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Chen X, Yi J, Liu S, Chen W, Guan J, Pan C. Yin-Yang tongue sign: An imaging clue of lesions involving the skull base segment in the hypoglossal pathway. Dentomaxillofac Radiol 2023; 52:20220201. [PMID: 36168971 PMCID: PMC9793452 DOI: 10.1259/dmfr.20220201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic value of the Yin-Yang tongue sign in patients with tongue deviation. METHODS According to the presence of the Yin-Yang tongue sign on CT/MR, 107 patients with tongue deviation were divided into a positive group and a negative group. The involvement categories of the hypoglossal canal (HC) in the positive group were evaluated and classified as HC dilation and HC erosion. The correlations between HC involvement categories and the presence of the sign were analysed. RESULTS There were 55 cases (55/107, 51.4%) in the positive group and 52 cases (52/107, 48.6%) in the negative group. Hypoglossal nerve (HN) involvement mainly occurred in the skull base (61.8%), skull base and carotid space (10.9%), and carotid space segment (12.7%). Neurogenic (50.9%), squamous cell carcinoma (14.5%), and metastases (12.7%) were the predominant aetiologies. The sensitivity, specificity, and accuracy of this sign for suggesting skull base lesions around HC were 72.4%, 80.8%, and 76.6%, respectively. In the positive group, HC dilation was seen in 21 patients (21/55, 38.2%) and 21 cases were all benign. HC erosion were noted in 19 patients (19/55, 34.5%), of whom 12 cases were malignant. CONCLUSION The Yin-Yang tongue sign is formed by unilateral tongue atrophy and fat infiltration caused by lesions in the HN pathway, especially compressive or invasive lesions involving the skull base segment.
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Affiliation(s)
| | - Jingru Yi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Simin Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chu Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Preoperative ultrasound accurately characterizes surgically confirmed extracranial spinal accessory nerve injuries. Skeletal Radiol 2022; 51:1179-1188. [PMID: 34686889 DOI: 10.1007/s00256-021-03945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/07/2021] [Accepted: 10/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the accuracy of preoperative ultrasound and MRI in surgically confirmed spinal accessory nerve injuries and present the benefits of a multimodality image review. MATERIALS AND METHODS A retrospective review of 38 consecutive patients referred to a peripheral nerve surgical practice at an academic teaching hospital with surgically confirmed spinal accessory nerve injuries. All cases were reviewed for patient demographics, date and cause of injury, preoperative EMG, and surgical diagnosis and management. Additionally, prospective interpretation of preoperative ultrasound and MRI reports were reviewed for concordance or discordance with the surgical diagnosis. RESULTS Iatrogenic injury was present in 37 (97%) cases and most commonly a result of an excisional lymph node biopsy (68%). Surgically confirmed spinal accessory nerve injury diagnoses consisted of 25 (66%) stump neuromas and 13 (34%) incomplete nerve injuries. Nine months was the average time from injury to surgery. Twenty-nine patients underwent preoperative ultrasound and/or MRI evaluation: 12 ultrasound only, 10 MRI only, and seven with both ultrasound and MRI. Eighteen (95%) preoperative ultrasound reports compared to four (24%) preoperative MRI reports were concordant with the surgical diagnosis. In the seven cases with both preoperative ultrasound and MRI, six had discordant ultrasound and MRI imaging diagnoses for which the ultrasound was concordant with the surgical diagnoses in all cases. CONCLUSION Preoperative ultrasound more accurately characterizes spinal accessory nerve injuries compared to MRI and should serve as the modality of choice when a spinal accessory nerve injury is suspected.
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Ong V, Bourcier AJ, Florence T, Mozaffari K, Mekonnen M, Sheppard JP, Duong C, Ding K, Yang I. Stereotactic Radiosurgery for Glomus Jugulare Tumors: Systematic Review and Meta-Analysis. World Neurosurg 2022; 162:e49-e57. [DOI: 10.1016/j.wneu.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
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Kim HJ, Seong M, Kim Y. Normal Anatomy of Cranial Nerves III–XII on Magnetic Resonance Imaging. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:501-529. [PMID: 36238638 PMCID: PMC9431917 DOI: 10.3348/jksr.2020.81.3.501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/02/2020] [Indexed: 11/15/2022]
Abstract
복잡한 해부학적 구조와 기능 때문에 뇌신경 질환의 신경영상검사는 항상 어려운 과제이다. 최근 자기공명영상(이하 MRI) 기법의 발달로 많은 경우에서 뇌신경 질환의 원인이 규명되고 있으며, 신경영상의학 의사들은 다학제 팀의 핵심적 팀원으로서 다양한 뇌신경 질환의 원활한 진단을 위하여 MRI에서 관찰되는 뇌신경의 세밀한 해부학적 구조를 잘 알아야 한다. 이 종설에서는 말초성 뇌신경 III–XII에 대해 뇌간으로부터 두개 밖까지 해부학적으로 비슷한 구조를 가지는 구역별로 분류하여 각 구역에서 보이는 뇌신경의 정상 해부학 및 MRI 소견을 설명하고자 한다. 또한 각 구역에서 가장 적합한 MRI 기법에 관하여도 기술하고자 한다.
