OBJECTIVE: To investigate the causes of misdiagnosis for skull base lesions by PET-CT, and to recognize the working principal and the false-positive results of PET-CT for reducing the misdiagnosis rate. METHOD: The lesions of case 1 involved the pharynx nasalis, pterygopalatine fossa, and orbital apex base of skull, and the lesions of case 2 involved the base of sella were performed with CT, MRI and PET-CT examination. Both of the cases were treated with surgery and histopathologic examination. RESULT: Two cases were diagnosed as nasopharyngeal carcinoma and carcinoma of base of sella by PET-CT, respectively. However, they were finally diagnosed mycosis and pituitary tumor by histopathologic examination after operation. CONCLUSION PET-CT examination in the skull base lesions may give false-positive result. Both clinical information and other imaging examinations should be considered to reduce the misdiagnosis skull base lesions only by PET-CT.
Diagnostic Errors ; Female ; Humans ; Middle Aged ; Positron-Emission Tomography ; Skull Base ; diagnostic imaging ; Skull Base Neoplasms ; diagnostic imaging

Carotid Artery Injuries/etiology* ; Carotid Artery, Internal/diagnostic imaging* ; Foreign Bodies/complications* ; Humans ; Skull ; Skull Base/diagnostic imaging*

OBJECTIVETo investigate the feasibility and reliability of the measurement of critical anatomic landmarks of endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa using multislice spiral computed tomography (MSCT), and to illustrate the spatial relationship of the surgical landmarks in pterygopalatine fossa and infratemporal fossa through an endoscopic endonasal view and radiological images.

METHODSIncluded in this study were eleven fixed cadaver heads (22 pterygopalatine fossa and infratemporal fossa), which were prepared from MSCT scans for establishing a spatial coordinates system to calculate the radiological anatomic data and attaining 3D reconstruction image, and also were anatomically dissected to get anatomic data. The anatomic data in two groups were compared, the endoscopic and radiological images of the same regions acquired during the endoscopic endonasal approaches observed.

RESULTSThe distance (x(-) ± s) from nasal columella to sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, carotid canal, foramen lacerum in radiological group were: (68.83 ± 3.00), (72.49 ± 2.88), (75.26 ± 3.14), (88.55 ± 5.00), (95.19 ± 4.31), (106.76 ± 3.77), (88.16 ± 2.87) mm and in anatomic group were: (68.90 ± 3.04), (72.73 ± 3.08), (75.44 ± 3.07), (89.75 ± 4.13), (96.22 ± 3.37), (106.68 ± 3.75), (88.47 ± 2.64) mm. There was no statistical difference between two groups (t value were -0.856, -1.134, -0.920, -1.923, -1.903, 2.820 and 1.209, respectively, all P > 0.05). Sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, foramen lacerum, carotid canal were the corresponding anatomic structures in endoscope and radiology, which provided the surgeons with anatomic landmarks to identify the spatial relationship of the surgical structures in pterygopalatine fossa and infratemporal fossa.

CONCLUSIONSMSCT measurements of anatomic landmarks are feasible and reliable, can be used in clinical individualized surgery. The corresponding anatomic structures of endoscopic and radiological landmarks provide useful reference to surgeons when operating in these areas through an endoscopic endonasal approach.

Endoscopy ; Humans ; Imaging, Three-Dimensional ; Pterygopalatine Fossa ; anatomy & histology ; diagnostic imaging ; Skull Base ; anatomy & histology ; diagnostic imaging ; Tomography, Spiral Computed

An uncommon case of a patient with recurrent mandibular ameloblastoma involving various adjacent soft tissues is presented with plain film radiography, computed tomography and magnetic resonance imaging(MRI) and bone scan. The tumor involved mandible and eroded several bones including foramen ovale. This case shows that although an ameloblastoma primarily affect mandible, exact radiographic evaluation of tumor extent will assist the surgeon in the progress of rational approaches to the management of ameloblastoma.
Ameloblastoma* ; Cytochrome P-450 CYP1A1 ; Diagnostic Imaging* ; Foramen Ovale ; Humans ; Mandible ; Radiography ; Recurrence ; Skull Base

OBJECTIVE: To discuss imaging characteristics of CT, MRI of tumors involving skull base in the parapharyngeal space,maximatily limit and improve the diagnosis rate of tumors involving skull base in the parapharyngeal space. METHOD: Thirty-one patients with tumors involving skull base in the parapharyngeal space treated in our department were collected and reviewed. All the patients have pathological diagnosis and were examined by CT and/or MRI. To explore shape of tumor, its relation with surrounding structures, CT shows density size and the MRI signal directly through retrospective analysis of imaging characteristics of CT, MRI. RESULT: In all the 31 cases, 19 tumors were schwannoma, 8 tumors were mixed tumor of salivary gland, 2 tumors were carotid body tumor. 2 tumors were nasopharyngeal carcinoma involving skull base. Schwannomas and salivary gland mixed tumor can be expressed as round or oval with periphery smooth, and had intact capsule. The tumors had necrosis, sac variable area. Pleomorphic adenoma are all derived from deep parotid. Schwannoma had clear boundary with deep parotid. The effect of cavum nasopharyngeal and cavum oropharyngeal is relevant to tumor sizes and locations. Imaging characteristics of CT, MRI for carotid body tumor show soft tissue mass with attenuation similar to that of muscle. CT enhancement scan show intense enhancement. MRI show imaging of flowing empty vein. Imaging characteristics of MRI for nasopharyngeal carcinoma involving skull base in the parapharyngeal space show oval mass with low density signal, T1WI enhancement scan show necrosis, sac variable area. CONCLUSION CT and MRI could provide the position, size, boundary of the tumor and its relationship with cervical blood vessels well, which were important to operation schemes. CT and MRI before operation are valuable to the treatment of PPS tumors.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pharyngeal Neoplasms ; diagnostic imaging ; pathology ; Retrospective Studies ; Skull Base Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo investigate the diagnostic value of F-18-fluoro-deoxyglucose positron emission tomography (FDG-PET) for the recurrent or residual nasopharyngeal carcinomas in the skull base area.

