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1.
Ann Oncol ; 30(3): 471-477, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30596812

ABSTRACT

BACKGROUND: The survival advantage of induction chemotherapy (IC) followed by locoregional treatment is controversial in locally advanced head and neck squamous cell carcinoma (LAHNSCC). We previously showed feasibility and safety of cetuximab-based IC (paclitaxel/carboplatin/cetuximab-PCC, and docetaxel/cisplatin/5-fluorouracil/cetuximab-C-TPF) followed by local therapy in LAHNSCC. The primary end point of this phase II clinical trial with randomization to PCC and C-TPF followed by combined local therapy in patients with LAHNSCC stratified by human papillomavirus (HPV) status and T-stage was 2-year progression-free survival (PFS) compared with historical control. PATIENTS AND METHODS: Eligible patients were ≥18 years with squamous cell carcinoma of the oropharynx, oral cavity, nasopharynx, hypopharynx, or larynx with measurable stage IV (T0-4N2b-2c/3M0) and known HPV by p16 status. Stratification was by HPV and T-stage into one of the two risk groups: (i) low-risk: HPV-positive and T0-3 or HPV-negative and T0-2; (ii) intermediate/high-risk: HPV-positive and T4 or HPV-negative and T3-4. Patient reported outcomes were carried out. RESULTS: A total of 136 patients were randomized in the study, 68 to each arm. With a median follow up of 3.2 years, the 2-year PFS in the PCC arm was 89% in the overall, 96% in the low-risk and 67% in the intermediate/high-risk groups; in the C-TPF arm 2-year PFS was 88% in the overall, 88% in the low-risk and 89% in the intermediate/high-risk groups. CONCLUSION: The observed 2-year PFS of PCC in the low-risk group and of C-TPF in the intermediate/high-risk group showed a 20% improvement compared with the historical control derived from RTOG-0129, therefore reaching the primary end point of the trial.


Subject(s)
Neoplasm Recurrence, Local/drug therapy , Papillomaviridae/pathogenicity , Papillomavirus Infections/drug therapy , Squamous Cell Carcinoma of Head and Neck/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carboplatin/administration & dosage , Cetuximab/administration & dosage , Cisplatin/administration & dosage , Docetaxel/administration & dosage , Female , Fluorouracil/administration & dosage , Humans , Induction Chemotherapy/adverse effects , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/virology , Neoplasm Staging , Paclitaxel/administration & dosage , Papillomaviridae/drug effects , Papillomaviridae/genetics , Papillomavirus Infections/pathology , Papillomavirus Infections/virology , Progression-Free Survival , Squamous Cell Carcinoma of Head and Neck/pathology , Squamous Cell Carcinoma of Head and Neck/virology
3.
AJNR Am J Neuroradiol ; 37(11): 2134-2137, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27418476

ABSTRACT

The purpose of this study was to present the imaging features of primary and secondary malignant lacrimal sac and nasolacrimal duct tumors and their pattern of tumor spread in 18 patients. The most common tumor histology in our series was squamous cell carcinoma. In 15/18 patients, tumor involved both the lacrimal sac and duct at the time of diagnosis. In 11/16 patients on CT, the nasolacrimal bony canal was smoothly expanded without erosive changes. The medial canthus region (16/18) was a frequent site of direct tumor spread. Two patients had intraconal orbital spread of tumor. Tumor spread to the sinus or nasal cavity was observed in 5/13 primary tumors. Only 1 patient presented with nodal metastasis. There was no intracranial tumor extension, perineural tumor spread along the infraorbital nerve, distant metastasis, or dacryocystocele formation in any of the patients at the time of diagnosis.

4.
AJNR Am J Neuroradiol ; 37(10): 1925-1929, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27390322

ABSTRACT

SMARCB1 (INI1)-deficient sinonasal carcinomas were first described in 2014, and this series of 17 cases represents the first imaging description. This tumor is part of a larger group of SMARCB1-deficient neoplasms, characterized by aggressive behavior and a rhabdoid cytopathologic appearance, that affect multiple anatomic sites. Clinical and imaging features overlap considerably with other aggressive sinonasal malignancies such as sinonasal undifferentiated carcinoma, which represents a common initial pathologic diagnosis in this entity. SMARCB1 (INI1)-deficient sinonasal tumors occurred most frequently in the nasoethmoidal region with invasion of the adjacent orbit and anterior cranial fossa. Avid contrast enhancement, intermediate to low T2 signal, and FDG avidity were frequent imaging features. Approximately half of the lesions demonstrated calcification, some with an unusual "hair on end" appearance, suggesting aggressive periosteal reaction.

