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Chan T, Richter H, Del Chicca F. Sample strategies for the assessment of the apparent diffusion coefficient in single large intracranial space-occupying lesions of dogs and cats. Front Vet Sci 2024; 11:1357596. [PMID: 38803797 PMCID: PMC11129633 DOI: 10.3389/fvets.2024.1357596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Diffusion-weighted imaging is increasingly available for brain investigation. Image interpretation of intracranial space-occupying lesions often includes the derived apparent diffusion coefficient (ADC) analysis. In human medicine, ADC can help discriminate between benign and malignant lesions in intracranial tumors. This study investigates the difference in ADC values depending on the sample strategies of image analysis. MRI examination, including diffusion-weighted images of canine and feline patients presented between 2015 and 2020, were reviewed retrospectively. Patients with single, large intracranial space-occupying lesions were included. Lesions homogeneity was subjectively scored. ADC values were calculated using six different methods of sampling (M1-M6) on the ADC map. M1 included as much as possible of the lesion on a maximum of five consecutive slices; M2 included five central and five peripheral ROIs; M3 included a single ROI on the solid part of the lesion; M4 included three central ROIs on one slice; M5 included three central ROIs on different slices; and M6 included one large ROI on the entire lesion. A total of 201 animals of various breeds, genders, and ages were analyzed. ADC values differed significantly between M5 against M2 (peripheral) (p < 0.001), M5 against M6 (p = 0.009), and M4 against M2 (peripheral) (p = 0.005). When lesions scored as homogeneous in all sequences were excluded, an additional significant difference in three further sampling methods was present (p < 0.005). ADC of single, large, intracranial space-occupying lesions differed significantly in half of the tested methods of sampling. Excluding homogeneous lesions, additional significant differences among the sampling methods were present. The obtained results should increase awareness of the variability of the ADC, depending on the sample strategies used.
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Affiliation(s)
- Tatjana Chan
- Department of Diagnostics and Clinical Services, Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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2
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Battal B, Zamora C. Imaging of Skull Base Tumors. Tomography 2023; 9:1196-1235. [PMID: 37489465 PMCID: PMC10366931 DOI: 10.3390/tomography9040097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.
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Affiliation(s)
- Bilal Battal
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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3
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Urbančič J, Vozel D, Battelino S, Bošnjak R, Kokošar Ulčar B, Matos T, Munda M, Papst L, Steiner N, Vouk M, Zidar N. Atypical Skull-Base Osteomyelitis: Comprehensive Review and Multidisciplinary Management Viewpoints. Trop Med Infect Dis 2023; 8:tropicalmed8050254. [PMID: 37235302 DOI: 10.3390/tropicalmed8050254] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Atypical skull-base osteomyelitis is a rare but fatal disease that usually involves infection of the ethmoid, sphenoid, occipital, or temporal bones that form the skull base. Unlike typical (so-called otogenic), atypical skull-base osteomyelitis has no otogenic cause. Instead, some authors call atypical skull-base osteomyelitis sinonasal, since the infection most often originates from the nose and paranasal sinuses. Diagnosing and treating this disease is challenging. To assist in managing atypical skull-base osteomyelitis, a review of the most recent literature, with patient cases and multidisciplinary perspectives from otolaryngologists, neurosurgeons, radiologists, infectious disease specialists, pathologists, and clinical microbiologists, is provided in this paper.
