MyT3 17 - Head and Neck

Purpose:

To evaluate the role of apparent diffusion coefficient values in differentiating between malignant and benign solitary thyroid nodules and its correlation with histopathological results as the reference standard.

Methods and materials:

30 patients with solitary thyroid nodules were included and evaluated by ultrasound, colour Doppler ultrasound, conventional magnetic resonance imaging (MRI), MRI with diffusion-weighted imaging (DWI-MR) using b-values (500, 1000 mm²/s) with ADC value measurement. Fine needle aspiration was done after DW-MRI to avoid affecting diffusion characters of the nodules. Histopathological examinations were done for all cases after surgery and correlated with the imaging finding.

Results:

24 nodules were benign (12 adenomatous hyperplasias, nine follicular hyperplasias, and three solitary nodular goiters) and six nodules were malignant (three papillary carcinoma and three follicular carcinoma). The mean ADC value of benign thyroid nodules (2.1± 0.2× 10−3 mm²/s – 1.87± 0.3× 10−3 mm²/s) was statistical significance higher than malignant ones ( 1.06± 0.2× 10−3 mm²/s -0.970.3× 10−3 mm²/s) using b-values 500, 1000 mm²/s (P=0.001 and 0.001) respectively. The mean ADC value of benign and malignant nodules done using b-values 1000 mm²/s was statistical significance higher than using b-values 500 mm²/s (P=0001). A cut-off ADC value of (1.5) has been suggested as a reference point to differentiate benign from malignant nodules with (83.3 % sensitivity, 96.0% specificity, 83.3 % PPV and 96.02% NPV, P=.001) using b-values 500 mm²/s and (100 % sensitivity, 100% specificity, 100% PPV and 100% NPV, P=.001) using b-values 1000 mm²/s.

Conclusion:

ADC value calculation is a good quantitative measurement that can differentiate benign from malignant solitary thyroid nodules with recommendable b-value 1000 mm2/s.

Limitations:

This study is limited by the motion artefact, a small number of patients and difficult to detect nodules < 5mm.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To ascertain any correlation of diffusion tensor imaging (DTI) parameters - fractional anisotropy (FA) and apparent diffusion coefficient (ADC) with standard MR findings and clinical severity.

Methods and materials:

Patients presenting with cervical myelopathy to neurosurgery/orthopedic outpatient department and without recent traumatic history, neuroparenchymal pathology or contraindication to MRI and agreeing to undergo MRI were examined with MRI of the cervical spine. In addition to standard MRI sequences for imaging the cervical spinal cord, diffusion tensor imaging based on single-shot EPI with 20 diffusion directions, each encoded with b-values of 0mm2/s and 1000mm2/s was performed in both sagittal and axial planes. Postprocessing of the raw DTI data was done using ready view developed by GE (Advantage4.7). Stenotic and non-stenotic levels were compared with Kang's grading and DTI parameters. Baseline clinical severity was assessed based on modified Japanese Orthopaedic Association (mJOA) score. Using SPSS(ver23), Anova's test was done to assess different Grade individuals. Pearson's correlation of FA with ADC, Kang's grade and mJOA score were calculated.

Results:

43 patients were included in the study. Mean FA values recorded at stenotic (0.346) was less than non-stenotic (0.600) levels. A negative correlation of -0.661 and -0.362 was recorded between FA and ADC and stenotic grading (Kang's), respectively. Level of significance was recorded at 0.013.

Conclusion:

Diffusion tensor imaging can serve as a potential tool for understanding pathophysiology thereby complementing anatomical information from standard sequences and aid in prognostication of patients with cervical spondylotic myelopathy prior to surgical and non-surgical management.

Limitations:

Changes in DTI parameters were not recorded following treatment. Technical limitations of DTI may be overcome by using HARDI and Q space imaging.

Ethics committee approval

Institutional ethics committee approved the study. Written informed consent was obtained from all patients.

Funding:

No funding was received for this work.

Purpose:

Cochlear implantation is the recommended treatment for patients presenting with severe to profound pre- or post-lingual sensorineural hearing loss. Imaging plays a pivotal role in the selection of candidates. A pre-operative knowledge of variant anatomy helps in the planning of the surgical approach and aids in identifying potential complications.

