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Zhang D, Li X, Xiong H, Yang C, Lv F, Huang X, Li Q, Tang Z, Luo T. Tuberculosis of the parotid lymph nodes: clinical and imaging features. Infect Drug Resist 2018; 11:1795-1805. [PMID: 30349336 PMCID: PMC6188200 DOI: 10.2147/idr.s164993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives To characterize clinical, computed tomography (CT) and magnetic resonance imaging (MRI) features of tuberculosis (TB) of the parotid nodes. Materials and methods CT (n=21) and MR (n=7) images, and clinical data from 25 patients with TB of the parotid nodes were retrospectively analyzed by two experienced radiologists who reached consensus. Results Younger patients (aged <50 years) accounted for 72%. Eighty percent of patients were asymptomatic, and had no history of TB exposure. According to clinical and imaging findings, 64% and 60% patients were misdiagnosed as having tumors, respectively. A total of 43 lesions were identified. Thirty-eight (88.4%) lesions involved the superficial lobe. Fourteen (56%) cases had multiple lesions. There were four types of changes in the parotid fascia: local thickening (40%, n=10); local rupture with thickened adjacent skin (28%, n=7); focal bulge (20%, n=5); and no changes (12%, n=3). Cervical lymphadenopathy was seen in 14 out of 25 cases (56%). The lesions were contrast-enhanced in four patterns on CT images: homogeneous enhancement (37.1%, n=13), irregular cyst-like enhancement (37.1%, n=13), thick-walled ring enhancement (14.2%, n=5), and garland-like enhancement (11.4%, n=4). On MRI, the signal intensity of lesions was isointense on T1-weighted image, hyperintense on T2-weighted image, markedly hyperintense on diffusion-weighted imaging, and low on the apparent diffusion coefficient map. The surrounding parotid parenchymal edema was identified clearly on coronal MR images. Conclusion TB of the parotid nodes tend to simulate tumors clinically and radiologically. Their preferential sites are the superficial lobe. In young patients with positive purified protein derivative skin test and lesions accompanied by cervical lymphadenopathy, changes in the parotid fascia and parotid parenchymal edema adjacent to the lesions on CT and MRI may be helpful in the diagnosis and to facilitate differential diagnosis.
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Affiliation(s)
- Dan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China, .,Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Chao Yang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China,
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China,
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China,
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Han PK, Ma C, Deng K, Hu S, Jee KW, Ying K, Chen YL, El Fakhri G. A minimum-phase Shinnar-Le Roux spectral-spatial excitation RF pulse for simultaneous water and lipid suppression in 1H-MRSI of body extremities. Magn Reson Imaging 2018; 45:18-25. [PMID: 28917812 PMCID: PMC5709164 DOI: 10.1016/j.mri.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To develop a spectral-spatial (SPSP) excitation RF pulse for simultaneous water and lipid suppression in proton (1H) magnetic resonance spectroscopic imaging (MRSI) of body extremities. METHODS An SPSP excitation pulse is designed to excite Creatine (Cr) and Choline (Cho) metabolite signals while suppressing the overwhelming water and lipid signals. The SPSP pulse is designed using a recently proposed multidimensional Shinnar-Le Roux (SLR) RF pulse design method. A minimum-phase spectral selectivity profile is used to minimize signal loss from T2⁎ decay. RESULTS The performance of the SPSP pulse is evaluated via Bloch equation simulations and phantom experiments. The feasibility of the proposed method is demonstrated using three-dimensional, short repetition-time, free induction decay-based 1H-MRSI in the thigh muscle at 3T. CONCLUSION The proposed SPSP excitation pulse is useful for simultaneous water and lipid suppression. The proposed method enables new applications of high-resolution 1H-MRSI in body extremities.
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Affiliation(s)
- Paul Kyu Han
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Chao Ma
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kexin Deng
- Biomedical Engineering, Tsinghua University, Beijing, People's Republic of China
| | - Shuang Hu
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Department of Nuclear Medicine, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kui Ying
- Engineering Physics, Tsinghua University, Beijing, People's Republic of China
| | - Yen-Lin Chen
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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State of the art MRI in head and neck cancer. Clin Radiol 2017; 73:45-59. [PMID: 28655406 DOI: 10.1016/j.crad.2017.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
Head and neck cancer affects more than 11,000 new patients per year in the UK1 and imaging has an important role in the diagnosis, treatment planning, and assessment, and post-treatment surveillance of these patients. The anatomical detail produced by magnetic resonance imaging (MRI) is ideally suited to staging and follow-up of primary tumours and cervical nodal metastases in the head and neck; however, anatomical images have limitations in cancer imaging and so increasingly functional-based MRI techniques, which provide molecular, metabolic, and physiological information, are being incorporated into MRI protocols. This article reviews the state of the art of these functional MRI techniques with emphasis on those that are most relevant to the current management of patients with head and neck cancer.
