Tomoko Shiraishi

The Principal of Dynamic Contrast Enhanced MRI, the Method of Pharmacokinetic Analysis, and Its Application in the Head and Neck Region

Many researchers have established the utility of the dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in the differential diagnosis in the head and neck region, especially in the salivary gland tumors. The subjective assessment of the pattern of the time-intensity curve (TIC) or the simple quantification of the TIC, such as the time to peak enhancement (T peak) and the wash-out ratio (WR), is commonly used. Although the semiquantitative evaluations described above have been widely applied, they do not provide information on the underlying pharmacokinetic analysis in tissue. The quantification of DCE-MRI is preferable; therefore, many compartment model analyses have been proposed. The Toft and Kermode (TK) model is one of the most popular compartment models, which provide information about the influx forward volume transfer constant from plasma into the extravascular-extracellular space (EES) and the fractional volume of EES per unit volume of tissue is used in many clinical studies. This paper will introduce the method of pharmacokinetic analysis and also describe the clinical application of this technique in the head and neck region.

A Quantitative Analysis of Sonographic Images of the Salivary Gland: A Comparison Between Sonographic and Sialographic Findings

We performed three quantitative analyses (particle analysis, fractional Brownian motion [fBM] model analysis, two-dimensional [2-D] fractal analysis) of the ultrasonographic (US) images of the salivary gland and evaluated whether the obtained indices correlated with the sialographic stage of Rubin-Holt. Our study included 192 patients suspected of having Sjögrens syndrome (SS). In 89 patients, sialography demonstrated abnormal findings. Based on a particle analysis, we calculated both the average size of the particles (avg-area) and the area ratio to evaluate the presence of hypoechoic areas and echogenic lines, which are characteristic of SS. According to the fBM model, we calculated the Hurst index of the original image (Hurst-ori) and the background-subtracted image (Hurst-bs) to evaluate the complexity of the pixel value distribution. We also obtained the 2-D fractal dimension (2-D-FD) to evaluate the complexity of the contour lines. We entered these indices of the parotid glands (PG) into a logistic regression analysis and evaluated which indices were useful predictors for detecting an abnormal sialographic stage. Significant differences were observed between the normal and abnormal groups in all five indices of the PG (Mann-Whitney U test) and all five indices were correlated with the Rubin-Holt stage (Spearmans Rank Correlation Test). As the Rubin-Holt stage became more severe, both the Hurst-ori and 2-D-FD became smaller. Alternatively, the Hurst-bs, avg-area, and area ratio became higher. Three indices (avg-area, area ratio and Hurst-ori) were selected as useful predictors for detecting abnormal sialographic stages. This quantitative analysis system is therefore considered to have potentially useful clinical applications for the detection of abnormal sialographic findings.

Quantitative evaluation of vascularity within cervical lymph nodes using Doppler ultrasound in patients with oral cancer: relation to lymph node size

OBJECTIVES The aim of this study was to quantitatively evaluate the relationship between vascularity within lymph nodes and lymph node size on Doppler ultrasound images of patients with oral cancer. METHODS A total of 310 lymph nodes (86 metastatic, 224 benign) from 63 patients with oral cancer were classified into 4 groups according to their short axis diameters: Group 1, short axis diameters of 4-5 mm; Group 2, 6-7 mm; Group 3, 8-9 mm; and Group 4, ≥ 10 mm. Vascular and scattering indices of lymph nodes on Doppler ultrasound images were analysed quantitatively. The vascular index was defined as the ratio of blood flow area to the whole lymph node area and the scattering index was defined as the number of isolated blood flow signal units. RESULTS For metastatic lymph nodes, the vascular index was highest in Group 1 and decreased as lymph node size increased. The vascular index of benign lymph nodes did not differ significantly among the four groups. The vascular index of metastatic lymph nodes was significantly higher than that of benign lymph nodes in Group 1. For metastatic lymph nodes, the scattering index increased as lymph node size increased and was significantly higher than that of benign lymph nodes in Groups 2-4. CONCLUSIONS An increase in vascularity is a characteristic of Doppler ultrasound findings in small metastatic lymph nodes. As the metastatic lymph node size increases, blood flow signals become scattered, and the scattering index increases.

