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A 48-year-old woman was referred with an anterior midline neck mass which had gradually appeared without tenderness. The patient had a previous history of frequent painful swelling of the anterior part of her neck

diagnostic accuracy of computed tomography in neoplastic invasion of the laryngeal cartilage

Cartilage invasion is important in the management plan of laryngeal and hypopharyngeal neoplasms. This study was conducted to determine the diagnostic accuracy of computed tomography [CT] to detect the neoplastic invasion of the laryngeal cartilages. 37 patients with proved laryngeal or hypopharyngeal neoplasm that were candidates for total laryngectomy were included in this study. For all patients, standard contrast-enhanced laryngeal CT was performed. Two imaging findings were considered as neoplastic invasion of the laryngeal cartilage increased density and chondrolysis. These findings were evaluated in thyroid, cricoid and arytenoid cartilages. Then, all patients underwent total laryngectomy and the cartilages were sent for histopathologic evaluation. The sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios of CT findings were evaluated for the diagnosis of neoplastic invasion of these cartilages. The mean [ +/- SD] age of patients was 61.4 +/- 8.8 [range: 39-76] years. Thirty-four patients were male; 25 had laryngeal tumor and 12 had hypopharyngeal tumor. Totally, 139 cartilages were evaluated [37 thyroid, 37 cricoid and 65 arytenoid cartilages]. Among these cartilages, 49 [16 thyroid, 11 cricoid and 22 arytenoid cartilages] had neoplastic invasion. In thyroid cartilage, the sensitivity of increased density was 0.81 and the specificity of chondrolysis was 0.91; the specificity of both findings together was 0.95. In cricoid cartilage, the sensitivity of increased density was 0.73; the specificity was 0.73; the specificity of chondrolysis was 0.96 and specificity of both findings was 1. In arytenoid cartilage, the specificity of increased density was 0.67; the specificity of chondrolysis was 0.98; and the specificity of both findings together was 1. Considering all 139 cartilages together, the sensitivity of increased density was 0.69 and the specificity of chondrolysis was 0.96. Setting all cartilages in a single group and considering both of these CT findings, the sensitivity was 0.89 and the specificity was 0.76. Chondrolysis is a specific and increased density is a relatively sensitive CT finding for the diagnosis of laryngeal cartilage neoplastic invasion; considering both findings together makes a very specific imaging finding for the diagnosis

Diagnostic accuracy of triplex ultrasound in malignant parotid tumors

The gray scale sonography [GSS] in initial studies and color Doppler sonography in more recent studies have been used for evaluation of parotid tumors. The objective of this study is to evaluate the validity of triplex sonography, i.e., GSS, color Doppler mapping [CDM] and spectral Doppler sonography [SDS] to differentiate the malignant from benign parotid tumors. Fifty parotid tumors were evaluated. On GSS the tumor margin was evaluated and divided into [well-defined] and [ill-defined.] On CDM, tumors vascularity was divided into two groups of [hypovascular] [/= 2 arteries]. On SDS, the peak systolic velocity [PSV] of tumor arterial blood flow was measured. The diagnostic indices [sensitivity, specificity, positive predictive value and negative predictive value] of GSS, CDM and SDS findings alone and in combination were calculated, considering the histopathology results as the gold standard. For PSV, we used the receiver operating characteristic [ROC] curve analysis and calculated the area under the ROC curve. After excisional biopsy and histopathologic examination, 18 out of 50 tumors were malignant and 32 were benign. The sensitivity and specificity of the GSS was 77.8% and 90.6%, respectively. These diagnostic indices for CDM were 83.3% and 87.5%, respectively. The mean +/- SD PSV was significantly higher in malignant tumors than in benign ones [40.1 +/- 9.9 vs 19.1 +/- 4.9 cm/s] [p<0.0001]. For PSV, the area under the ROC curve was 0.98; with a cut-off point of >/= 24 cm/s; the sensitivity was 100% and the specificity was 81.2%. With a cut-off point of >/= 29 cm/s for PSV, the sensitivity was 83.3% and the specificity was 100%. Using a cut-off value of 27.5 cm/s for PSV, the sensitivity and specificity of this modality for differentiation of malignant tumors were 88.9% and 96.9%, respectively. Combining the results of triplex sonography in a scoring system showed a little improvement in the diagnostic indices. The PSV alone and combination of the GSS, CDM and SDS findings are sensitive and specific methods in differentiation of malignant parotid tumors from benign diseases

