Lawrence E Ginsberg

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (114)453.09 Total impact

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    International Journal of Radiation OncologyBiologyPhysics 11/2015; 93(3-3, Supplement):E340 -. DOI:10.1016/j.ijrobp.2015.07.1413 · 4.26 Impact Factor
  • F. Nasseri · K. Munjal · L.E. Ginsberg · F. Eftekhari ·

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    ABSTRACT: Enhanced phosphoinositide 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway is one of the key adaptive changes accounting for epidermal growth factor receptor (EGFR) inhibitor-resistant growth in head and neck squamous cell carcinoma (HNSCC). We designed a phase II clinical trial of EGFR tyrosine kinase inhibitor (TKI), erlotinib, in association with the mTOR inhibitor, everolimus, based on the hypothesis that the downstream effects of Akt through inhibition of mTOR may enhance the effectiveness of the EGFR-TKI in patients with recurrent/metastatic HNSCC. Patients with histologically or cytologically confirmed platinum-resistant HNSCC received everolimus 5 mg and erlotinib 150 mg daily orally until disease progression, intolerable toxicity, investigator or patient decision. Cytokines and angiogenic factors profile, limited mutation analysis and p16 immunohistochemistry status were included in the biomarker analysis. Of the 35 assessable patients, 3 (8%) achieved partial response at 4 weeks, 1 confirmed at 12 weeks; overall response rate at 12 weeks was 2.8%. Twenty-seven (77%) patients achieved disease stabilization at 4 weeks, 11 (31%) confirmed at 12 weeks. Twelve-week progression-free survival (PFS) was 49%, median PFS 11.9 weeks and median overall survival (OS) 10.25 months. High neutrophil gelatinase lipocalin (P = 0.01) and vascular endothelial growth factor (VEGF) (P = 0.04) plasma levels were significantly associated with worse OS. The combination of erlotinib and everolimus did not show significant benefit in unselected patients with platinum-resistant metastatic HNSCC despite a manageable toxicity profile. Markers of tumor invasion and hypoxia identify a group of patients with particularly poor prognosis. NCT00942734. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email:
    Annals of Oncology 05/2015; 26(7). DOI:10.1093/annonc/mdv194 · 7.04 Impact Factor
  • Rami Saade · Amy Hessel · Lawrence Ginsberg · Greg Fuller · Diana Bell ·

    Journal of Neurological Surgery, Part B: Skull Base 02/2015; 76(S 01). DOI:10.1055/s-0035-1546702 · 0.72 Impact Factor
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    ABSTRACT: BACKGROUND The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer. METHODS Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated. RESULTS The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01). CONCLUSIONS Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.
    Cancer 01/2015; 121(10). DOI:10.1002/cncr.29241 · 4.89 Impact Factor
  • Rami Saade · Amy Hessel · Lawrence Ginsberg · Greg Fuller · Diana Bell ·
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    ABSTRACT: Background: Primary extradural meningiomas (PEMs) are rare, particularly those involving the paraspinal cervical area, so little is known about them. We identified a new case and compared it with 10 previous cases, addressed the diagnostic challenges, and highlighted the clinical and pathologic characteristics. Methods: We conducted a case report and literature review of PEM cases reported since 1976. Results: A 59-year-old man presented with right neck stiffness and discomfort that was present over the last several months, which is consistent with other cases. CT scan and MRI revealed a paraspinal cervical mass. Fine-needle aspiration (FNA) and core biopsy revealed spindle cells with whorling consistent with meningioma. The patient underwent complete en bloc resection of the tumor. The PEM was histologically benign. Conclusion: Cervical PEMs should be considered in the differential diagnosis of a deep neck mass. These tumors are typically benign and are surgically resected.
    Head & Neck 09/2014; 37(8). DOI:10.1002/hed.23874 · 2.64 Impact Factor
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    Marc-Elie Nader · Diana Bell · Erich M Sturgis · Lawrence E Ginsberg · Paul W Gidley ·
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    ABSTRACT: Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.
