Solitary bone plasmacytoma mimicking a lesion of odontogenic origin: A case report.

INTRODUCTION AND IMPORTANCE: Solitary bone plasmacytoma (SBP) is an early-stage plasma cell malignancy. It is an extremely rare condition and its diagnosis may not be straightforward. This report presents a case of maxillary SBP. CASE PRESENTATION: A 48-year old man sought care for persistent swelling and pain in the periapical region of the left maxillary molars. He had been diagnosed with "apical periodontitis" and root canal treatment of teeth #26 and #27 was ineffective. Extra-oral examination revealed swelling at the left maxilla. Intraoral examination revealed a hard, non-fluctuant swollen region in the buccal alveolar mucosa adjacent to the apices of teeth #25-27. Cone-beam computed tomography revealed extensive bone destruction in the left maxilla. The patient underwent partial maxillary resection and radical maxillary sinusotomy. Further testing (positron emission CT scan, histopathological and immunohistochemical examination) confirmed the diagnosis of SBP. The patient had a recurrence two years later, which was managed with left subtotal maxillectomy and radiotherapy. There was no evidence of recurrence during 20 months of follow-up. DISCUSSION: SBP may mimic an odontogenic lesion when found in the jaw bone. To confirm the diagnosis, routine blood test, complete body skeletal survey, metastatic investigations and histopathology should be performed. Radiotherapy is the primary treatment. CONCLUSION: SBP may occur in the maxilla mimicking an odontogenic lesion. Surgery may be part of the diagnostic procedure and an adjunct to definitive radiation. Radiotherapy is the primary treatment.

A narrative review on machine learning in diagnosis and prognosis prediction for tongue squamous cell carcinoma.

Background: Tongue squamous cell carcinoma (TSCC) is the most common subtype of oral cavity squamous cell carcinoma (OCSCC), and it also has the worst prognosis. It is crucial to find an effective way to solve the challenges in diagnosis and prognosis prediction for TSCC. Machine learning (ML) has been widely used in medical research and has shown good performance. It can be used for feature extraction, feature selection, model construction, etc. Radiomics and deep learning (DL), the new components of ML, have also been utilized to explore the relationship between image features and diseases. The current study aimed to highlight the importance of ML as a potential method for addressing the challenges in diagnosis and prognosis prediction of TSCC by reviewing studies on ML in TSCC. Methods: The studies on ML in TSCC in PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure published between the dates of inception of these databases and April 30, 2022, were reviewed. Key Content and Findings: ML (including radiomics and DL) which was used in diagnosis and prognosis prediction for TSCC, has shown promising performance. Conclusions: Despite its limitations, ML is still a potential approach that can help to deal with the challenges in diagnosis and prognosis prediction for TSCC. Nevertheless, more efforts are needed to enhance the usefulness of ML in this field.

Biometric analysis of apical surgery-related anatomy of mandibular first molars: a cone-beam computed tomography study in a Mongoloid population.

OBJECTIVE: To evaluate the apical surgery-related anatomy of two-rooted and three-rooted mandibular first molars (MFMs) in a Mongoloid population. METHODS: A total of 502 cone-beam computed tomographic images were used to evaluate the root configuration, the distance from the buccal bone to each root, root dimensions, and the complete root resection distance at the resection level for roots of MFMs. RESULTS: The prevalence of two-rooted and three-rooted MFMs was 85.1% and 14.9%, respectively. At the resection level, the distance from the buccal bone to the mesial and distal roots of two-rooted MFMs was 2.24 and 3.15 mm, respectively, while the distance was 2.44, 2.01, and 8.55 mm for the mesial, distobuccal, and distolingual roots of three-rooted MFMs, respectively. The distance from the buccal bone to each root was longer in men than in women. The largest distance for complete root resection was detected for the distal root in two-rooted MFMs and for the distolingual root in three-rooted MFMs. CONCLUSIONS: The prevalence of three-rooted MFMs is common in the Mongoloid population. The distance from the buccal bone to root apex differs according to root configurations and sex. Surgical access to the distolingual root is difficult because of the long access distance.

Presence of isthmi in mandibular mesial roots and associated factors: an in vivo analysis.

