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Purpose: Radiological extranodal extension (rENE) is a well-known negative prognosticator in head and neck squamous cell carcinoma (HNSCC). However, controversy remains regarding the prognostic effect of rENE in HPV-positive oropharyngeal SCCs (OPSCC). This single-center retrospective cohort analysis assessed the prognostic role of rENE in an HPV + OPSCC population and tried to validate a recently proposed modification of the TNM8 N-classification. Methods: 129 patients with HPV + OPSCC, of whom 106 cN + patients, were included. Radiological imaging (CT, MRI or both) was reanalyzed by a senior head and neck radiologist. Overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRFS), and disease-specific survival (DSS) were evaluated. Cox proportional hazard models were used for estimating hazard ratios (HR). Results: A non-significant trend towards better outcomes in the rENE– group, as compared to the rENE + population, was observed for 5 year OS [80.99% vs 68.70%, HR: 2.05, p = 0.160], 5 year RFS [78.81% vs 67.87%, HR: 1.91, p = 0.165], 5 year DFS [77.06% vs 60.16%, HR: 2.12, p = 0.0824] and 5 year DSS [88.83% vs 81.93%, HR: 2.09, p = 0.195]. OS declined with ascending levels of rENE (p = 0.020). Multivariate analysis identified cT-classification and smoking as independent negative predictors for OS/DFS. The proposed modification of the TNM8 N-classification could not be validated. Conclusions: Although rENE could not be identified as an independent negative prognosticator for outcome in our HPV + OPSCC population, outcomes tend to deteriorate with increasing rENE. [ABSTRACT FROM AUTHOR]

Background: In patients treated for head and neck cancer, imaging studies are usually obtained within 3–6 months after treatment for assessment of treatment response. After 6 months, most guidelines advocate clinical follow-up, with imaging reserved for patients with clinically suspect or equivocal findings. However, some guidelines do recommend systematic imaging surveillance, and many clinicians tend to include some type of imaging in their follow-up schemes. Objectives: This systematic review focuses on the usefulness of routine (systematic) post-treatment imaging surveillance of head and neck cancer beyond the first 3–6-month baseline imaging study. Methods: A systematic literature search was conducted using PubMed and Google Scholar. Additional studies were identified by reviewing reference lists. Only original studies and review papers were considered. Results obtained with systematic post-treatment surveillance imaging were compared to symptom-directed imaging and/or clinical finding-directed imaging. Results: Five hundred twenty-one records were identified through the database search, and 44 additional records were identified through other sources. Forty-eight articles were selected for the final review. Analysis of these records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging (40.9%), and the mean time of detection of recurrent or metastatic disease (11.5 months) was well beyond the period of the first post-treatment scan. Most authors reported superior results with PET-CT when compared to other imaging techniques. Conclusion: Strong arguments were found in favor of systematic imaging surveillance in locoregional advanced head and neck cancer during at least one and preferably 2 years after treatment. Critical relevance statement: Analysis of the selected records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging. This systematic review suggests that imaging may currently be underused in the post-treatment surveillance of patients with head and neck cancer. Key points: • This systematic review focuses on the usefulness of long-term systematic imaging surveillance in patients treated for head and neck cancer. • Analysis of 521 articles revealed that systematic imaging allowed the initial detection of locoregional recurrences and/or metastases in more than 40% of patients. • Imaging may currently be underused in the post-treatment surveillance of patients with advanced head and neck cancer. [ABSTRACT FROM AUTHOR]

Purpose: To compare photon-counting CT (PCCT) and multi-detector CT (MDCT) for visualization of temporal bone anatomic structures. Methods: Thirty-six exams of temporal bones without pathology were collected from consecutive patients on a MDCT, and another 35 exams on a PCCT scanner. Two radiologists independently scored visibility of 14 structures for the MDCT and PCCT dataset, using a 5-point Likert scale, with a 2-month wash-out period. For MDCT, the acquisition parameters were: 110 kV, 64 × 0.6 mm (slice thickness reconstructed to 0.4 mm), pitch 0.85, quality ref. mAs 150, and 1 s rotation time; for PCCT: 120 kV, 144 × 0.2 mm, pitch 0.35, IQ level 75, and 0.5 s rotation time. Patient doses were reported as dose length product values (DLP). Statistical analysis was done using the Mann–Whitney U test, visual grading characteristic (VGC) analysis, and ordinal regression. Results: Substantial agreement was found between readers (intraclass correlation coefficient 0.63 and 0.52 for MDCT and PCCT, resp.). All structures were scored higher for PCCT (p < 0.0001), except for Arnold's canal (p = 0.12). The area under the VGC curve was 0.76 (95% CI, 0.73–0.79), indicating a significantly better visualization on PCCT. Ordinal regression showed the odds for better visualization are 354 times higher (95% CI, 75–1673) in PCCT (p < 0.0001). Average (range) of DLP was 95 (79–127) mGy*cm for MDCT and 74 (50–95) mGy*cm for PCCT (p < 0.001). Conclusion: PCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose. Critical relevance statement: PCCT provides a better depiction of temporal bone anatomy than MDCT, at a lower radiation dose. Key points: PCCT allows high-resolution imaging of temporal bone structures. Compared to MDCT, the visibility of normal temporal bone structures is scored better with PCCT. PCCT allows to obtain high-quality CT images of the temporal bones at lower radiation doses than MDCT. [ABSTRACT FROM AUTHOR]

