Comparison of the visibility of the anatomical structures of the facial skeleton in panoramic zonography and linear tomography

The value of cylindrical panoramic radiography (using one rotational axis), a modification of orthopantomography (using three rotational axes), in radiographic examination of maxillo-facial skeleton was estimated by evaluating the visualization of anatomical structures of the facial skeleton on cylindrical panoramic and linear tomographic radiographs of 51 patients examined with both methods. The radiographs were independently reviewed by four radiologists. The visualization of the lateral wall of the orbit and maxillary sinus, nasal septum, alveolar process and zygomatic corpus was better on cylindrical panoramic radiographs. Linear tomography visualized the media wall of orbit better. In visualizing the frontal sinus, orbital floor, medial wall of maxillary sinus and hard palate there were no significant differences between linear tomography and panoramic zonography.     

Multiplanar reconstructions in the study of ethmoid anatomy

Summary Multiplanar and surface reconstructions are useful tools in anatomical studies. Details of ethmoid architecture which are hard to image in axial and coronal scans are well displayed by means of oblique sections. This paper addresses reformatted images of a) the nasal lateral wall; b) the middle meatus lateral wall; c) the lamina basilaris of the middle turbinate and d) the frontonasal duct.     

Conventional radiology and computed tomography in facial fractures

The possibilities and limitations of conventional radiography and CT in detecting maxillo-facial fractures are shown both experimentally and in a clinical setting. In 36 patients examined by both methods after maxillo-facial trauma, CT and conventional radiography (including pluridirectional tomography) proved to be equal in detecting fractures of the orbital roof, the anterior wall of the frontal sinus, the nasal bone and the pterygoid process. CT is inferior to conventional radiography in fracture of the orbital floor, the frontal base of the skull, the hard plate and the zygomatic arch. CT is superior to conventional radiography in fractures of the medial and lateral wall of the orbit, the posterior wall of the frontal sinus, the posterior, medial and anterior wall of the maxillary sinus as well as the zygomatic bone.     

Aberrant middle turbinate masquerading as a nasopharyngeal mass

We present a unique variant of the middle turbinate that extends posteriorly through the choana to wrap around the posterior free edge of the nasal septum. The embryology and anatomy of the lateral nasal wall and the nasal septum are reviewed.     

Significant regional heterogeneity of coronary flow reserve in paediatric hypertrophic cardiomyopathy

Previous studies have indicated that cardiac events in young patients with hypertrophic cardiomyopathy (HCM) are related to ischaemia rather than to arrhythmia. We measured coronary flow reserve in paediatric HCM and compared the values with those in adult HCM. We studied 12 patients with HCM including six paediatric (<20 years old; mean 13 years) and six adult patients (>20 years old: mean 62 years), and six healthy young adults (mean 29 years) as controls. Every patient underwent magnetic resonance imaging (MRI) for anatomical assessment. Myocardial blood flow at rest and after dipyridamole infusion was measured with dynamic nitrogen-13 ammonia positron emission tomography (PET). Partial volume effect was corrected for using the anatomical data obtained with MRI. In adult patients with HCM, coronary flow reserve in the hypertrophied septal region was not significantly different from that in the non-hypertrophied lateral wall (1.38+/-0.29 vs 1.77+/-0.39, respectively). In the paediatric patients, coronary flow reserve in the hypertrophied septal region was significantly lower than in the non-hypertrophied lateral wall (0.84+/-0.33 vs 2.74+/-0.90, respectively, P<0.01). In addition, coronary flow reserve in adult patients was lower than in control subjects both in the septal wall (1.38+/-0.29 vs 2.94+/-0.35, respectively, P<0.0001) and in the lateral wall (1.77+/-0.39 vs 2.85+/-0.69, respectively, P<0.05). In contrast, coronary flow reserve in paediatric patients was not significantly different from that in control subjects in the lateral wall (2.74+/-0.90 vs 2.85+/-0.69, respectively), while absolute reduction of myocardial blood flow was noted after pharmacological vasodilatation in the hypertrophied septal region. In conclusion, significant regional differences of coronary flow reserve were present in the paediatric patients with HCM. These results suggest that paediatric patients with HCM intrinsically have the potential to experience significant regional ischaemia even in the absence of coronary stenosis.     

