Preliminary Results from Retrospective Correlation of Circulating Tumor DNA (ct-DNA) with Imaging for HPV-positive Oropharyngeal Squamous Cell Carcinoma.

The role of molecular markers is increasingly being recognized for head and neck tumors ranging from benign lesions like paragangliomas to malignancies like squamous cell carcinomas (SCCa). Multiple studies have recently validated blood tests for circulating tumor tissue modified viral- human papillomavirus DNA (HPV ct-DNA) (NavDx, Naveris Laboratories) for posttreatment surveillance of HPV-driven oropharyngeal SCCa. This technology quantifies fragments of circulating DNA that are shed into the blood stream with very high (>95%) positive and negative predictive values and are also highly sensitive in distinguishing tumor HPV-DNA from a non-cancerous source. This study has a cohort of 34 patients with HPV-driven oropharyngeal SCCa, having at least three sequential imaging studies and ct-DNA values. The study showed a strong positive correlation between the imaging findings and ct-DNA level in recurrent HPV positive oropharyngeal SCCa. Findings also include 100% negative predictive value of HPV ct-DNA tests to rule out tumor recurrence. At our institution, we are now routinely performing the ct-DNA assay for surveillance of treated HPV-oropharyngeal SCCa. Correlation between clinical, radiological, and biomarker findings are now part of routine discussions during the multidisciplinary tumor boards.ABBREVIATIONS: ct-DNA=circulating tumor deoxyribonucleic acid; HPV=Human Papilloma virus;OPC=Oropharyngeal SCCa=Squamous cell carcinomas; PCR= Polymerase chain reaction.

Submucosal Epstein-Barr Virus Positive Polymorphic B-cell Lymphoproliferative Disorder of the Larynx: A Case Report.

Epstein-Barr virus (EBV) belongs to the group of human herpes virus and can cause clinical and subclinical infections. Although EBV-related disease presentations are similar, they can lead to oncogenic transformation with various clinical manifestations. A thorough workup with morphology, immunohistochemistry, and molecular studies is crucial for the diagnosis of EBV-positive polymorphic B-cell lymphoproliferative disorder, not otherwise specified (NOS), which is a new entity introduced by International Consensus Classification in 2022. We describe an interesting presentation of EBV-positive polymorphic B-cell lymphoproliferative disorder with laryngeal involvement to bring awareness to this entity and we would like to address the need for more accessible treatment options.

Imaging of the Posttreatment Head and Neck: Expected Findings and Potential Complications.

Interpretation of posttreatment imaging findings in patients with head and neck cancer can pose a substantial challenge. Malignancies in this region are often managed through surgery, radiation therapy, chemotherapy, and newer approaches like immunotherapy. After treatment, patients may experience various expected changes, including mucositis, soft-tissue inflammation, laryngeal edema, and salivary gland inflammation. Imaging techniques such as CT, MRI, and PET scans help differentiate these changes from tumor recurrence. Complications such as osteoradionecrosis, chondroradionecrosis, and radiation-induced vasculopathy can arise because of radiation effects. Radiation-induced malignancies may occur in the delayed setting. This review article emphasizes the importance of posttreatment surveillance imaging to ensure proper care of patients with head and neck cancer and highlights the complexities in distinguishing between expected treatment effects and potential complications. Keywords: CT, MR Imaging, Radiation Therapy, Ear/Nose/Throat, Head/Neck, Nervous-Peripheral, Bone Marrow, Calvarium, Carotid Arteries, Jaw, Face, Larynx © RSNA, 2024.

Cervical Osteomyelitis and Diskitis as a Complication of Neopharyngeal Breakdown: A Multisite Case Series Review.

Laryngectomy and pharyngectomy are surgical options for advanced laryngeal or pharyngeal squamous cell carcinoma. Cervical osteomyelitis-diskitis, occurring when there is dehiscence of the posterior neopharyngeal wall, is an uncommon complication of laryngopharyngectomy. This case series describes imaging findings of pharyngoesophageal wall breakdown with subsequent cervical spine infection and demonstrates that most of these patients had undergone prior esophageal or neopharyngeal dilations for benign posttreatment stricture. Neck pain, fever, or serologic evidence of infection should prompt careful evaluation for osteomyelitis-diskitis and assessment for neopharyngeal breakdown and sinus tract formation, especially in the postdilation setting.

Primary Pathology of the Parapharyngeal Space.

The radiologically defined parapharyngeal space is a distinct location on cross-sectional imaging and is often described based on its displacement or invasion by tumors or other pathologies in adjacent spaces; however, there are multiple primary pathologic entities of the parapharyngeal space, which are often forgotten. Recognizing that a lesion is arising from the parapharyngeal space is important in generating an accurate differential diagnosis that will guide management.

Preference Signaling for the Diagnostic Radiology Match: A Single Institution Experience.

