慢性侵袭性真菌性鼻窦炎的CT和MRI诊断

目的探讨慢性侵袭性真菌性鼻窦炎的CT和MRI表现及诊断价值。方法回顾性分析经手术、组织病理学证实的10例慢性侵袭性真菌性鼻窦炎的影像学资料。结果慢性侵袭性真菌性鼻窦炎发生于蝶窦5例，上颌窦3例，筛窦2例。CT表现：受累窦腔内充以软组织影，其中1例伴斑点状钙化；窦壁骨质破坏，同时伴周围骨质增生肥厚。MRI表现：T1WI为低信号（与脑实质比较，以下相同）2例，等信号7例；T2WI信号不均匀，7例以低信号为主，2例以高信号为主；增强后病变明显强化。侵犯邻近结构：眼眶9例，其中6例累及眶尖区，可见不规则软组织肿块影，与邻近眼外肌分界不清楚，7例包绕视神经；6例侵犯海绵窦，可见形态不一的软组织影；脑膜增厚、强化5例，3例侵犯脑实质，表现为水肿1例，肉芽肿2例；4例侵犯翼腭窝及颞下窝；3例鼻咽部软组织增厚；2例上颌神经和1例下颌神经明显增粗、强化；3例面颊部软组织肿胀；1例硬腭骨质破坏。结论窦壁骨质破坏伴硬化、MR T2WI低信号、易侵犯眶尖及海绵窦为本病特征性影像学表现。结合CT和MRI2种检查方法能够对本病的诊断、鉴别和治疗提供更可靠的信息。     

Primary malignant lymphoma of the maxillary sinus: CT and MRI

We reviewed the CT and MRI of seven patients with primary malignant lymphoma of the maxillary sinus to find if there are characteristic imaging findings suggestive of the disease. The images were analysed for appearance, size, signal, internal characteristics, extent of tumour, bone change and lymph node enlargement. In two patients, the tumour first presented with mucosal thickening. In the remaining five, the tumours were an expansile mass 4–6 cm in diameter at the time of detection. Although it was difficult to distinguish tumour from mucosa or obstructed fluid on CT, T2-weighted MRI enabled us to separate tumour from normal mucosa or fluid. In two patients, the tumours were heterogeneous. Calcification and haemorrhage were observed in one patient. Periantral soft-tissue infiltration was always present, even when tumour appeared as slight mucosal thickening. Posterior extension was seen in all patients. Permeative and lytic bone destruction accompanied most cases of periantral soft-tissue infiltration; mixed destruction and sclerosis was also observed. Mucosal thickening with periantral soft-tissue infiltration may suggest malignant lymphoma of the maxillary sinus in its early form. Various types of bone change may accompany the periantral soft-tissue infiltration. Received: 25 January 1999 Accepted: 21 July 1999     

非侵袭性真菌性上颌窦炎的CT诊断

目的总结非侵袭性真菌性上颌窦炎的CT表现特征,以提高本病的正确诊断率。方法对经手术、病理证实的50例非侵袭性真菌性上颌窦炎的CT表现进行回顾性分析。结果 43例病变累及一侧上颌窦,7例累及同侧筛窦及鼻腔。病变窦腔内充以软组织密度影,内见斑点斑块状钙化36例,窦腔高密度影内见气泡影19例。34例见上颌窦窦壁骨质改变,窦壁骨质增生硬化26例;窦壁骨质吸收破坏24例。结论非侵袭性真菌性上颌窦炎具有特征性的CT表现,CT对该病的诊断有较高价值。     

Acute Invasive Fungal Rhinosinusitis: A Comprehensive Update of CT Findings and Design of an Effective Diagnostic Imaging Model

