Gul Moonis

Retropharyngeal Lipoma Causing Obstructive Sleep Apnea: Case Report Including Five‐Year Follow‐Up

Objectives/Hypothesis Lipomas of the retropharyngeal space are rare and do not cause symptoms until they reach a large size. Although retropharyngeal lipoma is an uncommon entity, several reports of it appear in the literature, and the treatment has routinely been surgical excision. Such fatty tumors also carry the rare possibility of being liposarcomas, which further warrants their excision. We present the case of a lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum causing symptoms of obstructive sleep apnea. The patient had multiple medical problems and was on a regimen of anticoagulation therapy; therefore, he opted against surgical treatment. He has used continuous positive airway pressure and has been followed clinically and radiographically for 5 years. Radiographic follow‐up of a retropharyngeal lipoma after a needle biopsy confirming its benign nature is a legitimate means of management of this rare condition.

Comparing MR image intensity standardization against tissue characterizability of magnetization transfer ratio imaging

To evaluate existing methods of standardization by exploiting the well‐known tissue characterizing property of magnetization transfer ratio (MTR) values obtained from MT imaging, and compare the tissue characterizability of standardized T2, proton density (PD), and T1 images against the MTR images.

T2ρ-weighted contrast in MR images of the human brain

In this work, the feasibility of using T2ρ weighting as an MR contrast mechanism is evaluated. Axial images of a human brain were acquired using a single‐slice spin‐lock T2ρ‐weighted pulse sequence and compared to analogous T2‐weighted images of the same slice. The contrast between white matter and gray matter in T2ρ‐weighted images was approximately 40% greater than that from T2‐weighted data. These preliminary data suggest that the novel contrast mechanism of T2ρ can be used to yield high‐contrast T2‐like images. Magn Reson Med 52:1223–1227, 2004.

Brain tumor segmentation in MRI by using the fuzzy connectedness method.

The aim of this paper is the precise and accurate quantification of brain tumor via MRI. This is very useful in evaluating disease progression, response to therapy, and the need for changes in treatment plans. We use multiple MRI protocols including FLAIR, T1, and T1 with Gd enhancement to gather information about different aspects of the tumor and its vicinity- edema, active regions, and scar left over due to surgical intervention. We have adapted the fuzzy connectedness framework to segment tumor and to measure its volume. The method requires only limited user interaction in routine clinical MRI. The first step in the process is to apply an intensity normalization method to the images so that the same body region has the same tissue meaning independent of the scanner and patient. Subsequently, a fuzzy connectedness algorithm is utilized to segment the different aspects of the tumor. The system has been tested, for its precision, accuracy, and efficiency, utilizing 40 patient studies. The percent coefficient of variation (% CV) in volume due to operator subjectivity in specifying seeds for fuzzy connectedness segmentation is less than 1%. The mean operator and computer time taken per study is 3 minutes. The package is designed to run under operator supervision. Delineation has been found to agree with the operators visual inspection most of the time except in some cases when the tumor is close to the boundary of the brain. In the latter case, the scalp is included in the delineation and an operator has to exclude this manually. The methodology is rapid, robust, consistent, yielding highly reproducible measurements, and is likely to become part of the routine evaluation of brain tumor patients in our health system.

Taste dysfunction in multiple sclerosis

Empirical studies of taste function in multiple sclerosis (MS) are rare. Moreover, a detailed assessment of whether quantitative measures of taste function correlate with the punctate and patchy myelin-related lesions found throughout the CNS of MS patients has not been made. We administered a 96-trial test of sweet (sucrose), sour (citric acid), bitter (caffeine) and salty (NaCl) taste perception to the left and right anterior (CN VII) and posterior (CN IX) tongue regions of 73 MS patients and 73 matched controls. The number and volume of lesions were assessed using quantitative MRI in 52 brain regions of 63 of the MS patients. Taste identification scores were significantly lower in the MS patients for sucrose (pxa0=xa00.0002), citric acid (pxa0=xa00.0001), caffeine (pxa0=xa00.0372) and NaCl (pxa0=xa00.0004) and were present in both anterior and posterior tongue regions. The percent of MS patients with identification scores falling below the 5th percentile of controls was 15.07xa0% for caffeine, 21.9xa0% for citric acid, 24.66xa0% for sucrose, and 31.50xa0% for NaCl. Such scores were inversely correlated with lesion volumes in the temporal, medial frontal, and superior frontal lobes, and with the number of lesions in the left and right superior frontal lobes, right anterior cingulate gyrus, and left parietal operculum. Regardless of the subject group, women outperformed men on the taste measures. These findings indicate that a sizable number of MS patients exhibit taste deficits that are associated with MS-related lesions throughout the brain.

