Source: www.straitstimes.com Author: staff Vlastimil Gular's life took an unwelcome turn a year ago: minor surgery on his vocal cords revealed […]
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Δευτέρα 14 Ιανουαρίου 2019
New app gives throat cancer patients their voice back
New app gives throat cancer patients their voice back
Source: www.straitstimes.com Author: staff Vlastimil Gular's life took an unwelcome turn a year ago: minor surgery on his vocal cords revealed […]
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Atopic Dermatitis | Medscape Atopic Dermatitis | Medscape
Atopic dermatitis is a chronic inflammatory skin disease with a complex etiology that encompasses immunologic responses, susceptibility genes, environmental triggers, and compromised skin-barrier function. (Source: Medscape Today Headlines)
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Clinical trial testing fecal microbiota transplant for recurrent diarrheal disease begins
(NIH/National Institute of Allergy and Infectious Diseases) A research consortium recently began enrolling patients in a clinical trial examining whether fecal microbiota transplantation (FMT) by enema--putting stool from a healthy donor in the colon of a recipient--is safe and can prevent recurrent Clostridium difficile-associated disease (CDAD), a potentially life-threatening diarrheal illness. Investigators aim to enroll 162 volunteer participants 18 years or older who have had two or more episodes of CDAD within the previous six months. (Source: EurekAlert! - Infectious and Emerging Diseases)
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Atopic Dermatitis | Medscape Atopic Dermatitis | Medscape
Atopic dermatitis is a chronic inflammatory skin disease with a complex etiology that encompasses immunologic responses, susceptibility genes, environmental triggers, and compromised skin-barrier function. (Source: Medscape Today Headlines)
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Clinical trial testing fecal microbiota transplant for recurrent diarrheal disease begins
(NIH/National Institute of Allergy and Infectious Diseases) A research consortium recently began enrolling patients in a clinical trial examining whether fecal microbiota transplantation (FMT) by enema--putting stool from a healthy donor in the colon of a recipient--is safe and can prevent recurrent Clostridium difficile-associated disease (CDAD), a potentially life-threatening diarrheal illness. Investigators aim to enroll 162 volunteer participants 18 years or older who have had two or more episodes of CDAD within the previous six months. (Source: EurekAlert! - Infectious and Emerging Diseases)
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2018 Reviewer Thank You
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2018 Reviewer Thank You
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Flap Reconstruction after Groin and Medial Thigh Sarcoma Resection Reduces the Risk of Lower-Extremity Lymphedema
Extensive resection is an effective treatment for sarcomas in the groin and medial thigh region; however, various complications may develop postoperatively.1,2 Infection, lymphorrhea, and lymphedema frequently develop in the groin/medial thigh because of the important lymphatic pathways from the lower extremities. Prolonged lymphorrhea and lymphatic cysts are causes of chronic lower-extremity lymphedema.1 Symptoms become further exacerbated because of repeated cellulitis and movement limitations.
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LIVE Surgery – An innovative plastic surgery teaching programme for medical students utilising real-time operating theatre audiovisual link-ups
We sought to evaluate the concept of Live Surgery, a novel, modern method of surgical education utilising interactive tele-conferencing, immersive 360-degree recording and accompanying focused lectures. Through Live Surgery, we set out to improve general understanding of Plastic Surgery, whilst driving innovation to deliver novel ways to complement the current undergraduate curriculum.
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Flap Reconstruction after Groin and Medial Thigh Sarcoma Resection Reduces the Risk of Lower-Extremity Lymphedema
Extensive resection is an effective treatment for sarcomas in the groin and medial thigh region; however, various complications may develop postoperatively.1,2 Infection, lymphorrhea, and lymphedema frequently develop in the groin/medial thigh because of the important lymphatic pathways from the lower extremities. Prolonged lymphorrhea and lymphatic cysts are causes of chronic lower-extremity lymphedema.1 Symptoms become further exacerbated because of repeated cellulitis and movement limitations.
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LIVE Surgery – An innovative plastic surgery teaching programme for medical students utilising real-time operating theatre audiovisual link-ups
We sought to evaluate the concept of Live Surgery, a novel, modern method of surgical education utilising interactive tele-conferencing, immersive 360-degree recording and accompanying focused lectures. Through Live Surgery, we set out to improve general understanding of Plastic Surgery, whilst driving innovation to deliver novel ways to complement the current undergraduate curriculum.
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When and how should we cluster and cross over: methodological and ethical issues (letter 2)
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Massive subcutaneous emphysema during bag-mask ventilation after failed intubation
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Canada: over-pressurized
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In reply: When and how should we cluster and cross over: methodological and ethical issues (letters 1 and 2)
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When and how should we cluster and cross over: methodological and ethical issues (letter 1)
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Clinical Pediatric Anesthesia: A Case-Based Handbook, Second Edition
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Critical Care Canada Forum 2018 Abstracts
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When and how should we cluster and cross over: methodological and ethical issues (letter 2)
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Massive subcutaneous emphysema during bag-mask ventilation after failed intubation
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Canada: over-pressurized
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In reply: When and how should we cluster and cross over: methodological and ethical issues (letters 1 and 2)
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When and how should we cluster and cross over: methodological and ethical issues (letter 1)
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Clinical Pediatric Anesthesia: A Case-Based Handbook, Second Edition
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Critical Care Canada Forum 2018 Abstracts
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Gut microbes from healthy infants block milk allergy development in mice
NIH-funded study links gut microbiome to food allergy. (Source: National Institutes of Health (NIH) News Releases)
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Gut microbes from healthy infants block milk allergy development in mice
NIH-funded study links gut microbiome to food allergy. (Source: National Institutes of Health (NIH) News Releases)
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2018 Reviewer Thank You
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2018 Reviewer Thank You
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Gut microbes from healthy infants block milk allergy development in mice
NIH-funded study links gut microbiome to food allergy. (Source: National Institutes of Health (NIH) News Releases)
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Gut microbes from healthy infants block milk allergy development in mice
NIH-funded study links gut microbiome to food allergy. (Source: National Institutes of Health (NIH) News Releases)
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Feasibility of intra-arterial chemotherapy for retinoblastoma: experiences in a large single center cohort study
Abstract
Purpose
In the last 10 years, intra-arterial chemotherapy (IAC) has been increasingly used in the clinical management of retinoblastoma. It is reported to provide tumor control even in advanced stage disease that might have previously required enucleation. In our clinical experience, there are three conditions that may impair the use of IAC: (1) significant collaterals to meningeal arteries, (2) technical failure of ophthalmic artery catheterization, or (3) retina blood supply from collaterals different to the ophthalmic artery. In the current study, we assessed the rate of IACs that could not be carried out in our institution due to these three reasons.
Methods
All patients admitted for IAC in our hospital were retrospectively assessed by chart review. Non-application rate of IAC was assessed and classified according to the three abovementioned criteria. Complication rate of both finalized and interrupted interventions was recorded.
Results
Ninety-eight patients (median age 21.4 months, range 5.3 months–10.5 years) were identified. IAC was performed in 69 (70.4%) patients and interrupted in 12 (12.2%) cases because of meningeal collaterals, in 8 (8.2%) because of technical failure to cannulate the ophthalmic artery, and in 9 (9.2%) because of alternative blood supply of the retina.
Conclusion
The rather defensive approach that is pursued in our center resulted in an overall non-application rate of IAC around 30%. The relatively high probability of conditions that impair the use of IAC needs to be addressed adequately in the patient conversation prior to the procedure. Our rate of 8% of abstention from IAC due to technical limitations might be reduced by the application of more rigorous therapeutic approaches such as balloon occlusion of the distal internal carotid artery. More research is finally needed to determine if IAC can be safely performed in the presence of meningeal collaterals and via branches of the external carotid artery.
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Feasibility of intra-arterial chemotherapy for retinoblastoma: experiences in a large single center cohort study
Abstract
Purpose
In the last 10 years, intra-arterial chemotherapy (IAC) has been increasingly used in the clinical management of retinoblastoma. It is reported to provide tumor control even in advanced stage disease that might have previously required enucleation. In our clinical experience, there are three conditions that may impair the use of IAC: (1) significant collaterals to meningeal arteries, (2) technical failure of ophthalmic artery catheterization, or (3) retina blood supply from collaterals different to the ophthalmic artery. In the current study, we assessed the rate of IACs that could not be carried out in our institution due to these three reasons.
Methods
All patients admitted for IAC in our hospital were retrospectively assessed by chart review. Non-application rate of IAC was assessed and classified according to the three abovementioned criteria. Complication rate of both finalized and interrupted interventions was recorded.
Results
Ninety-eight patients (median age 21.4 months, range 5.3 months–10.5 years) were identified. IAC was performed in 69 (70.4%) patients and interrupted in 12 (12.2%) cases because of meningeal collaterals, in 8 (8.2%) because of technical failure to cannulate the ophthalmic artery, and in 9 (9.2%) because of alternative blood supply of the retina.
