Patterns of spread of head and neck adenoid cystic carcinoma.

We present a review of head and neck adenoid cystic carcinoma (ACC). Imaging features of the primary tumour, patterns of locoregional spread, and distant metastasis with emphasis on perineural extension and imaging pitfalls are discussed with illustrated examples.

Is dual-phase abdominal CT necessary for the optimal detection of metastases from renal cell carcinoma?

AIM: To determine whether dual-phase abdominal computed tomography (CT) detected more metastases than portal-phase CT alone in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: Audit committee approval was obtained. A retrospective audit was undertaken in 100 patients who underwent both arterial and portal phase CT. The CT images were independently reviewed by two consultant radiologists. The presence of metastases in the liver, pancreas, and contralateral kidney were recorded for each phase of contrast enhancement. RESULTS: Metastases were identified in the liver in 27 patients, pancreas in 12, and contralateral kidney in 23 patients. Nine of the 27 (33%) liver metastases, three of the 12 (25%) pancreatic metastases, and two of the 23 (9%) renal metastases were only detected in the arterial phase, whilst four of the 27 (15%) liver metastases, three of the 12 (25%) pancreatic metastases, and two of the 23 (9%) renal metastases were only detected in the portal phase. Nine patients (9%) had metastases only visualized in the arterial phase, and six (6%) only in the portal phase. Detection of metastases only visible in the arterial phase led to a change of management in two patients (2%). CONCLUSION: The audit results support our current standard of dual-phase abdominal CT for optimal detection of RCC metastases.

The value of hyoscine butylbromide in pelvic MRI.

AIM: To evaluate the effect of hyoscine butylbromide (HBB) on image quality and lesion and organ visualization in pelvic magnetic resonance imaging (MRI) MATERIALS AND METHODS: A prospective, ethically approved study was undertaken of 47 patients attending for pelvic MRI at a cancer centre. T2-weighted transverse and sagittal sequences were performed before and after intravenous injection of 20 mg HBB. Three radiologists independently scored anonymized image series for overall image quality, visualization of pelvic lesions and visualization of individual pelvic organs. Statistical analysis was performed to assess improvements in radiologists' scores post-HBB administration. Radiologists also assessed pre-HBB administration T1-weighted images for degree of bowel peristalsis to determine whether this could predict improvement in post-HBB T2-weighted image scores. Side effects of HBB were recorded using a patient questionnaire. RESULTS: Radiologists' scores for image quality and lesion visualization were significantly higher on the post-HBB administration T2-weighted series (p<0.0005). Scores for the visualization of the bladder, rectum, pelvic bowel, prostate, and seminal vesicles (all p<0.0005), cervix (p=0.019) and vagina (p=0.0001) were also significantly higher post-HBB administration. Scores for the degree of peristalsis on T1-weighted images were not related to improvement in image quality or lesion visualization on T2-weighted images post-HBB administration. Side effects of HBB were mild and self-limiting. CONCLUSION: Intravenous HBB administration improves image quality and lesion visualization in oncological pelvic MRI and is recommended for routine use.

Cerebral metastasis and other cerebral events in women with ovarian cancer.

AIM: To determine the incidence, imaging findings and prognostic significance of cerebral metastases and other cerebral events in women with ovarian cancer. METHOD: A 5-year retrospective review of all women with ovarian cancer who had cranial imaging was undertaken at two major gynaecological oncology centers. RESULTS: Of 1222 women under clinical review, 78 underwent cranial imaging and 13 (1.1%) had cerebral metastasis. Computed tomography (CT) was diagnostic of parenchymal disease in 12 and magnetic resonance imaging (MRI) showed leptomeningeal disease in two. The women were aged between 23 and 73 years and all had stage III or IV disease at presentation. Cerebral metastasis occurred at 6-60 months from initial diagnosis, with death occurring predominantly within 12 months, but with five survivors at 4-45 months. Of the remaining 65 women, 10 had cerebrovascular disease and three had unrelated lesions. CONCLUSION: Cerebral metastasis remains a rare event in women with ovarian cancer but may be an isolated late event associated with survival beyond a year after neurosurgery and chemotherapy. CT should be the first investigation as the incidence of cerebrovascular disease is similar to that of metastatic disease.