The impact of multimodality integrated positron emission tomography-computed tomography on improving the staging and management of head and neck malignancy: a cross- sectional study

ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.

Inconsistent and consistent classifications for small liver lesions by contrast-enhanced ultrasound LI-RADS and CECT/MRI LI-RADS / 中华超声影像学杂志

Objective:To explore the inconsistent and consistent classifications for lesions ≤2 cm by contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Data System(LI-RADS) v2017 and contrast-enhanced computed tomography/contrast-enhanced magnetic resonance imaging(CECT/MRI) LI-RADS v2018.Methods:The focal liver lesions ≤2 cm underwent CEUS and CECT/MRI within 1 month were enrolled in this retrospective study.Each nodule was categorized according to the CEUS LI-RADS v2017 and CECT/MRI LI-RADS v2018. Intermodality agreement between the CEUS LI-RADS and CECT/MRI LI-RADS for each lesion was assessed with Cohen′s Kappa. Lesions with inconsistent classification for CEUS LI-RADS and CECT/MRI were analyzed.Results:A total of 145 lesions with a size of (1.65±0.33)cm in 145 patients were included. The numbers of lesions in LR-3, 4, 5 and M were 16, 23, 90 and 16 on CEUS LI-RADS, 25, 31, 87 and 2 on CECT/MRI, respectively. And 73.1% lesions were classified as LR-5 or M on CEUS, while 61.4% lesions were classified as LR-5 or M on CECT/MRI ( P=0.033). The incidences of HCC in LR-3, 4 and 5 were 37.5%, 52.2% and 97.8% on CEUS LI-RADS, 56.0%, 64.5% and 96.6% on CECT/MRI LI-RADS respectively. Among the 145 lesions, 56 lesions had inconsistent classifications of CEUS and CECT/MRI LI-RADS. Twenty-eight lesions in CECT/MRI LR-3 and 4 were escalated to LR-4 and 5 by CEUS and 82.1% of them were found to be HCC. Fourteen lesions on CEUS LR-3 and 4 were escalated to LR-4 and 5 by CECT/MRI and 85.7% of them were found to be HCC. Conclusions:The LR-5 of the CEUS and CECT/EOB-MRI LI-RADS has a comparable incidence of HCC. However, the inter-modality agreement of the LI-RADS category between CEUS and CECT/EOB-MRI is poor. The proportion of lesions in CEUS LR-5 and M is much higher than that in CECT/MRI LR-5 and M, while the proportion of lesions in CECT/MRI LR-3 and 4 is high than that in CEUS LR-3 and 4.

Retroperitoneal lymphangiectasia: a great clinical masquerade

Retroperitoneal lymphangiectasia is a very rare lymphatic disorder characterized by abnormal proliferation of lymphatics. We present series of 3 cases of retroperitoneal lymphangiectasia which are diagnosed in our institute with the help of Ultrasonography (USG), Computed Tomography (CT) and Magnetic resonance imaging (MRI) of abdomen and pelvis with unusual clinical presentation. We include clinical features and imaging findings of this disorder with its pathogenesis and diagnosis. Two of the cases were clinically masquerading as hernia and one case was mimicking varicocele. Thorough clinical examination and USG, colour Doppler, CT and MRI are extremely helpful imaging investigation that aid in differentiating these lesions from hernia/ varicocele and the cross sectional imaging like CT and MRI can  depict the anatomical extent of the disease.

Untargeted contrast-enhanced ultrasound versus contrast-enhanced computed tomography: a differential diagnostic performance (DDP) study for kidney lesions

OBJECTIVES: Histopathology is the 'gold standard' for diagnosing renal cell carcinoma but is limited by sample size. Contrast-enhanced ultrasound can differentiate malignant and benign lesions, but the Chinese guidelines on the management of renal cell carcinoma do not include this method. The purpose of this study was to compare the diagnostic parameters of contrast-enhanced ultrasound against those of contrast-enhanced computed tomography for detecting kidney lesions, with histopathology considered the reference standard. METHODS: Patients with suspected kidney lesions from prior grayscale ultrasonography and computed tomography were included in the analysis (n=191). The contrast-enhanced ultrasound, contrast-enhanced computed tomography, and histopathology data were collected and analyzed. A solid, enhanced mass was considered a malignant lesion, and an unenhanced mass or cyst was considered a benign lesion. The Bosniak criteria were used to characterize the lesions. RESULTS: Contrast-enhanced ultrasound and contrast-enhanced computed tomography both detected that 151 patients had malignant tumors and 40 patients had benign tumors. No significant differences in the tumors and their subtypes were reported between contrast-enhanced ultrasound and histopathology (p=0.804). Chromophobe renal cell carcinoma was detected through contrast-enhanced computed tomography (n=1), but no such finding was reported by contrast-enhanced ultrasound. A total of 35 cases of papillary renal cell carcinoma were reported through contrast-enhanced ultrasound while 32 were reported through histopathology. CONCLUSIONS: Contrast-enhanced ultrasound might be safe and as accurate as histopathology in diagnosing kidney lesions, especially renal cell carcinoma. Additionally, this study provides additional information over histopathology and has an excellent safety profile. Level of evidence: III.

