An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning... more An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning as well as for evaluation and comparison of the results of different treatment modalities. Neoplastic invasion of the laryngeal cartilage may have important therapeutic implications. To our knowledge, no data are available comparing the impact of endoscopic examination, computed tomography (CT), and magnetic resonance (MR) imaging on pretherapeutic staging accuracy. The purpose of our study was to determine which imaging should be used as an adjunct to other clinical examinations in the pretherapeutic staging of laryngeal carcinoma. In this study, 40 consecutive patients with neoplasms of the larynx, who were treated surgically, were included in a prospective pretherapeutic staging protocol that included indirect laryngoscopy, direct microlaryngoscopy, contrast-enhanced CT, and gadolinium-diethylenetriamine pentaacetic acid-enhanced MR imaging at 1.5 Tesla. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were compared with the clinical findings including the CT and MR images. The impact of each diagnostic method on pretherapeutic staging was analyzed. Clinical/endoscopic evaluation failed to correctly stage 17 tumors due to invasion of the paraglottic space (1 tumor), preepiglottic space (2 tumors), and extralaryngeal soft tissues (14 tumors), resulting in a pretherapeutic staging accuracy of 57.5%. Neoplastic invasion of cartilage was present in 28 patients and absent in 12 patients. Although MR imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (94% vs. 67%; P = 0.001), MR imaging was less specific than CT (74% vs. 87%; P = 0.007). There was no difference between the overall accuracy of CT and MR imaging in detecting neoplastic invasion of cartilage (80% vs. 82%). The accuracy of combined clinical/endoscopic examination and CT staging was 80% and the accuracy of combined clinical/endoscopic examination and MR imaging staging was 87.5%; the difference was not statistically significant. Clinical/endoscopic examination alone failed to identify tumor invasion of the laryngeal cartilages and of the extralaryngeal soft tissues, resulting in a low staging accuracy (57.5%). Many pT4 (according to the International Union against Cancer TNM Staging System) tumors were clinically unrecognized. The combination of clinical/endoscopic evaluation and an additional radiologic examination, either CT or MR imaging, resulted in significantly improved staging accuracy (80% vs. 87.5%). MR imaging is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR imaging tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and may lead to inadequate therapy.
Three cases of cervical necrotizing fasciitis are presented. One case was odontogenic in origin a... more Three cases of cervical necrotizing fasciitis are presented. One case was odontogenic in origin and two were due to pharyngeal infectious. Bacteria cultured represented multiple bacterial species. Airway control was necessary early, as was wide surgical exploration of the fascial spaces of the neck with re-exploration as necessary. Intensive medical support was crucial to prevent or treat complications. Cervical necrotizing fasciitis has an overall mortality rate of 30 per cent at the University of Bern.
TOC for Mafee et al: Imaging of the Head and Neck 2/e Section I: Temporal Bone Chapter 1: Imaging... more TOC for Mafee et al: Imaging of the Head and Neck 2/e Section I: Temporal Bone Chapter 1: Imaging of the Temporal Bone (Dr. Valvassori) Section II: Eye and Orbit, Base of the Skull Chapter 2: Eye and Orbit (Dr. Mafee) Part 1: The Eye Part 2: The Orbit Chapter 3: Base of the Skull (Dr. Mafee) Section III: Nasal Cavity and Paranasal Sinuses Chapter 4: Imaging of the Nasal Cavity and Paranasal Sinuses (Dr. Mafee) Section IV: Masticatory System Chapter 5: Temporomandibular Joint (Dr. Mafee) Chapter 6: Mandible and Maxilla (Dr. Weber) Section V: Suprahyoid Neck Chapter 7: Nasopharynx (Dr. Mafee) Chapter 8: Parapharyngeal Spaces (Dr. Lewin) Chapter 9: Salivary Glands (Dr. Mafee) Chapter 10: Oral Cavity and Oropharynx (Dr. Becker) Section VI: Infrahyoid Neck Chapter 11: Larynx and Hypopharynx (Dr. Becker) Chapter 12: Other Infrahyoid Neck Lesions (Dr. Becker
Aneurysmal bone cysts is a benign, slow growing expansile lesion usually found in long bones or v... more Aneurysmal bone cysts is a benign, slow growing expansile lesion usually found in long bones or vertebrae. Only 5 cases of ABC of the ethmoid bone have been reported in the literature. Plain radiographs are not specific. CT and MRI are very useful to depict the extent of the lesion and demonstrate the presence of blood-fluid levels, which is a characteristic finding of ABC. We present one atypical case of ABC of the ethmoid bone in a 15-year-old female characterised by its extensive involvement and its rare location.