Objectives: We aim to validate 3D CRANI, a novel high-field STIR TSE, MR neurography sequence in the visualisation of the extraforaminal cranial and occipital nerve branches on a 3-T system. Furthermore, we wish to evaluate the role of gadolinium administration and calculate nerve benchmark values for future reference. Methods: Eleven consecutive patients underwent MR imaging including the 3D CRANI sequence before and immediately after intravenous gadolinium administration. Two observers rated suppression quality and nerve visualisation using Likert scales before and after contrast administration. Extraforaminal cranial and occipital nerves were assessed. Nerve calibers and signal intensities were measured at predefined anatomical landmarks, and apparent signal intensity ratios were calculated. Results: The assessed segments of the cranial and occipital nerves could be identified in most cases. The overall intrarater agreement was 79.2% and interrater agreement was 82.7% (intrarater κ =.561, p <.0001; interrater κ =.642, p <.0001). After contrast administration, this significantly improved to an intrarater agreement of 92.7% and interrater agreement of 93.6% (intrarater κ =.688, p <.0001; interrater κ =.727, p <.0001). Contrast administration improved suppression quality and significant changes in nerve caliber and signal intensity measurements. Nerve diameter and signal intensity benchmarking values were obtained. Conclusion: 3D CRANI is reliable for the visualization of the extraforaminal cranial and occipital nerves. Intravenous gadolinium significantly improves MR neurography when applying this sequence. Benchmarking data are published to allow future assessment of the 3D CRANI sequence in patients with pathology of the extraforaminal cranial and occipital nerves. Key Points: • MR neurography using the 3D CRANI sequence is a reliable method to evaluate the extraforaminal cranial and occipital nerves. • Gadolinium contrast administration significantly improves suppression quality and nerve visualisation. • Benchmarking values including apparent signal intensity ratios and nerve calibers depend on contrast administration and might play an important role in future studies evaluating extraforaminal cranial and occipital neuropathies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of percutaneous doxycycline sclerotherapy of head and neck lymphatic malformations (LM) with a 40-month follow-up of 27 cases. Materials and methods: Twenty-seven consecutive patients with head and neck LM who underwent doxycycline sclerotherapy from 2010 to 2019 were retrospectively reviewed. Pre- and peri-interventional data collection included patients' demographics, clinical and radiological presentation, number of treatment procedures, amount of doxycycline used for each session of sclerotherapy. Postinterventional clinical outcome data were assessed based on the electronic, medical reports with special attention to clinical improvement, measurement of the lesion on ultrasound and magnetic resonance imaging after the last session of sclerotherapy and complications of sclerotherapy. Results: Twenty-seven patients underwent a mean of four doxycycline sclerotherapy sessions (range 1–23). The mean total dose of injected doxycycline per session was 170 mg. Maximal diameter of the LM decreased from mean 59.7 mm (median 58 mm; 25–130 mm) before treatment to mean of 29.6 mm (median 30 mm; 0 mm 64 mm) after the last session (P < 0.0001). Over a mean follow-up period of 40 months, complete or incomplete disappearance of symptoms was found in 23 (85%) and 3 (11%) of patients, respectively. In one patient, sclerotherapy did not result in better clinical outcome. Two out of 27 patients presented with minor post-procedural complications, and one patient with a post-procedural intralesional bleeding considered as a major complication. Conclusion: Ultrasound-guided, percutaneous doxycycline sclerotherapy is a safe and effective method of managing symptomatic LM of the head and neck. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis causes conductive, sensorineural and mixed hearing loss (CHL, SNHL, MHL) and tinnitus in young adults. It is best diagnosed on high-resolution CT (HRCT). Occasionally, patients presenting with SNHL and/or tinnitus may undergo temporal bone MRI as the first investigation. In this study, we have described the role of MRI as the first-line modality in the detection of previously undiagnosed otosclerosis. Using search words 'MRI otosclerosis' we found 15 cases in the PACS of our institute, (University Hospitals, KU Leuven, Belgium) from 2003 to 2018. Of these, 2 were known cases of otosclerosis, hence excluded from the study. The remaining 13 patients underwent MRI as first-line investigation for unilateral SNHL (8/13), bilateral SNHL (3/13), unilateral MHL (1/13) and bilateral pulsatile tinnitus (1/13). All MRI studies were reported by the same senior radiologist. Results: Of these 13 cases, 12 were reported as showing MRI features suspicious for otosclerosis. The typical positive findings in these cases were intermediate T1 signal and post-contrast enhancement in the perilabyrinthine/pericochlear regions. Out of 13 patients, 9 underwent subsequent HRCT, confirming otosclerosis in all. The single MRI which was reported as normal initially showed otosclerosis on HRCT. Retrospective evaluation of this MRI study showed subtle positive findings of otosclerosis. Conclusion: The end point of this study was to validate the subtle findings of otosclerosis on MRI, by comparison to the gold-standard modality HRCT. Our hypothesis is that in the appropriate clinical setting, familiarity with MRI features of otosclerosis would increase the diagnostic 'catch' in the first 'net' itself i.e. first-line MRI. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate image quality and radiation dose of a state of the art cone beam computed tomography (CBCT) system and a multislice computed tomography (MSCT) system in patients with sinonasal poliposis. Methods: In this retrospective study two radiologists evaluated 57 patients with sinonasal poliposis who underwent a CBCT or MSCT sinus examination, along with a control group of 90 patients with normal radiological findings. Tissue doses were measured using a phantom model with thermoluminescent dosimeters (TLD). Results: Overall image quality in CBCT was scored significantly higher than in MSCT in patients with normal radiologic findings (p-value: 0.00001). In patients with sinonasal poliposis, MSCT scored significantly higher than CBCT (p-value: 0.00001). The average effective dose for MSCT was 42 % higher compared to CBCT (108 μSv vs 63 μSv). Conclusions: CBCT and MSCT are both suited for the evaluation of sinonasal poliposis. In patients with sinonasal poliposis, clinically important structures of the paranasal sinuses can be better delineated with MSCT, whereas in patients without sinonasal poliposis, CBCT turns out to define the important structures of the sinonasal region better. However, given the lower radiation dose, CBCT can be considered for the evaluation of the sinonasal structures in patients with sinonasal poliposis. Key Points: • CBCT and MSCT are both suited for evaluation of sinonasal poliposis. • Effective dose for MSCT was 42 % higher compared to CBCT. • In patients with sinonasal poliposis, clinically important anatomical structures are better delineated with MSCT. • In patients with normal radiological findings, clinically important anatomical structures are better delineated with CBCT. [ABSTRACT FROM AUTHOR]

