Validity and sensitivity to change of the extended Glasgow Outcome Scale in mild to moderate traumatic brain injury.

Using a structured outcome interview, this study addressed the validity and sensitivity to change of the Glasgow Outcome Scale (GOS) and the Extended GOS (GOSE) in a prospective study of patients who sustained mild (n = 30) to moderate (n = 13) traumatic brain injury (TBI) or general trauma (n = 44). The patients were recruited from the emergency center or inpatient units of Ben Taub General Hospital and invited to participate in follow-up examinations at 3 and 6 months. Using a series of functional outcome measures, assessment of affective status, and neuropsychological tests as criteria, the validity of the GOSE generally exceeded the GOS. Analysis of the outcome data for the patients who completed both the 3-month and 6-month assessments disclosed that the GOSE was more sensitive to change than the GOS. Comparison of the 3-month outcome data disclosed that the GOSE and GOS scores did not differ for the TBI and general trauma groups. These findings lend further support for utilization of the GOSE in clinical trials when it is based on a structured interview.

Acute temporal bone trauma: utility of high-resolution computed tomography.

OBJECTIVE: To determine the clinical utility of high-resolution computed tomography (HRCT) for temporal bone trauma evaluation and management. STUDY DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS: Patients (n = 105) with evidence of temporal bone trauma. MAIN OUTCOME MEASURES: Statistically significant associations between HRCT, clinical, audiometric, and head CT findings, and management decisions; role of HRCT in management decisions. RESULTS: Statistical analysis demonstrated poor association between specific clinical and HRCT findings, and between HRCT findings and management decisions. The HRCT complemented decision making in 10% of cases and revealed asymptomatic carotid canal fractures in 9% of cases. CONCLUSION: Routine HRCT yields minimal clinical utility. Selective use of HRCT may complement decision making, but patient management is predominantly influenced by other factors. Although angiography was performed in cases of asymptomatic carotid canal fractures, no clinical utility for this practice was demonstrated. An algorithm for temporal bone trauma evaluation and management is presented.

Triple-dose contrast-enhanced images in neurologically symptomatic HIV-positive patients.

Our purpose was to determine whether triple-dose delayed contrast-enhanced images would improve lesion detection in patients with symptomatic human immunodeficiency virus (HIV) infection. We reviewed 33 MRI studies on 29 patients. Single-dose immediate T1-weighted spin-echo (1x-T1) images were compared with delayed triple-dose images (D3x-T1). Two neuroradiologists decided which technique showed more lesions, increased lesion conspicuity and/or altered the radiologic diagnosis. The D3x-T1 technique improved lesion detection in 14 of 29 patients (48%). In two patients (7%), the improvement changed the radiologic diagnosis by showing new meningeal lesions.

Severity staging in chronic sinusitis: are CT scan findings related to patient symptoms?

Chronic sinusitis is a prevalent problem. The symptoms of CS cause patients to seek medical attention, and therefore the presence of symptoms drives the use of health care resources. There is widespread clinical belief that computed tomography (CT) scan findings may be a reasonable proxy for disease severity in chronic sinusitis, and many authors have proposed that CT scan findings make up the key component in severity staging systems for chronic sinusitis. However, the relationship between symptom severity and CT scan findings in chronic sinusitis has not been well explained to date. To explore this relationship further, we examined data from consecutive patients with both a CT scan and a sinusitis symptom score, from ongoing prospective outcomes studies at two large academic centers in different cities (n = 254). CT scans were graded using two validated staging systems; symptom severity was assessed using two validated health status instruments and summary items. In addition, we explored multiple statistical modifications and permutations of CT staging to identify potential relationships between the two variables. In summary, no association between CT scan findings and symptom severity could be identified using both CT staging systems and patient-based symptom instruments. For instance, CT scans were examined: after eliminating normal scans, using different scoring algorithms, by worst side, by nonlinear association, when grouped into strata, and by eliminating patients with very severe disease; no statistical association was found between CT findings and patient-based symptoms using any of those techniques. Since symptom severity is a pivotal outcome measure in chronic sinusitis, these findings have significant implications for outcomes research and the development of severity staging systems.

Intradural-extramedullary spinal cysticercosis: MR imaging findings.

A rare case with intradural-extramedullary cysticercosis is presented here. MR imaging with and without gd-DTPA were performed. There were multiple cysts in the basal cistern, cisterna magna, and cervical subarachnoid space which were isointense with cerebrospinal fluid both on T2- and T1-weighted images. Swelling and increased signal intensity in the cord parenchyma were detected on T2-weighted images. Gadolinium enhanced studies showed rim-shaped enhancement in the cysts and irregular, diffuse enhancement in the meninges.

Spinal disease in neurologically symptomatic HIV-positive patients.

We review the MRI findings of human immunodeficiency virus (HIV)-positive patients with "spinal" symptoms and review the literature. In 23 consecutive HIV-positive patients presenting with acute neurologic complaints thought to be referable to the spine, we reviewed spinal MRI, medical charts, and laboratory, pathologic, and autopsy data. In the early stages of HIV infection, the common causes of spinal complaints (i. e., degenerative spine and disc disease) predominated. However, pathology may be missed without contrast-enhanced MRI of the spine. In more advanced cases, the differential diagnosis includes one or more neoplastic and/or infectious causes which require contrast-enhanced MRI for detection. In these cases, normal cerebrospinal fluid findings should not preclude contrast-enhanced MRI of the spine. Imaging of the brain may also be indicated in cases when the spinal study is negative.

