Prognostic role of the MRI-based involvement of superior pharyngeal constrictor muscle in oropharyngeal squamous cell carcinoma.

OBJECTIVES: The aim of this study was to determine the impact of the involvement of the superior pharyngeal constrictor muscle (SPCM) evaluated by magnetic resonance imaging (MRI) on outcome in oropharyngeal squamous cell carcinomas (OPSCCs). METHODS: A retrospective study including consecutive patients with OPSCC treated with curative intent. RESULTS: A total of 82 consecutive patients with OPSCC met inclusion criteria. At multivariate analysis, patients with SPCM infiltration were at significantly higher risk of death (HR: 3.37, CI: 1.21-9.38) and progression (HR: 3.39, CI: 1.38-8.32). In a multivariate model conditioned on HPV status, a significantly higher risk of death and progression was observed by combining both SPCM and HPV status with patients harboring an HPV-negative OPSCC with SPCM infiltration showing the poorest outcome. CONCLUSION: MRI evidence of SPCM involvement significantly and independently increases the risk of death and progression in subjects with OPSCC. Considering both MRI-assessed SPCM infiltration and HPV status significantly improved risk stratification in these malignancies.

Is there a role for tumor volume in prediction of prognosis for oral cancer?

PURPOSE: New prognostic factors in oral squamous cell carcinoma (OSCC) (tumor-, host-, and environment-related) have been introduced recently to complete those traditionally considered. Among them, tumor volume (TV) could be the most interesting and applicable in clinical practice, considering the routine use of computed tomography in tumor staging. In this retrospective study we aimed to investigate whether a correlation exists among these new prognostic factors and survival outcomes. METERIALS AND METHODS: We collected data about 140 patients affected by OSCC who underwent primary surgery. Prognostic factors were collected and Overall Survival (OS), Disease Specific Survival (DSS) and Disease Free Survival (DFS) were estimated using Kaplan-Meier method; the Log-Rank test (Mantel-Cox) and Cox regression models were applied to investigate predictors of survival. RESULTS: The 5-year OS, DSS and DFS were 73.6 %, 89.2 % and 75.2 % respectively. Nodal metastasis (pN+), relapse and American Society of Anesthesiologists ASA-II were found independent prognostic factors for OS, and significantly associated to worst DSS (p < 0.001). TV significantly correlated with higher relapse occurrence (p = 0.03). CONCLUSIONS: In our experience, lymph-node status, ASA classification and relapse significantly influenced DSS on univariate analysis. TV could represent an interesting additional parameter, since it significantly influenced DFS. However, prospective studies with standardized TV measurements and a greater number of patients are needed to validate this result.

HPV impact on oropharyngeal cancer radiological staging: 7th vs 8th edition of AJCC TNM classification.

PURPOSE: To evaluate the agreement between pathological and radiological staging in oropharyngeal cancer by comparing the 7th and the 8th edition of the AJCC TNM system. METHODS: This retrospective cohort study included 57 cases of oropharyngeal cancer with lymph node metastases staged with the 7th and 8th editions of the AJCC TNM system. Comparison between clinical and radiological features and differences in agreement rates were calculated between radiological and pathological staging for the primary tumor (T) and lymph nodes (N) in HPVpos and HPVneg cases. RESULTS: Comparison of HPVpos and HPVneg revealed a significantly different distribution between early and advanced stages in the 8 th edition, with a relevant number of HPVpos patients redefined from advanced stages whit the 7 th ed. to early stages with 8 th ed. (p < 0.01); no significant differences were found when comparing all diagnostic methods for T and N. CONCLUSIONS: The 8th edition of the AJCC TNM seems to lead to better pretreatment staging. For both HPVpos and HPVneg, the agreement between pretreatment radiological and pathological staging.

Accuracy of the Anatomage Table in detecting extranodal extension in head and neck cancer: a pilot study.

Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ( pENE + ) were considered "cases" and patients with negative histological examination for ENE ( pENE - ) were considered "controls." Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT > 15 mm ) and a minor nodes (MiN) group (lymph nodes on CT ≤ 15 mm ). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE + patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE - patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.

Diagnosis and treatment of melanoma bone metastasis: A multidisciplinary approach.

Bone is the fourth most common site of melanoma metastasis after lung, liver, and brain. Melanoma bone metastases typically occur in patients who already have widespread metastases in other organs. Current available approaches for bone metastases from melanoma include chemotherapy, radiotherapy, biological therapy, combination therapy, and surgery. In this narrative review, we describe the management of patients affected by melanoma bone metastases, discussing the diagnostic and treatment approaches as well as their impact on survival and quality of life. Despite the fact that clinical and surgical trials will be required to determine the most appropriate treatment, we do expect a newer and more important role of multidisciplinary approach in the management of melanoma patients with bone metastases in the next future.

Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound.

OBJECTIVE: The purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes. MATERIALS AND METHODS: Forty-seven renal lesions (range, 0.8-7.7 cm; average, 2.6 cm) with equivocal enhancement at CT underwent contrast-enhanced ultrasound using sulfur hexafluoride-filled microbubbles. Examinations were digitally recorded for retrospective blinded evaluation by two radiologists with 20 and 10 years' experience in urologic imaging. Histologic results were available for 30 of 47 (64%) lesions (25 primary malignant tumors, two metastases, and three primary benign lesions). Two lesions increased in size and complexity during the follow-up and were considered malignant. One Bosniak category III and 14 category IIF cysts were stable after a follow-up of at least 3 years and were considered benign. ROC curve analysis was used to assess the capability of contrast-enhanced ultrasound to differentiate benign from malignant lesions. RESULTS: Twelve likely complex cystic lesions at gray-scale ultrasound were cystic also on contrast-enhanced ultrasound and reference procedures. Eleven of 34 lesions that appeared solid at gray-scale ultrasound were cystic on contrast-enhanced ultrasound and reference procedures. One lesion considered likely solid by one radiologist and possibly cystic by the other was a solid tumor at contrast-enhanced ultrasound and histologic analysis. The diagnostic performance of contrast-enhanced ultrasound to characterize the lesions as benign or malignant was high for both readers (AUC, 0.958 and 0.966, respectively). CONCLUSION: Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.

Imaging of haemodialysis: renal and extrarenal findings.

Electrolyte alterations and extra-renal disorders are quite frequent in patients undergoing haemodialysis or peritoneal dialysis. The native kidneys may be the site of important pathologies in patients undergoing dialysis, especially in the form of acquired renal cystic disease with frequent malignant transformation. Renal neoplasms represents an important complication of haemodialysis-associated acquired cystic kidney disease and imaging surveillance is suggested. Extra-renal complications include renal osteodistrophy, brown tumours, and thoracic and cardiovascular complications. Other important fields in which imaging techniques may provide important informations are arteriovenous fistula and graft complications. Teaching points • Renal neoplasms represent a dreaded complication of haemodialysis.• In renal osteodystrophy bone resorption typically manifests along the middle phalanges.• Brown tumours are well-defined lytic lesions radiographically, possibly causing bone expansion.• Vascular calcifications are very common in patients undergoing haemodialysis.• Principal complications of the AV fistula consist of thrombosis, aneurysms and pseudoaneurysms.

Biochemical markers and MR imaging findings as predictors of crohn disease activity in patients scanned by contrast-enhanced MR enterography.