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Affiliation(s)
- Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Roman Bošnjak
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Barbara Kokošar Ulčar
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tadeja Matos
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Lea Papst
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nejc Steiner
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Matej Vouk
- Department of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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4
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Wu W, Xia J, Li B, Liu W, Ge Z, Tan Z, Bu Q, Chen W, Li Y. Feasibility evaluation of intravoxel incoherent motion diffusion-weighted imaging in the diagnosis of skull-base invasion in nasopharyngeal carcinoma. J Cancer 2023; 14:290-298. [PMID: 36741262 PMCID: PMC9891879 DOI: 10.7150/jca.80679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/25/2022] [Indexed: 01/12/2023] Open
Abstract
Objective: This study aimed to evaluate the feasibility of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the diagnosis of skull-base invasion (SBI) in nasopharyngeal carcinoma (NPC). Materials and methods: A total of 50 patients pathologically diagnosed with NPC and a group of 40 controls comprised of those with either normal nasopharynx or patients with nasopharyngitis underwent conventional MRI and IVIM-DWI scans with 3 different groups of b values. Among the 50 patients, 36 patients diagnosed with SBI in NPC were included in the case group according to SBI criteria. All subjects (including those in the control group and case group) were divided into the b1, b2, and b3 groups based on their b values. The pure diffusion coefficient (D), perfusion-related incoherent microcirculation (D*), and microvascular volume fraction (f) values obtained in each measurement area of each group were tested for variance. Next,2 groups of b-value parameters with statistically significant data in the 3 groups were randomly selected for use in both the control group and the case group. A t-test was performed on the D, D*, and f values obtained by measuring each area of the skull base, and the area under the curve (AUC) of the receiver operating characteristic (ROC) was used to evaluate the diagnostic efficacy of the D, D*, and f values. Results: There was no statistical significance among the D, D*, and f values of the b1 and b3 groups (P>0.05), and the differences in parameters between the b1 and b2 groups were statistically significant(P < 0.05),and the differences in parameters between the b3 and b2 groups were also statistically significant(P < 0.05).The f value of the case group, which was obtained using the b1 and b2 parameters in each area of the skull base, was lower than that of the control group (P <0.05).The D, D*, and f values of the case group obtained by the b1 and b2 parameters in the pars petrosa of the temporal bone (including the foramen lacerum) were lower than those of the control group (P<0.05).When the parameters of the b1 group were used in the corpus of sphenoid bone (including the foramen ovale), the D, D*, and f values of the control group and the case group were compared, yielding a statistically significant difference (P<0.05).When the parameters of the b1 group were used, the diagnostic efficacy of the f value in each area of the skull base was the highest (AUC=0.908-0.991), followed by the D* value (AUC=0.624-0.692). Conclusion: When the number of b values <200 s/mm2 in IVIM-DWI accounts for more than half of the selected b values, IVIM-DWI is highly stable for the diagnosis of SBI in NPC. The D, D*, and f values of the bone and muscle areas of the skull base in patients with SBI of NPC showed a downward trend, and the f value had the best diagnostic performance, followed by the D* value, while the D value had the worst. Thus, IVIM-DWI can be used as a noninvasive method in the diagnosis of SBI in NPC.
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Affiliation(s)
- Weiquan Wu
- Clinical Research Experiment Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Jun Xia
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Bin Li
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Wenci Liu
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhan Ge
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhi Tan
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Qiujin Bu
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Wubiao Chen
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.,✉ Corresponding authors: Yuange Li, Department of Radiology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Rd., Xiashan District, Zhanjiang, Guangdong Province, 524001, China. Tel: +86-13692380351; E-mail: . Wubiao Chen, Department of Radiology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Rd., Xiashan District, Zhanjiang, Guangdong Province, 524001, China. Tel: +86-13509931577; E-mail:
| | - Yuange Li
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.,✉ Corresponding authors: Yuange Li, Department of Radiology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Rd., Xiashan District, Zhanjiang, Guangdong Province, 524001, China. Tel: +86-13692380351; E-mail: . Wubiao Chen, Department of Radiology, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Rd., Xiashan District, Zhanjiang, Guangdong Province, 524001, China. Tel: +86-13509931577; E-mail:
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Arora V, Sidhu BS, Singh K. Comparison of computed tomography and magnetic resonance imaging in evaluation of skull lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Computed tomography (CT) and magnetic resonance imaging (MRI) have been incorporated into the basic imaging tools for evaluation of skull lesions. Despite the known advantages and disadvantages of CT and MRI in various aspects of evaluating skull lesions, it is not always feasible to perform both CT and MRI in evaluation of the same patient. The purpose of this study is to compare CT and MRI in evaluation of various skull lesions and to determine which imaging modality out of the two is more appropriate in evaluation of skull lesions and their characterization.
