Carol R. Archer

The Degree to Which Accuracy of Preoperative Staging of Laryngeal Carcinoma has been Enhanced by Computed Tomography

In this retrospective study, the accuracy of preoperative staging by high-resolution CT and clinical evaluation (indirect-direct laryngoscopy) is compared to the postsurgical pathologic staging of laryngeal cancer. Forty-two patients who were admitted to St. Louis University Hospital between the years of 1978 to 1985 with diagnoses of laryngeal cancer were included. All patients received high-resolution CT scan of the larynx preoperatively and subsequently underwent total or partial laryngectomy. None of these patients received preoperative radiotherapy. The accuracy of the clinical vs. CT staging—as well as the accuracy of the staging by combination of the two modalities—was determined by comparison with the postsurgical pathologic staging. The accuracy was assessed separately for glottic, supraglottic, and transglottic carcinoma. The accuracy of CT staging for glottic carcinoma was 75%. However, clinical evaluation in this group of lesions was very reliable, offering 92.9% accuracy. The accuracy of CT staging increased in the supraglottic and transglottic lesions, to become superior to the clinical staging. With combined information gained by both examinations, the preoperative staging accuracy was 91.4% for supraglottic carcinoma and 87.5% for transglottic carcinoma. It is, therefore, recommended that high-resolution CT should be included in the preoperative staging of laryngeal cancer.

Case report. Aphasia in thalamic stroke: CT stereotactic localization.

We present a patient in whom dysphasia followed suddenly upon an apparently discrete thalamic infarct proven by computed tomography (CT). Detailed psychometric data of the patients speech and memory disorder obtained during the acute and chronic stages were correlated with the evaluation of a focal thalamic lesion as demonstrated by serial CT. The findings and deductions drawn from selective reports in the literature form the basis of this presentation.

Evaluation of laryngeal cartilages by computed tomography.

Computed tomography of the laryny was performed in 21 patients and 3 anatomic specimens for evaluation of laryngeal cancer. Special attention was directed to the appearance of the laryngeal cartilages in both the normal and abnormal examinations in order to establish criteria for cancerous invasion. The problem presented by the normal nonuniformity of density of the cartilages is discussed in detail.

Ossification of the laryngeal cartilages as it relates to computed tomography.

Ossification of adult laryngeal cartilages was studied using cross sections cut in planes parallel to those used in computed tomography (CT). The percentage of ossification of surfaces of thyroid laminae was calculated and marked variations were found. There was no correlation between ossification and age (all subjects were 50 years or older). Generally, laryngeal cartilages of men were ossified to a greater extent than those of women. Some male cartilages were only slightly ossified, however, while some female cartilages were nearly completely ossified. Inner and outer surfaces of thyroid laminae differed by as much as 35% in some cases. Left and right laminae showed even greater differences, indicating that symmetry of ossification is not the rule. Ossification of arytenoid and cricoid cartilages also varies. This study reveals that there is no reliable pattern of ossification of laryngeal cartilage that would be of use the radiologist in evaluating CT scans for invasion of cartilage by cancer.

Enlarged Cisternae Magnae and Posterior Fossa Cysts Simulating Dandy-Walker Syndrome on Computed Tomography

Computed tomography was performed on 5 children with posterior fossa cystic abnormalities. On an axial tomogram, an enlarged cisterna magna could not be distinguished from a Dandy-Walker variant, nor could an encysted fourth ventricle be distinguished from a subarachnoid cyst. Supplementary air encephalography or sagittal reconstruction of tomograms is necessary to define posterior fossa cysts accurately.

Evaluation of laryngeal cancer by computed tomography.

Six cases of laryngeal cancer have been examined by computed tomography. The findings were correlated with those obtained by laryngoscopy and in five cases by pathological examination of the surgical specimens. Computed tomography accurately delineated the extent of tumor involvement of the laryngeal and paralaryngeal soft tissues. The diagnosis of involvement of the laryngeal cartilages presents some problems, which are discussed.

Hypersomnia, bithalamic lesions, and altered sleep architecture in Kearns‐Sayre syndrome

An 11-year-old boy with Kearns-Sayre syndrome developed hypersomnia associated with bithalamic lesions and had complete absence of sleep spindles on a nocturnal polysomnogram.

Histological and radiological analyses of hydroxyapatite orbital implants in rabbits.

Summary To date, only anectodal clinical data exist pertaining to the histological changes of hydroxyapatite within an enucleated socket. This study was conducted to determine the histological and radiological changes in a coralline hydroxyapatite sphere placed into the central socket, in a controlled fashion. Rabbits underwent simple enucleation with implantation of an autologous sclera-wrapped hydroxyapatite spheres with extraocular muscle reattachment. Preoperatively, the mineral density of each sphere was determined using quantitative computed tomography (CT) that was repeated 2− and 6 weeks postoperatively. The implants were harvested at 2− and 6 weeks and submitted for light and electron microscopic analysis. The results demonstrated a uniform influx of fibrovascular tissue that did not reach the center of the implant, even at 6 weeks. A marked mixed-cell inflammatory response was noted at the interface between the fibrovascular tissue and the hydroxyapatite. Giant cells were noted only at the scierai windows. This study demonstrated that the early response to hydroxyapatite implants was fibrovascular ingrowth with mixed-cell inflammation. These histological observations correlated with findings observed with quantitative CT. Quantitative CT appears to be an ideal modality for observing the early temporal tissue density changes in hydroxyapatite implants.

Improved diagnostic accuracy in laryngeal cancer using a new classification based on computed tomography

The most commonly accepted classification of laryngeal cancer is based on the definition of regions formulated by the American Joint Committee on Laryngeal Cancer. The limitations of this classification are discussed. A new radiologic classification based on computed tomography (CT) is presented, its application illustrated, and its accuracy documented. This classification has the advantage that it provides information preoperatively which closely agrees with the pathologic facts seen postoperatively. It also helps to separate those tumors that tend to invade cartilage from those that do not. Cancer 53:44‐57, 1984.

Computed Tomography of the Larynx

Evaluation of computed tomography of the normal larynx has been performed utilizing corresponding tomographic and anatomic planes. The transaxial, coronal, and sagittal planes have been evaluated. While all three planes have distinct potential diagnostic value, the transaxial plane offers a unique view of laryngeal structures not afforded by any other technique. It is hoped that diagnostic criteria developed in this study will prove applicable to the evaluation of clinical laryngeal disease.