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Affiliation(s)
- Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minjung Seong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Guarnizo A, Glikstein R, Torres C. Imaging Features of isolated hypoglossal nerve palsy. J Neuroradiol 2019; 47:136-150. [PMID: 31034896 DOI: 10.1016/j.neurad.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Abstract
The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric speech herein, we review the anatomy of the hypoglossal nerve as well as common and infrequent lesions that can affect this nerve along its course.
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Affiliation(s)
- Angela Guarnizo
- Neuroradiology Fellow, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
| | - Rafael Glikstein
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada.
| | - Carlos Torres
- Neuroradiologist, University of Ottawa - The Ottawa Hospital, Ottawa, Canada
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Duque-Parra JE, Barco-Ríos J, Barco-Cano JA. El verdadero origen aparente de los nervios glosofaríngeo, vago y accesorio. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.15446/revfacmed.v67n2.68096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. Existe un vacío conceptual asociado con los sitios precisos por donde emergen las raíces de los nervios glosofaríngeo, vago y accesorio, un conocimiento que es de suma importancia para los neurocirujanos.Objetivo. Determinar el sitio preciso por donde las raíces de los nervios glosofaríngeo, vago y accesorio emergen como origen aparente en la médula oblongada.Materiales y métodos. Se valoraron 67 troncos encefálicos humanos que con anterioridad habían sido fijados en solución de formalina al 10%. Mediante inspección directa, luego de retirar las meninges, se examinó y registró el sitio preciso por donde emergen las raíces de tales nervios y se comparó con lo registrado en la literatura.Resultados. En el 100% de los troncos encefálicos estudiados se encontró que las raíces nerviosas emergen entre 2mm a 3mm por detrás del surco retro-olivar, distinto a lo reportado en la literatura consultada.Conclusión. Hay disparidad de criterios en cuanto al origen aparente de los nervios glosofaríngeo, vago y accesorio, lo que amerita un estudio más amplio que permita llegar a un consenso generalizado sobre el sitio preciso por donde las raíces de tales nervios hacen su aparición.
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Jorquera Moya M, Merino Menéndez S, Porta Etessam J, Escribano Vera J, Yus Fuertes M. Sintomatología derivada de los pares craneales: Clínica y topografía. RADIOLOGIA 2019; 61:99-123. [DOI: 10.1016/j.rx.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 09/16/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
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Jorquera Moya M, Merino Menéndez S, Porta Etessam J, Escribano Vera J, Yus Fuertes M. Cranial nerve disorders: Clinical manifestations and topography. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chhabra A, Bajaj G, Wadhwa V, Quadri RS, White J, Myers LL, Amirlak B, Zuniga JR. MR Neurographic Evaluation of Facial and Neck Pain: Normal and Abnormal Craniospinal Nerves below the Skull Base. Radiographics 2018; 38:1498-1513. [DOI: 10.1148/rg.2018170194] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Khaku A, Patel V, Zacharia T, Goldenberg D, McGinn J. Guidelines for radiographic imaging of cranial neuropathies. EAR, NOSE & THROAT JOURNAL 2018; 96:E23-E39. [PMID: 29121382 DOI: 10.1177/0145561317096010-1106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Disruption of the complex pathways of the 12 cranial nerves can occur at any site along their course, and many, varied pathologic processes may initially manifest as dysfunction and neuropathy. Radiographic imaging (computed topography or magnetic resonance imaging) is frequently used to evaluate cranial neuropathies; however, indications for imaging and imaging method of choice vary considerably between the cranial nerves. The purpose of this review is to provide an analysis of the diagnostic yield and the most clinically appropriate means to evaluate cranial neuropathies using radiographic imaging. Using the PubMed MEDLINE NCBI database, a total of 49,079 articles' results were retrieved on September 20, 2014. Scholarly articles that discuss the etiology, incidence, and use of imaging in the context of evaluation and diagnostic yield of the 12 cranial nerves were evaluated for the purposes of this review. We combined primary research, guidelines, and best practice recommendations to create a practical framework for the radiographic evaluation of cranial neuropathies.