5.
Ann Oncol ; 26(7): 1476-80, 2015 Jul.
Article in English | MEDLINE | ID: mdl-26025965

ABSTRACT

BACKGROUND: Enhanced phosphoinositide 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway is one of the key adaptive changes accounting for epidermal growth factor receptor (EGFR) inhibitor-resistant growth in head and neck squamous cell carcinoma (HNSCC). We designed a phase II clinical trial of EGFR tyrosine kinase inhibitor (TKI), erlotinib, in association with the mTOR inhibitor, everolimus, based on the hypothesis that the downstream effects of Akt through inhibition of mTOR may enhance the effectiveness of the EGFR-TKI in patients with recurrent/metastatic HNSCC. PATIENTS AND METHODS: Patients with histologically or cytologically confirmed platinum-resistant HNSCC received everolimus 5 mg and erlotinib 150 mg daily orally until disease progression, intolerable toxicity, investigator or patient decision. Cytokines and angiogenic factors profile, limited mutation analysis and p16 immunohistochemistry status were included in the biomarker analysis. RESULTS: Of the 35 assessable patients, 3 (8%) achieved partial response at 4 weeks, 1 confirmed at 12 weeks; overall response rate at 12 weeks was 2.8%. Twenty-seven (77%) patients achieved disease stabilization at 4 weeks, 11 (31%) confirmed at 12 weeks. Twelve-week progression-free survival (PFS) was 49%, median PFS 11.9 weeks and median overall survival (OS) 10.25 months. High neutrophil gelatinase lipocalin (P = 0.01) and vascular endothelial growth factor (VEGF) (P = 0.04) plasma levels were significantly associated with worse OS. CONCLUSIONS: The combination of erlotinib and everolimus did not show significant benefit in unselected patients with platinum-resistant metastatic HNSCC despite a manageable toxicity profile. Markers of tumor invasion and hypoxia identify a group of patients with particularly poor prognosis. CLINICAL TRIAL NUMBER: NCT00942734.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Drug Resistance, Neoplasm/drug effects , Head and Neck Neoplasms/drug therapy , Neoplasm Recurrence, Local/drug therapy , Salvage Therapy , Administration, Oral , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/secondary , Erlotinib Hydrochloride/administration & dosage , Everolimus/administration & dosage , Female , Follow-Up Studies , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Humans , Male , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Platinum/administration & dosage , Prognosis , Survival Rate
6.
AJNR Am J Neuroradiol ; 34(9): 1818-22, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23764725

ABSTRACT

BACKGROUND AND PURPOSE: Imaging correlates of genetic expression have been found for prognostic and predictive biomarkers of some malignant diseases, including breast and brain tumors. This study tests the hypothesis that imaging findings correlate with relevant genomic biomarkers in oral cavity squamous cell carcinoma. MATERIALS AND METHODS: Surplus frozen tissue from 27 untreated patients with oral cavity squamous cell carcinoma who underwent preoperative CT imaging was analyzed for gene expression. A team of neuroradiologists blinded to the genomic analysis results reviewed an extensive list of CT findings. The imaging correlated with genomic expression for cyclin D1, angiogenesis-related genes (vascular endothelial growth factor receptors and ligands), which relate to enhancement on the basis of other tumor types; and epidermal growth factor receptor, which may relate to proliferation and mass effect. RESULTS: Expression of vascular endothelial growth factor receptors 1 and 2 correlated with the enhancement of the primary tumor (P = .018 and P = .025, respectively), whereas the epidermal growth factor receptor correlated with mass effect (P = .03). Other exploratory correlations included epidermal growth factor receptor to perineural invasion (P = .05), and certain vascular endothelial growth factor receptors and ligands to mass effect (P = .03) and increased (P = .01) or decreased (P = .02) primary tumor size. CONCLUSIONS: We report that CT imaging correlates with gene expression in untreated oral cavity squamous cell carcinoma. Enhancement of the primary tumor and degree of mass effect correlate with relevant genomic biomarkers, which are also potential drug targets. Eventually, treatment decisions may be aided by combining imaging findings into meaningful phenotypes that relate directly to genomic biomarkers.


