RESUMEN
Head and neck (H&N) eponyms serve to honour physicians who have made important contributions. Compared with more descriptive diagnostic names, eponyms can sometimes be confusing, especially to the novice. Adding to the confusion, eponyms are sometimes applied incorrectly. Nevertheless, their use remains common in the medical literature and clinical practice. Familiarity with H&N eponyms is important for accurate communication with radiology colleagues and clinicians. Some eponyms describe potentially fatal infections and their urgency should be appreciated. Other eponyms, such as those for inner ear congenital anomalies, are probably best avoided as they can be used imprecisely and cause confusion. This review summarizes the clinical and imaging findings of some common and important H&N eponyms under the following categories of disease: (1) neck infections, (2) diseases in the temporal bone, (3) orbital diseases, and (4) sinus disease.
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Enfermedades Óseas , Epónimos , Enfermedades Orbitales , Enfermedades de los Senos Paranasales , Absceso/diagnóstico por imagen , Adolescente , Anciano , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/etiología , Oído Interno/anomalías , Oído Interno/diagnóstico por imagen , Enfermedades del Nervio Facial/diagnóstico , Enfermedades del Nervio Facial/etiología , Femenino , Hueso Frontal , Oftalmopatía de Graves/diagnóstico , Oftalmopatía de Graves/etiología , Humanos , Lactante , Venas Yugulares/microbiología , Angina de Ludwig/diagnóstico , Imagen por Resonancia Magnética , Masculino , Mastoiditis/diagnóstico , Persona de Mediana Edad , Pólipos Nasales/diagnóstico por imagen , Cuello , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/etiología , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/etiología , Hueso Petroso , Radiografía , Sepsis/etiología , Infecciones Estreptocócicas , Síndrome , Tromboflebitis/diagnóstico , Síndrome de Tolosa-Hunt/diagnóstico , Síndrome de Tolosa-Hunt/etiología , Adulto JovenRESUMEN
BACKGROUND: Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown. AIM: To evaluate ethnic differences in the natural history of CHC and the impact of SVR. METHODS: We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis. RESULTS: Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status. CONCLUSION: Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.
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Carcinoma Hepatocelular/epidemiología , Hepatitis C Crónica/complicaciones , Cirrosis Hepática/epidemiología , Neoplasias Hepáticas/epidemiología , Adulto , Anciano , California , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Hepatitis C Crónica/etnología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND AND PURPOSE: Patients with multigland primary hyperparathyroidism are at higher risk for missed lesions on imaging and failed parathyroidectomy. The purpose of this study was to prospectively validate the ability of previously derived predictive score systems, the composite multigland disease score, and the multiphase multidetector contrast-enhanced CT (4D-CT) composite multigland disease score, to identify patients with a high likelihood of multigland disease. MATERIALS AND METHODS: This was a prospective study of 71 patients with primary hyperparathyroidism who underwent 4D-CT and successful parathyroidectomy. The size and number of lesions identified on 4D-CT, serum calcium levels, and parathyroid hormone levels were collected. A composite multigland disease score was calculated from 4D-CT imaging findings and the Wisconsin Index (the product of the serum calcium and parathyroid hormone levels). A 4D-CT multigland disease score was obtained by using the CT data alone. RESULTS: Twenty-eight patients with multigland disease were compared with 43 patients with single-gland disease. Patients with multigland disease had a significantly smaller lesion size (P < .01) and a higher likelihood of having either ≥2 or 0 lesions identified on 4D-CT (P < .01). Composite multigland disease scores of ≥4, ≥5, and 6 had specificities of 72%, 86%, and 100% for multigland disease, respectively. 4D-CT multigland disease scores of ≥3 and 4 had specificities of 74% and 88%. CONCLUSIONS: Predictive scoring systems based on 4D-CT data, with or without laboratory data, were able to identify a subgroup of patients with a high likelihood of multigland disease in a prospectively accrued population of patients with primary hyperparathyroidism. These scoring systems can aid in surgical planning.