    Journal of Neurological Surgery 08/2014; 75(1):e84-8. DOI:10.1055/s-0034-1368149 · 0.49 Impact Factor
  • Sarah C Cantrell · Holly H Reid · Guojun Li · Qingyi Wei · Erich M Sturgis · Lawrence E Ginsberg ·
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    ABSTRACT: Background and purpose: Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than do HPV-negative oropharyngeal cancers. However, among patients with HPV-positive oropharyngeal carcinomas, those with a significant smoking history have a much worse prognosis. Recently, imaging characteristics of oropharyngeal cancers were identified as markers of poor prognosis. The purpose of this study was to determine whether nodal imaging characteristics differ between smokers and never/light smokers with HPV-positive oropharyngeal cancer. Materials and methods: A review of 130 pretreatment computed tomographic examinations of HPV-positive oropharyngeal cancers in smokers (>10 pack-years) and never/light smokers (10 pack-years) matched for T stage and tumor subsite was performed, with the reviewing radiologist blinded to the HPV status, smoking history, and clinical stage. Additionally 24 pretreatment computed tomographic examinations of patients with HPV-negative oropharyngeal cancers were also reviewed in a blinded fashion. Imaging characteristics of metastatic nodal disease were compared using the testing (Fisher exact testing where appropriate) and McNemar testing for the matched-pair analysis. Results: As expected, those with HPV-positive oropharyngeal cancer were more likely to be younger, male, non-Hispanic white, never/former smokers, and never drinkers than were those with HPV-negative oropharyngeal cancer. Furthermore, the HPV-positive oropharyngeal cancers were more likely to be in the tonsil, smaller T category, higher N category, poorly differentiated, than were the HPV-negative oropharyngeal cancers. However, among the HPV-positive oropharyngeal cancers, we could identify no obvious difference in the pretreatment imaging characteristics of paired smokers and never/light smokers. Conclusions: Among the patients with HPV-positive oropharyngeal cancer, no imaging characteristics were identified to correlate with the critical prognostic feature smoking status. Cystic and necrotic nodal metastases, as described previously, were more common among the patients with HPV-positive than those with HPV-negative oropharyngeal cancers. Although cystic nodal metastases were more common among the never/light smokers with HPV-positive oropharyngeal cancer than among smokers with HPV-positive oropharyngeal cancer, however, because these results did not reach statistical significance, we concluded that the imaging results cannot serve as a surrogate for an HPV-driven phenotype.
    Journal of Computer Assisted Tomography 06/2014; 38(5). DOI:10.1097/RCT.0000000000000100 · 1.41 Impact Factor
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    ABSTRACT: Purpose: Tumors that recur following orbital exenteration may not be evident on clinical examination, highlighting the need for imaging surveillance. The goal of this study was to report the imaging characteristics of recurrent tumors following orbital exenteration and free flap reconstruction. Methods: The authors retrospectively reviewed the records of 48 patients who underwent orbital exenteration for the treatment of orbital malignancy and identified 17 recurrent tumors in 17 patients. The lesions were assessed for the presence of a soft tissue mass, imaging characteristics, and fluorodeoxyglucose avidity. Results: The recurrent tumors were detected 1 month to 6 years 10 months (median, 1 year 3 month) after orbital exenteration. On both CT and MRI, all 17 lesions were soft tissue masses at presentation. On CT, the lesions demonstrated heterogeneous to homogeneous to centrally necrotic enhancement; on MRI, the lesions were T1 hypointense to isointense and T2 hypointense to hyperintense. Twelve of the 15 recurrent tumors with available preoperative imaging had an enhancing appearance similar to that of the original tumor. Thirteen of the 17 recurrent tumors were at the margin of a flap placed for reconstruction; the other 4 lesions were remote from the operative site. Conclusion: Recurrent tumors following orbital exenteration and free flap reconstruction demonstrate a wide range of imaging appearances but most often appear as a soft tissue masses often similar in appearance to the primary tumor and arising near the flap margin. Awareness of the imaging features of recurrent disease is important because failure to diagnose recurrence can delay appropriate treatment.
