Impact of 80 kVp with iterative reconstruction algorithm and low-dose contrast medium on the image quality of craniocervical CT angiography.

PURPOSE: To assess the image quality of 80-kVp craniocervical CT angiography (CCCTA) protocol combined with adaptive statistical iterative reconstruction-V (ASIR-V) and low-dose contrast medium (CM). METHODS: A total of 119 patients were randomly divided into three groups. For group A, 120-kVp protocol was followed with 60 ml CM and filtered back projection; for group B, 80-kVp protocol with 60 ml CM and ASIR-V; and for group C, 80-kVp protocol with 45 ml CM and ASIR-V. Both subjective and objective image quality and radiation doses were evaluated. RESULTS: Arterial attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the head, neck, and shoulder regions were significantly higher in groups B and C compared with group A. Group C yielded significantly better subjective image quality than that observed in groups A and B (both p < .05). As compared with group A, effective radiation dose and the iodine load of group C were reduced by 51.4% and 25%, respectively. CONCLUSIONS: The CCCTA protocol with 80 kVp, ASIR-V, and 45 ml of CM injected at 3 ml/s significantly reduced the radiation dose, iodine load, and iodine delivery rate while providing better subjective and objective image quality, including higher arterial enhancement and a higher SNR and CNR compared with the 120-kVp protocol.

Susceptibility-weighted imaging provides complementary value to diffusion-weighted imaging in the differentiation between pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors.

PURPOSE: The purpose of this retrospective study was to investigate the differentiation of abscess and necrotic tumors, using susceptibility-weighted imaging (SWI) and apparent diffusion coefficients (ADC) either separated or combined. METHODS: Imaging was performed on 26 patients with pyogenic brain abscesses, 31 patients with rim-enhancing glioblastomas, and 21 patients with rim-enhancing metastases. The degree of intralesional susceptibility signal (ILSS) was independently assessed by three observers. Average ADC in the lesion core was calculated. After receiver operating characteristic (ROC) analysis, the area under the ROC curve was compared using three different analytical models (ILSS, ADC, and ILSS-ADC combined) to differentiate abscess from the two rim-enhancing necrotic tumors. RESULTS: The ILSS-ADC combined model had greater area under the ROC curves than ILSS or ADC used alone. In this study, the ILSS-ADC combined model showed 100% diagnostic accuracy differentiating abscesses from glioblastoma. The ADC model and the ILSS-ADC combined model performed equally well in distinguishing abscesses from metastases. CONCLUSION: It is concluded that SWI and ADC are complementary, and the combination of SWI and ADC may improve results compared with the use of only one model. Validation by an independent cohort is the next necessary step to broaden its applicability in routine clinical settings.

The effects of erythromycin towards the treatment of persistent rhinosinusitis after functional endoscopic sinus surgery: A randomized, active comparator-controlled study.

BACKGROUND: Long-term, low-dose macrolide treatment has been in recent use to treat chronic rhinosinusitis. In this study, we investigated the effect of long-term, low-dose erythromycin on patients who had persistent rhinosinusitis after functional endoscopic sinus surgery (FESS). METHODS: Patients with persistent rhinosinusitis for 3 months after FESS were recruited and randomly assigned to two groups. Patients in the erythromycin group took erythromycin (250 mg twice a day) for 12 weeks, while those in the intranasal steroid group were administered with mometasone furoate nasal spray for 12 weeks. Both before and after treatment, sino-nasal symptoms were assessed via questionnaires. Patients also received an endoscopic examination, acoustic rhinometry, smell test, and saccharine transit test. A bacterial culture was obtained from the middle meatus. RESULTS: Seventy-two patients completed the study, with 35 in the erythromycin group and 37 in the intranasal steroid group. Endoscopic scores decreased significantly after treatment in both groups. Erythromycin improved the smell threshold and saccharine transit time better than the intranasal steroid. In contrast, the intranasal steroid increased the second minimal cross-sectional area of the nasal cavity at a level greater than erythromycin had. CONCLUSION: Our study showed that long-term, low-dose erythromycin treatment improved the endoscopic score, smell threshold, and saccharine transit time in patients with persistent rhinosinusitis after FESS.

Coexistence of intracranial solitary fibrous tumor/hemangiopericytoma and right middle cerebral artery aneurysm.

