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Alouda N, Alshammari NH, Alomar KS, Shami I, Alobaid AO. A misdiagnosed aneurysm of the petrous internal carotid artery: A case report. Int J Surg Case Rep 2023; 110:108671. [PMID: 37634430 PMCID: PMC10509807 DOI: 10.1016/j.ijscr.2023.108671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION An aneurysm is characterized by the weakening of the arterial wall, which leads to a bulge that can be filled with blood. Aneurysms of the petrous portion of the internal carotid artery are rare and predominantly detected incidentally. This is a report of multiple misdiagnoses of an aneurysm of the petrous segment of the internal carotid artery (ICA) that highlights its imaging-based diagnosis and risk of mortality. PRESENTATION OF CASE A 60-year-old woman with chronic kidney disease and a history of stroke presented with left ear discharge, decreased hearing, and non-pulsatile tinnitus that had persisted for four months. Clinical examination showed wet tympanic membrane perforation, and imaging revealed an ill-defined infiltrative mass involving the left petrous apex initially misdiagnosed as glomus jugulare. Diagnostic computed tomography (CT) angiography revealed a left aneurysm in the petrous part of the ICA, which was successfully treated with interventional radiology. Follow-up was planned for infectious diseases and internal medicine, but she was lost to follow-up by the otolaryngology department. DISCUSSION Aneurysms in the petrous portion of the ICA are rare and usually asymptomatic. However, their clinical manifestations vary, and they have various differential diagnoses. CT and magnetic resonance imaging are essential for diagnosis, and CT angiography is the gold standard. CONCLUSION Diagnosing petrous ICA aneurysms requires a high level of suspicion and CT angiography. Their clinical presentations vary from asymptomatic to severe. Case-specific management and endovascular treatment yield positive neurological outcomes.
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Affiliation(s)
- Nada Alouda
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Nouf H Alshammari
- Department of Otolaryngology-Head & Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Suwayyid Alomar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Shami
- Department of Otolaryngology-Head & Neck Surgery, Main Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh 11525, Saudi Arabia
| | - Abdullah Omar Alobaid
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Arsovic E, Montava M, Fakhry N, Lavieille JP, Pacak K, Taïeb D, Varoquaux A. Quantitative biomarkers allow the diagnosis of head and neck paraganglioma on multiparametric MRI. Eur J Radiol 2021; 143:109911. [PMID: 34508941 DOI: 10.1016/j.ejrad.2021.109911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study is to identify quantitative MR biomarkers in head and neck paragangliomas. METHODS The study was approved by an institutional review board. A retrospective review of patients with head and neck paragangliomas (HNPGL) evaluated by time-resolved MRA sequences between 2009 and 2019 was performed. A control group investigated during the same period was analyzed, including nerve sheath tumors and metastatic lymph nodes from squamous cell carcinomas or undifferentiated nasopharyngeal cancer (UCNT). A gold standard was obtained for all cases. Semi-quantitative parameters of enhancement were extracted from time-intensity curves on time-resolved MRA sequences and diffusion weighted imaging/DWI was assessed for each lesion. RESULTS Sixty head and neck paragangliomas (HNPGLs) were included from 50 patients. The control group consisted of 30 parapharyngeal space lesions (27 patients), which included nerve sheath tumors (n = 12) and metastatic lymph nodes (n = 18) from squamous cell carcinomas or UCNT. PGLs showed a shorter time-to-peak value compared to other groups, measured at 25.0 +/- 29 sec. The wash-in and wash-out ratios were also significantly higher for PGLs, respectively measured at 5.34 ± 2.99 (p < 0,001) and 1.24 ± 0.80 (p < 0.001). On DWI sequences, the mean ADC value for PGLs (1.17 ± 0.19 10^-3 mm2/s) was significantly different than the other tumor groups (p < 0.001). HNPGLs were clearly distinguishable from other tumors on classification with regression tree based on TTP and ADC values. These distinct group features were also consistent on principal component analysis. CONCLUSION Our study identifies a multiparametric signature for disease subtyping, providing a strong impetus for switching from qualitative to quantitative analysis of deep soft-tissue tumors of the neck.
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Affiliation(s)
- Emina Arsovic
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France
| | - Marion Montava
- Department of Head and Neck Surgery, Conception Hospital, Aix-Marseille Univ, France
| | - Nicolas Fakhry
- Department of Head and Neck Surgery, Conception Hospital, Aix-Marseille Univ, France
| | - Jean-Pierre Lavieille
- Department of Head and Neck Surgery, Conception Hospital, Aix-Marseille Univ, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health, Bethesda, MD 20892, USA
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France
| | - Arthur Varoquaux
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille Univ, France; Center for Magnetic Resonance in Biology and Medicine, UMR 7339, La Timone University Hospital, Aix-Marseille Univ, France.
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Ota Y, Naganawa S, Kurokawa R, Bapuraj JR, Capizzano A, Kim J, Moritani T, Srinivasan A. Assessment of MR Imaging and CT in Differentiating Hereditary and Nonhereditary Paragangliomas. AJNR Am J Neuroradiol 2021; 42:1320-1326. [PMID: 33985956 DOI: 10.3174/ajnr.a7166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/15/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Head and neck paragangliomas have been reported to be associated with mutations of the succinate dehydrogenase enzyme family. The aim of this study was to assess whether radiologic features could differentiate between paragangliomas in the head and neck positive and negative for the succinate dehydrogenase mutation. MATERIALS AND METHODS This single-center retrospective review from January 2015 to January 2020 included 40 patients with 48 paragangliomas (30 tumors positive for succinate dehydrogenase mutation in 23 patients and 18 tumors negative for the succinate dehydrogenase mutation in 17 patients). ADC values and tumor characteristics on CT and MR imaging were evaluated by 2 radiologists. Differences between the 2 cohorts in the diagnostic performance of ADC and normalized ADC (ratio to ADC in the medulla oblongata) values were evaluated using the independent samples t test. P < .05 was considered significant. RESULTS ADCmean (1.07 [SD, 0.25]/1.04 [SD, 0.12] versus 1.31 [SD, 0.16]/1.30 [SD, 0.20]× 10-3 mm2/s by radiologists 1 and 2; P < .001), ADCmaximum (1.49 [SD, 0.27]/1.49 [SD, 0.20] versus 2.01 [SD, 0.16]/1.87 [SD, 0.20] × 10-3 mm2/s; P < .001), normalized ADCmean (1.40 [SD, 0.33]/1.37 [SD, 0.16] versus 1.73 [SD, 0.22]/1.74 [SD, 0.27]; P < .001), and normalized ADCmaximum (1.95 [SD, 0.37]/1.97 [SD, 0.27] versus 2.64 [SD, 0.22]/2.48 [SD, 0.28]; P < .001) were significantly lower in succinate dehydrogenase mutation-positive than mutation-negative tumors. ADCminimum, normalized ADCminimum, and tumor characteristics were not statistically significant. CONCLUSIONS ADC is a promising imaging biomarker that can help differentiate succinate dehydrogenase mutation-positive from mutation-negative paragangliomas in the head and neck.
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Affiliation(s)
- Y Ota
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - S Naganawa
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - R Kurokawa
- Department of Radiology (R.K.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - J R Bapuraj
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Capizzano
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - J Kim
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - T Moritani
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Srinivasan
- From the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Malla SR, Bhalla AS, Manchanda S, Kandasamy D, Kumar R, Agarwal S, Shamim SA, Kakkar A. Dynamic contrast-enhanced magnetic resonance imaging for differentiating head and neck paraganglioma and schwannoma. Head Neck 2021; 43:2611-2622. [PMID: 33938085 DOI: 10.1002/hed.26732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/27/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Morphological assessment with conventional magnetic resonance imaging (MRI) sequences has limited specificity to distinguish between paragangliomas and schwannomas. Assessing the differences in microvascular properties through pharmacokinetic parameters of dynamic contrast-enhanced (DCE)-MRI can provide additional information to aid in this differentiation. MATERIALS AND METHODS A prospective study on MR characterization of neck masses was performed between January 2017 and March 2019 in our department, out of which 40 patients with head and neck paragangliomas (HNPGLs) (33 lesions) and schwannomas (15 lesions) were included in this analysis. MR perfusion using dynamic axial T1WI fat suppressed fast spoiled gradient recalled sequence with parallel imaging was performed in all the patients, in addition to single-shot turbo spin-echo axial diffusion weighted imaging (DWI) and routine MRI. ROI-based method was used to obtain signal-time curves, permeability measurements, and mean apparent diffusion coefficient (ADC) to differentiate paragangliomas from schwannomas. Statistical analysis was done to assess the significance and establish a cutoff to distinguish between the two entities. The available images of DOTANOC PET/CT (34 lesions) were analyzed retrospectively. Correlations between the perfusion, diffusion, and molecular PET/CT parameters were done. RESULTS Paragangliomas had a higher wash-in rate, wash-out rate, Ktrans, Kep , and Vp (p < 0.001); while schwannomas had a higher relative enhancement (p < 0.012), time to peak, time of onset, brevity of enhancement, and Ve (p < 0.001). Among the perfusion parameters, Kep (area under curve (AUC) 0.994) and Vp (AUC 0.992) were found to have the highest diagnostic value. In diffusion-weighted imaging, paragangliomas had a lower mean ADC compared to schwannomas (p < 0.001). The SUVmax and SUVmean were significantly associated with Ktrans , Kep , and Vp in paragangliomas. CONCLUSION DCE-MRI in addition to DWI-MRI can accurately distinguish HNPGL from schwannoma and may replace the need for any additional imaging and preoperative biopsy in most cases.
