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.

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


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.…

Head and Neck Ultrasonography: Essential and Extended Applications, 2nd Edition

Orloff LA. Head and Neck Ultrasonography: Essential and Extended Applications. 2nd ed. Plural Publishing; 2017; 544 pp; $299.95

Cover of Orloff

The second edition of Head and Neck Ultrasonography: Essential and Extended Applications is an inclusive and detailed review of office-based and intraoperative ultrasonography. The book caters to a diverse audience, including radiologists, surgeons, and clinicians such as endocrinologists.

This publication is organized into 21 chapters covering a diverse range of topics. The initial chapters outline the history of head and neck ultrasonography, as well as basic US physics and current equipment and techniques, which builds on the knowledge base of the reader. There is also a chapter on healthy head and neck anatomy, which may serve as a good review for some before gaining access to more advanced material.

The diagnostic chapters may be of particular interest to general radiologists, neuroradiologists, and pediatric radiologists. These range from discussions of more common applications, such as thyroid and parathyroid disease, to more specialized knowledge, such as salivary gland and laryngeal ultrasonography.

Chapters on transesophageal and endobronchial ultrasound, as well as interventional ultrasonography, contain text covering anatomy, pathology, and procedural technical aspects that are geared towards a more procedurally inclined audience, including interventional radiologists, otolaryngologists, gastroenterologists, and pulmonologists, as well as endocrinologists who perform office-based diagnostic procedures, such as US-guided FNA.

One distinct characteristic throughout the book is its particular attention to descriptive and pictorial consideration of ultrasonographic technique, which might be of interest to the radiologist who is less experienced in head and neck “hands-on“ scanning.

Image quality is overall robust and representative illustrations are clear, with several containing 2 axes depicting the same finding. A few figures are rendered in lower resolution, likely due to inherent technique or the equipment utilized.

Sonographic dynamic clips are also included on the companion website, providing a …

Differential Diagnosis in Neuroimaging: Brain and Meninges, Spine, and Head and Neck

Meyers SP. Differential Diagnosis in Neuroimaging: Brain and Meninges. Thieme; 2016; 652 pp; 1713 ill; $179.99

Meyers SP. Differential Diagnosis in Neuroimaging: Spine. Thieme; 2016; 288 pp; 309 ill; $149.99

Meyers SP. Differential Diagnosis in Neuroimaging: Head and Neck. Thieme; 2016; 664 pp; 1538 ill; $179.99

Brain and Meninges cover Spine cover Head and Neck cover

With an unprecedented trifecta, Dr. Steven Meyers from the University of Rochester Medical Center has single-handedly authored and simultaneously published 3 books: Differential Diagnosis in Neuroimaging: Brain and Meninges (652 pages), Differential Diagnosis in Neuroimaging: Spine (288 pages), and Differential Diagnosis in Neuroimaging: Head and Neck (664 pages). The set up in each book is similar and follows the same format, which in turn adds to the appeal of these 3 publications.

Each book has a short introduction related to anatomy and/or development, and in some areas there are short descriptions of anatomy and function that precede specific material. Pathological cases are presented in well-defined sections, each containing abundant and well-chosen images that are combined with tables that list each disease and adjacent to columns containing findings and comments on the disease under consideration. This is not a common way of presenting material; however, it is effective, allowing a substantial amount of material to be discussed in a compact space. It also allows a nice separation of imaging findings from other important clinical and pathologic information. I do find it amazing that Dr. Meyers was able to obtain all of these images from his own files and collate them so completely.

The chapters in Brain are: congenital malformations; supratentorial intra-axial lesions; infratentrial intra-axial lesions; multiple lesions; white matter lesions and diffuse lesions in children; lesions of the basal ganglia; neurodegenerative disorders; ischemia/infarction in adults; ischemia/infarction in children; intra- and parasellar lesions; and pineal region lesions. The chapters in Spine are: congenital/development; …

RadCases: Head and Neck Imaging

Shah G, Wesolowski J, Choi J, Friedman ER. RadCases: Head and Neck Imaging. Thieme; 2016; 224 pp; 441 ill; $59.99

Cover of Shah

RadCases: Head and Neck Imaging features a nice series of 100 cases that illustrates both relatively common and challenging head and neck abnormalities; these cases are supplemented with additional material (150 cases), which is accessible through a scratch-off code that readers can enter into the Thieme website. These extra 150 cases provide an excellent self-quiz.