Conclusion
The rather defensive approach that is pursued in our center resulted in an overall non-application rate of IAC around 30%. The relatively high probability of conditions that impair the use of IAC needs to be addressed adequately in the patient conversation prior to the procedure. Our rate of 8% of abstention from IAC due to technical limitations might be reduced by the application of more rigorous therapeutic approaches such as balloon occlusion of the distal internal carotid artery. More research is finally needed to determine if IAC can be safely performed in the presence of meningeal collaterals and via branches of the external carotid artery.
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Carfentanil: a weapon of mass destruction
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Carfentanil: a weapon of mass destruction
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The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging
In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation. (Source: Dysphagia)
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The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging
In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation. (Source: Dysphagia)
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MR imaging features of spinal pilocytic astrocytoma
Abstract
Background
The purpose of this retrospective review is to determine the MR imaging features of pilocytic astrocytoma (PA) in the spinal cord to help neuroradiologists preoperatively differentiate PA from other intramedullary tumors.
Methods
Neuro-oncology database review revealed 13 consecutive patients with a pathological spinal PA diagnosis and availability of preoperative MR imaging. Three patients had preoperative diffusion-weighted MR imaging. Demographics and conventional and diffusion MR imaging records were retrospectively evaluated.
Results
Among 13 cases of spinal PA, six PAs were located in the cervical region, 4 in the cervical-thoracic region, and 3 in the thoracic region. The average length of vertebral segments involved for the tumors were 4.7 ± 4.6 segments. Six tumors had associated syringomyelia. Eight PAs were located eccentrically in the spinal cord, and eleven had well-defined margins. Eight tumors (61.5%) were intermixed cystic and solid. All were contrast-enhanced, and 53.8% of all PAs showed focal nodule enhancement of the solid components. Two PAs showed intratumoral hemorrhages, and only one demonstrated cap sign. The ADC values (n = 3) of the tumors were 1.40 ± 0.28 × 10− 3 mm2/s (min–max: 1.17–1.71 × 10− 3 mm2/s).
Conclusions
PA should be considered in the differential diagnosis of intramedullary tumors that occur in the cervical and thoracic regions. Eccentric growth pattern, well-defined margin, intermixed cystic and solid appearance, focal nodular enhancement of solid components and syringomyelia are relatively frequent features. Relatively high ADC values compared with normal-appearing spinal cord parenchyma are common in spinal PA.
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MR imaging features of spinal pilocytic astrocytoma
Abstract
Background
The purpose of this retrospective review is to determine the MR imaging features of pilocytic astrocytoma (PA) in the spinal cord to help neuroradiologists preoperatively differentiate PA from other intramedullary tumors.
Methods
Neuro-oncology database review revealed 13 consecutive patients with a pathological spinal PA diagnosis and availability of preoperative MR imaging. Three patients had preoperative diffusion-weighted MR imaging. Demographics and conventional and diffusion MR imaging records were retrospectively evaluated.
Results
Among 13 cases of spinal PA, six PAs were located in the cervical region, 4 in the cervical-thoracic region, and 3 in the thoracic region. The average length of vertebral segments involved for the tumors were 4.7 ± 4.6 segments. Six tumors had associated syringomyelia. Eight PAs were located eccentrically in the spinal cord, and eleven had well-defined margins. Eight tumors (61.5%) were intermixed cystic and solid. All were contrast-enhanced, and 53.8% of all PAs showed focal nodule enhancement of the solid components. Two PAs showed intratumoral hemorrhages, and only one demonstrated cap sign. The ADC values (n = 3) of the tumors were 1.40 ± 0.28 × 10− 3 mm2/s (min–max: 1.17–1.71 × 10− 3 mm2/s).
Conclusions
PA should be considered in the differential diagnosis of intramedullary tumors that occur in the cervical and thoracic regions. Eccentric growth pattern, well-defined margin, intermixed cystic and solid appearance, focal nodular enhancement of solid components and syringomyelia are relatively frequent features. Relatively high ADC values compared with normal-appearing spinal cord parenchyma are common in spinal PA.
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Food-related anaphylaxis fatalities: analysis of the Allergy Vigilance Network database - Pouessel G, Beaudouin E, Tanno LK, Drouet M, Deschildre A, Labreuche J, Renaudin JM.
[Abstract unavailable] Language: en... (Source: SafetyLit)
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Food-related anaphylaxis fatalities: analysis of the Allergy Vigilance Network database - Pouessel G, Beaudouin E, Tanno LK, Drouet M, Deschildre A, Labreuche J, Renaudin JM.
[Abstract unavailable] Language: en... (Source: SafetyLit)
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Food-related anaphylaxis fatalities: analysis of the Allergy Vigilance Network database - Pouessel G, Beaudouin E, Tanno LK, Drouet M, Deschildre A, Labreuche J, Renaudin JM.
[Abstract unavailable] Language: en... (Source: SafetyLit)
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Food-related anaphylaxis fatalities: analysis of the Allergy Vigilance Network database - Pouessel G, Beaudouin E, Tanno LK, Drouet M, Deschildre A, Labreuche J, Renaudin JM.
[Abstract unavailable] Language: en... (Source: SafetyLit)
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Why sophisticated IVF patients love technology - and how this can hurt them
We treat IVF patients who come from different backgrounds , and it's interesting to see that the ones who are engineers and MBAs want to use the latest advanced technology in order to solve their problems . These are the patients who want us to do all kinds of tests, such as ERA ( endometrial receptivity assay) , PGT ( preimplantation genetic testing) and sperm DNA fragmentation, because they've read about these newest tests on Dr Google. They believe that the more the technology we use, the better their chances of getting pregnant with IVF. They know that IVF success rates are not 100%, and their belief is that the deeper we investigate problems using sophisticated technology ( for example, genetics and immunology), the higher their chances of success with IVF will be.This is a ...
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Fight Aging! Newsletter, January 14th 2019
In conclusion, reduction of LDL-C to less than 50 mg/dl seems safe and provides greater CV benefits compared with higher levels. Data for achieved LDL-C lower than 20-25 mg/dl is limited, although findings from the above mentioned studies are encouraging. However, further evaluation is needed for future studies and post-hoc analyses. Wary of the Beautiful Fairy Tale of Near Term Rejuvenation http://bit.ly/2FmmMyu One might compare this interview with researcher Leonid Peshkin to last year's discussion with Vadim Gladyshev. There is a spectrum of caution and pessimism regarding near term progress towards rejuvenation; the pessimists in the research and development communities are not all ali...
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Why sophisticated IVF patients love technology - and how this can hurt them
We treat IVF patients who come from different backgrounds , and it's interesting to see that the ones who are engineers and MBAs want to use the latest advanced technology in order to solve their problems . These are the patients who want us to do all kinds of tests, such as ERA ( endometrial receptivity assay) , PGT ( preimplantation genetic testing) and sperm DNA fragmentation, because they've read about these newest tests on Dr Google. They believe that the more the technology we use, the better their chances of getting pregnant with IVF. They know that IVF success rates are not 100%, and their belief is that the deeper we investigate problems using sophisticated technology ( for example, genetics and immunology), the higher their chances of success with IVF will be.This is a ...
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Fight Aging! Newsletter, January 14th 2019
In conclusion, reduction of LDL-C to less than 50 mg/dl seems safe and provides greater CV benefits compared with higher levels. Data for achieved LDL-C lower than 20-25 mg/dl is limited, although findings from the above mentioned studies are encouraging. However, further evaluation is needed for future studies and post-hoc analyses. Wary of the Beautiful Fairy Tale of Near Term Rejuvenation http://bit.ly/2FmmMyu One might compare this interview with researcher Leonid Peshkin to last year's discussion with Vadim Gladyshev. There is a spectrum of caution and pessimism regarding near term progress towards rejuvenation; the pessimists in the research and development communities are not all ali...
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[Maximum monosyllabic score as a predictor for cochlear implant outcome].
CONCLUSION: The preoperatively measured PBmax may be used as a predictor for the minimum speech perception obtained with CI. This is of high clinical relevance for CI candidates with a PBmax above zero. PMID: 30635677 [PubMed - as supplied by publisher] (Source: HNO)
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Imaging bioluminescent exogenous stem cells in the intact guinea pig cochlea.
This article is protected by copyright. All rights reserved. PMID: 30635981 [PubMed - as supplied by publisher] (Source: Anatomical Record)
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[Maximum monosyllabic score as a predictor for cochlear implant outcome].
CONCLUSION: The preoperatively measured PBmax may be used as a predictor for the minimum speech perception obtained with CI. This is of high clinical relevance for CI candidates with a PBmax above zero. PMID: 30635677 [PubMed - as supplied by publisher] (Source: HNO)
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Imaging bioluminescent exogenous stem cells in the intact guinea pig cochlea.
