Preoperative Determination of Depth of Invasion in Oral Cavity Squamous Cell Carcinoma by Standard Cross-Sectional Imaging With Computed Tomography and Positron Emission Tomography/Computed Tomography.

Background Depth of invasion (DOI) is a known indicator of metastatic potential in oral cavity squamous cell carcinoma (SCC). Our purpose was to investigate the accuracy of preoperative determination of DOI in oral cavity SCC by computed tomography (CT) and positron emission tomography/computed tomography (PET/CT). Methodology A retrospective study was performed using consecutive patients with histologically proven oral cavity SCC presenting to our otorhinolaryngology department between January 2014 and July 2019 who underwent preoperative contrast-enhanced CT and/or PET/CT. Pathological assessment of DOI was determined by a review of pathology reports. The degree of DOI determined by radiographic studies was correlated to pathology results. Results A total of 79 patients were screened of whom appropriate radiographic studies were available for 63 patients. The mean DOI by pathological assessment was 12.3 ± 9.1 mm. CT and PET/CT determined depth both correlated with pathological DOI (r = 0.710; p < 0.001, r = 0.798; p < 0.001). No significant correlation was seen for CT-determined depth (r = 0.136; p = 0.709) or PET-determined depth (r = 0.234; p = 0.707) with pathologically confirmed superficial tumors (<5 mm). For patients with pathological tumor depth >10 mm, CT and PET determined depth both correlated with pathological depth (r = 0.577; p = 0.002, r = 0.668; p = 0.001). The sensitivity and specificity of CT and PET for the identification of deep invasion were 88.2% and 41.7% and 52.9% and 50%, respectively. Conclusions DOI measurement is feasible with routine preoperative CT and PET/CT images and is comparable to pathological measurement in patients with oral cavity SCC.

Weak-anchoring effects in a thin pinned ridge of nematic liquid crystal.

A theoretical investigation of weak-anchoring effects in a thin two-dimensional pinned static ridge of nematic liquid crystal resting on a flat solid substrate in an atmosphere of passive gas is performed. Specifically, we solve a reduced version of the general system of governing equations recently derived by Cousins et al. [Proc. R. Soc. A 478, 20210849 (2022)10.1098/rspa.2021.0849] valid for a symmetric thin ridge under the one-constant approximation of the Frank-Oseen bulk elastic energy with pinned contact lines to determine the shape of the ridge and the behavior of the director within it. Numerical investigations covering a wide range of parameter values indicate that the energetically preferred solutions can be classified in terms of the Jenkins-Barratt-Barbero-Barberi critical thickness into five qualitatively different types of solution. In particular, the theoretical results suggest that anchoring breaking occurs close to the contact lines. The theoretical predictions are supported by the results of physical experiments for a ridge of the nematic 4^{'}-pentyl-4-biphenylcarbonitrile (5CB). In particular, these experiments show that the homeotropic anchoring at the gas-nematic interface is broken close to the contact lines by the stronger rubbed planar anchoring at the nematic-substrate interface. A comparison between the experimental values of and the theoretical predictions for the effective refractive index of the ridge gives a first estimate of the anchoring strength of an interface between air and 5CB to be (9.80±1.12)×10^{-6}Nm^{-1} at a temperature of (22±1.5)^{∘}C.

Autoincudotomy as an uncommon etiology of conductive hearing loss: Case report and review of literature.

Ossicular pathology is a recognized etiology of conductive hearing loss. Ossicular pathology includes 2 main categories, that is, ossicular chain fixation and ossicular discontinuity. Ossicular discontinuity can be congenital or acquired. Auto-incudotomy is an uncommon form of acquired ossicular discontinuity that usually occurs as a sequel of spontaneous expulsion of cholesteatoma. Typically, it manifests with conductive hearing loss without evidence of cholesteatoma. In this report, we presented CT imaging finding of a 34-year-old male with tympanic membrane perforation and defective long process of the incus (auto-incudotomy) with minimal middle ear granulation tissue and adhesions, sequela of cholesteatoma. Radiologists should pay attention for evaluation of ossicles especially in patients presented with conductive hearing loss.

Cross-sectional imaging evaluation of atypical and uncommon extra-nodal head and neck Non-Hodgkin lymphoma: Case series.

