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Lobo R, Turk S, Bapuraj JR, Srinivasan A. Advanced CT and MR Imaging of the Posttreatment Head and Neck. Neuroimaging Clin N Am 2021; 32:133-144. [PMID: 34809834 DOI: 10.1016/j.nic.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in MR and computed tomography (CT) techniques have resulted in greater fidelity in the assessment of treatment response and residual tumor on one hand and the assessment of recurrent head and neck malignancies on the other hand. The advances in MR techniques primarily are related to diffusion and perfusion imaging which rely on the intrinsic architecture of the tissues and organ systems. The techniques exploit the density of the cellular architecture; and the vascularity of benign and malignant lesions which in turn affect the changes in the passage of contrast through the vascular bed. Dual-energy CT and CT perfusion are the major advances in CT techniques that have found significant applications in the assessment of treatment response and tumor recurrence.
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Affiliation(s)
- Remy Lobo
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Sevcan Turk
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - J Rajiv Bapuraj
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, B2A209, Ann Arbor, MI 48109, USA
| | - Ashok Srinivasan
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, B2A209, Ann Arbor, MI 48109, USA.
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Abdel Razek AAK, Saleh GA, Denever AT, Mukherji SK. Preimaging and Postimaging of Graft and Flap in Head and Neck Reconstruction. Magn Reson Imaging Clin N Am 2021; 30:121-133. [PMID: 34802575 DOI: 10.1016/j.mric.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Head and neck reconstructive surgical techniques are complex; now the microvascular free tissue transfer is the most frequently used. The postreconstruction imaging interpretation is challenging due to the altered anatomy and flap variability. We aim to improve radiologists' knowledge with diverse methods of flap reconstruction for an accurate appreciation of their expected cross-sectional imaging appearance and early detection of tumor recurrence and other complication.
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Affiliation(s)
| | - Gehad A Saleh
- Faculty of Medicine, Department of Diagnostic Radiology, Mansoura University, Elgomhoria Street, Mansoura 35512, Egypt
| | - Adel T Denever
- Faculty of Medicine, Department of Surgery, Mansoura University, Elgomhoria Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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Coronary artery disease imaging reporting and data system (CAD-RADS): what radiologists need to know? Emerg Radiol 2021; 28:1185-1203. [PMID: 34387783 DOI: 10.1007/s10140-021-01973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022]
Abstract
The aim of this work is to review Coronary Artery Disease Imaging Reporting and Data System (CAD-RADS) that was designed to standardize reporting language and improve the communication of data among radiologists and clinicians. Stenotic lesions are graded into 5 grades ranging from 0 (no stenosis) to 5 (total occlusion), where the highest grade represents the final score. The expert consensus platform has added 4 special modifiers (non-diagnostic, stent, graft, and vulnerability) to aid patient management through linking these scores with decision algorithm and treatment plan. Adherence to standard imaging protocol; knowledge of normal, variant, and anomalous anatomy; and skillful evaluation of stenosis are important for proper utilization of this reporting system. Lastly, radiologists should be aware of the inherited benefits, limitations, and common pitfalls of this classification system.
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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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Peripheral Nerve Sheath Tumors of Head and Neck: Imaging-Based Review of World Health Organization Classification. J Comput Assist Tomogr 2020; 44:928-940. [DOI: 10.1097/rct.0000000000001109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Neck Imaging Reporting and Data System: What Does Radiologist Want to Know? J Comput Assist Tomogr 2020; 44:527-532. [DOI: 10.1097/rct.0000000000001032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Niazi M, Mohammadzadeh M, Aghazadeh K, Sharifian H, Karimi E, Shakiba M, Baniasadi M, Rahmaty B, Adel S, Moharreri M. Perfusion Computed Tomography Scan Imaging in Differentiation of Benign from Malignant Parotid Lesions. Int Arch Otorhinolaryngol 2020; 24:e160-e169. [PMID: 32256836 PMCID: PMC6828566 DOI: 10.1055/s-0039-1697005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 07/08/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction
The most common site of salivary gland tumors is the parotid gland. Computed tomography (CT), magnetic resonance imaging (MRI), and sonography are imaging modalities to differentiate benign from malignant parotid tumors.
