Nadia Nada

Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes.

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate whether diffusion-weighted MR imaging can be used in differentiating residual or recurrent head and neck tumors from postoperative or postradiation changes. MATERIALS AND METHODS: This study included 32 patients clinically suspected for recurrent head and neck tumor after surgery (n=3), radiation therapy (n=13), or both (n=16). Diffusion-weighted MR imaging was done by using a single-shot spin-echo echo-planar sequence. The apparent diffusion coefficient (ADC) value of the suspected lesion was calculated and correlated with pathologic results. RESULTS: Adequate diffusion-weighted MR images and ADC maps were obtained in 30 patients (93.8%). The mean ADC value of residual or recurrent lesions (1.17 ± 0.33 × 10−3 mm2/s) was less than that of posttherapeutic changes (2.07 ± 0.25 × 10−3 mm2/s), and the difference was statistically significant (P < .001). When an ADC value of 1.30 × 10−3 mm2/s was used as a threshold value for differentiation, the best results were obtained with an accuracy of 87%, sensitivity of 84%, specificity of 90%, positive predictive value of 94%, and negative predictive value of 76%. CONCLUSIONS: Diffusion-weighted MR imaging with ADC measurement has promising results for differentiating residual or recurrent head and neck tumors from postoperative or postradiation changes.

Invasive ductal carcinoma: correlation of apparent diffusion coefficient value with pathological prognostic factors

The aim of this study was to correlate the apparent diffusion coefficient (ADC) value of invasive ductal carcinoma with pathological prognostic factors. A prospective study was conducted on 59 untreated female patients (mean age 46 years) with invasive ductal carcinoma. All patients were examined at 1.5 Tesla using dedicated bilateral breast coil. They underwent diffusion weighted MR imaging of the breast using a single shot echo planar imaging with a b‐factor of 200 and 400 sec/mm2. Apparent diffusion coefficient (ADC) maps were reconstructed. The ADC value of the breast cancer was calculated and correlated with the pathologic prognostic factors (tumor size, grade and lymph nodes). The mean ADC values of invasive ductal carcinoma were significantly lower in patients with high grade, large breast cancer as well as those with axillary lymph nodes metastasis in a statistically significant way (p = 0.001 for the three factors). The mean ADC value of invasive ductal carcinoma was correlated with histologic grade (r = −0.675, p = 0.001), tumor size (r = 0.504, p = 0.001) and showed lower ADC values with positive lymph node metastasis. Apparent diffusion coefficient value is correlated with pathological parameters of invasive ductal carcinoma. The lower ADC values are associated with higher histological grade, larger tumor size and presence of axillary lymph nodes. So, the ADC value can be considered as a promising prognostic parameter that may identify highly aggressive breast cancer. Copyright

Role of Apparent Diffusion Coefficient Values in Differentiation Between Malignant and Benign Solitary Thyroid Nodules

BACKGROUND AND PURPOSE: Accurate imaging characterization of a solitary thyroid nodule has been clearly problematic. The purpose of this study was to evaluate the role of the apparent diffusion coefficient (ADC) values in the differentiation between malignant and benign solitary thyroid nodules. MATERIALS AND METHODS: A prospective study was conducted in 67 consecutive patients with solitary thyroid nodules who underwent diffusion MR imaging of the thyroid gland. Diffusion-weighted MR images were acquired with b factors of 0, 250, and 500 s/mm2 by using single-shot echo-planar imaging. ADC maps were reconstructed. The ADC values of the solitary thyroid nodules were calculated and correlated with the results of histopathologic examination. Statistical analysis was performed. RESULTS: The mean ADC value of malignant solitary thyroid nodules was 0.73 ± 0.19 × 10−3 mm2/s and of benign nodules was 1.8 ± 0.27 × 10−3 mm2/s. The mean ADC values of malignant nodules were significantly lower than those of benign ones (P = .0001). There were no significant differences between the mean ADC values of various malignant thyroid nodules, but there were significant differences between the subtypes of benign thyroid nodules (P = .0001). An ADC value of 0.98 × 10−3 mm2/s was proved as a cutoff value differentiating between benign and malignant nodules, with 97.5%, 91.7%, and 98.9% sensitivity, specificity, and accuracy, respectively. CONCLUSION: The ADC value is a new promising noninvasive imaging approach used for differentiating malignant from benign solitary thyroid nodules.