Methods and materials:

Patients suffering from profound to severe sensorineural hearing loss with the candidacy for cochlear implantation were evaluated by high-resolution CT of the temporal bone (HRCT). A total of 100 cases were referred from July 2018 to February 2019 and were included in the study after taking patient consent. Many anatomical variants were observed including mastoid pneumatisation, level of middle cranial fossa dura, Korner’s septum, mastoid emissary vein, sigmoid sinus and jugular bulb position, bony facial canal, position of mastoid segment of facial nerve canal with respect to round window for visualisation of round window during surgery and alignment of cochlear basal turn with respect to axis of internal carotid artery canal for round window accessibility.

Results:

The pre-cochlear implant imaging had a sensitivity of 97.22% and diagnostic accuracy of 90% in identifying accessibility of round window when correlating with intra-operative findings. Surgeon acceptability was a highlight of this study.

Conclusion:

Pre-cochlear implantation imaging in addition to performing the accepted role of imaging of the middle and internal ear anatomy is also crucial in the identification of various non-otologic landmarks which affect procedure planning and possible complications. Attention to these small but significant details can greatly improve surgical outcome.

Limitations:

There is possibility that changes could have happened in the period between imaging and surgery which was appreciated in surgery and was absent during imaging.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

The aim of this study was to assess the usefulness of ultra-high frequency ultrasound (UHFUS), with frequencies up to 70 MHz and resolution up to 30 μm, for the examination of the minor salivary glands in primary Sjögren’s syndrome (pSjS). In particular we assessed the diagnostic accuracy of UHFUS, and the improvement of bioptic sampling under UHFUS guidance.

Methods and materials:

Seventy-eight patients with Sicca syndrome suspected secondary to pSjS (72 females and 6 males) with a mean age of 56 years (standard deviation=±15 years) were enrolled. The following UHFUS parameters were evaluated: glands distribution, parenchymal inhomogeneity (score 0-3, from absent inhomogeneity to evident), fibrosis, and vascular pattern and degree of vascular intensity (by means of echo color-Doppler analysis). The minor salivary gland of the lower lip with more significant UHFUS abnormalities was marked with a dermographic pen and underwent biopsy for calculation of the focus score (FS).

Results:

In 38/78 cases (48.7%) pSjS was diagnosed on the basis of ACR/EULAR criteria. Glands with UHFUS score≥1 were considered suggestive of pSjS (sensitivity=100%, specificity=26.7%, NPV=100% and PPV=50%). We found a good correlation between the FS and the following UHFUS parameters: lateral inhomogeneity (r=0.532), central inhomogeneity (r=0.496), central fibrosis (r=0.398). Under UHFUS guidance, the percentage of adequate bioptic samples increased from 62.5% in 2017 to 83.6% in the period 2018/2019.

Conclusion:

UHFUS findings accurately predict the FS. Moreover, this modality provides reliable guidance for biopsy. The 100% negative predictive value makes UHFUS suitable as a screening tool for pSjS, with the potential to avoid unnecessary biopsies.

Limitations:

The small number of patients enrolled.

Ethics committee approval

Ethics committee approval was obtained.

Funding:

No funding was received for this work.

Purpose:

To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the evaluation of patients with choroidal melanoma at the time of diagnosis and in the evaluation of therapeutic response after brachytherapy.

Methods and materials:

We performed a prospective, unicentric study approved by the research ethics committee, which included patients with choroidal melanoma and indication for brachytherapy. Three DW-MRI examinations were proposed for each patient, one before and two after treatment. The apparent diffusion coefficient (ADC) value was calculated on DW-MRI and compared with local tumour control assessed by ophthalmologic follow-up.

Results:

From 07/2018 to 06/2019, 19 patients were included, of which 13 underwent follow-up examinations. Patients’ ages ranged from 24 to 78 years and 52.9% were male. At the ocular ultrasound, the mean tumour thickness and diameter were 6.3 mm and 11.5 mm, respectively. At initial MRI, most tumours presented high or intermediate signal at T1 (82.3%) and a low signal at T2 (70.6%). Two patients (15.4%) showed signs of tumour progression during follow-up. There was no statistically significant difference in tumour size between MR before and after treatment, however, there was a significant reduction in mean ADC in patients with progression (p = 0.02).

