Head and Neck Neoplasms/diagnostic imaging* ; Humans ; Molecular Imaging ; Squamous Cell Carcinoma of Head and Neck

OBJECTIVETo investigate the feasibility of differentiation of lymphoma, metastatic lymph nodes of squamous cell carcinoma (SCC) and papillary thyroid carcinoma (PTC) in the head and neck by single-source dual-energy spectral CT.

METHODS25 cases of non-Hodgkin lymphoma (NHL) with 236 lymph nodes, 3 cases of Hodgkin's lymphoma (HL) with 32 lymph nodes, 21 cases of SCC with 86 lymph nodes and 19 cases of PTC with 92 lymph nodes were evaluated by enhanced GSI. CT attenuation of lymph nodes in the monochromatic images at different keV levels and the iodine and water contents of these lymph nodes were measured. The slope of spectral curve was calculated using CT value at 40 keVand 90 keV. All results were analyzed with ANOVA and t test.

RESULTS70 keV had the best single energy images. Normalized Hounsfield unit (NHU) of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), T lymphoblastic lymphoma (T-LBL), HL, PTC and SCC was 0.32 ± 0.10, 0.46 ± 0.08, 0.41 ± 0.11, 0.41 ± 0.11, 0.56 ± 0.15 and 0.34 ± 0.16, respectively. Normalized iodine concentration (NIC) of them was 0.20 ± 0.08, 0.32 ± 0.08, 0.25 ± 0.09, 0.30 ± 0.12, 0.49 ± 0.18 and 0.23 ± 0.18, respectively. The slope of spectral curve (k) of them was -1.92 ± 0.55, -2.45 ± 0.60, -1.82 ± 0.57, -2.57 ± 0.54, -5.44 ± 2.41 and -1.97 ± 0.81, respectively. Compared with the NHU, there was a statistically significant difference in each pair except DLBCL and SCC, and T-LBL and HL. Compared with the NIC, there was a statistically significant difference in each pair except DLBCL and SCC, FL and HL, T-LBL and SCC, and T-LBL and HL. Compared with the slope of spectral curve, there was statistically significant difference in each pair except DLBCL and T-LBL, DLBCL and SCC, FL and HL, and T-LBL and SCC.

CONCLUSIONSMalignant lymph nodes of different types of diseases have certain different values of quantitative parameters in spectral CT imaging. By using CT attenuation, the shape and slope of spectral curve and the iodine content, single-source dual-energy CT may potentially provide a quantitative analysis tool for the diagnosis and differential diagnosis of lymph node alterations.

Carcinoma ; diagnostic imaging ; Carcinoma, Papillary ; Carcinoma, Squamous Cell ; diagnostic imaging ; Diagnosis, Differential ; Head and Neck Neoplasms ; diagnostic imaging ; Hodgkin Disease ; diagnostic imaging ; Humans ; Lymph Nodes ; diagnostic imaging ; Lymphoma ; diagnostic imaging ; Lymphoma, Follicular ; diagnostic imaging ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; Lymphoma, Non-Hodgkin ; diagnostic imaging ; Neck ; Thyroid Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo investigate the blood supply of primary lung cancer (PLC) using CT angiography for bronchial artery (BA) and pulmonary artery (PA).

METHODSThin-section enhanced multi-layer spiral CT (MSCT) were carried out in 147 primary lung cancer patients and 46 healthy subjects as control. Three-dimensional images of bronchial artery and pulmonary artery were obtained using volume render (VR) and multi-planar reconstruction (MPR) or maximum intensity projection (MIP) at the workstation, and their morphological findings and relationship with the mass were assessed.

