Computed tomography imaging strategies and perspectives in orbital fractures

OBJECTIVE: The objective of this study was to demonstrate the sensitivity and specificity of multislice computed tomography (CT) for diagnosis of orbital fractures following different protocols, using an independent workstation. MATERIALS AND METHODS: CT images of 36 patients with maxillofacial fractures (symptomatic to orbit region) who were submitted to multislice CT scanning were analyzed, retrospectively. The images were interpreted based on 5 protocols, using an independent workstation: 1) axial (original images); 2) multiplanar reconstruction (MPR); 3) 3D images; 4) association of axial/MPR/3D images and 5) coronal images. The evaluated anatomical sites were divided according to the orbital walls: lateral (with or without zygomatic frontal process fracture); medial; superior (roof) and inferior (anterior, medial). The collected data were analyzed statistically using a validity test (Youden's J index;

Use of Carbon Dioxide Laser for the Treatment of Early Squamous Cell Carcinoma and Severe Leukoplakia

Leukoplakija je potencijalno predmaligno zariste, te se u malog broja slučajeva na njezinu mjestu razvije invazivni karcinom. Prema podatcima iz najnovije literature, čestoća zloćudne pretvorbe iznosi 3 do 6%. Među metodama na raspolaganju za liječenje tih žarišta jesu kriokirurgija, kemijsko Ijuštenje, kirurško uklanjanje i uklanjanje laserom s COr U ovom je radu prikazan slučaj obostranih žarišta na bukalnoj sluznici nastao tijekom 5-godišnjeg praćenja. Zahvaćena površina epitela i podsluznica s obje strane pod lokalnom su anestezijom tretirane laserom C 02 u sedmodnevnom razdoblju i s kontinuiranom zrakom apsorpcijske površine 2 mm pri 10 wata. Sluznica se razarala do dubine pri kojoj su se mogla vidjeti mišićna vlakna, s uvjetno postavljenim rubom od oko 5 mm. Žarišta su se kontrolirala 1, 3, 6, 9 i 12 mjeseci nakon kirurškoga zahvata i nije bilo znakova recidiva ni ikakvih drugih komplikacija.Leukoplakia is potentially a premalignant lesion and, in a small number o f cases, invasive carcinoma occurs at the same site. In recent literature, the commonly accepted rate of malignant transformation varies between 3 and 6%. Among the methods advocated for the treatment of these lesions are cryosurgery, chemical peel, surgical excision, and C 02 laser vaporization. In the following case, bilateral lesions in buccal mucosa with a 5-year history of development are presented. Utilizing local anesthesia, the involved surface epithelium and submucosa on each side were treated at 7-day interval with a continuous wave C 02 laser vaporization, 2.0 mm defocused spot at 10.0 watts. Mucosal destruction was carried out to the depth at which muscle fibers could be seen with arbitrary margins of approximately 5 mm. Lesions were followed up after 1, 3, 6, 9, and 12 months following surgery and there was neither recurrence nor any other intercurrent problems observed

Topographic metabolic map of head and neck squamous cell carcinoma using image fusion between 18 F-FDG PET - TC.

O objetivo desta pesquisa foi estabelecer uma metodologia para avaliar carcinomas espinocelulares (CEC) de cabeça e pescoço, identificando e distinguindo áreas de maior atividade metabólica dentro da neoplasia, associando dados simultaneamente adquiridos, obtidos por diferentes modalidades de aquisição de imagens, combinando informações metabólicas e anatômicas num único exame. A população estudada consistiu de 17 pacientes com carcinoma espinocelular (CEC) de cabeça e pescoço pertencentes aos arquivos do Departamento de Imagem do Hospital do Câncer, São Paulo. As imagens de TC (tomografia computadorizada) e do 18 F-FDG-PET (tomografia por emissão de pósitrons) foram simultaneamente adquiridas utilizando um aparelho não dedicado. Os dados originais foram transferidos para uma estação de trabalho independente com programa de computação gráfica para o processamento dos grupos individuais e fusão em um único grupo, contendo os dados fisiológicos e metabólicos. Os achados foram definidos como positivos na presença de focos com aumento da concentração do radiofármaco em áreas não relacionadas à distribuição normal do mesmo. Em 77% dos casos (n=13), a hipercaptação foi detectada ao centro da lesão e em 23% (n=4) dos casos houve comportamento diferente, com hipercaptação excêntrica. A fusão de imagens simultaneamente adquiridas num único exame ( 18 F- FDG PET e TC) possibilitou o mapeamento topográfico metabólico das lesões estudadas e foi possível localizar áreas de maior atividade metabólica dentro do próprio 13 tumor, verificando recidivas ou metástases, possibilitando aumentar as opções quanto ao planejamento radioterápico ou cirúrgico a serem seguidos.The aim of this study is to propose a methodological approach to evaluate head and neck squamous cell carcinoma (SCCA) in order to identify and to distinguish areas of higher metabolic activity inside the lesion combining the functional metabolic and morphological data simultaneously acquired in a non dedicated PET-CT device. The study population consisted of 17 patients, with SCCA of the head and neck carcinoma. These patients were submitted to a non-dedicated 18 F- FDG- PET imaging using a system with low dose CT and Positron emission coincidence acquisition capabilities. The image acquisition was then transferred to an ENTEGRA 2 NT workstation to generate groups of individual images (metabolic and anatomical data) and image fusion (CT + PET). In those patients with anomalous concentrations of 18 F-FDG, the lesion was depicted on three planes (axial, coronal and sagittal) in CT, PET, and the image fusion at the computer screen. The findings were defined as positive in the presence of well-defined focal area of increased uptake in regions unrelated to the normal biodistribution of the tracer on visual inspection. Two examiners interpreted the images in different sessions, in order to get an agreement. Subsequently, the sites of higher metabolic activity inside the tumor were identified and classified in centric or eccentric, according to their relative location. Observing the images, we found 77.00% of the patients with the site of higher activity at the center of lesion. In 23.00% of the patients a different 15 behavior, with the tracer increased eccentrically to the lesion. This technique gave a realistic view of the functional metabolism, locating the anatomical tumor area and helping in future treatment planning