第12回臨床画像大会

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たつぞうのじま
7 years ago
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1 Landmarks for Imaging of Head Neck Cancer Hugh D. Curtin, MD Department of Radiology Massachusetts Eye and Ear Infirmary Head and neck carcinoma is almost always diagnosed clinically before the patient comes to be imaged. Imaging determines the deeper extent of the lesion. The major types of spread are direct encroachment, submucosal spread, perineural extension, lymphatic metastasis. The specific landmarks that must be checked depend on location of the primary. Certain important landmarks can illustrate the basic principles of cancer imaging and are the focus of this lecture. Anterior oral cavity/floor of mouth: The inner cortex of the mandible is the key landmark. CT evaluates direct extension into bone. Is the bone normal? Is there minimal cortical erosion or has the tumor reached the medullary space? These findings determine the feasibility of marginal vs. segmental mandibulectomy. Retromolar trigone/tonsillar pillar/posterior floor of mouth: In this complex anatomic region, submucosal spread can carry tumor along the tonsillar pillar from soft palate to the underside of the tongue. The posterior floor of mouth is immediately adjacent to a gap in the sheet-like musculature. Tumor encounters less resistence in spreading into the soft tissues close to the submandibular gland. Roof of mouth : Perineural spread is particularly important in this location. Tumor can grow along the palatine nerves to the pterygopalatine fossa. The status of the fat in the fossa is an important indicator of the presence or absence of perineural spread. The entire course of the second division of the trigeminal nerve must be examined. The important structures include the infraorbial canal and the fat at the infraorbital foramen, the foramen rotundum and gasserian ganglion. The trigeminal fat pad just medial to the lateral pterygoid muscle and just inferior to foramen ovale is a key landmark for tumor spreading along the trigeminal or auriculotemporal nerves. The fat in the stylomastoid foramen is the key landmark for tumor extension along the facial nerve into the temporal bone. Lymph nodes : Nodal metastasis is a major determinant of prognosis. CT, MRI, Ultrasound and PET scanning can all assess the nodes. The best examination would have a low false negative rate. The key statistic is the error rate of the negative finding. This percentage indicates the number of patients that have insidious tumor though the imaging is negative. 1 CT MRI 2 preslyloid retrostyloid CT MRI 2 CT multi-detector row CT MDCT 10 CT MDCT

2 CT CT MDCT 3 CT MDCT 3 computer-aided diagnosis CT 3 CT 256 CT cone beam CT dual energy CT CT CT MRI 1 CT MRI CT 1970 MDCT 1970 MRI 20 2 modality modality EBM CT MRI 2 CT MRI CT MRI CT MR1? 3 CT MRI CT MRI X CT MRI X CT MRI X CT MRI X CT MRI X CT MRI X CT MRI X CT MRI 3 CT MRI CT MRI 131

3 CT 1986 X CT X CT 1997 CT CT CT MRI B MRI MRI MRI CT MRI MRI CT MRI Boston Harvard Massachusetts Eye and Ear Infirmary MEEI Dr. Hugh D. Curtin 1 MEEI Work in progress 1 CT 1 X CT PSR9000N ALPHARD X CT 2004 PSR9000N ALPHARD 132

4 ALPHARD ALPHARD VEGA 2 PSR9000N CT CT CT CT CT 41mm 40mm CT CT CT ALPHARD ALPHARD ALPHARD VEGA 2 ALPHARD 3 VEGA 4 VEGA 200mm 179mm CT 3 2 X CT CB MercuRay CB Throne XR X X X CT CT D CT Veraviewepocs 3D 2 CT CT X CT DX CT CT 3 2 line pair/mm X CT 3 5 CT X I.I FPD IDS CT X 3D CT X Veraviewepocs 3D 3 3DX Veraviewepocs 3D 4 CBCT 1 CT 2 FOV 81.0mm H75.2mm 147 m FOV 55.7mm H51.7mm 101 m FOV CT CCD CT 133

5 3 3D DICOM Work in progress 2 MRI 1 3 MRMAGNETOM Trio, A Tim System MR 3 MR MAGNETOM Trio A Tim System SPACE 1 mm 1 1 mm SPACE T1 T2 FLAIR MR SAR SPACE SAR SE 3T 3D S/N 3T 3 MR 1.5 MR BLADE BLADE blade k-space k-space BLADE Tl T2 FLAIR 2 Work in progress MRI MRI MRI 25 T1 MRI Atlas SPEEDER MRA FBI 10 Time-SLIP 3 MRI MRI MRI MRI 3.0T MRI MRI MRI MRI MRI MRI MRI 1987 MRI MRI MRI MRI

6 2 3 MRI MRI RF RF 2 MRI MRI MRI 4 PHILIPS MRI So advanced, it s simple T&C MR 1.5TMRI 20 MRI MRI MR1 3.0TMRI 3.0TMI 1.5TMRI RF-SMART RF 1.5T 47mm 23mm 100 m 2 3.0TMRI SMR 3.0TMRI 1.5TMRI SmartExam MRI 1 CT CT CT / / / mm SD mm SD mm SD