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Affiliation(s)
- Soumya Ranjan Malla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rakesh Kumar
- Department of Otorhinolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shamim Ahmed Shamim
- Department of Nuclear Medicine & PET, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Khaled M, Moghazy K, Elsaadany W, Eissa L. Additional diagnostic role of MRI spectroscopy, diffusion and susceptibility imaging in differentiation of CPA masses: our experience with emphasis on schwannomas and meningiomas. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00256-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
CPA masses are uncommon lesions and usually have quite distinctive imaging features. Still, diagnosis can be challenging in some cases, carrying a significant impact on the choice of treatment and surgical approach. The purpose of this study was to validate the usefulness of MRI spectroscopy, diffusion, and susceptibility in the characterization of CPA masses with the emphasis on the two commonest lesions: schwannomas and meningiomas.
Results
The study included a total of 27 cases: schwannomas (n = 12), meningiomas (n = 7), epidermoid cysts (n = 2), two chondrosarcomas (n = 2), arachnoid cyst (n = 1), glomus tumor (n = 1), a meningeal metastasis (n = 1), and an endolymphatic sac tumor (n = 1). DWI revealed: eight lesions showed low ADC (<1 × 10−3 mm2/s), 15 lesions with intermediate ADC values (1–1.8 × 10−3 mm2/s), and 4 lesions had high ADC (>1.8 × 10−3 mm2/s.) Meningiomas showed low to intermediate ADC values while schwannomas showed intermediate to high ADC values. A cut-off ADC value of (1 × 10−3 mm2/s) is statistically significant in the differentiation of meningioma from schwannoma. A myoinositol peak was in all 12 schwannomas and single meningioma while 6 meningiomas displayed alanine peak, with a very good statistical significance. Remaining lesions revealed non-specific spectra. SWI made in 18 lesions revealed signal voids in three schwannomas and glomus.
Conclusions
Though MRI features of CPA masses are distinctive in most clinical settings; MRI spectroscopy, diffusion, and susceptibility can provide highly informative additional data in problematic cases. An intermediate to high ADC value plus myoinositol peak and signal voids of micro-bleeds are highly suggestive of schwannomas. This is in contrary to meningiomas displaying low to intermediate ADC and an alanine peak with no micro-bleeds. The less common lesions revealed non-specific data.
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Laviv Y, Thomas A, Kasper EM. Hypervascular Lesions of the Cerebellopontine Angle: The Relevance of Angiography as a Diagnostic and Therapeutic Tool and the Role of Stereotactic Radiosurgery in Management. A Comprehensive Review. World Neurosurg 2016; 100:100-117. [PMID: 28049034 DOI: 10.1016/j.wneu.2016.12.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The cerebellopontine angle (CPA) is a narrowed skull base area containing important cranial nerves and vessels and bordering with eloquent areas of the posterior fossa. Tumors of the CPA are a heterogeneous group and can have extradural, intradural/extra-axial, or intra-axial origins. Their vascular supply changes depending on their anatomic origin. Symptomatic, large CPA tumors require surgical resection in order to prevent irreversible, severe neurological damages. However, its tight and strategical location make surgery in the CPA very challenging and require appropriate pre-surgical planning. Pre-surgical diagnosis is of great importance as it allows us to choose the optimal management for the particular patient. This is of further significance when encountering high-risk lesions such as hypervascular tumors. Neurosurgeons should utilize every available pre-surgical diagnostic modalities as well as neo-adjuvant treatments in order to reduce such risks. METHODS We review all reported cases of hypervascular lesions of the CPA and discuss the roles of angiography and stereotactic radiosurgery in their management. RESULTS Three lesions of the CPA can be considered as truly hypervascular: hemangioblastomas, hemangiopericytomas and paragangliomas. All lesions share many radiological features. However, each lesion has a different anatomical origin and hence, has a characteristic vascular supply. Pre-surgical angiography can be utilized as a diagnostic tool to narrow down the differential diagnosis of a vascular CPA lesion, based on the predominant supplying vessel. In addition, pre-surgical embolization at time of angiography will narrow the associated surgical risks. CONCLUSIONS Angiography is a crucial diagnostic and therapeutic tool, helping both in narrowing the presurgical differential diagnosis and in controlling intraoperative bleeding. Because of the high surgical risks associated with resection of vascular tumors in the CPA, noninvasive treatments, such as stereotactic radiosurgery, also may have a crucial role.