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In the head and neck, squamous cell carcinoma is one of the most common tumour types. Currently, the primary imaging modalities for initial locoregional staging are computed tomography and—to a lesser extent—magnetic resonance imaging, whilst [18F]fluorodeoxyglucose (FDG) positron emission tomography has additional value in the detection of subcentimetric metastatic lymph nodes and of tumour recurrence after chemoradiotherapy (CRT). However, dependency on the morphological and size-related criteria of anatomical imaging and the limited spatial resolution and FDG avidity of inflammation in metabolic imaging may reduce diagnostic accuracy in the head and neck. Diffusion-weighted magnetic resonance imaging (DWI) is a noninvasive imaging technique that measures the differences in water mobility in different tissue microstructures. Water mobility is likely influenced by cell size, density, and cellular membrane integrity and is quantified by means of the apparent diffusion coefficient. As such, the technique is able to differentiate tumoural tissue from normal tissue, inflammatory tissue and necrosis. In this article, we examine the use of DWI in head and neck cancer, focussing on technique optimization and image interpretation. Afterwards, the value of DWI will be outlined for clinical questions regarding nodal staging, lesion characterization, differentiation of post-CRT tumour recurrence from necrosis and inflammation, and predictive imaging towards treatment outcome. The possible consequences of adding DWI towards therapeutic management are outlined. [ABSTRACT FROM AUTHOR]