This article is protected by copyright. All rights reserved. PMID: 30635981 [PubMed - as supplied by publisher] (Source: Anatomical Record)
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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia
Condition: Acute Myeloid Leukemia Intervention: Genetic: Immunogenic profile Sponsor: Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)
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Clinical and Immunological Long-term Follow-up of Patients With Pemphigus Included in the " RITUXIMAB 3 " Trial
Condition: Autoimmune Diseases Interventions: Drug: Rituximab; Drug: corticosteroids'therapy Sponsor: University Hospital, Rouen Not yet recruiting (Source: ClinicalTrials.gov)
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Exploring Disease Immunogenicity and the Immunological Effects of Hypomethylating Agents in Acute Myeloid Leukemia
Condition: Acute Myeloid Leukemia Intervention: Genetic: Immunogenic profile Sponsor: Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori Not yet recruiting (Source: ClinicalTrials.gov)
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Clinical and Immunological Long-term Follow-up of Patients With Pemphigus Included in the " RITUXIMAB 3 " Trial
Condition: Autoimmune Diseases Interventions: Drug: Rituximab; Drug: corticosteroids'therapy Sponsor: University Hospital, Rouen Not yet recruiting (Source: ClinicalTrials.gov)
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Dermatitis and occupational (meth) acrylate contact allergy in nail technicians ‐ a 10 year study
Acrylates and methacrylates, in this report from here on called (meth)acrylates, are present in various coatings, plastics, dental prosthesis, glass substitutes, and acrylic nails. (Meth)acrylic polymers are obtained by polymerization of monomeric derivatives of (meth)acrylic acids, esters being the most important source. Polymerization into acrylic plastics can occur in either room temperature, with heat, or via UV‐radiation or visible light
This article is protected by copyright. All rights reserved.
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Dermatitis and occupational (meth) acrylate contact allergy in nail technicians ‐ a 10 year study
Acrylates and methacrylates, in this report from here on called (meth)acrylates, are present in various coatings, plastics, dental prosthesis, glass substitutes, and acrylic nails. (Meth)acrylic polymers are obtained by polymerization of monomeric derivatives of (meth)acrylic acids, esters being the most important source. Polymerization into acrylic plastics can occur in either room temperature, with heat, or via UV‐radiation or visible light
This article is protected by copyright. All rights reserved.
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Regarding Laryngeal precursor lesions: Interrater and intrarater reliability of histopathological assessment
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In response to Laryngeal precursor lesions: Interrater and intrarater reliability of histopathological assessment
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In Response to Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux
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In Reference to Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux
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In Response to Letter to the Editor Regarding: Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies
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Regarding Laryngeal precursor lesions: Interrater and intrarater reliability of histopathological assessment
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In response to Laryngeal precursor lesions: Interrater and intrarater reliability of histopathological assessment
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In Response to Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux
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In Reference to Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux
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In Response to Letter to the Editor Regarding: Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies
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The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging
Abstract
Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Thirteen patients with dysphagia due to brainstem stroke completed dynamic 320-detector row computed tomography while swallowing a trial of 10 ml honey-thick barium. 3D volumes of pharyngeal residue were compared to 2D lateral and anterior–posterior areas, and a laterality index for residue location was computed. Although the anteroposterior area of residue was larger than the lateral area, the two measures were positively correlated with one another and with residue volume. On separate bivariate regression analyses, residue volume was accurately predicted by both lateral (R2 = 0.91) and anteroposterior (R2 = 0.88) residue areas, with limited incidence of high residuals. Half of the sample demonstrated a majority of pharyngeal residue lateralized to one side of the pharynx, with no effect of laterality on the association between areas and volume. In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation.
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The Association of 3-D Volume and 2-D Area of Post-swallow Pharyngeal Residue on CT Imaging
Abstract
Pharyngeal residue, the material that remains in the pharynx after swallowing, is an important marker of impairments in swallowing and prandial aspiration risk. The goals of this study were to determine whether the 2D area of post-swallow residue accurately represents its 3D volume, and if the laterality of residue would affect this association. Thirteen patients with dysphagia due to brainstem stroke completed dynamic 320-detector row computed tomography while swallowing a trial of 10 ml honey-thick barium. 3D volumes of pharyngeal residue were compared to 2D lateral and anterior–posterior areas, and a laterality index for residue location was computed. Although the anteroposterior area of residue was larger than the lateral area, the two measures were positively correlated with one another and with residue volume. On separate bivariate regression analyses, residue volume was accurately predicted by both lateral (R2 = 0.91) and anteroposterior (R2 = 0.88) residue areas, with limited incidence of high residuals. Half of the sample demonstrated a majority of pharyngeal residue lateralized to one side of the pharynx, with no effect of laterality on the association between areas and volume. In conclusion, the area of post-swallow pharyngeal residue was associated with volume, with limitations in specific cases. Direct measurement of pharyngeal residue volume and swallowing physiology with 3D-CT can be used to validate results from standard 2D instrumentation.
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Diffusion kurtosis imaging‐derived histogram metrics for prediction of KRAS mutation in rectal adenocarcinoma: Preliminary findings
Background
Although histological examination is the standard method for assessing genetic status, the development of a noninvasive method, which can display the heterogeneity of the whole tumor to supplement genotype analysis, might be important for personalized treatment strategies.
Purpose
To evaluate the potential role of diffusion kurtosis imaging (DKI)‐derived parameters using histogram analysis derived from whole‐tumor volumes for prediction of the status of KRAS mutations in patients with rectal adenocarcinoma.
Study Type
Retrospective.
Subjects
In all, 148 consecutive patients with histologically confirmed rectal adenocarcinoma who were treated at our institution.
Sequence
DKI was performed with a 3.0 T MRI system using a single‐shot echo‐planar imaging sequence with b values of 0, 700, 1400, and 2100 sec/mm2.
Assessment
D, K, and apparent diffusion coefficient (ADC) values were measured using whole‐tumor volume histogram analysis and were compared between different KRAS mutations status.
Statistical Tests
Student's t‐test or Mann–Whitney U‐test, and receiver operating characteristic (ROC) curves were used for statistical analysis.
Results
All the percentile metrics of ADC and D values were significantly lower in the mutated group than those in the wildtype group (all P < 0.05), except for the minimum value of ADC and D (both P > 0.05), while K‐related percentile metrics were higher in the mutated group compared with those in the wildtype group (all P < 0.05). Regarding the comparison of the diagnostic performance of all the histogram metrics, K75th showed the highest AUC value of 0.871, and the corresponding values for sensitivity, specificity, positive predictive value, and negative predictive value were 81.43%, 78.21%, 77.03%, and 82.43%, respectively.
Data Conclusion
DKI metrics with whole‐tumor volume histogram analysis is associated with KRAS mutations, and thus may be useful for predicting the KRAS status of rectal cancers for guiding targeted therapy.
Level of Evidence: 3
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
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Accessible magnetic resonance imaging: A review
The role of MRI in diagnostics, prognostics, and discoveries in basic sciences has been well established. However, access to this life‐saving technology is largely restricted to countries in upper‐middle to high‐income groups. In this article, we collate recent global MR scanner density data and group them into six geographical regions based on the WHO classification. We then analyze these data with respect to demographic factors such as population size, life expectancy, the percentage of internet users, and World Bank income grouping. We map these demographic factors to five dimensions or characteristics of accessible MRI, adapting definitions from the healthcare literature. With this background, the study then reviews recent demonstrations of accessible MRI categorized based on main magnetic field strength. We describe demonstrated examples for each of these categories, ranging from ultralow‐field to ultrahigh‐field MRI. Lastly, we review MR methods and associated developments impacting accessible MRI such as increasing/augmenting MR awareness and local expertise, incorporating hardware‐cognizant methods, rapid quantitative imaging, and leveraging innovations from adjacent fields.
The spatial quantification methodology proposed in this study, which works based on cellular distributions within ADC maps of adnexal masses, may provide a helpful computer‐aided strategy for objective characterization of adnexal masses.
Level of Evidence: 5
Technical Efficacy Stage: 6
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SYCmV7
Accuracy of blood flow assessment in cerebral arteries with 4D flow MRI: Evaluation with three segmentation methods
Background
Accelerated 4D flow MRI allows for high‐resolution velocity measurements with whole‐brain coverage. Such scans are increasingly used to calculate flow rates of individual arteries in the vascular tree, but detailed information about the accuracy and precision in relation to different postprocessing options is lacking.
Purpose
To evaluate and optimize three proposed segmentation methods and determine the accuracy of in vivo 4D flow MRI blood flow rate assessments in major cerebral arteries, with high‐resolution 2D PCMRI as a reference.
Study Type
Prospective.
Subjects
Thirty‐five subjects (20 women, 79 ± 5 years, range 70–91 years).
