Impact of systematic dynamic maneuvers during computed tomography scan on the T classification of head and neck cancers.

OBJECTIVES: To evaluate the impact of systematic dynamic maneuvers during CT scan on the T-staging of head and neck cancer (HNC). MATERIALS AND METHODS: CT scans from the initial workup of 443 consecutive patients treated for HNC in our institution were retrospectively analyzed. CT scans were performed in both expert centers (comprehensive cancer center and university hospital) and non-expert centers. We noted whether dynamic maneuvers (DM) were performed, in 3 categories, namely: DM not done (DMND), done and inadequate (DMDI), done and adequate (DMDA). In the group with DMDA, T-stage was evaluated without and with DM. Interobserver agreement for T staging was assessed after independent double reading of CT scans with and without DM by two radiologists in a random sample. RESULTS: Among the 443 CT scans, DMND was observed in 36.3%, DMDI in 9.3% and DMDA in 54.4%. DMDA were significantly more frequent in expert than in non-expert centers (93.4 vs 6.6%, p < 0.001). In CT scans with DMDA, analysis of the 141 scans rated as T1, T2, T3, or T4 without DM showed agreement of 88.7% with scans with DM, corresponding to a reclassification rate of 11.3% (kappa = 0.85, 95%CI [0.78;0.92]). Among lesions initially classed as Tx without DM (N = 100), the reclassification rate was 76% including DM. CONCLUSION: The performance of systematic DM integrated into CT protocols is useful to reclassify the T stage in HNC and is essential in case of lesions initially classified as Tx without DM. DM should be performed routinely in expert and nonexpert centers.

Imaging appearance and prevalence of the anteromedial meniscofemoral ligament: A potential pitfall to anterior cruciate ligament analysis on MRI.

PURPOSE: To describe the aspect of the anteromedial meniscofemoral ligament on MRI and to assess its prevalence. METHOD: One thousand five hundred sixty knee MRI studies were retrospectively evaluated for the presence of an anteromedial meniscofemoral ligament. In addition to these studies, nine full MRI studies from our department's image archive were also analysed. The anteromedial meniscofemoral ligament length, thickness, and angle with respect to the tibial plateau were evaluated independently by two radiologists. For comparison purposes, the anterior cruciate ligament was assessed in the same manner. RESULTS: There was a 0.77% prevalence of the anteromedial meniscofemoral ligament in the study population. Compared to the anterior cruciate ligament, the anteromedial meniscofemoral ligament was 80.6%-83.8% thinner according to both observers (P =  0.0002), with a mean thickness of 1.53 ±â€¯0.47 mm and 1.80 ±â€¯0.66 mm determined by observers 1 and 2, respectively. The anteromedial meniscofemoral ligament angles were 15%-17.7% lower than the anterior cruciate ligament angles (P <  0.003). Interobserver reproducibility was considered excellent for the length and angle measurements (ICCs varying from 0.85-0.97) and good for the thickness measurements (ICCs 0.66-0.77). CONCLUSIONS: The anteromedial meniscofemoral ligament is a rare structure that can be differentiated from the anterior cruciate ligament based on morphologic criteria.