Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma.

AIM: To estimate the sensitivity and specificity of computed tomography used for the detection of extranodal spread of metastatic head and neck squamous cell carcinoma, by experienced head and neck radiologists. MATERIALS AND METHODS: Participants had undergone a neck dissection for head and neck squamous cell carcinoma, together with computed tomography scanning prior to surgery (accessible for reporting). Computed tomography images were independently examined by two experienced head and neck radiologists. Nodal involvement by squamous cell carcinoma and the presence or absence of extranodal spread were recorded. Results were compared to the histological specimen. The sensitivity, specificity and positive predictive value of using computed tomography for the detection of nodal involvement and presence or absence of extranodal spread were estimated, and 95 per cent confidence intervals were calculated. RESULTS AND ANALYSIS: The study analysed 149 neck dissections. When using computed tomography to detect the extranodal spread of head and neck squamous cell carcinoma, radiologists A and B had sensitivities of 66 and 80 per cent, specificities of 91 and 90 per cent, and positive predictive values of 85 and 87 per cent, respectively. DISCUSSION: The sensitivity and specificity of radiological detection of extranodal spread from head and neck squamous cell carcinoma is not well reported in the literature. Accuracy of reporting improves in the hands of experienced head and neck radiologists. This finding has clinical implications for surgical planning and adjuvant therapy requirements.

Atlanto-axial rotatory fixation: improved demonstration using spiral CT.

Atlanto-axial rotatory fixation (AARF) is an uncommon condition which is often missed at presentation because of its rarity and the relative subtlety of plain film X-ray findings, but early detection and appropriate management are vital for a cure. We describe three cases in which the use of spiral computed tomography scanning with 3D and sagittal reconstructions greatly aided diagnosis and management. The 3D images gave a more graphic picture of the overall alignment of the upper cervical spine and the skull base, while the sagittal reconstructions demonstrated the presence or absence of compensatory atlanto-occipital subluxation. The literature is briefly reviewed.

Vertebral osteomyelitis due to Staphylococcus lugdunensis.

We present the first reported case of vertebral osteomyelitis due to Staphylococcus lugdunensis. The infection occurred in an 80-year-old woman who had been taking glucocorticosteroids. S. lugdunensis is a coagulase-negative staphylococcus with considerable potential as a human pathogen. Isolation of this organism should be regarded as significant unless evidence suggests otherwise.

Infra-hyoid metastases in supra-hyoid squamous cell carcinoma.

The CT scans of 71 patients with primary squamous cell tumours of head and neck sites were reviewed and compared with clinical examination in the assessment of lymph nodes above and below the hyoid. Above the hyoid, CT and clinical examination disagreed on the presence or absence of metastases in 13/42 cases (31%); below the hyoid where palpation is presumably easier, there was disagreement in 1 of 10 cases (10%). Abandoning infra-hyoid scans to save scanner time would save only seven slices on average per case and it is possible that further, clinically silent lesions would be missed. We conclude that staging scans in head and neck cancer should continue to include the infra-hyoid region. The inadequacies of existing knowledge based on clinical staging are discussed.

Limited CT scanning techniques of the paranasal sinuses.

Computerized tomographic (CT) imaging provides detailed information on the paranasal sinuses and is now well established as an alternative to standard radiographs. The planning and safety of surgery to the paranasal sinuses is greatly improved by CT imaging. We describe a new CT protocol comprising a limited coronal and axial scan series, based on our experience with the previously described 'CT-Mini-series'.

Giant aneurysm of the petrous carotid artery presenting with facial numbness.

We present the case of a 56-year-old man who complained of numbness in his cheek, and was shown to have a very large partly thrombosed aneurysm of the ipsilateral petrous carotid artery. The radiological findings and differential diagnosis are discussed. Aneurysm of the petrous carotid should be included in the differential diagnosis of any parasellar mass.

Clinical significance of ureteric diameter on intravenous urography after spinal cord injury.

The ureteric diameter on IVU was compared with the MCU findings of reflux or lower urinary tract dysfunction in a group of patients followed up after spinal cord injury. A wide ureter was associated with reflux in 20%, but 8 normal sized ureters on IVU also refluxed--5 of them to a significant degree. In the non-refluxing group, wide ureters were noted more often in patients whose bladder pressures were high and wildly fluctuating than in those with normal bladder pressures. Similarly, the incidence of reflux was higher in patients with high bladder pressures and wild fluctuations of bladder pressure than in those with normal pressures. While a wide ureter on IVU should arouse suspicion that reflux or lower urinary tract dysfunction might be present, these conditions are not necessarily excluded by the finding of a ureter of normal size.