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Tomografía Computarizada Cuatridimensional/métodos , Hiperparatiroidismo Primario/diagnóstico por imagen , Hiperparatiroidismo Primario/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND AND PURPOSE: Multigland disease represents a challenging group of patients with primary hyperparathyroidism. Additional lesions may be missed on imaging because they are not considered or are too small to be seen. The aim of this is study was to identify 4D-CT imaging and biochemical predictors of multigland disease. MATERIALS AND METHODS: This was a retrospective study of 155 patients who underwent 4D-CT and successful surgery with a biochemical cure that compared patients with multigland and single-gland disease. Variables studied included the size of the largest lesion on 4D-CT, the number of lesions prospectively identified on 4D-CT, serum calcium levels, serum parathyroid hormone levels, and the Wisconsin Index (the product of serum calcium and parathyroid hormone levels). Imaging findings and the Wisconsin Index were used to calculate a composite multigland disease scoring system. We evaluated the predictive value of individual variables and the scoring system for multigland disease. RESULTS: Thirty-six patients with multigland disease were compared with 119 patients with single-gland disease. Patients with multigland disease had significantly lower Wisconsin Index scores, smaller lesion size, and a higher likelihood of having either multiple or zero lesions identified on 4D-CT (P ≤ .01). Size cutoff of <7 mm had 85% specificity for multigland disease, but including other variables in the composite multigland disease score improved the specificity. Scores of ≥4, ≥5, and 6 had specificities of 81%, 93%, and 98%, respectively. CONCLUSIONS: The composite multigland disease scoring system based on 4D-CT imaging findings and biochemical data can identify patients with a high likelihood of multigland disease. Communicating the suspicion for multigland disease in the radiology report could influence surgical decision-making, particularly when considering re-exploration in a previously operated neck or initial limited neck exploration.
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Biomarcadores/sangre , Tomografía Computarizada Cuatridimensional/métodos , Hiperparatiroidismo Primario/sangre , Hiperparatiroidismo Primario/diagnóstico por imagen , Hiperparatiroidismo Primario/patología , Adulto , Calcio/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND PURPOSE: Variability in radiologists' reporting styles and recommendations for incidental thyroid nodules can lead to confusion among clinicians and may contribute to inconsistent patient care. Our aim was to describe reporting practices of radiologists for incidental thyroid nodules seen on CT and MR imaging and to determine factors that influence reporting styles. MATERIALS AND METHODS: This is a retrospective study of patients with incidental thyroid nodules reported on CT and MR imaging between January and December 2011, identified by text search for "thyroid nodule" in all CT and MR imaging reports. The studies included CT and MR imaging scans of the neck, spine, and chest. Radiology reports were divided into those that mentioned the incidental thyroid nodules only in the "Findings" section versus those that reported the incidental thyroid nodules in the "Impression" section as well, because this latter reporting style gives more emphasis to the finding. Univariate and multivariate analyses were performed to identify radiologist, patient, and nodule characteristics that influenced reporting styles. RESULTS: Three hundred seventy-five patients met the criterion of having incidental thyroid nodules. One hundred thirty-eight (37%) patients had incidental thyroid nodules reported in the "Impression" section. On multivariate analysis, only radiologists' divisions and nodule size were associated with reporting in "Impression." Chest radiologists and neuroradiologists were more likely to report incidental thyroid nodules in the "Impression" section than their abdominal imaging colleagues, and larger incidental thyroid nodules were more likely to be reported in "Impression" (P ≤ .03). Seventy-three percent of patients with incidental thyroid nodules of ≥20 mm were reported in the "Impression" section, but higher variability in reporting was seen for incidental thyroid nodules measuring 10-14 mm and 15-19 mm, which were reported in "Impression" for 61% and 50% of patients, respectively. CONCLUSIONS: Reporting practices for incidental thyroid nodules detected on CT and MR imaging are predominantly influenced by nodule size and the radiologist's subspecialty. Reporting was highly variable for nodules measuring 10-19 mm; this finding can be partially attributed to different reporting styles among radiology subspecialty divisions. The variability demonstrated in this study further underscores the need to develop CT and MR imaging practice guidelines with the goal of standardizing reporting of incidental thyroid nodules and thereby potentially improving the consistency and quality of patient care.