BACKGROUND AND PURPOSE:Acute invasive fungal rhinosinusitis carries a high mortality rate. An easy-to-use and accurate predictive imaging model is currently lacking. We assessed the performance of various CT findings for the identification of acute invasive fungal rhinosinusitis and synthesized a simple and robust diagnostic model to serve as an easily applicable screening tool for at-risk patients.MATERIALS AND METHODS:Two blinded neuroradiologists retrospectively graded 23 prespecified imaging abnormalities in the craniofacial region on craniofacial CT examinations from 42 patients with pathology-proven acute invasive fungal rhinosinusitis and 42 control patients proved negative for acute invasive fungal rhinosinusitis from the same high-risk population. A third blinded neuroradiologist decided discrepancies. Specificity, sensitivity, positive predictive value, and negative predictive value were determined for all individual variables. The 23 variables were evaluated for intercorrelations and univariate correlations and were interrogated by using stepwise linear regression.RESULTS:Given the low predictive value of any individual variable, a 7-variable model (periantral fat, bone dehiscence, orbital invasion, septal ulceration, pterygopalatine fossa, nasolacrimal duct, and lacrimal sac) was synthesized on the basis of multivariate analysis. The presence of abnormality involving a single variable in the model has an 87% positive predictive value, 95% negative predictive value, 95% sensitivity, and 86% specificity (R² = 0.661). A positive outcome in any 2 of the model variables predicted acute invasive fungal rhinosinusitis with 100% specificity and 100% positive predictive value.CONCLUSIONS:Our 7-variable CT-based model provides an easily applicable and robust screening tool to triage patients at risk for acute invasive fungal rhinosinusitis into a disease-positive or -negative category with a high degree of confidence.

Fungal-related diseases of the nasal cavity and paranasal sinuses represent a broad spectrum of clinical entities, with acute invasive fungal rhinosinusitis (AIFR) being the most urgent and life-threatening.^1–3 The primary risk factors for acquiring AIFR are neutropenia or dysfunctional neutrophils, and the most commonly reported predisposing conditions are hematologic malignancies, poorly controlled diabetes mellitus, chemotherapy, or organ transplantation.^4–6 Although AIFR is a relatively rare disease, it carries a high mortality rate, with the largest published meta-analysis showing a mortality rate of approximately 50%.⁷ The high mortality rate underscores the importance of a timely diagnosis. Patients with AIFR limited to the nasal cavity have lower mortality rates,² while intracranial extension is associated with twice the mortality.⁷ Accurate and easy-to-use predictive screening models that could help diagnose AIFR in a timely manner are currently lacking.CT has long been considered an integral part of screening at-risk patients, despite the reported low specificity.^8,9 The most commonly reported CT findings in early disease include severe unilateral nasal cavity mucosal thickening and soft-tissue infiltration of the maxillary periantral fat planes.^8,10 Involvement of the pterygopalatine fossa has also been described.¹¹ The most commonly affected areas are the middle turbinate, maxillary sinus, ethmoid air cells, and sphenoid sinus.² The frontal sinus has been reported as the least frequently affected.² Bone dehiscence, orbital invasion, and intracranial extension are more specific features of AIFR but are uncommon in early disease.^1,8,9,12 These findings have also been implicated as indicative of advanced disease.^10,11,13A central purpose of this study was to characterize the imaging abnormalities of the nasal cavities, sinuses, and surrounding structures commonly associated with AIFR, as well as their incidence and predictive values. Previous institutional experience suggested that some features of AIFR are sparsely mentioned in or absent from the literature. This study was designed as a blinded retrospective study to comprehensively analyze the craniofacial region for changes on CT associated with AIFR. Because previous literature implicated the severity of the abnormality as a marker of AIFR,⁷ we applied ordinal scales to capture the degrees of nasal and paranasal mucosal disease and regional disease involvement. A key goal of our multivariate analysis was the synthesis of a simple and robust CT-based diagnostic model that could be deployed as a routine screening tool for at-risk patients. Ideally, this model would allow the diagnosis or exclusion of AIFR with a higher degree of confidence than any model previously suggested.     

Dehiscence of the lamina papyracea of the ethmoid bone: CT findings.

PURPOSETo describe the CT findings characterizing dehiscence of the lamina papyracea.METHODSAxial and coronal CT scanning of the paranasal sinuses was performed on 783 patients.RESULTSDehiscence of the lamina papyracea was noted incidentally in six patients. In all cases dehiscence was characterized by protrusion of orbital fat through a gap in the anterior ethmoid. The posterior limit of the dehiscence was always the basal lamella. The anterior limit varied.CONCLUSIONCT scans are often taken to detect polyps or assess chronic sinusitis. Awareness of dehiscence of the lamina papyracea is important to avoid misdiagnosis as infectious or tumoral process and possible injury of the orbit during endoscopic surgery.     

