The role of the ostiomeatal unit anatomic variations in inflammatory disease of the maxillary sinuses

Objective: The purpose of the study was to determine the correlation between bony anatomic variations of the ostiomeatal unit (OMU) and chronic maxillary sinusitis. The study was based on the hypothesis that the mucosal contact caused by the variations represents the critical factor in increasing the risk of maxillary sinusitis. Materials and methods: Thin section high resolution computerised tomography (CT) examinations of the paranasal sinuses in 73 consecutive patients with 113 anatomic variations of the OMU were retrospectively reviewed. The following CT features were assessed: (1) Type of anatomic variations, (2) presence of a mucosal contact in the OMU and (3) presence of maxillary disease. Statistical evaluation was carried out using z²-test. Results: The following bony anatomic variations were found: Concha bullosa (67 cases), abnormalities of the uncinate process (18 cases), Haller's cells (24 cases) and large ethmoidal bulla (four cases). Only 52 of the 113 anatomic variations were associated with ipsilateral maxillary disease (mucosal thickening, mucous retention cysts, polyps, retained secretions). Of 113 variations, 44 caused a mucosal contact, 35 of these were associated with maxillary abnormalities, while in nine cases there were no pathologic changes. Of 69 variations, 17 did not cause mucosal contact (P < 0.05). Conclusion: Our data shows that, in the presence of anatomic bony variations, a contact between the mucosal surface of the OMU is valuable in predicting the likelihood of a maxillary inflammatory disease.     

Important anatomic variations of the sinonasal anatomy in light of endoscopic surgery: a pictorial review

Advances in surgical techniques and instrumentations, utilization of the imaging tools, and understanding the regional anatomy have served to make functional operations with less complications in the paranasal sinus area. In the context of this article, some of these anatomical structures and their variations were reviewed through images. These structures were as follows: course of the anterior ethmoidal artery; roof of the ethmoid; lamina papyracea; uncinate process; optic nerve; and internal carotid artery.     

Spectrum of imaging findings in gender-affirming genital surgery: Intraoperative photographs,normal post-operative anatomy,and common complications

Gender-affirming surgery is becoming more accessible, and radiologists must be familiar with both terminology and anatomy following gender-affirming surgical procedures. This essay will review the most common gender-affirming genital surgeries, their post-operative anatomy, and common complications by providing intraoperative photographs, illustrations, and cross-sectional images. Routine radiologic imaging recommendations for transgender patients will also be reviewed.     

Frequency and imaging findings of variations in human aortic arch anatomy based on multidetector computed tomography data

The purpose of this study was to describe the frequency of the variations in the branching pattern of the aortic arch (AA) according to multidetector computed tomography (MDCT) imaging findings. MDCT images of 1136 consecutive patients who had undergone imaging of the chest were retrospectively examined. Eleven different branching patterns were observed. A left-sided AA with three major branches was seen in 74.4% of the patients. Bovine-type AA (21.1%) and independent origin of the left vertebral artery (3.7%) were the next two most common patterns.     

The normal topographic and CT-tomographic anatomy of the ostiomeatal complex]

Recent advances in the pathophysiology of the nasal cavity and paranasal sinuses and the development of endoscopic equipment and techniques have led to a new "functional" surgical management of chronic or recurrent sinusal conditions. The ostiomeatal complex is a narrow and intricate passage way providing aeration and mucus clearance from anterior ethmoid sinus, maxillary sinus and frontal sinus. CT, allowing the detailed demonstration of normal and abnormal patterns of the ostiomeatal complex, permits accurate preoperative planning, which has reduced the number of surgical complications. Ostiomeatal complex anatomy and the corresponding CT features are analyzed, as seen in 85 patients with or without rhinosinusal inflammatory lesions. The CT technique with coronal and axial scans and electronic parasagittal reconstructions, is also reported. Finally, the images obtained on different CT planes are compared, as proposed by other authors.     

Coronal imaging of the osteomeatal unit: anatomy of 24 variants.

The purpose of this paper is to present a user-friendly reference for 24 of the most common normal variants of the osteomeatal unit. A five image set of consecutive normal coronal hanging head computed tomography (CT) images was obtained. Half of each image was duplicated enough times to allow superimposition of the variants. For organizational purposes, each variant was sorted into six color-coded regions: middle turbinate (five variants), inferior turbinate (three variants), maxillary sinus (three variants), nasal septum (three variants), ethmoid sinuses (five variants), and uncinate process (five variants). This reference can be used to rapidly identify a CT scan level and obtain an overview of common variants in that level. In addition, the color-coded system can be used to find any variant on all appropriate CT levels quickly by locating its colored column.     

