The significance of MRI findings for non-rhinological disease

Prevalence of incidental maxillary sinus pathologies in dental patients on cone-beam computed tomographic images

OBJECTIVES

The aim of the present study was to infer and to record the prevalence of incidental maxillary sinus pathologies in patients presenting with dental problems using the cone-beam computed tomography (CBCT) scans performed for maxillofacial diagnostic purposes.

MATERIALS AND METHODS

This retrospective study has evaluated 201 patients (402 maxillary sinuses consecutive CBCT) for various incidental maxillary sinus pathologies by two observers. Pathologic findings were categorized as mucosal thickening (MT), opacification (OPA), polypoidal-mucosal thickening (PT), others (antrolith and discontinuity of the sinus floor) and no pathologic findings. Correlations for pathologic findings and the factors of age and gender were calculated.

RESULTS

The prevalence for total incidental findings is 59.7%. The present study showed MT (35.1%) as most prevalent finding followed by OPA in (16.6%), PT in 7.2% and others in 0.7%. There was no statistically significant difference between gender and between the age groups. There was no statistically significant difference between different indications groups for CBCT scans.

CONCLUSIONS

The incidental maxillary sinus abnormalities are highly prevalent in the asymptomatic dental patients; hence oral radiologists should be aware of these incidental findings and comprehensively evaluate the entire captured CBCT volume, which can help in early diagnosis, treatment and follow-up of the patient.

The frequency and nature of incidental findings in large-field cone beam computed tomography scans of an orthodontic sample

Background

The aim of this study is to evaluate the nature and frequency of incidental findings in large-field maxillofacial cone beam computed tomography (CBCT).

Methods

A total of 427 consecutive CBCT radiologic reports obtained for orthodontic purposes were retrospectively reviewed. Findings were summarized and categorized into six anatomic categories.

Results

A total of 842 incidental findings were reported in the 427 CBCT scans (1.97 findings/scan). The most prevalent findings were those located in the airway (42.3%), followed by the paranasal sinuses (30.9%), dentoalveolar (14.7%), surrounding hard/soft tissues (4.0%), temporomandibular joint (TMJ) (6.4%), and cervical vertebrae (1.3%) regions. Non-odontogenic findings, defined as those located outside the dentition and associated alveolus, represented 718 of the 842 (85.3%) findings.

Conclusions

This study confirms the high occurrence of incidental findings in large-field maxillofacial CBCT scans in a sample of orthodontically referred cases. The majority are extragnathic findings, which can be normally considered outside the regions of interest of many dental clinicians. Specifically, incidental findings in the naso-oropharyngeal and paranasal air sinuses are the most frequent. This underscores the need for comprehensive review of the entire data volume and the requisite to properly document all findings, regardless of the region of interest.

Electronic supplementary material

The online version of this article (doi:10.1186/s40510-014-0037-x) contains supplementary material, which is available to authorized users.

Incidental findings on cone beam computed tomography in orthodontic patients

OBJECTIVES

The objective of this study was to find out the incidence of incidental findings seen in cone beam computed tomography scans taken for orthodontic purposes and to see if these findings influence orthodontic treatment.

SUBJECTS AND METHOD

Three hundred and twenty-nine consecutive scans carried out for orthodontic purposes using an i-CAT Classic were included in the study. Each scan was evaluated by a single radiologist and any incidental findings recorded. The incidental findings were further classified depending on whether the finding would influence orthodontic management.

RESULTS

There were a total of 370 incidental findings in the 329 scans, with at least one incidental finding in 66% of patients. The most common incidental findings were dental (n = 120) and included retained deciduous roots (n = 24) and periapical disease (n = 15). Of the incidental findings 200 required no follow-up. A total of 168 findings required follow-up, but the overall orthodontic treatment plan was not altered. Only two findings were significant in that the orthodontic treatment was amended in light of the incidental finding.

CONCLUSIONS

Incidental findings are very common on CBCT. However the majority of these findings do not affect orthodontic treatment planning.

Incidental findings on MRI scans of patients presenting with audiovestibular symptoms

Background

The evaluation of patients presenting with audiovestibular symptoms usually includes MRI of the internal auditory meatus, the cerebellopontine angle and the brain. A significant percentage of these scans will present unexpected, incidental findings, which could have important clinical significance.

