ABSTRACT
Despite advances in technology, the radiologic assessment of certain head and neck lesions may still pose difficulties because of the complex anatomy of this region, the small and mobile structures that this region harbors, and the apposition of mucosal surfaces in the neutral position. Certain maneuvers have been described in the literature to overcome these difficulties. We review the use of the Valsalva and the modified Valsalva maneuver, the puffed-cheek technique, phonation, and inspiration, with possible applications in head and neck imaging.
Subject(s)
Head and Neck Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Diagnosis, Differential , Humans , Inhalation/physiology , Phonation/physiology , Respiratory Physiological Phenomena , Valsalva Maneuver/physiologyABSTRACT
OBJECTIVE: To determine the clinical utility of using dynamic maneuvers during imaging of larynx via 256-Slice Multi-Detector Computed Tomography in the pre-therapeutic evaluation of laryngeal tumors. MATERIALS AND METHODS: A total of 27 patients (7 women, 20 men; aged 53-76 years) diagnosed with laryngeal squamous cell carcinoma were evaluated pre-therapeutically via contrast enhanced axial CT scans during consecutive phases of phonation (PP), inspiration (IP) and Valsalva maneuver (VP). RESULTS: In 2 of 5 patients diagnosed with T1a glottic tumor, scans obtained during VP and PP were normal while the CT scans obtained during IP clearly showed a mass. In all patients (27/27) PP provided visualization of the ventricle, on coronal plane images and the pyriform sinus apices, on axial plane images. Involvement of the anterior commissure was best assessable on axial plane IP images (sensitivity 93%, specificity 92%). In cases of stage T1-T3 tumors use of dynamic maneuvers during laryngeal CT imaging showed the location and extension of the tumor better than the single phase CT scans did. We did not find a significant improvement in the pre-therapeutic evaluation in stage T4 tumors. CONCLUSION: Providing markedly clearer and more detailed evaluation of mucosal surfaces and deep structures of the larynx and mobility of the cords than do conventional scans, use of dynamic laryngeal maneuvers during laryngeal CT imaging seems to be an useful alternative in the pre-therapeutic assessment of laryngeal tumors.
Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Image Enhancement/methods , Laryngeal Neoplasms/diagnostic imaging , Larynx/diagnostic imaging , Speech Production Measurement/methods , Tomography, X-Ray Computed/methods , Aged , Early Diagnosis , Female , Humans , Male , Middle Aged , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Congenital vascular variants involving the temporal bones are rare. Awareness of these variants is important as they may mimic glomus tumors or complicate middle ear surgery. We present a case of a persistent stapedial artery associated with an aberrant carotid artery in the left temporal bone, which is highlighted in computed tomography imaging findings. We further discuss a possible relationship between hypoplasia of the A1 segment of the anterior cerebral artery and this congenital variant.