Sinonasal imaging after Caldwell-Luc surgery: MDCT findings of an abandoned procedure in times of functional endoscopic sinus surgery

Background and purpose

Today, functional endoscopic sinus surgery (FESS) is performed in most of the patients with sinonasal inflammatory disease. The postoperative imaging findings of FESS in multidetector computed tomography (MDCT) considerably differ from those of historic Caldwell–Luc (CL) maxillary sinus surgery which is an uncommon procedure today. Thus, the postoperative CL imaging findings may lead to diagnostic confusion and misinterpretation. Therefore, this study explicitly presents the MDCT findings of post-CL patients which have not been described previously.

Methods

Twenty-eight patients with clinically suspected sinusitis and documented history of CL-procedure underwent 16 row MDCT (MDCT Mx8000 IDT Philips) with multiplanar reconstructions of the paranasal sinuses in the axial plane. The following parameters were used: 140 kV, 50 mAs; 16 mm × 0.75 mm detector collimation; 1 mm reconstructed slice thickness; 0.5 mm increment. The studies were reconstructed with a bone algorithm (W3000/L600; 1 mm slice thickness) in axial plane and coronal plane (3 mm slice thickness). The images were retrospectively evaluated for the presence of normal surgery-related and pathological findings.

Results

Surgery-related imaging characteristics presented as follows: an anterior and a medial bony wall defect and sclerosis and sinus wall thickening were observed in all 28/28 cases (100%). Collaps of the sinus cavity was seen in 26/28 cases (92.9%). Furthermore, inflammatory disease of the operated sinus(es) was found in 23/28 cases (82.1%): 14/28 patients (50%) had inflammatory mucosal thickening of the operated sinus(es) as well as of other sinonasal cavities and 9/28 patients (32.1%) had inflammatory mucosal thickening limited to the operated sinus(es). A postoperative mucocele was depicted in 3/28 cases (10.7%). 2/28 patients (7.1%) showed neither maxillary nor other mucosal swelling.

Conclusion

MDCT with multiplanar reconstructions is a precise method to evaluate post-CL patients and helps to differentiate normal surgery-related findings, which may mimic pathology, from real pathological findings.     

The subscapularis: anatomy,injury, and imaging

The subscapularis is the largest and most powerful of the rotator cuff muscles and fulfills an important role in glenohumeral movement and stability. The spectrum and implications of subscapularis muscle or tendon injury differ from injury to other rotator cuff components because of its unique structure and function. Diagnosing subscapularis injury is clinically difficult and assessment of subscapularis integrity may be limited during arthroscopy or open surgery. Diagnostic imaging plays an important part in diagnosing and evaluating the extent of subscapularis injury. The radiologist should be aware of the anatomy of the subscapularis, the variations in muscle or tendon injury, and the potential implications for treatment and prognosis.     

Cervical spine and crystal-associated diseases: imaging findings

The cervical spine may be specifically involved in crystal-associated arthropathies. In this article, we focus on the three common crystals and diseases: hydroxyapatite crystal deposition disease, calcium pyrophosphate dihydrate (CPPD) deposition disease, and monosodium urate crystals (gout). The cervical involvement in crystal-associated diseases may provoke a misleading clinical presentation with acute neck pain, fever, or neurological symptoms. Imaging allows an accurate diagnosis in typical cases with calcific deposits and destructive lesions of the discs and joints. Most of the cases are related to CPPD or hydroxyapatite crystal deposition; gout is much less common.     

The magnetic resonance imaging of infections and inflammatory diseases

The MR features of inflammatory lesions of the central nervous system are reviewed in this article, and the sensitivity and specificity of MR and CT in the detection of these lesions are compared. The advent of CT dramatically improved the morbidity and mortality of inflammatory disease by facilitating earlier and more accurate diagnosis which, in turn, produced more timely medical and surgical intervention. The efficacy of MR in the evaluation of inflammatory lesions must, therefore, be compared to CT in order to accurately asses its role.     

