PURPOSE: To prospectively determine whether combined positron emission tomography (PET) and computed tomography (CT) is more accurate than either PET or CT alone in depicting malignant lesions in the head and neck. MATERIALS AND METHODS: Study was approved by the institutional review board, and patient informed consent was waived. Sixty-five consecutive patients (42 men, 23 women; age range, 43–83 years) known to have or suspected of having head and neck cancer were examined with combined PET/CT. CT was performed with intravenous administration of a contrast agent, and the CT data were used for attenuation correction. Each examination was interpreted in three ways: PET images in the absence of CT data, CT images in the absence of PET data, and fused PET/CT images. Probability of malignancy of each lesion was assigned a score by using a five-point scale. Receiver operating characteristic (ROC) analyses were performed by using biopsy, imaging, or clinical follow-up as the reference standard. The minimum fol...

Head and neck malignancy: is PET/CT more accurate than PET or CT alone?

BACKGROUND AND PURPOSE: Metastasis to the regional cervical lymph nodes may be associated with alterations in water diffusivity and microcirculation of the node. We tested whether diffusion-weighted MR imaging could discriminate metastatic nodes. METHODS: Diffusion-weighted echo-planar and T1- and T2-weighted MR imaging sequences were performed on histologically proved metastatic cervical lymph nodes (25 nodes), benign lymphadenopathy (25 nodes), and nodal lymphomas (five nodes). The apparent diffusion coefficient (ADC) was calculated by using two b factors (500 and 1000 s/mm2). RESULTS: The ADC was significantly greater in metastatic lymph nodes (0.410 ± 0.105 × 10−3 mm2/s, P CONCLUSION: Diffusion-weighted imaging is useful in discriminating metastatic nodes.

http://www.ajnr.org/content/ajnr/24/8/1627.full.pdf

Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer

// Alexey Surov 1, * , Hans Jonas Meyer 1, * and Andreas Wienke 2, * 1 Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany 2 Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany * All authors contributed equally for this work Correspondence to: Alexey Surov, email: Alexey.Surov@medizin.uni-leipzig.de Keywords: DWI, MRI, ADC, cellularity, tumor Received: March 31, 2017      Accepted: April 27, 2017      Published: May 10, 2017 ABSTRACT The purpose of this meta-analysis was to provide clinical evidence regarding relationship between ADC and cellularity in different tumors based on large patient data. Medline library was screened for associations between ADC and cell count in different tumors up to September 2016. Only publications in English were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) was used for the research. Overall, 39 publications with 1530 patients were included into the analysis. The following data were extracted from the literature: authors, year of publication, number of patients, tumor type, and correlation coefficients. The pooled correlation coefficient for all studies was ρ = -0.56 (95 % CI = [−0.62; −0.50]),. Correlation coefficients ranged from ρ =−0.25 (95 % CI = [−0.63; 0.12]) in lymphoma to ρ=−0.66 (95 % CI = [−0.85; −0.47]) in glioma. Other coefficients were as follows: ovarian cancer, ρ = −0.64 (95% CI = [−0.76; −0.52]); lung cancer, ρ = −0.63 (95 % CI = [−0.78; −0.48]); uterine cervical cancer, ρ = −0.57 (95 % CI = [−0.80; −0.34]); prostatic cancer, ρ = −0.56 (95 % CI = [−0.69; −0.42]); renal cell carcinoma, ρ = −0.53 (95 % CI = [−0.93; −0.13]); head and neck squamous cell carcinoma, ρ = −0.53 (95 % CI = [-0.74; −0.32]); breast cancer, ρ = −0.48 (95 % CI = [−0.74; −0.23]); and meningioma, ρ = -0.45 (95 % CI = [−0.73; −0.17]).

/pdf/correlation-between-apparent-diffusion-coefficient-adc-and-2wl1ljfpss.pdf

Correlation between apparent diffusion coefficient (ADC) and cellularity is different in several tumors: a meta-analysis.

Purpose: To determine the value of adding diffusion-weighted (DW) magnetic resonance (MR) imaging to dynamic contrast material–enhanced MR imaging when distinguishing between benign and malignant parotid tumors. Materials and Methods: This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. The authors analyzed MR images of 50 lesions (36 benign, 14 malignant) in 47 patients. DW MR imaging and dynamic contrast-enhanced MR imaging were performed in all patients. Time-intensity curve (TIC) patterns were categorized as follows: type A, time to peak was more than 120 seconds; type B, time to peak was 120 seconds or less with high washout ratio (≥30%); type C, time to peak was 120 seconds or less with low washout ratio (<30%); and type D, flat. The apparent diffusion coefficient (ADC) values were measured on DW MR images. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for type A, B, and D tumors re...