Conclusion:

DW-MRI has shown to be useful in assessing patients with choroidal melanoma and mean ADC values ​​can be used for response assessment, allowing early identification of patients at risk for progression after brachytherapy.

Limitations:

This study was limited by the small number of cases.

Ethics committee approval

The IRB approval was obtained.

Funding:

This study was funded by the São Paulo Research Foundation - FAPESP (grant n. 2016/05967-5).

Purpose:

To measure the volume and measurements of the maxillary, sphenoid and frontal sinuses and in healthy Mexican patients, using computed tomography (CT) scans.

Methods and materials:

A retrospective, case series study in a single academic centre, CT scans of 210 subjects, 10 of every age, between 0 and 20 years of age, performed between January 2016 and November 2017 in the Hospital Universitario of Monterrey, Mexico. A comparative analysis of the volume and dimensions of the paranasal sinuses was performed using multiplanar reformating and volume rendering with segmentation. Patients with prior history of trauma, surgery, and pathology of the paranasal sinuses were excluded. The study population was subdivided by gender and age.

Results:

A total of 210 CT scans were analysed, 104 (49.5%) males and 106 (50.5%) females. The groups were subdivided by age (<5, 6-10, 11-15 and >16 years). The largest volumes were reached by 16 to 20 years of age. In the 6-10 age group, the females had larger volumes than the males. The males had a tendency to present larger volumes in general. There is a high correlation in between the volume of sinus and its contralateral r (0.01) and there is also a significant relation of the sinus volume and age Z (<0.004).

Conclusion:

There is a clear volumetric correlation according to age and gender, there is a direct relation between a sinus and its contralateral homologous. The expected volume development can influence clinical decision making in this age group.

Limitations:

The normal variants of the paranasal sinuss were not part of the study design.

Ethics committee approval

This study was approved by the Ethics Comitee of the Hospital Universitario.

Funding:

No founding was received for this work.

Purpose:

To study the role of multi-detector computed tomography (MDCT) in the evaluation of neck masses in adults in the Lady Hardinge Medical College, New Delhi. To correlate MDCT findings with clinical/perioperative/pathological follow-up findings whenever possible.

Methods and materials:

The hospital-based descriptive observational study conducted from November 2015 to March 2017 in the department of radio-diagnosis. The study population was adults (>18 years) with neck masses. The sample size was 33 patients. The inclusion criteria was the following: age ≥ 18 years with clinically detected neck masses and neck masses detected on ultrasonography who were referred for MDCT and incidentally diagnosed neck masses by MDCT. The exclusion criteria were the following: a history of trauma of neck area and pregnancy. The study instruments were clinical proforma and PHILIPS BRILLIANCE 40 slices multi-detector CT. The methodology used included clinical evaluation and CT. Plain and contrast-enhanced scans using non-ionic contrast media were performed sequentially from the base of the skull to the 4th thoracic vertebra. Multi-planar reconstruction was created.

Results:

Nodal masses were the most common masses (39.4%). These included metastatic (27.27%), lymphomatous (6.06%), tubercular adenopathy (6.06%). Non-nodal masses constituted 60.6%, included salivary gland lesions (30%), thyroid masses (30%), masses of developmental origin (15%), neurogenic (10%), vascular (5%), mesenchymal origin (5%) and inflammatory masses (5%). 84.6% of the nodal masses were malignant, 15.3% were benign. 25% of the non-nodal masses were malignant, 75% were benign. In total, 48.48% had malignant lesions and 51.5% of the cases had benign lesions.

Conclusion:

MDCT ensure anatomical localisation, characterisation and lesion extent of the neck masses.

Limitations:

This study was performed as a single centre study and is limited by small sample size.

Ethics committee approval

The study was approved by the institutional ethical committee and written informed consent was taken by each patient.

Funding:

This study was funded by our institute.

Purpose:

Our goal has been to determine if PEG treatment determined a reduction of pneumonia cases in a population with neurologic functional dysphagia.

