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PurposeTo determine the diagnostic performance of FDG-PET/MRI with diffusion-weighted imaging (FDG-PET/DWIMRI) for detection and local staging of head and neck squamous cell carcinoma (HNSCC) after radio(chemo)therapy.Materials and methodsThis was a prospective study that included 74 consecutive patients with previous radio(chemo)therapy for HNSCC and in whom tumour recurrence or radiation-induced complications were suspected clinically. The patients underwent hybrid PET/MRI examinations with morphological MRI, DWI and FDG-PET. Experienced readers blinded to clinical/histopathological data evaluated images according to established diagnostic criteria taking into account the complementarity of multiparametric information. The standard of reference was histopathology with whole-organ sections and follow-up ≥24 months. Statistical analysis considered data clustering.ResultsThe proof of diagnosis was histology in 46/74 (62.2%) patients and follow-up (mean ± SD = 34 ± 8 months) in 28/74 (37.8%). Thirty-eight patients had 43 HNSCCs and 46 patients (10 with and 36 without tumours) had 62 benign lesions/complications. Sensitivity, specificity, and positive and negative predictive value of PET/DWIMRI were 97.4%, 91.7%, 92.5% and 97.1% per patient, and 93.0%, 93.5%, 90.9%, and 95.1% per lesion, respectively. Agreement between imaging-based and pathological T-stage was excellent (kappa = 0.84, p < 0.001).ConclusionFDG-PET/DWIMRI yields excellent results for detection and T-classification of HNSCC after radio(chemo)therapy.Key points• FDG-PET/DWIMRI yields excellent results for the detection of post-radio(chemo)therapy HNSCC recurrence.• Prospective one-centre study showed excellent agreement between imaging-based and pathological T-stage.• 97.5% of positive concordant MRI, DWI and FDG-PET results correspond to recurrence.• 87% of discordant MRI, DWI and FDG-PET results correspond to benign lesions.• Multiparametric FDG-PET/DWIMRI facilitates planning of salvage surgery in the irradiated neck.

Purpose We compare the quantitative accuracy of magnetic resonance imaging (MRI)-based attenuation correction (AC) using the 3-class attenuation map (PET-MRAC3c) implemented on the Ingenuity TF PET/MRI and the 4-class attenuation map (PET-MRAC4c) similar to the approach used on the Siemens mMR PET/MR considering CT-based attenuation-corrected PET images (PET-CTAC) as standard of reference. Procedures Fourteen patients with malignant tumors underwent whole-body sequential 2-deoxy-2-[ 18 F]fluoro- d -glucose ( 18 F-FDG) positron emission tomography (PET)/X-ray computed tomography (CT) and PET/MR imaging. A 3-class attenuation map was obtained from segmentation of T1-weighted MR images followed by assignment of attenuation coefficients (air 0 cm −1 , lung 0.022 cm −1 , soft tissue 0.096 cm −1 ), whereas a 4-class attenuation map was derived from a MR Dixon sequence (air 0 cm −1 , lung 0.018 cm −1 , fat 0.086 cm −1 , soft tissue 0.096 cm −1 ). Additional adipose tissue class and inner body air cavities ( e.g. , sinus and abdomen) were also considered. Different attenuation coefficients were assigned to the lungs since the two techniques were implemented as they were proposed without any modification. Standardized uptake value (SUV) mean and SUV max metrics were calculated for volumes of interest in various organs/tissues and malignant lesions. Well-established metrics were used for the analysis of SUVs estimated using both PET-MRAC techniques and PET-CTAC including relative error, Spearman rank correlation, and Bland and Altman analysis. Results PET-MRAC3c and PET-MRAC4c revealed significant underestimation of SUV for normal organs (−17.4 ± 8.5 and −22.0 ± 6.8 %, respectively) compared to PET-CTAC. Lesions’ SUV presented the same trend with larger underestimation for PET-MRAC4c (−9.2 ± 6.1 %) compared to PET-MRAC3c (−3.9 ± 9.0). The different attenuation coefficients assigned to the lungs with both techniques resulted in significant positive bias on PET-MRAC3c (18.6 ± 15.3 %) and low negative bias on PET-MRAC4c (−0.5 ± 13.3 %). Both approaches yielded the largest differences in and near bony structures. Despite the large bias, there was good correlation between PET-MRAC3c ( R  = 0.97, P  < 0.01) and PET-CTAC, and PET-MRAC4c ( R  = 0.97, P  < 0.01) and PET-CTAC, respectively. Conclusions PET-MRAC3c resulted in significant systematic positive bias in the lungs owing to the lower attenuation coefficient used and negative bias in other regions. PET-MRAC4c slightly underestimated tracer uptake in the lungs and led to even larger negative bias than PET-MRAC3c in other body regions. The presence of artifacts in the MRAC might lead to misinterpretation of clinical studies. As such, the attenuation map needs to be checked for artifacts as part of the reading procedure to avoid misinterpretation of SUV measurements.