PURPOSE: To investigate the prevalence of isthmi and middle mesial (MM) canals in the mesial roots of mandibular first molars (MFM) in a Mongoloid subpopulation and to evaluate their association with demographic and anatomic characteristics. METHODS: Cone-beam computed tomography (CBCT) images of 496 patients with 823 MFMs were selected and analyzed. The following data were collected: patient age and gender, side, presence and distribution of MM canal and isthmus, distance between mesiobuccal (MB) and mesiolingual (ML) orifices, and MB-ML root canal system (RCS) morphology. Logistic regression was used to determine the association between demographic and anatomic characteristics and the presence of isthmi in the apical third. RESULTS: The overall prevalence of isthmus and an MM canal in MFM was 64.6% and 10.8%, respectively. The highest prevalence of isthmi and MM canals was found in patients of ≤ 20 and of 41-60 years, respectively (p < 0.05). The prevalence of isthmi declines with age. A total of 41.3% of the MFMs had isthmi in the apical third of the mesial roots. Younger age, shorter MB-ML orifice distance, and Weine type II RCS increased the probability of the presence of an isthmus in the apical third (p < 0.05). CONCLUSION: The prevalence of isthmus in MFM is high in the subject population, but the prevalence of MM canals is not as high as previously reported. Demographic and anatomic characteristics could aid clinicians to better predict the presence of MM canal and an isthmus.

External root resorption in maxillary and mandibular second molars associated with impacted third molars: a cone-beam computed tomographic study.

OBJECTIVE: To separately investigate the prevalence and risk factors of external root resorption (ERR) in maxillary and mandibular second molars (M2s) adjacent to impacted third molars (M3s). MATERIALS AND METHODS: CBCT scans involving 184 maxillary and 323 mandibular impacted M3s were included. Age, gender, the impaction status of M3, the presence, severity, and location of ERR in M2 were assessed. Risk factors were identified by multivariate logistic regression analyses. RESULTS: The prevalence of ERR was 32.6% in maxillary and 52.9% in mandibular M2s (P < 0.001). Mesio-angulated and deeply impacted M3s were identified as risk factors for both ERR in maxillary and mandibular M2s (P < 0.05). Besides, age over 25 increased the risk of ERR in maxillary M2s (P < 0.05). ERR in maxillary M2s was overall more severe than that in mandibular M2s (P < 0.001). For maxillary M2s, ERR mostly occurred at the apical third, while the mandibular M2s ERR was most frequently detected at the cervical third. CONCLUSIONS: ERR occurring in M2s adjacent to impacted M3s is common, especially in mandibular M2s. ERR in maxillary M2s cannot be neglected because of its relatively high severity. Mesial angulation and impaction depth of M3 are significantly associated with ERR in M2s. For ERR in maxillary M2s, age is another predictive parameter. CLINICAL RELEVANCE: Considering the presence of ERR is associated with M3s' impaction, watchful monitoring or prophylactic removal of impacted M3s should be deliberated especially for the patients over 25 years and with mesially inclined and deeply positioned M3s.

Regenerative Endodontics Versus Apexification in Immature Permanent Teeth with Apical Periodontitis: A Prospective Randomized Controlled Study.

INTRODUCTION: The aim of the study was to compare the outcomes of regenerative endodontic treatment (RET) and apexification on immature permanent teeth with pulp necrosis and apical periodontitis. METHODS: A total of 118 patients (118 teeth) were recruited and randomly assigned to either RET or apexification treatment. Each treatment group was divided into 2 subgroups according to the etiology: dens evaginatus or trauma. Clinical symptoms and complications were recorded, and cone-beam computed tomographic imaging with a limited field of view was used to measure the change of root length, root thickness, and apical foramen size at the 12-month follow-up. The t test/rank sum test and Fisher exact test were applied to compare the change of root morphology between RET and apexification. RESULTS: One hundred three of 118 cases were completed at the 12-month follow-up. The survival rate was 100% for both treatment groups. All cases were asymptomatic with apical healing. The RET group showed a significant increase in root length and root thickness compared with the apexification group (P < .05). In the RET group, the cases caused by dens evaginatus achieved increased root length and root thickness compared with those caused by trauma (P < .05). CONCLUSIONS: RET and apexification achieved a comparable outcome in regard to the resolution of symptoms and apical healing. RET showed a better outcome than apexification regarding increased root thickness and root length. The etiology had an impact on the outcome of RET. Dens evaginatus cases showed better prognoses than trauma cases after RET.

Folate­targeted polymeric micelles loaded with superparamagnetic iron oxide as a contrast agent for magnetic resonance imaging of a human tongue cancer cell line.

