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.

[Woodworker's nasal adenocarcinoma revealed by anosmia]. / Anosmie révélatrice d'un adénocarcinome nasal chez les travailleurs du bois.

OBJECTIVES: The aim of this article is to report two cases illustrating the origin of woodworkers' adenocarcinoma in the olfactory cleft and to discuss screening, prevention, and surgical approaches. MATERIAL AND METHOD: Retrospective study of the charts of two cases of adenocarcinoma of the olfactory cleft revealed by a loss of the sense of smell. RESULTS: Of 30 consecutive cases of woodworkers' adenocarcinoma of the olfactory cleft observed during the last 3 years, the two cases revealed by anosmia were diagnosed as small tumors located in one olfactory cleft. CONCLUSION: In light of these two cases, we discuss anosmia in the diagnostic screening of this tumor and its consequences in the olfactory cleft: flexible endoscopic examination of the olfactory cleft seems preferable to rigid endoscope examination of the middle meatus at screening; endoscopic resection of the olfactory cleft seems preferable to resection through external approaches; and nasal lavages seem preferable to the Proetz technique for preventive sinus lavage. The new knowledge on adenocarcinoma of the olfactory cleft should be familiar to occupational health physicians, general practitioners, and otorhinolaryngologists because of its practical consequences for screening, diagnosis, prevention, and surgical treatment.

Endoscopic surgery reveals that woodworkers' adenocarcinomas originate in the olfactory cleft.

The olfactory cleft is a narrow chamber located under the cribriform plate and between the turbinate wall of the ethmoidal labyrinth and the corresponding nasal septum. Nasal adenocarcinomas are mostly described as originating in the ethmoid sinus and operated via external approaches. We designed a prospective study on twenty consecutive woodworkers' adenocarcinomas without intracranial extension to determine the precise site of origin of the tumour. All patients were operated under endoscopic endonasal control according to a methodical surgical procedure as follows: 1) debulking of the tumour and identification of the middle turbinate or conchal lamina, 2) exenteration of the ethmoidal labyrinth according to the nasalisation procedure, and 3) exenteration of the olfactory cleft. Endoscopic endonasal surgery showed that woodworkers' adenocarcinomas constantly originated in the olfactory cleft, appearing as polyp-like neoplasms with well-defined bodies. Over a long period of time, they do not invade, but just displace and push out the surrounding structures, i.e. the nasal septum and the turbinate wall. More than the volume of the tumour, the precise location of the pedicle and especially its connection to the cribriform plate could be of major prognosis value.

[Propositions for the selection and the delineation of peritumoral microscopic disease volumes in oral cavity and oropharyngeal cancers (lymph nodes excluded)]. / Proposition de sélection et délimitation des volumes cibles microscopiques péritumoraux dans les cancers de la cavité buccale et de l'oropharynx (aires ganglionnaires exclues).

This article reviews the concept of selectivity in peritumoral microscopic disease to be included in the Clinical Target Volume (CTV) for elective treatment for oral cavity and oropharyngeal squamous cell carcinoma, using the local tumoral spread. The objective of the present article is to present a procedure for the delineation of the target volumes, required for an appropriate application of 3-DCRT and IMRT for head and neck cancers. These propositions are for the delineation of microscopic peritumoral target volumes when external beam irradiation is required. CTVs are illustrated on CT sections.

Implantation of fiducial markers in the liver for stereotactic body radiation therapy: Feasibility and results.