Objectives Radiolucent mandibular lesions seen on panoramic radiographs develop from both odontogenic and non-odontogenic structures. They represent a broad spectrum of lesions with a varying degree of malignant potential. The purpose of this review is to illustrate the characteristic imaging findings—as well as the clinical and histological features—of common and uncommon radiolucent lesions of the mandible. Methods This review article is based on the retrospective evaluation of 11,725 panoramic radiographs seen in our institution during the past 6 years. It provides a comprehensive, practical approach to the radiological interpretation of radiolucent lesions of the mandible. To facilitate the diagnostic approach, we have classified radiolucent lesions into two groups: lesions with well-defined borders and those with ill-defined borders. Results Lesion prevalence, age of manifestation, location within the mandible, relationship to dental structures, effect on adjacent structures and characteristic findings at computed tomography (CT), cone beam CT (CBCT) and magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) are discussed. Pitfalls including malignant lesions mimicking benign disease and pseudo-lesions are equally addressed. Conclusion Knowledge of the characteristic imaging features of radiolucent mandibular lesions narrows the differential diagnosis and is crucial for the identification of those lesions, where biopsy is indicated for definitive histology. Teaching points • Panoramic X-rays, CT and MRI are essential for the work-up of radiolucent mandibular lesions. • Lesion borders, location within the mandible, relationship to dental structures and tissue characteristics on cross-sectional imaging are indispensable to narrow the differential diagnosis. • High-resolution CT and CBCT play a major role for the assessment of lesion margins and their relationship to important anatomic structures, such as the inferior alveolar nerve. • Although most radiolucent lesions with well-defined sclerotic borders are benign, MRI may reveal clinically unsuspected malignant disease.