Extra-nodal Non-Hodgkin lymphoma (ENHL) of the head and neck is not uncommon and has variable clinical and imaging presentations. It represents about 25% of extra-nodal lymphomas. In addition, lymphoma is the third most common malignancy of the head and neck just after squamous cell carcinoma (SCC) and salivary gland neoplasms. Unlike SCC, ENHL usually presents as a well-defined mass in the oral cavity, along the pharyngeal mucosa, sinonasal cavity, orbit, and other different neck spaces. One of the common presentations of ENHL is the glandular type which can arise within the salivary or thyroid glands as marginal zone non-Hodgkin lymphoma. ENHL can infiltrate the bone resembling high grade osseous malignancies. Rarely, ENHL can present as perineural spread without definitive mass and manifest clinically with several neuropathies. In this case series, we presented different imaging features and presentation of ENHL of the head and neck. The knowledge of various presentations of ENHL of the head and neck can help early diagnosis and prompt management of these patients' population.

A 62-Year-Old Man Presenting with Bilateral Tremor of the Upper Limb After a Diagnosis of COVID-19 with Confirmed Volumetric Brain Loss.

BACKGROUND The SARS-CoV-2 viral infection is associated with respiratory and multi-organ systemic disease. It has been shown to affect the central nervous system and produce varied neurological symptoms, including ischemic strokes, seizures, and encephalitis. Neurological manifestations of this viral infection are thought to be due to neurotropic reactions on the central nervous system or post-infectious immune-mediated damage. This report presents a case of bilateral tremor of the upper limbs more than 6 weeks after a diagnosis of COVID-19, with confirmed volumetric brain loss shown by follow-up brain magnetic resonance imaging (MRI) combined with 3-dimensional volumetric NeuroQuant image analysis. CASE REPORT We report a case of new-onset tremors in a 62-year-old man after SARS-CoV-2 infection. MRI of the brain was performed shortly after the onset of tremors, and a follow-up MRI after 2 months showed evidence of rapid parenchymal volume, loss of midbrain substance, and increased cerebrospinal fluid volume within 2 months of the initial examination. CONCLUSIONS This case report shows central neurological effects of COVID-19, which can be evaluated by quantitative volumetric MRI analysis, although further studies are warranted to determine how this type of brain imaging can be used to evaluate the effects of SARS-CoV-2 infection over time.

Young and Young-Laplace equations for a static ridge of nematic liquid crystal, and transitions between equilibrium states.

Motivated by the need for greater understanding of systems that involve interfaces between a nematic liquid crystal, a solid substrate and a passive gas that include nematic-substrate-gas three-phase contact lines, we analyse a two-dimensional static ridge of nematic resting on a solid substrate in an atmosphere of passive gas. Specifically, we obtain the first complete theoretical description for this system, including nematic Young and Young-Laplace equations, and then, making the assumption that anchoring breaking occurs in regions adjacent to the contact lines, we use the nematic Young equations to determine the continuous and discontinuous transitions that occur between the equilibrium states of complete wetting, partial wetting and complete dewetting. In particular, in addition to continuous transitions analogous to those that occur in the classical case of an isotropic liquid, we find a variety of discontinuous transitions, as well as contact-angle hysteresis, and regions of parameter space in which there exist multiple partial wetting states that do not occur in the classical case.

Reliability of Magnetic Resonance Spectroscopy and Positron Emission Tomography Computed Tomography in Differentiating Metastatic Brain Tumor Recurrence from Radiation Necrosis.