RESULTS136 primary lung cancer patients and 32 healthy controls were evaluated for at least one bronchial artery displayed clearly in VR. The detective rate of the bronchial artery was 92.5% and 69.6%, respectively. The bronchial artery caliber and the total section area of lesion side in lung cancer patients were significantly larger than that on the contralateral side and that of the control (P < 0.05). Bronchial artery on the lesion side in lung cancer was dilated and tortuous, directly penetrating into the mass with reticularly anastomosed branches. In the PLC patients, all PA were shown clearly with normal morphological image though crossing over the masses in 54 patients; In 25 PLC patients, the PA being essentially intact, was pushed around and surrounded the mass, giving the "hold ball" sign; In 40 other PLC patients, PA being also intact, the mass surrounded and buried the PA from the outside, crushing the PA flat resulting in an eccentric or centrifugal shrinkage, forming the "dead branch" sign; In the rest 28 patients, the PA was surrounded and even compressed, forming the "residual root" sign.

CONCLUSIONPrimary lung cancer patient shows dilated bronchial arteries and increased bronchial artery blood flow, whereas pulmonary arteries just pass through the mass or are compressed by the mass. It is further demonstrated that the bronchial artery, instead of the pulmonary artery, is the main vessel of blood supply to the primary lung cancer as shown by MSCT angiography of bronchial artery and pulmonary artery.

Adenocarcinoma ; blood supply ; diagnostic imaging ; Angiography ; methods ; Bronchial Arteries ; diagnostic imaging ; Carcinoma, Squamous Cell ; blood supply ; diagnostic imaging ; Female ; Humans ; Lung Neoplasms ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Pulmonary Artery ; diagnostic imaging ; Tomography, Spiral Computed ; methods

OBJECTIVETo evaluate imaging features of benign and malignant solitary pulmonary nodules (SPN) using dynamic computed tomography (dCT) to improve the accuracy of radiological diagnosis.

METHODSFifty-one patients with SPN were studied by dCT. In this procedure, a bolus of 100 ml contrast medium was administrated intravenously at a rate of 4 ml/sec. The same-located dynamic scans were carried out from 15 sec to 120 sec following the injection. Time-attenuation curves (TAC) were created according to circular or oval ROI drawn over nodules. Histopathological diagnosis was considered as the golden standard in all patients. Double-blind examination and evaluation were carried out and the data were analyzed statistically with Mann-Whitney U test.

RESULTSThirty eight cases were diagnosed to be malignant SPN (mSPN) and 13 cases to be benign SPN (bSPN). The benign SPN were further divided into two groups, bSPN(1) consisting 6 cases with chronic pneumonitis, nodular tuberculosis or sclerosing hemangioma and bSPN(2) consisting 7 cases with tuberculoma, pulmonary cyst, pulmonary sequestration or mycosis ball. There were statistically significant differences between mSPN and bSPN(2) in peak heights of enhancement (87.6 HU vs. 57.8 HU, P < 0.01), enhancement values (peak heights- unenhanced CT values, 59.6 HU vs. 11.1 HU, P < 0.01). However, no statistically significant differences of those two values existed between mSPN and bSPN(1). TAC of mSPN reached to peak height more rapidly and remained a plateau. TAC of bSPN(1)s showed similar changes to that of mSPN despite a delayed reach to a peak height or even a descending branch. TAC of the bSPN(2)s was lower and flatter without peak height. If a threshold of 20 HU was taken for dCT, the lesions with < or = 20 HU were diagnosed as benign, and the lesions with > 20 HU were diagnosed as malignant, with a sensitivity of 100%, a specificity of 54.0% and an accuracy of 88.4%.

CONCLUSION(1) Absence of the marked enhancement (< or = 20 HU) in dynamic CT is strongly predictive of benignancy. (2) The peak height and enhancement value of dCT are helpful to differentiate malignant SPNs from benign ones. (3) The TAC configuration is helpful in differentiating malignant SPNs from benign ones. Descending branches could be found in some benign lesions, but not in the malignant ones. The TAC of tuberculoma and mycosis ball is usually relatively low and flat without any peak height.

