Adenoid cystic carcinoma of the head and neck is an uncommon malignancy that can arise in the major or minor salivary glands. Perineural invasion (PNI) is an extremely frequent finding in cases of adenoid cystic carcinoma (ACC) that can be associated with significant patient morbidity and poor prognosis. By contrast, ACC rarely demonstrates lymphovascular space invasion thereby making PNI the major avenue for metastasis and a driver of treatment rationale and design. Radiotherapy is often utilized post-operatively to improve locoregional control or as a primary therapy in unresectable disease. Here we aim to review the role of radiotherapy in the management of this malignancy with a focus on target delineation and treatment regimens in the definitive, recurrent, and metastatic settings.

Purpose: High-resolution vessel wall magnetic resonance imaging (VW-MRI) could provide a way to identify high risk arteriovenous malformation (AVM) features. We present the first pilot study of clinically unruptured AVMs evaluated by high-resolution VW-MRI. Methods: A retrospective review of clinically unruptured AVMs with VW-MRI between January 1, 2016 and December 31, 2018 was performed documenting the presence or absence of vessel wall "hyperintensity," or enhancement, within the nidus as well as perivascular enhancement and evidence of old hemorrhage (EOOH). The extent of nidal vessel wall "hyperintensity" was approximated into five groups: 0, 1-25, 26-50, 51-75, and 76-100%. Results: Of the nine cases, eight demonstrated at least some degree of vessel wall nidus "hyperintensity." Of those eight cases, four demonstrated greater than 50% of the nidus with hyperintensity at the vessel wall, and three cases had perivascular enhancement adjacent to nidal vessels. Although none of the subjects had prior clinical hemorrhage/AVM rupture, of the six patients with available susceptibility weighted imaging to assess for remote hemorrhage, only two had subtle siderosis to suggest prior sub-clinical bleeds. Conclusion: Vessel wall "enhancement" occurs in AVMs with no prior clinical rupture. Additional studies are needed to further investigate the implication of these findings.

This multicenter retrospective study evaluated the diagnostic performance of a deep learning (DL)-based application for detecting, classifying, and highlighting suspected aortic dissections (ADs) on chest and thoraco-abdominal CT angiography (CTA) scans. CTA scans from over 200 U.S. and European cities acquired on 52 scanner models from six manufacturers were retrospectively collected and processed by CINA-CHEST (AD) (Avicenna.AI, La Ciotat, France) device. The diagnostic performance of the device was compared with the ground truth established by the majority agreement of three U.S. board-certified radiologists. Furthermore, the DL algorithms time to notification was evaluated to demonstrate clinical effectiveness. The study included 1303 CTAs (mean age 58.8 ± 16.4 years old, 46.7% male, 10.5% positive). The device demonstrated a sensitivity of 94.2% [95% CI: 88.8-97.5%] and a specificity of 97.3% [95% CI: 96.2-98.1%]. The application classified positive cases by the AD type with an accuracy of 99.5% [95% CI: 98.9-99.8%] for type A and 97.5 [95% CI: 96.4-98.3%] for type B. The application did not miss any type A cases. The device flagged 32 cases incorrectly, primarily due to acquisition artefacts and aortic pathologies mimicking AD. The mean time to process and notify of potential AD cases was 27.9 ± 8.7 s. This deep learning-based application demonstrated a strong performance in detecting and classifying aortic dissection cases, potentially enabling faster triage of these urgent cases in clinical settings.

Purpose. To analyze the patterns and associations of adjunctive service visits by head and neck cancer patients receiving primary, concurrent chemoradiation therapy. Methods. Retrospective chart review of patients receiving adjunctive support during a uniform chemoradiation regimen for stages III-IV head and neck squamous cell carcinoma. Univariate and multivariate models for each outcome were obtained from simple and multivariate linear regression analyses. Results. Fifty-two consecutive patients were assessed. Female gender, single marital status, and nonprivate insurance were factors associated with an increased number of social work visits. In a multivariate analysis, female gender and marital status were related to increased social work services. Female gender and stage IV disease were significant for increased nursing visits. In a multivariate analysis for nursing visits, living greater than 20 miles between home and hospital was a negative predictive factor. Conclusion. Treatment of advanced stage head and neck cancer with concurrent chemoradiation warrants a multidisciplinary approach. Female gender, single marital status, and stage IV disease were correlated with increased utilization of social work and nursing services. Distance over 20 miles from the center was a negative factor. This information may help guide the treatment team to allocate resources for the comprehensive care of patients.