PURPOSE: Robotic stereotactic body radiation therapy (SBRT) for the treatment of hepatocellular carcinoma requires the perilesional implant of gold fiducial markers for detection by scopy. The purpose of this study is to determine whether the implant of gold fiducial markers is still possible and, if so, with which imaging technique and with what results. MATERIALS AND METHODS: This is a prospective study based on the implant of fiducial markers in the liver in our department for a treatment by SBRT for a hepatocellular carcinoma in 38 patients (49 lesions to treat) over a period of one year. As the first choice, it consisted of sonographic guidance and, if not possible, CT-scan guidance was used. RESULTS: The mean number of fiducial markers implanted per procedure was 2.68(±0.61) with almost exclusive sonographic guidance (36 out of 38 patients or 95% of the patients). The mean distance between the markers and the lesion was 32mm (±11mm) and that between the markers was 17mm (±7mm). CONCLUSION: SBRT is being evaluated for the treatment of liver lesions. The radiologist has an important role to play since the implant of fiducial markers in the liver is indispensable. It is almost always possible with sonographic guidance, including for lesions not accessible to microbiopsies, a treatment by radiofrequency or for lesions poorly individualisable by sonography or CT-scan.

Synthesis, structure and biological properties of Z-17alpha-(2-iodovinyl)-11beta-chloromethyl estradiol-17beta (Z-CMIV), a high affinity ligand for the characterization of estrogen receptor-positive tumors.

Linkage of a 11beta-chloromethyl group to estradiol-17beta (E2) dramatically increases the binding affinity of the steroid for the estrogen receptor (ER) with the formation of a quasi-irreversible steroid-receptor complex. We have synthesized the two isomers of 11beta-chloromethyl-17alpha-iodovinyl-estradiol (E-CMIV and Z-CMIV) by a novel route. Both derivatives demonstrated high binding affinity and selectivity for ER (RBAs: ER = 820 and 1008; SHBG = 1.2 and 0.25, respectively; E2 = 100). On the basis of X-ray crystallographic data for Z-CMIV and its precursor, we have postulated that Z-CMIV might interact strongly with aromatic amino-acids within a hydrophobic groove of the ER hormone binding domain (HBD) that incorporates pockets corresponding to the 11beta and 17alpha steroid substituents. The binding properties of Z-CMIV labeled with 125I were investigated, especially its ability to detect and quantify altered ER forms with low binding affinity for E2. Sucrose density gradient analysis revealed that Z-CMIV has a higher activation potency than E2 as it converts a higher proportion of non-activated monomers in the cytosol into activated monomers with the potential to dimerize. In in vitro (MCF-7 cells) and in vivo (rat uterus) determinations of estrogenic activity, Z-CMIV was as potent as E2 in increasing progesterone receptor (PgR) concentrations and decreasing ER levels and in stimulating uterine growth. [125I]-Z-CMIV could open the way to new applications in the diagnosis and therapy of ER-positive breast cancers, especially those containing altered (variant) ERs.

[How to assess the value of scientific publications?]. / Comment calculer la valeur des publications scientifiques?

The Institute of Scientific Information has edited an index to evaluate the diffusion of scientific articles. It is based on the fact that the more an article is cited as a reference in other articles, the more it is considered to be important, and the higher the coefficient attributed to the journal in which it was originally published. Several methods of evaluation have been proposed, the two main ones being the impact and citation half-life. The impact factor takes into account the average number of times which a journal is mentioned for recent articles published in a given year. The citation half-life gives an insight into the longeivity of the articles of a journal by the number of citations received. This index is an attempt to quantify the notoriety of scientific journals for all scientific medical specialties. Each year, the institute for Scientific Information publishes a classification of the journals of each medical specialty.

[Value of volume rendering in musculo-skeletal disorders]. / Intérêt de la technique de rendu volumique en pathologie ostéo-articulaire.

Three dimensional imaging is increasingly important for evaluation of anatomic relationships and extent of disease, for treatment planning and for follow-up evaluation. The volume rendering technique allows creation of accurate 3D images that can be used for several clinical applications especially in musculo-skeletal disorders such as evaluation of tumors or fractures. This article describes the methods used for volume rendering technique and focuses on the specific aspects of volume rendering applied to musculo-skeletal applications.

[Comparative value of MR-angiography, helical CT and digital angiography in the preoperative assessment of abdominal aortic aneurysms]. / Valeur comparative de l'angio-IRM, du scanner hélicoïdal et de l'angiographie numérisée dans le bilan préopératoire des anévrismes de l'aorte abdominale.

