Head and Neck

Dynamic Contrast-Enhanced MRI–Derived Intracellular Water Lifetime (τi): A Prognostic Marker for Patients with Head and Neck Squamous Cell Carcinomas

Editor’s Choice

The authors evaluated 60 patients with dynamic contrast-enhanced MR imaging before treatment. Median, mean intracellular water molecule lifetime, and volume transfer constant values from metastatic nodes were computed from each patient. Kaplan-Meier analyses were performed to associate mean intracellular water molecule lifetime and volume transfer constant and their combination with overall survival and beyond. Patients with high mean intracellular water molecule lifetime had overall survival significantly prolonged by 5 years compared with those with low mean intracellular water molecule lifetime. Patients with high mean intracellular water molecule lifetime had significantly longer overall survival at long-term duration than those with low mean intracellular water molecule lifetime. Volume transfer constant was a significant predictor for only the 5-year follow-up period. They conclude that a combined analysis of mean intracellular water molecule lifetime and volume transfer constant provided the best model to predict overall survival in patients with squamous cell carcinomas of the head and neck.

CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy

Fellows’ Journal Club

This was a retrospective study including 62 patients diagnosed with primary head and neck squamous cellcarcinoma who underwent contrast-enhanced CT examinations for staging, followed by chemoradiotherapy. CT texture features of thewhole primary tumor were measured using an in-house developed Matlab-based texture analysis program. Histogram, gray-level co-occurrence matrix, gray-level run-length, gray-level gradient matrix, and Laws features were used for texture feature extraction. Three histogram features (geometric mean, harmonic, and fourth moment) and 4 gray-level run-length features (short-run emphasis, gray-level nonuniformity, run-length nonuniformity, and short-run low gray-level emphasis) were significant predictors of outcome.

Setting the Stage for 2018: How the Changes in the American Joint Committee on Cancer/Union for International Cancer Control Cancer Staging Manual Eighth Edition Impact Radiologists

Fellows’ Journal Club

The updated eighth edition of the Cancer Staging Manual of the American Joint Committee on Cancer will be implemented in January 2018. There are multiple changes to the head and neck section of the manual, which will be relevant to radiologists participating in multidisciplinary head and neck tumor boards and reading pretreatment head and neck cancer scans.

Apparent Diffusion Coefficient Histograms of Human Papillomavirus–Positive and Human Papillomavirus–Negative Head and Neck Squamous Cell Carcinoma: Assessment of Tumor Heterogeneity and Comparison with Histopathology

Fellows’ Journal Club

One hundred five consecutive patients with primary oropharyngeal and oral cavity head and neck squamous cell carcinoma underwent MR imaging with anatomic and DWI sequences. The collected tumor voxels from the contoured ROIs provided histograms from which position, dispersion, and form parameters were computed. Histogram data were correlated with histopathology, p16-immunohistochemistry, and polymerase chain reaction for human papillomavirus DNA. Diffusion phenotypes of human papillomavirus–positive and human papillomavirus–negative head and neck squamous cell carcinomas showed significant differences, which reflect their distinct degree of tumor heterogeneity.

The American Society of Head and Neck Radiology Presents 2017 Gold Medal to Edward E. Kassel, M.D., FACR

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PRESS RELEASE

The American Society of Head and Neck Radiology Presents 2017 Gold Medal to Edward E. Kassel, M.D., FACR during 51st Annual Meeting

Edward E. Kassel, M.D., FACR
Edward E. Kassel, M.D., FACR

The American Society of Head and Neck Radiology (ASHNR) awarded its 2017 Gold Medal to Edward E. Kassel, M.D., FACR during the Gold Medal Award Luncheon on September 18, 2017 during the ASHNR 51stAnnual Meeting at Caesars Palace in Las Vegas, Nevada, September 16-20, 2017.

The ASHNR Gold Medal is presented annually to a member who has provided dedicated service to the Society, and to the science and education of head and neck radiology.  Dr. Kassel became the twenty-first recipient of the ASHNR Gold Medal since the Awards inception in 2000.

Dr. Kassel obtained his DDS from the University of Toronto’s Faculty of Dentistry and his MD at the University of Western Ontario. He completed his post-graduate training in Medical Imaging at U of T in 1977. He was an attending neuroradiologist at Sunnybrook Health Sciences Centre (1977- 1992), Radiologist-in-Chief at Mount Sinai Hospital (1992-1996) and the attending neuroradiologist in the University Health Network/Mount Sinai Hospital Joint Department of Medical Imaging (1997-2014).  Dr. Kassel served as 2008-2009 ASHNR President.

For more information on the ASHNR Gold Medal, or the Society in general, contact Business Manager Ken Cammarata at ASHNR, 800 Enterprise Drive, Suite 205, Oak Brook, IL 60523-4216, Phone: 630-574-0220, ext. 226, Fax: 630-574-0661, Email: kcammarata@asnr.org, Website: www.ashnr.org.…

CT and MR Imaging in the Diagnosis of Scleritis

Fellows’ Journal Club

Scleritis is a rare vision-threatening condition that can occur isolated or in association with other orbital abnormalities and whose etiology is typically inflammatory/noninfectious, either idiopathic or in the context of systemic disease. The authors analyzed 11 cases of scleritis in which CT and/or MR imaging were performed during the active phase of disease and assessed the diagnostic utility of these techniques. The most important imaging findings of scleritis were scleral enhancement, scleral thickening, and focal periscleral cellulitis. MR imaging is the recommended imaging technique.

Summary

Figure 1 from paper
Asynchronous IOID with scleritis. A, CECT depicts outward, eccentric thickening and enhancement of the right globe wall with focal periscleral cellulitis (black arrow), compatible with posterior scleritis. There is associated pre- and postseptal cellulitis (white arrow) and proptosis. B, CECT 18 months after examination (A) shows almost identical findings in the left orbit. Black and white arrows point to the scleritis and cellulitis, respectively. Notice the complete resolution of the alterations of the right orbit. Also, notice involvement of the tendon of the lateral rectus anteriorly (dashed arrow).

Scleritis is a rare, underdiagnosed vision-threatening condition that can occur isolated or in association with other orbital abnormalities. The etiology of scleritis is mainly inflammatory noninfectious, either idiopathic or in the context of systemic disease. Ultrasonography remains the criterion standard in diagnostic imaging of this condition but might prove insufficient, and studies on the diagnostic value of CT and MR imaging are lacking. We retrospectively analyzed 11 cases of scleritis in which CT and/or MR imaging were performed during the active phase of disease and assessed the diagnostic utility of these techniques. The most important imaging findings of scleritis were scleral enhancement, scleral thickening, and focal periscleral cellulitis. MR imaging is the recommended imaging technique, though posterior scleritis also can be accurately diagnosed on

Imaging Features of Malignant Lacrimal Sac and Nasolacrimal Duct Tumors

Fellows’ Journal Club

This case series presents 18 patients with primary and secondary malignant lacrimal sac and nasolacrimal duct tumors and their pattern of tumor spread. Squamous cell carcinoma was the most common histology and, 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. Tumor was not observed solely within the nasolacrimal duct in any patient. Only 1 patient presented with nodal metastasis and there was no intracranial tumor extension or perineural tumor spread. The authors conclude that malignant lacrimal sac and nasolacrimal duct tumors tend to expand the nasolacrimal bony canal, rather than erode it. CT was superior to MR imaging in characterizing expansion versus erosion of the nasolacrimal bony canal.

Summary

Figure 5 from paper
A 73-year-old woman with well-differentiated SCCA of the lacrimal sac and nasolacrimal duct. A, Post-contrast-enhanced CT demonstrates an enhancing tumor within the left lacrimal sac (arrow). B, At a slightly more inferior level (bone window), note the mild expansion of the lacrimal bony canal by tumor (arrow).

