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Sample records for neck preoperative imaging

  1. Preoperative embolization of hypervascular head and neck tumours

    International Nuclear Information System (INIS)

    Gupta, A. K.; Purkayastha, S.; Bodhey, N. K.; Kapilamoorthy, T. R.; Kesavadas, C.

    2007-01-01

    Full text: The embolization of vascular tumours of the head and neck has become an important adjunct to the surgical treatment of these tumours. A vascular tumour in the head and neck region in a surgically treatable patient may be a candidate for embolization. Palliative embolization may be the sole treatment for high risk patients. Reducing intraoperative bleeding may shorten surgery time thus decreasing morbidity and mortality. The purpose of this study is to assess the efficacy of embolization as an adjunct to surgery or as a curative measure in the management of hypervascular head and neck tumours. We retrospectively reviewed the records of 46 consecutive patients 27 men and 16 women; mean age, 37.8 years) with 48 hypervascular head and neck tumours that had undergone preoperative transarterial, direct puncture or combined mode of embolization. Diagnosis of tumours was made on the basis of findings of imaging studies. The 46 patients underwent embolization either through transarterial route, by direct puncture technique or both direct puncture and arterial route. The devascularization reached 90-95% with the use of NBCA. The amount of devascularization reached by transarterial particle embolization is a little lesser. One patient (carotid body tumour) developed mild unilateral seventh, ninth and 10th cranial nerve palsy after transarterial embolization, transient hemiparesis was seen in another patient (nasopharyngeal angiofibroma). Both patients improved completely with steroids and had no deficit on follow up. One patient developed delayed glue migration into the middle cerebral artery territory 6 h after the procedure with no reported increase in size of the lesion in the following 5 years. Preoperative embolization of hypervascular tumour of head and neck region appears to be safe and improves the chance of complete removal during surgery with minimal blood loss

  2. Pitfalls in neck imaging

    International Nuclear Information System (INIS)

    Gay, S.B.; Phillips, C.D.; Cornett, J.B.

    1991-01-01

    CT and MR imaging have become effective imaging modalities in the evaluation of primary head and neck neoplasms. As radiologists have gained experience in head and neck imaging, certain pitfalls have become evident. Identification of pathologic lymph nodes is the critical element in staging neoplasms of the head and neck. The diagnosis of cervical lymphadenopathy may be complicated by confusion with normal structures, inadequate contrast opacification of vascular structures, and poor scanning technique. This paper illustrates these potential problem areas on both CT and MR images and offers the authors' approach to further evaluation in problem cases

  3. Value of retrospective image fusion of 18F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI

    International Nuclear Information System (INIS)

    Kanda, Tomonori; Kitajima, Kazuhiro; Suenaga, Yuko; Konishi, Jyunya; Sasaki, Ryohei; Morimoto, Koichi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi; Sugimura, Kazuro

    2013-01-01

    Purpose: To assess the clinical value of retrospective image fusion of neck MRI and 18 F-fluorodeoxyglucose ( 18 F-FDG) PET for locoregional extension and nodal staging of neck cancer. Materials and methods: Thirty patients with carcinoma of the oral cavity or hypopharynx underwent PET/CT and contrast-enhanced neck MRI for initial staging before surgery including primary tumor resection and neck dissection. Diagnostic performance of PET/CT, MRI, and retrospective image fusion of PET and MRI (fused PET/MRI) for assessment of the extent of the primary tumor (T stage) and metastasis to regional lymph nodes (N stage) was evaluated. Results: Accuracy for T status was 87% for fused PET/MRI and 90% for MRI, thus proving significantly superior to PET/CT, which had an accuracy of 67% (p = 0.041 and p = 0.023, respectively). Accuracy for N status was 77% for both fused PET/MRI and PET/CT, being superior to MRI, which had an accuracy of 63%, although the difference was not significant (p = 0.13). On a per-level basis, the sensitivity, specificity and accuracy for detection of nodal metastasis were 77%, 96% and 93% for both fused PET/MRI and PET/CT, compared with 49%, 99% and 91% for MRI, respectively. The differences for sensitivity (p = 0.0026) and accuracy (p = 0.041) were significant. Conclusion: Fused PET/MRI combining the individual advantages of MRI and PET is a valuable technique for assessment of staging neck cancer

  4. Value of retrospective image fusion of {sup 18}F-FDG PET and MRI for preoperative staging of head and neck cancer: Comparison with PET/CT and contrast-enhanced neck MRI

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    Kanda, Tomonori [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Department of Radiology, Hyogo Cancer Center, Hyogo (Japan); Kitajima, Kazuhiro, E-mail: kitajima@med.kobe-u.ac.jp [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Suenaga, Yuko; Konishi, Jyunya [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Sasaki, Ryohei [Division of Radiation Oncology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Morimoto, Koichi; Saito, Miki; Otsuki, Naoki; Nibu, Ken-ichi [Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe (Japan); Sugimura, Kazuro [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan)

    2013-11-01

    Purpose: To assess the clinical value of retrospective image fusion of neck MRI and {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG) PET for locoregional extension and nodal staging of neck cancer. Materials and methods: Thirty patients with carcinoma of the oral cavity or hypopharynx underwent PET/CT and contrast-enhanced neck MRI for initial staging before surgery including primary tumor resection and neck dissection. Diagnostic performance of PET/CT, MRI, and retrospective image fusion of PET and MRI (fused PET/MRI) for assessment of the extent of the primary tumor (T stage) and metastasis to regional lymph nodes (N stage) was evaluated. Results: Accuracy for T status was 87% for fused PET/MRI and 90% for MRI, thus proving significantly superior to PET/CT, which had an accuracy of 67% (p = 0.041 and p = 0.023, respectively). Accuracy for N status was 77% for both fused PET/MRI and PET/CT, being superior to MRI, which had an accuracy of 63%, although the difference was not significant (p = 0.13). On a per-level basis, the sensitivity, specificity and accuracy for detection of nodal metastasis were 77%, 96% and 93% for both fused PET/MRI and PET/CT, compared with 49%, 99% and 91% for MRI, respectively. The differences for sensitivity (p = 0.0026) and accuracy (p = 0.041) were significant. Conclusion: Fused PET/MRI combining the individual advantages of MRI and PET is a valuable technique for assessment of staging neck cancer.

  5. Preoperative percutaneous cranial nerve mapping in head and neck surgery.

    Science.gov (United States)

    Park, Jung I

    2003-01-01

    To identify and map the course of the peripheral branches of the cranial nerve preoperatively and percutaneously. Prospective study. Preoperative percutaneous nerve mapping performed prior to the operation under deep sedation or general anesthesia without muscle paralysis. Private office surgery suite, freestanding surgery center, and regional medical centers. A total of 142 patients undergoing head and neck surgery and facial plastic surgery between August 1994 and July 1999. Monopolar probe was used for nerve stimulation. Electromyographic reading was done through intramuscular bipolar recording electrodes. The equipment used was a nerve monitor. The mandibular divisions were tested in 142 cases, the frontal division in 60 cases, the accessory nerve in 12 cases, and the hypoglossal nerve in 3 cases. Satisfactory mappings were obtained in 115 cases of the mandibular division, 49 cases of the frontal division, 8 cases of the accessory division, and 1 case of the hypoglossal nerve. Preoperative percutaneous nerve mapping is a new method of identifying the location of the peripheral branches of the cranial nerves. Identifying and mapping the course of peripheral branches of the cranial nerves safely assists the head and neck surgeon in the placement of incisions in a favorable location and in the dissection of the area involving the nerves. Mapping alerts the surgeon to an area containing a nerve and allows the surgeon to avoid just the specific area where a nerve is present, preventing large-scale abandonment of unmapped areas for fear of potential nerve damage.

  6. Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients.

    Science.gov (United States)

    Leung, John S L; Seto, Alfred; Li, George K H

    2017-04-01

    Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.

  7. Preoperative sup(99m)Tc-MDP scintimetry of femoral neck fractures

    International Nuclear Information System (INIS)

    Holmberg, S.; Thorngren, K.-G.

    1984-01-01

    Preoperative sup(99m)Tc-MDP-scintimetry was performed in 117 patients with femoral neck fractures. Scintimetry was shown to be superior to visual evaluation. The ratio was calculated of the uptake in the femoral head of the fractured side over that in the unfractured side, with compensation for the increased trochanteric femoral activity found on the fractured side. A ratio above 0.90 correlated well with uneventful healing in both undisplaced and displaced fractures. Preoperative scintimetry is of great value in the choice of primary treatment of femoral neck fractures. (author)

  8. A pain in the neck-Imaging in neck sepsis

    International Nuclear Information System (INIS)

    Lyle, N.J.; Rutherford, E.E.; Batty, V.B.

    2011-01-01

    Deep neck infection has a high morbidity and mortality and the extent of infection is often difficult to estimate clinically. The complex anatomy and the communication between neck spaces means that infection can spread along fascial planes leading to life-threatening complications such as airway compromise, vascular erosion/thrombosis, neural dysfunction, and ultimately descending necrotizing mediastinitis. Imaging has an important role to play in identifying the extent of infection and the presence of complications.

  9. A pain in the neck-Imaging in neck sepsis

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    Lyle, N.J., E-mail: nickylyle@doctors.org.uk [Department of Diagnostic Imaging, Southampton General Hospital, Southampton (United Kingdom); Rutherford, E.E.; Batty, V.B. [Department of Diagnostic Imaging, Southampton General Hospital, Southampton (United Kingdom)

    2011-09-15

    Deep neck infection has a high morbidity and mortality and the extent of infection is often difficult to estimate clinically. The complex anatomy and the communication between neck spaces means that infection can spread along fascial planes leading to life-threatening complications such as airway compromise, vascular erosion/thrombosis, neural dysfunction, and ultimately descending necrotizing mediastinitis. Imaging has an important role to play in identifying the extent of infection and the presence of complications.

  10. The preoperative imaging evaluation for cochlear implantation

    International Nuclear Information System (INIS)

    Liu Zhonglin; Wang Zhenchang; Fu Lin; Li Yong; Xian Junfang; Yang Bentao; Lan Baosen; Li Yongxin; Zheng Jun; Song Yan; Liu Bo; Chen Xueqing; He Haili

    2006-01-01

    Objective: To analyze CT and MRI findings of temporal bone and to evaluate preoperative diagnostic value for cochlear implantation. Methods: One hundred and sixty candidates for cochlear implantation were examined with axial CT scan, 64 of them also with coronal CT scan, and 119 patients with MRI. Results: All of 320 ears were well-aerated, and 206 ears had mastoid cavities extended posteriorly to the sigmoid sinus. The length from posterior-lateral tympanic wall to the outer cortex was (2.34±0.42) mm (left side) and (2.25±0.40) mm (right side) (U=1.887, P 1 and T 2 signal on MRI. The congenital malformations of inner ear occurred in 67 ears, including complete dysplasia in 1 ear, cochlear hypodysplasia in 6 ears, Mondini deformation in 5 ears, enlarged vestibular aqueduct in 40 ears, dysplastic semicircular canal and the vestibulae in 10 ears, and narrowing of internal auditory canal in 5 ears. Conclusion: Preoperative imaging examinations can provide critical information to ensure successful cochlear' implantation. (authors)

  11. Treatment results of preoperative radiotherapy for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Shikama, Naoto; Oguchi, Masahiko; Kurita, Hiroshi; Katsuno, Satoshi

    2000-01-01

    One hundred and nine patients with advanced head and neck cancers (oral cavity: 50, oropharynx: 11, hypopharynx: 18, larynx: 30) received preoperative radiotherapy from 1987 through 1997 in our institute. The median age was 66 years (20-83). Almost all patients had advanced disease (stage II: 17, III: 34, IV: 58). The median dose of preoperative radiotherapy was 40 Gy (20-50). Seventy patients received chemotherapy. The median follow-up time was 30 months. The 5-year overall and disease-free survival rates of all patients were 66% and 56%, respectively. The 5-year locoregional and distant failure rates were 36% and 10%, respectively. The locoregional failure rate of oral cavity cancer (54%) was worse than those of other sites (13-28%) (p=0.0015). The locoregional failure rates of oral cavity cancers according to clinical stage were 59% (II), 57% (III) and 48% (IV), respectively. Incidentally those of other sites were 0% (II), 16% (III) and 30% (IV), respectively. Thirty-eight patients had major complication after surgery. The locoregional failure rates of preoperative radiotherapy following surgery for oral cavity cancers of all stages and other sites of stage IV were high. Preoperative radiotherapy should be stopped and postoperative radiotherapy for these patients should be considered. (author)

  12. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup

    International Nuclear Information System (INIS)

    Ashraf, M.; Biswas, J.; Jha, J.; Nayak, S.; Singh, V.; Majumdar, S.; Bhowmick, A.; Dam, A.

    2011-01-01

    Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%. This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region. Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n=148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n=148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively. The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India. (author)

  13. Histomorphological changes of vessel structure in head and neck vessels following preoperative or postoperative radiotherapy

    International Nuclear Information System (INIS)

    Schultze-Mosgau, S.; Wehrhan, F.; Wiltfang, J.; Grabenbauer, G.G.; Sauer, R.; Roedel, F.; Radespiel-Troeger, M.

    2002-01-01

    Patients and Methods: In 348 patients (October 1995-March 2002) receiving primarly or secondarily 356 microvascular hard- and soft tissue reconstruction, a total of 209 vessels were obtained from neck recipient vessels and transplant vessels during anastomosis. Three groups were analysed: group 1 (27 patients) treated with no radiotherapy or chemotherapy; group 2 (29 patients) treated with preoperative irradiation (40-50 Gy) and chemotherapy (800 mg/m 2 /day 5-FU and 20 mg/m 2 /day cisplatin) 1.5 months prior to surgery; group 3 (20 patients) treated with radiotherapy (60-70 Gy) (median interval 78.7 months; IQR: 31.3 months) prior to surgery. From each of the 209 vessel specimens, 3 sections were investigated histomorphometrically, qualitatively and quantitatively (ratio media area/total vessel area) by NIH-Image-digitized measurements. To evaluate these changes as a function of age, radiation dose and chemotherapy, a statistical analysis was performed using an analysis of covariance and χ 2 tests (p > 0.05, SPSS V10). Results: In group 3, qualitative changes (intima dehiscence, hyalinosis) were found in recipient arteries significantly more frequently than in groups 1 and 2. For group 3 recipient arteries, histomorphometry revealed a significant decrease in the ratio media area/total vessel area (median 0.51, IQR 0.10) in comparison with groups 1 (p = 0.02) (median 0.61, IQR 0.29) and 2 (p = 0.046) (median 0.58, IQR 0.19). No significant difference was found between the vessels of groups 1 and 2 (p = 0.48). There were no significant differences in transplant arteries and recipient or transplant veins between the groups. Age and chemotherapy did not appear to have a significant influence on vessel changes in this study (p > 0.05). Conclusions: Following irradiation with 60-70 Gy, significant qualitative and quantitative histological changes to the recipient arteries, but not to the recipient veins, could be observed. In contrast, irradiation at a dose of 40-50 Gy

  14. MR imaging in squamous cell carcinoma of the head and neck with no palpable lymph nodes

    International Nuclear Information System (INIS)

    Yucel, T.; Sennaroglu, L.; Kaya, S.; Saatci, I.; Cekirge, S.; Aydingoz, U.

    1997-01-01

    Purpose: To assess the efficacy of MR imaging in the detection of lymph node metastasis in patients with no palpable lymph nodes ('N 0 neck') who have squamous cell carcinoma of the head and neck region. Material and Methods: MR neck imagings in 18 patients who underwent neck dissection (bilaterally in 2) for squamous cell carcinoma of the head and neck region were examined preoperatively for the purpose of detecting lymph node metastases. The imaging features taken into consideration were: size (cutoff point 10 mm), grouping, presence of central necrosis, and appearance of extracapsular spread. The MR examinations comprised spin-echo T1- and T2-weighted sequences. The MR findings were compared with those of surgery and histopathological examination. Results: MR suggested metastatic lymph node involvement in 5 necks. In 2 of these, central necrosis was seen in the enlarged lymph nodes. In a third, a grouping of the lymph nodes was noted. Extracapsular spread was not present. Histopathological examination revealed metastatic lymph nodes in 7 of 20 necks, the rate of clinically occult disease being 35%, and 4 of then had been accurately graded by MR. There was one false-positive MR examination. The MR sensitivity was 57.1% and specificity 92.3%. Conclusion: MR may reveal metastatic lymph nodes in patients with no clinical evidence of metastasis. However, conventional MR techniques are not always sufficient for decision-making on surgery in cases of 'N 0 neck'. (orig.)

  15. Imaging of head and neck venous malformations

    International Nuclear Information System (INIS)

    Flis, Christine M.; Connor, Stephen E.

    2005-01-01

    Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. (orig.)

  16. Indications of laparoscopic cholecystectomy based on preoperative imaging findings

    International Nuclear Information System (INIS)

    Wakizaka, Yoshitaka; Sano, Syuichi; Nakanishi, Yoshimi; Koike, Yoshinobu; Ozaki, Susumu; Iwanaga, Rikizo; Uchino, Junichi.

    1994-01-01

    We studied the indications for laparoscopic cholecystectomy (LC) and values of preoperative imaging findings in 82 patients who underwent preoperative imaging diagnostic tests (abdominal echogram, abdominal CAT scan, ERCP). We analyzed mainly patients who were considered to be indicated for LC but whose gallbladders could be removed by open laparotomy, or whose gallbladders were removed by open laparotomy but were considered indicated for LC from retrospective study. We found the following results. LC could be easily performed in patients with a history of severe acute cholecystitis if they had no findings of a thickened wall or negative gallbladder signs. Abdominal echogram and CAT scan were the best preoperative imaging tests for determining the gallbladder's state, especially for obstruction of the cystic duct. These results are important today when the operative indications of LC are extremely indefinite because of the accumulation of operative experience and technological improvements. (author)

  17. Improving the preoperative care of patients with femoral neck fractures through the development and implementation of a checklist.

    Science.gov (United States)

    Agha, Riaz; Edison, Eric; Fowler, Alexander

    2014-01-01

    The incidence of femoral neck fractures (FNFs) is expected to rise with life expectancy. It is important to improve the safety of these patients whilst under the care of orthopaedic teams. This study aimed to increase the performance of vital preoperative tasks in patients admitted for femoral neck fracture operations by producing and implementing a checklist as an aide memoir. The checklist was designed primarily for use by senior house officers (SHOs) admitting patients from the emergency department. A list of 12 preoperative tasks was identified. A baseline audit of 10 random patients showed that the mean proportion of the 12 tasks completed was 53% (range 25% - 83%). A survey of 14 nurses and surgeons found that the majority of respondents agreed that there was a problem with the performance of most of the tasks. The tasks were incorporated into a checklist which was refined in three plan-do-study-act cycles and introduced into the femoral neck fracture pathway. In the week following the introduction of the checklist, 77% of the checklist tasks were completed, 24% more than at the baseline audit (53%). In week 3, the completion of checklist tasks rose to 88% and to 95% in week 4. In conclusion, a simple checklist can markedly improve the performance and recording of preoperative tasks by SHOs. We recommend the wider adoption of the new checklist to be produced as a sticker for patients' medical records. Further study is required to ascertain the effect of the checklist on clinical outcomes.

  18. Manual of head and neck imaging

    International Nuclear Information System (INIS)

    Raghavan, Prashant; Mukherjee, Sugoto; Jameson, Mark J.; Wintermark, Max

    2014-01-01

    Easy-to-read short chapters. Tables, checklists, and algorithms to assist in arriving at a quick diagnosis. Clinical pearls that will enable the radiologist to issue a relevant report. One-stop resource when preparing for radiology and otolaryngology exams. Line diagrams to illustrate key concepts. This book is designed as an easily readable manual that will be of great practical value for radiology and otolaryngology residents during their clinical rotations. Key facts on head and neck imaging are presented in short chapters written in an easily readable style. Line drawings are used to illustrate key concepts, and tables, checklists, and algorithms will enable the readers to arrive at a quick diagnosis. In addition, emphasis is placed on clinical pearls that will assist them in preparing suitable reports. The Manual of Head and Neck Imaging is sized to allow residents to read it completely within a matter of days, and it will also serve as an ideal quick reference guide as different clinical situations arise.

  19. Diagnostic imaging in liver transplantation. Preoperative evaluation and postoperative complications

    International Nuclear Information System (INIS)

    Schroeder, T.; Ruehm, S.G.

    2005-01-01

    Complimentary to orthotopic liver transplantation (OLT), living donor liver transplantation (LDLT) is increasingly considered a therapeutic option in the therapy of end-stage liver disease. Accurate pre- and postoperative imaging is crucial for the transplantation success and represents an established part of the current evaluation algorithms. This article summarizes the most important requirements and the current imaging standards. Preoperative imaging is important for exclusion of transplantation contraindications in the recipient and for reliable assessment of anatomical variants in the donor. The main purpose of postoperative imaging is the early detection and characterization of complications. In both instances, multislice CT currently represents the most versatile and reliable imaging modality, still superior to MRI. For postoperative follow-up, the imaging modality of first choice is still bedside ultrasound; however, unclear findings usually need to be further assessed by CT. (orig.) [de

  20. Value of MR and CT Imaging for Assessment of Internal Carotid Artery Encasement in Head and Neck Squamous Cell Carcinoma

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    W. L. Lodder

    2013-01-01

    Full Text Available Objective. This study was conducted to assess the value of CT and MR imaging in the preoperative evaluation of ICA encasement. Methods. Based upon three patient groups this study was performed. Retrospective analysis of 260 neck dissection reports from 2001 to 2010 was performed to determine unexpected peroperative-diagnosed encasement. Two experienced head and neck radiologists reviewed 12 scans for encasement. Results. In four out of 260 (1.5% patients undergoing neck dissection, preoperative imaging was false negative as there was peroperative encasement of the ICA. Of 380 patients undergoing preoperative imaging, the radiologist reported encasement of the ICA in 25 cases. In 342 cases no encasement was described, 125 of these underwent neck dissection, and 2 had encasement peroperatively. The interobserver variation kappa varied from 0.273 to 1 for the different characteristics studied. Conclusion. These retrospectively studied cohorts demonstrate that preoperative assessment of encasement of the ICA using MRI and/or CT was of value in evaluation of ICA encasement and therefore contributively in selecting operable patients (without ICA encasement, since in only 1.5% encasement was missed. However, observer variation affects the reliability of this feature.

  1. Can preoperative MR imaging predict optic nerve invasion of retinoblastoma?

    International Nuclear Information System (INIS)

    Song, Kyoung Doo; Eo, Hong; Kim, Ji Hye; Yoo, So-Young; Jeon, Tae Yeon

    2012-01-01

    Purpose: To evaluate the accuracy of pre-operative MRI for the detection of optic nerve invasion in retinoblastoma. Materials and methods: Institutional review board approval and informed consent were waived for this retrospective study. A total of 41 patients were included. Inclusion criteria were histologically proven retinoblastoma, availability of diagnostic-quality preoperative MR images acquired during the 4 weeks before surgery, unilateral retinoblastoma, and normal-sized optic nerve. Two radiologists retrospectively reviewed the MR images independently. Five imaging findings (diffuse mild optic nerve enhancement, focal strong optic nerve enhancement, optic sheath enhancement, tumor location, and tumor size) were evaluated against optic nerve invasion of retinoblastoma. The predictive performance of all MR imaging findings for optic nerve invasion was also evaluated by the receiver operating characteristic curve analysis. Results: Optic nerve invasion was histopathologically confirmed in 24% of study population (10/41). The differences in diffuse mild enhancement, focal strong enhancement, optic sheath enhancement, and tumor location between patients with optic nerve invasion and patients without optic nerve invasion were not significant. Tumor sizes were 16.1 mm (SD: 2.2 mm) and 14.9 mm (SD: 3.6 mm) in patients with and without optic nerve involvement, respectively (P = 0.444). P-Values from binary logistic regression indicated that all five imaging findings were not significant predictors of tumor invasion of optic nerve. The AUC values of all MR imaging findings for the prediction of optic nerve invasion were 0.689 (95% confidence interval: 0.499–0.879) and 0.653 (95% confidence interval: 0.445–0.861) for observer 1 and observer 2, respectively. Conclusion: Findings of MRI in patients with normal-sized optic nerves have limited usefulness in preoperatively predicting the presence of optic nerve invasion in retinoblastoma.

  2. Can preoperative MR imaging predict optic nerve invasion of retinoblastoma?

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    Song, Kyoung Doo, E-mail: kdsong0308@gmail.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of); Eo, Hong, E-mail: rtombow@gmail.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of); Kim, Ji Hye, E-mail: jhkate.kim@samsung.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of); Yoo, So-Young, E-mail: sy1131.yoo@samsung.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of); Jeon, Tae Yeon, E-mail: hathor97.jeon@samsung.com [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710 (Korea, Republic of)

    2012-12-15

    Purpose: To evaluate the accuracy of pre-operative MRI for the detection of optic nerve invasion in retinoblastoma. Materials and methods: Institutional review board approval and informed consent were waived for this retrospective study. A total of 41 patients were included. Inclusion criteria were histologically proven retinoblastoma, availability of diagnostic-quality preoperative MR images acquired during the 4 weeks before surgery, unilateral retinoblastoma, and normal-sized optic nerve. Two radiologists retrospectively reviewed the MR images independently. Five imaging findings (diffuse mild optic nerve enhancement, focal strong optic nerve enhancement, optic sheath enhancement, tumor location, and tumor size) were evaluated against optic nerve invasion of retinoblastoma. The predictive performance of all MR imaging findings for optic nerve invasion was also evaluated by the receiver operating characteristic curve analysis. Results: Optic nerve invasion was histopathologically confirmed in 24% of study population (10/41). The differences in diffuse mild enhancement, focal strong enhancement, optic sheath enhancement, and tumor location between patients with optic nerve invasion and patients without optic nerve invasion were not significant. Tumor sizes were 16.1 mm (SD: 2.2 mm) and 14.9 mm (SD: 3.6 mm) in patients with and without optic nerve involvement, respectively (P = 0.444). P-Values from binary logistic regression indicated that all five imaging findings were not significant predictors of tumor invasion of optic nerve. The AUC values of all MR imaging findings for the prediction of optic nerve invasion were 0.689 (95% confidence interval: 0.499–0.879) and 0.653 (95% confidence interval: 0.445–0.861) for observer 1 and observer 2, respectively. Conclusion: Findings of MRI in patients with normal-sized optic nerves have limited usefulness in preoperatively predicting the presence of optic nerve invasion in retinoblastoma.

  3. Head and neck imaging with MDCT

    International Nuclear Information System (INIS)

    Imhof, H.; Czerny, Chr.; Dirisamer, A.

    2003-01-01

    Multi-slice CT (MDCT) is rapidly becoming the new standard in radiological imaging. Although its advantages in cardiovascular, thoracic and abdominal imaging are evident, the extent of its usefulness for imaging the head and neck has yet to be clarified. Because of the shorter examination time motion artifacts are reduced, phonation-studies are possible. Due to the thin-slicing and nearly isotropic multiplanar reconstruction (MPR) examination in only one plane is necessary, saving both time and radiation exposure. The shorter examination requires the use of higher concentrated contrast medium (400 mg of iodine/ml). The use of such a contrast medium produces a higher degree of contrast enhancement and provides a 5-10% higher contrast between the surrounding normal and pathological tissue, but is more time critical. MPRs are easily done in any plane within seconds and enables also three-dimensional visualization, what helps in the use of minimal invasive therapy, training and teaching and provides a way of handling the hundreds of images acquired during scanning

  4. Markerless registration for image guided surgery. Preoperative image, intraoperative video image, and patient

    International Nuclear Information System (INIS)

    Kihara, Tomohiko; Tanaka, Yuko

    1998-01-01

    Real-time and volumetric acquisition of X-ray CT, MR, and SPECT is the latest trend of the medical imaging devices. A clinical challenge is to use these multi-modality volumetric information complementary on patient in the entire diagnostic and surgical processes. The intraoperative image and patient integration intents to establish a common reference frame by image in diagnostic and surgical processes. This provides a quantitative measure during surgery, for which we have been relied mostly on doctors' skills and experiences. The intraoperative image and patient integration involves various technologies, however, we think one of the most important elements is the development of markerless registration, which should be efficient and applicable to the preoperative multi-modality data sets, intraoperative image, and patient. We developed a registration system which integrates preoperative multi-modality images, intraoperative video image, and patient. It consists of a real-time registration of video camera for intraoperative use, a markerless surface sampling matching of patient and image, our previous works of markerless multi-modality image registration of X-ray CT, MR, and SPECT, and an image synthesis on video image. We think these techniques can be used in many applications which involve video camera like devices such as video camera, microscope, and image Intensifier. (author)

  5. MR images of oral cancer treated with preoperative radiotherapy

    International Nuclear Information System (INIS)

    Onizawa, Kojiro; Niitsu Mamoru; Yusa, Hiroshi; Yanagawa, Toru; Yoshida, Hiroshi

    2003-01-01

    This study was carried out to evaluate the relationship between the effect of preoperative radiotherapy for oral cancer and the changes of signal intensity with MR images. T2-weighted images were compared before and after radiotherapy in 18 patients with primary oral cancer, and the effect on the lesions was histologically evaluated in surgically resected specimens obtained four weeks after the therapy. The MR images showed significantly decreased signal intensity of the lesions. The decrease of signal intensity was remarkable starting at two weeks after completion of the radiotherapy, compared with the decrease at less than two weeks after the therapy. The change of signal intensity was more obvious in tongue cancer than in other oral cancers. There was no significant difference in the change of the signal intensity between cancers with histologically poor response to the therapy and those with good response. These results suggested that signal intensity of oral cancer on T2-weighted images showed a significant decrease after preoperative radiotherapy, and that the intensity could be affected by duration after radiotherapy and primary sites. (author)

  6. Preoperative subtyping of meningiomas by perfusion MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Hao [University Medical Center Groningen, University of Groningen (Netherlands); Shanghai Jiaotong University affiliated First People' s Hospital, Department of Radiology, Shanghai (China); Department of Radiology, University of Groningen (Netherlands); Roediger, Lars A.; Oudkerk, Matthijs [University Medical Center Groningen, University of Groningen (Netherlands); Department of Radiology, University of Groningen (Netherlands); Shen, Tianzhen [Fudan University Huashan Hospital, Department of Radiology, Shanghai (China); Miao, Jingtao [Shanghai Jiaotong University affiliated First People' s Hospital, Department of Radiology, Shanghai (China)

    2008-10-15

    This paper aims to evaluate the value of perfusion magnetic resonance (MR) imaging in the preoperative subtyping of meningiomas by analyzing the relative cerebral blood volume (rCBV) of three benign subtypes and anaplastic meningiomas separately. Thirty-seven meningiomas with peritumoral edema (15 meningothelial, ten fibrous, four angiomatous, and eight anaplastic) underwent perfusion MR imaging by using a gradient echo echo-planar sequence. The maximal rCBV (compared with contralateral normal white matter) in both tumoral parenchyma and peritumoral edema of each tumor was measured. The mean rCBVs of each two histological subtypes were compared using one-way analysis of variance and least significant difference tests. A p value less than 0.05 indicated a statistically significant difference. The mean rCBV of meningothelial, fibrous, angiomatous, and anaplastic meningiomas in tumoral parenchyma were 6.93{+-}3.75, 5.61{+-}4.03, 11.86{+-}1.93, and 5.89{+-}3.85, respectively, and in the peritumoral edema 0.87{+-}0.62, 1.38{+-}1.44, 0.87{+-}0.30, and 3.28{+-}1.39, respectively. The mean rCBV in tumoral parenchyma of angiomatous meningiomas and in the peritumoral edema of anaplastic meningiomas were statistically different (p<0.05) from the other types of meningiomas. Perfusion MR imaging can provide useful functional information on meningiomas and help in the preoperative diagnosis of some subtypes of meningiomas. (orig.)

  7. Magnetic resonance imaging of head and neck vascular anomalies ...

    African Journals Online (AJOL)

    Magnetic resonance imaging of head and neck vascular anomalies: pearls and pitfalls. Shaimaa Abdelsattar Mohammad, Amr Abdelhamid Abou Zeid, Ahmed M. Fawzi, Mohamed M. Dahab, Iman A. Ragab, Osama El-Naggar ...

  8. Preoperative imaging as the basis for image-guided neurosurgery

    International Nuclear Information System (INIS)

    Winkler, D.; Strauss, G.; Hesse, S.; Sabri, O.; Goldammer, A.; Meixensberger, J.; Hund-Georgiadis, M.; Richter, A.; Kahn, T.

    2004-01-01

    With the progressive development of soft- and hardware, the acceptance of image-guided neurosurgery has increased dramatically. Additional image data are required to analyze the nature and the dimensions of pathological processes and the surrounding tissue. In this context, fMRI, SPECT, PET, as well as special modalities of CT and MR imaging, are routinely used. Secondary post-processing options are used to detect intracerebral lesions as well as adjacent functional eloquent regions in the parenchymatous organ pre- and intraoperatively. The integration of different image information guarantees the precise planning and realization of surgical maneuvers. The segmentation of interesting structures and risk structures, as well as their implementation in the neuronavigation systems, help to avoid additional intraoperative traumatization and offer a higher level of safety and precision. In this article the value and limitations of presurgical imaging will be discussed. (orig.) [de

  9. Imaging manifestations of neck masses in the immunocompromised host

    International Nuclear Information System (INIS)

    Taylor, N.; Scarsbrook, A.F.; Conlon, C.P.; Anslow, P.A.; Phillips, R.R.

    2007-01-01

    Human immunodeficiency virus (HIV) infection, haematological malignancy, and immunosuppression for transplantation and autoimmune disorders have led to a large increase in immunocompromised patients. Neck masses are relatively common in this patient group and include both opportunistic and severe manifestations of common infections, benign hyperplasia, and primary or secondary malignancies. Although biopsy may be necessary for definitive diagnosis, features on cross-sectional imaging may suggest a specific diagnosis or limit the differential diagnosis and facilitate optimal patient management. This article will review critical aspects of neck anatomy, illustrate the spectrum of imaging features, and discuss the interpretative pearls and pitfalls when evaluating neck masses in immunocompromised patients

  10. The usefulness of CT and MR imaging in the preoperative evaluation of neoplasms of the craniofacial region

    International Nuclear Information System (INIS)

    Grzesiakowska, U.; Tacikowska, M.; Krajewski, R.; Starosciak, S.; Smorczewska, M.; Wiszniewska-Rawlik, D.

    2005-01-01

    The aim of the study was to determine the usefulness of CT and MR imaging in the preoperative evaluation of neoplasms of the craniofacial region. All the patients were treated surgically. CT and/or MR imaging was done in every patient for preoperative evaluation of soft tissue infiltration, destruction of bone structures, and metastasis of lymph nodes of the head and neck. The results of these imagings were compared with surgical evaluations and microscopic examination of postoperative specimens. Both CT and MR imaging have high accuracy in evaluating soft tissue infiltration. CT imaging is much better than MR in evaluating bony destruction. MR imaging is better in evaluating recurrent tumors, in which CT has very low specificity. MR imaging is the only method for evaluating infiltration of the central nervous system.The authors propose the following diagnostic algorithm: CT imaging for initial evaluation before treatment, MR imaging in suspected cases of infiltration of the central nervous system, and MR imaging in recurrent tumors after surgical and radiation treatment. (author)

  11. Value of preoperative imaging localization for primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Gao Shuo; Tan Jian; Xu Jiahua; Zhou Yinbao

    1998-01-01

    Purpose: To evaluate the values of ultrasound, CT and 99m Tc-MIBI in the localization of hyperfunctioning parathyroid tissue. Methods: 23 patients with primary hyperparathyroidism underwent 23 ultrasound, 20 CT scans and 21 double phase 99m Tc-MIBI imagings. Surgical and histological correlation was obtained for all studies. Results: 23 adenomas and 2 hyperplastic glands were removed from 23 patients. The results showed the sensitivities were 60%, 68%, 91%; the specificities were 97%, 97%, 100%; and the accuracies were 89%, 91%, 98% respectively with ultrasound, CT and 99m Tc-MIBI. There was no significant difference between ultrasound and CT (P > 0.05), but 99m Tc-MIBI was superior to ultrasound and CT in the sensitivity and accuracy, the specificity was similar for all of three imaging methods (P > 0.05). Conclusions: Double phase 99m Tc-MIBI imaging is a promising technique for localization of parathyroid adenomas. It is necessary for patients to undergo the noninvasive imaging procedures before their initial neck exploration

  12. Quantitative Ultrasonic Nakagami Imaging of Neck Fibrosis After Head and Neck Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiaofeng [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Yoshida, Emi [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California (United States); Cassidy, Richard J.; Beitler, Jonathan J.; Yu, David S.; Curran, Walter J. [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Liu, Tian, E-mail: tliu34@emory.edu [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2015-06-01

    Purpose: To investigate the feasibility of ultrasound Nakagami imaging to quantitatively assess radiation-induced neck fibrosis, a common sequela of radiation therapy (RT) to the head and neck. Methods and Materials: In a pilot study, 40 study participants were enrolled and classified into 3 subgroups: (1) a control group of 12 healthy volunteers; (2) an asymptomatic group of 11 patients who had received intensity modulated RT for head and neck cancer and had experienced no neck fibrosis; and (3) a symptomatic group of 17 post-RT patients with neck fibrosis. Each study participant underwent 1 ultrasound study in which scans were performed in the longitudinal orientation of the bilateral neck. Three Nakagami parameters were calculated to quantify radiation-induced tissue injury: Nakagami probability distribution function, shape, and scaling parameters. Physician-based assessments of the neck fibrosis were performed according to the Radiation Therapy Oncology Group late morbidity scoring scheme, and patient-based fibrosis assessments were rated based on symptoms such as pain and stiffness. Results: Major discrepancies existed between physician-based and patient-based assessments of radiation-induced fibrosis. Significant differences in all Nakagami parameters were observed between the control group and 2 post-RT groups. Moreover, significant differences in Nakagami shape and scaling parameters were observed among asymptomatic and symptomatic groups. Compared with the control group, the average Nakagami shape parameter value increased by 32.1% (P<.001), and the average Nakagami scaling parameter increased by 55.7% (P<.001) for the asymptomatic group, whereas the Nakagami shape parameter increased by 74.1% (P<.001) and the Nakagami scaling parameter increased by 83.5% (P<.001) for the symptomatic group. Conclusions: Ultrasonic Nakagami imaging is a potential quantitative tool to characterize radiation-induced asymptomatic and symptomatic neck fibrosis.

  13. Quantitative Ultrasonic Nakagami Imaging of Neck Fibrosis After Head and Neck Radiation Therapy

    International Nuclear Information System (INIS)

    Yang, Xiaofeng; Yoshida, Emi; Cassidy, Richard J.; Beitler, Jonathan J.; Yu, David S.; Curran, Walter J.; Liu, Tian

    2015-01-01

    Purpose: To investigate the feasibility of ultrasound Nakagami imaging to quantitatively assess radiation-induced neck fibrosis, a common sequela of radiation therapy (RT) to the head and neck. Methods and Materials: In a pilot study, 40 study participants were enrolled and classified into 3 subgroups: (1) a control group of 12 healthy volunteers; (2) an asymptomatic group of 11 patients who had received intensity modulated RT for head and neck cancer and had experienced no neck fibrosis; and (3) a symptomatic group of 17 post-RT patients with neck fibrosis. Each study participant underwent 1 ultrasound study in which scans were performed in the longitudinal orientation of the bilateral neck. Three Nakagami parameters were calculated to quantify radiation-induced tissue injury: Nakagami probability distribution function, shape, and scaling parameters. Physician-based assessments of the neck fibrosis were performed according to the Radiation Therapy Oncology Group late morbidity scoring scheme, and patient-based fibrosis assessments were rated based on symptoms such as pain and stiffness. Results: Major discrepancies existed between physician-based and patient-based assessments of radiation-induced fibrosis. Significant differences in all Nakagami parameters were observed between the control group and 2 post-RT groups. Moreover, significant differences in Nakagami shape and scaling parameters were observed among asymptomatic and symptomatic groups. Compared with the control group, the average Nakagami shape parameter value increased by 32.1% (P<.001), and the average Nakagami scaling parameter increased by 55.7% (P<.001) for the asymptomatic group, whereas the Nakagami shape parameter increased by 74.1% (P<.001) and the Nakagami scaling parameter increased by 83.5% (P<.001) for the symptomatic group. Conclusions: Ultrasonic Nakagami imaging is a potential quantitative tool to characterize radiation-induced asymptomatic and symptomatic neck fibrosis

  14. Preoperative hyperfractionated accelerated radiotherapy and radical surgery in advanced head and neck cancer: A prospective phase II study

    International Nuclear Information System (INIS)

    Lindholm, Paula; Valavaara, Ritva; Aitasalo, Kalle; Kulmala, Jarmo; Laine, Juhani; Elomaa, Liisa; Sillanmaeki, Lauri; Minn, Heikki; Grenman, Reidar

    2006-01-01

    Background and purpose: To evaluate whether preoperative hyperfractionated accelerated radiotherapy (RT) combined with major radical surgery is feasible and successful in the treatment of advanced primary head and neck cancer. Patients and methods: Ninety four patients with histologically confirmed head and neck squamous cell cancer (HNSCC) in the oral cavity (41/96; 43%), supraglottis (14/96; 15%), glottis (5/96; 5%), oropharynx (16/96; 17%), nasal cavity/paranasal sinuses (8/96; 8%), nasopharynx (3/96; 3%), hypopharynx (7/96; 7%) and two (2%) with unknown primary tumour and large cervical lymph nodes entered into the study. 21/96 patients (22%) had stage II, 17/96 (18%) stage III and 58/96 patients (60%) stage IV disease. The patients received preoperative hyperfractionated RT 1.6 Gy twice a day, 5 days a week to a median tumour dose of 63 Gy with a planned break for 11 days (median) after the median dose of 37 Gy. Then, after a median of 27 days the patients underwent major radical surgery of the primary tumour and metastatic lymph nodes including reconstructions with pedicled or microvascular free flaps when indicated as a part of the scheduled therapy. 12/96 patients had only ipsilateral or bilateral neck dissections. Results: After a median follow-up time of 37.2 mos 77/96 (80.2%) patients had complete locoregional control. All but 2 patients had complete histological remission after surgery. 40/96 pts were alive without disease, two of them after salvage surgery. 32/96 patients had relapsed; 15 had locoregional and 13 distant relapses, 4 patients relapsed both locoregionally and distantly. Fifty patients have died; 29 with locoregional and/or distant relapse, eight patients died of second malignancy, and 19 had intercurrent diseases. Disease-specific and overall survival at 3 years was 67.7 and 51%, respectively. Acute grade three mucosal reactions were common, but transient and tolerable. Late grade 3-4 adverse effects were few. Conclusions: Preoperative

  15. Imaging findings and significance of deep neck space infection

    International Nuclear Information System (INIS)

    Zhuang Qixin; Gu Yifeng; Du Lianjun; Zhu Lili; Pan Yuping; Li Minghua; Yang Shixun; Shang Kezhong; Yin Shankai

    2004-01-01

    Objective: To study the imaging appearance of deep neck space cellulitis and abscess and to evaluate the diagnostic criteria of deep neck space infection. Methods: CT and MRI findings of 28 cases with deep neck space infection proved by clinical manifestation and pathology were analyzed, including 11 cases of retropharyngeal space, 5 cases of parapharyngeal space infection, 4 cases of masticator space infection, and 8 cases of multi-space infection. Results: CT and MRI could display the swelling of the soft tissues and displacement, reduction, or disappearance of lipoid space in the cellulitis. In inflammatory tissues, MRI imaging demonstrated hypointense or isointense signal on T 1 WI, and hyperintense signal changes on T 2 WI. In abscess, CT could display hypodensity in the center and boundary enhancement of the abscess. MRI could display obvious hyperintense signal on T 2 WI and boundary enhancement. Conclusion: CT and MRI could provide useful information for deep neck space cellulitis and abscess

  16. Magnetic resonance imaging in the head and neck tumor diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Fujimoto, Yasuyuki; Igarashi, Masahito; Miyata, Mamoru; Sonoda, Tetsushi; Miyoshi, Shunji; Hiraide, Fumihisa; Morita, Mamoru; Tanaka, Osamu

    1987-06-01

    MRI (magnetic resonance imaging) is a new diagnostic technique that is being applied to study disease processes that involve the upper aero-digestive tract and cranial nerves of interest to otolaryngologist. Seventy four patients with head and neck tumor were enrolled to study the diagnostic efficacy of MRI in comparison with X-ray computed tomography (X-ray CT). Five cases of head and neck tumors were presented. Characteristic findings of MRI were discussed. T2 weighted images are very useful in the diagnosis of head and neck tumors. Tumors in the areas surrounded by bone tissue were clearly imaged without such artifacts as recognized in X-ray CT. Information from mutiplane imaging, especially from coronal and sagittal sections, made it easier to determine the type and extent of the lesion. High signal linear parts which are in the periphery of the tumor offer important information that no adhesion is present.

  17. [Preoperative imaging/operation planning for liver surgery].

    Science.gov (United States)

    Schoening, W N; Denecke, T; Neumann, U P

    2015-12-01

    The currently established standard for planning liver surgery is multistage contrast media-enhanced multidetector computed tomography (CM-CT), which as a rule enables an appropriate resection planning, e.g. a precise identification and localization of primary and secondary liver tumors as well as the anatomical relation to extrahepatic and/or intrahepatic vascular and biliary structures. Furthermore, CM-CT enables the measurement of tumor volume, total liver volume and residual liver volume after resection. Under the condition of normal liver function a residual liver volume of 25 % is nowadays considered sufficient and safe. Recent studies in patients with liver metastases of colorectal cancer showed a clear staging advantage of contrast media-enhanced magnetic resonance imaging (CM-MRI) versus CM-CT. In addition, most recent data showed that the use of liver-specific MRI contrast media further increases the sensitivity and specificity of detection of liver metastases. This imaging technology seems to lead closer to the ideal "one stop shopping" diagnostic tool in preoperative planning of liver resection.

  18. Research for correction pre-operative MRI images of brain during operation using particle method simulation

    International Nuclear Information System (INIS)

    Shino, Ryosaku; Koshizuka, Seiichi; Sakai, Mikio; Ito, Hirotaka; Iseki, Hiroshi; Muragaki, Yoshihiro

    2010-01-01

    In the neurosurgical procedures, surgeon formulates a surgery plan based on pre-operative images such as MRI. However, the brain is transformed by removal of the affected area. In this paper, we propose a method for reconstructing pre-operative images involving the deformation with physical simulation. First, the domain of brain is identified in pre-operative images. Second, we create particles for physical simulation. Then, we carry out the linear elastic simulation taking into account the gravity. Finally, we reconstruct pre-operative images with deformation according to movement of the particles. We show the effectiveness of this method by reconstructing the pre-operative image actually taken before surgery. (author)

  19. Optimization of MR imaging for extracranial head and neck lesions

    International Nuclear Information System (INIS)

    Dalley, R.W.; Maravilla, K.R.; Cohen, W.

    1989-01-01

    The authors have used a 1.5T MR imager to study 28 pathologically proven extracranial head and neck lesions. Multiple pulse sequences were performed pre-and/or post-gadolinium, including T1-weighted, short TI inversion-recovery (STIR), spin-density, and T2-weighted sequences. T1-weighted images provided excellent anatomic detail but relatively poor muscle/lesion contrast. Gadolinium often improved lesion visibility; however, discrimination from surrounding fat was impaired. Postcontrast T2-weighted images seemed to provide better lesion conspicuity than did pre-gadolinium images. STIR imaging provided the highest lesion conspicuity in fatty areas. No single sequence was optimal for all head and neck imaging. The authors analyze the advantages and limitations of each sequence and formulate rational imaging protocols based on the primary region of interest

  20. Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes

    International Nuclear Information System (INIS)

    Nakamura, Takashi; Sumi, Misa

    2007-01-01

    The presence of lymph node metastasis in the neck in patients with head and neck cancer is an important prognostic determinant in staging cancers and in planning surgery and chemo- and radiotherapy for the cancer patients. Therefore, metastatic nodes should be effectively differentiated from benign lymphadenopathies and nodal lymphomas. Here, we review recent advances in the diagnostic imaging of metastatic nodes in the neck, with emphasis placed on the diagnostic performance of MR imaging, Doppler sonography, and CT. (orig.)

  1. Cross-sectional imaging in pediatric neck masses

    International Nuclear Information System (INIS)

    Koenigsberg, R.A.; Patel, M.; Horowitz, C.

    1990-01-01

    This paper reports on US, CT, and MR imaging that demonstrates unique roles in the evaluation of pediatric neck masses. The causes of these masses range from infections/abscesses to primary and secondary tumors. The purpose of this paper is to review pediatric neck masses and the current role of cross-sectional imaging. Seventy-one examinations of the neck by means of CT, US, and MR imaging on 62 patients aged 1-21 y were retrospectively reviewed. Diseases were categorized according to benign versus malignant causes. Benign: 9 abscesses/cellulitis, 5 thyroglossal duct cysts, 3 branchial cleft cysts, 2 parotid cysts, 2 benign enlarged lumphadenopathies, 2 cystic hydromas, 1 ranula, and 1 hematoma

  2. Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Matthias; Dietlein, Markus; Weber, Kerstin; Moka, Detlef; Schicha, Harald [Klinik und Poliklinik fuer Nuklearmedizin, Universitaet zu Koeln, Joseph-Stelzmann-Strasse 9, 50924 Koeln (Germany); Fischer, Eva; Michel, Olaf; Stennert, Eberhard [Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenheilkunde, Universitaet zu Koeln, Koeln (Germany)

    2002-12-01

    Paragangliomas or glomus tumours of the head and neck region are rare somatostatin receptor-expressing neuroendocrine tumours. Precise preoperative diagnosis is of special importance in order to adequately weigh the potential benefit of the operation against the inherent risks of the procedure. In this study, the clinical value of somatostatin receptor imaging was assessed in 19 patients who underwent somatostatin receptor scintigraphy because of known or suspected paraganglioma of the head and neck region. The results were compared with the results of computed tomography and/or magnetic resonance imaging, histology and clinical follow-up. [{sup 111}In-DTPA-D-Phe{sup 1}]-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 140-220 MBq {sup 111}In-octreotide. Whole-body and planar images as well as single-photon emission tomography images were acquired and lesions were graded according to qualitative tracer uptake. Somatostatin receptor imaging was positive in nine patients, identifying paragangliomas for the first time in three patients and recurrent disease in six patients. In one patient, a second, previously unknown paraganglioma site was identified. Negative results were obtained in ten patients. These patients included one suffering from chronic hyperplastic otitis externa, one with granuloma tissue and an organised haematoma, one with an acoustic neuroma, one with an asymmetric internal carotid artery, two with ectasia of the bulbus venae jugularis and one with a jugular vein thrombosis. In two patients with a strong family history of paraganglioma, individual involvement could be excluded. In only one patient did somatostatin receptor imaging and magnetic resonance imaging yield false negative results in respect of recurrent paraganglioma tissue. It is concluded that somatostatin receptor scintigraphy provides important information in patients with suspected paragangliomas of the head and neck region and has a strong impact on further

  3. Comparison of preoperative and postoperative radiation therapy for patients with carcinoma of head and neck

    International Nuclear Information System (INIS)

    Snow, J.B.; Gelber, R.D.; Kramer, S.; Davis, L.W.; Marcial, V.A.; Lowry, L.D.

    1981-01-01

    Three hundred and fifty-four patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, hypopharynx or maxillary sinus have been randomized for preoperative radiation therapy and surgery versus surgery and postoperative radiation therapy plus, in the case of patients with lesions of the oral cavity and oropharynx, radical radiation therapy. Data have been analyzed on 320 patients in this interim report. In the supraglottic larynx group local-regional control is significantly better for surgery and postoperative radiation therapy. The treatment differences in local-regional control in the oral cavity oropharynx and hypopharynx groups are statistically significant. No statistically significant treatment differences exist for survival in all sites or in any site; continued follow- up is necessary to make definite treatment comparisons. (authors)

  4. Multimodal Imaging Nanoparticles Derived from Hyaluronic Acid for Integrated Preoperative and Intraoperative Cancer Imaging

    Directory of Open Access Journals (Sweden)

    William M. Payne

    2017-01-01

    Full Text Available Surgical resection remains the most promising treatment strategy for many types of cancer. Residual malignant tissue after surgery, a consequence in part due to positive margins, contributes to high mortality and disease recurrence. In this study, multimodal contrast agents for integrated preoperative magnetic resonance imaging (MRI and intraoperative fluorescence image-guided surgery (FIGS are developed. Self-assembled multimodal imaging nanoparticles (SAMINs were developed as a mixed micelle formulation using amphiphilic HA polymers functionalized with either GdDTPA for T1 contrast-enhanced MRI or Cy7.5, a near infrared fluorophore. To evaluate the relationship between MR and fluorescence signal from SAMINs, we employed simulated surgical phantoms that are routinely used to evaluate the depth at which near infrared (NIR imaging agents can be detected by FIGS. Finally, imaging agent efficacy was evaluated in a human breast tumor xenograft model in nude mice, which demonstrated contrast in both fluorescence and magnetic resonance imaging.

  5. Image features of herniation pit of the femoral neck

    International Nuclear Information System (INIS)

    Zhang Xuezhe; Li Guangming; Wang Cunli; Wang Guimin

    2008-01-01

    Objective: To evaluate imaging appearances of herniation pit of the femoral neck. Methods: We retrospectively analyzed the X-ray, CT and MRI findings of 9 patients with herniation pit of the femoral neck. All nine patients were male with the age ranging from 21 to 73 years. They had pain in the hip from two months to two years duration. Results: The bilateral hips were affected in six patients, the right hips in the other 3 patients. Of the nine patients, X-ray plain films (2 cases), CT scanning(6 cases), and MR scanning (5 cases ) were performed. The size of the lesions ranged from 0.5 cm x 0.6 cm to 1.0 cm x 1.5 cm, located in the anterosuperior portion of the femoral neck (n=7) or anteroinferior portion (n=2). X-ray plain films showed an osteolytic lesion surrounded by a sclerotic rim. CT scanning showed the lesion just below the cortex of the femoral neck surrounded by a rim of sclerosis or associated with a small cortical break in two patients. MR scanning showed low signal intensity in five patients on T 1 WI and high signal intensity surrounded by a rim of low signal intensity (n=3) or low signal intensity (n=2) on T 2 WI, and high signal intensity on fat suppression MR image. A small joint effusion was observed in two cases on T 2 WI. Conclusion: The CT and MRI findings of herniation pit of the femoral neck are characteristic, it is useful in defining the diagnosis of the herniation pit of the femoral neck. (authors)

  6. Preoperative magnetic resonance imaging protocol for endoscopic cranial base image-guided surgery.

    Science.gov (United States)

    Grindle, Christopher R; Curry, Joseph M; Kang, Melissa D; Evans, James J; Rosen, Marc R

    2011-01-01

    Despite the increasing utilization of image-guided surgery, no radiology protocols for obtaining magnetic resonance (MR) imaging of adequate quality are available in the current literature. At our institution, more than 300 endonasal cranial base procedures including pituitary, extended pituitary, and other anterior skullbase procedures have been performed in the past 3 years. To facilitate and optimize preoperative evaluation and assessment, there was a need to develop a magnetic resonance protocol. Retrospective Technical Assessment was performed. Through a collaborative effort between the otolaryngology, neurosurgery, and neuroradiology departments at our institution, a skull base MR image-guided (IGS) protocol was developed with several ends in mind. First, it was necessary to generate diagnostic images useful for the more frequently seen pathologies to improve work flow and limit the expense and inefficiency of case specific MR studies. Second, it was necessary to generate sequences useful for IGS, preferably using sequences that best highlight that lesion. Currently, at our institution, all MR images used for IGS are obtained using this protocol as part of preoperative planning. The protocol that has been developed allows for thin cut precontrast and postcontrast axial cuts that can be used to plan intraoperative image guidance. It also obtains a thin cut T2 axial series that can be compiled separately for intraoperative imaging, or may be fused with computed tomographic images for combined modality. The outlined protocol obtains image sequences effective for diagnostic and operative purposes for image-guided surgery using both T1 and T2 sequences. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Preoperative imaging and surgical margins in maxillectomy patients

    NARCIS (Netherlands)

    Kreeft, Anne Marijn; Smeele, Ludwig E.; Rasch, Coen R. N.; Hauptmann, Michael; Rietveld, Derk H. F.; Leemans, C. René; Balm, Alfons J. M.

    2012-01-01

    Background High rates of positive surgical margins are reported after a maxillectomy. A large part of tumors that are preoperatively considered operable can thus not be resected with tumor-free margins. Methods This was a retrospective study on medical files of 69 patients that underwent

  8. Imaging Parkinson's disease below the neck

    DEFF Research Database (Denmark)

    Borghammer, Per; Knudsen, Karoline; Fedorova, Tatyana D

    2017-01-01

    )F-dopamine, and (11)C-donepezil. Other radiotracer and radiological imaging methods have shown highly prevalent dysfunction of pharyngeal and esophageal motility, gastric emptying, colonic transit time, and anorectal function. Here, we summarize the methodology and main findings of radio...

  9. New concepts in preoperative imaging of anorectal malformation

    International Nuclear Information System (INIS)

    Taccone, A.; Delliacqua, A.; Marzoli, A.; Martucciello, G.; Jasonni, V.; Dodero, P.; Salomone, G.

    1992-01-01

    In this study of 14 patients with anorectal anomalies CT and MRI were employed for preoperative assessment. The use of a pressure enhanced water soluble enema via the colostomy proved to be an extremely efficient method for showing a fistula. MRI studies were enhanced by the use of vaseline oil and in one case this technique was used prior to surgery to provide important information by injecting through a perineal fistula. CT and axial MRI proved to be more valuable than sagittal MRI which is only useful for the length of the atretic segment. The authors consider that a combined approach using pressure enhanced water soluble enema and MRI will provide the most valuable preoperative information to plan a successful operative approach and enable an accurate prognostic evaluation of continence in these difficult and complex patients. (orig.)

  10. Castleman disease of the neck: CT and MR imaging findings

    International Nuclear Information System (INIS)

    Jiang, Xin-hua; Song, Hao-ming; Liu, Qing-yu; Cao, Yun; Li, Guo-hong; Zhang, Wei-dong

    2014-01-01

    Objective: To characterize the computed tomography (CT) and magnetic resonance imaging (MRI) findings of Castleman disease of the neck. Methods: The imaging findings of 21 patients with Castleman disease of the neck were reviewed retrospectively. Of the 21 patients, 16 underwent unenhanced and contrast-enhanced CT scans; 5 underwent unenhanced and contrast-enhanced MRI scans. Results: The unenhanced CT images showed isolated or multiple well-defined homogenous mild hypodensity lesions in fifteen cases, and a heterogeneous nodule with central areas of mild hypodensity in one case. Calcification was not observed in any of the patients. In five patients, MR T1-weighted images revealed well-defined, homogeneous isointense or mild hyperintense lesions to the muscle; T2-weighted images showed these as intermediate hyperintense. Sixteen cases showed intermediate to marked homogeneous enhancement on contrast-enhanced CT or MR T1-weighted images. Of the other five cases that underwent double-phase CT scans, four showed mild or intermediate heterogeneous enhancement at the arterial phase, and homogeneous intermediate or marked enhancement at the venous phase; the remaining case showed mild and intermediate ring-enhancement with a central non-enhanced area at the arterial and venous phases, respectively. Conclusion: Castleman disease of the neck can be characterized as solitary or multiple well-defined, mild hypodensity or homogeneous intense lesions on plain CT/MR scans, and demonstrates intermediate and marked enhancement on contrast-enhanced CT/MR scans. On double-phase CT scans, Castleman disease often demonstrates mild enhancement at the arterial phase, and gradually uniform enhancement at venous phase. Double-phase enhanced CT or MRI may help to differentiate Castleman disease from other diseases

  11. Castleman disease of the neck: CT and MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Xin-hua [Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060 (China); Song, Hao-ming [Department of Cardiology, Shanghai Tongji Hospital, Shanghai 200065 (China); Liu, Qing-yu [Department of Radiology, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120 (China); Cao, Yun [Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060 (China); Li, Guo-hong [Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060 (China); Zhang, Wei-dong, E-mail: dongw.z@163.com [Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060 (China)

    2014-11-15

    Objective: To characterize the computed tomography (CT) and magnetic resonance imaging (MRI) findings of Castleman disease of the neck. Methods: The imaging findings of 21 patients with Castleman disease of the neck were reviewed retrospectively. Of the 21 patients, 16 underwent unenhanced and contrast-enhanced CT scans; 5 underwent unenhanced and contrast-enhanced MRI scans. Results: The unenhanced CT images showed isolated or multiple well-defined homogenous mild hypodensity lesions in fifteen cases, and a heterogeneous nodule with central areas of mild hypodensity in one case. Calcification was not observed in any of the patients. In five patients, MR T1-weighted images revealed well-defined, homogeneous isointense or mild hyperintense lesions to the muscle; T2-weighted images showed these as intermediate hyperintense. Sixteen cases showed intermediate to marked homogeneous enhancement on contrast-enhanced CT or MR T1-weighted images. Of the other five cases that underwent double-phase CT scans, four showed mild or intermediate heterogeneous enhancement at the arterial phase, and homogeneous intermediate or marked enhancement at the venous phase; the remaining case showed mild and intermediate ring-enhancement with a central non-enhanced area at the arterial and venous phases, respectively. Conclusion: Castleman disease of the neck can be characterized as solitary or multiple well-defined, mild hypodensity or homogeneous intense lesions on plain CT/MR scans, and demonstrates intermediate and marked enhancement on contrast-enhanced CT/MR scans. On double-phase CT scans, Castleman disease often demonstrates mild enhancement at the arterial phase, and gradually uniform enhancement at venous phase. Double-phase enhanced CT or MRI may help to differentiate Castleman disease from other diseases.

  12. Molecular Imaging and Precision Medicine in Head and Neck Cancer.

    Science.gov (United States)

    Mena, Esther; Thippsandra, Shwetha; Yanamadala, Anusha; Redy, Siddaling; Pattanayak, Puskar; Subramaniam, Rathan M

    2017-01-01

    The concept of using tumor genomic profiling information has revolutionized personalized cancer treatment. Head and neck (HN) cancer management is being influenced by recent discoveries of activating mutations in epidermal growth factor receptor and related targeted therapies with tyrosine kinase inhibitors, targeted therapies for Kristen Rat Sarcoma, and MET proto-oncogenes. Molecular imaging using PET plays an important role in assessing the biologic behavior of HN cancer with the goal of delivering individualized cancer treatment. This review summarizes recent genomic discoveries in HN cancer and their implications for functional PET imaging in assessing response to targeted therapies, and drug resistance mechanisms. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. What's in a name? Eponyms in head and neck imaging

    International Nuclear Information System (INIS)

    Hoang, J.K.; Eastwood, J.D.; Glastonbury, C.M.

    2010-01-01

    Head and neck (H and N) eponyms serve to honour physicians who have made important contributions. Compared with more descriptive diagnostic names, eponyms can sometimes be confusing, especially to the novice. Adding to the confusion, eponyms are sometimes applied incorrectly. Nevertheless, their use remains common in the medical literature and clinical practice. Familiarity with H and N eponyms is important for accurate communication with radiology colleagues and clinicians. Some eponyms describe potentially fatal infections and their urgency should be appreciated. Other eponyms, such as those for inner ear congenital anomalies, are probably best avoided as they can be used imprecisely and cause confusion. This review summarizes the clinical and imaging findings of some common and important H and N eponyms under the following categories of disease: (1) neck infections, (2) diseases in the temporal bone, (3) orbital diseases, and (4) sinus disease.

  14. PET/CT imaging in head and neck tumors

    International Nuclear Information System (INIS)

    Roedel, R.; Palmedo, H.; Reichmann, K.; Reinhardt, M.J.; Biersack, H.J.; Straehler-Pohl, H.J.; Jaeger, U.

    2004-01-01

    To evaluate the usefulness of combined PET/CT examinations for detection of malignant tumors and their metastases in head and neck oncology. 51 patients received whole body scans on a dual modality PET/CT system. CT was performed without i.v. contrast. The results were compared concerning the diagnostic impact of native CT scan on FDG-PET images and the additional value of fused imaging. From 153 lesions were 97 classified as malignant on CT and 136 on FDG/PET images, as suspicious for malignancy in 33 on CT and 7 on FDG-PET and as benign in 23 on CT and 10 on FDG-PET. With combined PET/CT all primary and recurrent tumors could be found, the detection rate in patients with unknown primary tumors was 45%. Compared to PET or CT alone the sensitivity, specifity and accuracy could be significantly improved by means of combined PET/CT. Fused PET/CT imaging with [F18]-FDG and native CT-scanning enables accurate diagnosis in 93% of lesions and 90% of patients with head and neck oncology. (orig.) [de

  15. Importance of preoperative imaging in acetabular revision surgery - a case report.

    Science.gov (United States)

    Schmitz, Hc; Egidy, Cc; Al-Khateeb, H; Cárdenas, G; Gehrke, T; Kendoff, D

    2012-01-01

    Acetabular defects, particularly as a result of protrusion of acetabular components into the hemipelvis, may cause serious complications during revision procedures as a result of iatrogenic injury to surrounding anatomical structures. In these challenging cases, we advocate the utilisation of preoperative three dimensional imaging. MRI and CT- imaging offer superior understanding of the three-dimensional quality of bony defects and the relationship of implants to important anatomical structures. Appropriate preoperative planning may also prevent major complications during the removal of the pre-existing hardware, prior to re-implantation of implants. Potential complications include injury of nerves, blood vessels and other intrapelvic structures.In our case, a major bony defect of the acetabulum was a result of the protrusion of an implanted reinforcement ring. A preoperative, contrast-enhanced CT scan showed that the urethra was in close proximity to the hook of the reinforcement ring.The preoperative imaging aided in identifying and understanding the potential complications that could occur intraoperatively. Additionally, it delineated the intact anatomic structures prior to surgery, which could have medico-legal implications.The importance of preoperative imaging and the existing literature is discussed within this case description.

  16. Preoperative localization of epileptic foci with SPECT brain perfusion imaging, electrocorticography, surgery and pathology

    International Nuclear Information System (INIS)

    Jia Shaowei; Xu Wengui; Chen Hongyan; Weng Yongmei; Yang Pinghua

    2002-01-01

    Objective: The value of preoperative localization of epileptic foci with SPECT brain perfusion imaging was investigated. Methods: The study population consisted of 23 patients with intractable partial seizures which was difficult to control with anticonvulsant for long period. In order to preoperatively locate the epileptic foci, double SPECT brain perfusion imaging was performed during interictal and ictal stage. The foci were confirmed with electrocorticography (EcoG), surgery and pathology. Results: The author checked with EcoG the foci shown by SPECT, 23 patients had all typical spike discharge. The regions of radioactivity increase in ictal matched with the abnormal electrical activity areas that EcoG showed. The spike wave originated in the corresponding cerebrum cortex instead of hyperplastic and adherent arachnoid or tumor itself. Conclusions: SPECT brain perfusion imaging contributes to distinguishing location, size, perfusion and functioning of epileptogenic foci, and has some directive function on to making out a treatment programme at preoperation

  17. [The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer].

    Science.gov (United States)

    Rödel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-08-01

    Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category.

  18. The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer

    International Nuclear Information System (INIS)

    Roedel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-01-01

    Background: Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Methods: Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). Results: By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. Conclusion: To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category. (orig.)

  19. Spectrum of imaging findings in hyperextension injuries of the neck.

    Science.gov (United States)

    Rao, Sameet K; Wasyliw, Christopher; Nunez, Diego B

    2005-01-01

    Nonphysiologic hyperextension and lateral forces acting on the cervical spine and soft-tissue structures of the neck can result in a wide spectrum of injury patterns. Multiple factors (eg, patient age; the underlying morphologic features of the cervical spine; the magnitude, vector, and maximal focus of the force) all influence the observed patterns and the severity of injury. A review of the 5-year trauma database in two trauma centers revealed various injury patterns that were frequently recognized in patients with clinical evidence or historical documentation of a predominant hyperextension mechanism. Injuries included anterior arch avulsion and posterior arch compression fractures of the atlas, odontoid fractures, traumatic spondylolisthesis and teardrop fracture of C2, laminar and articular pillar fractures, and hyperextension dislocation injuries. More severe injuries were observed in patients with underlying predisposing conditions (eg, degenerative spondylosis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis). Knowledge of the involved biomechanical factors provides a framework for understanding these injury patterns. Diagnostic imaging, especially computed tomography and magnetic resonance imaging, plays a fundamental role in the assessment of patients with suspected cervical injury. Furthermore, cross-sectional imaging facilitates the recognition of accompanying injuries to the face, the head, and the vascular structures of the neck. (c) RSNA, 2005.

  20. Imaging of connective tissue diseases of the head and neck

    Science.gov (United States)

    2016-01-01

    We review the imaging appearance of connective tissue diseases of the head and neck. Bilateral sialadenitis and dacryoadenitis are seen in Sjögren’s syndrome; ankylosis of the temporo-mandibular joint with sclerosis of the crico-arytenoid joint are reported in rheumatoid arthritis and lupus panniculitis with atypical infection are reported in patients with systemic lupus erythematosus. Relapsing polychondritis shows subglottic stenosis, prominent ear and saddle nose; progressive systemic sclerosis shows osteolysis of the mandible, fibrosis of the masseter muscle with calcinosis of the subcutaneous tissue and dermatomyositis/polymyositis shows condylar erosions and autoimmune thyroiditis. Vascular thrombosis is reported in antiphospholipid antibodies syndrome; cervical lymphadenopathy is seen in adult-onset Still’s disease, and neuropathy with thyroiditis reported in mixed connective tissue disorder. Imaging is important to detect associated malignancy with connective tissue disorders. Correlation of the imaging findings with demographic data and clinical findings are important for the diagnosis of connective tissue disorders. PMID:26988082

  1. PET imaging biomarkers in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Differding, Sarah; Gregoire, Vincent [Universite Catholique de Louvain, St-Luc University Hospital, Department of Radiation Oncology, and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Experimentale et Clinique (IREC), Brussels (Belgium); Hanin, Francois-Xavier [Universite Catholique de Louvain, St-Luc University Hospital, Department of Nuclear Medicine, and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Experimentale et Clinique (IREC), Brussels (Belgium)

    2015-04-01

    In locally advanced head and neck squamous cell carcinoma (HNSCC), the role of imaging becomes more and more critical in the management process. In this framework, molecular imaging techniques such as PET allow noninvasive assessment of a range of tumour biomarkers such as metabolism, hypoxia and proliferation, which can serve different purposes. First, in a pretreatment setting they can influence therapy selection strategies and target delineation for radiation therapy. Second, their predictive and/or prognostic value could help enhance the therapeutic ratio in the management of HNSCC. Third, treatment modification can be performed through the generation of a molecular-based heterogeneous dose distribution with dose escalation to the most resistant parts of the tumour, a concept known as dose painting. Fourth, they are increasingly becoming a tool for monitoring response to therapy. In this review, PET imaging biomarkers used in the routine management of HNSCC or under investigation are discussed. (orig.)