In vivo CT and MR appearance of prosthetic intraocular lens.

PURPOSE: We present the first in vivo CT and MR imaging description of intraocular lenses (IOLs), which are commonly encountered in elderly patients who have undergone cataract surgery. METHODS: A retrospective review was done of the imaging studies of 20 patients (22 eyes) with IOLs and of three patients (four eyes) with aphakia. CT and MR studies were performed with standard clinical protocols. RESULTS: Sixteen patients with 18 posterior IOLs underwent six CT and 43 MR studies. Four patients with four anterior IOLs had one CT and eight MR studies. The exact position of the optic portion of the IOL could be optimally determined on CT scans with 1-mm-thick sections and on fat-saturated fast T2-weighted MR orbital coil studies performed on a 1.5-T imager. The haptics could not be distinguished from the ciliary body. Three patients with aphakia had eight MR and two CT studies. Aphakia was difficult to identify if the image thickness was greater than the diameter of the pupil (2.5 to 4.0 mm). CONCLUSION: The optic portion of an IOL is visible on either high-quality CT or MR studies. However, the haptic portion is not visible on clinical in vivo images.

Optimal imaging protocol after intraocular silicone oil tamponade.

PURPOSE: Our purpose was to define the optimal protocol for imaging of the orbits after vitreous humor replacement with silicone oil. METHODS: Eleven eyes in 10 patients with tractional and/or rhegmatogenous retinal detachment were studied. Five CT scans and 18 high-field (1.5 T) MR images were obtained. Standard T1-weighted, T1-weighted with fat and silicone saturation, fast spin density-weighted, and T2-weighted orbital MR sequences were performed. Unique pulse sequences included fast spin density-weighted and T2-weighted imaging with and without fat saturation or silicone saturation, gradient-echo imaging, and short-tau inversion recovery imaging. RESULTS: The T1-weighted MR and CT studies were comparable in displaying the silicone. However, the fat- or silicone-saturated fast T2-weighted sequences always showed the fibrous bands and subretinal fluid to best advantage. In one case, the eye also contained inadvertently retained perfluorocarbon liquid, which blended with silicone oil on both saturated images, requiring companion T1-weighted sequences without saturation to demonstrate its presence. CONCLUSION: Simple, commonly available fat-saturated fast T2-weighted MR images supplemented by standard T1-weighted images are all that are needed to evaluate the eye efficiently after vitrectomy and tamponade.

Clinical and magnetic resonance imaging features of Gradenigo syndrome.

PURPOSE: To describe the clinical and magnetic resonance imaging findings of a patient with Gradenigo syndrome. METHODS: A 4 1/2-year-old boy developed Gradenigo syndrome with unilateral facial pain, ophthalmoplegia, and facial weakness secondary to ipsilateral otitis media. The clinical, laboratory, and radiologic findings are discussed. RESULTS: The patient was treated with antibiotics and had complete resolution of symptoms and signs. CONCLUSION: Ophthalmologists should be aware of the potential for petrosal involvement of cranial nerves secondary to otitis media and Gradenigo syndrome.

Artifacts and pitfalls in MR imaging of the orbit: a clinical review.

High-resolution magnetic resonance (MR) imaging of the orbit has become widely accepted as a valuable diagnostic technique. However, there are a number of artifacts and pitfalls associated with orbital MR imaging. Chemical shift artifacts may be induced by orbital fat or silicone oil used to treat retinal detachment. Motion artifacts are caused primarily by unavoidable globe motion during imaging. Artifacts due to a nonuniform magnetic field are particularly noticeable at air-tissue interfaces but may also be caused by incomplete fat saturation or highly magnetic materials near the orbit. Protocol errors may cause artifacts such as saturation, phase wraparound, truncation, shading, and partial-volume artifacts. This information can be used to improve orbital image quality and avoid misinterpretation of image artifacts. Use of fat saturation, silicone saturation, and careful patient screening for metal near the eyes and instruction to reduce motion can help reduce the occurrence of artifacts. In addition, optimal imaging technique is essential and should include use of proper surface coils, plane of section, and pulse sequences.

Imaging the temporal fossa.

OBJECTIVE: The purpose of our study was to delineate the interconnections in the temporal fossa that are visible on high-resolution clinical images. SUBJECTS AND METHODS: Thin-section MR images and CT scans of the temporal fossa in two normal volunteers were obtained in coronal and axial sections. MR images, CT scans, or both of 20 patients with demonstrable spread of disease were reviewed. RESULTS: The imaging studies of patients with disease proved more informative than images of the normal subject or the published anatomic and surgical descriptions of the temporal fossa. We recognized five discrete radiographically defined regions: the connective tissue layer, compartment of the superficial fat pad, compartment of the deep fat pad, compartment of the temporal muscle (superior recess of the suprazygomatic masticator), and subperiosteal zone. Important, tortuous, and to our knowledge undescribed interconnections between the scalp, posterior neck, eyelid, face, and the suprazygomatic masticator were delineated. CONCLUSION: Imaging studies of the temporal fossa can be used to formulate a clinically useful approach that simplifies the complex anatomy of the temporal fossa.

MR imaging of the eyelids: normal and pathologic findings.

MR imaging is commonly used to evaluate orbital and facial soft-tissue disease. Although the eyelids are visible on these images, the radiographic appearance and the detailed anatomy of these structures has received little attention in the literature [1-4]. Anatomic correlation with MR images may be extremely helpful in the accurate interpretation and staging of eyelid malignancies and infections.