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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 34649

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Dr. Daniel Thomas Ginat

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Department of Radiology, The University of Chicago, Chicago, IL, USA
Interests: diagnostic radiology; head and neck imaging; neuroradiology
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Dear Colleagues,

This Special Issue showcases recent advances in the realm of quantitative head and neck imaging. In particular, selected original research articles are included that highlight the use of artificial intelligence and radiomics to better characterize abnormalities in the head and neck depicted on CT and MRI. These techniques will likely become ubiquitous tools to assist head and neck radiologist interpretations as they are eventually incorporated into the workflow. Potential applications that are of research interest include implementing automated anatomy and lesion segmentation and measurement, using texture and surface features to differentiate lesions, predicting optimal treatment selection, and assessing treatment response.

Dr. Daniel Thomas Ginat
Guest Editor

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Keywords

head and neck imaging
CT
MRI
quantitative

Published Papers (12 papers)

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19 pages, 2234 KiB

Open AccessArticle

Semantic Segmentation of Extraocular Muscles on Computed Tomography Images Using Convolutional Neural Networks

by Ramkumar Rajabathar Babu Jai Shanker, Michael H. Zhang and Daniel T. Ginat

Diagnostics 2022, 12(7), 1553; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12071553 - 26 Jun 2022

Cited by 3 | Viewed by 1648

Abstract

Computed tomography (CT) imaging of the orbit with measurement of extraocular muscle size can be useful for diagnosing and monitoring conditions that affect extraocular muscles. However, the manual measurement of extraocular muscle size can be time-consuming and tedious. The purpose of this study is to evaluate the effectiveness of deep learning algorithms in segmenting extraocular muscles and measuring muscle sizes from CT images. Consecutive CT scans of orbits from 210 patients between 1 January 2010 and 31 December 2019 were used. Extraocular muscles were manually annotated in the studies, which were then used to train the deep learning algorithms. The proposed U-net algorithm can segment extraocular muscles on coronal slices of 32 test samples with an average dice score of 0.92. The thickness and area measurements from predicted segmentations had a mean absolute error (MAE) of 0.35 mm and 3.87 mm², respectively, with a corresponding mean absolute percentage error (MAPE) of 7 and 9%, respectively. On qualitative analysis of 32 test samples, 30 predicted segmentations from the U-net algorithm were accepted while 2 were rejected. Based on the results from quantitative and qualitative evaluation, this study demonstrates that CNN-based deep learning algorithms are effective at segmenting extraocular muscles and measuring muscles sizes. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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12 pages, 1326 KiB

Open AccessArticle

Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma

by Volker Hans Schartinger, Daniel Dejaco, Natalie Fischer, Anna Lettenbichler-Haug, Maria Anegg, Matthias Santer, Joachim Schmutzhard, Barbara Kofler, Samuel Vorbach, Gerlig Widmann and Herbert Riechelmann

Diagnostics 2022, 12(6), 1377; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12061377 - 02 Jun 2022

Viewed by 4665

Abstract

Clinical lymph node staging in head and neck carcinoma (HNC) is fraught with uncertainties. Established clinical algorithms are available for the problem of occult cervical metastases. Much less is known about clinical lymph node overstaging. We identified HNC patients clinically classified as lymph node positive (cN+), in whom surgical neck dissection (ND) specimens were histopathologically negative (pN0) and in addition the subgroup, in whom an originally planned postoperative radiotherapy (PORT) was omitted. We compared these patients with surgically treated patients with clinically and histopathologically negative neck (cN0/pN0), who had received selective ND. Using a fuzzy matching algorithm, we identified patients with closely similar patient and disease characteristics, who had received primary definitive radiotherapy (RT) with or without systemic therapy (RT ± ST). Of the 980 patients with HNC, 292 received a ND as part of primary treatment. In 128/292 patients with cN0 neck, ND was elective, and in 164 patients with clinically positive neck (cN+), ND was therapeutic. In 43/164 cN+ patients, ND was histopathologically negative (cN+/pN−). In 24 of these, initially planned PORT was omitted. Overall, survival did not differ from the cN0/pN0 and primary RT ± ST control groups. However, more RT ± ST patients had functional problems with nutrition (p = 0.002). Based on these data, it can be estimated that lymph node overstaging is 26% (95% CI: 20% to 34%). In 15% (95% CI: 10% to 21%) of surgically treated cN+ HNC patients, treatment can be de-escalated without the affection of survival. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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12 pages, 17206 KiB

