Contents
\ 1\ Imaging of Facial Cosmetic Surgery\ 1 Charles J. Schatz and Daniel Thomas Ginat
\ 2\ Imaging the Postoperative Orbit\ 31 Daniel Thomas Ginat, Gul Moonis, and Suzanne K. Freitag
\ 3\ Imaging the Paranasal Sinuses and Nasal Cavity\ 75 Daniel Thomas Ginat, Mary Elizabeth Cunnane,
and Robert M. Naclerio
\ 4\ Imaging the Postoperative Scalp and Cranium\ 117 Daniel Thomas Ginat, Ann-Christine Duhaime,
and Marc Daniel Moisi
\ 5\ Imaging the Intraoperative and Postoperative Brain\ 183 Daniel Thomas Ginat, Pamela W. Schaefer,
and Marc Daniel Moisi
\ 6\ Imaging of Cerebrospinal Fluid Shunts, Drains, and
Diversion Techniques\ 259 Daniel Thomas Ginat, Per-Lennart A. Westesson,
and David Frim
\ 7\ Imaging of the Postoperative Skull Base and
Cerebellopontine Angle\ 311 Daniel Thomas Ginat, Peleg M. Horowitz, Gul Moonis,
and Suresh K. Mukherji
\ 8\ Imaging of the Postoperative Ear and Temporal Bone\ 351 Daniel Thomas Ginat, Gul Moonis, Suresh K. Mukherji,
and Michael B. Gluth
\ 9\ Imaging of Orthognathic, Maxillofacial, and
Temporomandibular Joint Surgery\ 421
Daniel Thomas Ginat, Per-Lennart A. Westesson,
and Russell Reid
10\ \ Imaging the Postoperative Neck\ 453 Daniel Thomas Ginat, Elizabeth Blair, and Hugh D. Curtin
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\11\ Imaging of Postoperative Spine\ 523 Daniel Thomas Ginat, Ryan Murtagh, Per-Lennart A. Westesson, Marc Daniel Moisi, and Rod J. Oskouian
12\ \ Imaging of Vascular and Endovascular Surgery\ 627 Daniel Thomas Ginat, Javier M. Romero,
and Gregory Christoforidis
Index\ 697
Contributors
Elizabeth Blair, M.D. Department of Surgery, Section of Otolaryngology- Head and Neck Surgery, University of Chicago, Chicago, IL, USA
Gregory Christoforidis, M.D. Department of Radiology, University of Chicago, Chicago, IL, USA
Mary Elizabeth Cunnane, M.D. Department of Radiology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
Hugh D. Curtin, M.D. Department of Radiology, Harvard Medical School, Boston, MA, USA
Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
Ann-Christine Duhaime, M.D. Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
Suzanne K. Freitag, M.D., M.S. Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
Daniel Thomas Ginat, M.D., M.S. Department of Radiology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
Michael B. Gluth, M.D. Department of Surgery, Division of Otolaryngology, University of Chicago, Chicago, IL, USA
Peleg M. Horowitz, M.D., Ph.D. Department of Surgery, University of Chicago, Chicago, IL, USA
Gul Moonis, M.D. Department of Radiology, Columbia University Medical Center, New York City, NY, USA
Suresh K. Mukherji, M.D., FACR Division of Radiology, Michigan State University, East Lansing, MI, USA
Ryan Murtagh, M.D., M.B.A Department of Radiology, Diagnostic Imaging Moffitt Cancer Center, Tampa, FL, USA
MarcD.Moisi,M.D.,M.S. DepartmentofNeurosurgery,SwedishNeuroscience
Institute, Seattle, WA, USA
Robert M. Naclerio, M.D. Section of Otolaryngology-Head and Neck Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Contributors |
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Rod J. Oskouian, M.D. Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, WA, USA
Russell Reid, M.D., Ph.D. Department of Surgery, University of Chicago, Chicago, IL, USA
Javier M. Romero, M.D. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
Pamela W. Schaefer, M.D. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
Charles J. Schatz, M.D., FACR Beverly Wilshire TowerAdvanced Imaging, Beverly Hills, CA, USA
University of Southern California Keck School of Medicine, Los Angeles, CA, USA
Per-Lennart A. Westesson, M.D., Ph.D., DDS Division of Neuroradiology, University of Rochester Medical Center, Rochester, NY, USA
Imaging of Facial Cosmetic |
1 |
Surgery |
Charles J. Schatz and Daniel Thomas Ginat
1.1\ Overview of Facial Cosmetic
Materials and Their Imaging
Features
A wide variety of materials have been used to augment facial tissues in the form of implants, grafts, fillers, and injectables (Fig. 1.1). The main types of implant and graft materials (Table 1.1) include solid silicone, polytetrafluoroethylene, high-density porous polyethylene, bone, and fat, while the main types of fillers and injectables (Table 1.2) include hyaluronic acid preparations, calcium hydroxyapatite, collagen,
polytetrafluoroethylene, silicone, alkyl-imide gel polymer, and botulinum toxin, among others.
On occasion, CT or MRI will be obtained to evaluate complications, which include foreign body granuloma formation, seroma, infection/fistula/draining sinus, skin atrophy, implant migration and extrusion, change in cosmetic result, functional alteration, vision loss, dysesthesia, ossification, and obstructed breathing, among others, depending on the type of implant or graft. Alternatively, changes related to facial surgery may be encountered incidentally on imaging.