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Imagen por Resonancia Magnética , Nódulo Tiroideo/diagnóstico , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Radiografía Torácica , Radiología/normas , Estudios Retrospectivos , Columna Vertebral/diagnóstico por imagen , Tórax , Nódulo Tiroideo/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Contrast is used in CT-guided epidural steroid injections to ensure proper needle placement. Once injected, undiluted contrast often obscures the needle, hindering subsequent repositioning. The purpose of this investigation was to establish the optimal contrast dilution for CT-guided epidural steroid injections. MATERIALS AND METHODS: This investigation consisted of an initial phantom study, followed by a prospective, randomized, single-center trial assessing a range of contrast dilutions. In the phantom study, a phantom housing a chamber containing a 22-gauge needle and various dilutions of contrast was scanned, and images were evaluated for needle visibility. On the basis of these results, concentrations of 66, 100, 133, and 150 mg/mL iodine were selected for evaluation in a clinical study. Patients presenting for CT-guided epidural steroid injections were randomly assigned to a contrast dilution, and images from the procedure were evaluated by 2 readers blinded to the contrast assignment. Needle visibility was scored by use of a 5-point scale. RESULTS: In the phantom study, the needle was not visible at contrast concentrations of ≥133 mg/mL. In the clinical study, needle visibility was strongly associated with contrast concentration (P < .0001). Significant improvements in visibility were found in 66 mg/mL and 100 mg/mL compared with higher iodine concentrations; no difference was found comparing 66 mg/mL with 100 mg/mL iodine. Neither injection location (cervical versus lumbar) nor technique (interlaminar versus transforaminal) influenced visibility scores. CONCLUSIONS: For CT-guided epidural steroid injections, the optimal contrast concentration is 66-100 mg/mL iodine. Because these concentrations are not commercially available, proceduralists must dilute their contrast for such procedures.
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Yodo/administración & dosificación , Mielografía/métodos , Intensificación de Imagen Radiográfica/métodos , Radiografía Intervencional/métodos , Esteroides/administración & dosificación , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Medios de Contraste/administración & dosificación , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Inyecciones Epidurales/métodos , Masculino , Persona de Mediana Edad , Mielografía/instrumentación , Fantasmas de Imagen , Radiografía Intervencional/instrumentación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/instrumentación , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: Incidental thyroid nodules are commonly seen on imaging, and their work-up can ultimately lead to surgery. We describe characteristics and pathology results of imaging-detected incidental thyroid nodules that underwent surgery. MATERIALS AND METHODS: A retrospective review was performed of 303 patients who underwent thyroid surgery over a 1-year period to identify patients who presented with incidental thyroid nodules on imaging. Medical records were reviewed for the types of imaging studies that led to detection, nodule characteristics, and surgical pathology. RESULTS: Of 303 patients, 208 patients (69%) had surgery for thyroid nodules. Forty-seven of 208 patients (23%) had incidental thyroid nodules detected on imaging. The most common technique leading to detection was CT (47%). All patients underwent biopsy before surgery. The cytology results were nondiagnostic (6%), benign (4%), atypia of undetermined significance or follicular neoplasm of undetermined significance (23%), follicular neoplasm or suspicious for follicular neoplasm (19%), suspicious for malignancy (17%), and diagnostic of malignancy (30%). Surgical pathology was benign in 24 of 47 (51%) cases of incidental thyroid nodules. In the 23 incidental cancers, the most common histologic type was papillary (87%), the mean size was 1.4 cm, and nodal metastases were present in 7 of 23 cases (30%). No incidental cancers on imaging had distant metastases. CONCLUSIONS: Imaging-detected incidental thyroid nodules led to nearly one-fourth of surgeries for thyroid nodules, and almost half were initially detected on CT. Despite indeterminate or suspicious cytology results that lead to surgery, more than half were benign on final pathology. Guidelines for work-up of incidental thyroid nodules detected on CT could help reduce unnecessary investigations and surgery.
