Diffusion-weighted imaging in oral squamous cell carcinoma using 3 Tesla MRI: is there a chance for preoperative discrimination between benign and malignant lymph nodes in daily clinical routine?

Background Preoperative staging of cervical lymph nodes is important to determine the extent of neck dissection in patients with oral squamous cell carcinoma (OSCC). Purpose To evaluate whether a preoperative discrimination of benign and malignant cervical lymph nodes with diffusion-weighted imaging (DWI) (3T) is feasible for clinical application. Material and Methods Forty-five patients with histological proven OSCC underwent preoperative 3T-MRI. DWI (b=0, 500, and 1000s/mm(2)) was added to the standard magnetic resonance imaging (MRI) protocol. Mean apparent diffusion coefficients (ADC(mean)) were measured for lymph nodes with 3mm or more in short axis by two independent readers. Finally, these results were matched with histology. Results Mean ADC was significantly higher for malignant than for benign nodes (1.1430.188 * 10(-3) mm(2)/s vs. 0.987 +/- 0.215 * 10(-3) mm(2)/s). Using an ADC value of 0.994 * 10(-3) mm(2)/s as threshold results in a sensitivity of 80%, specificity of 65%, positive predictive value of 31%, and negative predictive value of 93%. Conclusion Due to a limited sensitivity and specificity DWI alone is not suitable to reliably discriminate benign from malignant cervical lymph nodes in daily clinical routine. Hence, the preoperative determination of the extent of neck dissection on the basis of ADC measurements is not meaningful

Clinical Benefits of Combining Different Visualization Modalities in Neurosurgery

The prevailing philosophy in oncologic neurosurgery, has shifted from maximally invasive resection to the preservation of neurologic function. The foundation of safe surgery is the multifaceted visualization of the target region and the surrounding eloquent tissue. Recent advancements in pre-operative and intraoperative visualization modalities have changed the face of modern neurosurgery. Metabolic and functional data can be integrated into intraoperative guidance software, and fluorescent dyes under dedicated filters can potentially visualize patterns of blood flow and better define tumor borders or isolated tumor foci. High definition endoscopes enable the depiction of tiny vessels and tumor extension to the ventricles or skull base. Fluorescein sodium-based confocal endomicroscopy, which is under scientific evaluation, may further enhance the neurosurgical armamentarium. We aim to present our institutional workup of combining different neuroimaging modalities for surgical neuro-oncological procedures. This institutional algorithm (IA) was the basis of the recent publication by Haj et al. describing outcome and survival data of consecutive patients with high grade glioma (HGG) before and after the introduction of our Neuro-Oncology Center

Initial sequencing and analysis of the human genome

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62798/1/409860a0.pd

Multiplatform Analysis of 12 Cancer Types Reveals Molecular Classification within and across Tissues of Origin

Recent genomic analyses of pathologically-defined tumor types identify “within-a-tissue” disease subtypes. However, the extent to which genomic signatures are shared across tissues is still unclear. We performed an integrative analysis using five genome-wide platforms and one proteomic platform on 3,527 specimens from 12 cancer types, revealing a unified classification into 11 major subtypes. Five subtypes were nearly identical to their tissue-of-origin counterparts, but several distinct cancer types were found to converge into common subtypes. Lung squamous, head & neck, and a subset of bladder cancers coalesced into one subtype typified by TP53 alterations, TP63 amplifications, and high expression of immune and proliferation pathway genes. Of note, bladder cancers split into three pan-cancer subtypes. The multi-platform classification, while correlated with tissue-of-origin, provides independent information for predicting clinical outcomes. All datasets are available for data-mining from a unified resource to support further biological discoveries and insights into novel therapeutic strategies

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Vermessung der Cochlea mittels eines Tablet-basierten Softwarepakets: Einfluss der Bildgebungsmodalität und des Untersucherhintergrunds

Hintergrund Die Größe der Cochlea ist individuell unterschiedlich, was sich in der variablen Länge des Ductus cochlearis (CDL) ausdrücken lässt. In der Cochleaimplantatversorgung ist ein in der Länge angepasster Elektrodenträger durch eine optimale Abdeckung der Cochlea erfolgversprechend. Dazu kann die CDL auf Höhe des Corti-Organs (CDLOC) mittels eines Tablet-basierten Softwarepakets ausgemessen werden, um abgestimmt auf die Anatomie einen passenden Elektrodenträger auszuwählen. Fragestellung Haben die Modalität der Bildgebung und der Untersucherhintergrund einen Einfluss auf die Vermessung der CDL? Methoden Die Datensätze der Magnetresonanztomographie (MRT) und Flachdetektor-Volumen-Computertomographie (fpVCT) von 10 Patienten (20 Cochleae) wurden in der Software OTOPLAN (MED-EL, Innsbruck, Österreich) analysiert. Als Untersucher wurden eine Oberärztin der Hals-Nasen-Ohren-Heilkunde, eine Assistenzärztin der HNO-Heilkunde und ein Audiologe ausgewählt. Zur Analyse der Effekte der Bildgebung und des Untersucherhintergrunds auf die CDL-Messungen wurden linear gemischte Modelle konstruiert. Ergebnisse Die Messungen ergaben einen Mittelwert CDLOC(fpVCT) = 36,69 ± 1,78 mm und CDLOC(MRT) = 36,81 ± 1,87 mm. Die Analysen zeigten keinen signifikanten Effekt des Untersucherhintergrunds auf die Messergebnisse (F (2, 105) = 0,84; p = 0,437). Die Bildgebungsmodalität zeigte einen signifikanten Einfluss (F (1, 105) = 20,70; p < 0,001), wobei die Messungen an MRT im Mittel um 0,89 mm größer waren. Schlussfolgerung Da der Untersucherhintergrund keinen Einfluss auf die Messungen hatte, lässt sich schließen, dass die Messungen nicht ausschließlich von ärztlichem Personal, insbesondere nicht nur von erfahrenen Neurootologen, durchgeführt werden müssen. Die Methode der Bildgebung (fpVCT vs. MRT) kann die CDL-Werte statistisch signifikant beeinflussen, wobei eine klinische Relevanz fraglich ist