Results
There was no statistically significant difference between CT and MRI for detection of number of lesions, distribution of lesions, margins of the lesions, nature of the lesions, zone of transition, cortical breach, intralesional calcification, intralesional hemorrhage, associated soft tissue, and invasion into brain parenchyma (p value > 0.05 in all these parameters). Dural involvement was picked up better on MRI as compared to CT (p value 0.031). Another advantage of MRI over CT was better characterization of lesions by diffusion weighted imaging.
Conclusion
CT and MRI are equally efficient in providing adequate diagnostic information in various skull lesions and each of them can be used independent of the other to characterize and diagnose the lesions of skull. The slight advantage of MRI over CT is detection of dural involvement.
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Nardi C, Maraghelli D, Pietragalla M, Scola E, Locatello LG, Maggiore G, Gallo O, Bartolucci M. A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus. Neuroradiology 2022; 64:1483-1509. [PMID: 35657394 PMCID: PMC9271108 DOI: 10.1007/s00234-022-02986-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/18/2022] [Indexed: 11/28/2022]
Abstract
The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird’s-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.
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Affiliation(s)
- Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit N. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Elisa Scola
- Department of Neuroradiology, Careggi University Hospital, Largo Piero Palagi 1, 50134, Florence, Italy
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Via Taddeo Alderotti, 50139, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Maurizio Bartolucci
- Department of Radiology, Azienda USL Toscana Centro, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20/22, 59100, Prato, Italy
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7
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D’Arco F, Ugga L. Pearls, Pitfalls, and Mimics in Pediatric Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:433-445. [DOI: 10.1016/j.nic.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Mahendrakar AK, Kumaran SP, Reddy BN, Viswamitra S. Utility of apparent diffusion coefficient (ADC) values in differentiating benign and malignant skull lesions with histopathological (HPE) correlation. J Clin Neurosci 2022; 98:21-28. [DOI: 10.1016/j.jocn.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/03/2022] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
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9
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Radiologic Differentiation between Granulomatosis with Polyangiitis and Its Mimics Involving the Skull Base in Humans Using High-Resolution Magnetic Resonance Imaging. Diagnostics (Basel) 2021; 11:diagnostics11112162. [PMID: 34829509 PMCID: PMC8618208 DOI: 10.3390/diagnostics11112162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 12/20/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) can involve the skull base or the Eustachian tubes. GPA is diagnosed on the basis of clinical manifestations and serological tests, although it is challenging to discriminate GPA from infectious processes driving skull base osteomyelitis (SBO) and malignant processes such as nasopharyngeal carcinoma (NPC). Moreover, current serological tests have a low sensitivity and cannot distinguish GPA from these other conditions. We hypothesized that certain MRI characteristics would differ significantly among conditions and aimed to evaluate whether the features could differentiate between GPA, SBO, and NPC involving the skull base. We retrospectively evaluated the MRI findings of patients with GPA, SBO, and NPC. We performed univariable logistic regression analyses to identify the predictive variables for differentiating between conditions and evaluated their diagnostic values. We showed, for the first time, that certain MRI findings significantly differed between patients with GPA and those with SBO or NPC, including the lesion morphology and extent, the apparent diffusion coefficient (ADC) values, the contrast enhancement patterns, the presence or absence of necrosis, and retropharyngeal lymphadenopathy. In conclusion, utilizing certain MRI features can improve the diagnostic performance of MRI by differentiating GPA with skull base involvement from other conditions with similar radiologic findings, including SBO and NPC, facilitating treatment plans and, thus, improving patient outcomes.
