Calcified lymph nodes in the setting of head and neck squamous cell carcinoma: A predictor of HPV positivity?

PURPOSE: Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC) and accounts for a large majority of new cases. The purpose of this study is to determine whether there is an association between nodal calcification and HPV positivity in the setting of metastatic HNSCC. METHODS: Consecutive patients with HNSCC who underwent CT were retrospectively identified. Patients were then divided into two groups: those with HPV-positive HNSCC and those with HPV-negative HNSCC. Demographic, clinical, and CT data were compared between the two groups to determine factors associated with HPV-positive HNSCC. RESULTS: A total of 179 patients with HNSCC were included in the final analyses, 104 (58%) of whom had HPV-positive tumors. Univariate analyses demonstrated that those with HPV-positive HNSCC were more likely to have calcified lymph nodes (p = 0.044). Analyses also confirmed previously known associations with male gender (p = 0.001), primary oropharyngeal tumors (p < 0.001), and cystic lymph nodes (<0.001). The HPV-positive HNSCC group was also less likely to have necrotic lymph nodes (p < 0.001). CONCLUSION: In addition to known clinical and imaging factors associated with HPV-positive metastatic HNSCC, such as male gender, oropharyngeal primary location, and cystic lymph nodes, the presence of calcifications within cervical lymph nodes, although infrequent, provides an additional useful feature to predict HPV positivity in HNSCC. Additionally, if calcified lymph nodes are present, then a primary oropharyngeal tumor site should be considered.

A retrospective review of cases preoperatively diagnosed by radiologic imaging as cavernous venous malformations.

The purpose of this study is to examine orbital lesions identified on preoperative radiologic imaging as cavernous venous malformations (CVMs), identify their imaging characteristics, and determine if these may help differentiate CVMs from other intraorbital masses. An IRB-approved retrospective chart review over 30 years was undertaken identifying lesions "consistent with cavernous hemangioma" on radiologic studies, which were subsequently surgically resected with a tissue diagnosis. All radiologic images (CT and MRI) obtained preoperatively were re-reviewed by a single masked neuroradiologist. The pattern of contrast enhancement on sequential MRI views was used to determine whether the enhancing characteristics helped identify CVMs compared to other intraorbital masses. Fifty-seven orbital lesions consistent with a CVM were identified on imaging. Fourteen (25%) of them were resected, of which nine (64%) were found to be CVMs on pathologic examination. Five (36%) were found to be a different lesion, most commonly schwannoma (21%). On imaging, CVMs tended to display heterogeneous progressive enhancement, whereas other tumors, in particular schwannomas, enhanced at their maximum level immediately. Based on these characteristics, on re-review, the masked neuroradiologist was able to differentiate a CVM versus other tumors for all 14 imaging cases. This study suggests that examining the pattern of contrast enhancement may help to correctly differentiate a CVM from other isolated, encapsulated orbital lesions on CT/MR imaging.

CT findings in a patient with bilateral metachronous carotidynia.

Carotidynia is a self-limiting, idiopathic clinical syndrome characterized by acute unilateral neck pain and tenderness of the carotid artery. We describe a unique case of bilateral carotidynia that occurred metachronously, with each incident resolving without long-term sequelae. Knowledge of this entity is important to properly interpret the imaging findings and to not mistake this finding as an ill-defined tumor, thus avoiding unnecessary biopsy.

Potential correlation between menopausal status and the clinical course of orbital cavernous hemangiomas.

PURPOSE: To evaluate the clinical course of radiologically diagnosed orbital cavernous hemangiomas in the setting of presumed changes in estrogen/progesterone levels. METHODS: An institutional review board-approved retrospective cohort chart review of patients from January 1, 1983, to January 1, 2013, was undertaken searching both outpatient ophthalmology diagnoses and radiologic diagnoses, identifying 32 orbital cavernous hemangiomas, which were subsequently divided into group 1, presumed to have stable levels of estrogen/progesterone, and group 2, presumed to have decreasing levels of estrogen/progesterone. Patients were then categorized as having short-term, mid-range, or long-term follow up. Serial imaging studies were evaluated and graded as having increased, decreased, or remained stable in size. RESULTS: In group 1, no lesions decreased in size, 69% remained stable, and 31% increased in size. In group 2, no lesions increased in size, 45% remained stable, and 55% decreased in size. When evaluating only those patients with long-term follow up, many masses in group 1 increased in size, while the majority in group 2 decreased in size. CONCLUSIONS: In this study evaluating orbital cavernous hemangiomas over a span of 30 years, the authors found that in postmenopausal women with assumed decreasing levels of circulating estrogen/progesterone, the vast majority of lesions either remained stable or decreased in size, suggesting the effect of hormone levels on such vascular lesions and supporting the role for observation in asymptomatic individuals in this patient population.

Frequency and diagnostic utility of intralabyrinthine FLAIR hyperintensity in the evaluation of internal auditory canal and inner ear pathology.

RATIONALE AND OBJECTIVES: Fluid-attenuated inversion recovery (FLAIR) imaging can detect elevated protein levels in fluid that may be difficult or impossible to detect with T1- or T2-weighted imaging. The purpose of this study is to evaluate the frequency and asses the diagnostic utility of abnormal FLAIR signal in various types of inner ear and internal auditory canal (IAC) pathology. MATERIALS AND METHODS: A retrospective review of medical records and magnetic resonance images from 187 consecutive patients who underwent imaging of the temporal bones for possible inner ear or IAC pathology over a 1-year period were reviewed for abnormal increased FLAIR signal, increased intrinsic T1 signal, abnormal enhancement after gadolinium administration, and the presence of a mass lesion within the cerebellopontine angle, IAC, or inner ear. Reviewers were blinded to clinical diagnosis. RESULTS: Twenty-five of 32 (78%) patients with schwannomas restricted to the IAC and cerebellopontine angle demonstrated associated increased FLAIR signal within the ipsilateral inner ear structures. The sensitivity, specificity, positive predictive value, and negative predictive value of inner ear FLAIR hyperintensity for a schwannoma were 80%, 95%, 78%, and 95%, respectively. Inner ear FLAIR hyperintensity was also seen in cases of intracochlear hemorrhage, labyrinthitis, and labyrinthitis ossificans, but these conditions did not occur with sufficient frequency in our study population to determine statistical significance. CONCLUSION: Identification of inner ear FLAIR hyperintensity can alert the radiologist to scrutinize pre- and post-gadolinium T1-weighted images and T2-weighted images for subtle IAC and inner ear abnormalities. Although enhancement after the administration of gadolinium contrast media is the gold standard for detection of schwannoma, inner ear FLAIR hyperintensity may be a helpful diagnostic adjunct for vestibular schwannoma. This may be particularly helpful when gadolinium was not administered and the T2-weighted images are equivocal, especially when dedicated thin-section imaging of the IACs and temporal bones was not performed.