Role of Diffusion-Weighted Magnetic Resonance Imaging in Differentiation between the Viable and Necrotic Parts of Head and Neck Tumors

Background: Differentiation between the viable and necrotic parts of a tumor is essential for accurate biopsy results and for treatment planning. Purpose: To determine the role of diffusion-weighted magnetic resonance (MR) imaging in differentiation between the viable and necrotic parts of head and neck tumors. Material and Methods: Thirty patients with malignant head and neck tumors underwent postcontrast MR imaging. Diffusion MR imaging was done on a 1.5T unit using multislice single-shot echo-planar imaging. Diffusion-weighted MR images were acquired with a diffusion-weighted factor b of 0, 500, and 1000 s/mm2, and an apparent diffusion coefficient (ADC) map was reconstructed. The ADC value was measured within the enhanced and nonenhanced part of the tumor, and the mean ADC values were calculated. The ADC value was correlated with biopsy results. Results: The mean ADC value of a viable part of the tumor was 1.17±0.33×10−3 mm2/s, and of the necrotic parts of the tumor 2.11±0.05×10−3 mm2/s. The difference in the ADC value between the viable and necrotic parts of the head and neck tumors was statistically significant (P<0.001). Sensitivity, specificity, and accuracy of the ADC value were 92.9%, 93%, and 94.6%, respectively. Conclusion: Creation of an ADC map is an excellent method for differentiation between the viable and necrotic parts of head and neck tumors. Thus, the ADC map can be used to select the best biopsy site and to detect tumor viability in post-treatment follow-up of patients after radiation therapy.

Dynamic susceptibility contrast perfusion MR imaging in distinguishing malignant from benign head and neck tumors: A pilot study

PURPOSE To preliminarily investigate the utility of dynamic susceptibility contrast perfusion MR imaging in distinguishing malignant from benign head and neck tumors. MATERIAL AND METHODS Seventy eight patients with head and neck masses underwent single shot dynamic susceptibility contrast T2*-weighted perfusion weighted MR imaging after bolus infusion of gadolinium-DTPA was administrated. The signal intensity time curve of the lesion was created. Dynamic susceptibility contrast percentage (DSC%) was calculated and correlated with pathological findings. RESULTS The mean DSC% of malignant tumor (n=40) was 39.3±9.6% and of benign lesions (n=38) was 24.3±10.3%. There was a statistically significant difference of the DSC% between benign and malignant tumors (P=0.001) and within benign tumors (P=0.001). When DSC% of 30.7% was used as a threshold for differentiating malignant from benign tumors, the best results were obtained: accuracy of 84.6%, sensitivity of 80% and specificity of 89.2%. CONCLUSION Dynamic susceptibility contrast perfusion weighted MR imaging is a non-invasive imaging technique that can play a role in differentiation between malignant and benign head and neck tumors.

Diffusion-weighted MR Imaging in Thymic Epithelial Tumors: Correlation with World Health Organization Classification and Clinical Staging