Open AccessArticle

Cerebral Infarction and Evan’s Ratio on MRI Affect the Severity and Prognosis of Tuberculosis Meningitis Patients

by Xin Cao, Qingluan Yang, Xian Zhou, Kun Lv, Zhe Zhou, Feng Sun, Qiaoling Ruan, Jun Zhang, Lingyun Shao and Daoying Geng

Diagnostics 2022, 12(5), 1264; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051264 - 19 May 2022

Viewed by 3729

Abstract

Background: Magnetic resonance imaging (MRI) is widely used in the diagnosis of tuberculous meningitis (TBM) and its complications. We aimed to explore the relationship between MRI features and neurological deficits and TBM patients’ prognosis. Methods: patients diagnosed with TBM were subjected to a neurological evaluation on admission and divided into groups based on the Medical Research Council (MRC) scale. After several years of follow-up, the patients were further divided into groups according to the Modified Rankin Score (MRS). Their MR images were analyzed for meningeal enhancement, tuberculomas, infarction, hydrocephalus, and abscess, including the location and size of the lesion. Any changes in MRI features during the follow-up were recorded. MRI features between groups were compared, and the relationship between dynamic changes in images and Rankin grading was explored. Results: We found significant differences in acute cerebral infarction (ACI) and old cerebral infarctions (OCI) between the MRC groups, and the ORs of ACI and OCI were 21.818 (95% CI: 2.440–195.075) and 6.788 (95% CI: 1.516–30.392), respectively. There were significant differences in ACI, OCI, and Evan’s ratio between the MRS groups (p < 0.05), and the ORs of ACI, OCI, and hydrocephalus were 6.375 (95% CI: 1.501–27.080), 5.556 (95% CI: 1.332–23.177), and 9.139 (95% CI: 2.052–40.700), respectively. The changes of Evan’s ratio were related to the MRS grading (r = 0.335, p = 0.040). Conclusions: For patients with TBM, the presence of ACI or OCI is associated with neurological deficits, and ACI, OCI, and hydrocephalus can be regarded as poor prognostic predictors. Changes in Evan’s ratio will affect the outcome. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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12 pages, 1166 KiB

Open AccessArticle

“A Head Start or a Pain in the Neck?”—Establishment and Evaluation of a Video-Based “Hands-On” Head and Neck Ultrasound Course

by Lukas Pillong, Alessandro Bozzato, Dietmar Hecker, Victoria Bozzato, Bernhard Schick and Philipp Kulas

Diagnostics 2022, 12(5), 1239; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051239 - 16 May 2022

Cited by 1 | Viewed by 1810

Abstract

The COVID-19 pandemic has strongly highlighted the need for more digitalization in healthcare. Teaching ultrasound skills in online courses is a key challenge in this context. The aim of this study was to establish an online video-based head and neck ultrasound course with an evaluation of the quality, effectiveness, and feasibility of this teaching method compared to in-person teaching. Twenty-two medical students were taught head and neck ultrasound in two groups: one group in an in-person course and the other one in a video-based course. Learning success was analyzed using self-evaluation forms and external assessment by an experienced ultrasonographer. Comparing pre- and post-training self-evaluation, all participants showed statistically significant learning progress. In the external assessment, the overall scores in both groups did not differ significantly. The courses themselves were positively evaluated by all participants. Herein, we present the first feasibility study of a web-based head and neck-ultrasound course for medical students. The methodology provides the potential for future changes in telemedical education and sustainable improvements in telemedical teaching and global intra-clinical and interdisciplinary patient care. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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17 pages, 21600 KiB

Open AccessArticle

Radiologic Differentiation between Granulomatosis with Polyangiitis and Its Mimics Involving the Skull Base in Humans Using High-Resolution Magnetic Resonance Imaging

by Boeun Lee, Yun Jung Bae, Byung Se Choi, Byung Yoon Choi, Se Jin Cho, Hyojin Kim and Jae Hyoung Kim

Diagnostics 2021, 11(11), 2162; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112162 - 22 Nov 2021