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10
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New and Advanced Magnetic Resonance Imaging Diagnostic Imaging Techniques in the Evaluation of Cranial Nerves and the Skull Base. Neuroimaging Clin N Am 2021; 31:665-684. [PMID: 34689938 DOI: 10.1016/j.nic.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The skull base and cranial nerves are technically challenging to evaluate using magnetic resonance (MR) imaging, owing to a combination of anatomic complexity and artifacts. However, improvements in hardware, software and sequence development seek to address these challenges. This section will discuss cranial nerve imaging, with particular attention to the techniques, applications and limitations of MR neurography, diffusion tensor imaging and tractography. Advanced MR imaging techniques for skull base pathology will also be discussed, including diffusion-weighted imaging, perfusion and permeability imaging, with a particular focus on practical applications.
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Abstract
PURPOSE OF REVIEW Skull base osteomyelitis (SBO) is a challenging entity to diagnose and treat. The goal of this review is to summarize the imaging findings of SBO and present these in the context of recent studies on imaging of SBO. RECENT FINDINGS This review discusses the clinical presentation, pathophysiology and imaging appearances of SBO. The review further emphasizes the results of latest studies on imaging of SBO, and the role of different modalities in diagnosis and evaluation of disease course and treatment response. Brief discussion on differential diagnoses from an imaging standpoint is also included. SUMMARY Various imaging modalities play different and complimentary roles in diagnosis and management of SBO, which are discussed in this review.
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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Álvarez Jáñez F, Barriga LQ, Iñigo TR, Roldán Lora F. Diagnosis of Skull Base Osteomyelitis. Radiographics 2021; 41:156-174. [PMID: 33411616 DOI: 10.1148/rg.2021200046] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Skull base osteomyelitis (SBO) is an infection of the temporal, sphenoid, or occipital bone that can be a challenge to diagnose because of its nonspecific symptoms, long clinical course, and radiologic findings that mimic those of other entities. The authors review this unusual infection on the basis of six proven cases. The diagnosis of SBO should be made according to four points: a high index of clinical suspicion, radiologic evidence of infection, repeated biopsies that are negative for malignancy, and positive results of microbiologic tests. SBO typically manifests clinically in patients with diabetes and recurrent otitis externa; the infection usually extends inferiorly to the compact bone of the infratemporal fossa, affecting the lower cranial nerve foramina. Several image-based techniques should be used to diagnose SBO. CT is the best option for evaluating bone erosion and demineralization, MRI can help delineate the anatomic location and extent of disease, and nuclear imaging is useful for confirming bone infection with high sensitivity. However, the standard diagnostic procedure for SBO is for patients to undergo repeated biopsies to rule out malignancy, with histopathologic signs of infection and detection of microorganisms in the biopsied bone or soft tissue indicating SBO. The ability to diagnose SBO can be increased by identifying patients at risk, recognizing the most important causes and routes of infection, describing the main radiologic findings, and always considering the differential diagnosis. ©RSNA, 2021.