validity of computed tomography in complicated chronic otitis media

We assessed the validity of computed tomography [CT] in the diagnosis of complicated chronic otitis media [COM]. The findings obtained from a pre-operative high resolution CT of temporal bone including coronal and axial views of 20 patients with complicated COM were compared to their intraoperative findings. In our study, CT was helpful in determining the anatomy of the mastoid and could accurately predict the mastoid air cell aeration, size and status of ossicles, presence of lateral semicircular canal [SCC] fistula and post-auricular fistula [All sensitivities equal to 100%]. But it overdiagnosed the erosion of tegmen [positive predictive value of 50%]. CT was unable to distinguish between cholesteatoma and fluid [abscess or effusion] and granulation tissue or polyps and was also unable to correctly reveal the facial nerve dehiscence and had a low sensitivity for showing erosion of facial canal [50%] and sigmoid sinus [60%] Because most complications resulting from cholesteatoma are caused by bony erosions, CT is helpful in determining the complications of COM. CT can accurately predict the extent of disease and is helpful in detection of some complications such as fistula of Lateral Semicircular Canal [LSC], erosions of dural plate and ossicular erosions. However, it is unable to distinguish between cholesteatoma, mucosal disease and fluid, and little it did contribute to detecting the facial nerve course and dehiscence. It cannot also be used for the diagnosis of the sigmoid sinus problems which could be related to no contrast administration in our study

diagnostic value of computed tomography in determining invasion to carotid arteries by head and neck malignant tumors

Awareness of invasion to the walls of the carotid arteries by malignant tumors, either tumoral mass or metastatic lymph nodes, is of great clinical importance before surgery and can change the management strategy. This study was conducted to assess the diagnostic value of computed tomography [CT] in determining invasion to carotid artery [CA] by oromaxillofacial and neck malignant tumors. CT with contrast was performed in 40 patients who has had oromaxillofacial and neck malignant tumors before surgical intervention. Abnormal CT findings in our patients were categorized into 6 types: I] tumor encasement of carotid arteries >/= 270 degrees; II] tumor encasement of carotid arteries >/= 180 degrees; III] compression and deformation of CA; IV] displacement of CA; V] ill-defined CA wall; and VI] the segmental deletion of fat or fascial planes between tumor and CA. The CT appearances of all tumors were prospectively compared with surgical findings. Abnormal CT findings in our patients included 6 with form I; 17 with type II; 2 with type III; 8 with type IV; 7 with type V; and 33 with type VI. Surgical findings showed that the tumors invaded CA vessels in 13 of 40 patients. The sensitivity, specificity, accuracy and positive and negative likelihood ratio values with 95% confidence interval for type I were 0.31, 0.93, 0.7, 4.15 and 1.3; for type II were 0.62, 0.67, 0.65, 1.8 and 1.7; for type III were 0, 0.93, 0. 63, 0 and 0.93; for type IV were 0.07, 0.74, 0.53, 0.3 and 0.8; for type V were 0.39, 0. 93, 0.69, 5.2 and 1.6; and for type VI were 1, 0.26, 0.50 and 1.35, respectively. Though many CT findings are of value in determining of CA invasion by head and neck tumors, our study demonstrated that encasement >/= 270 degree [type I], ill-defined wall of the artery [type V] and segmental deletion of fat or fascial planes between tumor and CA [type VI] are valuable in determining CA invasion by tumors. However, CT is not a definite way for the diagnosis of CA in-volvement by malignant tumoral lesions

Assessment of the accuracy of paranasal sinuses limited CT scans in the diagnosis of sinusitis

CT scan of paranasal sinuses [PNS] has replaced the standard plain radiography in patients suspected of sinusitis. Since the standard CT scan [SCT] of PNS has high patient x-ray absorption dose, limited CT scan [LCT] of PNS is performed. The purpose of this study is to assess the diagnostic accuracy rate of PNS LCT in cases suspected of sinusitis. This cross-sectional study was performed on 120 patients with paranasal sinuses SCT requested by clinicians to diagnose sinusitis. After interpretation of paranasal sinuses SCT, limited slices consisting of 5 noncontiguous slices of 5 mm thickness in both axial and coronal plains were selected to be interpreted by another radiologist. In this study paranasal sinuses LCT had a sensitivity of 95%, specificity of 92%, positive predictive value [PPV] of 96% and negative predictive value [NPV] of 90%. The limited CT scan in diagnosis of sinusitis has acceptable sensitivity and specificity which indicates a suitable diagnostic value