Intracranial solitary fibrous tumors are rare mesenchymal neoplasms originating in the meninges and constitute a heterogeneous group of rare spindle cell tumors that include benign and malignant neoplasms of which hemangiopericytoma is nowadays considered a cellular phenotypic variant. From literatures, the incidence of coexistence of brain tumors and intracranial aneurysms is ~0.7-5.4%. Meningioma is the most frequent tumor coexisted with intracranial aneurysms, followed by pituitary adenoma, neuroepithelial tumor, and metastatic tumor. We would like to report a case of 74-year-old man harboring a rare intracranial solitary fibrous tumor/hemangiopericytoma and an unruptured aneurysm of the right middle cerebral artery which probably the first report of these combinations in the English literature. Both lesions were treated surgically in one session with favorable outcome. Magnetic resonance angiography should be performed in patients with brain tumor preoperatively not only to visualize neoplastic vascularization but also to pick up incidental aneurysm.

Combination of Adaptive Statistical Iterative Reconstruction-V and Lower Tube Voltage During Craniocervical Computed Tomographic Angiography Yields Better Image Quality with a Reduced Radiation Dose.

RATIONALE AND OBJECTIVES: To evaluate image quality and radiation exposure when using the adaptive statistical iterative reconstruction-V (ASIR-V) algorithm for reconstructing craniocervical computed tomographic angiography images acquired at 100 kVp. MATERIALS AND METHODS: We randomly divided 121 patients into three groups: group A (conventional protocol), 120 kVp with filtered back projection; group B, 120 kVp with 50% ASIR-V; and group C, 100 kVp with 50% ASIR-V. All patients underwent scans in a 256-slice computed tomography (CT) scanner. Radiation dose (volume CT dose index), dose-length product, and effective dose, objective parameters such as arterial attenuation value, signal-to-noise ratio, contrast-to-noise ratio, and noise obtained at head, neck, and shoulder levels were compared among the groups. Subjective image quality was independently assessed by two radiologists, and interobserver reliability was assessed using kappa analysis. RESULTS: The radiation dose in group C was the lowest (p < 0.01) with a 40% reduction in volume CT dose index, dose-length product, and effective dose values compared to group A, and group C showed higher arterial attenuation than either group A or B (p < 0.01). Additionally, signal-to-noise ratio and contrast-to-noise ratio were higher and noise was lower in groups B and C than group A. Group C had better subjective image quality than groups A and B (p < 0.05), and the interobserver reliability between the two radiologists was high (k = 0.783). CONCLUSION: Compared to the conventional protocol, using 50% ASIR-V and the 100 kVp protocol during craniocervical computed tomographic angiography yields better objective and subjective image quality at lower radiation doses.

Amphotericin B nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery.

BACKGROUND: Fungus-driven inflammation is proposed to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). Previous studies evaluated the efficacy of intranasal amphotericin B (AMB) in the treatment of patients with CRS, but the results were controversial. The purpose of this study was to evaluate the efficacy of 100 µg/mL of AMB nasal irrigation as postoperative care after functional endoscopic sinus surgery (FESS). METHODS: Patients with CRS who received FESS for treatment were recruited and randomly assigned to two groups at 1 month after surgery. Patients in the AMB group received 100 µg/mL of AMB nasal irrigation daily for 2 months, and those in the normal saline (NS) group received NS solution nasal irrigation daily for 2 months. Pre-FESS, pre-irrigation, and postirrigation sinonasal symptoms were assessed by questionnaires, and the patients received endoscopic examination, acoustic rhinometry, smell test, and saccharine transit test. RESULTS: Seventy-seven patients were enrolled between June 2012 and December 2014. Among the patients who completed the study, 38 received AMB irrigation, and 39 received NS solution irrigation. Although all the patients reported improvement after irrigation, there was no difference in outcome between patients who received AMB and those who received NS solution. CONCLUSION: Our study showed that nasal irrigation with 100 µg/mL of AMB did not confer a greater benefit than that of NS solution nasal irrigation in post-FESS care.

Discriminating pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors by means of susceptibility-weighted imaging.