BACKGROUND: Clinical and/or neuroimaging changes after whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) for metastatic brain tumor(s) present the clinical dilemma of differentiating tumor recurrence from radiation necrosis. Several imaging modalities attempt to answer this clinical question, including magnetic resonance spectroscopy (MRS) and positron emission tomography (PET) computed tomography (CT). We evaluated our experience regarding the ability of MRS and PET CT to differentiate tumor recurrence from radiation necrosis in patients who have received WBRT or SRS. METHODS: We retrospectively reviewed records of 242 patients with previous WBRT or SRS to identify those who had MRS and/or PET CT to differentiate tumor recurrence from radiation necrosis. Patients were sorted into true-positive, false-positive, false-negative, and true-negative groups on the basis of imaging interpretation and clinical course combined with surgical pathology results or reaction to nonsurgical treatments including SRS, dexamethasone, or observation. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were then calculated. RESULTS: Of 25 patients presenting such diagnostic questions, 19 were evaluated with MRS and 13 with PET CT. MRS sensitivity was 100%, specificity was 50%, and accuracy was 81.8%, whereas PET CT sensitivity was 36.4%, specificity was 66.7%, and accuracy was 42.9%. CONCLUSIONS: MRS has better accuracy than PET CT and a high negative predictive value, therefore making it more useful in distinguishing recurrent tumor from radiation necrosis. We encourage correlation with symptoms at imaging to aid in clinical decision making.

Dural Contact to the Malleus Head in Patients with Superior Semicircular Canal Dehiscence (SSCD): Case Series and Review of SSCD and Tegmen Defects.

OBJECTIVE: Report a series of cases in which patients have concomitant superior semicircular canal dehiscence (SSCD) and a dehiscent tegmen tympani with Dural contact to the malleus head (DCMH). METHODS: An analysis of radiologic and audiologic data in 4 patients who presented with SSCD and DCMH at a tertiary care institution. A pertinent literature review was performed. RESULTS: Four patients (5 ears) had SSCD and DCMH. In 3 patients with unilateral DCMH, the mean maximum air-bone gap was 15 dB in the ear with DCMH compared to 50 dB in the ear without DCMH. Of the 5 ears with DCMH, the mean air conduction threshold at 250 Hz was 17 dB compared to 42 dB in the 3 ears without DCMH. CONCLUSIONS: We report the findings of DCMH in a series of 4 patients with bilateral SSCD. This limited series suggests that ears with SSCD and DCMH have less of an air-bone gap than would be expected, as 1 would expect an additive effect of DCMH and SSCD on the air-bone gap.

Multi-parametric magnetic resonance imaging evaluation of cerebral amyloid angiopathy related inflammation: Case series and review of literature.

Cerebral amyloid angiopathy related inflammation is a rare disorder in the spectrum of cerebral amyloid angiopathy which is characterized by vascular and/or perivascular inflammation related to Aß deposits. Clinically, the patient typically presents with acute to subacute encephalitis-like symptoms with focal neurological deficits, rapidly cognitive decline, and/or seizures. Typical magnetic resonance imaging findings include asymmetric mass-like non-enhancing white matter hyperintensity with scattered microhemorrhages. Additionally, in these cases diffusion weighted imaging, perfusion weighted imaging and magnetic resonance spectroscopy help to exclude neoplastic processes and could determine the correct diagnosis.

Magnetic resonance imaging criteria of immune checkpoint inhibitor-induced hypophysitis.

Autoimmune hypophysitis is a rare complication of immune checkpoint inhibitors. Immune checkpoint inhibitors have been used for advanced stages of melanoma, renal cell carcinoma, and lung cancer. Multiple endocrinopathies, among them hypophysitis, could result as a reverse event from this therapy. MRI is the imaging modality of choice and usually demonstrates pituitary gland hypertrophy, irregular thickening of the pituitary infundibulum, and diffuse enhancement. We present a case of stage IV metastatic renal cell carcinoma complicated with hypophysitis secondary to combined nivolumab and ipilimumab therapy.

Right aortic arch with mirror image branching pattern and isolated left brachiocephalic artery: A case report.

We present a very rare case of right aortic arch with an isolated left brachiocephalic artery in a 35-year-old female. This entity is an extremely uncommon aortic arch anomaly which has associated multisystem symptoms. We briefly discuss the hypothetical double aortic arch model originally described by Edwards. The aortic embryology can explain the anatomic findings and imaging manifestations of the isolated left brachiocephalic artery. Multimodality imaging evaluation can be helpful in detection and categorization of aortic arch abnormalities. A diagnostic imaging approach should focus on elucidating the abnormal aortic arch and great vessels arrangement with determination of associated cardiac, vascular or visceral congenital abnormalities.

Percutaneous Fenestration of a Spinal Arachnoid Web Using an Intrathecal Catheter: Effect on Cerebrospinal Fluid Flow and Clinical Status.

