The accurate diagnosis of vascular anomalies (VAs) is considered a challenging endeavor. Misdiagnosis of VAs can lead clinicians in the wrong direction, such as the performance of an unnecessary biopsy or inappropriate surgical procedures, which can potentially lead to unforeseen consequences and increase the risk of patient injury. The purpose of the present study was to develop an approach for the diagnosis of VAs of the oral and maxillofacial region based on computed tomography (CT), magnetic resonance imaging (MRI) and dynamic contrast-enhanced MRI (DCE-MRI). In the present study, the CT and MR images of 87 VAs were examined, and the following imaging features were evaluated: Detectability of the lesion, the periphery of the lesion, the inner nature of the lesion, the density of the lesion on CT, the signal intensity of the lesion on MRI, the detectability of phleboliths and the shape of the lesion. A total of 29 lesions were further evaluated using the contrast index (CI) curves created from the DCE-MRI images. A diagnostic diagram, which is based on the imaging features of VAs and CI curve patterns, was subsequently extrapolated. The results obtained demonstrated that the VAs were detected more readily by MRI compared with CT, whereas the detectability of phleboliths was superior when using CT compared with MRI. VAs showed a propensity for homogeneous isodensity on CT, whereas, by contrast, they exhibited a propensity for heterogeneous hyperdensity on CE-CT. VAs also showed a propensity for homogeneous intermediate signal intensity when performing T1-weighted imaging (T1WI), heterogeneous high signal intensity when performing short tau inversion recovery MRI, and heterogeneous high signal intensity when performing fat-saturated CE-T1WI. The CI curves of VAs were found to exhibit a specific pattern: Of the 29 CI curves, 23 (79.3%) showed early weak enhancement, followed by a plateau leading up to 400-600 sec. An imaging-based diagnostic diagram was ultimately formulated. This diagram can act as an aid for radiologists when they are expecting to find a VA, and hopefully serve the purpose of simplifying the diagnostic process. Taken together, the findings of the present study indicated that DCE-MRI may be considered a useful tool for the diagnosis of VAs.
The purpose of this study was to use panoramic radiography and cone beam computed tomography images to investigate (1) the accuracy of these methods concerning osteopenia and osteoporosis diagnosis, and (2) the correlation between presence of stylohyoid ligament calcification and osteopenia and osteoporosis. A hundred seventy-one images from digital archive were enrolled in this study. All panoramic radiography and cone beam computed tomography images were obtained using the Veraviewepocs 3D system and observed at i-VIEW-3DX software. For osteopenia and osteoporosis diagnosis, the mandibular cortex was assessed. Presence of stylohyoid ligament calcification was also assessed and mineralization in all parts of the stylohyoid complex was considered. All recorded data were referred to statistical analysis and the significance level was set at 5%. There is an agreement between the imaging modalities for osteopenia and osteoporosis diagnosis, since the rate of disagreement is 21.6%. The results confirmed the osteoporosis diagnosis in elderly women and the correlation between osteopenia and osteoporosis diagnosis and the presence of stylohyoid ligament calcification (p 0.06). The present study suggests that (1) panoramic radiography and computed tomography images are accurate enough for osteopenia and osteoporosis diagnosis with low disagreement rate between methods and (2) there is a significant correlation between presence of stylohyoid ligament calcification and osteopenia and osteoporosis diagnosis in elderly women.
We evaluated the usefulness of simple diffusion kurtosis (SD) imaging, which was developed to generate diffusion kurtosis images simultaneously with an apparent diffusion coefficient (ADC) map for 27 cystic disease lesions in the head and neck region. The mean kurtosis (MK) and ADC values were calculated for the cystic space. The MK values were dentigerous cyst (DC): 0.74, odontogenic keratocyst (OKC): 0.86, ranula (R): 0.13, and mucous cyst (M): 0, and the ADC values were DC: 1364 × 10−6 mm2/s, OKC: 925 × 10−6 mm2/s, R: 2718 × 10−6 mm2/s, and M: 2686 × 10−6 mm2/s. The MK values of DC and OKC were significantly higher than those of R and M, whereas their ADC values were significantly lower. One reason for the characteristic signal values in diffusion-weighted images of DC may be related to content components such as fibrous tissue and exudate cells. When imaging cystic disease in the head and neck region using SD imaging, the maximum b-value setting at the time of imaging should be limited to approximately 1200 s/mm2 for accurate MK value calculation. This study is the first to show that the MK values of DC are characteristically higher than those of other cysts.
Mandibular bone depression, also known as Stafne bone cavity, is defined as a bone depression filled mainly with salivary gland tissue. Parotid gland bone defects are infrequently observed. We report the case of a 52-year-old male patient who underwent radiographic examinations due to temporomandibular joint dysfunction, and a radiolucent area was detected in the mandibular ramus, with a provisional diagnosis of traumatic bone cyst or parotid mandibular bone defect. The patient was then referred for magnetic resonance imaging, which demonstrated a hyperintense area eroding the mandibular ramus, which corresponded to glandular tissue. Although the defect was a benign lesion, radiolucencies in the mandibular ramus lead to concerns among professionals, because their radiographic features can resemble various intrabony neoplastic lesions, such as giant cell tumors or benign tumors of the parotid gland.