PURPOSE: To compare helical CT with MR angiography in pre-operative assessment of abdominal aortic aneurysm (AAA). MATERIAL AND METHODS: Twenty patients with AAA underwent helical-CT, MR-angiography and digital angiography. All exams were interpreted independently by two groups of observers. Kappa and rho were calculated to assess correlations. Sensitivity and specificity were calculated to compare each method with the "gold standard" digital angiography. RESULTS: Inter-observer correlation was excellent. There was a very good agreement between both methods in the assessment of the maximal diameter and the proximal neck of the aneurysm. There was no significant difference in the assessment of stenoses of the visceral and iliac arteries, the number of renal arteries, and iliac extension. CONCLUSION: Helical CT and MR angiography are equivalent in pre-operative assessment of AAA.

[MRI and leg stump neuroma]. / IRM et névromes des moignons damputation des membres inférieurs.

OBJECTIVE: To describe RMI aspects of leg stump neuroma and to evaluate RMI scan interest for neuroma diagnosis and management. POPULATION AND METHOD: During a 2 years period, 224 amputated patients consulting for pain or prostetics problems were studied. In 10 cases, a characteristic pain leads to neurona diagnosis. This is described as a sensation of ascending or descending electric shock induced by the stimulation of an identified point with a reproducible topography. In all these cases, RMI scans were performed. In thirty two other cases, a RMI scan was performed to confirm a pathology (bursitis, bone abnormality) or in order to establish an etiologic diagnosis. Twelve neuromas were diagnosed. RESULTS: RMI scan showed a neuroma in the ten cases with a clinical suspicion and two asymptomatic neuromas were diagnosed out of the 32 patients without clinical suspicion. Medium delay between amputation and neuroma diagnosis is 11,6 year. In six cases, staking was modified and in six other cases, surgery was necessary. In aIl cases, clinical manifestations disappeared. Vanous RMI aspects ofneuromas are described and illustrated. Neuroma is observed on the extremity of a nerve that have a wavy aspect on its top. The neuroma is an oblong structure, with clear limits. There is an hyposignal with Ti sequence and variable signal with T2 and after gadolinium injection. DISCUSSION: RMI scan is a good way to diagnose amputee neuroma. It makes it possible to demonstrate the pathological character of the neuroma. It has to be performed when a neuroma is suspected. It enables to confirm the diagnosis and establish the exact topography and anatomic connection. Mechanical strains role as a factor of discovering the neuroma is discussed because of the concomitant evolution of associated lesions (bursitis, bone edema). Surgical repair takes place after correcting abnormal mechanical strains.

Breast microcalcifications: the lesions in anatomical pathology.

Microcalcifications are actually indirect signs of pathological processes, and only a few of these processes may be correctly correlated to the morphologic pattern of calcifications. This is true of the microcalcifications typically classified as benign by the 4th edition of the BI-RADS Atlas, except for round and punctuate microcalcifications. This is also the case of polymorphous fine and linear fine microcalcifications most often, but not exclusively, associated with DCIS with necrosis. For other types of microcalcifications, other parameters are analyzed in a more global approach: the associated clinical or mammographical signs; the context, especially genetic; the spatial distribution; the number; the evolution over time. The radiologist should compare the images with the anatomy of the terminal ductal-lobular unit, from where most cancers arise, and estimates the risk by taking into account the clinical context and the antecedents.

[Imaging follow-up of soft tissue sarcomas]. / Intérêt de l'imagerie dans la surveillance des sarcomes des parties molles des membres.

PURPOSE: We have studied the post-treatment follow-up of patients with history of limb soft tissue sarcoma including MR imaging to determine its added value compared to simple clinical follow-up and the impact of MR imaging findings on patient management. We have also studied the value of chest CT to detect metastases. PATIENTS AND METHODS: Retrospective study of 85 patients treated for limb soft tissue sarcoma with post-treatment MR imaging of the affected region. We have studied the percentage of local recurrences and the modality of detection of these recurrences. We have evaluated the impact on management of patients with abnormalities detected on MRI. For distant metastases, we have recorded their percentage and date of occurrence. RESULTS: There were five cases of local recurrence, for a percentage of 6%, with 50% detected clinically. The percentage of metastases was 26%. Six biopsies were performed and complementary examinations were performed in 18 cases based on abnormalities detected on MR. CONCLUSION: These results are in keeping with recommendations from the Fédération nationale des centres de lutte contre le cancer. Imaging is necessary to detect lung metastases.

