues of the base of the skull that is frequently difficult to diagnose. The effectiveness of antibiotic therapy is likewise difficult to assess. Serial computed tomographic (CT) scans were obtained in 11 consecutive patients with malignant external otitis at time of diagnosis and periodically after conclusion of antibiotic therapy. All patients demonstrated abnormalities of the external auditory canal, with or without bone destruction. Soft tissue or fluid in the middle ear and mastoid, around the eustachian tube, and in the parapharyngeal space (both pre- and poststyloid) was seen in greater than 50% of the cases. While remineralization of bone was not seen, soft-tissue disease improved dramatically, and recurrence or persistence could be corroborated by detection of more extensive soft-tissue changes. By delineating the extra- and intracranial extent of disease, serial CT scans enable one to make the diagnosis, determine the extent of infection, document recurrence, exclude progression, and confirm resolution of malignant external otitis.

    Title Bilateral Optic Disc Colobomas with Orbital Cysts and Hypoplastic Optic Nerves and Chiasm.
    Date November 1989
    Journal Journal of Clinical Neuro-ophthalmology
    Excerpt

    A 3-month-old boy with bilateral optic disc colobomas and orbital cysts is presented. Both eyes appeared relatively normal in size. Ultrasonography on one side demonstrated a communication between the globe and cyst by way of the optic disc coloboma. On computed tomography and magnetic resonance imaging, the cysts' contents were similar to vitreous. The optic nerves and chiasm appeared markedly hypoplastic on neuroimaging tests. Fluorescein angiography, electroretinography, and visual evoked responses suggested that the visual deficit primarily was ascribable to optic nerve or anterior visual pathway dysfunction.

    Title Imaging of the Larynx: Current Concepts.
    Date October 1989
    Journal Radiology
    Excerpt

    Not every laryngeal abnormality requires imaging. If a lesion is small and there is no evidence of deep extension, the clinician can derive all visual examination. Similarly, when a lesion is large and obviously involves both true and false cords (transglottic), the clinician already knows that a total laryngectomy is necessary and imaging is of little value unless there is a question about nodal involvement. The real value of imaging is in the questionable cases in which a decision must be made about the feasibility of speech conservation therapy. The radiologist must understand the various conservation techniques and the key information needed to determine the feasibility of each. In cases in which patients are able to cooperate with the examination, MR with multiplanar imaging capabilities and increased tissue differentiation has, in my view, an edge over CT. However, many patients cannot cooperate, and in these cases CT provides a more consistently good examination. Some centers rely totally on CT and some rely completely on MR imaging units with low or middle field strength. Either can give excellent laryngeal imaging. At my institution, with a high-field-strength unit, MR imaging is the first choice if the patient is fairly cooperative and is thought able to undergo the examination. Even if the patient cannot tolerate the entire protocol, the examination usually provides enough necessary information. If the patient has major problems with secretions or has difficulty cooperating, we do not try MR imaging but use CT; the examination is almost always adequate even though restricted to one plane. The imaging modality used is less important than the radiologist's knowledge of the key anatomic landmarks. The most important landmarks, from a surgeon's perspective, are the ventricle, anterior commissure, and the cricoid cartilage. The structures most helpful in identifying the position of the ventricle are the paraglottic fat, the thyroarytenoid muscle, and the arytenoid cartilage. The clinician remains responsible for evaluating the mucosal surface. The goal of the radiologic examination is to find deep tumoral extension that the clinician cannot see.

    Title Otologic Manifestations of Langerhans' Cell Histiocytosis.
    Date August 1989
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Eighteen of 62 children diagnosed with Langerhans' cell histiocytosis at the Children's Hospital of Pittsburgh (Pa) between 1970 and 1986 demonstrated ear and temporal bone involvement. In six children, such otologic disease was their sole presenting manifestation. Common signs and symptoms included aural discharge, postauricular swelling, and conductive hearing loss. The otologic findings in these children, if not investigated properly, could easily be attributed to acute or chronic infectious ear disease. Computed tomography with contrast enhancement proved to be particularly valuable as a diagnostic study because of its clear delineation of both osseous and soft-tissue temporal bone involvement. Computed tomographic findings could also be used to enhance local treatment by guiding surgical biopsy and curettage procedures or defining low-dose radiation therapy portals. Eleven of these 18 children with otologic Langerhans' cell histiocytosis additionally required chemotherapy due to the systemic nature of their disease.