RATIONALE AND OBJECTIVES: To define the best independent predictors for active inflammation in patients with Crohn disease (CD) examined by contrast-enhanced magnetic resonance (MR) enterography. MATERIALS AND METHODS: Ninety-one patients (47 men and 44 women; aged 39.58 ± 17.1 years) with a diagnosis of CD; CD activity index (CDAI) ≥ 150 (n = 19 patients) or <150 (n = 72) underwent MR enterography including T2-weighted half-Fourier acquisition single-shot turbo spin-echo, T2-weighted spectral fat presaturation with inversion recovery, T1-weighted balanced steady-state free precession, and T1-weighted breath-hold resolution isotropic high volume three-dimensional MR imaging sequences before and after administration of gadobenate dimeglumine during arterial (30 seconds), portal venous (70 seconds), and delayed phase (3 and 5 minutes from contrast injection). Two readers analyzed the MR images in consensus. Reference standard was the Crohn's Disease Endoscopic Index of Severity (CDEIS) with deep mucosal biopsy or the histologic analysis of the surgical specimen in those patients (n = 30) who underwent elective small-bowel resection. Univariate and multivariate logistic regression analyses were performed to assess CDAI, biochemical markers (C-reactive protein and fecal calprotectin levels) and MR imaging findings as potential predictors of inflammatory CD activity. RESULTS: Patients revealed prevalently active (n = 47 patients) or quiescent CD with mural fibrosis (n = 44 patients). The bowel wall T2 hyperintensity (odds ratio [OR], 9.20; 95% confidence interval [CI], 2.71-31.19) and total length of disease (OR, 1.29; 95% CI, 1.11-1.49) were found as the best independent predictors of active CD. CDAI, C-reactive protein, and fecal calprotectin were not found independent predictors of active CD. CONCLUSIONS: The bowel wall T2 hyperintensity and the length of the involved bowel tract were predictors of active inflammation in patients with CD examined by contrast-enhanced MR enterography.

Predictors of dysplastic nodule diagnosis in patients with liver cirrhosis on unenhanced and gadobenate dimeglumine-enhanced MRI with dynamic and hepatobiliary phase.

OBJECTIVE: The purpose of this article is to assess whether unenhanced and gadobenate dimeglumine-enhanced MRI with dynamic and hepatobiliary phase may predict the diagnosis of dysplastic nodules in patients with liver cirrhosis. MATERIALS AND METHODS: We retrospectively analyzed 75 cirrhotic patients (47 men and 28 women; mean [± SD] age, 55 ± 12 years) with 82 hepatocellular nodules, including histology-proven dysplastic nodules (n = 25; diameter, 1-3 cm) and hepatocellular carcinomas (n = 57; diameter, 2-3 cm) scanned by MRI before and after gadobenate dimeglumine injection during hepatic arterial phase (HAP), portal venous phase (PVP), equilibrium phase, and hepatobiliary phase. Nodule T1 and T2 intensities before contrast agent injection and nodule HAP, PVP, equilibrium phase, and hepatobiliary phase intensities were compared with the adjacent liver. Univariate and multivariate logistic regression analysis was conducted to assess how the nodule could predict dysplastic nodule diagnosis. RESULTS: Some imaging findings were independent predictors of dysplastic nodule diagnosis-namely, nodule T2 isohypointensity (odds ratio [OR], 12.28; 95% CI, 3.88-38.82), T1 isohyperintensity (OR, 26.74; 95% CI, 7.53-94.90), HAP isohypointensity (OR, 97.16; 95% CI, 20.06-470.49), PVP-equilibrium phase isohyperintensity (OR, 20.53; 95% CI, 5.36-78.62), and hepatobiliary phase isohyperintensity (OR, 119.6; 95% CI, 21.59-662.40). Nodule T2 and HAP isohypointensity (OR 31.47; 95% CI, 7.88-125.58), nodule T2 isohypointensity and hepatobiliary phase isohyperintensity (OR, 28.77; 95% CI, 7.79-106.19), nodule T1 isohyperintensity and HAP isohypointensity (OR, 17.22; 95% CI, 4.85-61.14), and nodule T1 and hepatobiliary phase isohyperintensity (OR, 19.39; 95% CI, 5.38-69.90) were also predictors of dysplastic nodule diagnosis. CONCLUSION: The combination of nodule appearance on T2-weighted MRI and nodule enhancement after gadobenate dimeglumine injection may predict dysplastic nodule diagnosis in patients with liver cirrhosis.