PURPOSE To assess thymic epithelial tumors with diffusion-weighted magnetic resonance (MR) imaging. MATERIALS AND METHODS Informed consent from patients and institutional review board approval were obtained. Prospective study was conducted on 30 consecutive patients (21 men and nine women; age range, 35-71 years) with thymic epithelial tumors. They underwent true fast imaging with steady-state precession and single-shot echo-planar diffusion-weighted MR imaging of the mediastinum with b values of 0, 400, and 800 sec/mm(2). Apparent diffusion coefficient (ADC) of the thymic epithelial tumors was calculated by the same observer at two settings and was correlated with World Health Organization classification and clinical staging. RESULTS There was significant difference in longest diameter (P = .001) and necrotic part of the tumor (P = .014) between low-risk thymoma, high-risk thymoma, and thymic carcinoma. Mean ADC value of both readings of thymic epithelial tumors (n = 30) was 1.24 × 10(-3) mm(2)/sec and 1.22 × 10(-3) mm(2)/sec, with good intraobserver agreement (κ = 0.732). There was significant difference in both readings (P = .01 and .20) of low-risk thymoma (1.30 × 10(-3) mm(2)/sec and 1.29 × 10(-3) mm(2)/sec), high-risk thymoma (1.16 × 10(-3) mm(2)/sec and 1.14 × 10(-3) mm(2)/sec), and thymic carcinoma (1.18 × 10(-3) mm(2)/sec and 1.06 × 10(-3) mm(2)/sec). Cutoff ADC values of both readings used to differentiate low-risk thymoma from high-risk thymoma and thymic carcinoma were 1.25 and 1.22 × 10(-3) mm(2)/sec with area under the curve of 0.804 and 0.851, respectively. There was significant difference in both readings of ADC value of early (stage I, II) and advanced stages (stage III, IV) of thymic epithelial tumors (P = .006 and .005, respectively). CONCLUSION ADC value is a noninvasive, reliable, and reproducible imaging parameter that may help to assess and characterize thymic epithelial tumors.

The Role and Limitations of Mammary Ductoscope in Management of Pathologic Nipple Discharge

Abstract:  Mammary ductoscope allows visualization of the breast ductal wall and sampling of the abnormal area for diagnostic purposes. We are reporting our center experience in application of mammary ductoscope in detecting the underlying etiology of pathologic nipple discharge. Between November 2005 and December 2006 a total of 54 women, with spontaneous persistent nonlactational unilateral uniductal nipple discharge of no palpable lesions and negative breast sono‐mammography, were included in the study for morphologic assessment of ductal epithelium, ductal lavage and ductoscopically guided procedures as punch biopsy and ductoscopically guided microdochectomy. Forty‐one patients (76%) with nipple discharge were positive ductoscopically. Thirteen patients (24%) appeared normal. Ductoscopic lavage has a much more cellular yield than ordinary squeezing cytology. Ductal thickening by the ductoscope (11 cases) revealed to be hyperplasia on pathology (five cases), papilloma (two cases), atypical ductal hyperplasia (two cases), ductal carcinoma in situ (one case), and invasive breast carcinoma (one case). There was a significant association between intraductal visual observations and histopathologic diagnosis. Mammary Ductoscope is a promising tool in management of pathologic nipple discharge. Biopsy and ablation techniques can be performed during ductoscopy with correlation between visual findings and histopathology, but there are still some limitations of in clinical practice.

Role of diffusion-weighted MRI in differentiation of masticator space malignancy from infection.

OBJECTIVE The aim of this study was to assess the role of the apparent diffusion coefficient (ADC) value in differentiation of masticator space malignancy from infection. METHODS A retrospective study of 49 patients (31 male and 18 female; age range 5-66 years) with masticator space lesion was conducted. They underwent spin-echo-type echo planar diffusion-weighted MRI of the head and neck with b-values of 0 mm(2) s(-1), 500 mm(2) s(-1) and 1000 mm(2) s(-1). The ADC maps were reconstructed and the ADC value of the masticator space lesion was calculated. RESULTS The mean (± standard deviation) ADC value of masticator space malignancy (0.91 ± 0.21 × 10(-3) mm(2) s(-1)) was significantly lower (p = 0.001) than that of masticator space infection (1.59 ± 0.32 × 10(-3) mm(2) s(-1)). When an ADC value of 1.20 × 10(-3) mm(2) s(-1) was used as a threshold value for differentiating masticator space malignancy from infection, the best result was obtained with an accuracy of 88%, sensitivity of 88%, specificity of 87%, negative predictive value of 94%, positive predictive value of 86% and area under the curve of 0.92. There was a significant difference in the ADC value between squamous cell carcinoma and soft tissue sarcoma (p = 0.001), as well as between bacterial and fungal infection of the masticator space (p = 0.001). CONCLUSION We concluded that ADC value is a non-invasive promising imaging parameter that can be used for differentiation of masticator space malignancy from infection.

