Diagnostic Yield of Computed Tomography in Evaluation of Vocal Fold Paresis: Is It Worth It?

Objectives: This study aimed to compare the characteristics of idiopathic unilateral vocal fold paralysis (IUVFP) in elderly versus younger patients, including the diagnostic yield of computed tomography (CT) scans for identifying the structural causes of IUVFP. Methods: We retrospectively analyzed medical records of the patients initially diagnosed with IUVFP in a single referral tertiary hospital. We compared patients’ baseline characteristics, initial symptoms, laryngoscopic findings, and prevalence of structural causes on CT scans with respect to age (younger, <65 years vs older, ⩾65 years). Results: One hundred forty-two patients were enrolled (90 younger, 52 older). Evident structural causes were more frequently found on CT in older patients than younger patients (40.4% vs 22.2%, P = .034). Among truly idiopathic cases (70 younger, 31 older), recovered vocal fold mobility was identified in 48.6% younger and 41.9% older patients ( P = .666). There was no statistically significant difference in the characteristics between unrecovered and recovered subjects of the older patients with true IUVFP (all P > .05). Conclusions: The CT scans provided significantly higher diagnostic yields in older patients than younger patients. The degrees of symptoms and complications and likelihood of natural recovery did not significantly differ between younger and older patients with IUVFP.

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Diagnostic yield of computed tomography in the evaluation of unilateral vocal fold palsy

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000463 ◽

2021 ◽

pp. 1-4

Author(s):

H S Chew ◽

J C G Goh ◽

D Y A Tham

Keyword(s):

Computed Tomography ◽

Vocal Fold ◽

Diagnostic Yield ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

Vocal Fold Paralysis ◽

Initial Assessment ◽

Contrast Enhanced ◽

Vocal Fold Palsy ◽

Enhanced Computed Tomography

Abstract Background There is a paucity of Asian-based data regarding the diagnostic yield of computed tomography imaging in the initial assessment of idiopathic unilateral vocal fold palsy. Objectives To investigate the diagnostic yield of computed tomography in idiopathic unilateral vocal fold palsy cases in an Asian tertiary hospital, and to determine the causative pathologies and positive predictive factors. Method A retrospective chart review was conducted of patients (between 2010 and 2018) with a clinical diagnosis of idiopathic unilateral vocal fold palsy who underwent contrast-enhanced computed tomography of the neck and chest at Tan Tock Seng Hospital, Singapore. Results The overall computed tomography diagnostic yield was 21 per cent, with malignancy accounting for 63.6 per cent of diagnoses. Degree of vocal fold weakness was the only significant predictor of positive computed tomography findings (11.5 per cent in vocal fold paresis vs 29.1 per cent in vocal fold paralysis, p = 0.025). None of the patients with negative computed tomography findings went on to develop disease after a mean follow up of 14.3 months. Conclusion Computed tomography is a useful initial investigation for idiopathic unilateral vocal fold palsy, particularly in cases with vocal fold paralysis.

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Computed tomography has low yield in the evaluation of idiopathic unilateral true vocal fold paresis

The Laryngoscope ◽

10.1002/lary.23538 ◽

2012 ◽

Vol 123 (1) ◽

pp. 204-207 ◽

Cited By ~ 15

Author(s):

Pedro I. Badia ◽

Alexander T. Hillel ◽

Manish D. Shah ◽

Michael M. Johns ◽

Adam M. Klein

Keyword(s):

Computed Tomography ◽

Vocal Fold ◽

Vocal Fold Paresis

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The diagnostic yield using ultrasound-guided needle-aspiration for subpleural primary lung cancer is not affected by the radiological properties of the lesions resulting from computed tomography

Respiratory Investigation ◽

10.1016/j.resinv.2018.01.004 ◽

2018 ◽

Vol 56 (3) ◽

pp. 238-242

Author(s):

Naoko Iwakami ◽

Shin-ichiro Iwakami ◽

Munechika Hara ◽

Mitsuaki Sekiya ◽

Takashi Dambara ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Diagnostic Yield ◽

Primary Lung Cancer ◽

Needle Aspiration ◽

Ultrasound Guided ◽

Radiological Properties

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Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions

Respiration ◽

10.1159/000515181 ◽

2021 ◽

pp. 1-9

Author(s):

Kai-Lun Yu ◽

Shun-Mao Yang ◽

Huan-Jang Ko ◽

Hui-Yu Tsai ◽

Jen-Chung Ko ◽

...