Patellar tendon–lateral femoral condyle friction syndrome: MR imaging in 42 patients

OBJECTIVE: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. PATIENTS AND DESIGN: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. RESULTS: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. CONCLUSION: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain.     

Calcification in chronic maxillary sinusitis: comparison of CT findings with histopathologic results.

BACKGROUND AND PURPOSE: It is important to differentiate fungal from nonfungal sinusitis in order to determine the optimal treatment for chronic sinusitis. The purpose of this study was to describe the CT findings of calcifications in chronic fungal and nonfungal maxillary sinusitis. METHODS: Five hundred ten patients with pathologically proved chronic maxillary sinusitis were studied with unenhanced CT before undergoing sinonasal surgery. In 36 patients, the CT scans were reviewed retrospectively to ascertain the shape and location of intrasinus calcifications. RESULTS: Calcifications were found in 20 (51%) of 39 patients with fungal sinusitis and in 16 (3%) of 471 patients with nonfungal sinusitis. Direct histopathologic correlation was performed in two of 16 patients with nonfungal sinusitis who had intrasinus calcification. The location of intrasinus calcification was central in 95% of the patients with fungal sinusitis and peripheral in 81% of those with nonfungal sinusitis. Although calcifications with a nodular or linear shape were seen in both fungal and nonfungal sinusitis, fine punctate type calcifications were seen only in those with fungal sinusitis (50%) and round or eggshell type calcifications only in those with nonfungal sinusitis (19%). CONCLUSION: Intrasinus calcifications are different in location and shape between fungal and nonfungal maxillary sinusitis. Although intrasinus calcification is uncommon in nonfungal sinusitis, the CT finding of intrasinus calcification may be helpful for differentiating fungal from nonfungal maxillary sinusitis.     

MR of the cerebral operculum: topographic identification and measurement of interopercular distances in healthy infants and children.

PURPOSETo evaluate the role of axial, coronal, and sagittal MR in identification of surface landmarks of the cerebral operculum and to determine the reference values of interopercular distances of each hemisphere in healthy infants and children on MR images.METHODSTwo hundred fourteen cerebral opercula of 35 healthy infants and 72 healthy children were retrospectively evaluated from 107 routine MR brain examinations. The surface landmarks of the operculum and interopercular distances of each hemisphere, which were subjectively divided into anterior interopercular distance (anterior sylvian width) and posterior interopercular distance (posterior sylvian width), were recorded from axial, coronal, and sagittal MR images, respectively. The mean value of anterior interopercular distance of each hemisphere was obtained by averaging two linear measurements of the anterior sylvian width from lateral, sagittal, and axial planes of the same side. Likewise, the posterior interopercular distance of each side of the brain was obtained from averaging of two measurements on lateral, sagittal, and coronal planes.RESULTSThe landmarks of the operculum were best identified by sagittal MR, followed by axial and coronal images. The average values of left anterior interopercular distance, right anterior interopercular distance, left posterior interopercular distance, and right posterior interopercular distance in infants were 1.9 +/- 1.3, 1.6 +/- 1.1, 0.4 +/- 0.7, and 0.2 +/- 0.4 mm, and in children, 0.9 +/- 1.3, 1.0 +/- 1.4, 0.03 +/- 0.23, and 0.01 +/- 0.07 mm, respectively. Infants showed significantly wider interopercular distances than children. Left anterior interopercular distance was significantly wider than right in infants, but not in children. Male children displayed a more significant increase in anterior interopercular distance than did female children. There was no statistic difference in measurements of anterior interopercular distance and posterior interopercular distance between female and male infants.CONCLUSIONSThe operculum should be evaluated with MR in three planes. Infants may show conspicuous sylvian fissures that should not exceed 4.5 mm (mean + 2 SD) anteriorly on axial and sagittal planes and 1.8 mm posteriorly on sagittal and coronal planes. Healthy children who have fully developed opercula should have an anterior interopercular distance of no more than 3.5 mm and a posterior interopercular distance of 0.5 mm.     