The print version shows each unknown with its history and, on the overleaf, the diagnosis is stated, the images are reproduced and labeled, and a differential diagnosis is provided, along with what are called “essential facts,” other potential and associated imaging findings, and “pearls and pitfalls.” These 100 cases and the 150 online are well chosen; however, it would have been worthwhile to include additional postoperative neck scans (along with the PET scanning). It also might have been valuable to have included more cases in which the findings were not so blatant. As we all know, the major challenge is finding or identifying lesions, not necessarily giving a differential diagnosis. For the online cases, the ability to go from images, to image annotations, to differential diagnoses, to key points makes learning efficient. This book serves as a refresher that helps one sharpen diagnostic abilities in head and neck imaging.

Side note: When some minor difficulty was encountered in accessing these web-based images, Thieme was contacted directly, and its representatives were immediately responsive and helpful in their assistance. This should be reassuring to those who purchase Thieme publications that have a web link to extra material.…

Vascular Lesions of the Head and Neck: Diagnosis and Management

Persky MS, Waner M, Blei F, et al. Vascular Lesions of the Head and Neck: Diagnosis and Management. Thieme; 2015; 168 pp; 236 ill; $99.99

Persky-vasc-lesions_ThiemeAs neuroradiologists we often diagnose various types of vascular malformations with CT, MR and/or DSA. Rarely do we actually see the patients with these abnormalities unless we are performing interventions, either as a primary treatment or as a prelude to a surgical procedure. This book (134 pages, hardcover) is edited by Drs. Persky, Waner, Blei and Berenstein. The inclusion of Dr. Berenstein, an interventional neuroradiologist, is important because it adds to the various disciplines involved in the care of these patients (Dermatology, Otolaryngology, Plastic Surgery, Pathology, and Radiology).

Drs. Shatules and Lefton contributed a short chapter on the Radiologic Evaluation of Vascular Malformations (description and illustration of the 4 types) and a separate chapter on hemangiomas alone. This book covers (14 chapters) all the critical aspects of head and neck vascular lesions, including the current classification systems and the clinical and pathologic findings in congenital vascular tumors. The pathology of congenital tumors is particularly well-written and well-illustrated chapter (many of these types are unknown to most neuroradiologists).

The chapters include information classification, genetics, pathology, natural history, various syndromes associated with vascular anomalies, imaging interventional management of these patients, and vascular neoplasms of the head and neck.

What would interest those in our specialty the most are the many pictures of patients with a variety of such lesions. Who amongst us has actually seen the clinical findings of a blue rubber bleb nevus or a proteus syndrome or an infantile Kaposioform hemogioendothelioma? And the patient illustrations go on for many more common and uncommon lesions. These are enlightening.

The endovascular treatment of these lesions is very nicely written, and as with all the other chapters, …

Tumors of the Nose, Sinuses and Nasopharynx

Lund VJ, Howard DJ, Wei WI. Tumors of the Nose, Sinuses and Nasopharynx. Thieme; 2014; 608 pp.; 700 il.; $219.99

tumors of nose sinus nasopharynxIn a 608-page hardcover book entitled Tumors of the Nose, Sinuses and Nasopharynx, the authors (Drs. Lund, Howard, and Wei) devote the majority of the book to descriptions of individual tumors affecting the nasal cavity, nasopharynx and paranasal sinuses. After two introductory chapters—one on historical aspects and the other on surgical anatomy, diagnostic workup, and imaging—the authors, along with seven contributors, present in an orderly fashion different tumoral conditions, each in a chapter-by-chapter format.

The material is divided into sections: (1) histological types of tumors, under which there are 18 subtypes, including entities which mimic tumors; (2) treatment options; and (3) a separate section on the nasopharynx. Under each tumor type there is a description of individual tumors that covers basically all those masses one would likely encounter. The major categories (under which there are more specific defined tumors) are epithelial tumors, mesencehymal tumors, vascular tumors, muscle tumors, cartilage based masses, tumors of the jaw, osseous lesions, neoplasms of the lymphatic based tumors, neuroectodermal lesions, germ cell tumors, metastases, and mimics of tumors. Each entity is described in terms of its classification (or what the authors call definition), potential etiologies, demographic factors, imaging, and histology, along with occasional clinical pictures of the patients, intraoperative photographs, and gross specimens. Treatment options and descriptions of them are, as one would expect, an important part of each tumor’s description.