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Affiliation(s)
- Fátima Álvarez Jáñez
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
| | - Luis Quintana Barriga
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
| | - Tania Rocha Iñigo
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
| | - Florinda Roldán Lora
- From the Department of Radiology, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, S/n, 41013, Seville, Spain
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14
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Russo C, Elefante A, Cavaliere M, Di Lullo AM, Motta G, Iengo M, Brunetti A. Apparent diffusion coefficients for predicting primary cholesteatoma risk of recurrence after surgical clearance. Eur J Radiol 2020; 125:108915. [PMID: 32114332 DOI: 10.1016/j.ejrad.2020.108915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Beside the well-known accuracy of non-EPI DWI techniques and relative ADC maps in detecting cholesteatomatous tissue, ADC can also represent a useful tool for stratifying cholesteatoma risk of recurrence. Aim of this study is to test the role of ADC in determining risk of recurrence for primary middle ear cholesteatoma, proposing stratification based on pre-operative mean (mADC) and normalized (nADC) ADC values. METHODS In this prospective study, 60 patients with primary unilateral middle ear cholesteatoma underwent a three-years-long follow-up to assess the presence of recurrent disease after macroscopically complete excisional surgery. Baseline MRI examination mADC and nADC values in the group with early evidence of recurrent cholesteatoma were compared to the group with no evidence of recurrence by using T statistics. RESULTS ADC values on pre-operative MRI examination were lower in cholesteatomas with early evidence of recurrence, and statistical significance was slightly higher for nADC compared to mADC measurements. We also determined a cut-off between the two groups, proposing stratification in high-risk of recurrence cholesteatomas (mADC≤ 1000 or nADC< 1.3) and low-risk cholesteatomas (mADC>1000 or nADC≥1.3). CONCLUSIONS ADC values resulted discriminating in identifying cholesteatomas with higher risk of early recurrence, both for mean and normalized ADC, with optimized tissue characterization and outcome prediction.
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Affiliation(s)
- Camilla Russo
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Andrea Elefante
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Michele Cavaliere
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Antonella M Di Lullo
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Gaetano Motta
- Dipartimento di Scienze Anestesiologiche, Chirurgiche e dell'Emergenza - Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Iengo
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche - Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate - Università degli Studi di Napoli "Federico II", Naples, Italy
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Pottabatula B, Smith G, Nagaraja N, Albayram MS. Demonstration of acute retinal ischemia on diffusion weighted magnetic resonance imaging. Clin Imaging 2020; 59:126-128. [DOI: 10.1016/j.clinimag.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022]
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Kee TP, Liauw L, Sathiyamoorthy S, Lee HY, Tan GSL, Yu WY. Large solitary lytic skull vault lesions in adults: radiological review with pathological correlation. Clin Imaging 2019; 59:129-143. [PMID: 31816540 DOI: 10.1016/j.clinimag.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/29/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022]
Abstract
The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article is to demonstrate the use of an imaging approach to narrow the differential diagnosis when a large solitary lytic skull vault lesion is encountered. The initial imaging assessment using computed tomography (CT) is invaluable in determining lesion aggressiveness based on bony margins and skull tables involvement. Further assessment with magnetic resonance (MR) imaging including diffusion weighted imaging (DWI) aids in soft tissue characterization. We present cases of large solitary lytic skull vault lesions in adults, emphasizing on salient and atypical imaging features, with pathological correlation for better understanding of the disease processes that underlie the imaging features.
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Affiliation(s)
- Tze Phei Kee
- Department of Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.
| | - Lishya Liauw
- Department of Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.
| | | | - Hwei Yee Lee
- Department of Pathology, Tan Tock Seng Hospital, 308433, Singapore.
| | - Grace Siew Lim Tan
- Department of Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.
| | - Wai Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, 308433, Singapore.
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Mejzlik J, Cerny M, Zeinerova L, Dedkova J, Kopriva J, Zadrobilek K, Adamkov J, Chrobok V, Pellantova V. The routes of infection spread in central skull-base osteomyelitis and the diagnostic role of CT and MRI scans. BMC Med Imaging 2019; 19:60. [PMID: 31370785 PMCID: PMC6676590 DOI: 10.1186/s12880-019-0331-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Central skull-base osteomyelitis (CSBO) represents a life-threatening complication of external ear canal infection. Computed tomography (CT) and magnetic resonance imaging (MRI) play key roles in assessment of CSBO progression. Methods Twelve patients with CSBO were included in a retrospective clinical study. In total, 62 scans (30 CTs and 32 MRIs) were performed to evaluate the extent of inflammatory changes. The scans were read independently by two radiologists specialised in imaging of the head and neck. The regions under the skull base were specified using the online Anatomy Atlas of the skull base. To clarify the timeline, the time period was divided into four parts, and inflammatory changes in the skull-base regions were tracked. Data were statistically analysed. Results In early stages of the disease, CT scan detects inflammatory changes closely related to the stylomastoid foramen and medially to the posterior belly of the digastric muscle, changes which have been proved to be crucial for the diagnosis of CSBO. Later the infection spreads to the contralateral side causing demineralisation of the bones. Conclusion Imaging methods play a crucial role not only in establishing the diagnosis, but also in anticipating the direction of infection spread underneath the skull base.