Adenocarcinoma ; diagnostic imaging ; Adult ; Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases ; diagnostic imaging ; Lung Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Radiographic Image Enhancement ; Solitary Pulmonary Nodule ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

OBJECTIVE: To evaluate the diagnostic performance of a non-invasive, non-radiating, economical and convenient infrared thermal imaging in the detection of oral squamous cell carcinoma (OSCC) cervical lymph node metastasis, and evaluate its applicability via parallel test and series test. METHODS: This study was a prospective clinical study which passed the ethical review by the Biomedical Ethics Committee, Hospital of Stomatology, Peking University, and had been submitted for clinical trial registration. Totally 74 OSCC patients who were to undergo a neck dissection were included in this study. The inclusion criteria were patients who: (1) were pathologically diagnosed as malignant tumors and planned to undergo surgical treatment including neck dissection; (2) agreed to participate in this study. The exclusion criteria were those who: (1) had undergone surgeries at head and neck previously; (2) with a history of systemic tumor adjuvant therapies such as radiotherapy or chemotherapy etc; (3) were unwilling or unable to cooperate. Basal information as well as clinical examination results were collected, such as physical examination and contradictive enhanced CT. Besides, infrared thermal imaging was done ahead of surgery. Analysis of the diagnostic power of infrared thermal imaging followed the principles of diagnostic test. The positive signs of infrared thermal imaging were: (1) asymmetric thermographic pattern including vascular pattern in ROI; (2) thickening image of unilateral facial artery/vein, submental artery/vein or external carotid artery; (3) surface temperature of ROI raised over 1 °C compared with the opposite side; (4) changes of neck profile with abnormal temperature pattern. The gold standard of this diagnostic test was pathology diagnosis of cervical lymph nodes. RESULTS: The sensitivity of infrared thermal imaging was 75.0%, while the specificity was 69.0%, accuracy was 71.6%, positive predictive value was 64.9% and negative predictive value was 78.4%. The sensitivity of parallel test which stood for the combination of infrared thermal imaging and conventional clinical examinations was 87.9% while the specificity of series test was 97.6%. CONCLUSION Infrared thermal imaging is a promising non-invasive, non-radiating and economical tool in the detection of cervical lymph node metastasis from OSCC when combined with conventional pre-operative examination.
Carcinoma, Squamous Cell/diagnostic imaging* ; Diagnostic Tests, Routine ; Head and Neck Neoplasms ; Humans ; Infrared Rays ; Lymph Nodes ; Mouth Neoplasms/diagnostic imaging* ; Prospective Studies ; Sensitivity and Specificity

OBJECTIVE: To investigate the value of MRI and MSCT in TNM staging of laryngocarcinoma. METHOD: Thirty-seven patients with laryngocarcinoma were underwent by contrast enhanced scan and multiplanar reconstruction. Thirty-five patients with laryngocarcinoma were underwent contrast enhanced multislice spiral CT, which of them were done by MPR. There are 28 cases which were scan by MRI and MSCT in the two former and we contrasted the accuracy rating in laryngeal manifestation of abnormality. In the former two groups, we observed them the variability in the aspect of lymphaden metastasis and TNM staging. RESULT: In all 28 cases, the MRI had better accuracy rating in displaying the parts of preepiglottic space, larynx side interspace, lingual root, neck tissue, vocal cord. In the TNM staging, there was no difference in stage one in accuracy rating, as the stag stepping up, the accuracy rating of MRI had became better. The last result was that the two methods had difference in staging. In the two methods, MSCT had better sensitivity, specificity and accuracy rating. CONCLUSION MRI and MSCT had good accuracy rating in TNM staging, MRI has better accuracy rating in some of laryngeal, but as the lymphaden metastasis, the MSCT was better. There were variability in staging, and the MRI was better.
Adult ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Tomography, Spiral Computed

