Role of multi-slice CT in staging of neuroblastoma

Background: The International Neuroblastoma Risk Group Staging System [INRGSS] is a recent pretreatment staging system for neuroblastoma [NB], based on imaging by CT before surgery

Purpose: this study aimed to stage NB cases using CT scan, in relation to available clinicopathologic data

Patients and Methods: Twenty pathologically proven NB cases were included. All were reviewed for patients' characteristics, includingage; sex, clinical picture, LN status and metastatic spread. All cases underwent CT scan for diagnosis. Stagingwas done using IDRFs, LN status and metastatic spread according to the INRGSS and INSS when available

Results: an abdominal mass was found in 85% of cases and the suprarenal gland was the most common site of primary tumor [50% of cases]. Concerning tumor grade, 85 % of cases were poorly differentiated. LNs were positive in 70%, and metastatic spread was found in 35% of patients respectively. Staging according to the INRGSS showed that L2 was the most common stage [45% of cases], followed by M stage [35%]. L1 and MS stages were found in 15% and 5% of cases respectively. Only 7 cases had postsurgical CT scans, and were staged according to the INSS

Conclusion: it was concluded that the use of the INRGSS using CT scan, is a recent valuable pretreatment staging system, allowing accurate classification of neuroblastoma

Discrimination of small hepatic hemangiomas from hypervascular malignant hepatic tumors with three phase helical CT

To compare the appearance of small hepatic hemangiomas at non-enhanced and contrast enhanced helical computed tomography [CT] with that of small [>3 cm] hyper-vascular malignant tumors and to evaluate the accuracy of multiphase helical CT in such aspects. A total of 30 patients with small hemangioma like lesions detected by ultrasonographic scanning were examined using 3 phase helical CT images in the pre-contrast and after contrast material injection, in the arterial and portal venous phases. Radiologists evaluated the lesion type and degree of change in enhancement from arterial to portal venous phase. They rated their confidence in the discrimination of hemangiomas from malignant tumors. Diagnosis was established by means of histologic findings in specimens obtained at percutaneous biopsy, or MRI for hemangioma like in ultrasonography. Ten HCCs were shown as nodular enhancement on early arterial-phase CT. The density of the whole tumor decreased rapidly on late and delayed phases, and the edge of 4 tumors [4/10] remained relatively hyperdense compared with the surrounding liver tissue, and demonstrated as rim enhancement. Rim enhancement was shown as 1 to 2-mm-wide irregular, uneven and discontinuous circumferential enhancement at late, and delayed-phase of CT. Eight hyper-vascular metastases were noted [6 in breast carcinomas, 1 in renal cell carcinoma and 1 in neuroendocrine tumors]. Twelve hemangiomas were found. Multiphase CT showed atypical pattern in 4 cases of small hemangiomas, [homogenus enhancement in arterial phase, 3 cases and non enhancement in 1 case]. Readers diagnosed hemangiomas with 66% mean sensitivity with all enhancement phases and diagnosed malignant lesions with 96% mean specificity. Small hemangiomas frequently show atypical appearances at CT. Two-phase helical CT does not improve sensitivity but does improve specificity for differentiating hemangiomas from hypervascular malignant tumors. If initial US scanning of the liver depicts a hemangioma like lesions, especially in patients at risk, other confirmatory imaging studies are necessary since 50% of hemangioma in this study were hypervascular malignant tumors. Percutaneous biopsy can be safely performed and findings can be used to confirm the diagnosis

Diagnostic accuracy of staging squamous cell carcinoma of the oral cavity using computed tomography and magnetic resonance imaging: a prospective study with histopathologic correlation

The accurate staging of patients prior to embarking on treatment for squamous cell carcinoma of the head and neck is essential. The aim of this prospective study is to compare the diagnostic accuracy of computed tomography [CT] and magnetic resonance imaging [MRI] in tumor staging of squamous cell carcinoma of the oral cavity. The value of magnetic resonance imaging [MRI] and computerized tomography [CT] in preoperative tumor T-staging was assessed prospectively in 24 patients with squamous cell carcinoma of the oral cavity. In each case, the MRI and CT findings were compared with post-operative histopathologic staging. The results of this study reveled that there were no statistical significance difference regarding tumor detection [although MRI was better than CT], bone invasion, lymph node involvement, and breaking down of the lesion [P>0.05]. MRI was better than CT regarding soft tissue extension and tumor margin detection and there were a high statistical significance difference [P<0.05]. For tumor staging, MR scanning is overall more accurate than CT. 90% of the cases were correctly staged with pathological findings compared to 80% on CT examination. Conclusion: If degraded images and Tl tumors are excluded, the techniques are comparable. MRI should also be used instead of CT when dental fillings obscure the region of interest. If there are good MRI facilities and an experienced team available, MRI can be used before CT. The ability of MRI to give an axial, coronal, and sagittal image allows an exact pre-operative view of tumor spread and assessment of infiltration into adjacent structures. MRI was superior to CT in soft tissue extension and tumor margin detection