To improve the teaching effect of head and neck imaging and to further train most high quality talents majoring in head and neck imaging,some teaching experiences were summarized in this article. First,the‘step teaching method’was put forward for students to master the head and neck imag-ing anatomy. Second,students were taught to familiarize the imaging modalities of head and neck and to know the optimal imaging pathway and protocol of this region. Last, students were taught to develop good ideas for analyzing imaging of head and neck disease including localization diagnosis and characteri-zation diagnosis. Additionally,teaching supervision system,including taking notes,attending morning shifts,following up patients and reading literatures,was established for students.

Objective To study the CT and MR imaging feature of adult sphenoid spontaneous cerebrospinal fluid (CSF) rhinorrhea and accompanying intracranial hypertension. Methods Thirty consecutive patients including 11 males and 19 females with mean age of (50 ± 8) years (range, 31 to 64 years) were retrospectively reviewed. Imaging findings in 30 patients with adult sphenoid spontaneous CSF rhinorrhea (CT in 26 patients, MR in 29 patients, and both CT and MR in 25 patients) were analyzed. The MR imaging and CT features were evaluated by two experienced head and neck radiologists. The CT and MR imaging parameters of 30 fistulas were evaluated, including side, location, size, amount, bony change, and the adjacent structures change. Results Of the 30 patients of adult sphenoid spontaneous CSF rhinorrhea lesions, the site of the CSF fistula confirmed by endoscopy surgery was at the junction of the roof of the inferolateral recess and the floor of the middle cranial in 25 (83%, 25/30) patients, the roof of the inferolateral recess in 3 (10%,3/30) patients, and the lateral wall of the sphenoid sinus in 2 (7%,2/30). CT images revealed the osseous defects of the sphenoid sinus walls in 21 patients (80.7%, 21/26) patients, excessive pneumatization of the inferolateral recess of the sphenoid sinuses in 25 cases (96.1%, 25/26). MRI demonstrated the linear hyperintensity communicating subarachnoid space and sphenoid cavity, accompanying meningoencephalocele in 26 (89.6%, 26/29) patients, sphenoid sinus filled with CSF in 24 (82.7%,24/29) patients and air-fluid level in the sphenoid sinus in 8 cases (27.6%, 8/29), excessive expansion of adjoining lateral fissure cistern in 22 cases (75.9%,22/29), adjoining sulcus in one case (3.4%, 1/29), adjoining lateral ventricle in one case (3.4%,1/29). The imaging feature of accompanying intracranial hypertension included empty sella in 29 cases (100%, 29/29), augmentation of the complex of the optic sheath in 27 cases (93.1%, 27/29), the arachnoid pits in the middle cranial fossa in 30 cases (100%). Conclusions The spontaneous CSF fistula coexists with intracranial hypertension. The combined application of CT and MRI can accurately identify the fistula with accompanying symptom and the intracranial hypertension.

Objective To investigate the diagnostic value of apparent diffusion coefficient in the evaluation of sinonasal masses.Methods Sixty-seven sinonasal solid masses over 1 cm in diameter confirmed by pathology were retrospectively analyzed,all patients underwent preoperative routine MRI with DWI,the ADC values were measured in ROI within the solid mass.The patients were divided into benign and malignant groups by the histopathology,according to pathological findings,the patients were further divided into the hematolymphoid tumors,the malignancy of epithelium and mesenchymal tissue,the benign tumors of epithelial and mesenchymal tissue,and vasogenic masses.ANOVA test and t test were used to compare the ADC values of different groups.The receiver operating characteristic curve (ROC) was constructed using various cut points of ADC for different parameters to confirm the diagnostic threshold value and evaluate the diagnostic efficacy.Results All lesions were solitary.There were 22 malignant tumors,of which 6 lesions were hematolymphoid tumors and 16 lesions malignancy from epithelium and mesenchymal tissue.There were 45 benign tumors,of which 22 lesions were benign tumors from epithelium and mesenchymal tissue and 23 lesions vasogenic masses.The mean ADC value of malignant and benign masses was(0.88 ± 0.26) × 10-3 mm2/s and (1.54 ± 0.41) × 10-3 mm2/s respectively.There was statistically significant differences between them (t =6.897,P ＜ 0.01).The mean ADC value was(0.63 ± 0.10) × 10-3 mm2/s in hematolymphoid tumors,(0.97 ±0.24) × 10 3 mm2/s in malignancy from epithelium and mesenchymal tissue,(1.38 ± 0.23) × 10-3 mm2/s in benign tumors from epithelium and mesenchymal tissue,(1.68 ± 0.49) × 10-3 mm2/s in vasogenic masses respectively.There was statistically significant difference among all 4 groups(F =22.788,P ＜ 0.01),and the differences between any 2 groups were still statistically significant(P ＜ 0.05).The area under the ROC calculated was 0.945.Using an ADC value of 1.08 × 10-3 mm2/s as the threshold value for differentiating malignant from benign lesions,the best result obtained had a sensitivity of 81.8％ (18/22),specificity of 97.8％ (44/45),accuracy of 92.5 ％ (62/67).Conclusion The ADC value is a valuable tool in differentiating benign from malignant masses and different kinds of masses in sinus and nasal cavity.

