To estimate the accuracy of different radiologic criteria used to detect cervical lymph node metastasis in patients with head and neck carcinoma, seven different characteristics of 2,719 lymph nodes in 71 neck dissection specimens from 55 patients were assessed. Three lymph node diameters, their location, their number, the presence of a tumor, and the amount of necrosis and fatty metaplasia were recorded. The minimal diameter in the axial plane was found to be the most accurate size criterion for predicting lymph node metastasis. A minimal axial diameter of 10 mm was determined to be the most effective size criterion. The size criterion for lymph nodes in the subdigastric region was 1 mm larger (11 mm). Groups of three or more borderline nodes were proved to increase the sensitivity but did not significantly decrease the specificity. Radiologically detectable necrosis (3 mm or larger) was found only in tumorous nodes and was present in 74% of the positive neck dissection specimens. Shape was not a valuable criterion for the radiologic assessment of the cervical lymph node status.

Background. The incidence of distant metastases in head and neck cancer patients is rising because of greater locoregional control of the disease. Methods. The relative risks for having distant metastases as first site of failure relative to the regional lymph node involvement were determined. Results. The overall incidence was 10.7%, with a clear relationship between the number of involved lymph nodes and extranodal spread on one hand, and distant spread on the other hand. The group with histopathologic presence of disease in the neck had twice as much distant metastases as did those with histopathologic absence (13.6% versus 6.9%). Patients with more than three histologically positive lymph nodes were most at risk for having distant metastases (46.8%). The presence of extranodal spread meant a threefold increase in the incidence of distant metastases, compared with patients without this feature (19.1% versus 6.7%). Conclusions. Patients with three or more positive nodes and with extranodal spread may benefit from adjuvant systemic therapy.

There is now widespread agreement that serial brain MRI is useful in monitoring treatments designed to modify the course of multiple sclerosis. It has been less clear whether gadolinium enhancement is needed. We therefore compared the relative sensitivity of long repetition time (TR) spin echo (SE) and gadolinium enhanced short TR SE sequences in detecting active lesions. A blind analysis of the two sequences was performed in 26 untreated patients with early relapsing--remitting (19) or secondary progressive (seven) multiple sclerosis who underwent monthly MRI on four occasions (one baseline and three follow-up). Active lesions were defined as either new or enlarged lesions on long TR SE, or new or persistent enhancing lesions on short TR SE. In one patient there were 144 active lesions, all of which were seen with enhancement on short TR SE, but only 17 were seen on long TR SE. Amongst the remaining 25 cases, a total of 106 active lesions were seen: 68 (64%) were seen only with enhancement on short TR SE, 16 (15%) were seen only on long TR SE, while 22 (21%) were active on both sequences. We conclude that gadolinium enhancement markedly increases the sensitivity of monthly brain MRI in monitoring the treatment of relapsing--remitting or secondary progressive multiple sclerosis. With this frequency of scanning, a post contrast short TR SE sequence is the most sensitive method for detecting active lesions. The smaller yet still substantial incidence of active lesions seen only on the long TR SE sequence suggests that it should also be obtained.

To establish the initial location of metastases within vertebrae and to determine the association between pedicle destruction and involvement of other parts of the vertebra by metastases, we performed a retrospective analysis of CT and plain film findings in patients in whom spinal metastases were identified for the first time.The location of destruction seen on CT was compared with the location of destruction seen on plain films. Special attention was paid to the location of destruction seen on CT in patients in whom destruction of a pedicle was seen on plain films.We tested the hypothesis that the observed location of vertebral destruction followed the sites of entry of the vertebral vessels. Materials and MethodsDuring the years i 987-i 989, 20i patients in our hospital were examined radiologically for skeletal metastases.From this group, we selected 86 patients in whom symptoms and/or signs of vertebral metastases were identified for the first time, and in whom both CT scans and plain films of the spine were obtained within a period of i week (maximum interval between both examinations, 7 days; average, 2.i days). We excluded from evaluation 4i Downloaded from www.ajronline.org by 54.245.13.81 on 05/11/18 from IP address 54.245.13.81.

Previous studies have shown that 80-90 per cent of cases of atypical hyperplasia of the endometrium do not progress to cancer. Criteria to predict the outcome in an individual patient with hyperplasia are lacking, and hysterectomy is the usual (over)treatment in order to avoid a 10-20 per cent chance of confrontation with cancer later on in the course of the disease. A recent study has shown that using a nuclear morphometric classification rule, 15 per cent of patients without progression can be accurately separated from patients with progression. However, as it is unlikely that nuclear morphometrical features are the only morphological factors reflecting the outcome of the disease, other quantitative parameters describing the architecture of the glands have also been studied for their potential value in selecting patients who will progress to cancer. In total, 10 nuclear features and 12 glandular architectural features were studied in 39 cases of atypical endometrial hyperplasia. Among these cases, seven (18 per cent) progressed to cancer. Using linear stepwise regression analysis and discriminant analysis, the volume percentage stroma and the standard deviation of the shortest nuclear axis are the best discriminators, although the outer surface density of the glands also adds to the discriminating power. The volume percentage stroma is the best single prognosticator; this feature is highly reproducible. In total, using these combined architectural and nuclear morphometrical features, 20 of the 32 cases without progression were separated from those who subsequently progressed (62.5 per cent). This is a considerable improvement over nuclear morphometrical features alone (15 per cent separated).