Mikiko Sue

Immunohistochemical localization of parathyroid hormone-related protein (PTHrP) and serum PTHrP in normocalcemic patients with oral squamous cell carcinoma.

Cancer cells produce parathyroid hormone-related protein (PTHrP) in the early phase of malignancy development, before hypercalcemia occurs. The relationship between PTHrP and the clinicopathologic features of oral squamous cell carcinoma is poorly understood. We studied 60 patients (43 men, 17 women; mean age, 64.8 ± 11.2 years) with primary oral squamous cell carcinoma, from whom pretreatment biopsy specimens were obtained. We examined the relationship among immunohistochemical PTHrP expression, serum PTHrP levels, clinical characteristics of the tumor, and histopathologic aspects of the tumor. The mean calcium concentration for the 60 patients was 9.1 ± 0.4 mg/dl. No patients had laboratory evidence of hypercalcemia before treatment. Six patients had serum levels of C-terminal (C)-PTHrP higher than the normal level of 55.3 pmol/l. There were no significant differences in serum C-PTHrP levels according to TNM stages. Abundant positive immunoreactivity for anti-PTHrP (1-34) antibody was recognized diffusely in the whole cytoplasm of many tumor cells. Anti-PTHrP (38-64) antibody staining tended to localize as small granules in the cytoplasm, especially close to the nuclear periphery. There was no correlation between the serum C-PTHrP concentration and the intensity of either immunostain. The intensity of PTHrP was proportionally related to the degree of differentiation or extent of keratinization (P < 0.05) and the histologic malignancy grade of the tumor (P < 0.05), when using antibody against PTHrP (1-34), but not when using antibody against PTHrP (38-64). Serum C-PTHrP levels did not correlate with the intensity of cellular PTHrP expression and characteristics of the tumor at the initial patient visit. The fragment that includes PTHrP (1-34) may be involved in the differentiation of oral squamous cell carcinoma. The differences between immunoreactivities may have been due to differing tissue malignancies and the use of different antibodies. The results suggest the need for caution when interpreting immunoreactivities of PTHrP in malignancies.

Changes of cerebrospinal fluid in the upper neck area with age using diffusion weighted MR imaging

Purpose: Few studies have concerned the absolute apparent diffusion coefficient (ADC) values in the normal cerebrospinal fluid in the upper neck area and the effect of aging on diffusion. The purpose of this study was to evaluate changes of cerebrospinal fluid in the upper neck area with age using diffusion weighted MR imaging (DWI). Methods and methods: Our study included 160 patients who underwent MR imaging for oral and maxillofacial diseases. All patients were examined by DWI with 2 b values (0 and 800 sec/mm 2 ) at 1.5 Tesla and ADC maps. The cerebrospinal fluid and spinal cord in the upper neck area were analyzed using the ADC values and age. Results: ADC value of cerebrospinal fluid was significantly correlated to ADC value of spinal cord ( R 2 = 0.141, p = .000). ADC value of spinal cord had no relation to age ( R 2 = 0.015, p = .125). ADC value of cerebrospinal fluid had significant relation to age ( R 2 = 0.026, p = .042). Conclusions: We indicated the changes of cerebrospinal fluid in the upper neck area with age using DWI. The data reported herein are representative, and the ADC values can be used for reference in future studies and in clinical settings.

Usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases

Purpose To evaluate the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Materials and Methods Ten patients with oral and maxillofacial diseases and 28 volunteers drawn from our student doctors were examined by shear wave elastography with a 14-MHz linear transducer using an Aplio 300 apparatus (Canon Medical Systems, Otawara, Japan). A statistical analysis of the shear elastic modulus (kPa) of healthy tissue (the sublingual gland, submandibular gland, anterior belly of the digastric muscle, and geniohyoid muscle) in the 28 volunteers was performed using 1-way repeated measures analysis of variance with the Tukey honest significant difference test. The maximum shear elastic modulus (kPa) of 8 patients with squamous cell carcinoma (SCC) and 2 patients with benign lesions was evaluated with the Mann-Whitney U test. The analysis used a 5% significance level. Results The mean shear elastic modulus of the sublingual gland (9.4±3.7 kPa) was lower than that of the geniohyoid muscle (19.2±9.2 kPa, P=.000) and the anterior belly of the digastric muscle (15.3±6.1 kPa, P=.004). The maximum shear elastic modulus of the SCCs (109.6±14.4 kPa) was higher than that of the benign lesions (46.4±26.8 kPa, P=.044). Conclusion Our results demonstrated the usefulness of shear wave elastography in the diagnosis of oral and maxillofacial diseases. Shear wave elastography has the potential to be an effective technique for the objective and quantitative diagnosis of oral and maxillofacial diseases.

