SS 1008 - Skull base and face
Purpose: Our purpose is to determine the dynamic enhancement curves of inflamed TMJ synovia in juvenile idiopathic arthritis that may provide a basis for the assessment of response to therapeutic interventions such as intraarticular steroid injections.
Methods and Materials: MRI parameters include a pre-contrast coronal T1 sequence followed by 10 consecutive post-contrast T1-weighted sequences each with a scan time of 1 minute for a total duration of 10 minutes. A region of interest (ROI) was placed in the synovium of the left and right TMJ with a reference ROI placed in the longus capitus muscle belly. Dynamic enhancement characteristics of the inflamed TMJs were determined and compared to clinical exam findings of synovitis.
Results: The synovia in the JIA patients demonstrated an initial peak enhancement at 5 minutes after contrast administration followed by a second peak at 10 minutes and showed twice the intensity of enhancement compared to normal controls. The synovia of control subjects demonstrated peak enhancement at approximately 3-4 minutes after contrast administration and slowly decreased in enhancement thereafter. The synovia of asymptomatic TMJs in JIA patients showed a peak at 5 minutes but above that of control subjects without JIA.
Conclusion: This study demonstrates proof of concept and the utility of dynamic post-contrast-enhanced images of the TMJs in patients with synovitis. This method demonstrates peak enhancement of inflamed synovia and maximal difference between inflamed and non-inflamed synovia at 5 minutes postinjection, and may be utilised to evaluate treatment-related response in patients with JIA.
Purpose: A subset of patients with zygomatic complex fractures (ZCFs) develop trismus and limitation of jaw opening. We hypothesise that in the group with trismus the ZCF results in closer approximation of the zygoma to the coronoid process of the mandible.
Methods and Materials: The clinical and CT imaging findings of 30 patients, 22 male and 8 female (median age, 37 years; age range, 14-85 years), with zygomatic complex fractures, were retrospectively reviewed. Patients with mandibular fractures or h/o prior facial surgery were excluded. The CTs were reviewed for fractures in the maxillae, zygomae, sphenoid, and temporal bones, for retroposition of the fractured zygomatic body, and for the distance between the coronoid process of the mandible and the fractured zygomatic body, zygomatic arch, and the posterolateral wall of the maxilla. The results of the trismus and nontrismus groups were then compared by standard T test and a p value was calculated.
Results: 16 of the 30 patients reported trismus following ZCF. There were statistically significant differences between the trismus and nontrismus groups in the relative retroposition of the fractured zygomatic body compared to the unfractured side. In the group with trismus, the zygomatic body and the zygomatic arch more closely approximated the coronoid process compared to the non-trismus group and this difference reached statistical significance.
Conclusion: Our study confirms that in patients with ZCF fractures and trismus, the fractured zygoma more closely approaches the coronoid process compared to those patients with ZCF without trismsus.
Purpose: To assess the capability of ultrasonography of soft tissue in the identification of foreign bodies in the maxillofacial region.
Methods and Materials: 18 patients aged 18 to 45 with suspicion regarding the existence of foreign bodies in maxillofacial region were surveyed . The study was carried out on ultrasonic scanner IU-22 (Philips, Netherlands) using intraoperative linear sensor with a frequency of 7-15MHz in B-mode and Color Doppler.
Results: The study revealed the following foreign bodies in the soft tissues of the maxillofacial region of 18 examined patients: intubation tube in the tear ducts (n=1), drainage tube in the parotid duct (n=2), mustache shrimp into the floor of the oral cavity (n=1), a fragment of plastic in the main excretory duct of the parotid gland (n=1), husk of sunflower seed in the area of the sublingual salivary gland duct (n=1), ear of cereal plants (rye) (n=1), glass splinters in the cheek area (n=2), helminth disease (dirofilariasis) of the upper eyelid (n=1) and parotid-masticatory area (n=1). There have also been identified fillers after contour plastics (n=7), silicone in the lip area (n=3), polyacrylamide gel in nasolabial fold (n=2), hyaluronic acid in nasolabial fold (n=2). 14 patients have been operated, 4 patients are subjected to dynamic ultrasound monitoring.
Conclusion: Thus, ultrasound allows to visualise the foreign bodies in the maxillofacial region, to determine their precise location, the depth of occurrence, the relation to surrounding structures and to predict the possible nature of it.
Lateral cephalometric analysis for treatment planning in orthodontics based on MRI compared with radiographs: a feasibility study in children and adolescents
Purpose: To evaluate whether magnetic resonance imaging (MRI) can serve as a non-ionizing alternative modality to lateral cephalometric radiographs (LCR, “gold standard”) in cephalometric analysis.
Methods and Materials: This prospective study was approved by the local research ethics committee, informed patient consent was obtained. The applied MRI technique was optimized for detection of cephalometric landmarks and geometric accuracy. Prior to orthodontic treatment, 20 patients (mean age ± SD, 13.95 years ± 5.34; 8 females) received MRI and LCR. MRI datasets were postprocessed into lateral cephalograms. Based on 19 landmarks 24 widely used cephalometric measurements (14 angles, 10 distances) were taken twice by two observers for both modalities. Statistical analysis was performed by using intraclass correlation coefficient (ICC), Bland-Altman analysis and two one-sided tests (TOST) with an equivalence margin of ± 2 °/mm.
Results: Geometric accuracy of the MRI technique was confirmed. Mean intraobserver ICC were 0.977/0.975 for MRI and 0.975/0.961 for LCR. Average interobserver ICC were 0.980 for MRI and 0.929 for LCR. Bland-Altman analysis showed high of levels agreement between the two modalities, bias range (mean ± SD) was -0.66 to 0.61 mm (0.06 ± 0.44) for distances and -1.33 to 1.14 ° (0.06 ± 0.71) for angles. Except for the interincisal angle (P = .17) all measurements were statistically equivalent (P < .05).
Conclusion: MRI datasets can be transformed into lateral cephalograms allowing reliable measurements as applied in orthodontic routine with high levels of agreement to the corresponding measurements on LCR. Thus, MRI-based orthodontic treatment planning appears feasible.
Purpose: Inflammatory pseudotumour is a benign condition mimicking malignant tumours, due to its infiltrative behaviour. MR and CT findings in 4 patients affected by skull base IPT are described.
Methods and Materials: Clinical records and imaging findings of 4 patients (2 men, 2 women, age range 42-75 years), complaining multiple cranial nerve neuropathies, including tinnitus, dysphagia, hoarseness, dysphonia, and haemitongue palsy, were reviewed. Patients were studied by MR and CT of the head and neck with different clinical suspicion, as nasopharynx tumour, paraganglioma, otitis. The diagnosis of IPT was made basing on of clinical data, response to systemic corticosteroids and MR findings.
Results: On 4/4 patients the IPT was located in the carotid space, in two involving the hypoglossal canal. On 3/4 patients an otomastoiditis was present, two of them had diabetes, while the third had a nasopharynx carcinoma treated some years before by radiotherapy with osteonecrosis and recurrent bilateral petrous bone osteomyelitis. Masticatory space was involved in 2/4 patients, hemipharynx in 1/4 patients; 1/4 patients had a jugular vein and sigmoid sinus thrombosis. 2/4 patients had a hypoglossal nerve palsy. Typical MR findings were areas of moderately diffuse enhancement after i.v. Gadolinium, that showed only slight hyperintensity and/or hypointensity on T2 images. At MR follow up at 1-3 months findings were significantly decreased and symptoms dramatically improved.
Conclusion: Radiologists and other specialists should be aware of IPT among disease involving the skull base, in order to differentiate this condition especially from tumours and avoiding more and unnecessary invasive treatment.