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Nasal septum perforation presents with the symptoms of epistaxis and crusting. Obturation of the defect will decrease the symptoms and increase patient comfort. Prosthetic closure is more predictable and thus the treatment of choice in larger defects. This article describes a procedure for construction of a magnet-retained, heat-processed acrylic nasal septum prosthesis. The two-piece nasal septum prosthesis was processed and joined together in situ by magnets. Each piece of the septum prosthesis conforms to the remaining medial wall of each nostril and forms the missing half of the nasal septum. The prosthesis not only alleviates symptoms, but also provides structural support to the saddle-shaped nose and improves esthetics.

The purpose of this paper is to retrospectively evaluate CT and MR findings of central nervous system (CNS) involvement of leukemia and systemic lymphoma in children. Over a 12-year period, sixty-five patients with leukemia and fifteen patients with systemic lymphoma underwent cerebral CT and/or MR imaging. Nine patients (11.3%) were diagnosed as CNS involvement of leukemia and lymphoma. The diagnostic criteria of CNS involvement were as follows; 1) Histological proof was confirmed by surgery, 2) Tumor cells were found in the cerebrospinal fluid examinations, 3) Increase in size of the lesion during observation without specific treatment, and 4) Response to the treatment for leukemia or lymphoma. All of nine patients fulfilled more than two criteria of 1)-4). The CT and MR abnormalities in these patients were correlated with the findings of histology, cerebrospinal fluid cytology, and/or treatment. The age of the patients ranged from 0 to 15 years old. They consisted of 6 boys and 3 girls. The CT examinations were performed before and after contrast administration. MR examinations were performed on a 1.5-T unit, and T1-weighted, T2-weighted, and proton density-weighted images were obtained using spin-echo or fast spin-echo sequences. Tumor masses were present in seven with leukemia (acute lymphoblastic leukemia 4; acute myeloblastic leukemia 1; acute promyelocytic leukemia 1; acute monocytic leukemia 1), and in two with malignant lymphoma. On the CT scan, tumor masses were hyperdense with contrast enhancement. On the MR images, their signals were variable. In all of nine patients, tumor masses were contiguous with a meningeal surface. Postcontrast T1 weighted images were valuable in demonstrating meningeal infiltration. Tumoral hemorrhage was found in two patients. In a patient with tumor at the superior sagittal sinus, venous infarct was observed. CNS leukemic and lymphomatous masses are almost hyperdense on the CT and they are characteristically contiguous with a meningeal surface. MR imaging was valuable in demonstrating meningeal infiltration. Findings of CT and MR imaging, cerebrospinal fluid examinations, and response to the treatment are useful in the differentiation of CNS involvement of leukemia and lymphoma from other lesions such as infectious diseases and leukoencephalopathy.

The fast spin-echo (FSE) technique has been a successful alternative to conventional spin-echo (CSE) imaging in the brain, spine, and pelvis, but not in the knee. This study evaluated the performance of the FSE technique in comparison with the established CSE technique as a reference standard. Oblique coronal images of 30 shoulders were obtained by both FSE and CSE techniques. The FSE images were compared with CSE images in terms of blurring and motion artifact, fat signal intensity, structural conspicuity, and visualization of joint effusion and rotator cuff tears. We imaged 30 consecutive patients with suspected rotator cuff tears who were referred for MR examination. FSE images often were worse in blurring and motion artifact than CSE images. FSE images showed higher fat signal intensity, but visualized structural conspicuity, joint effusion, and rotator cuff tear as well as CSE images. Our results suggest that the FSE technique is not equal to the CSE technique but can be used for the diagnosis of rotator cuff tears.