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Affiliation(s)
- Yosef Laviv
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ajith Thomas
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Jiang JX, Tang ZH, Zhong YF, Qiang JW. Diffusion kurtosis imaging for differentiating between the benign and malignant sinonasal lesions. J Magn Reson Imaging 2016; 45:1446-1454. [PMID: 27758016 DOI: 10.1002/jmri.25500] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/20/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The study aimed to evaluate diffusion kurtosis imaging (DKI) in the differentiation between benign and malignant sinonasal lesions, and to compare the diagnostic performance of DKI with diffusion weighted imaging (DWI). MATERIALS AND METHODS Eight-one patients with solid sinonasal lesions confirmed by surgery and pathology (46 malignant and 35 benign) underwent conventional MRI, DWI, and DKI. DKI was performed employing a 13 extended b-value ranging from 0 to 2500 s/mm2 . Apparent diffusion coefficient (ADC) from DWI, kurtosis (K), and diffusion coefficient (D) from DKI were measured and compared between two groups. RESULTS ADC and D values were significantly lower in the malignant sinonasal lesions than in the benign sinonasal lesions (1.11 ± 0.41 versus 1.58 ± 0.50 × 10-3 mm2 /s and 1.45 ± 0.36 versus 2.03 ± 0.49 × 10-3 mm2 /s, respectively, both P < 0001). K value was significantly higher in the malignant lesions than in the benign lesions (0.91 ± 0.23 versus 0.57 ± 0.24, P < 0001). The receiver operating characteristic curve analyses yielded a cutoff ADC value of 1.27 × 10-3 mm2 /s for differentiating between benign and malignant lesions, with a sensitivity of 69.6%, a specificity of 77.1% and an accuracy of 74.0%; a cutoff D value of 1.75 × 10-3 mm2 /s, with a sensitivity of 82.6%, a specificity of 77.1% and an accuracy of 80.2%; a cutoff K value of 0.63 with a sensitivity of 95.7%, a specificity of 77.1% and an accuracy of 87.7%. The area under the curve of K value was significantly larger than that of ADC value (0.875 versus 0.762; P < 0.05). CONCLUSION K value of DKI demonstrates significantly higher accuracy compared with ADC value for the differentiation between benign and malignant sinonasal lesions. DKI may be a noninvasive method to evaluate the sinonasal lesions. LEVEL OF EVIDENCE 1 J. MAGN. RESON. IMAGING 2017;45:1446-1454.
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Affiliation(s)
- Jing Xuan Jiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Zuo Hua Tang
- Department of Radiology, Eye and ENT Hospital, Fudan University Shanghai, China
| | - Yu Feng Zhong
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Abstract
Paragangliomas of the head and neck are rare vascular skull-base tumors derived from the paraganglionic system with an estimated incidence of 1:30,000 accounting for 3% of all paragangliomas. The most common paraganglioma locations of the head and neck in descending order are the carotid body, jugular, tympanic, and vagal paragangliomas. This article discusses the clinical characterics, normal anatamy, imaging findings and protocols, pathology, staging, and differential diagnosis for paragangliomas of the head and neck.
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Das A, Bhalla AS, Sharma R, Kumar A, Sharma M, Gamanagatti S, Thakar A, Sharma S. Benign neck masses showing restricted diffusion: Is there a histological basis for discordant behavior? World J Radiol 2016; 8:174-182. [PMID: 26981226 PMCID: PMC4770179 DOI: 10.4329/wjr.v8.i2.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/27/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion weighted imaging (DWI) evolved as a complementary tool to morphologic imaging by offering additional functional information about lesions. Although the technique utilizes movement of water molecules to characterize biological tissues in terms of their cellularity, there are other factors related to the histological constitution of lesions which can have a significant bearing on DWI. Benign lesions with atypical histology including presence of lymphoid stroma, inherently increased cellularity or abundant extracellular collagen can impede movement of water molecules similar to malignant tissues and thereby, show restricted diffusion. Knowledge of these atypical entities while interpreting DWI in clinical practice can avoid potential misdiagnosis. This review aims to present an imaging spectrum of such benign neck masses which, owing to their distinct histology, can show discordant behavior on DWI.