  2. Clinical usefulness of a newly-developed head and neck surface coil for MR imaging

    International Nuclear Information System (INIS)

    Shimada, Morio; Kogure, Takashi; Hayashi, Sanshin

    1995-01-01

    To obtain correct diagnosis at early stages of cervical lymph node swelling, especially cases with suspected epipharyngeal carcinoma, and cerebral arterial sclerotic diseases, high-quality MR images visualizing the entire head and neck structures and vessels are of crucial importance. When obtaining images of head and neck regions using a head coil, signal intensity (SI) and signal to noise ratio (SNR) of regions below the hypopharynx are weakened. Moreover, when obtaining images of head and neck regions using an anterior neck coil, SI and SNR of upper regions of epipharynx are also weakened. In an attempt to solve these problems, we developed a new head and neck surface coil for MR imaging. With this new coil we were able to obtain better images (153 cases) from regions below the hypopharynx to the upper regions of the epipharynx in the same time as images obtained using the head coil and anterior neck coil. 2D TOF MR angiographic images (11 cases) obtained by the head and neck surface coil are superior to 2D TOF angiographic images obtained by the anterior neck coil. MR images obtained with this improved method are valuable in the evaluation and management of head and neck region disease. (author)

  3. The Role of Preoperative Imaging in the Management of Nonsyndromic Lambdoid Craniosynostosis.

    Science.gov (United States)

    Ranganathan, Kavitha; Rampazzo, Antonio; Hashmi, Asra; Muraszko, Karin; Strahle, Jennifer; Vercler, Christian J; Buchman, Steven R

    2018-01-01

    The necessity of imaging for patients with craniosynostosis is controversial. Lambdoid synostosis is known to be associated with additional anomalies, but the role of imaging in this setting has not been established. The purpose of this study was to evaluate the impact of preoperative imaging on intraoperative and postoperative management among patients undergoing operative intervention for lambdoid craniosynostosis. A retrospective review of patients undergoing cranial vault remodeling for lambdoid craniosynostosis between January 2006 and 2014 was conducted. Patient demographics, age at computed tomography scan, age at surgery, results of the radiologic evaluation, operative technique, and modification of the diagnosis following the radiologic studies were analyzed. A pediatric neuroradiology and the surgical team interpreted the radiographs. The primary outcome was change in intraoperative or postoperative management based on imaging results. A total of 11 patients were diagnosed with lambdoid synostosis. Of these patients, 81.8% had abnormalities on imaging relevant to operative planning. The most common anomalies were Chiari I malformation (45%) and venous anomalies of the posterior fossa (36%). Preoperative imaging altered the management of 9 (81.8%) patients. Closer follow-up was required for 6 patients (54%). Suboccipital decompression was performed in 4 patients (36%). Venous anomalies were found in 4 patients (36%). The diagnosis was changed from positional plagiocephaly to lambdoid synostosis in 2 patients (18%). Given the frequency and significance of radiographic abnormalities in the setting of lamboid synostosis, preoperative imaging should be considered during the operative planning phase as it can affect postoperative and intraoperative management.

  4. Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.

    Science.gov (United States)

    Beets-Tan, R G H; Lettinga, T; Beets, G L

    2005-08-01

    To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.

  5. Detection and preoperative staging of carcinoma of the cervix: Comparison between MR imaging and CT

    International Nuclear Information System (INIS)

    Mayr, B.; Schmidt, H.; Baieri, P.; Scheidel, P.; Meier, W.; Schramm, T.

    1986-01-01

    Twenty-four patients with carcinoma of the cervix were examined preoperatively by MR imaging and CT. In all patients histopathologic confirmation was available for specimens obtained either by radical hysterectomy or at staging laparotomy. MR imaging was equivalent to contrast CT in the detection and evaluation of tumor extension in the cervix. Tumor extension to the parametria and pelvic wall was difficult to evaluate on both modalities, as neither had a higher accuracy than pelvic examination conducted under anesthesia. Nodal staging was nearly equivalent on MR imaging and CT. In the detection and staging of carcinoma of the cervix, MR imaged proved to be as good as CT with contrast agent enhancement

  6. Diagnostic yield of preoperative computed tomography imaging and the importance of a clinical decision for lung cancer surgery

    International Nuclear Information System (INIS)

    Sato, Shuichi; Koike, Teruaki; Yamato, Yasushi

    2010-01-01

    This study aimed to evaluate the diagnostic yield of preoperative computed tomography (CT) imaging and the validity of surgical intervention based on the clinical decision to perform surgery for lung cancer or suspected lung cancer. We retrospectively evaluated 1755 patients who had undergone pulmonary resection for lung cancer or suspected lung cancer. CT scans were performed on all patients. Surgical intervention to diagnose and treat was based on a medical staff conference evaluation for the suspected lung cancer patients who were pathologically undiagnosed. We evaluated the relation between resected specimens and preoperative CT imaging in detail. A total of 1289 patients were diagnosed with lung cancer by preoperative pathology examination; another 466 were not pathologically diagnosed preoperatively. Among the 1289 patients preoperatively diagnosed with lung cancer, the diagnoses were confirmed postoperatively in 1282. Among the 466 patients preoperatively undiagnosed, 435 were definitively diagnosed with lung cancer, and there were 383 p-stage I disease patients. There were 38 noncancerous patients who underwent surgery with a diagnosis of confirmed or suspected lung cancer. Among the 1755 patients who underwent surgery, 1717 were pathologically confirmed with lung cancer, and the diagnostic yield of preoperative CT imaging was 97.8%. Among the 466 patients who were preoperatively undiagnosed, 435 were compatible with the predicted findings of lung cancer. Diagnostic yields of preoperative CT imaging based on clinical evaluation are sufficiently reliable. Diagnostic surgical intervention was acceptable when the clinical probability of malignancy was high and the malignancy was pathologically undiagnosed. (author)

  7. Reducing radiation dose without compromising image quality in preoperative perforator flap imaging with CTA using ASIR technology.

    Science.gov (United States)

    Niumsawatt, Vachara; Debrotwir, Andrew N; Rozen, Warren Matthew

    2014-01-01

    Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients.

  8. Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy-a systematic review.

    Science.gov (United States)

    Haldane, Chloe E; Ekhtiari, Seper; de Sa, Darren; Simunovic, Nicole; Ayeni, Olufemi R

    2017-08-01

    The purpose of this systematic review is to report current preoperative assessment for femoroacetabular impingement (FAI) including physical examination and imaging modalities prior to hip arthroscopy, and report current imaging measures used in the diagnosis of FAI. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, non-operative treatment, preoperative assessment including physical examination and imaging prior to hip arthroscopy were abstracted. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. Sixty-eight studies of fair quality evidence that involved a total of 5125 patients (5400 hips) were included. In total, 56% of all patients were male and mean age was 36 years (SD ± 10.0). Within physical examination, FADIR impingement testing was reported in 57% of patients. All included studies reported plain radiographic imaging as a component of preoperative assessment with anterior-posterior pelvis view being the most commonly reported view, followed by the cross-table lateral and Dunn views. Magnetic resonance imaging was obtained for 52% of included patients and computed tomography for 26% of patients. The most commonly reported measure within imaging for the diagnosis of cam type impingement was alpha angle (66%), whereas for pincer type impingement, the cross-over sign (48%) was most reported. Preoperative assessment is underreported in the FAI literature. Improved reporting is warranted to develop a more consistent and validated diagnostic algorithm for FAI to enhance patient selection. Level of evidence : Level IV, Systematic Review of Level I-IV Studies.

  9. Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy—a systematic review

    Science.gov (United States)

    Haldane, Chloe E.; Ekhtiari, Seper; de SA, Darren; Simunovic, Nicole

    2017-01-01

    Abstract The purpose of this systematic review is to report current preoperative assessment for femoroacetabular impingement (FAI) including physical examination and imaging modalities prior to hip arthroscopy, and report current imaging measures used in the diagnosis of FAI. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, non-operative treatment, preoperative assessment including physical examination and imaging prior to hip arthroscopy were abstracted. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. Sixty-eight studies of fair quality evidence that involved a total of 5125 patients (5400 hips) were included. In total, 56% of all patients were male and mean age was 36 years (SD ± 10.0). Within physical examination, FADIR impingement testing was reported in 57% of patients. All included studies reported plain radiographic imaging as a component of preoperative assessment with anterior–posterior pelvis view being the most commonly reported view, followed by the cross-table lateral and Dunn views. Magnetic resonance imaging was obtained for 52% of included patients and computed tomography for 26% of patients. The most commonly reported measure within imaging for the diagnosis of cam type impingement was alpha angle (66%), whereas for pincer type impingement, the cross-over sign (48%) was most reported. Preoperative assessment is underreported in the FAI literature. Improved reporting is warranted to develop a more consistent and validated diagnostic algorithm for FAI to enhance patient selection. Level of evidence: Level IV, Systematic Review of Level I–IV Studies. PMID:28948032

  10. Preoperative Visualization of Cranial Nerves in Skull Base Tumor Surgery Using Diffusion Tensor Imaging Technology.

    Science.gov (United States)

    Ma, Jun; Su, Shaobo; Yue, Shuyuan; Zhao, Yan; Li, Yonggang; Chen, Xiaochen; Ma, Hui

    2016-01-01

    To visualize cranial nerves (CNs) using diffusion tensor imaging (DTI) with special parameters. This study also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. 3T magnetic resonance imaging scans including 3D-FSPGR, FIESTA, and DTI were used to collect information from 18 patients with skull base tumor. DTI data were integrated into the 3D slicer for fiber tracking and overlapped anatomic images to determine course of nerves. 3D reconstruction of tumors was achieved to perform neighboring, encasing, and invading relationship between lesion and nerves. Optic pathway including the optic chiasm could be traced in cases of tuberculum sellae meningioma and hypophysoma (pituitary tumor). The oculomotor nerve, from the interpeduncular fossa out of the brain stem to supraorbital fissure, was clearly visible in parasellar meningioma cases. Meanwhile, cisternal parts of trigeminal nerve and abducens nerve, facial nerve were also imaged well in vestibular schwannomas and petroclival meningioma cases. The 3D-spatial relationship between CNs and skull base tumor estimated preoperatively by tumor modeling and tractography corresponded to the results determined during surgery. Supported by DTI and 3D slicer, preoperative 3D reconstruction of most CNs related to skull base tumor is feasible in pathological circumstances. We consider DTI Technology to be a useful tool for predicting the course and location of most CNs, and syntopy between them and skull base tumor.

  11. The usefulness of multiplanar reconstruction images in preoperative t-staging of advanced gastric cancer

    International Nuclear Information System (INIS)

    Koo, Young Baek; Kim, Suk; Lee, Jun Woo; Kim, Soo Jin; Choo, Ki Seok; Lee, Tae Hong; Moon, Tae Yong; Lee, Suk Hong; Jeon, Tae Yong

    2004-01-01

    The purpose of this study was to evaluate the performance of multidetector-row CT (MDCT) in the preoperative T-staging of patients with advanced gastric cancer. A total of 65 patients with an established diagnosis of advanced gastric cancer (T2 or more) were evaluated with MDCT. The protocol of MDCT consisted of high-quality (HQ) mode helical scanning with a slice thickness of 2.5 mm. The axial CT images were reconstructed with a slice thickness of 5 mm. MPR images were reconstructed from the raw axial data with a slice thickness of 5 mm. A comparison between the standard axial and axial MPR images was performed by two radiologists with regard to the evaluation of the tumor location and T-stage. These findings were compared with the pathologic and surgical findings. T-staging of the advanced stomach cancer was correct in 89% (58/65) and 69% (45/65) of the MPR images and axial images, respectively. The MPR images improved the detection rate (5 lesions) of the tumors and increased the accuracy of the T-staging (13 lesions) in comparison with the axial images. The MPR images are of greater diagnostic value for the evaluation of omental seeding (5 lesions: axial images, 9 lesions: MPR images), tumor location and extension. Multiplanar reconstruction (MPR) images provide increased confidence in the location and T-staging of certain cases of advanced gastric cancer, such as those in locations where CT images are susceptible to be affected by the difficulties associated with partial volume averaging. In this study, the MPR images provided more precise information about the tumor location and T-staging than the standard axial images in the preoperative evaluation of advanced gastric cancer

  12. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  13. Preoperative functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS)

    DEFF Research Database (Denmark)

    Hartwigsen, G.; Siebner, Hartwig R.; Stippich, C.

    2010-01-01

    Neurosurgical resection of brain lesions aims to maximize excision while minimizing the risk of permanent injury to the surrounding intact brain tissue and resulting neurological deficits. While direct electrical cortical stimulation at the time of surgery allows the precise identification...... of essential cortex, it cannot provide information preoperatively for surgical planning.Brain imaging techniques such as functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG) and transcranial magnetic stimulation (TMS) are increasingly being used to localize functionally critical cortical......, if the stimulated cortex makes a critical contribution to the brain functions subserving the task. While the relationship between task and functional activation as revealed by fMRI is correlative in nature, the neurodisruptive effect of TMS reflects a causal effect on brain activity.The use of preoperative f...

  14. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery.

    Science.gov (United States)

    Yeh, Michael W; Bauer, Andrew J; Bernet, Victor A; Ferris, Robert L; Loevner, Laurie A; Mandel, Susan J; Orloff, Lisa A; Randolph, Gregory W; Steward, David L

    2015-01-01

    The success of surgery for thyroid cancer hinges on thorough and accurate preoperative imaging, which enables complete clearance of the primary tumor and affected lymph node compartments. This working group was charged by the Surgical Affairs Committee of the American Thyroid Association to examine the available literature and to review the most appropriate imaging studies for the planning of initial and revision surgery for thyroid cancer. Ultrasound remains the most important imaging modality in the evaluation of thyroid cancer, and should be used routinely to assess both the primary tumor and all associated cervical lymph node basins preoperatively. Positive lymph nodes may be distinguished from normal nodes based upon size, shape, echogenicity, hypervascularity, loss of hilar architecture, and the presence of calcifications. Ultrasound-guided fine-needle aspiration of suspicious lymph nodes may be useful in guiding the extent of surgery. Cross-sectional imaging (computed tomography with contrast or magnetic resonance imaging) may be considered in select circumstances to better characterize tumor invasion and bulky, inferiorly located, or posteriorly located lymph nodes, or when ultrasound expertise is not available. The above recommendations are applicable to both initial and revision surgery. Functional imaging with positron emission tomography (PET) or PET-CT may be helpful in cases of recurrent cancer with positive tumor markers and negative anatomic imaging.

  15. Using 3 Tesla magnetic resonance imaging in the pre-operative evaluation of tongue carcinoma.

    Science.gov (United States)

    Moreno, K F; Cornelius, R S; Lucas, F V; Meinzen-Derr, J; Patil, Y J

    2017-09-01

    This study aimed to evaluate the role of 3 Tesla magnetic resonance imaging in predicting tongue tumour thickness via direct and reconstructed measures, and their correlations with corresponding histological measures, nodal metastasis and extracapsular spread. A prospective study was conducted of 25 patients with histologically proven squamous cell carcinoma of the tongue and pre-operative 3 Tesla magnetic resonance imaging from 2009 to 2012. Correlations between 3 Tesla magnetic resonance imaging and histological measures of tongue tumour thickness were assessed using the Pearson correlation coefficient: r values were 0.84 (p Tesla magnetic resonance imaging had 83 per cent sensitivity, 82 per cent specificity, 82 per cent accuracy and a 90 per cent negative predictive value for detecting cervical lymph node metastasis. In this cohort, 3 Tesla magnetic resonance imaging measures of tumour thickness correlated highly with the corresponding histological measures. Further, 3 Tesla magnetic resonance imaging was an effective method of detecting malignant adenopathy with extracapsular spread.

  16. Imaging and management of head and neck paragangliomas

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Rene van den [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands)

    2005-07-01

    Paragangliomas of the head and neck are highly vascular lesions originating from paraganglionic tissue located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). Diagnostic imaging can be considered in two clinical situations: (1) patients who present with clinical symptoms suggestive of a paraganglioma, and (2) individuals from families with hereditary paragangliomas. It is not only necessary to detect and characterize the lesion, but also to study the presence of multiplicity. For these purposes, MR imaging, and especially 3D TOF MRA, is the modality of choice. CT scanning is especially useful to show destruction of the temporal bone. Angiography in combination with embolization will mainly be used prior to surgical resection, but can also be used for diagnostic purposes when the diagnosis is not yet clear. Many parameters play a role in the decision to treat of which multifocality and impairment of cranial nerves are the most important. The primary therapeutic option for paragangliomas is complete excision of tumor with preservation of vital neurovascular structures. Resection however, should be balanced against a more conservative ''wait and scan'' policy or palliative treatments such as radiotherapy. (orig.)

  17. NMR imaging of the head-neck region. Topography of function - clinical findings - imaging and spectroscopy

    International Nuclear Information System (INIS)

    Vogl, T.J.

    1991-01-01

    The book on nmr imaging in the head-neck region offers, on a total of 221 pages, 344 detailed representations with 141 figures and 44 tables. It provides information as to the relevant topography of function, presents clinical findings, explains imaging characteristics and also takes account of spectroscopic procedures. The multifarious methods of investigation are described and discussed in connection with the differential diagnoses. A score of suitable diagnostic measures is assigned to each region of examination. The method's value is assessed against that of other imaging techniques. (orig.) [de

  18. Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery.

    Science.gov (United States)

    Law, Y; Cheung, Polly S Y; Lau, Silvia; Lo, Gladys G

    2013-08-01

    To review the impact of preoperative breast magnetic resonance imaging on the management of planned surgery, and the appropriateness of any resulting alterations. Retrospective review. A private hospital in Hong Kong. PATIENTS; For the 147 consecutive biopsy-proven breast cancer patients who underwent preoperative magnetic resonance imaging to determine tumour extent undergoing operation by a single surgeon between 1 January 2006 and 31 December 2009, the impact of magnetic resonance imaging findings was reviewed in terms of management alterations and their appropriateness. The most common indication for breast magnetic resonance imaging was the presence of multiple indeterminate shadows on ultrasound scans (53%), followed by ill-defined border of the main tumour on ultrasound scans (19%). In 66% (97 out of 147) of the patients, the extent of the operation was upgraded. Upgrading entailed: lumpectomy to wider lumpectomy (23 out of 97), lumpectomy to mastectomy (47 out of 97), lumpectomy to bilateral lumpectomy (15 out of 97), and other (12 out of 97). Mostly, these management changes were because magnetic resonance imaging showed more extensive disease (n=29), additional cancer foci (n=39), or contralateral disease (n=24). In five instances, upgrading was due to patient preference. In 34% (50 out of 147) of the patients, there was no change in the planned operation. Regarding 97 of the patients having altered management, in 12 the changes were considered inappropriately extensive (due to false-positive magnetic resonance imaging findings). In terms of magnetic resonance imaging detection of more extensive, multifocal, multicentric, or contralateral disease, the false-positive rate was 13% and false-negative rate 7%. Corresponding rates for sensitivity and specificity were 95% and 81%, using the final pathology as the gold standard. Preoperative magnetic resonance imaging had a clinically significant and mostly correct impact on management plans. Magnetic resonance

  19. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography, computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with pathologically positive neck lymph node

    International Nuclear Information System (INIS)

    Jwa, Eun Jin; Lee, Sang Wook; Kim, Jae Seung

    2012-01-01

    To evaluate the prognostic value of preoperative neck lymph node (LN) assessment with 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET), computed tomography (CT), and magnetic resonance imaging (MRI) in oral cavity squamous cell carcinoma (OSCC) patients with pathologically positive LN. In total, 47 OSCC patients with pathologically positive LN were retrospectively reviewed with preoperative 18 F-FDG PET and CT/MRI. All patients underwent surgical resection, neck dissection and postoperative adjuvant radiotherapy and/or chemotherapy between March 2002 and October 2010. Histologic correlation was performed for findings of 18 F-FDG PET and CT/MRI. Thirty-six (76.6%) of 47 cases were correctly diagnosed with neck LN metastasis by 18 F-FDG PET and 32 (68.1%) of 47 cases were correctly diagnosed by CT/MRI. Follow-up ranged from 20 to 114 months (median, 56 months). Clinically negative nodal status evaluated by 18 F-FDG PET or CT/MRI revealed a trend toward better clinical outcomes in terms of overall survival, disease-free survival, local recurrence-free survival, regional nodal recurrence-free survival, and distant metastasis-free survival rates even though the trends were not statistically significant. However, there was no impact of neck node standardized uptake value (SUV max ) on clinical outcomes. Notably, SUVmax showed significant correlation with tumor size in LN (p 2 = 0.62). PET and CT/MRI status of LN also had significant correlation with the size of intranodal tumor deposit (p 2 = 0.37 and p 2 = 0.48, respectively). 18 F-FDG PET and CT/MRI at the neck LNs might improve risk stratification in OSCC patients with pathologically positive neck LN in this study, even without significant prognostic value of SUV max .

  20. Adjunctive role of preoperative liver magnetic resonance imaging for potentially resectable pancreatic cancer.

    Science.gov (United States)

    Kim, Hyoung Woo; Lee, Jong-Chan; Paik, Kyu-Hyun; Kang, Jingu; Kim, Young Hoon; Yoon, Yoo-Seok; Han, Ho-Seong; Kim, Jaihwan; Hwang, Jin-Hyeok

    2017-06-01

    The adjunctive role of magnetic resonance imaging of the liver before pancreatic ductal adenocarcinoma has been unclear. We evaluated whether the combination of hepatic magnetic resonance imaging with multidetector computed tomography using a pancreatic protocol (pCT) could help surgeons select appropriate candidates and decrease the risk of early recurrence. We retrospectively enrolled 167 patients in whom complete resection was achieved without grossly visible residual tumor; 102 patients underwent pCT alone (CT group) and 65 underwent both hepatic magnetic resonance imaging and pCT (magnetic resonance imaging group). By adding hepatic magnetic resonance imaging during preoperative evaluation, hepatic metastases were newly discovered in 3 of 58 patients (5%) without hepatic lesions on pCT and 17 of 53 patients (32%) with indeterminate hepatic lesions on pCT. Patients with borderline resectability, a tumor size >3 cm, or preoperative carbohydrate antigen 19-9 level >1,000 U/mL had a greater rate of hepatic metastasis on subsequent hepatic magnetic resonance imaging. Among 167 patients in whom R0/R1 resection was achieved, the median overall survival was 18.2 vs 24.7 months (P = .020) and the disease-free survival was 8.5 vs 10.0 months (P = .016) in the CT and magnetic resonance imaging groups, respectively (median follow-up, 18.3 months). Recurrence developed in 82 (80%) and 43 (66%) patients in the CT and magnetic resonance imaging groups, respectively. The cumulative hepatic recurrence rate was greater in the CT group than in the magnetic resonance imaging group (P magnetic resonance imaging should be considered in patients with potentially resectable pancreatic ductal adenocarcinoma, especially those with high tumor burden. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora.

    Science.gov (United States)

    Yang, Ching-Hsiang; Chew, Khong-Yik; Solomkin, Joseph S; Lin, Pao-Yuan; Chiang, Yuan-Cheng; Kuo, Yur-Ren

    2013-12-01

    Salivary contamination of surgical wounds in clean-contaminated head and neck surgery with free flap reconstruction remains a major cause of infection and leads to significant morbidity. This study investigates the correlation between intraoral flora and surgical site infections (SSIs) among high-risk head and neck cancer patients undergoing resection and free flap reconstruction. One hundred twenty-nine patients were identified as being at high risk for infective complications based on cancer stage, tumor size, comorbid factors, and extent of reconstruction. All patients had intraoral swab cultures before surgery. Patients with culture-confirmed SSI after surgery were chosen for analysis, using the κ index and its 95% confidence interval for concordance analysis. All patients received clindamycin and gentamicin for antibiotic prophylaxis for 5 days. Antibiotic susceptibility testing of all isolates was obtained and analyzed. Thirty-seven patients experienced SSI, or an infection rate of 28.3%, occurring at a mean of 9.3 postoperative days. The overall concordance between oral flora and SSI was fair to moderate (κ index of 0.25), but detailed analysis shows a higher concordance for known and opportunistic pathogens, such as Pseudomonas aeruginosa and Enterococcus faecalis, compared to typical oral commensals. Antibiotic susceptibility tests show rapid and significant increases in resistance to clindamycin, indicating a need for a more effective alternative. Predicting pathogens in SSI using preoperative oral swabs did not demonstrate a good concordance in general for patients undergoing clean-contaminated head and neck surgery, although concordance for certain pathogenic species seem to be higher than for typical intraoral commensals. The rapid development of resistance to clindamycin precludes its use as a prophylactic agent.

  2. Preoperative implant planning considering alveolar bone grafting needs and complication prediction using panoramic versus CBCT images

    Energy Technology Data Exchange (ETDEWEB)

    Guerrero, Maria Eugenia; Jacobs, Reinhilde [OIC, OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven (Belgium); Noriega, Jorge [Master of Periodontology, Universidad San Martin de Porres, Lima (Peru)

    2014-09-15

    This study was performed to determine the efficacy of observers' prediction for the need of bone grafting and presence of perioperative complications on the basis of cone-beam computed tomography (CBCT) and panoramic radiographic (PAN) planning as compared to the surgical outcome. One hundred and eight partially edentulous patients with a need for implant rehabilitation were referred for preoperative imaging. Imaging consisted of PAN and CBCT images. Four observers carried out implant planning using PAN image datasets, and at least one month later, using CBCT image datasets. Based on their own planning, the observers assessed the need for bone graft augmentation as well as complication prediction. The implant length and diameter, the need for bone graft augmentation, and the occurrence of anatomical complications during planning and implant placement were statistically compared. In the 108 patients, 365 implants were installed. Receiver operating characteristic analyses of both PAN and CBCT preoperative planning showed that CBCT performed better than PAN-based planning with respect to the need for bone graft augmentation and perioperative complications. The sensitivity and the specificity of CBCT for implant complications were 96.5% and 90.5%, respectively, and for bone graft augmentation, they were 95.2% and 96.3%, respectively. Significant differences were found between PAN-based planning and the surgery of posterior implant lengths. Our findings indicated that CBCT-based preoperative implant planning enabled treatment planning with a higher degree of prediction and agreement as compared to the surgical standard. In PAN-based surgery, the prediction of implant length was poor.

  3. High-resolution imaging of neural anatomy and pathology of the neck

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Hyun; Choi, Young Jun; Baek, Jung Hwan [Dept. of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Cheng, Kai Lung [Dept. of Medical Imaging, Chung Shan Medical University Hospital, Taichung (China)

    2017-01-15

    The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.

  4. Imaging of the head and neck. 2. rev. and enl. ed

    Energy Technology Data Exchange (ETDEWEB)

    Mafee, M.F.; Valvassori, G.E. [University of Illinois, Chicago, IL (United States); Becker, M. [Geneva University Hospital (Switzerland)

    2004-07-01

    Remarkable advances in medical diagnostic imaging have been made during the past three decades. The development of new imaging techniques and continuous improvements in the display of digital images have opened new horizons in the study of head and neck anatomy and pathology. The American Society of Head and Neck Radiology (ASHNR) and its European and Asiatic counterparts evolved because of the emerging awareness of the roles that head and neck radiologists play in the diagnosis and management of head and neck, base of the skull, neuro-ophthalmologic and neuro-otologic diseases. This edition continues the tradition of excellence set by the first edition of Valvassori's Head and Neck Imaging (which was also the first textbook in head and neck radiology), and provides a comprehensive review of the most pertinent and up-to-date knowledge in the field of head and neck imaging. The content of this edition has been organized into 12 chapters according to anatomic regions. It now includes new material on the temporomandibular joint, the lacrimal drainage system, dental scanning, fibro-osseous and cartilaginous lesions of the head and neck, MRI sialography, MR interventional technique, and thyroid and parathyroid glands. All chapters have been expanded to address new developments in the field and to stress the importance of imaging anatomy, pathologic correlation, and pertinent clinical data. For each anatomic region, the embryology and anatomy are introduced, followed by congenital and developmental disorders, inflammatory processes, benign and malignant neoplastic diseases, trauma, and postoperative changes. The detailed reference lists in each chapter include key references and are as recent as possible. Care has been taken to include exquisitely reproduced illustrations that provide the maximum of pertinent information. It is our hope that this textbook will be useful to students and physicians in the fields of radiology, otolaryngology, neurootology, rhinology

  5. Imaging of the head and neck. 2. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Mafee, M.F.; Valvassori, G.E.; Becker, M.

    2004-01-01

    Remarkable advances in medical diagnostic imaging have been made during the past three decades. The development of new imaging techniques and continuous improvements in the display of digital images have opened new horizons in the study of head and neck anatomy and pathology. The American Society of Head and Neck Radiology (ASHNR) and its European and Asiatic counterparts evolved because of the emerging awareness of the roles that head and neck radiologists play in the diagnosis and management of head and neck, base of the skull, neuro-ophthalmologic and neuro-otologic diseases. This edition continues the tradition of excellence set by the first edition of Valvassori's Head and Neck Imaging (which was also the first textbook in head and neck radiology), and provides a comprehensive review of the most pertinent and up-to-date knowledge in the field of head and neck imaging. The content of this edition has been organized into 12 chapters according to anatomic regions. It now includes new material on the temporomandibular joint, the lacrimal drainage system, dental scanning, fibro-osseous and cartilaginous lesions of the head and neck, MRI sialography, MR interventional technique, and thyroid and parathyroid glands. All chapters have been expanded to address new developments in the field and to stress the importance of imaging anatomy, pathologic correlation, and pertinent clinical data. For each anatomic region, the embryology and anatomy are introduced, followed by congenital and developmental disorders, inflammatory processes, benign and malignant neoplastic diseases, trauma, and postoperative changes. The detailed reference lists in each chapter include key references and are as recent as possible. Care has been taken to include exquisitely reproduced illustrations that provide the maximum of pertinent information. It is our hope that this textbook will be useful to students and physicians in the fields of radiology, otolaryngology, neurootology, rhinology, head

  6. Is pre-operative imaging essential prior to ureteric stone surgery?

    Science.gov (United States)

    Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

    2012-09-01

    The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

  7. Ectopic posterior pituitary high signal in preoperative and postoperative macroadenomas: dynamic MR imaging

    International Nuclear Information System (INIS)

    Takahashi, Takahiro; Miki, Yukio; Takahashi, Jun A.; Kanagaki, Mitsunori; Yamamoto, Akira; Fushimi, Yasutaka; Okada, Tsutomu; Haque, Tabassum Laz; Hashimoto, Nobuo; Konishi, Junji; Togashi, Kaori

    2005-01-01

    Background and purpose: In patients with macroadenoma, posterior pituitary high signal (PPHS) on T1-weighted magnetic resonance (MR) imaging is sometimes observed in an ectopic location. The present study compared incidences of ectopic PPHS before and after macroadenoma surgery using MR imaging, including dynamic MR imaging to ascertain whether this ectopic change is irreversible. Materials and methods: MR imaging was performed preoperatively in 111 cases of macroadenoma, and then repeated more than 1-year postoperatively in 47 patients. Enhancement of PPHS was assessed using dynamic MR imaging. Areas of enhanced hyperintensity were considered true PPHS, and the relationship between presence and location of true PPHS and adenoma volume was analyzed. Moreover, changes in the presence and location of true PPHS were ascertained among the patients who underwent postoperative follow-up MR imaging. Results: Preoperatively, PPHS was seen only in the normal location in 29 patients (Group A: 26.1%). High signal was detected only in an ectopic location in 58 patients, and early enhancement of this ectopic high signal was confirmed by dynamic MR imaging in 56 patients (Group B: 50.5%). No PPHS was observed in 24 patients (Group C: 21.6%). Adenoma volume was significantly greater for Group B than for Group A (p < 0.001). Among the Group B patients who underwent MR imaging postoperatively (n = 31), the location of PPHS was not changed, except for two patients in whom PPHS was absent. Postoperatively, PPHS was not observed in the normal location in any patient in the Group B. Conclusions: Greater volume of adenoma is associated with a higher incidence of ectopic PPHS, and the ectopic change is irreversible

  8. Imaging techniques in the study of lipomatous neck lesions

    International Nuclear Information System (INIS)

    Munoz, M. M.; Herrero, C.; Garcia, M. J.; Sanchez-Lafuente, J.

    2001-01-01

    Lipomas of the neck are uncommon lesions. Those situated in deep locations and diffuse lipomatosis of the neck can be clinically mis diagnosed. We reviewed the 20 lipomatous neck lesions treated in our hospital over a 15-year period (1985-1999). Computed tomography was diagnostic in nearly 100% of cases and, this, is the method of choice for the detection and characterization of lipomatous tumors. It also provides data that aid in planning the surgical approach and enables the follow-up of clinically stable lesions that do not require surgical treatment. (Author) 11 refs

  9. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease

    Energy Technology Data Exchange (ETDEWEB)

    Barco, Israel [Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona (Spain); Chabrera, Carolina [Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme (Spain); and others

    2016-10-15

    Highlights: • Preoperative MRI displays additional disease in 10.4% of cases in patients with infiltrating ductal carcinoma. • In cases with a complex intraductal-associated component, MRI is helpful in managing the surgical approach, and can potentially reduce reoperation rates. • Preoperative MRI showed a 91.9% agreement with the final histology, but core-needle biopsy cannot be rejected, so as to limit unnecessary surgery. • When MRI shows additional disease, there is often a change in the initial surgical plan. • Evolving surgery techniques, such as oncoplastic procedures, can be safely performed as an alternative to mastectomy in some patients. - Abstract: Objective: The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. Patients and methods: There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. Results: Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p = 0.020) and lobular carcinomas (p = 0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional

  10. Preoperative imaging in 78 living kidney donors using CE-MRA and DSA

    International Nuclear Information System (INIS)

    Lemke, U.; Taupitz, M.; Hamm, B.; Kroencke, T.J.; Kluener, C.; Giessing, M.; Schoenberger, B.

    2008-01-01

    Purpose: to evaluate contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) in comparison with the intraoperative findings in living kidney donors. Materials and methods: a total of 156 kidneys in 78 potential kidney donors were prospectively examined using CE-MRA (0.2 mmol Gd/kg, voxel size 1.3 x 0.8 x 2.0) and DSA. Two experienced radiologists assessed the images in consensus regarding the renal vascular anatomy and variants. The results for the 67 candidates accepted for donation were compared to the intraoperative findings. In the other kidneys not accepted for donor nephrectomy, MRA and DSA were compared with each other. Results: nineteen arterial variants were identified intraoperatively, of which 11 (58%) were also detected by preoperative CE-MRA and 10 (53%) by preoperative DSA. Of the 10 venous variants found intraoperatively, CE-MRA detected 8 (80%) and DSA 3 (30%). The agreement (kappa test) between MRI and DSA for all 156 evaluated kidneys was 0.7 for arterial variants (McNemar p = 0.12) and 0.3 for venous variants (McNemar p = 0.01). The preoperative choice of kidney (right or left) made on the basis of the renal vascular anatomy seen on CE-MRA and DSA differed in 22% of the 78 potential donors (McNemar P = 0.3). (orig.)

  11. The importance of preoperative magnetic resonance imaging in valve surgery for active infective endocarditis

    International Nuclear Information System (INIS)

    Takagi, Yasushi; Higuchi, Yoshiro; Kondo, Hiroshi; Akita, Kiyotoshi; Ishida, Michiko; Kaneko, Kan; Hoshino, Ryo; Sato, Masato; Ando, Motomi

    2011-01-01

    Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T 2 *-weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes. Eighteen patients were referred to our department for native valve IE during 2006-2010. Urgent surgery was indicated in cases of hemodynamic failure resulting from valve destruction, refractory sepsis, and mobile vegetations measuring >10 mm. For these patients, we performed preoperative MRI and MRA. Males comprised 67% of the subjects, with average age 53±15 years. No clinical evidence of acute stroke was noted. Of the 18 patients, urgent surgery was indicated in 15; of these, 10 (67%) showed a brain lesion related to IE: 6 patients had acute or subacute brain infarctions, 2 patients had brain infarction with brain abscess, and 2 patients had hemorrhagic brain infarction and so did not undergo urgent surgery. Thus, 13 patients underwent urgent valve surgery. Among the 5 patients who did not undergo urgent surgery, 4 patients later underwent valve surgery for healed IE. No hospital deaths or neurological complications occurred. MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes. (author)

  12. Surgical neuro navigator guided by preoperative magnetic resonance images, based on a magnetic position sensor

    International Nuclear Information System (INIS)

    Perini, Ana Paula; Siqueira, Rogerio Bulha; Carneiro, Antonio Adilton Oliveira; Oliveira, Lucas Ferrari de; Machado, Helio Rubens

    2009-01-01

    Image guided neurosurgery enables the neurosurgeon to navigate inside the patient's brain using pre-operative images as a guide and a tracking system, during a surgery. Following a calibration procedure, three-dimensional position and orientation of surgical instruments may be transmitted to computer. The spatial information is used to access a region of interest, in the pre-operative images, displaying them to the neurosurgeon during the surgical procedure. However, when a craniotomy is involved and the lesion is removed, movements of brain tissue can be a significant source of error in these conventional navigation systems. The architecture implemented in this work intends the development of a system to surgical planning and orientation guided by ultrasound image. For surgical orientation, the software developed allows the extraction of slices from the volume of the magnetic resonance images (MRI) with orientation supplied by a magnetic position sensor (Polhemus R ). The slices extracted with this software are important because they show the cerebral area that the neurosurgeon is observing during the surgery, and besides they can be correlated with the intra-operative ultrasound images to detect and to correct the deformation of brain tissue during the surgery. Also, a tool for per-operative navigation was developed, providing three orthogonal planes through the image volume. In the methodology used for the software implementation, the Python tm programming language and the Visualization Toolkit (VTK) graphics library were used. The program to extract slices of the MRI volume allowed the application of transformations in the volume, using coordinates supplied by the position sensor. (author)

  13. Positron emission tomography-computed tomography protocol considerations for head and neck cancer imaging.

    Science.gov (United States)

    Escott, Edward J

    2008-08-01

    Positron emission tomographic-computed tomographic (PET-CT) imaging of patients with primary head and neck cancers has become an established approach for staging and restaging, as well as radiation therapy planning. The inherent co-registration of PET and CT images made possible by the integrated PET-CT scanner is particularly valuable in head and neck cancer imaging due to the complex and closely situated anatomy in this part of the body, the varied sources of physiologic and benign 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) tracer uptake that occurs in the neck, and the varied and complex posttreatment appearance of the neck. Careful optimization of both the CT and the PET portion of the examination is essential to insure the most accurate and clinically valuable interpretation of these examinations.

  14. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease.

    Science.gov (United States)

    Barco, Israel; Chabrera, Carolina; García-Fernández, Antonio; Fraile, Manel; Vidal, MCarmen; González, Sonia; Lain, Jose María; Reñé, Assumpta; Canales, Lidia; Vallejo, Elena; Deu, Jordi; Pessarrodona, Antoni; Giménez, Nuria; García-Font, Marc

    2016-10-01

    The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p=0.020) and lobular carcinomas (p=0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional foci diagnosed by MRI as a dependent variable. Preoperative MRI seems to have a role in preoperative tumour staging for breast cancer patients, as it discloses additional disease foci in some patients, including contralateral involvement. However, given the lack of absolute accuracy, core-needle biopsy cannot be neglected in the diagnosis of such additional malignant foci, which could result in a change in surgical treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Relationship between Northwick Park neck pain questionnaire and cervical spine MR imaging findings.

    Science.gov (United States)

    Arana, Estanislao; Martí-Bonmatí, Luis; Montijano, Ruben; Bautista, Daniel; Molla, Enrique; Costa, Salvador

    2006-08-01

    The study was aimed at determining the association between the self-report of pain and disability by means of Northwick neck pain questionnaire (NPQ) and cervical spine MR imaging findings. A random sample of 251 patients, 132 men and 119 women aged 43+/-13 years, submitted with neck pain were investigated. Patients with previous discitis, surgery, neoplasm or hospitalized for cervical spine trauma were excluded. All patients completed the NPQ and were studied with sagittal gradient-echo T1 and turbo spin-echo T2, axial gradient-echo T2* and heavily T2 weighted MR myelographic weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30. There was no statistically significant correlation between NPQ and MR imaging scores. From the NPQ items, only difficulty in sleeping and numbness were related to the MR imaging score. Disc extrusion was the only MR finding almost significantly associated with NPQ (P=0.054). Neck injury did not increase NPQ scores. In patients with neck pain, NPQ scores do not correlate with MR imaging findings. NPQ and cervical spine MR imaging show different facets of the multidimensional complex of neck pain.

  16. First Report of Preoperative Imaging Diagnosis of a Surgically Confirmed Case of Valentino′s Syndrome

    Directory of Open Access Journals (Sweden)

    Parag Suresh Mahajan

    2014-01-01

    Full Text Available Perforation of a duodenal ulcer (DU into the retroperitoneal space presenting with clinical features of acute appendicitis is known as Valentino′s syndrome. Post duodenal perforation, the gastric and duodenal fluids tend to settle in the right paracolic gutter causing peritonitis and clinically mimicking acute appendicitis. Only three cases of Valentino′s syndrome have been reported till date in the published literature and there is only one previous report of its preoperative imaging diagnosis. To our knowledge, this is the first reported case of preoperative imaging diagnosis in a surgically confirmed case of Valentino′s syndrome. In most cases, patients with undiagnosed Valentino′s syndrome are operated for acute appendicitis, and on finding a normal appendix, search is made for the cause of peritonitis, which then leads to retroperitoneal perforation of duodenum. The diagnosis of Valentino′s syndrome by computed tomography (CT imaging is easy and can help in avoiding the surgery or directing the surgeon directly to the repair of the duodenal perforation. It is, therefore, essential for emergency physicians, surgeons, and radiologists to know about this entity and consider it in the differential diagnosis.

  17. Clinical application of synthesized brain surface imaging for preoperative simulation of brain biopsy under local anesthesia

    International Nuclear Information System (INIS)

    Ogura, Yuko; Katada, Kazuhiro; Imai, Fumihiro; Fujisawa, Kazuhisa; Takeshita, Gen; Kanno, Tetsuo; Koga, Sukehiko

    1994-01-01

    Surface anatomy scanning (SAS) is the technique which permits the direct visualization of brain surface structures, including cortical sulci, guri, subcortical lesions as well as skin markings for craniotomy. A synthesized brain surface image is a technique that combines MR angiography (MRA) with SAS, and it proposed by us for detecting cerebral superficial veins with these surface structures on the same image. The purpose of this report is to present the result of applying the synthesized brain surface image to the preoperative simulation of biopsy under local anesthesia in 2 cases of multiple metastatic brain tumors. The parameters for SAS were TR/TE=50/40 msec, flip angle=60deg by the fast T 2 technique using refocused FID in steady-state (STERF technique). SAS images were processed by gray scale reversal. The MRA data were acquired with two-dimensional time of flight (TOF) sequence after intravenous administration of Gd-DTPA. Before imaging, the water-filled plastic tubes were placed on the patients scalp as markings for craniotomy. Their positions were planned by the neurosurgeons. On SAS, the markings for burr-hole appeared located above the tumors. However on the synthesized brain surface images, the positions of burr-hole were considered to be inadequate, since superficial cerebral vein and sinus were also visualized in the area of the markings. From these results, the positions of burr-hole were reset to avoid the venous structures, and so as to include the lesions in operations. The biopsies were performed successfully and safely because the venous structure could be excluded from the operative field. By this technique it was easy to confirm the relationships among lesions, skin markings and venous structures. The technique described appears to be a useful method for preoperative simulation of biopsies for multiple metastatic brain tumors under local anesthesia. (author)

  18. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management

    Science.gov (United States)

    Subedi, Navaraj; Prestwich, Robin; Chowdhury, Fahmid; Patel, Chirag

    2013-01-01

    Abstract Neuroendocrine tumours (NETs) of the head and neck are rare neoplasms and can be of epithelial or non-epithelial differentiation. Although the natural history of NETs is variable, it is crucial to establish an early diagnosis of these tumours as they can be potentially curable. Conventional anatomical imaging and functional imaging using radionuclide scintigraphy and positron emission tomography/computed tomography can be complementary for the diagnosis, staging and monitoring of treatment response. This article describes and illustrates the imaging features of head and neck NETs, discusses the potential future role of novel positron-emitting tracers that are emerging into clinical practice and reviews contemporary management of these tumours. Familiarity with the choice of imaging techniques and the variety of imaging patterns and treatment options should help guide radiologists in the management of this rare but important subgroup of head and neck neoplasms. PMID:24240099

  19. The utility of preoperative diffusion tensor imaging in the surgical management of brainstem cavernous malformations.

    Science.gov (United States)

    Flores, Bruno C; Whittemore, Anthony R; Samson, Duke S; Barnett, Samuel L

    2015-03-01

    Resection of brainstem cavernous malformations (BSCMs) may reduce the risk of stepwise neurological deterioration secondary to hemorrhage, but the morbidity of surgery remains high. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are neuroimaging techniques that may assist in the complex surgical planning necessary for these lesions. The authors evaluate the utility of preoperative DTI and DTT in the surgical management of BSCMs and their correlation with functional outcome. A retrospective review was conducted to identify patients who underwent resection of a BSCM between 2007 and 2012. All patients had preoperative DTI/DTT studies and a minimum of 6 months of clinical and radiographic follow-up. Five major fiber tracts were evaluated preoperatively using the DTI/DTT protocol: 1) corticospinal tract, 2) medial lemniscus and medial longitudinal fasciculus, 3) inferior cerebellar peduncle, 4) middle cerebellar peduncle, and 5) superior cerebellar peduncle. Scores were applied according to the degree of distortion seen, and the sum of scores was used for analysis. Functional outcomes were measured at hospital admission, discharge, and last clinic visit using modified Rankin Scale (mRS) scores. Eleven patients who underwent resection of a BSCM and preoperative DTI were identified. The mean age at presentation was 49 years, with a male-to-female ratio of 1.75:1. Cranial nerve deficit was the most common presenting symptom (81.8%), followed by cerebellar signs or gait/balance difficulties (54.5%) and hemibody anesthesia (27.2%). The majority of the lesions were located within the pons (54.5%). The mean diameter and estimated volume of lesions were 1.21 cm and 1.93 cm(3), respectively. Using DTI and DTT, 9 patients (82%) were found to have involvement of 2 or more major fiber tracts; the corticospinal tract and medial lemniscus/medial longitudinal fasciculus were the most commonly affected. In 2 patients with BSCMs without pial presentation, DTI

  20. New concepts in preoperative imaging of anorectal malformation. New concepts in imaging of ARM

    Energy Technology Data Exchange (ETDEWEB)

    Taccone, A.; Delliacqua, A.; Marzoli, A. (Children' s Hospital G. Gaslini, Genoa (Italy). Dept. of Radiology); Martucciello, G.; Jasonni, V. (Children' s Hospital G. Gaslini, Genoa (Italy). Dept. of Pediatric Surgery); Dodero, P. (Children' s Hospital G. Gaslini, Genoa (Italy). Dept. of Intensive Care Unit); Salomone, G. (Children' s Hospital G. Gaslini, Genoa (Italy). Surgical Emergency Unit)

    1992-06-01

    In this study of 14 patients with anorectal anomalies CT and MRI were employed for preoperative assessment. The use of a pressure enhanced water soluble enema via the colostomy proved to be an extremely efficient method for showing a fistula. MRI studies were enhanced by the use of vaseline oil and in one case this technique was used prior to surgery to provide important information by injecting through a perineal fistula. CT and axial MRI proved to be more valuable than sagittal MRI which is only useful for the length of the atretic segment. The authors consider that a combined approach using pressure enhanced water soluble enema and MRI will provide the most valuable preoperative information to plan a successful operative approach and enable an accurate prognostic evaluation of continence in these difficult and complex patients. (orig.).

  1. Preoperative imaging in primary hyperparathyroidism. Role of thallium-technetium subtraction scintigraphy

    International Nuclear Information System (INIS)

    Foster, G.S.; Bekerman, C.; Blend, M.J.; Byrom, E.; Pinsky, S.M.

    1989-01-01

    Primary hyperparathyroidism, although often silent clinically, may lead to significant morbidity if it remains untreated. In more than 95% of all cases the cause is a parathyroid adenoma or glandular hyperplasia. Regression of disease follows successful surgical excision of the abnormal parathyroid gland. Recurrent or persistent hyperparathyroidism is most commonly caused by solitary adenomas, which may have an ectopic location. Preoperative localization of lesions may improve postoperative cure rates and decrease morbidity. Thallium T1 201 chloride-technetium Tc 99m pertechnetate subtraction scintigraphy was performed on 15 patients with primary hyperparathyroidism. The sensitivity and specificity for detection of abnormal glands were 90% and 95%, respectively. False-positive or false-negative results were minimize by strict adherence to a protocol and by the use of well-defined diagnostic criteria. Because of the superior sensitivity and specificity, this modality should be the primary imaging method of choice for preoperative evaluation of primary hyperparathyroidism. The relative role of other imaging modalities is also discussed. 31 references

  2. MR imaging of solitary fibrous tumors in the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Jeong [The Catholic University, Daejeon (Korea, Republic of); Lee, Ho Kyu; Shin, Ji Hoon; Lee, Jeong Hyun [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Seo, Jeong Jin [Chonnam National University Medical School, Kwangju (Korea, Republic of); Kim, Hyung Jim [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Jeong, Ae Kyung [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2005-09-15

    Solitary fibrous tumor (SFT) is a very rare tumor. The purpose of this study is to determine the MR imaging features of SFT in the intracranial and extracranial head and neck regions. We retrospectively reviewed six MR images and two CT images of six histologically proven cases of SFT that occurred in four men and two women, and their ages ranged from 46 to 59 years. These imaging findings were correlated with the microscopic findings of their surgical specimens. Six SFTs arose in the meninges (the petrous ridge and the pituitary fossa), the parotid gland, the parapharyngeal space, the buccal space and the maxillary sinus. On the MR images, SFTs in the intracranial and extracranial head and neck regions were mostly isointense to the muscle on the T1-weighted images, they were hyperintense on the T2-weighted images and they all had intense enhancement. On the T1- and T2-weighted images, hypointense lines were observed within in five SFTs. On the CT images, the SFTs were hypodense to the muscle on the unenhanced images and they were heterogeneously enhanced on the contrast-enhanced images. An exceptional case of pituitary SFT was hypointense on the T2-weighted images and it was hyperdense on the unenhanced CT images, which correlated with the increased collagenous component and the cellular compactness. The imaging features of SFT are nonspecific; however, SFT should be included in the differential diagnosis of masses involving the intracranial and extracranial head and neck regions.

  3. MR imaging of solitary fibrous tumors in the head and neck

    International Nuclear Information System (INIS)

    Kim, Hyun Jeong; Lee, Ho Kyu; Shin, Ji Hoon; Lee, Jeong Hyun; Seo, Jeong Jin; Kim, Hyung Jim; Jeong, Ae Kyung

    2005-01-01

    Solitary fibrous tumor (SFT) is a very rare tumor. The purpose of this study is to determine the MR imaging features of SFT in the intracranial and extracranial head and neck regions. We retrospectively reviewed six MR images and two CT images of six histologically proven cases of SFT that occurred in four men and two women, and their ages ranged from 46 to 59 years. These imaging findings were correlated with the microscopic findings of their surgical specimens. Six SFTs arose in the meninges (the petrous ridge and the pituitary fossa), the parotid gland, the parapharyngeal space, the buccal space and the maxillary sinus. On the MR images, SFTs in the intracranial and extracranial head and neck regions were mostly isointense to the muscle on the T1-weighted images, they were hyperintense on the T2-weighted images and they all had intense enhancement. On the T1- and T2-weighted images, hypointense lines were observed within in five SFTs. On the CT images, the SFTs were hypodense to the muscle on the unenhanced images and they were heterogeneously enhanced on the contrast-enhanced images. An exceptional case of pituitary SFT was hypointense on the T2-weighted images and it was hyperdense on the unenhanced CT images, which correlated with the increased collagenous component and the cellular compactness. The imaging features of SFT are nonspecific; however, SFT should be included in the differential diagnosis of masses involving the intracranial and extracranial head and neck regions

  4. Magnetic resonance imaging guided reirradiation of recurrent and second primary head and neck cancer

    OpenAIRE

    Chen, Allen M.; Cao, Minsong; Hsu, Sophia; Lamb, James; Mikaeilian, Argin; Yang, Yingli; Agazaryan, Nzhde; Low, Daniel A.; Steinberg, Michael L.

    2017-01-01

    Purpose: To report a single-institutional experience using magnetic resonance imaging (MRI) guided radiation therapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and materials: Between October 2014 and August 2016, 13 consecutive patients with recurrent or new primary cancers of the head and neck that occurred in a previously irradiated field were prospectively enrolled in an institutional registry trial to investigate the feasibility and efficacy of ...

  5. Preoperative evaluation of cardiac risk using dobutamine-thallium imaging in vascular surgery

    International Nuclear Information System (INIS)

    Zellner, J.L.; Elliott, B.M.; Robison, J.G.; Hendrix, G.H.; Spicer, K.M.

    1990-01-01

    Coronary artery disease is frequently present in patients undergoing evaluation for reconstructive peripheral vascular surgery. Dobutamine-thallium imaging has been shown to be a reliable and sensitive noninvasive method for the detection of significant coronary artery disease. Eighty-seven candidates for vascular reconstruction underwent dobutamine-thallium imaging. Forty-eight patients had an abnormal dobutamine-thallium scan. Twenty-two patients had infarct only, while 26 had reversible ischemia demonstrated on dobutamine-thallium imaging. Fourteen of 26 patients with reversible ischemia underwent cardiac catheterization and 11 showed significant coronary artery disease. Seven patients underwent preoperative coronary bypass grafting or angioplasty. There were no postoperative myocardial events in this group. Three patients were denied surgery on the basis of unreconstructible coronary artery disease, and one patient refused further intervention. Ten patients with reversible myocardial ischemia on dobutamine-thallium imaging underwent vascular surgical reconstruction without coronary revascularization and suffered a 40% incidence of postoperative myocardial ischemic events. Five patients were denied surgery because of presumed significant coronary artery disease on the basis of the dobutamine-thallium imaging and clinical evaluation alone. Thirty-nine patients with normal dobutamine-thallium scans underwent vascular reconstructive surgery with a 5% incidence of postoperative myocardial ischemia. Dobutamine-thallium imaging is a sensitive and reliable screening method which identifies those patients with coronary artery disease who are at high risk for perioperative myocardial ischemia following peripheral vascular surgery

  6. Preoperative implant selection for unilateral breast reconstruction using 3D imaging with the Microsoft Kinect sensor.

    Science.gov (United States)

    Pöhlmann, Stefanie T L; Harkness, Elaine; Taylor, Christopher J; Gandhi, Ashu; Astley, Susan M

    2017-08-01

    This study aimed to investigate whether breast volume measured preoperatively using a Kinect 3D sensor could be used to determine the most appropriate implant size for reconstruction. Ten patients underwent 3D imaging before and after unilateral implant-based reconstruction. Imaging used seven configurations, varying patient pose and Kinect location, which were compared regarding suitability for volume measurement. Four methods of defining the breast boundary for automated volume calculation were compared, and repeatability assessed over five repetitions. The most repeatable breast boundary annotation used an ellipse to track the inframammary fold and a plane describing the chest wall (coefficient of repeatability: 70 ml). The most reproducible imaging position comparing pre- and postoperative volume measurement of the healthy breast was achieved for the sitting patient with elevated arms and Kinect centrally positioned (coefficient of repeatability: 141 ml). Optimal implant volume was calculated by correcting used implant volume by the observed postoperative asymmetry. It was possible to predict implant size using a linear model derived from preoperative volume measurement of the healthy breast (coefficient of determination R 2  = 0.78, standard error of prediction 120 ml). Mastectomy specimen weight and experienced surgeons' choice showed similar predictive ability (both: R 2  = 0.74, standard error: 141/142 ml). A leave one-out validation showed that in 61% of cases, 3D imaging could predict implant volume to within 10%; however for 17% of cases it was >30%. This technology has the potential to facilitate reconstruction surgery planning and implant procurement to maximise symmetry after unilateral reconstruction. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Functional Magnetic Resonance Imaging for Preoperative Planning in Brain Tumour Surgery.

    Science.gov (United States)

    Lau, Jonathan C; Kosteniuk, Suzanne E; Bihari, Frank; Megyesi, Joseph F

    2017-01-01

    Functional magnetic resonance imaging (fMRI) is being increasingly used for the preoperative evaluation of patients with brain tumours. The study is a retrospective chart review investigating the use of clinical fMRI from 2002 through 2013 in the preoperative evaluation of brain tumour patients. Baseline demographic and clinical data were collected. The specific fMRI protocols used for each patient were recorded. Sixty patients were identified over the 12-year period. The tumour types most commonly investigated were high-grade glioma (World Health Organization grade III or IV), low-grade glioma (World Health Organization grade II), and meningioma. Most common presenting symptoms were seizures (69.6%), language deficits (23.2%), and headache (19.6%). There was a predominance of left hemispheric lesions investigated with fMRI (76.8% vs 23.2% for right). The most commonly involved lobes were frontal (64.3%), temporal (33.9%), parietal (21.4%), and insular (7.1%). The most common fMRI paradigms were language (83.9%), motor (75.0%), sensory (16.1%), and memory (10.7%). The majority of patients ultimately underwent a craniotomy (75.0%), whereas smaller groups underwent stereotactic biopsy (8.9%) and nonsurgical management (16.1%). Time from request for fMRI to actual fMRI acquisition was 3.1±2.3 weeks. Time from fMRI acquisition to intervention was 4.9±5.5 weeks. We have characterized patient demographics in a retrospective single-surgeon cohort undergoing preoperative clinical fMRI at a Canadian centre. Our experience suggests an acceptable wait time from scan request to scan completion/analysis and from scan to intervention.

  8. Inaccurate preoperative imaging assessment on biliary anatomy not increases biliary complications after living donor liver transplantation

    International Nuclear Information System (INIS)

    Xu Xiao; Wei Xuyong; Ling Qi; Wang Kai; Bao Haiwei; Xie Haiyang; Zhou Lin; Zheng Shusen

    2012-01-01

    Backgrounds and aims: Accurate assessment of graft bile duct is important to plan surgical procedure. Magnetic resonance cholangiopancreatography (MRCP) has become an important diagnostic procedure in evaluation of pancreaticobiliary ductal abnormalities and has been reported as highly accurate. We aim to estimate the efficacy of preoperative MRCP on depicting biliary anatomy in living donor liver transplantation (LDLT), and to determine whether inaccurate preoperative imaging assessment would increase the biliary complications after LDLT. Methods: The data of 118 cases LDLT were recorded. Information from preoperative MRCP was assessed using intraoperative cholangiography (IOC) as the gold standard. The possible risk factors of recipient biliary complications were analyzed. Results: Of 118 donors, 84 had normal anatomy (type A) and 34 had anatomic variants (19 cases of type B, 9 cases of type C, 1 case of type E, 2 cases of type F and 3 cases of type I) confirmed by IOC. MRCP correctly predicted all 84 normal cases and 17 of 34 variant cases, and showed an accuracy of 85.6% (101/118). The incidence of biliary complications was comparable between cases with accurate and inaccurate classification of biliary tree from MRCP, and between cases with normal and variant anatomy of bile duct. While cases with graft duct opening ≤5 mm showed a significant higher incidence of total biliary complications (21.1% vs. 6.6%, P = 0.028) and biliary stricture (10.5% vs. 1.6%, P = 0.041) compared with cases with large duct opening >5 mm. Conclusion: MRCP could correctly predict normal but not variant biliary anatomy. Inaccurate assessment of biliary anatomy from MRCP not increases the rate of biliary complications, while small-sized graft duct may cause an increase in biliary complications particularly biliary stricture after LDLT.

  9. ROLE OF IMAGING TESTS FOR PREOPERATIVE LOCATION OF PATHOLOGIC PARATHYROID TISSUE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM.

    Science.gov (United States)

    Coelho, Maria Caroline Alves; de Oliveira E Silva de Morais, Nathalie Anne; Beuren, Andrea Cristiani; Lopes, Cristiane Bertolino; Santos, Camila Vicente; Cantoni, Joyce; Neto, Leonardo Vieira; Lima, Maurício Barbosa

    2016-09-01

    Primary hyperparathyroidism (PHPT) can be cured by parathyroidectomy, and the preoperative location of enlarged pathologic parathyroid glands is determined by imaging studies, especially cervical ultrasonography and scintigraphy scanning. The aim of this retrospective study was to evaluate the use of preoperative cervical ultrasonography and/or parathyroid scintigraphy in locating pathologic parathyroid tissue in a group of patients with PHPT followed in the same endocrine center. We examined the records of 61 patients who had undergone parathyroidectomy for PHPT following (99m)Tc-sestamibi scintigraphy scan and/or cervical ultrasonography. Scintigraphic and ultrasonographic findings were compared to histopathologic results of the surgical specimens. Ultrasonography detected enlarged parathyroid glands in 87% (48/55) of patients with PHPT and (99m)Tc-sestamibi scintigraphy in 79% (37/47) of the cases. Ultrasonography was able to correctly predict the surgical findings in 75% (41/55) of patients and scintigraphy in 72% (34/47). Of 7 patients who had negative ultrasonography, scintigraphy correctly predicted the surgical results in 2 (29%). Of 10 patients who had negative scintigraphy, ultrasonography correctly predicted the surgical results in 4 (40%). When we analyzed only patients with solitary eutopic parathyroid adenomas, the predictive positive values of ultrasonography and scintigraphy were 90% and 86%, respectively. Cervical ultrasonography had a higher likelihood of a correct positive test and a greater predictive positive value for solitary adenoma compared to (99m)Tc-sestamibi and should be used as the first diagnostic tool for preoperative localization of affected parathyroid glands in PHPT. Ca = calcium IEDE = Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione PHPT = primary hyperparathyroidism PTH = parathyroid hormone.

  10. Pitfalls of CT for deep neck abscess imaging assessment: a retrospective review of 162 cases.

    Science.gov (United States)

    Chuang, S Y; Lin, H T; Wen, Y S; Hsu, F J

    2013-01-01

    To investigate the diagnostic value of contrast-enhanced computed tomography (CT) for the prediction of deep neck abscesses in different deep neck spaces and to evaluate the false-positive results. We retrospectively analysed the clinical charts, CT examinations, surgical findings, bacteriology, pathological examinations and complications of hospitalised patients with a diagnosis of deep neck abscess from 2004 to 2010. The positive predictive values (PPV) for the prediction of abscesses by CT scan in different deep neck spaces were calculated individually on the basis of surgical findings. A total of 162 patients were included in this study. All patients received both intravenous antibiotics and surgical drainage. The parapharyngeal space was the most commonly involved space. The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. The PPV was 91.3% when more than one deep neck space was involved but only 50.0% in patients with isolated retropharyngeal abscesses. In the false-positive group, cellulitis was the most common final result, followed by cystic degeneration of cervical metastases. Five specimens taken intra-operatively revealed malignancy and four of these were not infected. There are some limitations affecting the differentiation of abscesses and cellulitis, particularly in the retropharyngeal space. A central necrotic cervical metastatic lymph node may sometimes also mimic a simple pyogenic deep neck abscess on both clinical pictures and CT images. Routine biopsy of the tissue must be performed during surgical drainage.

  11. A comparative study of MR imaging scores and MR perfusion imaging in pre-operative grading of intracranial gliomas

    International Nuclear Information System (INIS)

    Wu Honglin; Chen Junkun; Zhang Zongjun; Lu Guangming; Chen Ziqian; Wang Wei; Ji Xueman; Tang Xiaojun; Li Lin

    2005-01-01

    Objective: To compare the accuracy of MR imaging scores with MR perfusion imaging in pre-operative grading of intracranial gliomas. Methods: Thirty patients with intracranial gliomas (8 low-grade and 22 high-grade, according to WHO criteria) were examined with MR perfusion imaging pre-operatively. The lesions were evaluated by using an MR imaging score based on nine criteria. rCBV of the lesions were calculated by comparing the CBV of the lesion and that of contralateral normal white matter. The scores and ratios in high-grade and low-grade tumours were compared. Results: The MR imaging score of low grade (grades I and II) gliomas (0.67±0.29) were significantly lower than that of grades III (1.32 ± 0.47) (t=-3.48, P=0.003) and IV (1.56 ± 0.20) (t=-7.36, P=0.000) gliomas. There was no statistical difference when MR imaging scores of grades III and IV gliomas (t=-1.39, P=0.182) were compared. The maximum rCBV ratio of low grade (grades I and II) gliomas (2.38 ± 0.66 ) were significantly lower than that of grades III (5.81 ± 3.20) (t=-3.57, P=0.003) and IV (6.99 ± 2.47) (t=-5.09, P=0.001). There was no statistical difference when rCBV ratios of grades III and IV (t =-0.93, P=0.365) gliomas were compared. The accuracy of MR imaging scores in the noninvasive grading of untreated gliomas was all most the same as that of MR perfusion imaging (90.00% vs 89.29%). Conclusion: The MR imaging scores and MR perfusion imaging are two very useful tools in the evaluation of the histopathologic grade of cerebral gliomas. The overall accuracy in the noninvasive grading of gliomas may be imp roved if MR imaging scores and MR perfusion imaging are combined. (authors)

  12. A comparison of kV and MV imaging in head and neck image guided radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Devereux, B. [Radiation Oncology Queensland, 280 North St, Toowoomba 4350 (Australia)], E-mail: beth.devereux@roq.net.au; Frantzis, J.; Sisson, T.; Jones, M.; Martin, J.; Middleton, M. [Radiation Oncology Queensland, 280 North St, Toowoomba 4350 (Australia)

    2010-02-15

    Purpose: To compare and assess kV and MV imaging modalities and their role in image guided radiotherapy (IGRT) for head and neck cancer patients. Method: Twelve patients receiving radical radiotherapy to the head and neck were analysed in this study. Six patients undertook MV daily online intervention and a further six patients undertook kV daily online intervention. Pre-intervention field placement data were collected from three separate observers' image match analysis for each patient. The radiotherapy collective involved in the daily online image match analysis formed the fourth observer in the study. The primary end point was to establish the difference in inter- and intra-observer variance between kV and MV imaging modalities. Results: The range of the standard deviations of systematic set-up error for MV imaging calculated was 1.47-2.33 mm (MV) and 1.61-1.64 mm (kV) for the right-left (RL), 2.10-2.17 mm (MV) and 1.53-1.84 mm (kV) for the cranio-caudal (CC) and 1.43-1.63 mm (MV) and 1.02-1.11 mm (kV) for the anterior-posterior (AP). The mean inter-observer variance was 0.21 mm (MV) and 0.41 mm (kV) for the RL, 0.53 mm (MV) and 0.55 mm (kV) for the CC and 0.23 mm (MV) and 0.16 mm (kV) for the AP direction. Intra-observer mean variance was in the order of 0.60 mm (MV) and 0.16 mm (kV) for the RL, 1.41 mm (MV) and 0.05 mm (kV) for the CC and 1.41 mm (MV) and 0.08 mm (kV) for the AP. Discussion: The data in this study suggest both inter- and intra-observer consistency across kV and MV imaging modalities were comparable. However, it is felt that the improved clarity and quality of kV imaging allows all observers to analyse images in a consistent manner, identifying and acting on potential field placement moves. Conclusion: The introduction of kV imaging has maintained the high levels of inter- and intra-observer consistency achieved with MV imaging. This in turn further enables positive verification outcomes and supports the implementation of potential

  13. Image cytometric nuclear texture features in inoperable head and neck cancer: a pilot study

    International Nuclear Information System (INIS)

    Strojan-Flezar, Margareta; Lavrencak, Jaka; Zganec, Mario; Strojan, Primoz

    2011-01-01

    Image cytometry can measure numerous nuclear features which could be considered a surrogate end-point marker of molecular genetic changes in a nucleus. The aim of the study was to analyze image cytometric nuclear features in paired samples of primary tumor and neck metastasis in patients with inoperable carcinoma of the head and neck. Image cytometric analysis of cell suspensions prepared from primary tumor tissue and fine needle aspiration biopsy cell samples of neck metastases from 21 patients treated with concomitant radiochemotherapy was performed. Nuclear features were correlated with clinical characteristics and response to therapy. Manifestation of distant metastases and new primaries was associated (p<0.05) with several chromatin characteristics from primary tumor cells, whereas the origin of index cancer and disease response in the neck was related to those in the cells from metastases. Many nuclear features of primary tumors and metastases correlated with the TNM stage. A specific pattern of correlation between well-established prognostic indicators and nuclear features of samples from primary tumors and those from neck metastases was observed. Image cytometric nuclear features represent a promising candidate marker for recognition of biologically different tumor subgroups

  14. MR imaging and MR angiography in preoperative evaluation of intracranial meningiomas

    International Nuclear Information System (INIS)

    Goldmann, A.; Kunz, U.; Bader, C.; Leibing, U.; Friedrich, J.M.; Oldenkott, P.

    1994-01-01

    A group of 41 patients with intracranial meningiomas were examined by MR imaging (MRI) and MR angiography (MRA) to assess the clinical value of MRA in the preoperative evaluation of these patients. The results of MRA were compared with the results of intraarterial cerebral catheter X-ray angiography (XRA; n 19) and with the operative findings (n = 41). Our results showed a good correlation between MRA and XRA/surgery in demonstrating the relationship between the tumor and adjacent venous and arterial structures. Use of MRA was also helpful in demonstrating the degree of intrinsic tumor vascularity. It also supplied important information for operative planning. Adjunct XRA was mandatory if detailed information about tumor-feeding vessels was requested by the neurosurgeon, especially in highly vascularized angiomatous meningiomas and in meningiomas suspected of tumor feeding by vessels of the internal carotid artery. (orig.)

  15. MR imaging and MR angiography in preoperative evaluation of intracranial meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    Goldmann, A. [Dept. of Diagnostic Radiology, Univ. of Ulm (Germany); Kunz, U. [Dept. of Neurosurgery, Military Hospital, Academic Hospital of the University, Ulm (Germany); Bader, C. [Dept. of Diagnostic Radiology, Univ. of Ulm (Germany); Leibing, U. [Dept. of Diagnostic Radiology, Univ. of Ulm (Germany); Friedrich, J.M. [Dept. of Diagnostic Radiology, Univ. of Ulm (Germany); Oldenkott, P. [Dept. of Neurosurgery, Military Hospital, Academic Hospital of the University, Ulm (Germany)

    1994-12-01

    A group of 41 patients with intracranial meningiomas were examined by MR imaging (MRI) and MR angiography (MRA) to assess the clinical value of MRA in the preoperative evaluation of these patients. The results of MRA were compared with the results of intraarterial cerebral catheter X-ray angiography (XRA; n = 19) and with the operative findings (n = 41). Our results showed a good correlation between MRA and XRA/surgery in demonstrating the relationship between the tumor and adjacent venous and arterial structures. Use of MRA was also helpful in demonstrating the degree of intrinsic tumor vascularity. It also supplied important information for operative planning. Adjunct XRA was mandatory if detailed information about tumor-feeding vessels was requested by the neurosurgeon, especially in highly vascularized angiomatous meningiomas and in meningiomas suspected of tumor feeding by vessels of the internal carotid artery. (orig.)