Imaging spectrum and prevalence of variant branching pattern of aortic arch

Background: Variant branching patterns of the aortic arch are not infrequent but are commonly under reported. This study was conducted to determine the spectrum of Variant branching pattern of aortic arch and their prevalence using contrast enhanced computed tomography (CECT) images of the cases from a tertiary care centre.Methods:  Contrast enhanced computed tomography (CECT) images of aortic arch region from 1116(629 male and 487 female) cases from 18 to 85 years of age were examined retrospectively. The images were reviewed for normal and variant anatomy of aortic arch and the results were analyzed statistically.Results: Of 1116 patients, 878 (78.6%) cases showed normal and 238 (21.3%) cases had variant branching pattern of the aortic arch. The most common variation was the common origin of brachiocephalic trunk (BCT) and the left common carotid artery (LCCA) which was observed in 160 (14.3%) cases. In 8 (0.7%) cases, BCT and LCCA took origin from a single common trunk arising from the aortic arch. In 60(5.4%) cases, the left vertebral artery (LVA) originated directly from the aortic arch between the origin of the LCCA and left subclavian artery (SCA). 8 (0.7%) cases had aberrant right subclavian artery. Two (0.2%) cases showed right aortic arch.Conclusions: Interventional radiologists and surgeons should be well aware of variant anatomy of aortic arch. Contrast CT is a highly reliable imaging method for demonstrating anatomical features and variations of the arch.

Value of 18F-FDG PET-CT in the diagnosis, staging and treatment decision of lymphoma / 白血病·淋巴瘤

Objective To investigate the clinical value of 18F-FDG PET-CT in the diagnosis, clinical staging and treatment guide of malignant lymphoma. Methods A total of 136 lymphoma patients confirmed by pathological diagnosis who received 18F-FDG PET-CT and contrast enhanced CT (CECT) examination in Gansu Provincial Hospital from January 2011 to December 2016 were collected. The sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of 18F-FDG PET-CT and CECT were evaluated, respectively. The effects of 18F-FDG PET-CT on diagnosis, clinical staging and treatment regimens of lymphoma were analyzed. Results The sensitivity, specificity, accuracy, PPV and NPV of 18F-FDG PET-CT in the diagnosis of lymphoma for all 136 patients was 98.2%, 82.1%, 94.9%, 95.5% and 92.0%, respectively. CECT was 80.6%, 67.9%, 77.9%, 90.6% and 47.5%, respectively. The difference in sensitivity and specificity between 18F-FDG PET-CT and CECT was statistically significant (χ2＝ 16.0, P<0.01). The accuracy of 18F-FDG PET-CT was higher than that of CECT. Compared with CECT, 26 (20.6%) patients with image of 18F-FDG PET-CT showed the increase of the clinical staging, 4 (2.9%) patients showed the decrease of the clinical staging, and 16 (11.8%) patients changed the treatment regimen after the stage alteration. Conclusion 18F-FDG PET-CT is superior to CECT in the diagnosis, clinical staging and treatment guide of lymphoma, which shows the promising prospect in the diagnosis and treatment of lymphoma.

Differentiation Of Lung Masses With Radiodensity Determined Contrast Enhanced Computed Tomography

Lung cancer remains the leading cause of cancer-related death in both males and females. The disease has a poor prognosis with an overall 5-year mortality rate of approximately 84% (1). Twenty patients with lung cancer, 25 with pulmonary tuberculosis (TB) and 5 with inflammatory lung pseudotumors diagnosed by CTand confirmed by pathology in our hospital were selected. There were no significant differences in the radiodensities of the masses detected by plain CTamong patients with lung cancer, TB and inflammatory lung pseudotumors (P> 0.05). However, there were significant differences (P< 0.01) between all the groups in terms of radiodensities of masses detected by contrast enhanced CT. The radiodensities of lung masses detected by contrast enhanced CTcould potentially be used to differentiate between lung cancer, pulmonary TB and inflammatory lung pseudotumors.