Sagittal femoral condyle morphology correlates with femoral tunnel length in anatomical single bundle ACL reconstruction

Purpose

The purpose of this study was to reveal the correlation between femoral tunnel length and the morphology of the femoral intercondylar notch in anatomical single bundle anterior cruciate ligament (ACL) reconstruction using three-dimensional computed tomography (3D-CT).

Methods

Thirty subjects undergoing anatomical single bundle ACL reconstruction were included in this study (23 female, 7 male: average age 45.5?±?16.7). In the anatomical single bundle ACL reconstruction, the femoral and tibial tunnels were created close to the antero-medial bundle insertion site with trans-portal technique. Using post-operative three-dimensional computed tomography (3D-CT), accurate axial and lateral views of the femoral condyle were evaluated. The correlation of femoral tunnel length, which was measured intra-operatively, with the transepicondylar length (TEL), notch width index, notch outlet length, the notch area (axial), length of Blumensaat’s line, and the height and area of the lateral wall of the femoral intercondylar notch was statistically analyzed. Tunnel placement was also evaluated using a Quadrant method.

Results

The average femoral tunnel length was 35.4?±?4.4 mm. The average TEL, NWI, notch outlet length, and the axial notch area, were 76.9?±?5.1 mm, 29.1?±?3.8%, 19.5?±?3.9 mm, and 257.4?±?77.4 mm², respectively. The length of Blumensaat’s line and the height and area of the lateral wall of the femoral intercondylar notch were 33.8?±?3.2 mm, 22.8?±?2.3 mm, and 738.7?±?129 mm², respectively. The length of Blumensaat’s line, the height, and the area of the lateral wall of the femoral intercondylar notch were significantly correlated with femoral tunnel length. Femoral tunnel placement was 23.4?±?4.5% in a shallow-deep direction and 35.4?±?8.8% in a high-low direction.

Conclusion

The length of Blumensaat’s line, height, and area of the lateral wall of the femoral intercondylar notch are correlated with femoral tunnel length in anatomical single bundle ACL reconstruction. For clinical relevance, these parameters are useful in predicting the length of the femoral tunnel in anatomical single bundle ACL reconstruction for the prevention of extremely short femoral tunnel creation.

Level of evidence

Case controlled study, Level III.

     

Significant regional heterogeneity of coronary flow reserve in paediatric hypertrophic cardiomyopathy

Previous studies have indicated that cardiac events in young patients with hypertrophic cardiomyopathy (HCM) are related to ischaemia rather than to arrhythmia. We measured coronary flow reserve in paediatric HCM and compared the values with those in adult HCM. We studied 12 patients with HCM including six paediatric (<20 years old; mean 13 years) and six adult patients (>20 years old: mean 62 years), and six healthy young adults (mean 29 years) as controls. Every patient underwent magnetic resonance imaging (MRI) for anatomical assessment. Myocardial blood flow at rest and after dipyridamole infusion was measured with dynamic nitrogen-13 ammonia positron emission tomography (PET). Partial volume effect was corrected for using the anatomical data obtained with MRI. In adult patients with HCM, coronary flow reserve in the hypertrophied septal region was not significantly different from that in the non-hypertrophied lateral wall (1.38ǂ.29 vs 1.77ǂ.39, respectively). In the paediatric patients, coronary flow reserve in the hypertrophied septal region was significantly lower than in the non-hypertrophied lateral wall (0.84ǂ.33 vs 2.74ǂ.90, respectively, P<0.01). In addition, coronary flow reserve in adult patients was lower than in control subjects both in the septal wall (1.38ǂ.29 vs 2.94ǂ.35, respectively, P<0.0001) and in the lateral wall (1.77ǂ.39 vs 2.85ǂ.69, respectively, P<0.05). In contrast, coronary flow reserve in paediatric patients was not significantly different from that in control subjects in the lateral wall (2.74ǂ.90 vs 2.85ǂ.69, respectively), while absolute reduction of myocardial blood flow was noted after pharmacological vasodilatation in the hypertrophied septal region. In conclusion, significant regional differences of coronary flow reserve were present in the paediatric patients with HCM. These results suggest that paediatric patients with HCM intrinsically have the potential to experience significant regional ischaemia even in the absence of coronary stenosis.     

