Computed tomography of the carotid space and related cervical spaces. Part I: Anatomy

The carotid space, parapharyngeal space, and paraspinal space are described. The carotid space is shown on computed tomography (CT) to be posterior to the parapharyngeal space and separated from it by the styloid apparatus. The paraspinal space is posterior to the carotid space and separated from it by the longus and anterior scalene muscles.     

Computed tomography of the nasopharynx and related spaces. Part II: Pathology

Malignant tumors of the nasopharynx were analyzed by region of origin and route of spread. Nasopharyngeal carcinomas produced early submucosal infiltration of the deglutitional muscle layer with enlargement of the levator palati muscle and lateral displacement of the parapharyngeal space. Serous otitis media was frequently associated, and the trigeminal nerve was occasionally involved. Intracranial extension via the foramen lacerum was frequent. Metastases to the infratemporal fossa produced early involvement of the masticatory muscle layer with medial displacement of the parapharyngeal space. Adenoid cystic carcinomas showed late but disproportionate involvement of the sphenoid sinus. Chordomas extended into the retropharyngeal soft tissues via the petro-occipital fissure. Maxillary sinus carcinomas, which were very large at the time of presentation and impinged on the nasopharynx, showed extensive destruction of the pterygoid plates.     

Computed tomography in adrenal tumors.

Computed tomography (CT) was used to evaluate 26 patients with a variety of adrenal lesions. Surgical proof was available in 22 patients and clinical confirmation with a variety of other studies in the other four patients. Nine patients ahd aldosterone-producing adrenal adenomas and CT correctly identified seven. Four patients had cortisol-producing adenomas and five patients had cortisol-producing carcinomas; CT identified each of these tumors. Prominent but normal shaped glands were seen in each of the four patients with adrenal hyperplasia. Adrenal metastases from malignant melanoma in two patients were identified. Only one of two pheochromocytomas in two patients could be seen on CT. CT is a noninvasive method of localizing adrenal tumors and may be helpful in distinguishing adenomas from adrenal hyperplasia.     

Computed tomography of pineal, parapineal, and histologically related tumors

Thirty-one of 32 pineal and related tumors were diagnosed by computed tomography (CT). There were 7 germinomas, 4 primary pineal tumors, 4 embryonal cell carcinomas, one teratoma, one epidermoid, one primitive neuroectodermal tumor, 8 astrocytomas and 6 lipomas. Histologic confirmation was obtained in 22. The CT characteristics allow differentiation of benign tumors such as teratomas and epidermoids from malignant germinal lesions such as germinoma and embryonal cell carcinoma. Abnormal calcification occurs most frequently in the primary pineal tumors, pineoblastoma and pineocytoma. The CT characteristics and consideration of the patient's age and sex often lead to histologic prediction and better treatment planning.     

Computed tomography of lower extremity tumors.

Fifty cases of lower extremity tumors examined with computed tomography were reviewed. Of the 50 cases, 41 had gross pathologic correlation, either by enbloc resection (26) or by amputation (15). Important information regarding size, location, definition, and anatomic relation of tumors to vital structures (neural, vascular, and osseous) may be ascertained by this means with great accuracy. Localization of vessels by intravenous infusion of contrast material during the scan, or after arteriography with intraarterial contrast infusion, is found to enhance such evaluation. This information is particularly important where the feasibility of en-bloc resection is being evaluated.     

Computed tomography of the retroperitoneal space

Computed body tomography is an easily accomplished method that precisely displays the normal and pathologic anatomy of the retroperitoneal space. Suspected retroperitoneal disorders, which are often clinically confusing or obscure, can now be detected or excluded with remarkable accuracy. Few innovations in radiology have more effectively fulfilled such a conspicuous need.     

Computed tomography of the parapharyngeal space

The parapharyngeal space with its complex anatomy is of great clinical importance. Because of its location deep within the neck, this space is difficult to examine by ordinary methods but can be well demonstrated in the axial transverse plane by computed tomography (CT). This paper is primarily concerned with the normal anatomy of the parapharyngeal space as seen on CT but also includes examples of representative pathological conditions.     

Computed tomography of the bony pelvis: a protocol for multiplanar imaging. Part II: Trauma

Fractures of the pelvis are frequently complex, and conventional radiography, including special views, may be inadequate for accurate diagnosis. One must ascertain the integrity of the anterior and posterior columns, hip joint spaces for debris, and the medial walls of the acetabula. Computed tomography (CT) is indicated early in management, whenever initial plain radiographs reveal complex or questionable fractures of any of these structures. I have developed a unique, multiplanar reformatting protocol using oblique reformations of transverse CT images. This allows clear spatial perception of the nature and extent of pelvic fractures. Twelve selected patients with complex pelvic fractures, as determined by conventional and special radiographs, underwent transaxial and multiplanar CT scanning according to the devised protocol, using transverse CT and multiplanar reformation of the pelvis. The planes of reformation are illustrated by drawings, and multiplanar radiographs demonstrate the injuries. Nine of the 12 patients had additional injuries revealed, over and above the abnormalities shown by CT, by the use of the reformatting technique I describe. Also fractures or fracture dislocations of the sacroiliac joints were diagnosed in four of the 12 patients using CT but in six patients when reformatted images were examined.     

