Introduction: The facial nerve is a small structure that can be displaced into unexpected positions by tumors growing within the parotid gland.
Hololens2 is an augmented reality headset which allows ...the holographic projection of images onto the wearers view of their surroundings creating a mixed image.
In this study we assessed the ability of 3T MRI and Hololens2 to visualise the path of facial nerve around parotid tumors and the impact on surgical planning.
Methods: 18 patients with parotid neoplasms underwent 3T MRI imaging. MRI images were subsequently segmented using 3D slicer software and uploaded into a mixed reality device (Microsoft HoloLens2) using ApoQlar software. This created a 3D hologram of the facial nerve and the relations to the surrounding structure.Images were later compared to observations made intraoperatively.
Results: 18 patients with parotid neoplasms were included in this study. 14 females and 4 males between the ages of 18 and 66. This included 13 benign and 5 malignant neoplasms.
Identical match of projected 3D hologram images to the surgical findings was present in 100% of the patients. Age, sex, tumor type, size, site did not make a change in the predicted images.
Conclusions: The facial nerve can be faithfully visually traced in 3D hologram as it passes through the parotid gland and weaves its way past resident tumors.
This allows surgeons to be forewarned of unusual configuration of the facial nerve and also opens up the opportunity to plan and execute operations in a way that minimizes nerve contact.
Objective
Determine feasibility of vocal fold (VF) abduction and adduction assessment by cine magnetic resonance imaging (cine-MRI)
Methods
Cine-MRI of the VF was performed on five healthy and nine ...unilateral VF paralysis (UVFP) participants using an axial gradient echo acquisition with temporal resolution of 0.7 s. VFs were continuously imaged with cine-MRI during a 10-s period of quiet respiration and phonation. Scanning was repeated twice within an individual session and then once again at a 1-week interval. Asymmetry of VF position during phonation (VF phonation asymmetry, VFPa) and respiration (VF respiration asymmetry, VFRa) was determined. Percentage reduction in total glottal area between respiration and phonation (VF abduction potential, VFAP) was derived to measure overall mobility. An un-paired t-test was used to compare differences between groups. Intra-session, inter-session and inter-reader repeatability of the quantitative metrics was evaluated using intraclass correlation coefficient (ICC).
Results
VF position asymmetry (VFPa and VFRa) was greater (
p
=0.012;
p
=0.001) and overall mobility (VFAP) was lower (
p
=0.008) in UVFP patients compared with healthy participants. ICC of repeatability of all metrics was good, ranged from 0.82 to 0.95 except for the inter-session VFPa (0.44).
Conclusion
Cine-MRI is feasible for assessing VF abduction and adduction. Derived quantitative metrics have good repeatability.
Key points
•
Cine-MRI is used to assess vocal folds (VFs) mobility: abduction and adduction.
•
New quantitative metrics are derived from VF position and abduction potential.
•
Cine-MRI able to depict the difference between normal and abnormal VF mobility.
•
Cine-MRI derived quantitative metrics have good repeatability.
Background/Objective
Intraoperative parathyroid hormone (IOPTH) monitoring during surgery for primary hyperparathyroidism (PHPT) could improve cure rate and simplify current care pathways. This study ...assesses the performance of US, MIBI and IOPTH monitoring and their impact on outcomes and perioperative strategy.
Design
This is a retrospective study of a prospectively maintained database of patients who underwent parathyroidectomy guided by preoperative US, MIBI and IOPTH monitoring. Test performance (sensitivity, specificity, PPV, NPV, accuracy) and IOPTH added value (percentage of patients in whom test contributed to achieving cure) were calculated.
Results
A total of 617 patients (median age 59 years, 75% females), 603 (97.7%) of them cured, were included in analysis. Sensitivity of US was higher than MIBI (78.2% vs 70%, P < 0.05), but both were inferior to IOPTH (98.6%, P < 0.05). US and MIBI were more sensitive at detecting single gland disease (SGD) than multigland disease (MGD) (85% vs 55% and 77.5% vs 45.5%, respectively, P < 0.05), while IOPTH performed well in both situations (98.8% vs 96.7%, P > 0.05). In 41 patients with incorrect US predictions, MIBI gave correct result only in 12 (29.3%) cases, while IOPTH gave correct predictions in all but one patient (97.6%). Minimally invasive parathyroidectomy (MIP) was completed in 409 patients, with a similar completion rate regardless whether both or one scan was positive. IOPTH added value was significant in whole cohort (14%) and in subgroups of patients with concordant vs discordant scans, minimally invasive vs conventional surgery, and initial vs reoperative surgery.
Conclusions
Intraoperative parathyroid hormone monitoring is more accurate at predicting cure than US and MIBI are at identifying abnormal glands in patients undergoing parathyroidectomy for PHPT and significantly contributes to cure rate in range of clinical scenarios. This implies that its routine use could facilitate successful surgery in patients with single positive imaging and increase number of MIPs while maintaining high cure rate.
