Functional Imaging: CT and MRI

SYNOPSIS: Numerous imaging techniques permit evaluation of regional pulmonary function. Contrast-enhanced CT methods now allow assessment of vasculature and lung perfusion. Techniques using spirometric controlled MDCT allow for quantification of presence and distribution of parenchymal and airway pathology, Xenon gas can be employed to assess regional ventilation of the lungs and rapid bolus injections of iodinated contrast agent can provide quantitative measure of regional parenchymal perfusion. Advances in magnetic resonance imaging (MRI) of the lung include gadolinium-enhanced perfusion imaging and hyperpolarized helium imaging, which can allow imaging of pulmonary ventilation and .measurement of the size of emphysematous spaces

Superior vestibular neurectomy: a novel transmeatal approach for a denervation of the superior and lateral semicircular canals

OBJECTIVE: To assess morphologically a transmeatal approach to the lateral and superior ampullary nerves performable under local anesthesia and simultaneously with the existing approach to the singular nerve developed by Gacek during the same operation. MATERIALS AND METHODS: Eighty halves of human heads preserved with the Thiel method were operated on by an otologist. Two surgical approaches were tested on each specimen, 1 superior and 1 inferior to the tympanic segment of the facial nerve. The 80 specimens were divided into 2 groups. In the first group, the osseous canal of the nerves of the lateral and superior semicircular canal were previously probed and next operated. In the second group, the osseous canal of the nerves were operated prior assessment by dissection. Afterward, all 80 halves underwent computed tomographic investigation to measure the distance between the entrance point of the drill in the medial wall of the tympanic cavity and the osseous canal the ampullary nerves. RESULTS: Inferior approach to the canal of the nerves could not be done without wide opening of the vestibulum in all 80 specimens. In the superior approach, the nerve could be reached directly in 5 cases, and only via the osseous ampulla of the lateral semicircular canal in 28 cases in the first group. In 7 cases, the nerves could not be reached without damage to the membranous labyrinth. In the second group, the nerve could be reached directly in 2 cases, via the osseous ampulla in 36 cases, and was unreachable in 2 cases. Significantly, distances longer than 3 mm between the surgical access and the nerve were found on the inaccessible cases. CONCLUSION: A transmeatal approach is possible superiorly but not inferiorly to the facial nerve, although it is necessary to open the osseous ampulla but not the membranous labyrinth in most cases

Primary sarcomas of the spine: population-based demographic and survival data in 107 spinal sarcomas over a 23-year period in Ontario, Canada

BACKGROUND CONTEXT Spinal sarcomas are a rare, heterogeneous group of mesenchymal tumors. Current literature reporting demographic variables and survival information is limited to small case series, and a single registry with variable treatment modalities and time periods. PURPOSE We report on population-level data regarding all spinal sarcomas diagnosed over a 23-year period in Ontario, Canada, for the purposes of calculating incidence and prevalence of these tumors. Secondarily, survival is assessed by tumor type as well as adjuvant therapies during this time period. STUDY DESIGN Retrospective Cohort Study PATIENT SAMPLE: Population-based data from the Institute for Clinical Evaluative Sciences (ICES) between 1993 and 2015. OUTCOME MEASURES Outcome measures include incidence and prevalence of spinal osteosarcoma, Ewing's sarcoma, and chondrosarcoma of the spine, as well as 2-, 5-, 10- and 15-year survival and prevalence of adjuvant therapies. METHODS Utilizing population-based data from the Institute for Clinical Evaluative Sciences (ICES) between 1993 and 2015, ICD codes were searched and available data extracted for the purposes of reporting basic demographic information and calculation of Kaplan Meyer survival curves. Databases include the Ontario Cancer Registry, Discharge Abstract Database, Ontario Health Insurance Plan, National Ambulatory Care Reporting System, Registered Persons DataBase (death) were analyzed. RESULTS One hundred and seven spinal sarcomas were identified, with a mean incidence was 0.38 sarcomas per million population per year, that was stable over time. The mean prevalence was 8.1 sarcomas per million population. The most common diagnosis was Ewing's sarcoma (48 [44.9%] patients), followed by chondrosarcoma (33 [30.8%] patients), and osteosarcoma (26 [24.3%] patients). Chondrosarcoma had the highest survival rates with 77.2% and 64.2% 5- and 10-year survival rates, respectively, followed by Ewing's sarcoma with 48.1% and 44.9% 5 and 10-year survival and osteosarcoma with 36.0% and 30.9% 5- and 10-year survival. CONCLUSIONS Spinal sarcoma is a rare disease with variable survival depending on the histologic diagnosis. This population-level study involves a heterogeneous group of patients with variable stages of disease at presentation and variable treatments. Our data fit with the published literature for survival for those treated conservatively and surgically. Our data show considerable improvement in 5- and 10-year mortality when compared with previous population level studies on earlier patient cohorts, likely reflecting improvements in systemic and surgical treatments