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PubMed2006

Melatonin inhibits cortical spreading depression-evoked trigeminal nociception.

This study was conducted to determine the effect of melatonin on cortical spreading depression-evoked trigeminovascular nociception. Melatonin (20 or 40 mg/kg) or saline was given to Wistar rats. KCl was placed on the cortical surface to elicit the cortical spreading depression. Cortical blood flow was monitored and ultrastructure of cerebral microvessels was studied. The medulla and cervical cord were removed for Fos and nitric oxide synthase immunohistochemical study. The results showed that melatonin pretreatment significantly minimized the cortical spreading depression-evoked cerebral hyperaemia and attenuated the cortical spreading depression-induced microvascular changes. Pretreatment with melatonin also reduced the number of Fos and nitric oxide synthase immunoreactive cells in the trigeminal nucleus caudalis. The results of this study suggest that melatonin can attenuate the process of trigeminovascular nociception induced by cortical spreading depression.

Animals↗
PubMed2005

Lasting accelerative effects of 1 Hz and 20 Hz electrical stimulation on cortical spreading depression: relevance for clinical applications of brain stimulation.

Clinical applications of brain stimulation have been increasing during the last decade; however, the mechanisms of action remain unknown. One proposed mechanism of action is that repetitive stimulation modulates cortical excitability. Herein, we explore the question of whether repetitive electric stimulation increases cortical excitability as indexed by the cortical spreading depression. Twenty-four Wistar rats were divided into three groups according to the treatment: sham, 1-Hz and 20-Hz stimulation. Stimulation was applied to the left frontal cortex through a pair of epidurally implanted silver-wire electrodes. The cortical spreading depression-features were analysed at three time points (one day before, one day after and 2 weeks after treatment) in both the stimulated and unstimulated hemisphere. A 3 x 2 x 3 factorial anova with repeated measures showed significant differences in the main effect of time (P < 0.0001), hemisphere (P = 0.0002) and stimulation group (P = 0.008). The interaction between time vs. hemisphere vs. stimulation group was also significant (P < 0.0001). Posthoc analysis demonstrated that 1-Hz and 20-Hz repetitive electrical stimulation significantly increased the velocity of cortical spreading depression in the stimulated hemisphere. Furthermore, 20-Hz stimulation showed a greater effect on cortical spreading depression compared to 1-Hz stimulation. The results show that 1-Hz and 20-Hz repetitive electrical stimulation results in an increase in cortical spreading depression velocity that is associated with the frequency and the hemisphere of stimulation. Furthermore, the effects are found to be long lasting. We believe that these findings have strong relevance to support the clinical application of therapies involving electrical stimulation for diseases of reduced cortical excitability.

Analysis of Variance↗
PubMed2005

Leao's cortical spreading depression: from experimental "artifact" to physiological principle.

Cortical spreading depression was described in 1943 by Aristides Leão, a Brazilian neurophysiologist. Initially considered to be a mysterious event as it was discovered serendipitously, its nature has become progressively better known. Cortical spreading depression is now accepted as the mechanism underlying migraine aura and has became known as either Leão's spreading depression or cortical spreading depression. Recent studies have suggested a role for Leão's cortical spreading depression in the pathogenesis and symptomatology of neurologic disorders such as transient global amnesia, head injury, and cerebrovascular diseases.

Brain Ischemia↗
PubMed2004

Changes in magnetization transfer MRI correlate with spreading depression-induced astroglial reactivity and increased protein expression in mice.

OBJECTIVE: Gliosis refers to a range of glial cell transformations that vary according to specific brain pathologic states. Disease, however, is not a prerequisite for gliosis because glial reactivity may also be seen in regions of increased physiologic activity. Our study tests the hypothesis that high-field-strength magnetization transfer MRI is a sensitive technique for detecting transient glial reactivity after experimental spreading depression, a relatively benign perturbation unaccompanied by cell injury. MATERIALS AND METHODS: Unilateral neocortical spreading depression was elicited in mouse cerebral hemispheres and confirmed by transcranial blood flow and extracellular potential measurements. After 3 days, mice were imaged at 4 T using magnetization transfer techniques. Astroglial reactivity was determined immunohistochemically, and protein expression in control and experimental hemispheres was compared using proteomic techniques. RESULTS: Sixteen ([mean +/- SD] +/- 3) spreading depressions (n = 10) were recorded in experimental hemispheres. Spreading depression was never observed in control hemispheres. At 3 days, an 8% decrease (p < 0.05, n = 4) in magnetization transfer signal intensity was measured in experimental hemispheres, which was associated with a 37% increase (p < 0.001, n = 4) in the intensity of glial fibrillary acidic protein staining. Proteomic analysis performed 3 days after the induction of spreading depression showed upregulation of at least 56 proteins, including extracellular and intracellular elements. CONCLUSION: Magnetization transfer at 4.0-T MRI is a sensitive method for detecting glial reactivity and changes in protein expression not associated with cell injury. These results suggest magnetization transfer MRI techniques may have potential for detecting glial reactivity in physiologic processes such as learning and in early disease states.