The aim of the present study was to investigate the feasibility of using folate­targeted superparamagnetic iron oxide nanoparticles (SPIO) as a magnetic resonance (MR) contrast agent that targets human tongue cancer cells. Folate­targeted and folate­free bilayer micelles composed of a diblock copolymer of polyethylene glycol (PEG) and poly­caprolactone (PCL) that encapsulated SPIO in their hydrophobic core (SPIO­PEG­PCL micelles) were synthesized. The cytotoxicity of each set of micelles towards Tca­8113 cells was examined using methyl thiazolyl tetrazolium (MTT) assays. Tca­8113 cells were incubated with folate­free SPIO­PEG­PCL micelles and folate­targeted SPIO­PEG­PCL micelles at an Fe concentration of 80 µg/ml for 0.5, 1 and 2 h. MR imaging was subsequently performed and relative T2 relaxation time was recorded. Endocytosis of each micelle type was observed using Prussian blue staining. The MTT assays demonstrated that varying concentrations of folate­targeted SPIO­PEG­PCL micelles did not result in statistically significant differences in Tca­8113 cell viability when compared with folate­free SPIO­PEG­PCL micelles (F=0.698; P=0.676). In the MR images obtained, decreased T2­weighted signal intensity was observed for the folate­targeted SPIO­PEG­PCL and folate­free SPIO­PEG­PCL micelle treatments, particularly after the 2­h incubation period. However, the folate­targeted micelles exhibited a significantly greater decrease in signal intensity and a higher relative T2 relaxation time at each time point (P=0.002). In addition, blue intracellular particles were observed in the cells that were incubated with each type of micelle and stained with Prussian blue. However, a greater number of blue particles underwent endocytosis in the folate­targeted group. Thus, folate­targeted SPIO­PEG­PCL micelles exhibited preferential targeting of Tca­8113 cells when compared with folate­free SPIO­PEG­PCL micelles, and these results support the potential for these micelles to be used for the early diagnosis of tongue cancer.

Nanoparticles for Colorectal Cancer Targeted Drug Delivery and MR Imaging: Current Situation and Perspectives.

The application of nanoparticles (NPs) offers new prospects for the early detection and effective therapy of colorectal cancer (CRC). Various NPs have been designed and explored as diagnostic and/or therapeutic drug delivery vehicles. To achieve selective treatment and to reduce toxicity, these nanoparticles are usually endowed with targeting abilities. Passive targeting is based on the extravasation and enhanced permeability and retention effect of tumors, while active targeting always involves binding to specific ligands that are recognizable by CRC tissues, such as vascular endothelial growth factor, folate, monoclonal antibodies (mAbs), aptamers, and membrane penetrating peptides. In addition, contrast agents, such as gadolinium complexes and iron oxide particles, can be introduced into the delivery system to enable MR imaging and lesion detection. Furthermore, smart carriers have been gradually applied to the delivery system. These carriers are designed to respond to certain changes in the bio-environment and release encapsulated contents on demand, thus achieving effective drug concentrations at tumor sites. This review focuses on recent advances of NP technology for the targeted diagnosis and treatment of CRC and aims to unveil the emerging possibilities of using nanocarriers to enhance therapeutic applications.

Evaluation of intestinal tuberculosis by multi-slice computed tomography enterography.

BACKGROUND: Multi-slice computed tomography enterography (MSCTE) is now widely used to diagnose and monitor intestinal disease. Preliminary studies suggest that MSCTE may be useful in detecting intestinal tuberculosis (ITB). We sought to assess the use of MSCTE for the diagnosis of ITB in our medical center. METHODS: In this retrospective study, 15 patients (11 males and 4 females, 6 to 65 years old) were enrolled and diagnosed with ITB by MSCTE. Diagnosis were confirmed by pathology or clinical criteria. Two experienced abdominal radiologists evaluated the images and defined the location, number, shape, edge, surrounding tissue alterations of ITB and other associated changes in the peritoneum, mesentery and solid abdominal organs. RESULTS: The interval between the onset of symptoms and diagnosis varied from 20 days to 10 years. The most common symptom was abdominal pain (80 %). The ileocecum was the most common site affected by ITB (87 %). Morphological MSCTE findings were variable and included multi-segmental symmetric intestinal mural thickening found in 6 patients (40 %), solid masses found in 9 patients (60 %), and enlarged lymph nodes (LNs) found in 13 (87 %) patients. Non-enhancing central necrosis and rim enhancement were noted in 10 patients (67 %). CONCLUSIONS: Characteristic MSCTE findings of ITB include solid mass or multi-segmental symmetric mural thickening involving the ileocecal area and rim enhanced LNs. Knowledge of these features in combination with a high index of suspicion can be useful in early diagnosis of ITB.