p53, Bcl-2 and C-Myc Expressions in Colorectal Carcinoma Associated with Schistosomiasis in Egypt

Background and Aims: Oncogenes and tumor suppressor genes expression are well described in bladder cancer associated with schistosomiasis especially in Egypt. Scarce studies were directed to colorectal cancer (CRC) associated with Schistosoma mansoni (S. mansoni). Apoptosis (programmed cell death) and the genes regulating this process (e.g., Bcl-2) have recently become a focus of interest in the study of cancer development and progression. In the present study, we aimed to investigate the expression pattern of p53, Bcl-2 and C-Myc in CRC tissues obtained from Egyptian colorectal cancer patients divided in two different groups, one associated with Schistosoma mansoni (CRC-Sm) and the other without Schistosoma mansoni (CRC-NSm). Methods: Seventy-five CRC tumors containing 36 draining lymph node metastatic tumors were immunohistochemically stained using specific monoclonal antibodies for p53, Bcl-2 and C-Myc, in addition the apoptotic activity of these tumors were analyzed. Results and Conclusions: Regardless of the S. mansoni infection, the obtained Results showed that the apoptotic activity was more evident in p53 diffuse positive tumors (P=0.021). There was a significant correlation between p53 diffuse positive staining and Bcl-2 positive immunostaining (P=0.011). Signet ring cell carcinoma and mucinous adenocarcinoma exhibited both intense C-Myc expression than non-mucinous carcinoma (P=0.001). When adjusting for S. mansoni infection, 58.3% of CRC-Sm cases were Bcl-2 positive compared to only (33.3%) of CRC-NSm (P=0.046). Apoptotic activity was more evident in the latter group than of CRC-Sm tumors (P=0.009). p53 and C-Myc expressions were found insignificantly different in CRC-Sm compared with CRC-NSm (P>0.05). These observations suggest that the genotoxic agents produced endogenously through the course of schistosomiasis mansoni may play a role in CRC-Sm pathogenesis through the dysregulation of apoptosis by alteration the expression pattern of Bcl-2 protein differently from CRC-NSm suggesting a different biological behavior.

Correlation of Choline/Creatine and Apparent Diffusion Coefficient values with the prognostic parameters of Head and Neck Squamous Cell Carcinoma.

The aim of this study was to measure choline/creatine (Ch/Cr) levels through 1H‐MRS and apparent diffusion coefficient (ADC) values through diffusion‐weighted MRI, and to correlate these values with the prognostic parameters of head and neck squamous cell carcinoma (HNSCC). The institutional review board approved this study and informed written consent was obtained from all study participants. A prospective study of 43 patients (31 men and 12 women; mean age, 65 years) with HNSCC was conducted. Single‐voxel 1H‐MRS was performed at the tumor or metastatic cervical lymph node with point‐resolved spectroscopy (PRESS) at TE = 135 ms. Diffusion‐weighted MR images with b values of 0, 500 and 1000 s/mm2 and contrast MRI of the head and neck were performed. The Ch/Cr levels and ADC values of HNSCC were calculated. The gross tumor volume (GTV) was also calculated. The degree of tumor differentiation was determined through pathological examination. The HNSCC Ch/Cr level was negatively correlated with the ADC value (r = −0.662, p = 0.001). There was a significant difference in the Ch/Cr and ADC values at different degrees of tumor differentiation (p = 0.003 and p = 0.001) and with different GTVs (p = 0.122 and p = 0.001). The following prognostic parameter categories were used: (i) poorly differentiated and undifferentiated versus well differentiated to moderately differentiated; and (ii) HNSCC with GTV < 30 cm3 versus GTV > 30 cm3. The cut‐off values for Cho/Cr and ADC for each category were 1.83, 0.95 and 1.94, 0.99, respectively, and the areas under the curve were 0.771, 0.967 and 0.726, 0.795, respectively, for each category. We conclude that the Ch/Cr levels determined using 1H‐MRS and the ADC values are well correlated with several prognostic parameters of HNSCC. Copyright