Animals↗
PubMed1984

Spreading depression and the blood-brain barrier.

The propagation of spreading cortical depression was studied in rabbits during the reversible opening of the blood-brain barrier induced by hypertonic aqueous solutions of sodium chloride and sodium diatrizoate. The rupture of the blood-brain barrier was monitored by the leakage of Evans blue-albumin from pial vessels. Spreading depression was monitored by recording its characteristic slow voltage variations. Test substances were injected into the carotid artery or topically applied to the pia-arachnoid surface. Intracarotid injection of hypertonic solutions that open the blood-brain barrier do not block the propagation of spreading depression. Topical application of NaCl solutions can block the spread of the cortical depression reaction without opening the blood-brain barrier. Recurrent spreading depression waves at a mean frequency of one every 5 min, for 4 h do not cause the release of Evans blue-albumin complex from pial vessels.

Administration, Topical↗
PubMed1994

Elicitation of retinal spreading depression by barium ions.

The association of potassium ions with the occurrence and propagation of spreading depression is well known. The effects of barium ions, a potassium-channel blocker, on spreading depression in isolated retina are described. Pulses of 1-4 mM BaCl2, when applied to the retina, first induce the reaction, then hinder the propagation of the wave which finally stops. The threshold level which triggers the reaction is 0.4-0.6 mM BaCl2 but it varies with the composition of the superfusing Ringer solution. For example, in retinas superfused with low NaCl, or NaCl partially substituted by sodium isethionate, spreading depression may be evoked by barium ions at micromolar concentrations, without changing the velocity of spreading. The delayed blocking actions observed with higher doses may predominantly affect the recovery processes of the wave front, and are related to the refractory period of a preceding spreading depression.

Animals↗
PubMed1992

Extracapsular spread and the perineural extension of squamous cell cancer in the cervical plexus.

Extracapsular spread of squamous cell carcinoma in cervical lymph nodes is associated with approximately 50% decrease in survival and a twofold increase in regional recurrence. This study examines the hypothesis that increased regional recurrence may be, in part, due to unrecognized microscopic perineural invasion of the nerve rootlets of the cervical plexus. Thirty patients with head and neck squamous cell carcinoma with clinically N+ necks undergoing radical neck dissection were prospectively studied. Neck dissection specimens were evaluated for extracapsular spread, and the cervical plexus rootlets were histologically examined for perineural invasion. The incidence of extracapsular spread was 83% (25 of 30 patients). Only one (4%) of 25 had involvement of the cervical plexus, and this patient had gross as well as microscopic cervical plexus invasion. Microscopic perineural spread of squamous cell carcinoma in the cervical plexus occurs infrequently when extracapsular spread is present. Routine histologic evaluation of cervical rootlets for margins is warranted only when gross tumor is in close proximity to the cervical plexus.

Aged↗
PubMed1996

Generation of autonomously pathogenic neo-autoreactive Th1 cells during the development of the determinant spreading cascade in murine autoimmune encephalomyelitis.

Chronic progression of autoimmune disease is accompanied by the acquisition of autoreactivity to new self-determinants. Recent evidence indicates that this process, commonly referred to as determinant spreading, may be pathogenic for chronicity. Our studies on experimental autoimmune encephalomyelitis (EAE), a murine model widely used in multiple sclerosis (MS) studies, have shown that determinant spreading develops as a predictable sequential cascade of neo-autoimmunity during progression to chronic disease. By 7-8 weeks after immunization of (SWR x SJL)F1 mice with the immunodominant myelin proteolipid protein determinant (PLP 139-151), splenocytes consistently respond to the immunodominant myelin basic protein determinant (MBP 87-99). In the present study, we directly address the pathogenicity of neo-autoimmunity resulting from endogenous self-priming during the course of disease. Our results indicate that T cells responding to the spreading MBP 87-99 determinant produce a proinflammatory cytokine profile consistent with type 1 helper T cells (Th1) cells. In addition, splenocytes activated to the spreading MBP 87-99 determinant consistently transfer acute EAE in naive recipients even when T cells reactive to the priming PLP 139-151 immunogen are eliminated by bromodeoxyuridine (BUdR)-mediated photolysis. Our data indicate that endogenous neo-autoantigen priming during chronic autoimmune disease generates type 1 helper T cells (Th1) cells that are autonomously pathogenic. These results provide further evidence supporting the view that determinant spreading is a pathogenic process that leads to chronic progression of autoimmune disease.

Adoptive Transfer↗
PubMed1996

Photoreactive analog of peptide FN-C/H-V from the carboxy-terminal heparin-binding domains of fibronectin supports endothelial cell adhesion and spreading on biomaterial surfaces.

The extracellular matrix protein fibronectin (FN) plays an important role in cell adhesion, spreading, and motility. Several cell-adhesion promoting domains exist within fibronectin, and peptide sequences from these domains have been shown to play an important role in cell interactions with fibronectin. Recently, a peptide sequence (FN-C/H-V) from the 33/66 kD carboxy-terminal heparin-binding domains of fibronectin was shown to promote the adhesion and spreading of vascular endothelial cells in vitro. Endothelial cell spreading on this peptide was followed by cytoskeletal reorganization, focal contact formation, and, ultimately, cell migration. In the current study, a photoreactive analog of FN-C/H-V (ASD-V) was generated using a heterobifunctional photoreactive crosslinking agent, sulfosuccinimidyl 2-(pazidosalicylamido) ethyl-1,3'-dithio-propionate. ASD-V was then covalently coupled to polystyrene (PS) and polyethylene terephthalate film (PET) in order to assess the utility of ASD-V for preparing biomaterial surfaces with endothelial cell-adhesion promoting properties. The effects of pre-adsorption time and initial coating concentration on the efficiency of ASD-V coupling to PS and to PET were examined. Contact angle measurements and atomic force microscopy were used to characterize ASD-V-modified surfaces. Finally, the adhesion and spreading of vascular endothelial cells on ASD-V-modified surfaces was assessed. Our results suggest that photoreactive peptides are an effective and convenient means of modifying biomaterial surfaces to impart adhesion-promoting properties and that ASD-V, when coupled to PS and PET, promotes endothelial cell adhesion and spreading and may therefore be useful as a biomaterial surface modification in applications where re-endothelialization is desired (e.g., autologous endothelial seeding of vascular grafts, or transplantation of genetically engineered endothelial cells via polymer-coated stents.

Animals↗
PubMed2000

Differentiation of multicentric origin from intra-organ metastatic spread of hepatocellular carcinomas by comparative genomic hybridization.

In hepatocellular carcinoma (HCC), multifocal growth may be due to intrahepatic metastatic spread or to the multicentric origin of clonal neoplasms. Although this issue is of potential clinical and prognostic importance, reliable differentiation cannot be achieved using clinical or morphological criteria alone. In this study, comparative genomic hybridization (CGH) was used to differentiate between metastatic spread and multicentric growth in two cases of HCC. In the first case, six carcinoma nodules were examined. The affected chromosomes and their pattern of aberrations were almost identical for all six nodules. In addition to aberrations of chromosomes 1, 4, 9, and 13, further aberrations were observed for chromosomes 2, 5, 7, and 17, which are less typical for HCC. These findings were seen as indicative of metastatic spread of the HCC. In the second case, 75% (3/4) of the nodules showed comparable aberration patterns involving chromosomes 1, 4, 8, 13, and 17, together with a number of further aberrations also not frequently seen in HCC including chromosomes 5, 7, 10, 12, 14, and 18. Chromosomes 4, 5, 8, 10, and 12 were also altered in the fourth nodule examined for this case, but they exhibited a unique aberration pattern. Additionally, gain of chromosome 15q was seen in only this fourth nodule. In the two cases examined, metastatic spread and multicentric origin of HCC could be differentiated by different patterns of karyotypic change. The CGH results were confirmed by fluorescence in situ hybridization (FISH). In conclusion, CGH facilitates the differentiation of multicentric growth from metastatic spread in HCC and appears to be superior to techniques previously used to resolve this clinically important diagnostic problem.

Adult↗
PubMed1987

Intraductal spread of esophageal squamous cell carcinoma.

In order to determine the pathways of tumor dissemination in esophageal carcinoma, 175 lesions of squamous cell carcinoma of the esophagus were studied histopathologically and by electron microscope in relation to the intraepithelial spread and involvement of the esophageal glands by the carcinoma. The study compared vessel invasion and lymph node metastasis. Intraepithelial spread was seen in 111 lesions (63%) and gland duct involvement in 33 lesions (19%). Gland duct involvement was observed in 30% of the lesions positive for intraepithelial spread. In the intramucosal carcinomas, gland duct involvement was observed in 24%. Even in a very small carcinoma 7 X 5 mm in size, ductal spread was detected. This carcinoma did not reach the submucosa through stromal invasion. Patients with intramucosal carcinoma showed low incidence (20%) of lymphatic and/or blood vessel invasion and no incidence of lymph node metastasis. Examination by electron microscope showed that the cancer cells of the intraepithelial spread entered the duct by raising the normal ductal epithelium in the ductal cavity although the basal lamina was retained. Normal gland duct cells and cancer cells were either attached with desmosomes directly or were separated by degenerated epithelial cells. A high incidence of ductal involvement of the esophageal glands was seen in squamous cell carcinoma of the esophagus, indicating its possible importance as a route to the deep tissue in the early stage of this carcinoma.

Adult↗
PubMed2000

Modeling the influence of settlement structure on the spread of influenza among communities.

Several factors play critical roles in the geographic spread of infectious diseases, including the movement of people between communities and the social and economic structure of groups of communities. A mathematical model has been developed to examine the individual and shared impact of these factors. This model was applied to the spread of the 1918-1919 influenza epidemic in three Aboriginal communities in central Canada. Previously published results from simulations of the model used parameter estimates for mobility patterns that were derived from historical documents from the study communities, especially Hudson's Bay Company post journals. We have termed this model the Frontier pattern. In this paper we extend that work to consider the consequences of three additional travel scenarios, which represent idealized trade and travel relationships between different communities. The three patterns include (a) the Central Marketplace scenario, an idealization of relations between a central community and its satellites in which a single central community satisfies all needs of the satellite communities; (b) the Sister Towns scenario, which allows travel among all communities and overemphasizes communication between satellites so that the ramifications of small town interactions are easier to observe; and (c) the Circuit scenario, which represents a hypothetical trade network that is a series of unidirectional dyad relationships linking all communities within a region. Results from simulations of the four mobility patterns are compared to assess the potential impact different social and economic relationships among communities may have had on the geographic spread of the 1918 influenza epidemic in central Canada and in other regions. These results reinforce conclusions that show that variation in patterns of mobility significantly influences the timing of epidemic peaks but only minimally alters the number of cases within a community. In addition, comparisons of the different models indicate that a central location in the social and political hierarchy of a region may be more important in influencing patterns of epidemic spread than just a central location with regard to travel patterns. Furthermore, who was actually travelling and where they were travelling had important consequences for epidemic spread. Am. J. Hum. Biol. 12:736-748, 2000. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗
PubMed2002

Influence of calcium on Manduca sexta plasmatocyte spreading and network formation.

Plasmatocytes are a class of insect hemocytes important in the cellular defense response. In some species, they are phagocytic, protecting the insect from smaller pathogens. In many insects, they work in concert with other hemocytes (particularly other plasmatocytes and granular cells) to form nodules and to encapsulate foreign material. To perform these functions, plasmatocytes attach to, spread on, and surround suitable targets. Because of their importance, because we had previously observed that prolonged incubation of hemocytes in solutions containing the divalent cation chelator ethylenediaminetetraacetic acid (EDTA) inhibited plasmatocyte spreading, and because of the importance of divalent cations in many immune-related functions, we investigated the effect of calcium and magnesium on spreading of plasmatocytes from fifth instar Manduca sexta larvae. On glass slides, plasmatocytes spread more quickly and elongated in Grace's medium containing 5 mM calcium, compared to calcium-free medium. In the presence of calcium, plasmatocyte adhesion, spreading, and network formation were not visibly different in magnesium-free and magnesium-containing Grace's medium. Using immunomicroscopy with a monoclonal antibody specific for plasmatocytes, we measured the length and width of plasmatocytes incubated with several different concentrations of calcium. Plasmatocyte length positively correlated with calcium concentration to 5 mM (maximum concentration tested and approximately the hemolymph concentration). Mean plasmatocyte width was less in 0 and 5 mM calcium than in 0.05 or 0.5 mM calcium. On plastic, hemocytes survived longer than on glass (they survived beyond 24 h) and, in 5 mM calcium, formed an extensive network readily visible by phase-contrast microscopy. This network was never as extensive in the absence of calcium. Network formation in the absence of magnesium, but presence of calcium, resembled network formation in standard Grace's medium.