Assessment of the sequential change of the masseter muscle by clenching: a quantitative analysis of T1, T2, and the signal intensity of the balanced steady-state free precession

Background: The persistent muscle contractions during clenching are thought to cause some temporomandibular disorders. However, no report has so far evaluated the effect of clenching on the masticatory muscles by magnetic resonance imaging (MRI). Purpose: To investigate the effect of clenching with maximum voluntary contraction on the T1, T2, and signal intensity (SI) of the balanced fast field-echo (b FFE) of the masseter muscle. Material and Methods: A total of 11 volunteers participated. Multi-echo spin-echo echo-planar imaging was used for T2 measurements, and multi-shot Look-Locker sequence for T1 measurements. The Look-Locker sequence has been used for fast T1 mapping and this method has been applied for the imaging of various tissues. In addition, the b FFE was used due to the high temporal resolution. These three sequences lasted for 10 min and the participants were instructed to clench from 60 s to 80 s after the start of the data acquisition. T2, T1, and SI were normalized compared to pre-clenching values. Results: T2 decreased by clenching, which reflected a decrease of tissue perfusion due to the mechanical pressure. It increased rapidly after the clenching (peak value, 1.11±0.03; peak time, 16.8±7.6 s after the clenching), which corresponded to the reactive hyperemia and later, it gradually returned to the initial values (half period, 2.22±0.84 min). The change in the SI of the b FFE was triphasic and similar to that of T2 clenching. T1 increased after the cessation of the clenching and later gradually decreased during the recovery periods. However, the change of T1 was quite different from that of T2, with a lower peak value (1.04±0.02), a later peak time (36.0±28.0 s), and a longer half period (4.76±3.40 min) (P<0.0001, 0.0066, 0.02, respectively). Conclusion: The change in T2 was triphasic and we considered that it predominantly reflected the tissue perfusion.

Effect of clenching on T2 and diffusion parameters of the masseter muscle

Background: Persistent muscle contractions during clenching are considered to be one reason for temporomandibular disorders. However, no report has evaluated the effect of clenching on the masticatory muscles, as measured by magnetic resonance imaging (MRI). Purpose: To investigate whether clenching has an effect on either T2 or the coefficients for diffusion of the masseter muscles (MM), and to evaluate the effect of the distribution of bite force on such indices. Material and Methods: Twenty-three subjects were examined. Bite force was measured by a pressure-sensitive sheet, and the force of the right and the left sides was calculated. MRI was used to evaluate T2, the apparent diffusion coefficient (ADC), and the primary (λ1), secondary (λ2), and tertiary eigenvalues (λ3). These indices on the stronger side of the bite force were compared to those on the weaker side. Thereafter, the indices were compared between at rest and during clenching. Results: There was no significant difference in any of the indices (T2, ADC, λ1, λ2, and λ3) between the side of stronger bite force and the side with weaker. T2 increased by clenching, and the difference was significant in the side with stronger bite force (P = 0.006). ADC, λ1, λ2, and λ3 increased significantly by clenching (P <0.01, P <0.01, P <0.01, and P <0.01, respectively) on both sides. The percentage of change of λ2 by clenching was 26.2±15.7% on the stronger side and 26.9±18.6% on the weaker side, which was significantly greater than either that of λ1 or λ3. Conclusion: The coefficients for diffusion of the MM were sensitive to change by clenching, and λ2 was the most sensitive. Moreover, the relative distribution of the bite forces had no effect on any of the indices.

Development of a simple image viewer designed for small X-ray field CT equipment 3DX

ObjectivesTo develop a simple image viewer that utilizes image files in general-purpose formats that are written from the original 3DX volume data.MethodsWe used FLASH MX2004 for Macintosh to develop a simple image viewer. In developing the software for the simple image viewer, we decided that the viewer should provide the following features: (1) be available to both Windows OS and Mac OS, (2) allow interlocking of the 3D images, (3) display image enlargement, and (4) allow distance measurements. The accuracy of the distance measurements was evaluated.ResultsThe procedure was as follows: (1) write 3D images in jpeg format to a folder on i-VIEW; (2) place the folder containing the 3D images into the directory of the simple image viewer software on a PC; (3) start the software and open the window to input the folder name containing the 3D images; and (4) display the 3D images. Our viewer had features such as image enlargement, interlocking 3D images, drawing, and distance measurements. No significant differences were shown between the measurements made by our simple viewer and the actual values of the images in any direction.ConclusionsOur image-viewing software for 3DX is beneficial for clinical use.

Evaluation of diffusion parameters and T2 values of the masseter muscle during jaw opening, clenching, and rest

Background Diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI) can be used to evaluate changes that accompany skeletal muscle contraction. Purpose To investigate whether jaw opening or closure affect the diffusion parameters of the masseter muscles (MMs). Material and Methods Eleven healthy volunteers were evaluated. Diffusion-tensor images were acquired to obtain the primary (λ1), secondary (λ2), and tertiary eigenvalues (λ3). We estimated these parameters at three different locations: at the level of the mandibular notch for the superior site, the level of the mandibular foramen for the middle site, and the root apex of the mandibular molars for the inferior site. Results Both λ2 and λ3 during jaw opening were significantly lower than that at rest at the superior (P = 0.006, P < 0.0001, respectively) and middle site (P = 0.004, P = 0.0001, respectively); however, the change in λ1 was not significant. At the lower site, no parameter was significantly different at rest and during jaw opening. There was no significant difference in T2 between at rest (40.3 ± 4.4 ms) and during jaw opening (39.2 ± 2.7 ms; P = 0.12). The changes induced by jaw closure were marked at the inferior site. In the middle and inferior sites, the three eigenvalues were increased by jaw closure, and the changes in λ1 (P = 0.0145, P = 0.0107, respectively) and λ2 (P = 0.0003, P = 0.0001) were significant (especially λ2). Conclusion The eigenvalues for diffusion of the MM were sensitive to jaw position. The recruitment of muscle fibers, specific to jaw position, reflects the differences in changes in muscle diffusion parameters.