CT demonstration of accessory nasal turbinates: secondary middle turbinate and bifid inferior turbinate

Normally, there are three pairs of nasal turbinates in the nasal cavity. Coronal computed tomographies of 253 cases of sinusitis were examined for the presence of additional turbinates and bilateral secondary middle turbinates were detected in two cases. Also, we describe another accessory turbinate, 'bifid inferior turbinate', in one of these cases. Existence of these accessory turbinates may occur during embryologic development of lateral nasal wall.     

High-resolution CT: pre-operative assessment of chronic and recurrent rhinosinusitis

The better understanding of chronic and recurrent rhinosinusitis and the advance in endoscopic endonasal surgery have modified the radiological pre-operative investigation of this condition. The ethmoid labyrinth, not accessible to the endoscope, may be explored by axial and coronal high-resolution thin section (2 mm) CT. We have reviewed 100 CT scans with endoscopic correlation in order to assess the accuracy of this pre-operative method.This anatomical study reveals the presence and extent of parasinus diseases which are usually concentrated in the area of the ostiomeatal unit. The anatomic variations of the lateral nasal wall that have been reporded as predisposing to sinusitis and the morphologic variations altering the relationships of the ethmoid with the orbits and the brain were also studied. This pre-operative radiological assessment is currently necessary for functional and safe surgery.Correspondence to: J. C. FerriePaper presented at ECR 1991     

Lateral wall of the olfactory fossa in determining intracranial extension of sinus carcinomas.

The role of plain skull radiography and pluridirectional tomography in determining anterior cranial fossa extension of paranasal sinus tumors is reassessed. The lateral wall of the olfactory fossa, a thin bony plate forming part of the roof of the ethmoid sinuses, is routinely visualized on plain skull radiography and pluridirectional tomography in the coronal plane and serves as an indicator of intracranial tumor extension. In a series of 47 patients with paranasal sinus tumors, 100% true positive and 3% false negative interpretations of the integrity of the lateral wall of the olfactory fossa were made with pluridirectional tomography. Interpretations with plain skull radiography were 90% true positive and 3% false negative. Assessment of the integrity of the lateral wall of the olfactory fossa by these techniques provides an accurate evaluation of the presence of intracranial tumor extension by this route. Computed tomography in the coronal plane with contrast infusion is a useful adjunct.     

The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction

The purposes of this study were to establish the technique to arthroscopically identify the resident’s ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 × 10 mm was created just behind the ridge. At 3–4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7–10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident’s ridge. The resident’s ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction.     

鼻NK/T细胞淋巴瘤同鼻息肉、内翻乳头状瘤的CT对比分析

目的 分析鼻NK/T细胞淋巴瘤的CT表现.方法 回顾性分析11例鼻NK/T细胞淋巴瘤、134例鼻息肉、24例鼻内翻乳头状瘤的CT征象,将相应征象在3类疾病中出现的差异用Fisher精确检验比较.结果 较鼻息肉,鼻NK/T细胞淋巴瘤多单侧鼻腔发病,表现为结节肿块或铸型生长,易侵犯鼻前庭、鼻翼及鼻背部皮肤、鼻咽侧壁、鼻中隔或鼻底部黏膜、周围骨质破坏;较鼻内翻乳头状瘤,鼻NK/T细胞淋巴瘤病变易侵犯鼻前庭、鼻翼及鼻背部皮肤、后鼻孔及鼻咽腔、鼻中隔或鼻底部黏膜.结论 鼻NK/T细胞淋巴瘤多发生于单侧鼻腔,密度均匀,沿侧壁匍匐生长,易侵及鼻黏膜及前后组织结构,早期骨质破坏轻微.     