Thyroid tumors affect adjacent structures and reveal their nature as they grow. Differences in benign and malignant tumor growth patterns were studied by CT. Twenty-nine benign (follicular adenoma) and 29 malignant (papillary carcinoma) tumors with their findings were arranged according to size to speculate on how they grew. Benign tumors grew expansively and made a beak-like appearance in the marginal thyroid tissue (beak sign). They displaced vessels but kept a fat plane or deep sulcus between them (sulcus sign). Malignant tumors, on the other hand, grew invasively and reached the trachea rapidly without the beak sign. They destroyed the fat plane and contacted the vessels without the sulcus sign. Expansive and invasive growth forms of benign and malignant thyroid tumors could be represented schematically.

We connected two 3-inch coils to a dual phased array receiver system and sandwiched the shoulder between the two coils. To obtain a quantitative assessment of the improved SNR, we imaged a phantom with both the dual phased array coils and the standard shoulder coil. SNR as a function of distance from the coils was computed by the National Electrical Manufacturers Association (NEMA) standard. At the expected depth of the humeral head, the SNR of the phased array coils on single excitation was 1.42 times that of the standard shoulder coil on two excitations. The higher quality of the images on single excitation shortened the imaging procedure. The dual phased array coils realized the minimum FOV: 8 cm with a pixel of 0.31 x 0.41 mm. The dual phased array coils achieved high spatial resolution images of the shoulder with significantly shorter imaging times.

During a 3-year period, 6 of 50 children with systemic malignacies developed neurologic complications such as hemiparesis, convulsions and loss of consciousness. The children consisted of 1 boy and 5 girls, from 3 to 12 years old, 3 with acute lymphoblastic leukemia and 3 with malignant lymphoma. Four patients received induction treatment that included intravenous administration of L-asparaginase and/or intrathecal administration of methotrexate. One patient received induction treatment and consolidation treatment that included intravenous administration of L-asparaginase. One patient received induction and consolidation treatment, and the protocol for peripheral blood stem cell transplantation. Laboratory examinations revealed coagulation dysfunction in 3 patients treated with L-asparaginase and 1 patient with disseminated intravascular coagulation (DIC). Magnetic resonance imaging (MRI) was performed on a 1.5-T unit, using spin-echo or fast spin-echo sequences. T1-weighted, T2-weighted, and proton density-weighted images were obtained in the axial and/or coronal plane (section thickness, 4 mm; inter-section gap, 2 mm). MRI was initially performed within 36 hours after the onset in all patients, and follow-up MRIs were performed for 6 months. MRI showed lesions involving the cortex and subcortex in 4 patients with coagulation dysfunction. In 2 of these 4 patients, Gd-enhanced T1-weighted images showed contrast enhancement in the surface of the gyrus, suggesting focal vascular stasis. Serial MRI revealed nearly complete resolution of the lesions. Symptoms were relieved in every case. The lesions on MRI were presumed to be due to venous thrombosis related to the coagulation dysfunction caused by L-asparaginase or DIC. On the other hand, in 2 patients with onset after intrathecal administration of high-dose methotrexate and cytarabine, MRI revealed multiple lesions involving the centrum semiovale and periventricular white matter. No Gd-enhancement of the lesion was detected. This MRI finding was consistent with leukoencephalopathy. As time passed, the symptoms improved completely, and the lesions became better demarcated. MRI is useful for differentiating lesions related to coagulation dysfunction from leukoencephalopathy.

The increasing use of interventional angiography makes it important to know the anatomy of the maxillary artery. The course and ramification pattern of the first and second segments of this artery were studied angiographically in 100 cases. The branches of the maxillary artery were identified on lateral stereoscopic images. The maxillary artery has three segments divided by the external pterygoid muscle, and the second of these segments divides into superficial and deep types. Of the 100 Japanese angiograms, 93% were of the superficial type and 7% of the deep type. The 93% was a much higher incidence than in Western populations. In the superficial types, the middle deep temporal artery and inferior alveolar artery arose separately from the maxillary artery, while in the deep types, they had a common trunk. This made it easy to differentiate the two types. The maxillary artery was classified into four subgroups (Ia, Ib, IIa and IIb) by the ramification patterns of the middle meningeal and accessory meningeal arteries from the first segment.