Animals↗
PubMed1997

The 52-kd protein as a target of intermolecular spreading of the immune response to components of the SS-A/Ro-SS-B/La complex.

OBJECTIVE: To determine whether immunization of healthy non-autoimmune mice with 52-kd SS-A/Ro induces a secondary antibody response to other components of the 48-kd SS-B/La-60-kd SS-A/Ro RNP complex and vice versa, since anti-52-kd antibodies have been invariably linked to these antigens in patients with Sjogren's syndrome and in mothers whose children have neonatal lupus. METHODS: Female BALB/c mice were immunized with 100 microg of 6xHis recombinant human 48-kd SS-B/La, 52-kd SS-A/Ro, or 60-kd SS-A/Ro proteins, or the 6xHis polypeptide control, each purified by Ni2+ affinity chromatography. Mice subsequently received booster injections with 50 microg of the same antigen every 10-21 days. Immune responses were measured by enzyme-linked immunosorbent assay (ELISA), immunoblotting of recombinant antigens, and immunoprecipitation of 35S-methionine-labeled in vitro translation products. RESULTS: Immunization with 48-kd SS-B/La resulted in anti-48-kd SS-B/La antibodies within 45 days, followed 10 days later by a secondary response to 52-kd SS-A/Ro, as measured by ELISA. Antibody spreading to 60-kd SS-A/Ro was not detected. Immunization with 52-kd SS-A/Ro resulted in rapid high-titer anti-52-kd SS-A/Ro responses within 27 days. Spreading to 48-kd SS-B/La occurred in only 1 mouse and 60-kd SS-A/Ro was detected in a minority of the mice after prolonged antigen exposure. Immunization with 60-kd SS-A/Ro led to anti-60-kd SS-A/Ro responses within 37 days, followed 3 months later by low-titer anti-48-kd SS-B/La and anti-52-kd SS-A/Ro antibodies. All primary immune responses were confirmed by immunoblotting and immunoprecipitation. While immunoblotting of the recombinant proteins revealed reciprocal intermolecular spreading in the majority of mice, immunoprecipitation clearly demonstrated that predominant spreading was generated after immunization with 48-kd SS-B/La, which consistently resulted in antibodies to 52-kd SS-A/Ro. CONCLUSION: The murine responses observed in the present study, demonstrating reciprocal intermolecular spreading to 48-kd SS-B/La, 52-kd SS-A/Ro, and 60-kd SS-A/Ro, support the linkage of 52-kd SS-A/Ro with the other proteins, despite their as-yet-undetected association in vivo. The marked recruitment of anti-52-kd SS-A/Ro responses elicited by 48-kd SS-B/La may provide a lead to exploring the physical interaction, direct or indirect, of 52-kd SS-A/Ro with the SS-A/Ro-SS-B/La RNP particle and its presentation to the immune system. These data should facilitate the establishment of a murine model of neonatal lupus.

Animals↗
PubMed2004

Intramolecular T cell spreading in unprimed MRL/lpr mice: importance of the U1-70k protein sequence 131-151.

OBJECTIVE: To analyze spontaneous T cell spreading against determinants of the U1-70K protein in young autoimmune MRL/lpr lupus mice, in comparison with the T cell spreading occurring in normal BALB/c mice immunized with peptide 131-151 of this protein. METHODS: Peripheral blood lymphocytes (PBLs) from both unprimed MRL/lpr mice and immunized BALB/c mice were tested for their ability to proliferate ex vivo in response to 18 overlapping peptides of the U1-70K spliceosomal protein, using assays for lymphocyte proliferation and secretion of interleukin-2. RESULTS: The proliferative response to peptides of the U1-70K protein evolved rapidly in MRL/lpr mice tested at different ages. At least 5 peptides were recognized by PBLs from 8-week-old autoimmune mice, whereas a different peptide was recognized by PBLs from MRL/lpr mice at 12 weeks of age. At 15 weeks, the proliferative response was weak or negative when assessed with any of the test peptides. At least 2 major peptides recognized by MRL/lpr PBLs were also recognized by PBLs generated in the BALB/c mice primed with peptide 131-151. We further demonstrated that, in preautoimmune MRL/lpr mice, repeated administration of phosphorylated peptide 131-151 (called P140), which was shown previously to be protective, transiently abolished T cell intramolecular spreading to other regions of the 70K protein. CONCLUSION: This is the first study to demonstrate that intramolecular T cell spreading effectively occurs in MRL/lpr mice with lupus, and that region 131-151 is important in the cascade of events observed in the murine lupus response. This sequence might originate a mechanism of tolerance spreading that leads to the beneficial effect observed in MRL/lpr mice after treatment with the phosphorylated peptide 131-151.

