Evaluation of the patient with hoarseness.

Hoarseness has a broad range of etiologies, and in most cases a diagnosis can be made by recording an accurate history and by conducting a thorough physical examination. This paper will present an overview of the more common voice disorders and explain in which cases imaging studies such as computed tomography or magnetic resonance imaging are necessary. The essential imaging features will be discussed.

Tumoural perfusion as measured by dynamic computed tomography in head and neck carcinoma.

PURPOSE: To investigate the intra- and interobserver variability, as well as the intra- and interpatient variability of CT-determined tumour perfusion in head and neck tumours, and to evaluate the preliminary value of this parameter as predictive factor of local failure after treatment by definitive radiotherapy. MATERIALS AND METHODS: In 41 patients the perfusion of a primary head and neck squamous cell carcinoma was estimated using dynamic CT. A 40-ml intravenous bolus of a low-osmolar non-ionic contrast agent was rapidly injected over 5 s (8 ml/s), while a dynamic acquisition of image data was obtained during the first pass at the level of the largest axial tumour surface. A time-density curve was constructed for the primary tumour and the carotid artery. The perfusion in the selected tumour region of interest was calculated by dividing the slope of the tumour-time density curve by the maximal value in arterial density. Tumour volume was calculated on the CT-images and correlated with perfusion rate. RESULTS: The mean perfusion rate was 86.4 ml/min per 100 g (median, 80.6; SD, 43.05; range, 31.7-239.8 ml/min per 100 g). No systematic difference was found between the measurements performed by two independent observers. The intratumoural COV was 0.22, the intertumoural COV 0.37. No correlation was found with tumour volume. Ten out of 20 patients with a perfusion rate < 80 ml/min per 100 g were not locally controlled, while nine out of 21 patients with a value > 80 ml/min per 100 g did show a local failure (P = 0.19). CONCLUSIONS: CT-determined perfusion measurements of head and neck tumours are feasible. No correlation with tumour volume and a sufficiently large COV were found to consider this parameter as a possible prognostic factor for outcome after radiotherapy. More patients need to be investigated to test the hypothesis that tumours with a low CT determined perfusion rate have a higher risk of local failure.

MRI screening for acoustic neuroma without gadolinium: value of 3DFT-CISS sequence.

To evaluate the efficacy of a gradient-echo sequence (3DFT-CISS) in the diagnosis of acoustic neuromas, two independent observers twice reviewed the images of the temporal bones of 83 patients. Contrast-enhanced T1-weighted spin echo images were used as the reference, showing 18 acoustic neuromas, including 5 purely intracanalicular and one intralabyrinthine tumours. High sensitivity (89-94%), specificity (94-97%) and accuracy (94-95%) were found. Intraobserver (kappa 0.93-1) and interobserver (kappa 0.83-0.84) reproducibility were very good. The smallest intracanalicular tumour was overlooked twice by both observers; the intralabyrinthine tumour once by one observer. All tumours were detected with a less stringent decision criterion, at the expense of lower specificity.

Non-invasive tumour perfusion measurement by dynamic CT: preliminary results.

In 18 patients the perfusion of a malignant head and neck tumour was estimated using contrast enhanced dynamic computed tomography. The mean estimated perfusion was 75.5 ml/100 g/min, varying between 27.9 and 131.9. Eleven patients were treated with radiation therapy; the obtained perfusion rates were significantly different between tumours with a favourable and those with an unfavourable early outcome.

Image interpretation in CT of laryngeal carcinoma: a study on intra- and interobserver reproducibility.

The object of our study was to evaluate the intra- and interobserver reproducibility of the interpretation of CT examinations of laryngeal carcinoma. The CT examinations of 100 laryngeal cancers were retrospectively reviewed twice by two independent reviewers. Involvement of different structures was assessed, using a standard scoring form. Statistical analysis was done using the Wilcoxon signed rank test and Cohen's kappa. A borderline significant difference between the observers (p < 0.04) was present. Fair to substantial intraobserver reproducibility (kappa = 0.29-0.86), and fair to substantial interobserver reproducibility (average kappa = 0. 26-0.74) were found for most laryngeal structures when a dichotomous categorical scale was used. On the average somewhat lower, but still fair to substantial, intraobserver (kappa = 0.36-0.72), and fair to moderate interobserver (average kappa = 0.29-0.47) reproducibility, were found when a nominal or ordinal categorical scale was used. In conclusion, the interpretation of CT images of laryngeal tumors is reproducible.

Imaging of maxillo-facial trauma.

The maxillofacial skeleton is vulnerable to injury. Radiological evaluation of facial injury can be difficult due to the complex anatomy and the difficulties in obtaining high-quality imaging studies in the severely traumatised patient. Adequate imaging is nevertheless necessary to obtain satisfactory clinical results. This paper gives a review of common and some less common injuries that may be encountered in facial trauma.

First branchial complex anomalies: report of 3 cases.

Three cases of first branchial cleft anomalies are presented. The embryology and pathology of first branchial complex anomalies, their imaging characteristics and differential diagnosis are discussed.

Volume estimation of the preepiglottic and paraglottic space using spiral computed tomography.

The purpose of this study was to estimate the volume variability of the preepiglottic and paraglottic space in the normal larynx. In 23 adult patients (12 women, 11 men), a spiral CT acquisition through the larynx was obtained. No laryngeal pathology was observed. The area of the this submucosal fat space was estimated on each slice by semi-automatic segmentation; the volume was calculated by the summation-of-areas technique. The obtained volumes were correlated with body area, body mass index and gender. The mean estimated volume of the preepiglottic and paraglottic space was 2.8 ml (SD 1.7 ml, range 0.7-5.9). No correlation with body mass index (p = 0.6), but a significant correlation with body area (p < 0.001) was found. A significant volume difference was present between men (mean 4.5 ml, SD 1.0 ml, range 2.8-5.9) and women (mean 1.4 ml, SD 0.5 ml, range 0.7-2.4)(p < 0.0001). Multiple regression analysis showed gender (p < 0.0001) to be a more important variable than body area (p = 0.17) in predicting the volume of the preepiglottic and paraglottic space. In conclusion, the volume of the preepiglottic and paraglottic space appears to be very variable, and should only be analysed with consideration of the gender of the examined subjects.

Imaging features in 35 cases of submucosal laryngeal mass lesions.

We evaluated the clinical and radiological findings in 35 patients with submucosal laryngeal masses. The presenting symptoms were hoarseness, stridor, dysphagia and external neck mass. In 20 cases an important delay between the onset of symptoms and direct laryngoscopy was found. There was a considerable delay between laryngoscopy and definitive diagnosis in 13 cases due to repeated negative biopsies. Computed tomography pointed out the location and extension of the masses in all cases. In 27 mass lesions CT allowed correct prediction of the malignant or benign character of the lesion. In 6 cases no reliable differentiation could be made. The lesion was mischaracterised in 2 cases. Magnetic resonance imaging was also performed in 4 patients, and showed the extent of the lesion better; in 1 case MRI narrowed the differential diagnosis. In the case of a negative biopsy result, radiological findings should incite further investigation, reducing the possible delay between the onset of symptoms and definitive diagnosis.

Submandibular gland mucocele of the extravasation type. Report of two cases.

The clinical and radiological differential diagnosis of cystic lesions of the head and neck region can be difficult. We report two cases of submandibular gland mucoceles presenting as cystic masses in the submandibular region. The imaging characteristics and differential diagnosis are discussed.