Strain elastography of tongue carcinoma using intraoral ultrasonography: A preliminary study to characterize normal tissues and lesions

Purpose The aim of this study was to evaluate the quantitative strain elastography of tongue carcinoma using intraoral ultrasonography. Materials and Methods Two patients with squamous cell carcinoma (SCC) who underwent quantitative strain elastography for the diagnosis of tongue lesions using intraoral ultrasonography were included in this prospective study. Strain elastography was performed using a linear 14 MHz transducer (Aplio 300; Canon Medical Systems, Otawara, Japan). Manual light compression and decompression of the tongue by the transducer was performed to achieve optimal and consistent color coding. The variation in tissue strain over time caused by the compression exerted using the probe was displayed as a strain graph. The integrated strain elastography software allowed the operator to place circular regions of interest (ROIs) of various diameters within the elastography window, and automatically displayed quantitative strain (%) for each ROI. Quantitative indices of the strain (%) were measured for normal tissues and lesions in the tongue. Results The average strain of normal tissue and tongue SCC in a 50-year-old man was 1.468% and 0.000%, respectively. The average strain of normal tissue and tongue SCC in a 59-year-old man was 1.007% and 0.000%, respectively. Conclusion We investigated the quantitative strain elastography of tongue carcinoma using intraoral ultrasonography. Strain elastography using intraoral ultrasonography is a promising technique for characterizing and differentiating normal tissues and SCC in the tongue.

Structural Variations in Parotid Glands Induced by Radiation Therapy in Patients with Oral Carcinoma Observed on Contrast-Enhanced Computed Tomography

Summary Background Xerostomia is one of the commonest radiation-induced complications in patients with head and neck carcinoma. The aim of this study was to assess structural variations in parotid glands induced by radiation therapy in patients with oral carcinoma with contras-enhanced computed tomography (CECT). Material/Methods A retrospective study was performed in 41 patients with oral carcinoma who underwent CECT for head and neck malignancies before and after radiotherapy. We analyzed the relationship between parotid density variations, parotid volume change, as seen on CECT, and the mean radiation dose applied to the parotid glands in patients with oral carcinoma immediately after radiotherapy, and 2 and 3 years later. Results Immediately after radiotherapy, high-density changes on contrast-enhanced CT were observed in 70.5% of the irradiated parotids. Low-density changes due to fat degeneration were seen in 46.2% and 72.2% of the irradiated parotids 2 and 3 years after radiotherapy, respectively. The mean dose applied to the parotids with the low-density changes and without such changes 3 years after radiotherapy was 46.0 Gy and 27.7 Gy, respectively (p=0.049). Furthermore, parotid shrinkage was observed in 63.6% of the irradiated parotids. Conclusions This study suggests that the structural variations in parotid glands induced by radiotherapy included high-density changes that were observed immediately after radiotherapy and low-density changes that were seen at late follow-up. This study should be useful for clinicians in the assessment of radiation-induced injuries in the parotids with respect to early prediction of xerostomia.

Characteristic Multimodal Imaging of Medication- Related Osteonecrosis of the Jaw: Comparison Between Oral and Parenteral Routes of Medication Administration

Summary Background To assess multimodal imaging features of medication-related osteonecrosis of the jaw (MRONJ) and to analyze the differences between oral and parenteral routes of medication administration. We retrospectively reviewed panoramic radiographs, CT, MRI, and bone scintigraphy of patients with MRONJ. Material/Methods A retrospective study was conducted in 16 patients with MRONJ who underwent panoramic radiography, CT, MRI, and bone scintigraphy. Statistical analysis for the comparison between routes of medication administration and multimodal imaging features was performed with the Pearson’s χ2 test. Results The percentage of cases with sequestrum separation was 25.0% (4/16 cases) on panoramic radiography and 81.3% (13/16 cases) on CT. The percentage of cases with periosteal bone proliferation on CT was 41.7% (5/12 cases) in the oral route of administration vs. 100% (4/4 cases) in the parenteral route of administration (p=0.042). The percentage of cases with spread of soft tissue inflammation to buccal and other spaces on CT and MRI was 33.3% (4/12 cases) in the oral route of administration vs. 100% (4/4 cases) in the parenteral route of administration (p=0.021). Conclusions The sequestrum separation on panoramic radiography in patients with MRONJ was unclear in comparison to CT. Furthermore, characteristic CT findings of patients with MRONJ in the parenteral administration group were periosteal bone proliferation and spread of soft tissue inflammation to buccal and other spaces.