Application of contrast enhanced ultrasound in TN staging of pancreas cancer: comparison with contrast enhanced computed tomography / 中华超声影像学杂志

Objective@#To assess value of contrast enhanced ultrasound (CEUS) in TN staging of pancreatic cancer and compared with contrast enhanced computed tomography(CECT).@*Methods@#Seventy-eight cases with pancreatic cancer confirmed by pathology were enrolled in this study. All patients were examined using CEUS and CECT and staged according to the 8th guideline of pancreas tumors of AJCC. The diagnostic accuracies of CEUS in TN staging of pancreas tumors were compared with CECT.@*Results@#The diagnostic accuracies of CEUS in T staging and N staging of pancreatic cancer were 80.8%, and 78.2%, respectively. For CECT, the diagnostic accuracies in T staging and N staging were 88.5%, and 88.5%, respectively. There was no significant difference in the diagnostic accuracies between CEUS and CECT in T staging(χ2=1.56, P=0.21). The diagnostic accuracy of CEUS in N staging was significantly lower than that of CECT(χ2=3.86, P=0.04).@*Conclusions@#The diagnostic accuracy of CEUS in T staging of pancreatic cancer is similar to that of CECT, while in its N staging is lower than that of CECT.

Application of three-dimensional reconstruction of the enhanced CT with iPlan CMF software in head and neck neoplasms / 北京大学学报(医学版)

Objective:Three-dimensional reconstruction of the enhanced CT is increasingly becoming a valuable tool in head and neck neoplasms.The aim of this study is to reconstruct three-dimensional imaging of tumor and its surrounding important anatomical structure using iPlan CMF software,and to investigate the application of three-dimensional tumor mapping technique for the diagnosis and treatment of the head and neck neoplasms.Methods:In the study,13 cases with head and neck tumors in Department of Oral and Maxilloficial Surgery,Peking University School and Hospital of Stomatology from June 2014 to June 2015 were studied using spiral CT scanning technology based on the same scanning condition.iPlan CMF software was used to read the original CT data,and surface shaded technology was applied to reconstruct the spatial relationship of the tumor,vessel and skull.The distance between the tumor and its surrounding important anatomical structure could be measured.iPlan CMF software was also used to accomplish the virtual osteotomy to expose the tumor,vessel and skull.The preoperative preparation,operative situation and postoperative complication were reviewed.Results:In this study 6 patients were male and 7 female.The age range was from 23 to 65 years,and the median patient age was 50 years.The threedimensional reconstruction image clearly demonstrated the extent of the tumor size,location,and the relation to its surrounding important anatomical structure.According to the three-dimensional image,the surgical risk of the patients was evaluated.The preoperative preparation and surgeries were successfully performed for 10 patients.Blood transfusion for 3 patients was considered before the surgery and actually accomplished during the operation.The operations for 2 patients were performed with the help of doctors from other departments.Only one patient had hoarseness because the tumor resulted from the pneumogastric nerves.For 10 patients,the average operation time was (202 ± 135) min,and the average operation bleeding was (235 ± 252) mL.The other 3 patients were not suitable cases for surgery.Conclusion:The three-dimensional reconstruction of enhanced CT image with iPlan CMF software is very helpful to make the treatment plan to avoid damaging important anatomical structures and postoperative complications.

Intra-abdominal Organ Injuries in Blunt Injury Abdomen in SRM Medical College, Potheri: A Prospective Study.

Introduction: Blunt Abdominal trauma is the most common caused by road traffi c accidents (RTA). It also occurs as a result of fall from a height, assault with blunt objects, industrial mishaps, sports injuries, bomb blast. Investigative modality can only supplement the clinical evaluation and cannot replace it in the diagnosis of blunt abdominal trauma. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remain at large. Purpose: To estimate the frequency of various intra-abdominal organ involved, assess the various mode of blunt abdominal trauma and clinical presentation and various available investigation, treatment and complications. Methods: This a prospective study conducted in SRM Medical College among patients presenting to the casualty and general surgery outpatient department with a sample size of 72. Results: Males (91.6%) outnumbered females (8.33%). RTA forms the most common mode of injury. The most common age group affected is 21-30 years. Majority of the population presented with pain abdomen. Focused assessment with sonography for trauma has picked up solid organ injury in 46 cases. Computed tomography abdomen was performed in 100% of the population and forms the core investigation of choice and becomes more important in dealing operative versus conservative management. For splenic injury, the most common surgery performed was splenectomy (26 cases). Multiple intra-abdominal organs were involved accounting for 9.7%. Wound infection is the most common post-operative complication. The study showed a mortality of 19%. Conclusion: Blunt injury abdomen with solid organ injury forms a considerable load of patients in our society and is usually less obvious. Early diagnosis, repeated clinical examination and use of appropriate investigations form the key in the management.