ObjectivesLung carcinoids and atypical hamartomas may be difficult to differentiate but require different treatment. The aim was to differentiate these tumors using contrast-enhanced CT semantic and radiomics criteria.MethodsBetween November 2009 and June 2020, consecutives patient operated for hamartomas or carcinoids with contrast-enhanced chest-CT were retrospectively reviewed. Semantic criteria were recorded and radiomics features were extracted from 3D segmentations using Pyradiomics. Reproducible and non-redundant radiomics features were used to training a random forest algorithm with cross-validation. A validation-set from another institution was used to evaluate of the radiomics signature, the 3D ‘median’ attenuation feature (3D-median) alone and the mean value from 2D-ROIs.ResultsSeventy-three patients (median 58 years [43‒70]) were analyzed (16 hamartomas; 57 carcinoids). The radiomics signature predicted hamartomas vs carcinoids on the external dataset (22 hamartomas; 32 carcinoids) with an AUC = 0.76. The 3D-median was the most important in the model. Density thresholds < 10 HU to predict hamartoma and > 60 HU to predict carcinoids were chosen for their high specificity > 0.90. On the external dataset, sensitivity and specificity of the 3D-median and 2D-ROIs were, respectively, 0.23, 1.00 and 0.13, 1.00 < 10 HU; 0.63, 0.95 and 0.69, 0.91 > 60 HU. The 3D-median was more reproducible than 2D-ROIs (ICC = 0.97 95% CI [0.95‒0.99]; bias: 3 ± 7 HU limits of agreement (LoA) [− 10‒16] vs. ICC = 0.90 95% CI [0.85‒0.94]; bias: − 0.7 ± 21 HU LoA [− 4‒40], respectively).ConclusionsA radiomics signature can distinguish hamartomas from carcinoids with an AUC = 0.76. Median density < 10 HU and > 60 HU on 3D or 2D-ROIs may be useful in clinical practice to diagnose these tumors with confidence, but 3D is more reproducible.Critical relevance statementRadiomic features help to identify the most discriminating imaging signs using random forest. ‘Median’ attenuation value (Hounsfield units), extracted from 3D-segmentations on contrast-enhanced chest-CTs, could distinguish carcinoids from atypical hamartomas (AUC = 0.85), was reproducible (ICC = 0.97), and generalized to an external dataset.Key points• 3D-‘Median’ was the best feature to differentiate carcinoids from atypical hamartomas (AUC = 0.85).• 3D-‘Median’ feature is reproducible (ICC = 0.97) and was generalized to an external dataset.• Radiomics signature from 3D-segmentations differentiated carcinoids from atypical hamartomas with an AUC = 0.76.• 2D-ROI value reached similar performance to 3D-‘median’ but was less reproducible (ICC = 0.90).

Background: The first year of life is the period of greatest brain plasticity. Postpartum depression can adversely affect the first interactions with the child and, consequently, their emotional, social, and cognitive development. Objectives: First, to describe the developmental profile of six-month-old infants of mothers suffering from severe postpartum depression, and, second, to compare the development of infants whose mothers suffer from depression with or without bipolar disorder. Methods: This is a retrospective descriptive study on 6-month-old babies hospitalized with their mothers at the Marseille Mother–Baby Unit (MBU) for maternal postpartum depression with or without bipolar disorder. Mothers were clinically diagnosed by a psychiatrist specialized in postpartum depression using the DSM-5; infant development was assessed at 6 months by an independent health professional using the revised Brunet–Lézine Scale, which allowed the calculation of global and partial developmental quotients (DQ). Results: We followed 40 mother–infant dyads. None of the 40 infants had a global developmental delay. However, maternal depression was significantly associated with poorer sociability (mean sociability DQ score of 94 ± 9.6, p < 0.001) and lower postural development (mean postural DQ score of 96.2 ± 8.9 *, p < 0.001) in the infants at 6 months of age. Postural development was significantly lower in children of bipolar mothers than in children of non-bipolar mothers (p = 0.03). Conclusions: Postpartum depression was associated with a weakness in sociability and posture at the age of 6 months, without relevant developmental delay. Screening infants at an early age with specific tools allows for earlier intervention, which would positively influence their developmental trajectory.