Objective: To construct the diagnostic model of superficial esophageal squamous cell carcinoma (ESCC) and precancerous lesions in endoscopic images based on the YOLOv5l model by using deep learning method of artificial intelligence to improve the diagnosis of early ESCC and precancerous lesions under endoscopy. Methods: 13, 009 endoscopic esophageal images of white light imaging (WLI), narrow band imaging (NBI) and lugol chromoendoscopy (LCE) were collected from June 2019 to July 2021 from 1, 126 patients at the Cancer Hospital, Chinese Academy of Medical Sciences, including low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, ESCC limited to the mucosal layer, benign esophageal lesions and normal esophagus. By computerized random function method, the images were divided into a training set (11, 547 images from 1, 025 patients) and a validation set (1, 462 images from 101 patients). The YOLOv5l model was trained and constructed with the training set, and the model was validated with the validation set, while the validation set was diagnosed by two senior and two junior endoscopists, respectively, to compare the diagnostic results of YOLOv5l model and those of the endoscopists. Results: In the validation set, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the YOLOv5l model in diagnosing early ESCC and precancerous lesions in the WLI, NBI and LCE modes were 96.9%, 87.9%, 98.3%, 88.8%, 98.1%, and 98.6%, 89.3%, 99.5%, 94.4%, 98.2%, and 93.0%, 77.5%, 98.0%, 92.6%, 93.1%, respectively. The accuracy in the NBI model was higher than that in the WLI model (P<0.05) and lower than that in the LCE model (P<0.05). The diagnostic accuracies of YOLOv5l model in the WLI, NBI and LCE modes for the early ESCC and precancerous lesions were similar to those of the 2 senior endoscopists (96.9%, 98.8%, 94.3%, and 97.5%, 99.6%, 91.9%, respectively; P>0.05), but significantly higher than those of the 2 junior endoscopists (84.7%, 92.9%, 81.6% and 88.3%, 91.9%, 81.2%, respectively; P<0.05). Conclusion: The constructed YOLOv5l model has high accuracy in diagnosing early ESCC and precancerous lesions in endoscopic WLI, NBI and LCE modes, which can assist junior endoscopists to improve diagnosis and reduce missed diagnoses.
Artificial Intelligence ; Endoscopy/methods* ; Esophageal Neoplasms/pathology* ; Esophageal Squamous Cell Carcinoma/diagnostic imaging* ; Humans ; Narrow Band Imaging ; Precancerous Conditions/diagnostic imaging* ; Sensitivity and Specificity

OBJECTIVEUsing the volume calculating function of treatment planning system of 3DCRT to work out the value of GTV standard classifications and to provide the reference for clinical staging of esophageal carcinoma.

METHODSSix hundred and seven patients underwent radical resection of thoracic esophageal carcinoma in our hospital, and their pre-operative CT images were transmitted in digital format to the three-dimensional conformal radiotherapy planning system by the network. Esophageal lesion GTV targets were outlined, and their volumes were automatically computed by the planning system. Compared the differences of the GTV volumes in different pathological T stages, and analyzed the relationship between GTV volumes and pathological T stages. According to the median volume of GTV at different pathological T stages, divided the values of GTV volume corresponding to different T stages and selected the suitable classification standard of GTV volume.

RESULTSThe esophageal carcinoma GTV length, maximum diameter and volume were related to pathological T staging and with a positive correlation (all P < 0.001). The Spearman correlation coefficient (r) was 0.376, 0.466 and 0.464, respectively, P < 0.001. Except that the length, maximum diameter and volume of GTV in pathological T3 and T4 had no significant difference, other indicators of the pathological T stages showed significant differences between the groups (P < 0.001). According to the median volume of GTV at different pathological T stages, the GTV volumes were divided into three grades: 13.0 cm(3). When compared them with pathological T1, T2, and T3-T4 stages, the coincidence rate was 73.8%. The consistency was good between the GTV volume grades and pathological T stages (Kappa = 0.40, P < 0.001). The overall 5-year survival rates of GTV grades 1, 2, 3 were 78.1%, 31.5% and 33.5%, respectively (P < 0.0001). If the GTVs were divided into four grades: 39.0 cm(3), the coincidence rate of GTV volume grades and pathology T staging was only 54.7%, and the consistency was poor, Kappa = 0.24, P < 0.001. The overall 5-year survival rate of GTV 1, 2, 3, 4 were 78.1%, 31.5%, 36.2% and 27.5%, respectively (P < 0.0001).