La maladie de Menière est caractérisée par des épisodes récidivants de vertige associés à des flu... more La maladie de Menière est caractérisée par des épisodes récidivants de vertige associés à des fluctuations de l’audition, des acouphènes et une sensation de plénitude dans l’oreille atteinte. Même s’il ne permet pas d’expliquer toutes les manifestations de la maladie, l’élargissement de l’espace endolymphatique – ou hydrops endolymphatique (HE) – en est une caractéristique histologique classique. Les progrès de l’imagerie par résonance magnétique permettent maintenant la visualisation in vivo des espaces liquidiens de l’oreille interne et l’appréciation d’un éventuel HE. Cet article traite de ces avancées et leurs potentielles implications diagnostiques dans le contexte d’une maladie de Menière et plus généralement dans les affections cochléovestibulaires
Menière's disease is characterized by episodic vertigo associated with fluctuating hearing lo... more Menière's disease is characterized by episodic vertigo associated with fluctuating hearing loss, tinnitus and fullness of the ear on the affected side. Endolymphatic space enlargement - or endolymphatic hydrops (EH) - is a histological hallmark of the disease that does not explain all its clinical manifestations. Magnetic resonance imaging improvements now allow in vivo visualization of inner ear liquid spaces and appreciation of potential EH. This article discusses these advances and their potential diagnostic implications in the context of Menière's disease and more generally in cochleovestibular disorders.
The purpose of this study was to evaluate the radiation dose delivered to radiosensitive organs (... more The purpose of this study was to evaluate the radiation dose delivered to radiosensitive organs (thyroid, parotid glands and eye lens) during dentomaxillofacial imaging with multislice computed tomography (CT), cone beam CT (CBCT) and panoramic radiographs (orthopantomography, OPT). The dose was estimated individually for each modality and each clinical protocol by measuring the absorbed dose at the surface of a head phantom with thermoluminescence dosimeters. The measured radiation dose was between 0.01–1.22 mGy for the thyroid gland (systematically outside the primary beam), 1.34–29.11 mGy for the parotid glands (systematically exposed to the primary beam) and 0.02–26.22 mGy for the eye lens (in the primary beam depending on imaging protocol). For all organs, CT was found to be the most irradiating modality followed by CBCT and OPT. However, CBCT with a “limited dental” protocol and OPT deliver similar doses to the parotid glands.
Introduction Maxillofacial radiologic examinations often result in irradiation of the thyroid gla... more Introduction Maxillofacial radiologic examinations often result in irradiation of the thyroid gland, parotid glands and lens due to primary exposure or scatter radiation. Organ exposure depends on imaging modalities and protocols. Purpose The purpose of this investigation was to evaluate radiation doses to the above-mentioned organs for CT, cone beam CT (CBCT) and panoramic radiographs (orthopantomography, OPT). Materials and methods The absorbed dose was measured on the surface of a head phantom with thermoluminescence dosimeters. The phantom was imaged with CT, CBCT and OPT using standardized protocols employed in clinical routine. The areas examined included the paranasal sinuses, the entire head and the mandible depending on the protocol used. Dose measurements were performed individually for each modality and each protocol. Results Doses to the thyroid gland when located outside the area of interest were lowest for all modalities (range: 0.01–1.22 mGy; measurement uncertainty: 10% at k = 2). Depending on the examination protocol, doses to the eye lens (due to primary beam or scattered radiation) showed wide variability (range: 0.02–26.22 mGy). The parotid glands were the only organs systematically placed in the primary beam for all modalities and protocols. Values ranged from 1.40–29.11 mGy with the highest values for CT examinations. For OPT, doses to the parotid glands were strongly inhomogeneous due to its operating mode. Conclusion CT was the most irradiating modality. The mean doses to the parotid glands were similar for CBCT and OPT, while doses to organs in the scattered field were systematically higher for CBCT than OPT. Disclosure The authors declare that they have no relevant material or financial interests that relate to the research described in this study.