Parotid Gland Tumors: Can Addition of Diffusion-weighted MR Imaging to Dynamic Contrast-enhanced MR Imaging Improve Diagnostic Accuracy in Characterization?

BACKGROUND AND PURPOSE: Our aim was to determine the value of echo-planar diffusion-weighted MR imaging (epiDWI) in differentiating various types of primary parotid gland tumors. MATERIALS AND METHODS: One hundred forty-nine consecutive patients with suspected tumors of the parotid gland were examined with an epiDWI sequence by using a 1.5T unit. Image analysis was performed by 2 radiologists independently, and the intraclass correlation coefficient was computed. Histologic diagnosis was obtained in every patient. For comparison of apparent diffusion coefficients (ADCs), a paired 2-tailed Student t test with a Bonferroni correction was used. RESULTS: In 136 patients, a primary parotid gland tumor was confirmed by histology. Among the observers, a high correlation was calculated (0.98). ADC values of pleomorphic adenomas were significantly higher than those of all other entities, except for myoepithelial adenomas (P = .054). ADC values of Warthin tumors were different from those of myoepithelial adenomas, lipomas, and salivary duct carcinomas (P CONCLUSION: epiDWI has the potential to differentiate pleomorphic adenoma and myoepithelial adenomas from all other examined entities. Due to an overlap not only within the group of benign and malignant lesions but also between groups, diagnoses should not be addressed on the basis of ADC values solely. Therefore, further studies combining DWI, morphologic criteria, and probably other MR imaging techniques seem warranted.

http://www.ajnr.org/content/ajnr/30/3/591.full.pdf

Diffusion-Weighted Echo-Planar MR Imaging of Primary Parotid Gland Tumors: Is a Prediction of Different Histologic Subtypes Possible?

Purpose:

To evaluate the stepwise approach in differentiating between benign and malignant salivary gland tumors using time-intensity curves (TICs) and apparent diffusion coefficients (ADCs).



Materials and Methods:

TICs and ADCs were analyzed on the tumor-by-tumor (overall) and pixel-by-pixel (TIC and ADC maps) bases in patients with benign (n = 52) or malignant (n = 18) salivary gland tumor. TICs were categorized into Types 1 ( 120 sec peak time), 3 (≥20% increment ratio, ≤120 sec peak time, and <30% washout ratio), or 4 (≥20% increment ratio, ≤120 sec peak time, and ≥30% washout ratio). ADCs were classified as extremely low (<0.6 × 10−3 mm2/sec), low (<1.2), intermediate (<1.8), or high (≥1.8).



Results:

Malignant tumors had small ( 40%) areas with low or extremely low ADCs.



Conclusion:

We propose a stepwise approach by using multiparametric MRI techniques as an effective tool for differentiating between benign and malignant salivary gland tumors J. Magn. Reson. Imaging 2010;31:673–679. © 2010 Wiley-Liss, Inc.

Multiparametric magnetic resonance imaging for the differentiation between benign and malignant salivary gland tumors

BACKGROUND AND PURPOSE: Although sonographic evaluation of cervical adenopathy by use of size criteria is effective, the sensitivity and specificity fall short of that required to make adequate judgments regarding neck dissection. Therefore, we tested whether the combined use of size criteria and Doppler sonographic findings would improve the predictive ability for metastatic cervical nodes.

METHODS: We analyzed 338 histologically proved cervical lymph nodes (108 metastatic and 230 nonmetastatic) in 73 patients with head and neck cancer. The sonographic topography of the nodes was compared with dissected specimens, and their position in the neck was categorized into three levels (I, II, and III+IV). The diagnostic accuracy of sonography was evaluated by using the single criterion of short-axis diameter of the node or by the combined criteria of short-axis diameter and Doppler blood flow features (the absence or presence of normal hilar flow).

RESULTS: As compared with the single criterion of short-axis nodal diameter, the combined criteria of nodal size and Doppler blood flow patterns increased the diagnostic accuracy of sonography at all levels in the neck. Accordingly, the best cut-off values were improved to 6, 7, and 5 mm for nodes at levels I, II, and III+IV, respectively. In addition, the combined criteria yielded high sensitivites (≥89%) and specificities (≥94%).