C.J. Schatz, M.D., FACR (*)
Department of Radiology, Beverly Tower Wilshire, Advanced Imaging, Beverly Hills, CA, USA
University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
D.T. Ginat, M.D., M.S.
Department of Radiology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA e-mail: dtg1@uchicago.edu
© Springer International Publishing Switzerland 2017 |
1 |
D.T. Ginat, P.-L.A. Westesson (eds.), Atlas of Postsurgical Neuroradiology,
DOI 10.1007/978-3-319-52341-5_1
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C.J. Schatz and D.T. Ginat |
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Fig. 1.1 Photographs |
a |
of various facial implants |
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(a, b) |
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b
1 Imaging of Facial Cosmetic Surgery |
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Table 1.1 Implants and grafts |
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Material |
Properties and uses |
Imaging appearance |
Solid silicone |
Rubber elastomer used since 1956 |
CT: variable attenuation, usually more |
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hyperattenuating than soft tissue, but less |
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hyperattenuating than bone and best |
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discerned using bone windows |
Well-tolerated
Indications: chin, lateral jaw, cheek, and nose augmentation
MRI: very low signal intensity on T1and T2-weighted sequences
Polytetrafluoroethylene |
Long-lasting, but can be removed |
CT: higher attenuation relative to soft |
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surgically |
tissues, but lower attenuation than bone |
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Indications: lower face-lift, nasal, and |
MRI: hypointense to fat on T1and |
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forehead augmentation |
T2-weighted sequences |
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High-density porous |
Inert and biocompatible |
CT: attenuation between fat and water |
polyethylene |
Low complication rate |
MRI: hypointense to fat on T1and |
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T2-weighted sequences |
Permanent
Indications: lower face and nasal augmentation. Also used for orbital and auricular reconstruction
Enhancement may occur due to fibrovascular ingrowth
Bone |
Used more frequently in the past for chin |
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and cheek augmentation, often in the form |
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of “button” implants |
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Bone or osteochondral grafts are |
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sometimes used in rhinoplasty |
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Harvest sites include the calvarium and rib |
CT: same as normal bone elsewhere; cortex and trabecular can be identified unless resorption has occurred
MRI: same as bone elsewhere
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C.J. Schatz and D.T. Ginat |
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Table 1.2 Fillers and injectables |
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Filler material |
Properties and uses |
Imaging appearance |
Liquid silicone |
Analogous to intraocular silicone |
CT: variable attenuation, usually similar to |
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injection, but not currently FDA |
soft tissue density |
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approved for facial cosmesis |
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Permanent agent |
MRI: variable signal on T1 and T2 depending |
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on viscosity |
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Relatively higher risk of granuloma |
Decrease in signal with fat suppression |
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formation, particularly with non-medical |
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grade formulations |
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More conspicuous on STIR
Collagen |
Naturally occurring protein derived from |
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purified bovine collagen given via a |
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subdermal injection |
CT: soft tissue attenuation; subcutaneous fat appears infiltrated
Indications: wrinkles, scars, and lines Lasts approximately 3–6 months
MRI: same signal intensity as water (hypointense to fat on T1 and hyperintense to fat on T2); occasional minimal peripheral enhancement that can persist up to 2 months
Hyaluronic acid |
Injectable gel |
CT: water attenuation; subcutaneous fat |
preparations |
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appears infiltrated |
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FDA approved |
MRI: same signal intensity as water |
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Indications: wrinkles, scars, and lines |
(hypointense to fat on T1 and hyperintense to |
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Lasts about 6 months and can be |
fat on T2); occasional minimal peripheral |
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removed using hyaluronidase injection |
enhancement that can persist up to 2 months |
Polytetrafluoroethylene |
Implanted – not injected |
CT: higher attenuation relative to soft tissues |
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Permanent, threadlike material (not |
MRI: hypointense to fat on T1and |
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metabolized, but can be removed |
T2-weighted sequences |
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surgically) |
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Indications: filler in multiple sites |
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(nasolabial folds, lips, glabella) |
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Calcium |
US FDA approved |
CT: high attenuation (generally 280–700 HU) |
hydroxyapatite |
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initially; eventually the calcium resorbs, |
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typically incites fibrous tissue formation that |
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may be visible on imaging |
Temporary injectable that lasts up to at least 2 years
MRI: similar to bone (hypointense to muscle on T1and T2-weighted sequences); no enhancement
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Indications: wrinkles, lines, scars, and |
PET: can lead to hypermetabolic response |
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HIV lipoatrophy |
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Alkyl-imide gel |
Injectable, biocompatible, nontoxic, |
CT: water attenuation masses surrounded by |
polymer |
nonallergenic soft tissue filler |
thin collagen capsule |
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Uses: HIV lipoatrophy and rejuvenation |
MRI: same signal intensity as water |
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(hypointense to fat on T1 and hyperintense to |
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fat on T2) |
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Botulinum toxin |
Neurotoxin for the temporary |
CT: nil |
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improvement of glabellar lines |
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Intramuscular injection (corrugator and |
MRI: nil |
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procerus muscles; 5 sites – 0.1 ml each) |
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Maximum effect at 30 days. Lasts up to |
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6 months |
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