Andrea Borghesi

Perineural Tumor Spread

Perineural spread (PNS) refers to the extent of tumor cells or other nonneoplastic lesions along the tissues of the nerve sheath, its overall incidence ranges from 2.5% to 5%. PNS is more frequently associated with carcinoma arising from minor or major salivary glands (more often adenoid cystic carcinoma), mucosal or cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, lymphoma, and sarcoma. Although PNS was previously associated with worsening prognosis, increasing evidence shows that cure is possible. Therefore, radiologists must be aware of the relevant cranial nerve anatomy and thoroughly scrutinize not only the nerves close to the primary tumor site but also the whole neural pathways that can be accessed by PNS. Equally critical is knowledge of the radiologic appearance of perineural tumor extension and the best imaging strategies to detect PNS.

TMJ disorders and pain: Assessment by contrast-enhanced MRI

Though magnetic resonance (MRI) is a widely accepted standard for the assessment of patients with temporomandibular joint (TMJ) disorders, efforts to correlate symptoms to MRI findings have often given controversial results. Aim of this study was to investigate the correlation between TMJ pain and findings of contrast-enhanced MRI. Thirty-eight consecutive patients with TMJ dysfunction syndrome (study group) were examined with MRI. Protocol included T2 turbo spin-echo sequence, T1 spin-echo sequence, and T2 gradient-echo (acquired with closed jaw, at intermediate and maximal opening). Post-contrast phase was obtained through a fat sat 3D T1 gradient-echo sequence (VIBE). Post-contrast findings in the study group were matched with those obtained in a control group of 33 patients submitted to MRI of the paranasal sinuses. Statistically significant difference was found between condylar medullary bone enhancement in painful TMJ, in painless TMJ and control group. In addition the average thickness of joint soft tissue enhancement in painful TMJ was superior to painless TMJ (p<0.0001) and to control group. On multivariate logistic regression analysis, the odds ratio that a painful TMJ showed disk displacement, osteoarthrosis, effusion and JST enhancement were 3.05, 3.18, 1.2 and 11.36, respectively. Though not histologically proven, TMJ enhancement could reflect the presence of inflammation in painful joints. Furthermore, the administration of contrast could be of help for the assessment of patients with orofacial pain, particularly when clinical exploration is insufficient to ascribe the pain to TMJ.

MRI findings of necrotizing sialometaplasia

Necrotizing sialometaplasia (NS) is a benign self-limiting inflammatory disease of mucus-secreting glands, mainly involving the minor salivary glands. This lesion can mimic a malignant neoplasm, as more frequently it manifests as a submucosal swelling or as an ulcer of the palate. Awareness of the disease is crucial to avoid undue surgical treatment. We herewith report MR findings in a histologically proven case of NS.

Treatment monitoring of paranasal sinus tumors by magnetic resonance imaging

Abstract Treatment monitoring of paranasal tumors is crucial, given the high rate of local and regional relapses that impairs the overall prognosis of patients. Magnetic resonance imaging (MRI) is the technique of choice to detect changes in the submucosa and deep spaces of the suprahyoid neck, inaccessible at clinical and endoscopic assessment. Correct interpretation of MRI requires detailed knowledge of the treatment applied and of the changes treatments are supposed to produce on macroscopic anatomy and tissue signals. Once such background of information is obtained, detection of recurrences is a less challenging task.

CT and MR Anatomy of Paranasal Sinuses: Key Elements

A conceptual understanding of the anatomic and functional relationships between the nasal cavity and paranasal sinuses is of the utmost importance, particularly when dealing with chronic infl ammatory diseases. According to their drainage pathway, the sinusal cavities may be functionally classifi ed into two subgroups. The fi rst one includes the anterior ethmoid cells, the frontal sinus, and the maxillary sinus; all these cavities drain mucus into the middle meatus. The second group encompasses the posterior ethmoid cells and the sphenoid sinus, both draining into the superior meatus. 2.1.1 Nasal Cavity and Lateral Nasal Wall

The ethmoidal arteries: a cadaveric study based on cone beam computed tomography and endoscopic dissection

PurposeTo describe the anatomical variability of the ethmoidal arteries (EAs). To evaluate the reliability of cone beam computed tomography (CBCT) in preoperative assessment of EAs.MethodsFourteen cadaver heads underwent CBCT and endoscopic dissection. The following anatomical features were evaluated for anterior (AEA), middle (MEA), and posterior (PEA) EAs: presence, cranio-caudal position, antero-posterior position, and dehiscence of the bony canal. Accuracy of radiological assessment was calculated.Results AEA, MEA, and PEA were identified in 100, 28.6, and 100% of sides. They were caudal to the skull base in 60.7, 25, and 17.9%, respectively. CBCT showed a high accuracy in identifying these features. The antero-posterior position of EAs, which was highly variable, was correctly assessed by CBCT. A dehiscent bony canal of AEA, MEA, and PEA was found in 46.4, 12.5, and 28.6% of sides, respectively. Accuracy of CBCT in picking up this feature was poor but negative predictive value was high.Conclusions CBCT was adequate in identifying and localizing EAs. In addition, it can be used to exclude the presence of MEA and dehiscence of ethmoidal canals, whereas the accuracy in detecting these anatomic variants was low.