Objective: To evaluate diffusion-weighted (DWI) magnetic resonance imaging (MRI) for treatment prediction during chemoradiotherapy (CRT) of head and neck squamous cell carcinoma (HNC).Methods: Thirty patients with HNC underwent echo-planar DWI and anatomical MRI before and 2 and 4 weeks into CRT. Patient follow-up lasted 2 years post-CRT. Tumour ADC (DeltaADC) and volume changes (DeltaV) between baseline, and 2 and 4 weeks' follow-up were compared for lesions with recurrence versus complete remission (CR) using a Mann-Whitney U test. The predictive value of the DeltaADC and DeltaV for locoregional control (LRC) was examined with the Kaplan-Meier method. The study was approved by the local ethics committee. All patients gave written informed consent.Results: The DeltaADC in primary tumours and nodal metastases, 2 and 4 weeks after the start of CRT, was significantly lower in lesions with post-CRT recurrence than in lesions with CR (DeltaADC(2 weeks) and DeltaADC(4 weeks) for primary tumours, relative to nodal metastases: p < 0.0001). The DeltaV only showed a significant difference for primary tumours at 2 weeks (DeltaV(2 weeks): p = 0.03). The DeltaADC correlated significantly with 2-year LRC (p < 0.001); the DeltaV did not (p > 0.05).Conclusion: DWI during CRT for HNC allows more accurate response prediction than anatomical imaging, correlating significantly with 2-year LRC. [ABSTRACT FROM AUTHOR]

An aberrant channel was identified on CT in the petrous bone in four patients presenting with unrelated otological symptoms. These channels occurred unilaterally in each case. In two patients, the channel was seen to run between the sigmoid sinus sulcus and the superior petrosal sinus sulcus; in one of these patients, a vascular structure was identified within this channel on MRI, connecting the sigmoid sinus and the superior petrosal sinus. In the two other patients, an aberrant channel was seen between the superior petrosal sinus sulcus and the posterior genu of the facial nerve canal. There were no symptoms that could be attributed to the presence of these channels.We postulate that these aberrant vascular channels correspond to a persistent embryological vein, the lateral capital vein. [ABSTRACT FROM AUTHOR]

Imaging methods assist in the pre-treatment planning of laryngeal and hypopharyngeal neoplasms, by better defining the local extension of infiltrating tumours and by detecting subclinical neck adenopathies. Imaging has also an important role in excluding or detecting distant metastasis. Furthermore, there is evidence that several imaging-derived parameters can be used as predictors of locoregional control after radiotherapy, and this independently from the TN classification. Such prognostic information is helpful in determining the relative value of surgery and radiation therapy, in selecting patients who may benefit from adjuvant treatment, and in identifying patients at high risk for recurrence to be followed up more closely. [ABSTRACT FROM AUTHOR]

A rare case of multiple low-flow vascular malformations in the larynx, neck and mediastinum - reported as angiomatosis in the literature - is described. Sonography, CT, angiography and MRI were performed in our case, followed by laryngoscopy with biopsies to establish the diagnosis. The radiological features and a review of relevant literature are briefly discussed. [ABSTRACT FROM AUTHOR]

Head and neck tumours presenting as a neck abscess are extremely rare. Two patients with laryngeal squamous cell carcinoma, presenting with a prelaryngeal abscess, are described. Although clinically and on the CT studies these cases were suspect for underlying malignancy, the initial biopsies were negative for cancer. Because of persistent suspicion, repeat biopsies finally confirmed the presence of a squamous cell carcinoma. Pathological examination after total laryngectomy showed cancer localised in one of the true vocal cords, invading the anterior commissure and thyroid cartilage. However, the prelaryngeal soft tissues were free of tumour, showing only inflammatory changes and collections of pus. These cases emphasize the importance of repeat targeted biopsies and follow-up CT-studies in patients with a prelaryngeal abscess of obscure aetiology, in order to exclude or confirm a possible underlying malignancy. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the feasibility of functional MR imaging (fMRI) at 1.5 T, exploiting blood oxygenation level-dependent (BOLD) contrast, for detecting changes in whole-tumour oxygenation induced by carbogen (5% CO2+95% O2) inhalation of the host. Adult WAG/Rij rats with rhabdomyosarcomas growing subcutaneously in the lower flank were imaged when tumours reached sizes between 1 and 11 cm3 (n=12). Air and carbogen were alternatively supplied at 2 l/min using a snout mask. Imaging was done on a 1.5-T MR scanner using a T2*-weighted gradient-echo, echo-planar imaging (GE-EPI) sequence. Analysis of the whole-tumour EPI images was based on statistical parametric maps. Voxels with and without signal intensity changes (SIC) were recorded. Significance thresholds were set at p<0.05, corrected for multiple comparisons. In continuous air breathing condition, 3 of 12 tumours showed significant negative SIC and 1 tumour had a clear-cut positive SIC. The remaining tumours showed very little or no change. When switching to carbogen breathing, the SIC were significantly positive in 10 of 12 tumours. Negative SIC were present in 4 tumours, of which three were simultaneously characterised by positive SIC. The overall analysis indicated that 6 of the 12 tumours could be considered as strong positive responders to carbogen. Our research demonstrates the applicability of fMRI GE-EPI at 1.5 T to study whole-tumour oxygenation non-invasively. The observed negative SIC during air condition may reflect the presence of transient hypoxia during these measurements. Selection of tumours on the basis of their individual response to carbogen is possible, indicating a role of such non-invasive measurements for using tailor-made treatments. [ABSTRACT FROM AUTHOR]