Objective:To evaluate the value of CT in the diagnosis of skeletal metastases from hepatoma.Methods:27 patients proved by clinical or pathological materials were analysed retrospectively.Results:All the lesion were osteolytic on CT scans.The most frequently involved areas were spine(26%),ribs(22%),pelvis(19%)and femur(11%).Conclusion:CT scan is superior to X-ray plain flims in showing the lesions.Most foci can be diagnosed accurately.

Objective To explore the MRI features of solitary fibrous tumor(SFT)in the orbit.Methods The MRI findings of 7 patients with SFT in the orbit confirmed by histopathology were analyzed retrospectively.Re sults Of the 7 lesions,5 occurred in the right orbit and 2 in the left orbit.Six lesions were located in the extraconal space near the lacrimal gland fossa,including 5 in the superomedial region and 1 in the inferolateral region.The other one was located in the retrobulbar intraconal space.The lesions with well-defined margin showed elliptic shape in 6 cases and lobulated configuration in 1.The maximum diameter of the lesions ranged from 18 to 40 mm(mean,31 mm).The lesions showed homogeneous isointense relative to gray matter on T1-weighted images in 6 patients.On T2-weighted images,the lesions showed heterogeneous hypointense in 5 patients,isointense and hyperintense in one patient respectively.SFT demonstrated markedly homogeneous enhancement in 6 patients and inhomogeneous enhancement in one patient The time-intensity curves(TIC)of 7 patients exhibited a rapidly enhancing and rapid washout pattern on dynamic contrast-enhanced(DCE)MRI.Conclusion Hypointense signal on T2WI,marked enhancement on contrast-enhanced T1 WI,and a rapidly enhancing and rapid washout pattern TIC on DCE MRI are the typical MRI features of orbital SFT.

Objective To investigate the imaging findings of early heterotopic ossification. Methods The imaging findings of 30 rehabilitation patients with heterotopic ossification were analyzed. Results The early heterotopic ossification performance of X-ray and CT showed articular soft tissue edema, and higher density. MR images showed different signal characteristics at different stages of heterotopic ossification. Immature bone performance the same or long T1 and T2 signal, enhanced scan showed the edge of the lace-like "strengthen". Conclusion Heterotopic ossification at different stages shows different imaging features. Magnetic resonance imaging is the best effective methods for the diagnosis of early ectopic ossification, X-ray and CT can be used for review.

Objective To study the CT and MR characteristic features of the respiratory epithelial adenomatoid hamartoma of olfactory clefts. Methods (1)The CT and MRI findings of 29 patients with histologically proved respiratory epithelial adenomatoid hamartoma in the olfactory clefts were retrospectively reviewed.All patients underwent CT and 8 of them underwent MRI. Location, CT and MRI features, and associated findings of the disease were reviewed;(2)The CT findings, olfactory clefts width, total nasal distance, and the ratio of OC to the total nasal distance of the case patients (29 cases) and the control patients (33 patients with sinusitis) were compared to investigate the correlation of the olfactory clefts distance and the incidence of respiratory epithelial adenomatoid hamartoma in olfactory clefts. Results All patients were associated with sinusitis, and 23 had sinonasal polyps, 1 had papilloma. On nonenhanced CT, the OC lesions with the OC widening were isodense to gray matter in all cases, and the lesions caused the adjacent bony expansion and absorption rather than erosion; 15 cases were bilateral diseases and 14 were unilateral;The olfactory clefts width of the case patients and the control patients were (1.03±0.24) cm, (0.71± 0.17) cm, respectively. There was statistically significant difference (t=4.963, P<0.01) for the olfactory clefts width between the case patients and the control patients, and there was no significant difference (t=1.640, P>0.05) for the total nasal distance, and was significant difference(t=6.029,P<0.01)in the ratio of OC to the total nasal distance between the two groups. On T1WI, the disease appeared isointense in 6 patients and slightly hypointense in 2 patients compared with gray matter. On T2WI, the lesions revealed heterogeneous isointense in all patients. Regular cribriform pattern was found on MR T2WI and enhanced TlWI. Conclusions The unilateral or bilateral olfactory cleft opacification in chronic sinusitis patients with or without sinonasal polyposis, with involved OC widening and the adjacent bony walls compressed and remodeled may highly suggests the presence of REAH in the OC. The lesions showed inhomogeneous isointense signal on T2WI images, regular cribriform pattern enhancement are typical imaging feature of this entity.