The Association of American Medical Colleges announced the addition of preference signaling to the 2022-2023 residency match cycle for Diagnostic and Interventional Radiology. This new offering provided applicants the option to indicate their specific interest in up to 6 residency programs during initial application submission. Our institutional diagnostic radiology residency program received a total of 1294 applications. One hundred and eight applicants signaled the program. Interview invitations were sent to 104 applicants, 23 of which signaled the program. Out of the top 10 ranked applicants, 6 applicants signaled the program. Out of the 5 matched applicants, 80% used the program signal, and 100% did the geographic preference. Opting to signal programs during the initial application submission may be beneficial for both the applicants and the programs in finding the optimal match.

Compressive lesions of the head and neck: Common and uncommon must-know entities.

There are many lesions that cause compression of nerves and vessels in the head and neck, and they can often be overlooked in the absence of adequate history or if not suspected by the radiologist. Many of these lesions require a high index of suspicion and optimal positioning for imaging. While a multimodality approach is critical in the evaluation of compressive lesions, an MRI utilizing high-resolution (heavily weighted) T2-weighted sequence is extremely useful as a starting point. In this review, we aim to discuss the radiological features of the common and uncommon compressive lesions of the head and neck which are broadly categorized into vascular, osseous, and miscellaneous etiologies.

Sinonasal Schwannomas: Imaging Findings and Review of Literature.

OBJECTIVE: Schwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations. METHODS: A literature review was conducted using the PubMed Database with the terms "sinonasal schwannoma," "intracranial," "anterior skull base," and "schwannoma." Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma. RESULTS: We identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%). CONCLUSION: We identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.

Newly Discovered Parotid Lesion: What Next?

When a parotid lesion is discovered incidentally, it can be challenging for the radiologist to provide specific recommendations for the next steps. This article describes how the radiologist can play an active role in managing incidentally discovered parotid lesions. First, we explore the significance of parotid lesions. Next, the pertinent anatomy of the parotid space is presented to develop an appropriate differential diagnosis. Lastly, we discuss critical clinical and imaging characteristics the radiologist can use to provide specific recommendations.

Are Standardized Video Interviews Useful for Selecting Integrated Interventional Radiology Residents?

The objective of this project is to evaluate the usefulness of the asynchronous or standardized video interview (SVI) for selecting integrated interventional radiology residents. All selected interviewees were asked to provide a brief recorded video answering 2 standardized questions. The applicants were interviewed in the virtual real-time format by 8 interviewers and ranked by group consensus. The SVIs were independently reviewed by a separate group of 4 interviewers and ranked by group consensus. These consensus ranks were compared to each other to determine similarities and differences in rank order. The results show that the SVIs are not statistically reliable as compared to the real-time interviews. There was a trend for an agreement for the lowest tiers in ranking; however, this was not statistically significant. The asynchronous interview is not equivalent to the virtual real-time interview and would not represent an equivalent replacement. However, the SVI may be useful for screening applicants to interview.

Supralabyrinthine air cell is not present in superior semicircular canal dehiscence.

Objectives: Superior semicircular canal dehiscence (SSCD) is defined as a defect in the bone overly the superior semicircular canal (SSC). The purpose of this study is to evaluate the pre-operative imaging examinations of patients who have undergone SSCD repair. We hypothesize that these patients will not have a supralabyrinthine air cell on the side of surgery. Material and Methods: Our group retrospectively reviewed 50 consecutive pre-operative computed tomography (CT) temporal bone examinations who had confirmed SSCD on intraoperative examination and underwent repair for the presence of a supralabyrinthine air cell. Results: 100% of patients who had confirmed SSCD on intraoperative examination had no supralabyrinthine air cell on pre-operative CT of the temporal bone. Conclusion: This study shows that a supralabyrinthine air cell is not present in SSCD. When a supralabyrinthine air cell is present, the roof of the SSC is intact. CT and magnetic resonance imaging (MRI) are often performed together to evaluate for SSCD and exclude other etiologies. We propose that if a supralabyrinthine air cell is seen on MRI, no CT is necessary, thus avoiding unnecessary radiation exposure and additional imaging costs to the patient.

Imaging of the Aging Spine.

Degeneration of the spine is a normal aspect of aging. The associated changes of spine degeneration seen on imaging are typically asymptomatic. However, distinguishing normal age-related change from symptomatic pathologic change can be challenging owing to the overlap in imaging features. Understanding the general prevalence, timing, and evolution of age-related change can aid in this differentiation and help prevent imaging overdiagnosis and unnecessary workup.

New bone formation over dehiscent semicircular canal with cartilage cap.

