Functional MRI for Treatment Evaluation in Patients with Head and Neck Squamous Cell Carcinoma:A Review of the Literature from a Radiologist Perspective

Purpose of review: To show the role of functional MRI in patients treated for head and neck squamous cell carcinoma. Recent findings: MRI is commonly used for treatment evaluation in patients with head and neck tumors. However, anatomical MRI has its limits in differentiating between post-treatment effects and tumor recurrence. Recent studies showed promising results of functional MRI for response evaluation. Summary: This review analyzes possibilities and limitations of functional MRI sequences separately to obtain insight in the post-therapy setting. Diffusion, perfusion and spectroscopy show promise, especially when utilized complimentary to each other. These functional MRI sequences aid in the early detection which might improve survival by increasing effectiveness of salvage therapy. Future multicenter longitudinal prospective studies are needed to provide standardized guidelines for the use of functional MRI in daily clinical practice

Preservation of the optic radiations based on comparative analysis of diffusion tensor imaging tractographyand anatomical dissection

Background Visualization of the precise course of the visual pathways is relevant to prevent damage that may inflict visual field deficits during neurosurgical resections. In particular the optic radiations (OR) are susceptible to such damage during neurosurgery. Cortical pathways can be mapped in vivo, by using Diffusion Tensor Imaging (DTI). Visualization of these pathways would be potentially helpful to prevent neurosurgical visual morbidity. In this study an anatomical dissection of the visual pathways was compared to DTI fiber tractography (DTI-FT) data of four human brains. The feasibility of a definition of a Safety Zone is investigated.Methods Four adult brains were dissected using Klingler’s fiber dissection method, which allowed preparation of the OR. Measurements before and after dissection were used to establish distances from the cortex to the OR. DTI-scans were also obtained from these brains to determine the same distances.Results Measurements from specific landmark points on the cortex to the lateral border of the OR were performed in four brains. Analysis through DTI tractography corresponded with the dissection results. Based on the combined results of both dissection and DTI-FT, we defined a quantitative surgical Safety Zone with respect to various anatomical landmarks (in particular the ventricle system)Conclusion We conclude that there is a good correlation between the visualizations of the optic pathways based on dissection and DTI. Furthermore, we conclude that defining a neurosurgical Safety Zone which could preserve the integrity of the OR during surgery, based on the combination of DTI-FT images and dissection is feasible

Comparison of the course and key points of the Optic Radiations using dissection and Diffusion Tensor Imaging

Background: Mapping the course of the visual pathways is of great importance for preventing damage to it during neurosurgical operations. Current technology allows certain ways to identify pathways. The pathways of the brain can be mapped in vivo, by using diffusion tensor imaging (DTI). The optic radiations (OR) are susceptible to damage during neurosurgery, therefore there is a need to visualize these in patients prior to surgery. It is important to establish a “safety zone” around the course of the OR and its key points to prevent problems following surgery. In this study, the aim is to compare the course of the OR as determined using dissection and DTI in order to establish such a safety zone. Methods: Four brains were dissected using Klingler’s fiber dissection method, which allowed dissection of the OR. Measurements of these brains and their OR were performed before and after dissection to establish distances from the cortex to the OR. On three of these brains a DTI-scan was performed (before dissection) to determine similar distances. Results: Measurements of the OR were obtained through dissection and correspond to results published in the literature. The same measurements were gained through DTI-scans and correspond with results published in the literature. This resulted in the ability to compare DTI-scans with dissection and also to establish a safety zone. Conclusion: A combination of dissection methods and DTI was used to establish safety boundaries for neurosurgery. Furthermore, by using the two methods a comparison between these two could be made.

Epistaxis following skull trauma

AchtergrondEpistaxis is een veelvoorkomende aandoening die meestal onschuldig van aard is. Soms is epistaxis echter een symptoom van een ernstige onderliggende aandoening.CasusEen 20-jarige man werd conservatief behandeld na schedel-hersenletsel dat bestond uit aangezichtsfracturen en schedelbasisfracturen. Enkele weken na de behandeling maakte hij recidiverende episoden van epistaxis door. Bij aanvullend onderzoek werd een extraduraal aneurysma dissecans van de linker A. carotis interna gezien, dat uitpuilde in de sinus sphenoidalis. Daarop werd patiënt endovasculair behandeld met plaatsing van een ‘coil’ in het aneurysma en een stent in de arterie. Aan de hand van deze casus beschrijven wij de diagnostiek en behandeling bij patiënten met posttraumatische posterieure epistaxis.ConclusieBij epistaxis die enige tijd na een schedel-hersenletsel is ontstaan, moet men bedacht zijn op letsel van de A. carotis interna. Dit is een potentieel levensbedreigende situatie, die snelle behandeling behoeft.BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition.CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus. The aneurysm was treated endovascularly by placing a coil in the aneurism and a stent in the artery. On the basis of this case study we describe the diagnostics and treatment of patients with posttraumatic posterior epistaxis.CONCLUSION: In cases if delayed epistaxis following head injury the physician should be alert for the possibility of trauma to the ICA. This is a potentially life-threatening situation that requires prompt treatment.</p

Epistaxis na een schedeltrauma

BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition. CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures. Recurrent episodes of epistaxis occurred some weeks after treatment. Further investigation showed an extradural dissecting aneurysm of the left internal carotid artery (ICA), projecting into the sphenoid sinus. The aneurysm was treated endovascularly by placing a coil in the aneurism and a stent in the artery. On the basis of this case study we describe the diagnostics and treatment of patients with posttraumatic posterior epistaxis. CONCLUSION: In cases if delayed epistaxis following head injury the physician should be alert for the possibility of trauma to the ICA. This is a potentially life-threatening situation that requires prompt treatment