This study aimed to compare the efficacy of late‑course accelerated hyperfractionation radiotherapy (LAFR) and concurrent chemoradiotherapy (CRT) in patients with esophageal carcinoma and to evaluate the side effects of the two treatments. A total of 22 patients with primary esophageal squamous cell carcinoma were prospectively treated with LAFR, while 25 patients, during the same period, served as the control group and received CRT. The 22 patients in the LAFR group received conventional fractionated radiotherapy of 30 Gy over a 3‑week period (5 daily fractions of 2.0 Gy per week), followed by accelerated hyperfractionated radiotherapy of 30 Gy for 2 weeks (twice daily, 1.5 Gy per fraction, with a minimal interval of 6 h between fractions, 10 fractions per week). The 25 patients in the CRT group received conventional fractionated radiotherapy of 50 Gy for 5 weeks, with 5 daily fractions of 2.0 Gy per week. Chemotherapy was started on the first day of irradiation (cisplatin 52.5 mg/m2 on Day 1 and 5‑fluorouracil 700 mg/m2 on Days 1‑5, repeated four times every 28 days). The median survival time in the LAFR and CRT groups were noted to be 17 and 21 months, respectively. The 1‑ and 2‑year overall survival rates were 63.6 and 31.6% in the LAFR group and 76 and 57.4% in the CRT group (χ2=1.670; P=0.196). The median local control in the LAFR group was 17 months, while that in the CRT group was not determined. The 1‑ and 2‑year local control rates were 54.5 and 39% in the LAFR group while those in the CRT group were 82.2 and 66.1% (χ2=3.527; P=0.060). The overall survival and local control rates of the LAFR group were lower than those of the CRT group, although the difference was not significant. The metastasis rates of the two groups were also not significantly different (χ2=0.030; P=0.862). Both acute and late adverse events in the two groups were tolerated. The side effects, including hematological toxicities, severe nausea and vomiting, and severe anorexia were significantly less in the LAFR group than those in the CRT group (P<0.05). In this small‑sample exploratory study, the overall survival and local control rates were lower with LAFR than with CRT, but the difference was not significant. Moreover, LAFR was found to have fewer side effects and be more cost‑effective compared to CRT. The long‑term effects on LAFR survival should be evaluated in a phase III clinical trial.
The usefulness of the field‑in‑field with two reference points (FIF w/ 2RP) method, in which the dose reference points are set simultaneously at two positions in the irradiation field and the high‑dose range is completely eliminated, was examined in the present study with the aim of decreasing acute skin toxicity in adjuvant breast radiotherapy (RT). A total of 573 patients with breast cancer who underwent postoperative whole breast RT were classified into 178 cases with wedge (W) method, 142 cases with field‑in‑field without 2 reference points (FIF w/o 2RP) method and 253 cases with FIF w/ 2RP method. Using the FIF w/ 2RP method, the high‑dose range was the lowest among the three irradiation methods. The planning target volume (PTV) V105% and the breast PTV for evaluation (BPe) V105% decreased to 0.09 and 0.10%, respectively. The FIF w/ 2RP method vs. the FIF w/o 2RP method had a strong association (η) with PTV V105% (η=0.79; P<0.001) and BPe V105% (η=0.76; P<0.001). The FIF w/ 2RP method had a significant impact on lowering the skin toxicity grade in weeks 3 and 4, and increasing the occurrence of skin toxicity grade 0. The FIF w/ 2RP method vs. the W method had a moderate association with skin toxicity grade at week 3 (η=0.49; P<0.001). Using the FIF w/ 2RP method, the high‑dose range V105% of the target decreased to 0%, and skin adverse events were decreased in conjunction. For patients with early‑stage breast cancer, particularly patients with relatively small‑sized breasts, the FIF w/ 2RP method may be an optimal irradiation method.
The objective of this study was to assess the types and frequencies of basilar expansion of the sphenoidal sinus and internal septa by using cone beam computed tomography. Archived images from 300 adult subjects of both genders were retrieved. A descriptive analysis relating age and gender to basilar expansion of the sphenoidal sinus and internal septa types and frequencies was performed. The associations between basilar expansion of the sphenoidal sinus, internal septa and gender for each age group were assessed using the chi-square test or Fisher’s exact test. Among all the images evaluated, 69% showed basilar expansion of the sphenoidal sinus, of which 81% were considered critical. Internal septa were observed in 60% of the images. There was no relationship between the presence of basilar expansion of the sphenoidal sinus and gender and age. Internal septa were independent of gender; however, of the subjects older than age 40, 36% had only a main septum, 6% had accessory septa, and 18% had both types of septa. Cone beam computed tomography is an accurate method that should be considered for the evaluation of this anatomic segment in order to avoid unnecessary exposure to radiation.
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