Magnetic Resonance Imaging of the Temporal Bone in Patients with Meniere's Disease

Meniere's disease (MD) is still controversial in several aspects. The vestibular aqueduct, the osseous channel that carries the endolymphatic duct and sac, has previously been studied by tomography and computed tomography, with shortening and narrowing of this structure observed. These findings are apparently correlated to the development of the endolymphatic hydrops present in MD and related to its episodic symptoms. In studying the endolymphatic duct, the key structure in the pathology of this disease, magnetic resonance imaging (MRI) studies of the temporal bone were performed in 12 patients with unilateral MD and in 9 bilateral cases; the results were compared with images obtained from 30 normal ears. The endolymphatic duct appeared to be statistically less visible in MD patients, with no difference between symptomatic and asymptomatic ears in the presence of unilateral disease. No relationship was found between visualization of the endolymphatic duct and time of evolution or response to clinical treatment in these cases. The distance from the posterior semicircular canal to the posterior temporal border was found to be bilaterally reduced in MD. The authors conclude that although the demonstration of endolymphatic hydrops ?in vivo? is not yet possible by MRI, some features can be observed that can support a clinical hypothesis of MD.     

Cortical Magnetic Resonance Imaging Findings in Patients With Posttraumatic Olfactory Dysfunction: Comparison According to the Interval Between Trauma and Evaluation

Objectives

Patients with smell loss after craniocerebral trauma are known to have some brain abnormalities, but there was no study to analyze the findings according to the time interval between injury and evaluation. We aimed to identify whether the time interval may influence on the findings in the brain.

Methods

Medical records of 19 patients with posttraumatic olfactory dysfunction were reviewed. All of them underwent a magnetic resonance imaging and olfactory function tests. The patients were divided into early (n=10) and delayed (n=9) groups according to the time interval.

Results

Magnetic resonance imaging was taken at a mean time of 2.2 and 59.6 months after trauma in the early and delayed groups, respectively. Abnormal findings in the brain were found in 6 and 8 patients in the early and delayed groups, respectively. The olfactory bulb and orbitofrontal cortex were commonly affected olfactory pathways in both groups. In the early group, the abnormalities were brain tissue defect, hemorrhage, and focal edema whereas tissue defect was the only finding in the delayed group. In the early group, 5 of 6 patients with severe olfactory dysfunction showed brain abnormality while 1 of 4 patients with mild dysfunction had abnormality. In the delayed group, all the patients had severe dysfunction and 8 of 9 patients showed brain abnormality.

Conclusion

Most patients with traumatic olfactory dysfunction had abnormality in the brain, and brain abnormality might be different according to the timing of evaluation. Furthermore, there might be an association between the severity of olfactory dysfunction and radiological abnormalities.     

Laryngeal Findings in Patients with Contact Granuloma: a Long-Term Follow-Up Study

In order to evaluate the long-term outcome of contact granuloma a follow-up study of 59 patients was conducted. Primary treatment consisted mainly of voice therapy or of voice therapy in combination with surgery. A careful history was taken and the patients were examined using videolaryngoscopy. The average follow-up time was 12 years (range 5-20 years). In total, 10 out of 59 patients (17%) had a granuloma at the follow-up examination, 6 of them presenting without subjective symptoms. Another 28 patients had various signs of inflammation of the posterior glottis. The history taken at follow-up revealed that eight patients had had a previous temporary recurrence during the follow-up time. The recurrence frequency was the same for patients who received voice therapy after postoperative recurrence and patients who were treated with voice therapy only. About 80% of the patients had no symptoms at follow-up. The findings of the present study indicate that contact granuloma is one of several manifestations of chronic posterior laryngitis and that it may occur without symptoms.     

Echo-Planar Magnetic Resonance Imaging of Deglutitive Vocal Fold Closure: Normal and Pathologic Patterns of Displacement

Abnormalities of vocal fold closure during deglutition predispose to aspiration due to impairment of airway protection. Conventional assessment of deglutitive vocal fold motion with laryngoscopy does not permit visualization through a complete adduction-abduction cycle. We determined spatiotemporal patterns of deglutitive vocal fold adduction through echo-planar magnetic resonance imaging in 15 normal volunteers and 6 patients with vocal fold paralysis. In normal volunteers, deglutitive vocal fold adduction was synchronized with laryngeal elevation, with complete vocal fold closure at the apex. Patients with unilateral vocal fold paralysis demonstrated reduced elevation and medial movement of the involved vocal fold. At maximal laryngeal elevation the uninvolved vocal fold attained a position superior to the paralyzed fold, resulting in level differences and an interglottic gap. Patients with bilateral vocal fold paralysis demonstrated reduced elevation and medial movement of both vocal folds. These findings indicate that normal and abnormal patterns of vocal fold displacement can be distinguished noninvasively through the use of echo-planar imaging. Laryngoscope, 106:568-572, 1996     