Keyword(s):

Computed Tomography ◽

Propensity Score ◽

Cone Beam Computed Tomography ◽

Diagnostic Yield ◽

Endobronchial Ultrasound ◽

Cone Beam ◽

Complication Rates ◽

Efficacy And Safety ◽

Pulmonary Lesions ◽

Peripheral Pulmonary Lesions

Background: The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated. Objectives: The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. Methods: We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety. Results: While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; p = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; p = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; p = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm2, respectively. Conclusions: TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

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Metrizamide Computed Tomographic Cisternography for the Diagnosis of Occult Lesions of the Hypothalamic-Hypophyseal Axis in Children

Neurosurgery ◽

10.1227/00006123-198105000-00004 ◽

1981 ◽

Vol 8 (5) ◽

pp. 531-541 ◽

Cited By ~ 5

Author(s):

Dachling Pang ◽

Arthur E. Rosenbaum ◽

James E. Wilberger ◽

James P. Gutai

Keyword(s):

Computed Tomography ◽

Diagnostic Yield ◽

Empty Sella ◽

Functional Disorders ◽

Ct Cisternography ◽

Empty Sella Syndrome ◽

Computed Tomographic ◽

Suprasellar Cistern ◽

Enhanced Computed Tomography ◽

Metrizamide Ct Cisternography

Abstract In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.

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Pediatric Vocal Fold Paresis and Paralysis

JAMA Otolaryngology–Head & Neck Surgery ◽

10.1001/jamaoto.2021.1050 ◽

2021 ◽

Author(s):

Chelsea Ridgway ◽

Sarah Bouhabel ◽

Lisa Martignetti ◽

Yo Kishimoto ◽

Nicole Y. K. Li-Jessen

Keyword(s):

Vocal Fold ◽

Vocal Fold Paresis

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Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions

Diagnostics ◽

10.3390/diagnostics12010041 ◽

2021 ◽

Vol 12 (1) ◽

pp. 41

Author(s):

Ching-Kai Lin ◽

Hung-Jen Fan ◽

Zong-Han Yao ◽

Yen-Ting Lin ◽

Yueh-Feng Wen ◽

...

Keyword(s):

Computed Tomography ◽

Success Rate ◽

Diagnostic Yield ◽

Study Groups ◽

Transbronchial Biopsy ◽

Endobronchial Ultrasound ◽

Cone Beam ◽

Ultrasound Guided ◽

Pulmonary Lesions ◽

Peripheral Pulmonary Lesions

Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs.

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Extra-fascial hemithyreoidectomy

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2007-2-98-102 ◽

2007 ◽

Vol 6 (2) ◽

pp. 98-102

Author(s):

D. I. Malinin ◽

V. G. Petrov

Keyword(s):

Thyroid Gland ◽

Parathyroid Gland ◽

Nerve Injury ◽

Vocal Fold ◽

Laryngeal Nerve ◽

Recurrent Nerve ◽

Surgical Results ◽

Vocal Fold Paresis ◽

Laryngeal Nerve Injury

The aim of the study was to improve surgical results of patients having thyroid gland pathology by the development of the surgery method directed to increasing possibility of injury and maintenance of the upper laryngeal nerve integrity. Method of performing extrafascial hemithyreoidectomy with visualization of recurrent nerve, parathyroid gland and upper thyroid artery is presented which is directed to decrease specific complications (vocal fold paresis, hypoparathyreosis) and complications associated with the upper laryngeal nerve injury. Using this method, 166 patients having node pathology of thyroid gland were operated on. This method resulted in decreased number of complications (from 15,0 to 2,6%).

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