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SYNOPSIS
OF
DISSERTATION
DR. ERSHAD AHAMED. S
DEPARTMENT OF RADIO-DIAGNOSIS
VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTRE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE CANDIDATE &
DR. ERSHAD AHAMED. S
ADDRESS
DEPARTMENT OF RADIODIAGNOSIS, VIMS &
(IN BLOCK LETTERS)
RC, WHITEFIELD, BANGALORE – 560066.
VYDEHI INSTITUTE OF MEDICAL SCIENCES &
2.
NAME OF THE INSTITUTION
RESEARCH CENTRE
3.
COURSE OF STUDY & SUBJECT
MD - RADIODIAGNOSIS
DATE OF ADMISSION TO
5TH JUNE 2013
4.
COURSE
EVALUATION OF MAGNETIC RESONANCE
5.
TITLE OF THE TOPIC
IMAGING IN ORAL CAVITY TUMOURS
6. Brief resume of intended work
6.1 Need for study
Squamous cell carcinoma is the most frequent malignancy of oral cavity region,
accounting to 5% of all malignant tumours worldwide1, amongst which carcinoma of buccal
mucosa is the most common intraoral malignancy. Clinical examination often underestimates the
extent of tumour in advanced diseased stages owing to the tendency of these lesion to spread
submucosally and majority of metastatic lymph node less than 10 mm being interpreted as
regular cervical lymph node status2. Therefore, staging of oral cavity tumours is essential for
appropriate surgical and radiation therapy planning. Cross sectional imaging technique such as
magnetic resonance (MR) imaging and computed tomography (CT) becomes mandatory for
meticulous therapeutic planning.
CT is preferred to MR in detecting lymph node involvement, but found significant
limitation in detecting micro metastasis. Medullary bone invasion is best visualized by highresolution non-enhanced T1 weighted images; however CT found to be more appropriate to
visualize small cortical bone erosion3. Thus MR is recommended as the imaging modality of
choice for treatment selection with CT being an alternative imaging technique in patients with
limited compliance in MR imaging. Hence, there is a need to evaluate the role of this imaging
modality in staging and diagnosis of oral cavity tumours.
6.2 Review of literature
Edzard Wiener et al. reported2 that MR imaging demonstrated a higher sensitivity in
depiction of the primary tumour of the oral cavity than computed tomography (CT). Both
imaging modalities exhibited 65% accuracy in assessing the extent of local soft tissue tumour
invasion into adjacent structures, known to be one of the most vital prognostic factor for oral
cavity tumours.
Devvrat singh et al reported4, CT is useful for evaluating bony invasion and is highly
sensitive for extra capsular spread of tumour but does not differentiate reactively enlarged lymph
node from metastatic lymphadenopathy5. MR imaging is used for soft tissue evaluation and
provides superior soft tissue contrast compared to CT. Therefore it is particularly useful for
assessment of local spread of carcinomas. It shows superior sensitivity for invasion especially
into the bone marrow and gives delineation of tumour invasion of fascia and small muscles. It
provides relationship of tumour to vessels6. These are mandatory for surgical planning and more
readily evaluated with MR imaging.
6.3 Objectives of the study
1. To correlate CT staging with histopathological staging
2. To correlate MR imaging staging with histopathological staging
3. To evaluate the role of MR imaging in staging of oral cavity tumours and to assess
sensitivity and specificity of the same.
7. Material and methods
7.1 Source of data
All clinically diagnosed oral cavity tumours will be subjected to CT and MR imaging in
the department of diagnostic radiology and imaging, VIMS & RC, Bangalore.
a. Sample size – Minimum of 30 cases
b. Duration of study – Jan 2014 to Dec 2015
c. Inclusion criteria –
i.
All patients with clinically diagnosed oral cavity tumours (oral cavity includes the
anterior two thirds of the tongue, the hard palate, the mylohyoid muscle and the
buccal mucosa.)
d. Exclusion criteria –
i.
Recurrent/treated oral cavity tumours
ii.
Tumours of the oropharynx and hypopharynx
iii.
Severely debilitated patient
iv.
Renal impairment
v.
Allergic to contrast media
7.2 Method of collection of data
Detailed history will be taken regarding clinical complaints.
All patients will undergo the following:
1. Magnetic resonance imaging of head and neck will be performed. Conventional
Sequences (T1W1, T2W1, fat suppressal images with contrast) will be obtained.
2. Computed Tomography of head and neck will be performed. Plain and contrast
enhanced images will be obtained.
EQUIPMENT:

Philips Achieva 1.5 T MRI machine.

GE Lightspeed Xtra 16 slice multi detector scanner.
Statistical analysis:
i. Sensitivity
ii. Specificity
iii. positive predictive value
will be calculated for MR imaging and CT.
7.3 Does the study require any investigations or interventions to be conducted on patients
or other humans or animals? If so, please describe briefly:
All patients will be subjected to
a. Contrast enhanced computed tomography of head and neck
b. Contrast enhanced magnetic resonance imaging of head and neck
c. Histopatholgical study of the surgical specimen.
7.4 Has the ethical clearance has been obtained from your institution in case of 7.3?
Yes, copy enclosed
8. List of References
1. Lambert R et al. Epidemiology of cancer from oral cavity and oropharynx 2011 (8):63341.
2. Edzard Wiener, Christoph Pautke et al. Comparison of 16-slice MSCT and MRI in the
assessment of squamous cell carcinoma of the oral cavit 2006. Eur J Radiol 58:113-118.
3. Bolzoni A, Cappiello J, Piazza C, et al. Diagnostic accuracy of magnetic resonance
imaging in the assessment of mandibular involvement in oral-oropharyngeal squamous
cell carcinoma: a prospective study. 2004 Arch Otolaryngol Head Neck Surg 130:837–
43.
4. Devvrat singh et al. Latest advancements in imaging of oral and maxillofacial neoplasm
2013. Journal of oral and maxillofacial radiology 10.4103/2321-3841.120094.
5. Sham ME, Nishat S. Imaging modalities in head and neck cancer patients overview. J
Canc Res Expe Oncol 2011;3:22-5.
6. King AD. Multimodality imaging of head and neck cancer. Cancer Imaging 2007;7:3746.
9. Signature of candidate
10.Remarks of the guide – The study will help assess the comparative efficacy of MR imaging
and CT in the staging of oral cavity tumours
11. Name & Designation of (in block letters)
Dr. Bala Thimmiah, MD
Professor
11.1 Guide
Department of Radiodiagnosis and Imaging
VIMS & RC, Bangalore
11.2 Signature
Dr. H. V. RAMPRAKASH MBBS, MDRD
11.7 Head of the Department
Professor and HOD
Department of Radio-diagnosis and Imaging
VIMS & RC Bangalore
11.8 Signature
12.Remarks of the Principal
12.1 Signature