Diffusion-Weighted Imaging in the Oral and Maxillofacial Region: Usefulness of Apparent Diffusion Coefficient Maps and Maximum Intensity Projection for Characterization of Normal Structures and Lesions

Summary Background The aim of this study was to investigate diffusion-weighted imaging (DWI) in the oral and maxillofacial region, with a special focus on the usefulness of apparent diffusion coefficient (ADC) maps and maximum intensity projection (MIP) for characterization of normal structures and lesions. Material/Methods Thirty-five patients who underwent magnetic resonance imaging (MRI) for diagnosis of oral and maxillofacial lesions were included in this prospective study. DWI was performed on a 1.5 T unit, with b factor of 0 and 800 s/mm2; moreover, ADC maps were generated. ADC values were measured for normal structures, odontogenic infections, squamous cell carcinomas (SCC), and hemangiomas. Results As regards the normal structures, the mean ADC value of the cerebrospinal fluid (3.65±0.60×10–3 mm2/s) in the upper neck area was higher than that of the spinal cord (0.74±0.15×10–3 mm2/s, P=0.000), lymph nodes (0.87±0.17×10–3 mm2/s, P=0.000), and Waldeyer’s ring (0.92±0.29×10–3 mm2/s, P=0.000). The mean ADC value of hemangiomas (1.52±0.31×10–3 mm2/s) was higher than that of odontogenic infections (0.85±0.36×10–3 mm2/s, P=0.034) and SCC (1.38±0.22×10–3 mm2/s, P=0.840). Furthermore, MIP (DWI) showed the normal structures and lesions in the oral and maxillofacial region in an improved way. Conclusions DWI, ADC maps, and MIP can be used to characterize and differentiate normal structures and lesions in the oral and maxillofacial region.

Extraosseous plasmacytoma of the Maxilla: CT and MRI findings

Abstract Plasmacytomas are a localized proliferation of plasma cells in the bone marrow and are less frequently seen in extraosseous organs or tissues. Extraosseous plasmacytoma is a rare malignant neoplasm and constitutes 3–5% of all plasma cell neoplasms. In this article, we describe a case of a patient with extraosseous plasmacytoma of the maxilla and the related computed tomography (CT) and magnetic resonance imaging (MRI) findings.

Comparison between mandibular malignant tumors and inflammatory lesions using 67Ga scintigraphy: Relationship with panoramic radiography, CT and MRI findings

Purpose: Gallium 67 ( 67 Ga) scintigraphy is useful for the estimation of head and neck squamous cell carcinoma, especially tumor recurrence and distant metastases. We compared mandibular malignant tumors with inflammatory lesions using 67 Ga scintigraphy with multimodal imaging, such as panoramic radiography, CT and MRI. Methods: Nineteen patients with mandibular malignant tumors (7 squamous cell carcinoma and 2 malignant lymphoma) and inflammatory lesions (6 osteoradionecrosis, 3 medication-related osteonecrosis of the jaw [MRONJ] and 1 osteomyelitis) underwent 67 Ga scintigraphy with panoramic radiography, CT and MRI. The statistical analysis with respect to comparison between imaging features of 67 Ga scintigraphy and lesions was performed with the Pearsons chi-squared test. Results: 67 Ga scintigraphy for 2 of 2 patients with malignant lymphoma were positive (100%), 4 of 7 patients with squamous cell carcinoma were positive (57.1%), and 10 of 10 patients with inflammatory lesions were positive (100%) in the mandible. The detection of squamous cell carcinoma with 67 Ga scintigraphy was lower than that of inflammatory lesions ( p = .047). Conclusions: 67 Ga scintigraphy is useful for detection of malignant lymphoma and inflammatory lesions in the mandible.

Submandibular sialolithiasis with CT and scintigraphy: CT values and salivary gland excretion in the submandibular glands

Purpose Sialolithiasis is one of the most prevalent large obstructive disorders of the submandibular glands. The aim of this study was to investigate submandibular sialolithiasis with computed tomography (CT) and scintigraphy, with a particular focus on the relationship between CT values of the submandibular glands and their excretion rate. Materials and Methods Fifteen patients with submandibular sialolithiasis who underwent CT and salivary gland scintigraphy were included in this study. The relationship between the CT values of submandibular glands with and without sialoliths and salivary gland excretion measured using salivary gland scintigraphy was statistically analyzed. Dynamic images were recorded on the computer at 1 frame per 20 seconds. The salivary gland excretion fraction was defined as A (before stimulation test [counts/frame]) / B(after stimulation test [counts/frame]) using time-activity curves. Results The CT values in the submandibular glands with and without sialoliths was 9.9±44.9 Hounsfield units (HU) and 34.2±21.8 HU, respectively (P=.233). Regarding the salivary gland excretion fraction using scintigraphy, the A/B value in the submandibular glands with sialoliths (1.09±0.23) was significantly lower than in the submandibular glands without sialoliths (1.99±0.57, P=.000). Conclusion Assessments of the CT values and the salivary gland excretion fraction using scintigraphy in the submandibular glands seem to be useful tools evaluating submandibular sialolithiasis.