    Ophthalmic Plastic and Reconstructive Surgery 05/2014; 30(4). DOI:10.1097/IOP.0000000000000100 · 0.88 Impact Factor
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    ABSTRACT: Purpose: The goal of this study was to describe computed tomographic findings in patients with clinically proven temporal bone (TB) osteoradionecrosis (ORN) (TB-ORN). Materials and Methods: Computed tomographic scans of 20 patients were retrospectively evaluated for bony and soft tissue abnormalities. Clinical severity was graded based on level of therapy administered: mild (observation), moderate (antibiotics/hyperbaric oxygen), or severe (surgery). Results: Radiation dose to the primary tumor ranged from 30 to 75.6 Gy. Time to onset of ORN from completion of radiation therapy was 2 to 22 years (median, 7 years). Clinical findings: exposed bone, 20 of the 20 patients; otorrhea, 17 of the 20 patients; hearing loss, 11 of the 20 patients; otalgia, 10 of the 20 patients; facial nerve paralysis, 2 of the 20 patients; gait imbalance, 2 of the 20 patients. Computed tomographic findings: external auditory canal erosions, 18 of the 20 patients; mastoid effusion, 18 of the 20 patients; mastoid bony coalescence, 5 of the 20 patients; enhancing soft tissue, 6 of the 20 patients; soft tissue gas, 6 of the 20 patients; temporomandibular joint/condylar erosion, 3 of the 20 patients. Three patients developed an abscess. Conclusion: Mastoid effusion and external auditory canal erosions are commonly seen with TB-ORN. Clinically moderate or severe cases of TB-ORN are more likely to demonstrate enhancing soft tissue (P = 0.002), soft tissue gas (P = 0.002), and temporomandibular joint involvement (P = 0.07).
    Journal of Computer Assisted Tomography 05/2014; 38(5). DOI:10.1097/RCT.0000000000000096 · 1.41 Impact Factor
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    ABSTRACT: To facilitate detection of tumor recurrence, the authors reviewed the MRI characteristics of myocutaneous and fasciocutaneous free flaps following orbital exenteration for treatment of orbital or maxillofacial tumors. The authors retrospectively reviewed the MRI characteristics, including T1 and T2 signal intensity, and enhancement pattern of 28 such flaps. The study included 17 myocutaneous flaps and 11 fasciocutaneous flaps placed in 28 patients. For 23 flaps, additional imaging was performed after baseline imaging (range, 2-65 months after surgery). On precontrast T1 imaging, 15 of 17 myocutaneous flaps demonstrated a striated appearance similar to that of native muscle. Twenty-six of the 28 flaps in the series were T2 hyperintense. On baseline imaging, 26 flaps showed linear (n = 5), patchy (n = 10), or homogeneous (n = 11) enhancement. No flaps demonstrated mass-like enhancement. Five fasciocutaneous and 5 myocutaneous flaps showed decreased enhancement on follow-up imaging, while 4 myocutaneous flaps showed increased enhancement. Fourteen patients received postoperative radiation, 4 of which demonstrated increased enhancement, which subsequently decreased in 3 flaps. Fourteen of 23 followed flaps became smaller over time. On MRI, both myocutaneous and fasciocutaneous flaps placed after orbital exenteration generally demonstrate persistent non-mass-like enhancement and T2 hyperintensity, and both types of flaps may become smaller over time. Head and neck radiologists, ophthalmologic and plastic surgeons, and oncologists should be aware of the range of imaging features of these flaps to avoid misinterpreting the postoperative appearance as tumor recurrence.
    Ophthalmic plastic and reconstructive surgery 04/2014; 30(4). DOI:10.1097/IOP.0000000000000103 · 0.88 Impact Factor