Objective

To determine the frequency and clinical significance of incidental findings on MRI scans of patients with audiovestibular symptoms.

Materials and methods

A retrospective analysis of 200 serial MRI scans.

Results

Gender distribution: equal. Age range: 17-82 years. One-hundred and four scans (52%) were normal and 1 scan (0.5%) demonstrated a unilateral vestibular schwannoma. Ninety-five scans (47.5%) demonstrated incidental findings. Sixty-six of these (33%) were considered of ishaemic origin and did not require further action. Five (2.5%) scans demonstrated significant findings which warranted appropriate referral; Two Gliomas (1%), 2 cases of extensive White Matter Lesions (1%), 1 lipoma (0.5%). The remaining scans demonstrated various other findings.

Conclusion

Investigation of patients with audiovestibular symptoms with MRI scans revealed incidental findings in a significant percentage (47.5%). The majority of these findings were benign warranting no further action and only 2.5% required further referral. It is the responsibility of the referring Otolaryngologist to be aware of these findings, to be able to assess their significance, to inform the patient and if needed to refer for further evaluation.

Diagnostic strategies in nasal congestion

Nasal congestion is a major symptom of upper respiratory tract disorders, and its characterization an important part of the diagnosis of these illnesses. Patient history and assessment of nasal symptoms are essential components of diagnosis, providing an initial evaluation that may be adequate to rule out serious conditions. However, current congestion medications are not always fully effective. Thus, if symptoms do not respond adequately to therapy, or symptoms suggestive of more serious conditions are present, specialized assessments may be needed. Various techniques are available for diagnosing patients, including those used chiefly by primary care clinicians and those requiring the expertise of otolaryngologists, allergists, and other specialists. Endoscopy remains a mainstay for evaluating nasal blockage and its causes, while modalities such as peak nasal inspiratory flow and acoustic rhinometry are evolving to provide easy-to-use, noninvasive procedures that are sensitive enough to measure small but clinically important abnormalities and therapeutic changes. Several imaging modalities are available to the specialist for severe or unusual cases, as are specialized diagnostic procedures that measure adjunctive features of congestion, such as impaired mucociliary function.

The prevalence and significance of incidental middle ear and mastoid cavity abnormalities on MRI in a pediatric population

OBJECTIVE

The purposes of this study were to determine the prevalence of abnormalities in the middle ear and mastoid cavity on the magnetic resonance imaging (MRI) in children and correlate the results with clinical data, tympanometric findings and paranasal sinus changes.

MATERIALS AND METHODS

A total of 85 consecutive pediatric patients for suspected non-inflammatory intracranial pathologies were prospectively examined. MRI was conducted for the suspected intracranial pathology. All patients were also examined by an otolaryngologist for otologic pathologies. A tympanometry examination was performed in patients prior to MRI scan.

RESULTS

In 23 (27.1%) of 85 (39 males, 46 females) children, MRI demonstrated middle ear and/or mastoid cavity abnormalities. MRI abnormalities of the middle ear and/or mastoid cavity were correlated with clinical data and tympanometric findings.

CONCLUSIONS

Incidental abnormal signal intensities in the middle ear and/or mastoid cavity are frequent in children, especially in first years of life. MRI will demonstrate incidental middle ear and mastoid cavity abnormalities seems to have clinical significance.

Paranasal sinus imaging

Endonasal surgery is currently extending its application beyond inflammatory sinonasal lesions to successfully treat both benign and malignant neoplasms. This progression has been possible by the detailed information provided by imaging techniques (CT, MRI and PET). Inflammatory diseases are the "domain" of CT. CT provides excellent details about the thin bony sinonasal walls separating the ethmoid from the anterior skull base and the orbit. Benign and malignant neoplasms are the "domain" of MRI because the tumor is more easily separated from adjacent structures, the periosteal linings (periorbita, dura mater) and perineural spread can be accurately shown. Whereas MRI precisely assess pre-treatment tumor extent, early submucosal local recurrences are difficult to demonstrate because of post-treatment changes of the anatomy and of the signal of treated tissues. Though diffusion-weighted imaging and dynamic contrast-enhanced techniques are promising developments, PET-CT may overcome the limits of morphological MRI.