Cranial computed tomography in the detection of dural, orbital, and skull involvement in metastatic neuroblastoma.
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Biomedical subjects
Publications and source records attributed to J F Healy.
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This paper presents 3 examples of cavum vergae, a normal variant in cranial computed tomography (CCT) and pneumoencephalography. The CCT appearance of cavum vergae is illustrated in both axial and coronal planes, and the means of distinguishing cavum vergae from cavum velum interpositum and cystic lesions of the third ventricle by reference to normal anatomical landmarks is discussed.
The authors describe 3 patients with Raeder syndrome who also had lesions of the internal carotid artery in the region of the ascending sympathetic chain. One patient apparently had weakening of the artery wall, caused by extension of inflammatory disease, with hemorrhage brought on by exertion; another patient had a psuedoaneurysm possibly related to biopsy or irradiation, while a third had an aneurysm which may have been caused by a carotid artery dissection at the time of a whiplash injury many years earlier.
Wooden foreign bodies have surprisingly low attenuation coefficients and can be difficult to discern on computed tomography when located in the paranasal sinuses or retroorbital fat unless using either a "measured mode" or statistical analysis. A case is presented of a wooden pool cue inserted into a patient's nostril and sinus that illustrates this point.
Intraventricular metastases from extracranial tumors are uncommon. Cranial computed tomography provides a uniquely noninvasive method to diagnose such metastases. However, enhanced intraventricular metastases may mimic normal enhancement of the choroid plexus.
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The case presented emphasizes the complimentary nature of isotope scanning, CT, and skull radiography in the detection and evaluation of lytic skull lesions. We feel that, if the CT diagnosis of metastatic skull disease is going to change the patient's prognosis and/or therapy, a confirmatory examination, preferably isotope scanning should be undertaken. If the CT and isotope studies are contradictory, skull radiographs may be helpful, the calvarium may be biopsied, or re-examined after an appropriate clinical interval. Multiple lytic areas on a skull CT examination may well represent metastases, but a more benign cause, as illustrated in the case presented, should be considered and ruled out before therapy is instituted.
Thirty-three patients with depressed skull fractures examined by cranial computed tomography were reviewed. CCT not only reveals the vast majority of depressed skull fractures but also reveals underlying hematoma and contusions, delineates the depressed fragment or fragments, and estimates the degree of intracerebral mass effect present. Scans may be grossly abnormal in patients who do well clinically. Thus, while CT findings are important in guiding proper therapy, the clinical status of the patient upon admission has far more prognostic value than the CT findings.
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Modern imaging includes many studies performed to examine limited fields of view (i.e., paranasal sinus studies). These studies are frequently retrospectively coned to the limited field of view and are often examined only at one window and level setting. However, classic radiology teaching demands that all irradiated structures be examined by a qualified physician; for examples, on an intravenous pyelogram the examiner should look at not only the kidneys, ureters, and bladder, but also the bones, soft tissues, and gas patterns. This article illustrates unsuspected intracranial pathology noted on computed tomographic examinations of the paranasal sinuses and temporal bones.
OBJECTIVE: The athletic activity of the adult U.S. population has increased markedly in the last 20 years. To evaluate the possible long-term effects of such activity on the cervical and lumbar spine, we studied a group of asymptomatic currently very active lifelong male athletes over age 40 (41-69 years old, av. age 53). MATERIALS AND METHODS: Nineteen active, lifelong male athletes were studied with MRI and the results compared with previous imaging studies of other populations. An athletic history and a spine history were also taken. RESULTS: Evidence of asymptomatic degenerative spine disease was similar to that seen in published series of other populations. Degenerative changes including disk protrusion and herniation, spondylosis, and spinal stenosis were present and increased in incidence with increasing patient age. In this group, all MRI findings proved to be asymptomatic and did not limit athletic activity. CONCLUSION: The incidence of lumbar degenerative changes in our study population of older male athletes was similar to those seen in other populations.
Twenty-eight persons with contiguous intracranial skull, and often extracranial metastatic disease are reported. These lesions comprised 7.6% of a series of 250 consecutive patients with intracranial metastatic disease. Only three of 28 patients had other intracranial lesions and only seven of 28 patients has other skull lesions demonstrable on computed tomography (CT). Carcinoma of the prostate and breast, multiple myeloma, and neuroblastoma are especially likely to appear in this manner. All metastases enhanced. The bone destruction was so pervasive that in 19 of the patients it was obvious at routine CT settings. In the nine other patients, it could be clearly seen only at bone settings (high window and level). The CT demonstration of an enhancing intracranial mass involving the skull and often the scalp is highly suggestive but not diagnostic of a metastatic lesion.
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