The utility of three-dimensional dynamic contrast-enhanced

Aneurysmal bone cysts (ABCs) are classified as bone-related lesions based on the 2005 World Health Organization histological classification of odontogenic tumors. Most ABCs are diagnosed using a combination of conventional radiography, computed tomography, magnetic resonance imaging (MRI), and digital subtraction angiography. ABCs should be differentiated from true cysts or other pseudocysts because their treatment is different. Additionally, unlike other cysts, ABCs pose a hemorrhagic risk in surgery; thus, preoperative evaluation of intralesional blood flow is required. Here we report a case of a mandibular ABC in a 39-year-old woman and focus on its dynamic contrast-enhanced MRI (DCE-MRI) features. On DCE-MRI, the lesion was divided into two areas according to the enhancement pattern: the blood-pooling and blood-flow areas. The series of DCE-MR images of the blood-pooling area showed marked enhancement of the margin, but no enhancement in the inner part of the cavity. Additionally, the time-signal intensity curve (TIC) demonstrated no change in the signal intensity (SI) until approximately 15 min after gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA) administration. In contrast, the series of DCE-MR images of the blood-flow area exhibited marked enhancement in the cyst cavity in the early phase. The TIC showed a rapid increase in SI in the early phase, followed by a rapid decrease until 150 s, and finally a gradual decrease until approximately 15 min after Gd-DTPA administration. Thus, in the current patient, preoperative DCE-MRI clearly delineated the vessel-rich area within the lesion

Application of dynamic contrast-enhanced MRI to differentiate malignant lymphoma from squamous cell carcinoma in the head and neck

Because malignant lymphoma, the second most common malignant tumor of the head and neck, and squamous cell carcinoma (SCC), the most common malignant tumor of the head and neck, require different treatments, it is important to be able to differentiate them. In the present study, we attempted to differentiate malignant lymphomas from SCCs using dynamic contrast-enhanced MRI (DCE-MRI). Seventeen lesions (in 8 cases) of malignant lymphoma and 30 cases of SCC were compared by DCE-MRI. Thirteen of 17 malignant lymphomas (76.5%) showed the maximum contrast index (CI) at 90–180 s, while 26 of 30 SCCs (86.7%) showed the maximum CI at a much faster 60–105 s. There was a statistically significant difference between SCC and malignant lymphoma in the time needed reach the maximum CI (p=0.0177). There was also significant difference between SCC and malignant lymphoma in their maximum CIs (p&#60;0.001), with the maximum CIs of 29/30 SCCs (96.7%) above 2.0, while 12/17 malignant lymphomas (70.6%) showed CIs of less than 2.0. We consider these findings to be useful for distinguishing lymphomas from SCCs.</p

Diagnostic value of dynamic contrast-enhanced MRI for unilocular cystic-type ameloblastomas with homogeneously bright high signal intensity on T2-weighted or STIR MR images

Typical MR images of ameloblastomas on T2-weighted image (WI) or short inversion time inversion-recovery (STIR) show multiple bright high-signal-intensity loci on a high-signal-intensity background. Unilocular cystic-type ameloblastomas show homogeneously bright high signal intensity on T2WI or STIR as a water-like signal intensity. Therefore, it is difficult to distinguish unilocular cystic-type ameloblastoma from other cystic lesions such as keratocystic odontogenic tumors, radicular cysts (residual cysts) and dentigerous cysts only on the basis of MRI signal intensity. In the present study, we evaluated whether contrast-enhanced (CE)-T1WI and dynamic CE-MRI (DCE-MRI) could provide additional information for differential diagnosis in unilocular cystic-type ameloblastoma. Images from 12 cases of suspected unilocular cystic-type ameloblastoma were evaluated in the present study. Of them, 5 had areas suspected of indicating a solid component on T1WI and T2WI (or STIR). Ten had undergone additional CE-T1WI and DCE-MRI. On 5 of 10 cases of CE-T1WI, a tiny enhancement area was detected. On 6 of 10 DCE-images, a time-course enhanced area which was suspected to be a solid component was detected. CE-T1WI was helpful in the diagnosis of ameloblastoma because the tiny enhanced areas were taken to indicate possible solid components. Moreover, the rim-enhancement area on CE-T1WI could be divided into small regions of interest, and some of these showed slightly increased enhancement on DCE-MRI, which was taken to indicate a solid component and/or intramural nodule with focal invasion of ameloblastoma tissue. DCE-MRIs of the four remaining cases, which provided no clues to the diagnosis of ameloblastoma in the manner of the above descriptions, showed thicker rim enhancement than odontogenic cysts. Thus, CE-T1WI and DCE-MRI were helpful in the differential diagnosis of unilocular cystic-type ameloblastomas with homogeneously bright high signal intensity on T2WI or STIR