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

Imaging Appearance of SMARCB1 (INI1)-Deficient Sinonasal Carcinoma: A Newly Described Sinonasal Malignancy

Editor’s Choice

SMARCB1 (INI1) is a tumor-suppressor gene that has been implicated in a growing number of malignancies involving multiple anatomic sites, including the kidneys, soft tissues, and the CNS (See OMIM *601607). The authors describe a case series of 17 patients collected from 6 different centers to give a comprehensive description of the appearance of these tumors on CT, MR, and PET/CT studies. SMARCB1 (INI1)-deficient sinonasal carcinoma should be included in the differential diagnosis of a central sinonasal mass demonstrating aggressive imaging features, particularly when there is associated calcification.

Atlas of Anatomy: Head, Neck, and Neuroanatomy

Schuenke M, Schulte E, Schumacher U, eds. Atlas of Anatomy: Head, Neck, and Neuroanatomy. Thieme; 2016; 600 pp; 1743 ill; $79.99

schuenke-atlas-anatomy-thieme_coverIn a beautifully illustrated 600-page softcover entitled Atlas of Anatomy: Head, Neck and Neuroanatomy, the authors describe and illustrate anatomic details we encounter on a daily basis. There are many outstanding features of the book, including the physiologic correlates and the anatomy. For example, in the excellent portions on the temporal bone, the anatomy is exquisite, even on the highly detailed drawings of small structures, and one comes away with a good understanding of how the whole assembly works to propagate and register sounds. This type of highly informative material is repeated in many sections/areas.

If one only looks at titles of the sections in the Table of Contents, it minimally spells out what lies in this book. When it comes to the neuroanatomy section, the details of functional systems, and the interconnectivity of parts of the brain, the drawings clarify many issues that are often complex and confusing. The book ends with a glossary and a synopsis to which the reader can often refer.

This book is simply wonderful. To this reviewer, the anatomy as shown in this book is the best available. Its purchase as a personal copy is highly recommended.…

Diagnostic Pathology: Neuropathology and Head & Neck Pathology

Covers of Diagnostic Pathology editions Neuropathology and Head and Neck PathologyKleinschmidt-Demasters BK, Rodriguez F, Tihan T, et al. Diagnostic Pathology: Neuropathology. 2nd ed. AMIRSYS Elsevier; 2016; 864 pp; 2800 ill; 224.99

Thompson LDR, Wenig BM, et al. Diagnostic Pathology: Head & Neck. 2nd ed. AMIRSYS Elsevier; 2017; 1192 pp; 3000 ill; $247.49

In two newly published and remarkable diagnostic pathology textbooks, both second editions, one on neuropathology and one on head and neck pathology, the neuroradiologist has access to vividly illustrated and comprehensive details relating to the histopathology and some gross pathology in a wide range of abnormalities. There are so many plaudits one could give for these books that it is difficult to know where to start.

The neuropathology text is edited by Drs. Kleinschmidt-Demasters, Rodríguez, and Tihan, with major contributions from Drs. Burger, Scheithauer, Ersen, and Rushing. The text is more encompassing in score and somewhat more descriptive in the text material than the prior edition. Interestingly, the beginning of the book starts with a 2-page run down of what is new in WHO Classifications. Highlighted are diffuse astrocytomas, oligodenrogliomas, and other tumoral redesignations. Most, as one can imagine, rely on genetic definitions and explanations. In the neuropathology text there are 2 parts—the first, on neoplastic, and the second, on non-neoplastic pathologies. The former contains (as in the 1st edition) 5 sections: Brain and Cord, Sella, Meninges, Nerves, and Tumoral Syndromes, while the latter contains 4 sections: Benign Cysts, Infections and Inflammations, Vascular Disease, and a short segment on cortical dysplasia.

What is beautiful about this book, and also about the head and neck pathology book, is the widespread integration of the imaging and classic pathology of the same entity. Not only does one get a deep sense of the underlying causes of the familiar imaging findings, but one is also educated in virtually all …