Subject(s)
Angiogenic Proteins/genetics , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/genetics , Genes, bcl-1/genetics , Mouth Neoplasms/diagnostic imaging , Mouth Neoplasms/genetics , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Genetic Predisposition to Disease/genetics , Genome, Human/genetics , Humans , Male , Middle Aged , Statistics as Topic
7.
AJNR Am J Neuroradiol ; 34(10): 2005-9, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23660291

ABSTRACT

BACKGROUND AND PURPOSE: Human papillomavirus-positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics. MATERIALS AND METHODS: A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ(2) test was used for the matched-pair analysis. RESULTS: By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002). CONCLUSIONS: In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.


Subject(s)
Carcinoma, Squamous Cell , Human papillomavirus 16/isolation & purification , Oropharyngeal Neoplasms , Papillomavirus Infections/epidemiology , Tomography, X-Ray Computed , Adult , Aged , Alcohol Drinking/epidemiology , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/secondary , Female , Humans , Incidence , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Oropharyngeal Neoplasms/diagnostic imaging , Oropharyngeal Neoplasms/epidemiology , Oropharyngeal Neoplasms/pathology , Papillomavirus Infections/pathology , Prognosis , Retrospective Studies , Risk Factors , Single-Blind Method , Smoking/epidemiology
8.
AJNR Am J Neuroradiol ; 34(8): 1637-42, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23471023

ABSTRACT

BACKGROUND AND PURPOSE: Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity. MATERIALS AND METHODS: Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data. RESULTS: New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity. CONCLUSIONS: Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity.


Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/radiotherapy , Lymph Nodes/diagnostic imaging , Oropharyngeal Neoplasms/diagnostic imaging , Oropharyngeal Neoplasms/radiotherapy , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed/statistics & numerical data , Carcinoma, Squamous Cell/epidemiology , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Oropharyngeal Neoplasms/epidemiology , Prevalence , Prognosis , Reproducibility of Results , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Texas/epidemiology , Tomography, X-Ray Computed/methods , Treatment Outcome
9.
AJNR Am J Neuroradiol ; 32(10): 1926-9, 2011.
Article in English | MEDLINE | ID: mdl-21799037

ABSTRACT

Palatal tumors are often treated with palatectomy or maxillectomy. The resulting surgical defect produces an oroantral communication. An obturator is a removable prosthesis used to close the palatal or maxillectomy defect. Fifteen patients who had undergone palatectomy or maxillectomy for carcinoma and subsequent obturator prosthesis placement were retrospectively studied. Obturators were characterized by Hounsfield units and were subdivided into 3 CT imaging groups: either hyperattenuated, hollow (air-containing), or heterogeneous (isoattenuated to hyperattenuated with internal foci of air). Eight patients had hyperattenuated obturators either representing acrylic resin or Trusoft. Four patients had hollow obturators also composed of acrylic resin or Trusoft. Three patients had heterogeneous obturators, which were composed of only Trusoft. The postoperative imaging of patients treated for palatal or maxillary tumors can be complicated by the presence of obturator prostheses. The intent of this article was to familiarize the reader with the CT imaging features of obturator prostheses.


Subject(s)
Maxilla/diagnostic imaging , Maxilla/surgery , Palatal Obturators , Palate/diagnostic imaging , Palate/surgery , Tomography, X-Ray Computed/methods , Adult , Dental Prosthesis Retention , Female , Humans , Male , Oral Surgical Procedures/instrumentation , Palatal Neoplasms/diagnostic imaging , Palatal Neoplasms/surgery , Treatment Outcome
10.
AJNR Am J Neuroradiol ; 32(7): 1212-5, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21778243

ABSTRACT

One case report of a schwannoma involving the sympathetic plexus in the carotid canal has been reported previously. This article presents 2 additional cases of this rare entity with associated clinical and unique radiographic findings. All patients presented with diplopia among other symptoms, and they had enhancing masses that smoothly expanded the carotid canal on cross-sectional imaging. Comparison with the index case and differential diagnosis of more common pathologies in this area are discussed.