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Hallazgos Incidentales , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico por Imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: The "polar vessel" sign has been previously described on sonography of parathyroid adenomas. We estimated the 4D CT prevalence of the polar vessel sign and determined features of parathyroid adenomas that are associated with this sign. MATERIALS AND METHODS: Twenty-eight consecutive patients with parathyroid adenomas underwent 4D CT between 2008 and 2012 at 2 institutions. 4D CT images were reviewed for the presence of the polar vessel sign and a second vascular finding of an enlarged ipsilateral inferior thyroid artery. The polar vessel sign was correlated with adenoma weight and size and arterial phase CT attenuation. RESULTS: Thirty-two parathyroid adenomas in 28 patients were studied, with a mean adenoma weight of 0.66 ± 0.65 g, a mean maximal CT diameter of 11.1 ± 4.9 mm, and a mean arterial attenuation of 148 ± 47 HU. The polar vessel sign was seen in 20/32 (63%) adenomas. Adenomas with a polar vessel had higher arterial phase attenuation than adenomas without a polar vessel (163 and 122 HU, respectively, P < .01). Size and weight were not significantly different for adenomas with and without polar vessels. An enlarged inferior thyroid artery was seen in only 2/28 (7%) patients with unilateral disease. CONCLUSIONS: The polar vessel sign was present in nearly two-thirds of parathyroid adenomas on 4D CT and was more likely to be present in adenomas that had greater arterial phase enhancement. This sign can be used along with enhancement characteristics to increase the radiologist's confidence that a visualized lesion is a parathyroid adenoma rather than a thyroid nodule or lymph node.
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Adenoma/diagnóstico por imagen , Tomografía Computarizada Cuatridimensional , Neoplasias de las Paratiroides/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arterias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: There are no guidelines for reporting incidental thyroid nodules seen on CT and MR imaging. We evaluated radiologists' current reporting practices for incidental thyroid nodules detected on these imaging modalities. MATERIALS AND METHODS: Radiologists were surveyed regarding their reporting practices by using 14 scenarios of incidental thyroid nodules differing in size, patient demographics, and clinical history. Scenarios were evaluated for the following: 1) radiologists' most commonly selected response, and 2) the proportion of radiologists selecting that response (degree of agreement). These measures were used to determine how the patient scenario and characteristics of the radiologists affected variability in practice. RESULTS: One hundred fifty-three radiologists participated. In 8/14 scenarios, the most common response was to "recommend sonography." For the other scenarios, the most common response was to "report in only body of report." The overall mean agreement for the 14 scenarios was 53%, and agreement ranged from 36% to 75%. Smaller nodules had lower agreement: 43%-51% for 8-mm nodules compared with 64%-75% for 15-mm nodules. Agreement was poorest for the 10-mm nodule in a 60-year-old woman (36%) and for scenarios with additional history of lung cancer (39%) and multiple nodules (36%). There was no significant difference in reporting practices and agreement when radiologists were categorized by years of practice, practice type, and subspecialty (P > .55). CONCLUSIONS: The reporting practice for incidental thyroid nodules on CT or MR imaging is highly variable among radiologists, especially for patients with smaller nodules (≤10 mm) and patients with multiple nodules and a history of cancer. This variability highlights the need for practice guidelines.
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Documentación/estadística & datos numéricos , Hallazgos Incidentales , Imagen por Resonancia Magnética/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Nódulo Tiroideo/diagnóstico , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Registros de Salud Personal , Humanos , Masculino , North Carolina , Radiología/estadística & datos numéricosRESUMEN
BACKGROUND AND PURPOSE: The CT table strap may impair shoulder lowering during cervical spine CT. The purpose of this investigation was to evaluate the effect of the CT table strap on radiation exposure and image quality during CT of the cervical spine. MATERIALS AND METHODS: Patients undergoing cervical spine CT were prospectively randomized to having the CT table strap placed around the torso and arms (control group) or around the torso only (intervention group). Radiation exposure, shoulder position, and image quality were evaluated. Potential confounders, including neck diameter and scan length, were also assessed. RESULTS: Fifty-eight patients were enrolled and randomized, and 51 subjects were included in the final study population. There was a 21% decrease in radiation exposure in the intervention group compared with the control group (mean dose-length product, 540 ± 152 versus 686 ± 200 mGy × cm, P = .005). Subjects in the intervention group achieved shoulder lowering of an average of >1 vertebral body lower than the control group (mean shoulder level, 7.7 ± 1.3 versus 6.5 ± 1.3, P = .001). Subjective image quality, determined by the lowest level of spinal cord visibility, was also better in the intervention group (mean cord visibility level, 6.9 ± 1.3 versus 5.9 ± 1.3, P = .006). No differences in neck diameter (P = .28) or scan length (P = .55) were observed between groups. CONCLUSIONS: The CT table strap inhibits shoulder lowering during CT of the cervical spine. Placement of the patient's arms outside the CT table strap results in decreased radiation exposure and increased image quality compared with patients whose arms are placed inside the strap.
