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Postprocessing in Maxillofacial Multidetector Computed Tomography
Silvio Mazziotti, MD, Alfredo Blandino, MD, Michele Gaeta, MD, Antonio Bottari, MD, Carmelo Sofia, MD, Tommaso D’Angelo, MD, Giorgio Ascenti, MD Canadian Association of Radiologists Journal Volume 66, Issue 3, Pages (August 2015) DOI: /j.carj Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 1 “Puffed-cheek” computed tomography (CT) scan: multiplanar reconstruction (MPR) image obtained at the level of the superior dental arch along the axial plane (A). Superior oral vestibule (asterisks). “Open-mouth” CT scan: MPR image obtained along the sagittal plane (B). Hard palate (arrows). T = tongue. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 2 Coronal multiplanar reconstruction (MPR) image (A) shows an osteolytic lesion involving the mandibular symphysis. Curved-MPR image (B), obtained along the course of both mandibular canals, better defines the extension of the osteolytic process involving both mandibular canals. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 3 Volumetric rendering technique image obtained using trapezoids with various colors and transparency levels which refer to different ranges of density of diverse tissues. Note the possibility to differentiate between skin surface (green), vascular structures (red), and skeletal components (white). This figure is available in colour online at Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 4 Image of the maxillofacial skeleton obtained through a particular volume-rendering based technique (A) that seems to be similar to maximum intensity projection (MIP) image (B). Note the spatial depth perception appreciable on VR image, which is absent on MIP reconstruction. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 5 Myxofibroma of the mandible in a pediatric patient. Coronal multiplanar reconstruction image (A) shows an expansive osteolytic lesion in the right mandibular ramus. Volumetric rendering technique images better define the morphology of the osteolytic lesion: using too high resolution kernel may cause blurring artifacts (B), rather than using a lower one (C). Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 6 Thin maximum intensity projection image obtained along a sagittal-oblique plane showing a fracture of the mandibular angle. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 7 Shaded surface display image of the maxillofacial skeleton. It is possible to identify circumscribed bone “pseudodefects” of the orbital floors and of the anterior walls of maxillary sinuses (A). Lowering of the threshold value eliminates bone “pseudodefects,” although it could cause the appearance of the “flying pixels” (B). Bone “pseudodefects” can increase by raising up the segmentation threshold value (C). Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 8 Craniofacial trauma. Preoperative computed tomography (CT) scan: the shaded surface display (SSD) image of maxillofacial skeleton shows dislocated multiple fracture fragments (A). Face deformity is also appreciated through SSD image of skin (B). Postoperative CT scan: the SSD image of maxillofacial skeleton (C) and of skin surface (D) shows the reduction of fractures using osteosynthesis material (miniplates) and the restoring of facial aesthetics. This figure is available in colour online at Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 9 Pierre-Robin malformation. Shaded surface display (SSD) image of maxillofacial skeleton (A) demonstrates a complex facial malformation, particularly evident in the mandible, which presents hypoplasia of horizontal rami, severe maxillary prognathism, condylar hypoplasia, and anteriorly dislocated condyles inside a less concave than normal mandibular fossa. There is evidence of a previous maxillo-malar osteotomy. SSD image of the skin surface (B) shows the typical facial aspect. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 10 Adenoid cystic carcinoma of the right soft palate with perineural invasion. Axial computed tomography image (A) and multiplanar reconstruction image of the facial bones along the coronal plane (B) show the enlargement of the right major palatine foramen (asterisk in A) and of pterygopalatine canal (arrow in B), as signs of perineural spread through palatine nerves. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 11 Multiplanar reconstruction image (A) and volumetric rendering technique image (B) are used in Cyberknife radiosurgical treatment of postsurgical recidive of adenoid cystic carcinoma of the palate, in this case occurring in the right apex of orbital cavity (same patient as in Figure 10). This figure is available in colour online at Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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Figure 12 Odontogenic inflammation. Multiplanar reconstruction (MPR) image of the maxillofacial bones obtained along an oblique-coronal plane (A) shows an osteolytic area near the apex of 4.6, with cortical erosion of the mandible in its lingual side (arrow). MPR image, performed after i.v. contrast medium injection and obtained with soft tissue kernel (B), shows a voluminous abscess in the submandibular space (asterisk), enclosed cranially by the mylohyoid muscle (arrows) and sparing the sublingual space. Canadian Association of Radiologists Journal , DOI: ( /j.carj ) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions
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