CONCLUSION: Hilar blood flow information obtained by Doppler sonography significantly improves diagnostic accuracy for the detection of nodes metastatic from head and neck squamous cell carcinoma.

http://www.ajnr.org/content/ajnr/22/1/163.full.pdf

Contribution of Doppler Sonography Blood Flow Information to the Diagnosis of Metastatic Cervical Nodes in Patients with Head and Neck Cancer: Assessment in Relation to Anatomic Levels of the Neck

We retrospectively evaluated the effectiveness of combined use of salivary gland ultrasonography (US) and the 2016 American College of Rheumatology/European League Against Rheumatic Disease (ACR/EULAR) classification criteria for improving the diagnostic efficiency in patients with Sjogren's syndrome (SS). A US-based salivary gland disease grading system was developed using a cohort comprising 213 SS or non-SS patients who fulfilled the minimum requirements for classifying SS based on the American-European Consensus Group (AECG) and ACR criteria. Using 62 SS or non-SS patients from the 213 patients and who had also undergone all the 5 examinations needed for the ACR/EULAR classification, we compared the diagnostic accuracy of various combinations of the ACR/EULAR and US classifications for diagnosing SS, using the clinical diagnosis of SS by rheumatologists as the gold standard. The ACR/EULAR criteria discriminated clinical SS patients with 77% and 79% accuracy for those with primary or secondary SS and for those with primary SS, respectively. However, the integrated score system of the ACR/EULAR and US classifications yielded 92% and 93% accuracy for these 2 SS patient groups, respectively, provided that US score of 3 was assigned to patients with US grade ≥2, and then patients with integrated threshold score of ≥5 were diagnosed as SS. Cross-validation also indicated improved accuracy of the integrated ACR/EULAR and US score system (91.9 and 93.0% for primary/secondary and primary SS patients, respectively) over that by the ACR/EULAR criteria alone. (74.2 and 86.0%, respectively). The integrated ACR/EULAR and US scoring system can improve the diagnosis of patients with clinical SS.

/pdf/combined-classification-system-based-on-acr-eular-and-8ecy3zi2lu.pdf

Combined classification system based on ACR/EULAR and ultrasonographic scores for improving the diagnosis of Sjögren's syndrome.

We asked in this study if the quantitative sonographic analysis could diagnose effectively the benign and malignant tumors of the parotid gland. Sonographic analyses using mean grey values and SDs of echo levels were performed on the 21 benign tumors and 22 malignant tumors of the parotid glands. Both the mean grey level and the SD of the echo levels were significantly and characteristically different among the different parotid tumor groups. Discrimination analysis showed that, compared with single uses, a combined use of these two criteria improved diagnostic accuracy to 81% (carcinoma vs. pleomorphic adenomas), 93% (malignant lymphomas vs. pleomorphic adenomas), 91% (carcinomas vs. malignant lymphomas), 100% (pleomorphic adenomas vs. Warthin's tumors), 100% (carcinomas vs. Warthin's tumors) and 100% (malignant lymphomas vs. Warthin's tumors). These findings suggest that quantitative sonographic analysis is effective in differentiating benign and malignant tumors of the parotid gland.

Parotid tumors: differentiation of benign and malignant tumors with quantitative sonographic analyses

BACKGROUND AND PURPOSE: Correctly diagnosing metastatic nodes is important for the follow-up of patients with clinical N0 stage neck disease and oral cancer A combination of helical CT and Doppler sonography may facilitate the accurate detection of lymph node metastasis in patients with clinical N0 stage neck disease METHODS: A combination of contrast-enhanced helical CT and Doppler sonography was performed to monitor the necks of 58 patients with initial clinical N0 stage neck disease Of these patients, 17 underwent surgery; nodal metastasis in the neck was histopathologically confirmed A node was diagnosed as metastatic if it fulfilled the CT criteria for metastatic nodes (short-axis diameter equal to or greater than the cutoff points for each level of the neck or central nodal necrosis) and if, additionally, it did not exhibit sonographic features for nonmetastatic nodes (normal hilar echogenicity and hilar flows) The presence of metastasis was confirmed histopathologically RESULTS: During the follow-up periods, metastatic nodes were histologically confirmed in 17 (29%) patients Of 30 metastatic nodes from the 17 patients with metastatic nodes, 22 (73%) appeared within the first year and 28 (93%) within the first 2 years; 20 developed from nonmetastatic nodes, and 10 were newly detectable The combined criteria were effective in revealing 26 (87%) nodes, yielding 87% sensitivity, 100% specificity, and 100% positive and 99% negative predictive values The independent use of one of these techniques alone resulted in low (67%) or moderate (87%) positive predictive values for sonography and CT, respectively Seven hundred forty-one (97%) of 761 nodes that were nonmetastatic at initial examination remained nonmetastatic (737 nodes) or had disappeared (four nodes) As a result, a combination of CT and sonography was effective in revealing all 17 cases of metastatic nodes CONCLUSION: A combination of contrast-enhanced helical CT and Doppler sonography is useful for the follow-up study of clinical N0 stage neck disease

http://www.ajnr.org/content/ajnr/24/3/312.full.pdf

Combination of helical CT and Doppler sonography in the follow-up of patients with clinical N0 stage neck disease and oral cancer.

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