  16. Preoperative chemotherapy of bone and soft tissue sarcomas. Evaluation with dynamic MR imaging

    International Nuclear Information System (INIS)

    Ando, Yoko; Fukatsu, Hiroshi; Isomura, Takayuki; Itoh, Shigeki; Ishigaki, Takeo; Yamamura, Shigeki; Sugiura, Hideshi; Satoh, Keiji.

    1995-01-01

    Dynamic MR imaging and conventional angiography were performed in eleven patients with musculoskeletal malignant tumors before and after preoperative chemotherapy in order to evaluate its effect. Dynamic MRI was obtained with GRASS (TR/TE/FA=50/10-13/30) or SE (TR/TE=150-350/20). Although resected specimen in one case of osteosarcoma had the necrotic ratio of more than 90%, it had marked early enhancement in dynamic MRI, and microscopic examination revealed fibrotic necrosis with many capillaries. In soft tissue sarcomas with hemorrhage and/or cystic change, dynamic MRI findings did not necessarily correlate with the chemotherapy effect. Dynamic MRI was more useful than angiography because of its ability to show tumor vascularity and of its non-invasiveness. (author)

  17. Head and neck: normal variations and benign findings in FDG positron emission tomography/computed tomography imaging.

    Science.gov (United States)

    Højgaard, Liselotte; Berthelsen, Anne Kiil; Loft, Annika

    2014-04-01

    Positron emission tomography (PET)/computed tomography with FDG of the head and neck region is mainly used for the diagnosis of head and neck cancer, for staging, treatment evaluation, relapse, and planning of surgery and radio therapy. This article is a practical guide of imaging techniques, including a detailed protocol for FDG PET in head and neck imaging, physiologic findings, and pitfalls in selected case stories. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Preoperative magnetic resonance and intraoperative ultrasound fusion imaging for real-time neuronavigation in brain tumor surgery.

    Science.gov (United States)

    Prada, F; Del Bene, M; Mattei, L; Lodigiani, L; DeBeni, S; Kolev, V; Vetrano, I; Solbiati, L; Sakas, G; DiMeco, F

    2015-04-01

    Brain shift and tissue deformation during surgery for intracranial lesions are the main actual limitations of neuro-navigation (NN), which currently relies mainly on preoperative imaging. Ultrasound (US), being a real-time imaging modality, is becoming progressively more widespread during neurosurgical procedures, but most neurosurgeons, trained on axial computed tomography (CT) and magnetic resonance imaging (MRI) slices, lack specific US training and have difficulties recognizing anatomic structures with the same confidence as in preoperative imaging. Therefore real-time intraoperative fusion imaging (FI) between preoperative imaging and intraoperative ultrasound (ioUS) for virtual navigation (VN) is highly desirable. We describe our procedure for real-time navigation during surgery for different cerebral lesions. We performed fusion imaging with virtual navigation for patients undergoing surgery for brain lesion removal using an ultrasound-based real-time neuro-navigation system that fuses intraoperative cerebral ultrasound with preoperative MRI and simultaneously displays an MRI slice coplanar to an ioUS image. 58 patients underwent surgery at our institution for intracranial lesion removal with image guidance using a US system equipped with fusion imaging for neuro-navigation. In all cases the initial (external) registration error obtained by the corresponding anatomical landmark procedure was below 2 mm and the craniotomy was correctly placed. The transdural window gave satisfactory US image quality and the lesion was always detectable and measurable on both axes. Brain shift/deformation correction has been successfully employed in 42 cases to restore the co-registration during surgery. The accuracy of ioUS/MRI fusion/overlapping was confirmed intraoperatively under direct visualization of anatomic landmarks and the error was surgery and is less expensive and time-consuming than other intraoperative imaging techniques, offering high precision and

  19. Improved CHESS imaging with the use of rice pads: Investigation in the neck, shoulder, and elbow.

    Science.gov (United States)

    Moriya, Susumu; Miki, Yukio; Yokobayashi, Tsuneo; Yamamoto, Akira; Kanagaki, Mitsunori; Komori, Yoshiaki; Fujimoto, Koji; Ishikawa, Mitsunori

    2010-06-01

    To investigate the feasibility of rice pads for improving nonuniform fat suppression in magnetic resonance imaging (MRI) of the neck, shoulder, and elbow using the chemical shift selective (CHESS) technique. CHESS imaging of the neck, shoulder, and elbow was performed on 10 healthy volunteers with and without the use of rice pads. Images were visually assessed by one radiologist and one radiologic technologist using a four-point scale. Results were compared using Wilcoxon's signed rank sum test. Images with and without rice pads were rated 3.9 and 1.5 for the neck (P = 0.002), 3.85 and 2.5 for the shoulder (P = 0.002), and 3.4 and 2.45 for the elbow (P = 0.004). Fat-suppressed images obtained using the CHESS technique were significantly improved by rice pads for the neck, shoulder, and elbow, indicating that image deterioration with CHESS caused by magnetic field nonuniformity can be improved by rice pads in all body areas.

  20. Head and neck computed tomography virtual endoscopy: evaluation of a new imaging technique.

    Science.gov (United States)

    Gallivan, R P; Nguyen, T H; Armstrong, W B

    1999-10-01

    To evaluate a new radiographic imaging technique: computed tomography virtual endoscopy (CTVE) for head and neck tumors. Twenty-one patients presenting with head and neck masses who underwent axial computed tomography (CT) scan with contrast were evaluated by CTVE. Comparisons were made with video-recorded images and operative records to evaluate the potential utility of this new imaging technique. Twenty-one patients with aerodigestive head and neck tumors were evaluated by CTVE. One patient had a nasal cylindrical cell papilloma; the remainder, squamous cell carcinomas distributed throughout the upper aerodigestive tract. Patients underwent complete head and neck examination, flexible laryngoscopy, axial CT with contrast, CTVE, and in most cases, operative endoscopy. Available clinical and radiographic evaluations were compared and correlated to CTVE findings. CTVE accurately demonstrated abnormalities caused by intraluminal tumor, but where there was apposition of normal tissue against tumor, inaccurate depictions of surface contour occurred. Contour resolution was limited, and mucosal irregularity could not be defined. There was very good overall correlation between virtual images, flexible laryngoscopic findings, rigid endoscopy, and operative evaluation in cases where oncological resections were performed. CTVE appears to be most accurate in evaluation of subglottic and nasopharyngeal anatomy in our series of patients. CTVE is a new radiographic technique that provides surface-contour details. The technique is undergoing rapid technical evolution, and although the image quality is limited in situations where there is apposition of tissue folds, there are a number of potential applications for this new imaging technique.

  1. Diagnostic imaging of hilar cholangiocarcinoma: preoperative evaluation of ERC, MRC and PTC in comparison with histopathology

    International Nuclear Information System (INIS)

    Romaneehsen, B.; Mainz Univ.; Otto, G.; Lohse, A.W.; Bittinger, F.; Herber, S.; Oberholzer, K.; Pitton, M.B.; Thelen, M.

    2004-01-01

    Purpose: To compare the results of the preoperative workup consisting of endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), and percutaneous resonance cholangiography (PTC) with the tumor extent of the surgical specimen in patients with hilar cholangiocarcinoma (hilCC). Materials and Methods: Between 9/1997 and 12/2002. 59 patients with hilCC tumor underwent surgical resection. Preoperative ERC, MRC, and PTC were analyzed, blinded for the identity of the patient, and compared with the surgical specimen. For this retrospective analysis, 55 of the initial 59 ERCs, 39 of the initial 40 MRCs and 32 of the initial 38 PTCs were available. Most of the ERCs and MRCs had been performed at referring institutions by various investigators. In 20 patients, all three imaging modalities were available for direct comparison. Results: The mean scores of the visualization of the bile ducts and tumor differ considerably for ERC, MRC and PTC, with PTC visualizing the bile ducts better than ERC (p<0.001) and MRC (p=0.019). The tumor classification according to Bismuth and Corlette was correctly predicted by ERC in 29%, by MRC in 36% and by PTC in 53%. The tumor extent was overestimated in 40% (ERC), 41% (MRC) and 31% (PTC) and underestimated in less than 10% for all modalities. Twenty patients, who underwent all three imaging modalities, were included in an additional analysis for a direct comparison of ERC, MRC and PTC. PTC provided correct or acceptable information on tumor extent in 19 of 20 patients, MRC in 15 of 20 patients, and ERC in only 11 of 20 patients. The statistical analysis revealed a significant superiority of PTC to ERC (McNemar test: p<0.01) but not to MRC (p=0.22). (orig.)

  2. Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pengel, Kenneth E., E-mail: k.pengel@nki.nl [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Loo, Claudette E. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Wesseling, Jelle [Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Pijnappel, Ruud M. [Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands); Rutgers, Emiel J.Th. [Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Gilhuijs, Kenneth G.A. [Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam (Netherlands); Department of Radiology/Image Sciences Institute, University Medical Center Utrecht Heidelberglaan 100, 3584 CX Utrecht (Netherlands)

    2014-02-15

    Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted.

  3. Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

    International Nuclear Information System (INIS)

    Pengel, Kenneth E.; Loo, Claudette E.; Wesseling, Jelle; Pijnappel, Ruud M.; Rutgers, Emiel J.Th.; Gilhuijs, Kenneth G.A.

    2014-01-01

    Aim: To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT). Methods: We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC). Results: MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68. Conclusions: It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted

  4. Role of fine needle aspiration cytology in the preoperative investigation of branchial cysts.

    Science.gov (United States)

    Slater, Jacqueline; Serpell, Jonathan W; Woodruff, Stacey; Grodski, Simon

    2012-01-01

    Successful preoperative diagnosis of a branchial cyst requires a systematic approach. The aim of this study was to evaluate methods of investigation of a lateral neck swelling suspicious for a branchial cyst, and to highlight cases where a less benign cause for the swelling should be suspected and therefore management altered appropriately. A retrospective case study of 24 patients with presumed branchial cysts managed operatively was undertaken. Demographic, clinical, imaging, cytology and histopathological data were analysed to formulate an approach to the work-up of a lateral neck swelling suspected to be a branchial cyst. All 24 patients presented with a lateral neck mass thought to be a branchial cyst preoperatively underwent preoperative fine-needle aspiration cytology. The overall accuracy of cytology in predicting a benign branchial cyst histopathologically was 83.3% (20 out of 24). Successful preoperative diagnosis of a branchial cyst requires a combination of imaging and cytology. If there is concern that a lateral neck swelling is not a branchial cyst on clinical, imaging or cytological features, then a full preoperative work-up, including computed tomography scan of the neck and upper aero-digestive tract endoscopy should be performed, prior to an excisional biopsy. © 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons.

  5. Radiolabeled cetuximab: dose optimization for epidermal growth factor receptor imaging in a head-and-neck squamous cell carcinoma model

    NARCIS (Netherlands)

    Hoeben, B.A.W.; Molkenboer-Kuenen, J.D.M.; Oyen, W.J.G.; Peeters, W.J.M.; Kaanders, J.H.A.M.; Bussink, J.; Boerman, O.C.

    2011-01-01

    Noninvasive imaging of the epidermal growth factor receptor (EGFR) in head-and-neck squamous cell carcinoma could be of value to select patients for EGFR-targeted therapy. We assessed dose optimization of (111) Indium-DTPA-cetuximab ((111) In-cetuximab) for EGFR imaging in a head-and-neck squamous

  6. Molecular imaging of head and neck cancers. Perspectives of PET/MRI

    International Nuclear Information System (INIS)

    Stumpp, P.; Kahn, T.; Purz, S.; Sabri, O.

    2016-01-01

    The 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG-PET/CT) procedure is a cornerstone in the diagnostics of head and neck cancers. Several years ago PET-magnetic resonance imaging (PET/MRI) also became available as an alternative hybrid multimodal imaging method. Does PET/MRI have advantages over PET/CT in the diagnostics of head and neck cancers ?The diagnostic accuracy of the standard imaging methods CT, MRI and PET/CT is depicted according to currently available meta-analyses and studies concerning the use of PET/MRI for these indications are summarized. In all studies published up to now PET/MRI did not show superiority regarding the diagnostic accuracy in head and neck cancers; however, there is some evidence that in the future PET/MRI can contribute to tumor characterization and possibly be used to predict tumor response to therapy with the use of multiparametric imaging. Currently, 18 F-FDG-PET/CT is not outperformed by PET/MRI in the diagnostics of head and neck cancers. The additive value of PET/MRI due to the use of multiparametric imaging needs to be investigated in future research. (orig.) [de

  7. Uterine cervical cancer. Preoperative staging with magnetic resonance imaging; Zervixkarzinom. Praeoperatives Staging mittels Magnetresonanztomographie

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Hamm, B. [Charite-Universitaetsmedizin Berlin, Campus Charite Mitte, Klinik fuer Radiologie, Berlin (Germany)

    2011-07-15

    The treatment of uterine cervical carcinoma is largely dependent on the tumor stage. Despite significant inaccuracies in the clinical examination, uterine cervical cancer remains the only gynecological form of cancer still largely staged according to clinical findings. Although imaging is still not included in the staging the recently published revised FIGO (Federation International de Gynecologie et d'Obstetrique) system encourages the use of modern cross-sectional imaging (magnetic resonance imaging MRI and computed tomography CT). Due to its high soft tissue contrast MRI allows excellent non-invasive assessment of the cervix with direct tumor delineation as well as assessment of the prognosis based on morphological factors. Studies in the literature report an accuracy of 93% for MRI in the preoperative assessment of tumor size and in the differentiation of operable from advanced cervical cancer. Therefore MRI is considered to be the optimal modality for diagnostic evaluation starting from FIGO stage IB1, for radiation therapy planning, and for exclusion of recurrence in follow-up. In this paper we give an overview of the role of magnetic resonance imaging in preoperative staging of uterine cervical cancer. (orig.) [German] Die Therapieplanung beim Zervixkarzinom ist weitgehend von der Stadieneinteilung nach FIGO (Federation International de Gynecologie et d'Obstetrique) abhaengig, die trotz erheblicher Ungenauigkeiten bei der klinischen Stadieneinteilung weiterhin aufgrund klinischer Untersuchungsbefunde erfolgt. Obwohl bildgebende Verfahren nach wie vor fuer die Stadieneinteilung nicht vorgesehen sind, wird im kuerzlich erschienen revidierten Stagingsystem der FIGO zum ersten Mal die Verwendung moderner Schnittbilddiagnostik (MRT und CT) befuerwortet. Die MRT ermoeglicht dank ihres hohen Weichteilkontrasts ein ausgezeichnetes nichtinvasives Staging des Zervixkarzinoms mit direkter Tumordarstellung sowie einer Prognoseabschaetzung anhand

  8. Imaging diagnosis of venous malformation in head and neck

    International Nuclear Information System (INIS)

    Ha, Doo Hoe; Kim, Dong Ik; Suh, Jung Ho; Jung, Tae Sub

    1992-01-01

    The venous malformation in head and neck is a development vascular disease which arises from the arrest in the certain stage of vascular embryogenesis. However, the lesion extends along the fascia and has a tendency to recur after incomplete therapy. Retrospectively, the authors reviewed radiologic studies of 20 patients diagnosed as venous malformation during the last 5 years. The diagnosis was verified by histopathology (5 patients) and direct puncture angiography (15 patients). The radiologic studies included. CT with intravenous contrast injection (20 patients), RI angiography with 99mTc-pyrophosphate (6 patients), and direct puncture angiography (15 patients). Multiplicity of venous malformation was noted in 9 patients. On CT scan, the lesions had lobulated irregular shape, with heterogeneous appearance, showed delayed enhancing characteristics, and had the phleboliths (21 lesions). The venous malformations were located at the masticator space (including masseter muscle) (n = 12), retrobulbar space (n 6), submandibular space (n = 4), paravertebral space (n = 3) and so on. In two cases, the lesions were very extensive involving entire neck and parapharynx. On RI angiography using 99m Tc-pyrophosphate, all of the lesions showed persistent and delayed uptake. With direct puncture angiography the lesions could be classified as acinar pattern (n = 17) and mixed pattern (acinar and saccular) (n = 2). Venous connections were noted in 10 lesions. In conclusion, if a soft tissue mass on head and neck shows a heterogeneous attenuation density with or without calcified phlebolith on CT scan, RI angiography is recommended as a next diagnostic study. If it shows delayed persistent uptake, venous malformation can be suspected. Finally direct puncture angiography can verify the nature and extent of the lesion

  9. Preoperative conventional magnetic resonance images versus magnetic resonance arthrography of subacromial impingement syndrome

    International Nuclear Information System (INIS)

    Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong; Lee, In Sook; Lee, Seung Jun

    2012-01-01

    To evaluate the usefulness of conventional magnetic resonance images (MRI) for arthroscopic surgery in subacromial impingement syndrome of the shoulder, as an alternative to MR arthrography with additional T2 fat saturation images (MRA). The preoperative MRI of 77 patients (45 females, 32 males) (52 right, 25 left) and MRA of 34 patients (14 females, 20 males) (24 right, 10 left) with subsequent arthroscopic confirmation of subacromial impingement syndrome were reviewed retrospectively. The lesions requiring arthroscopic surgery were 95 subacromial spurs, 101 subacromial bursitis, and 51 full-thickness and 44 partial thickness tears of the supraspinatus among 111 cases for both studies. A two by two table was constructed in order to calculate the sensitivity and specificity of both studies against arthroscopic outcomes. Also we analyzed the false positive and false negative cases of the full-thickness tears individually. The detection rates of subacromial spur and bursitis and full and partial thickness tears of the supraspinatus were 91%, 94%, 77%, and 65% in MRI and 93%, 100%, 83%, and 77% in MRA respectively. Their specificities were 33%, 33%, 90%, and 76% in MRI and 50%, 75%, 100%, and 71% in MRA respectively. Eleven false negative cases in regards to MRI resulted in Ellman's grade 3 partial thickness tear (72.7%), mild bursitis (63.6%), greater tuberosity erosion (45.5%), and negative fluid signal of the glenohumeral joint (81.8%). Three false positive cases on the MRI were induced from errors with lower window depth and width on the imagings. Two false negative cases on MRA were induced from the adhesion between Ellman's grade 3 rim rent tear and the glenohumeral joint cavity. Conventional MR images could be used to decide the arthroscopic surgery in subacromial impingement syndrome, as an alternative to MR arthrography with additional T2 fat saturation images

  10. Preoperative conventional magnetic resonance images versus magnetic resonance arthrography of subacromial impingement syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong [Pusan National Univ. Yangsan Hospital, Yangsan (Korea, Republic of); Lee, In Sook; Lee, Seung Jun [Pusan National Univ. Hospital, Busan (Korea, Republic of)

    2012-09-15

    To evaluate the usefulness of conventional magnetic resonance images (MRI) for arthroscopic surgery in subacromial impingement syndrome of the shoulder, as an alternative to MR arthrography with additional T2 fat saturation images (MRA). The preoperative MRI of 77 patients (45 females, 32 males) (52 right, 25 left) and MRA of 34 patients (14 females, 20 males) (24 right, 10 left) with subsequent arthroscopic confirmation of subacromial impingement syndrome were reviewed retrospectively. The lesions requiring arthroscopic surgery were 95 subacromial spurs, 101 subacromial bursitis, and 51 full-thickness and 44 partial thickness tears of the supraspinatus among 111 cases for both studies. A two by two table was constructed in order to calculate the sensitivity and specificity of both studies against arthroscopic outcomes. Also we analyzed the false positive and false negative cases of the full-thickness tears individually. The detection rates of subacromial spur and bursitis and full and partial thickness tears of the supraspinatus were 91%, 94%, 77%, and 65% in MRI and 93%, 100%, 83%, and 77% in MRA respectively. Their specificities were 33%, 33%, 90%, and 76% in MRI and 50%, 75%, 100%, and 71% in MRA respectively. Eleven false negative cases in regards to MRI resulted in Ellman's grade 3 partial thickness tear (72.7%), mild bursitis (63.6%), greater tuberosity erosion (45.5%), and negative fluid signal of the glenohumeral joint (81.8%). Three false positive cases on the MRI were induced from errors with lower window depth and width on the imagings. Two false negative cases on MRA were induced from the adhesion between Ellman's grade 3 rim rent tear and the glenohumeral joint cavity. Conventional MR images could be used to decide the arthroscopic surgery in subacromial impingement syndrome, as an alternative to MR arthrography with additional T2 fat saturation images.

  11. National variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic carotid artery stenosis.

    Science.gov (United States)

    Arous, Edward J; Simons, Jessica P; Flahive, Julie M; Beck, Adam W; Stone, David H; Hoel, Andrew W; Messina, Louis M; Schanzer, Andres

    2015-10-01

    Carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis is among the most common procedures performed in the United States. However, consensus is lacking regarding optimal preoperative imaging, carotid duplex ultrasound criteria, and ultimately, the threshold for surgery. We sought to characterize national variation in preoperative imaging, carotid duplex ultrasound criteria, and threshold for surgery for asymptomatic CEA. The Society for Vascular Surgery Vascular Quality Initiative (VQI) database was used to identify all CEA procedures performed for asymptomatic carotid artery stenosis between 2003 and 2014. VQI currently captures 100% of CEA procedures performed at >300 centers by >2000 physicians nationwide. Three analyses were performed to quantify the variation in (1) preoperative imaging, (2) carotid duplex ultrasound criteria, and (3) threshold for surgery. Of 35,695 CEA procedures in 33,488 patients, the study cohort was limited to 19,610 CEA procedures (55%) performed for asymptomatic disease. The preoperative imaging modality used before CEA varied widely, with 57% of patients receiving a single preoperative imaging study (duplex ultrasound imaging, 46%; computed tomography angiography, 7.5%; magnetic resonance angiography, 2.0%; cerebral angiography, 1.3%) and 43% of patients receiving multiple preoperative imaging studies. Of the 16,452 asymptomatic patients (89%) who underwent preoperative duplex ultrasound imaging, there was significant variability between centers in the degree of stenosis (50%-69%, 70%-79%, 80%-99%) designated for a given peak systolic velocity, end diastolic velocity, and internal carotid artery-to-common carotid artery ratio. Although 68% of CEA procedures in asymptomatic patients were performed for an 80% to 99% stenosis, 26% were performed for a 70% to 79% stenosis, and 4.1% were performed for a 50% to 69% stenosis. At the surgeon level, the range in the percentage of CEA procedures performed for a duplex ultrasound

  12. The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma

    International Nuclear Information System (INIS)

    Oezsarlak, Oe.; Schepens, E.; Corthouts, B.; Beeck, B.O. de; Parizel, P.M.; De Schepper, A.M.; Tjalma, W.; Marck, E. van

    2003-01-01

    The aim of this study was to compare the preoperative findings of abdominal/pelvic CT and MRI with the preoperative clinical International Federation of Obstetrics and Gynecology (FIGO) staging and postoperative pathology report in patients with primary cancer of the cervix. Thirty-six patients with surgical-pathological proven primary cancer of the cervix were retrospectively studied for preoperative staging by clinical examination, CT, and MR imaging. Studied parameters for preoperative staging were the presence of tumor, tumor extension into the parametrial tissue, pelvic wall, adjacent organs, and lymph nodes. The CT was performed in 32 patients and MRI (T1- and T2-weighted images) in 29 patients. The CT and MR staging were based on the FIGO staging system. Results were compared with histological findings. The group is consisted of stage 0 (in situ):1, Ia:1, Ib:8, IIa:2, IIb:12, IIIa:4, IVa:6, and IVb:2 patients. The overall accuracy of staging for clinical examination, CT, and MRI was 47, 53, and 86%, respectively. The MRI incorrectly staged 2 patients and did not visualize only two tumors; one was an in situ (stage-0) and one stage-Ia (microscopic) disease. The MRI is more accurate than CT and they are both superior to clinical examination in evaluating the locoregional extension and preoperative staging of primary cancer of the cervix. (orig.)

  13. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik [Dept. of Radiology, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of); Park, Hong Gi; Kwak, Ji Hoon [Dept. of Orthopedic Surgery, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of)

    2012-02-15

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  14. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    International Nuclear Information System (INIS)

    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik; Park, Hong Gi; Kwak, Ji Hoon

    2012-01-01

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  15. Lesion-induced pseudo-dominance at functional magnetic resonance imaging: implications for preoperative assessments.

    Science.gov (United States)

    Ulmer, John L; Hacein-Bey, Lotfi; Mathews, Vincent P; Mueller, Wade M; DeYoe, Edgar A; Prost, Robert W; Meyer, Glenn A; Krouwer, Hendrikus G; Schmainda, Kathleen M

    2004-09-01

    To illustrate how lesion-induced neurovascular uncoupling at functional magnetic resonance imaging (fMRI) can mimic hemispheric dominance opposite the side of a lesion preoperatively. We retrospectively reviewed preoperative fMRI mapping data from 50 patients with focal brain abnormalities to establish patterns of hemispheric dominance of language, speech, visual, or motor system functions. Abnormalities included gliomas (31 patients), arteriovenous malformations (AVMs) (11 patients), other congenital lesions (4 patients), encephalomalacia (3 patients), and tumefactive encephalitis (1 patient). A laterality ratio of fMRI hemispheric dominance was compared with actual hemispheric dominance as verified by electrocortical stimulation, Wada testing, postoperative and posttreatment deficits, and/or lesion-induced deficits. fMRI activation maps were generated with cross-correlation (P frontal gyrus gliomas and in one patient with focal tumefactive meningoencephalitis, fMRI incorrectly suggested strong right hemispheric speech dominance. In two patients with lateral precentral gyrus region gliomas and one patient with a left central sulcus AVM, the fMRI pattern incorrectly suggested primary corticobulbar motor dominance contralateral to the side of the lesion. In a patient with a right superior frontal gyrus AVM, fMRI revealed pronounced left dominant supplementary motor area activity in response to a bilateral complex motor task, but right superior frontal gyrus perilesional hemorrhage and edema subsequently caused left upper-extremity plegia. Pathophysiological factors that might have caused neurovascular uncoupling and facilitated pseudo-dominance at fMRI in these patients included direct tumor infiltration, neovascularity, cerebrovascular inflammation, and AVM-induced hemodynamic effects. Sixteen patients had proven (1 patient), probable (2 patients), or possible (13 patients) but unproven lesion-induced homotopic cortical reorganization. Lesion-induced neurovascular

  16. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography, computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with pathologically positive neck lymph node

    Energy Technology Data Exchange (ETDEWEB)

    Jwa, Eun Jin; Lee, Sang Wook; Kim, Jae Seung [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); and others

    2012-12-15

    To evaluate the prognostic value of preoperative neck lymph node (LN) assessment with {sup 18}F-fluorodeoxyglucose positron emission tomography ({sup 18}F-FDG PET), computed tomography (CT), and magnetic resonance imaging (MRI) in oral cavity squamous cell carcinoma (OSCC) patients with pathologically positive LN. In total, 47 OSCC patients with pathologically positive LN were retrospectively reviewed with preoperative {sup 18}F-FDG PET and CT/MRI. All patients underwent surgical resection, neck dissection and postoperative adjuvant radiotherapy and/or chemotherapy between March 2002 and October 2010. Histologic correlation was performed for findings of {sup 18}F-FDG PET and CT/MRI. Thirty-six (76.6%) of 47 cases were correctly diagnosed with neck LN metastasis by {sup 18}F-FDG PET and 32 (68.1%) of 47 cases were correctly diagnosed by CT/MRI. Follow-up ranged from 20 to 114 months (median, 56 months). Clinically negative nodal status evaluated by {sup 18}F-FDG PET or CT/MRI revealed a trend toward better clinical outcomes in terms of overall survival, disease-free survival, local recurrence-free survival, regional nodal recurrence-free survival, and distant metastasis-free survival rates even though the trends were not statistically significant. However, there was no impact of neck node standardized uptake value (SUV{sub max}) on clinical outcomes. Notably, SUVmax showed significant correlation with tumor size in LN (p < 0.01, R{sup 2} = 0.62). PET and CT/MRI status of LN also had significant correlation with the size of intranodal tumor deposit (p < 0.05, R{sup 2} = 0.37 and p < 0.01, R{sup 2} = 0.48, respectively). {sup 18}F-FDG PET and CT/MRI at the neck LNs might improve risk stratification in OSCC patients with pathologically positive neck LN in this study, even without significant prognostic value of SUV{sub max}.

  17. Edema in the retropharyngeal space associated with head and neck tumors: CT imaging characteristics

    International Nuclear Information System (INIS)

    Kurihara, Noriko; Nakamura, Mamoru; Tsuda, Masashi; Saito, Haruo; Takahashi, Shoki; Higano, Shuichi

    2005-01-01

    To determine computed tomographic (CT) imaging characteristics of retropharygeal edema, we reviewed CT images in 18 patients with head and neck tumors. Retropharyngeal edema spread craniocaudally between soft palate and upper half of thyroid cartilage in all patients. No edema fluid extended above soft palate and below thyroid cartilage. Horizontally, it spread symmetrically in ten and asymmetrically in eight patients. Predominance in asymmetrical retropharyngeal edema was found on the same side as that of unilateral predominance both in lymph nodes enlargement and jugular vein stenosis/occlusion. All patients had edema also in other cervical spaces. Edema of retropharyngeal and other spaces fluctuated synchronously. In 14 patients, as primary lesion and/or cervical lymph nodes regressed, retropharyngeal edema disappeared or decreased. Retropharyngeal edema had some imaging characteristics. With knowledge of that, we could avoid diagnostic confusion when evaluating head and neck CT images. (orig.)

  18. The comparison of aneurysmal necks measured on three dimensional reconstruction images of rotational DSA and those of traditional DSA

    International Nuclear Information System (INIS)

    Wu Chunhong; Chen Zuoquan; Gu Binxian; Zhang Guiyun

    2006-01-01

    Objective: To evaluate the value of three dimensional reconstruction images of rotational DSA on measuring aneurysmal necks and make a comparison with traditional DSA so as to provide more abundant and accurate information for the embolization of aneurysm. Methods: A comparison was made between the measurement of aneurismal necks from 14 cases with traditional DSA examination and a measurement made on three dimensional reconstruction images of the same patients. Results: There was a difference shown in the measurement of the aneurysmal necks between three dimensional reconstruction images of rotational DSA and those of traditional DSA, outcoming with more angles and data on three dimensional reconstruction images. Conclusions: There are more angles of aneurysmal neck can be shown on rotational 3D DSA especially for the demonstration of the largest aneurysmal neck with a directional value for the intervention. (authors)

  19. MRI imaging of fetal neck masses with airway compromise: utility in delivery planning

    Energy Technology Data Exchange (ETDEWEB)

    Kathary, N.; Bulas, D.I. [Dept. of Radiology, Children' s National Medical Center, Washington, DC (United States); Newman, K.D. [Dept. of Surgery, Children' s National Medical Center, Washington, DC (United States); Schonberg, R.L. [Dept. of Medical Genetics, Children' s National Medical Center, Washington, DC (United States)

    2001-10-01

    We present two cases of fetal neck masses that were initially diagnosed by ultrasound and further evaluated with prenatal MRI. MRI findings aided in further delineating the neck masses, increasing confidence in the final diagnosis (cervical teratoma and cystic hygroma). With the fetal airway typically filled with fluid that is of high signal on T2-weighted sequences, MRI images in three planes could identify whether the fetal larynx and trachea were partially or completely compressed by the neck tumor. This information was particularly useful in determining if a controlled delivery such as ex utero intrapartum treatment (EXIT) was necessary and aided the surgeons in planning their approach to establishing airway control in the delivery room. (orig.)

  20. MRI imaging of fetal neck masses with airway compromise: utility in delivery planning

    International Nuclear Information System (INIS)

    Kathary, N.; Bulas, D.I.; Newman, K.D.; Schonberg, R.L.

    2001-01-01

    We present two cases of fetal neck masses that were initially diagnosed by ultrasound and further evaluated with prenatal MRI. MRI findings aided in further delineating the neck masses, increasing confidence in the final diagnosis (cervical teratoma and cystic hygroma). With the fetal airway typically filled with fluid that is of high signal on T2-weighted sequences, MRI images in three planes could identify whether the fetal larynx and trachea were partially or completely compressed by the neck tumor. This information was particularly useful in determining if a controlled delivery such as ex utero intrapartum treatment (EXIT) was necessary and aided the surgeons in planning their approach to establishing airway control in the delivery room. (orig.)

  1. Negative magnetic resonance imaging in femoral neck stress fracture with joint effusion: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Nobutoshi; Okuyama, Koichiro; Kamo, Keiji; Chiba, Mitsuho [Akita Rosai Hospital, Department of Orthopedic Surgery, Odate, Akita (Japan); Shimada, Yoichi [Akita University School of Medicine, Department of Orthopedic Surgery, Akita (Japan)

    2016-06-15

    Femoral neck stress fracture (FNSF) is well documented in the orthopedic literature and is generally associated with strenuous activities such as long-distance running and military training. The diagnostic yield of magnetic resonance imaging (MRI) for FNSF was reported to be 100 %, and early MRI is recommended when this fracture is suspected. We encountered a 16-year-old male long-distance runner with FNSF in whom the left femoral neck showed no signal changes on MRI although an effusion was detected in the left hip joint. One month later, roentgenograms revealed periosteal callus and oblique consolidation of the left femoral neck, confirming the diagnosis of compression FNSF. Because FNSF with a normal bone marrow signal on MRI is very rare, this patient is presented here. (orig.)

  2. Paperback atlas of anatomical sectional images: Computerized tomography and NMR imaging. Vol. 1. Head, neck, vertebral column, joints

    International Nuclear Information System (INIS)

    Moeller, T.B.; Reif, E.

    1993-01-01

    Using the nomenclature relating to X-ray findings, the paperback atlas provides a concise, yet accurate description of fine anatomical structures visualized by sectional imaging procedures. Each of the approx. 250 sample images shown for the regions of the head (including neurocranium), vertebral column, neck, thorax, abdomen and muscosceletal system (including joints) is supplemented with a drawing that permits an immediate identification of any structure of interest. (orig.) [de

  3. Evaluation of the response to preoperative chemotherapy with PET image in osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Dae Geun; Lee, Jong Seok; Kim, Sug Jun; Lee, Soo Yong

    1999-12-01

    F18 FDG PET scan has an advantage in evaluating the biologic status of the tumors. The purpose of this study is evaluate the role of PET scan in pre- and post chemotherapeutic osteosarcomas and correlate the findings with pathologic examination. Nine cases of osteosarcoma had biopsy and preoperative chemotherapy at our department. There were 4 distal femur, 4 proximal tibia and 1 distal ulna. All case had initial MRI and PET scan and these were repeated after 2 cycles of chemotherapy. Under PET image parameters such as VOI (volume of interest), total activity, degree of necrosis and T/N (tumor/normal tissue) ratio were analyzed. There was a significant correlation between the calculated necrosis in PET and observed one on pathologic specimen (r2=0.78, p<0.05). Cross correlation among identified variables revealed meaningful result between T/N ration and tumor necrosis (r2=0.45, p<0.05). As the T/N ratio decrease, so much more the tumor necrosis was. F18 FDG PET scan could get objective data such as volume, degree of necrosis and total activity and was also useful in estimating the contribution of chemotherapy in tumor necrosis over the innate necrosis before treatment.

  4. Evaluation of the response to preoperative chemotherapy with PET image in osteosarcoma

    International Nuclear Information System (INIS)

    Jeon, Dae Geun; Lee, Jong Seok; Kim, Sug Jun; Lee, Soo Yong

    1999-12-01

    F18 FDG PET scan has an advantage in evaluating the biologic status of the tumors. The purpose of this study is evaluate the role of PET scan in pre- and post chemotherapeutic osteosarcomas and correlate the findings with pathologic examination. Nine cases of osteosarcoma had biopsy and preoperative chemotherapy at our department. There were 4 distal femur, 4 proximal tibia and 1 distal ulna. All case had initial MRI and PET scan and these were repeated after 2 cycles of chemotherapy. Under PET image parameters such as VOI (volume of interest), total activity, degree of necrosis and T/N (tumor/normal tissue) ratio were analyzed. There was a significant correlation between the calculated necrosis in PET and observed one on pathologic specimen (r2=0.78, p<0.05). Cross correlation among identified variables revealed meaningful result between T/N ration and tumor necrosis (r2=0.45, p<0.05). As the T/N ratio decrease, so much more the tumor necrosis was. F18 FDG PET scan could get objective data such as volume, degree of necrosis and total activity and was also useful in estimating the contribution of chemotherapy in tumor necrosis over the innate necrosis before treatment

  5. Prospective evaluation of stress myocardial perfusion imaging for pre-operative cardiac risk assessment

    International Nuclear Information System (INIS)

    Byrne, A.J.; Rowe, C.C.; Flannery, G.

    2002-01-01

    Full text: A prospective evaluation of patients who underwent stress myocardial perfusion imaging (MPI) to assess preoperative cardiac risk was undertaken. At the time of the scan patients were classified into 4 Clinical Risk groups (CR) based on known clinical data. On completion of the scan, the patient was then categorised into 4 Scan based Risk groups (SR), incorporating size of perfusion deficit, single versus multi-vessel disease and ejection fraction. Surgery at Austin and Repatriation Medical Centre within 6 months of scan and complications were identified using the hospital medical database. Major early cardiac events coded were death (cardiac related), myocardial infarction, unstable angina, acute pulmonary oedema, cardiac arrest, and urgent revascularisation. 208 patients have reached 6 months post-MPI scan. Of these 119 (57%) were identified as having surgery. Of the Scan Risk groups, 63% of normal, 57% of increased, and 47% of high and very high groups have had surgery. An abnormal scan is associated with a three-fold risk of cardiac complication (3.5% vs 11.3%). This is lower than most previous reports and may be due to higher representation of low risk surgical procedures (14% in this series), improved peri-operative care and/or the test result influence on management (suggested by decreasing surgical rate as SR estimate rose). Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  6. 3D Rapid Prototyping for Otolaryngology—Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling

    Science.gov (United States)

    Chan, Harley H. L.; Siewerdsen, Jeffrey H.; Vescan, Allan; Daly, Michael J.; Prisman, Eitan; Irish, Jonathan C.

    2015-01-01

    The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques

  7. 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

    Science.gov (United States)

    Chan, Harley H L; Siewerdsen, Jeffrey H; Vescan, Allan; Daly, Michael J; Prisman, Eitan; Irish, Jonathan C

    2015-01-01

    The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i) a mono-material paranasal sinus phantom for endoscopy training ii) a multi-material skull base simulator and iii) 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and fabrication techniques

  8. 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

    Directory of Open Access Journals (Sweden)

    Harley H L Chan

    Full Text Available The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i a mono-material paranasal sinus phantom for endoscopy training ii a multi-material skull base simulator and iii 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and

  9. Interleaving cerebral CT perfusion with neck CT angiography. Pt. II. Clinical implementation and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Oei, Marcel T.H.; Meijer, Frederick J.A.; Woude, Willem-Jan van der; Smit, Ewoud J.; Ginneken, Bram van; Manniesing, Rashindra; Prokop, Mathias [Radboud University Medical Centre, Department of Radiology and Nuclear Medicine, P.O. Box 9101, Nijmegen (Netherlands)

    2017-06-15

    Feasibility evaluation of the One-Step Stroke Protocol, which is an interleaved cerebral computed tomography perfusion (CTP) and neck volumetric computed tomography angiography (vCTA) scanning technique using wide-detector computed tomography, and to assess the image quality of vCTA. Twenty patients with suspicion of acute ischaemic stroke were prospectively scanned and evaluated with a head and neck CTA and with the One-Step Stroke Protocol. Arterial enhancement and contrast-to-noise ratio (CNR) in the carotid arteries was assessed. Three observers scored artefacts and image quality of the cervical arteries. The total z-coverage was evaluated. Mean enhancement in the carotid bifurcation was rated higher in the vCTA (595 ± 164 HU) than CTA (441 ± 117 HU). CNR was rated higher in vCTA. Image quality scores showed no significant difference in the region of the carotid bifurcation between vCTA and CTA. Lower neck image quality scores were slightly lower for vCTA due to artefacts, although not rated as diagnostically relevant. In ten patients, the origin of the left common carotid artery was missed by 1.6 ± 0.8 cm. Mean patient height was 1.8 ± 0.09 m. Carotid bifurcation and origin of vertebral arteries were covered in all patients. The One-Step Stroke Protocol is feasible with good diagnostic image quality of vCTA, although full z-coverage is limited in tall patients. (orig.)

  10. Can Preoperative Magnetic Resonance Imaging Predict the Reparability of Massive Rotator Cuff Tears?

    Science.gov (United States)

    Kim, Jung Youn; Park, Ji Seon; Rhee, Yong Girl

    2017-06-01

    Numerous studies have shown preoperative fatty infiltration of rotator cuff muscles to be strongly negatively correlated with the successful repair of massive rotator cuff tears (RCTs). To assess the association between factors identified on preoperative magnetic resonance imaging (MRI), especially infraspinatus fatty infiltration, and the reparability of massive RCTs. Case-control study; Level of evidence, 3. We analyzed a total of 105 patients with massive RCTs for whom MRI was performed ≤6 months before arthroscopic procedures. The mean age of the patients was 62.7 years (range, 46-83 years), and 46 were men. Among them, complete repair was possible in 50 patients (48%) and not possible in 55 patients (52%). The tangent sign, fatty infiltration of the rotator cuff, and Patte classification were evaluated as predictors of reparability. Using the receiver operating characteristic curve and the area under the curve (AUC), the prediction accuracy of each variable and combinations of variables were measured. Reparability was associated with fatty infiltration of the supraspinatus ( P = .0045) and infraspinatus ( P 3 and grade >2, respectively. The examination of single variables revealed that infraspinatus fatty infiltration showed the highest AUC value (0.812; sensitivity: 0.86; specificity: 0.76), while the tangent sign showed the lowest AUC value (0.626; sensitivity: 0.38; specificity: 0.87). Among 2-variable combinations, the combination of infraspinatus fatty infiltration and the Patte classification showed the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96). The combination of 4 variables, that is, infraspinatus and supraspinatus fatty infiltration, the tangent sign, and the Patte classification, had an AUC of 0.866 (sensitivity: 0.28; specificity: 0.98), which was lower than the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96) among the 2-variable combinations. The tangent sign or Patte classification alone was not a predictive

  11. Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times.

    Directory of Open Access Journals (Sweden)

    Anna Sophie Berghoff

    Full Text Available BACKGROUND: MRI-based diffusion-weighted imaging (DWI visualizes the local differences in water diffusion in vivo. The prognostic value of DWI signal intensities on the source images and apparent diffusion coefficient (ADC maps respectively has not yet been studied in brain metastases (BM. METHODS: We included into this retrospective analysis all patients operated for single BM at our institution between 2002 and 2010, in whom presurgical DWI and BM tissue samples were available. We recorded relevant clinical data, assessed DWI signal intensity and apparent diffusion coefficient (ADC values and performed histopathological analysis of BM tissues. Statistical analyses including uni- and multivariate survival analyses were performed. RESULTS: 65 patients (34 female, 31 male with a median overall survival time (OS of 15 months (range 0-99 months were available for this study. 19 (29.2% patients presented with hyper-, 3 (4.6% with iso-, and 43 (66.2% with hypointense DWI. ADCmean values could be determined in 32 (49.2% patients, ranged from 456.4 to 1691.8*10⁻⁶ mm²/s (median 969.5 and showed a highly significant correlation with DWI signal intensity. DWI hyperintensity correlated significantly with high amount of interstitial reticulin deposition. In univariate analysis, patients with hyperintense DWI (5 months and low ADCmean values (7 months had significantly worse OS than patients with iso/hypointense DWI (16 months and high ADCmean values (30 months, respectively. In multivariate survival analysis, high ADCmean values retained independent statistical significance. CONCLUSIONS: Preoperative DWI findings strongly and independently correlate with OS in patients operated for single BM and are related to interstitial fibrosis. Inclusion of DWI parameters into established risk stratification scores for BM patients should be considered.

  12. Imaging of denervation in the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Alexandra [Radiology Department, Instituto Portugues de Oncologia Francisco Gentil, Centro de Lisboa, Rua Prof. Lima Basto, 1093 Lisboa (Portugal)], E-mail: borgalexandra@gmail.com

    2010-05-15

    Denervation changes maybe the first sign of a cranial nerve injury. Recognition of denervation patterns can be used to determine the site and extent of a lesion and to tailor imaging studies according to the most likely location of an insult along the course of the affected cranial nerve(s). In addition, the extent of denervation can be used to predict functional recovery after treatment. On imaging, signs of denervation can be misleading as they often mimic recurrent neoplasm or inflammatory conditions. Imaging can both depict denervation related changes and establish its cause. This article briefly reviews the anatomy of the extracranial course of motor cranial nerves with particular emphasis on the muscles supplied by each nerve, the imaging features of the various stages of denervation, the different patterns of denervation that maybe helpful in the topographic diagnosis of nerve lesions and the most common causes of cranial nerve injuries leading to denervation.

  13. Imaging of denervation in the head and neck.

    Science.gov (United States)

    Borges, Alexandra

    2010-05-01

    Denervation changes maybe the first sign of a cranial nerve injury. Recognition of denervation patterns can be used to determine the site and extent of a lesion and to tailor imaging studies according to the most likely location of an insult along the course of the affected cranial nerve(s). In addition, the extent of denervation can be used to predict functional recovery after treatment. On imaging, signs of denervation can be misleading as they often mimic recurrent neoplasm or inflammatory conditions. Imaging can both depict denervation related changes and establish its cause. This article briefly reviews the anatomy of the extracranial course of motor cranial nerves with particular emphasis on the muscles supplied by each nerve, the imaging features of the various stages of denervation, the different patterns of denervation that maybe helpful in the topographic diagnosis of nerve lesions and the most common causes of cranial nerve injuries leading to denervation. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Imaging of denervation in the head and neck

    International Nuclear Information System (INIS)

    Borges, Alexandra

    2010-01-01

    Denervation changes maybe the first sign of a cranial nerve injury. Recognition of denervation patterns can be used to determine the site and extent of a lesion and to tailor imaging studies according to the most likely location of an insult along the course of the affected cranial nerve(s). In addition, the extent of denervation can be used to predict functional recovery after treatment. On imaging, signs of denervation can be misleading as they often mimic recurrent neoplasm or inflammatory conditions. Imaging can both depict denervation related changes and establish its cause. This article briefly reviews the anatomy of the extracranial course of motor cranial nerves with particular emphasis on the muscles supplied by each nerve, the imaging features of the various stages of denervation, the different patterns of denervation that maybe helpful in the topographic diagnosis of nerve lesions and the most common causes of cranial nerve injuries leading to denervation.

  15. Comparison of bladder neck position in nulliparous and parous women using MR images in the sitting position

    International Nuclear Information System (INIS)

    Masaki, Kiyoko; Okayama, Hisayo; Tuchikawa, Sachi; Saito, Yoshino; Endo, Yoshihiro; Morikawa, Shigehiro; Ninomiya, Sanae; Saito, Izumi; Hiraiwa, Yasuyuki

    2011-01-01

    The purpose of this study was to investigate the influence of childbirth on pelvic floor relaxation in females using the bladder neck position. The position of bladder neck was examined in 17 nulligravid (19-24 years of age) and 55 parous women (35-54) using MR images in the sitting position. The position of bladder neck from pubococcygeal line was 13.4 mm (mean) in nulligravid women, and 8.5 mm in parous women (p<0.05). The bladder neck position in parous women was significantly lower than that in nulligravid women. Therefore, it was clearly shown that childbirth causes the pelvic floor relaxation. (author)

  16. Is there a need for preoperative imaging of the internal mammary recipient site for autologous breast reconstruction?

    Science.gov (United States)

    Rozen, Warren M; Alonso-Burgos, Alberto; Murray, Alice C A; Whitaker, Iain S

    2013-01-01

    Preoperative imaging of recipient-site vasculatur in autologous breast reconstruction may potentiate improved outcomes through the identification of individual variations in vascular architecture. There are a range of both normal and pathologic states which can substantially affect the internal mammary vessels in particular, and the identification of these preoperatively may significantly affect operative approach. There are a range of imaging modalities available, with ultrasound particularly useful, and computed tomography angiography (CTA) evolving as a useful option, albeit with radiation exposure. The benefits of CTA must be balanced against its risks, which include contrast nephrotoxicity and allergic reactions, and radiation exposure. The radiation risk with thoracic imaging is substantially higher than that for donor sites, such as the abdominal wall, with reasons including exposure of the contralateral breast to radiation (with a risk of contralateral breast cancer in this population 2 to 6 times higher than that of primary breast cancer, reaching a 20-year incidence of 15%), as well as proximity to the thyroid gland. Current evidence suggests that although many cases may not warrant such imaging because of risk, the benefits of preoperative CTA in selected patients may outweigh the risks of exposure, prompting an individualized approach.

  17. Nonrigid Image Registration for Head and Neck Cancer Radiotherapy Treatment Planning With PET/CT

    International Nuclear Information System (INIS)

    Ireland, Rob H.; Dyker, Karen E.; Barber, David C.; Wood, Steven M.; Hanney, Michael B.; Tindale, Wendy B.; Woodhouse, Neil; Hoggard, Nigel; Conway, John; Robinson, Martin H.

    2007-01-01

    Purpose: Head and neck radiotherapy planning with positron emission tomography/computed tomography (PET/CT) requires the images to be reliably registered with treatment planning CT. Acquiring PET/CT in treatment position is problematic, and in practice for some patients it may be beneficial to use diagnostic PET/CT for radiotherapy planning. Therefore, the aim of this study was first to quantify the image registration accuracy of PET/CT to radiotherapy CT and, second, to assess whether PET/CT acquired in diagnostic position can be registered to planning CT. Methods and Materials: Positron emission tomography/CT acquired in diagnostic and treatment position for five patients with head and neck cancer was registered to radiotherapy planning CT using both rigid and nonrigid image registration. The root mean squared error for each method was calculated from a set of anatomic landmarks marked by four independent observers. Results: Nonrigid and rigid registration errors for treatment position PET/CT to planning CT were 2.77 ± 0.80 mm and 4.96 ± 2.38 mm, respectively, p = 0.001. Applying the nonrigid registration to diagnostic position PET/CT produced a more accurate match to the planning CT than rigid registration of treatment position PET/CT (3.20 ± 1.22 mm and 4.96 ± 2.38 mm, respectively, p = 0.012). Conclusions: Nonrigid registration provides a more accurate registration of head and neck PET/CT to treatment planning CT than rigid registration. In addition, nonrigid registration of PET/CT acquired with patients in a standardized, diagnostic position can provide images registered to planning CT with greater accuracy than a rigid registration of PET/CT images acquired in treatment position. This may allow greater flexibility in the timing of PET/CT for head and neck cancer patients due to undergo radiotherapy

  18. Usefulness of fat suppression MR imagings for head and neck cancers

    International Nuclear Information System (INIS)

    Kitagawa, Yoshimasa; Ishii, Yasuo; Morihiro, Hironori; Ogasawara, Toshiyuki

    1996-01-01

    Large amounts of fat and complex anatomy make the head and neck region one of the more challenging areas for MR imagings. The high signal intensity of fat on T1 weighted images (T1W1) has limited the utility of Gd-DTPA in imaging of head and neck lesions. The contrast enhanced lesions may have T1W1 signal intensity similar to fat, which results in diagnostic difficulty. A fat suppression technique used in conjunction with Gd-DTPA ensures that enhancing lesions will not be obscured by high signal from the surrounding fat or by chemical shift artifact. We evaluated the role or chemical shift imagings for fat suppression in the depiction of 15 patients with head and neck cancers. Gd-DTPA-enhanced fat suppression T1W1 were compared with conventional pre and postcontrast T1- and T2W1 using a four-point grading system (Grade 0-3) in detecting and defining the extent of primary lesions and lymphnodes. Gd-DTPA-enhanced fat suppression T1W1 (average score 2.93) which had a score of 3 in 14 patients, were superior to conventional T1W1 (0.73), postcontrast T1W1 (1.80) and T2W1 (1.67). Gd-DTPA enhanced fat suppression T1W1 were particularly beneficial in the detection of central necrosis or extracapsular invasion of neck lymphnodes as well as in defining the extent of tumor invasion to fat-containing areas such as bone marrow or cheek. Our data suggested that fat suppression technique was extremely useful to delineate the primary tumors and regional lymphnodes without increasing scan time or image postprocessing. (author)

  19. Atlas of postsurgical neuroradiology. Imaging of the brain, spine, and neck

    International Nuclear Information System (INIS)

    Ginat, Daniel Thomas; Westesson, Per-Lennart A.

    2012-01-01

    Covers the normal appearances and complications that may be encountered on neuroradiological examinations following surgery to the head, neck, and spine. Contains numerous images and to-the-point case descriptions. Serves as an invaluable and convenient resource for both neuroradiologists and neurosurgeons. The number of surgical procedures performed on the brain, head, neck, and spine has increased markedly in recent decades. As a result, postoperative changes are being encountered more frequently on neuroradiological examinations and constitute an important part of the workflow. However, the imaging correlates of postsurgical changes can be unfamiliar to neuroradiologists and neurosurgeons and are sometimes difficult to interpret. This book is written by experts in the field and contains an abundance of high-quality images and concise descriptions, which should serve as a useful guide to postsurgical neuroradiology. It will familiarize the reader with the various types of surgical procedure, implanted hardware, and complications. Indeed, this work represents the first text dedicated to the realm of postoperative neuroimaging. Topics reviewed include imaging after facial cosmetic surgery; orbital and oculoplastic surgery; sinus surgery; scalp and cranial surgery; brain tumor treatment; psychosurgery, neurodegenerative surgery, and epilepsy surgery; skull base surgery including transsphenoidal pituitary resection; temporal bone surgery including various ossicular prostheses; orthognathic surgery; surgery of the neck including the types of dissection and flap reconstruction; CSF diversion procedures and devices; spine surgery; and vascular and endovascular neurosurgery.

  20. Atlas of postsurgical neuroradiology. Imaging of the brain, spine, and neck

    Energy Technology Data Exchange (ETDEWEB)

    Ginat, Daniel Thomas [Massachusetts General Hospital, Boston, MA (United States). Harvard Medical School; Westesson, Per-Lennart A. [Univ. of Rochester Medical Center, Rochester, NY (United States). Div. of Neuroradiology

    2012-11-01

    Covers the normal appearances and complications that may be encountered on neuroradiological examinations following surgery to the head, neck, and spine. Contains numerous images and to-the-point case descriptions. Serves as an invaluable and convenient resource for both neuroradiologists and neurosurgeons. The number of surgical procedures performed on the brain, head, neck, and spine has increased markedly in recent decades. As a result, postoperative changes are being encountered more frequently on neuroradiological examinations and constitute an important part of the workflow. However, the imaging correlates of postsurgical changes can be unfamiliar to neuroradiologists and neurosurgeons and are sometimes difficult to interpret. This book is written by experts in the field and contains an abundance of high-quality images and concise descriptions, which should serve as a useful guide to postsurgical neuroradiology. It will familiarize the reader with the various types of surgical procedure, implanted hardware, and complications. Indeed, this work represents the first text dedicated to the realm of postoperative neuroimaging. Topics reviewed include imaging after facial cosmetic surgery; orbital and oculoplastic surgery; sinus surgery; scalp and cranial surgery; brain tumor treatment; psychosurgery, neurodegenerative surgery, and epilepsy surgery; skull base surgery including transsphenoidal pituitary resection; temporal bone surgery including various ossicular prostheses; orthognathic surgery; surgery of the neck including the types of dissection and flap reconstruction; CSF diversion procedures and devices; spine surgery; and vascular and endovascular neurosurgery.

  1. Magnetic resonance imaging: Atlas of the head, neck and spine

    International Nuclear Information System (INIS)

    Mills, C.M.; De Groot, J.; Posin, J.P.

    1987-01-01

    The purpose of this atlas is to provide the reader with a means to complement existing sources of information and to correlate the superb soft tissue contrast realized in magnetic resonance images with the appropriate anatomic and functional structures. Where appropriate, pathologic examples have been included to complement normal images. In addition, since MRI (magnetic resonance imaging) clearly separates gray from white matter, and thus accurately visualizes the position of functional tracts as they extend from cortex to spinal cord, a separate section on functional neuroanatomy has been provided. Likewise, the improved visualization of vascular structures and associated pathologic processes has led to the inclusion of vascular anatomy and associated perfusion territories. These additions will be of particular use in clinical practice, as precise lesion identification and localization can now be correlated to specific clinical symptomatology

  2. The accuracy of magnetic resonance imaging for preoperative deep myometrium assessment in endometrial cancer

    Directory of Open Access Journals (Sweden)

    Wan-Ju Wu

    2013-06-01

    Conclusion: In patients with endometrial cancer, a preoperative MRI contributes to accurate staging, allowing planning for the scale of surgery and preoperative counseling. In our study, the pretreatment identification of myometrium invasion provided the opportunity for small-scale surgery in the premenopausal women with early endometrial cancer. However, for the postmenopausal patients, the standard surgical procedure is indicated even if the degree of myometrium invasion is low.

  3. Ultrasound and MR-imaging in preoperative evaluation of two rare cases of scar endometriosis

    OpenAIRE

    Pados, George; Tympanidis, John; Zafrakas, Menelaos; Athanatos, Dimitrios; Bontis, John N

    2008-01-01

    Scar or incisional endometriosis is a rare, often misdiagnosed, pathologic condition of the abdominal wall. Two cases of incisional endometriosis are presented. Both patients presented with atypical cyclic pain and palpable nodules on scars of previous cesarean sections. In both cases, the mass was totally excised, after accurate preoperative evaluation with 2-D ultrasound, power Doppler and MRI. Microscopic examination confirmed the preoperatively presumed diagnosis of cutaneous endometriosi...

  4. Resting-State Functional Magnetic Resonance Imaging for Language Preoperative Planning

    Science.gov (United States)

    Branco, Paulo; Seixas, Daniela; Deprez, Sabine; Kovacs, Silvia; Peeters, Ronald; Castro, São L.; Sunaert, Stefan

    2016-01-01

    Functional magnetic resonance imaging (fMRI) is a well-known non-invasive technique for the study of brain function. One of its most common clinical applications is preoperative language mapping, essential for the preservation of function in neurosurgical patients. Typically, fMRI is used to track task-related activity, but poor task performance and movement artifacts can be critical limitations in clinical settings. Recent advances in resting-state protocols open new possibilities for pre-surgical mapping of language potentially overcoming these limitations. To test the feasibility of using resting-state fMRI instead of conventional active task-based protocols, we compared results from fifteen patients with brain lesions while performing a verb-to-noun generation task and while at rest. Task-activity was measured using a general linear model analysis and independent component analysis (ICA). Resting-state networks were extracted using ICA and further classified in two ways: manually by an expert and by using an automated template matching procedure. The results revealed that the automated classification procedure correctly identified language networks as compared to the expert manual classification. We found a good overlay between task-related activity and resting-state language maps, particularly within the language regions of interest. Furthermore, resting-state language maps were as sensitive as task-related maps, and had higher specificity. Our findings suggest that resting-state protocols may be suitable to map language networks in a quick and clinically efficient way. PMID:26869899

  5. Diagnostic accuracy and prognostic impact of restaging by magnetic resonance imaging after preoperative chemoradiotherapy in patients with rectal cancer

    International Nuclear Information System (INIS)

    Huh, Jung Wook; Kim, Hee Cheol; Lee, Soon Jin; Yun, Seong Hyeon; Lee, Woo Yong; Park, Yoon Ah; Cho, Yong Beom; Chun, Ho-Kyung

    2014-01-01

    Background: The prognostic role of restaging rectal magnetic resonance imaging (MRI) in patients with preoperative CRT has not been established. The goal of this study was to evaluate the diagnostic accuracy and prognostic role of radiological staging by rectal MRI after preoperative chemoradiation (CRT) in patients with rectal cancer. Methods: A total of 231 consecutive patients with rectal cancer who underwent preoperative CRT and radical resection from January 2008 to December 2009 were prospectively enrolled. The diagnostic accuracy and prognostic significance of post-CRT radiological staging by MRI was evaluated. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of radiological diagnosis of good responders (ypTNM stage 0–I) were 32%, 90%, 65%, and 69%, respectively. The overall accuracy of MRI restating for good responders was 68%. The 5-year disease-free survival rates of patients with radiological and pathological TNM stage 0, stage I, and stage II–III were 100%, 94%, and 76%, respectively (P = 0.037), and 97%, 87%, and 73%, respectively (P = 0.007). On multivariate analysis, post-CRT radiological staging by MRI was an independent prognostic factor for disease-free survival. Conclusion: Radiological staging by MRI after preoperative CRT may be an independent predictor of survival in patients with rectal cancer

  6. The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Hasan Hüseyin Tavukçu

    2015-06-01

    Full Text Available Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA, and Gleason scores (GSs. Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity.

  7. Preoperative staging of endometrial cancer using reduced field-of-view diffusion-weighted imaging: a preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Takashi; Hori, Masatoshi; Onishi, Hiromitsu; Sakane, Makoto; Tsuboyama, Takahiro; Tatsumi, Mitsuaki; Tomiyama, Noriyuki [Osaka University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Suita, Osaka (Japan); Nakamoto, Atsushi; Narumi, Yoshifumi [Osaka Medical College, Department of Radiology, Osaka (Japan); Kimura, Tadashi [Osaka University Graduate School of Medicine, Department of Obstetrics and Gynaecology, Osaka (Japan)

    2017-12-15

    To compare the image quality and diagnostic performance of reduced field-of-view (rFOV) versus conventional full field-of-view (fFOV) diffusion-weighted (DW) imaging of endometrial cancer. Fifty women with endometrial cancer underwent preoperative rFOV and fFOV DW imaging. Two radiologists compared the image qualities of both techniques, and five radiologists assessed superficial and deep myometrial invasion using both techniques. The statistical analysis included the Wilcoxon signed-rank test and paired t-test for comparisons of image quality and mean diagnostic values. Distortion, tumour delineation, and overall image quality were significantly better with rFOV DW imaging, compared to fFOV DW imaging (P < 0.05); however, the former was inferior in noise (P < 0.05). Regarding superficial invasion, the mean accuracies of the techniques did not differ statistically (rFOV, 58.0% versus fFOV, 56.0%; P = 0.30). Regarding deep myometrial invasion, rFOV DW imaging yielded significantly better mean accuracy, specificity, and positive predictive values (88.4%, 97.8%, and 91.7%, respectively), compared with fFOV DW imaging (84.8%, 94.1%, and 77.4%, respectively; P = 0.009, 0.005, and 0.011, respectively). Compared with fFOV DW imaging, rFOV DW imaging yielded less distortion, improved image quality and, consequently, better diagnostic performance for deep myometrial invasion of endometrial cancer. (orig.)

  8. Potential Impact of Preoperative Magnetic Resonance Imaging of the Breast on Patient Selection for Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Kühr, Marietta; Wolfgarten, Matthias; Stölzle, Marco; Leutner, Claudia; Höller, Tobias; Schrading, Simone; Kuhl, Christiane; Schild, Hans; Kuhn, Walther; Braun, Michael

    2011-01-01

    Purpose: Accelerated partial breast irradiation (APBI) after breast-conserving therapy is currently under investigation in prospective randomized studies. Multifocality and multicentricity are exclusion criteria for APBI. Preoperative breast magnetic resonance imaging (MRI) can detect ipsilateral and contralateral invasive tumor foci or ductal carcinoma in situ in addition to conventional diagnostic methods (clinical examination, mammography, and ultrasonography). The objective of this retrospective study was to evaluate the impact of preoperative MRI on patient selection for APBI. Methods and Materials: From 2002 to 2007, a total of 579 consecutive, nonselected patients with newly diagnosed early-stage breast cancer received preoperative breast MRI in addition to conventional imaging studies at the Bonn University Breast Cancer Center. In retrospect, 113 patients would have met the criteria for APBI using conventional imaging workup (clinical tumor size ≤3 cm; negative axillary lymph node status; unifocal disease; no evidence of distant metastases; no invasive lobular carcinoma, ductal and lobular carcinoma in situ, or Paget’s disease). We analyzed the amount of additional ipsilateral and contralateral tumor foci detected by MRI. Results: MRI detected additional tumor foci in 8.8% of patients eligible for APBI (11 tumor foci in 10 of 113 patients), either ipsilateral (n = 7, 6.2%) or contralateral (n = 4, 3.5%). In 1 patient, MRI helped detect additional tumor focus both ipsilaterally and contralaterally. Conclusions: Preoperative breast MRI is able to identify additional tumor foci in a clinically relevant number of cases in this highly selected group of patients with low-risk disease and may be useful in selecting patients for APBI.

  9. Potential Impact of Preoperative Magnetic Resonance Imaging of the Breast on Patient Selection for Accelerated Partial Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kuehr, Marietta, E-mail: marietta.kuehr@ukb.uni-bonn.de [Department of Obstetrics and Gynecology and Center of Integrated Oncology, University of Bonn, Bonn (Germany); Wolfgarten, Matthias; Stoelzle, Marco [Department of Obstetrics and Gynecology and Center of Integrated Oncology, University of Bonn, Bonn (Germany); Leutner, Claudia [Department of Radiology, Center of Integrated Oncology, University of Bonn, Bonn (Germany); Hoeller, Tobias [Department of Medical Statistics and Epidemiology, University of Bonn, Bonn (Germany); Schrading, Simone; Kuhl, Christiane; Schild, Hans [Department of Radiology, Center of Integrated Oncology, University of Bonn, Bonn (Germany); Kuhn, Walther; Braun, Michael [Department of Obstetrics and Gynecology and Center of Integrated Oncology, University of Bonn, Bonn (Germany)

    2011-11-15

    Purpose: Accelerated partial breast irradiation (APBI) after breast-conserving therapy is currently under investigation in prospective randomized studies. Multifocality and multicentricity are exclusion criteria for APBI. Preoperative breast magnetic resonance imaging (MRI) can detect ipsilateral and contralateral invasive tumor foci or ductal carcinoma in situ in addition to conventional diagnostic methods (clinical examination, mammography, and ultrasonography). The objective of this retrospective study was to evaluate the impact of preoperative MRI on patient selection for APBI. Methods and Materials: From 2002 to 2007, a total of 579 consecutive, nonselected patients with newly diagnosed early-stage breast cancer received preoperative breast MRI in addition to conventional imaging studies at the Bonn University Breast Cancer Center. In retrospect, 113 patients would have met the criteria for APBI using conventional imaging workup (clinical tumor size {<=}3 cm; negative axillary lymph node status; unifocal disease; no evidence of distant metastases; no invasive lobular carcinoma, ductal and lobular carcinoma in situ, or Paget's disease). We analyzed the amount of additional ipsilateral and contralateral tumor foci detected by MRI. Results: MRI detected additional tumor foci in 8.8% of patients eligible for APBI (11 tumor foci in 10 of 113 patients), either ipsilateral (n = 7, 6.2%) or contralateral (n = 4, 3.5%). In 1 patient, MRI helped detect additional tumor focus both ipsilaterally and contralaterally. Conclusions: Preoperative breast MRI is able to identify additional tumor foci in a clinically relevant number of cases in this highly selected group of patients with low-risk disease and may be useful in selecting patients for APBI.

  10. Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

    Science.gov (United States)

    Error, Marc; Ashby, Shaelene; Orlandi, Richard R; Alt, Jeremiah A

    2018-01-01

    Objective To determine if the introduction of a systematic preoperative sinus computed tomography (CT) checklist improves identification of critical anatomic variations in sinus anatomy among patients undergoing endoscopic sinus surgery. Study Design Single-blinded prospective cohort study. Setting Tertiary care hospital. Subjects and Methods Otolaryngology residents were asked to identify critical surgical sinus anatomy on preoperative CT scans before and after introduction of a systematic approach to reviewing sinus CT scans. The percentage of correctly identified structures was documented and compared with a 2-sample t test. Results A total of 57 scans were reviewed: 28 preimplementation and 29 postimplementation. Implementation of the sinus CT checklist improved identification of critical sinus anatomy from 24% to 84% correct ( P identification of sinus anatomic variants, including those not directly included in the systematic review implemented. Conclusion The implementation of a preoperative endoscopic sinus surgery radiographic checklist improves identification of critical anatomic sinus variations in a training population.

  11. Gastric cancer metastatic to neck lipoma. A case report with imaging consideration

    Energy Technology Data Exchange (ETDEWEB)

    Nomura, Shuko [Tohoku University Hospital, Department of Radiology, Sendai, Miyagi (Japan); National Sendai Medical Center, Department of Radiology, Sendai, Miyagi (Japan); Kurihara, Noriko [National Sendai Medical Center, Department of Radiology, Sendai, Miyagi (Japan); Ishikawa, Tomohiko; Tateda, Masaru [National Sendai Medical Center, Department of Otorhinolaryngology, Sendai, Miyagi (Japan); Sakurada, Junko [National Sendai Medical Center, Department of Pathology, Sendai, Miyagi (Japan)

    2018-04-15

    A 71-year-old man visited our hospital for examination of a soft neck mass. Computed tomography and magnetic resonance imaging scans showed a well-circumscribed large lipomatous tumor with multiple nodules inside. Atypical lipomatous tumor or lipoma involving the lymph nodes was considered. Pathological examination of the surgical specimen suggested typical lipoma including multiple metastatic foci from gastric cancer. Subsequent endoscopy revealed a gastric tumor, which was histologically proven to be signet-ring cell carcinoma. Considering these findings, this case was diagnosed as tumor-to-tumor metastasis to lipoma. We present the first such case with imaging and clinical characteristics. (orig.)