Acute Middle Cerebral Artery Occlusion Detection Using Mobile Non-Imaging Brain Perfusion Ultrasound—First Case

Mobile brain perfusion ultrasound (BPU) is a novel non-imaging technique creating only hemispheric perfusion curves following ultrasound contrast injection and has been specifically designed for early prehospital large vessel occlusion (LVO) stroke identification. We report on the first patient investigated with the SONAS® system, a portable point-of-care ultrasound system for BPU. This patient was admitted into our stroke unit about 12 h following onset of a fluctuating motor aphasia, dysarthria and facial weakness resulting in an NIHSS of 3 to 8. Occlusion of the left middle cerebral artery occlusion was diagnosed by computed tomography angiography. BPU was performed in conjunction with injection of echo-contrast agent to generate hemispheric perfusion curves and in parallel, conventional color-coded sonography (TCCS) assessing MCAO. Both assessments confirmed the results of angiography. Emergency mechanical thrombectomy (MT) achieved complete recanalization (TICI 3) and post-interventional NIHSS of 2 the next day. Telephone follow-up after 2 years found the patient fully active in professional life. Point-of-care BPU is a non-invasive technique especially suitable for prehospital stroke diagnosis for LVO. BPU in conjunction with prehospital stroke scales may enable goal-directed stroke patient placement, i.e., directly to comprehensive stroke centers aiming for MT. Further results of the ongoing phase II study are needed to confirm this finding

Fat suppression in magnetic resonance imaging of the head and neck region: is the two-point DIXON technique superior to spectral fat suppression?

Objective: The aim of our study was to systematically compare two-point Dixon fat suppression (FS) and spectral FS techniques in contrast enhanced imaging of the head and neck region. Methods: Three independent readers analysed coronal T-1 weighted images recorded after contrast medium injection with Dixon and spectral FS techniques with regard to FS homogeneity, motion artefacts, lesion contrast, image sharpness and overall image quality. Results: 85 patients were prospectively enrolled in the study. Images generated with Dixon-FS technique were of higher overall image quality and had a more homogenous FS over the whole field of view compared with the standard spectral fat-suppressed images (p < 0.001). Concerning motion artefacts, flow artefacts, lesion contrast and image sharpness no statistically significant difference was observed. Conclusion: The Dixon-FS technique is superior to the spectral technique due to improved homogeneity of FS and overall image quality while maintaining lesion contrast. Advances in knowledge: T-1 with Dixon FS technique offers, compared to spectral FS, significantly improved FS homogeneity and over all image quality in imaging of the head and neck region

Contrast-enhanced ultrasonography as a new method for assessing autonomization of pedicled and microvascular free flaps in head and neck reconstructive surgery

OBJECTIVE: Evaluating vascular autonomization of pedicled and microvascular free flaps for soft tissue reconstruction in the head and neck area by means of postoperative quantitative measurement of dynamic contrast values obtained with contrast-enhanced ultrasound. METHODS: 8/18 patients underwent lip reconstruction with a pedicle flap, 10 patients reconstruction of other parts of the head with a microvascular free transplant. Ultrasound examinations were conducted within the 1st postoperative week and 4 weeks after surgery. After the intravenous bolus of the ultrasound contrast agent, examinations were carried out for 30 sec without compression followed by 30 sec with compression of the vascular pedicle in bolus and flash kinetics. Digital cine loops were analyzed off-line with a quantification software (VueBox (TM)) to determine the Rise Time (RT) between flap tissue with and without compression. RESULTS: Measurements showed increasing autonomous perfusion, independent of the vascular pedicle. No transplant was lost, but 4/10 patients with a microvascular flap and 1/8 patients with a pedicle flap developed postoperative complications. RT values for the pedicled and microvascular flaps obtained under compression differed significantly between the 1st and the 4th week (p = 0.025). CONCLUSIONS: Reliable neovascularization was achieved 4 weeks postoperatively. CEUS showed to be a useful method for assessing the degree of autonomization of pedicle and microvascular free flaps

High resolution contrast-enhanced ultrasound and 3-tesla dynamic contrast-enhanced magnetic resonance imaging for the preoperative characterization of cervical lymph nodes: First results

The reliable detection of cervical lymph node (LN) metastases is the planning basis of a selective neck dissection for patients with oral squamous cell carcinoma (OSCC). The aim of this study was to evaluate whether contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) together are able to improve the preoperative characterisation of LNs. A time intensity curve analysis has been performed using CEUS and DCE-MRI for ten LNs, where one LN has been examined per patient. The studied LNs consist of five with and five without metastases. In CEUS the mean time to peak (TTP) was 18 s (range 13–29 s, standard deviation (SD) ± 7 s) for benign and 12 s (range 9–16 s, SD ± 4 s) for malignant LNs. In DCE-MRI the mean TTP was 27 s (range 18–36 s, SD ± 9 s) for benign and 21 s (range 18–27 s, SD ± 5 s) for malignant LNs. Moreover, the relative signal change with respect to reference tissue was significantly higher for LNs with than for those without metastases in both CEUS and DCE-MRI. A combination of imaging morphology, CEUS and DCE-MRI might be a promising method for a reliable differentiation of benign and malignant LNs