An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning... more An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning as well as for evaluation and comparison of the results of different treatment modalities. Neoplastic invasion of the laryngeal cartilage may have important therapeutic implications. To our knowledge, no data are available comparing the impact of endoscopic examination, computed tomography (CT), and magnetic resonance (MR) imaging on pretherapeutic staging accuracy. The purpose of our study was to determine which imaging should be used as an adjunct to other clinical examinations in the pretherapeutic staging of laryngeal carcinoma. In this study, 40 consecutive patients with neoplasms of the larynx, who were treated surgically, were included in a prospective pretherapeutic staging protocol that included indirect laryngoscopy, direct microlaryngoscopy, contrast-enhanced CT, and gadolinium-diethylenetriamine pentaacetic acid-enhanced MR imaging at 1.5 Tesla. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were compared with the clinical findings including the CT and MR images. The impact of each diagnostic method on pretherapeutic staging was analyzed. Clinical/endoscopic evaluation failed to correctly stage 17 tumors due to invasion of the paraglottic space (1 tumor), preepiglottic space (2 tumors), and extralaryngeal soft tissues (14 tumors), resulting in a pretherapeutic staging accuracy of 57.5%. Neoplastic invasion of cartilage was present in 28 patients and absent in 12 patients. Although MR imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (94% vs. 67%; P = 0.001), MR imaging was less specific than CT (74% vs. 87%; P = 0.007). There was no difference between the overall accuracy of CT and MR imaging in detecting neoplastic invasion of cartilage (80% vs. 82%). The accuracy of combined clinical/endoscopic examination and CT staging was 80% and the accuracy of combined clinical/endoscopic examination and MR imaging staging was 87.5%; the difference was not statistically significant. Clinical/endoscopic examination alone failed to identify tumor invasion of the laryngeal cartilages and of the extralaryngeal soft tissues, resulting in a low staging accuracy (57.5%). Many pT4 (according to the International Union against Cancer TNM Staging System) tumors were clinically unrecognized. The combination of clinical/endoscopic evaluation and an additional radiologic examination, either CT or MR imaging, resulted in significantly improved staging accuracy (80% vs. 87.5%). MR imaging is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR imaging tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and may lead to inadequate therapy.
Three cases of cervical necrotizing fasciitis are presented. One case was odontogenic in origin a... more Three cases of cervical necrotizing fasciitis are presented. One case was odontogenic in origin and two were due to pharyngeal infectious. Bacteria cultured represented multiple bacterial species. Airway control was necessary early, as was wide surgical exploration of the fascial spaces of the neck with re-exploration as necessary. Intensive medical support was crucial to prevent or treat complications. Cervical necrotizing fasciitis has an overall mortality rate of 30 per cent at the University of Bern.
TOC for Mafee et al: Imaging of the Head and Neck 2/e Section I: Temporal Bone Chapter 1: Imaging... more TOC for Mafee et al: Imaging of the Head and Neck 2/e Section I: Temporal Bone Chapter 1: Imaging of the Temporal Bone (Dr. Valvassori) Section II: Eye and Orbit, Base of the Skull Chapter 2: Eye and Orbit (Dr. Mafee) Part 1: The Eye Part 2: The Orbit Chapter 3: Base of the Skull (Dr. Mafee) Section III: Nasal Cavity and Paranasal Sinuses Chapter 4: Imaging of the Nasal Cavity and Paranasal Sinuses (Dr. Mafee) Section IV: Masticatory System Chapter 5: Temporomandibular Joint (Dr. Mafee) Chapter 6: Mandible and Maxilla (Dr. Weber) Section V: Suprahyoid Neck Chapter 7: Nasopharynx (Dr. Mafee) Chapter 8: Parapharyngeal Spaces (Dr. Lewin) Chapter 9: Salivary Glands (Dr. Mafee) Chapter 10: Oral Cavity and Oropharynx (Dr. Becker) Section VI: Infrahyoid Neck Chapter 11: Larynx and Hypopharynx (Dr. Becker) Chapter 12: Other Infrahyoid Neck Lesions (Dr. Becker
Aneurysmal bone cysts is a benign, slow growing expansile lesion usually found in long bones or v... more Aneurysmal bone cysts is a benign, slow growing expansile lesion usually found in long bones or vertebrae. Only 5 cases of ABC of the ethmoid bone have been reported in the literature. Plain radiographs are not specific. CT and MRI are very useful to depict the extent of the lesion and demonstrate the presence of blood-fluid levels, which is a characteristic finding of ABC. We present one atypical case of ABC of the ethmoid bone in a 15-year-old female characterised by its extensive involvement and its rare location.