CT assessment of woodworkers' nasal adenocarcinomas confirms the origin in the olfactory cleft.

BACKGROUND AND PURPOSE: Endoscopic endonasal surgery let us observe that woodworkers' nasal adenocarcinomas originate in the olfactory cleft. Our aim was the identification of CT imaging features that corroborate the olfactory cleft as the site of origin for woodworkers' adenocarcinoma. MATERIALS AND METHODS: We designed a retrospective study to compare CT scans of 27 unilateral olfactory cleft adenocarcinomas with 30 cases of nasosinusal polyposis (NSP) and 33 healthy sinus controls. Enlargement of the olfactory cleft, lateralization of the ethmoidal turbinate wall, and contralateral bulging of the nasal septum were measured on coronal scans passing through crista galli and posterior half of both ocular globes. Comparisons have been performed by using analysis of variance and the Bonferroni procedure. RESULTS: The nasal septum was significantly bulging across the midline in adenocarcinoma (4.6 +/- 3 mm; range, -0.1-13.7 mm) compared with NSP (0.7 +/- 1 mm; range, -2.1-2.3 mm) or healthy sinus controls (0.5 +/- 1 mm; range, -1.2-2 mm) (P < .001). The olfactory cleft was significantly wider in adenocarcinoma (15.1 +/- 4.5 mm; range, 8.6-25.7 mm) than in NSP (3.6 +/- 0.4 mm; range, 2.8-4.6 mm) or healthy sinus controls (3.3 +/- 0.7 mm; range, 1.4-4.6 mm). The ethmoidal labyrinth width was significantly smaller on the pathologic side in adenocarcinoma (7.2 +/- 2.7 mm; range, 3.2-14.2 mm) than in the control groups (P < .001). Whereas the angle between the conchal lamina and vertical midline was close to zero degrees in NSP (0.03 +/- 2.25 degrees ; range, -5 degrees -3 degrees ) and healthy sinus controls (0.45 +/- 2.13 degrees , range, -5 degrees -5 degrees ), it reached 39.76 +/- 13.83 degrees (P < .001) in adenocarcinoma. CONCLUSIONS: Radiologists should suspect nasal adenocarcinoma on sinus CT scans showing a unilateral expanding opacity of the olfactory cavity.

Imaging of the painful lower limb stump.

Several postoperative complications associated with pain may develop in the stump of an amputated lower limb. Clinical findings are often nonspecific; however, radiologic evaluation, especially with magnetic resonance (MR) imaging, is useful in the early diagnosis of these complications, thereby helping minimize physical disability with its psychologic and socioeconomic implications. Conventional radiography can demonstrate evidence of osseous origins of pain (eg, aggressive bone edge, heterotopic ossification, osteomyelitis) and should be the first imaging study performed after clinical examination. Videofluoroscopy can help evaluate improper prosthetic fit by demonstrating abnormal residual limb motion, piston action, rolling of soft tissues, and abnormal angle between the limb axis and the prosthesis during gait. Ultrasonography can demonstrate inflammatory changes in the stump as well as soft-tissue fluid collections. However, MR imaging is the modality of choice when clinical and other imaging findings are indeterminate. Because of its high spatial and contrast resolution, MR imaging can demonstrate subtle inflammatory changes, fluid collections, cancers, neuromas, and subtle traumatic bone lesions. Knowledge of various surgical and rehabilitation techniques is required for accurate diagnosis of complications associated with stump pain. Correct diagnosis allows choice of the most appropriate therapy, which may involve treating the stump, remodeling the prosthesis, or both.