Field Strength/Sequence
4D flow MRI with PC‐VIPR and 2D PCMRI acquired with a 3 T scanner.
Assessment
We compared blood flow rates measured with 4D flow MRI, to the reference, in nine main cerebral arteries. Lumen segmentation in the 4D flow MRI was performed with k‐means clustering using four different input datasets, and with two types of thresholding methods. The threshold was defined as a percentage of the maximum intensity value in the complex difference image. Local and global thresholding approaches were used, with evaluated thresholds from 6–26%.
Statistical Tests
Paired t‐test, F‐test, linear correlation (P < 0.05 was considered significant) along with intraclass correlation (ICC).
Results
With the thresholding methods, the lowest average flow difference was obtained for 20% local (0.02 ± 15.0 ml/min, ICC = 0.97, n = 310) or 10% global (0.08 ± 17.3 ml/min, ICC = 0.97, n = 310) thresholding with a significant lower standard deviation for local (F‐test, P = 0.01). For all clustering methods, we found a large systematic underestimation of flow compared with 2D PCMRI (16.1–22.3 ml/min).
Data Conclusion
A locally adapted threshold value gives a more stable result compared with a globally fixed threshold. 4D flow with the proposed segmentation method has the potential to become a useful reliable clinical tool for assessment of blood flow in the major cerebral arteries.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
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MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta‐analysis
Background
Accurate preoperative differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma is clinically crucial because the treatment strategies differ substantially.
Purpose
To evaluate the diagnostic performance of MRI for differentiating PCNSL from glioblastoma.
Study Type
Systematic review and meta‐analysis.
Subjects
Ovid‐MEDLINE and EMBASE databases were searched to find relevant original articles up to November 25, 2018. The search term combined synonyms for "lymphoma," "glioblastoma," and "MRI."
Field Strength/Sequence
Patients underwent at least one MRI sequence including diffusion‐weighted imaging (DWI), dynamic susceptibility‐weighted contrast‐enhanced imaging (DSC), dynamic contrast‐enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility‐weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS) using 1.5 or 3 T.
Assessment
Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool.
Statistical Tests
Hierarchical logistic regression modeling was used to obtain pooled sensitivity and specificity. Meta‐regression was performed.
Results
Twenty‐two studies with 1182 patients were included. MRI sequences demonstrated high overall diagnostic performance with pooled sensitivity of 91% (95% confidence interval [CI], 87–93%) and specificity of 89% (95% CI, 85–93%). The area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90–0.94). Studies using DSC or ASL showed high diagnostic performance (sensitivity of 93% [95% CI, 89–97%] and specificity of 91% [95% CI, 86–96%]). Heterogeneity was only detected in specificity (I2 = 66.84%) and magnetic field strength was revealed to be a significant factor affecting study heterogeneity.
Data Conclusion
MRI showed overall high diagnostic performance for differentiating PCNSL from glioblastoma, with studies using DSC or ASL showing high diagnostic performance. Therefore, MRI sequences including DSC or ASL is a potential diagnostic tool for differentiating PCNSL from glioblastoma.
Level of Evidence: 3
Technical Efficacy Stage: 2
J. Magn. Reson. Imaging 2019.
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Symptoms that are associated with decreased pancreatic enzyme flow: MRCP assessment
Background
Pancreatic exocrine insufficiency is one of the causes of malabsorption syndrome. In many cases of malabsorption syndrome, pancreatic exocrine insufficiency can be treated with pancreatic enzyme replacement therapy. Therefore, it is important to detect pancreatic endocrine insufficiency as early and accurately as possible. Recent studies have shown that cine‐dynamic MR cholangiopancreatography (MRCP) may be useful to evaluate pancreatic exocrine function
Purpose
To identify abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion for which cine‐dynamic MRCP should be performed to diagnose pancreatic exocrine insufficiency.
Study Type
Prospective.
Population
In all, 111 patients with various types of abdominal symptoms.
Field Strength/Sequence
5 T or 3 T, MRCP with spatially selective inversion recovery pulse (cine‐dynamic MRCP).
Assessment
Cine‐dynamic MRCP was performed and an 18‐question clinical questionnaire on abdominal symptoms was administered. The secretion grade derived from cine‐dynamic MRCP was compared between those answering "yes" and "no" for all 18 items
Statistical Tests
Univariate analysis and further analyzed using multiple regression analysis. The associations between the secretion grade and the items in the clinical questionnaire were analyzed by univariate analysis and further analyzed using multiple regression analysis.
Results
The following three items showed significantly negative correlations with secretion grade: Q9, Does your rectal gas smell foul? (β = –0.44, P = 0.001); Q13, Is stool quantity large? (β = –0.41, P = 0.001); and Q18, Are your stools soft? (β = –0.53, P < 0.001). No significant correlations with exocrine pancreatic function measured by cine‐dynamic MRCP were seen for the remaining 15 abdominal symptom items.
Data Conclusion
Abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion were foul rectal gas, large stool, and soft stool. Pancreatic exocrine insufficiency due to decreased pancreatic enzyme flow may be suspected in patients with these abdominal symptoms.
Level of Evidence: 1
Technical Efficacy Stage: 3
J. Magn. Reson. Imaging 2019.
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Patient respiratory‐triggered quantitative T2 mapping in the pancreas
Background
Long acquisition times and motion sensitivity limit T2 mapping in the abdomen. Accelerated mapping at 3 T may allow for quantitative assessment of diffuse pancreatic disease in patients during free‐breathing.
Purpose
To test the feasibility of respiratory‐triggered quantitative T2 analysis in the pancreas and correlate T2‐values with age, body mass index, pancreatic location, main pancreatic duct dilatation, and underlying pathology.
Study Type
Retrospective single‐center pilot study.
Population
Eighty‐eight adults.
Field Strength/Sequence
Ten‐fold accelerated multiecho‐spin‐echo 3 T MRI sequence to quantify T2 at 3 T.
Assessment
Two radiologists independently delineated three regions of interest inside the pancreatic head, body, and tail for each acquisition. Means and standard deviations for T2 values in these regions were determined. T2‐value variation with demographic data, intraparenchymal location, pancreatic duct dilation, and underlying pancreatic disease was assessed.
Statistical Tests
Interreader reliability was determined by calculating the interclass coefficient (ICCs). T2 values were compared for different pancreatic locations by analysis of variance (ANOVA). Interpatient associations between T2 values and demographical, clinical, and radiological data were calculated (ANOVA).
Results
The accelerated T2 mapping sequence was successfully performed in all participants (mean acquisition time, 2:48 ± 0:43 min). Low T2 value variability was observed across all patients (intersubject) (head: 60.2 ± 8.3 msec, body: 63.9 ± 11.5 msec, tail: 66.8 ± 16.4 msec). Interreader agreement was good (ICC, 0.82, 95% confidence interval: 0.77–0.86). T2‐values differed significantly depending on age (P < 0.001), location (P < 0.001), main pancreatic duct dilatation (P < 0.001), and diffuse pancreatic disease (P < 0.03).
Data Conclusion
The feasibility of accelerated T2 mapping at 3 T in moving abdominal organs was demonstrated in the pancreas, since T2 values were stable and reproducible. In the pancreatic parenchyma, T2‐values were significantly dependent on demographic and clinical parameters.
Level of Evidence: 4
Technical Efficacy: Stage 1
J. Magn. Reson. Imaging 2019.
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MRI in autosomal dominant polycystic kidney disease
Magnetic resonance imaging (MRI) is increasingly used in autosomal dominant polycystic kidney disease (ADPKD) for diagnosis, classification, assessment of disease progression and treatment response, and for identifying complications. Herein we review the role of MRI in the management of patients with ADPKD. We show how MRI‐derived total kidney volume is a biomarker for assessing ADPKD severity and predicting decline in renal function. We also demonstrate the MR appearances of common complications.
Level of Evidence: 3
Technical Efficacy Stage: 5
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AJxNXs
MRI screening for uterine leiomyosarcoma
Background
Uterine fibroids are a common benign tumor and can be symptomatic, necessitating resection. Surgical myomectomy is an effective treatment option with a risk of disseminating occult uterine leiomyosarcoma (LMS), creating a need for an effective presurgical screening protocol. Clinical collaboration with contrast‐enhanced MRI including T2 and diffusion‐weighted imaging (DWI) can be utilized as a screening exam.
Purpose
To review the accuracy and feasibility of an interdisciplinary prospective contrast‐enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection.
Study Type
Retrospective cohort study.
Population
In all, 1960 adult female patients aged 18–87 undergoing screening MRI pelvis prior to uterine fibroid resection.
Field Strength/Sequence
T1 and T2‐weighted imaging, DWI, and contrast‐enhanced images were acquired at 1.5 T and 3.0 T.
