Imaging in treatment planning for sinonasal diseases

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Therefore, in cases of organized hematoma of the nasal cavity, it can be diagnosed at early stages due to early nasal symptoms compared to OHMS. The reported CT findings of organized hematoma include an expansive, clearly demarcated and compressive mass causing bony erosion but never destructive 1.

After administration of contrast, heterogeneous enhancement in a patchy distribution is usually found within the lesion 2. In our case, CT scans showed a full-filling soft tissue mass with heterogeneous patchy enhancement in the nasal cavity and opacification of maxillary and ethmoid sinuses without loss of bony contour of sinus wall. Moreover, nasal cavity expansion was evident with bowing of posterior septum to the left side and the inferior turbinate was very thin, upwardly displaced and compressed. Those findings were suggestive of organized hematoma originating from the nasal cavity.

MR imaging is superior to CT for determining the margin and extent of lesion. In MR images, the heterogeneous signal intensity reflects the various components contained within the lesion, such as hemorrhage, fibrosis and vascular proliferation. It has biphasic appearance that central part of the lesion presents low intensity on T1-weighted images and high intensity on T2-weighted images, corresponded with hematoma and peripheral part is less enhanced with zone of fibrosis 1. These shells were part of the soft tissue mass and were not dead space in the sinus 7.

However, there is no report on MRI in case of organized hematoma restricted to nasal cavity. Because enhanced CT showed typical findings of organized hematoma except for the lesion located in the nasal cavity rather than the paranasal sinus, we suspected the organized hematoma originated from the nasal cavity as preoperative diagnosis based on endoscopic and imaging findings.


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Recently, according to the development of endoscopic sinus surgery, it is possible to completely remove the lesion without excessive surgical invasion in the treatment of sinonasal organized hematoma 4. In cases where adequate endoscopic operative field is not achieved for the lesion such as in our case, endoscopic sinus surgery with the assistance of a microdebrider should be chosen for complete removal.

In addition, during the operation, we could verify the precise origin site of this mass as anterior portion of the inferior turbinate, but it had not extended into the sinus.

The specific pathologic findings suggesting organized hematoma might help to increase the incidence of reports. Histologically, combination of three findings of fibrous tissue, neovascularization and extravasated red blood cells in the subepithelium with no evidence of malignancy is characteristic to confirm organized hematoma 6.

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Although there is no serious complication reported, preoperative biopsy is consistently nondiagnostic and does not provide helpful information in differentiating more worrisome neoplastic processes 7. The nasal cavity may be involved in a wide variety of hypervascular lesions, either benign or malignant and differential diagnosis may be challenging. The most important disease that should be differentiated with organized hematoma of the nasal cavity is lobular capillary hemangioma LCH.

The reasons are as follows. First, both may rarely present as a mass of considerable size and thus entire filling of the nasal cavity. Second, both accompany clinical manifestations such as nasal obstruction and recurrent epistaxis and both may be seen as a red to purple single hypervascularized mass on endoscopic findings. Third, surgery is the treatment of choice for both and radical resection can be performed through an endoscopic approach even in large lesions. Finally, microtrauma from nasal packing and intubation is one of the most common predisposing factors for LCH 9 , and in cases of organized hematoma, history of trauma is an important factor.

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The calibration of CT Hounsfield units for radiotherapy treatment planning

However, unlike organized hematoma of the nasal cavity, LCH is well-circumscribed and intensely enhanced with no internal calcification or phleboliths on contrast-enhanced CT scan. Furthermore, MR images result in low signal intensity T1-weighted images and very high signal intensity on T2-weighted image In conclusion, we reported CT findings of a case of huge organized hematoma of the nasal cavity originating from the inferior turbinate, which completely obstructed the right nasal cavity and the nasopharynx without any involvement of sinus, with an emphasis on different patterns of enhancement of the tumor on the enhanced CT scans.

Therefore, organized hematoma in nasal cavity alone is a rare lesion of unknown etiology, which should be considered in the differential diagnosis of rapidly enlarging vascular lesions within the nasal cavity. Organized hematoma in the paranasal sinus and nasal cavity--imaging diagnosis and pathological findings.

However, most publications to date have focused on treatment planning techniques and theoretical plan comparisons of IMRT plans as compared to conformal RT plans [ 5 , 40 , 44 — 47 ]. For tumors of the PNS the potential benefits of IMRT are obvious due to the anatomical site: the target volumes to be treated are in very close vicinity to sensitive normal tissues and organs at risk OAR , especially the eyes, optic nerves, chiasm, brain stem and spinal cord.

With conventional RT techniques, the dose application to the target volumes is limited by the tolerated doses of the OAR in order to avoid high rates of treatment-related toxicity. Duthoy et al. However, acute toxicity was mild, and no patient developed Grade or 4 ocular toxicity.

Two patients developed decreased vision after RT, however, no RT-induced blindness was observed. Our results are in good accordance with these data.

The development of severe radiation-induced side-effects could be prevented in our study group as well. A significant number of patients developed ocular side effects, however, no Grade 3 and 4 reactions occurred, especially, no RT-induced blindness. However, follow-up time still remains relatively short.

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

The results of the present study therefore confirm the idea that IMRT can lead to equal local control and survival rates as compared to conventional or conformal RT in patients with carcinomas of the PNS. Thus, the risk of severe treatment related side effects especially to the optic system can be minimized.

Muir CS, Nectoux J: Descriptive epidemiology of malignant neoplasms of nose, nasal cavities, middle ear and accessory sinuses. Clin Otolaryngol Allied Sci , 5: Ayiomamitis A, Parker L, Havas T: The epidemiology of malignant neoplasms of the nasal cavities, the paranasal sinuses and the middle ear in Canada.

ECR 2017 / C-2130

Arch Otorhinolaryngol , A commentary on the second edition. Cancer , Publisher Full Text Strahlenther Onkol , Can we avoid dry eye syndrome? Radiother Oncol , A series of patients and a systematic review. J Otolaryngol , Donald PJ: Obliteration of compressed frontal sinus. Plast Reconstr Surg , Donald PJ: Recent advances in paranasal sinus surgery. Head Neck Surg , 4: Richtsmeier WJ: Head and neck cancer.

Otolaryngol Head Neck Surg , Otolaryngol Clin North Am , An analysis of 73 cases.


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    Correspondence to Stephanie E Combs. This article is published under license to BioMed Central Ltd. Reprints and Permissions. By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines. Imaging in treatment planning for sinonasal diseases, , The British journal of radiology 81 , ee , The British journal of radiology 90 , , International journal of cardiology 3 , ee , European journal of radiology open 5, , Diagnostic and Interventional Radiology 22 6 , , European journal of cardio-thoracic surgery 30 3 , , Surgical and Radiologic Anatomy 40 6 , , Surgical and Radiologic Anatomy 39 9 , , Imaging in Treatment Planning for Sinonasal Diseases, , Articoli 1—20 Mostra altri.

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