Recurrence paralysis: computed tomographic analysis of intrathoracic findings]

The long and singular course of the inferior (recurrent) laryngeal nerve makes it very vulnerable to infiltration by tumors of various locations. In particular, mediastinal and pulmonary lesions must be considered in the case of left vocal chord palsy. Recurrent nerve paralysis caused by a tumor indicates advanced disease. We retrospectively reviewed the computed tomography (CT) findings in 29 patients with bronchogenic carcinoma or mediastinal tumors and recurrent nerve paralysis with respect to the site, size and extent of the tumor and the lymph node status. The review revealed a marked predominance of left upper lobe tumors with extensive lymph node metastases to the anterior mediastinum and the aortopulmonary window. The extent of mediastinal involvement exceeded the average involvement in a control group of 30 randomly selected patients with bronchogenic carcinoma at the time of presentation. In all patients CT demonstrated tumor tissue which could have caused the paralysis at one or more sites along the anatomical course of the recurrent nerve. In most cases the tumor was located at the aortic arch. The left paratracheal region, right paratracheal region and right pulmonary apex were affected in one case each. We conclude that in patients with cancer, CT is a suitable method for localizing a recurrent nerve lesion.     

Ventricular volume and cognitive deficit: a computed tomographic study

A group of 35 patients with presumptive diagnosis of Alzheimer disease and 29 normal volunteer spouse controls, all over the age of 60, underwent medical and neurologic evaluation, an extensive psychometric battery, and CT scanning. CT ventricular volume was derived for each CT section by algorithm summation of the number of pixels within a user-defined cerebrospinal fluid range. Composite ventricular volume for each patient, obtained by summation of the individual section ventricular volumes, was corrected for brain size by dividing by the sum of the five largest brain section volumes. For the normal group, composite ventricular volume thus derived was 5.2% and for the impaired group 7.5%; the 44% difference was significant (p less than .009). Increasing ventricular volume was significantly associated with increasing severity of cognitive impairment (p less than .05).     

Jugular foramen: anatomic and computed tomographic study

The computed tomographic (CT) appearance of the jugular foramen was examined in detail, and anatomic and CT sections were correlated. The pars nervosa and pars vascularis were identified, and, with intravenous contrast enhancement, a rapid sequence of scans at a gantry angle of +30 degrees to the canthomeatal line demonstrated cranial nerves IX, X, and XI. The osseous margins of the jugular foramen were best shown by CT at planes of sections parallel and positive (0 degrees - 30 degrees) of the canthomeatal line. CT can be used to evaluate osseous anatomy and the jugular foramen with precision sufficient to confidently exclude an intracanalicular mass.     

喉返神经麻痹的CT表现

目的 分析喉返神经麻痹的CT表现，探讨其解剖和病理形态变化基础，提高对其影像学表现的认识。方法 搜集2001至2003年经临床诊断的喉返神经麻痹患者32例，回顾性分析CT资料。所有患者均行全颈部CT增强扫描，范围从舌骨水平到上胸部水平，层厚及间隔均为5mm。结果 喉返神经麻痹后，CT检查可出现一系列相应表现：杓会厌皱襞、杓状软骨及环杓关节前内侧移位，同侧梨状窝扩张、松弛27例（84．4％）；喉室扩大16例（50．0％）；声带不对称且固定11例（34．4％）等。结论 喉返神经支配除环甲肌以外的所有喉内肌，其麻痹后所支配的肌肉群可以发生去神经性萎缩。CT扫描可以有效地显示其相应改变，同时有助于明确麻痹原因。     

Patterns of skull base fracture: a three-dimensional computed tomographic study

Three-dimensional (3D) computed tomographic (CT) reconstructions were studied retrospectively in 14 patients with skull base fractures. Our aim was to assess the clarity of visualisation and pattern of these fractures. The reformations were obtained from 3 mm thick two-dimensional (2D) CT images. The 2D data stored on optical discs were retrieved and reformatted using the scanner's software. The 3D technique could demonstrate the presence of fractures as well as 2D images. It was of special value in defining the depth and extent of fractures in the floor of the cranial fossae. Undisplaced and displaced fractures could both be demonstrated. Fractures in the anterior fossa run diagonally towards the midline and then cross the cribriform plate of the ethmoid bone. Fractures of the middle fossa run obliquely anteroposterior. Fractures in the lamina papyracea and cribriform plate were difficult to reconstruct due to the the thinness of these bones and threshold definitions. The volume of the 3D block determines the angles suitable for viewing the fractures. In spite of present technical difficulties, the 3D images are of greater anatomical and diagnostic value, particularly in anterior fossa fractures. There is no additional radiation risk to the patient, since reconstructions are made from routine 2D images.     