Spectrum of appearances on CT and MRI of hepatic epithelioid hemangioendothelioma.

BACKGROUND: This study aims to analyze the computed tomography (CT) and magnetic resonance imaging(MRI) characteristics of hepatic epithelioid hemangioendothelioma (HEHE). METHODS: Eleven patients with histopathologically confirmed HEHE via surgical excision or biopsy were included. Imaging findings of these 11 patients were retrospectively analyzed (CT images obtained from all patients and MR images from five patients). Patterns of growth, characteristics of distribution, density/signal features, patterns of contrast enhancement, and changes of adjacent tissues were evaluated. RESULTS: HEHE is characterized by multiple lesions in the liver. HEHE could be further categorized as three types when considering patterns of growth: nodular type(5 cases), coalescent type(1 case) and mixed type(5 cases). In this study, a total of 312 lesions were detected, 214(74.3%) of which were subcapsular. All lesions appeared as hypodense while round lower density were found within 10 lesions(<2 cm) on unenhanced CT images. On MRI, all lesions demonstrated low signal intensity on T1 weighted images and high heterogeneous signal intensity on T2 weighted images when compared to the normal liver parenchyma. Other imaging features included "lollipop sign"(6 cases) and capsular retraction(6 cases). On contrast-enhanced CT and MRI, lesions smaller than 2.0 cm mostly showed mild homogeneous enhancement (214/227, 94.3%); lesions measuring 2.0-3.0 cm in diameter showed ring-like enhancement (16/53,30.2%) and heterogeneous delayed enhancement (29/53,54.7%); lesions larger than 3.0 cm demonstrated heterogeneous delayed enhancement (26/32, 81.3%). CONCLUSION: The imaging findings of HEHE showed some typical imaging features and size-dependent patterns with contrast enhancement on both CT and MR images, these features can be used for accurate imaging diagnosis of HEHE.

Diagnostic and post-treatment CT appearance of biopsy proven mixed Cryptococcus and Candida cholangitis.

Cryptococcus neoformans and Candida are common opportunistic pathogens of human. There is very limited literature on Cryptococcus neoformans cholangitis or Candida cholangitis in immunocompetent patient while mixed Cryptococcus neoformans and Candida cholangitis has not been reported in the literature ever before. We hereby report the imaging findings of a case of mixed Cryptococcus neoformans and Candida cholangitis in an immunocompetent boy. The CT features included nodules in the cystic duct and common bile duct, dilatation of the intra- and extrahepatic bile ducts with mural thickening, irregular hypodense mass-like lesion extending along the bile ducts from the liver hilum to the periphery which was confirmed by the presence of enlarged and confluent lymph nodes. CT characteristics can contribute to timely diagnosis and treatment of this disease.

Retrobulbar and common carotid artery haemodynamics and carotid wall thickness in patients with non-arteritic anterior ischaemic optic neuropathy.

PURPOSE: To evaluate retrobulbar and common carotid artery (CCA) haemodynamics and CCA wall thickness in the patients with acute unilateral non-arteritic anterior ischaemic optic neuropathy (NAION) by colour Doppler imaging (CDI). METHODS: Twenty-two patients with acute unilateral NAION and 28 age- and sex-matched controls were included in this prospective study. By CDI, the peak-systolic velocity (PSV) and end-diastolic velocity (EDV) of the ophthalmic artery (OA) and central retinal artery (CRA) in both eyes were measured or calculated. Intima-media thickness (IMT) and blood flow velocity were measured in both CCAs. Measurements on the affected side of the patients were compared to the contralateral healthy side and the controls. RESULTS: Compared to the controls, the blood flow velocities in the CRA were significantly decreased (p < 0.05), and IMT of CCA was greater (p < 0.001) on the affected side, while the blood flow velocities in the OA and CCA showed no statistically significant difference. The blood flow velocities in the CRA tended to be reduced bilaterally in the patients with NAION, and the difference of PSV and EDV was insignificant between the affected eyes and fellow eyes (p = 0.69, 0.86 respectively). No marked differences between the controls and the unaffected sides were detected, neither for the blood flow velocities in CRA, OA, CCA nor for the IMT of CCA. CONCLUSION: Decreased blood velocities of CRA and increased carotid wall thickness were found on the affected side of acute NAION compared to healthy controls. These findings might be potentially useful in the treatment monitoring of NAION.

Tumor volumes measured from static and dynamic 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography scan: comparison of different methods using magnetic resonance imaging as the criterion standard.