7 2 CT US CT CT CT US CT US 3 CBCT CT CBCT CBCT CBCT 3D Accuitomo MPR i-view mm 2 mm CBCT CT CBCT 4 CT CBCT X 3 CT X CT CT 64 CT Alphard VEGA 102mm 102mm 0.2mm 0.2mm 0.2mm DICOM OsiriX

8 cm CT CT 5 CT-arthorography CT M.A. CT CTarthrography multi detector CT MDCT 2 cone beam CT CBCT 0.128mm 0.5mm Iohexol 350mgI/ml 5 50 MDCT Sensation64 CBCT 3DX FineCube MDCT FOV 50mm 50mm 0.6mm 3DX FOV 4 cm 3 cm 0.5mm FineCube FOV 56.5mm 51.7mm 0.5mm mm MDCT 2 CBCT 0.405mm CT 80MDCT 0.33mm 3DX 0.235mm FineCube 0.205mm 50 3DX Fine- Cube 3DX mgI/ml FineCube 3DX MDCT 0.4mm 3 6 CT CT 15 CT X X 7 MR 1 ADC ADC 2 ADC ADC MRI 1 ADC 2 Time-signal intensity curve TIC 2003 MR ADC TIC ADC TIC ADC TIC TIC 137

9 8 CT MRI CT MRI CT MRI CT MRI 70 CT MRI 7 CT Light Speed QX/i MRI Signa LX T1 T2 T1 Analyze 7 CT mm 3 T mm 3 T mm 3 T mm 3 T1 T2 MRI T2 7 4 T2 T1 T1 CT MRI T1 T2 9 CT MR CT MR class MRI T1W T2W STIR T1W 5 CT low density 10MRI CT X CT CT MRI CT MRI CT MRI CT 3 MRI 5 CT T1 T2 6 MRI 15 CT 12 T1 15 T2 13 CT HU 38.2HUCT 5 MRI MRI MRI CT 138

10 11 MRI MRI MRI mm mm 39mm mm 18mm 5 10 MRI T2wI mm I T2wI 12 Neuroendocrine tumor Neuroendocrine tumor chromatin Neuroendocrine tumor Neuroendocrine tumor sarcoma CT mm MRI T1WI T2WI FS FU Total 4100mg8 1 Total 30Gy8 25 Neuroendocrine tumor carcinoid tumor Hodgkin Waldeyer mm X CT MRI T1 T2 STIR T1 Hodgkin diffuse large B cell type Ga 139

11 mm 6 CT MRI T1 T2 T1 US T2 15 CT MRI 47 1 X X CT MRI T1 T2 16 MRI MRI MRI 7 open lock MRI 1 MRI 140

12 open lock 17 MRI CT MRI MRI mm 7 mm US MRI T1 T2 T US CT MRI T1 1 2 MRI T1 1 Mucoepidermoid carcinoma 2 Pleomorphic adenoma X 1 MR X 10 MR MR Gy 141

13 Gy Gy 20Gy 68Gy 1 57Gy 2 75Gy 4 61Gy 3 50Gy 5 44Gy 20 Real-Time Tissue Elastography Real-Time Tissue Elastography Real-time tissue elastography EUB-8500 Tsukuba Elastography Score PPV 85NPV cm CT 2 Synapse FUJI FILM Japan / / / / retrospective MRI retrospective

14 MRI MRA 23 focal defect focal defect focal defect focal defect apparent diffusion coefficient ADC Gyroscan Intera 1.5T Master ADC b 0,500 1,000 ADC focal defect ADC 24 MR US MR US MR US MR US 1 MR US MR US MR US 25 ADC ADC ADC ADC ADC 40Gy MR Intera 1.5T Master Philips 1 4 MR T1 T2 T1 T2 ADC MR ADC ADC ADC MR

15 Retrospective CT MRI 27 MR sialography 48 MR sialography Dynamic MR sialography Dynamic MR sialography 30 Dynamic MR sialography 30 MR MIP Dynamic MR sialography 23 Pearson r P Pearson r P Dynamic MR sialography Dynamic MR sialography 28 pulse Doppler pulse Doppler Sjögren 67 US pulse Doppler ml Vmax Vmax Vmax 10 Vmax Vmax Vmax Vmax Vmax Vmax

16 CT High Density Area CT ECG 30 Madelung disease 1 Madelung disease CT US CT CT 100 X US 10 18mm CT CT Madelung disease Madelung disease H X X CT mm CT 145

17 MRI T2WI T1WI 15mm PET 18FDG 11C-Choline SUV 18FDG C-Choline WHO X X X X X X X CT CT CT mm osteolytic lesion lesion MR lesion T1WI isointense T2WI isointense hyperintense dynamic study lesion wash out lesion contamination ameloblastoma follow-up 146

口腔癌の早期発見のために For the early detection of oral cancer Kazumasa Sugihara Department of Maxillofacial Diagnostic and Surgical Science, Field of Oral and M

Title 口腔癌の早期発見のために Author(s) 杉原, 一正 Citation 鹿児島大学歯学部紀要, 34: 3-11 Issue Date 2014 URL http://hdl.handle.net/10232/20682 http://ir.kagoshima-u.ac.jp 口腔癌の早期発見のために For the early detection of oral cancer Kazumasa