Forty-one patients were examined (39 prospectively and 2 retrospectively) with computed tomography (CT) to determine its value in staging cervical and retropharyngeal nodal metastases. Precise surgical confirmation of CT findings was available in 25 patients. CT correctly increased the stage of the disease in six necks, and showed extranodal extent more precisely than the clinical examination in six others. The clinical evaluation proved superior to CT at predicting the extent of extranodal disease in two patients. Both CT and the clinical examination failed to detect microscopic tumor in normal-size nodes in two patients and falsely predicted tumor in enlarged nodes in one. CT offers information important for management and prognosis that is not available from the clinical examination in patients who have already been treated for cancer of the neck, and in patients with extranodal spread or retropharyngeal adenopathy. In the untreated neck CT will increase the stage of the disease from N0 to N1 about 5% of the time. Simple criteria for integrating CT into current clinical-diagnostic staging systems based on this and other experience are presented.

Despite the rapid growth of the Internet for storage and display of World Wide Web-based teaching files, the available image file formats have remained relatively limited. The recently developed portable networks graphics (PNG) format is versatile and offers several advantages over the older Internet standard image file formats that make it an attractive option for digital teaching files. With the PNG format, it is possible to repeatedly open, edit, and save files with lossless compression along with gamma and chromicity correction. The two-dimensional interlacing capabilities of PNG allow an image to fill in from top to bottom and from right to left, making retrieval faster than with other formats. In addition, images can be viewed closer to the original settings, and metadata (ie, information about data) can be incorporated into files. The PNG format provides a network-friendly, patent-free, lossless compression scheme that is truly cross-platform and has many new features that are useful for multimedia and Web-based radiologic teaching. The widespread acceptance of PNG by the World Wide Web Consortium and by the most popular Web browsers and graphic manipulation software companies suggests an expanding role in the future of multimedia teaching file development.

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OBJECTIVE. The purpose of this article is to acquaint the reader with the clinical and imaging features of the silent sinus syndrome, which is relatively unknown. Discussion of the presentation, treatment, and theory regarding pathogenesis of the syndrome follows. CONCLUSION. The silent sinus syndrome consists of painless facial asymmetry and enophthalmos caused by chronic maxillary sinus atelectasis. Although the diagnosis is usually suspected clinically, it is confirmed radiologically by characteristic imaging features that include maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss caused by inward retraction of the sinus walls.