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Affiliation(s)
- J Mejzlik
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic.
| | - M Cerny
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic
| | - L Zeinerova
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic
| | - J Dedkova
- Department of Radiology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - J Kopriva
- Department of Radiology, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - K Zadrobilek
- Department of Neurosurgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - J Adamkov
- Department of Neurosurgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - V Chrobok
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Sokolska 581, Hradec Kralove, 500 05, Hradec Kralove, Czech Republic
| | - V Pellantova
- Department of Infectious Diseases, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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Tu Z, Xiao Z, Zheng Y, Huang H, Yang L, Cao D. Benign and malignant skull-involved lesions: discriminative value of conventional CT and MRI combined with diffusion-weighted MRI. Acta Radiol 2019; 60:880-886. [PMID: 29742920 DOI: 10.1177/0284185118773541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the value of computed tomography (CT) and magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) in distinguishing malignant from benign skull-involved lesions. PURPOSE To evaluate the discriminative value of DWI combined with conventional CT and MRI for differentiating between benign and malignant skull-involved lesions. MATERIAL AND METHODS CT and MRI findings of 58 patients with pathologically proven skull-involved lesions (43 benign and 15 malignant) were retrospectively reviewed. Conventional CT and MRI characteristics and apparent diffusion coefficient (ADC) value of the two groups were evaluated and compared. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter separately and together. RESULTS The presence of cortical defects or break-through and ill-defined margins were associated with malignant skull-involved lesions (both P < 0.05). Malignant skull-involved lesions demonstrated a significantly lower ADC (P = 0.016) than benign lesions. ROC curve analyses indicated that a combination of CT, MRI, and DWI with an ADC ≤ 0.703 × 10-3 mm2/s showed optimal sensitivity, while DWI along showed optimal specificity of 88.4% in differentiating between benign and malignant skull-involved lesions. CONCLUSION The combination of CT, MRI, and DWI can help to differentiate malignant from benign skull-involved lesions. CT + MRI + DWI offers optimal sensitivity, while DWI offers optimal specificity.
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Affiliation(s)
- Zhanhai Tu
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Zebin Xiao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Yingyan Zheng
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Hongjie Huang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Libin Yang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
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Andreu-Arasa VC, Chapman MN, Kuno H, Fujita A, Sakai O. Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach. Radiographics 2018; 38:890-911. [PMID: 29624481 DOI: 10.1148/rg.2018170145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Many systemic diseases or conditions can affect the maxillofacial bones; however, they are often overlooked or incidentally found at routine brain or head and neck imaging performed for other reasons. Early identification of some conditions may significantly affect patient care and alter outcomes. Early recognition of nonneoplastic hematologic disorders, such as thalassemia and sickle cell disease, may help initiate earlier treatment and prevent serious complications. The management of neoplastic diseases such as lymphoma, leukemia, or Langerhans cell histiocytosis may be different if diagnosed early, and metastases to the maxillofacial bones may be the first manifestation of an otherwise occult neoplasm. Endocrinologic and metabolic disorders also may manifest with maxillofacial conditions. Earlier recognition of osteoporosis may alter treatment and prevent complications such as insufficiency fractures, and identification of acromegaly may lead to surgical treatment if there is an underlying growth hormone-producing adenoma. Bone dysplasias sometimes are associated with skull base foraminal narrowing and subsequent involvement of the cranial nerves. Inflammatory processes such as rheumatoid arthritis and sarcoidosis may affect the maxillofacial bones, skull base, and temporomandibular joints. Radiologists should be familiar with the maxillofacial computed tomographic and magnetic resonance imaging findings of common systemic disorders because these may be the first manifestations of an otherwise unrevealed systemic process with potential for serious complications. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- V Carlota Andreu-Arasa
