Radiological features of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma: case series and systematic review.

PURPOSE: To comprehensively summarize the clinical data and CT/MRI characteristics of thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA). METHODS: Twenty-seven lesions from 25 study articles identified through a systematic review and three lesions from our institution associated with TL-LGNPPA were evaluated. RESULTS: The mean age of the patients at diagnosis was 35.7 years, and the male-to-female ratio was nearly half. The chief complaint was nasal obstruction, followed by epistaxis. All patients underwent excision. None of the patients had neck nodes or distant metastases. All patients survived with no locoregional/distant recurrence during 3-93 months of follow-up. All lesions were located at the posterior edge of the nasal septum, attached to the nasopharyngeal parietal wall, and showed no laterality. The mean lesion diameter was 1.7 cm. The margins of lesions were well-defined and lobulated, followed by well-defined smooth margins. None of lesions were associated with parapharyngeal space or skull base destruction. All lesions were iso- and low-density on non-contrast CT. Adjacent skull base sclerosis was detected in 63.6% of lesions. High signal intensity on T2-weighted imaging and mostly iso-signal intensity on T1-weighted imaging compared to muscle tissue. Most lesions were heterogeneous and exhibited moderate contrast enhancement. Relatively large lesions (≥1.4 cm) tended to be more lobulated than smooth margins compared to relatively small lesions (<1.4 cm) (p = 0.016). CONCLUSION: We summarized the clinical and radiological features of TL-LGNPPA to facilitate accurate diagnosis and appropriate management.

Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics.

Accurate diagnosis and therapeutic intervention at an early stage is paramount for the management of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), which are the two major types of inflammatory arthritis that involve the hand joints. As more disease-specific medications are developed, medication selection according to the correct diagnosis becomes more important. A delay in diagnosis and inappropriate medication selection may result in poor functional prognosis. However, clinical differentiation between RA and PsA can be challenging and may become largely dependent on imaging interpretation results. Although there is substantial overlap in the imaging findings of RA and PsA, there are differences in the affected primary target sites, reflected by the various patterns of joint involvement, and different microanatomic localization of abnormalities within a single joint in each disease. Therefore, appropriate use of various imaging modalities and accurate image interpretation add significant value to the diagnosis and treatment process. The synovio-entheseal complex is an important concept for understanding the imaging features of PsA. The authors review the different features of RA and PsA of the hands seen with various imaging modalities, including radiography, US, MRI, and dual-energy CT, with updates on the contemporary role of imaging in diagnosis and treatment. The radiologist should have sufficient knowledge to interpret imaging findings and understand the strengths and weaknesses of each modality to recommend the appropriate imaging method and differentiate both diseases accurately. ©RSNA, 2020.

Comparison of the axillary lymph node between rheumatoid arthritis and psoriatic arthritis with computed tomography.

Backgrounds: There is a lack of universally available biomarker to differentiate rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Purpose: to see if the size of the axillary lymphnodes (ALNs) and the frequency of lymphadenopathy are useful biomarker to differentiate RA and PsA. Material and Methods: Forty RA and 19 PsA patients without previous biologics usage were retrospectively included. Chest CT was assessed for the presence of lymphadenopathy and the size of the largest ALN. Frequency of lymphadenopathies was statistically compared between RA and PsA. The short axis and the long axis of the largest ALN were also compared and receiver operating characteristic (ROC) curve analysis was performed. Results: Frequency of axillary lymphadenopathy was significantly higher in RA than in PsA (80% vs 31.6%, p < .001). Number of lymphadenopathies in each patient was also significantly higher in RA than in PsA (3.0 vs 1.2 per patient, p = .005). Sensitivity and specificity for differentiating RA from PsA by the presence of at least one axillary lymphadenopathy were 0.8 and 0.68, respectively.The short axis of the largest ALNs in RA was significantly longer than in PsA (6.5 ± 1.6 mm vs 4.7 ± 1.7 mm, p < .001). ROC curve analysis of the short axis showed AUC of 0.75 (p = .002) and the cutoff value of 5.1 mm with a sensitivity of 0.83 and specificity of 0.74, when differentiating RA and PsA. Conclusion: Presence of ALN lymphadenopathy and the short axis of the largest ALN may have a potential utility in differentiating RA and PsA.

A rare case of positional changes of carotid artery depicted within a single MR study and a wandering carotid artery depicted on a serial MR studies.