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Affiliation(s)
- Aliasgher Khaku
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, 500 University Dr., MC H091, Hershey, PA 17033-0850, USA
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García Santos JM, Sánchez Jiménez S, Tovar Pérez M, Moreno Cascales M, Lailhacar Marty J, Fernández-Villacañas Marín MA. Tracking the glossopharyngeal nerve pathway through anatomical references in cross-sectional imaging techniques: a pictorial review. Insights Imaging 2018; 9:559-569. [PMID: 29949035 PMCID: PMC6108977 DOI: 10.1007/s13244-018-0630-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
Abstract The glossopharyngeal nerve (GPN) is a rarely considered cranial nerve in imaging interpretation, mainly because clinical signs may remain unnoticed, but also due to its complex anatomy and inconspicuousness in conventional cross-sectional imaging. In this pictorial review, we aim to conduct a comprehensive review of the GPN anatomy from its origin in the central nervous system to peripheral target organs. Because the nerve cannot be visualised with conventional imaging examinations for most of its course, we will focus on the most relevant anatomical references along the entire GPN pathway, which will be divided into the brain stem, cisternal, cranial base (to which we will add the parasympathetic pathway leaving the main trunk of the GPN at the cranial base) and cervical segments. For that purpose, we will take advantage of cadaveric slices and dissections, our own developed drawings and schemes, and computed tomography (CT) and magnetic resonance imaging (MRI) cross-sectional images from our hospital’s radiological information system and picture and archiving communication system. Teaching Points • The glossopharyngeal nerve is one of the most hidden cranial nerves. • It conveys sensory, visceral, taste, parasympathetic and motor information. • Radiologists’ knowledge must go beyond the limitations of conventional imaging techniques. • The nerve’s pathway involves the brain stem, cisternal, skull base and cervical segments. • Systematising anatomical references will help with nerve pathway tracking.
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Affiliation(s)
- José María García Santos
- Radiology Department, University General Hospital JM Morales Meseguer, University of Murcia, Murcia, Spain. .,Radiology Department, University General Hospital JM Universitario Morales Meseguer, C/ Marqués de los Velez s/n, 30008, Murcia, Spain.
| | - Sandra Sánchez Jiménez
- Radiology Department, University General Hospital JM Morales Meseguer, University of Murcia, Murcia, Spain.,Radiology Department, University Hospital Santa Lucía, University of Murcia, Cartagena (Murcia), Spain
| | - Marta Tovar Pérez
- Radiology Department, University General Hospital JM Morales Meseguer, University of Murcia, Murcia, Spain.,Radiology Department, University Hospital Santa Lucía, University of Murcia, Cartagena (Murcia), Spain
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Varoquaux A, Rager O, Dulguerov P, Burkhardt K, Ailianou A, Becker M. Diffusion-weighted and PET/MR Imaging after Radiation Therapy for Malignant Head and Neck Tumors. Radiographics 2015; 35:1502-27. [PMID: 26252192 DOI: 10.1148/rg.2015140029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Interpreting imaging studies of the irradiated neck constitutes a challenge because of radiation therapy-induced tissue alterations, the variable appearances of recurrent tumors, and functional and metabolic phenomena that mimic disease. Therefore, morphologic magnetic resonance (MR) imaging, diffusion-weighted (DW) imaging, positron emission tomography with computed tomography (PET/CT), and software fusion of PET and MR imaging data sets are increasingly used to facilitate diagnosis in clinical practice. Because MR imaging and PET often yield complementary information, PET/MR imaging holds promise to facilitate differentiation of tumor recurrence from radiation therapy-induced changes and complications. This review focuses on clinical applications of DW and PET/MR imaging in the irradiated neck and discusses the added value of multiparametric imaging to solve diagnostic dilemmas. Radiologists should understand key features of radiation therapy-induced tissue alterations and potential complications seen at DW and PET/MR imaging, including edema, fibrosis, scar tissue, soft-tissue necrosis, bone and cartilage necrosis, cranial nerve palsy, and radiation therapy-induced arteriosclerosis, brain necrosis, and thyroid disorders. DW and PET/MR imaging also play a complementary role in detection of residual and recurrent disease. Interpretation pitfalls due to technical, functional, and metabolic phenomena should be recognized and avoided. Familiarity with DW and PET/MR imaging features of expected findings, potential complications, and treatment failure after radiation therapy increases diagnostic confidence when interpreting images of the irradiated neck. Online supplemental material is available for this article.