Animals↗
PubMed1992

The role of beta 1 integrin in spreading and myofibrillogenesis in neonatal rat cardiomyocytes in vitro.

The influence of the extracellular matrix (ECM) on cell behavior, myofibrillogenesis and cytoarchitecture was investigated in neonatal rat cardiac myocytes in vitro. Cell behavior was examined by analyzing cell spreading on different ECM components under a variety of experimental conditions. Area measurements were made on digitized images of cells grown for various time intervals on fibronectin (FN), laminin (LN), collagens I and III (C I+III), plastic, and bovine serum albumin (BSA). The amount of spreading was varied on the different matrices and was maximal on FN greater than LN greater than C I+III greater than plastic greater than BSA. Addition of anti-beta 1 integrin antibodies to myocytes cultured on FN, LN and C I+III blocked spreading outward on the substrates and altered normal myofibrillogenesis, especially on LN. Concomitantly, the integrin antibodies induced the formation of giant pseudopodial processes which protruded upward from the substrates. These pseudopods contained actin polygonal networks which exhibited a regular geometrical configuration. Effects of the ECM on cytoarchitecture was examined by analyzing the temporal and spatial patterns of fluorescence and immunogold labeling of cytoskeletal and integrin proteins as myocytes spread in culture. The first indication of sarcomeric patterns was the appearance at 4 hours of striations formed by lateral alignment of alpha-actinin aggregates into Z bands. At later times, vinculin at 8 hours and beta 1 integrin at 22 hours became co-localized with alpha-actinin at the Z bands and focal adhesions. These data indicate that ECM components influence myocyte spreading and that myofibril assembly and/or stability is associated with ECM-integrin-cytoskeleton associations.

Actinin↗
PubMed1992

Steady-state heat transfer and thermal zone spreading in gel isoelectric focusing.

The zone spreading caused by a transverse pH profile due to a temperature gradient through the thickness of a gel slab is estimated. The temperature difference (delta T) between the upper and lower gel surfaces can be calculated as a function of the electric power dissipated in the gel and the gel dimensions. It is found that when delta T is only 1 degree C the zone spreading due to this thermal excursion is as high as 0.5 mm. Thus, an admissible delta T is found to be equal to 0.2 degrees C, since this corresponds to a thermal zone spreading of only 0.1 mm, i.e. the same order of magnitude as the spatial resolution of a laser scanner. A thermal zone spreading of 0.1 mm is compatible with a resolving power of 0.01 pH unit, the current limit of conventional isoelectric focusing in amphoteric buffers. A requirement for the thickness of a gel slab is formulated: e.g., at 40 W applied power (over a gel surface area of 25 x 11 cm), a thermal zone spreading limited to 0.1 mm can only be obtained with a gel thickness of approximately 170 microns.

Hot Temperature↗
PubMedDate not supplied

Computed tomography of primary subglottic cancer: clinical importance of typical spread pattern.

The spread pattern of 14 cases of primary subglottic cancer, as seen on computed tomography (CT), is analyzed. Cricoid cartilage invasion was present in nine cases. Tracheal invasion was definite in four cases and questionable in three. Extralaryngeal soft tissue spread was present in nine cases; all but one had cartilage destruction. The patterns of spread seen accurately reflect reports in previous whole-organ section studies, and suggest that the elastic cone has a primary role in directing the spread of tumor. Anticipating spread to areas described above with CT and/or magnetic resonance imaging (MRI) can be used to try to improve treatment planning and perhaps outcome by: (1) avoiding placement of urgent tracheostomies close to the tumor; (2) helping to modify standard surgical approaches by suggesting lower-than-usual tracheostomies, or more extensive-than-usual thyroid gland resection; and (3) avoiding delay in diagnosis by strongly suggesting rebiopsy when imaging indicates a tumor is present, and initial endoscopy and biopsy cannot confirm the imaging findings.

Aged↗