Demonstration of nerve roots on unenhanced computed tomographic scans

Small foci of high attenuation are seen within the subarachnoid space on high resolution axial transverse computed tomography (CT) of the lumbar spine. By use of reformatted images in oblique planes, these foci form linear structures of high attenuation corresponding to the nerve roots of the cauda equina. Unenhanced CT is therefore capable of demonstrating the nerves of the cauda equina in selected cases.     

Aging, dementia, and brain atrophy: a longitudinal computed tomographic study

Studies involving linear measurements of ventricular size and a volumetric measurement of the cerebrospinal fluid (CSF) space were performed on elderly subjects with mild dementia of the Alzheimer type and on age-matched controls. Forty-five subjects were studied twice at a 1 year interval; linear ventricular measurements showed not only a greater degree but a more rapid evolution of brain atrophy in individuals with mild dementia as compared with controls. An additional 12 normal subjects were studied twice over a 1 year period with volumetric estimates of the CSF space, which demonstrated development of significant brain atrophy within 1 year, while linear measurements on the same scans showed no significant change. The volumetric method is regarded as a more sensitive indicator of brain volume and is potentially useful in further studies in dementia.     

替代神经吻合法治疗喉返神经麻痹的解剖学研究

对３０例喉神经、膈神经颈的解剖观测及利用图象分析仪二维重建技术对相关神经的截面积、纤维数量的测量比较分析，结合有关实验研究资料，设计了在甲状软骨板后下方开窗鱼 甲的肌神经起点处切断该神经，用颈主支与甲杓肌神经吻合，用膈神经与喉下神经吻合，同时重建声带的内收和外展功能，并探讨了其解剖和生理学基础，认为此手术方法 神经麻痹是较理想和可行的。     

Bronchiolitis: computed tomographic findings

Bronchiolitis includes a broad range of conditions with variable clinical, functional and morphological expression. Bronchiolar disease may be a primary or a secondary condition. Non-specific inflammatory changes are observed at the histology examination, involving respiratory and membranous bronchioles with or without extension to the alveoli. CT findings vary from subtle to quite marked abnormalities related to alveolar involvement, including small centrilobular lesions (nodular and branching linear opacities), ground-glass attenuation, and airspace consolidation. All are potentially reversible and treatable. Cicatrization processes may lead to constrictive bronchiolitis, an irreversible condition characterized by circumferential submucosal or periadventitial fibrosis causing an obstruction of the bronchiolar lumen. CT findings include decreased lung attenuation and expiratory air trapping within the areas of bronchiolar obstruction. The contrast with normally ventilated and perfused areas creates a mosaic perfusion pattern.     

Ovarian metastases: computed tomographic appearances

Computed tomographic scans of 34 patients with ovarian metastases were reviewed to assess the radiographic appearances and to correlate these with the primary neoplasms. Primary neoplasms were located in the colon (20 patients), breast (six), stomach (five), small bowel (one), bladder (one), and Wilms tumor of the kidney (one). The radiographic appearance of the metastatic lesions could be described as predominantly cystic (14 lesions), mixed (12 lesions), or solid (seven lesions). There was one false-negative examination which showed no ovarian enlargement, although neoplastic deposits were found on the ovary at laparotomy. The cystic and mixed lesions tended to be larger in overall diameter than the solid. The metastases from gastric carcinoma appeared solid in four of five cases. The metastases from the other neoplasms had variable appearances simulating primary ovarian carcinoma.     

Childhood diskitis: computed tomographic findings

The spectrum of computed tomographic findings in seven children with diskitis is reported. Paravertebral inflammatory masses, intraspinal (epidural) soft-tissue extension with thecal sac deformity, and psoas involvement with abscess were demonstrated in 7/7, 6/7, and 1/7 patients, respectively. Plain radiographic findings of disk space narrowing and vertebral end-plate destruction were confirmed by CT in all cases. Follow-up CT in two patients revealed persistent bone destruction despite resolution of soft-tissue inflammation and clinical abnormalities. CT proved most useful in the diagnosis of early and atypical cases. The CT spectrum of childhood diskitis may simulate other diseases, including neoplasm, tuberculosis, and disk herniation. While CT is not routinely indicated in typical childhood diskitis, it may confirm the diagnosis in those patients with atypical clinical presentation or nonspecific plain radiographs, and exclude other lesions in patients unresponsive to routine treatment.     

Multiseptate gallbladder: computed tomographic appearance

We report a case of multiseptate gallbladder in a 43-year-old female with ultrasonographic and computed tomographic (CT) findings. The postcontrast CT delineated multiple septations with honeycomb appearance in the gallbladder. This finding should raise the suspicion of multiseptate gallbladder.     

Retrosomatic clefts: computed tomographic appearance

A case of bilateral clefts in the pedicles of the L1 vertebra, diagnosed by computed tomography, is presented. The differentiation from other clefts located laterally in the neural arch is briefly summarized, and the possible origin of this entity is discussed. It is improbable that the clefts represent persistent neurocentral synchondroses.