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Affiliation(s)
- Arthur Varoquaux
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Olivier Rager
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Pavel Dulguerov
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Karim Burkhardt
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Angeliki Ailianou
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
| | - Minerva Becker
- From the Department of Imaging, Divisions of Radiology (A.V., A.A., M.B.) and Nuclear Medicine (O.R.); Department of Clinical Neurosciences, Division of Otorhinolaryngology-Head and Neck Surgery (P.D.); and Department of Medical Genetics and Laboratory, Division of Clinical Pathology (K.B.); Geneva University Hospital, University of Geneva, Rue Gabrielle Perret Gentil 4, 1211 Geneva 14, Switzerland
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FDG-PET/CT pitfalls in oncological head and neck imaging. Insights Imaging 2014; 5:585-602. [PMID: 25154759 PMCID: PMC4195840 DOI: 10.1007/s13244-014-0349-x] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/08/2014] [Accepted: 07/21/2014] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Positron emission tomography-computed tomography (PET/CT) with fluorine-18-fluorodeoxy-D-glucose (FDG) has evolved from a research modality to an invaluable tool in head and neck cancer imaging. However, interpretation of FDG PET/CT studies may be difficult due to the inherently complex anatomical landmarks, certain physiological variants and unusual patterns of high FDG uptake in the head and neck. The purpose of this article is to provide a comprehensive approach to key imaging features and interpretation pitfalls of FDG-PET/CT of the head and neck and how to avoid them. METHODS We review the pathophysiological mechanisms leading to potentially false-positive and false-negative assessments, and we discuss the complementary use of high-resolution contrast-enhanced head and neck PET/CT (HR HN PET/CT) and additional cross-sectional imaging techniques, including ultrasound (US) and magnetic resonance imaging (MRI). RESULTS The commonly encountered false-positive PET/CT interpretation pitfalls are due to high FDG uptake by physiological causes, benign thyroid nodules, unilateral cranial nerve palsy and increased FDG uptake due to inflammation, recent chemoradiotherapy and surgery. False-negative findings are caused by lesion vicinity to structures with high glucose metabolism, obscuration of FDG uptake by dental hardware, inadequate PET scanner resolution and inherent low FDG-avidity of some tumours. CONCLUSIONS The interpreting physician must be aware of these unusual patterns of FDG uptake, as well as limitations of PET/CT as a modality, in order to avoid overdiagnosis of benign conditions as malignancy, as well as missing out on actual pathology. TEACHING POINTS • Knowledge of key imaging features of physiological and non-physiological FDG uptake is essential for the interpretation of head and neck PET/CT studies. • Precise anatomical evaluation and correlation with contrast-enhanced CT, US or MRI avoid PET/CT misinterpretation. • Awareness of unusual FDG uptake patterns avoids overdiagnosis of benign conditions as malignancy.
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Roldan-Valadez E, Martinez-Anda JJ, Corona-Cedillo R. 3T MRI and 128-slice dual-source CT cisternography images of the cranial nerves a brief pictorial review for clinicians. Clin Anat 2013; 27:31-45. [PMID: 24302433 DOI: 10.1002/ca.22311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/25/2013] [Indexed: 02/05/2023]
Affiliation(s)
| | - Jaime J. Martinez-Anda
- Department of Neurosurgery; National Institute of Neurology and Neurosurgery; Mexico City Mexico
| | - Roberto Corona-Cedillo
- Magnetic Resonance Unit; Medica Sur Clinic & Foundation; Mexico City Mexico
- Computed Tomography Unit; Medica Sur Clinic & Foundation; Mexico City Mexico
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Vachha B, Cunnane MB, Mallur P, Moonis G. Losing your voice: etiologies and imaging features of vocal fold paralysis. J Clin Imaging Sci 2013; 3:15. [PMID: 23814687 PMCID: PMC3690671 DOI: 10.4103/2156-7514.109751] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/18/2013] [Indexed: 11/29/2022] Open
Abstract
Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis.
