The glossopharyngeal, vagus and spinal accessory nerves

The glossopharyngeal, vagus and spinal accessory nerves are closely related anatomically, and to a certain extent, functionally. We present an overview of their anatomy, highlighting the important clinical and imaging implications. The main pathologic lesions arising from these nerves are also discussed and the imaging features reviewed.     

Chronic submasseteric abscess: anatomic,radiologic, and pathologic features

Herein we present five cases of submasseteric abscess that most commonly occurred in patients with a history dental disease. CT has been the main imaging method for diagnosing lesions in the masticator space and adjacent to the mandible; however, we found that, in some of our cases, CT defined the lesion poorly or not at all. In some cases, MR imaging defined the lesion better. Radiologic manifestations of this condition and pathologic correlations are discussed.     

Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation

OBJECTIVE: Papillary lesions of the breast are a heterogeneous group of lesions that are difficult to diagnose as benign or malignant. The purpose of this article is to review clinical presentation, imaging features, and pathologic correlation of papillary lesions of the breast and to discuss the prognosis and management of these lesions. CONCLUSION: Recognition of the variety of benign and malignant papillary lesions of the breast will facilitate diagnosis and proper management.     

Cystic masses of the spleen: radiologic-pathologic correlation.

Many focal splenic lesions may appear to be cystic at cross-sectional imaging. In this article, the following types of cystic splenic masses are discussed: congenital (true cyst), inflammatory (abscesses, hydatid cyst), vascular (infarction, peliosis), posttraumatic (hematoma, false cyst), and neoplastic (hemangioma, lymphangioma, lymphoma, metastasis). The key findings at ultrasound, computed tomography, and magnetic resonance imaging can be correlated with underlying gross and microscopic pathologic findings. Although tissue sampling is still required in many cases to yield a definitive diagnosis, recognition and understanding of the spectrum of imaging and pathologic features of these lesions often help narrow the differential diagnosis.     

Cervical spine: postmortem assessment of accident injuries--comparison of radiographic, MR imaging, anatomic, and pathologic findings.

PURPOSE: To assess the ability of postmortem radiography and magnetic resonance (MR) imaging to depict occult cervical spine injuries as compared with anatomic and pathologic findings. MATERIALS AND METHODS: The cervical spines of 10 adult accident victims underwent radiography and MR imaging, with T1-weighted, fast spin-echo T2-weighted, and four gradient-echo pulse sequences. The frozen specimens were cut into 3-mm-thick slices (sagittal plane) and photographed, and microfocus radiographs were obtained. Imaging findings were compared with the anatomic and pathologic findings. RESULTS: Eight of the 10 specimens had 28 posttraumatic lesions: three fractures (two missed at the initial MR imaging reading), 10 facet joint capsule lesions with bleeding, five soft-tissue and ligament lesions, eight disk lesions, and two spinal cord lesions. Radiography depicted one lesion (4%). Two partial ruptures of the anterior annulus fibrosus were depicted at only MR imaging. Initially, 11 of 28 lesions were detected on MR images; retrospectively, 17 of 28 lesions were correlated with anatomic findings. CONCLUSION: Soft-tissue and intervertebral disk and ligament injuries account for 89% (25 of 28) of posttraumatic cervical spine lesions detected on postmortem images. Occult lesions, including apophyseal joint injuries, were found in clinically noninjured cervical spines. MR imaging was limited in the depiction of discrete lesions when T1-weighted non-fat-saturated, fast spin-echo T2-weighted, and gradient-echo pulse sequences were used.     

Magnetic resonance of the shoulder: technic, anatomy ana clinical results

MR imaging was employed in 232 patients with traumatic or degenerative lesions of the shoulder. MR diagnosis was compared with arthrotomic findings in 19 cases, and with arthroscopic results in 3 cases. MR technique is here presented and the choice of scanning planes is discussed, together with the sequences of image acquisition and with the features of the surface coil employed. Axial, sagittal, and coronal scans were used in all cases. Both sagittal and coronal planes were performed obliquely on the basis of precise anatomical structures. T1-weighted sequences were used for they are reliable in locating the various anatomical structures and efficient in defining the several different pathologic conditions. The role of T2-weighted sequences was complementary, and they were employed in selected cases only. A surface coil is presented with a particular configuration of easy clinical use and with such technical features as to allow reduced fields to be imaged, with good spatial resolution. MR imaging could demonstrate with equal accuracy both skeletal-cartilage components and capsulo-ligamentous structures, thus defining associated lesions and small tears. In both degenerative and traumatic lesions of the rotator cuff, MR imaging showed both extent and entity of the pathologic process, with high accuracy in defining the impingement syndrome. MR imaging allowed the depiction of the anterior and posterior glenoid labra, even without intraarticular contrast media. Moreover, MR imaging made it possible to recognize both fractures and degenerative processes within the glenoid labrum on the basis of their signal intensities. This preliminary experience allows the authors to conclude that MR imaging is an accurate and non-invasive diagnostic method for the study of traumatic lesions and of degenerative changes of the shoulder.     

Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage.

Transvaginal ultrasonographically (US) guided procedures are simple and safe and often represent the only means of access to pelvic disease. Aspiration of cystic pelvic masses and core biopsy of solid pelvic masses can be easily performed by using the transvaginal route, an endoluminal US transducer, and a needle guide. Because of concerns about false-negative diagnosis and potential tumor seeding with biopsy of primary ovarian cystic lesions, the indications for transvaginal aspiration and biopsy of ovarian and adnexal lesions are predominantly therapeutic. Similarly, using an endoluminal probe with modification of the guide, one can also perform safe and effective trocar catheter drainage of pelvic abscesses via the transvaginal route. The transvaginal route is ideally suited to pelvic abscess drainage because of the proximity of the vaginal fornices to most pelvic fluid collections. The transvaginal route has the disadvantage of being semisterile; because of the risk of superinfecting previously noninfected pelvic pathologic conditions, the transvaginal approach should be used only for solid lesions or cystic lesions that can be completely aspirated. Familiarity with the transvaginal route of access is crucial for adequate treatment of many gynecologic and nongynecologic pelvic pathologic conditions.     

Primary nonspecific ulcers of the small intestine: an unsolved diagnostic problem

Two patients with nonspecific small intestinal ulceration were observed. In the two cases, the ulceration was responsible for (sub)obstruction. The medical history, the gastrointestinal roentgenographic examination and the pathologic anatomy were remarkably similar. Some aspects of these quite rare lesions are discussed.     

Accessory fissures of the liver: CT and sonographic appearance

Invaginations of the liver by the diaphragm form accessory fissures that may mimic the major hepatic fissures on sectional images. Accessory fissures are most common in the superior right hepatic lobe. Their average incidence on computed tomographic (CT) scans is 25%. Their frequency increases with age, approaching 70% in the seventh and eighth decades. Their depth may equal or exceed 2 cm in one-third of cases. Multiple accessory fissures may mimic pathologic liver nodules on CT and may be associated with diaphragmatic scalloping or eventration on the chest film. When only parts of these fissures are seen sonographically, they may be mistaken for echogenic liver lesions. The differentiation of accessory fissures from the major hepatic fissures, from pathologic lesions, and from sonographic pseudofissure artifacts is discussed.     

Thoracic neurilemmoma: case report and review of the world literature

Thoracic tumors are unusual and tend to occur in the posterior mediastinum. A case of anterior thoracic neurilemmoma is presented, with plain film, computed tomographic, and pathologic correlation. Diagnosis of chest wall masses, including the role of computed tomography, is discussed, along with the significance of calcification in these lesions.     

CT and MR imaging of the central skull base. Part 1: Techniques, embryologic development, and anatomy

Recent advances in surgical techniques have enabled surgeons to approach previously inoperable deep-seated lesions of the skull base. The radiologist requires a thorough knowledge of the normal anatomy and the pathologic spectrum of this region and an understanding of imaging modalities in order to determine the extent of pathologic conditions and help plan the surgical approach. The embryologic development of the central skull base, normal gross anatomy, and anatomy as seen on computed tomographic and magnetic resonance images are presented.     

Inflammatory pseudotumor of the liver in a patient with congenital granulocytopenia and HCV infection

Inflammatory pseudotumor (IPT) of the liver is a rare pathologic lesion. Although IPTs within the liver shows spontaneous regression, these lesions are frequently misdiagnosed as malignant on the basis of the clinical manifestation and the results of diagnostic imaging. With special regard to magnetic resonance imaging (MRI), differential diagnosis such as hepatocellular or cholangiocellular carcinoma (HCC/CCC) as well as regenerative liver lesions are discussed in a case of IPT with concomitant hepatitis C virus (HCV) infection and congenital granulocytopenia.     

Molecular pathology of chondroid neoplasms: part 1, benign lesions

This two-part review presents an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. This first part presents a brief review of methods in molecular pathology along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images. Malignant chondroid neoplasms will be considered in the second part of this review.G.P. Siegal is supported by NIH grants CA93796, AR046031, CA098543 and the Haley’s Hope Memorial Support Fund for Osteosarcoma Research at the University of Alabama at Birmingham, USA.     

肺水肿和呼吸窘迫综合征动物模型的CT,X线及病理对照研究

Animal models of cardiogenic edema, overhydration edema and respiratory distress syndrome (RDS) were established in 12 rabbits, radiography and CT of the chest were taken in supine position and compared with pathology. In cardiogenic and overhydration edema, the lesion is located at the posterior part of the lungs and around the hili both on CT image and the pathologic specimen. On the radiograph the lesion was projected onto the middle and inner zones of the lungs. In RDS, both CT and pathology showed that the peripheral and posterior parts of the lungs were involved, while on radiograph, the hazy shadows were situated at the periphery of the lungs or in a diffuse pattern. The authors were of the opinion that CT can demonstrate the lesions more clearly than radiography. The underlying mechanism for different distribution of lesions in pulmonary edema and RDS was discussed.     