  12. Clinical and imaging features of intra-articular osteoid osteoma in the femoral neck

    International Nuclear Information System (INIS)

    Zeng Yonghan; Cheng Xiaoguang; Gu Xian; Luan Yixin; Li Jiangtao

    2012-01-01

    Objective: To evaluate the clinical and imaging characteristics of osteoid osteoma in femoral neck and to improve diagnostic accuracy of this disease. Methods: Twenty-one patients (18 males and 3 females, age, 7-26 years, median age, 13 years) with pathologically proven osteoid osteoma of the femoral neck were retrospectively analyzed for their clinical profile and radiologic features. CT and X-ray examinations were performed in all patients, 10 of them performed post-contrast CT scan and 4 of them performed MRI examinations. Results: Nineteen patients had hip pain (pain worse at night in 11, and 8 received salicylates treatment with good response), and 2 patients only with intermittent claudication. The duration ranged from 2 months to 54 months (median duration 12 months). X-ray: Nidus was seen on plain film in 10 cases, 18 cases showed different degrees of bone sclerosis of the nidus. CT: Nidus was demonstrated in all cases. Among them, 8 were intracortical, 6 were subperiosteal, 7 were endosteal. Twenty cases showed different degrees of bone sclerosis of the nidus-extra-articular anteromedial cortical surface of the femur neck. Nineteen cases showed 'vascular groove sign'. MRI: Nidus was seen in 4 cases. Bone sclerosis was low signal on all sequences. Three cases had joint effusion, 4 cases had bone marrow edema, and 2 cases had synovial thickening. Conclusions: Although osteoid osteoma of femoral neck has non-specific clinical features, the radiographic findings are usually typical. The nidus of osteoid osteoma is often located within the joint. Bony sclerosis occurs at the area of extra-articular anteromedial cortical surface of the femur neck.CT examination remains an optimal method to identify the nidus. (authors)

  13. An analysis of stabilisation for head and neck image guided IMRT

    International Nuclear Information System (INIS)

    Middleton, Mark; Nguyen, Huong; Plank, Ashley; Jones, Mark; Shannon, Debbie; Sisson, Toni

    2014-01-01

    Aims: Daily IGRT using kV imaging has allowed an enhanced field of view for head and neck IMRT patients. This has allowed the treating radiation therapists to note set-up error beyond traditional spatial or translational and include angular error. This study compares two stabilisation methods for head and neck IGRT and compares spatial and angular error between them. Methods and materials: 9 patients were assessed using a CIVCO S-board and generic Silverman head rest and another 9 patients were assessed using a CIVCO S-board with a CIVCO S-type vac-fix bag. Daily IGRT was undertaken and pre-intervention set-up error collected. This was inclusive of error in the lateral, longitudinal and vertical plans and angular discrepancy between cervical spine 1 and cervical spine 7. Results: The vac-fix solution provided a significant reduction in the systematic yaw position (anterior–posterior) (p = 0.04). It also reduced the mean resultant systematic angular error significantly (p = 0.01). The lateral systematic spatial error was decreased significantly by the vac-fix (p = 0.03) whilst the longitudinal and vertical systematic errors were not. The differences in random error between the two stabilisation solutions were not significant. Conclusion: kV IGRT has allowed treating radiation therapists to note angular error in the head and neck region. This can be difficult to deal with using only IGRT. Stabilisation solutions in the head and neck region must be able to manage both spatial and angular set-up error. The vac-fix solution has improved the management of angular error for head and neck IMRT patients

  14. PET-CT imaging fusion in the assessment of head and neck carcinoma

    International Nuclear Information System (INIS)

    Santos, Denise Takehana dos; Chojniak, Rubens; Lima, Eduardo Nobrega Pereira; Cavalcanti, Marcelo Gusmao Paraiso

    2006-01-01

    Objective: The authors have established a methodological approach to evaluate head and neck squamous cell carcinoma aiming at identifying and distinguishing high metabolic activity inside the lesion, combining in a single examination, functional, metabolic and morphological data simultaneously acquired by means of different non-dedicated positron emission tomography (PET)-computed tomography (CT) device. Materials and Methods: The study population included 17 patients with head and neck squamous cell carcinoma submitted to a non-dedicated 18 F-FDG-PET imaging at Department of Diagnostic Imaging of Hospital do Cancer, Sao Paulo, SP, Brazil. CT and 18 F-FDG-PET images were simultaneously acquired in a non-dedicated device. The original data were transferred to an independent workstation by means of the Entegra 2 NT software to generate PET-CT imaging fusion. Results: The findings were defined as positive in the presence of a well defined focal area of increased radiopharmaceutical uptake in regions not related with the normal biodistribution of the tracer. Conclusion: The fusion of simultaneously acquired images in a single examination ( 18 F-FDGPET and CT) has allowed the topographic-metabolic mapping of the lesion as well as the localization of high metabolic activity areas inside the tumor, indicating recidivation or metastasis and widening the array of alternatives for radiotherapy or surgical planning. (author)

  15. Validation of the deformable image registration system elastix in the head and neck region

    DEFF Research Database (Denmark)

    Zukauskaite, R.; Brink, C.; Hansen, C. R.

    2015-01-01

    evaluates the accuracy of the open source deformable registration tool elastix when used for registration of different organ structures on planning CT and relapse CT scans of head and neck patients. Materials and Methods: Twenty patients treated with definitive IMRT for oral cavity, oropharynx...... cord, mandible, right/left parotid and submandibular glands, thyroid gland and vertebrae C3-5) on planning CT (pCT), relapse CT (rCT) and re-delineated again on the planning CT (reCT). The contouring on the relapse CT was mapped to the planning CT using elastix (http://elastix.isi.uu.nl/). Spatial...... delineation. Significant correlations within single organs were not found. Conclusions: Deformable registration of head and neck CT images using elastix resulted in a combined delineation and deformation uncertainty of approximately twice the uncertainty related to the manual delineation performed on one CT...

  16. Head and neck imaging with PET and PET/CT: artefacts from dental metallic implants

    International Nuclear Information System (INIS)

    Goerres, Gerhard W.; Hany, Thomas F.; Kamel, Ehab; Schulthess von, Gustav K.; Buck, Alfred

    2002-01-01

    Germanium-68 based attenuation correction (PET Ge68 ) is performed in positron emission tomography (PET) imaging for quantitative measurements. With the recent introduction of combined in-line PET/CT scanners, CT data can be used for attenuation correction. Since dental implants can cause artefacts in CT images, CT-based attenuation correction (PET CT ) may induce artefacts in PET images. The purpose of this study was to evaluate the influence of dental metallic artwork on the quality of PET images by comparing non-corrected images and images attenuation corrected by PET Ge68 and PET CT . Imaging was performed on a novel in-line PET/CT system using a 40-mAs scan for PET CT in 41 consecutive patients with high suspicion of malignant or inflammatory disease. In 17 patients, additional PET Ge68 images were acquired in the same imaging session. Visual analysis of fluorine-18 fluorodeoxyglucose (FDG) distribution in several regions of the head and neck was scored on a 4-point scale in comparison with normal grey matter of the brain in the corresponding PET images. In addition, artefacts adjacent to dental metallic artwork were evaluated. A significant difference in image quality scoring was found only for the lips and the tip of the nose, which appeared darker on non-corrected than on corrected PET images. In 33 patients, artefacts were seen on CT, and in 28 of these patients, artefacts were also seen on PET imaging. In eight patients without implants, artefacts were seen neither on CT nor on PET images. Direct comparison of PET Ge68 and PET CT images showed a different appearance of artefacts in 3 of 17 patients. Malignant lesions were equally well visible using both transmission correction methods. Dental implants, non-removable bridgework etc. can cause artefacts in attenuation-corrected images using either a conventional 68 Ge transmission source or the CT scan obtained with a combined PET/CT camera. We recommend that the non-attenuation-corrected PET images also be

  17. Improving breast cancer outcome by preoperative systemic therapy and image-guided surgery

    NARCIS (Netherlands)

    Mieog, Jan Sven David

    2011-01-01

    This thesis consists of two parts. In part I, we have demonstrated that preoperatively administrated systemic (neoadjuvant) therapy is a feasible treatment strategy in early stage breast cancer to achieve improved surgical options and to assess tumor response. We also demonstrated that

  18. Comparison of preoperative computerized tomography scan imaging of temporal bone with the intra-operative findings in patients undergoing mastiodectomy

    International Nuclear Information System (INIS)

    Gerami, H.; Naghavi, E.; Wahabi-Moghadam, M.; Forghanparast, K.; Akbar, Manzar H.

    2009-01-01

    Objective was to compare the consistency rates of pre- and intra-operative radiological findings in patients with chronic suppurative otitis media (CSOM). In a cross-sectional study, 80 patients with CSOM underwent pre-operative CT scanning and we compared the results with intra-operative clinical findings during mastiodectomy from 2000-2004 in the Otology Department, Amiralmomenin Hospital of Guilan Medical University, Rasht, Iran. Sensitivity, specificity, positive and negative predictive value of CT scan in tympanic and mastoid cholesteatoma, ossicular chain erosion, tegmentympani erosion, dehiscence of facial canal, lateral semicircular canal (LSCC) fistula were assessed. Then, correlation between radiological findings and intra-operative findings were calculated. The mean age of patients was 27.9+-16.3 years. Mostly were males (n=57 [71.3%]). Correlation of preoperative radiological images with intra-operative clinical findings were moderate to good on tympanic cholesteatoma, mastoid cholesteatoma and ossicular chain erosion, but weak and insignificant in cases of tegmen erosion, facial canal dehiscene and LSCC fistulae. Preoperative CT scan may be helpful in decision-making for surgery in cases of cholesteatoma and ossicular erosion. Despite of limitations radiological scanning is a useful adjunct to management of CSOM. (author)

  19. Management for BI-RADS category 3 lesions detected in preoperative breast MR imaging of breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Gweon, Hye Mi [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Gangnam Severance Hospital, Yonsei University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Cho, Nariya; Kim, Soo-Yeon [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Koo, Hye Ryoung [Hanyang University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seo, Mirinae [Kyung Hee University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Chu, Ajung [Seoul National University College of Medicine, Boramae Medical Center, Department of Radiology, Seoul (Korea, Republic of); Son, Eun Ju [Gangnam Severance Hospital, Yonsei University College of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2017-08-15

    To retrospectively evaluate characteristics of and determine appropriate follow-up recommendations for BI-RADS category 3 lesions detected in preoperative MRI of breast cancer patients. BI-RADS category 3 assessments were identified from the breast MRI database for 5,110 consecutive breast cancer patients who had undergone preoperative MRI and surgery. Patient and lesion characteristics, malignancy rate, and interval between lesion detection and cancer diagnosis were analysed. Histopathological results or imaging at or after 2-year follow-up were used as reference standards. Of the 626 lesions, morphological features included a single focus in 26.5% (n = 166), multiple foci in 47.1% (n = 295), mass in 21.7% (n = 136) and non-mass enhancement in 4.6% (n = 29). Cancer was found in 0.8% (5/626) at a median interval of 50 months (range, 29-66 months). Malignancy rate according to morphological feature was: 1.8% (3/166) in a single focus, 0.7% (1/136) in mass and 3.4% (1/29) in non-mass enhancement. All detected cancers were stage 0 or IA. Annual follow-up might be adequate for BI-RADS category 3 lesions detected at preoperative MRI because of the 0.8% (5/626) malignancy rate, long interval between lesion detection and cancer diagnosis, and early stage of diagnosed cancers. (orig.)

  20. Exploratory use of cardiovascular magnetic resonance imaging in liver transplantation: a one-stop shop for preoperative cardiohepatic evaluation.

    Science.gov (United States)

    Reddy, Sahadev T; Thai, Ngoc L; Fakhri, Asghar A; Oliva, Jose; Tom, Kusum B; Dishart, Michael K; Doyle, Mark; Yamrozik, June A; Williams, Ronald B; Grant, Saundra B; Poydence, Jacqueline; Shah, Moneal; Singh, Anil; Nathan, Swami; Biederman, Robert W W

    2013-11-15

    Preoperative cardiovascular risk stratification in orthotopic liver transplantation candidates has proven challenging due to limitations of current noninvasive modalities. Additionally, the preoperative workup is logistically cumbersome and expensive given the need for separate cardiac, vascular, and abdominal imaging. We evaluated the feasibility of a "one-stop shop" in a magnetic resonance suite, performing assessment of cardiac structure, function, and viability, along with simultaneous evaluation of thoracoabdominal vasculature and liver anatomy. In this pilot study, patients underwent steady-state free precession sequences and stress cardiac magnetic resonance (CMR), thoracoabdominal magnetic resonance angiography, and abdominal magnetic resonance imaging (MRI) on a standard MRI scanner. Pharmacologic stress was performed using regadenoson, adenosine, or dobutamine. Viability was assessed using late gadolinium enhancement. Over 2 years, 51 of 77 liver transplant candidates (mean age, 56 years; 35% female; mean Model for End-stage Liver Disease score, 10.8; range, 6-40) underwent MRI. All referred patients completed standard dynamic CMR, 98% completed stress CMR, 82% completed late gadolinium enhancement for viability, 94% completed liver MRI, and 88% completed magnetic resonance angiography. The mean duration of the entire study was 72 min, and 45 patients were able to complete the entire examination. Among all 51 patients, 4 required follow-up coronary angiography (3 for evidence of ischemia on perfusion CMR and 1 for postoperative ischemia), and none had flow-limiting coronary disease. Nine proceeded to orthotopic liver transplantation (mean 74 days to transplantation after MRI). There were six ascertained mortalities in the nontransplant group and one death in the transplanted group. Explant pathology confirmed 100% detection/exclusion of hepatocellular carcinoma. No complications during CMR examination were encountered. In this proof-of-concept study, it

  1. Preoperative Lateralization Modalities for Cushing Disease: Is Dynamic Magnetic Resonance Imaging or Cavernous Sinus Sampling More Predictive of Intraoperative Findings?

    Science.gov (United States)

    Sun, Hai; Yedinak, Chris; Ozpinar, Alp; Anderson, Jim; Dogan, Aclan; Delashaw, Johnny; Fleseriu, Maria

    2015-06-01

    Objective To analyze whether cavernous sinus sampling (CSS) and dynamic magnetic resonance imaging (dMRI) are consistent with intraoperative findings in Cushing disease (CD) patients. Design Retrospective outcomes study. Setting Oregon Health & Science University; 2006 and 2013. Participants A total of 37 CD patients with preoperative dMRI and CSS to confirm central adrenocorticotropic hormone (ACTH) hypersecretion. Patients were 78% female; mean age was 41 years (at diagnosis), and all had a minimum of 6 months of follow-up. Main Outcome Measures Correlations among patient characteristics, dMRI measurements, CSS results, and intraoperative findings. Results All CSS indicated presence of CD. Eight of 37 patients had no identifiable tumor on dMRI. Three of 37 patients had no tumor at surgery. dMRI tumor size was inversely correlated with age (rs = - 0.4; p = 0.01) and directly correlated to intraoperative lateralization (rs = 0.3; p < 0.05). Preoperative dMRI was directly correlated to intraoperative lateralization (rs = 0.5; p < 0.002). CSS lateralization showed no correlation with intraoperative findings (rs = 0.145; p = 0.40) or lateralization observed on preoperative dMRI (rs = 0.17; p = 0.29). Postoperative remission rate was 68%. Conclusion dMRI localization was most consistent with intraoperative findings; CSS results were less reliable. Results suggest that small ACTH-secreting tumors continue to pose a challenge to reliable preoperative localization.

  2. CT detection of thyroid pyramidal lobe in preoperative patients with thyroid tumors

    International Nuclear Information System (INIS)

    Shin, Gi Won; Kim, Dong Won

    2013-01-01

    Thyroid pyramidal lobe (TPL) is a normal variant of the thyroid gland, but few imaging studies of TPL have been published. The purpose of this study is to investigate the frequency, location, size (length, maximal AP diameter, maximal transverse diameter), and upper end level of TPL with its separation from the main thyroid gland on preoperative neck CT and to compare them with operative findings in order to assess the diagnostic accuracy of neck CT for detection TPL. 46 patients, who underwent preoperative neck CT before thyroidectomy, were included in the study. The frequency, location, size, and upper end level of TPL with its separation from the main thyroid gland on the neck CT was analyzed by a single radiologist. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of neck CT for detecting TPL was 77.8%, 89.5%, 91.3%, 73.9% and 82.6%. There was a significant difference in maximal AP diameter, location, upper end level, and its separation from main thyroid gland between CT and operative findings (p 0.05). Diagnostic accuracy of neck CT for detecting TPL was high, and the neck CT may be useful for evaluating TPL in the suprahyoid neck.

  3. Cecal volvulus: a rare cause of bowel obstruction in a pediatric patient diagnosed pre-operatively by conventional imaging studies

    International Nuclear Information System (INIS)

    Vo, Nghia J.; O'Hara, Sara M.; Alonso, Maria H.

    2005-01-01

    Cecal volvulus is an acute surgical condition that is extremely rare in children, with a mortality rate of up to 40%. The clinical symptoms are often non-specific, and pediatric patients frequently have neurological deficits with associated communication difficulties, making the clinical diagnosis extremely challenging. Conventional radiographic imaging studies play a key role in the prospective diagnosis in children. We report a rare case of cecal volvulus in a 12-year-old boy who was diagnosed pre-operatively by abdominal radiographs and a contrast enema. (orig.)

  4. Cecal volvulus: a rare cause of bowel obstruction in a pediatric patient diagnosed pre-operatively by conventional imaging studies

    Energy Technology Data Exchange (ETDEWEB)

    Vo, Nghia J.; O' Hara, Sara M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati (United States); Alonso, Maria H. [Cincinnati Children' s Hospital Medical Center, Division of Pediatric and Thoracic Surgery, Cincinnati, Ohio (United States)

    2005-11-01

    Cecal volvulus is an acute surgical condition that is extremely rare in children, with a mortality rate of up to 40%. The clinical symptoms are often non-specific, and pediatric patients frequently have neurological deficits with associated communication difficulties, making the clinical diagnosis extremely challenging. Conventional radiographic imaging studies play a key role in the prospective diagnosis in children. We report a rare case of cecal volvulus in a 12-year-old boy who was diagnosed pre-operatively by abdominal radiographs and a contrast enema. (orig.)

  5. Virtual Whipple: preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the Whipple procedure.

    Science.gov (United States)

    Brennan, Darren D; Zamboni, Giulia; Sosna, Jacob; Callery, Mark P; Vollmer, Charles M V; Raptopoulos, Vassilios D; Kruskal, Jonathan B

    2007-05-01

    The purposes of this study were to combine a thorough understanding of the technical aspects of the Whipple procedure with advanced rendering techniques by introducing a virtual Whipple procedure and to evaluate the utility of this new rendering technique in prediction of the arterial variants that cross the anticipated surgical resection plane. The virtual Whipple is a novel technique that follows the complex surgical steps in a Whipple procedure. Three-dimensional reconstructed angiographic images are used to identify arterial variants for the surgeon as part of the preoperative radiologic assessment of pancreatic and ampullary tumors.

  6. Position tracking of moving liver lesion based on real-time registration between 2D ultrasound and 3D preoperative images

    International Nuclear Information System (INIS)

    Weon, Chijun; Hyun Nam, Woo; Lee, Duhgoon; Ra, Jong Beom; Lee, Jae Young

    2015-01-01

    Purpose: Registration between 2D ultrasound (US) and 3D preoperative magnetic resonance (MR) (or computed tomography, CT) images has been studied recently for US-guided intervention. However, the existing techniques have some limits, either in the registration speed or the performance. The purpose of this work is to develop a real-time and fully automatic registration system between two intermodal images of the liver, and subsequently an indirect lesion positioning/tracking algorithm based on the registration result, for image-guided interventions. Methods: The proposed position tracking system consists of three stages. In the preoperative stage, the authors acquire several 3D preoperative MR (or CT) images at different respiratory phases. Based on the transformations obtained from nonrigid registration of the acquired 3D images, they then generate a 4D preoperative image along the respiratory phase. In the intraoperative preparatory stage, they properly attach a 3D US transducer to the patient’s body and fix its pose using a holding mechanism. They then acquire a couple of respiratory-controlled 3D US images. Via the rigid registration of these US images to the 3D preoperative images in the 4D image, the pose information of the fixed-pose 3D US transducer is determined with respect to the preoperative image coordinates. As feature(s) to use for the rigid registration, they may choose either internal liver vessels or the inferior vena cava. Since the latter is especially useful in patients with a diffuse liver disease, the authors newly propose using it. In the intraoperative real-time stage, they acquire 2D US images in real-time from the fixed-pose transducer. For each US image, they select candidates for its corresponding 2D preoperative slice from the 4D preoperative MR (or CT) image, based on the predetermined pose information of the transducer. The correct corresponding image is then found among those candidates via real-time 2D registration based on a

  7. Magnetic resonance imaging guided reirradiation of recurrent and second primary head and neck cancer.

    Science.gov (United States)

    Chen, Allen M; Cao, Minsong; Hsu, Sophia; Lamb, James; Mikaeilian, Argin; Yang, Yingli; Agazaryan, Nzhde; Low, Daniel A; Steinberg, Michael L

    2017-01-01

    To report a single-institutional experience using magnetic resonance imaging (MRI) guided radiation therapy for the reirradiation of recurrent and second cancers of the head and neck. Between October 2014 and August 2016, 13 consecutive patients with recurrent or new primary cancers of the head and neck that occurred in a previously irradiated field were prospectively enrolled in an institutional registry trial to investigate the feasibility and efficacy of MRI guided radiation therapy using a 0.35-T MRI scanner with a cobalt-60 radiation therapy source called the ViewRay system (ViewRay Inc., Cleveland, OH). Eligibility criteria included biopsy-proven evidence of recurrent or new primary squamous cell carcinoma of the head and neck, measurable disease, and previous radiation to >60 Gy. MRI guided reirradiation was delivered either using intensity modulated radiation therapy with conventional fractionation to a median dose of 66 Gy or stereotactic body radiation therapy (SBRT) using 7 to 8 Gy fractions on nonconsecutive days to a median dose of 40 Gy. Two patients (17%) received concurrent chemotherapy. The 1- and 2-year estimates of in-field control were 72% and 72%, respectively. A total of 227 daily MRI scans were obtained to guide reirradiation. The 2-year estimates of overall survival and progression-free survival were 53% and 59%, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis and/or conjunctivitis, and 1 case of aspiration pneumonia. Our preliminary findings show that reirradiation with MRI guided radiation therapy results in effective disease control with relatively low morbidity for patients with recurrent and second primary cancers of the head and neck. The superior soft tissue resolution of the MRI scans that were used for planning and delivery has the potential to improve the therapeutic ratio.

  8. Morphologic assessment of thoracic deformities for the preoperative evaluation of pectus excavatum by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lollert, A.; Funk, J.; Tietze, N.; Laudemann, K.; Dueber, C.; Staatz, G. [Medical Center of the Johannes Gutenberg University, Department of Diagnostic and Interventional Radiology, Section Pediatric Radiology, Mainz (Germany); Turial, S. [Medical Center of the Johannes Gutenberg University, Department of Pediatric Surgery, Mainz (Germany)

    2014-10-15

    To assess whether MRI is a suitable modality for the preoperative assessment and quantification of pectus excavatum. A total of 69 patients (57 male, 12 female; median age 15 years, range 5-35 years) with pectus excavatum were evaluated preoperatively using standardized MRI sequences on 1.5- and 3-Tesla systems (T2-HASTE/inspiration and expiration, T1-VIBE, T2-TRUFI free-breathing, T2-BLADE). The MR sequences were analysed for quality semiquantitatively. The Haller index, correction index, sternal rotation angle and asymmetry index were assessed; correlations between these indices and changes in inspiration and expiration were evaluated. T2-HASTE was the best sequence to assess pectus excavatum morphology, with a higher quality at 3 T than at 1.5 T. All indices could be assessed in every patient. A total of 37 patients had a symmetric deformity, 32 patients an asymmetric deformity. The Haller index correlated significantly (p < 0.001) with the correction index, both becoming higher in expiration. The asymmetry index correlated with the sternal rotation angle (p < 0.001) and did not change significantly in expiration (p = 0.28). Thoracic MRI is suitable for the preoperative evaluation of patients with pectus excavatum. An exact morphologic assessment is possible without radiation exposure as well as the determination of several indices to quantify the deformities. (orig.)

  9. Simultaneous PET/MR head–neck cancer imaging: Preliminary clinical experience and multiparametric evaluation

    International Nuclear Information System (INIS)

    Covello, M.; Cavaliere, C.; Aiello, M.; Cianelli, M.S.; Mesolella, M.; Iorio, B.; Rossi, A.; Nicolai, E.

    2015-01-01

    Highlights: • Simultaneous PET/MRI is a suitable tool for head/neck T-staging. • No significant differences have been found for PET measures get by both PET/CT and PET/MRI. • SUV 2D and 3D measures in HN lesion offer comparable estimations. • Multiparametric evaluation allows a complete characterization of HN lesions. - Abstract: Purpose: To evaluate the role of simultaneous hybrid PET/MR imaging and to correlate metabolic PET data with morpho-functional parameters derived by MRI in patients with head–neck cancer. Methods: Forty-four patients, with histologically confirmed head and neck malignancy (22 primary tumors and 22 follow-up) were studied. Patients initially received a clinical exam and endoscopy with direct biopsy. Next patients underwent whole body PET/CT followed by PET/MR of the head/neck region. PET and MRI studies were separately evaluated by two blinded groups (both included one radiologist and one nuclear physician) in order to define the presence or absence of lesions/recurrences. Regions of interest (ROIs) analysis was conducted on the primary lesion at the level of maximum size on metabolic (SUV and MTV), diffusion (ADC) and perfusion (K trans , V e , k ep and iAUC) parameters. Results: PET/MR examinations were successfully performed on all 44 patients. Agreement between the two blinded groups was found in anatomic allocation of lesions by PET/MR (Primary tumors: Cohen's kappa 0.93; Follow-up: Cohen's kappa 0.89). There was a significant correlation between CT-SUV measures and MR (e.g., CT-SUV VOI vs. MR-SUV VOI: ρ = 0.97, p < 0.001 for the entire sample). There was also significant positive correlations between the ROI area, SUV measures, and the metabolic parameters (SUV and MTV) obtained during both PET/CT and PET/MR. A significant negative correlation was observed between ADC and K trans values in the primary tumors. In addition, a significant negative correlation existed between MR SUV and ADC in recurrent tumors

  10. Evaluation of image-guidance protocols in the treatment of head and neck cancers

    International Nuclear Information System (INIS)

    Zeidan, Omar A.; Langen, Katja M.; Meeks, Sanford L.; Manon, Rafael R.; Wagner, Thomas H.; Willoughby, Twyla R.; Jenkins, D. Wayne; Kupelian, Patrick A.

    2007-01-01

    Purpose: The aim of this study was to assess the residual setup error of different image-guidance (IG) protocols in the alignment of patients with head and neck cancer. The protocols differ in the percentage of treatment fractions that are associated with image guidance. Using data from patients who were treated with daily IG, the residual setup errors for several different protocols are retrospectively calculated. Methods and Materials: Alignment data from 24 patients (802 fractions) treated with daily IG on a helical tomotherapy unit were analyzed. The difference between the daily setup correction and the setup correction that would have been made according to a specific protocol was used to calculate the residual setup errors for each protocol. Results: The different protocols are generally effective in reducing systematic setup errors. Random setup errors are generally not reduced for fractions that are not image guided. As a consequence, if every other treatment is image guided, still about 11% of all treatments (IG and not IG) are subject to three-dimensional setup errors of at least 5 mm. This frequency increases to about 29% if setup errors >3 mm are scored. For various protocols that require 15% to 31% of the treatments to be image guided, from 50% to 60% and from 26% to 31% of all fractions are subject to setup errors >3 mm and >5 mm, respectively. Conclusion: Residual setup errors reduce with increasing frequency of IG during the course of external-beam radiotherapy for head-and-neck cancer patients. The inability to reduce random setup errors for fractions that are not image guided results in notable residual setup errors

  11. A Novel Method for Estimation of Femoral Neck Bone Mineral Density Using Forearm Images from Peripheral Cone Beam Computed Tomography

    Directory of Open Access Journals (Sweden)

    Kwanmoon Jeong

    2016-04-01

    Full Text Available The main goal of osteoporosis treatment is prevention of osteoporosis-induced bone fracture. Dual-energy X-ray absorptiometry (DXA and quantitative computed tomographic imaging (QCT are widely used for assessment of bone mineral density (BMD. However, they have limitations in patients with special conditions. This study evaluated a method for diagnosis of osteoporosis using peripheral cone beam computed tomography (CBCT to estimate BMD. We investigated the correlation between the ratio of cortical and total bone areas of the forearm and femoral neck BMD. Based on the correlation, we established a linear transformation between the ratio and femoral neck BMD. We obtained forearm images using CBCT and femoral neck BMDs using dual-energy X-ray absorptiometry (DXA for 23 subjects. We first calculated the ratio of the cortical to the total bone area in the forearm from the CBCT images, and investigated the relationship with the femoral neck BMDs obtained from DXA. Based on this relationship, we further investigated the optimal forearm region to provide the highest correlation coefficient. We used the optimized forearm region to establish a linear transformation of the form to estimate femoral neck BMD from the calculated ratio. We observed the correlation factor of r = 0.857 (root mean square error = 0.056435 g/cm2; mean absolute percentage error = 4.5105% between femoral neck BMD and the ratio of the cortical and total bone areas. The strongest correlation was observed for the average ratios of the mid-shaft regions of the ulna and radius. Our results suggest that femoral neck BMD can be estimated from forearm CBCT images and may be useful for screening osteoporosis, with patients in a convenient sitting position. We believe that peripheral CBCT image-based BMD estimation may have significant preventative value for early osteoporosis treatment and management.

  12. FDG-PET/CT Imaging for Staging and Target Volume Delineation in Preoperative Conformal Radiotherapy of Rectal Cancer

    International Nuclear Information System (INIS)

    Bassi, Maria Chiara; Turri, Lucia; Sacchetti, Gianmauro; Loi, Gianfranco; Cannillo, Barbara; La Mattina, Pierdaniele; Brambilla, Marco; Inglese, Eugenio; Krengli, Marco

    2008-01-01

    Purpose: To investigate the potential impact of using 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) on staging and target volume delineation for patients affected by rectal cancer and candidates for preoperative conformal radiotherapy. Methods and Materials: Twenty-five patients diagnosed with rectal cancer T3-4 N0-1 M0-1 and candidates for preoperative radiotherapy underwent PET/CT simulation after injection of 5.18 MBq/kg of FDG. Clinical stage was reassessed on the basis of FDG-PET/CT findings. The gross tumor volume (GTV) and the clinical target volume (CTV) were delineated first on CT and then on PET/CT images. The PET/CT-GTV and PET/CT-CTV were analyzed and compared with CT-GTV and CT-CTV, respectively. Results: In 4 of 25 cases (24%), PET/CT affected tumor staging or the treatment purpose. In 3 of 25 cases (12%) staged N0 M0, PET/CT showed FDG uptake in regional lymph nodes and in a case also in the liver. In a patient with a single liver metastasis PET/CT detected multiple lesions, changing the treatment intent from curative to palliative. The PET/CT-GTV and PET/CT-CTV were significantly greater than the CT-GTV (p = 0.00013) and CT-CTV (p = 0.00002), respectively. The mean difference between PET/CT-GTV and CT-GTV was 25.4% and between PET/CT-CTV and CT-CTV was 4.1%. Conclusions: Imaging with PET/CT for preoperative radiotherapy of rectal cancer may lead to a change in staging and target volume delineation. Stage variation was observed in 12% of cases and a change of treatment intent in 4%. The GTV and CTV changed significantly, with a mean increase in size of 25% and 4%, respectively

  13. Preoperative imaging of charcot neuroarthropathy. Does the additional application of 18F-FDG-PET make sense?

    International Nuclear Information System (INIS)

    Hoepfner, S.; Krolak, C.; Kessler, S.; Tiling, R.

    2006-01-01

    With about 4 million diabetics in Germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot's foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990's, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot's foot. PET were compared to magnetic resonance tomography (MRI). Patients, methods: MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot's foot requiring surgical treatment were made on the basis of clinical and radiologic criteria. Results: of 46 Charcot's lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impress as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5-2.9). Conclusions: the differentiation between Charcot's lesions and floride osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot's foot. (orig.)

  14. Preoperative imaging of charcot neuroarthropathy. Does the additional application of {sup 18}F-FDG-PET make sense?

    Energy Technology Data Exchange (ETDEWEB)

    Hoepfner, S. [Abt. fuer Diagnostische Radiologie, Universitaetsklinikum Giessen und Marburg, Standort Giessen (Germany); Krolak, C. [Inst. fuer Klinische Radiologie, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany); Kessler, S. [Chirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany); Tiling, R. [Klinik und Poliklinik fuer Nuklearmedizin, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany)

    2006-07-01

    With about 4 million diabetics in Germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot's foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990's, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot's foot. PET were compared to magnetic resonance tomography (MRI). Patients, methods: MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot's foot requiring surgical treatment were made on the basis of clinical and radiologic criteria. Results: of 46 Charcot's lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impress as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5-2.9). Conclusions: the differentiation between Charcot's lesions and floride osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot's foot. (orig.)

  15. Deep learning based classification for head and neck cancer detection with hyperspectral imaging in an animal model

    Science.gov (United States)

    Ma, Ling; Lu, Guolan; Wang, Dongsheng; Wang, Xu; Chen, Zhuo Georgia; Muller, Susan; Chen, Amy; Fei, Baowei

    2017-03-01

    Hyperspectral imaging (HSI) is an emerging imaging modality that can provide a noninvasive tool for cancer detection and image-guided surgery. HSI acquires high-resolution images at hundreds of spectral bands, providing big data to differentiating different types of tissue. We proposed a deep learning based method for the detection of head and neck cancer with hyperspectral images. Since the deep learning algorithm can learn the feature hierarchically, the learned features are more discriminative and concise than the handcrafted features. In this study, we adopt convolutional neural networks (CNN) to learn the deep feature of pixels for classifying each pixel into tumor or normal tissue. We evaluated our proposed classification method on the dataset containing hyperspectral images from 12 tumor-bearing mice. Experimental results show that our method achieved an average accuracy of 91.36%. The preliminary study demonstrated that our deep learning method can be applied to hyperspectral images for detecting head and neck tumors in animal models.

  16. Image quality and localization accuracy in C-arm tomosynthesis-guided head and neck surgery

    International Nuclear Information System (INIS)

    Bachar, G.; Siewerdsen, J. H.; Daly, M. J.; Jaffray, D. A.; Irish, J. C.

    2007-01-01

    The image quality and localization accuracy for C-arm tomosynthesis and cone-beam computed tomography (CBCT) guidance of head and neck surgery were investigated. A continuum in image acquisition was explored, ranging from a single exposure (radiograph) to multiple projections acquired over a limited arc (tomosynthesis) to a full semicircular trajectory (CBCT). Experiments were performed using a prototype mobile C-arm modified to perform 3D image acquisition (a modified Siemens PowerMobil). The tradeoffs in image quality associated with the extent of the source-detector arc (θ tot ), the number of projection views, and the total imaging dose were evaluated in phantom and cadaver studies. Surgical localization performance was evaluated using three cadaver heads imaged as a function of θ tot . Six localization tasks were considered, ranging from high-contrast feature identification (e.g., tip of a K-wire pointer) to more challenging soft-tissue delineation (e.g., junction of the hard and soft palate). Five head and neck surgeons and one radiologist participated as observers. For each localization task, the 3D coordinates of landmarks pinpointed by each observer were analyzed as a function of θ tot . For all tomosynthesis angles, image quality was highest in the coronal plane, whereas sagittal and axial planes exhibited a substantial decrease in spatial resolution associated with out-of-plane blur and distortion. Tasks involving complex, lower-contrast features demonstrated steeper degradation with smaller tomosynthetic arc. Localization accuracy in the coronal plane was correspondingly high, maintained to tot ∼30 deg. , whereas sagittal and axial localization degraded rapidly below θ tot ∼60 deg. . Similarly, localization precision was better than ∼1 mm within the coronal plane, compared to ∼2-3 mm out-of-plane for tomosynthesis angles below θ tot ∼45 deg. . An overall 3D localization accuracy of ∼2.5 mm was achieved with θ tot ∼ 90 deg. for most

  17. Assessment of a customised immobilisation system for head and neck IMRT using electronic portal imaging

    International Nuclear Information System (INIS)

    Humphreys, Mandy; Guerrero Urbano, M.Teressa; Mubata, Cefas; Miles, Elizabeth; Harrington, Kevin J.; Bidmead, Margaret; Nutting, Christopher M.

    2005-01-01

    Purpose: To evaluate set-up reproducibility of a cabulite shell and determine CTV-PTV margins for head and neck intensity-modulated-radiotherapy. Materials and methods: Twenty patients were entered into the study. A total of 354 anterior and lateral isocentric electronic portal images (EPIs) were compared to simulator reference images. Results: About 94% of all translational displacements were ≤3 mm, and 99% ≤5 mm. The overall systematic error was 0.9 mm (±1.0SD) in the Right-Left, 0.7 mm (±0.9SD) in the Superior-Inferior and -0.02 mm (±1.1SD) in the Anterior-Posterior directions. The corresponding SDs of the random errors were ±0.4, ±0.6 and ±0.7 mm. The estimated margins required from CTV-PTV were calculated according to the Van Herk formula was 2.9, 2.6 and 3.3 mm, respectively. Conclusions: This head and neck immobilisation system is of sufficient accuracy for its use with IMRT treatments and a 3 mm CTV-PTV margin has been adopted

  18. Preoperative radiological characterization of hepatic angiomyolipoma using magnetic resonance imaging and contrast-enhanced ultrasonography: a case report

    Directory of Open Access Journals (Sweden)

    Schmid Roland M

    2011-09-01

    Full Text Available Abstract Introduction A hepatic angiomyolipoma is a rare benign tumor of the liver composed of a mixture of smooth muscle cells, blood vessels and a variable amount of adipose tissue. Differentiating them from malignant liver tumors can often be very difficult. Case presentation We report the case of a 43-year-old Caucasian man presenting with a large liver mass in the right lobe. The results of magnetic resonance imaging and contrast-enhanced ultrasonography were consistent with a well-demarcated adipose tissue- containing tumor, showing prolonged hyperperfusion in comparison with the surrounding liver tissue. Surgery was performed and the diagnosis of hepatic angiomyolipoma was made with histopathology. Conclusion Preoperative radiological characterization using magnetic resonance imaging and contrast-enhanced ultrasonography may improve diagnostic accuracy of hepatic angiomyolipoma. Identification of smooth muscle cells, blood vessels and adipose tissue with a positive immunohistochemical reaction for HMB-45 is the final evidence for an angiomyolipoma.

  19. Clinical study of the image fusion between CT and FDG-PET in the head and neck region

    International Nuclear Information System (INIS)

    Shozushima, Masanori; Moriguchi, Hitoshi; Shoji, Satoru; Sakamaki, Kimio; Ishikawa, Yoshihito; Kudo, Keigo; Satoh, Masanobu

    1999-01-01

    Image fusion using PET and CT from the head and neck region was performed with the use of external markers on 7 patients with squamous cell carcinoma. The purpose of this study was to examine a resultant error and the clinical usefulness of image fusion. Patients had primary lesions of the tongue, the maxillary gingiva or the maxillary sinus. All patients underwent PET with FDG and CT to detect tumor sites. Of these 7 patients, diagnostic images and the clinical observation found 6 cases of regional lymph node metastasis of the neck. To ensure the anatomical detail of the PET images, small radioactive markers were placed on the philtrum and below both earlobes. The PET image and CT image were then overlapped on a computer. The image fusion of PET and CT was successfully performed on all patients. The superposition error of this method was examined between the PET and CT images. The accuracy of fit measured as the mean distance between the PET and CT image was in the range of 2-5 mm. PET-CT superimposed images produced an increase in the localization of tumor FDG uptake and localized FDG uptake on the palatine tonsils. The marker system described here for the alignment of PET and CT images can be used on a routine basis without the invasive fixation of external markers, and also improve the management and follow up on patients with head and neck carcinoma. (author)

  20. Accuracy of CT enterography and magnetic resonance enterography imaging to detect lesions preoperatively in patients undergoing surgery for Crohn's disease.

    Science.gov (United States)

    Seastedt, Kenneth P; Trencheva, Koiana; Michelassi, Fabrizio; Alsaleh, Doaa; Milsom, Jeffrey W; Sonoda, Toyooki; Lee, Sang W; Nandakumar, Govind

    2014-12-01

    CT enterography and magnetic resonance enterography have emerged as first-line imaging technologies for the evaluation of the gastrointestinal tract in Crohn's disease. The purpose of this work was to evaluate the accuracy of these imaging modalities to identify Crohn's disease lesions preoperatively. This was a retrospective chart review. The study was conducted at a single institution. Seventy-six patients with Crohn's disease with preoperative CT enterography and/or magnetic resonance enterography were included in the study. The number of stenoses, fistulas, and abscesses on CT enterography and/or magnetic resonance enterography before surgery were compared with operative findings. Forty patients (53%) were women, 46 (60%) underwent surgery for recurrent Crohn's disease, and 46 (57%) had previous abdominal surgery. Thirty-six (47%) had a preoperative CT enterography and 43 (57%) had a preoperative magnetic resonance enterography. CT enterography sensitivity was 75% for stenosis and 50% for fistula. MRE sensitivity was 68% for stenosis and 60% for fistula. The negative predictive values of CT enterography and magnetic resonance enterography for stenosis were very low (54% and 65%) and were 85% and 81% for fistula. CT enterography had 76% accuracy for stenosis and 79% for fistula; magnetic resonance enterography had 78% accuracy for stenosis and 85% for fistula. Both were accurate for abscess. False-negative rates for CT enterography were 50% for fistula and 25% for stenosis. False-negative rates for magnetic resonance enterography were 40% for fistula and 32% for stenosis. Unexpected intraoperative findings led to modification of the planned surgical procedure in 20 patients (26%). This study was limited by its small sample size, its retrospective nature, and that some studies were performed at outside institutions. CT enterography and magnetic resonance enterography in patients with Crohn's disease were accurate for the identification of abscesses but not for

  1. Preoperative staging of rectal cancer by magnetic resonance imaging (MRI) and computed tomography (CT)

    International Nuclear Information System (INIS)

    Itabashi, Michiaki; Kameoka, Shingo; Nakajima, Kiyotaka; Izumi, Kiminari; Miyazaki, Kaname; Hamano, Kyoichi; Kouno, Atsushi

    1991-01-01

    To clarify the usefulness and limitations of CT and MRI in preoperative assessment of the wall invasion of rectal cancer, we compared the results of CT and MRI with the histopathological findings, classifying tumors by the region and site in 34 patients with rectal cancer. Subjects were patients preoperatively examined by MRI and CT. Overall, the percent of cases with the extent of invasion accurately assessed by MRI was 88.2%, and that by CT was 64.7%. In all instances of wrong assessment, the extent of invasion was overestimated. The accurate assessment rate was significantly higher for MRI than for CT. After classification by the region, the accurate assessment rate at Rs was low as 50% for both MRI and CT because slices were not perpendicular to the tumor. The accurate assessment rate was 100% for MRI and 82% for CT at Ra, and respectively 94% and 59% at Rb. The majority of tumors at Ra or Rb centering on the lateral wall of the rectum were accurately assessed either by MRI or CT. With tumors at Ra or Rb (particularly Rb) centering on the anterior or posterior wall, CT frequently failed to identify the extent of invasion accurately, so that MRI seemed more suitable for these tumors. (author)

  2. Image-guided preoperative prediction of pyramidal tract side effect in deep brain stimulation

    Science.gov (United States)

    Baumgarten, C.; Zhao, Y.; Sauleau, P.; Malrain, C.; Jannin, P.; Haegelen, C.

    2016-03-01

    Deep brain stimulation of the medial globus pallidus is a surgical procedure for treating patients suffering from Parkinson's disease. Its therapeutic effect may be limited by the presence of pyramidal tract side effect (PTSE). PTSE is a contraction time-locked to the stimulation when the current spreading reaches the motor fibers of the pyramidal tract within the internal capsule. The lack of side-effect predictive model leads the neurologist to secure an optimal electrode placement by iterating clinical testing on an awake patient during the surgical procedure. The objective of the study was to propose a preoperative predictive model of PTSE. A machine learning based method called PyMAN (for Pyramidal tract side effect Model based on Artificial Neural network) that accounted for the current of the stimulation, the 3D electrode coordinates and the angle of the trajectory, was designed to predict the occurrence of PTSE. Ten patients implanted in the medial globus pallidus have been tested by a clinician to create a labeled dataset of the stimulation parameters that trigger PTSE. The kappa index value between the data predicted by PyMAN and the labeled data was .78. Further evaluation studies are desirable to confirm whether PyMAN could be a reliable tool for assisting the surgeon to prevent PTSE during the preoperative planning.

  3. Preoperative [18F]-fluorodeoxyglucose positron emission tomography standardized uptake value of neck lymph nodes may aid in selecting patients with oral cavity squamous cell carcinoma for salvage therapy after relapse

    International Nuclear Information System (INIS)

    Liao, Chun-Ta; Huang, Shiang-Fu; Chen, I. How; Chang, Joseph Tung-Chieh; Wang, Hung-Ming; Ng, Shu-Hang; Hsueh, Chuen; Lee, Li-Yu.; Lin, Chih-Hung; Cheng, Ann-Joy; Yen, Tzu-Chen

    2009-01-01

    Relapse of tumours in patients with oral cavity squamous cell carcinoma (OSCC) is associated with a dismal outcome. In this prospective study, we sought to investigate the clinical significance of the preoperative maximal standardized uptake value (SUVmax) at the neck lymph nodes in selecting patients with OSCC for salvage therapy after relapse. Between 2002 and 2007, 108 patients with early relapse of OSCC (n=75) or late relapse of OSCC (n=33) were identified. Salvage therapy was performed in 47 patients. All patients underwent 2-deoxy-2[ 18 F]-fluoro-d-glucose positron emission tomography during the 2 weeks before surgery and neck dissection. All patients were followed for 12 months or more after surgery or until death. The optimal cut-off value for the neck lymph node SUVmax (SUVnodal-max) was selected according to the 5-year disease-specific survival (DSS) rate. Independent risk factors were identified by Cox regression analysis. The mean follow-up for all patients was 20.3 months (41.1 months for surviving patients). In the early relapse group, several prognostic factors were identified in univariate and multivariate analyses, including a SUVnodal-max value of ≥4.2. A scoring system based on univariate analysis was formulated. Patients with a score of 0 had a better 5-year DSS than those with scores of 1 or higher (58% vs. 5%, p=0.0003). In patients with late relapse, a SUVnodal-max value of ≥4.2 had the highest prognostic value for predicting the 5-year DSS (45% vs. 0%, p=0.0005). Among patients with relapsed OSCC, the SUVnodal-max value may aid in selecting patients for salvage therapy. (orig.)

  4. Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

    Science.gov (United States)

    Bahl, Manisha; Pien, Irene J; Buretta, Kate J; Hwang, E Shelley; Greenup, Rachel A; Ghate, Sujata V; Hollenbeck, Scott T

    2016-08-01

    Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM. Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed. One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis. Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Image quality analysis to reduce dental artifacts in head and neck imaging with dual-source computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ketelsen, D.; Werner, M.K.; Thomas, C.; Tsiflikas, I.; Reimann, A.; Claussen, C.D.; Heuschmid, M. [Tuebingen Univ. (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Koitschev, A. [Tuebingen Univ. (Germany). Abt. fuer Hals-Nasen-Ohrenheilkunde

    2009-01-15

    Purpose: Important oropharyngeal structures can be superimposed by metallic artifacts due to dental implants. The aim of this study was to compare the image quality of multiplanar reconstructions and an angulated spiral in dual-source computed tomography (DSCT) of the neck. Materials and Methods: Sixty-two patients were included for neck imaging with DSCT. MPRs from an axial dataset and an additional short spiral parallel to the mouth floor were acquired. Leading anatomical structures were then evaluated with respect to the extent to which they were affected by dental artifacts using a visual scale, ranging from 1 (least artifacts) to 4 (most artifacts). Results: In MPR, 87.1 % of anatomical structures had significant artifacts (3.12 {+-} 0.86), while in angulated slices leading anatomical structures of the oropharynx showed negligible artifacts (1.28 {+-} 0.46). The diagnostic growth due to primarily angulated slices concerning artifact severity was significant (p < 0.01). Conclusion: MPRs are not capable of reducing dental artifacts sufficiently. In patients with dental artifacts overlying the anatomical structures of the oropharynx, an additional short angulated spiral parallel to the floor of the mouth is recommended and should be applied for daily routine. As a result of the static gantry design of DSCT, the use of a flexible head holder is essential. (orig.)

  6. MR imaging findings in granular cell tumor of the neurohypophysis: a difficult preoperative diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Iglesias, A.; Arias, M.; Brasa, J. [Unidad de Resonancia Magnetica (MEDTEC), Hospital Xeral-Cies, Vigo (Spain); Paramo, C. [Servicio de Endocrinologia, Hospital Xeral-Cies, Vigo (Spain); Conde, C. [Servicio de Neurocirugia, Hospital Xeral-Cies, Vigo (Spain); Fernandez, R. [Servicio de Anatomia Patologica, Hospital Xeral-Cies, Vigo (Spain)

    2000-12-01

    Granular cell tumor is a rare neoplasm arising within the neurohypophysis. We describe the MR imaging findings in two symptomatic patients. In one patient with history of panhypopituitarism, MR images showed a large sellar and suprasellar mass. The other patient presented with acute loss of vision in her left eye, and MR images showed a suprasellar mass with compression of the optic chiasm. (orig.)

  7. MR imaging findings in granular cell tumor of the neurohypophysis: a difficult preoperative diagnosis

    International Nuclear Information System (INIS)

    Iglesias, A.; Arias, M.; Brasa, J.; Paramo, C.; Conde, C.; Fernandez, R.

    2000-01-01

    Granular cell tumor is a rare neoplasm arising within the neurohypophysis. We describe the MR imaging findings in two symptomatic patients. In one patient with history of panhypopituitarism, MR images showed a large sellar and suprasellar mass. The other patient presented with acute loss of vision in her left eye, and MR images showed a suprasellar mass with compression of the optic chiasm. (orig.)

  8. Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira [Chiba Univ. (Japan). School of Medicine

    2000-11-01

    Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

  9. Preoperative assessment of trigeminal neuralgia and hemifacial spasm using constructive interference in steady state-three-dimensional fourier transformation magnetic resonance imaging

    International Nuclear Information System (INIS)

    Yamakami, Iwao; Kobayashi, Eiichi; Hirai, Shinji; Yamaura, Akira

    2000-01-01

    Results of microvascular decompression (MVD) for trigeminal neuralgia (TN) and hemifacial spasm (HFS) may be improved by accurate preoperative assessment of neurovascular relationships at the root entry/exit zone (REZ). Constructive interference in steady state (CISS)-three-dimensional Fourier transformation (3DFT) magnetic resonance (MR) imaging was evaluated for visualizing the neurovascular relationships at the REZ. Fourteen patients with TN and eight patients with HFS underwent MR imaging using CISS-3DFT and 3D fast inflow with steady-state precession (FISP) sequences. Axial images of the cerebellopontine angle (CPA) obtained by the two sequences were reviewed to assess the neurovascular relationships at the REZ of the trigeminal and facial nerves. Eleven patients subsequently underwent MVD. Preoperative MR imaging findings were related to surgical observations and results. CISS MR imaging provided excellent contrast between the cranial nerves, small vessels, and cerebrospinal fluid (CSF) in the CPA. CISS was significantly better than FISP for delineating anatomic detail in the CPA (trigeminal and facial nerves, petrosal vein) and abnormal neurovascular relationships responsible for TN and HFS (vascular contact and deformity at the REZ). Preoperative CISS MR imaging demonstrated precisely the neurovascular relationships at the REZ and identified the offending artery in all seven patients with TN undergoing MVD. CISS MR imaging has high resolution and excellent contrast between cranial nerves, small vessels, and CSF, so can precisely and accurately delineate normal and abnormal neurovascular relationships at the REZ in the CPA, and is a valuable preoperative examination for MVD. (author)

  10. Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note.

    Science.gov (United States)

    Yoshino, Masanori; Nakatomi, Hirofumi; Kin, Taichi; Saito, Toki; Shono, Naoyuki; Nomura, Seiji; Nakagawa, Daichi; Takayanagi, Shunsaku; Imai, Hideaki; Oyama, Hiroshi; Saito, Nobuhito

    2017-07-01

    Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3-5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging findings were compared with the operative findings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraoperatively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma.

  11. Neck x-ray

    Science.gov (United States)

    X-ray - neck; Cervical spine x-ray; Lateral neck x-ray ... There is low radiation exposure. X-rays are monitored so that the lowest amount of radiation is used to produce the image. Pregnant women and ...

  12. Automatic Delineation of On-Line Head-And-Neck Computed Tomography Images: Toward On-Line Adaptive Radiotherapy

    International Nuclear Information System (INIS)

    Zhang Tiezhi; Chi Yuwei; Meldolesi, Elisa; Yan Di

    2007-01-01

    Purpose: To develop and validate a fully automatic region-of-interest (ROI) delineation method for on-line adaptive radiotherapy. Methods and Materials: On-line adaptive radiotherapy requires a robust and automatic image segmentation method to delineate ROIs in on-line volumetric images. We have implemented an atlas-based image segmentation method to automatically delineate ROIs of head-and-neck helical computed tomography images. A total of 32 daily computed tomography images from 7 head-and-neck patients were delineated using this automatic image segmentation method. Manually drawn contours on the daily images were used as references in the evaluation of automatically delineated ROIs. Two methods were used in quantitative validation: (1) the dice similarity coefficient index, which indicates the overlapping ratio between the manually and automatically delineated ROIs; and (2) the distance transformation, which yields the distances between the manually and automatically delineated ROI surfaces. Results: Automatic segmentation showed agreement with manual contouring. For most ROIs, the dice similarity coefficient indexes were approximately 0.8. Similarly, the distance transformation evaluation results showed that the distances between the manually and automatically delineated ROI surfaces were mostly within 3 mm. The distances between two surfaces had a mean of 1 mm and standard deviation of <2 mm in most ROIs. Conclusion: With atlas-based image segmentation, it is feasible to automatically delineate ROIs on the head-and-neck helical computed tomography images in on-line adaptive treatments

  13. Self-image of the Patients with Head and Neck Cancer: A Mixed Method Research

    Science.gov (United States)

    Nayak, Shalini G; Pai, Mamatha Shivananda; George, Linu Sara

    2016-01-01

    Aim: The aim of the study was to assess the self-image of the patients with head and neck cancers (HNCs) by using a mixed method research. Subjects and Methods: A mixed method approach and triangulation design was used with the aim of assessing the self-image of the patients with HNCs. Data was gathered by using self-administered self-image scale and structured interview. Nested sampling technique was adopted. Sample size for quantitative approach was 54 and data saturation was achieved with seven subjects for qualitative approach. Institutional Ethical Committee clearance was obtained. Results: The results of the study showed that 30 (56%) subjects had positive self-image and 24 (44%) had negative self-image. There was a moderate positive correlation between body image and integrity (r = 0.430, P = 0.001), weak positive correlation between body image and self-esteem (r = 0.270, P = 0.049), and no correlation between self-esteem and integrity (r = 0.203, P = 0.141). The participants also scored maximum (24/24) in the areas of body image and self-esteem. Similar findings were also observed in the phenomenological approach. The themes evolved were immaterial of outer appearance and desire of good health to all. Conclusion: The illness is long-term and impacts the individual 24 h a day. Understanding patients’ self-concept and living experiences of patients with HNC is important for the health care professionals to improve the care. PMID:27559264

  14. Self-image of the patients with head and neck cancer: A mixed method research

    Directory of Open Access Journals (Sweden)

    Shalini G Nayak

    2016-01-01

    Full Text Available Aim: The aim of the study was to assess the self-image of the patients with head and neck cancers (HNCs by using a mixed method research. Subjects and Methods: A mixed method approach and triangulation design was used with the aim of assessing the self-image of the patients with HNCs. Data was gathered by using self-administered self-image scale and structured interview. Nested sampling technique was adopted. Sample size for quantitative approach was 54 and data saturation was achieved with seven subjects for qualitative approach. Institutional Ethical Committee clearance was obtained. Results: The results of the study showed that 30 (56% subjects had positive self-image and 24 (44% had negative self-image. There was a moderate positive correlation between body image and integrity (r = 0.430, P = 0.001, weak positive correlation between body image and self-esteem (r = 0.270, P = 0.049, and no correlation between self-esteem and integrity (r = 0.203, P = 0.141. The participants also scored maximum (24/24 in the areas of body image and self-esteem. Similar findings were also observed in the phenomenological approach. The themes evolved were "immaterial of outer appearance" and "desire of good health to all." Conclusion: The illness is long-term and impacts the individual 24 h a day. Understanding patients′ self-concept and living experiences of patients with HNC is important for the health care professionals to improve the care.

  15. Evaluation of the precision of portal-image-guided head-and-neck localization: An intra- and interobserver study

    International Nuclear Information System (INIS)

    Court, Laurence E.; Allen, Aaron; Tishler, Roy

    2007-01-01

    There is increasing evidence that, for some patients, image-guided intensity-modulated radiation therapy (IMRT) for head-and-neck cancer patients may maintain target dose coverage and critical organ (e.g., parotids) dose closer to the planned doses than setup using lasers alone. We investigated inter- and intraobserver uncertainties in patient setup in head-and-neck cancer patients. Twenty-two sets of orthogonal digital portal images (from five patients) were selected from images used for daily localization of head-and-neck patients treated with IMRT. To evaluate interobserver variations, five radiation therapists compared the portal images with the plan digitally reconstructed radiographs and reported shifts for the isocenter (∼C2) and for a supraclavicular reference point. One therapist repeated the procedure a month later to evaluate intraobserver variations. The procedure was then repeated with teams of two therapists. The frequencies for which agreement between the shift reported by the observer and the daily mean shift (average of all observers for a given image set) were less than 1.5 and 2.5 mm were calculated. Standard errors of measurement for the intra- and interobserver uncertainty (SEM intra and SEM inter ) for the individual and teams were calculated. The data showed that there was very little difference between individual therapists and teams. At isocenter, 80%-90% of all reported shifts agreed with the daily average within 1.5 mm, showing consistency in the ways both individuals and teams interpret the images (SEM inter ∼1 mm). This dropped to 65% for the supraclavicular point (SEM inter ∼1.5 mm). Uncertainties increased for larger setup errors. In conclusion, image-guided patient positioning allows head-and-neck patients to be controlled within 3-4 mm. This is similar to the setup uncertainties found for most head-and-neck patients, but may provide some improvement for the subset of patients with larger setup uncertainties

  16. 57Co-bleomycin imaging study of tumors of the head and neck

    International Nuclear Information System (INIS)

    Sawas-Dimopoulou, C.; Pantazopoulos, P.; Dokianakis, G.; Apostolopoulos, N.; Papafrangou, C.

    1978-01-01

    57 Co-Bleomycin ( 57 Co-BLM) was used to visualize malignancies of the head and neck because it does not present the disadvantages of many other radiopharmaceuticals. In a series of 21 patients with 9 control subjects and 12 cases of tumors, 57 Co-BLM showed a high and rapid uptake in primary site and metastases of malignant tumors of various histologic types, but not in benign tumors such as angiofibromas. Compared to 67 Ga-citrate, 57 Co-BLM has many advantages for tumor imaging in the areas of nose, pharynx and larynx: No background activity due to the concentration of 57 Co-BLM in normal structures of the head and neck has ever been observed, as opposed to what happens with 67 Ga-citrate. Furthermore, the blood clearance of 57 Co-BLM is much more rapid than that of 67 Ga-citrate, so that an early study may be performed in a 6 to 24 hr interval instead of 48 to 72 hr with 67 Ga-citrate. 57 Co-BLM scintigraphy is an easy, non-invasive and sensible diagnostic technique in determining the extent of malignant tumors in ORL patients

  17. Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a tracheostomy in head and neck malignancies.

    Science.gov (United States)

    Gupta, Karan; Mandlik, Dushyant; Patel, Daxesh; Patel, Purvi; Shah, Bankim; Vijay, Devanhalli G; Kothari, Jagdish M; Toprani, Rajendra B; Patel, Kaustubh D

    2016-09-01

    Tracheostomy is a mainstay modality for airway management for patients with head-neck cancer undergoing surgery. This study aims to define factors predicting need of tracheostomy and define an effective objective criterion to predict tracheostomy need. 486 patients undergoing composite resections were studied. Factors analyzed were age, previous surgery, extent of surgery, trismus, extent of mandibular resection and reconstruction etc. Factors were divided into major and minor, using the clinical assessment scoring system for tracheostomy (CASST) criterion. Sixty seven (13.7%) patients required tracheostomy for their peri-operative management. Elective tracheostomies were done in 53 cases during surgery and post-operatively in 14 patients. All patients in whom tracheostomies were anticipated had a score of seven or more. A decision on whether or not an elective tracheotomy in head and neck surgery is necessary and can be facilitated using CASST criterion, which has a sensitivity of 95.5% and a negative predictive value (NPV) of 99.3%. It may reduce post-operative complications and contribute to safer treatment. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  18. SU-E-J-225: CEST Imaging in Head and Neck Cancer Patients

    International Nuclear Information System (INIS)

    Wang, J; Hwang, K; Fuller, C; Mohamed, A; Ding, Y; Frank, S; Hazle, J; Zhou, J

    2015-01-01

    Purpose: Chemical Exchange Saturation Transfer (CEST) imaging is an MRI technique enables the detection and imaging of metabolically active compounds in vivo. It has been used to differentiate tumor types and metabolic characteristics. Unlike PET/CT,CEST imaging does not use isotopes so it can be used on patient repeatedly. This study is to report the preliminary results of CEST imaging in Head and Neck cancer (HNC) patients. Methods: A CEST imaging sequence and the post-processing software was developed on a 3T clinical MRI scanner. Ten patients with Human papilloma virus positive oropharyngeal cancer were imaged in their immobilized treatment position. A 5 mm slice CEST image was acquired (128×128, FOV=20∼24cm) to encompass the maximum dimension of tumor. Twenty-nine off-set frequencies (from −7.8ppm to +7.8 ppm) were acquired to obtain the Z-spectrum. Asymmetry analysis was used to extract the CEST contrasts. ROI at the tumor, node and surrounding tissues were measured. Results: CEST images were successfully acquired and Zspectrum asymmetry analysis demonstrated clear CEST contrasts in tumor as well as the surrounding tissues. 3∼5% CEST contrast in the range of 1 to 4 ppm was noted in tumor as well as grossly involved nodes. Injection of glucose produced a marked increase of CEST contrast in tumor region (∼10%). Motion and pulsation artifacts tend to smear the CEST contrast, making the interpretation of the image contrast difficult. Field nonuniformity, pulsation in blood vesicle and susceptibility artifacts caused by air cavities were also problematic for CEST imaging. Conclusion: We have demonstrated successful CEST acquisition and Z-spectrum reconstruction on HNC patients with a clinical scanner. MRI acquisition in immobilized treatment position is critical for image quality as well as the success of CEST image acquisition. CEST images provide novel contrast of metabolites in HNC and present great potential in the pre- and post-treatment assessment

  19. SU-E-J-225: CEST Imaging in Head and Neck Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, J; Hwang, K; Fuller, C; Mohamed, A; Ding, Y; Frank, S; Hazle, J; Zhou, J [UT MD Anderson Cancer Center, Houston, TX (United States)

    2015-06-15

    Purpose: Chemical Exchange Saturation Transfer (CEST) imaging is an MRI technique enables the detection and imaging of metabolically active compounds in vivo. It has been used to differentiate tumor types and metabolic characteristics. Unlike PET/CT,CEST imaging does not use isotopes so it can be used on patient repeatedly. This study is to report the preliminary results of CEST imaging in Head and Neck cancer (HNC) patients. Methods: A CEST imaging sequence and the post-processing software was developed on a 3T clinical MRI scanner. Ten patients with Human papilloma virus positive oropharyngeal cancer were imaged in their immobilized treatment position. A 5 mm slice CEST image was acquired (128×128, FOV=20∼24cm) to encompass the maximum dimension of tumor. Twenty-nine off-set frequencies (from −7.8ppm to +7.8 ppm) were acquired to obtain the Z-spectrum. Asymmetry analysis was used to extract the CEST contrasts. ROI at the tumor, node and surrounding tissues were measured. Results: CEST images were successfully acquired and Zspectrum asymmetry analysis demonstrated clear CEST contrasts in tumor as well as the surrounding tissues. 3∼5% CEST contrast in the range of 1 to 4 ppm was noted in tumor as well as grossly involved nodes. Injection of glucose produced a marked increase of CEST contrast in tumor region (∼10%). Motion and pulsation artifacts tend to smear the CEST contrast, making the interpretation of the image contrast difficult. Field nonuniformity, pulsation in blood vesicle and susceptibility artifacts caused by air cavities were also problematic for CEST imaging. Conclusion: We have demonstrated successful CEST acquisition and Z-spectrum reconstruction on HNC patients with a clinical scanner. MRI acquisition in immobilized treatment position is critical for image quality as well as the success of CEST image acquisition. CEST images provide novel contrast of metabolites in HNC and present great potential in the pre- and post-treatment assessment

  20. The Clinical Role of 99mTc-(V)-DMSA Imaging in Patients with Head and Neck Cancer

    International Nuclear Information System (INIS)

    Bae, Sun Kun; Lee, Jae Tae; Park, June Sik

    1995-01-01

    99m Tc-(V)-DMSA is a tumor seeking agent that has been used to image medullary carcinoma of thyroid, soft tissue sarcoma and lung cancer. This study was designed to assess the clinical role of DMSA in the diagnosis of head and neck cancers. We has evaluated the diagnostic efficacy of planar and SPECT imaging using 99m Tc-(V)-DMSA. Sixty-eight patients with head and neck mass were included in this study. All subjects were diagnosed by biopsy or surgery. Planar and SPECT images were obtained at 2 or 3 hour after intravenous injection of 740 MBq(20 mCi) 99m Tc-(V)-DMSA. Seventeen patients also underwent SPECT imaging using dual head camera. The diagnostic sensitivity of 99m Tc-(V)-DMSA planar and SPECT imaging was 65% and 90%, and specificity was 80% and 66%, respectively. The sensitivity of planar imaging in squamous cell carcinoma was similar to overall sensitivity. Six metastatic lesion were first diagnosed by scintigraphy. But benign lesions such as Kikuchi syndrome, tuberculous lymphadenitis also revealed increased uptake. 99m Tc-(V)-DMSA imaging seems to be a promising method in the evaluation of patients with head and neck mass. We recommend SPECT imaging to delineate anatomic localization of the lesion.

  1. The Contribution of Three-Dimensional Power Doppler Imaging in the Preoperative Assessment of Breast Tumors: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    K. Kalmantis

    2009-01-01

    Methods. One hundred and twenty five women with clinically or mammographically suspicious findings were referred for 3D Power Doppler ultrasound prior to surgery. Histological diagnosis was conducted after surgery and compared with ultrasound findings. Sonographic criteria used for breast cancer diagnosis were based on a system that included morphological characteristics and criteria of the vascular pattern of a breast mass by Power Doppler imaging. Results. Seventy-two lesions were histopathologically diagnosed as benign and 53 tumors as malignant. Three-dimensional ultrasound identified 49 out of 53 histologically confirmed breast cancers resulting in a sensitivity of 92.4% and a specificity of 86.1% in diagnosing breast malignancy (PPV: 0.83, NPV:0.94. Conclusions. 3D ultrasonography is a valuable tool in identifying preoperatively the possibility of a tumor to be malignant.

  2. Potentials of high resolution magnetic resonance imaging versus computed tomography for preoperative local staging of colon cancer

    International Nuclear Information System (INIS)

    Rollven, Erik; Blomqvist, Lennart; Holm, Torbjorn; Glimelius, Bengt; Loerinc, Esther

    2013-01-01

    Background: Preoperative identification of locally advanced colon cancer is of importance in order to properly plan treatment. Purpose: To study high resolution T2-weighted magnetic resonance imaging (MRI) versus computed tomography (CT) for preoperative staging of colon cancer with surgery and histopathology as reference standard. Material and Methods: Twenty-eight patients with a total of 29 tumors were included. Patients were examined on a 1.5 T MR unit using a phased array body coil. T2 turbo spin-echo high resolution sequences were obtained in a coronal, transverse, and perpendicular plane to the long axis of the colon at the site of the tumor. Contrast-enhanced CT was performed using a protocol for metastasis staging. The examinations were independently evaluated by two gastrointestinal radiologists using criteria adapted to imaging for prediction of T-stage, N-stage, and extramural venous invasion. Based on the T-stage, tumors were divided in to locally advanced (T3cd-T4) and not locally advanced (T1-T3ab). Surgical and histopathological findings served as reference standard. Results: Using MRI, T-stage, N-stage, and extramural venous invasion were correctly predicted for each observer in 90% and 93%, 72% and 69%, and 82% and 78% of cases, respectively. With CT the corresponding results were 79% and 76%, 72% and 72%, 78% and 67%. For MRI inter-observer agreements (Kappa statistics) were 0.79, 0.10, and 0.76. For CT the corresponding results were 0.64, 0.66, and 0.22. Conclusion: Patients with locally advanced colon cancer, defined as tumor stage T3cd-T4, can be identified by both high resolution MRI and CT, even when CT is performed with a metastasis staging protocol. MRI may have an advantage, due to its high soft tissue discrimination, to identify certain prognostic factors such as T-stage and extramural venous invasion

  3. Potentials of high resolution magnetic resonance imaging versus computed tomography for preoperative local staging of colon cancer

    Energy Technology Data Exchange (ETDEWEB)

    Rollven, Erik; Blomqvist, Lennart [Dept. of Diagnostic Radiology, Karolinska Univ. Hospital Solna, Stockholm (Sweden); Dept. of Molecular Medicine and Surgery, Karolinska Inst., Stockholm (Sweden)], e-mail: erik.rollven@ki.se; Holm, Torbjorn [Dept. of Molecular Medicine and Surgery, Karolinska Inst., Stockholm (Sweden); Dept. of Surgery, Karolinska Univ. Hospital Solna, Stockholm (Sweden); Glimelius, Bengt [Dept. of Radiology, Oncology and Radiation Science, Uppsala Univ., Uppsala (Sweden); Dept. of Oncology and Pathology, Karolinska Inst., Stockholm (Sweden); Loerinc, Esther [Dept. of Oncology and Pathology, Karolinska Inst., Stockholm (Sweden); Dept. of Pathology, Karolinska Univ. Hospital, Solna, Sweden (Sweden)

    2013-09-15

    Background: Preoperative identification of locally advanced colon cancer is of importance in order to properly plan treatment. Purpose: To study high resolution T2-weighted magnetic resonance imaging (MRI) versus computed tomography (CT) for preoperative staging of colon cancer with surgery and histopathology as reference standard. Material and Methods: Twenty-eight patients with a total of 29 tumors were included. Patients were examined on a 1.5 T MR unit using a phased array body coil. T2 turbo spin-echo high resolution sequences were obtained in a coronal, transverse, and perpendicular plane to the long axis of the colon at the site of the tumor. Contrast-enhanced CT was performed using a protocol for metastasis staging. The examinations were independently evaluated by two gastrointestinal radiologists using criteria adapted to imaging for prediction of T-stage, N-stage, and extramural venous invasion. Based on the T-stage, tumors were divided in to locally advanced (T3cd-T4) and not locally advanced (T1-T3ab). Surgical and histopathological findings served as reference standard. Results: Using MRI, T-stage, N-stage, and extramural venous invasion were correctly predicted for each observer in 90% and 93%, 72% and 69%, and 82% and 78% of cases, respectively. With CT the corresponding results were 79% and 76%, 72% and 72%, 78% and 67%. For MRI inter-observer agreements (Kappa statistics) were 0.79, 0.10, and 0.76. For CT the corresponding results were 0.64, 0.66, and 0.22. Conclusion: Patients with locally advanced colon cancer, defined as tumor stage T3cd-T4, can be identified by both high resolution MRI and CT, even when CT is performed with a metastasis staging protocol. MRI may have an advantage, due to its high soft tissue discrimination, to identify certain prognostic factors such as T-stage and extramural venous invasion.

  4. Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation

    International Nuclear Information System (INIS)

    Boer, Hans C.J. de; Soernsen de Koste, John R. van; Creutzberg, Carien L.; Visser, Andries G.; Levendag, Peter C.; Heijmen, Ben J.M.