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Vértebras Cervicales/diagnóstico por imagen , Exposición a la Radiación/prevención & control , Tomografía Computarizada por Rayos X/instrumentación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND AND PURPOSE: Workup of incidental thyroid nodules detected on CT imaging could be contributing to the increased diagnosis of small thyroid cancers. The purpose of this study was to evaluate recent trends in the incidence of thyroid cancer, and to determine the relationship between annual CT imaging volume and rate of thyroid cancer diagnosis. MATERIALS AND METHODS: This retrospective cohort study used data bases for thyroid cancer and CT imaging volume. Thyroid cancer data from 1983-2009 were obtained from the Surveillance, Epidemiology, and End Results data base. National Council of Radiation Protection and Measurements Report No. 160 provided data on hospital and nonhospital CT imaging volume for 1993-2006. Trends in thyroid cancer were modeled for overall incidence on the basis of patient age, tumor histologic features, and tumor size and stage. Linear regression analysis was performed to evaluate the strength of the relationship between annual CT scan volume and the incidence of thyroid cancer by tumor size and histologic type. RESULTS: In 2009, the incidence of thyroid cancer was 14 per 100,000, which represented a 1.9-fold increase compared with 2000. The growth in incidence was exponential compared with a minimal linear increase in thyroid cancer mortality rate. The subgroup with the greatest change was subcentimeter papillary carcinoma, with doubling in incidence approximately every 6.2 years. The linear relationship between annual CT scan volume and the incidence of subcentimeter papillary carcinoma was very strong (R(2) = 0.98; P < .0001). CONCLUSIONS: The incidence of subcentimeter papillary carcinoma is growing at an exponential rate without significant change in mortality rate. The strong linear relationship between new cases of subcentimeter papillary carcinomas and the number of CT scans per year suggests that an increase in CT scans may increase the detection of incidental thyroid cancers.
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Carcinoma Papilar , Neoplasias de la Tiroides , Nódulo Tiroideo , Tomografía Computarizada por Rayos X , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/epidemiología , Carcinoma Papilar/mortalidad , Femenino , Humanos , Incidencia , Hallazgos Incidentales , Modelos Lineales , Masculino , Estudios Retrospectivos , Programa de VERF , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/mortalidad , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/mortalidadRESUMEN
BACKGROUND AND PURPOSE: Quantification of both baseline variability and intratreatment change is necessary to optimally incorporate functional imaging into adaptive therapy strategies for HNSCC. Our aim was to define the baseline variability of SUV on FDG-PET scans in patients with head and neck squamous cell carcinoma and to compare it with early treatment-induced SUV change. MATERIALS AND METHODS: Patients with American Joint Committee on Cancer stages III-IV HNSCC were imaged with 2 baseline PET/CT scans and a third scan after 1-2 weeks of curative-intent chemoradiation. SUVmax and SUVmean were measured in the primary tumor and most metabolically active nodal metastasis. Repeatability was assessed with Bland-Altman plots. Mean percentage differences (%ΔSUV) in baseline SUVs were compared with intratreatment %ΔSUV. The repeatability coefficient for baseline %ΔSUV was compared with intratreatment %ΔSUV. RESULTS: Seventeen patients had double-baseline imaging, and 15 of these patients also had intratreatment scans. Bland-Altman plots showed excellent baseline agreement for nodal metastases SUVmax and SUVmean, but not primary tumor SUVs. The mean baseline %ΔSUV was lowest for SUVmax in nodes (7.6% ± 5.2%) and highest for SUVmax in primary tumor (12.6% ± 9.2%). Corresponding mean intratreatment %ΔSUVmax was 14.5% ± 21.6% for nodes and 15.2% ± 22.4% for primary tumor. The calculated RC for baseline nodal SUVmax and SUVmean were 10% and 16%, respectively. The only patient with intratreatment %ΔSUV above these RCs was 1 of 2 patients with residual disease after CRT. CONCLUSIONS: Baseline SUV variability for HNSCC is less than intratreatment change for SUV in nodal disease. Evaluation of early treatment response should be measured quantitatively in nodal disease rather than the primary tumor, and assessment of response should consider intrinsic baseline variability.