先天性感音性聋患者大脑皮层静息态功能磁共振研究

目的：应用血氧水平依赖功能磁共振成像（blood oxygenation level dependent functional magnetic resonance imag ing ,BOLD－ fM RI）技术观察先天性感音神经性聋患者静息态双侧大脑半球皮层功能活动。方法对23例行人工耳蜗植入术的双侧先天性感音性聋患者（实验组）和10例听力正常者（对照组）行静息态BOLD—fMRI检查,采用fMRI低频震荡振幅（ALFF）方法比较实验组和对照组双侧大脑皮层功能活动情况,并进行定量分析。结果实验组大脑皮层左侧颞下回、左侧梭状回、右侧扣带回及左侧中央后回静息态激活强度明显大于对照组相应皮层的激活强度（P＜0．01）。结论先天性感音性聋患者感觉系统相关皮层可能发生了功能重塑,其大脑皮层存在知觉补偿现象。     

喉癌患者染色体对致突变剂诱发畸变的敏感性研究

采用平阳霉素作为诱变剂，对２８例喉癌患者和２３例正常人做外周血淋巴细胞染色体对诱变剂敏感性研究，结果显示喉癌患者的染色体总畸变率、每细胞染色单体断裂率（ｂ／ｃ值）和细胞畸变率分别为１．９８％±０．０５％，０．５７％±０．３５％和４２．８％±１２％。正常人则分别为０．９４％±０．０４％，０．２８％±０．１２％和２７％±１２％。经统计学处理，喉癌患者组与正常人组的差异有高度显著性。并结合实验结果探讨了染色体对致突变剂的敏感性与患喉癌风险的关系。     

Submillimeter Magnetic Resonance Imaging of the Temporal Bone in Meniere's Disease

The pathoetiology of Meniere's disease remains elusive. Histopathologic and imaging studies have implicated congenital or developmental abnormality of the endolymphatic duct as a likely predisposing factor to the development of endolymphatic hydrops and clinical Meniere's disease. Recently, improved high-resolution magnetic resonance imaging (MRI) protocols have allowed better demonstration of the soft tissues of the endolymphatic duct and sac. This study is a prospective evaluation of the ability of submillimeter MRI to detect the endolymphatic duct in Meniere's disease patients and control subjects. In addition, the development of the temporal bone in the region of the endolymphatic sac and duct is evaluated by measurements of the distance from the posterior semicircular canal to the subarachnoid space and the distance from the vestibule to the subarachnoid space. Visualization of the endolymphatic duct was found to be significantly less frequent in the Meniere's disease patients (29%) than in the control subjects(91%). Temporal bone measurements in the region of the endolymphatic duct showed patients with Meniere's disease to have smaller dimensions than control subjects.     

蜗神经磁共振成像在感音神经性聋中的应用

目的探讨蜗神经磁共振成像在感音神经性聋(SNHL)中的应用价值。方法采用GE TwinExct1.5T磁共振扫描仪对130例(260耳)SNHL患者进行蜗神经磁共振成像及内耳水成像。蜗神经成像序列为斜矢状位FRFSET2加权像,内耳水成像为3DFIESTA序列。结果 90例大于等于18岁的患者中,85例170耳显示蜗神经、迷路正常;1例2耳前庭导水管扩大;1例1耳蜗神经信号缺失;3例6耳蜗神经细小;40例小于18岁的患者中,19例38耳显示蜗神经、迷路正常;2例3耳Michel畸形;6例12耳Mondini畸形;1例2耳共腔畸形;12例24耳前庭导水管扩大;21例畸形中7例14耳蜗神经信号缺失。2例4耳显示内听道狭窄伴蜗神经细小。结论磁共振内耳成像对诊断SNHL有着重要的价值,对判断患者内耳蜗神经发育情况及内耳畸形有着不可替代的作用,是这类患者进行人工耳蜗植入术前必要检查。     

结构磁共振成像和磁共振弥散张量成像应用于主观性耳鸣的研究进展

主观性耳鸣发病机制复杂,其发生不仅局限在听觉通路的异常,非经典通路的中枢可塑性变化也参与其中。随着影像学技术的发展,越来越多的学者试图利用结构磁共振成像(structural Magnetic Resonance Imaging,sMRI)和磁共振弥散张量成像(diffusion tensor imaging,DTI)对主观性耳鸣中枢机制进行探索。本文总结sMRI和DTI两种技术运用于主观性耳鸣中的研究进展,以期为耳鸣的发病机制及治疗提供新思路。     

Relationships between Cervical Node Histological Patterns and Rosette Test Scores: Possible Prognostic Value in Laryngeal Cancer

In previous research the authors have remarked that some hystological patterns — macrophagic hyperplasia and thymus-dependent areas hyperplasia — when prevailing in cervical nodes of laryngeal cancer patients, possess a positive prognostic value. In this study the possible relationship between the results of E and EAC-rosettes and prevailing hystologic patterns in cervical nodes is investigated. A positive correlation was not found. Conclusively, the inconsistency of aspecific tests for prognostic purposes and the need for a specific immunological monitoring system are outlined.     