Finding a Voice: Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis.

SUMMARY: Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis.

Computed Tomography Versus Magnetic Resonance in Head and Neck Cancer: When to Use What and Image Optimization Strategies

This article provides a practical overview of head and neck cancers, outlining an approach to evaluating these lesions and optimizing imaging strategies. Recognition of key anatomic landmarks as suggested by American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) criteria is emphasized. Further, the recently updated eighth edition of the AJCC staging manual has introduced some modifications that influence the TNM staging. These modifications are discussed throughout the article to provide an updated review on head and neck cancer.

A subjective and objective comparison of tissue contrast and imaging artifacts present in routine spin echoes and in iterative decomposition of asymmetric spin echoes for soft tissue neck MRI

OBJECTIVEnFSE sequences play key roles in neck MRI despite the susceptibility issues in neck region. Iterative decomposition of asymmetric echoes (IDEAL, GE) is a promising method that separates fat and water images resulting in high SNR and improved fat suppression. We tested how neck tissue contrasts, image artifacts and fat separation as opposed to fat suppression in terms of image quality compare between routine and IDEAL FSE.nnnMETHODSnIDEAL based and routine T1 and T2-weighted FSE sequences were applied for neck MRI at 1.5T and 3T. Overall image quality including fat suppression, tissue contrast, image artifacts and lesion conspicuity were subjectively assessed for 20 patients clinically indicated for neck MRI. Quantitative tissue contrast estimates from parotid area were compared between IDEAL and routine FSE for 7 patients. Four patients with oncocytoma were also reviewed to assess benefits of separately reconstructed fat specific image sets.nnnRESULTSnSubjective tissue contrast and overall image quality including image sharpness, fat suppression and image artifacts were superior for IDEAL sequences. For oncocytoma fat specific IDEAL images provided additional information. Objective CNR estimates from a central slice were equivalent for IDEAL and routine FSE at both field strengths.nnnCONCLUSIONSnWe demonstrated that high SNR inherent in IDEAL FSE consistently translates into high tissue contrast with image quality advantages in neck anatomy where large susceptibility variation and physiological motions reduce image quality for conventional FSE T1 and T2. However, the objective contrast estimates for parotid gland at isocenter were statistically equivalent for IDEAL and conventional FSE perhaps because at or near isocenter routine FSE works well. Additionally, fat specific IDEAL image sets add to diagnostic specificity for fat deficient lesions.

ACR Appropriateness Criteria® Cranial Neuropathy

Evaluation of cranial neuropathy can be complex given the different pathway of each cranial nerve as well as the associated anatomic landmarks. Radiological evaluation requires imaging of the entire course of the nerve from its nucleus to the end organ. MRI is the modality of choice with CT playing a complementary role, particularly in the evaluation of the bone anatomy. Since neoplastic and inflammatory lesions are prevalent on the differential diagnosis, contrast enhanced studies are preferred when possible. The American College of Radiology Appropriateness Criteria are evidencebased guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Hierarchical brain tissue segmentation and its application in multiple sclerosis and Alzheimer's disease

Based on Fuzzy Connectedness (FC) object delineation principles and algorithms, a hierarchical brain tissue segmentation technique has been developed for MR images. After MR image background intensity inhomogeneity correction and intensity standardization, three FC objects for cerebrospinal fluid (CSF), gray matter (GM), and white matter (WM) are generated via FC object delineation, and an intracranial (IC) mask is created via morphological operations. Then, the IC mask is decomposed into parenchymal (BP) and CSF masks, while the BP mask is separated into WM and GM masks. WM mask is further divided into pure and dirty white matter masks (PWM and DWM). In Multiple Sclerosis studies, a severe white matter lesion (LS) mask is defined from DWM mask. Based on the segmented brain tissue images, a histogram-based method has been developed to find disease-specific, image-based quantitative markers for characterizing the macromolecular manifestation of the two diseases. These same procedures have been applied to 65 MS (46 patients and 19 normal subjects) and 25 AD (15 patients and 10 normal subjects) data sets, each of which consists of FSE PD- and T2-weighted MR images. Histograms representing standardized PD and T2 intensity distributions and their numerical parameters provide an effective means for characterizing the two diseases. The procedures are systematic, nearly automated, robust, and the results are reproducible.