Usefulness of Simple Diffusion Kurtosis Imaging for Head and Neck Tumors: An Early Clinical Study

Diffusion kurtosis (DK) imaging (DKI), a type of restricted diffusion-weighted imaging, has been reported to be useful for tumor diagnoses in clinical studies. We developed a software program to simultaneously create DK images with apparent diffusion coefficient (ADC) maps and conducted an initial clinical study. Multi-shot echo-planar diffusion-weighted images were obtained at b-values of 0, 400, and 800 sec/mm2 for simple DKI, and DK images were created simultaneously with the ADC map. The usefulness of the DK image and ADC map was evaluated using a pixel analysis of all pixels and a median analysis of the pixels of each case. Tumor and normal tissues differed significantly in both pixel and median analyses. In the pixel analysis, the area under the curve was 0.64 for the mean kurtosis (MK) value and 0.77 for the ADC value. In the median analysis, the MK value was 0.74, and the ADC value was 0.75. The MK and ADC values correlated moderately in the pixel analysis and strongly in the median analysis. Our simple DKI system created DK images simultaneously with ADC maps, and the obtained MK and ADC values were useful for differentiating head and neck tumors from normal tissue

Characteristic Mean Kurtosis Values in Simple Diffusion Kurtosis Imaging of Dentigerous Cysts

We evaluated the usefulness of simple diffusion kurtosis (SD) imaging, which was developed to generate diffusion kurtosis images simultaneously with an apparent diffusion coefficient (ADC) map for 27 cystic disease lesions in the head and neck region. The mean kurtosis (MK) and ADC values were calculated for the cystic space. The MK values were dentigerous cyst (DC): 0.74, odontogenic keratocyst (OKC): 0.86, ranula (R): 0.13, and mucous cyst (M): 0, and the ADC values were DC: 1364 × 10−6 mm2/s, OKC: 925 × 10−6 mm2/s, R: 2718 × 10−6 mm2/s, and M: 2686 × 10−6 mm2/s. The MK values of DC and OKC were significantly higher than those of R and M, whereas their ADC values were significantly lower. One reason for the characteristic signal values in diffusion-weighted images of DC may be related to content components such as fibrous tissue and exudate cells. When imaging cystic disease in the head and neck region using SD imaging, the maximum b-value setting at the time of imaging should be limited to approximately 1200 s/mm2 for accurate MK value calculation. This study is the first to show that the MK values of DC are characteristically higher than those of other cysts

In Vitro Assessment of Factors Affecting the Apparent Diffusion Coefficient of Jurkat Cells Using Bio-phantoms

It is well known that many tumor tissues show lower apparent diffusion coefficient (ADC) values, and that several factors are involved in the reduction of ADC values. The aim of this study was to clarify how much each factor contributes to decreases in ADC values. We investigate the roles of cell density, extracellular space, intracellular factors, apoptosis and necrosis in ADC values using bio-phantoms. The ADC values of bio-phantoms, in which Jurkat cells were encapsulated by gellan gum, were measured by a 1.5-Tesla magnetic resonance imaging device with constant diffusion time of 30sec. Heating at 42℃ was used to induce apoptosis while heating at 48℃ was used to induce necrosis. Cell death after heating was evaluated by flow cytometric analysis and electron microscopy. The ADC values of bio-phantoms including non-heated cells decreased linearly with increases in cell density, and showed a steep decline when the distance between cells became less than 3μm. The analysis of ADC values of cells after destruction of cellular structures by sonication suggested that approximately two-thirds of the ADC values of cells originate from their cellular structures. The ADC values of bio-phantoms including necrotic cells increased while those including apoptotic cells decreased. This study quantitatively clarified the role of the cellular factors and the extracellular space in determining the ADC values produced by tumor cells. The intermediate diffusion time of 30msec might be optimal to distinguish between apoptosis and necrosis

Mechanomyographic activity in the human lateral pterygoid muscle during mandibular movement

The activity of the lateral pterygoid muscle has been regarded to be related to the pathological condition of the temporomandibular joint (TMJ) in the craniomandibular disorders. Because the lateral pterygoid muscle is a deep muscle, a needle electrode is necessary for EMG recordings. The purpose of this study was to establish a non-invasive method for the evaluation of muscle activity of the lateral pterygoid muscle using mechanomyogram (MMG). In three male subjects, surface electromyogram (EMG) in the left masseter muscle, left anterior and posterior belly of the temporal muscle, left anterior belly of the digastric muscle and needle EMG of the inferior head of the lateral pterygoid were recorded during mandibular movement tasks simultaneously with the MMG derived from a condenser microphone in the external ear canal. There were significant positive correlations between the needle EMG signal of the lateral pterygoid muscle and the MMG signal for the tasks of static jaw opened position of 30 mm of interincisal distance (p = 0.000, R(2)=0.725), static jaw opened position of 40 mm of interincisal distance (p = 0.000, R(2) = 0.753), 5 mm protruded mandibular position (p = 0.000, R(2) = 0.653), the most protruded mandibular position (p = 0.000, R(2) = 0803). On the contrary, for the task of maximal clenching, there was no significant correlation between the EMG signal of the lateral pterygoid muscle and the MMG signal. These results suggest that the activity of the lateral pterygoid muscle could be evaluated by the MMG signals recorded in the external ear canal, unless jaw closing major muscles show active contraction

Effects of demethylating agent 5-aza-2 '-deoxycytidine and histone deacetylase inhibitor FR901228 on maspin gene expression in oral cancer cell lines

Maspin, which belongs to the serine protease inhibitor (serpin) superfamily, has been proposed as a potent tumor suppressor that inhibits cell motility, invasion, angiogenesis, and metastasis. In the present study, we examined the effects of 5-aza-2'-deoxycytidine (5-aza-dC), a demethylating agent, and FR901228, a histone deacetylase (HDAC) inhibitor, on maspin expression in oral cancer cell tines. The expression levels of maspin mRNA were divided into two groups, which was the maspin tow-expressed and high-expressed cell lines in the 12 oral cancer cell lines. The maspin promoter contained only a few methylated CpG sites in the maspin low-expressed cell lines. Moreover, the methylation status was not altered after 5-aza-dC treatment. However, the transcription of the maspin gene was clearly increased following 5-aza-dC treatment in a number of oral cancer cell tines. These results imply that an action of 5-aza-dC is separate from induction of promoter demethylation. Treatment with FR901228 resulted in a time-dependent stimulation of the re-expression of maspin mRNA as early as 4 h after treatment in the maspin downregulated cells. The re-expression of the maspin gene may contribute to the recuperation of biological functions linked to FR901228 such as an inhibitory effect on tumor angiogenesis and cell invasion. These results indicate that maspin and its target genes may be excellent leads for future studies on the potential benefits of FR901228, a HDAC inhibitor, in cancer therapy.</p

Assessment of MRI and dynamic contrast-enhanced MRI in the differential diagnosis of adenomatoid odontogenic tumor

The radiographical differentiation of adenomatoid odontogenic tumor (AOT) from dentigerous cysts, calcifying odontogenic cysts, calcifying epithelial odontogenic tumors, odontogenic keratocysts, and amelobastomas is sometimes difficult. We attempted to differentiate AOT from other lesions similar to AOT in radiographic findings using MRI. The MRI features of AOT in our 3 cases included homogeneous low SI in the cystic portion and homogeneous intermediate SI in the solid portion on T1WI, homogeneous high SI in the cystic portion and intermediate to slightly high SI in the solid portion on T2WI, and enhancement of only the solid portion on CE-T1WI although non of the sequences included SI of calcifications. The contrast index curves in the 3 cases of AOT showed a gradual increase to 300 s, which signified a benign tumor. These MRI features were characteristic features of AOT and might be a basis for differentiating AOT from the above possible lesions in radiographic examinations.</p