    Title An Empirical Taxometric Alternative to Traditional Classification of Temporomandibular Disorders.
    Date May 1989
    Journal Pain
    Excerpt

    A number of investigators have suggested that the generic classification temporomandibular disorders (TMD) may consist of several subsets of patients. Two primary factors are to be significant in discriminating subgroups, namely, presence or absence of TM joint abnormalities and psychological characteristics such as traits, maladaptive behavioral patterns, and gross psychopathology. Few attempts, however, have been made to integrate psychosocial and behavioral parameters in order to identify a taxonomy of TMD patients and, subsequently, to examine the differentiation of subgroups on oral dysfunction/structural abnormalities (OD/SA). The primary purpose of this paper was to develop and cross-validate an empirically derived classification system of TMD patients. The first study identified three unique subgroups of TMD patients, labeled 'dysfunctional,' 'interpersonally distressed,' and 'adaptative copers.' A second study cross-validated and confirmed the uniqueness and accuracy of the taxonomy. Subsequent analyses were performed that demonstrated that these groups were not distinguishable on the basis of any measures of OD/SA. The taxonomy identified is compared and contrasted with other reported subgroups of TMD patients and the implications of this classification system for treatment of TMD patients are discussed.

    Title Floating Petrous Bone Fracture.
    Date April 1989
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Floating petrous bone fracture appears to occur when the elastic pediatric skull is subjected to large compressive forces. Unlike a longitudinal fracture, a floating petrous bone fracture does not involve the ear canal and squamous cortex. Rather, the fracture line runs through the middle ear, separating the petrous apex from its lateral and inferior bony attachments. Characteristic clinical findings include immediate onset of conductive hearing loss, with ipsilateral sixth and seventh cranial nerve paralysis. This article details the third known occurrence of this type of fracture, and includes a discussion of the pathophysiologic mechanism and treatment rationale.

    Title Mr of the Salivary Glands.
    Date April 1989
    Journal Radiologic Clinics of North America
    Excerpt

    MR has become the examination of choice for imaging salivary gland neoplasms. The improved soft tissue contrast of MR represents a significant improvement over CT, particularly for extension outside the gland. The appearance of various tumors and inflammatory processes is described.

    Title Modern Imaging in Ear, Nose and Throat Problems.
    Date March 1989
    Journal The Pediatric Infectious Disease Journal
    Excerpt

    Advances in imaging have had a considerable effect on the workup of many ear, nose and throat problems. The traditional plain films and tomography gave a limited amount of information compared to the more recent advances of ultrasound, computed tomography and magnetic resonance. The rapid advances in imaging further complicate the decision-making process with respect to the most appropriate imaging modality for each clinical situation. A brief description of the more frequently used examination is followed by an approach to imaging in various clinical problems.

    Title Fungal Sinusitis: Diagnosis with Ct and Mr Imaging.
    Date November 1988
    Journal Radiology
    Excerpt

    Of 293 patients who underwent computed tomography (CT), surgery, and pathologic examination for chronic sinusitis, 25 had a diagnosis of fungal sinusitis at pathologic examination. Of these, 22 had foci of increased attenuation at CT (in four patients the mean representative CT number [Hounsfied unit] was 122.2 HU [SD, 8.2 HU]), and three did not. Of the 22, 19 patients (76%) met the CT criterion of this study (there was a 12% false-positive and a 12% false-negative diagnostic rate). Six of the 19 patients and one additional patient underwent magnetic resonance (MR) imaging, and all demonstrated remarkably hypointense signal characteristics on T2-weighted images. The findings at MR imaging therefore appear more characteristic of fungal sinusitis than the findings at CT. Furnace atomic absorption spectrometry showed increased concentrations of iron and manganese in mycetoma compared with their concentrations in bacterially infected mucus. This finding and the presence of calcium in the fungal concretion may explain the hypointense T2-weighted signal on MR images.