Bizepsprobleme: Ultraschall, Magnetresonanztomographie und MR-Arthrographie

Ultrasound and MR imaging are competitive imaging modalities for the diagnosis of pathologic conditions of the biceps tendon. MR imaging has substantial advantages over ultrasound because biceps tendon lesions are most commonly located in the proximal part where lesions are hidden under the acromion for ultrasound assessment. The value of MR arthrography is substantiated by the capability to assess associated diagnoses which are otherwise difficult to assess. Associated diagnoses include full- and partial thickness tears of supraspinatus and subscapularis tendons, pulley lesions, and adhesive capsulitis (frozen shoulder). Moreover, MR arthrography is the method of choice for the assessment of superior labral anterior posterior (SLAP) lesions.     

Alphabet soup: cystic lesions of bone

Giant cell tumor (GCT), aneurysmal bone cyst (ABC), and simple bone cyst (SBC) represent relatively common tumors and tumorlike conditions to affect bone. This article describes the clinical presentation of these lesions, as well as the characteristic radiologic and pathologic findings of each. In addition, differential diagnoses, disease course, and various treatment options are discussed.     

Hyperprolactinemia: an unusual manifestation of suprasellar cystic lesions

Two patients with suprasellar cysts and hyperprolactinemia are described. These lesions were diagnosed by CT metrizamide cisternography. Suprasellar cysts are a rare cause of pathologic hyperprolactinemia, which most commonly results from pituitary adenomas. Tissue diagnosis revealed suprasellar arachnoid cysts in the first patient and Rathke's cleft cyst in the second. The differential diagnosis of suprasellar cysts is presented, and distinguishing radiographic characteristics are discussed.     

Radiologic–Pathologic Correlation of Hepatocellular Carcinoma Treated with Chemoembolization

To correlate posttreatment radiologic and pathologic findings in patients who underwent transarterial chemoembolization before transplantation or resection. Thirty-five patients with postchemoembolization follow-up imaging underwent liver transplantation/resection. Pre- and posttreatment contrast-enhanced magnetic resonance imaging were used to evaluate radiologic findings. Imaging characteristics using World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria after treatment were evaluated. Treated lesions were examined by pathology (gold standard) for the assessment of necrosis. Radiologic findings on magnetic resonance imaging were correlated to pathologic findings to assess the predictability by imaging of actual necrosis. Kappa (κ) statistics were used to determine intermethod agreement between WHO and EASL criteria. Fourteen (40%) of 35 lesions had biopsy-proven hepatocellular carcinoma. Thirteen (37%) of 35 target lesions showed complete pathologic necrosis. Complete pathologic necrosis was seen in 35% of lesions with pretreatment size <3 cm. Complete pathologic necrosis was seen in 1 (100%) of 1, 6 (67%) of 9, 6 (33%) of 18, and 0 (0%) of 7 of the lesions that exhibited complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD) by WHO criteria, respectively. Complete pathologic necrosis was seen in 9 (82%) of 11, 4 (36%) of 11, 0 (0%) of 8, and 0 (0%) of 5 of the lesions that showed CR, PR, SD, or PD by EASL criteria, respectively. EASL CR and WHO response were shown to have ≥85% specificity for predicting complete pathologic necrosis. The κ coefficient for agreement between WHO and EASL was 0.29. EASL and WHO criteria had minimal intermethod agreement. EASL CR and WHO response were able to predict pathologic necrosis.     

Use of a reusable shielded marker to enhance the accuracy, safety, and efficacy of nuclear medicine procedures

Three cases illustrate the use of a reusable, shielded marker to identify anatomic structures and mark pathologic lesions. No other nuclear medicine marker is available with a shutter mechanism designed to interrupt radiation, thus protecting the patient and technologist from unnecessary radiation and minimizing image artifacts.     

骨嗜酸性肉芽肿的影像学表现与病理对照分析

目的研究骨嗜酸性肉芽肿(EGB)影像学表现与生物学行为相关性,提高对EGB的认识。方法回顾分析31例EGB的影像表现及病理特征。结果影像表现:早期病灶5例(16.1%),中期病灶23例(74.2%),晚期病灶3例(9.7%),病理所见:早期病灶3例(9.7%),中期病灶26例(83.9%),晚期病灶2例(6.4%)。结论EGB影像学表现与病理过程有较一致的相对应关系,只是早期病理改变略早于X线表现,EGB影像学分期有利于指导临床治疗。