For a neuroradiologist, the value here would be basically in the nonimaging components of the text, because the remarkable textbook on head and neck radiology by Som/Curtin or the textbook by Mancuso are more informative. Nonetheless, there is value in this book because we are able to read of those items important to …

Pearls and Pitfalls in Head and Neck and Neuroimaging: Variants and Other Difficult Diagnoses

Aygun N, Shah G, Gandhi D.  Pearls and Pitfalls in Head and Neck and Neuroimaging: Variants and Other Difficult Diagnoses. Cambridge University Press; 2014; 498 pgs. 1063 illustrations; $130.00.

The book Pearls and Pitfalls in Head and Neck and Neurimaging: Variants and Other Difficult Diagnoses seeks to evaluate and discuss some of the more difficult interpretative issues in neuroradiology. The authors (Drs. Aygun, Shah, and Gandhi) have selected 106 cases they have deemed to fall into this category of elusive cases. To this reviewer, many of the cases have been properly selected to demonstrate and explain difficulties in interpretation, while other cases would not ordinarily cause much confusion.

The authors have divided the book into 19 sections, each with well selected cases (from 2 to 17 in each section). The major subdivisions are: Brain (CV disease, demyelinating diseases, tumors, infections, metabolic/degenerative disorders, trauma, miscellaneous); Artifacts and Anatomic variations; Skull Base; Head and Neck (temporal bone, paranasal sinus, orbits, salivary glands, neck masses, thyroid/parathyroid neck vessels); Spine (bony spine, discs, spinal canal/contents). The authors have clearly tried to define those areas of neuroradiology that they feel are particularly bothersome.

The cases are, for the most part, well-chosen, and the remarks about each entity are short (1 page); with each containing the following subdivisions: imaging description, importance, typical clinical scenario, differential diagnosis, major teaching points, and references.

Here are some examples of the types of cases chosen where confusion may be present: pseudoprogression of glioblastomas, RCVS (Call-Fleming), cortical vein thrombosis, intracerebral cavernous malformation, the multiple appearances of osmotic demyelination, low-grade tumors, pineal region abnormalities, PRES (and its various forms), perineural spread, fungal vs. invasive sinusitis, orbital pseudotumor and the variations of this inflammatory process, parathyroid adenomas, degenerative changes of the vertebral body end plates vs. infection (discitis).

Given the highly visual …

Otology and Neurotology

Kirane MV, De Souza CE, eds. Otology and Neurotology. Otorhinolaryngology—Head and Neck Surgery Series. Thieme; 2013; 520 pgs.; 416 illustrations. $149.99.

For those neuroradiologists who are deeply involved with head and neck imaging—temporal bone imaging in particular—this book will be of interest. It takes the reader through seven basic areas: Basic Sciences, Approaches to Patients with Ontological/Neurotological Diseases, Disorders of the Middle Ear, Disorders of the Inner Ear, Disorders of the Facial Nerve, Neurotologic and Lateral Skull Base Surgery, Electronic Listening Devices. There is one chapter on temporal bone imaging, but this does not contain information or imaging that cannot be found in more detailed papers and chapters in the neuroradiology literature; in fact, this chapter leaves out some of the more advanced MR techniques such as thin-section CISS sequences. In other words, this is very basic material, and it is surprising that two of the imaging figures are not published in a grayscale mode, while one figure does not show adequately what the authors claim (a unilateral Mondini malformation).

That aside, the neuroradiologist will be interested in the surgical anatomy of the temporal bone and how various lesions of the middle ear and inner ear are approached. The drawings and intraoperative pictures are very helpful in understanding the surgery involved. This reviewer would hope that in future editions of the book, the editors would pay closer attention to the quality of the CT and MR images, which are, frankly, of poor resolution in many instances.

Again, the value is not in the imaging but how the surgeon approaches various pathologies, removes masses, and performs reconstructive surgery. Understanding these problems will make the interpretation of the images (both pre- and postoperative) more meaningful.

Otology and Neurotology-Kirane