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Carcinoma de Células Escamosas/terapia , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/terapia , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Antineoplásicos/uso terapéutico , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/secundario , Quimioradioterapia , Cisplatino/uso terapéutico , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/métodos , Inducción de Remisión , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
Laryngopyocele recurrence after initial surgical resection is a very rare occurrence. We present a case of recurrent laryngopyocele in which CT fluoroscopy-guided hookwire placement was used to facilitate resection. In this article, we illustrate the imaging findings of laryngopyocele, review the approach to management, and describe the CT fluoroscopy-guided hookwire placement procedure.
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Laringocele/diagnóstico por imagen , Laringocele/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Quistes/diagnóstico por imagen , Quistes/cirugía , Fluoroscopía , Humanos , Masculino , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. MATERIALS AND METHODS: We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. RESULTS: The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. CONCLUSIONS: Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.
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Agujas , Radiculopatía/diagnóstico por imagen , Radiculopatía/tratamiento farmacológico , Radiografía Intervencional/métodos , Esteroides/administración & dosificación , Tomografía Computarizada por Rayos X/métodos , Antiinflamatorios/administración & dosificación , Femenino , Humanos , Inyecciones Espinales/métodos , Masculino , Persona de Mediana Edad , Raíces Nerviosas Espinales/diagnóstico por imagen , Raíces Nerviosas Espinales/efectos de los fármacos , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Thyroid nodules are common incidental findings on CT, but there are no clear guidelines regarding their further diagnostic work-up. This study compares the performance of 2 risk-categorization methods of selecting CT-detected incidental thyroid nodules for work-up. MATERIALS AND METHODS: The 2 categorization methods were method A, based on nodule size ≥10 mm, and method B, a 3-tiered system based on aggressive imaging features, patient age younger than 35 years or nodule size of ≥15 mm. In part 1, the 2 categorization methods were applied to thyroid cancers in the SEER data base of the National Cancer Institute to compare the cancer capture rates and survival. In part two, 755 CT neck scans at our institution were retrospectively reviewed for the presence of ITNs of ≥5 mm, and the same 2 categorization methods were applied to the CT cases to compare the number of patients who would theoretically meet the criteria for work-up. Comparisons of proportions of subjects captured under methods A and B were made by using the McNemar test. RESULTS: For 84,720 subjects in the SEER data base, methods A and B each captured 74% (62,708/84,720 and 62,586/84,720, respectively) of malignancies. SEER subjects who would not have met the criteria for further work-up by both methods had equally excellent 10-year cause-specific and relative survival of >99%. For part 2, the prevalence of ITNs of ≥5 mm at our institution was 133/755 (18%). The number of ITNs that would be recommended for work-up by method A was 57/133 (43%) compared with 31/133 (23%) for method B (P < .0005). CONCLUSIONS: Compared with using a 10-mm cutoff, the 3-tiered risk-stratification method identified fewer ITNs for work-up but captured the same proportion of cancers in a national data base and showed no difference in missing high-mortality cancers.
