Uncommon and rare causes of vocal fold paralysis detected via imaging.

BACKGROUND: Cross-sectional imaging can be used to trace the course of the vagus nerve and its laryngeal branches to detect many of the causes of vocal fold paralysis. The most frequent aetiologies are surgical injury and tumoural involvement of the recurrent laryngeal nerve anywhere along its course. METHOD: This review article focuses on the uncommon and rare causes of vocal fold paralysis that have been detected or diagnosed on cross-sectional imaging. RESULTS AND CONCLUSION: Uncommon causes included a tortuous oesophagus, tracheal diverticulum, cervical osteophytes and cardiovocal syndrome. These examples are presented with clinical case histories and radiological appearances, and are discussed in the context of the current literature.

Advances in imaging of obstructed salivary glands can improve diagnostic outcomes.

INTRODUCTION: Obstruction of the major salivary glands is a relatively common condition defined as the blockage of the salivary outflow in the glandular ductal system. It can however mimic more aggressive pathology. METHODS: The most common cause of salivary obstruction is sialolithiasis, followed by ductal strictures. Salivary obstruction is clinically characterized by a food-related painful swelling of the affected gland, known as 'mealtime syndrome'. RESULTS: When obstruction is clinically suspected, the role of imaging consists of confirming the obstruction, identifying its cause, evaluating the position and extent of the obstruction and evaluating for associated complications. However, if imaging shows up signs of a tumour or other pathology which can mimic an obstructed gland clinically instead, the radiologist can alert the clinician accordingly to change the course and plan of treatment. Several imaging techniques are available for investigating the obstructed salivary glands. CONCLUSIONS: This review looks at the causes of obstruction and the use, diagnostic performance and practicality of the various imaging modalities. Importantly, an imaging approach algorithm for the evaluation of the obstructed salivary gland is also proposed.

[Dynamic magnetic resonance imaging in the diagnosis of tumors and pseudotumors of the musculoskeletal system]. / Resonancia magnética dinámica en el diagnóstico de las lesiones tumorales y seudotumorales del sistema musculoesquelético.

The greater temporal resolution provided in ultrafast dynamic contrast-enhanced magnetic resonance imaging sequences makes it possible to know the physiological phenomenon of the distribution of the contrast material through a time-signal intensity curve. Analyzing these curves enables us to deduce information relevant to the vascularization and perfusion of tissues, capillary permeability, and the interstitial space in the tumor. A steep curve with early washout in a space-occupying lesion greatly increases the possibility of histological malignancy, although this type of curve is not rare in benign lesions and relatively flat curves are not rare in malignant tumors. Nevertheless, dynamic studies of the uptake of contrast material provide important information for the characterization of neoplasms that, together with the usual signs, can help to differentiate between benign and malignant tumors of adipocyte, chondroid, or neural lineage, clearing up diagnostic uncertainty in certain benign lesions such as osteoid osteoma and ischemic musculoskeletal disease. Furthermore, it enables the accurate determination of the response to chemotherapy, detecting recurrence within the treated tumor early, delimiting more precisely the margins between the tumor and peritumoral edema, and helping in diagnostic planning by determining the most vascularized areas of the tumor, which are more likely to be malignant.

Resonancia magnética dinámica en el diagnóstico de las lesiones tumorales y seudotumorales del sistema musculoesquelético / Dynamic magnetic resonance imaging in the diagnosis of tumors and pseudotumors of the musculoskeletal system

La mayor resolución temporal que ofrece la secuencia de imágenes ultrarrápidas de la resonancia magnética contrastada dinámica (RMD), permite conocer el fenómeno fisiológico de la distribución del contraste mediante una curva de intensidad de señal-tiempo (TIC), de cuyo análisis puede deducirse información relevante sobre la vascularización y perfusión tisular, la permeabilidad capilar y el espacio intersticial del tumor. El hallazgo de una curva de pendiente elevada con lavado precoz de contraste en una lesión ocupante de espacio aumenta sensiblemente la posibilidad de malignidad histológica, aunque no es raro el hallazgo de curvas de este tipo en lesiones histológicamente benignas y de curvas de perfil relativamente plano en tumores de reconocida malignidad. A pesar de todo, los estudios dinámicos de captación pueden aportar información de gran interés en el proceso de caracterización de las lesiones neoformativas, ayudando a los restantes datos semiológicos habituales a diferenciar las formas malignas de las benignas en las tumoraciones de estirpe adipocítica, condroide o neural, confirmando dudas diagnósticas en determinadas lesiones benignas como el osteoma osteoide y la patología isquémica osteomuscular, permitiendo determinar con precisión el grado de respuesta a la quimioterapia, detectando con precocidad la recidiva en el seno del tumor tratado, delimitando con mayor exactitud los márgenes del tumor frente al edema peritumoral y ayudando a la planificación diagnóstica al determinar las áreas más vascularizadas y, por tanto, más probablemente malignas del tumor (AU)

The greater temporal resolution provided in ultrafast dynamic contrast-enhanced magnetic resonance imaging sequences makes it possible to know the physiological phenomenon of the distribution of the contrast material through a time-signal intensity curve. Analyzing these curves enables us to deduce information relevant to the vascularization and perfusion of tissues, capillary permeability, and the interstitial space in the tumor. A steep curve with early washout in a space-occupying lesion greatly increases the possibility of histological malignancy, although this type of curve is not rare in benign lesions and relatively flat curves are not rare in malignant tumors. Nevertheless, dynamic studies of the uptake of contrast material provide important information for the characterization of neoplasms that, together with the usual signs, can help to differentiate between benign and malignant tumors of adipocyte, chondroid, or neural lineage, clearing up diagnostic uncertainty in certain benign lesions such as osteoid osteoma and ischemic musculoskeletal disease. Furthermore, it enables the accurate determination of the response to chemotherapy, detecting recurrence within the treated tumor early, delimiting more precisely the margins between the tumor and peritumoral edema, and helping in diagnostic planning by determining the most vascularized areas of the tumor, which are more likely to be malignant (AU)