PurposeThis prospective study aimed to compare the diagnostic performance of [18]FDG PET/MRI and PET/CT for the detection of distant metastases and distant second primary cancers in patients with head and neck squamous cell carcinoma (HNSCC). MethodsA total of 103 [18F]FDG PET/MRI examinations immediately followed by PET/CT were obtained in 82 consecutive patients for staging of primary HNSCC (n = 38), suspected loco-regional recurrence/follow-up (n = 41) or unknown primary HNSCC (n = 3). Histology and follow-up > 2 years formed the standard of reference. Blinded readers evaluated the anonymized PET/MRI and PET/CT examinations separately using a 5-point Likert score. Statistical analysis included: receiver operating characteristic (ROC) analysis, jackknife alternative free-response ROC (JAFROC) and region-of-interest (ROI)-based ROC to account for data clustering and sensitivity/specificity/accuracy comparisons for a score ≥ 3. ResultsDistant metastases and distant second primary cancers were present in 23/103 (22%) examinations in 16/82 (19.5%) patients, and they were more common in the post-treatment group (11/41, 27%) than in the primary HNSCC group (3/38, 8%), p = 0.039. The area under the curve (AUC) per patient/examination/lesion was 0.947 [0.927–1]/0.965 [0.917–1]/0.957 [0.928–0.987] for PET/MRI and 0.975 [0.950–1]/0.968 [0.920–1]/0.944 [0.910–0.979] for PET/CT, respectively (p > 0.05). The diagnostic performance of PET/MRI and PET/CT was similar according to JAFROC (p = 0.919) and ROI-based ROC analysis (p = 0.574). Sensitivity/specificity/accuracy for PET/MRI and PET/CT for a score ≥ 3 was 94%/88%/89% and 94%/91%/91% per patient, 96%/90%/91% and 96%/93%/93% per examination and 95%/85%/90% and 90%/86%/88% per lesion, respectively, p > 0.05.ConclusionsIn HNSCC patients, PET/MRI and PET/CT had a high and similar diagnostic performance for detecting distant metastases and distant second primary cancers.

Purpose Parotid pleomorphic adenomas present a risk of recurrence, higher when the tumour is a hypocellular subtype. The aim of the study was to determine whether it is possible to characterize this histological subtype with diffusion and perfusion sequences of the preoperative MRI. Methods This retrospective study included 97 patients operated between 2010 and 2020. Histologic slides review was performed to classify tumours into three histologic subtypes: hypocellular, classical and hypercellular. Univariate and multivariate analyses studied the correlation between histology and diffusion and perfusion MRI parameters obtained with OleaSphere® software. Results The hypocellular subtype had higher apparent diffusion coefficient values than the other two subtypes: 2.13 ± 0.23, 1.83 ± 0.42, and 1.61 ± 0.4 × 10 –3  mm 2 /s for hypocellular, classical and hypercellular subtype respectively ( p  < 0.0001). Multivariate analysis showed that an ADC mean > 1.88 × 10 –3  mm 2 /s was suggestive of a hypocellular pleomorphic adenoma in 79% of the cases, with a specificity and PPV of 94 and 96% ( p  < 0.001), respectively. Conclusion The histological subtype of a pleomorphic adenoma can be predicted preoperatively with ADC values. A prospective and multicentric study on a larger cohort is needed to confirm our results.

Purpose Pheochromocytomas/paragangliomas (PHEOs/PGLs) overexpress ă somatostatin receptors and recent studies have already shown excellent ă results in the localization of these tumors using Ga-68-labeled ă somatostatin analogs (Ga-68-DOTA-SSA), especially in patients with ă germline succinate dehydrogenase subunit B gene (SDHB) mutations and ă head and neck PGLs (HNPGLs). The value of Ga-68-DOTA-SSA has to be ă established in sporadic cases, including PHEOs. Thus, the aim of this ă study was to compare Ga-68-DOTATATE PET/CT, F-18-FDOPA PET/CT, and ă conventional imaging in patients with various PHEOs/PGLs with a special ă emphasis on sporadic cases, including