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Margaret N Chapman
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Hirofumi Kuno
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Akifumi Fujita
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
| | - Osamu Sakai
- From the Departments of Radiology (V.C.A.A., M.N.C., H.K., A.F., O.S.), Otolaryngology-Head and Neck Surgery (O.S.), and Radiation Oncology (O.S.), Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118
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Mahajan A, Rao VRK, Anantaram G, Polnaya AM, Desai S, Desai P, Vadapalli R, Panigrahi M. Clinical-radiological-pathological correlation of cavernous sinus hemangioma: Incremental value of diffusion-weighted imaging. World J Radiol 2017; 9:330-338. [PMID: 28932362 PMCID: PMC5583528 DOI: 10.4329/wjr.v9.i8.330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/18/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To elucidate the clinical, magnetic resonance imaging (MRI), pathological features of these lesions and asses the incremental value of diffusion-weighted imaging (DWI) in diagnosing them.
METHODS Fifteen consecutive patients (11 females and 4 males; mean age 40.93 years; age range 13-63 years) with cavernous sinus hemangiomas (CSH) who underwent examination between November 2008 and May 2016 were included for the analysis. MRI, clinical and surgical findings of each patient was retrospectively reviewed. DWI were also analysed and mean-apparent diffusion coefficient (ADC) value was calculated. Eleven patients underwent surgical removal of the lesion and 2 patients had biopsy only. Diagnosis of CSH was confirmed histologically in 13 patients.
RESULTS Eleven patients (73%) presented with headaches and 10 (66%) had cranial nerve involvement. Extra cavernous sinus extension was noted in 14 (94%). Surgery was performed in 13 (87%) and post-operative radiation was given to 4 (28%) patients. Thirteen patients remained asymptomatic on follow up. Three conspicuous imaging features were highly suggestive of the diagnosis: Lack of diffusion restriction (100%), homogeneous hyperintensity on T2 weighted image sequences (93.3%) and intense post-contrast enhancement (100%). The mean ADC was 1.82 × 10-3 ± 0.2186 cm2/s.
CONCLUSION T1-weighted hypointensity with homogeneous hyperintensity on T2-weighted sequences, intense enhancement and absence of hemosiderin within the lesion on GRE sequence favour the diagnosis. Facilitated diffusion on DWI differentiates CSH from other solid cavernous sinus lesions and significantly improves the diagnostic accuracy, a critical factor for planning surgery.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai 400012, India
| | - Vedula Rajni Kanth Rao
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad 500003, India
| | - Gudipati Anantaram
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad 500003, India
| | - Ashwin M Polnaya
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai 400012, India
| | - Sandeep Desai
- Department of Radiodiagnosis Clumax Imaging, Bangalore 560011, India
| | - Paresh Desai
- Department of Radiology, Apollo Victor Hospital, Goa 403601, India
| | - Rammohan Vadapalli
- Department of Radiology, Vijaya Diagnostics, Hyderabad, Secunderabad 500003, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad 500003, India
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Bhatt N, Gupta N, Soni N, Hooda K, Sapire JM, Kumar Y. Role of diffusion-weighted imaging in head and neck lesions: Pictorial review. Neuroradiol J 2017. [PMID: 28627953 DOI: 10.1177/1971400917708582] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Head and neck cancers are very common worldwide, causing significant morbidity and mortality. Squamous cell carcinoma originating from the epithelial lining of the upper aerodigestive tract is the most common histology. Many patients with head and neck cancers present with advanced stage disease requiring aggressive treatment consisting of extensive surgery and chemo-radiation. Appropriate treatment planning as well as prognosis of tumors depends to a large extent on accurate histological diagnosis and differentiation of malignant from benign lesions. Routine imaging modalities such as computed tomography and magnetic resonance imaging give volumetric and morphologic information. However, these modalities cannot be reliably used as a substitute for biopsy in treatment planning. However, diffusion-weighted imaging has shown promise in tissue characterization for primary tumors and nodal metastases, differentiation of recurrent tumor from post therapeutic changes, prediction and monitoring of treatment response, and many other clinical scenarios as described later in this article. In this review article, we describe the imaging findings in applications of diffusion-weighted imaging in the head and neck lesions and discuss their added value over anatomic imaging.