    Title Assessment of Salivary Gland Pathology.
    Date September 1988
    Journal Otolaryngologic Clinics of North America
    Excerpt

    At this institution, inflammatory problems and calculous disease are evaluated by plain films or sialography. CT can be used for stone evaluation but is not usually necessary. Although CT has been the mainstay of tumor evaluation, magnetic resonance imaging has several very definite advantages and is likely to supercede CT as the procedure of choice.

    Title Congenital Malformations of the Ear.
    Date May 1988
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Either CT or pluridirectional tomography is capable of demonstrating bony anomalies of the ear. For a variety of reasons, high-resolution "bone algorithm" CT is used as the first imaging procedure at our institution, and pluridirectional tomography is done only on rare occasion, usually when there is an ambiguity on the CT images.

    Title Facial Paralysis: Traumatic Neuromas Vs. Facial Nerve Neoplasms.
    Date March 1988
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Traumatic neuromas (TN) are benign proliferations of neural tissue that may occur without disruption of the facial nerve. The clinical presentation, as well as the radiographic appearance, may suggest neoplastic involvement of the facial nerve. Histologically, they may closely resemble neurilemomas (Schwannomas) or neurofibromas. Three cases of TN of the facial nerve associated with facial paralysis are presented here. Unlike previously reported cases, these tumors were not associated with chronic inflammatory middle ear disease. TN must be considered in the differential diagnosis and treatment of facial paralysis.

    Title Histiocytosis X of the Temporal Bone: Ct Findings.
    Date February 1988
    Journal Journal of Computer Assisted Tomography
    Excerpt

    The preoperative diagnosis of temporal bone histiocytosis X has been based traditionally on clinical examination, plain radiography, and pluridirectional tomography. Clinical misdiagnosis is common because otologic findings can mimic those of acute and chronic infectious ear disease. Similarly, plain radiographic and tomographic findings may be confused with those of mastoiditis, cholesteatoma, and temporal bone metastasis. The three cases of histiocytosis X presented here illustrate the advantages of CT compared with traditional radiographic methods in the diagnosis and staging of this disease. Computed tomography clearly delineates osseous involvement, including erosion of the bony labyrinth. Computed tomography also better defines the soft tissue margins of the granulomatous mass in relationship to the central nervous system and extratemporal tissues.

    Title A Cephalometric Tomographic Technique to Visualize the Buccolingual and Vertical Dimensions of the Mandible.
    Date December 1987
    Journal The Journal of Prosthetic Dentistry
    Title Deep Neck Lipoma.
    Date September 1987
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title Tumors of the Parapharyngeal Space and Upper Neck: Mr Imaging Characteristics.
    Date September 1987
    Journal Radiology
    Excerpt

    Magnetic resonance (MR) imaging characteristics of 40 tumors involving the parapharyngeal space and the upper part of the neck were reviewed. These lesions could be classified as being either hypervascular (glomus tumors or metastatic kidney, thyroid, or venous hemangiomas) or hypovascular (salivary gland tumors, neurogenic tumors, lymphomas, sarcomas). Detailed analysis of the contour of the neoplasm combined with clinical findings allowed further refinement of the differential diagnosis in each category. Most lesions had an intermediate signal intensity on T1-weighted images and a fairly high signal intensity on T2-weighted images. Hypervascular tumors had a number of "channel voids" caused by high-flow vessels on T1- and T2-weighted images, and on T2-weighted images there were areas of high signal intensity, presumably due to sites of slow flow within the image plane. The hypovascular lesions were quite homogeneous, and it was therefore more difficult to differentiate among the neoplasms in this group.