Magnetic Resonance Imaging in Coronavirus Disease - 2019 Associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) - Imaging Analysis of 50 Consecutive Patients

Background and PurposeRhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India.Materials and MethodsA retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed.ResultsFifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were “Black turbinate sign” and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%).ConclusionsCA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.     

The hypoglossal canal: normal MR enhancement pattern.

PURPOSETo review the anatomy of the hypoglossal canal and present the normal precontrast and postcontrast MR appearance of axial posterior fossa images.METHODSThirty-one axial MR examinations of the normal posterior fossa were retrospectively reviewed.RESULTSThe hypoglossal canals are well seen on 3-mm-thick axial MR images of the posterior fossa (28 [90%] of 31 patients). Symmetric intense intracanalicular enhancement after intravenous administration of gadopentetate dimeglumine is routine, typically with minor anterior extension into the nasopharyngeal region (28 [100%] of 28). A linear filling defect traversing the enhanced canal often is seen (21 [75%] of 28) and may represent hypoglossal nerve rootlets. Circumferential enhancement of the meninges at the level of the foramen magnum was a common finding (19 [64%] of 28).CONCLUSIONEnhancement within the hypoglossal canal with anterior extension beneath the skull base is a normal finding. This pattern is characteristic enough on MR imaging to aid interpretation of skull base lesions and to exclude the possibility of a mass within the hypoglossal canal.     

CT诊断真菌性鼻窦炎100例分析

目的回顾性总结真菌性鼻窦炎CT影像表现,并结合临床,探讨CT检查对诊断真菌性鼻窦炎的临床价值。方法收集100例确诊为真菌性鼻窦炎的病人资料并结合临床检查结果,与CT检查进行分析比较。鼻窦CT扫描采用骨窗和软组织窗扫描。结果 100例患者均为单侧鼻窦发病,其中真菌球型68例,慢性侵袭性真菌性鼻窦炎4例,变应性真菌性鼻窦炎28例。CT扫描影像特点为鼻窦腔散在较均匀毛玻璃特征或极不规则的线状,有星状分布的钙化点;伴不同程度骨质吸收或结构不清;窦壁骨质侵蚀15例。病变延伸到邻近结构3例,其中1例累及眼眶。有2例侧颅底骨质吸收。鼻腔或鼻窦内分布黏蛋白与CT显示毛玻璃样高密度影一致。结论真菌性鼻窦炎的鼻窦CT扫描显示与其他鼻窦炎不同。CT检查有助于准确诊断真菌性鼻窦炎。     

Performance of deep learning object detection technology in the detection and diagnosis of maxillary sinus lesions on panoramic radiographs

Objective:The first aim of this study was to determine the performance of a deep learning object detection technique in the detection of maxillary sinuses on panoramic radiographs. The second aim was to clarify the performance in the classification of maxillary sinus lesions compared with healthy maxillary sinuses.Methods:The imaging data for healthy maxillary sinuses (587 sinuses, Class 0), inflamed maxillary sinuses (416 sinuses, Class 1), cysts of maxillary sinus regions (171 sinuses, Class 2) were assigned to training, testing 1, and testing 2 data sets. A learning process of 1000 epochs with the training images and labels was performed using DetectNet, and a learning model was created. The testing 1 and testing 2 images were applied to the model, and the detection sensitivities and the false-positive rates per image were calculated. The accuracies, sensitivities and specificities were determined for distinguishing the inflammation group (Class 1) and cyst group (Class 2) with respect to the healthy group (Class 0).Results:Detection sensitivities of healthy (Class 0) and inflamed (Class 1) maxillary sinuses were 100% for both testing 1 and testing 2 data sets, whereas they were 98 and 89% for cysts of the maxillary sinus regions (Class 2). False-positive rates per image were nearly 0.00. Accuracies, sensitivities and specificities for diagnosis maxillary sinusitis were 90–91%, 88–85%, and 91–96%, respectively; for cysts of the maxillary sinus regions, these values were 97–100%, 80–100%, and 100–100%, respectively.Conclusion:Deep learning could reliably detect the maxillary sinuses and identify maxillary sinusitis and cysts of the maxillary sinus regions.Advances in knowledge:This study using a deep leaning object detection technique indicated that the detection sensitivities of maxillary sinuses were high and the performance of maxillary sinus lesion identification was ≧80%. In particular, performance of sinusitis identification was ≧90%.     