Presents a case study of a one-year old girl with fever and a unilateral swelling of the jaw. Description of symptoms; Diagnosis of the disease through CT scan as acute osteomyelitis (AOM), a suppurative infection of the bone the most frequent causative pathogen being Staphylococcus aureus; Illustration by patient of AOM as a differential diagnosis of neoplasia based on consistency with history and clinical evolution.

Background: Overall survival after chemo-radiotherapy (CRT) for head and neck cancer ranges between 50 and 60% after 5 year of follow-up. Local and/or regional recurrence is the most frequent form of therapy failure. The aim of this study is to investigate whether the initial location and size change of pathological lymph nodes as evaluated on Computed Tomography (CT) studies can help predict outcome., Methods: One hundred eighty-three patients with lymph node-positive head and neck cancer were treated with radiotherapy (RT) or CRT. CT studies pre- and post-treatment were reviewed for lymph node size and location. Data were correlated with local control, regional control, metastasis free survival, disease free survival and overall survival., Results: Regarding the risk for distant metastasis, a significant influence was seen for the location of the pathological lymph nodes. The metastatic risk increases when levels IV-V are affected rather than levels I-III. A similar observation is seen for levels VI-VII. Regional control improves with decreasing lymph node diameter and volume as evaluated on CT., Conclusions: Both location and size change of pathological lymph nodes are of prognostic value after CRT for head and neck cancer.

Lipoblastoma is a rare benign tumour arising from embryonic white fat. The tumours occur primarily in infancy and early childhood and usually arise from the limbs and the trunk, but neck involvement is rare. We report three cases of head and neck lipoblastoma. In all cases, imaging showed a well-delineated, fat-containing tumour. After surgical resection, the outcome of these patients was uneventful.

In patients presenting with a neck adenopathy from a clinically unknown primary, efforts should be made to localize the primary tumour, as this allows a more focused therapy. Imaging is helpful in identifying suspicious mucosal sites that should be further investigated endoscopically, including biopsy. In case no primary tumour is detected in the head and neck, a positron emission tomography (PET) study can be considered to search for an infraclavicular primary tumour. This article reviews the diagnostic value of computed tomography (CT), magnetic resonance imaging, PET and PET/CT in this clinical context.

In patients with head and neck squamous cell carcinoma (SCC), nodal metastases are an adverse prognostic factor compromising long term patient survival. Therefore, accurate detection of regional nodal metastases is required for optimization of treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) remain the primary imaging modalities for locoregional staging of head and neck SCC. Next to evaluation of the primary tumour, both modalities facilitate detection of non-palpable lymph nodes (LN). However, both modalities rely on size-related and morphological criteria to differentiate between benign and malignant lymph nodes, decreasing the sensitivity for detection of small metastases. Diffusion-weighted MRI (DW-MRI) measures differences in tissue microstructure, based on the random displacement of water molecules. The differences in water mobility are quantified using the apparent diffusion coefficient (ADC), which has an inverse relationship with tissue cellularity. As such the technique is able to differentiate between tumoral tissue and normal or necrotic tissue. The added value of DW-MRI to conventional imaging for staging of lymph nodes in head and neck cancer is discussed, before and after treatment. The possible consequences regarding therapeutic management are outlined.

Sophisticated imaging methods, such as computed tomography, magnetic resonance imaging and positron emission tomography, play an increasingly important role in the management of head and neck cancer. Pretreatment imaging findings have predictive value for patient outcome, independently from the currently used TNM classification, and may be used to tailor treatment to the individual patient. Based on per-treatment imaging, individualised replanning during radiotherapy may ameliorate tumour control rates and reduce toxic effects to normal tissues. Early posttreatment imaging studies contain important prognostic information, and allow selection of patients for further treatment or watchful waiting., ((c) International Cancer Imaging Society.)

Imaging studies have an important role in defining the extent of oropharyngeal neoplasms and coming to an accurate staging of these lesions. Besides influencing treatment choice, imaging studies can also be used to monitor tumour response to treatment, and as an adjunct to clinical follow-up in order to detect treatment failure as early as possible., (International Cancer Imaging Society.)