18F-FDG PET/CT as a semiquantitative imaging marker in HPV-p16-positive oropharyngeal squamous cell cancers

Purpose: There is evidence that the status of human papilloma virus subtype 16 (HPV-p16) alters the prognosis of patients with oropharyngeal squamous cell cancer (OSCC). We sought to establish whether there is a relationship between HPV-p16 status and F-FDG uptake in the prognosis of OSCC. Materials and methods: Patients with newly diagnosed OSCC at our institution between June 2011 and June 2012 were retrospectively evaluated. All patients underwent a baseline F-FDG PET/computed tomographic scan and HPV-p16 testing. Tumour maximum standardized uptake value (SUV), mean standardized uptake value (SUV) and total glycolytic activity (TGA) [defined as metabolic tumour volume (MTV) multiplied by SUV] were measured. All PET/computed tomographic scans were reviewed on a Siemens Syngo.via (version VA11B-HF03) workstation. A designated operator defined the region of the primary tumour with the MTV segmented by 40% of the SUV fixed threshold method. Results: Seventy-nine patients aged 27-84 years met the criteria for inclusion in the study. The types of primary tumour were tonsillar squamous cell carcinoma in 48% and base of tongue squamous cell carcinoma in 29%. The mean SUV was 17.5 and 17.7 in HPV-p16-positive and HPV-p16-negative groups, respectively (P=0.90). The mean MTV was 8.36 and 7.07 ml in HPV-p16-positive and HPVp16- negative patients, respectively (P=0.42). The mean TGA values were 96.3 and 82.5 g among the HPVp16- positive and HPV-p16-negative patients (P=0.54). There was no significant difference between HPV-p16 status and tumour grading for any of the imaging markers. Conclusion: There were no statistically significant differences between HPV-p16-positive and HPVp16- negative OSCC for any of the metabolic imaging markers (SUV, SUV, MTV and TGA) measured in this study

Massive Temporal Lobe Cholesteatoma

Introduction. Intracranial extension of cholesteatoma is rare. This may occur de novo or recur some time later either contiguous with or separate to the site of the original cholesteatoma. Presentation of Case. A 63-year-old female presented to a tertiary referral hospital with a fluctuating level of consciousness, fever, headache, and right-sided otorrhoea, progressing over several days. Her past medical history included surgery for right ear cholesteatoma and drainage of intracranial abscess 23 years priorly. There had been no relevant symptoms in the interim until 6 weeks prior to this presentation. Imaging demonstrated a large right temporal lobe mass contiguous with the middle ear and mastoid cavity with features consistent with cholesteatoma. The patient underwent a combined transmastoid/middle fossa approach for removal of the cholesteatoma and repair of the tegmen dehiscence. The patient made an uneventful recovery and remains well over 12 months later. Conclusion. This case presentation details a large intracranial cholesteatoma which had extended through a tegmen tympani dehiscence from recurrent right ear cholesteatoma treated by modified radical mastoidectomy over two decades priorly. There was a completely asymptomatic progression of disease until several weeks prior to this presentation

MRI versus 3-Dimensional ultrasound: a comparative study of levator hiatal dimensions in women with pelvic organ prolapse

Magnetic resonance imaging (MRI) has been used to identify both normal and abnormal female pelvic anatomy, permitting resolution and tissue definition not previously possible and faster acquisition times adding to our understanding of dynamic pelvic anatomy. These systems are, however, expensive and limited to tertiary centres. The alternative, three-dimensional ultrasound (3D USS), has undergone major advances in development, so that, today, dynamic axial plane imaging has become feasible. This study aimed to compare the two imaging modalities in the assessment of the levator hiatus. Eleven women undergoing prolapse surgery were assessed using MRI and 3D USS. Data volumes were acquired at rest and on maximum Valsalva, and were stored and reviewed independently at a later date to measure the dimensions of the levator hiatus. Similar measurements were undertaken in the equivalent axial slice on MRI using fast acquisition T2 weighted scanning. Independent, clinical pelvic examination was performed using the ICS POP-Q system. The mean age of participants was 58 years, median parity was 3, with 46% (5) having had a hysterectomy. A total of 82% (9) had a sensation of a lump, 55% (6) had constipation. Clinical grading on POP-Q was 2 (median). All had rectoceles at surgery, with 46% (5) having coexistent cystoceles, 18% (2) level 1 prolapse, and 82% (9) having enteroceles. The intra-class correlations were relatively poor – 0.22 for levator area at rest and 0.47 on Valsalva. Possible explanations for the poor correlations observed were the use of different points of reference and the difficulties of obtaining equivalent Valsalva manoeuvres. In particular, it was virtually impossible to consistently image the plane of minimal dimensions on Valsalva by single-slice MR imaging. Further larger studies comparing the two imaging modalities are required before final conclusions can be drawn

High resolution CT study of the chorda tympani nerve and normal anatomical variation

Objective: The aim of this study was to define the normal anatomical variation of the course of the CTN through the mastoid temporal bone on high resolution CT (HRCT).\ud \ud Materials and methods: Retrospective review of 27 consecutive normal HRCT bilateral temporal bones (n = 54, 14 males and 13 females, mean age 41 years) reconstructed at 0.4-mm slice thickness specifically measuring (1) origin of CTN from the posterior genu of the facial nerve (CNVII) and (2) the lateral-most position of the CTN from the mastoid segment of CNVII.\ud \ud Results: The mean distance of the CTN origin from the mastoid segment of CNVII was 11.5 mm (standard deviation, SD = 3.2, 95 % CI 10.7–12.3) with no statistically significant difference between the left and right side observed (p = 0.08). The most lateral distance of the CTN from CNVII was a mean of 1.3 mm (SD = 0.6, 95 % CI 1.2–1.7), range 0–2.5 mm and again no statistical significance between contralateral sides was observed (p = 0.11). These measurements demonstrated an excellent level of agreement between observers as assessed by intraclass correlation calculation.\ud \ud Conclusions: Reproducible measurements demonstrate variability of the CTN in both its origin from the mastoid segment of CNVII and its lateral-most course. Precise description of the course of the CTN with HRCT may be useful for planning of otologic surgery and limiting inadvertent nerve injury