Assessment
Each radiologist at the time of clinical study prospectively designated a confidence level of presence of LMS in the impression, which was reviewed retrospectively. A separate retrospective evaluation of the histologically proven LMS and the false positives was performed for the presence of five MRI features of LMS including low ADC values, intermediate/high T2 signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost‐effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI.
Statistical Tests
Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t‐tests were used to compare demographics and apparent diffusion coefficient values between LMS and false‐positive results.
Results
We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life‐year gained.
Data Conclusion
MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians.
Level of Evidence: 3
Technical Efficacy Stage: 2
J. Magn. Reson. Imaging 2019.
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Factors predicting the time‐length variability of identically protocoled MRI exams
Background
Clinical variability in MRI exam durations can impede efficient MRI utilization. There is a paucity of data regarding the degree of variability of identically protocoled MRI studies and when nontechnological factors contribute to time‐length variations in MRI exams.
Purpose
To measure the magnitude of variation in MRI exam duration for identically protocoled MRI exams and to identify potential contributors to variations in MRI exam times.
Study Type
Retrospective.
Subjects
2705 identically protocoled MRI examinations of the cervical spine without contrast, comprehensive stroke exams, and comprehensive brain examinations performed on adult patients from June 30, 2016 through June 30, 2017.
Assessment
MRI exam duration was obtained directly from the image data. Potential predictors for exam length variability were evaluated including patient age, patient gender, performing technologist, patient status (inpatient/outpatient/emergency department), MRI field strength, use of sedation, day of week, and the time of day.
Statistical Tests
Linear regression analysis was performed for each individual variable after correcting for the MRI exam type. A multivariate mixed model was generated to assess for independent associations between the predictors and exam duration.
Results
There was substantial variability in the duration of the selected clinical MRI exams, with standard deviations (SDs) ranging between 19% and 29% of the mean exam length for each individual type of exam. The performing technologist was the most significant identified factor contributing to this variation in exam length; SD = 2.645 (P < 0.001). Compared with outpatient exams, inpatient exams required 4.18 minutes longer to complete (P < 0.001), and emergency department studies 1.86 minutes longer (P = 0.005). Male gender was associated with an additional 1.36 minutes of exam time (P < 0.001).
Data Conclusion
Nontechnical factors are associated with substantial variation in MRI exam times. These variations can be predicted based on relatively simple clinical and demographic factors, with implications for MRI exam scheduling, protocol design, staff training, and workflow design.
Level of Evidence: 4
Technical Efficacy: Stage 6
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ALMWYc
Rapid automated liver quantitative susceptibility mapping
Background
Accurate measurement of the liver iron concentration (LIC) is needed to guide iron‐chelating therapy for patients with transfusional iron overload. In this work, we investigate the feasibility of automated quantitative susceptibility mapping (QSM) to measure the LIC.
Purpose
To develop a rapid, robust, and automated liver QSM for clinical practice.
Study Type
Prospective.
Population
13 healthy subjects and 22 patients.
Field Strength/Sequences
1.5 T and 3 T/3D multiecho gradient‐recalled echo (GRE) sequence.
Assessment
Data were acquired using a 3D GRE sequence with an out‐of‐phase echo spacing with respect to each other. All odd echoes that were in‐phase (IP) were used to initialize the fat‐water separation and field estimation (T2*‐IDEAL) before performing QSM. Liver QSM was generated through an automated pipeline without manual intervention. This IP echo‐based initialization method was compared with an existing graph cuts initialization method (simultaneous phase unwrapping and removal of chemical shift, SPURS) in healthy subjects (n = 5). Reproducibility was assessed over four scanners at two field strengths from two manufacturers using healthy subjects (n = 8). Clinical feasibility was evaluated in patients (n = 22).
Statistical Tests
IP and SPURS initialization methods in both healthy subjects and patients were compared using paired t‐test and linear regression analysis to assess processing time and region of interest (ROI) measurements. Reproducibility of QSM, R2*, and proton density fat fraction (PDFF) among the four different scanners was assessed using linear regression, Bland–Altman analysis, and the intraclass correlation coefficient (ICC).
Results
Liver QSM using the IP method was found to be ~5.5 times faster than SPURS (P < 0.05) in initializing T2*‐IDEAL with similar outputs. Liver QSM using the IP method were reproducibly generated in all four scanners (average coefficient of determination 0.95, average slope 0.90, average bias 0.002 ppm, 95% limits of agreement between –0.06 to 0.07 ppm, ICC 0.97).
Data Conclusion
Use of IP echo‐based initialization enables robust water/fat separation and field estimation for automated, rapid, and reproducible liver QSM for clinical applications.
Level of Evidence: 1
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SVnU02
Liver R2* is affected by both iron and fat: A dual biopsy‐validated study of chronic liver disease
Background
Liver iron content (LIC) in chronic liver disease (CLD) is currently determined by performing an invasive liver biopsy. MRI using R2* relaxometry is a noninvasive alternative for estimating LIC. Fat accumulation in the liver, or proton density fat fraction (PDFF), may be a possible confounder of R2* measurements. Previous studies of the effect of PDFF on R2* have not used quantitative LIC measurement.
Purpose
To assess the associations between R2*, LIC, PDFF, and liver histology in patients with suspected CLD.
Study Type
Prospective.
Population
Eighty‐one patients with suspected CLD.
Field Strength/Sequence
1.5 T. Multiecho turbo field echo to quantify R2*. PRESS MRS to quantify PDFF.
Assessment
Each patient underwent an MR examination, followed by two needle biopsies immediately following the MR examination. The first biopsy was used for conventional histological assessment of LIC, whereas the second biopsy was used to quantitatively measure LIC using mass spectrometry. R2* was correlated with both LIC and PDFF. A correction for the influence of fat on R2* was calculated.
Statistical Tests
Pearson correlation, linear regression, and area under the receiver operating curve.
Results
There was a positive linear correlation between R2* and PDFF (R = 0.69), after removing data from patients with elevated iron levels, as defined by LIC. R2*, corrected for PDFF, was the best method for identifying patients with elevated iron levels, with a correlation of R = 0.87 and a sensitivity and specificity of 87.5% and 98.6%, respectively.
Data Conclusion
PDFF increases R2*.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ALMWHG
Diffusion kurtosis imaging‐derived histogram metrics for prediction of KRAS mutation in rectal adenocarcinoma: Preliminary findings
Background
Although histological examination is the standard method for assessing genetic status, the development of a noninvasive method, which can display the heterogeneity of the whole tumor to supplement genotype analysis, might be important for personalized treatment strategies.
Purpose
To evaluate the potential role of diffusion kurtosis imaging (DKI)‐derived parameters using histogram analysis derived from whole‐tumor volumes for prediction of the status of KRAS mutations in patients with rectal adenocarcinoma.
Study Type
Retrospective.
Subjects
In all, 148 consecutive patients with histologically confirmed rectal adenocarcinoma who were treated at our institution.
Sequence
DKI was performed with a 3.0 T MRI system using a single‐shot echo‐planar imaging sequence with b values of 0, 700, 1400, and 2100 sec/mm2.
Assessment
D, K, and apparent diffusion coefficient (ADC) values were measured using whole‐tumor volume histogram analysis and were compared between different KRAS mutations status.
Statistical Tests
Student's t‐test or Mann–Whitney U‐test, and receiver operating characteristic (ROC) curves were used for statistical analysis.
Results
All the percentile metrics of ADC and D values were significantly lower in the mutated group than those in the wildtype group (all P < 0.05), except for the minimum value of ADC and D (both P > 0.05), while K‐related percentile metrics were higher in the mutated group compared with those in the wildtype group (all P < 0.05). Regarding the comparison of the diagnostic performance of all the histogram metrics, K75th showed the highest AUC value of 0.871, and the corresponding values for sensitivity, specificity, positive predictive value, and negative predictive value were 81.43%, 78.21%, 77.03%, and 82.43%, respectively.
Data Conclusion
DKI metrics with whole‐tumor volume histogram analysis is associated with KRAS mutations, and thus may be useful for predicting the KRAS status of rectal cancers for guiding targeted therapy.
Level of Evidence: 3
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AKsGGp
Accessible magnetic resonance imaging: A review
The role of MRI in diagnostics, prognostics, and discoveries in basic sciences has been well established. However, access to this life‐saving technology is largely restricted to countries in upper‐middle to high‐income groups. In this article, we collate recent global MR scanner density data and group them into six geographical regions based on the WHO classification. We then analyze these data with respect to demographic factors such as population size, life expectancy, the percentage of internet users, and World Bank income grouping. We map these demographic factors to five dimensions or characteristics of accessible MRI, adapting definitions from the healthcare literature. With this background, the study then reviews recent demonstrations of accessible MRI categorized based on main magnetic field strength. We describe demonstrated examples for each of these categories, ranging from ultralow‐field to ultrahigh‐field MRI. Lastly, we review MR methods and associated developments impacting accessible MRI such as increasing/augmenting MR awareness and local expertise, incorporating hardware‐cognizant methods, rapid quantitative imaging, and leveraging innovations from adjacent fields.