    Title "ossifying" Hemangiomas of the Temporal Bone: Evaluation with Ct.
    Date September 1987
    Journal Radiology
    Excerpt

    Hemangiomas of the temporal bone that affect the facial nerve are more frequent than previously suspected. Six patients with slowly progressive or recurrent facial paralysis were evaluated with computed tomography. In each case, a lesion was demonstrated that enlarged the facial nerve canal and contained intratumoral spicules of bone. Typically the temporal bone was expanded by a lesion with an indistinct margin. Demonstration of the typical radiologic findings, especially the intratumoral bone spicules, makes hemangioma a much more likely diagnosis than schwannoma.

    Title Pseudotumor.
    Date June 1987
    Journal Radiologic Clinics of North America
    Excerpt

    The term "pseuduotumor" is currently used to mean idiopathic orbital inflammation. CT can be of help in differentiating idiopathic orbital inflammation from thyroid ophthalmopathy and lymphoid tumors. The CT findings are reviewed along with important clinical and pathologic aspects.

    Title Separation of the Masticator Space from the Parapharyngeal Space.
    Date April 1987
    Journal Radiology
    Excerpt

    The separation of the masticator and parapharyngeal spaces is somewhat ambiguous. Anatomic specimens were dissected to define better the fascial layer representing the medial wall of the masticator space. A fascial layer was found extending from the medial pterygoid muscle to the skull base separating the masticator from the parapharyngeal space. The third branch of the trigeminal nerve was lateral to this fascial layer and thus passed through the masticator space. Clinical cases were reviewed. Tumors could be confidently assigned to the masticator, prestyloid, or poststyloid parapharyngeal spaces. Benign salivary gland tumors were found in the prestyloid parapharyngeal space only.

    Title Computed Tomography Appearance of Melanoma of Nasal Cavity.
    Date December 1985
    Journal The Journal of Computed Tomography
    Excerpt

    Melanoma of the nasal cavity is a mucosal lesion that is quite rare. It comprises less than 1% of all melanomas and constitutes 4% of primary malignant tumors of the nasal cavity. The computed tomography appearance of this entity is discussed and found to be nonspecific.

    Title Carcinoma Associated with Zenker's Diverticulum.
    Date July 1985
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title Ct of Perineural Tumor Extension: Pterygopalatine Fossa.
    Date January 1985
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    Tumors of the oral cavity and paranasal sinuses can spread along nerves to areas apparently removed from the primary tumor. In tumors of the palate, sinuses, and face, this "perineural" spread usually involves the maxillary division of the trigeminal nerve. The pterygopalatine fossa is a pathway of the maxillary nerve and becomes a key landmark in the detection of neural metastasis by computed tomography (CT). Obliteration of the fat in the fossa suggests pathology. Case material illustrating neural extension is presented and the CT findings are described.

    Title Computed Tomography of Orbital Myositis.
    Date September 1984
    Journal Ajr. American Journal of Roentgenology
    Excerpt

    The computed tomographic (CT) scans of 11 consecutive patients with orbital myositis were reviewed to better characterize the CT appearance of this condition. The findings in this series differed from those of previous reports in several ways. Multiple muscle involvement predominated. Bilateral involvement was more frequent than previously reported. Enlargement of the tendon as well as the muscle was a frequent finding, but a normal tendinous insertion did not preclude the diagnosis of orbital myositis. Although the CT appearance of orbital myositis is often helpful, the findings are not pathognomonic; correlation with history, clinical findings, and therapeutic response must be considered in making the diagnosis.

    Title Metrizamide Canalography in the Frontal Projection.
    Date June 1984
    Journal Revue De Laryngologie - Otologie - Rhinologie
    Title Extraocular Muscle Enlargement: a Ct Review.
    Date June 1984
    Journal Radiology
    Excerpt

    Extraocular muscle enlargement can result from a wide variety of disease processes. Although observations of the pattern of muscle involvement, muscle shape and enhancement, superior ophthalmic vein and cavernous sinus enlargement, sinus and bony wall abnormalities, and proptosis can lead to a limited differential diagnosis in some cases, no radiographic finding in itself seems to be pathognomonic. Correlative clinical findings are necessary to make a secure diagnosis.