Computed tomography of tumors of the pineal region.

Eight pathologically proven cases of pineal region tumors examined by computed tomography (CT) were found upon reviewing 11,000 consecutive CT studies at the Massachusetts General Hospital. The CT scan findings of the eight cases are described and related to a pathological classification of pineal tumors.     

Computed tomography in urothelial tumors of renal pelvis and related filling defects

Our study includes 12 patients. Of these, six had transitional cell carcinoma, three patients with stones and three patients with blood clots. With the use of computed tomography we were able to arrive at a reasonable staging and diagnosis of the filling defects. Computed tomography is not sufficiently sensitive to recognize microscopic invasion. Reactive fibrosis and postobstructive inflammatory changes can mimic tumor invasion on computed tomography, and in such cases staging will not be accurate.     

Computed tomography angiography in the investigation of carotid stenosis.

The assessment of carotid atherosclerotic disease is an essential pre-requisite for determining a patients suitability for carotid endarterectomy to prevent ischaemic stroke. Catheter angiography is regarded as the most accurate investigative tool for this purpose. However, with its finite morbidity and invasiveness, there is an increasing reliance upon non-invasive methods to accurately assess carotid disease. We present a review of the technique and applications of computed tomography angiography.     

Computed tomography of cervical infections

Computed tomography of 31 patients with infections of the face and neck was reviewed and correlated with the clinical and surgical results. Computed tomography was found to be valuable for (a) distinguishing cellulitis from abscess, (b) defining the precise location and extent of complex infections, (c) demonstrating secondary complications, and (d) occasionally suggesting the etiology of infection. Based on this review, we concluded that CT provides important diagnostic information that aids clinical assessment and guides medical and surgical management of cervical infections. The anatomic relationships of selected cervical spaces are reviewed with respect to pathways of spread and potential complications of cervical infections.     

Computed tomography of Krukenberg tumors

Computed tomography (CT) of three patients with Krukenberg tumor was reviewed retrospectively. CT showed large, lobulated, multicystic masses with soft-tissue components, indistinguishable from primary ovarian carcinoma. Indeed, CT and sonography of all three patients were initially interpreted as primary ovarian carcinoma. The ovary is a frequent site of metastases, particularly from colon carcinoma. These can be quite large, yet diagnosis is seldom made preoperatively. Much has been written about metastatic ovarian tumor, but this is the first report in the radiologic literature about their CT features. The authors emphasize the importance of recognizing the ovary as a frequent site of metastases and the proper approach to this problem. In patients with a history of colon or gastric carcinoma, the mixed cystic and solid ovarian mass on CT should be regarded as metastatic tumor until proven otherwise. A careful search for gastrointestinal tract signs or symptoms should be done in any patient with a pelvic tumor. When CT is done for evaluation of ovarian tumor, the stomach and colon should be carefully evaluated, and the ovaries routinely examined in the preoperative CT staging of gastric or colon carcinoma.     

Computed tomography of ureteral tumors

Ten patients with one or more ureteral tumors were examined with CT. The tumor was clearly recognizable as a soft tissue mass (average density 46 HU) filling the ureter in nine of the patients. In five of these patients the tumor was not detected by urography. Tumors less than 5 mm in diameter were missed on CT in one patient. Although most ureteral tumors are detectable with urography and retrograde pyelography, CT can be a valuable diagnostic tool. Computed tomography is particularly advantageous in patients with nonfunctioning kidneys and in those in whom retrograde pyelography is unsuccessful.     

Computed tomography of chondrogenic tumors

The computed tomography (CT) morphology of chondrogenic tumors and the utility of CT in their diagnostic work-up is presented on the basis of 19 cases. CT provided unique informations regarding definition of tumor extent and tumor relationship to adjacent structures particularly in the axial skeleton. CT has diminished the indications for angiography in chondrogenic tumors.     

Computed tomography of the orbit with special emphasis on coronal sections: Part II. Pathological anatomy

Visualization of orbital soft tissue structures by computed tomography in direct coronal and axial studies is extremely useful in diagnosis. Direct enlargement viewing of scans has disclosed minute anatomical details. This study reviews some of our experiences in the investigation of a variety of lesions within the orbit and attempts, in particular, to illustrate the value of direct coronal studies.