Objective To investigate the MRI findings of perihip heterotopic ossification (HO) in the early, mid and late stages. Meth-ods The MRI of 44 inpatients with HO from February, 2011 to September, 2013 were reviewed, in which 20 cases (28 joints) were in early stage, 18 cases (24 joints) in mid stage and 6 cases (8 joints) in late stage. For the enhanced T1WI, 9 cases (11 joints) were in early stage, 6 cases (7 joints) in mid stage, and 3 cases (4 joints) in late stage. Theχ2 trend test was used to evaluate the MRI signal change with the HO maturity. Results With the maturity of hip HO, the signal intensity of T2WI reduced (χ2=16.773, P<0.001), fat signal on T1WI increased, the enhancement reduced (χ2=16.048, P=0.007). Conclusion The MRI findings of perihip HO are characteristic in MRI in all the stages. MRI is useful for the diagnosis of perihip HO, especially for the early HO.

Objective To compare the accuracy of 64-slice spiral coronary angiography (CTA) and myocardial perfusion imaging (MPI) in the detection of functionally relevant coronary artery disease (CAD). Methods Twenty patients diagnosed as CAD and 11 suspected CAD were studied. Both 64-slice spiral CTA and MPI images were analyzed. For the evaluation of CTA,luminal narrowing ≥50% and ＜50% were visually assessed. Perfusion defects on MPI were detected and allocated to their corresponding coronary vessels.Results Among total 124 coronary vessels, CTA detected stenoses ≥50% in 23 arteries, and 7 showed perfusion defects in the corresponding myocardial areas on MPI. Ten of 101 vessels had stenoses＜50%,and no perfusion defects in the corresponding myocardial areas was found on MPI. There was difference between the degree of coronary artery stenoses and the risk probabilities of myocardial ischemia (χ~2=6.667, P=0.01). No statistical difference was detected between the coronary artery stenoses site and the risk probabilities of myocardial ischemia (χ~2=6.839, P=0.065). The sensitivity, specificity, negative and positive predictive values of 64-slice spiral CTA in detecting perfusion defects on MPI was 41.18%, 85.05%, 90.01% and 30.43%, respectively.Conclusion 64-slice spiral CTA can display important morphologic information of coronary arteries, but with a low positive predictive value. MPI can be used as an important method to evaluate the change of heart function resulted from CAD.

Objective To observe imaging characteristics of carotid body tumor and schwannoma in carotid space. Methods CT, MRI and digital subtraction angiography (DSA) appearances of 16 patients with carotid body tumors and schwannomas in carotid space confirmed pathologically were retrospectively analyzed. There were 8 patients with carotid body tumors and 8 patients with schwannomas. Six patients with carotid body tumors and 5 patients with schwannomas underwent CT plain scan. All the patients underwent MR plain and contrast-enhanced scan. Four patients with carotid body tumors and 2 patients with schwannomas underwent DSA examination. Results CT: Six carotid body tumors were lobulated soft tissue masses. The density of the tumors was similar to neck muscles. Two carotid body tumors involving jugular foramen expanded jugular foramen, and the margin was irregular and erosion-destructive. Five schwannomas were ovoid or fusiform soft tissue masses. The density of the tumors was mixed. Two schwannomas involved jugular foramen expanded jugular foramen, and the margin was smooth. MRI: Eight carotid body tumors were lobulated, well-defined, longitudinal growth masses with characteristic high-velocity flow voids. The tumor splayed and surrounded internal carotid artery and external carotid artery. The diameters of the arteries were normal. The tumors intensely enhanced on contrast-enhanced MRI. Eight schwannomas were ovoid or fusiform, well-defined, longitudinal growth masses with heterogeneous signal, splaying carotid artery and jugular vein. The diameters of the vessels were narrow. The tumors nonuniformly enhanced on contrast-enhanced MRI. DSA: Four carotid body tumors showed intense tumor blush, while 2 schwannomas showed slight tumor blush. Conclusion According to the imaging characteristic of the tumors, carotid body tumor and schwannoma in carotid space can be accurately differentiated.