Cited by 4 | Viewed by 2294

Abstract

Granulomatosis with polyangiitis (GPA) can involve the skull base or the Eustachian tubes. GPA is diagnosed on the basis of clinical manifestations and serological tests, although it is challenging to discriminate GPA from infectious processes driving skull base osteomyelitis (SBO) and malignant processes such as nasopharyngeal carcinoma (NPC). Moreover, current serological tests have a low sensitivity and cannot distinguish GPA from these other conditions. We hypothesized that certain MRI characteristics would differ significantly among conditions and aimed to evaluate whether the features could differentiate between GPA, SBO, and NPC involving the skull base. We retrospectively evaluated the MRI findings of patients with GPA, SBO, and NPC. We performed univariable logistic regression analyses to identify the predictive variables for differentiating between conditions and evaluated their diagnostic values. We showed, for the first time, that certain MRI findings significantly differed between patients with GPA and those with SBO or NPC, including the lesion morphology and extent, the apparent diffusion coefficient (ADC) values, the contrast enhancement patterns, the presence or absence of necrosis, and retropharyngeal lymphadenopathy. In conclusion, utilizing certain MRI features can improve the diagnostic performance of MRI by differentiating GPA with skull base involvement from other conditions with similar radiologic findings, including SBO and NPC, facilitating treatment plans and, thus, improving patient outcomes. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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11 pages, 3049 KiB

Open AccessArticle

An Image-Based Workflow for Objective Vessel Wall Enhancement Quantification in Intracranial Aneurysms

by Sricharan S. Veeturi, Nandor K. Pinter, Andre Monteiro, Ammad A. Baig, Hamid H. Rai, Muhammad Waqas, Adnan H. Siddiqui, Hamidreza Rajabzadeh-Oghaz and Vincent M. Tutino

Diagnostics 2021, 11(10), 1742; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11101742 - 22 Sep 2021

Cited by 7 | Viewed by 2960

Abstract

Background: VWE in contrast-enhanced magnetic resonance imaging (MRI) is a potential biomarker for the evaluation of IA. The common practice to identify IAs with VWE is mainly based on a visual inspection of MR images, which is subject to errors and inconsistencies. Here, we develop and validate a tool for the visualization, quantification and objective identification of regions with VWE. Methods: N = 41 3D T1-MRI and 3D TOF-MRA IA images from 38 patients were obtained and co-registered. A contrast-enhanced MRI was normalized by the enhancement intensity of the pituitary stalk and signal intensities were mapped onto the surface of IA models generated from segmented MRA. N = 30 IAs were used to identify the optimal signal intensity value to distinguish the enhancing and non-enhancing regions (marked by an experienced neuroradiologist). The remaining IAs (n = 11) were used to validate the threshold. We tested if the enhancement area ratio (EAR—ratio of the enhancing area to the IA surface-area) could identify high risk aneurysms as identified by the ISUIA clinical score. Results: A normalized intensity of 0.276 was the optimal threshold to delineate enhancing regions, with a validation accuracy of 81.7%. In comparing the overlap between the identified enhancement regions against those marked by the neuroradiologist, our method had a dice coefficient of 71.1%. An EAR of 23% was able to discriminate high-risk cases with an AUC of 0.7. Conclusions: We developed and validated a pipeline for the visualization and objective identification of VWE regions that could potentially help evaluation of IAs become more reliable and consistent. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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13 pages, 2103 KiB

Open AccessArticle

Masseter Muscle Thickness Measured by Ultrasound as a Possible Link with Sarcopenia, Malnutrition and Dependence in Nursing Homes

by Mikel González-Fernández, Javier Perez-Nogueras, Antonio Serrano-Oliver, Elena Torres-Anoro, Alejandro Sanz-Arque, Jose M. Arbones-Mainar and Alejandro Sanz-Paris

Diagnostics 2021, 11(9), 1587; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11091587 - 31 Aug 2021

Cited by 9 | Viewed by 2661

Abstract

Sarcopenia is a progressive and generalized loss of skeletal muscle mass and strength. It is frequently associated with malnutrition and dependence in nursing homes. Masticatory muscle strength could be the link between sarcopenia, malnutrition and dependence. We aimed to study the relation between sarcopenia, malnutrition and dependence with masseter muscle thickness measured by ultrasound. A cross-sectional study was realized, with 464 patients from 3 public nursing homes in Zaragoza (Spain). The diagnosis of sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People 2 criteria, malnutrition by the Mini Nutritional Assessment (MNA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria and functional capacity by the Barhel Index and the texture diet. Masseter muscle thickness (MMT) was measured by ultrasound. The median age was 84.7 years, and 70% of the participants were women. Sarcopenia was confirmed in 39.2% of patients, malnutrition in 26.5% (risk 47.8%), total dependence in 37.9% and diet texture was modified in 44.6%. By logistic regression, once the model was adjusted for age, sex, Barthel index and texture diet, our analyses indicated that each 1 mm decrease in MMT increased the risk of sarcopenia by ~57% (OR: 0.43), the risk of malnutrition by MNA by ~63% (OR: 0.37) and the risk of malnutrition by GLIM by ~34% (OR: 0.66). We found that MMT was reduced in sarcopenic, malnourished and dependent patients, and it could be the common point of a vicious cycle between sarcopenia and malnutrition. Further studies are needed to establish causality. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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10 pages, 991 KiB