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Affiliation(s)
- Neeraj Bhatt
- 1 Department of Radiology, Yale New Haven Health at Bridgeport Hospital, USA
| | - Nishant Gupta
- 2 Department of Radiology, St Vincent's Medical Center, USA
| | - Neetu Soni
- 3 Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, India
| | - Kusum Hooda
- 1 Department of Radiology, Yale New Haven Health at Bridgeport Hospital, USA
| | | | - Yogesh Kumar
- 1 Department of Radiology, Yale New Haven Health at Bridgeport Hospital, USA
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22
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Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O'Donnell LJ. White matter tractography for neurosurgical planning: A topography-based review of the current state of the art. Neuroimage Clin 2017; 15:659-672. [PMID: 28664037 PMCID: PMC5480983 DOI: 10.1016/j.nicl.2017.06.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
We perform a review of the literature in the field of white matter tractography for neurosurgical planning, focusing on those works where tractography was correlated with clinical information such as patient outcome, clinical functional testing, or electro-cortical stimulation. We organize the review by anatomical location in the brain and by surgical procedure, including both supratentorial and infratentorial pathologies, and excluding spinal cord applications. Where possible, we discuss implications of tractography for clinical care, as well as clinically relevant technical considerations regarding the tractography methods. We find that tractography is a valuable tool in variable situations in modern neurosurgery. Our survey of recent reports demonstrates multiple potentially successful applications of white matter tractography in neurosurgery, with progress towards overcoming clinical challenges of standardization and interpretation.
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Affiliation(s)
- Walid I Essayed
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Fan Zhang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Zamora C, Castillo M. Sellar and Parasellar Imaging. Neurosurgery 2016; 80:17-38. [DOI: 10.1093/neuros/nyw013] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Abstract
The skull base is a complex anatomical region that harbors many important neurovascular structures in a relatively confined space. The pathology that can develop at this site is varied, and many disease processes may present with similar clinical and neuroimaging findings. While computed tomography maintains a role in the evaluation of many entities and can, for instance, delineate osseous erosion with great detail and characterize calcified tumor matrices, magnetic resonance imaging (MRI) is the mainstay in the neuroimaging assessment of most pathology occurring at the skull base. Various MRI sequences have proven to be robust tools for tissue characterization and can provide information on the presence of lipids, paramagnetic and diamagnetic elements, and tumor cellularity, among others. In addition, currently available MRI techniques are able to generate high spatial resolution images that allow visualization of cranial nerves and their involvement by adjacent pathology. The information obtained from such examinations may aid in the distinction of these disease processes and in the accurate delineation of their extent prior to biopsy or treatment planning.
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Imaging of skull base tumours. Rep Pract Oncol Radiother 2016; 21:304-18. [PMID: 27330416 DOI: 10.1016/j.rpor.2015.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 11/12/2015] [Accepted: 12/23/2015] [Indexed: 11/21/2022] Open
Abstract
The skull base is a highly complex and difficult to access anatomical region, which constitutes a relatively common site for neoplasms. Imaging plays a central role in establishing the differential diagnosis, to determine the anatomic tumour spread and for operative planning. All skull base imaging should be performed using thin-section multiplanar imaging, whereby CT and MRI can be considered complimentary. An interdisciplinary team approach is central to improve the outcome of these challenging tumours.
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