Methods and materials:

20 patients with neurogenic dysphagia have been retrospectively examined. In 13 PEG-treated patients were evaluate the thorax x-rays and CT to find signs of pneumonia. The observation period is between 500 days before and after the endoscopic surgical procedure. Other seven patients were treated only with rehabilitation; the same evaluation was referred to the radiographic dynamic study of the swallowing (DSS - also called a videofluoroscopic study of the swallowing, VFSS). All 20 patients performed a DSS to confirm or exclude the presence of aspiration, this latter only determining the aspiration nature of pneumonia. The exact Fisher test was applied to each group and subgroup.

Results:

In the first group analysed of the 13 PEG-treated patients, 7 presented pneumonia before the procedure and the prevalence increased of 8/13 after it, six of whom did not present before. Regarding those ones without aspiration at DSS(low-risk for pneumonia) presented an increase of the cases from 3/8 to 5/8. In the remaining five patients with aspiration (high-risk pneumonia with the burden of aspiration pneumonia defined at DSS) the ratio decreased from 4/5 to 3/5. No significant p-value has merged at the Fisher tests. In the second group of seven patients, who were not treated with PEG the Fisher test on pneumonia cases was not significant as well, but the prevalence of pneumonia was higher than in the other subgroups (6/7).

Conclusion:

The DSS helped to distinguish patients with aspiration, and therefore with aspiration pneumonia, where the PEG treatment determined a reduction of pneumonia cases. In the other subgroups the prevalence of pneumonia increased.

Limitations:

Nothing to declare.

Ethics committee approval

Nothing to declare.

Funding:

nothing-to-declare

Purpose:

This study was conducted to compare the effectiveness of ultrasonography of the neck, ^99mTc-sestamibi and ¹⁸F-fluorocholine PET/CT imaging in the preoperative localisation of parathyroid lesions in patients with primary hyperparathyroidism.

Methods and materials:

Fifty-four patients of PHPT were included in this prospective study who underwent preoperative localisation of the parathyroid lesion(s) using three diagnostic modalities followed by surgery. The sensitivity, positive predictive value (PPV) and accuracy of the three imaging procedures to accurately detect abnormal parathyroid glands were determined using histopathology as the gold standard.

Results:

FCH PET/CT detected 52 out of 54 patients and 52 out of 56 lesions with histopathologically proven parathyroid adenomas on patient-based and lesion-based analysis respectively. Preoperative USG, MIBI and FCH PET/CT localised abnormal parathyroid gland(s) in 39 (72.2%), 43 (79.6%) and 54 (100%) patients respectively. The sensitivity and PPV were 69.3% and 87.1% for USG, 80.7% and 97.6% for MIBI, and 100% and 96.3% for FCH PET/CT. The accuracy was 62.9%, 79.6% and 96.3% for USG, MIBI and FCH PET/CT respectively in the patient-wise analysis. In six patients with ectopic lesions, FCH PET/CT demonstrated higher sensitivity and accuracy than MIBI and USG (100% vs 66.6% and 16.7% respectively).

Conclusion:

Among the three imaging techniques tested simultaneously, FCH PET/CT was superior for accurate preoperative localisation of parathyroid adenomas, especially for ectopic or small parathyroid lesions.

Limitations:

Various statistical measures like specificity, negative predictive value and serum PTH cut off values for FCH PET/CT could not be calculated in our study, as none of the patients was negative on FCH PET/CT imaging.

Ethics committee approval

The ethics committee approval was obtained.

Funding:

No funding was received for this work.

Purpose:

To assess the diagnostic performance of the ACR NI-RADS.

Methods and materials:

116 follow-up scans for 55 patients treated from primary HNSCC were included in combined retrospective and prospective study that was conducted in Ain-Shams University Hospitals. Scans timings followed our institution protocol; the first follow-up performed eight weeks after finishing treatment. A choice between CE-CT/MRI or PET-CT determined by the clinical scenario. Scans were reported using the ACR NI-RADS template, scores were assigned to each scan; one for the primary tumour site and one for neck nodes. The assigned NI-RADS scores were correlated to patients’ outcomes according to our gold standard: tissue pathological examination and/ or follow-up scans, with follow-up duration that extended for twelve months, except for two patients. We calculated the rate of disease recurrence for each score. We compared the diagnostic performance of the different NI-RADS templates for CE-CT; PET-CT and CE-MRI. We also assessed the diagnostic performance of the templates' imaging findings describing the primary tumor site morphological changes, enhancement, and FDG activity, and describing the neck nodes correlated to outcome. Data analysis was done by IBM SPSS (V.25.0, IBM Crop., USA, 2017-2018).

