Wise head and neck surgeons, for whom parotid gland surgery constitutes a substantial portion of their case load, make full use of the radiologist and cytologist in arriving at a rational pre-operative diagnosis. They utilize the skill of these allied consultants to qualify (by histology) and quantify (by staging) diffuse and mass lesions of the parotid gland (and subjacent parapharyngeal space) in order to evolve an effective surgical, radiation or other treatment plan. They understand the basic principles of diagnostic imaging and apply them to the clinical problem at hand. They minimize diagnostic and intra-operative "surprises", reduce intra-operative and post-operative complications and generally have a more "informed" patient and patient's family. The purpose of this manuscript is to discuss a contemporary role for diagnostic imaging in neoplastic (and other) diseases of the parotid gland and subjacent parapharyngeal space. Not all lesions of the parotid gland require imaging, although a pre-operative clinical photograph, including evidence of facial nerve function, is always welcome. Other lesions may need diagnostic imaging, from simple to complex and sophisticated, depending upon the problem. Properly used, effective and selective diagnostic imaging can improve the surgeon's confidence by providing a more realistic provisional diagnosis and a better pre-operative staging process and treatment plan, thereby avoiding the surgically unexpected and facilitating prognosis.

Humans↗

PubMedDate not supplied

Methanol poisoning: bilateral putaminal and cerebellar cortical lesions on CT and MR.

Bilateral putaminal necrosis is often recognized radiologically in severe methanol toxicity. We present a unique case of methanol toxicity in which putaminal and previously unreported bilateral cerebellar cortical lesions were demonstrable on CT and MR.

Adult↗

PubMedDate not supplied

Tomographic abnormalities simulating pituitary microadenomas.

False-positive and false-negative interpretations of sellar tomography were found in about one-fifth of cases in a recent autopsy study correlating the presence of pituitary microadenomas with abnormal sellar tomograms. An analysis of minor variations in the bony configuration of the sella disclosed variations due to posterior lobe asymmetry, intercavernous venous channels, bony asymmetry, and an empty sella in 27 of the 120 sellas examined. In some instances, the asymmetry resulted from a combination of these causes. A further study of 50 pituitary glands in situ showed posterior lobe asymmetry to be a common anomaly (76%) that can produce an obvious disparity between the two halves of the sella. Thus, the minor radiologic criteria of local thinning of the anterior wall or floor, slant of the floor, or asymmetry of the two halves of the sella must be interpreted with caution as being indicative of the presence of pituitary microadenoma. In the absence of clinical or biochemical dysfunction, the changes more likely result from explainable anatomic causes.

Adenoma↗