Fat Content Quantification Using Dual-Energy CT for Differentiation of Anterior Mediastinal Lesions from Normal or Hyperplastic Thymus

BackgroundDetection of fat content in thymic lesions is crucial to differentiate thymic hyperplasia from thymic tumors or other anterior mediastinal pathologies.PurposeTo assess the feasibility of dual-energy CT (DECT) fat content quantification for the differentiation of anterior mediastinal lesions from benign thymic lesions and the normal spectrum of the thymus.Materials and MethodsChest DECT images of 465 patients (median 61 years, 63% female) were visually evaluated by two radiologists and semiquantitatively scored based on the degree of fatty degeneration ranging from completely fatty (score 0) to predominantly soft-tissue (score 3), and anterior mediastinal mass (score 4). A subset of scans (n =134 including all cases with scores 2-4 and 20 randomly-selected cases from scores 0 and 1) underwent quantitative DECT analysis (fat fraction, iodine density, and conventional CT value). DECT values were compared across the semiquantitative scores.ResultsResults of visual evaluation included 35 with predominantly solid thymus (score 3) and 15 with anterior mediastinal mass (score 4). The most common clinical diagnoses of the 15 masses (including 8 with pathologic confirmation) were metastases (n = 10) and lymphoma (n = 4). CT values in the abnormal thymus were significantly higher than those in score 3 (median: 69.7 HU versus 19.9 HU, P <0.001). There was no significant difference in iodine density values (median: 1.7 mg/ml versus 1 mg/ml, P = 0.09). However, the fat fraction value was significantly lower in the abnormal thymus (score 4) than in the predominantly soft-tissue attenuation thymuses (score 3) (median: 12.8% versus 38.7%, P <0.001). ROC curve analysis showed that fat fraction had an AUC of 0.96 (P <0.001), with a cutoff of <39.2% fat fraction yielding 100% sensitivity and 85% specificity.ConclusionDECT fat fraction measurements of the thymus may provide additional value in distinguishing anterior mediastinal lesions from benign thymus. Use of DECT may reduce the need for subsequent imaging evaluation.     

霉菌性上颌窦炎CT表现特征及误诊分析

目的探讨霉菌性上颌窦炎CT特征及误诊原因。方法分析26例霉菌性上颌窦炎患者CT和临床资料,总结CT特征,结合临床,分析误诊原因。结果霉菌性上颌窦炎CT多单侧受累（23例）。受累窦腔内不均匀密度增高影及其内斑点、团块及条状钙化（21例）,分布在中间15例,散在4例,边缘2例。窦壁增厚7例,窦壁骨质吸收4例。5例均误诊为一般上颌窦炎。结论与窦壁无关的腔内钙化是CT诊断较可靠特征。无钙化的霉菌性上颌窦炎应注意鉴别诊断,充分考虑临床和基础病。     

Imaging Appearance of Dextranomer/Hyaluronic Acid Copolymer Implant Injections for Treatment of Velopharyngeal Insufficiency

BACKGROUND AND PURPOSE:Dextranomer/hyaluronic acid copolymer implants are used in treating velopharyngeal insufficiency. These posterior nasopharyngeal implants can be mistaken for pathologic conditions such as retropharyngeal abscess on imaging. We studied the imaging appearance of dextranomer/hyaluronic acid copolymer implants in patients treated for velopharyngeal insufficiency.MATERIALS AND METHODS:A consecutive series of patients with velopharyngeal insufficiency treated with dextranomer/hyaluronic acid copolymer were included in this study. Data on patient characteristics and volume of dextranomer/hyaluronic acid copolymer injected were obtained. Postoperative imaging characteristics on plain radiography, CT, and MR imaging were assessed. The imaging appearance of postoperative complications was determined.RESULTS:Sixteen patients were included in this study. Seven patients underwent postoperative plain radiographs, 5 patients underwent CT, and 9 patients underwent MR imaging. Plain radiographs demonstrated soft-tissue swelling in the retropharyngeal space, which resolved at 1 month. On CT, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses isoattenuated to hypoattenuated relative to muscle in 80% (4/5) of patients. On MR imaging, dextranomer/hyaluronic acid copolymer implants appeared as bilateral nasopharyngeal soft-tissue masses that were isointense to muscle on T1 (8/9, 88.9%) and hyperintense to muscle on T2 (8/9, 88.9%) and demonstrated no restricted diffusion (4/4, 100.0%) or peripheral enhancement (7/7, 100.0%).CONCLUSIONS:The normal postoperative findings of posterior nasopharyngeal dextranomer/hyaluronic acid copolymer injection on MR imaging is characterized by the presence of bilateral nasopharyngeal soft-tissue masses that are isointense to muscle on T1 and hyperintense on T2, with no restricted diffusion or peripheral enhancement. Velopharyngeal dextranomer/hyaluronic acid copolymer implants are iso- to hypoattenuated to muscle on CT and are not visible radiographically once associated implantation-related swelling has resolved.

