Objectives: To evaluate whether readout-segmented echo-planar imaging (RS-EPI) diffusion-weighted imaging (DWI) can reduce image distortion and improve the lesion identification in parathyroid adenomas (PTAs) compared to single-shot EPI (SS-EPI) DWI, and to determine whether PTAs can be differentiated from other soft tissue structures of the head and neck region by using the apparent diffusion coefficient (ADC) value. Design: Retrospective study. Setting: Kyoto University Hospital. Participants: 24 patients who underwent a magnetic resonance imaging (MRI) scan for the preoperative diagnosis of PTAs from January 2012 to March 2020 were enrolled. Main outcome measures: MRI was performed with the acquisition of a 1.5T MR imaging system (Avanto or Trio, Siemens, Erlangen, Germany) or a 3T MR imaging system (Prisma or Skyra, Siemens). Image quality and distortion of PTAs on RS-EPI and SS-EPI was evaluated using a reported five point score, and the ADC values of PTAs, thyroid glands and cervical neck lymph nodes were compared. Results: RS-EPI provided significantly less distortion but did not improve the lesion identification compared to SS-EPI. On SS-EPI, the PTAs had significantly higher ADC values compared to the cervical lymph nodes. On RS-EPI, the PTAs had significantly higher ADC values compared to the thyroid glands and cervical lymph nodes. Conclusions: RS-EPI reduces the DWI distortion in PTAs. The ADC value obtained using RS-EPI enables the differentiation of PTAs from nearby structures, such as thyroid glands and cervical lymph nodes.

Surgical management can be considered in patients with allergic rhinitis (AR) refractory to drug therapy, posterior nasal neurectomy (PNN) is one of the procedures. We developed a unique and simplified method for PNN, we called modified PNN (MPPN) and investigated the improvement in nasal symptoms after MPNN surgery for allergic rhinitis, other surgical outcomes, and surgical complications. In MPNN, following sufficient coagulation of the mucosa along the base of the inferior nasal turbinate, a full thickness mucoperiosteal incision up to the bony turbinate was performed using energy devices. Surgical manipulations to confirm the posterior nasal nerve, such as elevation of the mucosa, are not necessary with MPNN. MPNN was a simple and safe procedure, and no serious surgical complications were observed. Significant improvement in postoperative nasal symptoms and reduction in medication use compared to preoperative conditions.