- Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma
Dedicated nasopharyngeal MR imaging before (plain scan system) and after intravenous contrast administration (current and modified systems) was reviewed in patients from a nasopharyngeal carcinoma-endemic region, comprising 383 patients with suspected disease without nasopharyngeal carcinoma and 383 patients with nasopharyngeal carcinoma. The modified and plain scan systems refined primary tumor criteria, added a nodal assessment, and expanded the system from 4 to 5 grades. The current, modified, and plain scan MR imaging systems yielded sensitivities of 99.74%, 97.91%, and 97.65%, respectively, and specificities of 63.45%, 89.56%, and 86.42%, respectively. The modified system yielded significantly better performance than the current and plain systems. In conclusion, the authors propose a modified MR imaging grading system that improves diagnostic performance for nasopharyngeal carcinoma detection. Contrast was not valuable for low MR imaging grades, and the plain scan shows potential for use in screening programs.
- 4D–Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism
The authors tested the hypothesis that recently introduced 4D dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism. Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease—9 with double-gland hyperplasia; 3 with 3-gland hyperplasia, and 5 with 4-gland hyperplasia. For single-gland disease, the gland was correctly located in 92% of patients, with correct identification of the side in 100% and the quadrant in 92%. For multigland disease, the glands were correctly located in 74% of patients, with correct identification of the side in 74% and the quadrant in 77%. The high spatial and temporal resolution 4D dynamic contrast-enhanced MR imaging provides excellent diagnostic performance for preoperative localization in primary hyperparathyroidism.
- Long-Term Outcome of Patients with Spinal Dural Arteriovenous Fistula: The Dilemma of Delayed Diagnosis
Spinal dural arteriovenous fistulas (sdAVFs) usually become symptomatic in elderly men, who are affected 5 times more often than women. Symptoms caused by sdAVF comprise gait disturbances with or without paresis, sensory disturbances in the lower extremities, pain, and sphincter and erectile dysfunction. The authors retrospectively analyzed their medical data base for all patients treated for spinal dural arteriovenous fistula at their institution between 2006 and 2016. Patient age, neurologic status at the time of diagnosis, the duration of symptoms from onset to diagnosis, and follow-up information were evaluated. The extent of medullary T2WI hyperintensity, intramedullary contrast enhancement, and elongation of perimedullary veins on MR imaging at the time of diagnosis were additionally analyzed. Data for long-term outcome analysis were available in 40 patients with a mean follow-up of 52 months. The mean age at the time of diagnosis was 69 years (median, 71 years; range, 53-84 years) with a male predominance (80%). The mean duration of symptoms was 20 months. Spinal dural arteriovenous fistulas are characterized by inter-individually variable clinical presentations, which make a determination of specific predictors for long-term outcome more difficult. Fast and sufficient diagnosis might result in a better outcome after treatment. The diagnosis of spinal dural arteriovenous fistula remains markedly delayed, reflecting an ongoing lack of knowledge and awareness among treating physicians of this rare-but-serious disease.
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