Subject(s)
Carotid Arteries/diagnostic imaging , Head and Neck Neoplasms/diagnostic imaging , Neurilemmoma/diagnostic imaging , Superior Cervical Ganglion/diagnostic imaging , Tomography, X-Ray Computed , Aged , Carotid Arteries/innervation , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Sympathetic Fibers, Postganglionic/diagnostic imaging
11.
AJNR Am J Neuroradiol ; 32(8): 1532-8, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21757532

ABSTRACT

BACKGROUND AND PURPOSE: Radiographic determination of viable disease in cervical adenopathy following RT for head and neck cancer can be challenging. The purpose of this study was to evaluate the utility of US, with or without FNA, in regard to the postradiotherapy effects on documented metastatic adenopathy in patients with oropharyngeal cancer. MATERIALS AND METHODS: This study included 133 patients with node-positive oropharyngeal cancer who were irradiated from 1998 to 2004. Sonographic evaluation was performed within 6 months of completion of radiation. Posttreatment US results were compared with pretreatment CT images and were recorded as the following: progression, suspicious, indeterminate, posttreatment change, or regression (positive) versus nonsuspicious or benign (negative). FNAC was classified as nondiagnostic, negative, indeterminate, or positive. Results of US and US-guided FNAC were correlated with findings at neck dissection and disease outcome. RESULTS: Of 203 sonographic examinations, 90% were technically feasible and yielded a nonequivocal imaging diagnosis. Of 87 US-guided FNAs, 71% yielded a nonequivocal tissue diagnosis. The PPV and NPV of initial posttreatment US were 11% and 97%. Sensitivity and specificity were 92% and 28%. The PPV and NPV of US-guided FNA were 33% and 95%, and the sensitivity and specificity were 75% and 74%. On serial sonographic surveillance, of 33 patients with nonsuspicious findings, only 1 (3%) had neck recurrence. Of 22 patients with questionable findings on CT and negative findings on US, none had a neck recurrence. CONCLUSIONS: In experienced hands, serial US is an inexpensive noninvasive reassuring follow-up strategy after definitive head and neck RT, even when CT findings are equivocal.


Subject(s)
Neck/diagnostic imaging , Oropharyngeal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neck/pathology , Oropharyngeal Neoplasms/pathology , Retrospective Studies , Ultrasonography
12.
AJNR Am J Neuroradiol ; 31(7): 1261-5, 2010 Aug.
Article in English | MEDLINE | ID: mdl-20360337

ABSTRACT

BACKGROUND AND PURPOSE: The larynx is a rare site for primary NHL. Fewer than 100 cases have been reported in the literature, with the largest imaging review involving only 4 patients. We describe the findings of laryngeal lymphoma on CT, PET, and MR imaging and identify features that may distinguish laryngeal lymphoma from the far more common laryngeal squamous cell carcinoma. MATERIALS AND METHODS: Multi-institutional retrospective chart review revealed 20 patients with histopathologically proved laryngeal lymphoma. Pretreatment CT, PET, and MR images were reviewed by a head and neck radiologist, focusing on extent of tumor, cervical lymph node involvement, and enhancement patterns. RESULTS: Patients ranged from 30 to 90 years of age with a mean of 63 years at the time of initial diagnosis and a 2:1 female predominance. The average tumor size was 37 +/- 19 mm. In all patients, laryngeal lymphoma involved the supraglottis but also extended into the glottis (65%) and hypopharynx (60%). The subglottis was less frequently involved (35%). Laryngeal cartilage invasion and cervical lymphadenopathy were each seen in 20% of patients. Lymphoma was consistently FDG-avid (100%) and usually enhanced uniformly with iodinated contrast (73%). Necrosis and calcification were not seen in any cases. CONCLUSIONS: Although laryngeal lymphoma is rare, particular imaging features suggest this diagnosis. A large uniformly enhancing supraglottic tumor without central necrosis and without cervical lymphadenopathy is a characteristic finding of lymphoma. Similar to squamous cell carcinoma, lymphoma may extend into the subglottis, pharynx, and laryngeal cartilages.


