Kotaro Sekiya

Periapical Lucency around the Tooth: Radiologic Evaluation and Differential Diagnosis

Periapical lucencies are often seen incidentally at head and neck imaging studies performed for indications not related to the teeth. These lesions are, however, occasionally manifestations of diseases that have a wide range of effects and may at times represent the source of symptoms that prompted the study. The vast majority of periapical lucencies are the result of apical periodontal or pulpal disease. If found in an advanced state or left untreated, disease related to the tooth may spread to adjacent tissues, including the sinuses, orbits, deep fascial spaces of the neck, and intracranial structures, and result in a significant increase in patient morbidity and mortality. Although the majority of periapical lucencies seen on radiographs and computed tomographic images occur secondary to apical periodontal or pulpal disease, not all lucencies near the tooth root are due to infection. Lucency near the tooth root may be seen in the setting of other diseases of odontogenic and non-odontogenic origin, including neoplasms. Although imaging findings for these lesions can include periapical lucent components, awareness of the varied secondary imaging features can aid the radiologist in developing an accurate differential diagnosis. Familiarity with the imaging features and differential diagnoses of diseases or conditions that cause lucency around the tooth root results in appropriate referral and prompt diagnosis, management, and treatment, and can prevent unnecessary additional imaging or intervention. In addition, early recognition and appropriate treatment of infectious processes will result in improved clinical outcomes and a decrease in morbidity and mortality.

Nasopharyngeal cystic lesions: Tornwaldt and mucous retention cysts of the nasopharynx: findings on MR imaging.

Objective Nasopharyngeal cystic lesions are commonly encountered on magnetic resonance imaging with significantly overlapped imaging characteristics. The purpose of this study was to determine the prevalence and distinguishing imaging features of cystic lesions in the nasopharynx in the largest patient series to date. Methods After institutional review board approval, consecutive head magnetic resonance images of 3000 patients performed at 1.5 T between June 2010 and April 2011 were retrospectively reviewed for cystic nasopharyngeal lesions. Location, size, and signal characteristic of cystic lesions were recorded. Electronic medical records were reviewed for patient demographics, symptoms, and underlying conditions. Results Among 3000 patients, 6% had Tornwaldt cysts (peak prevalence, 51–60 years old) and 10% had mucous retention cysts (peak prevalence, 41–50 years old). A significant correlation between human immunodeficiency virus infection and mucous retention cysts was observed (P < 0.001). Conclusions The prevalence of Tornwaldt cysts was slightly higher than previously described in the literature. Additionally, younger and older patients had the lowest prevalence of Tornwaldt cyst, suggesting these lesions are acquired and subsequently involute with time. A significant correlation was observed between human immunodeficiency virus infection and mucous retention cysts.

Actinomycosis in the mandible: CT and MR findings.

SUMMARY: Mandibular actinomycosis is an uncommon disease. We retrospectively reviewed 6 patients with pathologically proven mandibular actinomycosis who underwent both CT and MR imaging to evaluate the characteristic imaging findings. CT results showed an irregularly marginated lesion with increased bone marrow attenuation, osteolysis, and involvement of the skin in all patients. Periosteal reaction and intralesional gas were seen in 4 patients. MR imaging results revealed low signal on T1-weighted and high signal on T2-weighted images of the mandible, and moderate heterogeneous enhancement was seen in all patients who received intravenous contrast. Cervical lymphadenopathy was not observed. Involvement of the masseter, lateral pterygoid, and medial pterygoid muscles was seen in 4 patients, whereas parotid gland and submandibular gland as well as parapharyngeal space involvement were seen in 3 patients. Familiarity with the imaging findings of mandibular actinomycosis may help to diagnosis this entity.