PURPOSE: Cartilage cap resurfacing is a method to seal a superior semicircular canal dehiscence. The purpose of this study was to evaluate the detection of new bone formation after surgical placement of a cartilage cap over a dehiscent semicircular canal. METHODS: In this retrospective review, two neuroradiologists blinded to each other's interpretation reviewed the temporal bones of 20 patients, five of which had a pre-operative computed tomography (CT) exam which was interpreted as unilateral superior semicircular canal dehiscence and with new bone formation following repair on follow-up CT. There were also 15 control subjects. Each neuroradiologist was blinded to history, including post-operative changes, and asked to determine if there was a dehiscence or no dehiscence. RESULTS: Out of the 15 controls, there was 100% inter-observer agreement. On the five post-operative patients, there was agreement in 4/5 that there was no dehiscence post-operatively and 1/5 agreement of dehiscence post-operatively, but ectopic bone adjacent to the dehiscence. CONCLUSION: Our results indicate that new bone formation can be seen at the site of cartilage cap placement over the dehiscence and be interpreted as bony closure of the dehiscence.

Parotid sebaceous lymphadenoma associated with Sjogren's syndrome: Review of pathologic and radiologic characteristics and clinical presentation.

Salivary lymphadenoma is an extremely rare neoplasm that is usually seen in the older patient population, arising sporadically on one side and almost exclusive to the parotid gland. Imaging and pathology findings can mimic both benign and malignant tumors, and therefore, this lesion may be misdiagnosed if not on the differential diagnosis. This article reviews the clinical presentation, as well as the pathology and imaging findings of salivary lymphadenoma in the setting of Sjogren's syndrome.

Radiology Resident Education - Keys to Successful Workstation Learning: A Resident Perspective.

Medical education can be overwhelming for radiology residents, particularly when during the first year. Although there is no one single formula or set of resources for success as a resident, a universal and often overlooked educational experience is the readout at the workstation with the attending. Getting the most out of this key interaction requires forethought and engagement from both the attending and the resident. The aim of this article is to discuss helpful tips in maximizing this educational experience from the resident's perspective.

Radiology resident education - Keys to successful workstation teaching.

Resident education is a complex process that requires many inputs from both the learner and the educator. As teaching faculty, many radiologists rely on two main methods to impart knowledge to their residents; namely didactic/case-based lectures and workstation teaching. The traditional lecture format is well known to both the learner and the educator, as this has been the primary platform that has been used almost universally. In addition, there are a multitude of excellent recorded and live lectures that faculty members can access from national society meetings that can be used as an example of how to give an effective well-organized lecture. Workstation teaching, on the other hand, is instead a more individualistic endeavor that is quite heterogeneous across institutions. In addition, there is very little in the literature that describes effective strategies that can be used to optimize the educational experience for the resident. This discussion will focus on pre-readout, readout, and post-readout strategies that educators can use at the workstation. Implementation of these techniques can be extremely helpful in accelerating resident progression through their training.

Neuroradiology in Transgender Care: Facial Feminization, Laryngeal Surgery, and Beyond.

Transgender individuals experience incongruence between their gender identity and the sex assigned to them at birth. This incongruence can cause many transgender individuals to experience distressing physical and mental discord, a diagnosis known as gender dysphoria. Craniofacial structures have distinct anthropometric characteristics that affect perceived masculinity and femininity. The face, neck, and voice are highly exposed anatomic areas that have recognizable gender-specific characteristics that may hinder a transgender individual's successful social integration and public acceptance. Reconstructive facial and laryngeal procedures are among the surgical options transgender persons may elect to undergo to better align their physical appearance with their gender identity. These include feminization surgeries such as facial feminization and reduction chondrolaryngoplasty, as well as masculinizing facial and laryngeal surgeries. Maxillofacial CT is frequently used in the preoperative evaluation of patients before facial feminization surgery (FFS). Several CT measurements guide surgeons to the optimal correction required in FFS to achieve appropriate aesthetic planes. Mapping important craniofacial landmarks to avoid untoward surgical complications is crucial. Transgender patients may encounter other neurologic complications that require neuroimaging evaluation. For example, gender-affirming hormone therapy (eg, estrogen and testosterone) may increase the risk of stroke or may influence growth of various hormone-sensitive tumors such as pituitary adenomas. Radiologists may interpret imaging examinations in transgender patients for routine care or for evaluation before and after facial and laryngeal surgeries and must be aware of the role of neuroimaging in the care of this population. An invited commentary by Callen is available online. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2022.

Navigating the Parotid Glands: Anatomy, Imaging Work-up and Next Steps.

Evaluation of lesions affecting the parotid gland is often challenging to both clinicians and radiologists. This article reviews parotid anatomy and function, as it relates to various lesions that may occur within the gland. Key morphlogic features of lesions are discussed with an emphasis on those that warrant biopsy and those that do not need biopsy. Various biopsy methods using ultrasound and computed tomography are reviewed.