Abstracts

Imaging of the opacified middle earLemmerling MM, De Foer B, Vande Vyver V, Vercruysse J-P, Verstraete KL[Department of Radiology, AZ Sint-Lucas Gent, Groenebriel 1, B-9000Gent, Belgium]. Eur J Radiol 2008;66:363-371.

Middle ear opacification on imaging studies performed in a nontraumaticsetting mostly reflects chronic inflammatory/infectious disease. In some ofthese patients an underlying cholesteatoma will be found. High-resolutioncomputed tomography examinations and magnetic resonance imaging areoften used in the workout of the disease. High-resolution computedtomography of the opacified middle ear serves to describe the status ofthe ossicular chain, and its suspensory apparatus, as well as the status ofthe tympanic and mastoid wall. When ossicular erosions are visualized,the probability of a present cholesteatoma is about 90%. Whereas high-resolution computed tomography is not able to differentiate cholesteatomafrom other types of opacification, magnetic resonance imaging is. Thecombined use of delayed post-Gd T1-weighted images and non–EPI-based diffusion-weighted imaging seems to be the actual best option onthis matter.

Skull base tumors: Part II. Central skull base tumors and intrinsictumors of the bony skull baseBorges A [Instituto Portugués de Oncologia Francisco Gentil, Serviço deRadiologia, Rua Professor Lima Baso, P-1093 Lisboa Codex, Portugal].Eur J Radiol 2008;66:348-362.

With the advances in cross-sectional imaging, radiologists gained anincreasing responsibility in the management of patients with skull basepathology. As this anatomic area is hidden to clinical exam, surgeons andradiation oncologists have to rely on imaging studies to plan the mostadequate treatment. To fulfill these endeavors, radiologists need to beknowledgeable about skull base anatomy, about the main treatment optionsavailable, their indications and contraindications, and need to be aware of thewide gamut of pathologies seen in this anatomic region. This article willprovide the radiologist with a friendly approach to the central skull base andwill review the most common central skull base tumors and tumors intrinsicto the bony skull base.

Nasopharyngeal carcinomaChong VFH, Ong CK [Department of Diagnostic Radiology, NationalUniversity Hospital, 5 Lower Kent Ridge Road, Singapore SGP-119074,Singapore]. Eur J Radiol 2008;66:437-447.

Imaging plays an important role in the staging of nasopharyngeal carcinoma.Accurate staging is necessary, as the treatment is directly dependent onstage. Clinical examination provides information on mucosal involvementbut is unable to determine the deep extension or the presence of skull baseinvasion or intracranial spread. The intent of this article was to provideinformation about specific imaging findings that will directly affect the stageand treatment of nasopharyngeal carcinoma as well as post-treatmentcomplications.

Impact of breast MRI on surgical treatment, axillary approach, andsystemic therapy for breast cancerMameri CS, Kemp C, Golman SM, Sobral LA, Ajzen S [Antonio Gil VelosoAve. 268-101, Vila Velha, ES, 29101010 Brazil]. Breast J 2008;14:236-244.

The purpose of this study was to determine how often breast magneticresonance imaging (MRI) brings additional information that influences themanagement of patients with breast cancer concerning surgical treatment,axillary lymph node approach, and systemic therapy. From July 2004 toJuly 2005, 99 patients recently diagnosed with breast cancer in clinicalstages 0, I, and II were prospectively evaluated about their therapeuticplans, at first based on usual protocol (physical examination, mammo-graphy, and ultrasound) and then going through bilateral breast MR.Examinations were carried out at 1.5 T on five sequences of FSPGR 3Dfor 90 s (four post-gadolinium diethylenetriaminepenta acetic acid0.16 mM/kg). Parameters analyzed on MRI were extension of primarylesion; detection of multifocality, multicentricity, or contralateral lesion;muscular or skin involvement; and presence of lymph node involvement.Pathologic confirmation of additional lesions was achieved by core orexcisional biopsy. MRI made 69 additional findings in 53 patients. Fifty-one findings were true positives (51/69=73.9%) including 16 larger singlelesions; 18 cases of multifocality; 7 cases of multicentricity; 3 cases ofcontralateral lesion; 5 cases of lymph node involvement (one of theminvolved medial thoracic chain); 1 case with muscular involvement; 1 casewith skin involvement. MRI has changed previous management plans in44.4% of 99 patients. We observed an increase in mastectomies (26.8%)on axillary lymph node dissection (25%) and changes on systemic therapy(20.2%), all because of additional MRI true-positive findings. Breast MRIalters significantly the rate of mastectomy, the approach of axillary chainfor staging, and the use of systemic therapy because of its accuracy inevaluating breast cancer local extent.

Quantitative 2- and 3-dimensional analysis of pharmacokineticmodel-derived variables for breast lesions in dynamic,contrast-enhanced MR mammographyHauth EAM, Jaeger HJ, Maderwald S, Muehler A, Kimmig R, Forsting M[Department of Diagnostic and Interventional Radiology and Neuroradiol-ogy, University Hospital Essen, Hufelandstr. 55, D-45122 Essen,Germany]. Eur J Radiol 2008;66:300-308.

Purpose: Two- (2D) and three-dimensional (3D) evaluation of quantitativepharmacokinetic parameters derived from the Tofts model modelingdynamic contrast enhancement of lesions in MR mammography.Materials and methods: In 95 patients, MR mammography revealed 127suspicious lesions. The initial rate of enhancement was coded by colorintensity; the post-initial enhancement change was coded by color hue. Two-and three-dimensional analysis of distribution of color hue and intensity,vascular permeability, and extracellular volume were performed.Results: In the 2D evaluation, malignant lesions showed a significantlyhigher number of bright red, medium red, dark red, bright green, mediumgreen, dark green, and bright blue pixels than benign lesions. In the 3D one,statistically significant differences between malignant and benign lesions

Clinical Imaging 32 (2008) 493–495

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