Computed Tomography Findings of Mandibular Nutrient Canals

Introduction:The purpose of this study was to assess computed tomography (CT) findings of mandibular nutrient canals using CT images. Materials and Methods:We retrospectively analyzed the mandibular CT images of 194 consecutive patients. For image analysis such as canal prevalence, location, number, size, shape, and the CT value of nutrient foramina were determined using CT axial images of 0.5 and 3 mm slice thickness. Results:We revealed that the nutrient canals were seen 94.3% in the mandible, mostly seen in the anterior region. By location, nutrient canals were particularly seen between the central and lateral incisors. The mean number of nutrient canals was 2.7. The mean diameter of the nutrient foramen between the central and lateral incisors was 1.0 mm. In about 80% of the cases, foramina between the central and lateral incisors were ovoid. The mean CT value for the nutrient foramina between the central and lateral incisors was 411 HU. Discussion and Conclusions:Mandibular nutrient canals were ovoid shape, and the mean CT value was 411 HU. By preoperative knowledge of the position and anatomy of the mandibular nutrient canals, complications such as injury to the nutrient canals can be avoided.

Comparison of MR Imaging and Dual-Energy CT for the Evaluation of Cartilage Invasion by Laryngeal and Hypopharyngeal Squamous Cell Carcinoma

BACKGROUND AND PURPOSE: Dual-energy CT can distinguish iodine-enhanced tumors from nonossified cartilage and has been investigated for evaluating cartilage invasion in patients with laryngeal and hypopharyngeal squamous cell carcinomas. In this study, we compared the diagnostic accuracy of MR imaging and of a combination of weighted-average and iodine overlay dual-energy CT images in detecting cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinomas, in particular thyroid cartilage invasion. MATERIALS AND METHODS: Fifty-five consecutive patients who underwent 3T MR imaging and 128-slice dual-energy CT for preoperative initial staging of laryngeal or hypopharyngeal squamous cell carcinomas were included. Two blinded observers evaluated laryngeal cartilage invasion on MR imaging and dual-energy CT using a combination of weighted-average and iodine-overlay images. Pathologic findings of surgically resected specimens were used as the reference standard for evaluating sensitivity, specificity, and the areas under the receiver operating characteristic curve of both modalities for cartilage invasion by each type of cartilage and for all cartilages together. Sensitivity and specificity were compared using the McNemar test and generalized linear mixed models. RESULTS: Dual-energy CT showed higher specificity than MR imaging for diagnosing all cartilage together (84% for MR imaging versus 98% for dual-energy CT, P < .004) and for thyroid cartilage (64% versus 100%, P < .001), with a similar average area under the curve (0.94 versus 0.95, P = .70). The sensitivity did not differ significantly for all cartilages together (97% versus 81%, P = .16) and for thyroid cartilage (100% versus 89%, P = .50), though there was a trend toward increased sensitivity with MR imaging. CONCLUSIONS: Dual-energy CT showed higher specificity and acceptable sensitivity in diagnosing laryngeal cartilage invasion compared with MR imaging.

Miscellaneous and Emerging Applications of Dual-Energy Computed Tomography for the Evaluation of Intracranial Pathology

Dual-energy computed tomography (CT) has the potential to improve detection of abnormalities and increase diagnostic confidence in the evaluation of a variety of neurologic conditions by using different x-ray energy-dependent absorption behaviors of different materials. This article reviews the virtual monochromatic imaging applications of dual-energy CT, particularly material decomposition algorithms to improve lesion conspicuity, define lesion-normal tissue interface using different reconstruction techniques, and discuss miscellaneous emerging applications of dual-energy CT for neuroimaging, with an emphasis on their potential clinical utility.

The Clinical Application of the LEBRA-PXR in Imaging Diagnosis

In 1895, Dr. Wilhelm Conrad Röentgen discovered the electromagnetic radiation called X-rays. Since the great finding, the applications of X-ray imaging have expanded. One of most important application is medical use, such as imaging diagnosis or radiation therapy. Also, applications of X-ray are based on the strong interactions with materials including transmission, absorption, diffraction, reflection, scattering, and emission. Today, X-ray imaging is applied to more delicate medical and life sciences, as well as basic sciences, because it is needed for its brilliance, power, and coherence. [1-6]