The spatial quantification methodology proposed in this study, which works based on cellular distributions within ADC maps of adnexal masses, may provide a helpful computer‐aided strategy for objective characterization of adnexal masses.
Level of Evidence: 5
Technical Efficacy Stage: 6
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SYCmV7
Accuracy of blood flow assessment in cerebral arteries with 4D flow MRI: Evaluation with three segmentation methods
Background
Accelerated 4D flow MRI allows for high‐resolution velocity measurements with whole‐brain coverage. Such scans are increasingly used to calculate flow rates of individual arteries in the vascular tree, but detailed information about the accuracy and precision in relation to different postprocessing options is lacking.
Purpose
To evaluate and optimize three proposed segmentation methods and determine the accuracy of in vivo 4D flow MRI blood flow rate assessments in major cerebral arteries, with high‐resolution 2D PCMRI as a reference.
Study Type
Prospective.
Subjects
Thirty‐five subjects (20 women, 79 ± 5 years, range 70–91 years).
Field Strength/Sequence
4D flow MRI with PC‐VIPR and 2D PCMRI acquired with a 3 T scanner.
Assessment
We compared blood flow rates measured with 4D flow MRI, to the reference, in nine main cerebral arteries. Lumen segmentation in the 4D flow MRI was performed with k‐means clustering using four different input datasets, and with two types of thresholding methods. The threshold was defined as a percentage of the maximum intensity value in the complex difference image. Local and global thresholding approaches were used, with evaluated thresholds from 6–26%.
Statistical Tests
Paired t‐test, F‐test, linear correlation (P < 0.05 was considered significant) along with intraclass correlation (ICC).
Results
With the thresholding methods, the lowest average flow difference was obtained for 20% local (0.02 ± 15.0 ml/min, ICC = 0.97, n = 310) or 10% global (0.08 ± 17.3 ml/min, ICC = 0.97, n = 310) thresholding with a significant lower standard deviation for local (F‐test, P = 0.01). For all clustering methods, we found a large systematic underestimation of flow compared with 2D PCMRI (16.1–22.3 ml/min).
Data Conclusion
A locally adapted threshold value gives a more stable result compared with a globally fixed threshold. 4D flow with the proposed segmentation method has the potential to become a useful reliable clinical tool for assessment of blood flow in the major cerebral arteries.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AIcvti
MRI as a diagnostic biomarker for differentiating primary central nervous system lymphoma from glioblastoma: A systematic review and meta‐analysis
Background
Accurate preoperative differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma is clinically crucial because the treatment strategies differ substantially.
Purpose
To evaluate the diagnostic performance of MRI for differentiating PCNSL from glioblastoma.
Study Type
Systematic review and meta‐analysis.
Subjects
Ovid‐MEDLINE and EMBASE databases were searched to find relevant original articles up to November 25, 2018. The search term combined synonyms for "lymphoma," "glioblastoma," and "MRI."
Field Strength/Sequence
Patients underwent at least one MRI sequence including diffusion‐weighted imaging (DWI), dynamic susceptibility‐weighted contrast‐enhanced imaging (DSC), dynamic contrast‐enhanced imaging (DCE), arterial spin labeling (ASL), susceptibility‐weighted imaging (SWI), intravoxel incoherent motion (IVIM), and magnetic resonance spectroscopy (MRS) using 1.5 or 3 T.
Assessment
Quality assessment was performed according to the Quality Assessment of Diagnostic Accuracy Studies‐2 tool.
Statistical Tests
Hierarchical logistic regression modeling was used to obtain pooled sensitivity and specificity. Meta‐regression was performed.
Results
Twenty‐two studies with 1182 patients were included. MRI sequences demonstrated high overall diagnostic performance with pooled sensitivity of 91% (95% confidence interval [CI], 87–93%) and specificity of 89% (95% CI, 85–93%). The area under the hierarchical summary receiver operating characteristic curve was 0.92 (95% CI, 0.90–0.94). Studies using DSC or ASL showed high diagnostic performance (sensitivity of 93% [95% CI, 89–97%] and specificity of 91% [95% CI, 86–96%]). Heterogeneity was only detected in specificity (I2 = 66.84%) and magnetic field strength was revealed to be a significant factor affecting study heterogeneity.
Data Conclusion
MRI showed overall high diagnostic performance for differentiating PCNSL from glioblastoma, with studies using DSC or ASL showing high diagnostic performance. Therefore, MRI sequences including DSC or ASL is a potential diagnostic tool for differentiating PCNSL from glioblastoma.
Level of Evidence: 3
Technical Efficacy Stage: 2
J. Magn. Reson. Imaging 2019.
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Symptoms that are associated with decreased pancreatic enzyme flow: MRCP assessment
Background
Pancreatic exocrine insufficiency is one of the causes of malabsorption syndrome. In many cases of malabsorption syndrome, pancreatic exocrine insufficiency can be treated with pancreatic enzyme replacement therapy. Therefore, it is important to detect pancreatic endocrine insufficiency as early and accurately as possible. Recent studies have shown that cine‐dynamic MR cholangiopancreatography (MRCP) may be useful to evaluate pancreatic exocrine function
Purpose
To identify abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion for which cine‐dynamic MRCP should be performed to diagnose pancreatic exocrine insufficiency.
Study Type
Prospective.
Population
In all, 111 patients with various types of abdominal symptoms.
Field Strength/Sequence
5 T or 3 T, MRCP with spatially selective inversion recovery pulse (cine‐dynamic MRCP).
Assessment
Cine‐dynamic MRCP was performed and an 18‐question clinical questionnaire on abdominal symptoms was administered. The secretion grade derived from cine‐dynamic MRCP was compared between those answering "yes" and "no" for all 18 items
Statistical Tests
Univariate analysis and further analyzed using multiple regression analysis. The associations between the secretion grade and the items in the clinical questionnaire were analyzed by univariate analysis and further analyzed using multiple regression analysis.
Results
The following three items showed significantly negative correlations with secretion grade: Q9, Does your rectal gas smell foul? (β = –0.44, P = 0.001); Q13, Is stool quantity large? (β = –0.41, P = 0.001); and Q18, Are your stools soft? (β = –0.53, P < 0.001). No significant correlations with exocrine pancreatic function measured by cine‐dynamic MRCP were seen for the remaining 15 abdominal symptom items.
Data Conclusion
Abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion were foul rectal gas, large stool, and soft stool. Pancreatic exocrine insufficiency due to decreased pancreatic enzyme flow may be suspected in patients with these abdominal symptoms.
Level of Evidence: 1
Technical Efficacy Stage: 3
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AJxQ5A
Patient respiratory‐triggered quantitative T2 mapping in the pancreas
Background
Long acquisition times and motion sensitivity limit T2 mapping in the abdomen. Accelerated mapping at 3 T may allow for quantitative assessment of diffuse pancreatic disease in patients during free‐breathing.
Purpose
To test the feasibility of respiratory‐triggered quantitative T2 analysis in the pancreas and correlate T2‐values with age, body mass index, pancreatic location, main pancreatic duct dilatation, and underlying pathology.
Study Type
Retrospective single‐center pilot study.
Population
Eighty‐eight adults.
Field Strength/Sequence
Ten‐fold accelerated multiecho‐spin‐echo 3 T MRI sequence to quantify T2 at 3 T.
Assessment
Two radiologists independently delineated three regions of interest inside the pancreatic head, body, and tail for each acquisition. Means and standard deviations for T2 values in these regions were determined. T2‐value variation with demographic data, intraparenchymal location, pancreatic duct dilation, and underlying pancreatic disease was assessed.
Statistical Tests
Interreader reliability was determined by calculating the interclass coefficient (ICCs). T2 values were compared for different pancreatic locations by analysis of variance (ANOVA). Interpatient associations between T2 values and demographical, clinical, and radiological data were calculated (ANOVA).
Results
The accelerated T2 mapping sequence was successfully performed in all participants (mean acquisition time, 2:48 ± 0:43 min). Low T2 value variability was observed across all patients (intersubject) (head: 60.2 ± 8.3 msec, body: 63.9 ± 11.5 msec, tail: 66.8 ± 16.4 msec). Interreader agreement was good (ICC, 0.82, 95% confidence interval: 0.77–0.86). T2‐values differed significantly depending on age (P < 0.001), location (P < 0.001), main pancreatic duct dilatation (P < 0.001), and diffuse pancreatic disease (P < 0.03).
Data Conclusion
The feasibility of accelerated T2 mapping at 3 T in moving abdominal organs was demonstrated in the pancreas, since T2 values were stable and reproducible. In the pancreatic parenchyma, T2‐values were significantly dependent on demographic and clinical parameters.