The retropharyngeal carotid artery (RCA) is a relatively rare anatomical malposition, and positional changes in the RCA is also extremely rare. In addition, there are some reports of "wandering carotid artery" which means that the carotid artery reciprocate positional changes (wandering) between its normal position and retropharyngeal regions, during follow-up evaluations. A male patient in his 50s with a chief complaint of globus pharyngeus. A pulsatile swelling of the posterior pharyngeal wall of the right side was found on clinical examination. In this case, the right carotid artery showed the clinical course of a wandering carotid artery, which reciprocated between its normal position and the retropharyngeal space during three serial MR investigations. Interestingly, both the most recent MR study and the MR study performed 4 years ago showed that the carotid artery at the level of the hyoid bone moved laterally (positional normalization) during the single MR investigation. This is a first case which showed a rare clinical course of a wandering carotid artery on serial follow-up MR studies and positional changes of carotid artery within a single MR study. It is important for clinicians to be aware of these phenomena, in order to avoid fatal and unexpected complications during clinical procedures.

CT and MR imaging of laryngeal metastasis from renal cell carcinoma: A case report.

Laryngeal metastasis is an extremely rare condition. To the best of our knowledge, there has been no previous report on a laryngeal metastasis from renal cell carcinoma, which describes on details of the CT and MR imaging findings. A male patient in his 80s. Laryngoscopy revealed reddish-colored masses in the right false vocal cord and in the subglottic larynx. CT and MR imaging of this case showed multiple hypervascularized lesions with a wash-out effect in the supra and subglottis of the larynx and in the right intervertebral foramen of the cervical spine. Angiography revealed a hypervascular tumor consistent with the subglottic lesion. The histopathology and immunohistochemistry findings were compatible with laryngeal metastasis from renal clear cell carcinoma. A history of postoperative renal clear cell carcinoma about 7 years ago was later confirmed, which was not stated at the time of the initial imaging evaluation. It is a possible differential diagnosis in cases of multiple hypervascular masses in the head and neck region with a history of renal carcinoma. In particular, if the contrast-enhancement pattern of the lesion on the dynamic CT is similar to that of renal cell carcinoma. It is also important to reconfirm the patient's medical history, including postoperative status.

Radiological approach for the newly incorporated T staging factor, depth of invasion (DOI), of the oral tongue cancer in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual: assessment of the necessity for elective neck dissection.

The 8th edition of American Joint Committee on Cancer's (AJCC) Cancer Staging Manual was modified by incorporating depth of invasion (DOI) in the T categorization of oral cavity cancer. This is because DOI is strongly associated with cervical lymph node metastasis, which is the most important negative prognostic factor of oral cavity cancer. This major change in the AJCC Cancer Staging Manual caused re-staging of T category in several cases. Although, the DOI on MRI and CT (radiological DOI; r-DOI) strongly correlated with pathological DOI (p-DOI), it is often 2-3 mm larger than p-DOI. Due to this variance, estimation of p-DOI based on r-DOI may not be accurate. However, when a lesion is undetectable on MRI, p-DOI was often smaller than 4 mm. On the other hand, when MRI depicts lesions with styloglossus and hyoglossus muscle invasion, p-DOI was always larger than 4 mm. These correlations between MRI findings and p-DOI are important when assessing the need for elective neck dissection, as the National Comprehensive Cancer Network (NCCN) recommends elective neck dissection in cases with DOI greater than 4 mm.

Quantitative analysis of therapeutic response in psoriatic arthritis of digital joints with Dual-energy CT iodine maps.

The aim of this study was to investigate the feasibility of quantitative assessment of the therapeutic response in psoriatic arthritis (PsA) by measuring iodine uptake using a Dual-energy CT (DECT) iodine map. The study included 74 symptomatic and 74 matching non-symptomatic joints of 26 consecutive PsA patients who underwent two contrast enhanced DECTs of the hand or foot, pre and post medical interventions. Symptomatic and matched non-symptomatic control joints were scored with the PsA DECT Scoring System (PsADECTS), which was derived by modifying the PsA MRI Scoring System (PsAMRIS), a recently validated scoring system that assesses PsA changes on MRI. Quantified iodine uptake measured using the DECT iodine map was compared to the PsADECTS score. Efficacy of PsA treatment was confirmed by the improved clinical findings. Both PsADECTS and iodine uptake also showed significant improvement after treatment (Wilcoxon signed-rank test: z = 7.38, p < 0.005; z = 6.20, p < 0.005, respectively). The treatment effects of PsADECTS score and iodine uptake showed a good correlation with each other (Spearman's ρ = 0.58 p < 0.005). Inter-reader agreement for PsADECTS score and iodine uptake were either moderate or good. In conclusion, our study showed that the DECT iodine map is a valid tool for quantitative assessment of the therapeutic response of PsA.