Subject(s)
Laryngeal Neoplasms/diagnosis , Lymphoma, B-Cell, Marginal Zone/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Glottis/diagnostic imaging , Glottis/pathology , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Necrosis , Pharynx/diagnostic imaging , Pharynx/pathology , Positron-Emission Tomography , Retrospective Studies , Tomography, X-Ray Computed
14.
AJNR Am J Neuroradiol ; 31(4): 761-6, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19942694

ABSTRACT

BACKGROUND AND PURPOSE: ORN is a postradiation complication that has been well-documented in the medical literature. Most cases in the head and neck have been described in the mandible or larynx. Only a handful of cases in the hyoid bone are documented, all in the clinical literature. Our purpose is to present the clinical and imaging features of ORN involving the hyoid bone. MATERIALS AND METHODS: We present a case series of 13 patients with imaging findings highly suggestive of hyoid ORN after radiation therapy for head and neck cancers, in which we observed progressive features of hyoid disruption along with adjacent soft-tissue ulceration. RESULTS: Pretreatment imaging, when available, showed a normal hyoid. Typical postradiation imaging findings included an initial tongue base ulcerative lesion with air approaching the hyoid bone, and subsequent observation of hyoid fragmentation, often with intraosseous or peri-hyoid air and the absence of associated mass-like enhancement. CONCLUSIONS: Findings of hyoid fragmentation, cortical disruption, and soft tissue or intraosseous air in the postradiation therapy patient should strongly suggest the diagnosis of hyoid ORN. It is important recognize this entity because the diagnosis may preclude potentially harmful diagnostic intervention and allow more appropriate therapy.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Hyoid Bone/radiation effects , Image Processing, Computer-Assisted , Osteoradionecrosis/diagnostic imaging , Otorhinolaryngologic Neoplasms/radiotherapy , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Female , Humans , Hyoid Bone/diagnostic imaging , Male , Middle Aged , Pharynx/diagnostic imaging , Pharynx/radiation effects , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Retrospective Studies , Tongue/radiation effects
15.
AJNR Am J Neuroradiol ; 30(4): 800-2, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19131415

ABSTRACT

BACKGROUND AND PURPOSE: Thyroglossal duct cyst remnants (TGDC) are a common midline neck mass that is mostly encountered in childhood. Enlargement after an upper respiratory tract infection or, rarely, cancer within TGDC, is a well-documented phenomenon. In the pediatric population, it rarely presents a diagnostic quandary. However, in an adult population, especially one treated for head and neck cancer with radiation therapy (RT), any enlarging cystic mass would be concerning and would raise the specter of metastatic disease. We propose that inflammation associated with RT results in secretory stimulation and/or obstruction of a persistent thyroglossal duct, resulting in changes within a pre-existing TGDC. MATERIALS AND METHODS: We present a case series of 8 patients with subclinical TGDC treated with RT for various head and neck cancers, in which we radiographically observed enlargement or cystic transformation (more cystlike appearance) of the cyst. RESULTS: In all patients there was in retrospect a small thyroglossal remnant, though not necessarily a discernible cyst, that was observed after radiotherapy to enlarge and become more cyst-like. CONCLUSIONS: In patients with pre-existing TGDC undergoing RT to the neck, enlargement and cystic transformation may be encountered radiographically and should not be misinterpreted as a tumor. Our series bolsters a recently reported description of the same phenomenon.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Head and Neck Neoplasms/radiotherapy , Thyroglossal Cyst/diagnostic imaging , Tomography, X-Ray Computed , Adult , Carcinoma, Mucoepidermoid/radiotherapy , Humans , Inflammation/diagnostic imaging , Male , Middle Aged , Radiation Injuries/diagnostic imaging , Radiotherapy/adverse effects , Retrospective Studies , Thyroglossal Cyst/etiology
16.
AJNR Am J Neuroradiol ; 30(1): 42-5, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18653688

ABSTRACT

Two modified fast spin-echo (FSE) techniques (a 2-point and a single-scan triple-echo Dixon) were used for T2-weighted imaging of the head and neck in 7 patients along with conventional FSE with fat saturation. Both Dixon techniques provided consistent and more uniform fat suppression (FS) than conventional FSE. The 2-point Dixon technique was noted to be more susceptible to motion artifacts. The triple-echo Dixon technique offered the best scan time efficiency and overall image quality.