Results:

We had 232 targets for primary tumour sites and for lymph nodes. Tumour recurrence occurred in 53 targets. Recurrence rates for each NI-RADS category. A significant correlation between template morphological and enhancement findings and patients' outcomes at the primary site and LNs. PET/CT template had the highest accuracy, sensitivity, and specificity.

Conclusion:

The performance of the ACR NI-RADS reporting system is excellent with a good correlation with the outcome.

Limitations:

This study is limited by the sample volume and time period.

Ethics committee approval

The ethics committee approval and written informed consent were obtained.

Funding:

No funding was received for this work.

Purpose:

Cochlear implantation is the recommended treatment for patients presenting with severe to profound pre- or post-lingual sensorineural hearing loss. Imaging plays a pivotal role in the selection of candidates. A pre-operative knowledge of variant anatomy helps in the planning of the surgical approach and aids in identifying potential complications.

Methods and materials:

Patients suffering from profound to severe sensorineural hearing loss with the candidacy for cochlear implantation were evaluated by high-resolution CT of the temporal bone (HRCT). A total of 100 cases were referred from July 2018 to February 2019 and were included in the study after taking patient consent. Many anatomical variants were observed including mastoid pneumatisation, level of middle cranial fossa dura, Korner’s septum, mastoid emissary vein, sigmoid sinus and jugular bulb position, bony facial canal, position of mastoid segment of facial nerve canal with respect to round window for visualisation of round window during surgery and alignment of cochlear basal turn with respect to axis of internal carotid artery canal for round window accessibility.

Results:

The pre-cochlear implant imaging had a sensitivity of 97.22% and diagnostic accuracy of 90% in identifying accessibility of round window when correlating with intra-operative findings. Surgeon acceptability was a highlight of this study.

Conclusion:

Pre-cochlear implantation imaging in addition to performing the accepted role of imaging of the middle and internal ear anatomy is also crucial in the identification of various non-otologic landmarks which affect procedure planning and possible complications. Attention to these small but significant details can greatly improve surgical outcome.

Limitations:

There is possibility that changes could have happened in the period between imaging and surgery which was appreciated in surgery and was absent during imaging.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

The aim of this study was to investigate the potential diagnostic value of point shear wave elastography (pSWE) and the contribution of concurrent diffusion-weighted MRI to diagnostic performance prospectively in patients with cervical lymphadenopathy.

Methods and materials:

188 cervical lymph nodes of 144 patients were included in the study. All patients with or without an underlying malignancy were included in the study and all lymph nodes were evaluated before the treatment or histopathological sampling. US characteristics were recorded, stiffness and ADC values of lymph nodes were measured. Lymph nodes were divided into benign and malign groups with histopathological findings, clinical and sonographic follow-up.

Results:

Short axis, hilus morphology, vascularisation patterns, pSWE, and ADC values were significant parameters in logistic regression tests between the two groups. The median stiffness of malign nodes were higher and the average ADC values were lower than others also the lowest ADC values were measured in lymphoproliferative disorders (p<0.001). Area under the curve values for pSWE and diffusion MRI were 0.846 (95% CI, 0.789-0.903), 0.796 (95% CI, 0.725-0.868), respectively. Tissue stiffness had the highest diagnostic accuracy with 80.3%. Accuracy rate increased to 87.2% from 83.5% when the pSWE was combined with the conventional US. No differences were detected when the DWI findings were added to these.

Conclusion:

The use of pSWE combined with B-mode US may be sufficient for the differentiation of lymph nodes and will reduce the number of biopsies. The main role of DWI in cases which underwent ultrasonography, may be specific to lymphoproliferative disorders rather than lymph node characterisation.

Limitations:

Study group was heterogeneous and not all cases had pathological evaluation.

Ethics committee approval

The ethics committee approval and written informed consent were obtained.

Funding:

No funding was received for this work.