Ira F. Braun

The use of transarterial microembolization in the management of hemangiomas of the perioral region

The management of oral and perioral hemangiomas depends on several clinical factors. Surgery of these benign lesions can at times be disfiguring, especially when the lips, muscles, or the maxilla and mandible are involved. In addition, by the very nature of these lesions, surgical treatment may be associated with excessive intra- and perioperative blood loss. A series of five patients who had hemangiomas in the perioral region and who were initially treated with transarterial microembolization, preoperatively in two cases and as the only treatment in three cases, is presented. The technique of microembolization is described and recommendations for its use are given.

Mastoid Size Determined with Lateral Radiographs and Computerized Tomography

Minimal pneumatization of the temporal bone is characteristic of otitis media. The classic radiographic assessment of mastoid air cell system size is the Runstrom II view, but the Law lateral view is the commonly used clinical view in the United States. Isolated temporal bone specimens are most accurately positioned using a modified Law lateral view (with the film perpendicular to the central X-ray beam). Computerized tomography is the best radiographic means of assessing mastoid pneumatization. The mathematical relationships of mastoid pneumatization size determined by the Runstrom II, Law, and modified Law lateral radiographs, and computerized tomography were determined in 30 adult cadaver specimens. These data may facilitate additional study of otitis media.

Pitfalls in the computed tomographic evaluation of the lumbar spine in disc disease

SummaryComputed tomography (CT) is an effective non-invasive method of evaluating the lumbar spine in cases of suspected disc disease. In over a 3-year period in a high volume neuroradiologic practice we have observed a number of pitfalls in the diagnosis of herniated nucleus pulposus which may lead to erroneous conclusions and therefore, decrease the overall accuracy of the examination. These pitfalls, and their implications are presented and discussed.

A nonplanimetric technique for measuring fluid volumes using MR imaging--phantom results.

A nonplanimetric algorithm for calculating the volume of homogeneous fluids, using data from a single slice MRI scan, is discussed. The algorithm uses the fact that the total MR signal from a homogeneous fluid placed inside an MR scanner is directly proportional to the volume of the fluid. A simple ratio of fluid volumes and signal strengths thus allows the determination of an unknown fluid volume from a known fluid volume and the measured signals from the known and unknown volumes. Signal strengths are obtained from a single image of the known and unknown volumes, by a simple summation of pixel intensities in the image. The volume algorithm was tested on a 0.5 T clinical imager using fluid-filled volume phantoms (85–500 ml) that ranged in complexity from simple bulk volumes (flasks) to a mock-brain phantom composed of two fluid-filled bottles (to represent ventricles) embedded in a tangle of small-diameter fluid-filled tubes (to represent sulci). The known volume was a 5 ml syringe filled with the same fluid as contained in the phantoms. Volumes were calculated using various single-slice spin-echo pulse sequences and were in all cases found to be within 3% of the known volumes. The phantom results imply that intracranial CSF volumes might be determined by comparing signals derived from intracranial CSF with those from known volumes of CSF. Such a procedure would require the use of a pulse sequence that returns a signal from the CSF only, such as a very long TE spin-echo sequence. Among the questions still to be addressed are the possible differences between intracranial and in vitro CSF and the effects of CSF flow. (AJNR 8: 267–270, 1987)

Gas computed tomographic cisternography: Evaluation of small and intracanalicular acoustic neuromas

With improvements in microsurgical techniques, early evaluation of small and intracanalicular acoustic neuromas has taken on added importance. Since its introduction in 1979 by Sortland, several authors have demonstrated the accuracy and safety of computed tomography combined with gas cerebellopontine angle cisternography in the early diagnosis of acoustic neuromas. We present our experience with 32 patients referred for gas computed tomographic cisternography yielding five surgically proved acoustic neuromas, three of which were less than 1 cm in size. This procedure can be performed on an outpatient basis, has a low morbidity, and is highly accurate in diagnosing even purely intracanalicular tumors. Gas computed tomography cisternography offers several advantages over positive contrast cisternography, and is the procedure of choice in the radiologic diagnosis of acoustic neuromas after contrast-enhanced computed tomography has excluded the presence of a large tumor.

An unusual computed tomography appearance of nasopharyngeal carcinoma: A case report

The computed tomography findings of an unusual case of nasopharyngeal carcinoma are presented. Typical features of nasopharyngeal carcinoma from clinical, pathologic, and radiologic aspects are discussed. Atypical features of this case are presented, consisting of extensive muscular infiltration and lack of destruction of contiguous bony structures.