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Takashima Y, Kamitani T, Kawanami S, Nagao M, Yonezawa M, Yamasaki Y, Baba S, Yabuuchi H, Hida T, Kohashi K, Nakamura K, Sonoda H, Oda Y, Honda H. Mediastinal paraganglioma. Jpn J Radiol 2015; 33:433-6. [PMID: 26025611 DOI: 10.1007/s11604-015-0436-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
We present a case of mediastinal paraganglioma with radiologic-pathologic correlation. A 48-year-old woman was found incidentally to have a middle mediastinal mass on CT. The mass showed iso-signal intensity compared to that of muscle on T1-weighted images and high signal intensity on T2-weighted images. The lesion showed intermediate intensity on diffusion-weighted imaging, and its apparent diffusion coefficient was 1.72 × 10(-3) mm(2)/s. A contrast-enhanced dynamic study revealed a rapid peak and washout enhancement pattern. (18)F-FDG-PET revealed abnormal uptake in the mediastinal tumor with a maximal standardized uptake value of 7.88. (123)I-meta-iodobenzylguanidine scintigraphy also showed abnormal uptake in the tumor. These findings corresponded to the hypervascularity, rich stroma, low nuclear/cytoplasmic ratio, and nest-forming proliferation of tumor cells with positive neuroendocrine markers.
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Affiliation(s)
- Yoko Takashima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Subedi N, Prestwich R, Chowdhury F, Patel C, Scarsbrook A. Neuroendocrine tumours of the head and neck: anatomical, functional and molecular imaging and contemporary management. Cancer Imaging 2013; 13:407-22. [PMID: 24240099 PMCID: PMC3830426 DOI: 10.1102/1470-7330.2013.0034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Neuroendocrine tumours (NETs) of the head and neck are rare neoplasms and can be of epithelial or non-epithelial differentiation. Although the natural history of NETs is variable, it is crucial to establish an early diagnosis of these tumours as they can be potentially curable. Conventional anatomical imaging and functional imaging using radionuclide scintigraphy and positron emission tomography/computed tomography can be complementary for the diagnosis, staging and monitoring of treatment response. This article describes and illustrates the imaging features of head and neck NETs, discusses the potential future role of novel positron-emitting tracers that are emerging into clinical practice and reviews contemporary management of these tumours. Familiarity with the choice of imaging techniques and the variety of imaging patterns and treatment options should help guide radiologists in the management of this rare but important subgroup of head and neck neoplasms.
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Affiliation(s)
- Navaraj Subedi
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Varoquaux A, Fakhry N, Gabriel S, Garcia S, Ferretti A, Chondrogiannis S, Rubello D, Taïeb D. Retrostyloid parapharyngeal space tumors: A clinician and imaging perspective. Eur J Radiol 2013; 82:773-82. [DOI: 10.1016/j.ejrad.2013.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/17/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Aschenbach R, Basche S, Esser D, Vogl TJ. Usefulness of ultrafast dynamic 3D-T1w data acquisition in detection of hypervascular lesions of the middle ear: first experience. Eur J Radiol 2010; 81:257-61. [PMID: 21123017 DOI: 10.1016/j.ejrad.2010.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 10/28/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate ultrafast dynamic 3D-T1w acquisition for improved detection of tympanic hypervascularized lesions. METHODS Retrospective evaluation of a total of 50 patients referred from ENT-Department for suspected tympanic lesion. All underwent magnetic resonance imaging including ultrafast dynamic 3D-T1w acquisition imaging. Quantitative and qualitative evaluation was performed as well as statistical analysis. Comparison with intra-operative results. RESULTS 12/50 patients showed a hypervascularized lesion proved intraoperative as 8 paragangliomas, 2 adenoms, 1 hemangioma and 1 neurinoma. 8/50 do not show hypervascularization though an enhancement was detected. Intra-operative granulation tissue was found. 30 patients did not show any lesions or enhancement. Sensitivity and specificity was 100%/100% for ultrafast dynamic imaging. CONCLUSION Additional ultrafast dynamic 3D-T1w imaging is superior to conventional imaging in detection of hypervascularized lesions.
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Affiliation(s)
- René Aschenbach
- HELIOS Klinikum Erfurt GmbH, Institute for Diagnostic and Interventional Radiology and Neuroradiology, Nordhauser Str 74, 99089 Erfurt, Germany.
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Abstract
Post-therapeutic imaging is crucial for treatment planning and control in patients with malignant lesions in the head and neck. Focussed on CT, PET-CT and MRI, imaging strategies for post-therapeutic follow-up have been developed and investigated during the last few years. This review should help to interpret the results of these studies and make the reader familiar with the latest developments.
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