Subject(s)
Adipose Tissue/pathology , Algorithms , Head and Neck Neoplasms/pathology , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Pattern Recognition, Automated/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Pilot Projects , Reproducibility of Results , Sensitivity and Specificity , Spin Labels
17.
AJNR Am J Neuroradiol ; 29(3): 558-62, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18202241

ABSTRACT

BACKGROUND AND PURPOSE: The purpose of this study was to review CT imaging findings of soft tissue mucosal ulceration in patients following radiation treatment for head and neck malignancies and to correlate these with patient outcomes. MATERIALS AND METHODS: The CT examinations in 20 patients with soft tissue ulceration after radiation therapy for treatment of head and neck cancer were reviewed. External beam radiation therapy was completed between 3 and 61 months (mean, 11.5 months) before the initial diagnosis of soft tissue ulceration. In all 20 patients, the initial diagnosis was made or confirmed on CT examination. RESULTS: Of the 20 ulcerations, 12 did not demonstrate enhancement, and the results of biopsy in 9 of these 12 were negative. Of the 12 nonenhancing ulcerations, biopsy was not performed in 3, but they have been followed clinically and radiologically for 15.7 months without evidence of recurrence. Of the 20 ulcerations, 8 demonstrated adjacent enhancement, and the results of a biopsy in 4 were positive for recurrent cancer and negative in 2; these 2 have been followed for 16.3 months without evidence of recurrence. Biopsy was not performed in 2 ulcerations, but they have been followed for 15.0 months without evidence of recurrence. CONCLUSION: For soft tissue ulceration occurring after radiation treatment, if there is no enhancement or clinical evidence of recurrence, it is likely benign and follow-up without biopsy seems warranted. If the ulceration is associated with adjacent enhancement, then differentiation between radiation necrosis and recurrent tumor is difficult. In these cases, correlation with clinical examination with close interval follow-up is necessary if a biopsy is not performed.


Subject(s)
Radiation Injuries/diagnostic imaging , Radiation Injuries/etiology , Radiotherapy/adverse effects , Soft Tissue Injuries/diagnostic imaging , Soft Tissue Injuries/etiology , Ulcer/diagnostic imaging , Ulcer/etiology , Aged , Female , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/radiotherapy , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Treatment Outcome
18.
AJNR Am J Neuroradiol ; 28(10): 1878-9, 2007.
Article in English | MEDLINE | ID: mdl-17905891

ABSTRACT

BACKGROUND AND PURPOSE: The purpose of this study was to review the imaging findings of nasal septal abscess in 2 patients with immunosuppression. MATERIALS AND METHODS: Two patients with immunosuppression were identified as having a nasal septal abscess, and correlative CT imaging in both patients was evaluated. RESULTS: The characteristic radiographic appearance of a nasal septal abscess included a fluid collection with thin rim enhancement, located within the cartilaginous nasal septum. After CT examination, incision and drainage was performed in both patients, and appropriate antibiotic coverage was initiated. Clinical and imaging follow-up demonstrated no signs of residual infection. CONCLUSION: Nasal septal abscess has a characteristic appearance on CT examination. Prompt diagnosis and treatment, including incision and drainage and appropriate antibiotic coverage, are necessary to avoid serious complications.


