Radiological imaging in primary parotid malignancy.

In a retrospective analysis of the preoperative imaging of patients presenting with primary malignant parotid disease, all relevant images were collected and reviewed by two experienced head and neck radiologists, blinded to the diagnosis. Forty-two patients (25 male, 17 female), median age 67.5 years (range 15-86), were included in the study of which 32 had undergone CT scanning, nine MR and three ultrasound. Forty tumours (93%) were correctly diagnosed as malignant when compared with histology. The two false negatives arose in a patient who had received an ultrasound scan only and in a patient with lymphoma, whose CT scan was reported as a pleomorphic adenoma. Neither had undergone prior radiotherapy. A poorly defined tumour boundary was the most consistent observation for both MR and CT images for the malignant tumours examined. Local infiltration was correctly correlated with pathological findings in eight of the nine MR scans, however, CT proved less reliable, correct in 14 of 24 cases (p=0.01). No correlation was identified between any of the imaging features examined and the final histological diagnosis. A poorly defined tumour boundary with evidence of local invasion was the best indicator of malignancy and was reported more frequently from MR scans than from CT. Imaging alone, however, proved unreliable in the prediction of final histological diagnosis or grade of tumour.

Prediction of the position of the intraparotid portion of the facial nerve on MRI and CT.

Despite developments in imaging technology, visualisation of the intraparotid portion of the facial nerve is not possible. Three separate radiological techniques have been described to predict the position of the facial nerve: Conn's arc; a plane extending posteriorly from the outer surface of the mandibular ramus; and soft-tissue structures, including the posterior belly of the digastric muscle, the retromandibular vein and the lateral border of the masseter muscle. We investigated the reliability of these techniques in predicting the relationship of tumours to the facial nerve. Cross-sectional imaging of the parotid glands was performed prior to the removal of a parotid mass in 26 patients. Twenty patients underwent MRI, and six had CT scans. We removed 14 malignant neoplasms, nine benign lesions and three non-neoplastic lesions. The relationship of the tumour to the facial nerve was assessed radiologically by each of the three techniques, and compared with the findings at surgery. In 18 patients the tumour involved the parotid gland deep to the facial nerve. The above techniques predicted the position of the facial nerve in 69%, 58% and 46% of cases, respectively. When planning parotid surgery, it is important that the surgeon understands the advantages and limitations of the radiological assessment of the position of parotid tumours in relation to the facial nerve.

MRI and malignant melanoma of the parotid gland.

A case is presented highlighting the unusual features and the value of MRI in the assessment of metastatic malignant melanoma of the parotid gland.

MRI appearances of the axilla in treated breast cancer.

Differentiation between recurrent axillary disease and changes due to radiotherapy or surgery has major implications for management in patients following breast cancer treatment, but clinical examination of the axilla may be difficult. This study was undertaken to correlate the MRI appearances of the axilla following breast cancer treatment with clinical outcome. 74 women with treated breast cancer were evaluated by MRI (0.5 T) and the appearances defined by consensus. Outcome was assessed by long-term clinical follow-up. 62 women had symptoms related to the axilla while 12 were scanned to stage the axilla. None of the axillary staging group had abnormal MRI appearances and none of these subsequently developed recurrence. The 62 symptomatic women were subdivided according to MRI appearances. 22 had normal axillary appearances, 18 had an axillary mass and 22 women had abnormal axillary appearances (rated mild, moderate and severe) in the absence of a mass. Normal axillary appearances on MRI excluded recurrent disease as the cause of symptoms with a specificity of 94.7% and a positive predictive value (PPV) of 95.5%. The presence of an axillary mass was commonly but not exclusively due to recurrent disease (sensitivity 68.4%, specificity 88.4%, PPV 72.2%). Sensitivity for diagnosis of axillary recurrence was increased to 89.5% with a specificity of 76.7% if the criteria for recurrent disease were taken as either the presence of an axillary mass or severe axillary changes in the absence of a mass lesion.

Computed tomography scan assessment of lung disease in primary immunodeficiencies.

UNLABELLED: A wide spectrum of lung disease can complicate primary immunodeficiencies and early recognition influences management and prognosis. Computed tomography (CT) especially high resolution computed tomography (HRCT) has been shown to detect lung disease in adult immunodeficient patients often when the chest radiograph (CXR) is normal, but this has not been studied in children. Twenty-five CT scans [10 HRCT] and CXRs were reviewed in 23 children [14 male, 9 female] with primary immunodeficiency. Eighteen [72%] of the CT scans were abnormal, bronchiectasis being the commonest finding present in eight CT scans in patients with antibody deficiency. In eight cases CT scan revealed changes not seen on CXR (bronchiectasis; interstitial changes; small parenchymal nodules; air trapping;and a small upper lobe cyst) which influenced treatment in six cases. CONCLUSION: CT scans have a valuable role in assessing lung disease in children with primary immunodeficiencies and will detect important changes not visible on CXR.

Malignant tumours of the parotid gland: a 12-year review.