CONCLUSIONThe length, maximum diameter and volume of esophageal carcinoma GTV are related to pathological T staging with a positive correlation. The classification that esophageal carcinoma GTVs divided into three grades has a good coincidence with the pathological T staging.

Adult ; Aged ; Carcinoma, Small Cell ; diagnostic imaging ; surgery ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; surgery ; Esophageal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; methods ; Survival Rate ; Tomography, X-Ray Computed ; Tumor Burden

Objective To assess the diagnostic accuracy of multidetector CT (MDCT) for restaging of patients with esophageal squamous cell carcinoma (SCC) after neoadjuvant chemotherapy and determine the feasibility of CT for assessing the treatment response and evaluating the prognosis. Methods Totally 135 patients with esophageal SCC who had received neoadjuvant treatment and surgery in Beijing Cancer Hospital from September 2005 to December 2011 were enrolled in this study. TN staging was performed using CT for lesions before and after neoadjuvant treatment by two radiologists,and the tumor regression grade (TRG) and pathological TRG were also assessed. Based on preoperative CT TN restaging results,the patients were defined as responders with TNafter therapy,non-responders with T3-4N+,and patients with undefined response (TN0 or TNN). Results The accuracy of T and N restaging using CT was 50%,54% (κ=0.718,P <0.001) and 59%,56% (κ=0.753,P <0.001) by two radiologists,respectively. TRG from CT was predicted correctly in 27% of patients. Pathological TRG was an accurate predictor of survival (χ=8.13,P=0.04). There was no significant trend toward better survival for lower CT TRG (χ=1.17,P=0.286). Among 135 patients with esophageal cancer,19 patients(14.07%) were responders ,46 patients(34.07%) were non-responders,and 70 patients (50.37%)were patients with undefined response . The overall survival rates of responders,non-responders and patients with undefined response were 71.5%,47.3%,and 18.5%,respectively. The overall survival of responders was better than that of patients with undefined response (χ=1.518,P=0.63) and non-responders(χ=12.04,P=0.0016),but the overall survival of patients with undefined response was better than that of non-responders (χ=14.468,P=0.0003). Conclusion sMDCT restaging after neoadjuvant treatment can not accurately predict pathological stage in esophageal SCC. The CT T and N restaging has certain clinical value in assessing the response to neoadjuvant chemotherapy in patients with esophageal cancer and predicting the prognosis.
Carcinoma, Squamous Cell ; diagnostic imaging ; drug therapy ; Esophageal Neoplasms ; diagnostic imaging ; drug therapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Survival Rate ; Tomography, X-Ray Computed

OBJECTIVE: To explore the significance of 8F-FDG PET-CT in the diagnosis of the recurrence and metastasis of head-and-neck tumor after definitive treatment. METHOD: Forty-two patients having received definitive treatment for head-and-neck tumor of whom the tumor could not be identified clinically underwent 18F-FDG PET-CT examination. Follow-up data could be obtained for all foci identified on PET-CT images. PET-CT and CT accuracy was compared on the basis of follow-up and histopathologic findings. RESULT: A total of 103 foci were noted on PET-CT images. Identified by follow-up data, the sensitivity, specificity and accuracy were 92.55%, 42.11% and 84.07% respectively for CT examination, and 100.00%, 52.63%, and 92.04% for PET-CT respectively. The sensitivity and accuracy of PET-CT were significantly higher than those of CT (P < 0.05 or P < 0.01), whereas the difference in specificity between the results of these two groups was not significant (P > 0.05). CONCLUSION The major benefits of FDG PET were that it differentiates scar and relapse, as well as detects LN and distant metastasis. Detailed clinical information and inclusion of results of morphological diagnostics are prerequisites for PET-CT final image interpretation, while scans should not be performed less than 6 weeks after definitive treatment.
Adult ; Aged ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; Female ; Head and Neck Neoplasms ; diagnostic imaging ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Positron-Emission Tomography ; methods