Assessment of Carotid Artery Invasion in Patients With Head and Neck Cancer

Purpose Define radiological and histological features in which patients with head and neck cancer would benefit from a carotid artery resection. Resection of the carotid artery has been advocated for local control of advanced squamous cell carcinoma of the head and neck. To provide appropriate preoperative counseling and optimize the utilization of resources, the criteria for patient selection has to be defined. Methods Thirty‐four patients underwent carotid artery resection based on the clinical impression of tumor fixation. Eighteen and 28 patients were evaluated using computed tomography (CT) and histological analysis, respectively. The distance between the tumor cells and external elastic lamina was measured. CT scans were examined to determine the circumference of tumor attachment around the carotid artery. Results Clinical assessment predicted tumor within 1.8 mm of the carotid artery in 68% of cases. The overall survival for patients with tumor greater than 1.8 mm (N = 9) was better than that of patients with less (N = 19) than 1.8 mm (33.3% vs. 5.3%; median 24 versus 9 mo, P = .0899). Three of six patients (50%) with less than 180° circumference tumor attachment had tumor within 1.8 mm from the external elastic lamina. Eight of twelve patients (67%) with tumors encompassing more than 180° of the artery wall had tumor within 1.8 mm from the external elastic lamina. The overall survival rates for patients with tumor attachment greater and less than 180° were 8.3% and 33%, respectively. Discussion Tumor invasion into the carotid artery was the strongest predictor of outcome. Clinical assessment was as predictive as CT for tumor invasion. If tumor involvement of the carotid artery is less than 180°, peeling the tumor is an alternative to carotid artery resection.     

双侧先天性重度感音神经性耳聋患儿低频振幅功能磁共振研究

目的研究应用静息态功能磁共振低频振幅方法分析双侧先天性重度感音神经性耳聋患儿脑功能磁共振改变。方法采集16例双侧先天性重度感音神经性耳聋患儿及20例正常听力儿童的静息态磁共振血氧水平依赖(blood oxygenation level dependent,BOLD)数据,对BOLD数据进行后处理,获得低频振幅(amplitude of low-frequency fluctuation,ALFF)图像,比较两组间ALFF信号得出两组间的差异性脑区。结果双侧先天性重度感音神经性耳聋组较正常听力儿童对照组ALFF增加且差异具有统计学意义(P<0.05)脑区包括左、右额中上回。双侧先天性重度感音神经性耳聋组较正常听力儿童对照组ALFF减低且差异具有统计学意义(P<0.05)脑区包括右后扣带回、右中央旁回。结论双侧先天性重度感音神经性耳聋患儿相关脑区的脑功能活动水平与正Gguiling,YANG Ming,LIU Yuting,WU Han,GUAN Hongmei(Department of Radiology,Children's Hospital Affiliated to Nanjing Medical University,Jiangsu Nanjing 210008常听力儿童不同提示耳聋患儿存在脑代偿性功能及相关脑区功能会发生改变及重组。     

Second Malignant Neoplasms in Patients Under 40 Years of Age With Laryngeal Cancer

Objectives/Hypothesis To determine the incidence of second malignant neoplasms (SMN) in patients under 40 years of age with invasive squamous cell carcinoma (SCC) of the larynx. Study Design Retrospective. Methods Using a National Cancer Institute tumor registry database encompassing 1973–1996, the incidence of SMN in patients under 40 years of age with laryngeal cancer was determined and compared with that of the registry's older, more traditional laryngeal cancer population. Median follow‐up was 136 months. Results Among the 364 patients under the age of 40 years with laryngeal cancer, 30 (8.2%) had developed a secondary malignancy to date. In comparison, 4876 (21.4%) of 22,786 patients 40 years or older with laryngeal cancer were affected by an SMN. Kaplan‐Meier analysis of the younger cohort projected 3.0%, 6.8%, and 10.7% relative risk of developing a SMN at any site over 5‐, 10‐, and 15‐year periods, respectively, after index tumor diagnosis. Similar results for the older cohort were 14.2%, 28.1%, and 39.4% at 5, 10, and 15 years, respectively. Further Kaplan‐Meier analysis demonstrated at least a fourfold increased risk for the development of secondary upper aerodigestive tract malignancies among older compared with younger patients. Conclusion Patients under 40 years of age with invasive SCC of the larynx are significantly less likely to develop a second malignancy than their older counterparts.