Adult Intussusception due to a Rare Tumor (Inflammatory Myofibroblastic Tumor of Mesentery): A Case Report.

Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology, and treatment. Diagnosis can be delayed because of its long-standing, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. We report a case of 23-year-old female with complaints of abdominal pain, constipation, and loss of appetite since 2 months. Computed tomography revealed right colonic obstruction caused by intussusception of the ileocecum. On exploration, a mesenteric mass was seen extending with the intussusceptum following, which ileocecal intussusception was found. The mass was excised. Histopathology examination of the specimen revealed an inflammatory myofibroblastic tumor. These tumors can occur throughout the body, most commonly in the lung, mesentery, and omentum. Complete surgical resection is the treatment of choice. A Review of this rare condition is interesting and should be borne on the mind.

Comparison of Non-contrast-Enhanced Computed Tomography and Intravenous Pyelogram for Detection of Patients With Urinary Calculi

PURPOSE: The aim of this study was to investigate the changing pattern in the use of intravenous pyelogram (IVP), conventional computed tomography (CT), and non-contrast-enhanced computed tomography (NECT) for evaluation of patients with acute flank pain. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 2,180 patients with acute flank pain who had visited Bundang Jesaeng General Hospital between January 2008 and December 2012 and analyzed the use of IVP, conventional CT, and NECT for these patients. RESULTS: During the study period there was a significant increase in NECT use (p<0.001) and a significant decrease in IVP use (p<0.001). Conventional CT use was also increased significantly (p=0.001). During this time the proportion of patients with acute flank pain who were diagnosed with urinary calculi did not change significantly (p=0.971). CONCLUSIONS: There was a great shift in the use of imaging study from IVP to NECT between 2008 and 2012 for patients with acute flank pain.

Contrast-Induced Nephropathy in Patients Undergoing Intravenous Contrast-Enhanced Computed Tomography in Korea: A Multi-Institutional Study in 101487 Patients

OBJECTIVE: To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. MATERIALS AND METHODS: Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. RESULTS: Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 +/- 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. CONCLUSION: Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.

Immature Teratoma with Somatic Tumor-Type Sarcoma: A Case Report.

Teratoma is a germ cell tumor seen mainly in neonates and young adults; it contains elements derived from all three germinal layers, with its usual site of occurrence being the ovary and testis and less common sites being several extragonadal locations. This case is of a 10-year-old boy who presented with an asymptomatic mass, heterogenous on ultrasonography and showing enhanced solid areas along with nonenhancing cystic areas on contrast enhanced computed tomography. Cytological diagnosis of malignant mesenchymal tumor was made; however, exact categorization could not be done. After surgical excision, histological and immunohistochemical studies yielded the diagnosis of immature teratoma with somatic malignancy – sarcoma. Teratomas with malignant transformation refer to a form of germ cell tumor in which a somatic teratomatous component becomes morphologically malignant and develops aggressively. These are associated with chromosomal abnormalities i (12p) reflecting germ cell tumor clonality. The occurrence of an identifiable sarcomatous component is a well recognized but distinctly uncommon phenomenon.

Pre-operative contrast enhanced computer tomographic evaluation of cervical nodal metastatic disease in oral squamous cell carcinoma.