Open AccessArticle

Sentinel Lymph Node Biopsy in Early Stages of Oral Squamous Cell Carcinoma Using the Receptor-Targeted Radiotracer ^99mTc-Tilmanocept

by Christian Doll, Claudius Steffen, Holger Amthauer, Nadine Thieme, Thomas Elgeti, Kai Huang, Kilian Kreutzer, Steffen Koerdt, Max Heiland and Benedicta Beck-Broichsitter

Diagnostics 2021, 11(7), 1231; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11071231 - 08 Jul 2021

Cited by 7 | Viewed by 2125

Abstract

Neck management in patients with early-stage, clinically node-negative oral squamous cell carcinoma (OSCC) remains a matter of discussion. Sentinel lymph node biopsy (SLNB) represents a treatment alternative to avoid elective neck dissection (END) in this cohort and different protocols and tracers exist. Here we present the clinical outcome of SLNB using ^99mTc-tilmanocept in a two-day protocol in patients suffering from early-stage OSCC. A total of 13 patients (males: 6; females: 7; mean age: 65.7 years, ranging from 47 to 89 years) were included in this study. Most of the patients suffered from an OSCC of the floor of mouth (n = 6), followed by tongue (n = 5) and upper alveolar crest/hard palate (n = 2). Sentinel lymph nodes (SLNs) were successfully identified in all cases (range: 1–7). The average length of hospital stay was 4.7 days (range: 3–8 days) and mean duration of surgical intervention was 121 min (range: 74–233 min). One patient who suffered from an OSCC of the tongue was sentinel lymph node positive (SLN+). The mean follow-up for all sentinel lymph node negative (SLN-) patients (n = 12) was 20.3 months (range: 10–28 months). No local or nodal recurrences were observed within the observation period. In our patient cohort, SLNB using ^99mTc-tilmanocept in a two-day protocol proved to be a reliable and safe staging method for patients suffering from early-stage, clinically node-negative OSCC. These results and their possible superiority to colloid tracers have to be confirmed in a prospective randomized controlled study. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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13 pages, 1776 KiB

Open AccessArticle

Dental Anomalies’ Characteristics

by Tatiana Sella Tunis, Ofer Sarne, Israel Hershkovitz, Tamar Finkelstein, Aikaterini Maria Pavlidi, Yehoshua Shapira, Moshe Davidovitch and Nir Shpack

Diagnostics 2021, 11(7), 1161; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11071161 - 25 Jun 2021

Cited by 18 | Viewed by 5627

Abstract

The aim of this study was to characterize dental anomalies. The pretreatment records (photographs and radiographs) of 2897 patients (41.4% males and 58.6% females) were utilized to detect dental anomalies. The dental anomalies studied were related to number, size and shape, position, and eruption. A Chi-square test was carried out to detect associations between dental anomalies, jaw, and sex. A total of 1041 (36%) of the subjects manifested at least one dental anomaly. The prevalence of all dental anomalies was jaw-dependent and greater in the maxilla, except for submerged and transmigrated teeth. The most frequently missing teeth were the maxillary lateral incisor (62.3%) and the mandibular second premolars (60.6%). The most frequent supernumerary teeth were the incisors in the maxilla (97%) and the first premolars in the mandible (43%). Dental anomalies are more frequent in the maxilla and mainly involve the anterior teeth; in the mandible, however, it is the posterior teeth. These differences can be attributed to the evolutionary history of the jaws and their diverse development patterns. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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9 pages, 6946 KiB

Open AccessArticle

Radiomic Model Predicts Lymph Node Response to Induction Chemotherapy in Locally Advanced Head and Neck Cancer

by Michael H. Zhang, David Cao and Daniel T. Ginat

Diagnostics 2021, 11(4), 588; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11040588 - 25 Mar 2021