Asunto(s)
Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Medición de Riesgo/métodos , Índice de Severidad de la Enfermedad , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/mortalidad , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Prevalencia , Reproducibilidad de los Resultados , Medición de Riesgo/estadística & datos numéricos , Sensibilidad y Especificidad , Análisis de Supervivencia , Tasa de Supervivencia , Adulto JovenRESUMEN
This clinical report describes the enhancement characteristics of hypersecreting parathyroid lesions on dual-phase neck CT. We retrospectively analyzed the enhancement characteristics of 5 pathologically confirmed PTH-secreting lesions on dual-phase CT examinations. Attenuation values were measured for PTH-secreting lesions, vascular structures (CCA and IJV), and soft tissue structures (thyroid gland, jugulodigastric lymph node, and submandibular gland). From the attenuation values, "relative enhancement washout percentage" and "tissue-vascular ratio" were calculated and compared. All lesions decreased in attenuation from arterial to venous phase, while the mean attenuation values of other soft tissue structures increased. A high relative enhancement washout percentage was correlated with parathyroid lesions (P < .006). The tissue-CCA ratio and tissue-IJV ratio for PTH-secreting lesions in the arterial phase were statistically significantly higher compared with soft tissue structures (P < .05). If these results are validated in future larger studies, noncontrast and delayed venous phases of 4D-CT could be eliminated to markedly reduce radiation exposure.
Asunto(s)
Medios de Contraste/administración & dosificación , Medios de Contraste/farmacocinética , Cuello/diagnóstico por imagen , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/metabolismo , Adolescente , Anciano , Femenino , Humanos , Inyecciones Intraarteriales , Inyecciones Intravenosas , Tasa de Depuración Metabólica , Persona de Mediana Edad , Radiografía , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND PURPOSE: Cervical epidural steroid injections are approached with trepidation because of concerns over safety, including direct spinal cord injury. CT fluoroscopy is an alternative to conventional fluoroscopy that could potentially help reduce the risk of injury by providing improved localization of the needle tip. We sought to determine rates of technical success and risk of complications in our initial cohort of patients treated with cervical interlaminar ESI performed under CTF guidance. MATERIALS AND METHODS: In this retrospective case series, we reviewed procedural details and CTF images of 53 consecutive cervical interlaminar ESIs performed on 50 patients over a period of 8 months. Rates of technical success, incidence of complications, procedure times, and factors that influence radiation exposure were examined. RESULTS: No symptomatic procedural complications were observed. A single case of intrathecal contrast injection was observed, from which the patient was asymptomatic. The remaining injections were all technically successful. Injections were performed at every cervical level, as high as C1-C2. Total procedure times averaged less than 20 minutes. Average CT fluoroscopic time was 24 seconds and median tube current was 70 mA. CONCLUSIONS: CTF-guided cervical interlaminar ESI can be performed at all levels in the cervical spine with a low rate of procedural complications. Short total procedure times, CT-fluoroscopy times, and reduced tube current make this procedure a practical alternative to cervical ESI performed under conventional fluoroscopy.
Asunto(s)
Vértebras Cervicales , Fluoroscopía/métodos , Inyecciones Epidurales/métodos , Protección Radiológica/métodos , Radiografía Intervencional/métodos , Esteroides/administración & dosificación , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Humanos , Inyecciones Epidurales/efectos adversos , Persona de Mediana Edad , Mielografía/métodos , Seguridad del Paciente , Dosis de Radiación , Estudios Retrospectivos , Esteroides/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Selecting a lower tube current for CT fluoroscopic spine injections is a method of radiation dose reduction. Ideally tube current should be tailored to the patient's body habitus, but a greater influence on tube current may be the proceduralist's personal preference. The purpose of this study was to compare tube current and fluoroscopy time of different proceduralists for lumbar spine CT-guided selective nerve root blocks, and to correlate image quality to patient diameter and tube current. MATERIALS AND METHODS: Eighty CT-guided SNRBs performed by 4 proceduralists were retrospectively reviewed for tube current and fluoroscopy time. Patient body habitus was evaluated by measuring anteroposterior diameters on scout images. Image quality was evaluated objectively and subjectively: noise was measured in the psoas muscle and images were graded on a 3-point scale. RESULTS: The mean tube current was 59 ± 20 mA and mean fluoroscopy time was 10.4 ± 7.5 seconds. The mean tube current between proceduralists differed by almost 2-fold, and there was greater than 2-fold difference in mean fluoroscopy time (P < .0001 and .01, respectively). Mean AP body size was 27 ± 5 cm. When categoric data of tube current and AP diameter were analyzed, only AP diameter was a statistically significant variable influencing image noise (P = .009). Twenty of 23 patients with AP diameter ≤30 cm had adequate to excellent image quality, even with lower tube current of ≤40 mA. CONCLUSIONS: Wide variability in tube current selection between proceduralists calls for a more objective method of selecting tube current to minimize radiation dose. Body size, measured by AP diameter, had the greatest influence on image quality. This could be used to identify patients for lower tube current selection.