Objective
The aim of this study is the evaluation of the diagnostic value of perfusion CT for differentiating histological categorization of benign and malignant parotid tumors.
Methods
A total of 29 patients with parotid neoplasms were enrolled in this study. Mean age and all CT perfusion variables (gradient and permeability, blood flow [BF], blood volume [BV], mean transit time [MTT], permeability surface [PS], maximum intensity projection [MIP], time-density curve [TDC], and time to peak [TTP]) were compared among three groups (malignant tumors [MTs], Warthin's tumor [WT] and pleomorphic adenomas [PA]).
Results
The mean age of the patients was 55.9 ± 14.1 (26–77), and 15 of them were male (51.7%). Eleven lesions were PAs [37.9%], 8 lesions were WTs (27.6%0 and 10 lesions (34.5%) were MTs (6 acinic cell carcinomas [ACCs], 3 adenocystic carcinomas [AdCCs], and 1 mucoepidermoid carcinoma [MEC]). The mean age of the patients with WTs was 62 ± 7.5 years; 52 ± 14.2 for patients with Pas, and 55.2 ± 17.2 for those with MTs (
p
= 0.32). The mean MIP was 122.7 ± 12.2 in WT, while it was 80.5 ± 19.5 in PA, and 76.2 ± 27.1 in MTs (
p
< 0.001); The mean MIP for WT was higher than for PAs and MTs; the values of MTs and PAs were not statistically different. The average of BF, BV, and curve peak were higher in WTs in comparison with the other two groups, and curve time 2 and TTP were higher in PAs in comparison with MTs.
Conclusion
Based on this study, perfusion CT of the parotid gland and its parameters can distinguish between benign and malignant parotid masses.
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Affiliation(s)
- Masume Niazi
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadzadeh
- Division of Neuroradiology, Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Aghazadeh
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sharifian
- Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Karimi
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Maria Baniasadi
- Department of Radiology, Amir Aalam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Suzan Adel
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melorina Moharreri
- Department of Otorhinolaryngology, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Wang T, Su H, Gu J, Chen Q, Xu Q, Chen BT. Evaluation of skeletal muscle perfusion in a canine hind limb ischemia model using CT perfusion imaging. Diagn Interv Radiol 2019; 26:28-33. [PMID: 31650969 DOI: 10.5152/dir.2019.18478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate skeletal muscle perfusion in a canine hind limb ischemia model using CT perfusion imaging (CTPI). METHODS Twelve beagles underwent embolization at the branch of the left deep femoral artery. The right hind limbs were used as controls. CTPI was performed immediately after embolization. The perfusion parameters of the regions of interest (ROI), including blood volume (BV), blood flow (BF), mean transit time (MTT) and permeability (PMB), were obtained in both the lateral and posterior hind limb muscle groups. RESULTS After embolization, the BV, BF and PMB values in the lateral muscles of the left hind limbs were significantly lower than those in the right hind limbs (P > 0.05), and the MTT was significantly prolonged (P > 0.05). The values for BV, BF, MTT and PMB in the posterior muscles of the left hind limbs were not significantly different from those in the right hind limbs (P > 0.05). The values for BV, BF and PMB in the lateral muscles of the left hind limbs were significantly lower than those in the posterior muscles of the left hind limbs (P > 0.05). CONCLUSION CTPI could be used to evaluate skeletal muscle perfusion in a canine model, which may have clinical relevance in lower limb ischemia and vascular reconstruction.
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Affiliation(s)
- Tao Wang
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China;Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jianping Gu
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Quan Xu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
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Abdel Razek AAK, Mukherji SK. State-of-the-Art Imaging of Salivary Gland Tumors. Neuroimaging Clin N Am 2018; 28:303-317. [DOI: 10.1016/j.nic.2018.01.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Oosterbroek J, Bennink E, Philippens MEP, Raaijmakers CPJ, Viergever MA, de Jong HWAM. Comparison of DCE-CT models for quantitative evaluation ofKtransin larynx tumors. Phys Med Biol 2015; 60:3759-73. [DOI: 10.1088/0031-9155/60/9/3759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Role of CT perfusion in monitoring and prediction of response to therapy of head and neck squamous cell carcinoma. BIOMED RESEARCH INTERNATIONAL 2014; 2014:917150. [PMID: 25140324 PMCID: PMC4129140 DOI: 10.1155/2014/917150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/05/2014] [Indexed: 01/06/2023]
Abstract
This review aims to summarize the technique and clinical applications of CT perfusion (CTp) of head and neck cancer. The most common pathologic type (90%) of head and neck cancer is squamous cell carcinoma (HNSCC): its diagnostic workup relies on CT and MRI, as they provide an accurate staging for the disease by determining tumour volume, assessing its extension, and detecting of lymph node metastases. Compared with conventional CT and MRI, CTp allows for obtaining measures of tumour vascular physiology and functional behaviour, and it has been demonstrated to be a feasible and useful tool in predicting local outcomes in patients undergoing radiation therapy and chemotherapy and may help monitor both treatments.