    Title Ct of Acoustic Neuroma and Other Tumors of the Ear.
    Date May 1984
    Journal Radiologic Clinics of North America
    Excerpt

    Computed tomography is the primary radiologic tool for evaluation of ear tumors. This article divides the temporal bone into several geographic regions, and the evaluation of tumors in each of these areas is discussed.

    Title Radiologic Approach to Paragangliomas of the Temporal Bone.
    Date March 1984
    Journal Radiology
    Excerpt

    High-resolution computed tomography (HRCT) has become the primary radiologic method for evaluation of paragangliomas of the temporal bone. The HRCT evaluation of the integrity of certain bony landmarks has a profound effect on selection of surgical approach. The most important landmarks are the bony walls separating the carotid artery and the jugular bulb from the middle ear. Arteriography is not necessary if the lesion is confined to the middle ear. However, it is indicated in tumors that have eroded the above landmarks or in those patients with related neurologic symptoms.

    Title Unusually Large Nasopalatine Cyst: Ct Findings.
    Date February 1984
    Journal Journal of Computer Assisted Tomography
    Excerpt

    In a patient presenting with nasal obstruction the clinical suspicion of a nasal mass led to computed tomography that demonstrated findings thought to be characteristic of an unusually large nasopalatine cyst. The definitive diagnosis of nasopalatine cyst is more easily made on plain films. The entity is described, emphasizing once again the necessity of including dental and facial abnormalities in the differential diagnosis of lesions of the sinuses and nose.

    Title Optic Nerve/sheath Enlargement. A Differential Approach Based on High-resolution Ct Morphology.
    Date February 1984
    Journal Radiology
    Excerpt

    A wide variety of neoplastic and non-neoplastic processes can cause the intraorbital optic nerve and sheath to be enlarged on CT. The authors reviewed a large number of high-resolution CT scans and divided enlargement into three groups: tubular, fusiform, and excrescent. Further subdivision was possible by determining whether distinct optic nerve lucency was present or absent.

    Title Pigmented Villonodular Synovitis of the Temporomandibular Joint.
    Date January 1984
    Journal Computerized Radiology : Official Journal of the Computerized Tomography Society
    Excerpt

    Pigmented villonodular synovitis (PVNS) rarely occurs in the temporomandibular joint. The bony changes are easily assessed by tomography. Pluridirectional tomography cannot, however, evaluate the soft tissue component of the lesion especially that medial to the mandibular condyle. This area is accessible to CT scan evaluation. A case is presented in which the medial extent of the lesion was determined by CT scan. The radiologic findings of PVNS of the temporomandibular joint are discussed.

    Title The Facial Nerve Between the Stylomastoid Foramen and the Parotid: Computed Tomographic Imaging.
    Date October 1983
    Journal Radiology
    Excerpt

    A small segment of the facial nerve between its exit from the stylomastoid foramen and its entrance into the parotid is surrounded by fat and, therefore, can be imaged well using modern computed tomography. A small dot can be seen surrounded by fat just beneath the stylomastoid foramen on computed tomographic scan. To verify that this indeed represented the facial nerve, tissue sections and an injection into the mastoid segment of the intratemporal facial nerve were performed. The anatomic correlation and clinical material demonstrating involvement of the facial nerve in this region are presented.

    Title Normal Pituitary Gland: 1. Macroscopic Anatomy-ct Correlation.
    Date September 1983
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    To improve the radiologic recognition of pituitary microadenomas that have subtle or no mass effect, the appearance of the normal pituitary gland on computed tomographic (CT) images was studied. Thirteen autopsy specimens of the pituitary gland and sella turcica were examined by coronal CT and histologically sectioned in similar coronal planes. The CT and histologic findings were correlated, then compared with the coronal CT images of 30 normal pituitary glands in vivo, most of which were contrast-enhanced. The normal pituitary gland had a nonhomogeneous CT appearance with a variety of frequently predictable patterns. This heterogeneity was in part the result of gross anatomic structural interrelations between the anterior lobe, para intermedia, and posterior lobe.