Posterior pharyngeal wall augmentation is a promising technique for the treatment of velopharyngeal insufficiency (VPI).¹ By augmenting the posterior pharyngeal wall so it extends more anteriorly, an easily reached contact point for the soft palate is created, allowing velopharyngeal closure. Numerous implant materials have been used, including cartilage, fat, paraffin, and calcium hydroxyapatite.^1–7 Injection of dextranomer/hyaluronic acid has emerged as an effective technique for treating vocal cord dysfunction and laryngeal insufficiency, and augmenting the posterior pharyngeal wall in the treatment of VPI.^8–12 Because many patients receiving these implants will undergo imaging studies unrelated to VPI, characterization of the normal imaging appearance of hyaluronic acid implants in the posterior pharyngeal wall is important to avoid confusion with pathologic processes.     

Temporal lobe epilepsy: the various MR appearances of histologically proven mesial temporal sclerosis.

PURPOSETo determine the frequency of appearance of various MR signs in mesial temporal sclerosis, to determine the optimal scanning planes for their visualization, and to propose a histologic explanation for the diminished demarcation between gray and white matter in the temporal lobe, a frequent MR finding in patients with mesial temporal sclerosis.METHODSMR scans of 14 surgically treated patients with epilepsy and histologically proven mesial temporal sclerosis were assessed for the presence of six features: feature 1, high signal intensity in the hippocampus; 2, reduced hippocampal size; 3, ipsilateral atrophy of the hippocampal collateral white matter; 4, enlarged temporal horn; 5, reduced gray-white matter demarcation in the temporal lobe; and 6, decreased temporal lobe size.RESULTSFeature 1 was present in 14 patients and was best appreciated on the T2-weighted images in planes parallel to the long axes of the hippocampi. Feature 2, present in 12 patients, and feature 6, present in 9 patients, were optimally seen in the coronal planes and on the inversion-recovery sequences in particular. Feature 3, present in 12 patients, was optimally seen on the coronal T2-weighted images. Feature 4, seen in 11 patients, was equally well seen in all planes (transverse, coronal, and parallel to the long axes of the hippocampi). Feature 5, seen in 10 patients, was best appreciated on the T2-weighted images in the planes of the long axes of the hippocampi. Histologic investigation of the temporal lobe white matter in the 10 patients with feature 5 demonstrated on the MR scan showed abnormalities in 7 cases. Oligodendroglia cell clusters were found in 6, with concomitant corpora amylacea in 1 case and perivascular macrophages with pigment a sole finding in another case.CONCLUSIONOf the six features found in cases of mesial temporal sclerosis on MR, increased hippocampal signal intensity is the most consistent. A decreased gray-white matter demarcation in the temporal lobe parenchyma is also a frequent feature of this disease. A combination of multiple scanning planes results in an optimal demonstration of lesions.     

Investigation of the accessory maxillary ostium: a congenital variation or acquired defect?