those located in the adrenal ă gland. ă Design Ga-68-DOTATATE, F-18-FDOPA PET/CT, and conventional imaging ă (contrast-enhanced CT and MRI with MR angiography sequences) were ă prospectively performed in 30 patients (8 with SDHD mutations, 1 with a ă MAX mutation and 21 sporadic cases) with PHEO/PGL at initial diagnosis ă or relapse. ă Results The patient-based sensitivities were 93 % (28/30), 97 % ă (29/30), and 93 % (28/30) for Ga-68-DOTATATE PET/CT, F-18-FDOPA PET/CT, ă and conventional imaging, respectively. The lesion-based sensitivities ă were 93 % (43/46), 89 % (41/46), and 76 % (35/46) for Ga-68-DOTATATE ă PET/CT, F-18-FDOPA PET/CT, and conventional imaging respectively (p = ă 0.042). Ga-68-DOTATATE PET/CT detected a higher number of HNPGLs (30/30) ă than F-18-FDOPA PET/CT (26/30; p = 0.112) and conventional imaging ă (24/30; p = 0.024). Ga-68-DOTATATE PET/CT missed two PHEOs of a few ă millimeters in size and a large recurrent PHEO. One lesion was ă considered false-positive on Ga-68-DOTATATE PET/CT and corresponded to a ă typical focal lesion of fibrous dysplasia on MRI. Among the 11 lesions ă missed by conventional imaging, 7 were detected by conventional imaging ă with knowledge of the PET results (4 HNPGLs, 2 LNs, and 1 recurrent ă PHEO). ă Conclusion Ga-68-DOTATATE PET/CT is the most sensitive tool in the ă detection of HNPGLs, especially SDHD-related tumors, which may be very ă small and fail to concentrate sufficient F-18-FDOPA. The present study ă further expands the use of Ga-68-DOTATATE for all patients with HNPGLs, ă regardless of their genotype. Ga-68-DOTATATE PET/CT may be inferior to ă F-18-FDOPA PET/CT in the detection PHEOs.

Pheochromocytomas/paragangliomas (PHEOs/PGLs) overexpress somatostatin receptors and recent studies have already shown excellent results in the localization of these tumors using (68)Ga-labeled somatostatin analogs ((68)Ga-DOTA-SSA), especially in patients with germline succinate dehydrogenase subunit B gene (SDHB) mutations and head and neck PGLs (HNPGLs). The value of (68)Ga-DOTA-SSA has to be established in sporadic cases, including PHEOs. Thus, the aim of this study was to compare (68)Ga-DOTATATE PET/CT, (18)F-FDOPA PET/CT, and conventional imaging in patients with various PHEOs/PGLs with a special emphasis on sporadic cases, including those located in the adrenal gland. (68)Ga-DOTATATE, (18)F-FDOPA PET/CT, and conventional imaging (contrast-enhanced CT and MRI with MR angiography sequences) were prospectively performed in 30 patients (8 with SDHD mutations, 1 with a MAX mutation and 21 sporadic cases) with PHEO/PGL at initial diagnosis or relapse. The patient-based sensitivities were 93 % (28/30), 97 % (29/30), and 93 % (28/30) for (68)Ga-DOTATATE PET/CT, (18)F-FDOPA PET/CT, and conventional imaging, respectively. The lesion-based sensitivities were 93 % (43/46), 89 % (41/46), and 76 % (35/46) for (68)Ga-DOTATATE PET/CT, (18)F-FDOPA PET/CT, and conventional imaging respectively (p = 0.042). (68)Ga-DOTATATE PET/CT detected a higher number of HNPGLs (30/30) than (18)F-FDOPA PET/CT (26/30; p = 0.112) and conventional imaging (24/30; p = 0.024). (68)Ga-DOTATATE PET/CT missed two PHEOs of a few millimeters in size and a large recurrent PHEO. One lesion was considered false-positive on (68)Ga-DOTATATE PET/CT and corresponded to a typical focal lesion of fibrous dysplasia on MRI. Among the 11 lesions missed by conventional imaging, 7 were detected by conventional imaging with knowledge of the PET results (4 HNPGLs, 2 LNs, and 1 recurrent PHEO). (68)Ga-DOTATATE PET/CT is the most sensitive tool in the detection of HNPGLs, especially SDHD-related tumors, which may be very small and fail to concentrate sufficient (18)F-FDOPA. The present study further expands the use of (68)Ga-DOTATATE for all patients with HNPGLs, regardless of their genotype. (68)Ga-DOTATATE PET/CT may be inferior to (18)F-FDOPA PET/CT in the detection PHEOs.