Cited by 11 | Viewed by 2078

Abstract

This study developed a pretreatment CT-based radiomic model of lymph node response to induction chemotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC) patients. This was a single-center retrospective study of patients with locally advanced HPV+ HNSCC. Forty-one enlarged lymph nodes were found from 27 patients on pretreatment CT and were split into 3:1 training and testing cohorts. Ninety-three radiomic features were extracted. A radiomic model and a combined radiomic-clinical model predicting lymph node response to induction chemotherapy were developed using multivariable logistic regression. Median age was 57 years old, and 93% of patients were male. Post-treatment evaluation was 32 days after treatment, with a median reduction in lymph node volume of 66%. A three-feature radiomic model (minimum, skewness, and low gray level run emphasis) and a combined radiomic-clinical model were developed. The combined model performed the best, with AUC = 0.85 on the training cohort and AUC = 0.75 on the testing cohort. A pretreatment CT-based lymph node radiomic signature combined with clinical parameters was able to predict nodal response to induction chemotherapy for patients with locally advanced HNSCC. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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8 pages, 1311 KiB

Open AccessBrief Report

Assessment of Neck Muscle Shear Modulus Normalization in Women with and without Chronic Neck Pain

by Angela V. Dieterich, Utku Şükrü Yavuz, Frank Petzke and Antoine Nordez

Diagnostics 2022, 12(8), 1791; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081791 - 23 Jul 2022

Viewed by 1334

Abstract

Identifying the objective stiffness of the neck muscles facilitates the early and specific diagnosis of neck pain and targeted therapy. However, individual variation in the muscle shear modulus obscures differences between healthy and diseased individuals. Normalization may improve the comparability between individuals. The shear modulus at different functional tasks served as a reference for normalizing the neck muscles’ shear modulus of 38 women, 20 with chronic neck pain and 18 asymptomatic. Reference tasks were maximal voluntary contraction, relaxed sitting, prone head lift, balancing 1 kg on the head, and neck extension at 48 N. The effects of normalization on within-group variation and between-group differences were compared. Normalization with maximal voluntary contraction was discarded due to imaging problems. Normalization with relaxed sitting, prone head lift, balancing 1 kg, and neck extension at 48 N reduced within-group variation, by 23.2%, 26.8%, 11.6%, and 33.6%, respectively. All four normalization approaches reduced the p-values when testing for between-group differences. For the pain group, normalization with relaxed sitting and head lift indicated less normalized muscle stiffness, while normalization with balancing 1 kg and extension at 48 N indicated higher stiffness. The contradictory results are explainable by non-significant group differences in the reference tasks. Normalization of the muscle shear modulus is effective to reduce within-group variation, but a trustworthy normalization approach for group comparisons has yet to be identified. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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5 pages, 938 KiB

Open AccessCase Report

The Tyndall Effect in High-Resolution Computed Tomography of Semicircular Canalolithiasis with Benign Paroxysmal Positional Vertigo

by Jiann-Jy Chen, Chun-Chung Lui, Tien-Yu Chen, Ping-Tao Tseng and Chao-Ming Hung

Diagnostics 2022, 12(4), 1000; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12041000 - 15 Apr 2022

Viewed by 1733

Abstract

To date, along with the progress of new technology and computer program development, the high-resolution computed tomography (HRCT) had been applied in different clinical application, such as HRCT for coronary angiography. In the current neuroimaging reports, we present HRCT images of the head/neck of two cases, in which one had a diagnosis of benign paroxysmal positional vertigo (BPPV) and the other did not, to represent the Tyndall effect, which describes the scattering of light by particles (i.e., semicircular canalolithiasis) in the path of light and enables clinicians to see a specific signal on the HRCT images. On the HRCT image of the patient with canalolithiasis with BPPV, we could obviously see the scattering effect (i.e., Tyndall effect) in the horizontal/posterior semicircular canal; however, on the HRCT image of the other without canalolithiasis, we could not see such findings. Therefore, through the assistance of technological progress, HRCT might be beneficial in the diagnosis of semicircular canalolithiasis, which has the advantage of being noninvasive and having a low risk of complications. However, because of the disadvantages of expense and risk of radiation exposure, HRCT should be reserved for patients who are difficult to diagnose. Full article

(This article belongs to the Special Issue Head and Neck Imaging)

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