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Affiliation(s)
- Behroze Vachha
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Terzic A, Becker M, Wissmeyer M, Scolozzi P. 18F-DOPA PET/CT unravels malignant paraganglioma mimicking temporomandibular joint disorder. Dentomaxillofac Radiol 2011; 40:315-9. [PMID: 21697158 DOI: 10.1259/dmfr/22707693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This report presents a 29-year-old patient with severe temporomandibular joint (TMJ) pain. Anamnesis and clinical examination led us to the diagnosis of TMJ disorder. He was also in control for a malignant paraganglioma originating from the right carotid body. After initial surgery 8.5 years ago and the removal of metastases 2 years ago he was deemed disease free. An (18)F-3,4-dihydroxyphenylalanine (DOPA) positron emission tomography (PET)/CT scan was obtained during follow-up 6 months before he was presented to our clinic. Suspicious of a connection between the actual pain and the tumour, we scrutinized these images. We found a tiny pathological tracer uptake in the right jugular foramen but no correlating finding in the matching CT. We repeated the DOPA PET/CT and found several metastases including the previously detected lesion. Further thin-slice CT and MRI showed a 5 mm paraganglioma located anteriorly to the jugular bulb within the jugular foramen. The lesion was in close relation to the Arnold's nerve, a branch of the vagus nerve which carries sensory information from the external tympanic membrane, external auditory canal and the external ear and explained the severe pain in our patient. He then underwent radiotherapy (45 Gy) during which the pain diminished considerably. In a variety of neuroendocrine tumours, including paraganglioma, DOPA PET/CT allows primary diagnosis, staging and restaging with a higher detection rate than conventional radiological imaging. Owing to low anatomical resolution however, high resolution contrast-enhanced CT and MRI are necessary to complete the investigations.
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Affiliation(s)
- A Terzic
- Service of Maxillo-Facial and Oral Surgery, Department of Surgery, University of Geneva Hospitals (HUG), Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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Bertelli JA, Ghizoni MF. Combined Injury of the Accessory Nerve and Brachial Plexus. Neurosurgery 2011; 68:390-5; discussion 396. [DOI: 10.1227/neu.0b013e318201d7d9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Stretch-induced spinal accessory nerve palsy has been considered extremely rare, with only a few cases reported.
OBJECTIVE:
In 357 patients with stretch lesions of the brachial plexus, we investigated the prevalence, course, and surgical treatment of accessory nerve palsy.
METHODS:
Accessory nerve palsy was ascertained when the patient was unable to shrug the ipsilateral shoulder. Patients underwent brachial plexus reconstruction between 6 and 8 months after trauma. To confirm paralysis, during surgery, the accessory nerve was stimulated electrically.
RESULTS:
Accessory nerve palsy occurred in 19 of the 327 patients (6%) with upper type or complete palsy of the brachial plexus. Proximal injuries of the accessory nerve accompanied by voice alteration and complete palsy of the sternocleidomastoid and trapezius muscle occurred in 2 patients. Proximal palsy without vocal alterations was observed in 6 patients. Palsy of the trapezius muscle with preservation of the sternocleidomastoid muscle occurred in 11 patients. All 7 patients who demonstrated muscle contractions upon electrical stimulation of the accessory nerve during surgery recovered completely. Patients with surgical reconstruction of the accessory nerve through grafting (n = 2) or repair by platysma motor nerve transfer (n = 2) recovered active shoulder shrugging within 36 months of surgery. Seven of the 8 patients without accessory nerve reconstruction recovered from their drop shoulder and head tilt, but remained unable to shrug.
CONCLUSION:
If intraoperative electrical stimulation produces contraction of the upper trapezius muscle, no repair is needed. In proximal injuries, the platysma motor branch should be transferred to the accessory nerve; whereas in paralysis distal to the sternocleidomastoid muscle, the accessory nerve should be explored and grafted.
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Affiliation(s)
- Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital. Florianópolis, Santa Catarina, Brazil
- Department of Neurosurgery, Nossa Senhora da Conceição Hospital, Tubarão, Santa Catarina, Brazil
| | - Marcos Flávio Ghizoni
- Department of Neurosurgery, Nossa Senhora da Conceição Hospital, Tubarão, Santa Catarina, Brazil
- Center of Biological and Health Sciences, University of Southern Santa Catarina (Unisul), Tubarão, Santa Catarina, Brazil
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