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Anatomy and pathology of the masticator space. Insights Imaging 2013; 4:605-16. [PMID: 23888350 PMCID: PMC3781239 DOI: 10.1007/s13244-013-0266-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 12/22/2022] Open
Abstract
Objective This article reviews and illustrates the anatomy and pathology of the masticator space (MS). Background Pathology of the masticator space includes inflammatory conditions, vascular lesions, and tumours. Intrinsic tumours of this space can be benign and malignant, and they may arise from the mandibular ramus, the third division of the trigeminal nerve, or the mastication muscles. Malignant tumours may appear well defined and confined by the masticator fascia, without imaging signs of aggressive extension into neighbouring soft tissues. Secondary invasion of the masticator space can also occur with tumours of the nasopharynx, oropharynx, oral cavity, and parotid glands. Perineural tumour spread (PNS), especially along the trigeminal nerve, can also occur with masticator space malignancies. Conclusion Masses of the MS are difficult to evaluate clinically, and computed tomographic (CT) and magnetic resonance (MR) images are essential for the diagnosis and characterisation of these lesions. Malignant tumours may appear well defined and confined by the fascia. Thus, when a mass is identified, a biopsy should be done promptly. PNS may occur in tumours involving the MS and its recognition on imaging studies is essential to plan the appropriate treatment. Teaching points • Differentiating between intrinsic and extrinsic lesions is essential to the differential diagnosis • Infections of the MS may cross the fascia and mimic neoplasms on imaging studies • Malignant tumours may show no aggressive signs, such as bone erosion or violation of the fascia • Perineural spread (PNS) is often clinically silent and frequently missed at imaging and leads to tumour recurrence
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Abdel Razek AAK, Poptani H. MR spectroscopy of head and neck cancer. Eur J Radiol 2013; 82:982-9. [PMID: 23485098 DOI: 10.1016/j.ejrad.2013.01.025] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/17/2013] [Accepted: 01/19/2013] [Indexed: 12/16/2022]
Abstract
The aim of this review is to discuss the technique and potential applications of magnetic resonance spectroscopy (MRS) in head and neck cancer. We illustrate the technical issues related to data acquisition, post processing and interpretation of MRS of head and neck lesions. MRS has been used for differentiation of squamous cell carcinoma from normal tissue. The main potential clinical application of proton MRS ((1)H-MRS) is monitoring patients with head and neck cancer undergoing therapy. Pretreatment prediction of response to therapy can be done with phosphorus MRS ((31)P-MRS). Although performance of MRS of head and neck is challenging, technological advances in both software and hardware has the potential to impact on the clinical management of patients with head and neck cancer.
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Abdel Razek AAK, Nada N. Role of diffusion-weighted MRI in differentiation of masticator space malignancy from infection. Dentomaxillofac Radiol 2013; 42:20120183. [PMID: 23420858 DOI: 10.1259/dmfr.20120183] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the role of the apparent diffusion coefficient (ADC) value in differentiation of masticator space malignancy from infection. METHODS A retrospective study of 49 patients (31 male and 18 female; age range 5-66 years) with masticator space lesion was conducted. They underwent spin-echo-type echo planar diffusion-weighted MRI of the head and neck with b-values of 0 mm(2) s(-1), 500 mm(2) s(-1) and 1000 mm(2) s(-1). The ADC maps were reconstructed and the ADC value of the masticator space lesion was calculated. RESULTS The mean (± standard deviation) ADC value of masticator space malignancy (0.91 ± 0.21 × 10(-3) mm(2) s(-1)) was significantly lower (p = 0.001) than that of masticator space infection (1.59 ± 0.32 × 10(-3) mm(2) s(-1)). When an ADC value of 1.20 × 10(-3) mm(2) s(-1) was used as a threshold value for differentiating masticator space malignancy from infection, the best result was obtained with an accuracy of 88%, sensitivity of 88%, specificity of 87%, negative predictive value of 94%, positive predictive value of 86% and area under the curve of 0.92. There was a significant difference in the ADC value between squamous cell carcinoma and soft tissue sarcoma (p = 0.001), as well as between bacterial and fungal infection of the masticator space (p = 0.001). CONCLUSION We concluded that ADC value is a non-invasive promising imaging parameter that can be used for differentiation of masticator space malignancy from infection.
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Affiliation(s)
- A A K Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt.
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Wang CK, Li CW, Hsieh TJ, Lin CJ, Chien SH, Tsai KB, Chang KC, Tsai HM. In vivo 1H MRS for musculoskeletal lesion characterization: which factors affect diagnostic accuracy? NMR IN BIOMEDICINE 2012; 25:359-368. [PMID: 21793078 DOI: 10.1002/nbm.1758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 05/31/2023]
Abstract
In vivo (1)H MRS is a noninvasive imaging technique for the identification of malignancy. Musculoskeletal lesions vary in their composition, causing field inhomogeneity and magnetic susceptibility effects which may be technical and diagnostic challenges for MRS. This study investigated the factors that affect diagnostic accuracy in the use of MRS for the characterization of musculoskeletal neoplasms. During a 7-year period, 210 consecutive patients with musculoskeletal lesions larger than 1.5 cm in diameter were examined. MRS of a single-voxel point-resolved spectroscopy sequence with TE = 135 ms was undertaken using a 1.5-T scanner. Lesions with a choline signal-to-noise ratio larger than 3.0 were considered to be malignant tumors. The diagnostic accuracy was calculated for all lesions and for subgroups on the basis of lesion type (bone and soft tissue), lesion composition (mixed and solid nonsclerotic), lesion size (≤4, >4-10 and >10 cm), MR scanner (MR scanner 1 and 2) and selected voxel size (≤3, >3-8 and >8 cm(3)). Multivariate logistic regressions were performed to estimate the associations between each factor and diagnostic accuracy. The diagnostic accuracy was 73.3% for all lesions. The accuracy was 54.4% for mixed lesions and 80.4% for solid nonsclerotic lesions (p < 0.001). The diagnostic accuracy was lower for larger lesions [86.8% for lesions of ≤4 cm, 71.6% for lesions of >4-10 cm (p = 0.04) and 63.6% for lesions of >10 cm (p = 0.007)]. There was no difference in diagnostic accuracy for bone versus soft-tissue lesions or as a function of MR scanner or voxel size. By the use of multivariate logistic regression, a solid nonsclerotic lesion was 3.15 times (95% confidence interval, 1.59-6.27) more likely than a mixed lesion to have a diagnosis (p = 0.001). MRS can be used to characterize musculoskeletal lesions, particularly solid nonsclerotic lesions.
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Affiliation(s)
- Chien-Kuo Wang
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan.
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