BACKGROUND: Spinal arachnoid webs are a rare anatomic entity manifesting as neuropathic back pain, compressive myelopathy, radiculopathy, and hydrocephalus. Typical treatments include hemilaminectomy or full laminectomy with durotomy and microsurgical resection, which can result in secondary scarring and recurrent blockage of cerebrospinal fluid (CSF) flow perpetuating the cycle. CASE DESCRIPTION: A 66-year-old woman presented with progressively worsening gait and memory. Magnetic resonance imaging demonstrated an arachnoid web in the high thoracic region, causing CSF flow obstruction and hydrocephalus. A standard lumbar drainage catheter was introduced percutaneously into the lumbar thecal sac and advanced in a cephalad direction, across the arachnoid web, to the high thoracic region. The patient underwent continuous CSF drainage through this catheter for a total of 3 days, displaying measurable clinical improvement that persisted at the 3-month follow-up visit. Phase-contrast magnetic resonance imaging demonstrated interval reconstitution of dorsal synchronous CSF flow at the second thoracic vertebral level, both on day 3 and at the 3-month control imaging study. CONCLUSIONS: This minimally invasive approach seems useful in achieving restoration of spinal fluid flow at the thoracic region when the underlying blockage results from an arachnoid web and leads to quantifiable clinical improvement.

Radio-pathological review of a metastatic renal cell carcinoma within a meningioma: A case report of collision tumor.

We report a case of a collision tumor, a meningioma complicated with metastasis from a primary renal cell carcinoma. A 75-year-old man, with known history of renal cell carcinoma, and 10-year history of stable meningioma developed neurological symptoms. Computed tomography and magnetic resonance imaging revealed left frontal intracranial extra-axial mass with imaging criteria suspicious for an atypical meningioma or hemangiopericytoma. Given the history of a known primary, the possibility of brain metastasis was included. Pathology confirmed the presence of metastatic renal cell carcinoma nidus with a surrounding meningioma. Tumor-to-tumor metastasis or collision tumor is a very rare phenomenon. Atypical radiologic findings with positive history of a primary extracranial tumor should raise the suspicion of potential metastases.

Easy Stapes Subluxation in 22q11.2 Deletion Syndrome: A Clinical Capsule and Literature Review.

OBJECTIVES: This report describes iatrogenic stapes subluxation in a 22q11 deletion syndrome patient and reviews the human and murine literature for evidence that these patients have stapes malformations. We aim to alert otologic surgeons regarding the possibility of stapes footplate abnormalities in 22q11 deletion patients. PATIENT: An adult woman with known 22q11 deletion syndrome. Additionally, the literature review focused on other patients with 22q11 deletion syndrome as well as mouse models of this disorder. INTERVENTIONS: A combination of diagnostic and therapeutic interventions were conducted consisting of middle ear exploration, removal of ossicular chain adhesions, and ultimately ossicular reconstruction. RESULTS: The stapes footplate was poorly attached to the oval window in our patient. During removal of ossicular adhesions, the entire stapes subluxed requiring placement of a stapes prosthesis. The postoperative audiogram was similar to the preoperative audiogram. Literature review identified one other case of stapes subluxation in a patient with 22q11 deletion syndrome, and mouse models suggest that the stapes footplate has an abnormal connection to the oval window in those affected by 22q11 deletion syndrome. CONCLUSIONS: Patients with 22q11 deletion syndrome have chronic middle ear pathology, and if middle ear exploration is undertaken, the surgeon should be aware that the stapes may have a weak attachment to the oval window. This could put the stapes at risk of injury and contribute to conductive hearing loss.

Excitation of singlet-triplet coherences in pairs of nearly-equivalent spins.