Advanced gastrointestinal endoscopic procedures: indications,imaging findings,and implications for the radiologist

There are a variety of advanced gastrointestinal endoscopic procedures, many of which are guided by endosonography, which are performed by interventional gastroenterologists or minimally-invasive surgeons. The purpose of this pictorial review is to briefly describe several advanced gastrointestinal endoscopically guided procedures, to review the implications for radiologists interpreting the associated imaging examinations, and to demonstrate the expected preprocedural imaging findings, as well as the expected and the unexpected postprocedural findings, in patients undergoing these procedures.     

Post colon surgery complications: imaging findings

Several standardized types of colonic resections are available in the clinical practice. All of them may produce early and late complications. Diagnostic imaging plays a pivotal role in the recognition of post-operative colorectal complications and provides fundamental information for therapeutic planning. In this paper we review the imaging findings of early and late post-operative complications of colorectal surgery.     

Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options

Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed.     

Postoperative imaging in cyanotic congenital heart diseases: part 1, Normal findings

OBJECTIVE: The objective of this article is to illustrate the most common surgical procedures performed in patients with cyanotic congenital heart diseases along with the respective postoperative MRI findings normally seen in clinical practice. CONCLUSION: Radiologists need a solid knowledge of the surgical procedures used to treat patients with cyanotic congenital heart diseases to identify what constitutes normal postoperative findings on MR images and to play an ongoing role in the integral lifelong care of these patients.     

Long bicipital tendon of the shoulder: normal anatomy and pathologic findings on MR imaging.

The tendon of the long head of the biceps muscle (long bicipital tendon) has a complex course from its muscle belly to its insertion onto the supraglenoid tubercle/glenoid labrum. It is stabilized by numerous tendinous and ligamentous structures and is, in turn, partly responsible for maintenance of normal glenohumeral function. In this report we describe the anatomy of this tendon, correlating high-resolution MR images with cryomicrotome sections. We illustrate typical MR findings in pathologic conditions affecting the long bicipital tendon sheath, the substance of the tendon, and finally the tendon position.     

Pathophysiology and imaging in inflammatory and blastomatous synovial diseases

Variable pathologies are subsumed under the term "synovial disease", including common pathologies such as rheumatoid arthritis. While formerly radiologists had to rely on conventional radiographs and bone scintigraphy with their inherent problems in visualizing soft tissue, noninvasive imaging of the synovium has recently improved substantially with the technical development of MRI and (Doppler) ultrasound. These imaging modalities allow differentiation of characteristic pathologic features based on a profound knowledge of normal anatomy and pathophysiology.     

Bronchiolar inflammatory diseases: high-resolution CT findings with histologic correlation

Bronchiolar diseases pose a significant challenge to the clinician confronted with the evaluation and management of the affected patient. A variety of infectious and non-infectious diseases may affect the bronchioles causing either reversible or fixed bronchiolar obstruction. High-resolution CT (HRCT) is currently the best imaging modality for evaluation of small-airway disease. In fact, a wide spectrum of abnormalities are identified at HRCT in patients with bronchiolar diseases. These abnormalities are shown on HRCT in the presence of a normal or unclear chest radiograph. Additionally, HRCT performed at suspended full expiration may demonstrate the physiologic consequences of bronchiolar disease, e. g., air trapping. The differential diagnosis of pulmonary manifestations of bronchiolar diseases at HRCT is based on the different patterns of abnormality. Familiarity with the presentation of different bronchiolar inflammatory processes aid the radiologist in narrowing the differential diagnosis or even in suggesting a specific diagnosis. This article reviews the HRCT findings of various bronchiolar inflammatory diseases outlining their pathologic features. Knowledge of the underlying gross and microscopic pathologic features leads to a better understanding of their CT appearances. Received: 23 January 1998; Revision received: 14 August 1998; Accepted: 10 February 1999     

真菌性鼻─鼻窦炎口鼻道复合体微生态的研究

目的:探讨微生态因素在真茵性鼻─鼻窦炎的病因及治疗学中的意义.方法:选择80例真菌性鼻─鼻窦炎患者,按术前、术后分组,于窦口鼻道复合体采集标本,进行真茵镜检及培养.结果:经统计学分析,术前组与术后备组真菌阳性率统计学差异无显著性意义(P＞0.05).结论:真茵作为条件致病茵在窦口鼻道复合体这一微生态系中可长期存在,FESS术的目的不是直接彻底清除真菌,而是消除真茵赖以生存的低氧微环境,从而达到微创、根治的目的.