X-ray computed tomographic study of the ethmoid and middle meatus. II. Radio-anatomy (axial incidence) and morphological variations

Chronic rhinosinusitis endoscopic surgery needs an accurate evaluation of diseases and paranasal sinus anatomic variations. High resolution CT by thin section (2 mm) allow this pre-operative assessment. An anatomical study of the ethmoid air cell system is always possible in axial plane. The bidimensional CT exploration (axial and coronal plane) displays the anatomic variations of ostiomeatal unit, that have been reported to predispose sinusitis. They are nasal septal deviation, pneumatization and paradoxical curvature of the middle turbinate, pneumatization of unciform process, Haller's cells, prominent agger nasi cell and ethmoid bulla. The endoscopic endonasal surgery landmarks, the individual morphologic variations, the topographic relations to the orbit and to the brain are also well shown by CT.     

X-ray computed tomographic study of the ethmoid and middle meatus. I. radioanatomy (coronal plane)

The advance of endoscopic endonasal surgery allows limited surgical resection in chronic rhinosinusitis. An accurate topographic evaluation of diseases and individual morphologic variation are necessary for this functional surgery. The preoperative radiological investigations require a precise knowledge of ethmoid and osteo-meatal unit anatomy. Thin sections by high resolution CT were performed in coronal plane. The anatomical land marks and the ethmoidal bony roots, which allow a study of the osteo-meatal unit and ethmoid air cells system, are showed. Like endoscopic view, coronal slices better display the different grooves for paranasal sinus draining and their relations with the ethmoid.     

蝶筛区域解剖结构的CT评价及对功能性内窥镜鼻窦外科的指导意义

目的探讨CT对蝶筛区域解剖结构的评价能力,以期为功能性内窥镜鼻窦外科手术提供帮助。材料和方法冠状和横轴位薄层CT扫描54例无病变的蝶筛区域,并重建矢状位图像。结果CT图像中蝶上筛房出现率13.0％。蝶窦气化CT分型中,甲介型占8.3％,半鞍型占51.9％,全鞍型占39.8％。蝶窦中隔居正中位置占24.1％。蝶窦的其他变异有翼突气化、前床突气化、蝶骨大翼气化和蝶骨小翼气化。视神经管纵轴与蝶筛窦的毗邻关系在CT图像上分为三型,视神经管横轴对蝶筛窦的压迫关系分为四型,并统计出各型的分布情况。结论CT扫描能显示蝶筛区域与功能性内窥镜鼻窦外科手术有关的绝大部分解剖结构及其变异,对手术有很大的指导作用。     

筛骨解剖变异的CT评价及其临床意义

目的 评价冠状位CT对功能性内镜鼻窦外科有关的筛骨解剖变异的显示能力，讨论筛骨解剖变异的CT评价对临床手术的指导意义。资料与方法 冠状位CT薄层扫描整个筛骨45例，以筛骨的断层为依据，以内镜鼻窦手术为对照，认证筛骨的解剖变异，并计算各种变异的出现率。结果 筛顶的解剖学特征中，倾斜式占73．3％，高台式占26．7％；蝶上筛房占13．3％；眶下筛房占8．9％；中鼻甲的气化和反向偏曲各占17．8％和2．2％；鼻中隔的气化占6．7％，偏曲占22．2％，形态呈S型、弧型、侧置V型等。结论 冠状位CT能很好显示有关内镜鼻窦手术的筛骨解剖变异，为手术提供详细的影像学资料，对该手术有很大的指导意义。     

Radiological findings in angiofibroma

Surgery after pre-operative embolization has become the main treatment modality in angiofibroma therapy. As surgical planning is based on precise pre-operative tumour evaluation, knowledge of the characteristic growth patterns is of great interest. Analysis of tumour extension and blood supply, as well as methods of controlling intra-operative bleeding, help in determining the appropriate surgical approach. Though benign, angiofibroma demonstrates a locally aggressive nature. This fibrovascular tumour is characterised by typical radiological findings and by predictable growth patterns. The tumour extension and blood supply can be accurately determined by CT, MR imaging and angiography. With classic radiological findings, no pre-operative biopsy is necessary in most angiofibromas. Advances in radiological imaging have contributed to improved surgical planning and tumour resection. The surgeon is able to select the least traumatic approach with secure haemostatic control, which is also critical for avoiding the disturbance of facial skeletal growth in this group of young patients. Embolization, pre-operative autologous donation and the cell saver system for immediate retransfusion of the collected blood after filtration, are important tools for dealing with blood loss in angiofibroma surgery as they minimize homologous blood transfusion.     

X-ray computed tomographic study of the ethmoid bone and middle meatus. III. Application to chronic infectious sinus pathology]

As nasal endoscopy, high resolution CT is a part of the chronic rhinosinusitis pre-operative assessment. It shows, thanks to a precise and anatomical study of the ethmoid and sinusal draining, the extension of the diseases and the local morphological variations which predispose to chronic diseases. The main aspects of chronic sinusitis, nasal polyposis and fungal maxillary sinus diseases are reported. The frequency of individual morphological variations and the mucosal changes due to a nasal cycle require a great care in the interpretation of the diseases.     