Subject(s)
Abscess/diagnostic imaging , Immunocompromised Host , Nasal Septum/diagnostic imaging , Adolescent , Aged , Humans , Male , Nose Diseases/diagnostic imaging , Tomography, X-Ray Computed
19.
AJNR Am J Neuroradiol ; 28(10): 1872-5, 2007.
Article in English | MEDLINE | ID: mdl-17921234

ABSTRACT

BACKGROUND AND PURPOSE: A dacryocystocele forms when tears accumulate within the lacrimal sac as a result of an obstruction more distally in the lacrimal drainage apparatus, which may occur as a complication of sinonasal surgery. The purpose of this study was to define the imaging characteristics of a postoperative dacryocystocele occurring after surgery for sinonasal cancer and to review the anatomy of the nasolacrimal drainage apparatus. MATERIALS AND METHODS: We reviewed the clinical records and imaging findings of 8 patients who underwent surgery for sinonasal cancer and were diagnosed with a postoperative dacryocystocele between August 2001 and November 2005. The imaging studies performed at the time of diagnosis of dacryocystocele were CT in 6 patients and MR imaging in 2 patients. RESULTS: On both CT and MR imaging, dacryocystoceles had a characteristic appearance of a fluid collection with thin rim enhancement along the course of the affected nasolacrimal duct, with no adjacent solid components. In none of the patients was the dacryocystocele confused with a recurrent tumor. CONCLUSION: Dacryocystocele after surgery for sinonasal cancer has a characteristic appearance on CT and MR imaging. Familiarity with this complication of sinonasal surgery and its appearance on imaging will enable radiologists to avoid misinterpreting dacryocystocele as a recurrent tumor or another process.


Subject(s)
Lacrimal Apparatus Diseases/diagnosis , Paranasal Sinus Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Hernia , Humans , Lacrimal Apparatus Diseases/diagnostic imaging , Lacrimal Apparatus Diseases/etiology , Magnetic Resonance Imaging , Male , Middle Aged , Nasolacrimal Duct/diagnostic imaging , Nasolacrimal Duct/pathology , Postoperative Complications , Tomography, X-Ray Computed
20.
AJNR Am J Neuroradiol ; 27(8): 1643-6, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16971603

ABSTRACT

BACKGROUND AND PURPOSE: Unilateral vocal cord paralysis (UVCP) occurs after iatrogenic injury or disease process and is associated with dysphonia and aspiration. Various surgical options are available for treatment of UVCP, including vocal cord medialization thyroplasty and injection laryngoplasty. These augmentative procedures improve phonation and airway protection. Our purpose was to demonstrate the CT appearance of implants used for the treatment of UVCP. METHODS: Twelve patients treated surgically for UVCP were studied with helical CT. The vocal cords were augmented by using Silastic implants (n = 7), polytetrafluoroethylene (Gore-Tex) implants (n = 2), Teflon injections (n = 2), or fat injection (n = 1). Augmented vocal cords were characterized by size, shape, and Hounsfield units (HU). Two other patients with failed medialization thyroplasty were evaluated for the position of the extruded implant relative to the paralyzed vocal cord. RESULTS: The 7 Silastic implants were triangular and hyperattenuated (293.4 +/- 90.4 HU). The 2 Gore-Tex implants were heterogeneous with lobulated medial margins and were hyperattenuating (320 and 414 HU). The injected materials demonstrated ovoid/masslike configurations: the 2 Teflon injections were hyperattenuated (107 and 429 HU), and the fat injection was hypoattenuated (-102 HU). Inferior displacement of the implant was demonstrated relative to the true vocal cord in 2 patients with failed Silastic thyroplasties. CONCLUSION: CT can distinguish various types of vocal cord augmentation. Silastic implants are recognized by their characteristic triangular configuration. The Gore-Tex implants had unique heterogeneous attenuation with lobulated medial margins. Fat and Teflon injections both appear ovoid/masslike. Teflon injection should not be mistaken for tumor.


Subject(s)
Adipose Tissue/transplantation , Dimethylpolysiloxanes , Image Enhancement , Image Processing, Computer-Assisted , Polytetrafluoroethylene , Postoperative Complications/diagnostic imaging , Prosthesis Implantation , Silicones , Tomography, X-Ray Computed , Vocal Cord Paralysis/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Patient Care Team , Recurrence , Reoperation , Retrospective Studies , Vocal Cord Paralysis/diagnostic imaging , Vocal Cord Paralysis/etiology
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