Level of Evidence: 4
Technical Efficacy: Stage 1
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SYCeF7
MRI in autosomal dominant polycystic kidney disease
Magnetic resonance imaging (MRI) is increasingly used in autosomal dominant polycystic kidney disease (ADPKD) for diagnosis, classification, assessment of disease progression and treatment response, and for identifying complications. Herein we review the role of MRI in the management of patients with ADPKD. We show how MRI‐derived total kidney volume is a biomarker for assessing ADPKD severity and predicting decline in renal function. We also demonstrate the MR appearances of common complications.
Level of Evidence: 3
Technical Efficacy Stage: 5
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AJxNXs
MRI screening for uterine leiomyosarcoma
Background
Uterine fibroids are a common benign tumor and can be symptomatic, necessitating resection. Surgical myomectomy is an effective treatment option with a risk of disseminating occult uterine leiomyosarcoma (LMS), creating a need for an effective presurgical screening protocol. Clinical collaboration with contrast‐enhanced MRI including T2 and diffusion‐weighted imaging (DWI) can be utilized as a screening exam.
Purpose
To review the accuracy and feasibility of an interdisciplinary prospective contrast‐enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection.
Study Type
Retrospective cohort study.
Population
In all, 1960 adult female patients aged 18–87 undergoing screening MRI pelvis prior to uterine fibroid resection.
Field Strength/Sequence
T1 and T2‐weighted imaging, DWI, and contrast‐enhanced images were acquired at 1.5 T and 3.0 T.
Assessment
Each radiologist at the time of clinical study prospectively designated a confidence level of presence of LMS in the impression, which was reviewed retrospectively. A separate retrospective evaluation of the histologically proven LMS and the false positives was performed for the presence of five MRI features of LMS including low ADC values, intermediate/high T2 signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost‐effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI.
Statistical Tests
Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t‐tests were used to compare demographics and apparent diffusion coefficient values between LMS and false‐positive results.
Results
We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life‐year gained.
Data Conclusion
MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians.
Level of Evidence: 3
Technical Efficacy Stage: 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SSSXcR
Factors predicting the time‐length variability of identically protocoled MRI exams
Background
Clinical variability in MRI exam durations can impede efficient MRI utilization. There is a paucity of data regarding the degree of variability of identically protocoled MRI studies and when nontechnological factors contribute to time‐length variations in MRI exams.
Purpose
To measure the magnitude of variation in MRI exam duration for identically protocoled MRI exams and to identify potential contributors to variations in MRI exam times.
Study Type
Retrospective.
Subjects
2705 identically protocoled MRI examinations of the cervical spine without contrast, comprehensive stroke exams, and comprehensive brain examinations performed on adult patients from June 30, 2016 through June 30, 2017.
Assessment
MRI exam duration was obtained directly from the image data. Potential predictors for exam length variability were evaluated including patient age, patient gender, performing technologist, patient status (inpatient/outpatient/emergency department), MRI field strength, use of sedation, day of week, and the time of day.
Statistical Tests
Linear regression analysis was performed for each individual variable after correcting for the MRI exam type. A multivariate mixed model was generated to assess for independent associations between the predictors and exam duration.
Results
There was substantial variability in the duration of the selected clinical MRI exams, with standard deviations (SDs) ranging between 19% and 29% of the mean exam length for each individual type of exam. The performing technologist was the most significant identified factor contributing to this variation in exam length; SD = 2.645 (P < 0.001). Compared with outpatient exams, inpatient exams required 4.18 minutes longer to complete (P < 0.001), and emergency department studies 1.86 minutes longer (P = 0.005). Male gender was associated with an additional 1.36 minutes of exam time (P < 0.001).
Data Conclusion
Nontechnical factors are associated with substantial variation in MRI exam times. These variations can be predicted based on relatively simple clinical and demographic factors, with implications for MRI exam scheduling, protocol design, staff training, and workflow design.
Level of Evidence: 4
Technical Efficacy: Stage 6
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ALMWYc
Rapid automated liver quantitative susceptibility mapping
Background
Accurate measurement of the liver iron concentration (LIC) is needed to guide iron‐chelating therapy for patients with transfusional iron overload. In this work, we investigate the feasibility of automated quantitative susceptibility mapping (QSM) to measure the LIC.
Purpose
To develop a rapid, robust, and automated liver QSM for clinical practice.
Study Type
Prospective.
Population
13 healthy subjects and 22 patients.
Field Strength/Sequences
1.5 T and 3 T/3D multiecho gradient‐recalled echo (GRE) sequence.
Assessment
Data were acquired using a 3D GRE sequence with an out‐of‐phase echo spacing with respect to each other. All odd echoes that were in‐phase (IP) were used to initialize the fat‐water separation and field estimation (T2*‐IDEAL) before performing QSM. Liver QSM was generated through an automated pipeline without manual intervention. This IP echo‐based initialization method was compared with an existing graph cuts initialization method (simultaneous phase unwrapping and removal of chemical shift, SPURS) in healthy subjects (n = 5). Reproducibility was assessed over four scanners at two field strengths from two manufacturers using healthy subjects (n = 8). Clinical feasibility was evaluated in patients (n = 22).
Statistical Tests
IP and SPURS initialization methods in both healthy subjects and patients were compared using paired t‐test and linear regression analysis to assess processing time and region of interest (ROI) measurements. Reproducibility of QSM, R2*, and proton density fat fraction (PDFF) among the four different scanners was assessed using linear regression, Bland–Altman analysis, and the intraclass correlation coefficient (ICC).
Results
Liver QSM using the IP method was found to be ~5.5 times faster than SPURS (P < 0.05) in initializing T2*‐IDEAL with similar outputs. Liver QSM using the IP method were reproducibly generated in all four scanners (average coefficient of determination 0.95, average slope 0.90, average bias 0.002 ppm, 95% limits of agreement between –0.06 to 0.07 ppm, ICC 0.97).
Data Conclusion
Use of IP echo‐based initialization enables robust water/fat separation and field estimation for automated, rapid, and reproducible liver QSM for clinical applications.
Level of Evidence: 1
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SVnU02
Liver R2* is affected by both iron and fat: A dual biopsy‐validated study of chronic liver disease
Background
Liver iron content (LIC) in chronic liver disease (CLD) is currently determined by performing an invasive liver biopsy. MRI using R2* relaxometry is a noninvasive alternative for estimating LIC. Fat accumulation in the liver, or proton density fat fraction (PDFF), may be a possible confounder of R2* measurements. Previous studies of the effect of PDFF on R2* have not used quantitative LIC measurement.
Purpose
To assess the associations between R2*, LIC, PDFF, and liver histology in patients with suspected CLD.
Study Type
Prospective.
Population
Eighty‐one patients with suspected CLD.
Field Strength/Sequence
1.5 T. Multiecho turbo field echo to quantify R2*. PRESS MRS to quantify PDFF.
Assessment
Each patient underwent an MR examination, followed by two needle biopsies immediately following the MR examination. The first biopsy was used for conventional histological assessment of LIC, whereas the second biopsy was used to quantitatively measure LIC using mass spectrometry. R2* was correlated with both LIC and PDFF. A correction for the influence of fat on R2* was calculated.
Statistical Tests
Pearson correlation, linear regression, and area under the receiver operating curve.
Results
There was a positive linear correlation between R2* and PDFF (R = 0.69), after removing data from patients with elevated iron levels, as defined by LIC. R2*, corrected for PDFF, was the best method for identifying patients with elevated iron levels, with a correlation of R = 0.87 and a sensitivity and specificity of 87.5% and 98.6%, respectively.
Data Conclusion
PDFF increases R2*.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2019.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ALMWHG
Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke
Abstract
Purpose
High-resolution vessel wall imaging (HRVWI) by MRI is a novel noninvasive imaging tool which provides direct information regarding vessel wall pathologies. The utility of HRVWI in differentiating various intracranial vasculopathies among ischemic stroke is still evolving.
Methods
Consecutive ischemic stroke/TIA patients within 2 weeks of symptom onset between January 2016 to December 2017, with symptomatic vessel stenosis of 50% or more/occlusion on baseline luminal imaging studies were recruited into the study. Stroke subtypes were classified as per TOAST classification initially on the basis of luminal imaging findings alone and subsequently after incorporation of HRVWI findings as well.
Results
Forty-nine subjects were recruited into the study. The median age of the population was 42 years (range 11 to 75) with 69% being males. Incorporation of HRVWI findings classified 38.8% subjects into intracranial atherosclerotic disease (ICAD), 32.6% as stroke of other determined aetiology (ODE) (inflammatory vasculopathy [IVas] being the major subgroup [81.2%]) and 28.6% into stroke of undetermined aetiology (UE). HRVWI enabled a diagnostic reclassification in an additional 47.3% among the baseline UE category as against luminal imaging findings alone. ICAD was likelier to have eccentric vessel wall thickening, eccentric vessel wall enhancement and T2 juxtaluminal hyperintensity with surrounding hypointensity (P < 0.001), while IVas were more likely to exhibit concentric vessel wall thickening with homogenous enhancement (P < 0.001).