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Abdel Razek AAK, Denewer AT, Hegazy MAF, Hafez MTA. Role of computed tomography angiography in the diagnosis of vascular stenosis in head and neck microvascular free flap reconstruction. Int J Oral Maxillofac Surg 2014; 43:811-5. [PMID: 24794762 DOI: 10.1016/j.ijom.2014.03.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/06/2014] [Accepted: 03/26/2014] [Indexed: 12/23/2022]
Abstract
The aim of this study was to evaluate the role of computed tomography angiography (CTA) in the diagnosis of vascular stenosis at the vascular pedicle of head and neck microvascular free flaps. A prospective study was done of 65 consecutive patients (49 male, 16 female; mean age 55 years) who had undergone head and neck microvascular free flap reconstruction. All patients underwent 64-slice CTA of the carotid artery. Post-processing with volume rendering reconstruction of CTA images was done. There was excellent inter-observer agreement (weighted kappa=0.82, 95% confidence interval (CI) 0.74-0.93) in grading of the degree of vascular stenosis. The true sensitivity of CTA for diagnosis of stenosis of the vascular pedicle to the flap was 63% (95% CI 63-100%). Patients with failed flaps showed complete occlusion (n=2) on CTA and underwent a replacement flap procedure. Patients with failing flaps showed severe stenosis (n=6) of the vascular pedicle on CTA and underwent revision surgery. There was no change in the degree of stenosis on follow-up CTA for patients with moderate stenosis (n=9). CTA is a reliable, non-invasive, high-quality imaging tool for the diagnosis and grading of vascular stenosis of the vascular pedicle of head and neck microvascular free flaps.
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Affiliation(s)
- A A K Abdel Razek
- Department of Diagnostic Radiology, Mansoura University, Mansoura, Egypt.
| | - A T Denewer
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - M A F Hegazy
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
| | - M T A Hafez
- Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt
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14
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Computed tomography and magnetic resonance imaging of lesions at masticator space. Jpn J Radiol 2014; 32:123-37. [DOI: 10.1007/s11604-014-0289-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/16/2014] [Indexed: 12/31/2022]
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Razek AAKA, Tawfik AM, Elsorogy LGA, Soliman NY. Perfusion CT of head and neck cancer. Eur J Radiol 2013; 83:537-44. [PMID: 24387935 DOI: 10.1016/j.ejrad.2013.12.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/05/2013] [Accepted: 12/08/2013] [Indexed: 12/17/2022]
Abstract
We aim to review the technique and clinical applications of perfusion CT (PCT) of head and neck cancer. The clinical value of PCT in the head and neck includes detection of head and neck squamous cell carcinoma (HNSCC) as it allows differentiation of HNSCC from normal muscles, demarcation of tumor boundaries and tumor local extension, evaluation of metastatic cervical lymph nodes as well as determination of the viable tumor portions as target for imaging-guided biopsy. PCT has been used for prediction of treatment outcome, differentiation between post-therapeutic changes and tumor recurrence as well as monitoring patient after radiotherapy and/or chemotherapy. PCT has a role in cervical lymphoma as it may help in detection of response to chemotherapy and early diagnosis of relapsing tumors.
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Affiliation(s)
| | - Ahmed Mohamed Tawfik
- Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura 13551, Egypt.
| | | | - Nermin Yehia Soliman
- Diagnostic Radiology Department, Mansoura Faculty of Medicine, Mansoura 13551, Egypt.
