ABSTRACT
Recurrent disk herniation and postoperative scarring are among the major causes of recurrent symptoms after surgery for lumbar disk disease. The myelographic differentiation between these two etiologies is, at best, difficult. To evaluate the role of intravenous contrast enhancement and its impact on making this differentiation using computed tomography (CT), 98 postoperative symptomatic patients were studied prospectively with this technique. Twenty-two patients had subsequent reexploration (23 disk spaces). The unenhanced and enhanced studies of these patients were interpreted independently without surgical information. With contrast enhancement, only three CT studies were considered indeterminate, whereas 10 studies without contrast enhancement were indeterminate. The overall correct diagnosis with contrast enhancement was 17 (74%) of 23, while only 43% of the unenhanced studies yielded the correct diagnosis. Therefore, intravenous contrast enhancement significantly increased the diagnostic accuracy and level of confidence in making the differentiation between recurrent herniated disk and scar.
Subject(s)
Cicatrix/diagnostic imaging , Intervertebral Disc Displacement/diagnostic imaging , Tomography, X-Ray Computed , Humans , Lumbosacral Region , Postoperative Complications/diagnostic imaging , RecurrenceABSTRACT
An anatomical-angiographic classification for carotid-cavernous sinus fistulas is introduced and a series of 14 patients with spontaneous carotid-cavernous sinus fistulas is reviewed to illustrate the usefulness of such a classification for patient evaluation and treatment. Fistulas are divided into four types: Type A are direct high-flow shunts between the internal carotid artery and the cavernous sinus; Type B are dural shunts between meningeal branches of the internal carotid artery and the cavernous sinus; Type C are dural shunts between meningeal branches of the external carotid artery and the cavernous sinus; and Type D are dural shunts between meningeal branches of both the internal and external carotid arteries and the cavernous sinus. The anatomy, clinical manifestations, angiographic evaluation, indications for therapy, and therapeutic options for spontaneous carotid-cavernous sinus fistulas are discussed.
Subject(s)
Arteriovenous Fistula/classification , Carotid Artery Diseases/classification , Cavernous Sinus , Aged , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/therapy , Carotid Arteries/anatomy & histology , Carotid Arteries/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/therapy , Cavernous Sinus/anatomy & histology , Cavernous Sinus/diagnostic imaging , Embolization, Therapeutic , Female , Humans , Male , Middle Aged , Radiography , Rupture, SpontaneousABSTRACT
Benign masseteric hypertrophy (BMH), although an uncommon condition, is important in the differential diagnosis of parotid region masses. We believe CT is the ideal imaging modality for investigating patients with parotid region masses and that it has proved to be most useful in the diagnosis of masseteric hypertrophy. We present three cases of BMH and describe and discuss the CT findings and differential diagnosis of parotid region masses.
Subject(s)
Masseter Muscle/pathology , Masticatory Muscles/pathology , Tomography, X-Ray Computed , Adult , Aged , Female , Humans , Hypertrophy/diagnostic imaging , Male , Masseter Muscle/diagnostic imaging , Middle AgedABSTRACT
Three patients with cervical radicular symptoms and normal metrizamide myelograms underwent thin-section high-resolution computed tomographic scanning because of a strong clinical suspicion of herniated disk. Herniated disk was demonstrated in all three cases. In two, the disk protrusions were recognized only by computed tomographic myelography, and in the third case, the diagnosis was made with plain computed tomography and confirmed by computed tomographic myelography.