OBJECTIVE: The objective of this study was to compare the accuracy of calculating the primary tumor volumes using a gradient-based method and fixed threshold methods on the standardized uptake value (SUV) maps and the net influx of FDG (Ki) maps from positron emission tomography-computed tomography (PET-CT) images. MATERIALS AND METHODS: Newly diagnosed patients with head and neck cancer were recruited, and dynamic PET-CT scan and T2-weighted magnetic resonance imaging were performed. The maps of Ki and SUV were calculated from PET-CT images. The tumor volumes were calculated using a gradient-based method and a fixed threshold method at 40% of maximal SUV or maximal Ki. Four kinds of volumes, VOLKi-Gra (from the Ki maps using the gradient-based method), VOLKi-40% (from the Ki maps using the threshold of 40% maximal Ki), VOLSUV-Gra (from the SUV maps using the gradient-based method), and VOLSUV-40% (from the SUV maps using the threshold of 40% maximal SUV), were acquired and compared with VOLMRI (the volumes acquired on T2-weighted images) using the Pearson correlation, paired t test, and similarity analysis. RESULTS: Eighteen patients were studied, of which 4 had poorly defined tumors (PDT). The positron emission tomography-derived volumes were as follows: VOLSUV-40%, 2.1 to 41.2 cm (mean [SD], 12.3 [10.6]); VOLSUV-Gra, 2.2 to 28.1 cm (mean [SD], 13.2 [8.4]); VOLKi-Gra, 2.4 to 17.0 cm (mean [SD], 9.5 [4.6]); and VOLKi-40%, 2.7 to 20.3 cm (mean [SD], 12.0 [6.0]). The VOLMRI ranged from 2.9 to 18.1 cm (mean [SD], 9.1 [3.9]). The VOLKi-Gra significantly correlated with VOLMRI with the highest correlation coefficient (PDT included, R = 0.673, P = 0.002; PDT excluded, R = 0.841, P < 0.001) and presented no difference from VOLMRI (P = 0.672 or 0.561, respectively, PDT included and excluded). The difference between VOLKi-Gra and VOLMRI was also the smallest. CONCLUSIONS: The tumor volumes delineated on the Ki maps using the gradient-based method are more accurate than those on the SUV maps and using the fixed threshold methods.

Image-derived arterial input function in dynamic positron emission tomography-computed tomography: a method using both positron emission tomographic and computed tomographic images.

OBJECTIVE: This study aimed to study the feasibility of measuring the arterial input function (AIF) in dynamic positron emission tomography (PET) studies using both PET and computed tomographic (CT) images. MATERIAL AND METHODS: Eighteen newly diagnosed patients with head and neck cancer were recruited, and dynamic PET-CT scan was performed with contrast-enhanced CT. Phantom study with PET-CT scan was also performed for partial volume effect (PVE) correction. The PET-CT AIF was measured from both PET-CT images and corrected for PVE, together with the PET AIF, which was calculated from PET images. Both AIFs were used for calculating the net flux of [18F]fluoro-2-deoxy-D-glucose, Ki, and the correlation between these 2 sets of Ki was studied by Spearman correlation. RESULTS: The PET-CT AIF was much larger than the PET AIF, whereas the Ki's by PET-CT AIF were much lower than the Ki's by PET AIF. However, the 2 sets of Ki were highly correlated (r = 0.969, P < 0.001). CONCLUSIONS: It is feasible to measure AIF in PET-CT images without blood sampling. The PET-CT AIF is very different from the PET AIF calculated by PET images only without PVE correction. The PET-CT AIF may be a better choice because the Ki by PET AIF can be overestimated.

[Radiation-induced maxillary malignancies: complications of radiotherapy treatment for head-neck malignant tumors].

OBJECTIVE: To investigate the incidence of radiation-induced maxillary malignancy after radiotherapy for head and neck cancer. METHODS: A total of 273 patients who suffered from osteoradionecrosis after radiotherapy for head and neck cancer were evaluated. Among them, 6 patients were presented with carcinoma and sarcoma arising from maxillary area after radiotherapy. RESULTS: Radiation-induced maxillary cancers happened at a rate of 2.2% in the patients with osteoradionecrosis. There were no statistically significant differences in age, sex and the time interval between the radiotherapy and the cancer occurrence. CONCLUSIONS: Radiation-induced malignancy after radiotherapy for head and neck cancer is mainly located in maxilla, presenting as squamous cell carcinoma or sarcoma of the maxillary sinus.