Preoperative evaluation of oral tongue squamous cell carcinoma with intraoral ultrasound and magnetic resonance imaging-comparison with histopathological tumour thickness and accuracy in guiding patient management.

The aim of this study was to investigate the correlation between tumour thickness (TT) on intraoral ultrasound (US) and magnetic resonance imaging (MRI) with the histologically determined TT of tongue cancers. Secondary objectives included evaluation of potential confounders that affect this association and the predictive value for simultaneous neck dissection. Eighty-eight consecutive patients referred to the study institution between January 2007 and August 2012 with the presumptive diagnosis of invasive squamous cell carcinoma (SCC) of the tongue were analyzed. Seventy-nine patients had preoperative US and 81 had MRI. Correlation between image-determined TT and histological TT was assessed by Bland-Altman plot and Pearson's correlation coefficient. Potential confounders were assessed by subgroup analysis. Preoperative TT as determined by US demonstrated high correlation and MRI moderate correlation with histological TT. With subgroup analysis, negative associations were biopsy prior to imaging and resection diagnosis other than invasive SCC. Our experience suggests that US could be considered the initial modality of choice for preoperative assessment of TT.

Imaging the oral cavity: key concepts for the radiologist.

The oral cavity is a challenging area for radiological diagnosis. Soft-tissue, glandular structures and osseous relations are in close proximity and a sound understanding of radiological anatomy and common pathways of disease spread is required. In this pictorial review we present the anatomical and pathological concepts of the oral cavity with emphasis on the complementary nature of diagnostic imaging modalities.

Fracture detection in the cervical spine with multidetector CT: 1-mm versus 3-mm axial images.

BACKGROUND AND PURPOSE: Multidetector CT imaging of the cervical spine performed with submillimeter collimation allows for the production of excellent quality multiplanar reformations and reconstructed axial images at any chosen section thickness. Currently there is no consensus on what images need to be reviewed for accurate diagnosis of cervical spine fractures. Our study assesses whether 1-mm axial images provide any diagnostic advantage over 3-mm images in detection of cervical spine fractures when read in conjunction with multiplanar reformations. MATERIALS AND METHODS: The dataset consisted 50 cases of CT of the cervical spine and included 25 consecutive cases of cervical spine fractures and 25 matched normal CTs. Axial images were reconstructed at 1- and 3-mm thicknesses, and the sagittal and coronal reformations between 2- and 3-mm thicknesses. Four radiologists reviewed all 50 of the cases twice, once at 1 mm and once at 3 mm. Reads were separated by 3 months. RESULTS: There were 39 fractures in total, consisting of 29 clinically significant and 10 insignificant fractures. Thirty-three fractures were missed in 400 reads. Twenty-one misses were at 3 mm (sensitivity, 86%), and 12 misses at 1 mm (sensitivity, 92%; P = .228). Ten of 33 misses were of clinically significant fractures, 6 misses at 1 mm and 4 at 3 mm (P = .52). Twenty-three of 33 misses were of clinically insignificant fractures, 6 at 1 mm and 17 at 3 mm (P = .006). CONCLUSION: For detection of clinically important fractures, there is no significant difference between 1- and 3-mm axial images when read in conjunction with multiplanar reformations.

Imaging findings of bisphosphonate-associated osteonecrosis of the jaws.

BACKGROUND AND PURPOSE: Bisphosphonates are drugs that decrease bone turnover by inhibiting osteoclast activity. An association between the use of bisphosphonates and osteonecrosis of the maxilla and mandible has recently been described. This study describes the imaging findings of bisphosphonate-associated osteonecrosis of the jaws. MATERIALS AND METHODS: This is a retrospective series of 15 clinically diagnosed patients, identified at 3 centers. Eleven patients were women, of whom 6 had breast cancer, 3 had osteoporosis, and 2 had multiple myeloma. Of the 4 male patients, 2 had prostate cancer, 1 had multiple myeloma, and 1 had osteoporosis. The age range of the patients was 52-85 years (average, 68 years). The mandible was the clinical site of involvement in 11 patients, and the maxilla was involved in 4 patients. Imaging consisted of orthopantomograms in 14 patients, CT scans in 5 patients, and radionuclide bone scan in 1 patient. Nine patients had sequential imaging. Two radiologists reviewed the images. RESULTS: All of the patients had a degree of osseous sclerosis, most commonly involving the alveolar margin, but lamina dura thickening and full-thickness sclerosis were also observed. The sclerotic change encroached on the mandibular canal in 3 patients. Less commonly encountered findings included poorly healing or nonhealing extraction sockets, periapical lucencies, widening of the periodontal ligament space, osteolysis, sequestra, oroantral fistula, soft tissue thickening, and periosteal new bone formation. CONCLUSIONS: The most common finding in bisphosphonate-associated osteonecrosis was osseous sclerosis. This varied from subtle thickening of the lamina dura and alveolar crest to attenuated osteopetrosis-like sclerosis.