    Title Malignant External Otitis: Ct Evaluation.
    Date December 1982
    Journal Radiology
    Excerpt

    Malignant external otitis is an aggressive infection caused by Pseudomonas aeruginosa that most often occurs in elderly diabetics. Malignant external otitis often spreads inferiorly from the external canal to involve the subtemporal area and progresses medically towards the petrous apex leading to multiple cranial nerve palsies. The computed tomographic (CT) findings in malignant external otitis include obliteration of the normal fat planes in the subtemporal area as well as patchy destruction of the bony cortex of the mastoid. The point of exit of the various cranial nerves can be identified on CT scans, and the extent of the inflammatory mass correlates well with the clinical findings. Four cases of malignant external otitis are presented. In each case CT provided a good demonstration of involvement of the soft tissues at the base of the skull.

    Title Orbital Roof Blow-out Fractures.
    Date December 1982
    Journal Ajr. American Journal of Roentgenology
    Title Table for Decubitus Tomography During Positive Contrast Studies of the Internal Auditory Canal.
    Date September 1982
    Journal Radiology
    Excerpt

    The authors describe a shelf attachment to a pluridirectional tomography table which makes decubitus tomography possible. This device is used for contrast medium filling of the internal auditory canal.

    Title Evaluation of Orbital Cellulitis and Results of Treatment.
    Date August 1982
    Journal The Laryngoscope
    Excerpt

    Optimal management of patients with orbital cellulitis depends on how accurately the disease is classified and on the appropriateness with which antibiotics and surgery are used to treat the disease. Therapy must be adjusted on the basis of the extent of the disease. In order to determine the balance of treatment modalities which is most beneficial for certain disease presentations, we reviewed a series of 303 patients with orbital cellulitis. The anatomical and bacteriological etiology of the disease was determined in each case on the basis of the examination, visual acuity, results of sinus radiography, results of culture, ultrasonography, and computerized tomography. To avoid the 5% complication rate that occurred in this series, an evaluation and treatment protocol is recommended.

    Title Evaluation of the Internal Auditory Canal Using Pluridirectional Tomography with Metrizamide.
    Date August 1982
    Journal Radiology
    Title Anomaly of the Facial Canal in a Mondini Malformation with Recurrent Meningitis.
    Date August 1982
    Journal Radiology
    Excerpt

    A patient with recurrent meningitis and congenital hearing loss was evaluated with tomography and metrizamide cisternography. Tomography showed an aberrant first portion of the facial nerve canal, while on cisternography, communication between the internal auditory canal and the dilated labyrinthine remnant was evident. The authors describe the radiographic findings and their significance and propose a mechanism for the formation of the anomalous facial nerve canal.

    Title A Criterion for Distinguishing Level V Nodes From Clavicular Nodes.
    Date
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Three-dimensional Computed Tomography.
    Date
    Journal Skull Base Surgery
    Excerpt

    Three-dimensional images were generated by reformating data from an axial image set. Separate contours were generated for bone and for tumor. The contour representing the tumor was generated by tracing the tumor using a cursor on the CRT. The contours showed the relationship of the tumor to the skull base. Three-dimensional imaging by this method is more of a communication tool than a diagnostic tool. The information on such images can be derived from close analysis of the axial image set. Indeed, determination of the position of the tumor relative to very precise structures requires analysis of the original images. The three-dimensional imaging does orient the observer and give an overall view of the position of the tumor. Because the contour of the tumor is traced, the final image represents the opinion of the radiologist. Various technical considerations and artifacts are discussed.