    2001-01-01

    Purpose: To quantify systematic and random patient set-up errors in head and neck irradiation and to investigate the impact of an off-line correction protocol on the systematic errors. Material and methods: Electronic portal images were obtained for 31 patients treated for primary supra-glottic larynx carcinoma who were immobilised using a polyvinyl chloride cast. The observed patient set-up errors were input to the shrinking action level (SAL) off-line decision protocol and appropriate set-up corrections were applied. To assess the impact of the protocol, the positioning accuracy without application of set-up corrections was reconstructed. Results: The set-up errors obtained without set-up corrections (1 standard deviation (SD)=1.5-2 mm for random and systematic errors) were comparable to those reported in other studies on similar fixation devices. On an average, six fractions per patient were imaged and the set-up of half the patients was changed due to the decision protocol. Most changes were detected during weekly check measurements, not during the first days of treatment. The application of the SAL protocol reduced the width of the distribution of systematic errors to 1 mm (1 SD), as expected from simulations. A retrospective analysis showed that this accuracy should be attainable with only two measurements per patient using a different off-line correction protocol, which does not apply action levels. Conclusions: Off-line verification protocols can be particularly effective in head and neck patients due to the smallness of the random set-up errors. The excellent set-up reproducibility that can be achieved with such protocols enables accurate dose delivery in conformal treatments

  5. Scintigraphic and MR perfusion imaging in preoperative evaluation for lung volume reduction surgery. Pilot study results

    International Nuclear Information System (INIS)

    Johkoh, Takeshi; Mueller, N.L.; Kavanagh, P.V

    2000-01-01

    To compare MR perfusion imaging with perfusion scintigraphy in the evaluation of patients with pulmonary emphysema being considered for lung volume reduction surgery. Six patients with pulmonary emphysema and two normal individuals were evaluated by MR perfusion imaging, perfusion scintigraphy, and selective bilateral pulmonary angiography. MR images were obtained with an enhanced fast gradient recalled echo with three-dimensional Fourier transformation technique (efgre 3D) (6.3/1.3; flip angle, 30 deg C; field of view, 45-48 cm; matrix, 256 x 160). The presence or absence of perfusion defects in each segment was evaluated by two independent observers. Using angiography as the gold standard, the sensitivity, specificity, and accuracy of MR perfusion imaging in detecting focal perfusion abnormalities were 90%, 87%, and 89%, respectively, while those of perfusion scintigraphy were 71%, 76%, and 71%, respectively. The diagnostic accuracy of MR perfusion imaging was significantly higher than that of scintigraphy (p<0.001, McNemar test). There was good agreement between two observers for MR perfusion imaging (kappa statistic, 0.66) and only moderate agreement for perfusion scintigraphy (kappa statistic, 0.51). MR perfusion imaging is superior to perfusion scintigraphy in the evaluation of pulmonary parenchymal perfusion in patients with pulmonary emphysema. (author)

  6. Imaging of head and neck tumors -- methods: CT, spiral-CT, multislice-spiral-CT

    International Nuclear Information System (INIS)

    Baum, Ulrich; Greess, Holger; Lell, Michael; Noemayr, Anton; Lenz, Martin

    2000-01-01

    Spiral-CT is standard for imaging neck tumors. In correspondence with other groups we routinely use spiral-CT with thin slices (3 mm), a pitch of 1.3-1.5 and an overlapping reconstruction increment (2-3 mm). In patients with dental fillings a short additional spiral parallel to the corpus of the mandible reduces artifacts behind the dental arches and improves the diagnostic value of CT. For the assessment of the base of the skull, the orbital floor, the palate and paranasal sinuses an additional examination in the coronal plane is helpful. Secondary coronal reconstructions of axial scans are helpful in the evaluation of the crossing of the midline by small tumors of the tongue base or palate. For an optimal vascular or tissue contrast a sufficient volume of contrast medium and a start delay greater than 70-80 s are necessary. In our opinion the best results can be achieved with a volume of 150 ml, a flow of 2.5 ml/s and a start delay of 80 s. Dynamic enhanced CT is only necessary in some special cases. There is clear indication for dynamic enhanced CT where a glomus tumor is suspected. Additional functional CT imaging during i-phonation and/or Valsalva's maneuver are of great importance to prove vocal cords mobility. Therefore, imaging during i-phonation is an elemental part of every thorough examination of the hypopharynx and larynx region. Multislice-spiral-CT allows almost isotropic imaging of the head and neck region and improves the assessment of tumor spread and lymph node metastases in arbitrary oblique planes. Thin structures (the base of the skull, the orbital floor, the hard palate) as well as the floor of the mouth can be evaluated sufficiently with multiplanar reformations. Usually, additional coronal scanning is not necessary with multislice-spiral-CT. Multislice-spiral-CT is especially advantageous in defining the critical relationships of tumor and lymph node metastases and for functional imaging of the hypopharynx and larynx not only in the

  7. Image-based modeling of tumor shrinkage in head and neck radiation therapy1

    Science.gov (United States)

    Chao, Ming; Xie, Yaoqin; Moros, Eduardo G.; Le, Quynh-Thu; Xing, Lei

    2010-01-01

    Purpose: Understanding the kinetics of tumor growth∕shrinkage represents a critical step in quantitative assessment of therapeutics and realization of adaptive radiation therapy. This article presents a novel framework for image-based modeling of tumor change and demonstrates its performance with synthetic images and clinical cases. Methods: Due to significant tumor tissue content changes, similarity-based models are not suitable for describing the process of tumor volume changes. Under the hypothesis that tissue features in a tumor volume or at the boundary region are partially preserved, the kinetic change was modeled in two steps: (1) Autodetection of homologous tissue features shared by two input images using the scale invariance feature transformation (SIFT) method; and (2) establishment of a voxel-to-voxel correspondence between the images for the remaining spatial points by interpolation. The correctness of the tissue feature correspondence was assured by a bidirectional association procedure, where SIFT features were mapped from template to target images and reversely. A series of digital phantom experiments and five head and neck clinical cases were used to assess the performance of the proposed technique. Results: The proposed technique can faithfully identify the known changes introduced when constructing the digital phantoms. The subsequent feature-guided thin plate spline calculation reproduced the “ground truth” with accuracy better than 1.5 mm. For the clinical cases, the new algorithm worked reliably for a volume change as large as 30%. Conclusions: An image-based tumor kinetic algorithm was developed to model the tumor response to radiation therapy. The technique provides a practical framework for future application in adaptive radiation therapy. PMID:20527569

  8. Image-based modeling of tumor shrinkage in head and neck radiation therapy

    International Nuclear Information System (INIS)

    Chao Ming; Xie Yaoqin; Moros, Eduardo G.; Le, Quynh-Thu; Xing Lei

    2010-01-01

    Purpose: Understanding the kinetics of tumor growth/shrinkage represents a critical step in quantitative assessment of therapeutics and realization of adaptive radiation therapy. This article presents a novel framework for image-based modeling of tumor change and demonstrates its performance with synthetic images and clinical cases. Methods: Due to significant tumor tissue content changes, similarity-based models are not suitable for describing the process of tumor volume changes. Under the hypothesis that tissue features in a tumor volume or at the boundary region are partially preserved, the kinetic change was modeled in two steps: (1) Autodetection of homologous tissue features shared by two input images using the scale invariance feature transformation (SIFT) method; and (2) establishment of a voxel-to-voxel correspondence between the images for the remaining spatial points by interpolation. The correctness of the tissue feature correspondence was assured by a bidirectional association procedure, where SIFT features were mapped from template to target images and reversely. A series of digital phantom experiments and five head and neck clinical cases were used to assess the performance of the proposed technique. Results: The proposed technique can faithfully identify the known changes introduced when constructing the digital phantoms. The subsequent feature-guided thin plate spline calculation reproduced the ''ground truth'' with accuracy better than 1.5 mm. For the clinical cases, the new algorithm worked reliably for a volume change as large as 30%. Conclusions: An image-based tumor kinetic algorithm was developed to model the tumor response to radiation therapy. The technique provides a practical framework for future application in adaptive radiation therapy.

  9. Image-based modeling of tumor shrinkage in head and neck radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Chao Ming; Xie Yaoqin; Moros, Eduardo G.; Le, Quynh-Thu; Xing Lei [Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, California 94305-5847 and Department of Radiation Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, Arkansas 72205-1799 (United States); Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, California 94305-5847 (United States); Department of Radiation Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, Arkansas 72205-1799 (United States); Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, California 94305-5847 (United States)

    2010-05-15

    Purpose: Understanding the kinetics of tumor growth/shrinkage represents a critical step in quantitative assessment of therapeutics and realization of adaptive radiation therapy. This article presents a novel framework for image-based modeling of tumor change and demonstrates its performance with synthetic images and clinical cases. Methods: Due to significant tumor tissue content changes, similarity-based models are not suitable for describing the process of tumor volume changes. Under the hypothesis that tissue features in a tumor volume or at the boundary region are partially preserved, the kinetic change was modeled in two steps: (1) Autodetection of homologous tissue features shared by two input images using the scale invariance feature transformation (SIFT) method; and (2) establishment of a voxel-to-voxel correspondence between the images for the remaining spatial points by interpolation. The correctness of the tissue feature correspondence was assured by a bidirectional association procedure, where SIFT features were mapped from template to target images and reversely. A series of digital phantom experiments and five head and neck clinical cases were used to assess the performance of the proposed technique. Results: The proposed technique can faithfully identify the known changes introduced when constructing the digital phantoms. The subsequent feature-guided thin plate spline calculation reproduced the ''ground truth'' with accuracy better than 1.5 mm. For the clinical cases, the new algorithm worked reliably for a volume change as large as 30%. Conclusions: An image-based tumor kinetic algorithm was developed to model the tumor response to radiation therapy. The technique provides a practical framework for future application in adaptive radiation therapy.

  10. Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance

    DEFF Research Database (Denmark)

    Truijers, M; Resch, T; Van Den Berg, J C

    2009-01-01

    and dual-source CT could reduce radiation dose and obviate the need for nephrotoxic contrast. Up-to-date knowledge of non-invasive vascular imaging and image processing is crucial for EVAR planning and is essential for the development of follow-up programs involving reduced risk of harmful side effects....... dynamic CTA and MRA, provide valuable information on dynamic changes in aneurysm morphology that might have an important impact on endograft selection. During follow-up, imaging of the graft and aneurysm is of utmost importance to identify patients in need of secondary intervention. This has led...... to rigorous follow-up protocols including duplex ultrasound and regular CT examinations. The use of these intense follow-up protocols has recently been questioned because of high radiation dose and the frequent use of nephrotoxic contrast agents. New imaging modalities like contrast enhanced DUS, dynamic MR...

  11. Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Joo; Kim, Ju Dong; Ryu, Hye In; Cho, Yeon Hee; Kong, Jun Ha; Ohe, Joo Young; Kwon, Yong Dae; Choi, Byung Joon; Kim, Gyu Tae [School of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)

    2011-12-15

    The advent and wide use of antibiotics have decreased the incidence of deep neck infection. When a deep neck infection does occur, however, it can be the cause of significant morbidity and death, resulting in airway obstruction, mediastinitis, pericarditis, epidural abscesses, and major vessel erosion. In our clinic, a patient with diffuse chronic osteomyelitis of mandible and fascial space abscess and necrotic fasciitis due to odontogenic infection at the time of first visit came. We successfully treated the patient by early diagnosis using contrast-enhanced CT and follow up dressing through the appropriate use of radiographic images.

  12. Molecular PET imaging for biology-guided adaptive radiotherapy of head and neck cancer.

    Science.gov (United States)

    Hoeben, Bianca A W; Bussink, Johan; Troost, Esther G C; Oyen, Wim J G; Kaanders, Johannes H A M

    2013-10-01

    Integration of molecular imaging PET techniques into therapy selection strategies and radiation treatment planning for head and neck squamous cell carcinoma (HNSCC) can serve several purposes. First, pre-treatment assessments can steer decisions about radiotherapy modifications or combinations with other modalities. Second, biology-based objective functions can be introduced to the radiation treatment planning process by co-registration of molecular imaging with planning computed tomography (CT) scans. Thus, customized heterogeneous dose distributions can be generated with escalated doses to tumor areas where radiotherapy resistance mechanisms are most prevalent. Third, monitoring of temporal and spatial variations in these radiotherapy resistance mechanisms early during the course of treatment can discriminate responders from non-responders. With such information available shortly after the start of treatment, modifications can be implemented or the radiation treatment plan can be adapted tailing the biological response pattern. Currently, these strategies are in various phases of clinical testing, mostly in single-center studies. Further validation in multicenter set-up is needed. Ultimately, this should result in availability for routine clinical practice requiring stable production and accessibility of tracers, reproducibility and standardization of imaging and analysis methods, as well as general availability of knowledge and expertise. Small studies employing adaptive radiotherapy based on functional dynamics and early response mechanisms demonstrate promising results. In this context, we focus this review on the widely used PET tracer (18)F-FDG and PET tracers depicting hypoxia and proliferation; two well-known radiation resistance mechanisms.

  13. Estimation of carrying angle based on CT images in preoperative surgical planning for cubitus deformities

    International Nuclear Information System (INIS)

    Park, Shinsuk; Kim, Eugene

    2009-01-01

    Conventionally, the carrying angle of the elbow is measured using simple two-dimensional radiography or goniometry, which has questionable reliability. This study proposes a novel method for estimating carrying angles using computed tomography that can enhance the reliability of the angle measurement. Data of CT scans from 25 elbow joints were processed to build segmented three-dimensional models. The cross-sectional centerlines of the ulna and the humerus were traced from the 3D models, and the angle between 2 vectors formed from the centerlines of the humerus and the ulna was defined as the 'three-dimensional carrying angle.' These angles were compared with those measured by simple radiograph. Two cases of angular deformity were underwent surgery based on this preoperative surgical planning, and the postoperative 3D carrying angles were evaluated using the proposed method. The mean value of the calculated three-dimensional carrying angle was 20.7deg±3.61, while it was 16.3deg±3.21 based on simple radiography without statistical difference. Based on the 3D carrying angle estimations, 2 surgical cases of cubitus deformities were planned by comparison with the normal contra-lateral elbow. Postoperative angle estimations confirmed that the corrected angles were nearly identical to the planned angles for both cases. The results of this study showed that the carrying angle can be accurately estimated using three-dimensional CT and that the proposed method is useful in evaluating deformities of the elbow with high reliability. (author)

  14. Preoperative evaluation of hyperparathyroidism. The role of dual-phase parathyroid scintigraphy and ultrasound imaging

    International Nuclear Information System (INIS)

    Sukan, A.; Reyhan, M.; Aydin, M.; Yapar, A.F.; Aktas, A.; Sert, Y.; Canpolat, T.

    2008-01-01

    The aim of this study was to evaluate the efficacy of dual-phase 99mTc-methoxyisobutylnitrile (MIBI) parathyroid scintigraphy (PS) and ultrasound (US) in primary (pHPT) and secondary (sHPT) hyperparathyroidism. A total of 69 patients (mean age 47±16; age range 14-79 years), including 19 patients with sHPT were enrolled in this study. Preoperative serum intact parathyroid hormone (iPTH) levels, calcium (Ca), phosphate (P), alkaline phosphatase, and 24-h urinary-free Ca measurements were obtained. Concomitant thyroid pathology was also recorded. Histopathology revealed 30 solitary adenomas and 71 hyperplastic glands in 55 patients. The remaining patients' histopathology revealed normal parathyroid, thyroid, or lymph nodes. The sensitivities of MIBI and US in pUPT were 70% and 60%, respectively. It was 60% for both procedures in sHPT. The overall sensitivity of combined US+MIBI in pHPT and sHPT was 81% and 71%, respectively. The overall specificity of MIBI and US was 87% and 91%; positive predictive value (PPV) was 94% and 92%, respectively. MIBI and US identified the parathyroid pathology in 92% and 85% of patients in the non-concomitant thyroid disease group, and in 53% and 47% of patients in the concomitant thyroid disease group, respectively. The weight of the gland between primary and secondary hyperparathyroidism did not reveal a significant difference (P=0.4). Significant differences were found with respect to age, PTH, Ca, and P levels between the pHPT and sHPT (P<0.001). Intact PTH levels showed significant differences between MIBI positive and negative patients (P=0.013), and also US positive and negative patients (P=0.012). A significant negative correlation was found between iPTH and Ca at sHPT (P<0.001). The concomitancy of thyroid disease greatly influences scintigraphic and ultrasonographic detection of parathyroid pathology in pHPT and sHPT. The combination of MIBI and US appears promising for localizing parathyroid pathology in patients with both

  15. Intraobserver and Interobserver Variability in GTV Delineation on FDG-PET-CT Images of Head and Neck Cancers

    International Nuclear Information System (INIS)

    Breen, Stephen L.; Publicover, Julia; De Silva, Shiroma; Pond, Greg; Brock, Kristy; O'Sullivan, Brian; Cummings, Bernard; Dawson, Laura; Keller, Anne; Kim, John; Ringash, Jolie; Yu, Eugene; Hendler, Aaron; Waldron, John

    2007-01-01

    Purpose: To determine if the addition of fluorodeoxyglucose positron emission tomography (FDG-PET) data changes primary site gross tumor volumes (GTVs) in head and neck cancers. Methods and Materials: Computed tomography (CT), contrast-enhanced CT, and FDG-PET-CT scans were obtained in 10 patients with head and neck cancers. Eight experienced observers (6 head and neck oncologists and 2 neuro-radiologists) with access to clinical and radiologic reports outlined primary site GTVs on each modality. Three cases were recontoured twice to assess intraobserver variability. The magnitudes of the GTVs were compared. Intra- and interobserver variability was assessed by a two-way repeated measures analysis of variance. Inter- and intraobserver reliability were calculated. Results: There were no significant differences in the GTVs across the image modalities when compared as ensemble averages; the Wilcoxon matched-pairs signed-rank test showed that CT volumes were larger than PET-CT. Observers demonstrated the greatest consistency and were most interchangeable on contrast-enhanced CT; they performed less reliably on PET-CT. Conclusions: The addition of PET-CT to primary site GTV delineation of head and neck cancers does not change the volume of the GTV defined by this group of expert observers in this patient sample. An FDG-PET may demonstrate differences in neck node delineation and in other disease sites

  16. Fibroblastic and myofibroblastic tumors of the head and neck: Comprehensive imaging-based review with pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Hourani, Roula, E-mail: rh64@aub.edu.lb [Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut (Lebanon); Taslakian, Bedros, E-mail: bt05@aub.edu.lb [Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut (Lebanon); Shabb, Nina S., E-mail: ns04@aub.edu.lb [Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut (Lebanon); Nassar, Lara, E-mail: ln07@aub.edu.lb [Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut (Lebanon); Hourani, Mukbil H., E-mail: mh17@aub.edu.lb [Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut (Lebanon); Moukarbel, Roger, E-mail: rm17@aub.edu.lb [Department of Otolaryngology – Head and Neck Surgery, American University of Beirut Medical Center, Beirut (Lebanon); Sabri, Alain, E-mail: as71@aub.edu.lb [Department of Otolaryngology – Head and Neck Surgery, American University of Beirut Medical Center, Beirut (Lebanon); Rizk, Toni, E-mail: tonirisk@hotmail.com [Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut (Lebanon)

    2015-02-15

    Highlights: • Almost all fibroblastic tumors are evaluated with non-invasive imaging. • Radiologists should be familiar with the imaging appearance of fibroblastic tumors. • Most appropriate initial examination when fibromatosis coli suspected is ultrasound. • Most common location of ossifying fibromas is the tooth-bearing regions. - Abstract: Fibroblastic and myofibroblastic tumors of the head and neck are a heterogeneous group of disorders characterized by the proliferation of fibroblasts, myofibroblasts, or both. These tumors may be further subclassified on the basis of their behavior as benign, intermediate with malignant potential, or malignant. There are different types of fibroblastic and myofibroblastic tumors that can involve the head and neck including desmoid-type fibromatosis, solitary fibrous tumor, myofibroma/myofibromatosis, nodular fasciitis, nasopharyngeal angiofibroma, fibrosarcoma, dermatofibrosarcoma protuberans, fibromatosis coli, inflammatory myofibroblastic tumor, ossifying fibroma, fibrous histiocytoma, nodular fasciitis, fibromyxoma, hyaline fibromatosis and fibrous hamartoma. Although the imaging characteristics of fibroblastic and myofibroblastic tumors of the head and neck are nonspecific, imaging plays a pivotal role in the noninvasive diagnosis and characterization of these tumors, providing information about the constitution of tumors, their extension and invasion of adjacent structures. Correlation with the clinical history may help limit the differential diagnosis and radiologists should be familiar with the imaging appearance of these tumors to reach an accurate diagnosis.

  17. Fibroblastic and myofibroblastic tumors of the head and neck: Comprehensive imaging-based review with pathologic correlation

    International Nuclear Information System (INIS)

    Hourani, Roula; Taslakian, Bedros; Shabb, Nina S.; Nassar, Lara; Hourani, Mukbil H.; Moukarbel, Roger; Sabri, Alain; Rizk, Toni

    2015-01-01

    Highlights: • Almost all fibroblastic tumors are evaluated with non-invasive imaging. • Radiologists should be familiar with the imaging appearance of fibroblastic tumors. • Most appropriate initial examination when fibromatosis coli suspected is ultrasound. • Most common location of ossifying fibromas is the tooth-bearing regions. - Abstract: Fibroblastic and myofibroblastic tumors of the head and neck are a heterogeneous group of disorders characterized by the proliferation of fibroblasts, myofibroblasts, or both. These tumors may be further subclassified on the basis of their behavior as benign, intermediate with malignant potential, or malignant. There are different types of fibroblastic and myofibroblastic tumors that can involve the head and neck including desmoid-type fibromatosis, solitary fibrous tumor, myofibroma/myofibromatosis, nodular fasciitis, nasopharyngeal angiofibroma, fibrosarcoma, dermatofibrosarcoma protuberans, fibromatosis coli, inflammatory myofibroblastic tumor, ossifying fibroma, fibrous histiocytoma, nodular fasciitis, fibromyxoma, hyaline fibromatosis and fibrous hamartoma. Although the imaging characteristics of fibroblastic and myofibroblastic tumors of the head and neck are nonspecific, imaging plays a pivotal role in the noninvasive diagnosis and characterization of these tumors, providing information about the constitution of tumors, their extension and invasion of adjacent structures. Correlation with the clinical history may help limit the differential diagnosis and radiologists should be familiar with the imaging appearance of these tumors to reach an accurate diagnosis

  18. MIDA: A Multimodal Imaging-Based Detailed Anatomical Model of the Human Head and Neck.

    Directory of Open Access Journals (Sweden)

    Maria Ida Iacono

    Full Text Available Computational modeling and simulations are increasingly being used to complement experimental testing for analysis of safety and efficacy of medical devices. Multiple voxel- and surface-based whole- and partial-body models have been proposed in the literature, typically with spatial resolution in the range of 1-2 mm and with 10-50 different tissue types resolved. We have developed a multimodal imaging-based detailed anatomical model of the human head and neck, named "MIDA". The model was obtained by integrating three different magnetic resonance imaging (MRI modalities, the parameters of which were tailored to enhance the signals of specific tissues: i structural T1- and T2-weighted MRIs; a specific heavily T2-weighted MRI slab with high nerve contrast optimized to enhance the structures of the ear and eye; ii magnetic resonance angiography (MRA data to image the vasculature, and iii diffusion tensor imaging (DTI to obtain information on anisotropy and fiber orientation. The unique multimodal high-resolution approach allowed resolving 153 structures, including several distinct muscles, bones and skull layers, arteries and veins, nerves, as well as salivary glands. The model offers also a detailed characterization of eyes, ears, and deep brain structures. A special automatic atlas-based segmentation procedure was adopted to include a detailed map of the nuclei of the thalamus and midbrain into the head model. The suitability of the model to simulations involving different numerical methods, discretization approaches, as well as DTI-based tensorial electrical conductivity, was examined in a case-study, in which the electric field was generated by transcranial alternating current stimulation. The voxel- and the surface-based versions of the models are freely available to the scientific community.

  19. Automatic tissue segmentation of head and neck MR images for hyperthermia treatment planning

    International Nuclear Information System (INIS)

    Fortunati, Valerio; Niessen, Wiro J; Veenland, Jifke F; Van Walsum, Theo; Verhaart, René F; Paulides, Margarethus M

    2015-01-01

    A hyperthermia treatment requires accurate, patient-specific treatment planning. This planning is based on 3D anatomical models which are generally derived from computed tomography. Because of its superior soft tissue contrast, magnetic resonance imaging (MRI) information can be introduced to improve the quality of these 3D patient models and therefore the treatment planning itself. Thus, we present here an automatic atlas-based segmentation algorithm for MR images of the head and neck.Our method combines multiatlas local weighting fusion with intensity modelling. The accuracy of the method was evaluated using a leave-one-out cross validation experiment over a set of 11 patients for which manual delineation were available.The accuracy of the proposed method was high both in terms of the Dice similarity coefficient (DSC) and the 95th percentile Hausdorff surface distance (HSD) with median DSC higher than 0.8 for all tissues except sclera. For all tissues, except the spine tissues, the accuracy was approaching the interobserver agreement/variability both in terms of DSC and HSD. The positive effect of adding the intensity modelling to the multiatlas fusion decreased when a more accurate atlas fusion method was used.Using the proposed approach we improved the performance of the approach previously presented for H and N hyperthermia treatment planning, making the method suitable for clinical application. (paper)

  20. Automatic tissue segmentation of head and neck MR images for hyperthermia treatment planning

    Science.gov (United States)

    Fortunati, Valerio; Verhaart, René F.; Niessen, Wiro J.; Veenland, Jifke F.; Paulides, Margarethus M.; van Walsum, Theo

    2015-08-01

    A hyperthermia treatment requires accurate, patient-specific treatment planning. This planning is based on 3D anatomical models which are generally derived from computed tomography. Because of its superior soft tissue contrast, magnetic resonance imaging (MRI) information can be introduced to improve the quality of these 3D patient models and therefore the treatment planning itself. Thus, we present here an automatic atlas-based segmentation algorithm for MR images of the head and neck. Our method combines multiatlas local weighting fusion with intensity modelling. The accuracy of the method was evaluated using a leave-one-out cross validation experiment over a set of 11 patients for which manual delineation were available. The accuracy of the proposed method was high both in terms of the Dice similarity coefficient (DSC) and the 95th percentile Hausdorff surface distance (HSD) with median DSC higher than 0.8 for all tissues except sclera. For all tissues, except the spine tissues, the accuracy was approaching the interobserver agreement/variability both in terms of DSC and HSD. The positive effect of adding the intensity modelling to the multiatlas fusion decreased when a more accurate atlas fusion method was used. Using the proposed approach we improved the performance of the approach previously presented for H&N hyperthermia treatment planning, making the method suitable for clinical application.

  1. Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lefkopoulos, A.; Haritanti, A.; Papadopoulou, E.; Karanikolas, D.; Fotiadis, N.; Dimitriadis, A.S. [AHEPA University Hospital, Department of Radiology, Thessaloniki (Greece)

    2005-05-01

    The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied. (orig.)

  2. Magnetic resonance imaging in 120 patients with intractable partial seizures: a preoperative assessment

    International Nuclear Information System (INIS)

    Lefkopoulos, A.; Haritanti, A.; Papadopoulou, E.; Karanikolas, D.; Fotiadis, N.; Dimitriadis, A.S.

    2005-01-01

    The aim of this study was to describe magnetic resonance imaging (MRI) findings in patients with medically intractable epilepsy and to compare different magnetic resonance (MR) sequences in order to establish a dedicated and shorter scan time imaging protocol of choice. One hundred and twenty patients with seizures that were refractory to medical treatment were assessed by MRI with spin-echo (SE) T1, fast spin-echo (FSE) T2, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR) and contrast-enhanced T1 SE sequences. Pathological scans were acquired in 78 patients. Hippocampal sclerosis was detected in 30 patients (25%), cerebral, tumoral, mass lesions in 12 patients (10%), vascular malformations in nine patients (7.5%), cortical infarcts in eight patients (6.7%), cerebral infections in four patients (4.2%) and developmental disorders in 15 patients (12.5%). The most common location of the lesions was the temporal lobe (60%). Coronal, thin (slice thickness 4-5 mm) images have proven to be the most useful in the assessment of the hippocampus. FLAIR and IR are particularly useful in the detection of lesions abutting cerebrospinal fluid (CSF) spaces and developmental disorders, respectively, while T1 SE sequences before and after the intravenous administration of gadolinium offer great facility in identifying space-occupying lesions and infections. MRI is the most important diagnostic tool for the assessment of epileptogenic foci, thus playing the primary role in indicating the type of treatment to be applied. (orig.)

  3. The role of three-dimensional multidetector CT gastrography in the preoperative imaging of stomach cancer: Emphasis on detection and localization of the tumor

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Woong; Shin, Sang Soo; Heo, Suk Hee; Lim, Hyo Soon; Park, Young Kyu; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam National University Medical School, Gwangju (Korea, Republic of); Lim, Nam Yeol [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2015-02-15

    Multidetector CT (MDCT) gastrography has been regarded as a promising technique for the preoperative imaging of gastric cancer. It has the ability to produce various three-dimensional (3D) images. Because 3D reconstruction images are more effective and intuitive for recognizing abnormal changes in the gastric folds and subtle mucosal nodularity than two-dimensional images, 3D MDCT gastrography can enhance the detection rate of early gastric cancer, which, in turn, contributes to the improvement of the accuracy of preoperative tumor (T) staging. In addition, shaded surface display and tissue transition projection images provide a global view of the stomach, with the exact location of gastric cancer, which may replace the need for barium studies. In this article, we discuss technical factors in producing high-quality MDCT gastrographic images and present cases demonstrating the usefulness of MDCT gastrography for the detection and T staging of gastric cancer while emphasizing the significance of preoperative localization of gastric cancer in terms of surgical margin.

  4. Bilateral femoral neck fractures resulting from pregnancy-associated osteoporosis showed bone marrow edema on magnetic resonance imaging.

    Science.gov (United States)

    Kasahara, Kyoko; Kita, Nobuyuki; Kawasaki, Taku; Morisaki, Shinsuke; Yomo, Hiroko; Murakami, Takashi

    2017-06-01

    Femoral neck fractures resulting from pregnancy-associated osteoporosis is a rare condition. Herein, we report an undoubted case of pregnancy-associated osteoporosis in a 38-year-old primiparous patient with pre-existing anorexia nervosa who suffered bilateral femoral neck fractures in the third trimester and early post-partum period. Magnetic resonance imaging revealed femoral neck fractures as well as diffuse marrow edema involving both femoral heads, which are considered under ordinary circumstances as characteristic imaging findings of transient osteoporosis of the hip. Based on our experience, we propose that pregnancy-associated osteoporosis might be present in femoral neck fractures attributed to transient osteoporosis of the hip in pregnancy. Conversely, bone status should be carefully and accurately estimated in cases of potential transient osteoporosis of the hip in pregnancy to reduce future fracture risk. © 2017 The Authors Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.

  5. Preoperative lymph-node staging of invasive urothelial bladder cancer with 18F-fluorodeoxyglucose positron emission tomography/computed axial tomography and magnetic resonance imaging

    DEFF Research Database (Denmark)

    Jensen, Thor Knak; Holt, Per; Gerke, Oke

    2011-01-01

    OBJECTIVE: The treatment and prognosis of bladder cancer are based on the depth of primary tumour invasion and the presence of metastases. A highly accurate preoperative tumour, node, metastasis (TNM) staging is critical to proper patient management and treatment. This study retrospectively...... investigated the value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed axial tomography (¹⁸F-FDG PET/CT) and magnetic resonance imaging (MRI) for preoperative N staging of bladder cancer. Material and methods. From June 2006 to January 2008, 48 consecutive patients diagnosed with bladder......) for MRI and ¹⁸F-FDG PET/CT, respectively. The differences in specificity and negative predictive values were not statistically significant. Conclusions. No significant statistical difference between ¹⁸F-FDG PET/CT and MRI for preoperative N staging of urothelial bladder cancer was found in the study...

  6. Value of coincidence gamma camera PET for diagnosing head and neck tumors: functional imaging and image coregistration

    International Nuclear Information System (INIS)

    Dresel, S.; Brinkbaeumer, K.; Schmid, R.; Hahn, K.

    2001-01-01

    54 patients suffering from head and neck tumors (30 m, 24 f, age: 32-67 years) were examined using dedicated PET and coincidence gamma camera PET after injection of 185-350 MBq [ 18 F]FDG. Examinations were carried out on the dedicated PET first (Siemens ECAT Exact HR+) followed by a scan on the coincidence gamma camera PET (Picker Prism 2000 XP-PCD, Marconi Axis g-PET 2 AZ). Dedicated PET was acquired in 3D mode, coincidence gamma camera PET was performed in list mode using an axial filter. Reconstruction of data was performed iteratively on both, dedicated PET and coincidence gamma camera PET. All patients received a CT scan in multislice technique (Siemens Somatom Plus 4, Marconi MX 8000). Image coregistration was performed on an Odyssey workstation (Marconi). All findings have been verified by the gold standard histology or in case of negative histology by follow-up. Results: Using dedicated PET the primary or recurrent lesion was correctly diagnosed in 47/48 patients, using coincidence gamma camera PET in 46/48 patients and using CT in 25/48 patients. Metastatic disease in cervical lymph nodes was diagnosed in 17/18 patients with dedicated PET, in 16/18 patients with coincidence gamma camera PET and in 15/18 with CT. False-positive results with regard to lymph node metastasis were seen with one patient for dedicated PET and hybrid PET, respectively, and with 18 patients for CT. In a total of 11 patients unknown metastatic lesions were seen with dedicated PET and with coincidence gamma camera PET elsewhere in the body (lung: n = 7, bone: n = 3, liver: n = 1). Additional malignant disease other than the head and neck tumor was found in 4 patients. (orig.) [de

  7. High-resolution single photon planar and spect imaging of brain and neck employing a system of two co-registered opposed gamma imaging heads

    Science.gov (United States)

    Majewski, Stanislaw [Yorktown, VA; Proffitt, James [Newport News, VA

    2011-12-06

    A compact, mobile, dedicated SPECT brain imager that can be easily moved to the patient to provide in-situ imaging, especially when the patient cannot be moved to the Nuclear Medicine imaging center. As a result of the widespread availability of single photon labeled biomarkers, the SPECT brain imager can be used in many locations, including remote locations away from medical centers. The SPECT imager improves the detection of gamma emission from the patient's head and neck area with a large field of view. Two identical lightweight gamma imaging detector heads are mounted to a rotating gantry and precisely mechanically co-registered to each other at 180 degrees. A unique imaging algorithm combines the co-registered images from the detector heads and provides several SPECT tomographic reconstructions of the imaged object thereby improving the diagnostic quality especially in the case of imaging requiring higher spatial resolution and sensitivity at the same time.

  8. Intravoxel incoehrent motion MR imaging in the head and neck: Correlation with dynamic contrast-enhanced MR imaging and diffusion-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Xiao Quan; Choi, Young Jun; Sung, Yu Sub; Jang, Seung Won; Park, Ji Eun; Heo, Young Jin; Beak, Jung Hwan; Lee, Jeong Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Yoon, Ra Gyoung [Dept. of Radiology, Catholic Kwandong University International St. Mary' s Hospital, Catholic Kwandong University College of Medicine, Incheon (Korea, Republic of)

    2016-09-15

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D{sup *}), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D{sup *} and model-free parameters from the DCE-MRI (wash-in, T{sub max}, E{sub max}, initial AUC{sub 60}, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D{sup *} and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D{sup *} (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

  9. Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Xiao Quan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029 (China); Choi, Young Jun; Sung, Yu Sub [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Yoon, Ra Gyoung [Department of Radiology, Catholic Kwandong University International St. Mary' s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711 (Korea, Republic of); Jang, Seung Won; Park, Ji Eun [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Heo, Young Jin [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of); Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392 (Korea, Republic of); Baek, Jung Hwan; Lee, Jeong Hyun [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505 (Korea, Republic of)

    2016-11-01

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D{sup *}), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D{sup *} and model-free parameters from the DCE-MRI (wash-in, T{sub max}, E{sub max}, initial AUC{sub 60}, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D{sup *} and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D{sup *} (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

  10. Intravoxel Incoherent Motion MR Imaging in the Head and Neck: Correlation with Dynamic Contrast-Enhanced MR Imaging and Diffusion-Weighted Imaging.

    Science.gov (United States)

    Xu, Xiao Quan; Choi, Young Jun; Sung, Yu Sub; Yoon, Ra Gyoung; Jang, Seung Won; Park, Ji Eun; Heo, Young Jin; Baek, Jung Hwan; Lee, Jeong Hyun

    2016-01-01

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D(*)), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D(*) and model-free parameters from the DCE-MRI (wash-in, Tmax, Emax, initial AUC60, whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D(*) and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D(*) (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck.

  11. Intravoxel incoehrent motion MR imaging in the head and neck: Correlation with dynamic contrast-enhanced MR imaging and diffusion-weighted imaging

    International Nuclear Information System (INIS)

    Xu, Xiao Quan; Choi, Young Jun; Sung, Yu Sub; Jang, Seung Won; Park, Ji Eun; Heo, Young Jin; Beak, Jung Hwan; Lee, Jeong Hyun; Yoon, Ra Gyoung

    2016-01-01

    To investigate the correlation between perfusion- and diffusion-related parameters from intravoxel incoherent motion (IVIM) and those from dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted imaging in tumors and normal muscles of the head and neck. We retrospectively enrolled 20 consecutive patients with head and neck tumors with MR imaging performed using a 3T MR scanner. Tissue diffusivity (D), pseudo-diffusion coefficient (D * ), and perfusion fraction (f) were derived from bi-exponential fitting of IVIM data obtained with 14 different b-values in three orthogonal directions. We investigated the correlation between D, f, and D * and model-free parameters from the DCE-MRI (wash-in, T max , E max , initial AUC 60 , whole AUC) and the apparent diffusion coefficient (ADC) value in the tumor and normal masseter muscle using a whole volume-of-interest approach. Pearson's correlation test was used for statistical analysis. No correlation was found between f or D * and any of the parameters from the DCE-MRI in all patients or in patients with squamous cell carcinoma (p > 0.05). The ADC was significantly correlated with D values in the tumors (p < 0.001, r = 0.980) and muscles (p = 0.013, r = 0.542), despite its significantly higher value than D. The difference between ADC and D showed significant correlation with f values in the tumors (p = 0.017, r = 0.528) and muscles (p = 0.003, r = 0.630), but no correlation with D * (p > 0.05, respectively). Intravoxel incoherent motion shows no significant correlation with model-free perfusion parameters derived from the DCE-MRI but is feasible for the analysis of diffusivity in both tumors and normal muscles of the head and neck

  12. Maximum-intensity-projection CT angiography for evaluating head and neck tumors. Usefulness of helical CT and auto bone masking method

    International Nuclear Information System (INIS)

    Sakai, Osamu; Nakashima, Noriko; Ogawa, Chiaki; Shen, Yun; Takata, Yasunori; Azemoto, Shougo.

    1994-01-01

    Angiographic images of 10 adult patients with head and neck tumors were obtained by helical computed tomography (CT) using maximum intensity projection (MIP). In all cases, the vasculature of the head and neck region was directly demonstrated. In the head and neck, bone masking is a more important problem than in other regions. We developed an effective automatic bone masking method (ABM) using 2D/3D connectivity. Helical CT angiography with MIP and ABM provided accurate anatomic depiction, and was considered to be helpful in preoperative evaluation of head and neck tumors. (author)

  13. Radiological image interpretation for hematoma and small tumors simulated in a head and neck phantom

    International Nuclear Information System (INIS)

    Thompson, Larissa; Campos, Tarcisio Passos Ribeiro

    2009-01-01

    Subarachnoidal hemorrhages (HSA) are caused by aneurysms and their symptom usually becomes evident after a rupture. Nevertheless, there are situations in which the aneurysms compress a nerve or produce a bleed before the rupture happens, as consequence one alert signal like headache occurs. It, often occurs after minutes or weeks previous the major rupture. The main goal is to prevent a massive hemorrhage. Thus the Computer Tomography (CT) scan of skull provides a basic and specific function: to reveal the position where the hemorrhage was produced, guiding to a additional medical procedures. On the other hand, CT does not prevent the cerebral tumor development, but precise diagnostic for some symptoms such as vomits, nauseas, epileptic attacks, weakness in arms or legs, require this image protocol. CT has its fundamental importance to tumor detection. Indeed CT reveals its importance in the tumor early diagnosis. Specialized training in CT analysis shall be done. Ahead of a precise diagnosis to manager an early intervention, a CT diagnostic training is suitable for a favorable prognostic. In this context, focusing on propose of radiological inquires; a head and neck phantom will be used to simulate hematomas and cerebral tumors. Images of CT of skull will be used to identify these lesions physically implanted in phantom. The radiological response will be analyzed with the purpose of validation of the skull's CT diagnosis, for a double blind test. The diagnostic with non contrast CT shows only higher 5mm diameter subjects (tumors) identified by the double blind test. Hemorrhage is identified by only the administrator (single-blind test). As conclusion, the author's launches the hypothesis that this object simulator shall provide assistance for specialized training on pathology interpretation on radiological images. (author)

  14. Atlas-based delineation of lymph node levels in head and neck computed tomography images

    International Nuclear Information System (INIS)

    Commowick, Olivier; Gregoire, Vincent; Malandain, Gregoire

    2008-01-01

    Purpose: Radiotherapy planning requires accurate delineations of the tumor and of the critical structures. Atlas-based segmentation has been shown to be very efficient to automatically delineate brain critical structures. We therefore propose to construct an anatomical atlas of the head and neck region. Methods and materials: Due to the high anatomical variability of this region, an atlas built from a single image as for the brain is not adequate. We address this issue by building a symmetric atlas from a database of manually segmented images. First, we develop an atlas construction method and apply it to a database of 45 Computed Tomography (CT) images from patients with node-negative pharyngo-laryngeal squamous cell carcinoma manually delineated for radiotherapy. Then, we qualitatively and quantitatively evaluate the results generated by the built atlas based on Leave-One-Out framework on the database. Results: We present qualitative and quantitative results using this atlas construction method. The evaluation was performed on a subset of 12 patients among the original CT database of 45 patients. Qualitative results depict visually well delineated structures. The quantitative results are also good, with an error with respect to the best achievable results ranging from 0.196 to 0.404 with a mean of 0.253. Conclusions: These results show the feasibility of using such an atlas for radiotherapy planning. Many perspectives are raised from this work ranging from extensive validation to the construction of several atlases representing sub-populations, to account for large inter-patient variabilities, and populations with node-positive tumors

  15. Preoperative nomograms incorporating magnetic resonance imaging and spectroscopy for prediction of insignificant prostate cancer

    Science.gov (United States)

    Shukla-Dave, Amita; Hricak, Hedvig; Akin, Oguz; Yu, Changhong; Zakian, Kristen L.; Udo, Kazuma; Scardino, Peter T.; Eastham, James; Kattan, Michael W.

    2011-01-01

    Objectives • To validate previously published nomograms for predicting insignificant prostate cancer (PCa) that incorporate clinical data, percentage of biopsy cores positive (%BC+) and magnetic resonance imaging (MRI) or MRI/MR spectroscopic imaging (MRSI) results. • We also designed new nomogram models incorporating magnetic resonance results and clinical data without detailed biopsy data. • Nomograms for predicting insignificant PCa can help physicians counsel patients with clinically low-risk disease who are choosing between active surveillance and definitive therapy. Patients and methods • In total, 181 low-risk PCa patients (clinical stage T1c–T2a, prostate-specific antigen level < 10 ng/mL, biopsy Gleason score of 6) had MRI/MRSI before surgery. • For MRI and MRI/MRSI, the probability of insignificant PCa was recorded prospectively and independently by two radiologists on a scale from 0 (definitely insignificant) to 3 (definitely significant PCa). • Insignificant PCa was defined on surgical pathology. • There were four models incorporating MRI or MRI/MRSI and clinical data with and without %BC+ that were compared with a base clinical model without %BC and a more comprehensive clinical model with %BC+. • Prediction accuracy was assessed using areas under receiver–operator characteristic curves. Results • At pathology, 27% of patients had insignificant PCa, and the Gleason score was upgraded in 56.4% of patients. • For both readers, all magnetic resonance models performed significantly better than the base clinical model (P ≤ 0.05 for all) and similarly to the more comprehensive clinical model. Conclusions • Existing models incorporating magnetic resonance data, clinical data and %BC+ for predicting the probability of insignificant PCa were validated. • All MR-inclusive models performed significantly better than the base clinical model. PMID:21933336

  16. The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas

    International Nuclear Information System (INIS)

    Krestan, C.; Czerny, C.; Gstoettner, W.; Franz, P.

    2003-01-01

    The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI. HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma, bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination. (orig.) [de

  17. Preoperative 3D FSE T1-Weighted MR Plaque Imaging for Severely Stenotic Cervical ICA: Accuracy of Predicting Emboli during Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    Yasushi Ogasawara

    2016-10-01

    Full Text Available The aim of the present study was to determine whether preoperative three-dimensional (3D fast spin-echo (FSE T1-weighted magnetic resonance (MR plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA. Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR and maximum plaque intensity for each patient, the contrast ratio (CR was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC—used to discriminate between the presence and absence of microembolic signals—was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity (0.941 than for that with the maximum POR (0.885 (p < 0.05. For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA.

  18. Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck.

    Science.gov (United States)

    Neuhaus, Victor; Große Hokamp, Nils; Abdullayev, Nuran; Maus, Volker; Kabbasch, Christoph; Mpotsaris, Anastasios; Maintz, David; Borggrefe, Jan

    2018-03-01

    To compare the image quality of virtual monoenergetic images and polyenergetic images reconstructed from dual-layer detector CT angiography (DLCTA). Thirty patients who underwent DLCTA of the head and neck were retrospectively identified and polyenergetic as well as virtual monoenergetic images (40 to 120 keV) were reconstructed. Signals (± SD) of the cervical and cerebral vessels as well as lateral pterygoid muscle and the air surrounding the head were measured to calculate the CNR and SNR. In addition, subjective image quality was assessed using a 5-point Likert scale. Student's t-test and Wilcoxon test were used to determine statistical significance. Compared to polyenergetic images, although noise increased with lower keV, CNR (p 0.05) of the cervical, petrous and intracranial vessels were improved in virtual monoenergetic images at 40 keV and virtual monoenergetic images at 45 keV were also rated superior regarding vascular contrast, assessment of arteries close to the skull base and small arterial branches (p virtual monoenergetic images reconstructed from DLCTA at low keV ranging from 40 to 45 keV improve the objective and subjective image quality of extra- and intracranial vessels and facilitate assessment of vessels close to the skull base and of small arterial branches. • Virtual monoenergetic images greatly improve attenuation, while noise only slightly increases. • Virtual monoenergetic images show superior contrast-to-noise ratios compared to polyenergetic images. • Virtual monoenergetic images significantly improve image quality at low keV.

  19. Preoperative mapping of speech-eloquent areas with functional magnetic resonance imaging (fMRI): comparison of different task designs

    International Nuclear Information System (INIS)

    Prothmann, S.; Zimmer, C.; Puccini, S.; Dalitz, B.; Kuehn, A.; Kahn, T.; Roedel, L.

    2005-01-01

    Purpose: Functional magnetic resonance imaging (fMRI) is a well-established, non-invasive method for pre-operative mapping of speech-eloquent areas. This investigation tests three simple paradigms to evaluate speech lateralisation and visualisation of speech-eloquent areas. Materials and Methods: 14 healthy volunteers and 16 brain tumour patients were given three tasks: to enumerate months in the correct order (EM), to generate verbs fitting to a given noun (GV) and to generate words fitting to a given alphabetic character (GW). We used a blocked design with 80 measurements which consisted of 4 intervals of speech activation alternating with relaxation periods. The data were analysed on the basis of the general linear model using Brainvoyager registered . The activated clusters in the inferior frontal (Broca) and the posterior temporal (Wernicke) cortex were analysed and the laterality indices calculated. Results: In both groups the paradigms GV and GW activated the Broca's area very robustly. Visualisation of the Wernicke's area was best achieved by the paradigm GV. The paradigm EM did not reliably stimulate either the frontal or the temporal cortex. Frontal lateralisation was best determined by GW and GV, temporal lateralisation by GV. Conclusion: The paradigms GV and GW visualise two essential aspects of speech processing: semantic word processing and word production. In a clinical setting with brain tumour patients, both, GV and GW can be used to visualise frontal and temporal speech areas, and to determine speech dominance. (orig.)

  20. Feasibility and implementation of a literature information management system for human papillomavirus in head and neck cancers with imaging.

    Science.gov (United States)

    Wu, Dee H; Matthiesen, Chance L; Alleman, Anthony M; Fournier, Aaron L; Gunter, Tyler C

    2014-01-01

    This work examines the feasibility and implementation of information service-orientated architecture (ISOA) on an emergent literature domain of human papillomavirus, head and neck cancer, and imaging. From this work, we examine the impact of cancer informatics and generate a full set of summarizing clinical pearls. Additionally, we describe how such an ISOA creates potential benefits in informatics education, enhancing utility for creating enduring digital content in this clinical domain.

  1. The value of imaging in standing position in preoperative breast lymphoscintigraphy.

    Science.gov (United States)

    Anagnostou, Christos; Baiocco, Cinzia; Arnulfo, Alberto; Liberatore, Mauro; Baccheschi, Anna Maria; Inglese, Eugenio

    2011-08-01

    Breast lymphoscintigraphy is an accurate technique, but in a minority of cases the sentinel node (SN) visualization cannot be achieved or can be very difficult. We evaluated the potential clinical advantages and limitations of performing imaging in the standing position. The aim was to establish if this examination modality is quicker and helpful in the presence of "hidden" SN, checking also for any influence of SN skin landmarking in the upright position on the correct intraoperative SN identification. The overall objective was to verify if the standing position can be routinely used in breast lymphoscintigraphy. A total of 144 patients underwent lymphoscintigraphy in both standing and supine positions. In both modalities, a skin landmark was set coincident with the SN orthogonal projections. The acquisition times of 2 groups (each consisting of 45 patients) examined with the standing or supine acquisition modality, were compared. In 6 cases with hidden SN and in 34 cases with difficult or partial visualization in one of the supine views, the standing protocol was effective and led to better and quicker visualization of lymph nodes (median examination time: 25.5 minutes standing, 35.5 minutes supine). Significant differences in skin landmark position between the 2 modalities were present only in overweight patients and in large breasts. This, however, did not have a negative impact on successful intraoperative localization of SN with the gamma probe. Standing acquisition resulted to be a faster, easier, and more accurate examination protocol and can be used as the routine method for SN detection in breast lymphoscintigraphy.

  2. Preoperative evaluation

    International Nuclear Information System (INIS)

    Murphy, C.H.; Murphy, M.R.

    1987-01-01

    The value of a preoperative chest radiograph is twofold. The examination may reveal unsuspected pathology that would alter the approach to surgery of anesthesia. Secondly, it provides a baseline or reference from which to evaluate subsequent post-operative films. The percentage of detection of unsuspected pathology on preoperative chest radiographs has been shown to be exceedingly small in certain patient populations. The authors do not recommend routine use of preoperative chest radiographs in children or in adults under the age of 40 who do not smoke, unless (1) the surgical disease has chest manifestations; (2) there is historic or clinical evidence of a coexisting disease with chest involvement; or (3) there is a likelihood that post-operative management will require follow-up films

  3. Imaging Modalities for Cervical Spondylotic Stenosis and Myelopathy

    Directory of Open Access Journals (Sweden)

    C. Green

    2012-01-01

    Full Text Available Cervical spondylosis is a spectrum of pathology presenting as neck pain, radiculopathy, and myelopathy or all in combination. Diagnostic imaging is essential to diagnosis and preoperative planning. We discuss the modalities of imaging in common practice. We examine the use of imaging to differentiate among central, subarticular, and lateral stenosis and in the assessment of myelopathy.

  4. Optical biopsy of head and neck cancer using hyperspectral imaging and convolutional neural networks

    Science.gov (United States)

    Halicek, Martin; Little, James V.; Wang, Xu; Patel, Mihir; Griffith, Christopher C.; El-Deiry, Mark W.; Chen, Amy Y.; Fei, Baowei

    2018-02-01

    Successful outcomes of surgical cancer resection necessitate negative, cancer-free surgical margins. Currently, tissue samples are sent to pathology for diagnostic confirmation. Hyperspectral imaging (HSI) is an emerging, non-contact optical imaging technique. A reliable optical method could serve to diagnose and biopsy specimens in real-time. Using convolutional neural networks (CNNs) as a tissue classifier, we developed a method to use HSI to perform an optical biopsy of ex-vivo surgical specimens, collected from 21 patients undergoing surgical cancer resection. Training and testing on samples from different patients, the CNN can distinguish squamous cell carcinoma (SCCa) from normal aerodigestive tract tissues with an area under the curve (AUC) of 0.82, 81% accuracy, 81% sensitivity, and 80% specificity. Additionally, normal oral tissues can be sub-classified into epithelium, muscle, and glandular mucosa using a decision tree method, with an average AUC of 0.94, 90% accuracy, 93% sensitivity, and 89% specificity. After separately training on thyroid tissue, the CNN differentiates between thyroid carcinoma and normal thyroid with an AUC of 0.95, 92% accuracy, 92% sensitivity, and 92% specificity. Moreover, the CNN can discriminate medullary thyroid carcinoma from benign multi-nodular goiter (MNG) with an AUC of 0.93, 87% accuracy, 88% sensitivity, and 85% specificity. Classical-type papillary thyroid carcinoma is differentiated from benign MNG with an AUC of 0.91, 86% accuracy, 86% sensitivity, and 86% specificity. Our preliminary results demonstrate that an HSI-based optical biopsy method using CNNs can provide multi-category diagnostic information for normal head-and-neck tissue, SCCa, and thyroid carcinomas. More patient data are needed in order to fully investigate the proposed technique to establish reliability and generalizability of the work.

  5. Local image variance of 7 Tesla SWI is a new technique for preoperative characterization of diffusely infiltrating gliomas: correlation with tumour grade and IDH1 mutational status.

    Science.gov (United States)

    Grabner, Günther; Kiesel, Barbara; Wöhrer, Adelheid; Millesi, Matthias; Wurzer, Aygül; Göd, Sabine; Mallouhi, Ammar; Knosp, Engelbert; Marosi, Christine; Trattnig, Siegfried; Wolfsberger, Stefan; Preusser, Matthias; Widhalm, Georg

    2017-04-01

    To investigate the value of local image variance (LIV) as a new technique for quantification of hypointense microvascular susceptibility-weighted imaging (SWI) structures at 7 Tesla for preoperative glioma characterization. Adult patients with neuroradiologically suspected diffusely infiltrating gliomas were prospectively recruited and 7 Tesla SWI was performed in addition to standard imaging. After tumour segmentation, quantification of intratumoural SWI hypointensities was conducted by the SWI-LIV technique. Following surgery, the histopathological tumour grade and isocitrate dehydrogenase 1 (IDH1)-R132H mutational status was determined and SWI-LIV values were compared between low-grade gliomas (LGG) and high-grade gliomas (HGG), IDH1-R132H negative and positive tumours, as well as gliomas with significant and non-significant contrast-enhancement (CE) on MRI. In 30 patients, 9 LGG and 21 HGG were diagnosed. The calculation of SWI-LIV values was feasible in all tumours. Significantly higher mean SWI-LIV values were found in HGG compared to LGG (92.7 versus 30.8; p Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and thus optimize patient management by quantification of hypointense microvascular structures. • 7 Tesla local image variance helps to quantify hypointense susceptibility-weighted imaging structures. • SWI-LIV is significantly increased in high-grade and IDH1-R132H negative gliomas. • SWI-LIV is a promising technique for improved preoperative glioma characterization. • Preoperative management of diffusely infiltrating gliomas will be optimized.

  6. Pre-operative radiotherapy in soft tissue tumors: Assessment of response by static post-contrast MR imaging compared to histopathology

    International Nuclear Information System (INIS)

    Einarsdottir, H.; Wejde, J.; Bauer, H.C.F.

    2000-01-01

    To evaluate if static post-contrast MR imaging was adequate to assess tumor viability after pre-operative radiotherapy in soft tissue sarcoma. Post-contrast MR imaging of 36 soft tissue sarcomas performed 0 - 54 days (median 13 days) after pre-operative radiotherapy, were retrospectively reviewed and compared to post-operative histopathology reports. The contrast enhancement of the tumor was visually graded as minor, moderate or extensive. From the post-operative histopathology reports, three types of tumor response to radiotherapy were defined: Poor, intermediate or good. The size of the tumors before and after radiation was compared. Even if most viable tumors enhanced more than non-viable tumors, there was major overlapping and significant contrast enhancement could be seen in tumors where histopathological examination revealed no viable tumor tissue. Based on histopathology, there were 12 good responders; 8 of these showed minor, 3 moderate and 1 extensive contrast enhancement on MR imaging. Sixteen tumors had an intermediate response; 3 showed minor, 8 moderate and 5 extensive enhancement. Eight tumors had poor response; none showed minor enhancement, 3 moderate and 5 extensive enhancement. Both increase and Decrease in tumor size was seen in lesions with a good therapy response. Static post-contrast MR imaging cannot reliably assess tumor viability after pre-operative radiotherapy in soft tissue sarcoma. In tumors with no viable tumor tissue, moderate and extensive contrast enhancement can be seen

  7. A PET/CT-based strategy is a stronger predictor of survival than a standard imaging strategy in patients with head and neck squamous cell carcinoma

    DEFF Research Database (Denmark)

    Rohde, Max; Nielsen, Anne L; Pareek, Manan

    2018-01-01

    Purpose: To examine whether tumor staging by upfront (18)F-fluoro-deoxy-glucose-positron emission tomography/computed tomography (PET/CT) leads to improved discrimination of survival, when compared with traditionally used imaging strategies based on chest X-ray + head and neck magnetic resonance...... imaging (CXR/MRI) or chest computed tomography + head and neck MRI (CCT/MRI) in patients with head and neck squamous cell carcinoma (HNSCC). Methods: Blinded prospective cohort study based on paired data. Consecutive patients with histologically verified primary HNSCC were recruited at Odense University...

  8. Advantages of hybrid SPECT-CT imaging in preoperative localization of parathyroid glands in a patient with secondary hyperparathyroidism. A case report

    International Nuclear Information System (INIS)

    Cytawa, Wojciech; Teodorczyk, Jacek; Lass, Piotr

    2013-01-01

    Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Patients resistant to pharmacotherapy are candidates for parathyroidectomy. Invasiveness of surgical treatment can be minimized by precise preoperative localization of parathyroid glands. Imaging modalities routinely used for this purpose are ultrasonography and MIBI-Tc99m scintigraphy. Our case report shows advantages of co-registered computer tomography and conventional SPECT imaging (SPECT/CT) in a patient with advanced secondary hyperparathyroidism successfully treated with surgery. Hybrid SPECT/CT parathyroid imaging enables better surgical planning and is superior to conventional scintigraphy

  9. A feasibility study of NIR fluorescent image-guided surgery in head and neck cancer based on the assessment of optimum surgical time as revealed through dynamic imaging

    Directory of Open Access Journals (Sweden)

    Yokoyama J

    2013-04-01

    Full Text Available Junkichi Yokoyama,* Mitsuhisa Fujimaki,* Shinichi Ohba, Takashi Anzai, Ryota Yoshii, Shin Ito, Masataka Kojima, Katsuhisa IkedaDepartment of Otolaryngology-Head and Neck Surgery, Juntendo University School of Medicine, Tokyo, Japan *These authors contributed equally to this study Background: In order to minimize surgical stress and preserve organs, endoscopic or robotic surgery is often performed when conducting head and neck surgery. However, it is impossible to physically touch tumors or to observe diffusely invaded deep organs through the procedure of endoscopic or robotic surgery. In order to visualize and safely resect tumors even in these cases, we propose using an indocyanine green (ICG fluorescence method for navigation surgery in head and neck cancer. Objective: To determine the optimum surgical time for tumor resection after the administration of ICG based on the investigation of dynamic ICG fluorescence imaging. Methods: Nine patients underwent dynamic ICG fluorescence imaging for 360 minutes, assessing tumor visibility at 10, 30, 60, 120, 180, and 360 minutes. All cases were scored according to near-infrared (NIR fluorescence imaging visibility scored from 0 to 5. Results: Dynamic NIR fluorescence imaging under the HyperEye Medical System indicated that the greatest contrast in fluorescent images between tumor and normal tissue could be observed from 30 minutes to 1 hour after the administration of ICG. The optimum surgical time was determined to be between 30 minutes to 2 hours after ICG injection. These findings are particularly useful for detection and safe resection of tumors invading the parapharyngeal space. Conclusion: ICG fluorescence imaging is effective for the detection of head and neck cancer. Preliminary findings suggest that the optimum timing for surgery is from 30 minutes to 2 hours after the ICG injection. Keywords: indocyanine green (ICG, navigation surgery, robotic surgery, endoscopic surgery, minimally invasive

  10. 99MTC-HL91 spect image versus 18F-FDG PET for detection of head and neck carcinoma

    International Nuclear Information System (INIS)

    Chu, L.S.; Liu, R.S.; Chou, K.L.; Yang, B.H.; Liao, S.Q.; Yeh, S.H.

    2004-01-01

    Objective: Tumor hypoxia is a major complication of oncologic cell switch for chemotherapy(C/T) and / or radiotherapy(R/T). Such lesions detected by selective modem conventional examination remains difficult. 99mTc-HL91 is a potential agent for imaging hypoxic tissue in vivo. This study aimed to assess efficacy of 99mTc- HL91 in imaging of head and neck cancer and compared the result with 18F-fluorodeoxyglucose(FDG)PET. Methods: Sixteen pts with head and neck cancers (7 hypopharyngeal cancers, 4 laryngeal cancers, 5 tongue base cancers) were enrolled in this study. Primary tumors and suspicious local,regional metastases were diagnosed by clinical examination, CT/MRI , and biopsy. After intravenous injection of 740 MBq of 99mTc-HL91, whole body planar scan and regional SPECT at 2hr postinjection were performed. Tumor lesion -to- normal background(T/N) ratios with 3x3 pixels of background ROI were also measured. The reference range of T/N ratio greater 3.0 defined +, close to 2.4 defined +/- and less than 1.5 defined as -. The FDG images with dedicated PET system was performed at 4hr after completion of 99mTc-HL91 study. The visualized tumors uptake with ratio of standardized uptake value (SUV) greater than 2.5 defined as +.. less than 2.5 defined -. Results: In 7 hypopharyngeal cancers, there are 2FDG+/HL91+, 3FDG+/HL91-, 2FDG+/HL91+/-, In 4 laryngeal cancers, there are 3FDG+/HL91-, 1FDG+/HL91 +/-. In 5 tongue base cancers, there are 5FDG+/HL91-.(Table 1). The T/N ratios of all head and neck cancers in primary tumor and regional lymph nodes were ranged from l.3/1.5 and 1.1/1.2 respectively. The frequency of FDG + in hypopharyngeal cancers is 1.0,in laryngeal cancers is 1.0 and in tongue base cancers is 1.0. The frequency of HL91+/+/- in hypopharyngeal cancers is 0..58,in laryngeal cancers is 0.25.and in tongue base cancers is 0. The overall detection rate of head and neck cancer by FDG+ in this study is 100% and overall detection rate of local-regional hypoxia, by

  11. Preoperative Diagnosis of Fallopian Tube Malignancy with Transvaginal Color Doppler Ultrasonography and Magnetic Resonance Imaging after Negative Hysteroscopy for Postmenopausal Bleedin

    OpenAIRE

    Arko, Darja; Žegura, Branka; Virag, Mirjana; Fokter Dovnik, Nina; Takač, Iztok

    2014-01-01

    Primary Fallopian tube carcinoma is a rare malignancy and is not often diagnosed preoperatively. We present a case of a 67-year old woman who complained of postmenopausal vaginal bleeding. After a negative hysteroscopy, transvaginal ultrasound showed a well vascularized solid-cystic tumor in the adnexal region separate from the ovary. The presence of an adnexal mass was confirmed by MR imaging. Total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy and appendectomy, as w...

  12. Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery.

    Science.gov (United States)

    Lam, D L; Mitsumori, L M; Neligan, P C; Warren, B H; Shuman, W P; Dubinsky, T J

    2012-12-01

    Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases patient morbidity.

  13. Preoperative Assessment of Craniopharyngioma Adherence: Magnetic Resonance Imaging Findings Correlated with the Severity of Tumor Attachment to the Hypothalamus.

    Science.gov (United States)

    Prieto, Ruth; Pascual, José M; Rosdolsky, Maria; Barrios, Laura

    2018-02-01

    Craniopharyngioma (CP) adherence represents a heterogeneous pathologic feature that critically influences the potentially safe and radical resection. The aim of this study was to define the magnetic resonance imaging (MRI) predictors of CP adherence severity. This study retrospectively investigated a cohort of 200 surgically treated CPs with their corresponding preoperative conventional MRI scans. MRI findings related to the distortions of anatomic structures along the sella turcica-third ventricle axis caused by CPs, in addition to the tumor's shape and calcifications, were analyzed and correlated with the definitive type of CP adherence observed during the surgical procedures. CP adherence is defined by 3 components, as follows: 1) the specific structures attached to the tumor, 2) the adhesion's extent, and 3) its strength. Combination of these 3 components determines 5 hierarchical levels of adherence severity with gradually increasing surgical risk of hypothalamic injury. Multivariate analysis identified 4 radiologic variables that allowed a correct overall prediction of the levels of CP adherence severity in 81.5% of cases: 1) the position of the hypothalamus in relation to the tumor-the most discriminant factor; 2) the type of pituitary stalk distortion; 3) the tumor shape; and 4) the presence of calcifications. A binary logistic regression model including the first 3 radiologic variables correctly identified the CPs showing the highest level of adherence severity (severe/critical) in almost 90% of cases. A position of the hypothalamus around the middle portion of the tumor, an amputated or infiltrated appearance of the pituitary stalk, and the elliptical shape of the tumor are reliable predictors of strong and extensive CP adhesions to the hypothalamus. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Computed tomography and magnetic resonance imaging findings of peripheral primitive neuroectodermal tumors of the head and neck

    International Nuclear Information System (INIS)

    Zhang Weidong; Chen Yanfeng; Li Chuanxing; Zhang Liang; Xu Zhibin; Zhang Fujun

    2011-01-01

    Purpose: We aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of peripheral primitive neuroectodermal tumor (pPNET) of the head and neck. Methods: Eight patients with pPNET of the head and neck confirmed by histopathological examination were analyzed retrospectively. Results: The average patient age was 8 years. The tumor location in the 8 patients was as follows: maxillofacial region (right, 2; left, 1), left maxillary sinus (1), right masticator space (1), left carotid space (1), right infratemporal fossa (1), and left parotid gland (1). All 5 patients who underwent CT demonstrated ill-defined soft masses and no calcification. Three patients with tumors in the maxillofacial region showed homogeneous small masses and a mild enhancement. The patient with left maxillary sinus tumor showed a heterogeneous mass with patchy, necrotic foci and mild heterogeneous enhancement. The patient with right masticator space tumor showed a heterogeneous mass, and marked heterogeneous enhancement. The T1-weighted images of the patients with right infratemporal fossa, left carotid space, and left parotid gland tumors were isointense. The T2-weighted images were heterogeneous and mildly hyperintense in 2 patients and hyperintense in 1 patient. Heterogeneous intermediate enhancement was demonstrated in 2 patients and mild ring enhancement in 1 patient. Conclusion: The imaging features of pPNET of the head and neck are non-specific. An ill-defined, aggressive mass and variable enhancement on CT and MR images may suggest the diagnosis of pPNET. Peripheral PNET should be included in the differential diagnosis of children and adolescents' regional tumors.

  15. Computed tomography and magnetic resonance imaging findings of peripheral primitive neuroectodermal tumors of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Weidong [State Key Laboratory of Oncology in South China, Department of Radiology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060 (China); Chen Yanfeng [State Key Laboratory of Oncology in South China, Department of Head and Neck Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060 (China); Li Chuanxing; Zhang Liang; Xu Zhibin [State Key Laboratory of Oncology in South China, Department of Radiology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060 (China); Zhang Fujun, E-mail: drzhangfj@163.com [State Key Laboratory of Oncology in South China, Department of Radiology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060 (China)

    2011-11-15

    Purpose: We aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of peripheral primitive neuroectodermal tumor (pPNET) of the head and neck. Methods: Eight patients with pPNET of the head and neck confirmed by histopathological examination were analyzed retrospectively. Results: The average patient age was 8 years. The tumor location in the 8 patients was as follows: maxillofacial region (right, 2; left, 1), left maxillary sinus (1), right masticator space (1), left carotid space (1), right infratemporal fossa (1), and left parotid gland (1). All 5 patients who underwent CT demonstrated ill-defined soft masses and no calcification. Three patients with tumors in the maxillofacial region showed homogeneous small masses and a mild enhancement. The patient with left maxillary sinus tumor showed a heterogeneous mass with patchy, necrotic foci and mild heterogeneous enhancement. The patient with right masticator space tumor showed a heterogeneous mass, and marked heterogeneous enhancement. The T1-weighted images of the patients with right infratemporal fossa, left carotid space, and left parotid gland tumors were isointense. The T2-weighted images were heterogeneous and mildly hyperintense in 2 patients and hyperintense in 1 patient. Heterogeneous intermediate enhancement was demonstrated in 2 patients and mild ring enhancement in 1 patient. Conclusion: The imaging features of pPNET of the head and neck are non-specific. An ill-defined, aggressive mass and variable enhancement on CT and MR images may suggest the diagnosis of pPNET. Peripheral PNET should be included in the differential diagnosis of children and adolescents' regional tumors.