CT imaging of the anterior ethmoidal artery: anatomic correlation

PURPOSE: To identify the anterior ethmoidal artery (AEA) of a skull specimen on CT prior to transnasal endoscopic surgical management of anterior epistaxis. MATERIALS AND METHODS: From a medial canthotomy approach, the AEA was located and a marker placed on 9 skull specimens (18 AEA). CT with 2D reformations was then performed. The AEA were then dissected using an endoscopic anterior ethmoidectomy approach. The presence of AEA procidence was recorded. RESULTS: Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA procidence: 1) presence of an ethmoid bulla above the AEA canal 2) AEA canal located below (not within) the ethmoid roof, anterior to the bulla. CONCLUSION: High resolution CT depiction of the AEA provides information regarding its accessibility for endoscopic ligation in patients with severe anterior epistaxis as an alternative to external ligation while demonstrating the upper limit of the anterior ethmoid.     

X-ray computed tomographic evaluation of the anterior ethmoid by parallel and perpendicular sections to the axis of nasofrontal duct. Preliminary study

The anterior ethmoid is revisited with CT sections parallel and perpendicular to the axis of the naso-frontal duct. The sections obtained in these 2 planes allow a more precise topographic study of the anterior ethmoid than the routinely used axial and coronal CT slices. For the surgeon these sections provide an optimal preoperative study of the anterior ethmoid allowing the most conservative endoscopic surgical treatment.     

螺旋CT三维重建评价筛窦解剖变异及临床意义

目的：探讨应用螺旋CT对筛窦进行三维图像重建，认证筛窦解剖变异及临床意义。材料和方法：应用GE Lightspeed Plus多排螺旋机扫描仪，对75例病例进行筛窦横断面扫描，通过GE W4．0工作站，在三维重建软件支持下作冠状位图像重建。结果：筛窦常见的解剖变异有5种：筛大泡占52％，Onodi气房21％，眶五气房5％，筛凹低位4％，纸样板过度内移7％。结论：经横断面CT扫描，通过三维重建，能够很好地显示筛窦冠状面图像及其解剖变异，为手术提供详细的影像学资料，对鼻内镜外科有重要临床指导意义。     

筛前动脉的解剖及影像学研究进展

筛前动脉是前颅底和额隐窝的重要解剖标志,手术损伤可导致严重并发症。了解其正常走行以及邻近结构,对提高手术安全性和副鼻窦内镜手术结果有非常重要的意义。本文综述了筛前动脉解剖结构及相关影像学检查,以及320层容积CT(VCT)筛前动脉血管成像的优势。     

Comparison of special interest computed tomography, endosonography and histopathological stage of oesophageal cancer

AIMS: To assess the strength of agreement between the perceived pre-operative stage of oesophageal tumours as determined by spiral computed tomography (CT) and endoscopic ultrasound (EUS), both alone and in combination, with the histopathological stage. METHODS: Sixty patients with oesophageal cancer underwent both pre-operative CT and EUS performed by two consultant radiologists with a special interest in upper gastrointestinal radiology. The strength of the agreement between the radiological stage and the histopathological stage was determined by means of the weighted Kappa statistic (Kw). RESULTS: Sensitivity for T and N stages was 58% and 79% for CT, and 72% and 91% for EUS. Specificity for T and N stages was 80% and 84% for CT, and 85% and 68% for EUS. Kw for T and N stages was 0.455 (p=0.0001) and 0.603 (p=0.0001) for CT compared with 0.604 (p=0.0001) and 0.610 (p=0.0001) for EUS. In patients when CT and EUS agreed regarding the T and N stages, the strength of agreement between the radiological and the histopathological stage was greater (Kw T 0.613 (p=0.0001), Kw N 0.781 (p=0.0001)).CONCLUSION: CT and EUS are complimentary techniques for the staging of oesophageal tumours, and these results reinforce the importance of specialist radiology in stage directed management.     

Topographic anatomy of the ethmoid labyrinth in x-ray computed tomography

These last years the surgical treatment of inflammatory ethmoid disease has been completely modified, with new endoscopic conservative procedures. In a preoperative phase it is mandatory to provide optimal CT imaging of the ethmoid labyrinth, and for this purpose sections perpendicular and parallel to the nasofrontal duct axis are better than axial and coronal slices. The anatomy of the ethmoid is fairly complex; however certain constant anatomic landmarks allow a systematic analysis of the ethmoid labyrinth: the unciform process, the bulla, the middle turbinate, the superior turbinate and their respective basal lamellae.     