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    ABSTRACT: Purpose/Objective(s):Primary brain and central nervous system (CNS) tumor incidence is approximately 19 per 100,000 individuals per year in the United States (US) compared with 7 per 100,000 individuals worldwide.The most common intra-axial tumor is gliomas, which account for 32% of all primary CNS tumors and 80% of all malignant tumors of the CNS.The most common diffuse glioma is grade IV astrocytoma (glioblastoma, GBM), which makes up 54% of diffuse glial tumors. GBM is also the most aggressive brain tumor with poor prognosis.GBM metastases outside the CNS are rare, so therapeutic experience with these types of tumors is limited.Materials/Methods:Herein, we present 3 GBM patients with extra-CNS metastasis.Results:One patient developed GBM metastasis in the lung and pleura 5 years after his GBM diagnosis had been confirmed. Another patient who underwent resection of the primary GBM developed disease that extended through the sphenoid to involve the orbit and skull and subsequently invaded the parotid gland and neck nodes 1 year after diagnosis. A third patient developed GBM metastasis in the skull and L5 vertebra 2 years after her primary brain tumor had been resected.Conclusions:The exact mechanism of GBM metastasis outside the central nervous system is not well understood but likely involves the invasion of structures such as bone, lymphatics, and vasculature, especially veins. Above-average survival time and repeated surgical intervention may place GBM patients at higher risk for these unusual metastases
    Journal of Clinical Oncology 02/2014; 32(22). DOI:10.1200/JCO.2013.48.7546 · 18.43 Impact Factor
  • Conference Paper: Perineural Spread
    Lawrence E. Ginsberg ·
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    ABSTRACT: LEARNING OBJECTIVES 1) Review the various cutaneous malignancies that may afflict the face and scalp, focusing on imaging appearance and staging evaluation. 2) Understand the clinical circumstances and imaging appearance and strategies related to perineural tumor spread in head and neck malignancies. 3) Understand the spectrum of upper aerodigestive tract malignancy attributable to minor salivary glands, including the anatomic distribution, imaging appearance including non-specificity, and patterns of spread, particularly by perineural mechanism.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
  • Vinodh A Kumar · Komal B Shah · Lawrence E Ginsberg ·
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    ABSTRACT: Our purpose was to present 3 cases of perineural tumor spread (PNS) to the oculomotor (CN III) nerve. To our knowledge, PNS to CN III has not been previously reported. In the course of advanced PNS, typically with involvement of the cavernous sinus, tumor may spread in a retrograde fashion to involve CN III in the interpeduncular fossa and can even invade the brainstem.
    Journal of computer assisted tomography 07/2013; 37(4):525-7. DOI:10.1097/RCT.0b013e31828f4ba8 · 1.41 Impact Factor
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    ABSTRACT: Background and purpose: Imaging correlates of genetic expression have been found for prognostic and predictive biomarkers of some malignant diseases, including breast and brain tumors. This study tests the hypothesis that imaging findings correlate with relevant genomic biomarkers in oral cavity squamous cell carcinoma. Materials and methods: Surplus frozen tissue from 27 untreated patients with oral cavity squamous cell carcinoma who underwent preoperative CT imaging was analyzed for gene expression. A team of neuroradiologists blinded to the genomic analysis results reviewed an extensive list of CT findings. The imaging correlated with genomic expression for cyclin D1, angiogenesis-related genes (vascular endothelial growth factor receptors and ligands), which relate to enhancement on the basis of other tumor types; and epidermal growth factor receptor, which may relate to proliferation and mass effect. Results: Expression of vascular endothelial growth factor receptors 1 and 2 correlated with the enhancement of the primary tumor (P = .018 and P = .025, respectively), whereas the epidermal growth factor receptor correlated with mass effect (P = .03). Other exploratory correlations included epidermal growth factor receptor to perineural invasion (P = .05), and certain vascular endothelial growth factor receptors and ligands to mass effect (P = .03) and increased (P = .01) or decreased (P = .02) primary tumor size. Conclusions: We report that CT imaging correlates with gene expression in untreated oral cavity squamous cell carcinoma. Enhancement of the primary tumor and degree of mass effect correlate with relevant genomic biomarkers, which are also potential drug targets. Eventually, treatment decisions may be aided by combining imaging findings into meaningful phenotypes that relate directly to genomic biomarkers.