  16. Interleaved 3D-CNNs for joint segmentation of small-volume structures in head and neck CT images.

    Science.gov (United States)

    Ren, Xuhua; Xiang, Lei; Nie, Dong; Shao, Yeqin; Zhang, Huan; Shen, Dinggang; Wang, Qian

    2018-02-26

    Accurate 3D image segmentation is a crucial step in radiation therapy planning of head and neck tumors. These segmentation results are currently obtained by manual outlining of tissues, which is a tedious and time-consuming procedure. Automatic segmentation provides an alternative solution, which, however, is often difficult for small tissues (i.e., chiasm and optic nerves in head and neck CT images) because of their small volumes and highly diverse appearance/shape information. In this work, we propose to interleave multiple 3D Convolutional Neural Networks (3D-CNNs) to attain automatic segmentation of small tissues in head and neck CT images. A 3D-CNN was designed to segment each structure of interest. To make full use of the image appearance information, multiscale patches are extracted to describe the center voxel under consideration and then input to the CNN architecture. Next, as neighboring tissues are often highly related in the physiological and anatomical perspectives, we interleave the CNNs designated for the individual tissues. In this way, the tentative segmentation result of a specific tissue can contribute to refine the segmentations of other neighboring tissues. Finally, as more CNNs are interleaved and cascaded, a complex network of CNNs can be derived, such that all tissues can be jointly segmented and iteratively refined. Our method was validated on a set of 48 CT images, obtained from the Medical Image Computing and Computer Assisted Intervention (MICCAI) Challenge 2015. The Dice coefficient (DC) and the 95% Hausdorff Distance (95HD) are computed to measure the accuracy of the segmentation results. The proposed method achieves higher segmentation accuracy (with the average DC: 0.58 ± 0.17 for optic chiasm, and 0.71 ± 0.08 for optic nerve; 95HD: 2.81 ± 1.56 mm for optic chiasm, and 2.23 ± 0.90 mm for optic nerve) than the MICCAI challenge winner (with the average DC: 0.38 for optic chiasm, and 0.68 for optic nerve; 95HD: 3.48 for

  17. Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Neuhaus, Victor; Grosse Hokamp, Nils; Abdullayev, Nuran; Maus, Volker; Kabbasch, Christoph; Mpotsaris, Anastasios; Maintz, David; Borggrefe, Jan [University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne (Germany)

    2018-03-15

    To compare the image quality of virtual monoenergetic images and polyenergetic images reconstructed from dual-layer detector CT angiography (DLCTA). Thirty patients who underwent DLCTA of the head and neck were retrospectively identified and polyenergetic as well as virtual monoenergetic images (40 to 120 keV) were reconstructed. Signals (± SD) of the cervical and cerebral vessels as well as lateral pterygoid muscle and the air surrounding the head were measured to calculate the CNR and SNR. In addition, subjective image quality was assessed using a 5-point Likert scale. Student's t-test and Wilcoxon test were used to determine statistical significance. Compared to polyenergetic images, although noise increased with lower keV, CNR (p < 0.02) and SNR (p > 0.05) of the cervical, petrous and intracranial vessels were improved in virtual monoenergetic images at 40 keV and virtual monoenergetic images at 45 keV were also rated superior regarding vascular contrast, assessment of arteries close to the skull base and small arterial branches (p < 0.0001 each). Compared to polyenergetic images, virtual monoenergetic images reconstructed from DLCTA at low keV ranging from 40 to 45 keV improve the objective and subjective image quality of extra- and intracranial vessels and facilitate assessment of vessels close to the skull base and of small arterial branches. (orig.)

  18. Use of diffusion-weighted imaging (DWI) in PET/MRI for head and neck cancer evaluation

    International Nuclear Information System (INIS)

    Queiroz, Marcelo A.; Schulthess, Gustav von; Huellner, Martin; Kuhn, Felix; Veit-Haibach, Patrick; Huber, Gerhardt; Meerwein, Christian; Kollias, Spyros

    2014-01-01

    The purpose of this study was to analyze whether diffusion-weighted imaging (DWI) adds significant information to positron emission tomography/magnetic resonance imaging (PET/MRI) on lesion detection and characterization in head and neck cancers. Seventy patients with different head and neck cancers were enrolled in this prospective study. All patients underwent sequential contrast-enhanced (ce) PET/computed tomography (CT) and cePET/MRI using a tri-modality PET/CT-MR setup either for staging or re-staging. First, the DWI alone was evaluated, followed by the PET/MRI with conventional sequences, and in a third step, the PET/MRI with DWI was evaluated. McNemar's test was used to evaluate differences in the accuracy of PET/MRI with and without DWI compared to the standard of reference. One hundred eighty-eight (188) lesions were found, and of those, 118 (62.8 %) were malignant and 70 (37.2 %) were benign. PET/MRI without DWI had a higher accuracy in detecting malignant lesions than DWI alone (86.8 % vs. 60.6 %, p < 0.001). PET/MRI combined with DWI detected 120 concurrent lesions (89 malignant and 31 benign), PET/MRI alone identified 48 additional lesions (20 malignant and 28 benign), and DWI alone detected 20 different lesions (nine malignant and 11 benign). However, lesions detected on DWI did not change overall staging. SUV maximum and mean were significantly higher in malignant lesions than in benign lesions. DWI parameters between malignant and benign lesions were not statistically different. The use of DWI as part of PET/MRI to evaluate head and neck cancers does not provide remarkable information. Thus, the use of DWI might not be needed in clinical PET/MRI protocols for the staging or restaging of head and neck cancers. (orig.)

  19. Dose cone-beam CT alter treatment plans? Comparison of preoperative implant planning using panoramic versus cone-beam CT images

    International Nuclear Information System (INIS)

    Guerrero, Maria Eugenia; Jacobs, Reinhilde; Norge, Jorge; Castro, Carmen

    2014-01-01

    The present study was performed to compare the planning of implant placement based on panoramic radiography (PAN) and cone-beam computed tomography (CBCT) images, and to study the impact of the image dataset on the treatment planning. One hundred five partially edentulous patients (77 males, 28 females, mean age: 46 years, range: 26-67 years) seeking oral implant rehabilitation were referred for presurgical imaging. Imaging consisted of PAN and CBCT imaging. Four observers planned implant treatment based on the two-dimensional (2D) image datasets and at least one month later on the three-dimensional (3D) image dataset. Apart from presurgical diagnostic and dimensional measurement tasks, the observers needed to indicate the surgical confidence levels and assess the image quality in relation to the presurgical needs. All observers confirmed that both imaging modalities (PAN and CBCT) gave similar values when planning implant diameter. Also, the results showed no differences between both imaging modalities for the length of implants with an anterior location. However, significant differences were found in the length of implants with a posterior location. For implant dimensions, longer lengths of the implants were planned with PAN, as confirmed by two observers. CBCT provided images with improved scores for subjective image quality and surgical confidence levels. Within the limitations of this study, there was a trend toward PAN-based preoperative planning of implant placement leading towards the use of longer implants within the posterior jaw bone.

  20. Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study.

    Science.gov (United States)

    Taylor, Fiona G M; Quirke, Philip; Heald, Richard J; Moran, Brendan J; Blomqvist, Lennart; Swift, Ian R; Sebag-Montefiore, David; Tekkis, Paris; Brown, Gina

    2014-01-01

    The prognostic relevance of preoperative high-resolution magnetic resonance imaging (MRI) assessment of circumferential resection margin (CRM) involvement is unknown. This follow-up study of 374 patients with rectal cancer reports the relationship between preoperative MRI assessment of CRM staging, American Joint Committee on Cancer (AJCC) TNM stage, and clinical variables with overall survival (OS), disease-free survival (DFS), and time to local recurrence (LR). Patients underwent protocol high-resolution pelvic MRI. Tumor distance to the mesorectal fascia of ≤ 1 mm was recorded as an MRI-involved CRM. A Cox proportional hazards model was used in multivariate analysis to determine the relationship of MRI assessment of CRM to survivorship after adjusting for preoperative covariates. Surviving patients were followed for a median of 62 months. The 5-year OS was 62.2% in patients with MRI-clear CRM compared with 42.2% in patients with MRI-involved CRM with a hazard ratio (HR) of 1.97 (95% CI, 1.27 to 3.04; P < .01). The 5-year DFS was 67.2% (95% CI, 61.4% to 73%) for MRI-clear CRM compared with 47.3% (95% CI, 33.7% to 60.9%) for MRI-involved CRM with an HR of 1.65 (95% CI, 1.01 to 2.69; P < .05). Local recurrence HR for MRI-involved CRM was 3.50 (95% CI, 1.53 to 8.00; P < .05). MRI-involved CRM was the only preoperative staging parameter that remained significant for OS, DFS, and LR on multivariate analysis. High-resolution MRI preoperative assessment of CRM status is superior to AJCC TNM-based criteria for assessing risk of LR, DFS, and OS. Furthermore, MRI CRM involvement is significantly associated with distant metastatic disease; therefore, colorectal cancer teams could intensify treatment and follow-up accordingly to improve survival outcomes.

  1. Comparison between ultrasonography and MR imaging for discriminating squamous cell carcinoma nodes with extranodal spread in the neck

    International Nuclear Information System (INIS)

    Katayama, Ikuo; Sasaki, Miho; Kimura, Yasuo; Hotokezaka, Yuka; Eida, Sato; Tashiro, Shigeki; Sumi, Misa; Nakamura, Takashi

    2012-01-01

    Objective: To compare the diagnostic ability of ultrasonography (US) and MR imaging for discriminating squamous cell carcinoma (SCC) nodes with extranodal spread (ENS) in the neck. Methods: US and MR imaging was retrospectively evaluated for differentiating ENS-positive (n = 28) from ENS-negative (n = 26) SCC nodes (>10 mm short-axis diameter) in 50 patients with head and neck SCCs. We assessed nodal size on US and MR images; irregular nodal margin on US; and vanishing nodal border, flare, and shaggy nodal margin signs on T1-, fat-suppressed T2-, and contrast-enhanced T1-weighted MR images, respectively. US and MR images were analyzed by 3 radiologists in consensus and the results were compared between ENS-positive and ENS-negative SCC nodes. Results: The nodal sizes of ENS-positive nodes (21 ± 9 mm) were significantly larger than those of ENS-negative SCC nodes (14 ± 4 mm) (p < 0.001). Irregular nodal margins were more frequently observed in ENS-positive SCC nodes (75%) than in ENS-negative SCC nodes (12%). The vanishing nodal margin, flare, and shaggy nodal margin signs were more frequently observed in ENS-positive SCC nodes (93%, 89%, and 82%, respectively) than in ENS-negative nodes (46%, 19%, and 19%, respectively). A combination of size (≥22 mm) and imaging criteria (irregular margin or flare sign) best discriminated ENS-positive SCC nodes with 82% sensitivity, 89% specificity, and 85% accuracy for US and 89% sensitivity, 81% specificity, and 85% accuracy for MR imaging. Conclusion: US discriminated ENS-positive from ENS-negative SCC nodes with comparable accuracy and higher specificity than MR imaging.

  2. Preoperative intensity-modulated and image-guided radiotherapy with a simultaneous integrated boost in locally advanced rectal cancer: Report on late toxicity and outcome

    International Nuclear Information System (INIS)

    Engels, Benedikt; Platteaux, Nele; Van den Begin, Robbe; Gevaert, Thierry; Sermeus, Alexandra; Storme, Guy; Verellen, Dirk; De Ridder, Mark

    2014-01-01

    Background and purpose: The addition of chemotherapy to preoperative radiotherapy has been established as the standard of care for patients with cT3-4 rectal cancer. As an alternative strategy, we explored intensity-modulated and image-guided radiotherapy (IMRT–IGRT) with a simultaneous integrated boost (SIB) in a prospective phase II study. Here, we report outcome and late toxicity after a median follow-up of 54 months. Methods and materials: A total of 108 patients were treated preoperatively with IMRT–IGRT, delivering a dose of 46 Gy in fractions of 2 Gy. Patients (n = 57) displaying an anticipated circumferential resection margin (CRM) of less than 2 mm based on magnetic resonance imaging received a SIB to the tumor up to a total dose of 55.2 Gy. Results: The absolute incidence of grade ⩾3 late gastrointestinal and urinary toxicity was 9% and 4%, respectively, with a 13% rate of any grade ⩾3 late toxicity. The actuarial 5-year local control (LC), progression-free survival (PFS) and overall survival (OS) were 97%, 57%, and 68%. On multivariate analysis, R1 resection and pN2 disease were associated with significantly impaired OS. Conclusions: The use of preoperative IMRT–IGRT with a SIB resulted in a high 5-year LC rate and non-negligible late toxicity

  3. Observer Evaluation of a Metal Artifact Reduction Algorithm Applied to Head and Neck Cone Beam Computed Tomographic Images

    Energy Technology Data Exchange (ETDEWEB)

    Korpics, Mark; Surucu, Murat; Mescioglu, Ibrahim; Alite, Fiori; Block, Alec M.; Choi, Mehee; Emami, Bahman; Harkenrider, Matthew M.; Solanki, Abhishek A.; Roeske, John C., E-mail: jroeske@lumc.edu

    2016-11-15

    Purpose and Objectives: To quantify, through an observer study, the reduction in metal artifacts on cone beam computed tomographic (CBCT) images using a projection-interpolation algorithm, on images containing metal artifacts from dental fillings and implants in patients treated for head and neck (H&N) cancer. Methods and Materials: An interpolation-substitution algorithm was applied to H&N CBCT images containing metal artifacts from dental fillings and implants. Image quality with respect to metal artifacts was evaluated subjectively and objectively. First, 6 independent radiation oncologists were asked to rank randomly sorted blinded images (before and after metal artifact reduction) using a 5-point rating scale (1 = severe artifacts; 5 = no artifacts). Second, the standard deviation of different regions of interest (ROI) within each image was calculated and compared with the mean rating scores. Results: The interpolation-substitution technique successfully reduced metal artifacts in 70% of the cases. From a total of 60 images from 15 H&N cancer patients undergoing image guided radiation therapy, the mean rating score on the uncorrected images was 2.3 ± 1.1, versus 3.3 ± 1.0 for the corrected images. The mean difference in ranking score between uncorrected and corrected images was 1.0 (95% confidence interval: 0.9-1.2, P<.05). The standard deviation of each ROI significantly decreased after artifact reduction (P<.01). Moreover, a negative correlation between the mean rating score for each image and the standard deviation of the oral cavity and bilateral cheeks was observed. Conclusion: The interpolation-substitution algorithm is efficient and effective for reducing metal artifacts caused by dental fillings and implants on CBCT images, as demonstrated by the statistically significant increase in observer image quality ranking and by the decrease in ROI standard deviation between uncorrected and corrected images.

  4. Medical image of the week: right neck mass with thoracic extension

    Directory of Open Access Journals (Sweden)

    Siddiqi TA

    2013-05-01

    Full Text Available A 28-year-old female with a history of chronic pancreatitis s/p total pancreatectomy and auto-islet cell transplantation developed a progressively enlarging right neck mass of 4 weeks duration. Coccidioides IgM antibodies were negative and IgG antibodies were positive by immunoassay (EIA, with titers 1:4 by complement fixation (CF. Fine needle aspiration with subsequent excisional biopsy of the right neck mass was performed and showed reactive lymphoid hyperplasia without fungal elements. Bronchoscopy with right upper lobe endobronchial biopsy and 4R lymph node endobronchial ultrasound-fine needle aspiration revealed granulomatous inflammation and Coccidioides spherules on Gomori's methenamine silver stain. Fungal cultures from the right neck mass fine needle aspiration, endobronchial biopsy, and 4R lymph node grew Coccidioides after three weeks of culture.

  5. Functional imaging to monitor vascular and metabolic response in canine head and neck tumors during fractionated radiotherapy.

    Science.gov (United States)

    Rødal, Jan; Rusten, Espen; Søvik, Åste; Skogmo, Hege Kippenes; Malinen, Eirik

    2013-10-01

    Radiotherapy causes alterations in tumor biology, and non-invasive early assessment of such alterations may become useful for identifying treatment resistant disease. The purpose of the current work is to assess changes in vascular and metabolic features derived from functional imaging of canine head and neck tumors during fractionated radiotherapy. Material and methods. Three dogs with spontaneous head and neck tumors received intensity-modulated radiotherapy (IMRT). Contrast-enhanced cone beam computed tomography (CE-CBCT) at the treatment unit was performed at five treatment fractions. Dynamic (18)FDG-PET (D-PET) was performed prior to the start of radiotherapy, at mid-treatment and at 3-12 weeks after the completion of treatment. Tumor contrast enhancement in the CE-CBCT images was used as a surrogate for tumor vasculature. Vascular and metabolic tumor parameters were further obtained from the D-PET images. Changes in these tumor parameters were assessed, with emphasis on intra-tumoral distributions. Results. For all three patients, metabolic imaging parameters obtained from D-PET decreased from the pre- to the inter-therapy session. Correspondingly, for two of three patients, vascular imaging parameters obtained from both CE-CBCT and D-PET increased. Only one of the tumors showed a clear metabolic response after therapy. No systematic changes in the intra-tumor heterogeneity in the imaging parameters were found. Conclusion. Changes in vascular and metabolic parameters could be detected by the current functional imaging methods. Vascular tumor features from CE-CBCT and D-PET corresponded well. CE-CBCT is a potential method for easy response assessment when the patient is at the treatment unit.

  6. Preoperative 18F-FDG-PET/CT imaging and sentinel node biopsy in the detection of regional lymph node metastases in malignant melanoma.

    Science.gov (United States)

    Singh, Baljinder; Ezziddin, Samer; Palmedo, Holger; Reinhardt, Michael; Strunk, Holger; Tüting, Thomas; Biersack, Hans-Jürgen; Ahmadzadehfar, Hojjat

    2008-10-01

    The objective of this study was to evaluate the role of preoperative 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scanning, preoperative lymphoscintigraphy (LS), and sentinel lymph node biopsy in patients with malignant melanoma. Fifty-two patients (36 men: 16 women; mean age 55.0+/-13.0 years; median age 61 years; range 17-76 years) with malignant melanoma were selected. According to the latest version of the American Joint Committee on Cancer staging system, the disease in the study patients was initially classified as either stage I or II. The other primary tumor characteristics were mean Breslow depth=2.87 mm and median=2 mm; range 1-12.0 mm and Clarks levels III-V. None of the study patients had clinical or radiological evidence of regional lymph node metastatic disease. At least one sentinel node was identified in all patients. Preoperative LS detected a total of 111 sentinel lymph nodes (average 2.13 sentinel lymph node per patient) and demonstrated a single nodal draining basin in 38 (73%) patients and multiple (2-3 draining basins) in the remaining 14 (27%) patients. Fourteen out of the 52 patients (27%) had at least one involved sentinel node. Positron emission tomography was true positive in two patients with a sentinel node greater than 1 cm and false positive in two other patients. In this study, the detection of sentinel lymph node by LS and gamma probe had a sensitivity of 100%. In contrast, 18F-FDG-PET imaging demonstrated very low sensitivity (14.3%; 95% CI, 2.5 to 44%) and positive predictive value (50%; 95% CI, 9 to 90%) for localizing the subclinical nodal metastases. The specificity, net present value, and diagnostic accuracy were 94.7, 75, and 73%, respectively. Preoperative fluorodeoxyglucose-positron emission tomography/computed tomography imaging is not able to substitute LS/sentinel lymph node biopsy in patients at stage I or II.

  7. Nonfunctional pancreatic neuroendocrine tumors <2 cm on preoperative imaging are associated with a low incidence of nodal metastasis and an excellent overall survival.

    Science.gov (United States)

    Toste, Paul A; Kadera, Brian E; Tatishchev, Sergei F; Dawson, David W; Clerkin, Barbara M; Muthusamy, Raman; Watson, Rabindra; Tomlinson, James S; Hines, Oscar J; Reber, Howard A; Donahue, Timothy R

    2013-12-01

    The optimal surgical management of small nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) remains controversial. We sought to identify (1) clinicopathologic factors associated with survival in NF-PNETs and (2) preoperative tumor characteristics that can be used to determine which lesions require resection and lymph node (LN) harvest. The records of all 116 patients who underwent resection for NF-PNETs between 1989 and 2012 were reviewed retrospectively. Preoperative factors, operative data, pathology, surgical morbidity, and survival were analyzed. The overall 5- and 10-year survival rates were 83.9 and 72.8 %, respectively. Negative LNs (p = 0.005), G1 or G2 histology (p = 0.033), and age <60 years (p = 0.002) correlated with better survival on multivariate analysis. The 10-year survival rate was 86.6 % for LN-negative patients (n = 73) and 34.1 % for LN-positive patients (n = 32). Tumor size ≥2 cm on preoperative imaging predicted nodal positivity with a sensitivity of 93.8 %. Positive LNs were found in 38.5 % of tumors ≥2 cm compared to only 7.4 % of tumors <2 cm. LN status, a marker of systemic disease, was a highly significant predictor of survival in this series. Tumor size on preoperative imaging was predictive of nodal disease. Thus, it is reasonable to consider parenchyma-sparing resection or even close observation for NF-PNETs <2 cm.

  8. Comparison of Oral Contrast-Enhanced Transabdominal Ultrasound Imaging With Transverse Contrast-Enhanced Computed Tomography in Preoperative Tumor Staging of Advanced Gastric Carcinoma.

    Science.gov (United States)

    He, Xuemei; Sun, Jing; Huang, Xiaoling; Zeng, Chun; Ge, Yinggang; Zhang, Jun; Wu, Jingxian

    2017-12-01

    This study assessed the diagnostic performance of transabdominal oral contrast-enhanced ultrasound (US) imaging for preoperative tumor staging of advanced gastric carcinoma by comparing it with transverse contrast-enhanced computed tomography (CT). This retrospective study included 42 patients with advanced gastric cancer who underwent laparoscopy, radical surgery, or palliative surgery because of serious complications and had a body mass index of less than 25 kg/m 2 . A cereal-based oral contrast agent was used for transabdominal oral contrast-enhanced US. Retrospective analyses were conducted using preoperative tumor staging data acquired by either transabdominal oral contrast-enhanced US or transverse contrast-enhanced CT. Both contrast-enhanced US and contrast-enhanced CT examinations were reviewed by 2 experienced radiologists independently for preoperative tumor staging according to the seventh edition of the TNM classification. The accuracy, sensitivity, and specificity were calculated by comparing the results of contrast-enhanced US and contrast-enhanced CT with pathologic findings. The overall accuracies of the imaging modalities were compared by the McNemar test. No significant difference was noted in the overall accuracy of transabdominal oral contrast-enhanced US (86% [36 of 42]) and transverse contrast-enhanced CT (83% [35 of 42] P > .999). For stage T2 to T4 gastric cancer, the accuracies of transabdominal oral contrast-enhanced US were 88%, 86%, and 98%, respectively, and those of transverse contrast-enhanced CT were 93%, 83%, and 90%. The overall accuracy of transabdominal oral contrast-enhanced US was comparable with that of transverse contrast-enhanced CT for preoperative tumor staging of advanced gastric cancer. © 2017 by the American Institute of Ultrasound in Medicine.

  9. Clinical and imaging diagnosis of IgG4-related disease in the head and neck

    International Nuclear Information System (INIS)

    Yu Changliang; Liu Bin; Yu Yongqiang

    2013-01-01

    IgG4-related disease in the head and neck is a newly recognized multi-organ system disease characterized by elevated serum IgG4, infiltration of numerous IgG4-positive plasma cells, tissue fibrosis, and dramatic response to corticosteroid treatment. IgG4-related disease of the head and neck has some relative characteristics on CT and MRI, which can provide valuable information for the diagnosis and differential diagnosis, and are helpful for the clinical treatment, evaluation of therapeutic effects and prediction of prognosis. (authors)

  10. Preoperative nodal staging of non-small cell lung cancer using 99mTc-sestamibi spect/ct imaging

    Directory of Open Access Journals (Sweden)

    Juliana Muniz Miziara

    2011-01-01

    Full Text Available OBJECTIVES: The proper nodal staging of non-small cell lung cancer is important for choosing the best treatment modality. Although computed tomography remains the first-line imaging test for the primary staging of lung cancer, its limitations for mediastinum nodal staging are well known. The aim of this study is to evaluate the accuracy of hybrid single-photon emission computed tomography and computed tomography using 99mTc-sestamibi in the nodal staging of patients with non-small cell lung cancer and to identify potential candidates for surgical treatment. METHODS: Prospective data were collected for 41 patients from December 2006 to February 2009. The patients underwent chest computed tomography and single-photon emission computed tomography/computed tomography examinations with 99mTc-sestamibi within a 30-day time period before surgery. Single-photon emission computed tomography/computed tomography was considered positive when there was focal uptake of sestamibi in the mediastinum, and computed tomography scan when there was lymph nodes larger than 10 mm in short axis. The results of single-photon emission computed tomography and computed tomography were correlated with pathology findings after surgery. RESULTS: Single-photon emission computed tomography/computed tomography correctly identified six out of 19 cases involving hilar lymph nodes and one out of seven cases involving nodal metastases in the mediastinum. The sensitivity, specificity, positive predictive value, and negative predictive value for 99mTc-sestamibi single-photon emission computed tomography/computed tomography in the hilum assessment were 31.6%, 95.5%, 85.7%, and 61.8%, respectively. The same values for the mediastinum were 14.3%, 97.1%, 50%, and 84.6%, respectively. For the hilar and mediastinal lymph nodes, chest tomography showed sensitivity values of 47.4% and 57.1%, specificity values of 95.5% and 91.2%, positive predictive values of 90% and 57.1% and negative

  11. Preoperative nodal staging of non-small cell lung cancer using 99mTc-sestamibi SPECT/CT imaging

    International Nuclear Information System (INIS)

    Miziara, Juliana Muniz; Rocha, Euclides Timoteo da; Miziara, Jose Elias Abrao; Garcia, Gustavo Fabene; Simoes, Maria Izilda Previato; Lopes, Marco Antonio; Kerr, Ligia Maria; Buchpiguel, Carlos Alberto

    2011-01-01

    Objectives: The proper nodal staging of non-small cell lung cancer is important for choosing the best treatment modality. Although computed tomography remains the first-line imaging test for the primary staging of lung cancer, its limitations for mediastinum nodal staging are well known. The aim of this study is to evaluate the accuracy of hybrid single-photon emission computed tomography and computed tomography using 99m Tc-sestamibi in the nodal staging of patients with non-small cell lung cancer and to identify potential candidates for surgical treatment. Methods: Prospective data were collected for 41 patients from December 2006 to February 2009. The patients underwent chest computed tomography and single-photon emission computed tomography/computed tomography examinations with 99m Tc-sestamibi within a 30-day time period before surgery. Single-photon emission computed tomography/computed tomography was considered positive when there was focal uptake of sestamibi in the mediastinum, and computed tomography scan when there was lymph nodes larger than 10 mm in short axis. The results of single-photon emission computed tomography and computed tomography were correlated with pathology findings after surgery. Results: Single-photon emission computed tomography/computed tomography correctly identified six out of 19 cases involving hilar lymph nodes and one out of seven cases involving nodal metastases in the mediastinum. The sensitivity, specificity, positive predictive value, and negative predictive value for 99m Tc-sestamibi single-photon emission computed tomography/computed tomography in the hilum assessment were 31.6%, 95.5%, 85.7%, and 61.8%, respectively. The same values for the mediastinum were 14.3%, 97.1%, 50%, and 84.6%, respectively. For the hilar and mediastinal lymph nodes, chest tomography showed sensitivity values of 47.4% and 57.1%, specificity values of 95.5% and 91.2%, positive predictive values of 90% and 57.1% and negative predictive values of 67

  12. Can axial-based nodal size criteria be used in other imaging planes to accurately determine "enlarged" head and neck lymph nodes?

    Science.gov (United States)

    Bartlett, Eric S; Walters, Thomas D; Yu, Eugene

    2013-01-01

    Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as "enlarged" if equal to or exceeding size criteria. Results. 222 lymph nodes were "enlarged" in one imaging plane; however, 53.2% (118/222) of these were "enlarged" in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = -0.09 and -0.07, resp., P planes. Conclusion. Classification of "enlarged" lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data.

  13. Fat suppression failure artifacts at the susceptibility interface on frequency selective fat suppression MR imaging in the head and neck

    International Nuclear Information System (INIS)

    Anzai, Yoshimi; Minoshima, Satoshi; Uno, Kimiichi; Arimizu, Noboru; Lufkin, R.B.; Ishihara, Makiko; Yui, Nobuharu.

    1994-01-01

    Fat suppression MR imaging is a valuable technique mainly used for the orbit, head and neck, and spine, where the high signal from fat can often obscure adjacent pathology. Fat suppression failure artifact manifested as a high signal area without geographic disortion. The purpose of this study was to investigate the frequency and common location of these artifacts in clinical MR imaging and to caution against their misinterpretation. Fat suppression MR imaging of the head and neck was performed in 30 consecutive patients. The artifact was found in the orbital floor (57%), the skull base (10%), and subcutaneous fat (10%), where the air-fat interface is parallel to the static magnetic field direction. The fat signal in the air-fat interface perpendicular to the static magnetic field was well suppressed. This artifact was independent of the duration of TE, frequency/phase encoding direction, and the strength of gradient amplitude, and appeared to be related to the amount of surrounding air. This may simulate pathology if fat suppression is only performed following Gd-DTPA administration. The radiologist should be aware of the presence of artifact by considering the geographic relation to the static magnetic field. (author)

  14. Magnetic resonance angiography for the head and neck region

    International Nuclear Information System (INIS)

    Aschenbach, R.; Esser, D.

    2004-01-01

    Magnetic resonance angiography is a noninvasive method in vascular imaging using noncontrast- enhanced and contrast-enhanced techniques. The contrast media used in contrast- enhanced magnetic resonance angiography are different from the X-ray contrast media and do not affect the thyroid gland or renal function. In detecting hypervascularized lesions in the head and neck, contrast-enhanced magnetic resonance angiography is the method of choice, which provides an acceptable quality in comparison to digital subtraction angiography. Future developments in magnetic resonance imaging techniques will cause a wider use of magnetic resonance angiography, especially in head and neck imaging. Digital subtraction angiography should therefore only be used in problem cases and for preoperative embolization [de

  15. Impact of organ-specific dose reduction on the image quality of head and neck CT angiography

    International Nuclear Information System (INIS)

    Schimmoeller, L.; Lanzman, R.S.; Heusch, P.; Dietrich, S.; Miese, F.; Aissa, J.; Heusner, T.A.; Antoch, G.; Kroepil, P.

    2013-01-01

    Organ-specific dose reduction (OSDR) algorithms can reduce radiation on radiosensitive organs up to 59 %. This study evaluates the influence of a new OSDR algorithm on image quality of head and neck computed tomographic angiography (CTA) in clinical routine. Sixty-two consecutive patients (68 ± 13 years) were randomised into two groups and imaged using 128-row multidetector CT. Group A (n = 31) underwent conventional CTA and group B (n = 31) CTA with a novel OSDR algorithm. Subjective and objective image quality were statistically compared. Subjective image quality was rated on a five-point scale. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated with region-of-interest measurements. The SNR of the common carotid artery and middle cerebral artery was 53.6 ± 22.7 and 43.3 ± 15.3 (group A) versus 54.1 ± 20.5 and 46.2 ± 14.6 (group B). The CNR was 40.0 ± 19.3 and 29.7 ± 12.0 (group A) compared with 40.7 ± 16.8 and 32.9 ± 10.9 (group B), respectively. Subjective image quality was excellent in both groups (mean score 4.4 ± 0.7 versus 4.4 ± 0.6). Differences between the two groups were not significant. The novel OSDR algorithm does not compromise image quality of head and neck CTA. Its application can be recommended for CTA in clinical routine to protect the thyroid gland and ocular lenses from unnecessary high radiation. (orig.)

  16. Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Mikayama, Ryoji; Yabuuchi, Hidetake; Nagatomo, Kazuya; Kimura, Mitsuhiro; Kumazawa, Seiji [Kyushu University, Department of Health Sciences, Graduate School of Medical Sciences, Fukuoka (Japan); Sonoda, Shinjiro; Kobayashi, Koji [Kyushu University Hospital, Division of Radiology, Department of Medical Technology, Fukuoka (Japan); Kawanami, Satoshi; Kamitani, Takeshi; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Fukuoka (Japan)

    2018-01-15

    To compare image quality, apparent diffusion coefficient (ADC), and intravoxel incoherent motion (IVIM)-derived parameters between turbo spin-echo (TSE)-diffusion-weighted imaging (DWI) and echo-planar imaging (EPI)-DWI of the head and neck. Fourteen volunteers underwent head and neck imaging using TSE-DWI and EPI-DWI. Distortion ratio (DR), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), ADC and IVIM-derived parameters were compared between the two techniques. Bland-Altman analysis was performed to analyse reproducibility between the quantitative parameters of TSE-DWI and EPI-DWI. DR of TSE-DWI was significantly smaller than that of EPI-DWI. SNR and CNR of TSE-DWI were significantly higher than those of EPI-DWI. ADC and IVIM-derived parameters of TSE-DWI showed higher values than those of EPI-DWI, although the difference was not significant. Bland-Altman analysis showed wide limits of agreement between the two sequences. TSE-DWI can produce better image quality than EPI-DWI, while TSE-DWI possibly exhibits different values of quantitative parameters. Therefore, TSE-DWI could be a good alternative to EPI-DWI for patients sensitive to distortion. However, it is not recommended to use both TSE-DWI and EPI-DWI on follow-up. (orig.)

  17. Magnetic resonance imaging guided reirradiation of recurrent and second primary head and neck cancer

    Directory of Open Access Journals (Sweden)

    Allen M. Chen, MD

    2017-04-01

    Conclusions: Our preliminary findings show that reirradiation with MRI guided radiation therapy results in effective disease control with relatively low morbidity for patients with recurrent and second primary cancers of the head and neck. The superior soft tissue resolution of the MRI scans that were used for planning and delivery has the potential to improve the therapeutic ratio.

  18. Radiological imaging of the neck for initial decision-making in oral squamous cell carcinomas-A questionnaire survey in the Nordic countries

    DEFF Research Database (Denmark)

    Norling, Rikke; Grau, Cai; Nielsen, Michael B

    2012-01-01

    by palpation and diagnostic imaging of the neck. We investigated the current practice of the initial radiological work-up of patients with oral squamous cell carcinomas (OSCC) in the Nordic countries. Methods. A questionnaire regarding the availability and use of guidelines and imaging modalities...

  19. Prediction of pathologic staging with magnetic resonance imaging after preoperative chemoradiotherapy in rectal cancer: pooled analysis of KROG 10-01 and 11-02.

    Science.gov (United States)

    Lee, Jong Hoon; Jang, Hong Seok; Kim, Jun-Gi; Lee, Myung Ah; Kim, Dae Yong; Kim, Tae Hyun; Oh, Jae Hwan; Park, Sung Chan; Kim, Sun Young; Baek, Ji Yeon; Park, Hee Chul; Kim, Hee Cheol; Nam, Taek-Keun; Chie, Eui Kyu; Jung, Ji-Han; Oh, Seong Taek

    2014-10-01

    The reported overall accuracy of MRI in predicting the pathologic stage of nonirradiated rectal cancer is high. However, the role of MRI in restaging rectal tumors after neoadjuvant CRT is contentious. Thus, we evaluate the accuracy of restaging magnetic resonance imaging (MRI) for rectal cancer patients who receive preoperative chemoradiotherapy (CRT). We analyzed 150 patients with locally advanced rectal cancer (T3-4N0-2) who had received preoperative CRT. Pre-CRT MRI was performed for local tumor and nodal staging. All patients underwent restaging MRI followed by total mesorectal excision after the end of radiotherapy. The primary endpoint of the present study was to estimate the accuracy of post-CRT MRI as compared with pathologic staging. Pathologic T classification matched the post-CRT MRI findings in 97 (64.7%) of 150 patients. 36 (24.0%) of 150 patients were overstaged in T classification, and the concordance degree was moderate (k=0.33, prectal cancer patients who received preoperative CRT. The diagnostic accuracy of restaging MRI is relatively high in rectal cancer patients who achieved clinical downstaging after CRT. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Preoperative imaging in 78 living kidney donors using CE-MRA and DSA; Donor-Evaluation vor Lebendnierenspende: Vergleich von CE-MRA und DSA an 78 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Lemke, U.; Taupitz, M.; Hamm, B.; Kroencke, T.J. [Inst. fuer Radiologie, Charite - Universitaetsmedizin Berlin (Germany); Kluener, C. [Inst. fuer Radiologie und Neuroradiologie, Evangelisches Krankenhaus Oldenburg (Germany); Giessing, M.; Schoenberger, B. [Urologische Klinik und Poliklinik, Charite - Universitaetsmedizin Berlin (Germany)

    2008-01-15

    Purpose: to evaluate contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) in comparison with the intraoperative findings in living kidney donors. Materials and methods: a total of 156 kidneys in 78 potential kidney donors were prospectively examined using CE-MRA (0.2 mmol Gd/kg, voxel size 1.3 x 0.8 x 2.0) and DSA. Two experienced radiologists assessed the images in consensus regarding the renal vascular anatomy and variants. The results for the 67 candidates accepted for donation were compared to the intraoperative findings. In the other kidneys not accepted for donor nephrectomy, MRA and DSA were compared with each other. Results: nineteen arterial variants were identified intraoperatively, of which 11 (58%) were also detected by preoperative CE-MRA and 10 (53%) by preoperative DSA. Of the 10 venous variants found intraoperatively, CE-MRA detected 8 (80%) and DSA 3 (30%). The agreement (kappa test) between MRI and DSA for all 156 evaluated kidneys was 0.7 for arterial variants (McNemar p = 0.12) and 0.3 for venous variants (McNemar p = 0.01). The preoperative choice of kidney (right or left) made on the basis of the renal vascular anatomy seen on CE-MRA and DSA differed in 22% of the 78 potential donors (McNemar P = 0.3). (orig.)

  1. Ability of preoperative 3.0-Tesla magnetic resonance imaging to predict the absence of side-specific extracapsular extension of prostate cancer.

    Science.gov (United States)

    Hara, Tomohiko; Nakanishi, Hiroyuki; Nakagawa, Tohru; Komiyama, Motokiyo; Kawahara, Takashi; Manabe, Tomoko; Miyake, Mototaka; Arai, Eri; Kanai, Yae; Fujimoto, Hiroyuki

    2013-10-01

    Recent studies have shown an improvement in prostate cancer diagnosis with the use of 3.0-Tesla magnetic resonance imaging. We retrospectively assessed the ability of this imaging technique to predict side-specific extracapsular extension of prostate cancer. From October 2007 to August 2011, prostatectomy was carried out in 396 patients after preoperative 3.0-Tesla magnetic resonance imaging. Among these, 132 (primary sample) and 134 patients (validation sample) underwent 12-core prostate biopsy at the National Cancer Center Hospital of Tokyo, Japan, and at other institutions, respectively. In the primary dataset, univariate and multivariate analyses were carried out to predict side-specific extracapsular extension using variables determined preoperatively, including 3.0-Tesla magnetic resonance imaging findings (T2-weighted and diffusion-weighted imaging). A prediction model was then constructed and applied to the validation study sample. Multivariate analysis identified four significant independent predictors (P Tesla diffusion-weighted magnetic resonance imaging findings, ≥2 positive biopsy cores on each side and a maximum percentage of positive cores ≥31% on each side. The negative predictive value was 93.9% in the combination model with these four predictors, meanwhile the positive predictive value was 33.8%. Good reproducibility of these four significant predictors and the combination model was observed in the validation study sample. The side-specific extracapsular extension prediction by the biopsy Gleason score and factors associated with tumor location, including a positive 3.0-Tesla diffusion-weighted magnetic resonance imaging finding, have a high negative predictive value, but a low positive predictive value. © 2013 The Japanese Urological Association.

  2. Local image variance of 7 Tesla SWI is a new technique for preoperative characterization of diffusely infiltrating gliomas: correlation with tumour grade and IDH1 mutational status

    International Nuclear Information System (INIS)

    Grabner, Guenther; Kiesel, Barbara; Millesi, Matthias; Wurzer, Ayguel; Knosp, Engelbert; Wolfsberger, Stefan; Widhalm, Georg; Woehrer, Adelheid; Goed, Sabine; Mallouhi, Ammar; Marosi, Christine; Preusser, Matthias; Trattnig, Siegfried

    2017-01-01

    To investigate the value of local image variance (LIV) as a new technique for quantification of hypointense microvascular susceptibility-weighted imaging (SWI) structures at 7 Tesla for preoperative glioma characterization. Adult patients with neuroradiologically suspected diffusely infiltrating gliomas were prospectively recruited and 7 Tesla SWI was performed in addition to standard imaging. After tumour segmentation, quantification of intratumoural SWI hypointensities was conducted by the SWI-LIV technique. Following surgery, the histopathological tumour grade and isocitrate dehydrogenase 1 (IDH1)-R132H mutational status was determined and SWI-LIV values were compared between low-grade gliomas (LGG) and high-grade gliomas (HGG), IDH1-R132H negative and positive tumours, as well as gliomas with significant and non-significant contrast-enhancement (CE) on MRI. In 30 patients, 9 LGG and 21 HGG were diagnosed. The calculation of SWI-LIV values was feasible in all tumours. Significantly higher mean SWI-LIV values were found in HGG compared to LGG (92.7 versus 30.8; p < 0.0001), IDH1-R132H negative compared to IDH1-R132H positive gliomas (109.9 versus 38.3; p < 0.0001) and tumours with significant CE compared to non-significant CE (120.1 versus 39.0; p < 0.0001). Our data indicate that 7 Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and thus optimize patient management by quantification of hypointense microvascular structures. (orig.)

  3. Local image variance of 7 Tesla SWI is a new technique for preoperative characterization of diffusely infiltrating gliomas: correlation with tumour grade and IDH1 mutational status

    Energy Technology Data Exchange (ETDEWEB)

    Grabner, Guenther [Medical University of Vienna, High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Medical University of Vienna, Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Vienna (Austria); Carinthia University of Applied Sciences, Department of Health Sciences and Social Work, Klagenfurt am Woerthersee (Austria); Kiesel, Barbara; Millesi, Matthias; Wurzer, Ayguel; Knosp, Engelbert; Wolfsberger, Stefan; Widhalm, Georg [Medical University of Vienna, Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Vienna (Austria); Medical University of Vienna, Department of Neurosurgery, Vienna (Austria); Woehrer, Adelheid [Medical University of Vienna, Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Vienna (Austria); Medical University of Vienna, Institute of Neurology, Vienna (Austria); Goed, Sabine [Medical University of Vienna, High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Mallouhi, Ammar [Medical University of Vienna, Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Vienna (Austria); Medical University of Vienna, Department of Radiology, Vienna (Austria); Marosi, Christine; Preusser, Matthias [Medical University of Vienna, Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Vienna (Austria); Medical University of Vienna, Department of Internal Medicine I, Vienna (Austria); Trattnig, Siegfried [Medical University of Vienna, High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Medical University of Vienna, Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Vienna (Austria)

    2017-04-15

    To investigate the value of local image variance (LIV) as a new technique for quantification of hypointense microvascular susceptibility-weighted imaging (SWI) structures at 7 Tesla for preoperative glioma characterization. Adult patients with neuroradiologically suspected diffusely infiltrating gliomas were prospectively recruited and 7 Tesla SWI was performed in addition to standard imaging. After tumour segmentation, quantification of intratumoural SWI hypointensities was conducted by the SWI-LIV technique. Following surgery, the histopathological tumour grade and isocitrate dehydrogenase 1 (IDH1)-R132H mutational status was determined and SWI-LIV values were compared between low-grade gliomas (LGG) and high-grade gliomas (HGG), IDH1-R132H negative and positive tumours, as well as gliomas with significant and non-significant contrast-enhancement (CE) on MRI. In 30 patients, 9 LGG and 21 HGG were diagnosed. The calculation of SWI-LIV values was feasible in all tumours. Significantly higher mean SWI-LIV values were found in HGG compared to LGG (92.7 versus 30.8; p < 0.0001), IDH1-R132H negative compared to IDH1-R132H positive gliomas (109.9 versus 38.3; p < 0.0001) and tumours with significant CE compared to non-significant CE (120.1 versus 39.0; p < 0.0001). Our data indicate that 7 Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and thus optimize patient management by quantification of hypointense microvascular structures. (orig.)

  4. Preoperative diagnosis of fallopian tube malignancy with transvaginal color doppler ultrasonography and magnetic resonance imaging after negative hysteroscopy for postmenopausal bleeding.

    Science.gov (United States)

    Arko, Darja; Žegura, Branka; Virag, Mirjana; Fokter Dovnik, Nina; Takač, Iztok

    2014-09-01

    Primary fallopian tube carcinoma is a rare malignancy and is not often diagnosed preoperatively. We present a case of a 67-year-old woman who complained of postmenopausal vaginal bleeding. After a negative hysteroscopy, transvaginal ultrasound showed a well vascularized solid-cystic tumor in the adnexal region separate from the ovary. The presence of an adnexal mass was confirmed by MR imaging. Total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy and appendectomy, as well as pelvic and paraaortic lymphadenectomy was performed. The pathohistological diagnosis was poorly differentiated serous adenocarcinoma of the fallopian tube, FIGO stage IA. The patient was subsequently treated with platinum based adjuvant chemotherapy.

  5. Preoperative computed tomography for determining nodal status combined with histologic grading as a prognostic factor for patients with tongue carcinoma

    International Nuclear Information System (INIS)

    Ogura, Ichiro; Kurabayashi, Tohru; Amagasa, Teruo; Iwaki, Hiroshi; Sasaki, Takehito

    2001-01-01

    The purpose of this study was to evaluate the predictive value of preoperative neck computed tomography (CT) in combination with histologic grading as a prognostic factor for patients with tongue carcinoma. Fifty-five patients with squamous cell carcinoma of the tongue were examined by CT prior to radical neck dissection. The locoregional failure and survival rates of these patients were analyzed in relation to their clinical characteristics, histologic grading (World Health Organization, WHO) based on tongue biopsy, and imaging diagnoses prior to surgery. Logistic multivariate regression analysis showed that both histologic grading and number of metastatic lymph nodes on CT were significant and independent prognostic factors in locoregional failure (p=0.009 and p=0.009, respectively). When the numebr of metastatic lymph nodes detected on preoperative neck CT were combined with the histologic grading for the evaluation, the five-year overall survival rates of A group (0 node with any Grade, or 1 node with Grade I-II) and B group (1 node with Grade III, or 2 or more nodes with any Grade) were 74.5% and 37.5%, respectively (p=0.001). The difference was more significant than histologic grading alone or the number of metastatic lymph nodes seen on CT alone. The combination of preoperative neck CT with histologic grading of the primary tumor is useful as a prognostic indicator for patients with tongue carcinoma. (author)

  6. Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial

    Directory of Open Access Journals (Sweden)

    Michael P. Achiam

    2016-01-01

    Full Text Available Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis. The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT.Methods. Consecutive patients diagnosed with rectal cancers were asked to participate in the study. Preoperative CT and diffusion weighted MR (DWMR were compared to contrast enhanced laparoscopic ultrasound (CELUS.Results. A total of 35 patients were included, 15 patients in Group-1 having the standard CT evaluation of the liver and 20 patients in Group-2 having the standard CT evaluation of the liver and DWMR of the liver. Compared with CELUS, the per-patient sensitivity/specificity was 50/100% for CT, and for DWMR: 100/94% and 100/100% for Reader 1 and 2, respectively. The per-lesion sensitivity of CT and DWMR were 17% and 89%, respectively compared with CELUS. Furthermore, one patient had non-resectable metastases after DWMR despite being diagnosed with resectable metastases after CT. Another patient was diagnosed with multiple liver metastases during CELUS, despite a negative CT-scan.Discussion. DWMR is feasible for preoperative evaluation of liver metastases. The current standard preoperative evaluation with CT-scan results in disadvantages like missed metastases and futile operations. We recommend that patients with rectal cancer, who are scheduled for MR of the rectum, should have a DWMR of the liver performed at the same time.

  7. Multi-institutional Quantitative Evaluation and Clinical Validation of Smart Probabilistic Image Contouring Engine (SPICE) Autosegmentation of Target Structures and Normal Tissues on Computer Tomography Images in the Head and Neck, Thorax, Liver, and Male Pelvis Areas

    NARCIS (Netherlands)

    Zhu, Mingyao; Bzdusek, Karl; Brink, Carsten; Eriksen, Jesper Grau; Hansen, Olfred; Jensen, Helle Anita; Gay, Hiram A.; Thorstad, Wade; Widder, Joachim; Brouwer, Charlotte L.; Steenbakkers, Roel J. H. M.; Vanhauten, Hubertus A. M.; Cao, Jeffrey Q.; McBrayne, Gail; Patel, Salil H.; Cannon, Donald M.; Hardcastle, Nicholas; Tome, Wolfgang A.; Guckenberg, Matthias; Parikh, Parag J.

    2013-01-01

    Purpose: Clinical validation and quantitative evaluation of computed tomography (CT) image autosegmentation using Smart Probabilistic Image Contouring Engine (SPICE). Methods and Materials: CT images of 125 treated patients (32 head and neck [HN], 40 thorax, 23 liver, and 30 prostate) in 7

  8. Evaluation of a processing scheme for calcified atheromatous carotid artery detection in face/neck CBCT images

    Science.gov (United States)

    Matheus, B. R. N.; Centurion, B. S.; Rubira-Bullen, I. R. F.; Schiabel, H.

    2017-03-01

    Cone Beam Computed Tomography (CBCT), a kind of face and neck exams can be opportunity to identify, as an incidental finding, calcifications of the carotid artery (CACA). Given the similarity of the CACA with calcification found in several x-ray exams, this work suggests that a similar technique designed to detect breast calcifications in mammography images could be applied to detect such calcifications in CBCT. The method used a 3D version of the calcification detection technique [1], based on a signal enhancement using a convolution with a 3D Laplacian of Gaussian (LoG) function followed by removing the high contrast bone structure from the image. Initial promising results show a 71% sensitivity with 0.48 false positive per exam.

  9. [F-18]FDG imaging of head and neck tumors: comparison of hybrid PET, dedicated PET and CT

    International Nuclear Information System (INIS)

    Dresel, S.; Brinkbaeumer, K.; Schmid, R.; Poepperl, G.; Hahn, K.; Szeimies, U.

    2001-01-01

    Aim: Aim of the study was to evaluate [F-18]FDG imaging of head and neck tumors using a Hybrid-PET device of the 2nd or 3rd generation. Examinations were compared to dedicated PET and Spiral-CT. Methods: 54 patients suffering from head and neck tumors were examined using dedicated PET and Hybrid-PET after injection of 185-350 MBq [F-18]FDG. Examinations were carried out on the dedicated PET first followed by a scan on the Hybrid-PET. Dedicated PET was acquired in 3D mode, Hybrid-PET was performed in list mode using an axial filter. Reconstruction of data was performed iteratively on both, dedicated PET and Hybrid-PET. All patients received a CT scan in multislice technique. All finding have been verified by the goldstandard histology or in case of negative histology by follow up. Results: Using dedicated PET the primary or recurrent lesion was correctly diagnosed in 47/48 patients, using Hybrid-PET in 46/48 patients and using CT in 25/48 patients. Metastatic disease in cervical lymph nodes was diagnosed in 17/18 patients with dedicated PET, in 16/18 patients with Hybrid-PET and in 15/18 with CT. False positive results with regard to lymph node metastasis were seen with one patient for dedicated PET and Hybrid-PET, respectively, and with 18 patients for CT. In a total of 11 patients unknown metastastic lesions were seen with dedicated PET and with Hybrid-PET elsewhere in the body. Additional malignant disease other than the head and neck tumor was found in 4 patients. Conclusion: Using Hybrid-PET for [F-18]FDG imaging reveals a loss of sensitivity and specificity of about 1-5% as compared to dedicated PET in head and neck tumors. [F-18]FDG PET with both, dedicated PET and Hybrid-PET is superior to CT in the diagnosis of primary or recurrent lesions as well as in the assessment of lymph node involvement. (orig.) [de

  10. Value of three-dimensional volume rendering images in the assessment of the centrality index for preoperative planning in patients with renal masses.

    Science.gov (United States)

    Sofia, C; Magno, C; Silipigni, S; Cantisani, V; Mucciardi, G; Sottile, F; Inferrera, A; Mazziotti, S; Ascenti, G

    2017-01-01

    To evaluate the precision of the centrality index (CI) measurement on three-dimensional (3D) volume rendering technique (VRT) images in patients with renal masses, compared to its standard measurement on axial images. Sixty-five patients with renal lesions underwent contrast-enhanced multidetector (MD) computed tomography (CT) for preoperative imaging. Two readers calculated the CI on two-dimensional axial images and on VRT images, measuring it in the plane that the tumour and centre of the kidney were lying in. Correlation and agreement of interobserver measurements and inter-method results were calculated using intraclass correlation (ICC) coefficients and the Bland-Altman method. Time saving was also calculated. The correlation coefficients were r=0.99 (ppresent study showed that VRT and axial images produce almost identical values of CI, with the advantages of greater ease of execution and a time saving of almost 50% for 3D VRT images. In addition, VRT provides an integrated perspective that can better assist surgeons in clinical decision making and in operative planning, suggesting this technique as a possible standard method for CI measurement. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    International Nuclear Information System (INIS)

    Vande Berg, Bruno C.; Gilon, Raphael; Malghem, Jacques; Lecouvet, Frederic; Depresseux, Genevieve; Houssiau, Frederic A.

    2006-01-01

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy

  12. The preoperative evaluation prevent the postoperative complications of thyroidectomy

    Directory of Open Access Journals (Sweden)

    Chien-Feng Huang

    2015-03-01

    Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

  13. The evaluation of composite dose using deformable image registration in adaptive radiotherapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Chul Hwan; Ko, Seong Jin; Kim, Chang Soo; Kim, Jung Hoon; Kim, Dong Hyun; Choi, Seok Yoon; Ye, Soo Young; Kang, Se Sik [Dept. of Radiological Science, College of Health Sciences, Catholic University of Pusan, Pusan (Korea, Republic of)

    2013-09-15

    In adaptive radiotherapy(ART), generated composite dose of surrounding normal tissue on overall treatment course which is using deformable image registration from multistage images. Also, compared with doses summed by each treatment plan and clinical significance is considered. From the first of May, 2011 to the last of July, 2012. Patients who were given treatment and had the head and neck cancer with 3-dimension conformal radiotherapy or intensity modulated radiotherapy, those who were carried out adaptive radiotherapy cause of tumor shrinkage and weight loss. Generated composite dose of surrounding normal tissue using deformable image registration was been possible, statistically significant difference was showed to mandible(48.95±3.89 vs 49.10±3.55 Gy), oral cavity(36.93±4.03 vs 38.97±5.08 Gy), parotid gland(35.71±6.22 vs 36.12±6.70 Gy) and temporomandibular joint(18.41±9.60 vs 20.13±10.42 Gy) compared with doses summed by each treatment plan. The results of this study show significant difference between composite dose by deformable image registration and doses summed by each treatment plan, composite dose by deformable image registration may generate more exact evaluation to surrounding normal tissue in adaptive radiotherapy.

  14. The evaluation of composite dose using deformable image registration in adaptive radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Hwang, Chul Hwan; Ko, Seong Jin; Kim, Chang Soo; Kim, Jung Hoon; Kim, Dong Hyun; Choi, Seok Yoon; Ye, Soo Young; Kang, Se Sik

    2013-01-01

    In adaptive radiotherapy(ART), generated composite dose of surrounding normal tissue on overall treatment course which is using deformable image registration from multistage images. Also, compared with doses summed by each treatment plan and clinical significance is considered. From the first of May, 2011 to the last of July, 2012. Patients who were given treatment and had the head and neck cancer with 3-dimension conformal radiotherapy or intensity modulated radiotherapy, those who were carried out adaptive radiotherapy cause of tumor shrinkage and weight loss. Generated composite dose of surrounding normal tissue using deformable image registration was been possible, statistically significant difference was showed to mandible(48.95±3.89 vs 49.10±3.55 Gy), oral cavity(36.93±4.03 vs 38.97±5.08 Gy), parotid gland(35.71±6.22 vs 36.12±6.70 Gy) and temporomandibular joint(18.41±9.60 vs 20.13±10.42 Gy) compared with doses summed by each treatment plan. The results of this study show significant difference between composite dose by deformable image registration and doses summed by each treatment plan, composite dose by deformable image registration may generate more exact evaluation to surrounding normal tissue in adaptive radiotherapy

  15. Preoperative Prediction of Ki-67 Labeling Index By Three-dimensional CT Image Parameters for Differential Diagnosis Of Ground-Glass Opacity (GGO.

    Directory of Open Access Journals (Sweden)

    Mingzheng Peng

    Full Text Available The aim of this study was to predict Ki-67 labeling index (LI preoperatively by three-dimensional (3D CT image parameters for pathologic assessment of GGO nodules. Diameter, total volume (TV, the maximum CT number (MAX, average CT number (AVG and standard deviation of CT number within the whole GGO nodule (STD were measured by 3D CT workstation. By detection of immunohistochemistry and Image Software Pro Plus 6.0, different Ki-67 LI were measured and statistically analyzed among preinvasive adenocarcinoma (PIA, minimally invasive adenocarcinoma (MIA and invasive adenocarcinoma (IAC. Receiver operating characteristic (ROC curve, Spearman correlation analysis and multiple linear regression analysis with cross-validation were performed to further research a quantitative correlation between Ki-67 labeling index and radiological parameters. Diameter, TV, MAX, AVG and STD increased along with PIA, MIA and IAC significantly and consecutively. In the multiple linear regression model by a stepwise way, we obtained an equation: prediction of Ki-67 LI=0.022*STD+0.001* TV+2.137 (R=0.595, R's square=0.354, p<0.001, which can predict Ki-67 LI as a proliferative marker preoperatively. Diameter, TV, MAX, AVG and STD could discriminate pathologic categories of GGO nodules significantly. Ki-67 LI of early lung adenocarcinoma presenting GGO can be predicted by radiologic parameters based on 3D CT for differential diagnosis.

  16. A Novel Functional Magnetic Resonance Imaging Paradigm for the Preoperative Assessment of Auditory Perception in a Musician Undergoing Temporal Lobe Surgery.

    Science.gov (United States)

    Hale, Matthew D; Zaman, Arshad; Morrall, Matthew C H J; Chumas, Paul; Maguire, Melissa J

    2018-03-01

    Presurgical evaluation for temporal lobe epilepsy routinely assesses speech and memory lateralization and anatomic localization of the motor and visual areas but not baseline musical processing. This is paramount in a musician. Although validated tools exist to assess musical ability, there are no reported functional magnetic resonance imaging (fMRI) paradigms to assess musical processing. We examined the utility of a novel fMRI paradigm in an 18-year-old left-handed pianist who underwent surgery for a left temporal low-grade ganglioglioma. Preoperative evaluation consisted of neuropsychological evaluation, T1-weighted and T2-weighted magnetic resonance imaging, and fMRI. Auditory blood oxygen level-dependent fMRI was performed using a dedicated auditory scanning sequence. Three separate auditory investigations were conducted: listening to, humming, and thinking about a musical piece. All auditory fMRI paradigms activated the primary auditory cortex with varying degrees of auditory lateralization. Thinking about the piece additionally activated the primary visual cortices (bilaterally) and right dorsolateral prefrontal cortex. Humming demonstrated left-sided predominance of auditory cortex activation with activity observed in close proximity to the tumor. This study demonstrated an fMRI paradigm for evaluating musical processing that could form part of preoperative assessment for patients undergoing temporal lobe surgery for epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Use of Molecular Imaging to Predict Clinical Outcome in Patients With Rectal Cancer After Preoperative Chemotherapy and Radiation

    International Nuclear Information System (INIS)

    Konski, Andre; Li Tianyu; Sigurdson, Elin; Cohen, Steven J.; Small, William; Spies, Stewart; Yu, Jian Q.; Wahl, Andrew; Stryker, Steven; Meropol, Neal J.

    2009-01-01

    Purpose: To correlate changes in 2-deoxy-2-[18F]fluoro-D-glucose (18-FDG) positron emission tomography (PET) (18-FDG-PET) uptake with response and disease-free survival with combined modality neoadjuvant therapy in patients with locally advanced rectal cancer. Methods and Materials: Charts were reviewed for consecutive patients with ultrasound-staged T3x to T4Nx or TxN1 rectal adenocarcinoma who underwent preoperative chemoradiation therapy at Fox Chase Cancer Center (FCCC) or Robert H. Lurie Comprehensive Cancer Center of Northwestern University with 18-FDG-PET scanning before and after combined-modality neoadjuvant chemoradiation therapy . The maximum standardized uptake value (SUV) was measured from the tumor before and 3 to 4 weeks after completion of chemoradiation therapy preoperatively. Logistic regression was used to analyze the association of pretreatment SUV, posttreatment SUV, and % SUV decrease on pathologic complete response (pCR), and a Cox model was fitted to analyze disease-free survival. Results: A total of 53 patients (FCCC, n = 41, RLCCC, n = 12) underwent pre- and postchemoradiation PET scanning between September 2000 and June 2006. The pCR rate was 31%. Univariate analysis revealed that % SUV decrease showed a marginally trend in predicting pCR (p = 0.08). In the multivariable analysis, posttreatment SUV was shown a predictor of pCR (p = 0.07), but the test results did not reach statistical significance. None of the investigated variables were predictive of disease-free survival. Conclusions: A trend was observed for % SUV decrease and posttreatment SUV predicting pCR in patients with rectal cancer treated with preoperative chemoradiation therapy. Further prospective study with a larger sample size is warranted to better characterize the role of 18-FDG-PET for response prediction in patients with rectal cancer.

  18. Recovery of Urinary Function after Radical Prostatectomy: Predictors of Urinary Function on Preoperative Prostate Magnetic Resonance Imaging

    Science.gov (United States)

    von Bodman, Christian; Matsushita, Kazuhito; Savage, Caroline; Matikainen, Mika P.; Eastham, James A.; Scardino, Peter T.; Rabbani, Farhang; Akin, Oguz; Sandhu, Jaspreet S.

    2016-01-01

    Purpose To determine if pelvic soft tissue and bony dimensions on endorectal MRI influence recovery of continence after radical prostatectomy (RP) and whether adding significant MRI variables to a statistical model improves prediction of continence recovery. Materials and Methods Between 2001 and 2004, 967 men undergoing RP had preoperative MRI. Soft tissue and bony dimensions were retrospectively measured by two raters blinded to clinical and pathological data. Patients who received neoadjuvant therapy, were preoperatively incontinent, or had missing followup for continence were excluded, leaving 600 patients eligible for analysis. No pad usage defined continent. Logistic regression was used to identify variables associated with continence recovery at 6 and 12 months. We evaluated whether predictive accuracy of a base model improved by adding independently significant MRI variables. Results Urethral length and urethral volume were both significantly associated with recovery of continence at 6 and 12 months. Larger inner and outer levator distances were significantly associated with a decreased probability of regaining continence at either 6 or 12 months; they did not reach statistical significance for the other time point. Addition of these four MRI variables to a base model including age, clinical stage, PSA and comorbidities marginally improved the discrimination (12 months AUC improved from 0.587 to 0.634). Conclusions Membranous urethral length, urethral volume and an anatomically close relation between the levator muscle and membranous urethra on preoperative MRI are independent predictors of continence recovery after RP. Addition of MRI variables to a base model improved the predictive accuracy for continence recovery but predictive accuracy remains low. PMID:22264458

  19. Preoperative detection of hepatocellular carcinoma: comparison of combined constrast-enhanced MR imaging and combined CT during arterial portography and CT hepatic arteriography

    International Nuclear Information System (INIS)

    Kwak, H.S.; Kim, C.S.; Lee, J.M.; Seoul National University Medical Research Center

    2004-01-01

    The aim of this study was to compare Gd-DTPA-enhanced dynamic MR images, superparamagnetic iron oxide (SPIO)-enhanced MR images, combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images, vs combined CT arterial portography (CTAP) and CT hepatic arteriography (CTHA), in the detection of hepatocellular carcinoma (HCC) using receiver operating characteristic (ROC) analysis. Twenty-four patients with 38 nodular HCCs (5-60 mm, mean 23.0 mm) were retrospectively analyzed. Image reviews were conducted on a liver segment-by-segment basis. A total of 192 segments, including 36 segments with 38 HCC, were reviewed independently by three radiologists. Each radiologist read four sets of images (set 1, unenhanced and Gd-DTPA-enhanced dynamic MR images; set 2, unenhanced and SPIO-enhanced MR images; set 3, combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images; set 4, combined CTAP and CTHA). To minimize any possible learning bias, the reviewing order was randomized and the reviewing procedure was performed in four sessions at 2-week intervals. The diagnostic accuracy (Az values) for HCCs of combined CTAP and CTHA, combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images, Gd-DTPA-enhanced dynamic MR images, and SPIO-enhanced MR images for all observers were 0.934, 0.963, 0.878, and 0.869, respectively. The diagnostic accuracy of combined CTAP and CTHA and combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images was significantly higher than Gd-DTPA-enhanced dynamic MR images or SPIO-enhanced MR images (p<0.005). The mean specificity of combined CTAP and CTHA (93%) and combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images (95%) was significantly higher than Gd-DTPA-enhanced dynamic MR images (87%) or SPIO-enhanced MR images (88%; p<0.05). Combined Gd-DTPA-enhanced dynamic and SPIO-enhanced MR images may obviate the need for more invasive combined CTAP and CTHA for the preoperative evaluation of patients with HCC

  20. A three-dimensional head-and-neck phantom for validation of multimodality deformable image registration for adaptive radiotherapy

    International Nuclear Information System (INIS)

    Singhrao, Kamal; Kirby, Neil; Pouliot, Jean

    2014-01-01

    Purpose: To develop a three-dimensional (3D) deformable head-and-neck (H and N) phantom with realistic tissue contrast for both kilovoltage (kV) and megavoltage (MV) imaging modalities and use it to objectively evaluate deformable image registration (DIR) algorithms. Methods: The phantom represents H and N patient anatomy. It is constructed from thermoplastic, which becomes pliable in boiling water, and hardened epoxy resin. Using a system of additives, the Hounsfield unit (HU) values of these materials were tuned to mimic anatomy for both kV and MV imaging. The phantom opens along a sagittal midsection to reveal radiotransparent markers, which were used to characterize the phantom deformation. The deformed and undeformed phantoms were scanned with kV and MV imaging modalities. Additionally, a calibration curve was created to change the HUs of the MV scans to be similar to kV HUs, (MC). The extracted ground-truth deformation was then compared to the results of two commercially available DIR algorithms, from Velocity Medical Solutions and MIM software. Results: The phantom produced a 3D deformation, representing neck flexion, with a magnitude of up to 8 mm and was able to represent tissue HUs for both kV and MV imaging modalities. The two tested deformation algorithms yielded vastly different results. For kV–kV registration, MIM produced mean and maximum errors of 1.8 and 11.5 mm, respectively. These same numbers for Velocity were 2.4 and 7.1 mm, respectively. For MV–MV, kV–MV, and kV–MC Velocity produced similar mean and maximum error values. MIM, however, produced gross errors for all three of these scenarios, with maximum errors ranging from 33.4 to 41.6 mm. Conclusions: The application of DIR across different imaging modalities is particularly difficult, due to differences in tissue HUs and the presence of imaging artifacts. For this reason, DIR algorithms must be validated specifically for this purpose. The developed H and N phantom is an effective tool

  1. Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact.

    Science.gov (United States)

    Wuest, W; May, M S; Brand, M; Bayerl, N; Krauss, A; Uder, M; Lell, M

    2015-10-01

    Metal artifacts from dental fillings and other devices degrade image quality and may compromise the detection and evaluation of lesions in the oral cavity and oropharynx by CT. The aim of this study was to evaluate the effect of iterative metal artifact reduction on CT of the oral cavity and oropharynx. Data from 50 consecutive patients with metal artifacts from dental hardware were reconstructed with standard filtered back-projection, linear interpolation metal artifact reduction (LIMAR), and iterative metal artifact reduction. The image quality of sections that contained metal was analyzed for the severity of artifacts and diagnostic value. A total of 455 sections (mean ± standard deviation, 9.1 ± 4.1 sections per patient) contained metal and were evaluated with each reconstruction method. Sections without metal were not affected by the algorithms and demonstrated image quality identical to each other. Of these sections, 38% were considered nondiagnostic with filtered back-projection, 31% with LIMAR, and only 7% with iterative metal artifact reduction. Thirty-three percent of the sections had poor image quality with filtered back-projection, 46% with LIMAR, and 10% with iterative metal artifact reduction. Thirteen percent of the sections with filtered back-projection, 17% with LIMAR, and 22% with iterative metal artifact reduction were of moderate image quality, 16% of the sections with filtered back-projection, 5% with LIMAR, and 30% with iterative metal artifact reduction were of good image quality, and 1% of the sections with LIMAR and 31% with iterative metal artifact reduction were of excellent image quality. Iterative metal artifact reduction yields the highest image quality in comparison with filtered back-projection and linear interpolation metal artifact reduction in patients with metal hardware in the head and neck area. © 2015 by American Journal of Neuroradiology.

  2. Radiation dose response simulation for biomechanical-based deformable image registration of head and neck cancer treatment

    International Nuclear Information System (INIS)

    Al-Mayah, Adil; Moseley, Joanne; Hunter, Shannon; Brock, Kristy

    2015-01-01

    Biomechanical-based deformable image registration is conducted on the head and neck region. Patient specific 3D finite element models consisting of parotid glands (PG), submandibular glands (SG), tumor, vertebrae (VB), mandible, and external body are used to register pre-treatment MRI to post-treatment MR images to model the dose response using image data of five patients. The images are registered using combinations of vertebrae and mandible alignments, and surface projection of the external body as boundary conditions. In addition, the dose response is simulated by applying a new loading technique in the form of a dose-induced shrinkage using the dose-volume relationship. The dose-induced load is applied as dose-induced shrinkage of the tumor and four salivary glands. The Dice Similarity Coefficient (DSC) is calculated for the four salivary glands, and tumor to calculate the volume overlap of the structures after deformable registration. A substantial improvement in the registration is found by including the dose-induced shrinkage. The greatest registration improvement is found in the four glands where the average DSC increases from 0.53, 0.55, 0.32, and 0.37 to 0.68, 0.68, 0.51, and 0.49 in the left PG, right PG, left SG, and right SG, respectively by using bony alignment of vertebrae and mandible (M), body (B) surface projection and dose (D) (VB+M+B+D). (paper)

  3. An Exploratory Study Into the Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging or Perfusion Computed Tomography for Detection of Intratumoral Hypoxia in Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Newbold, Kate [Royal Marsden Hospital, Sutton (United Kingdom); Castellano, Isabel [Institute of Cancer Research, London (United Kingdom); Charles-Edwards, Elizabeth [Institute of Cancer Research, Sutton, Surrey (United Kingdom); Mears, Dorothy; Sohaib, Aslam [Royal Marsden Hospital, Sutton (United Kingdom); Leach, Martin [Institute of Cancer Research, Sutton, Surrey (United Kingdom); Rhys-Evans, Peter; Clarke, Peter; Fisher, Cyril [Royal Marsden Hospital, London (United Kingdom); Harrington, Kevin [Institute of Cancer Research, London (United Kingdom); Royal Marsden Hospital, London (United Kingdom); Nutting, Christopher [Royal Marsden Hospital, London (United Kingdom)

    2009-05-01

    Purpose: Hypoxia in patients with head-and-neck cancer (HNC) is well established and known to cause radiation resistance and treatment failure in the management of HNC. This study examines the role of parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) as surrogate markers of intratumoral hypoxia, defined by using the exogenous marker of hypoxia pimonidazole and the endogenous marker carbonic anhydrase 9 (CA9). Methods and Materials: Patients with HNC underwent preoperative DCE-MRI, perfusion CT, and pimonidazole infusion. Imaging parameters were correlated with pimonidazole and CA9 staining. The strength of correlations was tested by using a two-tailed Spearman's rank correlation coefficient. Results: Twenty-three regions of interest were analyzed from the 7 patients who completed the DCE-MRI studies. A number of statistically significant correlations were seen between DCE-MRI parameters (volume transfer between blood plasma and extracellular extravascular space [EES], volume of EES, rate constant between EES and blood plasma, time at arrival of contrast inflow, time to peak, average gradient, and time to onset) and areas with a pimonidazole score of 4. In the case of CA9 staining, only a weak correlation was shown with wash-in rate. There were no significant correlations between perfusion CT parameters and pimonidazole staining or CA9 expression. Conclusion: Intratumoral hypoxia in patients with HNC may be predicted by using DCE-MRI; however, perfusion CT requires further investigation.