La maladie de Menière est caractérisée par des épisodes récidivants de vertige associés à des flu... more La maladie de Menière est caractérisée par des épisodes récidivants de vertige associés à des fluctuations de l’audition, des acouphènes et une sensation de plénitude dans l’oreille atteinte. Même s’il ne permet pas d’expliquer toutes les manifestations de la maladie, l’élargissement de l’espace endolymphatique – ou hydrops endolymphatique (HE) – en est une caractéristique histologique classique. Les progrès de l’imagerie par résonance magnétique permettent maintenant la visualisation in vivo des espaces liquidiens de l’oreille interne et l’appréciation d’un éventuel HE. Cet article traite de ces avancées et leurs potentielles implications diagnostiques dans le contexte d’une maladie de Menière et plus généralement dans les affections cochléovestibulaires
Menière's disease is characterized by episodic vertigo associated with fluctuating hearing lo... more Menière's disease is characterized by episodic vertigo associated with fluctuating hearing loss, tinnitus and fullness of the ear on the affected side. Endolymphatic space enlargement - or endolymphatic hydrops (EH) - is a histological hallmark of the disease that does not explain all its clinical manifestations. Magnetic resonance imaging improvements now allow in vivo visualization of inner ear liquid spaces and appreciation of potential EH. This article discusses these advances and their potential diagnostic implications in the context of Menière's disease and more generally in cochleovestibular disorders.
The purpose of this study was to evaluate the radiation dose delivered to radiosensitive organs (... more The purpose of this study was to evaluate the radiation dose delivered to radiosensitive organs (thyroid, parotid glands and eye lens) during dentomaxillofacial imaging with multislice computed tomography (CT), cone beam CT (CBCT) and panoramic radiographs (orthopantomography, OPT). The dose was estimated individually for each modality and each clinical protocol by measuring the absorbed dose at the surface of a head phantom with thermoluminescence dosimeters. The measured radiation dose was between 0.01–1.22 mGy for the thyroid gland (systematically outside the primary beam), 1.34–29.11 mGy for the parotid glands (systematically exposed to the primary beam) and 0.02–26.22 mGy for the eye lens (in the primary beam depending on imaging protocol). For all organs, CT was found to be the most irradiating modality followed by CBCT and OPT. However, CBCT with a “limited dental” protocol and OPT deliver similar doses to the parotid glands.
Introduction Maxillofacial radiologic examinations often result in irradiation of the thyroid gla... more Introduction Maxillofacial radiologic examinations often result in irradiation of the thyroid gland, parotid glands and lens due to primary exposure or scatter radiation. Organ exposure depends on imaging modalities and protocols. Purpose The purpose of this investigation was to evaluate radiation doses to the above-mentioned organs for CT, cone beam CT (CBCT) and panoramic radiographs (orthopantomography, OPT). Materials and methods The absorbed dose was measured on the surface of a head phantom with thermoluminescence dosimeters. The phantom was imaged with CT, CBCT and OPT using standardized protocols employed in clinical routine. The areas examined included the paranasal sinuses, the entire head and the mandible depending on the protocol used. Dose measurements were performed individually for each modality and each protocol. Results Doses to the thyroid gland when located outside the area of interest were lowest for all modalities (range: 0.01–1.22 mGy; measurement uncertainty: 10% at k = 2). Depending on the examination protocol, doses to the eye lens (due to primary beam or scattered radiation) showed wide variability (range: 0.02–26.22 mGy). The parotid glands were the only organs systematically placed in the primary beam for all modalities and protocols. Values ranged from 1.40–29.11 mGy with the highest values for CT examinations. For OPT, doses to the parotid glands were strongly inhomogeneous due to its operating mode. Conclusion CT was the most irradiating modality. The mean doses to the parotid glands were similar for CBCT and OPT, while doses to organs in the scattered field were systematically higher for CBCT than OPT. Disclosure The authors declare that they have no relevant material or financial interests that relate to the research described in this study.
Uploads
Papers by Minerva Becker