Radiology Head and Neck Imaging

[Head and Neck Imaging] Carotid Plaque Morphology and Composition: Initial Comparison between 1.5- and 3.0-T Magnetic Field Strengths

2008-07-18

Purpose: To prospectively compare the interpretation and quantification of carotid vessel wall morphology and plaque composition at 1.5-T with those at 3.0-T magnetic resonance (MR) imaging.

Materials and Methods: Twenty participants (mean age, 69.8 years [standard deviation] ± 10.5; 75% men) with 16%–79% carotid stenosis at duplex ultrasonography were imaged with 1.5-T and 3.0-T MR imaging units with bilateral four-element phased-array surface coils. This HIPAA-compliant study was approved by the institutional review board, and all participants gave written informed consent. Protocols designed for similar signal-to-noise ratios across platforms were implemented to acquire axial T1-weighted, T2-weighted, intermediate-weighted, time-of-flight, and contrast material–enhanced T1-weighted images. Lumen area, wall area, total vessel area, wall thickness, and presence or absence and area of plaque components were documented. Continuous variables from different field strengths were compared by using the intraclass correlation coefficient (ICC) and repeated measures analysis. The Cohen was used to evaluate agreement between 1.5 T and 3.0 T on compositional dichotomous variables.

Results: There was a strong level of agreement between field strengths for all morphologic variables, with ICCs ranging from 0.88 to 0.96. Agreement in the identification of presence or absence of plaque components was very good for calcification ( = 0.72), lipid-rich necrotic core ( = 0.73), and hemorrhage ( = 0.66). However, the visualization of hemorrhage was greater at 1.5 T than at 3.0 T (14.7% vs 7.8%, P < .001). Calcifications measured significantly (P = .03) larger at 3.0 T, while lipid-rich necrotic cores without hemorrhage were similar between field strengths (P = .9).

Conclusion: At higher field strengths, the increased susceptibility of calcification and paramagnetic ferric iron in hemorrhage may alter quantification and/or detection. Nevertheless, imaging criteria at 1.5 T for carotid vessel wall interpretation are applicable at 3.0 T.

[Head and Neck Imaging] Benign and Malignant Thyroid Nodules: US Differentiation--Multicenter Retrospective Study

2008-05-16

Purpose: To retrospectively evaluate the diagnostic accuracy of ultrasonographic (US) criteria for the depiction of benign and malignant thyroid nodules by using tissue diagnosis as the reference standard.

Materials and Methods: This study had institutional review board approval, and informed consent was waived. From January 2003 through June 2003, 8024 consecutive patients had undergone thyroid US at nine affiliated hospitals. A total of 831 patients (716 women, 115 men; mean age, 49.5 years ± 13.8 [standard deviation]) with 849 nodules (360 malignant, 489 benign) that were diagnosed at surgery or biopsy were included in this study. Three radiologists retrospectively evaluated the following characteristics on US images: nodule size, presence of spongiform appearance, shape, margin, echotexture, echogenicity, and presence of microcalcification, macrocalcification, or rim calcification. A ² test and multiple regression analysis were performed. Sensitivity, specificity, and positive and negative predictive values were obtained.

Results: Statistically significant (P < .05) findings of malignancy were a taller-than-wide shape (sensitivity, 40.0%; specificity, 91.4%), a spiculated margin (sensitivity, 48.3%; specificity, 91.8%), marked hypoechogenicity (sensitivity, 41.4%; specificity, 92.2%), microcalcification (sensitivity, 44.2%; specificity, 90.8%), and macrocalcification (sensitivity, 9.7%; specificity, 96.1%). The US findings for benign nodules were isoechogenicity (sensitivity, 56.6%; specificity, 88.1%; P < .001) and a spongiform appearance (sensitivity, 10.4%; specificity, 99.7%; P < .001). The presence of at least one malignant US finding had a sensitivity of 83.3%, a specificity of 74.0%, and a diagnostic accuracy of 78.0%. For thyroid nodules with a diameter of 1 cm or less, the sensitivity of microcalcifications was lower than that in larger nodules (36.6% vs 51.4%, P < .05).

Conclusion: Shape, margin, echogenicity, and presence of calcification are helpful criteria for the discrimination of malignant from benign nodules; the diagnostic accuracy of US criteria is dependent on tumor size.

[Head and Neck Imaging] Reproducibility of Carotid Intima-Media Thickness Measurements in Young Adults

Gonzalez, J., Wood, J. C., Dorey, F. J., Wren, T. A. L., Gilsanz, V. — 2008-04-22

Purpose: To prospectively compare the reproducibility of carotid intima-media thickness (CIMT) measurements obtained from the right and left carotid arteries in young adults by using ultrasonographic (US) images acquired at the maximum dimension, minimum dimension, and electrocardiographically (ECG)-triggered cardiac end diastole.

Materials and Methods: This study was HIPAA compliant and approved by the institutional review board; all participants provided informed consent. Medical history, anthropometric measurements, and blood pressure (BP) values were obtained from 50 men and 50 women aged 18–25 years. Images of the common carotid arteries were acquired from three independent complete cardiac cycles by using a 15L8-MHz US transducer. CIMT was measured on the images of each cycle that depicted the narrowest and widest vessel diameters, and at the R wave of the ECG. Measurements from the right and left carotid arteries were analyzed by using paired t tests; possible sex differences, by using unpaired t tests. Reproducibility was determined by using coefficients of variation and intraclass correlations (ICCs). Pearson correlations and multiple regression analyses were used to compare CIMT, body mass index (BMI), and BP.

Results: CIMT values were 7.2% and 7% greater in frames showing the narrowest lumen diameter and in R-wave ECG-triggered frames, respectively, than in those with the widest diameter. CIMT measurements were 2.2%–3.1% greater in the right carotid artery than in the left (P < .001) and were significantly related to BMI (r = 0.40, P < .001) and systolic BP (r = 0.34, P < .001). ICCs were stronger when assessments were obtained in three different cardiac cycles (0.92–0.98), rather than in one (0.79–0.91).

Conclusion: In healthy young adults, reproducibility of CIMT measurements is greatest when combining values from both carotid arteries and/or from the maximal and minimal arterial diameters.