  4. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study.

    Science.gov (United States)

    Taylor, Fiona G M; Quirke, Philip; Heald, Richard J; Moran, Brendan; Blomqvist, Lennart; Swift, Ian; Sebag-Montefiore, David J; Tekkis, Paris; Brown, Gina

    2011-04-01

    To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone. The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI "good prognosis" stage III with selective avoidance of neoadjuvant therapy. Data were collected prospectively on all patients included in the MERCURY study who were staged as MRI-defined "good" prognosis tumors. "Good" prognosis included MRI-predicted safe circumferential resection margins, with MRI-predicted T2/T3a/T3b (less than 5 mm spread from muscularis propria), regardless of MRI N stage. None received preoperative or postoperative radiotherapy. Overall survival, disease-free survival, and local recurrence were calculated. Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as "good prognosis" stage III or less on MRI. Overall and disease-free survival for all patients with MRI "good prognosis" stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%. The preoperative identification of good prognosis tumors using MRI will allow stratification of patients and better targeting of preoperative therapy. This study confirms the ability of MRI to select patients who are likely to have a good outcome with primary surgery alone.

  5. A retrospective comparison of outcome and toxicity of preoperative image-guided intensity-modulated radiotherapy versus conventional pelvic radiotherapy for locally advanced rectal carcinoma

    International Nuclear Information System (INIS)

    Huang, Chun-Ming; Huang, Ming-Yii; Tsai, Hsiang-Lin; Huang, Ching-Wen; Ma, Cheng-Jen; Lin, Chih-Hung; Huang, Chih-Jen; Wang, Jaw-Yuan

    2017-01-01

    The aim of the study was to compare clinical outcomes and toxicity between 3D conformal radiotherapy (3DCRT) and image-guided intensity-modulated radiotherapy (IG-IMRT) administered through helical tomotherapy in locally advanced rectal cancer (LARC) patients receiving preoperative chemoradiotherapy. We reviewed 144 patients with Stage II–III rectal cancer receiving preoperative fluoropyrimidine-based chemoradiotherapy followed by radical resection. Tumor responses following chemoradiotherapy were evaluated using the Dworak tumor regression grade (TRG). Of the 144 patients, 45 received IG-IMRT and 99 received 3DCRT. A significant reduction in Grade 3 or 4 acute gastrointestinal toxicity (IG-IMRT, 6.7%; 3DCRT, 15.1%; P = 0.039) was observed by IG-IMRT. The pathologic complete response (pCR) rate did not differ between the IG-IMRT and the 3DCRT group (17.8% vs 15.1%, P = 0.52). Patients in the IG-IMRT group had the trend of favorable tumor regressions (TRG 3 or 4) compared with those in the 3DCRT group (66.7% vs 43.5%, P = 0.071). The median follow-up was 53 months (range, 18–95 months) in the 3DCRT group and 43 months (range, 17–69 months) in the IG-IMRT group. Four-year overall, disease-free, and local failure–free survival rates of the IG-IMRT and 3DCRT groups were 81.6% and 67.9% (P = 0.12), 53.8% and 51.8% (P = 0.51), and 88% and 75.1% (P = 0.031), respectively. LARC patients treated with preoperative IG-IMRT achieved lower acute gastrointestinal adverse effects and a higher local control rate than those treated with 3DCRT, but there was no prominent difference in distant metastasis rate and overall survival between two treatment modalities.

  6. FAZA PET/CT hypoxia imaging in patients with squamous cell carcinoma of the head and neck treated with radiotherapy: Results from the DAHANCA 24 trial

    DEFF Research Database (Denmark)

    Mortensen, Lise Saksø; Johansen, Jørgen; Kallehauge, Jesper Folsted

    2012-01-01

    Hypoxia is a cause of resistance to radiotherapy, especially in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to evaluate (18)F-fluoroazomycin arabinoside (FAZA) positron emission tomography (PET)/computed tomography (CT) hypoxia imaging as a prognostic...

  7. Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with head and neck tumors, a systematic review and meta-analysis

    NARCIS (Netherlands)

    van der Hoorn, Anouk; van Laar, Peter Jan; Holtman, Gea A.; Westerlaan, Henriette E.

    2017-01-01

    Background Novel advanced MRI techniques are investigated in patients treated for head and neck tumors as conventional anatomical MRI is unreliable to differentiate tumor from treatment related imaging changes. Purpose As the diagnostic accuracy of MRI techniques to detect tumor residual or

  8. Occult primary tumors of the head and neck: accuracy of thallium 201 single-photon emission computed tomography and computed tomography and/or magnetic resonance imaging

    NARCIS (Netherlands)

    van Veen, S. A.; Balm, A. J.; Valdés Olmos, R. A.; Hoefnagel, C. A.; Hilgers, F. J.; Tan, I. B.; Pameijer, F. A.

    2001-01-01

    To determine the accuracy of thallium 201 single-photon emission computed tomography (thallium SPECT) and computed tomography and/or magnetic resonance imaging (CT/MRI) in the detection of occult primary tumors of the head and neck. Study of diagnostic tests. National Cancer Institute, Amsterdam,

  9. Reliability of the imaging software in the preoperative planning of the open-wedge high tibial osteotomy.

    Science.gov (United States)

    Lee, Yong Seuk; Kim, Min Kyu; Byun, Hae Won; Kim, Sang Bum; Kim, Jin Goo

    2015-03-01

    The purpose of this study was to verify a recently developed picture-archiving and communications system-photoshop method by comparing reliabilities between real-size paper template and the PACS-photoshop methods in preoperative planning of open-wedge high tibial osteotomy. A prospective case series was conducted, including patients with medial osteoarthritis undergoing open-wedge high tibial osteotomy. In the preoperative planning, the picture-archiving and communications system-photoshop method and real-size paper template method were used simultaneously in all patients. Preoperative hip-knee-ankle angle, height, and angle of the osteotomy were evaluated. The reliability of this newly devised method was evaluated, and the consistency between the two methods was also evaluated using intra-class correlation coefficient. Using the picture-archiving and communications system-photoshop method, the mean correction angle and height of osteotomy gap of rater-1 were 11.7° ± 3.6° and 10.7 ± 3.6 mm, respectively. The mean correction angle and height of osteotomy gap of rater-2 were 12.0 ± 2.6 and 10.8 ± 3.6, respectively. The inter- and intra-rater reliabilities of the correction angle were 0.956 ~ 0.979 and 0.980 ~ 0.992, respectively. The inter- and intra-rater reliabilities of the height of the osteotomy gap were 0.968 ~ 0.985 and 0.971 ~ 0.994, respectively (p photoshop method, mean values of the correction angle and height of the osteotomy gap were 11.9° ± 3.6° and 10.8 ± 3.6 mm, respectively. Consistency between the two methods by comparing the means of the correction angle and the height of the osteotomy gap were 0.985 and 0.985, respectively (p photoshop method enables direct measurement of the height of the osteotomy gap with high reliability.

  10. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism

    International Nuclear Information System (INIS)

    Pons, F.; Vidal-Sicart, S.; Fuster, D.; Herranz, R.; Torregrosa, J.V.; Sabater, L.; Fernandez-Cruz, L.

    1997-01-01

    Technetium-99m sestamibi scintigraphy has become a valuable tool in locating parathyroid glands in patients with primary hyperparathyroidism. The aim of this study was to evaluate its usefulness in secondary hyperparathyroidism. Twenty patients were injected intravenously with 740 MBq of 99m Tc-sestamibi and images were obtained at 15 min and 2 h post injection. All patients underwent parathyroid ultrasonography (US) as well as bilateral surgical neck exploration and 64 parathyroid glands were removed. US revealed at least one enlarged gland in 15/20 patients (75%), while 99m Tc-sestamibi scintigraphy showed focal areas of increased uptake in at least one gland in 17/20 patients (85%). When imaging results for all glands were evaluated according to surgical results, sensitivity was 54% for parathyroid scintigraphy and 41% for US, and specificity was 89% for both imaging techniques. There was a discrepancy between the two imaging modalities in 28 glands (35%). The mean surgical weight of US-positive glands (1492±1436 mg) was significantly higher than that of US-negative glands (775±703 mg) (P 99m Tc-sestamibi scintigraphy are complementary imaging techniques in the preoperative localization of abnormal parathyroid glands in patients with secondary hyperparathyroidism. The limited sensitivity of the techniques means that patients will still require bilateral neck exploration; therefore routine preoperative parathyroid scanning in renal patients is not justified. (orig.)

  11. Comparison of Safety Margin Generation Concepts in Image Guided Radiotherapy to Account for Daily Head and Neck Pose Variations.

    Science.gov (United States)

    Stoll, Markus; Stoiber, Eva Maria; Grimm, Sarah; Debus, Jürgen; Bendl, Rolf; Giske, Kristina

    2016-01-01

    Intensity modulated radiation therapy (IMRT) of head and neck tumors allows a precise conformation of the high-dose region to clinical target volumes (CTVs) while respecting dose limits to organs a risk (OARs). Accurate patient setup reduces translational and rotational deviations between therapy planning and therapy delivery days. However, uncertainties in the shape of the CTV and OARs due to e.g. small pose variations in the highly deformable anatomy of the head and neck region can still compromise the dose conformation. Routinely applied safety margins around the CTV cause higher dose deposition in adjacent healthy tissue and should be kept as small as possible. In this work we evaluate and compare three approaches for margin generation 1) a clinically used approach with a constant isotropic 3 mm margin, 2) a previously proposed approach adopting a spatial model of the patient and 3) a newly developed approach adopting a biomechanical model of the patient. All approaches are retrospectively evaluated using a large patient cohort of over 500 fraction control CT images with heterogeneous pose changes. Automatic methods for finding landmark positions in the control CT images are combined with a patient specific biomechanical finite element model to evaluate the CTV deformation. The applied methods for deformation modeling show that the pose changes cause deformations in the target region with a mean motion magnitude of 1.80 mm. We found that the CTV size can be reduced by both variable margin approaches by 15.6% and 13.3% respectively, while maintaining the CTV coverage. With approach 3 an increase of target coverage was obtained. Variable margins increase target coverage, reduce risk to OARs and improve healthy tissue sparing at the same time.

  12. Pure ground glass nodular adenocarcinomas: Are preoperative positron emission tomography/computed tomography and brain magnetic resonance imaging useful or necessary?

    Science.gov (United States)

    Cho, Hyoun; Lee, Ho Yun; Kim, Jhingook; Kim, Hong Kwan; Choi, Joon Young; Um, Sang-Won; Lee, Kyung Soo

    2015-09-01

    The utility of (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and brain magnetic resonance imaging (MRI) as a staging workup for lung adenocarcinoma manifesting as pure ground glass opacity (GGO) is unknown. The purpose of this study was to determine the utility of these 2 tests for preoperative staging of pure GGO nodular lung adenocarcinoma. The study included 164 patients (male:female, 73:91; mean age, 62 years) with pure GGO nodular lung adenocarcinoma who underwent PET/CT (in 136 patients) and/or brain MRI (in 109 patients) before surgery. Pathologic N staging and dedicated standard imaging or follow-up imaging findings for M staging were used as reference standards. The median follow-up time was 47.9 months. On PET/CT scan, abnormal FDG uptake of lymph nodes was found in 2 of 136 patients (1.5%); both were negative on final pathology. Abnormal FDG uptake of the liver was detected in 1 patient, which was also confirmed to be negative by dedicated abdominal CT. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in detecting metastases were not applicable, 98% (95% confidence interval [CI], 94%-100%), 0% (95% CI, 0%-71%), 100% (95% CI, 97%-100%), and 98% (95% CI, 94%-100%), respectively. No brain metastasis was found in preoperative brain MRI of 109 patients. Of 109 patients, 1 (0.9%) developed brain metastasis 30 months after surgical resection. PET/CT and brain MRI is not necessary in the staging of pure GGO nodular lung adenocarcinoma. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  13. Average arterial input function for quantitative dynamic contrast enhanced magnetic resonance imaging of neck nodal metastases

    International Nuclear Information System (INIS)

    Shukla-Dave, Amita; Lee, Nancy; Stambuk, Hilda; Wang, Ya; Huang, Wei; Thaler, Howard T; Patel, Snehal G; Shah, Jatin P; Koutcher, Jason A

    2009-01-01

    The present study determines the feasibility of generating an average arterial input function (Avg-AIF) from a limited population of patients with neck nodal metastases to be used for pharmacokinetic modeling of dynamic contrast-enhanced MRI (DCE-MRI) data in clinical trials of larger populations. Twenty patients (mean age 50 years [range 27–77 years]) with neck nodal metastases underwent pretreatment DCE-MRI studies with a temporal resolution of 3.75 to 7.5 sec on a 1.5T clinical MRI scanner. Eleven individual AIFs (Ind-AIFs) met the criteria of expected enhancement pattern and were used to generate Avg-AIF. Tofts model was used to calculate pharmacokinetic DCE-MRI parameters. Bland-Altman plots and paired Student t-tests were used to describe significant differences between the pharmacokinetic parameters obtained from individual and average AIFs. Ind-AIFs obtained from eleven patients were used to calculate the Avg-AIF. No overall significant difference (bias) was observed for the transfer constant (K trans ) measured with Ind-AIFs compared to Avg-AIF (p = 0.20 for region-of-interest (ROI) analysis and p = 0.18 for histogram median analysis). Similarly, no overall significant difference was observed for interstitial fluid space volume fraction (v e ) measured with Ind-AIFs compared to Avg-AIF (p = 0.48 for ROI analysis and p = 0.93 for histogram median analysis). However, the Bland-Altman plot suggests that as K trans increases, the Ind-AIF estimates tend to become proportionally higher than the Avg-AIF estimates. We found no statistically significant overall bias in K trans or v e estimates derived from Avg-AIF, generated from a limited population, as compared with Ind-AIFs. However, further study is needed to determine whether calibration is needed across the range of K trans . The Avg-AIF obtained from a limited population may be used for pharmacokinetic modeling of DCE-MRI data in larger population studies with neck nodal metastases. Further validation of

  14. The feasibility of endoscopy-CT image registration in the head and neck without prospective endoscope tracking.

    Directory of Open Access Journals (Sweden)

    W Scott Ingram

    Full Text Available Endoscopic examinations are frequently-used procedures for patients with head and neck cancer undergoing radiotherapy, but radiation treatment plans are created on computed tomography (CT scans. Image registration between endoscopic video and CT could be used to improve treatment planning and analysis of radiation-related normal tissue toxicity. The purpose of this study was to explore the feasibility of endoscopy-CT image registration without prospective physical tracking of the endoscope during the examination.A novel registration technique called Location Search was developed. This technique uses physical constraints on the endoscope's view direction to search for the virtual endoscope coordinates that maximize the similarity between the endoscopic video frame and the virtual endoscopic image. Its performance was tested on phantom and patient images and compared to an established registration technique, Frame-To-Frame Tracking.In phantoms, Location Search had average registration errors of 0.55 ± 0.60 cm for point measurements and 0.29 ± 0.15 cm for object surface measurements. Frame-To-Frame Tracking achieved similar results on some frames, but it failed on others due to the virtual endoscope becoming lost. This weakness was more pronounced in patients, where Frame-To-Frame tracking could not make it through the nasal cavity. On successful patient video frames, Location Search was able to find endoscope positions with an average distance of 0.98 ± 0.53 cm away from the ground truth positions. However, it failed on many frames due to false similarity matches caused by anatomical structural differences between the endoscopic video and the virtual endoscopic images.Endoscopy-CT image registration without prospective physical tracking of the endoscope is possible, but more development is required to achieve an accuracy suitable for clinical translation.

  15. Accuracy of magnetic resonance imaging in the pre-operative staging of rectal adenocarcinoma: Experience from a regional Australian cancer center.

    Science.gov (United States)

    White, Rohen; Ung, Kim Ann; Mathlum, Maitham

    2013-12-01

    Selection of the optimal treatment pathway in patients with rectal adenocarcinoma relies on accurate locoregional staging. This study aims to assess the accuracy of staging with magnetic resonance imaging (MRI) and in particular, its accuracy in differentiating patients with early stage disease from those with more advanced disease who benefit from a different treatment approach. Patients who were staged with MRI and received surgery as the first line of treatment for biopsy-proven adenocarcinoma of the rectum were identified. Comparison was made between the clinical stage on MRI and the pathological stage of the surgical specimen. The sensitivity, specificity and overall accuracy of MRI was assessed. In all, 58 eligible patients were identified. In 31% of patients, the extent of disease was underrepresented on preoperative MRI. Sensitivity, specificity and overall accuracy of anorectal MRI in detecting stage II/III disease status in this cohort was 59, 71 and 62%, respectively. MRI underestimated the pathological stage in many patients in this series who may have benefited from the addition of neoadjuvant radiotherapy to their management. This study supports further refinement of preoperative staging and demonstrates that impressive results from highly controlled settings may be difficult to reproduce in community practice. © 2012 Wiley Publishing Asia Pty Ltd.

  16. Magnetic resonance imaging-detected extramural venous invasion in rectal cancer before and after preoperative chemoradiotherapy. Diagnostic performance and prognostic significance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Sun [Chung-Ang University Hospital, Department of Radiology, Seoul (Korea, Republic of); Chung-Ang University, College of Medicine and Graduate School of Medicine, Seoul (Korea, Republic of); National Cancer Centre, Department of Radiology, Goyang-si, Gyeonggi-do (Korea, Republic of); Kim, Min Ju; Hur, Bo Yun [National Cancer Centre, Department of Radiology, Goyang-si, Gyeonggi-do (Korea, Republic of); Park, Sung Chan; Hyun, Jong Hee; Chang, Hee Jin; Baek, Ji Yeon; Kim, Dae Yong; Oh, Jae Hwan [National Cancer Centre, Centre for Colorectal Cancer, Goyang, Gyeonggi-do (Korea, Republic of); Kim, Sun Young [National Cancer Centre, Centre for Colorectal Cancer, Goyang, Gyeonggi-do (Korea, Republic of); University of Ulsan College of Medicine, Department of Oncology, Asan Medical Centre, Seoul (Korea, Republic of)

    2018-02-15

    We evaluated the diagnostic performance of magnetic resonance imaging (MRI) in terms of identifying extramural venous invasion (EMVI) in rectal cancer patients with preoperative chemoradiotherapy (CRT) and its prognostic significance. During 2008-2010, 200 patients underwent surgery following preoperative CRT for rectal cancer. Two radiologists independently reviewed all pre- and post-CRT MRI retrospectively. We investigated diagnostic performance of pre-CRT MR-EMVI (MR-EMVI) and post-CRT MR-EMVI (yMR-EMVI), based on pathological EMVI as the standard of reference. We assessed correlation between MRI findings and patients' prognosis, such as disease-free survival (DFS) and overall survival (OS). Additionally, subgroup analysis in MR- or yMR-EMVI-positive patients was performed to confirm the significance of the severity of EMVI in MRI on patient's prognosis. The sensitivity and specificity of yMR-EMVI were 76.19% and 79.75% (area under the curve: 0.830), respectively. In univariate analysis, yMR-EMVI was the only significant MRI factor in DFS (P = 0.027). The mean DFS for yMR-EMVI (+) patients was significantly less than for yMR-EMVI (-) patients: 57.56 months versus 72.46 months. yMR-EMVI demonstrated good diagnostic performance. yMR-EMVI was the only significant EMVI-related MRI factor that correlated with patients' DFS in univariate analysis; however, it was not significant in multivariate analysis. (orig.)

  17. Predictive value of diffusion-weighted imaging without and with including contrast-enhanced magnetic resonance imaging in image analysis of head and neck squamous cell carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Noij, Daniel P., E-mail: d.noij@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Pouwels, Petra J.W., E-mail: pjw.pouwels@vumc.nl [Department of Physics and Medical Technology, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Ljumanovic, Redina, E-mail: rljumanovic@adventh.org [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Knol, Dirk L., E-mail: dirklknol@gmail.com [Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Doornaert, Patricia, E-mail: p.doornaert@vumc.nl [Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Bree, Remco de, E-mail: r.debree@vumc.nl [Department of Otolaryngology – Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Castelijns, Jonas A., E-mail: j.castelijns@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands); Graaf, Pim de, E-mail: p.degraaf@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, Noord-Holland (Netherlands)

    2015-01-15

    Highlights: • Primary tumor volume and lymph node ADC1000 are predictors of survival. • CE-T1WI does not improve the prognostic capacity of DWI. • Using CE-T1WI for ROI placement results in lower interobserver agreement. - Abstract: Objectives: To assess disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy ([C]RT). Methods: Pretreatment MR-images of 78 patients were retrospectively studied. Apparent diffusion coefficients (ADC) were calculated with two sets of two b-values: 0–750 s/mm{sup 2} (ADC{sub 750}) and 0–1000 s/mm{sup 2} (ADC{sub 1000}). One observer assessed tumor volume on T1-WI. Two independent observers assessed ADC-values of primary tumor and largest lymph node in two sessions (i.e. without and with including CE-T1WI in image analysis). Interobserver and intersession agreement were assessed with intraclass correlation coefficients (ICC) separately for ADC{sub 750} and ADC{sub 1000}. Lesion volumes and ADC-values were related to DFS using Cox regression analysis. Results: Median follow-up was 18 months. Interobserver ICC was better without than with CE-T1WI (primary tumor: 0.92 and 0.75–0.83, respectively; lymph node: 0.81–0.83 and 0.61–0.64, respectively). Intersession ICC ranged from 0.84 to 0.89. With CE-T1WI, mean ADC-values of primary tumor and lymph node were higher at both b-values than without CE-T1WI (P < 0.001). Tumor volume (sensitivity: 73%; specificity: 57%) and lymph node ADC{sub 1000} (sensitivity: 71–79%; specificity: 77–79%) were independent significant predictors of DFS without and with including CE-T1WI (P < 0.05). Conclusions: Pretreatment primary tumor volume and lymph node ADC{sub 1000} were significant independent predictors of DFS in HNSCC treated with (C)RT. DFS could be predicted from ADC-values acquired without and with including CE-T1WI in image analysis. The inclusion of CE-T1WI did not result in significant improvements in the predictive value of

  18. Improved MR imaging of head and neck tumors with use of fat suppression with and without Gd-DTPA

    International Nuclear Information System (INIS)

    Tien, R.D.; Hesselink, J.R.; Szumowski, J.; Robbins, K.T.

    1990-01-01

    This paper determines the feasibility of using MR fat-suppression techniques for tumors and lymphadenopathies of the head and neck. To date, 28 patients with various tumors and lymphadenopathies have been evaluated. All patients were studied with standard spin-echo T1-weighted images (T1WI) and T2-weighted images (T2WI), with and without fat-suppression technique. T1WI with Gd-DTPA and fat suppression was performed in 17 patients. Conventional and paired fat-suppression MR images were compared by means of a grading system. The post-Gd-DTPA fat-suppression T1WI and fat-suppression T2WI were found to be most useful. Fat-suppression T2WI were generally even better than post-Gd-DTPA fat-suppression T1WI in cases of squamous cell carcinoma, due to its medium contrast enhancement. Post-Gd-DTPA fat-suppression T1WI were more useful than fat-suppression T2WI in a case of plexiform neurofibroma, due to its fibrous component and lack of protons

  19. Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI

    Energy Technology Data Exchange (ETDEWEB)

    Song, Sung Eun; Park, Eun Kyung; Cho, Kyu Ran; Cho, Sung Bum [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seo, Bo Kyoung [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of); Woo, Ok Hee [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Jung, Seung Pil [Korea University Anam Hospital, Korea University College of Medicine, Department of Surgery, Seoul (Korea, Republic of)

    2017-11-15

    To investigate whether diffusion-weighted imaging (DWI) aids pre-operative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate additional lesions in breast cancer patients. DCE-MRI and DWI were performed on 131 lesions, with available histopathological results. The apparent diffusion coefficient (ADC) of each lesion was measured, and the cut-off value for differentiation between malignant and benign lesions was calculated. A protocol combining the ADC cut-off value with DCE-MRI was validated in a cohort of 107 lesions in 77 patients. When an ADC cut-off value of 1.11 x 10{sup -3} mm{sup 2}/s from the development cohort was applied to the additional lesions in the validation cohort, the specificity increased from 18.9% to 67.6% (P < 0.001), and the diagnostic accuracy increased from 61.7% to 82.2% (P = 0.05), without significant loss of sensitivity (98.6% vs. 90.0%, P = 0.07). The negative predictive values of lesions in the same quadrant had decreased, as had those of lesions ≥1 cm in diameter. The ADC cut-off value in the validation cohort was 1.05 x 10{sup -3} mm{sup 2}/s. Additional implementation of DWI for breast lesions in pre-operative MRI can help to obviate unnecessary biopsies by increasing specificity. However, to avoid missing cancers, clinicians should closely monitor lesions located in the same quadrant or lesions ≥1 cm. (orig.)

  20. Dosimetric feasibility of magnetic resonance imaging-guided tri-cobalt 60 preoperative intensity modulated radiation therapy for soft tissue sarcomas of the extremity.

    Science.gov (United States)

    Kishan, Amar U; Cao, Minsong; Mikaeilian, Argin G; Low, Daniel A; Kupelian, Patrick A; Steinberg, Michael L; Kamrava, Mitchell

    2015-01-01

    The purpose of this study was to investigate the dosimetric differences of delivering preoperative intensity modulated radiation therapy (IMRT) to patients with soft tissue sarcomas of the extremity (ESTS) with a teletherapy system equipped with 3 rotating (60)Co sources and a built-in magnetic resonance imaging and with standard linear accelerator (LINAC)-based IMRT. The primary study population consisted of 9 patients treated with preoperative radiation for ESTS between 2008 and 2014 with LINAC-based static field IMRT. LINAC plans were designed to deliver 50 Gy in 25 fractions to 95% of the planning target volume (PTV). Tri-(60)Co system IMRT plans were designed with ViewRay system software. Tri-(60)Co-based IMRT plans achieved equivalent target coverage and dosimetry for organs at risk (long bone, skin, and skin corridor) compared with LINAC-based IMRT plans. The maximum and minimum PTV doses, heterogeneity indices, and ratio of the dose to 50% of the volume were equivalent for both planning systems. One LINAC plan violated the maximum bone dose constraint, whereas none of the tri-(60)Co plans did. Using a tri-(60)Co system, we were able to achieve equivalent dosimetry to the PTV and organs at risk for patients with ESTS compared with LINAC-based IMRT plans. The tri-(60)Co system may be advantageous over current treatment platforms by allowing PTV reduction and by elimination of the additional radiation dose associated with daily image guidance, but this needs to be evaluated prospectively. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  1. Assessment of three-dimensional set-up errors in conventional head and neck radiotherapy using electronic portal imaging device

    International Nuclear Information System (INIS)

    Gupta, Tejpal; Chopra, Supriya; Kadam, Avinash; Agarwal, Jai Prakash; Devi, P Reena; Ghosh-Laskar, Sarbani; Dinshaw, Ketayun Ardeshir

    2007-01-01

    Set-up errors are an inherent part of radiation treatment process. Coverage of target volume is a direct function of set-up margins, which should be optimized to prevent inadvertent irradiation of adjacent normal tissues. The aim of this study was to evaluate three-dimensional (3D) set-up errors and propose optimum margins for target volume coverage in head and neck radiotherapy. The dataset consisted of 93 pairs of orthogonal simulator and corresponding portal images on which 558 point positions were measured to calculate translational displacement in 25 patients undergoing conventional head and neck radiotherapy with antero-lateral wedge pair technique. Mean displacements, population systematic (Σ) and random (σ) errors and 3D vector of displacement was calculated. Set-up margins were calculated using published margin recipes. The mean displacement in antero-posterior (AP), medio-lateral (ML) and supero-inferior (SI) direction was -0.25 mm (-6.50 to +7.70 mm), -0.48 mm (-5.50 to +7.80 mm) and +0.45 mm (-7.30 to +7.40 mm) respectively. Ninety three percent of the displacements were within 5 mm in all three cardinal directions. Population systematic (Σ) and random errors (σ) were 0.96, 0.98 and 1.20 mm and 1.94, 1.97 and 2.48 mm in AP, ML and SI direction respectively. The mean 3D vector of displacement was 3.84 cm. Using van Herk's formula, the clinical target volume to planning target volume margins were 3.76, 3.83 and 4.74 mm in AP, ML and SI direction respectively. The present study report compares well with published set-up error data relevant to head and neck radiotherapy practice. The set-up margins were <5 mm in all directions. Caution is warranted against adopting generic margin recipes as different margin generating recipes lead to a different probability of target volume coverage

  2. Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck—a meta-analysis comparing different imaging modalities

    International Nuclear Information System (INIS)

    Liao, Li-Jen; Lo, Wu-Chia; Hsu, Wan-Lun; Wang, Chi-Te; Lai, Mei-Shu

    2012-01-01

    How to properly manage clinically negative neck of head and neck cancer patients is a controversial topic. Research is now directed toward finding a method sensitive enough to bring the risk of occult metastases below 20%. The aim of this review was to compare the diagnostic accuracy of different imaging modalities, including CT, MRI, PET and US, in clinically N0 head and neck cancer patients. For this systematic review and meta-analysis, PubMed and the Cochrane Database were searched for relevant original articles published up to May 2011. Inclusion criteria were as follows: articles were reported in English; CT, MRI, PET or US were performed to identify cervical metastases in clinically N0 head and neck squamous cell carcinoma; and data were sufficient for the calculation of true-positive or false-negative values. A bivariate random effect model was used to obtain pooled sensitivity and specificity. The positive and negative test probability of neck metastasis was generated based on Bayesian theory and collected data for different pre-test possibilities. Of the 168 identified relevant articles, 7 studies fulfilled all inclusion criteria for CT, 6 studies for MRI, 11 studies for PET and 8 studies for US. There was no difference in sensitivity and specificity among these imaging modalities, except CT was superior to US in specificity. The pooled estimates for sensitivity were 52% (95% confidence interval [CI], 39% ~ 65%), 65% (34 ~ 87%) 66% (47 ~ 80%), and 66% (45 ~ 77%), on a per-neck basis for CT, MRI, PET and US, respectively. The pooled estimates for specificity were 93% (87% ~ 97%), 81% (64 ~ 91%), 87% (77 ~ 93%), and 78% (71 ~ 83%) for CT, MRI, PET and US, respectively. With pre-examination nodal metastasis probabilities set at 10%, 20% and 30%, the post-exam probabilities of positive nodal metastasis rates were 47%, 66% and 77% for CT; 27%, 46% and 59% for MRI; 36%, 56% and 69% for PET; and 25%, 42% and 56% for US, respectively. Negative nodal metastasis

  3. Neck Pain

    Science.gov (United States)

    ... too many hours hunched over your computer or smartphone, often triggers muscle strains. Even minor things, such ... your shoulder. The weight can strain your neck. Sleep in a good position. Your head and neck ...

  4. Impact of preoperative functional magnetic resonance imaging during awake craniotomy procedures for intraoperative guidance and complication avoidance.

    Science.gov (United States)

    Trinh, Victoria T; Fahim, Daniel K; Maldaun, Marcos V C; Shah, Komal; McCutcheon, Ian E; Rao, Ganesh; Lang, Frederick; Weinberg, Jeffrey; Sawaya, Raymond; Suki, Dima; Prabhu, Sujit S

    2014-01-01

    We wanted to study the role of functional MRI (fMRI) in preventing neurological injury in awake craniotomy patients as this has not been previously studied. To examine the role of fMRI as an intraoperative adjunct during awake craniotomy procedures. Preoperative fMRI was carried out routinely in 214 patients undergoing awake craniotomy with direct cortical stimulation (DCS). In 40% of our cases (n = 85) fMRI was utilized for the intraoperative localization of the eloquent cortex. In the other 129 cases significant noise distortion, poor task performance and nonspecific BOLD activation precluded the surgeon from using the fMRI data. Compared with DCS, fMRI had a sensitivity and specificity, respectively, of 91 and 64% in Broca's area, 93 and 18% in Wernicke's area and 100 and 100% in motor areas. A new intraoperative neurological deficit during subcortical dissection was predictive of a worsened deficit following surgery (p awake craniotomy procedures. © 2014 S. Karger AG, Basel.

  5. 3D surface rendering of images from multiple MR pulse sequences in the pre-operative evaluation of hepatic lesions

    International Nuclear Information System (INIS)

    Bjerner, T.; Johansson, L.; Ahlstroem, H.; Haglund, U.

    1998-01-01

    Purpose: To develop a method for making three-dimensional (3D) reconstructions of liver vessels and hepatic lesions from different MR data sets. Material and Methods: To reduce the time required for segmentation and reconstructions, we used T1, T2 and phase contrast angiography, optimised for liver, lesion and vessels respectively. Following segmentation and reconstruction, the different volumes were combined on the same workstation and presented to the surgeon. Results and Conclusion: Segmentation and reconstruction took 1-2 h. To be able to combine the volumes from the different data sets, certain criteria had to be fulfilled: (a) the field of view had to be constant; (b) the same volume had to be scanned every time which meant that the slice thickness and the number of slices could be adjusted as long as the volume covered was the same; and (c) the positioning of each volume had to be identical between every scan. The resulting 3D reconstruction gave the surgeon a clear appreciation of the different lesions and their relation to the different liver segments in the pre-operative planning of hepatic resections. (orig.)

  6. Comparative studies of '18F-FDG PET/CT brain imaging and EEG in preoperative localization of temporal lobe epileptic focus

    International Nuclear Information System (INIS)

    Chen Ziqian; Zhao Chunlei; Liu Yao; Ni Ping; Zhong Qun; Bai Wei; Peng Dexin

    2012-01-01

    Objective: To compare the value of 18 F-FDG PET/CT brain imaging and EEG in preoperative localization of the epileptic focus at the temporal lobe. Methods: A total of 152 patients (108 males, 44 females, age ranged from 3 to 59 years old) with past history of temporal lobe epilepsy were included.All patients underwent 18 F-FDG PET/CT brain imaging and long-range or video EEG, and 29 patients underwent intracranial electrode EEG due to the failure to localize the disease focus by non-invasive methods.Histopathologic findings after operative treatment were considered the gold standard for disease localization. All patients were followed up for at least six months after the operation. The accuracy of the 18 F-FDG PET/CT brain imaging and long-range or video EEG examination were compared using χ 2 test. Results: The accuracy of locating the epileptic focus was 80.92% (123/152) for 18 F-FDG PET/CT brain imaging and 43.42% (66/152) for long-range or video EEG (χ 2 =22.72, P<0.01). The accuracy of locating the epileptic focus for the 29 cases with intracranial electrode EEG was 100%. Conclusions: Interictal 18 F-FDG PET/CT brain imaging is a sensitive and effective method to locate the temporal lobe epileptic focus and is better than long-range or video EEG. The combination of 18 F-FDG PET/CT brain imaging and intracranial electrode EEG examination can further improve the accuracy of locating the epileptic focus. (authors)

  7. Evaluation of Deformable Image Coregistration in Adaptive Dose Painting by Numbers for Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Olteanu, Luiza A.M., E-mail: AnaMariaLuiza.Olteanu@uzgent.be [Department of Radiotherapy, Ghent University Hospital, De Pintelaan, Ghent (Belgium); Madani, Indira; De Neve, Wilfried; Vercauteren, Tom; De Gersem, Werner [Department of Radiotherapy, Ghent University Hospital, De Pintelaan, Ghent (Belgium)

    2012-06-01

    Purpose: To assess the accuracy of contour deformation and feasibility of dose summation applying deformable image coregistration in adaptive dose painting by numbers (DPBN) for head and neck cancer. Methods and Materials: Data of 12 head-and-neck-cancer patients treated within a Phase I trial on adaptive {sup 18}F-FDG positron emission tomography (PET)-guided DPBN were used. Each patient had two DPBN treatment plans: the initial plan was based on a pretreatment PET/CT scan; the second adapted plan was based on a PET/CT scan acquired after 8 fractions. The median prescription dose to the dose-painted volume was 30 Gy for both DPBN plans. To obtain deformed contours and dose distributions, pretreatment CT was deformed to per-treatment CT using deformable image coregistration. Deformed contours of regions of interest (ROI{sub def}) were visually inspected and, if necessary, adjusted (ROI{sub def{sub ad}}) and both compared with manually redrawn ROIs (ROI{sub m}) using Jaccard (JI) and overlap indices (OI). Dose summation was done on the ROI{sub m}, ROI{sub def{sub ad}}, or their unions with the ROI{sub def}. Results: Almost all deformed ROIs were adjusted. The largest adjustment was made in patients with substantially regressing tumors: ROI{sub def} = 11.8 {+-} 10.9 cm{sup 3} vs. ROI{sub def{sub ad}} = 5.9 {+-} 7.8 cm{sup 3} vs. ROI{sub m} = 7.7 {+-} 7.2 cm{sup 3} (p = 0.57). The swallowing structures were the most frequently adjusted ROIs with the lowest indices for the upper esophageal sphincter: JI = 0.3 (ROI{sub def}) and 0.4 (ROI{sub def{sub ad}}); OI = 0.5 (both ROIs). The mandible needed the least adjustment with the highest indices: JI = 0.8 (both ROIs), OI = 0.9 (ROI{sub def}), and 1.0 (ROI{sub def{sub ad}}). Summed doses differed non-significantly. There was a trend of higher doses in the targets and lower doses in the spinal cord when doses were summed on unions. Conclusion: Visual inspection and adjustment were necessary for most ROIs. Fast automatic ROI

  8. Cross-sectional imaging with rotational panoramic X-ray machine for preoperative assessment of dental implant site. Comparisons of imaging properties with conventional film tomography and computed tomography

    International Nuclear Information System (INIS)

    Makihara, Masahiro; Nishikawa, Keiichi; Kuroyanagi, Kinya

    2001-01-01

    To clarify the validity of cross-sectional imaging with rotational panoramic x-ray machine for preoperative assessment of the dental implant site, the imaging properties were compared with those of spiral tomography and multi-planer reconstruction (MPR) manipulation of x-ray computed tomography. Cross-sectional imaging of the maxilla and mandible of an edentulous dry skull was performed by each technique at an image layer thickness of 1 mm. Steel spheres were used to identify cross-sectional planes and measure distance. Six oral radiologists scored the image clarity of structures with 5-grade rating scales and measured the distance between images of 2 steel spheres. Each measured distance was divided by the magnification factor. The actual distance was also measured on the skull. The score and the distance were statistically compared. The Spearman's rank correlation coefficients for the score and the absolute values of the difference in distances measured by different observers were calculated as test units to compare inter-observer agreements statistically. The same observation and measurement were repeated to compare intra-observer agreement. Image clarity of the linear tomography available with a panoramic machine was comparable to spiral tomography and superior to MPR, except for the cortical bone on the lingual side. The inter- and intra-observer agreements were comparable. The accuracy for measurement of distance, the inter- and intra-observer agreements were also comparable to the spiral tomography and superior to those of MPR. Therefore, it is concluded that cross-sectional imaging with a rotational panoramic x-ray machine is useful for preoperative assessment of the dental implant site. (author)

  9. Characterizing the Utility and Limitations of Repurposing an Open-Field Optical Imaging Device for Fluorescence-Guided Surgery in Head and Neck Cancer Patients.

    Science.gov (United States)

    Moore, Lindsay S; Rosenthal, Eben L; Chung, Thomas K; de Boer, Esther; Patel, Neel; Prince, Andrew C; Korb, Melissa L; Walsh, Erika M; Young, E Scott; Stevens, Todd M; Withrow, Kirk P; Morlandt, Anthony B; Richman, Joshua S; Carroll, William R; Zinn, Kurt R; Warram, Jason M

    2017-02-01

    The purpose of this study was to assess the potential of U.S. Food and Drug Administration-cleared devices designed for indocyanine green-based perfusion imaging to identify cancer-specific bioconjugates with overlapping excitation and emission wavelengths. Recent clinical trials have demonstrated potential for fluorescence-guided surgery, but the time and cost of the approval process may impede clinical translation. To expedite this translation, we explored the feasibility of repurposing existing optical imaging devices for fluorescence-guided surgery. Consenting patients (n = 15) scheduled for curative resection were enrolled in a clinical trial evaluating the safety and specificity of cetuximab-IRDye800 (NCT01987375). Open-field fluorescence imaging was performed preoperatively and during the surgical resection. Fluorescence intensity was quantified using integrated instrument software, and the tumor-to-background ratio characterized fluorescence contrast. In the preoperative clinic, the open-field device demonstrated potential to guide preoperative mapping of tumor borders, optimize the day of surgery, and identify occult lesions. Intraoperatively, the device demonstrated robust potential to guide surgical resections, as all peak tumor-to-background ratios were greater than 2 (range, 2.2-14.1). Postresection wound bed fluorescence was significantly less than preresection tumor fluorescence (P open-field imaging device was successfully repurposed to distinguish cancer from normal tissue in the preoperative clinic and throughout surgical resection. This study illuminated the potential for existing open-field optical imaging devices with overlapping excitation and emission spectra to be used for fluorescence-guided surgery. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

  10. Evaluation of deformable image registration for contour propagation between CT and cone-beam CT images in adaptive head and neck radiotherapy.

    Science.gov (United States)

    Li, X; Zhang, Y Y; Shi, Y H; Zhou, L H; Zhen, X

    2016-04-29

    Deformable image registration (DIR) is a critical technic in adaptive radiotherapy (ART) to propagate contours between planning computerized tomography (CT) images and treatment CT/Cone-beam CT (CBCT) image to account for organ deformation for treatment re-planning. To validate the ability and accuracy of DIR algorithms in organ at risk (OAR) contours mapping, seven intensity-based DIR strategies are tested on the planning CT and weekly CBCT images from six Head & Neck cancer patients who underwent a 6 ∼ 7 weeks intensity-modulated radiation therapy (IMRT). Three similarity metrics, i.e. the Dice similarity coefficient (DSC), the percentage error (PE) and the Hausdorff distance (HD), are employed to measure the agreement between the propagated contours and the physician delineated ground truths. It is found that the performance of all the evaluated DIR algorithms declines as the treatment proceeds. No statistically significant performance difference is observed between different DIR algorithms (p> 0.05), except for the double force demons (DFD) which yields the worst result in terms of DSC and PE. For the metric HD, all the DIR algorithms behaved unsatisfactorily with no statistically significant performance difference (p= 0.273). These findings suggested that special care should be taken when utilizing the intensity-based DIR algorithms involved in this study to deform OAR contours between CT and CBCT, especially for those organs with low contrast.

  11. Open source deformable image registration system for treatment planning and recurrence CT scans. Validation in the head and neck region

    International Nuclear Information System (INIS)

    Zukauskaite, Ruta; Brink, Carsten; Hansen, Christian Roenn; Bertelsen, Anders; Johansen, Joergen; Eriksen, Jesper Grau; Grau, Cai

    2016-01-01

    Clinical application of deformable registration (DIR) of medical images remains limited due to sparse validation of DIR methods in specific situations, e. g. in case of cancer recurrences. In this study the accuracy of DIR for registration of planning CT (pCT) and recurrence CT (rCT) images of head and neck squamous cell carcinoma (HNSCC) patients was evaluated. Twenty patients treated with definitive IMRT for HNSCC in 2010-2012 were included. For each patient, a pCT and an rCT scan were used. Median interval between the scans was 8.5 months. One observer manually contoured eight anatomical regions-of-interest (ROI) twice on pCT and once on rCT. pCT and rCT images were deformably registered using the open source software elastix. Mean surface distance (MSD) and Dice similarity coefficient (DSC) between contours were used for validation of DIR. A measure for delineation uncertainty was estimated by assessing MSD from the re-delineations of the same ROI on pCT. DIR and manual contouring uncertainties were correlated with tissue volume and rigidity. MSD varied 1-3 mm for different ROIs for DIR and 1-1.5 mm for re-delineated ROIs performed on pCT. DSC for DIR varied between 0.58 and 0.79 for soft tissues and was 0.79 or higher for bony structures, and correlated with the volumes of ROIs (r = 0.5, p < 0.001) and tissue rigidity (r = 0.54, p < 0.001). DIR using elastix in HNSCC on planning and recurrence CT scans is feasible; an uncertainty of the method is close to the voxel size length of the planning CT images. (orig.) [de

  12. Open source deformable image registration system for treatment planning and recurrence CT scans : Validation in the head and neck region.

    Science.gov (United States)

    Zukauskaite, Ruta; Brink, Carsten; Hansen, Christian Rønn; Bertelsen, Anders; Johansen, Jørgen; Grau, Cai; Eriksen, Jesper Grau

    2016-08-01

    Clinical application of deformable registration (DIR) of medical images remains limited due to sparse validation of DIR methods in specific situations, e. g. in case of cancer recurrences. In this study the accuracy of DIR for registration of planning CT (pCT) and recurrence CT (rCT) images of head and neck squamous cell carcinoma (HNSCC) patients was evaluated. Twenty patients treated with definitive IMRT for HNSCC in 2010-2012 were included. For each patient, a pCT and an rCT scan were used. Median interval between the scans was 8.5 months. One observer manually contoured eight anatomical regions-of-interest (ROI) twice on pCT and once on rCT. pCT and rCT images were deformably registered using the open source software elastix. Mean surface distance (MSD) and Dice similarity coefficient (DSC) between contours were used for validation of DIR. A measure for delineation uncertainty was estimated by assessing MSD from the re-delineations of the same ROI on pCT. DIR and manual contouring uncertainties were correlated with tissue volume and rigidity. MSD varied 1-3 mm for different ROIs for DIR and 1-1.5 mm for re-delineated ROIs performed on pCT. DSC for DIR varied between 0.58 and 0.79 for soft tissues and was 0.79 or higher for bony structures, and correlated with the volumes of ROIs (r = 0.5, p elastix in HNSCC on planning and recurrence CT scans is feasible; an uncertainty of the method is close to the voxel size length of the planning CT images.

  13. Surgical outcome of motor deficits and neurological status in brainstem cavernous malformations based on preoperative diffusion tensor imaging: a prospective randomized clinical trial.

    Science.gov (United States)

    Li, Da; Jiao, Yu-Ming; Wang, Liang; Lin, Fu-Xin; Wu, Jun; Tong, Xian-Zeng; Wang, Shuo; Cao, Yong

    2018-03-16

    OBJECTIVE Surgical management of brainstem lesions is challenging due to the highly compact, eloquent anatomy of the brainstem. This study aimed to evaluate the safety and efficacy of preoperative diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in brainstem cavernous malformations (CMs). METHODS A prospective randomized controlled clinical trial was performed by using stratified blocked randomization. The primary eligibility criterion of the study was being a surgical candidate for brainstem CMs (with informed consent). The study enrolled 23 patients who underwent preoperative DTI/DTT and 24 patients who did not (the control group). The pre- and postoperative muscle strength of both limbs and modified Rankin Scale (mRS) scores were evaluated. Muscle strength of any limb at 12 months after surgery at the clinic visit was the primary outcome; worsened muscle strength was considered to be a poor outcome. Outcome assessors were blinded to patient management. This study reports the preliminary results of the interim analysis. RESULTS The cohort included 47 patients (22 women) with a mean age of 35.7 years. The clinical baselines between these 2 groups were not significantly different. In the DTI/DTT group, the corticospinal tract was affected in 17 patients (73.9%): it was displaced, deformed/partially interrupted, or completely interrupted in 6, 7, and 4 patients, respectively. The surgical approach and brainstem entry point were adjusted in 3 patients (13.0%) based on DTI/DTT data. The surgical morbidity of the DTI/DTT group (7/23, 30.4%) was significantly lower than that of the control group (19/24, 79.2%, p = 0.001). At 12 months, the mean mRS score (1.1, p = 0.034) and percentage of patients with worsened motor deficits (4.3%, p = 0.006) were significantly lower in the DTI/DTT group than in the control group (1.7% and 37.5%). Multivariate logistic regression identified the absence of preoperative DTI/DTT (OR 0.06, 95% CI 0.01-0.73, p = 0

  14. Effects of breathing a hyperoxic hypercapnic gas mixture on blood oxygenation and vascularity of head-and-neck tumors as measured by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Rijpkema, Mark; Kaanders, Johannes H.A.M.; Joosten, Frank; Kogel, Albert J. van der; Heerschap, Arend

    2002-01-01

    Purpose: For head-and-neck tumors, breathing a hyperoxic hypercapnic gas mixture and administration of nicotinamide has been shown to result in a significantly improved tumor response to accelerated radiotherapy (ARCON, Accelerated Radiotherapy with CarbOgen and Nicotinamide). This may be caused by improved tumor oxygenation, possibly mediated by vascular effects. In this study, both blood oxygenation and vascular effects of breathing a hyperoxic hypercapnic gas mixture (98% O 2 +2% CO 2 ) were assessed by magnetic resonance imaging (MRI) in patients with head-and-neck tumors. Methods and Materials: Tumor vascularity and oxygenation were investigated by dynamic gadolinium contrast-enhanced MRI and blood oxygen level dependent (BOLD) MRI, respectively. Eleven patients with primary head-and-neck tumors were each measured twice; with and without breathing the hyperoxic hypercapnic gas mixture. Results: BOLD MR imaging revealed a significant increase of the MRI time constant of transverse magnetization decay (T 2 *) in the tumor during hypercapnic hyperoxygenation, which correlates to a decrease of the deoxyhemoglobin concentration. No changes in overall tumor vascularity were observed, as measured by the gadolinium contrast uptake rate in the tumor. Conclusion: Breathing a hyperoxic hypercapnic gas mixture improves tumor blood oxygenation in patients with head-and-neck tumors, which may contribute to the success of the ARCON therapy

  15. Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won [Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of); Park, Seong Jin [Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Department of Radiology, Seoul (Korea, Republic of)

    2012-06-15

    To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy. 53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria. CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively). Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings. circle Numerous patients with clinically equivocal appendicitis do not have acute appendicitis circle Computed tomography (CT) helps to reduce the negative appendectomy rate circle CT is not always infallible and may also demonstrate indeterminate findings circle However knowledge of significant CT variables can further reduce negative appendectomy rate circle An equivocal CT interpretation of appendicitis should be reassessed with this knowledge. (orig.)

  16. Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation

    International Nuclear Information System (INIS)

    Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won; Park, Seong Jin

    2012-01-01

    To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy. 53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria. CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively). Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings. circle Numerous patients with clinically equivocal appendicitis do not have acute appendicitis circle Computed tomography (CT) helps to reduce the negative appendectomy rate circle CT is not always infallible and may also demonstrate indeterminate findings circle However knowledge of significant CT variables can further reduce negative appendectomy rate circle An equivocal CT interpretation of appendicitis should be reassessed with this knowledge. (orig.)

  17. Apparent diffusion coefficient maps obtained from high b value diffusion-weighted imaging in the preoperative evaluation of gliomas at 3T: comparison with standard b value diffusion-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Zeng, Qiang; Ling, Chenhan; Zhang, Jianmin [Second Affiliated Hospital of Zhejiang University School of Medicine, Department of Neurosurgery, Hangzhou, Zhejiang (China); Dong, Fei; Jiang, Biao [Second Affiliated Hospital of Zhejiang University School of Medicine, Department of Radiology, Hangzhou, Zhejiang (China); Shi, Feina [Second Affiliated Hospital of Zhejiang University School of Medicine, Department of Neurology, Hangzhou, Zhejiang (China)

    2017-12-15

    To assess whether ADC maps obtained from high b value DWI were more valuable in preoperatively evaluating the grade, Ki-67 index and outcome of gliomas. Sixty-three patients with gliomas, who underwent preoperative multi b value DWI at 3 T, were enrolled. The ADC{sub 1000}, ADC{sub 2000} and ADC{sub 3000} maps were generated. Receiver operating characteristic analyses were conducted to determine the area under the curve (AUC) in differentiating high-grade gliomas (HGG) from low-grade gliomas (LGG). Pearson correlation coefficients (R value) were calculated to investigate the correlation between parameters with the Ki-67 proliferation index. Survival analysis was conducted by using Cox regression. The AUC of the mean ADC{sub 1000} value (0.820) was lower than that of the mean ADC{sub 2000} value (0.847) and mean ADC{sub 3000} value (0.875) in differentiating HGG from LGG. The R value of the mean ADC{sub 1000} value (-0.499) was less negative than that of the mean ADC{sub 2000} value (-0.530) and mean ADC{sub 3000} value (-0.567). The mean ADC{sub 3000} value was an independent prognosis factor for gliomas (p = 0.008), while the mean ADC{sub 1000} and ADC{sub 2000} values were not. ADC maps obtained from high b value DWI might be a better imaging biomarker in the preoperative evaluation of gliomas. (orig.)

  18. Automated 3D quantitative assessment and measurement of alpha angles from the femoral head-neck junction using MR imaging

    International Nuclear Information System (INIS)

    Xia, Ying; Chandra, Shekhar S; Crozier, Stuart; Fripp, Jurgen; Walker, Duncan; Engstrom, Craig

    2015-01-01

    To develop an automated approach for 3D quantitative assessment and measurement of alpha angles from the femoral head-neck (FHN) junction using bone models derived from magnetic resonance (MR) images of the hip joint.Bilateral MR images of the hip joints were acquired from 30 male volunteers (healthy active individuals and high-performance athletes, aged 18–49 years) using a water-excited 3D dual echo steady state (DESS) sequence. In a subset of these subjects (18 water-polo players), additional True Fast Imaging with Steady-state Precession (TrueFISP) images were acquired from the right hip joint. For both MR image sets, an active shape model based algorithm was used to generate automated 3D bone reconstructions of the proximal femur. Subsequently, a local coordinate system of the femur was constructed to compute a 2D shape map to project femoral head sphericity for calculation of alpha angles around the FHN junction. To evaluate automated alpha angle measures, manual analyses were performed on anterosuperior and anterior radial MR slices from the FHN junction that were automatically reformatted using the constructed coordinate system.High intra- and inter-rater reliability (intra-class correlation coefficients  >  0.95) was found for manual alpha angle measurements from the auto-extracted anterosuperior and anterior radial slices. Strong correlations were observed between manual and automatic measures of alpha angles for anterosuperior (r  =  0.84) and anterior (r  =  0.92) FHN positions. For matched DESS and TrueFISP images, there were no significant differences between automated alpha angle measures obtained from the upper anterior quadrant of the FHN junction (two-way repeated measures ANOVA, F  <  0.01, p  =  0.98).Our automatic 3D method analysed MR images of the hip joints to generate alpha angle measures around the FHN junction circumference with very good reliability and reproducibility. This work has the

  19. Interpolated sagittal and coronal reconstruction of CT images in the screening of neck abnormalities

    International Nuclear Information System (INIS)

    Koga, Issei

    1983-01-01

    Recontructed sagittal and coronal images were analyzed for their usefulness during clinical applications and to determine the correct use of recontruction techniques. Recontructed stereoscopic images can be formed by continuous or interrupted image reconstruction using interpolation. This study showed that lesions less than 10 mm in diameter should be made continuously and recontructed with uninterrupted technique. However, 5 mm interrupted distances are acceptable for interpolated reconstruction except in cases of lesions less than 10 mm in diameter. Clinically, interpolated reconstruction is not adequated for semicircular lesions less than 10 mm. Blood vessels and linear lesions are good condiated for the application of interpolated recontruction. Reconstruction of images using interrupted interpolation is therefore recommended for screening and for demonstrating correct stereoscopic information, except cases of small lesions less than 10 mm in diameter. Results of this study underscore the fact that obscure information in transverse CT images should be routinely utilized by interporating recontruction techniques, if transverse images are not made continuously. Interpolated recontruction may be helpful in obtaining stereoscopic information. (author)

  20. Preoperative Estimation of Future Remnant Liver Function Following Portal Vein Embolization Using Relative Enhancement on Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Sato, Yozo [Department of Radiology, Aichi Medical University, Aichi 480-1195 (Japan); Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Matsushima, Shigeru; Inaba, Yoshitaka [Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Sano, Tsuyoshi [Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Yamaura, Hidekazu; Kato, Mina [Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Shimizu, Yasuhiro; Senda, Yoshiki [Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681 (Japan); Ishiguchi, Tsuneo [Department of Radiology, Aichi Medical University, Aichi 480-1195 (Japan)

    2015-11-01

    To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE). In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE. Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023). Relative enhancement imaging can be used to estimate FRL function after PVE.

  1. Preoperative staging of rectal cancer

    International Nuclear Information System (INIS)

    Schaefer, A.O.; Baumann, T.; Pache, G.; Langer, M.; Wiech, T.

    2007-01-01

    Accurate preoperative staging of rectal cancer is crucial for therapeutic decision making, as local tumor extent, nodal status, and patterns of metastatic spread are directly associated with different treatment strategies. Recently, treatment approaches have been widely standardized according to large studies and consensus guidelines. Introduced by Heald, total mesorectal excision (TME) is widely accepted as the surgical procedure of choice to remove the rectum together with its enveloping tissues and the mesorectal fascia. Neoadjuvant radiochemotherapy also plays a key role in the treatment of locally advanced stages, while the use of new drugs will lead to a further improvement in oncological outcome. Visualization of the circumferential resection margin is the hallmark of any preoperative imaging and a prerequisite for high-quality TME surgery. The aim of this article is to present an overview on current cross-sectional imaging with emphasis on magnetic resonance imaging. Future perspectives in rectal cancer imaging are addressed. (orig.)

  2. Head and neck squamous cell carcinoma: usefulness of diffusion-weighted MR imaging in the prediction of a neoadjuvant therapeutic effect

    International Nuclear Information System (INIS)

    Kato, Hiroki; Tanaka, Osamu; Hoshi, Hiroaki; Kanematsu, Masayuki; Mizuta, Keisuke; Aoki, Mitsuhiro; Shibata, Toshiyuki; Yamashita, Tomomi; Hirose, Yoshinobu

    2009-01-01

    The purpose of our study was to evaluate the usefulness of diffusion-weighted imaging in predicting the responses to neoadjuvant therapy for head and neck squamous cell carcinomas. Diffusion-weighted, T2-weighted, and gadolinium-enhanced T1-weighted images were obtained from 28 patients with untreated head and neck squamous cell carcinomas with histological proof. A blinded radiologist evaluated the quantitative and qualitative signal intensities and apparent diffusion coefficients (ADCs) in the lesions on each sequence. All patients were treated by neoadjuvant therapies, and the post-therapeutic tumor regression rate was determined. Both the quantitative and qualitative signal intensities on diffusion-weighted images showed positive correlations (r=0.367 and 0.412, p<.05), and the ADCs showed a weak, inversed correlation (r=-0.384, p<.05) with the tumor regression rates. Diffusion-weighted imaging including an assessment by ADCs may be able to predict tumor response to neoadjuvant therapy for head and neck squamous cell carcinomas. (orig.)

  3. Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign.

    Science.gov (United States)

    Zhang, Lu; Haga, Nobuhiro; Ogawa, Soichiro; Matsuoka, Kanako; Koguchi, Tomoyuki; Akaihata, Hidenori; Hata, Junya; Kataoka, Masao; Ishibashi, Kei; Kojima, Yoshiyuki

    2017-11-01

    Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment. © 2017 The Japanese Urological Association.

  4. Can Axial-Based Nodal Size Criteria Be Used in Other Imaging Planes to Accurately Determine “Enlarged” Head and Neck Lymph Nodes?

    Science.gov (United States)

    Bartlett, Eric S.; Walters, Thomas D.; Yu, Eugene

    2013-01-01

    Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as “enlarged” if equal to or exceeding size criteria. Results. 222 lymph nodes were “enlarged” in one imaging plane; however, 53.2% (118/222) of these were “enlarged” in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = −0.09 and −0.07, resp., P planes. Conclusion. Classification of “enlarged” lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data. PMID:23984099

  5. Is there a role for pre-operative contrast-enhanced magnetic resonance imaging for radical surgery in malignant pleural mesothelioma?

    Science.gov (United States)

    Stewart, Duncan; Waller, David; Edwards, John; Jeyapalan, Kanagaratnam; Entwisle, James

    2003-12-01

    To assess the use of contrast-enhanced magnetic resonance imaging (CEMRI) in addition to computed tomography in the pre-operative assessment of patients for radical surgery in malignant pleural mesothelioma. Over a 45-month period, 51 of 76 patients assessed (69 men and seven women), underwent extra-pleural pneumonectomy or radical pleurectomy/decortication. Post-operative pathological stage was correlated with radiological staging, with particular emphasis on tumour resectability. Seventeen (22%) patients were found on CEMRI to have unresectable, but histologically unconfirmed disease, not previously seen on CT. Fifty-one (67%) patients proceeded to radical surgery, but pathological nodal data were incomplete in three, so excluding these patients from further analyses. The median pre-operative interval after CEMRI was 17 days. Two patients were found to have unexpectedly extensive disease at thoracotomy, thus the sensitivity of CEMRI for prediction of resectability was 97%. Using the International Mesothelioma Interest Group system, tumour stage was correctly predicted by CEMRI in 48% of patients, but understaged in 50% of cases, largely due to the underestimation of pericardial involvement, but this did not affect resectability and had no significant effect on prognosis. Nodal stage was correctly identified in 60% of patients. CEMRI was successful in predicting pathological tumour stage T3 or less (sensitivity of 85%; specificity of 100%), but less so in identifying tumour stage T2 or less (sensitivity of 23%; specificity of 96%) or N2 nodal disease (sensitivity 66%; specificity 73%). CEMRI is most useful in the differentiation of T3 and T4 disease and may be unnecessary at earlier stages. Its multiplanar tumour localisation abilities are of value in the assessment of resectability. It is unlikely to contribute significantly to nodal staging, but it remains a valuable adjunct in the selection of patients for radical surgery.

  6. Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points

    Directory of Open Access Journals (Sweden)

    Ahmed Abdullah

    2016-01-01

    Full Text Available Objectives: Surgical resection of low-grade gliomas (LGGs in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation; however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI, pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67% subtotal in 6 (28.57%, and biopsy in 1 case (4.57%. In long-term follow–up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.

  7. Repeatability of tumour hypoxia imaging using [{sup 18}F]EF5 PET/CT in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Silvoniemi, Antti [University of Turku, Turku PET Centre (Finland); Turku University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery (Finland); Suilamo, Sami [Turku University Hospital, Department of Oncology and Radiotherapy (Finland); Turku University Hospital, Department of Medical Physics (Finland); Laitinen, Timo; Forsback, Sarita; Solin, Olof [University of Turku, Turku PET Centre (Finland); Loeyttyniemi, Eliisa [University of Turku, Department of Biostatistics, Turku (Finland); Vaittinen, Samuli [Turku University Hospital, Department of Pathology (Finland); Saunavaara, Virva [University of Turku, Turku PET Centre (Finland); Turku University Hospital, Department of Medical Physics (Finland); Groenroos, Tove J.; Minn, Heikki [University of Turku, Turku PET Centre (Finland); Turku University Hospital, Department of Oncology and Radiotherapy (Finland)

    2018-02-15

    Hypoxia contributes to radiotherapy resistance and more aggressive behaviour of several types of cancer. This study was designed to evaluate the repeatability of intratumour uptake of the hypoxia tracer [{sup 18}F]EF5 in paired PET/CT scans. Ten patients with newly diagnosed head and neck cancer (HNC) received three static PET/CT scans before chemoradiotherapy: two with [{sup 18}F]EF5 a median of 7 days apart and one with [{sup 18}F]FDG. Metabolically active primary tumour volumes were defined in [{sup 18}F]FDG images and transferred to co-registered [{sup 18}F]EF5 images for repeatability analysis. A tumour-to-muscle uptake ratio (TMR) of 1.5 at 3 h from injection of [{sup 18}F]EF5 was used as a threshold representing hypoxic tissue. In 10 paired [{sup 18}F]EF5 PET/CT image sets, SUVmean, SUVmax, and TMR showed a good correlation with the intraclass correlation coefficients of 0.81, 0.85, and 0.87, respectively. The relative coefficients of repeatability for these parameters were 15%, 17%, and 10%, respectively. Fractional hypoxic volumes of the tumours in the repeated scans had a high correlation using the Spearman rank correlation test (r = 0.94). In a voxel-by-voxel TMR analysis between the repeated scans, the mean of Pearson correlation coefficients of individual patients was 0.65. The mean (± SD) difference of TMR in the pooled data set was 0.03 ± 0.20. Pretreatment [{sup 18}F]EF5 PET/CT within one week shows high repeatability and is feasible for the guiding of hypoxia-targeted treatment interventions in HNC. (orig.)

  8. Temporomandibular joint MR images: Incidental head and neck findings and pathologies.

    Science.gov (United States)

    Orhan, Kaan; Avsever, Hakan; Aksoy, Seçil; Seki, Umut; Bozkurt, Poyzan

    2017-10-17

    To report the number and frequency of incidental findings (IFs) detected during magnetic resonance (MR) imaging screening of the temporomandibular joint (TMJ) and to define related diseases. Bilateral TMJ MR images in the sagittal and coronal sections, from 518 patients with TMJ symptoms were evaluated retrospectively. Patients who were diagnosed with IFs were sent for consultation and clarification of the findings. Patient age, gender, IFs, locations, and diseases were classified and noted.  Results: Seventy-eight (15%) patients were diagnosed with 117 IFs. Of them, 43 were diagnosed with a single IF, and 35 were diagnosed with more than one IF. The most frequent locations were paranasal sinuses and mastoid air cells. The most frequent diseases were inflammatory and cystic lesions.  Discussion: While examining TMJ MR images, it is important to check for evidence of IFs or pathologies that may have mimicked signs and symptoms of TMJ disorders.

  9. Automated 3D quantitative assessment and measurement of alpha angles from the femoral head-neck junction using MR imaging

    Science.gov (United States)

    Xia, Ying; Fripp, Jurgen; Chandra, Shekhar S.; Walker, Duncan; Crozier, Stuart; Engstrom, Craig

    2015-10-01

    To develop an automated approach for 3D quantitative assessment and measurement of alpha angles from the femoral head-neck (FHN) junction using bone models derived from magnetic resonance (MR) images of the hip joint. Bilateral MR images of the hip joints were acquired from 30 male volunteers (healthy active individuals and high-performance athletes, aged 18-49 years) using a water-excited 3D dual echo steady state (DESS) sequence. In a subset of these subjects (18 water-polo players), additional True Fast Imaging with Steady-state Precession (TrueFISP) images were acquired from the right hip joint. For both MR image sets, an active shape model based algorithm was used to generate automated 3D bone reconstructions of the proximal femur. Subsequently, a local coordinate system of the femur was constructed to compute a 2D shape map to project femoral head sphericity for calculation of alpha angles around the FHN junction. To evaluate automated alpha angle measures, manual analyses were performed on anterosuperior and anterior radial MR slices from the FHN junction that were automatically reformatted using the constructed coordinate system. High intra- and inter-rater reliability (intra-class correlation coefficients  >  0.95) was found for manual alpha angle measurements from the auto-extracted anterosuperior and anterior radial slices. Strong correlations were observed between manual and automatic measures of alpha angles for anterosuperior (r  =  0.84) and anterior (r  =  0.92) FHN positions. For matched DESS and TrueFISP images, there were no significant differences between automated alpha angle measures obtained from the upper anterior quadrant of the FHN junction (two-way repeated measures ANOVA, F  hip joints to generate alpha angle measures around the FHN junction circumference with very good reliability and reproducibility. This work has the potential to improve analyses of cam-type lesions of the FHN junction for large

  10. Preoperative evaluation and monitoring chemotherapy in patients with high-grade osteogenic and Ewing's sarcoma: review of current imaging modalities

    International Nuclear Information System (INIS)

    Woude, H.-J. van der; Bloem, J.L.; Hogendoorn, P.C.W.

    1998-01-01

    Diagnostic imaging is pivotal in the initial detection, characterization, staging and post-treatment follow-up of patients with high-grade osteogenic and Ewing's sarcoma. In the present review article, conventional and new imaging modalities are discussed with regard to the monitoring of the effect of neoadjuvant chemotherapy in such patients. Presurgical monitoring of response to chemotherapy may have an impact on modification of neoadjuvant treatment protocols, on patient selection for the performance and timing of limb-salvage surgery and on planning of radiation therapy (in non-operated Ewing's sarcomas) and selection of postoperative chemotherapy regimens. Dynamic contrast-enhanced MR imaging, as part of a routine MR protocol, assists in the detection of the most viable parts of the tumour and serves as an initial standard for follow-up of the metabolic activity of the tumour during and after chemotherapy, both in small intraosseous tumours and in tumours with an associated soft tissue mass. In combination with selected morphological features, dynamic imaging parameters are therefore advocated for monitoring the effect of neoadjuvant chemotherapy in patients with osteogenic and Ewing's sarcoma. (orig.)

  11. MR imaging and MR cholangiopancreatography in the preoperative evaluation of hilar cholangiocarcinoma: correlation with surgical and pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Masselli, Gabriele; Gualdi, Gianfranco [Umberto I Hospital-La Sapienza University Rome, Department of Radiology, Rome (Italy); Manfredi, Riccardo [University of Verona, Department of Radiology, Verona (Italy); Vecchioli, Amorino [A. Gemelli Hospital-University of Sacred Heart, Department of Radiology, Rome (Italy)

    2008-10-15

    The primary aim was to evaluate delayed contrast-enhanced MRI in depicting perineural spread of hilar cholangiocarcinoma (CCC) and consequently to determine the capability of MRI/MRCP for staging CCC. Fifteen patients that underwent MRI/MRCP and surgical treatment were retrospectively included. Two radiologists evaluated MR images to assess delayed periductal enhancement, extent of bile duct stenosis, liver parenchymal and vascular involvement and presence of liver atrophy. An agreement between delayed enhancement of the bile duct walls and perineural neoplastic spread showed a very good correlation factor (0.93). The overall accuracy in detecting biliary neoplastic invasion was higher for delayed T1-weighted images (93.3%) than for the MRCP images (80%), and T1-delayed image increased the MR accuracy in assessing the neoplastic resectability (p < 0.05). MRI correctly predicted vascular involvement in 73% and liver involvement in 80% of the cases. The number of overall correctly assessed patients with regard to resectability was 11 true positive, 1 false positive and 3 true negative. The combination of MRI/MRCP is a reliable diagnostic method for staging hilar cholangiocarcinomas. Delayed periductal enhancement is accurate in the evaluation of neoplastic perineural spread, and it can improve diagnostic accuracy to identify resectable and unresectable tumours. (orig.)

  12. Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic

    2011-02-01

    Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD.

  13. PET/MR imaging of head/neck in the presence of dental implants

    DEFF Research Database (Denmark)

    Ladefoged, Claes; Beyer, Thomas; Keller, Sune

    2013-01-01

    Aim: In combined PET/MR, attenuation correction (AC) is performed indirectly based on the available MR image information. Implant-induced susceptibility artifacts and subsequent signal voids challenge MR-based AC (MR-AC). We evaluate the accuracy of MR-AC in PET/MR in patients with metallic denta...