    American Journal of Neuroradiology 06/2013; 34(9). DOI:10.3174/ajnr.A3635 · 3.59 Impact Factor
  • D Fried · C Pickering · A Rao · L Hunter · K Shah · S Ahmed · M Frederick · J Zhang · A Unruh · J Wang · L Ginsberg · A Kumar · J Myers · L Court · J Hamilton ·
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    ABSTRACT: Purpose: To determine whether correlations exist between CT‐generated texture features and genetic biomarkers in oral cavity squamous cell carcinoma (OCSCC). Methods: We retrospectively analyzed 27 OCSCC patients with surplus frozen tissue and preoperative CT for genetic expression of vascular endothelial growth factor (VEGF) ligands A B, and C, VEGF receptors 1, 2, and 3, Cyclin D1 protein, and epidermal growth factor receptor (EGFR). Each tumor was segmented, blinded to the results of the gene expression analysis, on their preoperative CT and was modified into a 6‐bit grayscale image prior to texture feature extraction. Seven calculated texture features were computed based on intensity histograms (IHIST) and co‐occurrence matrices (COM). Pearson correlation coefficients (PC) were calculated between texture features and genetic expression. A sub‐group analysis (n = 17) was performed excluding patients that had a CT slice thickness greater than 1mm. Results: Correlations were found between IHIST‐kurtosis and VEGF‐receptor1 (PC = 0.42, p = 0.03) as well as between IHIST‐mean and COM‐correlation with VEGF‐receptor 1 (PC = 0.40, p = 0.04 and ‐ 0.39, p = 0.04, respectively). In the subset analysis with more controlled preoperative CT scans, the correlation between IHIST‐kurtosis and VEGF‐receptor1 remained (PC = 0.54, p = 0.03) while the correlations with VEGF‐receptor 1 did not. Additionally, IHIST‐entropy was found to correlate with VEGF ligand A (PC = −0.51, p = 0.04). This correlation is arguably the most useful as an established chemotherapy agent exists for VEGFA (bevacizumab). However, no correlations survived a Bonferroni correction for multiple hypothesis testing in the initial or subset analyses. Conclusion: This study provides some preliminary data indicating that CT‐based texture features may be correlated with genetic expression in OCSCC. In future studies, a larger sample size and more focused hypothesis of texture correlations with specific genetic targets should be implemented.
    Medical Physics 06/2013; 40(6):377. DOI:10.1118/1.4815172 · 2.64 Impact Factor
  • S C Cantrell · B W Peck · G Li · Q Wei · E M Sturgis · L E Ginsberg ·
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    ABSTRACT: Background and purpose: Human papillomavirus-positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics. Materials and methods: A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ(2) test was used for the matched-pair analysis. Results: By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002). Conclusions: In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.
    American Journal of Neuroradiology 05/2013; 34(10). DOI:10.3174/ajnr.A3524 · 3.59 Impact Factor
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    ABSTRACT: Background and purpose: Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity. Materials and methods: Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data. Results: New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity. Conclusions: Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity.
    American Journal of Neuroradiology 03/2013; 34(8). DOI:10.3174/ajnr.A3461 · 3.59 Impact Factor
  • Komal Shah · Bita Esmaeli · Lawrence E Ginsberg ·
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    ABSTRACT: Perineural spread along the nasociliary branch of the ophthalmic nerve has not been previously described, to our knowledge. One case of cutaneous squamous carcinoma at the medial canthus and another of melanoma of the nasal ala, with nasociliary nerve perineural spread, are illustrated here. Whereas magnetic resonance imaging is preferred to search for perineural spread, computed tomography may also demonstrate perineural thickening and enhancement. Awareness of the computed tomography appearance of perineural spread will aid in avoiding misdiagnosis.
    Journal of computer assisted tomography 03/2013; 37(2):282-285. DOI:10.1097/RCT.0b013e31827cd39e · 1.41 Impact Factor
  • Jackson D Hamilton · Stephen Y Lai · Lawrence E Ginsberg ·
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    ABSTRACT: Radiation therapy can result in osteoradionecrosis (ORN) and mucosal ulceration predisposing to infection. Fourteen patients presenting with infectious sequelae related to mandibular ORN were retrospectively reviewed. In most patients, infection followed diagnosis of ORN; but in 4 patients, ORN was not diagnosed until after the time of infection and imaging. An early imaging finding of ORN was lingual cortical defects near the last molar. Pain followed by erythema, purulent drainage, and subperiosteal abscess by imaging were the most common signs of infection. In most patients, conservative management eventually failed and segmental mandibulectomies were required. Soft tissue infection with characteristic bone findings such as subperiosteal abscess and cortical bone erosions helps to distinguish infected ORN from recurrent tumor or sterile ORN. In patients previously treated with radiation who present with infection, pain or an avid PET scan with bone involvement, the mandible should be scrutinized.
    Journal of computer assisted tomography 11/2012; 36(6):725-31. DOI:10.1097/RCT.0b013e3182702f09 · 1.41 Impact Factor

Publication Stats

2k Citations
453.09 Total Impact Points


  • 1995-2015
    • University of Texas MD Anderson Cancer Center
      • • Division of Diagnostic Imaging
      • • Department of Radiology
      • • Endocrine Neoplasia and Hormonal Disorders
      Houston, Texas, United States
  • 1996-2010
    • University of Houston
      Houston, Texas, United States
  • 2001
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States