Paranasal sinuses and facial imaging: exploratory strategies

Advances in radiological and endoscopic imaging allow more accurate location and spread of nasosinusal diseases. These developments have led to a better understanding of sinusal anatomy and to widespread of surgical techniques as endoscopic sinus surgery. CT becomes the primary imaging modality for assessment of chronic rhinosinusitis and complex traumatic injury. Associated to CT, MRI is used to distinguish between inflammatory and neoplastic pathology and to assess lesions involving the skull base or intracranial structures. However, optimization of technical parameters according to the pathology is necessary.     

CT characterization of developmental variations of the paranasal sinuses in cystic fibrosis

Purpose: To describe variations of paranasal sinus development in patients with cystic fibrosis (CF) and in non-CF patients examined for inflammatory sinonasal disease. We focused on anatomic variants that predispose to orbital and cerebral penetration during functional endoscopic sinus surgery (FESS), e.g. hypoplasia of the maxillary sinus and low ethmoid roof.Material and Methods: One hundred and sixteen CF patients (3-54 years, median 18) and 136 control patients (7-51 years, median 31) were examined with coronal CT of the paranasal sinuses. CF patients were grouped according to number of confirmed mutations: CF-2 (n=70), CF-1 (n=32), CF-0 (n=14). CT images were evaluated with respect to paranasal sinus development, pneumatization variants and bony variants.Results: Frontal sinus aplasia and maxillary, ethmoid, and sphenoid sinus hypoplasia were markedly more frequent in CF-2 than in control patients. No CF-2 patient had pneumatization variants such as Haller cells or concha bullosa. Low ethmoid roof was seen in 30% of CF-2 children, but in no control children. CF-1 and CF-0 groups had prevalences of aplasia and hypoplasia intermediate to that of CF-2 and control patients.Conclusion: Genetically verified CF patients had less developed sinuses, lacked pneumatization variants, and more often had anatomic variants that predispose to complications during FESS. Normally developed sinuses and pneumatization variants in some genetically unverified CF patients (CF-1, CF-0) suggest that these patients may be erroneously diagnosed.     

Chronic invasive sinus aspergillosis in an immunocompetent patient: a case report

We report the case of an immunocompetent, 39 year old male who presented with diplopia and diffuse headache. The CT scan demonstrated the presence of a sizeable mass that took over the nasal cavity, the right maxillary sinus, the sphenoid and ethmoid sinus, extending to the sellar and suprasellar region, and eroding the adjacent bones. The patient also underwent MRI and endoscopic sinus surgery. Biopsy of the suspected tissue for pathology and culture demonstrated Aspergillus fumigatus.     

慢性鼻窦炎鼻窦CT报告书写内容现状调查

目的:调查目前慢性鼻窦炎（CRS）鼻窦CT报告对临床诊疗关注的鼻窦病变和解剖变异（或异常）的描述情况,并对描述较少的病变和解剖变异（或异常）进行总结分析,提高报告质量。方法:于2020年3月在全国范围内对书写鼻窦CT报告医师通过电子问卷调查鼻窦CT报告描述鼻腔鼻窦病变和解剖变异（或异常）的情况,并比较分析不同级别医院、...     

Ethmoid sinus disease: CT evaluation in 400 cases. Part II. Postoperative findings

Clinical, pathologic, and computed tomographic (CT) findings were reviewed in 400 patients with ethmoid sinus disease, including 272 who had undergone surgery. The postoperative appearance of ethmoid sinuses on CT scans is a highly neglected subject in radiologic literature. The unique ethmoid anatomy permits a variety of surgical approaches, and radiologists must be familiar with the postoperative appearances if they are to recognize the effects of prior surgery and detect, when possible, the recurrence of disease. It is often difficult to evaluate the clinical significance of soft-tissue disease, despite good clinical correlation.     

筛窦骨瘤鼻内镜微创手术切除（一例报告并文献复习）

目的分析筛窦骨瘤的临床特征,探讨其诊治方法及鼻内镜下微创手术切除的优点。方法报告1例筛窦骨瘤的临床诊治及手术过程,并就筛窦骨瘤的特点与诊治方法进行文献回顾复习分析。结果高分辨率CT及三维重建技术有助于分辨骨瘤的大小、毗邻结构关系及术式选择,术中需防止脑脊液鼻漏、眶壁损伤等并发症的发生。结论筛窦为鼻窦骨瘤的好发部位,局限于筛窦及鼻腔的骨瘤适于鼻内镜下手术切除,具有手术创伤小、术后无面部瘢痕等优点。     

Multiple primary tumors of the colon

Nine cases of multiple primary carcinomas of the large intestine are reported in order to emphasize the importance of an accurate pre-operative search of the other neoplastic lesions after a first cancer diagnosis. As the multiple carcinomas are often in various growing stages it is necessary an accurate X-ray examination for the early cancer diagnosis. It can be concluded that all "at risk" patients (including those already treated by surgery) must be yearly controlled by radiological and endoscopic examinations to assure the best long-term results.     

Remarkable anatomic variations in paranasal sinus region and their clinical importance

With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.