  14. Feasibility of Multiparametric Imaging with PET/MR in Head and Neck Squamous Cell Carcinoma

    DEFF Research Database (Denmark)

    Rasmussen, Jacob H; Nørgaard, Martin; Hansen, Adam E

    2017-01-01

    scanner. Gross tumor volumes were defined on T2-weighted MR images, and volumes of interest were defined on diffusion-weighted MRI and (18)F-FDG PET (VOIDWI, VOIPET). Overlap between volumes was assessed as a percentwise overlap. (18)F-FDG uptake and diffusion were measured using SUV and apparent...

  15. Comprehensive evaluation of ten deformable image registration algorithms for contour propagation between CT and cone-beam CT images in adaptive head & neck radiotherapy.

    Science.gov (United States)

    Li, Xin; Zhang, Yuyu; Shi, Yinghua; Wu, Shuyu; Xiao, Yang; Gu, Xuejun; Zhen, Xin; Zhou, Linghong

    2017-01-01

    Deformable image registration (DIR) is a critical technic in adaptive radiotherapy (ART) for propagating contours between planning computerized tomography (CT) images and treatment CT/cone-beam CT (CBCT) images to account for organ deformation for treatment re-planning. To validate the ability and accuracy of DIR algorithms in organ at risk (OAR) contour mapping, ten intensity-based DIR strategies, which were classified into four categories-optical flow-based, demons-based, level-set-based and spline-based-were tested on planning CT and fractional CBCT images acquired from twenty-one head & neck (H&N) cancer patients who underwent 6~7-week intensity-modulated radiation therapy (IMRT). Three similarity metrics, i.e., the Dice similarity coefficient (DSC), the percentage error (PE) and the Hausdorff distance (HD), were employed to measure the agreement between the propagated contours and the physician-delineated ground truths of four OARs, including the vertebra (VTB), the vertebral foramen (VF), the parotid gland (PG) and the submandibular gland (SMG). It was found that the evaluated DIRs in this work did not necessarily outperform rigid registration. DIR performed better for bony structures than soft-tissue organs, and the DIR performance tended to vary for different ROIs with different degrees of deformation as the treatment proceeded. Generally, the optical flow-based DIR performed best, while the demons-based DIR usually ranked last except for a modified demons-based DISC used for CT-CBCT DIR. These experimental results suggest that the choice of a specific DIR algorithm depends on the image modality, anatomic site, magnitude of deformation and application. Therefore, careful examinations and modifications are required before accepting the auto-propagated contours, especially for automatic re-planning ART systems.

  16. Comprehensive evaluation of ten deformable image registration algorithms for contour propagation between CT and cone-beam CT images in adaptive head & neck radiotherapy.

    Directory of Open Access Journals (Sweden)

    Xin Li

    Full Text Available Deformable image registration (DIR is a critical technic in adaptive radiotherapy (ART for propagating contours between planning computerized tomography (CT images and treatment CT/cone-beam CT (CBCT images to account for organ deformation for treatment re-planning. To validate the ability and accuracy of DIR algorithms in organ at risk (OAR contour mapping, ten intensity-based DIR strategies, which were classified into four categories-optical flow-based, demons-based, level-set-based and spline-based-were tested on planning CT and fractional CBCT images acquired from twenty-one head & neck (H&N cancer patients who underwent 6~7-week intensity-modulated radiation therapy (IMRT. Three similarity metrics, i.e., the Dice similarity coefficient (DSC, the percentage error (PE and the Hausdorff distance (HD, were employed to measure the agreement between the propagated contours and the physician-delineated ground truths of four OARs, including the vertebra (VTB, the vertebral foramen (VF, the parotid gland (PG and the submandibular gland (SMG. It was found that the evaluated DIRs in this work did not necessarily outperform rigid registration. DIR performed better for bony structures than soft-tissue organs, and the DIR performance tended to vary for different ROIs with different degrees of deformation as the treatment proceeded. Generally, the optical flow-based DIR performed best, while the demons-based DIR usually ranked last except for a modified demons-based DISC used for CT-CBCT DIR. These experimental results suggest that the choice of a specific DIR algorithm depends on the image modality, anatomic site, magnitude of deformation and application. Therefore, careful examinations and modifications are required before accepting the auto-propagated contours, especially for automatic re-planning ART systems.

  17. Prospective observer and software-based assessment of magnetic resonance imaging quality in head and neck cancer: Should standard positioning and immobilization be required for radiation therapy applications?

    Science.gov (United States)

    Ding, Yao; Mohamed, Abdallah S R; Yang, Jinzhong; Colen, Rivka R; Frank, Steven J; Wang, Jihong; Wassal, Eslam Y; Wang, Wenjie; Kantor, Michael E; Balter, Peter A; Rosenthal, David I; Lai, Stephen Y; Hazle, John D; Fuller, Clifton D

    2015-01-01

    The purpose of this study was to investigate the potential of a head and neck magnetic resonance simulation and immobilization protocol on reducing motion-induced artifacts and improving positional variance for radiation therapy applications. Two groups (group 1, 17 patients; group 2, 14 patients) of patients with head and neck cancer were included under a prospective, institutional review board-approved protocol and signed informed consent. A 3.0-T magnetic resonance imaging (MRI) scanner was used for anatomic and dynamic contrast-enhanced acquisitions with standard diagnostic MRI setup for group 1 and radiation therapy immobilization devices for group 2 patients. The impact of magnetic resonance simulation/immobilization was evaluated qualitatively by 2 observers in terms of motion artifacts and positional reproducibility and quantitatively using 3-dimensional deformable registration to track intrascan maximum motion displacement of voxels inside 7 manually segmented regions of interest. The image quality of group 2 (29 examinations) was significantly better than that of group 1 (50 examinations) as rated by both observers in terms of motion minimization and imaging reproducibility (P quality of head and neck MRI in terms of motion-related artifacts and positional reproducibility was greatly improved by use of radiation therapy immobilization devices. Consequently, immobilization with external and intraoral fixation in MRI examinations is required for radiation therapy application. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  18. A patient with a painless neck tumour revealed as a carotid paraganglioma: a case report.

    Science.gov (United States)

    Peric, Barbara; Marinsek, Ziva Pohar; Skrbinc, Breda; Music, Maja; Zagar, Ivana; Hocevar, Marko

    2014-08-20

    Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are recognized due to their typical location, vessel displacement and specific blood supply, features that are usually seen on different imaging modalities. Surgery for carotid paraganglioma can be associated with immediate cerebrovascular complications or delayed neurological impairment.We are reporting the case of a 36-year-old man who presented with a painless mass on the right side of his neck 11 months after being treated for testicular cancer. After a fine-needle aspiration biopsy, he was diagnosed with a testicular cancer lymph node metastasis. Neck US and fluorine [F-18]-fluorodeoxy-D-glucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. The patient underwent a level II to V functional neck dissection. During the procedure, suspicion of a carotid paraganglioma was raised and the tumour was carefully dissected from the walls of the carotid arteries with minimal blood loss and no cranial nerve dysfunction.The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes. The patient's history of testicular germ cell tumour led to a functional neck dissection during which a previously unrecognized carotid paraganglioma was removed.Surgery for carotid PG can be associated with complications that have major impact on quality of life. A thorough assessment of the patient and neck mass must therefore be performed preoperatively in order to perform the surgical procedure under optimal conditions.

  19. Dose-response relationship for elective neck irradiation of head and neck cancer - facts and controversies

    International Nuclear Information System (INIS)

    Suwinski, R.; Maciejewski, B.; Withers, H.R.

    1998-01-01

    The aim of this study is to assign dose-response relationship for subclinical neck metastases of squamous cell head and neck cancer based on extensive survey of 24 data sets collected from the literature. Neck relapse rates (NRR) without and after elective (ENI) or preoperative irradiation were estimated for each site and stage of primary tumor and the reduction in neck relapse rate was calculated. An average NRR without ENI was 22% (12-35% ) and only 2.5% (0-1 0%) after the ENI with total dose of 46- 50 Gy which gives high reduction rate in the risk of neck recurrences being on the average 89% and 42% (0-46%) after preoperative irradiation using 22-30 Gy. Dose response curve for elective and preoperative irradiation have shown that 50 Gy in 2 Gy fraction reduces the incidence of neck relapses in the NO patients by more than 90% and only by less than 50% after total doses lower than 30 Gy. No correlation between the risk of neck metastases without ENI and the reduction in neck relapses after ENI was found. (authors)

  20. Defining probabilities of bowel resection in deep endometriosis of the rectum: Prediction with preoperative magnetic resonance imaging.

    Science.gov (United States)

    Perandini, Alessio; Perandini, Simone; Montemezzi, Stefania; Bonin, Cecilia; Bellini, Gaia; Bergamini, Valentino

    2018-02-01

    Deep endometriosis of the rectum is a highly challenging disease, and a surgical approach is often needed to restore anatomy and function. Two kinds of surgeries may be performed: radical with segmental bowel resection or conservative without resection. Most patients undergo magnetic resonance imaging (MRI) before surgery, but there is currently no method to predict if conservative surgery is feasible or whether bowel resection is required. The aim of this study was to create an algorithm that could predict bowel resection using MRI images, that was easy to apply and could be useful in a clinical setting, in order to adequately discuss informed consent with the patient and plan the an appropriate and efficient surgical session. We collected medical records from 2010 to 2016 and reviewed the MRI results of 52 patients to detect any parameters that could predict bowel resection. Parameters that were reproducible and with a significant correlation to radical surgery were investigated by statistical regression and combined in an algorithm to give the best prediction of resection. The calculation of two parameters in MRI, impact angle and lesion size, and their use in a mathematical algorithm permit us to predict bowel resection with a positive predictive value of 87% and a negative predictive value of 83%. MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study. © 2017 Japan Society of Obstetrics and Gynecology.

  1. The clinical utility of reduced-distortion readout-segmented echo-planar imaging in the head and neck region: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Koyasu, Sho; Iima, Mami; Umeoka, Shigeaki; Morisawa, Nobuko; Togashi, Kaori [Kyoto University, Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Sakyo-Ku, Kyoto (Japan); Porter, David A. [Siemens AG, MED MR PLM AW Neurology, Allee am Roethelheimpark 2, Erlangen (Germany); Ito, Juichi [Kyoto University, Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Sakyo-Ku, Kyoto (Japan); Le Bihan, Denis [Kyoto University, Human Brain Research Center, Graduate School of Medicine, Sakyo-Ku, Kyoto (Japan); Neurospin, CEA-Saclay Center, Gif-sur-Yvette Cedex (France)

    2014-12-15

    To evaluate whether readout-segmented echo-planar imaging (RS-EPI) diffusion weighted image (DWI) can diminish image distortion in the head and neck area, compared with single-shot (SS)-EPI DWI. We conducted phantom and patient studies using 3 T magnetic resonance imaging (MRI) with a 16-channel coil. For the phantom study, we evaluated distortion and signal homogeneity in gel phantoms. For the patient study, 29 consecutive patients with clinically suspicious parotid lesions were prospectively enrolled. RS-EPI and SS-EPI DWI were evaluated by two independent readers for identification of organ/lesion and distortion, using semiquantitative scales and quantitative scores. Apparent diffusion coefficient (ADC) values and contrast-noise ratios of parotid tumours (if present; n = 15) were also compared. The phantom experiments showed that RS-EPI provided less distorted and more homogeneous ADC maps than SS-EPI. In the patient study, RS-EPI was found to provide significantly less distortion in almost all organs/lesions (p < 0.05), according to both semiquantitative scales and quantitative scores. There was no significant difference in ADC values and contrast-noise ratios between the two DWI techniques. The distortion in DWI was significantly reduced with RS-EPI in both phantom and patient studies. The RS-EPI technique provided more homogenous images than SS-EPI, and can potentially offer higher image quality in the head and neck area. (orig.)

  2. Clinical evaluation of bone-subtraction CT angiography (BSCTA) in head and neck imaging

    International Nuclear Information System (INIS)

    Lell, M.; Anders, K.; Bautz, W.; Klotz, E.; Ditt, H.; Tomandl, B.F.

    2006-01-01

    Fifty-one patients were examined with bone subtraction CT angiography (BSCTA). Data were acquired on 4-and 64-slice spiral CT systems. The post-processing method is based on fully automatic registration of non-enhanced and contrast-enhanced CT data and subsequent selective bone removal. Vascular structures and brain tissue are retained with the original CTA noise level. Image quality and delineation of the pathologic process were assessed and artifacts introduced by the bone removal process recorded. The bone subtraction algorithm worked successfully in all examinations. The processing time was 6 min on average. Image quality was rated excellent in 20 (39%), good in 26 (51%) and acceptable in 5 (10%) patients. Ophthalmic arteries were visible in 12 (24%) patients bilaterally, in 13 (25%) patients unilaterally and in 26 (51%) patients at least at the origin. BSCTA improved visualization of the infraclinoid ICA and the vertebral arteries. The depiction of stenosis of the extracranial ICA and supraclinoid aneurysms was not significantly improved. In patients with suspicion of sinus thrombosis, BSCTA and conventional CTA yielded similar results. To conclude, BSCTA improves the visualization of vessels with close contact to bone and can improve the diagnostic accuracy and therapy planning of infraclinoid aneurysms. (orig.)

  3. Preoperative Assessment of Neural Elements in Lumbar Spinal Stenosis by Upright Magnetic Resonance Imaging: An Implication for Routine Practice?

    Science.gov (United States)

    Lang, Gernot; Vicari, Marco; Siller, Alexander; Kubosch, Eva J; Hennig, Juergen; Südkamp, Norbert P; Izadpanah, Kaywan; Kubosch, David

    2018-04-06

    Introduction Lumbar spinal stenosis (LSS) is a kinetic-dependent disease typically aggravating during spinal loading. To date, assessment of LSS is usually performed with magnetic resonance imaging (MRI). However, conventional supine MRI is associated with significant drawbacks as it does not truly reflect physiological loads, experienced by discoligamentous structures during erect posture. Consequently, supine MRI often fails to reveal the source of pain and/or disability caused by LSS. The present study sought to assess neural dimensions via MRI in supine, upright, and upright-hyperlordotic position in order to evaluate the impact of patient positioning on neural narrowing. Therefore, radiological measures such as neuroforaminal dimensions, central canal volume, sagittal listhesis, and lumbar lordosis at spinal level L4/5 were extracted and stratified according to patient posture. Materials and methods Overall, 10 subjects were enclosed in this experimental study. MRI was performed in three different positions: (1) 0° supine (SP), (2) 80° upright (UP), and (3) 80° upright + hyperlordotic (HY) posture. Upright MRI was conducted utilizing a 0.25T open-configuration scanner equipped with a rotatable examination bed allowing for true standing MRI. Radiographic outcome of upright MRI imaging was extracted and evaluated according to patient positioning. Results Upright MRI-based assessment of neural dimensions was successfully accomplished in all subjects. Overall, radiographic parameters revealed a significant decrease of neural dimensions from supine to upright position: Specifically, mean foraminal area decreased from SP to UP by 13.3% (P ≤ 0.05) as well as from SP to HY position by 21% (P ≤ 0.05). Supplementation of hyperlordosis did not result in additional narrowing of neural elements (P ≥ 0.05). Furthermore, central canal volume revealed a decrease of 7% at HY and 8% at UP compared to SP position (P ≥ 0.05). Assessment of lumbar lordosis yielded in a

  4. A computer-aided system for automatic extraction of femur neck trabecular bone architecture using isotropic volume construction from clinical hip computed tomography images.

    Science.gov (United States)

    Vivekanandhan, Sapthagirivasan; Subramaniam, Janarthanam; Mariamichael, Anburajan

    2016-10-01

    Hip fractures due to osteoporosis are increasing progressively across the globe. It is also difficult for those fractured patients to undergo dual-energy X-ray absorptiometry scans due to its complicated protocol and its associated cost. The utilisation of computed tomography for the fracture treatment has become common in the clinical practice. It would be helpful for orthopaedic clinicians, if they could get some additional information related to bone strength for better treatment planning. The aim of our study was to develop an automated system to segment the femoral neck region, extract the cortical and trabecular bone parameters, and assess the bone strength using an isotropic volume construction from clinical computed tomography images. The right hip computed tomography and right femur dual-energy X-ray absorptiometry measurements were taken from 50 south-Indian females aged 30-80 years. Each computed tomography image volume was re-constructed to form isotropic volumes. An automated system by incorporating active contour models was used to segment the neck region. A minimum distance boundary method was applied to isolate the cortical and trabecular bone components. The trabecular bone was enhanced and segmented using trabecular enrichment approach. The cortical and trabecular bone features were extracted and statistically compared with dual-energy X-ray absorptiometry measured femur neck bone mineral density. The extracted bone measures demonstrated a significant correlation with neck bone mineral density (r > 0.7, p computed tomography images scanned with low dose could eventually be helpful in osteoporosis diagnosis and its treatment planning. © IMechE 2016.

  5. Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: Radiotherapy target volume transformation and dose de-escalation.

    Science.gov (United States)

    van den Bosch, Sven; Vogel, Wouter V; Raaijmakers, Cornelis P; Dijkema, Tim; Terhaard, Chris H J; Al-Mamgani, Abrahim; Kaanders, Johannes H A M

    2018-05-03

    Diagnostic imaging continues to evolve, and now has unprecedented accuracy for detecting small nodal metastasis. This influences the tumor load in elective target volumes and subsequently has consequences for the radiotherapy dose required to control disease in these volumes. Small metastases that used to remain subclinical and were included in elective volumes, will nowadays be detected and included in high-dose volumes. Consequentially, high-dose volumes will more often contain low-volume disease. These target volume transformations lead to changes in the tumor burden in elective and "gross" tumor volumes with implications for the radiotherapy dose prescribed to these volumes. For head and neck tumors, nodal staging has evolved from mere palpation to combinations of high-resolution imaging modalities. A traditional nodal gross tumor volume in the neck typically had a minimum diameter of 10-15 mm, while nowadays much smaller tumor deposits are detected in lymph nodes. However, the current dose levels for elective nodal irradiation were empirically determined in the 1950s, and have not changed since. In this report the radiobiological consequences of target volume transformation caused by modern imaging of the neck are evaluated, and theoretically derived reductions of dose in radiotherapy for head and neck cancer are proposed. The concept of target volume transformation and subsequent strategies for dose adaptation applies to many other tumor types as well. Awareness of this concept may result in new strategies for target definition and selection of dose levels with the aim to provide optimal tumor control with less toxicity. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Development and validation of a preoperative prediction model for colorectal cancer T-staging based on MDCT images and clinical information.

    Science.gov (United States)

    Sa, Sha; Li, Jing; Li, Xiaodong; Li, Yongrui; Liu, Xiaoming; Wang, Defeng; Zhang, Huimao; Fu, Yu

    2017-08-15

    This study aimed to establish and evaluate the efficacy of a prediction model for colorectal cancer T-staging. T-staging was positively correlated with the level of carcinoembryonic antigen (CEA), expression of carbohydrate antigen 19-9 (CA19-9), wall deformity, blurred outer edges, fat infiltration, infiltration into the surrounding tissue, tumor size and wall thickness. Age, location, enhancement rate and enhancement homogeneity were negatively correlated with T-staging. The predictive results of the model were consistent with the pathological gold standard, and the kappa value was 0.805. The total accuracy of staging improved from 51.04% to 86.98% with the proposed model. The clinical, imaging and pathological data of 611 patients with colorectal cancer (419 patients in the training group and 192 patients in the validation group) were collected. A spearman correlation analysis was used to validate the relationship among these factors and pathological T-staging. A prediction model was trained with the random forest algorithm. T staging of the patients in the validation group was predicted by both prediction model and traditional method. The consistency, accuracy, sensitivity, specificity and area under the curve (AUC) were used to compare the efficacy of the two methods. The newly established comprehensive model can improve the predictive efficiency of preoperative colorectal cancer T-staging.

  7. Clinical impact of preoperative brain MR angiography and MR imaging in candidates for liver transplantation: a propensity score-matching study in a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Mi Sun; Kim, Ho Sung; Jung, Seung Chai; Choi, Choong Gon; Kim, Sang Joon [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Song pa-gu, Seoul (Korea, Republic of); Lim, Young-Suk [University of Ulsan College of Medicine, Department of Gastroenterology, Seoul (Korea, Republic of); Jeon, Sang-Beom [University of Ulsan College of Medicine, Department of Neurology, Seoul (Korea, Republic of); Kim, Seon-Ok [University of Ulsan College of Medicine, Department of Clinical Epidemiology and Biostatistics, Seoul (Korea, Republic of); Kim, Hwa Jung [University of Ulsan College of Medicine, Department of Preventive Medicine, Seoul (Korea, Republic of); Hwang, Shin [University of Ulsan College of Medicine, Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Seoul (Korea, Republic of)

    2017-08-15

    To investigate the prevalence of cerebrovascular stenosis and white matter lesions on preoperative magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) in liver transplantation candidates. This retrospective study included 1,460 consecutive patients with liver cirrhosis (LC) who underwent MRA with/without brain MRI for pretransplantation evaluation. These patients were matched with 5,331 controls using propensity scores, and the prevalences of significant cerebrovascular stenosis and white matter lesions were compared. A matched analysis of 1,264 pairs demonstrated that the prevalence of significant stenosis was comparable between LC patients and controls (2.2% vs. 1.4%, P = 0.143). LC and most of LC-related parameters were not associated with stenosis. Significant white matter lesions were more common in LC patients (2.8% vs. 1.3%, P = 0.036). A high Model for End-Stage Liver Disease (MELD) score (OR 1.11, CI 1.03-1.20, P = 0.008, for infarction; OR 1.1, CI 1.04-1.16, P = 0.001, for haemorrhage) and stroke history (OR 179.06, CI 45.19-709.45, P < 0.001) were predictors of perioperative stroke. LC patients and control subjects demonstrated similar cerebrovascular stenosis prevalences, whereas white matter lesions were more common in LC patients. A high MELD score and stroke history contribute as predictors of perioperative stroke. (orig.)

  8. Clinico-statistical study on the patients who were applied preoperative CT imaging for dental implant treatment in Iwate Medical University Hospital

    International Nuclear Information System (INIS)

    Shoji, Satoru; Izumisawa, Mitsuru; Satoh, Hitoshi; Hoshino, Masayuki; Takahashi, Noriaki; Shozushima, Masanori; Nakasato, Tatsuhiko

    2007-01-01

    The diagnosis of jaw bones using X-ray computed tomography (CT) is important to determine placement of dental implants. A Clinico-statistical study were made on 490 cases which applied preoperative dental mutiplannar reconstructing CT (dental MPR) imaging for dental implant treatment in Iwate Medical University Hospital, during a five-year period from 2002 to 2006. The following results were obtained: The 490 cases consisted of 179 males and 311 females. They ranged in age from 16 to 80 years, the average age was 53.6 years old. The largest number of cases were in their 50's and, in most generations, there were more female cases than male. Similar cases have been increasing every year. Most patients were referred from other clinics to our hospital. Of the cases that underwent CT scanning more were mandible than maxilla. Implantation prearranged region revealed a predominance of mandible in anterior teeth, and maxilla in molar teeth. The cases that were using diagnostic surgical stents increased in the first three years, but were constant afterwards. (author)

  9. The neck-tongue syndrome.

    Science.gov (United States)

    Orrell, R W; Marsden, C D

    1994-01-01

    The neck-tongue syndrome, consisting of pain in the neck and altered sensation in the ipsilateral half of the tongue aggravated by neck movement, has been attributed to damage to lingual afferent fibres travelling in the hypoglossal nerve to the C2 spinal roots. The lingual afferents in the hypoglossal nerve are thought to be proprioceptive. Two further cases of the neck-tongue syndrome are described, the spectrum of its clinical manifestations is explored, and the phenomenon of lingual pseudoathetosis is illustrated as a result of the presumed lingual deafferentation. Images PMID:8158185

  10. Gadofosveset-enhanced MR imaging for the preoperative evaluation of potential living kidney donors. Correlation with intraoperative findings

    International Nuclear Information System (INIS)

    Kuhlemann, J.; Blondin, D.; Reichelt, D.; Heinen, W.; Scherer, A.; Lanzman, R.S.; Grotemeyer, D.; Zgoura, P.

    2010-01-01

    Purpose: The purpose of this study was to evaluate the blood pool contrast agent gadofosveset for MR angiography (MRA) of the renal vasculature in living kidney donors (LKD). Materials and Methods: Of the 28 consecutive potential LKDs (13 men, 15 women; mean age 55.14 years ± 11.97) initially included in this prospective study, 20 patients underwent surgery and were considered for further evaluation. 7 acquisitions of a 3D T1-weighted FLASH sequence were performed following administration of gadofosveset for the assessment of the vascular anatomy and collecting system at predefined time points at 1.5 T. All MR exams were prospectively analyzed by 2 radiologists in consensus mode prior to surgery. In addition, ROI-based relative SNR measurements were performed in the vena cava inferior and abdominal aorta. Results: MR image acquisition was completed in all 20 potential living donors. In 8 donors an additional CT scan was available for further comparison with the collateral anatomy, resulting in a total of 28 analyzed kidneys. MRA disclosed 36 renal arteries, since 8 accessory arteries were found in 8 subjects. One accessory artery and one case of fibromuscular dysplasia were missed by MRA. The venous anatomy and the collecting system were assessed correctly with MRI. In addition, MRI diagnosed two renal cell carcinomas. The overall sensitivity and positive predictive value of gadofosveset-enhanced MRI on a per kidney basis were 92.9 % and 100 %, respectively. Conclusion: Gadofosveset enables accurate evaluation of potential LKDs. (orig.)

  11. Gadofosveset-enhanced MR imaging for the preoperative evaluation of potential living kidney donors. Correlation with intraoperative findings

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlemann, J.; Blondin, D.; Reichelt, D.; Heinen, W.; Scherer, A.; Lanzman, R.S. [Universitaetsklinikum Duesseldorf (Germany). Inst. fuer Radiologie; Grotemeyer, D. [Universitaetsklinikum Duesseldorf (Germany). Klinik fuer Gefaesschirurgie und Nierentransplantation; Zgoura, P. [Universitaetsklinikum Duesseldorf (Germany). Klinik fuer Nephrologie

    2010-11-15

    Purpose: The purpose of this study was to evaluate the blood pool contrast agent gadofosveset for MR angiography (MRA) of the renal vasculature in living kidney donors (LKD). Materials and Methods: Of the 28 consecutive potential LKDs (13 men, 15 women; mean age 55.14 years {+-} 11.97) initially included in this prospective study, 20 patients underwent surgery and were considered for further evaluation. 7 acquisitions of a 3D T1-weighted FLASH sequence were performed following administration of gadofosveset for the assessment of the vascular anatomy and collecting system at predefined time points at 1.5 T. All MR exams were prospectively analyzed by 2 radiologists in consensus mode prior to surgery. In addition, ROI-based relative SNR measurements were performed in the vena cava inferior and abdominal aorta. Results: MR image acquisition was completed in all 20 potential living donors. In 8 donors an additional CT scan was available for further comparison with the collateral anatomy, resulting in a total of 28 analyzed kidneys. MRA disclosed 36 renal arteries, since 8 accessory arteries were found in 8 subjects. One accessory artery and one case of fibromuscular dysplasia were missed by MRA. The venous anatomy and the collecting system were assessed correctly with MRI. In addition, MRI diagnosed two renal cell carcinomas. The overall sensitivity and positive predictive value of gadofosveset-enhanced MRI on a per kidney basis were 92.9 % and 100 %, respectively. Conclusion: Gadofosveset enables accurate evaluation of potential LKDs. (orig.)

  12. Comparison of CT during arterial portography, delayed iodine CT, and MR imaging for the preoperative evaluation of hepatic tumors

    International Nuclear Information System (INIS)

    Nelson, R.C.; Chezmar, J.L.; Sugarbaker, P.H.; Bernardino, M.E.

    1988-01-01

    Twenty-eight patients with neoplastic involvement of the liver were studied with CT during arterial portography, delayed iodine CT, and MR imaging, to determine the number, size, and location of focal hepatic lesions prior to hepatic tumor surgery. The MR pulse-sequences used included T1- and T2-weighted spin-echo (SE) sequences and inversion-recovery (IR) sequences at 0.5 T, 1.5 T, or both. Results were compared with operative and pathologic findings. The sensitivities for the detection of individual focal lesions are as follows: CT during arterial portography, delayed iodine CT, 77%, IR at 0.5 T, 74%; T1-weighted SE at 0.5 T, 69%; T2-weighted SE at 1.5 T, 55%, IR at 1.5 T, 50%; T2-weighted SE at 0.5 T, 48%, and T1-weighted SE at 1.5 T, 31%. The positive predictive values ranged from 88% to 100% for all techniques. The authors' data suggest that CT during arterial portography is a superior technique for evaluating patients prior to hepatic tumor surgery

  13. The preliminary study of setup errors' impact on dose distribution of image guide radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    Xu Luying; Pan Jianji; Wang Xiaoliang; Bai Penggang; Li Qixin; Fei Zhaodong; Chen Chuanben; Ma Liqin; Tang Tianlan

    2011-01-01

    Objective: To measure the set-up errors of patients with head and neck (H and N) cancer during the image guided intensity-modulated radiotherapy (IMRT) treatment and analyze the impact of setup errors on dose distribution; then to further investigate the necessity of adjustment online for H and N cancer during IMRT treatment. Methods: Cone-beam CT (CBCT) scanning of thirty patients with H and N cancer were acquired by once weekly with a total of 6 times during IMRT treatment. The CBCT images and the original planning CT images were matched by the bony structure and worked out the translational errors of the x, y, z axis, as well as rotational errors. The dose distributions were recalculated based on the data of each setup error. The dose of planning target volume (PTV) and organs at risk were calculated in the re-planning, and than compared with the original plan by paired t-test. Results: The mean value of x, y, z axis translational set-up errors were (1.06 ± 0.95)mm, (0.95 ± 0.77)mm and (1.31 ± 1.07)mm, respectively. The rotational error of x, y, z axis were (1.04 ±0.791), (1.06 ±0.89) and (0.81 ±0.61 ), respectively. PTV 95% volume dose (D 95 ) and PTV minimal dose of re-planning for 6 times set-up were lower than original plan (6526.6 cGy : 6630.3 cGy, t =3.98, P =0.000 and 5632.6 cGy : 5792.5 cGy, t =- 2.89, P =0.007). Brain stem received 45 Gydose volume (V 45 ) and 1% brain stem volume dose (D 01 )were higher than original plan (3.54% : 2.75%, t =3.84, P =0.001 and 5129.7 cGy : 4919.3 cGy, t =4.36, P =0.000). Conclusions: The set-up errors led to the dose of PTV D 95 obviously insufficient and significantly increased V 45 , D 01 of the brainstem. So, adjustment online is necessary for H and N cancer during IMRT treatment. (authors)

  14. SU-E-J-154: Deformable Image Registration Based Delivered Dose Estimation for Head and Neck Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kumarasiri, A; Liu, C; Chetvertkov, M; Gordon, J; Siddiqui, F; Chetty, I; Kim, J [Henry Ford Health System, Detroit, MI (United States)

    2014-06-01

    Purpose: To estimate the accumulated dose to targets and organs at risk (OAR) for head and neck (H'N) radiotherapy using 3 deformable image registration (DIR) algorithms. Methods: Five H'N patients, who had daily CBCTs taken during the course of treatment, were retrospectively studied. All plans had 5 mm CTV-to-PTV expansions. To overcome the small field of view (FOV) limitations and HU uncertainties of CBCTs, CT images were deformably registered using a parameter-optimized B-spline DIR algorithm (Elastix, elastix.isi.uu.nl) and resampled onto each CBCT with a 4 cm uniform FOV expansion. The dose of the day was calculated on these resampled CT images. Calculated daily dose matrices were warped and accumulated to the planning CT using 3 DIR algorithms; SmartAdapt (Eclipse/Varian), Velocity (Velocity Medical Solutions), and Elastix. Dosimetric indices for targets and OARs were determined from the DVHs and compared with corresponding planned quantities. Results: The cumulative dose deviation was less than 2%, on average, for PTVs from the corresponding plan dose, for all algorithms/patients. However, the parotids show as much as a 37% deviation from the intended dose, possibly due to significant patient weight loss during the first 3 weeks of treatment (15.3 lbs in this case). The mean(±SD) cumulative dose deviations of the 5 patients estimated using the 3 algorithms (SmartAdapt, Velocity, and Elastix) were (0.8±0.9%, 0.5±0.9%, 0.6±1.3%) for PTVs, (1.6±1.9%, 1.4±2.0%, 1.7±1.9%) for GTVs, (10.4±12.1%, 10.7±10.6%, 6.5±10.1%) for parotid glands, and (4.5±4.6%, 3.4±5.7%, 3.9±5.7%) for mucosa, respectively. The differences among the three DIR algorithms in the estimated cumulative mean doses (1SD (in Gy)) were: 0.1 for PTVs, 0.1 for GTVs, 1.9 for parotid glands, and 0.4 for mucosa. Conclusion: Results of this study are suggestive that more frequent plan adaptation for organs, such as the parotid glands, might be beneficial during the course of H

  15. SU-E-J-154: Deformable Image Registration Based Delivered Dose Estimation for Head and Neck Radiotherapy

    International Nuclear Information System (INIS)

    Kumarasiri, A; Liu, C; Chetvertkov, M; Gordon, J; Siddiqui, F; Chetty, I; Kim, J

    2014-01-01

    Purpose: To estimate the accumulated dose to targets and organs at risk (OAR) for head and neck (H'N) radiotherapy using 3 deformable image registration (DIR) algorithms. Methods: Five H'N patients, who had daily CBCTs taken during the course of treatment, were retrospectively studied. All plans had 5 mm CTV-to-PTV expansions. To overcome the small field of view (FOV) limitations and HU uncertainties of CBCTs, CT images were deformably registered using a parameter-optimized B-spline DIR algorithm (Elastix, elastix.isi.uu.nl) and resampled onto each CBCT with a 4 cm uniform FOV expansion. The dose of the day was calculated on these resampled CT images. Calculated daily dose matrices were warped and accumulated to the planning CT using 3 DIR algorithms; SmartAdapt (Eclipse/Varian), Velocity (Velocity Medical Solutions), and Elastix. Dosimetric indices for targets and OARs were determined from the DVHs and compared with corresponding planned quantities. Results: The cumulative dose deviation was less than 2%, on average, for PTVs from the corresponding plan dose, for all algorithms/patients. However, the parotids show as much as a 37% deviation from the intended dose, possibly due to significant patient weight loss during the first 3 weeks of treatment (15.3 lbs in this case). The mean(±SD) cumulative dose deviations of the 5 patients estimated using the 3 algorithms (SmartAdapt, Velocity, and Elastix) were (0.8±0.9%, 0.5±0.9%, 0.6±1.3%) for PTVs, (1.6±1.9%, 1.4±2.0%, 1.7±1.9%) for GTVs, (10.4±12.1%, 10.7±10.6%, 6.5±10.1%) for parotid glands, and (4.5±4.6%, 3.4±5.7%, 3.9±5.7%) for mucosa, respectively. The differences among the three DIR algorithms in the estimated cumulative mean doses (1SD (in Gy)) were: 0.1 for PTVs, 0.1 for GTVs, 1.9 for parotid glands, and 0.4 for mucosa. Conclusion: Results of this study are suggestive that more frequent plan adaptation for organs, such as the parotid glands, might be beneficial during the course of H'N RT. This

  16. Preoperative staging of rectal cancer.

    Science.gov (United States)

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  17. Coherent Raman Scattering Microscopy for Evaluation of Head and Neck Carcinoma.

    Science.gov (United States)

    Hoesli, Rebecca C; Orringer, Daniel A; McHugh, Jonathan B; Spector, Matthew E

    2017-09-01

    Objective We aim to describe a novel, label-free, real-time imaging technique, coherent Raman scattering (CRS) microscopy, for histopathological evaluation of head and neck cancer. We evaluated the ability of CRS microscopy to delineate between tumor and nonneoplastic tissue in tissue samples from patients with head and neck cancer. Study Design Prospective case series. Setting Tertiary care medical center. Subjects and Methods Patients eligible were surgical candidates with biopsy-proven, previously untreated head and neck carcinoma and were consented preoperatively for participation in this study. Tissue was collected from 50 patients, and after confirmation of tumor and normal specimens by hematoxylin and eosin (H&E), there were 42 tumor samples and 42 normal adjacent controls. Results There were 42 confirmed carcinoma specimens on H&E, and CRS microscopy identified 37 as carcinoma. Of the 42 normal specimens, CRS microscopy identified 40 as normal. This resulted in a sensitivity of 88.1% and specificity of 95.2% in distinguishing between neoplastic and nonneoplastic images. Conclusion CRS microscopy is a unique label-free imaging technique that can provide rapid, high-resolution images and can accurately determine the presence of head and neck carcinoma. This holds potential for implementation into standard practice, allowing frozen margin evaluation even at institutions without a histopathology laboratory.

  18. Image quality in the anteroposterior cervical spine radiograph: Comparison between moving, stationary and non-grid techniques in a lamb neck

    International Nuclear Information System (INIS)

    Keating, Michelle; Grange, Stuart

    2011-01-01

    Background: Cervical spine radiography is a commonly employed examination for degenerative disease and trauma in the cervical spine. Traditionally, the anteroposterior projection is undertaken with the use of an anti-scatter grid. Some practitioners appear to have rejected this practice in favour of a non-grid technique, possibly because of the dose saving it affords. It is necessary to determine if image quality in the cervical spine is significantly degraded and whether the omission of the grid is justified. Method: Using a slaughtered lamb neck as a model of the human neck triplicate radiographs were obtained using a non-grid, a stationary grid and a moving grid technique. Entrance surface dose and dose area product was measured for these techniques. Image quality in terms of contrast, sharpness and overall acceptability was evaluated by 9 independent and blinded observers. Results: A significant reduction in measured dose was observed when the non-grid technique was compared to stationary or moving grid techniques. A statistically significant reduction in image contrast, sharpness and acceptability was also seen in the non-grid compared to grid techniques. Conclusion: These results show evidence of significantly greater image quality in the presence of either a moving or stationary grid in the lamb model. As such they support the continued use of scatter rejection methods such as the anti-scatter grid in AP radiography of the human cervical spine, to optimise radiographic image quality in this critical structure.

  19. Prospective, blinded trial of whole-body magnetic resonance imaging versus computed tomography positron emission tomography in staging primary and recurrent cancer of the head and neck.

    LENUS (Irish Health Repository)

    O'Neill, J P

    2012-02-01

    OBJECTIVES: To compare the use of computed tomography - positron emission tomography and whole-body magnetic resonance imaging for the staging of head and neck cancer. PATIENTS AND METHODS: From January to July 2009, 15 consecutive head and neck cancer patients (11 men and four women; mean age 59 years; age range 19 to 81 years) underwent computed tomography - positron emission tomography and whole-body magnetic resonance imaging for pre-therapeutic evaluation. All scans were staged, as per the American Joint Committee on Cancer tumour-node-metastasis classification, by two blinded consultant radiologists, in two sittings. Diagnoses were confirmed by histopathological examination of endoscopic biopsies, and in some cases whole surgical specimens. RESULTS: Tumour staging showed a 74 per cent concordance, node staging an 80 per cent concordance and metastasis staging a 100 per cent concordance, comparing the two imaging modalities. CONCLUSION: This study found radiological staging discordance between the two imaging modalities. Whole-body magnetic resonance imaging is an emerging staging modality with superior visualisation of metastatic disease, which does not require exposure to ionising radiation.

  20. Image quality in the anteroposterior cervical spine radiograph: Comparison between moving, stationary and non-grid techniques in a lamb neck

    Energy Technology Data Exchange (ETDEWEB)

    Keating, Michelle [School of Health and Social Care, Faculty of Health and Life Sciences, University of the West of England, Stapleton, Bristol BS16 1DD (United Kingdom); Grange, Stuart, E-mail: Stuart2.Grange@uwe.ac.u [School of Health and Social Care, Faculty of Health and Life Sciences, University of the West of England, Stapleton, Bristol BS16 1DD (United Kingdom)

    2011-05-15

    Background: Cervical spine radiography is a commonly employed examination for degenerative disease and trauma in the cervical spine. Traditionally, the anteroposterior projection is undertaken with the use of an anti-scatter grid. Some practitioners appear to have rejected this practice in favour of a non-grid technique, possibly because of the dose saving it affords. It is necessary to determine if image quality in the cervical spine is significantly degraded and whether the omission of the grid is justified. Method: Using a slaughtered lamb neck as a model of the human neck triplicate radiographs were obtained using a non-grid, a stationary grid and a moving grid technique. Entrance surface dose and dose area product was measured for these techniques. Image quality in terms of contrast, sharpness and overall acceptability was evaluated by 9 independent and blinded observers. Results: A significant reduction in measured dose was observed when the non-grid technique was compared to stationary or moving grid techniques. A statistically significant reduction in image contrast, sharpness and acceptability was also seen in the non-grid compared to grid techniques. Conclusion: These results show evidence of significantly greater image quality in the presence of either a moving or stationary grid in the lamb model. As such they support the continued use of scatter rejection methods such as the anti-scatter grid in AP radiography of the human cervical spine, to optimise radiographic image quality in this critical structure.

  1. The planning target volume margins detected by cone-beam CT in head and neck cancer patients treated by image-guided intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Liu Jun; Chen Hong; Zhang Guoqiao; Chen Fei; Zhang Li

    2011-01-01

    Objective: To determine the planning target volume margins of head and neck cancers treated by image guided radiotherapy (IGRT). Methods: 464 sets cone beam computed tomography (CBCT) images before setup correction and 126 sets CBCT images after correction were obtained from 51 head and neck cancer patients treated by IGRT in our department. The systematic and random errors were evaluated by either online or offline correction through registering the CBCT images to the planning CT. The data was divided into 3 groups according to the online correction times. Results: The isocenter shift were 0.37 mm ± 2.37 mm, -0.43 mm ± 2.30 mm and 0.47 mm ± 2.65 mm in right-left (RL), anterior-posterior (AP) and superior-inferior (SI) directions respectively before correction, and it reduced to 0.08 mm ± 0.68 mm, -0.03 mm ± 0.74 mm and 0.03 mm ± 0.80 mm when evaluated by 126 sets corrected CBCT images. The planning target volume (PTV) margin from clinical target volume (CTV) before correction were: 6.41 mm, 6.15 mm and 7.10 mm based on two parameter model, and it reduced to 1.78 mm, 1.80 mm and 1.97 mm after correction. The PTV margins were 3.8 mm, 3.8 mm, 4.0 mm; 4.0 mm, 4.0 mm, 5.0 mm and 5.4 mm, 5.2 mm, 6.1 mm in RL, AP and SI respectively when online-correction times were more than 15 times, 11-15 times, 5-10 times. Conclusions: CBCT-based on online correction reduce the PTV margin for head and neck cancers treated by IGRT and ensure more precise dose delivery and less normal tissue complications. (authors)

  2. Neck Pain

    Science.gov (United States)

    ... Vomiting Nausea and Vomiting in Infants and Children Neck Pain Neck Swelling Shortness of Breath Shortness of Breath ... worse or doesn’t get better. Start OverDiagnosisYour pain may be from DEGENERATIVE CERVICAL ARTHRITIS, a disorder that affects the bones and ...

  3. Immunohistochemical and molecular imaging biomarker signature for the prediction of failure site after chemoradiation for head and neck squamous cell carcinoma

    DEFF Research Database (Denmark)

    Rasmussen, Gregers Brünnich; Håkansson, Katrin E; Vogelius, Ivan R

    2017-01-01

    .23; p: .025), Bcl-2 (HR: 2.6; p: .08), SUVmax (HR: 3.5; p: .095) and GTV (HR: 1.7; p: .063). CONCLUSIONS: The models successfully distinguished between risk of locoregional failure and risk of distant metastasis, which is important information for clinical decision-making. High p53 expression has......OBJECTIVE: To identify a failure site-specific prognostic model by combining immunohistochemistry (IHC) and molecular imaging information to predict long-term failure type in squamous cell carcinoma of the head and neck. PATIENT AND METHODS: Tissue microarray blocks of 196 head and neck squamous...... cell carcinoma cases were stained for a panel of biomarkers using IHC. Gross tumor volume (GTV) from the PET/CT radiation treatment planning CT scan, maximal Standard Uptake Value (SUVmax) of fludeoxyglucose (FDG) and clinical information were included in the model building using Cox proportional...

  4. Prognostic value of tumor volumetry data of routine imaging data in a head and neck cancer registry.

    Science.gov (United States)

    Oemus, Daniela; Inhestern, Johanna; Schmalenberg, Harald; Schultze-Mosgau, Stefan; Mentzel, Hans-Joachim; Guntinas-Lichius, Orlando

    2014-09-01

    The purpose of this study was to analyze the impact of tumor volume (TV) measurements as prognosticator for recurrence-free survival (RFS) and overall survival (OS) from data of head and neck cancer (HNC) registries. TV measurements were performed in pre-treatment computed tomography (CT) or magnetic resonance images (MRI) of 392 unselected HNC patients. TV measurements were feasible in 275 patients (70 %). Median CT TV and MRI TV were 11.43 and 10.4 cm(3), respectively. The CT TV was significantly different only between T1 and T4. CT TV was significantly different only between T1 and T4 (p = 0.041). MRI TV was significantly different between T1 and T4 (p = 0.003) as well as between T2 and T4 (p = 0.002). Median follow-up was 26.1 months. Median RFS was 80.7 months. Median OS was 66.5 months. On univariate analysis, significant prognostic factors for decreased RFS were advanced T stage (p = 0.010); M1 (p = 0.001) and an MRI TV > 10.4 cm(3) (p = 0.001). Significant prognostic factors for a decreased OS were advanced T stage (p = 0.001), N+ (p = 0 006), M+ (p TV (p = 0.005), and MRI TV (p = 0.012). On multivariate analysis for RFS, MRI TV was the best independent prognosticator (p = 0.003). On multivariate analysis for OS, T stage (p = 0.006) was a better prognosticator than CT or MRI TV. Using CT and MRI data sets of an unselected series of HNC patients in a cancer registry, TV measurements were not feasible in all patients. MRT TV was a powerful prognosticator for RFS.

  5. Emergency CT head and neck imaging: effects of swimmer's position on dose and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Mueck, Fabian G.; Roesch, Sebastian; Geyer, Lucas; Scherr, Michael; Seidenbusch, Michael; Stahl, Robert; Deak, Zsuzsanna; Wirth, Stefan [LMU Klinikum Universitaet Muenchen (Germany). Inst. fuer Klinische Radiologie

    2014-05-15

    To compare the effects of different arm positions on dose exposure and image quality (IQ) in cervical spine CT after trauma in different patient groups. Patients in standard (STD = 126) and in swimmer's position (SWIM = 254) were included. Body mass index (BMI subgroup 1 = underweight to subgroup 4 = obese), anterior-posterior diameter (AP), left-right diameter (LR), area of an ellipse (AoE) and angle between the humeral heads (optimal STD < 3 , optimal SWIM > 10 ) were used as grouping criteria. Computed tomography dose index (CTDI) was documented. Two radiologists rated the IQ at three levels (CV1/2, CV4/5, CV7/T1) using a semi-quantitative scale (0 = not diagnostic, 1 = diagnostic with limitations, 2 = diagnostic without limitations). The Mann-Whitney U test correlations of grouping criteria with dose effects and intra-class correlation (ICC) were calculated. ICC was 0.87. BMI grouping showed the strongest correlation with dose effects: CTDI of optimal STD versus optimal SWIM positioning was 3.17 mGy versus 2.46 mGy (subgroup 1), 5.47 mGy versus 3.97 mGy (subgroup 2), 7.35 mGy versus 5.96 mGy (subgroup 3) and 8.71 mGy versus 8.18 mGy (subgroup 4). Mean IQ at CV7/T1 was 1.65 versus 1.23 (subgroup 1), 1.27 versus 1.46 (subgroup 2), 1.06 versus 1.46 (subgroup 3), 0.79 versus 1.5 (subgroup 4). Patients with a BMI > 20 kg/m{sup 2} benefited from both potential dose reduction and improved image quality at the critical cervicothoracic junction when swimmer's position was used. (orig.)

  6. TC pathological Neck

    International Nuclear Information System (INIS)

    Garcia Fontes, M.

    2012-01-01

    This presentation is about different imaging techniques such as ultrasound, CT, RNM, PET-CT. These techniques permit to detect head and neck tumors, breast and digestive pathologies as well as congenital diseases and glandular tumor in the thyroid, parathyroid, muscles, lymphatic, nerves and vessels

  7. Accuracy of Computed Tomography for Predicting Pathologic Nodal Extracapsular Extension in Patients With Head-and-Neck Cancer Undergoing Initial Surgical Resection

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Roshan S., E-mail: roshansprabhu@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Magliocca, Kelly R. [Department of Pathology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hanasoge, Sheela [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Aiken, Ashley H.; Hudgins, Patricia A. [Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hall, William A. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Chen, Susie A. [Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas (United States); Eaton, Bree R.; Higgins, Kristin A. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Saba, Nabil F. [Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Beitler, Jonathan J. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2014-01-01

    Purpose: Nodal extracapsular extension (ECE) in patients with head-and-neck cancer increases the loco-regional failure risk and is an indication for adjuvant chemoradiation therapy (CRT). To reduce the risk of requiring trimodality therapy, patients with head-and-neck cancer who are surgical candidates are often treated with definitive CRT when preoperative computed tomographic imaging suggests radiographic ECE. The purpose of this study was to assess the accuracy of preoperative CT imaging for predicting pathologic nodal ECE (pECE). Methods and Materials: The study population consisted of 432 consecutive patients with oral cavity or locally advanced/nonfunctional laryngeal cancer who underwent preoperative CT imaging before initial surgical resection and neck dissection. Specimens with pECE had the extent of ECE graded on a scale from 1 to 4. Results: Radiographic ECE was documented in 46 patients (10.6%), and pECE was observed in 87 (20.1%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 43.7%, 97.7%, 82.6%, and 87.3%, respectively. The sensitivity of radiographic ECE increased from 18.8% for grade 1 to 2 ECE, to 52.9% for grade 3, and 72.2% for grade 4. Radiographic ECE criteria of adjacent structure invasion was a better predictor than irregular borders/fat stranding for pECE. Conclusions: Radiographic ECE has poor sensitivity, but excellent specificity for pECE in patients who undergo initial surgical resection. PPV and NPV are reasonable for clinical decision making. The performance of preoperative CT imaging increased as pECE grade increased. Patients with resectable head-and-neck cancer with radiographic ECE based on adjacent structure invasion are at high risk for high-grade pECE requiring adjuvant CRT when treated with initial surgery; definitive CRT as an alternative should be considered where appropriate.

  8. A virtual phantom library for the quantification of deformable image registration uncertainties in patients with cancers of the head and neck.

    Science.gov (United States)

    Pukala, Jason; Meeks, Sanford L; Staton, Robert J; Bova, Frank J; Mañon, Rafael R; Langen, Katja M

    2013-11-01

    Deformable image registration (DIR) is being used increasingly in various clinical applications. However, the underlying uncertainties of DIR are not well-understood and a comprehensive methodology has not been developed for assessing a range of interfraction anatomic changes during head and neck cancer radiotherapy. This study describes the development of a library of clinically relevant virtual phantoms for the purpose of aiding clinicians in the QA of DIR software. These phantoms will also be available to the community for the independent study and comparison of other DIR algorithms and processes. Each phantom was derived from a pair of kVCT volumetric image sets. The first images were acquired of head and neck cancer patients prior to the start-of-treatment and the second were acquired near the end-of-treatment. A research algorithm was used to autosegment and deform the start-of-treatment (SOT) images according to a biomechanical model. This algorithm allowed the user to adjust the head position, mandible position, and weight loss in the neck region of the SOT images to resemble the end-of-treatment (EOT) images. A human-guided thin-plate splines algorithm was then used to iteratively apply further deformations to the images with the objective of matching the EOT anatomy as closely as possible. The deformations from each algorithm were combined into a single deformation vector field (DVF) and a simulated end-of-treatment (SEOT) image dataset was generated from that DVF. Artificial noise was added to the SEOT images and these images, along with the original SOT images, created a virtual phantom where the underlying "ground-truth" DVF is known. Images from ten patients were deformed in this fashion to create ten clinically relevant virtual phantoms. The virtual phantoms were evaluated to identify unrealistic DVFs using the normalized cross correlation (NCC) and the determinant of the Jacobian matrix. A commercial deformation algorithm was applied to the virtual

  9. Correlations between biochemical testing, anthology findings and preoperative sestamibi scans: a retrospective study of the minimally invasive radioguided parathyroidectomy (MIRP) approach

    International Nuclear Information System (INIS)

    Stawicki, S.; El Chaar, M.; Baillie, D.; Jaik, N.; Estrada, F.

    2007-01-01

    Sestamibi imaging is the most widely used preoperative localization study for patients with hyperparathyroidism. Previous reports examine the relationship between the weight and volume of excised parathyroid glands and preoperative serum calcium and parathyroid hormone (PTH) levels.The aim of this study was to examine whether these variables correlate with the results of preoperative Sestamibi scans. A retrospective review of 150 consecutive patients who underwent preoperative sestamibi imaging for primary hyperparathyroidism between 1998 and 2007 was performed. Variables studied included patient demographics, diagnostic test (sestamibi) results, operative/pathology findings and surgical outcome (normocalcaemia vs. persistent hypercalcaemia). Sestamibi scans were designated as either 'negative' (NSS) or 'positive' (PSS), where PSS correctly localized abnormal gland(s) enabling a focused neck exploration. The results of sestamibi imaging were correlated with calcium/PTH levels, weight/volume of excised glands and patient outcomes and demographics. Total excised gland weight/volume and preoperative serum calcium levels were significantly higher with PSS (all, p ≤ 0.04). Higher preoperative serum calcium levels and greater total gland weight/volume were significantly associated with successful operative outcome (presence of postoperative normocalcaemia; all, p ≤ 0.01). Factors associated with operative failure included multi-gland disease (p <≤ 0.01) and NSS (p ≤0.01). Higher diagnostic PTH levels (≥ 150 pg/mL) were associated with greater excised gland mass (p ≤ 0.05) and volume (p ≤ 0.05). Male gender was associated with higher preoperative serum calcium levels (p < 0.02). Of interest, patients with single-gland disease had significantly higher preoperative PTH levels than patients with multi-gland disease (155 vs. 109 pg/mL, p ≤ 0.05). Positive sestamibi scans are associated with heavier/larger parathyroid glands and higher preoperative serum

  10. Positron emission tomographic imaging with 11C-choline in differential diagnosis of head and neck tumors. Comparison with 18F-FDG PET

    International Nuclear Information System (INIS)

    Khan, N.; Oriuchi, Noboru; Ninomiya, Hiroshi; Higuchi, Tetsuya; Kamada, Hideo; Endo, Keigo

    2004-01-01

    The aim of this study was to evaluate the clinical value of positron emission tomography (PET) with 11 C-labeled choline (CHOL) for the differential diagnosis of malignant head and neck tumors from benign lesions as compared with 18 F-fluorodeoxyglucose PET. We studied 45 patients (28 males, 17 females, age range, 29-84 years) with suspected lesions in the head and neck region using both CHOL and FDG PET within a 2-week period on each patient. All patients fasted for at least 6 hours for both the CHOL and FDG studies. PET imaging was performed 5 min and 50-60 min after intravenous injection of CHOL and FDG, respectively. After data acquisition, PET images were corrected for attenuation, and the reconstructed images were analyzed by visual interpretation. Then, the standardized uptake value (SUV) was calculated for semiquantitative evaluation of tumor tracer uptake. Finally the results of PET scans were compared with the histological diagnoses from surgical specimens or biopsies. With CHOL PET, malignant tumors were correctly detected in 24 (96%) of 25 patients, and benign lesions in 14 (70%) of 20 patients with an accuracy of 84.4%. With FDG PET, malignancy was correctly diagnosed in 23 (92%) of 25 patients, and benign lesions in 13 (65%) of 20 patients resulting an accuracy of 80%. A significant positive correlation between CHOL and FDG SUVs was found for all lesions (r=0.677, p=0.004, n=45). Malignant tumors showed significantly higher tracer accumulation than the benign lesions in both CHOL and FDG studies (5.69±1.61, n=25 vs. 2.98±2.13, n=20, p<0.0001; 9.21±4.23, n=25 vs. 3.60±2.57, n=20, p<0.0001). The cutoff SUV for differentiating malignant and benign lesions was 3.5 for CHOL and 3.9 for FDG. CHOL showed slightly better differentiation between malignant and benign lesions than FDG although some overlap existed on both studies. But the difference was not statistically significant. The results of this study indicate that CHOL PET may be feasible clinically

  11. Molecular imaging of head and neck cancers. Perspectives of PET/MRI; Molekulare Bildgebung bei Kopf-ï]¿Hals-Tumoren. Perspektive der PET-MRT

    Energy Technology Data Exchange (ETDEWEB)

    Stumpp, P.; Kahn, T. [Universitaetsklinikum Leipzig AoeR, Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Leipzig (Germany); Purz, S.; Sabri, O. [Universitaetsklinikum Leipzig, Klinik und Poliklinik fuer Nuklearmedizin, Leipzig (Germany)

    2016-07-15

    The {sup 18}F-fluorodeoxyglucose positron emission tomography-computed tomography ({sup 18}F-FDG-PET/CT) procedure is a cornerstone in the diagnostics of head and neck cancers. Several years ago PET-magnetic resonance imaging (PET/MRI) also became available as an alternative hybrid multimodal imaging method. Does PET/MRI have advantages over PET/CT in the diagnostics of head and neck cancers ?The diagnostic accuracy of the standard imaging methods CT, MRI and PET/CT is depicted according to currently available meta-analyses and studies concerning the use of PET/MRI for these indications are summarized. In all studies published up to now PET/MRI did not show superiority regarding the diagnostic accuracy in head and neck cancers; however, there is some evidence that in the future PET/MRI can contribute to tumor characterization and possibly be used to predict tumor response to therapy with the use of multiparametric imaging. Currently, {sup 18}F-FDG-PET/CT is not outperformed by PET/MRI in the diagnostics of head and neck cancers. The additive value of PET/MRI due to the use of multiparametric imaging needs to be investigated in future research. (orig.) [German] Die {sup 18}F-Fluordesoxyglukose-Positronenemissionstomographie-Computertomographie ({sup 18}F-FDG-PET-CT) hat ihren festen Stellenwert in der Diagnostik von Kopf-Hals-Tumoren. Seit einigen Jahren ist die PET-MRT als weitere hybride Bildgebungsmodalitaet verfuegbar. Bringt die PET-MRT Fortschritte bei der Diagnostik von Kopf-Hals-Tumoren ?Darstellung der diagnostischen Genauigkeit der bisherigen Bildgebungsmethoden CT, MRT und PET-CT anhand von Metaanalysen und Zusammenfassung der bisherigen Publikationen zur PET-MRT auf diesem Gebiet. Die PET-MRT zeigt in allen bisherigen Studien keine Ueberlegenheit bzgl. der diagnostischen Genauigkeit von Kopf-Hals-Tumoren. Sie kann jedoch durch die multiparametrische Diagnostik perspektivisch Beitraege zur Tumorcharakterisierung und damit moeglicherweise Voraussagen zum

  12. A GPU based high-resolution multilevel biomechanical head and neck model for validating deformable image registration

    International Nuclear Information System (INIS)

    Neylon, J.; Qi, X.; Sheng, K.; Low, D. A.; Kupelian, P.; Santhanam, A.; Staton, R.; Pukala, J.; Manon, R.

    2015-01-01

    Purpose: Validating the usage of deformable image registration (DIR) for daily patient positioning is critical for adaptive radiotherapy (RT) applications pertaining to head and neck (HN) radiotherapy. The authors present a methodology for generating biomechanically realistic ground-truth data for validating DIR algorithms for HN anatomy by (a) developing a high-resolution deformable biomechanical HN model from a planning CT, (b) simulating deformations for a range of interfraction posture changes and physiological regression, and (c) generating subsequent CT images representing the deformed anatomy. Methods: The biomechanical model was developed using HN kVCT datasets and the corresponding structure contours. The voxels inside a given 3D contour boundary were clustered using a graphics processing unit (GPU) based algorithm that accounted for inconsistencies and gaps in the boundary to form a volumetric structure. While the bony anatomy was modeled as rigid body, the muscle and soft tissue structures were modeled as mass–spring-damper models with elastic material properties that corresponded to the underlying contoured anatomies. Within a given muscle structure, the voxels were classified using a uniform grid and a normalized mass was assigned to each voxel based on its Hounsfield number. The soft tissue deformation for a given skeletal actuation was performed using an implicit Euler integration with each iteration split into two substeps: one for the muscle structures and the other for the remaining soft tissues. Posture changes were simulated by articulating the skeletal structure and enabling the soft structures to deform accordingly. Physiological changes representing tumor regression were simulated by reducing the target volume and enabling the surrounding soft structures to deform accordingly. Finally, the authors also discuss a new approach to generate kVCT images representing the deformed anatomy that accounts for gaps and antialiasing artifacts that may

  13. A GPU based high-resolution multilevel biomechanical head and neck model for validating deformable image registration

    Energy Technology Data Exchange (ETDEWEB)

    Neylon, J., E-mail: jneylon@mednet.ucla.edu; Qi, X.; Sheng, K.; Low, D. A.; Kupelian, P.; Santhanam, A. [Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza, #B265, Los Angeles, California 90095 (United States); Staton, R.; Pukala, J.; Manon, R. [Department of Radiation Oncology, M.D. Anderson Cancer Center, Orlando, 1440 South Orange Avenue, Orlando, Florida 32808 (United States)

    2015-01-15

    Purpose: Validating the usage of deformable image registration (DIR) for daily patient positioning is critical for adaptive radiotherapy (RT) applications pertaining to head and neck (HN) radiotherapy. The authors present a methodology for generating biomechanically realistic ground-truth data for validating DIR algorithms for HN anatomy by (a) developing a high-resolution deformable biomechanical HN model from a planning CT, (b) simulating deformations for a range of interfraction posture changes and physiological regression, and (c) generating subsequent CT images representing the deformed anatomy. Methods: The biomechanical model was developed using HN kVCT datasets and the corresponding structure contours. The voxels inside a given 3D contour boundary were clustered using a graphics processing unit (GPU) based algorithm that accounted for inconsistencies and gaps in the boundary to form a volumetric structure. While the bony anatomy was modeled as rigid body, the muscle and soft tissue structures were modeled as mass–spring-damper models with elastic material properties that corresponded to the underlying contoured anatomies. Within a given muscle structure, the voxels were classified using a uniform grid and a normalized mass was assigned to each voxel based on its Hounsfield number. The soft tissue deformation for a given skeletal actuation was performed using an implicit Euler integration with each iteration split into two substeps: one for the muscle structures and the other for the remaining soft tissues. Posture changes were simulated by articulating the skeletal structure and enabling the soft structures to deform accordingly. Physiological changes representing tumor regression were simulated by reducing the target volume and enabling the surrounding soft structures to deform accordingly. Finally, the authors also discuss a new approach to generate kVCT images representing the deformed anatomy that accounts for gaps and antialiasing artifacts that may

  14. 18F-FLT uptake kinetics in head and neck squamous cell carcinoma: A PET imaging study

    International Nuclear Information System (INIS)

    Liu, Dan; Fenwick, John D.; Chalkidou, Anastasia; Landau, David B.; Marsden, Paul K.

    2014-01-01

    Purpose: To analyze the kinetics of 3 ′ -deoxy-3 ′ -[F-18]-fluorothymidine (18F-FLT) uptake by head and neck squamous cell carcinomas and involved nodes imaged using positron emission tomography (PET). Methods: Two- and three-tissue compartment models were fitted to 12 tumor time-activity-curves (TACs) obtained for 6 structures (tumors or involved nodes) imaged in ten dynamic PET studies of 1 h duration, carried out for five patients. The ability of the models to describe the data was assessed using a runs test, the Akaike information criterion (AIC) and leave-one-out cross-validation. To generate parametric maps the models were also fitted to TACs of individual voxels. Correlations between maps of different parameters were characterized using Pearson'sr coefficient; in particular the phosphorylation rate-constants k 3-2tiss and k 5 of the two- and three-tissue models were studied alongside the flux parameters K FLT-2tiss and K FLT of these models, and standardized uptake values (SUV). A methodology based on expectation-maximization clustering and the Bayesian information criterion (“EM-BIC clustering”) was used to distil the information from noisy parametric images. Results: Fits of two-tissue models 2C3K and 2C4K and three-tissue models 3C5K and 3C6K comprising three, four, five, and six rate-constants, respectively, pass the runs test for 4, 8, 10, and 11 of 12 tumor TACs. The three-tissue models have lower AIC and cross-validation scores for nine of the 12 tumors. Overall the 3C6K model has the lowest AIC and cross-validation scores and its fitted parameter values are of the same orders of magnitude as literature estimates. Maps ofK FLT and K FLT-2tiss are strongly correlated (r = 0.85) and also correlate closely with SUV maps (r = 0.72 for K FLT-2tiss , 0.64 for K FLT ). Phosphorylation rate-constant maps are moderately correlated with flux maps (r = 0.48 for k 3-2tiss vs K FLT-2tiss and r = 0.68 for k 5 vs K FLT ); however, neither phosphorylation

  15. High-frequency ultrasound imaging of tattoo reactions with histopathology as a comparative method. Introduction of preoperative ultrasound diagnostics as a guide to therapeutic intervention.

    Science.gov (United States)

    Carlsen, K Hutton; Tolstrup, J; Serup, J

    2014-08-01

    Tattoo adverse reactions requiring diagnostic evaluation and treatment are becoming more common. The aim of this study was to assess tattoo reactions by 20-MHz ultrasonography referenced to histopathology as a comparative method. A total of 73 individuals with clinical adverse reactions in their tattoos were studied. Punch biopsies for reference histology were available from 58 patients. The Dermascan C(®) of Cortex Technology, Denmark, was employed. Total skin thickness and echo density of the echolucent band in the outer dermis were measured. Biopsy served for diagnosis and for determination of the level of cellular infiltration in the dermis. In every tattoo reaction studied, the skin affected was found thicker compared with regional control of the same individual (mean difference 0.73 mm). A prominent echolucent band of mean thickness 0.89 mm was demonstrated, primarily located in the very outer dermis but propagating to deeper dermal layers parallel to increasing severity of reactions. The thickness of the echolucent band correlated with the thickness of cellular infiltration determined by microscopic examination, R = 0.6412 (P tattoo reactions showed no distinct characteristics by ultrasound, but mainly displayed themselves by their advanced inflammatory component. It is demonstrated for the first time that ultrasound, with histopathology as the comparative method, can quantify the severity of tattoo reactions and non-invasively diagnose the depth of the inflammatory process in the dermis elicited by the microparticulate tattoo pigment, which itself is too minute to be imaged by ultrasound. Preoperative 20-MHz ultrasound scanning is introduced as a potentially useful method to guide therapeutic interventions by surgery and lasers. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Preoperative axillary lymph node evaluation in breast cancer patients by breast magnetic resonance imaging (MRI): Can breast MRI exclude advanced nodal disease?

    International Nuclear Information System (INIS)

    Hyun, Su Jeong; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung

    2016-01-01

    To evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in preoperative evaluation of axillary lymph node metastasis (ALNM) in breast cancer patients and to assess whether breast MRI can be used to exclude advanced nodal disease. A total of 425 patients were included in this study and breast MRI findings were retrospectively reviewed. The diagnostic performance of breast MRI for diagnosis of ALNM was evaluated in all patients, patients with neoadjuvant chemotherapy (NAC), and those without NAC (no-NAC). We evaluated whether negative MRI findings (cN0) can exclude advanced nodal disease (pN2-pN3) using the negative predictive value (NPV) in each group. The sensitivity and NPV of breast MRI in evaluation of ALNM was 51.3 % (60/117) and 83.3 % (284/341), respectively. For cN0 cases on MRI, pN2-pN3 manifested in 1.8 % (6/341) of the overall patients, 0.4 % (1/257) of the no-NAC group, and 6 % (5/84) of the NAC group. The NPV of negative MRI findings for exclusion of pN2-pN3 was higher for the no-NAC group than for the NAC group (99.6 % vs. 94.0 %, p = 0.039). Negative MRI findings (cN0) can exclude the presence of advanced nodal disease with an NPV of 99.6 % in the no-NAC group. (orig.)

  17. The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

    Science.gov (United States)

    Tavukçu, Hasan Hüseyin; Aytaç, Ömer; Balcı, Numan Cem; Kulaksızoğlu, Haluk; Atuğ, Fatih

    2017-12-01

    We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.

  18. Preoperative axillary lymph node evaluation in breast cancer patients by breast magnetic resonance imaging (MRI): Can breast MRI exclude advanced nodal disease?

    Energy Technology Data Exchange (ETDEWEB)

    Hyun, Su Jeong [Yonsei University College of Medicine, Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Seoul (Korea, Republic of); Hallym University Medical Center, Department of Radiology, Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of); Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kim, Min Jung [Yonsei University College of Medicine, Department of Radiology, Breast Cancer Clinic, Severance Hospital, Research Institute of Radiological Science, Seoul (Korea, Republic of)

    2016-11-15

    To evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in preoperative evaluation of axillary lymph node metastasis (ALNM) in breast cancer patients and to assess whether breast MRI can be used to exclude advanced nodal disease. A total of 425 patients were included in this study and breast MRI findings were retrospectively reviewed. The diagnostic performance of breast MRI for diagnosis of ALNM was evaluated in all patients, patients with neoadjuvant chemotherapy (NAC), and those without NAC (no-NAC). We evaluated whether negative MRI findings (cN0) can exclude advanced nodal disease (pN2-pN3) using the negative predictive value (NPV) in each group. The sensitivity and NPV of breast MRI in evaluation of ALNM was 51.3 % (60/117) and 83.3 % (284/341), respectively. For cN0 cases on MRI, pN2-pN3 manifested in 1.8 % (6/341) of the overall patients, 0.4 % (1/257) of the no-NAC group, and 6 % (5/84) of the NAC group. The NPV of negative MRI findings for exclusion of pN2-pN3 was higher for the no-NAC group than for the NAC group (99.6 % vs. 94.0 %, p = 0.039). Negative MRI findings (cN0) can exclude the presence of advanced nodal disease with an NPV of 99.6 % in the no-NAC group. (orig.)

  19. Preoperative evaluation of the depth of anal canal invasion in very low rectal cancer by magnetic resonance imaging and surgical indications for intersphincteric resection

    International Nuclear Information System (INIS)

    Bamba, Yoshiko; Itabashi, Michio; Kameoka, Shingo

    2012-01-01

    The present study was performed to evaluate the depth of anal canal invasion (DACI), and determine whether magnetic resonance imaging (MRI) assessment of the conjoined longitudinal muscle (CLM) can be used to identify the surgical indication for intersphincteric resection. Sixty-six patients with T1 (n=2), T2 (n=20), T3 (n=39), and T4 (n=5) lower rectal cancer were included. Depth of anal canal invasion was defined as extension of the tumor to the anal canal. The outline of the CLM on MRI was assessed as clear, unclear, or absent (indicating invasion). A comparison of overall T-stage and DACI of 22 pT1-pT2 tumors revealed that none