Olfactory anomalies in CHARGE syndrome: imaging findings of a potential major diagnostic criterion.

BACKGROUND AND PURPOSE: CHARGE syndrome is a genetic disorder resulting in the association of multiple congenital anomalies. Although a high prevalence of olfactory anomalies in CHARGE syndrome has been reported in autopsy and functional studies, to our knowledge, such anomalies have not been included among the diagnostic criteria, and their radiographic prevalence has not been assessed. The purpose of this research was to determine the radiographic prevalence of olfactory anomalies in a small sample of subjects with diagnosed CHARGE syndrome. MATERIALS AND METHODS: The medical records and high-resolution MR images (section thickness < or =3 mm and in-plane resolution < or =1 mm) in 10 patients with clinically proved CHARGE syndrome were retrospectively reviewed by 3 neuroradiologists who consensually evaluated the status of the olfactory bulbs and sulci as either normal, hypoplastic, or absent. The prevalence (p) of congenital anomalies found in the medical records and of the olfactory structures was calculated with a 95% confidence interval (CI). RESULTS: MR imaging demonstrated olfactory anomalies in all 10 patients, including either absence or hypoplasia of the olfactory bulbs and olfactory sulci (p, 100%; CI, 0.65-1.00). CONCLUSION: These findings suggest that olfactory abnormalities detectable on high-resolution MR imaging are among the most prevalent features of CHARGE syndrome.

False-positive positron-emission tomography-CT of a Teflon granuloma in the parapharyngeal space occurring after treatment for a patulous eustachian tube.

This report presents a 55-year-old woman who underwent 2 Teflon injections in 1971 for a patulous eustachian tube. The patient returned in 2006 with a bloody left otorrhea. A positron-emission tomography-CT scan demonstrated a 2-cm hypermetabolic parapharyngeal mass, initially interpreted as a skull base tumor. Repeat neck CT confirmed a 2-cm hyperattenuated left parapharyngeal granulomatous mass. This is the first reported case of a Teflon granuloma presenting as a false-positive parapharyngeal mass.

Radiologic differentiation of intraocular glass: evaluation of imaging techniques, glass types, size, and effect of intraocular hemorrhage.

OBJECTIVE: The accurate detection of intraocular foreign bodies is critically important in treating ocular trauma. The purpose of this study was to evaluate the efficacy of CT, MR imaging, and sonography in detecting seven types of glass varying in size and placed in three locations in the globe, and to examine the effect of intraocular hemorrhage. MATERIALS AND METHODS: Glass pieces were cut into 1.5-, 1.0-, and 0.5-mm pieces and implanted on the corneal surface and the anterior and posterior chambers of 42 fresh porcine eyes. Twenty-one eyes were scanned comparing axial CT, helical CT, and MR imaging. The remaining 21 eyes were scanned using helical CT and sonography after implantation in a simulated human skull before and after placement of blood in the anterior chamber (hyphema). RESULTS: Detection rates were 57.1% for helical CT, 41.3% for axial CT, and 11.1% for T1-weighted MR imaging (n = 63 fragments). Results were significant (p < 0.0001). Sonography detected 43% of glass fragments in the posterior chamber and 24% in the anterior chamber. Detectability was greatest for green beer bottle glass (90.3%) and least for spectacle glass (43.1%) (p < 0.0001). Detection rates for size ranged from 96.2% at 1.5 mm to 48.3% at 0.5 mm, which was also significant (p < 0.0001). On helical CT, anterior chamber glass was easiest to detect (91.7%) and corneal surface glass the most difficult (64.9%). Hyphema made no statistical difference (p < 0.0001). CONCLUSION: Helical CT was the most sensitive imaging modality for the detection of intraocular glass. The sensitivity of detection was unaffected by hyphema but was determined by the type of glass, size, and location.

Tumefactive fibroinflammatory lesion of the neck with progressive invasion of the meninges, skull base, orbit, and brain.

SUMMARY: Tumefactive fibroinflammatory lesions of the head and neck are rare. CNS involvement has not been reported. We present a histologically proven case of a tumefactive fibroinflammatory lesion that originated in the left side of the neck and progressed over 2 years to involve the meninges, the cavernous sinuses, the right temporal lobe, and the right orbit. The lesion caused destruction of the skull base and a subdural hematoma. The relationship of the present lesion to idiopathic hypertrophic pachymeningitis and Tolosa-Hunt syndrome is discussed.

Early diagnosis and endovascular interventions for ischemic stroke.

In recent years there have been formidable advances in the war against stroke. The understanding and detection of stroke have undergone major progress at a rate previously unseen, partly due to major contributions from neuroradiology. Current routine neuroradiologic evaluation of acute stroke relies mainly on computed tomography scanning, although a number of radiologic modalities are becoming available that are based on various physical and chemical tissue properties, such as magnetic resonance imaging, single photon emission computed tomography, positron emission tomography, and magnetic resonance spectroscopy. All these new techniques allow the study of nervous tissue at the cellular and biochemical levels. A review of current diagnostic techniques for stroke follows in the first part of this article. The current status of endovascular therapy for ischemic stroke is reviewed in the second part of this article.

Persistent intrahepatic right umbilical vein: a prenatal sonographic series without significant anomalies.

Umbilical venous anatomy variation is considered extremely rare. The intrahepatic persistent right umbilical vein represents one version in the spectrum of umbilical vein variations. Prior reports of a prenatally diagnosed persistent right umbilical vein suggest it is strongly associated with severe fetal anomalies including congenital heart disease and gastrointestinal malformations. Our experience contrasts with these findings. Nine cases of intrahepatic persistent right umbilical vein were identified via prenatal sonography between July 1992 and January 1994. The gestational ages of the fetuses ranged from 20 to 36 weeks. Targeted fetal surveys were performed in all nine fetuses and formal fetal echocardiograms were obtained in six. All nine infants have been delivered. In nine cases, the intrahepatic persistent right umbilical vein was an isolated observation with no abnormalities identified pre- or postnatally except one case of hypospadias. Formal fetal echocardiography was normal in all six of the fetuses studied. Given previous reports describing a high risk of congenital malformations in association with the presence of a persistent right umbilical vein, the sonographic finding of this anomaly should still prompt targeted fetal sonography and fetal echocardiography. However, our series indicates that this vascular variant may occur as an isolated abnormality and may not necessarily represent the ominous finding suggested previously.

Focal amyloidosis of the head and neck: evaluation with CT and MR imaging.

Localized amyloidosis of the head and neck was found retrospectively in the nasopharynx (n = 3) and orbit (n = 1) of four female patients (mean age, 32 years), three of whom had a prior history of antigenic stimulation. In all patients, computed tomography revealed a slightly high absorption and a relatively homogeneous, partially calcified mass. In the one patient who underwent magnetic resonance (MR) imaging, a distinctive loss of signal intensity was seen on the long repetition time/echo time sequence. This enhanced T2 relaxation may be due to (a) static or slowly fluctuating internal magnetic fields arising from adjacent amyloid protons held in relatively fixed positions within the beta-pleated sheet, resulting in quick phase dispersion; (b) chemical exchange and spin-spin interaction with adjacent water protons; and (c) diffusion through differences in diamagnetic susceptibility. This unusual appearance at MR imaging may improve the ability of radiologists to distinguish focal amyloidosis from many other diseases that affect the head and neck.