Diffusion MRI characteristics assessed by apparent diffusion coefficient (ADC) histogram analysis in head and neck squamous cell carcinoma (HNSCC) have been reported as helpful in classifying tumours ...based on diffusion characteristics. There is little reported on HNSCC lymph nodes classification by diffusion characteristics. The aim of this study was to determine whether pretreatment nodal microstructural diffusion MRI characteristics can classify diseased nodes of patients with HNSCC from normal nodes of healthy volunteers. Seventy‐nine patients with histologically confirmed HNSCC prior to chemoradiotherapy, and eight healthy volunteers, underwent diffusion‐weighted (DW) MRI at a 1.5‐T MR scanner. Two radiologists contoured lymph nodes on DW (b = 300 s/m2) images. ADC, distributed diffusion coefficient (DDC) and alpha (α) values were calculated by monoexponential and stretched exponential models. Histogram analysis metrics of drawn volume were compared between patients and volunteers using a Mann–Whitney test. The classification performance of each metric between the normal and diseased nodes was determined by receiver operating characteristic (ROC) analysis. Intraclass correlation coefficients determined interobserver reproducibility of each metric based on differently drawn ROIs by two radiologists. Sixty cancerous and 40 normal nodes were analysed. ADC histogram analysis revealed significant differences between patients and volunteers (p ≤0.0001 to 0.0046), presenting ADC distributions that were more skewed (1.49 for patients, 1.03 for volunteers; p = 0.0114) and ‘peaked’ (6.82 for patients, 4.20 for volunteers; p = 0.0021) in patients. Maximum ADC values exhibited the highest area under the curve (AUC 0.892). Significant differences were revealed between patients and volunteers for DDC and α value histogram metrics (p ≤0.0001 to 0.0044); the highest AUC were exhibited by maximum DDC (0.772) and the 25th percentile α value (0.761). Interobserver repeatability was excellent for mean ADC (ICC = 0.88) and the 25th percentile α value (ICC = 0.78), but poor for all other metrics. These results suggest that pretreatment microstructural diffusion MRI characteristics in lymph nodes, assessed by ADC and α value histogram analysis, can identify nodal disease.
Significant differences revealed between patients' and healthy volunteers' lymph nodes of apparent diffusion coefficient (ADC), distributed diffusion coefficient (DDC) and alpha (α) values histogram analysis. Interobserver repeatability was excellent for mean ADC and 25th percentile α value. Pre‐treatment microstructural diffusion MRI characteristics in lymph nodes, assessed by ADC and α value histogram analysis can identify nodal disease.
Highlights • Commonly used non-linear regression algorithms are prone to hit local minima resulting in fitting errors and fitted parameters that depend on their initialization. • Pharmacokinetic ...parameters quantified from DCE-MRI using the proposed Bayesian Inference algorithms are more accurate and the quantification is not affected by their initialization. • These assets of the proposed Bayesian Inference algorithm are essential to train and validate robust CAD software based on DCE MRI that could be used between different sites. • The performance of the proposed Bayesian inference algorithm was consistent on two different populations, acquired with different settings.
Inflammatory conditions are the most common pathology to affect the salivary glands, of which sialolithiasis is the most frequent etiology. This article reviews the role of all imaging modalities in ...the management of inflammatory salivary disease. The technique for performing salivary gland ultrasound is described with some common pitfalls. The typical features of a comprehensive range of pathology including obstructive and infective sialadenitis, Sjogren’s syndrome, sarcoidosis, HIV sialopathy, and their complications are described.
Carcinoma Cuniculatum Arising in the Tongue Thavaraj, Selvam; Cobb, Alistair; Kalavrezos, Nicholas ...
Head & neck pathology (Totowa, N.J.),
03/2012, Letnik:
6, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Carcinoma cuniculatum (CC) is a rare, distinct clinico-pathological variant of squamous cell carcinoma (SCC) that is defined histologically by the characteristic infiltrative pattern of a deep, ...broad, and complex proliferation of stratified squamous epithelium with keratin cores and keratin-filled crypts. Herein, we present a case report of CC of the oral tongue and discuss its diagnosis, management, and outcome, as well as briefly review the world literature. To our knowledge, this is the first documented case of CC of the tongue to be reported in the English literature. We draw attention to its clinico-pathological features and highlight that awareness of this entity as a distinct variant of SCC facilitates its correct management.
Objective: To describe the long‐term audiologic findings in pediatric patients with enlarged vestibular aqueducts (EVAs). The relationship between the hearing loss (HL) and the dimensions of the EVA, ...enlarged endolymphatic duct (EED), or enlarged endolymphatic sac (EES) was also investigated. The influence of a Pendred syndrome (PS) diagnosis on the audiologic phenotype was also examined.
Study Design: Retrospective analysis of case notes and imaging records, including measurement of the dimensions of the EVA, EED, and EES.
Setting: Tertiary referral center.
Patients: Twenty‐seven patients (21 female, 6 male) had an EVA in at least one ear. Eighty‐five percent had bilateral enlargements. Median age at onset of follow‐up was 5.0 years, and median follow‐up was 9.7 years.
Main Outcome Measures: Hearing thresholds at the start and end of follow‐up, rate of progression of HL, history of sudden drops in hearing.
Results: All ears with an EVA had HL. Average HL at the start and end of follow‐up was severe. Thirty‐seven percent of patients had progressive HL, and 33% reported sudden drops in hearing. Progression was significantly associated with a history of sudden drops. PS patients had worse hearing at the end of follow‐up as compared with nonsyndromic patients. There was no evidence of a relationship between the dimensions of the EVA, EED, or EES and the severity or progression of HL.
Conclusions: Patients with EVAs should be advised to avoid known trigger factors for sudden drops in hearing (e.g., minor head trauma). A diagnosis of PS may be associated with a worse audiologic prognosis.
PDF