METHODSNine post-irradiation nasopharyngeal carcinoma patients did FDG-PET scanning, CT/MRI imaging and underwent nasopharynx and skull base-biopsy under endoscopy. The results of FDG-PET were evaluated and compared with CT/MRI studies and biopsies.

RESULTSIn 9 cases of post-irradiation nasopharyngeal carcinoma, CT/MRI detected 7 recurrent cases and 2 suspected recurrent cases in occipital bone and clivus. All 9 cases had accumulated FDG in nasopharynx and cranial base. A definite diagnosis was made by biopsy, 3 cases were confirmed recurrence, and others 6 cases were proved mucous chronic inflammation and (or) osteoradionecrosis. The accuracy of FDG-PET was 33.3% (3/9), and the false positive rate was 66.7% (6/9).

CONCLUSIONSDiagnosis of recurrent or residual nasopharyngeal carcinomas in the skull base area with FDG-PET had high false-positive rate, final diagnosis must depend on histopathologic examination under endoscopy.

Adult ; Aged ; False Positive Reactions ; Female ; Fluorodeoxyglucose F18 ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; drug therapy ; radiotherapy ; Positron-Emission Tomography ; methods ; Skull Base ; diagnostic imaging

OBJECTIVE: The harvesting procedures on cadaver heads and a radioanatomic study of measuring dimensions of skull base by endoscopic endonasal approach were performed. The measurements could do help to design the nasoseptal mucoperiosteum and improve the rate of repair success. METHOD: The surgical procedures were demonstrated on cadaver heads specimens. Then 20 adult CT scans of sinus and skull base were calculated by workstations. The dimensions of three different skull base (the defect of anterior skull base/cribriform plate approach, sellar region/planum sphenoidale region and clivus region) of maximum areas, length and width, were measured. And with these data the nasoseptal flap were designed for providing enough area to cover the defect. The distance from the projection of sphenopalatine foramen to related area of skull base were plused for obtaining desired the length of nasoseptal flap. RESULT: The mean length from the projection of sphenopalatine to the anterior skull base, planum/sella area and clivus were 49.56 mm, 57.47 and 67.19 mm, respectively. The means of areas of anterior dural defect, transsellar defect and panclivectomy were 16.13 cm2, 14.03 cm2 and 13.12 cm2, respectively. The average length of the nasoseptal flap ranged between 64.71-65.93 mm, the width ranged between 28.57-30.95 mm with an average area of 22.95 cm2. CONCLUSION One side of nasal septal flap can provide enough area to reconstruct the anterior skull base and planum/sella area. In some cases, the flap can not completely cover the area of clivus region because of the limitation of its length.
Adult ; Endoscopy ; methods ; Humans ; Nasal Septum ; anatomy & histology ; diagnostic imaging ; transplantation ; Skull Base ; diagnostic imaging ; surgery ; Surgical Flaps ; Tomography, X-Ray Computed

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.
Adolescent ; Adult ; Aged ; Carotid Artery, Internal/diagnostic imaging* ; Female ; Humans ; Intracranial Aneurysm/therapy* ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Skull Base/diagnostic imaging* ; Young Adult

OBJECTIVETo evaluate the craniofacial morphology of patients with isolated cleft palate in the mixed dentition after palatoplasty.

METHODSTwenty patients (7 to 11 years old) with isolated cleft palate in the mixed dentition were selected. The control group comprised 35 age-matched non-cleft children without orthodontic treatment. Cephalometric analysis was carried out to evaluate craniofacial morphology.

RESULTSThe mean values of total cranial base length, maxillary depth, mandibular effective length in cleft patients were 86.48 mm, 44.79 mm and 65.45 mm, respectively. Those in control group were 91.27 mm, 48.84 mm and 70.49 mm, respectively (P < 0.001).

CONCLUSIONSUnderdeveloped maxilla and class III skeletal profile were presented in patients with isolated cleft palate.

Case-Control Studies ; Cephalometry ; Child ; Cleft Palate ; pathology ; surgery ; Dentition, Mixed ; Female ; Head ; diagnostic imaging ; pathology ; Humans ; Male ; Mandible ; diagnostic imaging ; pathology ; Maxilla ; diagnostic imaging ; pathology ; Postoperative Period ; Radiography ; Skull Base ; diagnostic imaging ; pathology

OBJECTIVE: To evaluate the imaging characteristics of B-cell non-Hodgkin lymphoma of skull base. METHOD: Two patients with B-cell non-Hodgkin lymphoma of skull base in our hospital were reported, meanwhile the imaging characteristics were summarized and analyzed with the related literature. RESULT: The imaging feature of B-cell non-Hodgkin lymphoma of skull base was equal or low signal on MR T2-weighted and not obviously enhanced. The width of the soft tissue invaded in intracalvarium appeared much bigger than the width of bone destruction, and the lesion infiltrated along the dural surface. CONCLUSION Characteristic imaging appearance of B-cell non-Hodgkin lymphoma of skull base have the significance in diagnosis and differential diagnosis.
Adult ; Child, Preschool ; Humans ; Lymphoma, B-Cell ; diagnostic imaging ; pathology ; Lymphoma, Non-Hodgkin ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Skull Base Neoplasms ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed