Article Figures & Data
Figures
- Fig 1.
Example of a 5-mm ROI used for the assessment of laryngeal cancer and nearby sternocleidomastoid muscle. As described in detail in the text, in patients with head and neck squamous cell carcinoma, each lesion and a nearby structure were evaluated with 9 nonoverlapping ROIs on multiple sections.
- Fig 2.
Quality index across the range of VMIs in muscles at different levels in the neck. Signal-to-noise ratios are shown for the lateral pterygoid (LP, level of fossa of Rosenmuller), masseter (MS, level of parotid and masticator space), genioglossus (GG, oral cavity), or sternocleidomastoid (SCM-SMG, level of submandibular glands; SCM-TC, level of true vocal cords; SCM-TG, level of thyroid gland) (A) and for all muscles combined (B). The highest SNR for the individual muscle curves (A) and data from all the muscles combined (B) was on VMIs reconstructed at 65 keV (n = 10; total ROIs evaluated, 180). * P < .05; **** P < .0001 (1-way ANOVA).
- Fig 3.
Quality index across the range of VMIs in glands at different levels in the neck. Signal-to-noise ratios are shown for the parotid gland (P), sublingual gland (SLG), submandibular gland (SMG), and thyroid gland (TG) (A) and all glands combined (B). The highest SNR for the individual muscle curves (A) and data from all the glands combined (B) was on VMIs reconstructed at 65 keV (n = 10; total ROIs evaluated, 120). ** P < .01; **** P < .0001 (1-way ANOVA).
- Fig 4.
Quality index across the range of VMIs in HNSCC and metastatic lymph nodes. Combined SNRs from 30 tumors and 17 pathologic lymph nodes show that the highest SNR is at 65 keV. **** P < .0001 (1-way ANOVA).
- Fig 5.
Optimal virtual monochromatic energy level for evaluation of HNSCC and pathologic lymph nodes. A, Spectral Hounsfield unit curves of HNSCC compared with those of muscle (n = 30). The highest tumor attenuation was at 40 keV, with a statistically significant difference compared with all other energy levels and with mean muscle attenuation at 40 keV. B, Tumor–muscle CNR (n = 30). The CNR was highest at 40 keV, significantly different from those at all other energy levels. C, Pathologic lymph node–muscle CNR (n = 17). The CNR was highest at 40 keV, significantly different from those of all other energy levels. ** P < .01; **** P < .0001 (1-way ANOVA).
- Fig 6.
Optimal tumor attenuation and CNR comparisons. A, Tumor attenuation comparison of 40-keV VMIs with those on 60-, 65-, and 70-keV VMIs (n = 30). B, Scatterplot of CNRs comparing 40-keV VMIs with 60-, 65-, and 70-keV VMI reconstructions. **** P < .0001.
- Fig 7.
Case examples comparing the standard 70-keV VMI reconstructions with 40 keV VMIs. A and B, A 92-year-old man with supraglottic squamous cell carcinoma. The same VMIs reconstructed at 70 keV (A) and 40 keV (B) and with similar windowing (compare subcutaneous fat) are shown. There is increased tumor conspicuity and better visualization of the tumor interface with adjacent prelaryngeal strap muscle. C and D, A 60-year-old man with floor-of-mouth squamous cell carcinoma. VMIs reconstructed at 70 keV (C) and 40 keV (D) are shown. Note the increased tumor conspicuity on the 40-keV VMI reconstruction.
Tables
Summary of primary HNSCC tumor sites evaluated
Tumor Type No. of Patients Untreated (n = 22), primary site Larynx 7 Hypopharynx 1 Retromolar trigone, anterior tonsillar pillar 3 Oral cavity–other 5 Oropharynx–other 3 Sinuses, nose 3 Recurrent or metastatic (n = 8) Oral cavity 2 Oropharynx 1 Other 5a ↵a Head and neck squamous cell carcinoma invading the parotid gland, n = 2; parapharyngeal space metastasis, n = 1; cheek, n = 1; and neopharynx, n = 1.
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