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Dong Y, Lei GW, Wang SW, Zheng SW, Ge Y, Wei FC. Diagnostic value of CT perfusion imaging for parotid neoplasms. Dentomaxillofac Radiol 2013; 43:20130237. [PMID: 24186883 DOI: 10.1259/dmfr.20130237] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the value of CT perfusion imaging in the differentiation of different histological categorization of benign tumours from malignant tumours in patients with parotid neoplasms. METHODS CT perfusion was successfully performed in 62 patients with parotid neoplasms whose diagnoses were confirmed by surgery or biopsy. The software generated a tissue time-density curve (TDC) and measured blood volume, blood flow, mean transit time and capillary permeability surface product. One-way ANOVA and receiver operating characteristic curves were used to analyse the difference and diagnostic efficacies of all perfusion data between each one of the benign tumours and malignancies. Statistical significance was assigned at the 5% level. RESULTS Pleomorphic adenomas mainly had a gradually ascending TDC. Warthin tumours showed a fast ascent followed by a fast descent. The TDC of basal cell adenomas had a fast ascension followed by a plateau, then a gradual descent. Malignant tumours mainly showed a rapidly ascending curve with a stable plateau. Significant differences were observed in blood flow, blood volume and mean transit time between pleomorphic adenomas and malignant tumours (p < 0.05) as well as in blood flow and blood volume between the Warthin tumours, the basal cell adenomas and the malignant tumours (p < 0.05). Differences in permeability surface between the basal cell adenomas and malignant tumours were significant (p < 0.01). CONCLUSION CT perfusion of parotid gland could provide TDC and perfusion data, which were useful in the differentiation of different histological benign tumours and malignant tumours in the parotid gland.
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Affiliation(s)
- Y Dong
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
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Detection of subsequent cervical lymph node metastasis in a patient with gingival carcinoma using computed tomography perfusion with a single-compartment kinetic model. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0153-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paul J, Mbalisike EC, Nour-Eldin NEA, Vogl TJ. Dual-source 128-slice MDCT neck: Radiation dose and image quality estimation of three different protocols. Eur J Radiol 2013; 82:787-96. [DOI: 10.1016/j.ejrad.2012.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 09/13/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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Lu N, Di Y, Feng XY, Qiang JW, Zhang JW, Wang YG, Guo QY. Comparison between acetazolamide challenge and 10% carbon dioxide challenge perfusion CT in rat C6 glioma. Acad Radiol 2012; 19:159-65. [PMID: 22212420 DOI: 10.1016/j.acra.2011.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 09/21/2011] [Accepted: 09/26/2011] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to investigate the effect of perfusion computed tomography (PCT) with acetazolamide (ACZ) challenge and compare it to 10% carbon dioxide (CO(2)) challenge in rat C6 glioma. MATERIALS AND METHODS PCT was performed on 32 rats, including 20 with orthotopically implanted C6 gliomas and 12 serving as controls. Ten rats with gliomas and six normal rats underwent PCT with ACZ challenge. The other 10 rats with gliomas and six normal rats underwent PCT with 10% CO(2) challenge. The raw data were processed using Philips computed tomographic brain perfusion software. Perfusion parameters before and after the challenge were recorded. Percentage changes due to ACZ administration and 10% CO(2) challenge were calculated. Pearson's correlation coefficients were used to investigate relationships between percentage changes in perfusion parameters and vascular endothelial growth factor and microvessel density. RESULTS In C6 gliomas, percentage change in cerebral blood flow was significantly different between ACZ (72.73%) and 10% CO(2) (28.47%) challenge (P < .01). Percentage change in cerebral blood volume was 37.85% with ACZ and 24.69% with 10% CO(2) challenge (P = .02). In controls, percentage change in cerebral blood flow was significantly different between ACZ (117.42%) and 10% CO(2) (65.86%) challenge (P < .01). For percentage change in cerebral blood volume, there was no significant difference between ACZ (107.51%) and 10% CO(2) (92.95%) challenge. Significant correlations were observed among percentage changes in vascular endothelial growth factor, microvessel density, and cerebral blood volume (P < .01). Percentage change in cerebral blood flow correlated well with vascular endothelial growth factor. CONCLUSIONS The results of this study indicate that PCT with ACZ challenge is a more reliable technique compared to 10% CO(2) challenge for the quantitative evaluation of microcirculation in gliomas.
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