Aims: This prospective study was undertaken to evaluate the contrast enhanced computed tomography (CECT) criteria in detecting cervical lymph node metastasis in 50 patients with an oral squamous cell carcinoma (OSQCC). Materials and Methods: A total of 50 patients with OSQCC who underwent clinical assessment, routine CECT scanning of cervical lymph node and radical neck dissection were analyzed. Radiologic criteria for diagnosing nodal metastasis in this imaging study were: A nodal size of 1 cm, the presence of central lucency despite the size of the lymph node and grouping of lymph nodes. These criteria were based on modified American Joint Committee on Cancer Radiological Nodal Staging Guidelines. Statistical Analysis: Chi-square test/Fisher Exact test has been used to find the significant association of findings. Diagnostic statistics viz.: Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and diagnostic accuracy were obtained. The results were considered significant when P value was less than 0.05. Results: On using a nodal size of 1 cm and the presence of central nodal necrosis (CNN) as radiological criteria for nodal metastasis CT scanning staged 23 of the 27 histopathologically positive necks, providing accuracy of 88%, sensitivity of 92%, and specificity of 84% in detection of nodal metastasis. A significant relationship between the incidence of CNN, different nodal densities, and primary tumor differentiation was observed. Conclusions: The nodal size cut-off of 1-1.5 cm had a maximal sensitivity of 90.91% and PPV of 86.96%. Furthermore, observation of nodal densities in the absence of frank CNN on the CT scan may be necessary especially in low grade primary tumor. CT assessment of cervical node metastasis was found acceptable, although adjuncts like ultrasound guided fine needle aspiration may further increase efficacy of CT scan in nodes lesser than 1 cm in size.

Evaluation of the consistency between contrast-enhanced ultrasound and enhanced CT in determining the effect of radiofrequency ablation on hepatocellular carcinoma / 中国肿瘤临床

Objective:This study aims to evaluate the consistency between contrast-enhanced ultrasound (CEUS) and enhanced computed tomography (CT) in determining the effect of radiofrequency ablation (RFA) on hepatocellular carcinoma. Methods: RFA procedures guided by either ultrasound or CT were performed on 35 patients with 68 lesions. Enhanced CT and CEUS were regularly conducted after the procedures to evaluate the effect of RFA. The full ablation, residual, and recurrence rates of tumors, as well as the di-agnostic accuracies and kappa values of CEUS and enhanced CT, were determined. Results:The full ablation and residual rates of tumors for the 68 lesions diagnosed by CEUS were 84%and 16%, respectively;whereas those for the lesions diagnosed by enhanced CT were 90%and 10%, respectively. No significant difference was found between the obtained rates using the two diagnostic methods (χ2=0.576 3, P=0.447 8). Moreover, the two methods exhibited high consistency (K=0.882 9, Sk=0.120 4). Of the 68 lesions, 13 recurred within 24 months. The recurrence rate evaluated by CEUS was 19%(13/68). No significant difference was found between the detection rates of CEUS (92%, 12/13 lesions) and enhanced CT (100%, 13/13 lesions) in diagnosing recurrent lesions (P>0.05). Enhanced CT could be used as the gold standard for evaluating tumor residual and recurrence rates after RFA. The overall diagnostic accuracy of CEUS reached 92%(63/68 lesions). Conclusion:CEUS and enhanced CT exhibit high accuracy and consistency in evaluating the effect of RFA on hepatocellular carcinoma. CEUS can provide a reliable diagnostic proof for tumor patients after undergoing RFA procedure.

Pulmonary Spergilloma : An Interesting Case.

In many cases, the diagnosis of pulmonary aspergilloma become difficult on the basis of radiological sign by chest X-ray or computed tomography (CT) scan as it can produce wide variety of radiographic changes. Often there is a diagnostic dilemma between lung malignancy and pulmonary aspergilloma. The diagnosis also can be established by sputum examination and culture. In our case, we report a 40-year old male presented with cough and hemoptysis. He was subsequently diagnosed as a case of pulmonary aspergilloma on the basis of evidence of radiological findings mainly.

A Case of Massive Air Embolism after Contrast-enhanced Computed Tomography / 결핵및호흡기질환

A venous air embolism is a complication of various venous access procedures such as contrast-enhanced computed tomography (CECT). Although most cases of iatrogenic venous air embolisms during CECT involve a few milliliters of air and are asymptomatic, a massive venous air embolism can be fatal. We report a case of a massive intraventricular air embolism after CECT with a review of the literature regarding the pathophysiology and treatment of air embolisms.

A Case of Massive Air Embolism after Contrast-enhanced Computed Tomography / 결핵및호흡기질환

A venous air embolism is a complication of various venous access procedures such as contrast-enhanced computed tomography (CECT). Although most cases of iatrogenic venous air embolisms during CECT involve a few milliliters of air and are asymptomatic, a massive venous air embolism can be fatal. We report a case of a massive intraventricular air embolism after CECT with a review of the literature regarding the pathophysiology and treatment of air embolisms.