How does nose blowing effect the computed tomography of paranasal sinuses in chronic sinusitis?

OBJECTIVE: Our aim was to determine whether inward or outward movement of the secretions in the paranasal sinuses due to nose blowing after nasal decongestion has any effect on the paranasal sinus computed tomography (CT) images in patients with sinusitis and to asses whether nose blowing may result in misdiagnosis or overdiagnosis in radiological evaluation of sinusitis. MATERIALS AND METHODS: Twenty-four patients with chronic sinusitis were evaluated in an academic tertiary care hospital and data were collected prospectively. After coronal sinus computed tomography scans were performed at 100 mA setting which was half the value of the standard radiation dose suggested by the manufacturer, topical decongestion was applied to each nostril followed by nose blowing 10 min later. Sinus CT scans were then repeated at the same setting. We evaluated the mucosal thickness of medial, lateral, superior and inferior maxillary and frontal sinus walls and the maximal thickness in anterior ethmoidal cells. The measurements prior to and following nose blowing were compared with Wilcoxon signed ranks test. The obtained images were also staged using Lund-McKay staging system separately and the scores were compared with Student's t-test. RESULTS: We observed a tendency towards reduction in mucosal thickness after nose blowing. There were statistically significant differences between maxillary sinus inferior wall and frontal sinus inferior wall mucosal thickness values prior to and after nose blowing. The difference however was very small, about 0.5 mm in magnitude and Lund-McKay score did not change in any of the patients after nose blowing. CONCLUSION: Nose blowing and topical nasal decongestion does not have any effect on the diagnostic accuracy of sinus CT in chronic sinusitis patients.     

Lateral lumbar disk hernia

Eleven cases are reported of lateral lumbar herniated disc, an anatomical form presenting fairly atypical features and of relatively recent discovery. The patients presented with a highly painful single root lesion usually affecting L4 and L5 roots. Saccoradiculography was negative in almost all cases whereas computed tomography imaging allowed easy diagnosis of a lateral herniated disc, and demonstrated its foraminal or extraforaminal site. An appropriate surgical approach was thus possible, extremely lateral forms requiring an extraisthmian approach.     

鼻至斜坡区解剖特点及经扩大的鼻入路切除斜坡区肿瘤的可行性与安全性

 目的 研究扩大的内镜下经鼻至斜坡区手术入路的解剖要点及其位置关系。方法 防腐尸头标本10例,显微镜下解剖观察扩大的经鼻至斜坡区手术入路的解剖结构。新鲜尸头标本5例,模拟扩大的内镜经鼻入路斜坡手术。另外,对2例侵犯斜坡区的病例,采用扩大的内镜下经单鼻孔手术入路,结合影像检查资料,观察肿瘤影像解剖结构及切除情况。结果 扩大的内镜经鼻至斜坡区中线部位主要标志点由前至后依次为中鼻甲、后鼻孔、咽鼓管咽口、鼻咽部黏膜、双侧蝶窦口、头长肌和颈长肌、咽结节、枕骨大孔前缘中点等结构。手术中斜坡能够磨除的最大范围(分别以两侧颅内翼管和破裂孔为界,各自距中线最短距离):翼管左侧(9.25±0.26)mm,右侧(9.19±0.27)mm;破裂孔左侧(10.64±0.43)mm和右侧(10.75±0.51)mm。内镜下完全模拟手术操作表明,内镜经鼻入路可充分显露颅颈交界区及斜坡的解剖结构,完全达到真实内镜下操作要求。2例肿瘤全切,术中、术后未发现严重手术并发症。结论 采用扩大的单纯内镜经鼻入路可更直接到达斜坡区,并可安全切除肿瘤,避免损伤重要的神经血管和脑组织。     

Prediction of nasal morphology from the skull

The objective of this study was to compose a reliable and readily reproducible method of predicting nasal morphology from the bony aperture, which restricts subjectivity whilst allowing anatomical nuance to be taken into account. Clinical head CT data from a sample of 79 North American subjects of varied ancestry was analysed for interrelationships between the bone and soft tissue of the nose in three dimensions, then pooled with 60 lateral cephalograms of subjects of European ancestry from England to augment nasal profile data. A series of simple regression equations was produced using linear distances between pairs of bony landmarks to predict nasal profile dimensions and restrict potential subjective error in Gerasimov’s “Two-tangent” method. Maximum nasal width, the position of the alae and nostrils, and prediction of nasal asymmetry were incorporated into the resulting threedimensional nasal prediction method.     