Evaluation of T2 values and apparent diffusion coefficient of the masseter muscle by clenching

OBJECTIVE The aim of this study was to evaluate the changes in T2 values and apparent diffusion coefficient (ADC) in the masseter muscle by clenching in healthy volunteers. METHODS 37 volunteers were enrolled in the study. We measured bite force using pressure-sensitive paper and a T2 map. The ADC map was obtained at rest, during clenching, immediately after and 5 min after clenching. The spin-echo sequence was used to calculate T2, and single-shot spin-echo echo planar imaging was used to calculate the ADC. The motion-probing gradients (MPGs) were applied separately along the posterior-to-anterior (PA), right-to-left (RL) and superior-to-inferior (SI) directions, with b values of 0, 300 and 600 s mm(-2) in each direction. ADC-PA, ADC-RL, and ADC-SI values were obtained, and we calculated the ADC-iso for the mean diffusivity. RESULTS There were no significant differences between the stronger and weaker sides of bite force before, during or 5 min after clenching for T2 and ADC. The bite force had little effect on these parameters; thus, we used the average of the two sides for the following analyses. Time course analysis of ADC-iso, ADC-PA, ADC-RL and ADC-SI demonstrated a marked increase after clenching and a rapid decrease immediately after clenching, although they did not completely return to the initial values; however, the change in ADC-RL was significantly greater than those in ADC-PA or ADC-SI (P<0.001 each). The changes in T2 were similar to those of ADC, although not as marked. CONCLUSIONS ADC (especially ADC-RL) was altered by contraction of the masseter muscle.

Vascularity as assessed by Doppler intraoral ultrasound around the invasion front of tongue cancer is a predictor of pathological grade of malignancy and cervical lymph node metastasis

OBJECTIVES To quantitatively evaluate the relationship of vascularity of tongue cancer as demonstrated on intraoral ultrasonography images and tumour thickness with pathological grade of malignancy and the presence of cervical lymph node metastases. METHODS 18 patients with tongue cancer were enrolled in this retrospective study. Using Doppler ultrasonography images of the invasion front of the cancers along the length of their tumour boundaries, three vascular indexes were analysed quantitatively, namely ratio of blood flow signal area within the cancer to whole tumour area (BAR), blood flow signal number ratio (BNR) and blood flow signal width ratio (BWR). The associations between these three indexes and occurrence of cervical lymph node metastasis and pathological grade of malignancy [Yamamoto-Kohama (YK) classification] were assessed. Furthermore, the relationship between tumour thickness and occurrence of cervical lymph node metastasis was evaluated on B-mode intraoral ultrasonography images. RESULTS There was no significant association between BAR and tumour thickness or occurrence of cervical lymph node metastasis. The BNRs and BWRs of patients with cervical lymph node metastasis were significantly higher than those of patients without nodal involvement. The BWRs of patients with high-grade malignancy (YK-4C) were significantly higher than those of patients with low-grade malignancy (YK-2 or 3). CONCLUSIONS BNR and BWR on the invasion front of the tongue cancer are predictors of pathological grade of malignancy and cervical lymph node metastasis.

A new method for displaying the lingual artery using high-resolution three-dimensional phase-contrast magnetic resonance angiography

The aim of this study was to display the lingual artery superimposed on the anatomical image and to confirm its course and relation to the adjacent structures, noninvasively. Nineteen volunteers participated in the magnetic resonance imaging (MRI) study and one was excluded for excessive movement during scanning. A three-dimensional phase-contrast sequence (3D-PC) of magnetic resonance angiography (MRA) was used for vessel images, and a 3D-T1 high-resolution volume examination (THRIVE) was used for anatomical images. Colour-coded vessel images from 3D-PC MRA were superimposed on the 3D volume anatomical images, and the arterial course and relation to the adjacent structures were confirmed with multiplanar reconstructed cross-sectional (MPR) images. 3D-PC MRA images visualized the lingual artery in all 18 subjects and the sublingual artery in 14 subjects. In seven of 18 cases the bilateral sublingual arteries were shown to run side by side but had no contact with the sublingual veins. They ran together with the sublingual veins in four cases. Three cases showed irregular patterns. The bilateral sublingual arteries could not be identified in four cases. 3D-PC MRA images of the lingual artery superimposed on the anatomical images may be clinically useful to confirm its course and relationship to the adjacent structures before surgery, in order to prevent haemorrhage.