Pulmonary mucosa-associated lymphoid tissue lymphoma: 18F-FDG PET/CT and CT findings in 28 patients

OBJECTIVE The aim of the study was to evaluate the CT and fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) imaging findings of lung mucosa associated lymphoid tissue (MALT) lymphoma. METHODS 28 patients with histologically confirmed pulmonary MALT lymphoma who underwent a chest CT and 18F-FDG PET/CT for staging were retrospectively analysed. The CT images were evaluated to determine morphological pattern of appearance, laterality, localization, number, size, presence of thoracic lymphadenopaties and secondary/combined findings. PET images were analysed visually and semi-quantitatively by measuring the maximum standardized uptake value (SUVmax), lesion-to-liver SUVmax ratio and lesion-to-blood pool SUVmax ratio. The relationship between qualitative and semi-quantitative features at 18F-FDG PET/CT and CT findings were also analysed. RESULTS A total of 57 pulmonary lesions were identified by CT: 37 areas of consolidation, 4 masses, 12 nodules and 4 ground-glass opacities. Solitary and multiple lesions were detected in 10 and 18 patients, respectively; among patients with multiple lesions, 16 were bilateral and 2 unilateral. 18F-FDG PET/CT revealed increased 18F-FDG uptake in 47/57 lesions, in 26/28 patients. 18F-FDG avidity was significantly associated only with tumour size. CONCLUSIONS Pulmonary MALT lymphoma is 18F-FDG avid in most cases and 18F-FDG avidity is correlated with tumour size. Consolidation is the most frequent morphological pattern of disease presentation. Advances in knowledge: This study demonstrated that lung MALT lymphoma are 18F-FDG avid in most cases depending on tumour size. Single or multiple areas of consolidation are the most common pattern of presentation of lung MALT lymphoma at CT.

Pulmonary sarcoidosis presenting with acute respiratory distress syndrome

Sarcoidosis is a common disease that involve almost constantly the lung. Usually the onset is insidious, and symptoms are slowly ingravescent. Very rarely, as in the case here reported, sarcoidosis can cause an acute respiratory failure with acute respiratory distress syndrome (ARDS). A 20-year-old girl from Pakistan presented for acute fatigue, fever, and cough with a chest X-ray displayed the micronodular interstitial disease. Despite of anti-tuberculosis therapy, ARDS developed in a few days requiring continuous positive airway pressure treatment. Examinations on transbronchial specimens obtained by bronchoscopy permitted to reach the diagnosis of sarcoidosis and steroid therapy improved rapidly clinical conditions. This is the first case report reported in Europe that confirms the rare onset of sarcoidosis as ARDS. Steroid therapy allows to cure rapidly this severe complication.

Flying through congested airspaces: imaging of chronic rhinosinusitis.

The complex regional anatomy of the nose and paranasal sinuses makes the interpretation of imaging studies of these structures intimidating to many radiologists. This paper aims to provide a key to interpretation by presenting a simplified approach to the functional anatomy of the paranasal sinuses and their most common (and most relevant) variants. This knowledge is basic for the full understanding of chronic rhinosinusitis and its computed tomography (CT) patterns. As fungal infections may be observed in the setting of chronic rhinosinusitis, these are also discussed. Chronic sinus inflammation produces bone changes, clearly depicted on CT images. Finally, clues to suspecting neoplastic lesions underlying inflammatory sinus conditions are provided.

Brain, Head, and Neck

MRI in neuroradiology has evolved in the last 30 years, becoming faster, more precise, and more specific. The latest additions, including magnetic resonance spectroscopy (MRS), diffusion imaging, diffusion tensor imaging, functional MRI, and dynamic susceptibility contrast perfusion imaging, have expanded the applications for MR imaging. Currently, fluid attenuation inversion recovery (FLAIR) imaging, thin-section 3D volumetric imaging with spoiled gradient techniques, and the others mentioned above permit not only the precise localization of brain lesions, but also the evaluation of their metabolic profile, their location relative to eloquent regions of the cortex and subcortical white matter, and the relative blood volume and permeability of the vasculature that supplies the lesion. Thus, cellular, vascular, functional and anatomic information are obtained in one examination session and are available to treating physicians in their office, operating room, or radiation therapy suite.