Computed tomographic cephalometric analysis of Chinese patients with obstructive sleep apnoea

Variations of craniofacial and upper airway structures are recognized to contribute to the phenomenon of obstructive sleep apnoea (OSA). Most previous cephalometric studies were performed using erect lateral radiographs in Caucasian patients. The present project aims to determine cephalometric measurements, utilizing CT, in normal Chinese subjects and in Chinese patients with OSA. Computed tomography of 25 patients with OSA (proven using overnight polysomnography), and of 25 age-, sex-, height-, bodyweight- and body mass index (BMI)-matched control subjects were prospectively performed. Thirteen standard bony and soft-tissue measurements were obtained from the CT lateral scout view of the head and neck, taken with each subject in the neutral supine position. The cross-sectional area was calculated at two axial levels (velopharynx and hypopharynx). The measurements in the two groups, OSA and control subjects, were compared. The measurements for hyoid position (P = 0.00), nasal cavity length (P = 0.01), mandibular prognathism (P = 0.05), tongue size (P = 0.02), oropharyngeal airway space (P = 0.02), posterior tongue airway space (P = 0.04) and cross-sectional areas at the level of the velopharynx (P = 0.00) and hypopharynx (P = 0.01) differed significantly between the two groups. In conclusion, CT cephalometric measurements show that certain anatomical variations in the head and neck are likely to contribute to the pathogenesis of OSA in Chinese patients.     

Gas-forming abdominal wall abscess: unusual manifestation of perforated retroperitoneal appendicitis extending through the superior lumbar triangle

We present a case of an extensive gas-forming abdominal wall abscess secondary to ruptured retroperitoneal appendicitis in a diabetic patient. Computed tomography (CT) demonstrated a retroperitoneal abscess extending to the abdominal subcutaneous tissue through the superior lumbar triangle pathway, a known anatomical defect of the lumbar musculature. This case not only represents an unusual manifestation of acute appendicitis, but also alerts us to the importance of anatomical considerations in the imaging interpretation of disease extent. The applied anatomy of the lumbar triangle as a conduit of intra-abdominal and retroperitoneal processes into the abdominal wall is reviewed.     

HRCT轴位加薄层冠状位扫描及容积重建对鼻骨骨折的诊断价值

目的探讨高分辨率CT（HRCT）对鼻骨骨折的诊断价值。方法25例鼻外伤患者均经HRCT轴位扫描及冠状位薄层加三维重建（VR）,对检查结果与数字X线摄影（DR）进行对比分析。结果25例患者中,12例DR侧位X线平片显示鼻骨骨折,而HRCT图像22例显示鼻骨骨折线,其中,粉碎性骨折14例,线性骨折8例;单侧骨折15例,双侧骨折7例;横型骨折11例,纵形骨折2例,斜形骨折9例;合并上颌骨额突骨折12例。容积重建（VR）及冠状位像显示全部患者鼻骨骨折线。结论轴位HRCT扫描加冠状面重律对鼻骨骨折的诊断晶可靠．其敏感性显著优于DR。     

Abdominal wall hernias: imaging with spiral CT

Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other diseases such as hematomas, abscesses and neoplasia. In this study we examined the CT images of 94 patients affected by abdominal wall hernias observed over a period of 6 years. Computed tomography clearly demonstrates the anatomical site of the hernial sac, the content and any occlusive bowel complications due to incarceration or strangulation. Clinical diagnosis of external hernias is particularly difficult in obese patients or in those with laparotic scars. In these cases abdominal imaging is essential for a correct preoperative diagnosis and to determine the most effective treatment. Received: 20 May 1999; Revised: 10 August 1999; Accepted: 13 August 1999