Conclusion
HRVWI is a useful noninvasive adjunctive tool in the diagnostic evaluation of intracranial vasculopathies, with maximum benefit in ICAD and IVas subtypes.
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Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke
Abstract
Purpose
High-resolution vessel wall imaging (HRVWI) by MRI is a novel noninvasive imaging tool which provides direct information regarding vessel wall pathologies. The utility of HRVWI in differentiating various intracranial vasculopathies among ischemic stroke is still evolving.
Methods
Consecutive ischemic stroke/TIA patients within 2 weeks of symptom onset between January 2016 to December 2017, with symptomatic vessel stenosis of 50% or more/occlusion on baseline luminal imaging studies were recruited into the study. Stroke subtypes were classified as per TOAST classification initially on the basis of luminal imaging findings alone and subsequently after incorporation of HRVWI findings as well.
Results
Forty-nine subjects were recruited into the study. The median age of the population was 42 years (range 11 to 75) with 69% being males. Incorporation of HRVWI findings classified 38.8% subjects into intracranial atherosclerotic disease (ICAD), 32.6% as stroke of other determined aetiology (ODE) (inflammatory vasculopathy [IVas] being the major subgroup [81.2%]) and 28.6% into stroke of undetermined aetiology (UE). HRVWI enabled a diagnostic reclassification in an additional 47.3% among the baseline UE category as against luminal imaging findings alone. ICAD was likelier to have eccentric vessel wall thickening, eccentric vessel wall enhancement and T2 juxtaluminal hyperintensity with surrounding hypointensity (P < 0.001), while IVas were more likely to exhibit concentric vessel wall thickening with homogenous enhancement (P < 0.001).
Conclusion
HRVWI is a useful noninvasive adjunctive tool in the diagnostic evaluation of intracranial vasculopathies, with maximum benefit in ICAD and IVas subtypes.
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Diprosopus: a review of the aetiology and case report of early surgery in a 7-week-old infant with partial facial duplication
Abstract
Diprosopus is a rare craniofacial anomaly and is considered a subgroup of conjoined twinning. It encompasses a broad spectrum of duplications from single structure doubling to two completely formed heads on one neck. The aetiology of diprosopus remains a controversial topic, and many hypotheses exist. A multifactorial causal relationship is feasible because of the coexistence of other internal system anomalies of cardiac, gastrointestinal, neurological and respiratory origin. Ovid and PubMed databases were searched, using the key words: "diprosopus", "craniofacial duplication" and "duplicated mandible". The identified literature and key referenced articles therein were examined. The purpose was to consolidate the existing body of knowledge on the aetiology and management of diprosopus in order to improve our understanding of this rare condition. Our case report is relatively unique in that it represents a complete duplication of the mandible. Other tissues that were duplicated include the tongue, floor of mouth and the lower lip. It was hypothesised that associated growth abnormalities of the facial skeleton could undergo spontaneous correction if the duplicated mandible and associated tissues were excised early. On review, surgery is the only treatment that can offer functional, aesthetic and psychological improvement. Most patients who were offered surgery (in the reviewed literature) had a partial facial duplication. Surgery is usually deferred until the patient is older when more soft tissue is available to perform the reconstruction and when there would possibly be less growth restriction due to growth centre manipulation. This finding on the timing of surgery was in direct conflict with our hypothesis.
Level of Evidence: Level V, therapeutic study.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VT8hrU
Diprosopus: a review of the aetiology and case report of early surgery in a 7-week-old infant with partial facial duplication
Abstract
Diprosopus is a rare craniofacial anomaly and is considered a subgroup of conjoined twinning. It encompasses a broad spectrum of duplications from single structure doubling to two completely formed heads on one neck. The aetiology of diprosopus remains a controversial topic, and many hypotheses exist. A multifactorial causal relationship is feasible because of the coexistence of other internal system anomalies of cardiac, gastrointestinal, neurological and respiratory origin. Ovid and PubMed databases were searched, using the key words: "diprosopus", "craniofacial duplication" and "duplicated mandible". The identified literature and key referenced articles therein were examined. The purpose was to consolidate the existing body of knowledge on the aetiology and management of diprosopus in order to improve our understanding of this rare condition. Our case report is relatively unique in that it represents a complete duplication of the mandible. Other tissues that were duplicated include the tongue, floor of mouth and the lower lip. It was hypothesised that associated growth abnormalities of the facial skeleton could undergo spontaneous correction if the duplicated mandible and associated tissues were excised early. On review, surgery is the only treatment that can offer functional, aesthetic and psychological improvement. Most patients who were offered surgery (in the reviewed literature) had a partial facial duplication. Surgery is usually deferred until the patient is older when more soft tissue is available to perform the reconstruction and when there would possibly be less growth restriction due to growth centre manipulation. This finding on the timing of surgery was in direct conflict with our hypothesis.
Level of Evidence: Level V, therapeutic study.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VT8hrU
Regarding Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies
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Long‐term Survival in Head and Neck Cancer: Impact of Site, Stage, Smoking, and Human Papillomavirus Status
Objectives/Hypothesis
Literature examining long‐term survival in head and neck squamous cell carcinoma (HNSCC) with human papillomavirus (HPV) status is lacking. We compare 10‐year overall survival (OS) rates for cases to population‐based controls.
Study Design
Prospective cohort study.
Methods
Cases surviving 5 years postdiagnosis were identified from the Carolina Head and Neck Cancer Study. We examined 10‐year survival by site, stage, p16, and treatment using Kaplan‐Meier and Cox proportional hazard models. Cases were compared to age‐matched, noncancer controls with stratification by p16 and smoking status.
Results
Ten‐year OS for HNSCC is less than controls. In 581 cases, OS differed between sites with p16+ oropharynx having the most favorable prognosis (87%), followed by oral cavity (69%), larynx (67%), p16− oropharynx (56%), and hypopharynx (51%). Initial stage, but not treatment, also impacted OS. When compared to controls matched on smoking status, the hazard ratio (HR) for death in p16+ oropharynx cases was 1.5 (95% confidence interval [CI]: 0.7‐3.1) for smokers and 2.4 (95% CI: 0.7‐8.8) for nonsmokers. Similarly, HR for death in non–HPV‐associated HNSCC was 2.2 (95% CI: 1.7‐3.0) for smokers and 2.4 (95% CI: 1.4‐4.9) for nonsmokers.
Conclusions
OS for HNSCC cases continues to decrease 5 years posttreatment, even after stratification by p16 and smoking status. Site, stage, smoking, and p16 status are significant factors. These data provide important prognostic information for HNSCC.
Level of Evidence
2 Laryngoscope, 2019
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2M7b248
Regarding Evaluation and Treatment of Pulsatile Tinnitus Associated With Sigmoid Sinus Wall Anomalies
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2spGsK7
Long‐term Survival in Head and Neck Cancer: Impact of Site, Stage, Smoking, and Human Papillomavirus Status
Objectives/Hypothesis
Literature examining long‐term survival in head and neck squamous cell carcinoma (HNSCC) with human papillomavirus (HPV) status is lacking. We compare 10‐year overall survival (OS) rates for cases to population‐based controls.
Study Design
Prospective cohort study.
Methods
Cases surviving 5 years postdiagnosis were identified from the Carolina Head and Neck Cancer Study. We examined 10‐year survival by site, stage, p16, and treatment using Kaplan‐Meier and Cox proportional hazard models. Cases were compared to age‐matched, noncancer controls with stratification by p16 and smoking status.
Results
Ten‐year OS for HNSCC is less than controls. In 581 cases, OS differed between sites with p16+ oropharynx having the most favorable prognosis (87%), followed by oral cavity (69%), larynx (67%), p16− oropharynx (56%), and hypopharynx (51%). Initial stage, but not treatment, also impacted OS. When compared to controls matched on smoking status, the hazard ratio (HR) for death in p16+ oropharynx cases was 1.5 (95% confidence interval [CI]: 0.7‐3.1) for smokers and 2.4 (95% CI: 0.7‐8.8) for nonsmokers. Similarly, HR for death in non–HPV‐associated HNSCC was 2.2 (95% CI: 1.7‐3.0) for smokers and 2.4 (95% CI: 1.4‐4.9) for nonsmokers.
Conclusions
OS for HNSCC cases continues to decrease 5 years posttreatment, even after stratification by p16 and smoking status. Site, stage, smoking, and p16 status are significant factors. These data provide important prognostic information for HNSCC.
Level of Evidence
2 Laryngoscope, 2019
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