    Title Applications of Image-guided Navigation in the Middle Cranial Fossa: an Anatomic Study.
    Date
    Journal Skull Base Surgery
    Excerpt

    Determining the location of pertinent anatomic structures (ie, the internal auditory canal [IAC]) in middle cranial fossa surgery is commonly based on indirect inferences from bony landmarks. Several methods have been proposed for identification of the IAC, each using bony landmarks coupled with geometric formulation. Identification of the IAC based on bony architecture and geometry may be severely limited when a mass lesion is present. Image-guided surgery has the advantage of rapid localization and may be helpful in navigating a complex surgical field which has been distorted by tumor. This study evaluates the feasibility and accuracy of the ISG viewing wand in determining pertinent anatomic landmarks in the middle fossa of the human cadaver. High-resolution (1 mm) computed tomography was performed on a preserved human cadaver head in which fixed fiducial markers had been placed. Subsequently, the cadaver head was registered in a simulated operative field, and middle fossa craniotomy was performed. The foramen spinosum, foramen ovale, greater superficial petrosal nerve, internal carotid artery, arcuate eminence, and IAC were identified visually, and three independent localizations of each structure were performed with the viewing wand. Accurate localizations were consistently performed within 1 mm for each anatomic landmark. Image-guided navigation is both feasible and accurate in determining intraoperative landmarks in the middle fossa. Image-guidance may enhance surgical accuracy and efficiency. Further clinical studies evaluating image-guided techniques in the middle fossa are warranted.

    Title Giant-cell Tumors of the Sphenoid Bone in Four Children: Radiological, Clinical, and Pathological Findings.
    Date
    Journal Skull Base Surgery
    Excerpt

    We report the clinical pathological and radiological findings of giant cell tumor of the sphenoid bone in four children aged 10 to 16 years. The most common clinical finding was headache, followed by cranial nerve abnormalities. The computed tomographic findings of giant cell tumor consist of a lytic defect, sharply margmated with no sclerosis associated with an expansile, homogeneous mass (isodense with muscle). In the differential diagnosis, the lesion most similar to giant cell tumor is giant cell granuloma. The different histopathological features of the two lesions are discussed, along with other lesions, in the differential diagnosis. The magnetic resonance features consist of a mass with low signal intensities on T(1) and T(2) weighted images associated with moderate enhancement after introduction of gadolinium.

    Title Practical Applications of Image-guided Navigation During Anterior Craniofacial Resection.
    Date
    Journal Skull Base Surgery
    Excerpt

    Intraoperative image-guided navigation allows the surgeon to identify anatomic landmarks obscured by overlying normal tissue, neoplasms, infection, or previous surgery. This case presentation illustrates some of the practical applications of the ISG image-guided navigation system during anterior cranial base surgery. The advantages and the pitfalls of the ISG system are discussed.

    Title Craniofacial and Temporal Bone Ct Findings in Cleidocranial Dysplasia.
    Date
    Journal Pediatric Radiology
    Excerpt

    Cleidocranial dysplasia (CCD) is a multistructural polyostotic genetic disorder that results from mutation of the CBFA1 gene. Hearing loss is a frequent finding in CCD. We describe the CT craniofacial findings in CCD and provide a comprehensive discussion of the CT temporal bone findings in these patients.

    Title Imaging of Acoustic Neuromas.
    Date
    Journal Neurosurgery Clinics of North America
    Excerpt

    Diagnosis of acoustic neuromas has been simplified considerably by computed tomography (CT) and magnetic resonance imaging (MRI). Either enhanced method will visualize almost every acoustic neuroma. MRI is more sensitive inside the internal auditory canal. Currently, a gadolinium-enhanced MRI scan is considered an accurate indicator of whether or not an individual has an acoustic neuroma, although there have been false-positive enhanced MRI scans recently reported.

    Title A Venous Cause for Facial Canal Enlargement: Multidetector Row Ct Findings and Histopathologic Correlation.
    Date
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    SUMMARY: An enlarged facial nerve canal can be a seen in both pathologic and nonpathologic processes. The purposes of this report are the following: 1) to present a rare cause of bony facial nerve canal enlargement, due to an enlarged vein, with high-resolution MDCT and histopathologic correlation; and 2) to discuss the vascular anatomy that gives rise to this variant.

    Title Radiologic and Audiologic Evidence of the Location of an Intracochlear Mass.
    Date
    Journal Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

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