OBJECTIVES: To investigate the feasibility of using susceptibility-weighted imaging (SWI) to discriminate abscesses and necrotic tumours. METHODS: Twenty-one patients with pyogenic abscesses, 21 patients with rim-enhancing glioblastomas and 23 patients with rim-enhancing metastases underwent SWI. Intralesional susceptibility signal (ILSS) was analyzed employing both qualitative (QL) and semi-quantitative (SQ) methods. Logistic regression models and receiver operating characteristic analysis were used to demonstrate the discriminating power. RESULTS: In QL analysis, ILSSs were seen in 12 of 21 abscesses, in 20 of 21 glioblastomas, and in 16 of 23 metastases. In SQ analysis, a low degree of ILSS (85.8 %) was in the majority of abscesses and a high degree of ILSS (76.2 %) was in the majority of glioblastomas. SQ model was significantly better than QL model in distinguishing abscesses from glioblastomas (P < .001). A derived ILSS cutoff grade of 1 or less was quantified as having a sensitivity of 85.7 %, specificity of 90.5 %, accuracy of 88.1 %, PPV of 90.0 %, and NPV of 86.4 % in distinguishing abscesses from glioblastomas. CONCLUSIONS: A high-grade ILSS may help distinguish glioblastomas from abscesses and necrotic metastatic brain tumours. The lack of ILSS or low-grade ILSS can be a more specific sign in the imaging diagnosis of abscesses. KEY POINTS: • ILSS of SWI can contribute to differential diagnosis of rim-enhanced mass. • Low-grade ILSS can be a more specific sign in abscesses. • High-grade ILSS may help distinguish necrotic glioblastomas from abscesses. • ILSS spreads across the four ILSS categories in metastases.

Proton MR spectroscopy in patients with pyogenic brain abscess: MR spectroscopic imaging versus single-voxel spectroscopy.

PURPOSE: Single-voxel spectroscopy (SVS) has been the gold standard technique to diagnose the pyogenic abssess. Two-dimensional magnetic resonance spectroscopic imaging (MRSI) is able to provide spatial distribution of metabolic concentration, and is potentially more suitable for differential diagnosis between abscess and necrotic tumors. Therefore, the purpose of this study was to evaluate the equivalence of MRSI and SVS in the detection of the metabolites in pyogenic brain abscesses. MATERIALS AND METHODS: Forty-two patients with pyogenic abscesses were studied by using both SVS and MRSI methods. Two neuroradiologists reviewed the MRS data independently. A κ value was calculated to express inter-reader agreement of the abscesses metabolites, and a correlation coefficient was calculated to show the similarity of two spectra. After consensus judgment of two readers, the binary value of metabolites of pyogenic abscesses (presence or absence) was compared between SVS and MRSI. RESULTS: The consistency of spectral interpretation of the two readers was very good (κ ranged from 0.95 to 1), and the similarity of two spectra was also very high (cc=0.9±0.05). After consensus judgment of two readers, the sensitivities of MRSI ranged from 91% (acetate) to 100% (amino acids, succinate, lactate, lipid), and the specificities of MRSI were 100% for detecting all metabolites with SVS as reference. CONCLUSION: SVS and MRSI provide similar metabolites in the cavity of pyogenic brain abscess. With additional metabolic information of cavity wall and contralateral normal-appearing brain tissue, MRSI would be a more suitable technique to differentiate abscesses from necrotic tumors.

Survival analysis of patients with oral squamous cell carcinoma with simultaneous second primary tumors.

BACKGROUND: The purpose of this study was to investigate the rate of simultaneous second primary tumor (SPT) in patients with oral squamous cell carcinoma. The survival of patients with simultaneous SPT was also compared with patients without. METHODS: The presence of SPT was documented along with the patients' demographic data, tumor-related features, and survival status. Kaplan-Meier method was used for survival analysis. Relevant factors influencing the survival were examined by the Cox proportional hazard model. RESULTS: A total of 897 patients' medical records were obtained. Among them, 43 patients (4.8%) had simultaneous SPT and their prognosis was poorer than that of patients without. The Cox proportional hazard model revealed that patients with simultaneous SPT tended to have a higher probability of death (relative risk [RR], 1.694; p = .015). CONCLUSIONS: Simultaneous SPT is an independent prognostic factor for patients with oral squamous cell carcinoma. Those with simultaneous SPT have poorer survival when compared to those without.