We present approaches for an efficient excitation of singlet-triplet coherences in pairs of nearly-equivalent spins. Standard Nuclear Magnetic Resonance (NMR) pulse sequences do not excite these coherences at all or with very low efficiency. The single quantum singlet-triplet coherences, here termed the outer singlet-triplet coherences, correspond to lines of low intensity in the NMR spectrum of a strongly-coupled spin pair (they are sometimes referred to as "forbidden transitions"), whereas the zero-quantum coherences, here termed the inner singlet-triplet coherences, do not have a direct spectral manifestation. In the present study, we investigated singlet-triplet coherences in a pair of nearly-equivalent carbon spins of the 13C-isotopomer of a specially designed naphthalene derivative with optimized relaxation properties. We propose and compare several techniques to drive the singlet-triplet coherence in strongly coupled spin pairs. First, we study different methods for efficient excitation of the outer singlet-triplet coherences. The achieved conversion efficiency of magnetization to the coherences of interest is close to the theoretically allowed maximum. Second, we propose methods to convert the outer coherences into the inner singlet-triplet coherence. The inner singlet-triplet coherence is insensitive to field inhomogeneity and can be long-lived. By probing this coherence, we perform a very precise measurement of the spin-spin J-couplings. A remarkable property of this coherence is that it can be preserved even in absence of a spin-locking radiofrequency field. Consequently, it is possible to shuttle the sample between different magnetic fields preserving the coherence. This allows one to study the field dependence of the relaxation time, TIST, of the inner singlet-triplet coherence by performing field-cycling experiments. We observed dramatic changes of the ratio TIST/T1 from about 1 (in strong fields) up to 2.4 (in weak fields), which is the evidence of a significant influence of the chemical shift anisotropy on relaxation. We have detected a remarkably long lifetime of the inner singlet-triplet coherence of about 200 s at the magnetic field of 5 mT.

Constant-adiabaticity radiofrequency pulses for generating long-lived singlet spin states in NMR.

A method is implemented to perform "fast" adiabatic variation of the spin Hamiltonian by imposing the constant adiabaticity condition. The method is applied to improve the performance of singlet-state Nuclear Magnetic Resonance (NMR) experiments, specifically, for efficient generation and readout of the singlet spin order in coupled spin pairs by applying adiabatically ramped RF-fields. Test experiments have been performed on a specially designed molecule having two strongly coupled 13C spins and on selectively isotopically labelled glycerol having two pairs of coupled protons. Optimized RF-ramps show improved performance in comparison, for example, to linear ramps. We expect that the methods described here are useful not only for singlet-state NMR experiments but also for other experiments in magnetic resonance, which utilize adiabatic variation of the spin Hamiltonian.

Synthesis of an isotopically labeled naphthalene derivative that supports a long-lived nuclear singlet state.

The synthesis of an octa-alkoxy substituted isotopically labeled naphthalene derivative, shown to have excellent properties in singlet NMR experiments, is described. This highly substituted naphthalene system, which incorporates an adjacent (13)C spin pair, is readily accessed from a commercially available (13)C2-labeled building block via sequential thermal alkynyl- and arylcyclobutenone rearrangements. The synthetic route incorporates a simple desymmetrization approach leading to a small difference in the chemical shifts of the (13)C spin pair, a design constraint crucial for accessing nuclear singlet order.

Real-space imaging of macroscopic diffusion and slow flow by singlet tagging MRI.

Magnetic resonance imaging can be used to study motional processes such as flow and diffusion, but the accessible timescales are limited by longitudinal relaxation. The spatially selective conversion from magnetization to long-lived singlet order in designer molecules makes it possible to tag a region of interest for an extended period of time, of the order of several minutes. Here we exploit this concept of "singlet tagging" to monitor diffusion over a macroscopic scale as well as very slow flow.

Theory of long-lived nuclear spin states in methyl groups and quantum-rotor induced polarisation.

Long-lived nuclear spin states have a relaxation time much longer than the longitudinal relaxation time T1. Long-lived states extend significantly the time scales that may be probed with magnetic resonance, with possible applications to transport and binding studies, and to hyperpolarised imaging. Rapidly rotating methyl groups in solution may support a long-lived state, consisting of a population imbalance between states of different spin exchange symmetries. Here, we expand the formalism for describing the behaviour of long-lived nuclear spin states in methyl groups, with special attention to the hyperpolarisation effects observed in (13)CH3 groups upon rapidly converting a material with low-barrier methyl rotation from the cryogenic solid state to a room-temperature solution [M. Icker and S. Berger, J. Magn. Reson. 219, 1 (2012)]. We analyse the relaxation properties of methyl long-lived states using semi-classical relaxation theory. Numerical simulations are supplemented with a spherical-tensor analysis, which captures the essential properties of methyl long-lived states.