Malignant parotid tumours are uncommon and present a significant management challenge. Fifty-one such patients (25 male, 26 female, median age 64 years) operated on in the Newcastle Plastic Surgery Unit between 1983 and 1994 were retrospectively evaluated. Preoperative investigations included FNA cytology (n = 20), and for staging CT and/or MRI scans (n = 21). Of the 35 primary tumours 32 were epithelial and three lymphomatous. Metastatic tumours were squamous cell carcinoma (7), melanoma (6), renal cell carcinoma (2) and sebaceous carcinoma (1). FNA cytology correctly diagnosed malignancy with an 88% sensitivity (false negatives = 2). A total or radical parotidectomy was required in 60% of patients, the rest undergoing superficial parotidectomy. In continuity neck dissection was undertaken in 23 (45%) cases. Postparotidectomy reconstruction included 10 free, 3 myocutaneous, and 4 local transposition/rotation flaps. Thirty-seven patients (73%) received postoperative radiotherapy. Seventy-two per cent of patients are alive after a mean follow-up of 42 months. The crude 5- and 10-year survival rates were 68% and 49% respectively while the loco-regional control rate (Kaplan-Meier method) at 10 years was 79%. Fifteen patients (30%) have permanent facial palsy. It is concluded that radical surgery with appropriate reconstruction followed by planned postoperative adjuvant radiotherapy gives effective control of malignant parotid tumours.

Antibiotic prophylaxis in patients undergoing radiological procedures who are at risk of infective endocarditis--do radiologists know what they are doing?

The British Society for Antimicrobial Chemotherapy has published guidelines recommending that all patients with prosthetic heart valves, or those with a previous history of bacterial endocarditis, should receive prophylactic antibiotics before procedures likely to cause a bacteraemia, due to the potential risk of bacterial endocarditis. The guidelines are widely available, notably in the British National Formulary. Two separate and independent surveys of radiologists in this Region showed that there was poor awareness of these guidelines and their implications for radiology departments.

MRI T staging of squamous cell carcinoma of the oral cavity: radiological-pathological correlation.

Fifty patients with primary or suspected recurrent squamous cell carcinoma of the oral cavity were examined pre-operatively with magnetic resonance imaging (MRI) to determine the tumour stage. Pathological correlation was available in all cases. Twenty-five of 35 patients with primary disease were correctly staged (MR Tstage 0-4). In another four patients there was good size correlation between MR and pathology, but two cases had false positive MR interpretation of bone invasion. MRI has proved accurate at excluding the presence of bone invasion (negative predictive value 97%), but a positive scan may not discriminate between tumour and other dental pathology (positive predictive value 67%). Assessment of local extent was otherwise good with invasion of muscles of the floor of the mouth and muscles of mastication always predicted correctly. Salivary gland abnormality was frequent, and MRI correctly distinguished between obstructive sialectasis and direct invasion. The results of MR staging in patients with recurrent disease were less accurate. Where diagnostic scans can be obtained MRI can provide useful information for the surgeon or radiotherapist regarding the local extent of tumour, and may assist in treatment planning. Assessment of cervical lymphadenopathy can be performed as part of same procedure.

The value of magnetic resonance imaging in the assessment of a sublingual epidermoid cyst.

A case is presented demonstrating the value of magnetic resonance imaging (MRI) in the assessment of a midline sublingual epidermoid cyst in a 22-year-old female. The advantages of MRI compared with CT in the evaluation of soft-tissue lesions in the sublingual space are discussed.

Platyspondylic lethal osteochondrodysplasia: Shiraz type with radiological-pathological correlation.

We report two cases of a platyspondylic lethal osteochondrodysplasia in siblings. The condition affects predominantly the metaphyses of the axial skeleton associated with limb shortening and mild platyspondyly. The radiological and pathological features correlate very closely with Sedaghatian's lethal metaphyseal chondrodysplasia, which has previously been described only in Iranian Nationals. Both the radiological and pathological appearances will be described, together with a discussion of the differential diagnosis, the genetical implications and a review of literature.

Case report: small bowel histiocytosis-X.

A case of histiocytosis-X with gastrointestinal involvement is described in a 4-month-old child presenting with bloody diarrhoea and obstructive symptoms. Diagnosis was made following laparotomy. The child subsequently developed classical multisystem manifestations of the disease.

Two unusual cases of pneumatosis coli.

We present two patients with pneumatosis coli. The first patient demonstrates the variable distribution of gas cysts prior to spontaneous resolution. The second case presented with colonic obstruction due to gas cysts at the recto-sigmoid junction.

A case of necrobacillosis.

A case of empyema due to Fusobacterium necrophorum infection is described. A history of sore throat followed by metastatic abscesses may alert the clinician to the possibility of this unusual infection.

Experience with the Merck small bowel enema tube.

We describe our experience using the Merck 10 French small bowel enema tube in 50 patients. Small bowel intubation was quick and easy to perform, and the tube was well tolerated by our patients. Kinking of the Merck tube was correctable, but prolonged the examination. The examination had to be abandoned in 6% of cases due to retrograde movement of the tube back into the stomach.

Two patients with symptomatic renal metastases.

Two patients with symptoms referable to the urinary tract who were found to have renal metastatic disease are presented. The first case illustrates typical radiological features of metastatic malignancy affecting the kidney. In the second case angiographic features were suggestive of a grossly dilated renal collecting system conflicting with the sonographic appearances of a solid renal mass. At surgery the pelvicalyceal system and proximal ureter were found to be grossly distended with an intraluminal metastasis.