Asunto(s)
Anestésicos Locales/administración & dosificación , Vértebras Lumbares/efectos de la radiación , Bloqueo Nervioso/métodos , Dosis de Radiación , Protección Radiológica/métodos , Raíces Nerviosas Espinales/diagnóstico por imagen , Adolescente , Adulto , Carga Corporal (Radioterapia) , Femenino , Humanos , Inyecciones , Vértebras Lumbares/efectos de los fármacos , Masculino , Persona de Mediana Edad , Radiografía Intervencional , Radiometría , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Raíces Nerviosas Espinales/efectos de los fármacos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
The aim is to describe the technique of preoperative CT-guided hookwire localization of small, but suspicious, cervical lymph nodes. We present 3 patients who underwent the procedure for nonpalpable cervical nodes detected on PET/CT prior to complete surgical resection of the nodes. The details of the radiological procedure, surgical outcomes, and pathologic results are described. The mean intervention time for preoperative hookwire localization was 9 minutes (range 7-14 minutes). There were no complications. All surgeons felt that the lengths of the surgical skin incision and operative times were reduced because of localization. The pathologic diagnoses were 2 benign nodes and 1 case of metastatic ovarian carcinoma. In conclusion, preoperative CT-guided hookwire localization is a useful technique for guiding surgical excision, especially when cervical nodes are small and deep in location.
Asunto(s)
Marcadores Fiduciales , Escisión del Ganglio Linfático/instrumentación , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Mamografía/métodos , Radiografía Intervencional/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/secundario , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metástasis Linfática , Persona de Mediana Edad , Agujas , Cuidados Preoperatorios , Implantación de Prótesis/métodosRESUMEN
Involvement of a cranial nerve caries a poor prognosis for many malignancies. Recurrent or residual disease in the trigeminal or facial nerve after primary therapy poses a challenge due to the location of the nerve in the skull base, the proximity to the brain, brainstem, cavernous sinus, and optic apparatus and the resulting complex geometry. Surgical resection caries a high risk of morbidity and is often not an option for these patients. Stereotactic radiosurgery and radiotherapy are potential treatment options for patients with cancer involving the trigeminal or facial nerve. These techniques can deliver high doses of radiation to complex volumes while sparing adjacent critical structures. In the current study, seven cases of cancer involving the trigeminal or facial nerve are presented. These patients had unresectable recurrent or residual disease after definitive local therapy. Each patient was treated with stereotactic radiation therapy using a linear accelerator based system. A multidisciplinary approach including neuroradiology and surgical oncology was used to delineate target volumes. Treatment was well tolerated with no acute grade 3 or higher toxicity. One patient who was reirradiated experienced cerebral radionecrosis with mild symptoms. Four of the seven patients treated had no evidence of disease after a median follow up of 12 months (range 2-24 months). A dosimetric analysis was performed to compare intensity modulated fractionated stereotactic radiation therapy (IM-FSRT) to a 3D conformal technique. The dose to 90% (D90) of the brainstem was lower with the IM-FSRT plan by a mean of 13.5 Gy. The D95 to the ipsilateral optic nerve was also reduced with IM-FSRT by 12.2 Gy and the D95 for the optic chiasm was lower with FSRT by 16.3 Gy. Treatment of malignancies involving a cranial nerve requires a multidisciplinary approach. Use of an IM-FSRT technique with a micro-multileaf collimator resulted in a lower dose to the brainstem, optic nerves and chiasm for each case examined.