Objective:We sought to determine whether an accessory maxillary ostium (AMO) is a congenital or acquired condition and we investigated concomitant sinus pathologies associated with this structure.Methods:Paranasal sinus CT examinations of individuals aged ≥13 years and <13 years were compared retrospectively. In total, 552 sinuses of 276 patients aged ≥13 years (Group 1) and 284 maxillary sinuses of 142 children aged <13 years (Group 2) were evaluated. Patients were classified as AMO-positive or -negative. The following features were evaluated in Group 1: AMO presence, mucus retention cysts, mucosal thickening, sinusitis of the maxillary sinus, nasal septum deviation, concha hypertrophy, concha bullosa, primary ostium obstruction, uncinate process atelectasis, paradox concha, Agger nasi and Haller cells, and sinus hypoplasia. The sizes and locations of AMOs were also evaluated. The presence of an AMO and sinusitis were evaluated in Group 2.Results:AMOs were detected in 122 sinuses in Group 1. In the AMO-positive group, sinusitis, mucosal thickening, and primary ostium obstruction were significantly more common than in the AMO-negative group (p < 0.00001). Statistically significant associations were not observed between AMO presence and other parameters. AMOs were present in two sinuses in Group 2.Conclusion:Our results suggest that AMOs are acquired defects caused by sinus diseases. The rare occurrence of these structures in patients aged <13 years suggests that they may be a perforation or secondary drainage pathway in patients with sinusitis or primary ostium obstruction.     

Computed tomography (CT) of fractures of the ankle and foot: correlating fracture patterns with the presence of tenosynovial fat: Tenosynovial fat in ankle and foot fractures

PurposeTo correlate ankle and foot fracture patterns with the presence of tenosynovial fat on computed tomography (CT).Materials and MethodsIn this retrospective, cross-sectional, observation study, two blinded musculoskeletal radiologists independently reviewed 89 CT scans of patients with ankle or foot fractures and recorded the presence of fat about Henry’s knot, tibialis posterior tendon, and peroneus longus tendon.ResultsThe agreement between the two readers ranged from excellent to substantial. Sixteen to 23 percent of fractures were associated with tenosynovial fat.ConclusionsThe finding of tenosynovial fat following ankle or foot trauma warrants a closer search for a fracture.     

霉菌性鼻窦炎的CT和MRI表现

目的:探讨霉菌性鼻窦炎的特征性CT和MRI表现.方法:回顾性分析经手术病理证实的28例霉菌性鼻窦炎的临床及CT、MRI资料.结果:病变累及一侧上颌窦者17例,累及一侧上颌窦及同侧筛窦者5例,累及一侧上颌窦及同侧筛窦、鼻腔者3例,累及双侧上颌窦者3例.病理表现为被覆假复层纤毛柱状上皮黏膜组织中有较多炎性渗出物,坏死物及淋...     

The influence of different pelvic technical marker sets upon hip kinematics during gait

BackgroundThe pelvis is commonly tracked during three-dimensional motion analysis using markers located on the anterior and posterior superior iliac spines. However, these markers are prone to soft tissue artefact and marker occlusion, highlighting the need for alternative technical marker sets.Research questionHow comparable are hip joint kinematics calculated using two alternative pelvic technical marker sets and a conventionally modelled pelvis?MethodsFourteen participants undertook 3D gait analysis, walking overground at a self-selected pace (1.38 ± 0.14 m·s⁻¹), barefoot. Hip joint kinematics were compared using root mean square error (RMSE) between a conventionally tracked pelvis and two alternative technical marker sets; (1) posterior cluster and (2) additional iliac crest markers.ResultsThe average RMSE in the sagittal, frontal and transverse planes was 2.5° ± 2.8°, 1.6° ± 0.4° and 0.8° ± 0.4°, respectively for the posterior cluster, and 1.3° ± 0.7°, 0.8° ± 0.3° and 1.4° ± 0.5° for the iliac crest marker set. The RMSE was significantly larger for the posterior cluster compared to the iliac crest model in the sagittal (p = .05, d = .28) and frontal planes (p < .001, d = 7.65). In contrast, the RMSE was significantly lower for the posterior cluster in the transverse plane (p = .01, d = -2.85).SignificanceThe findings of this study suggest that either a posterior cluster or additional iliac crest markers offer means of accurately calculating hip joint kinematics within 3° of the conventional pelvic model. Therefore, either technical marker set offers a viable alternative to the conventional pelvic model for calculating hip joint kinematics.