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Publications (10 of 26) Show all publications
Flygare, L., Erdogan, S. T. & Söderkvist, K. (2023). PET/MR versus PET/CT for locoregional staging of oropharyngeal squamous cell cancer. Acta Radiologica, 64(5), 1865-1872
Open this publication in new window or tab >>PET/MR versus PET/CT for locoregional staging of oropharyngeal squamous cell cancer
2023 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 64, no 5, p. 1865-1872Article in journal (Refereed) Published
Abstract [en]

Background: The value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for TN staging in head and neck cancer (HNC) has been proven in numerous studies. A few studies have investigated the value of FDG-PET/magnetic resonance imaging (MRI) in the staging of HNC; the combined results indicate potential for FDG-PET/MRI, but the scientific evidence remains weak.

Purpose: To compare performance of FDG-PET/CT and FDG-PET/MRI for locoregional staging in patients with oropharyngeal carcinomas.

Material and Methods: Two radiologists independently of each other retrospectively reviewed primary pre-therapeutic FDG-PET/CT and FDG-PET/MRI examinations from 40 individuals with oropharyngeal carcinomas. TN stage and primary tumor size were noted. The results were compared between observers and modalities and against TN stage set at a multidisciplinary conference.

Results: For nodal staging, PET/MRI had slightly higher specificity and accuracy than PET/CT for the most experienced observer. Both methods demonstrated excellent sensitivity (≥ 0.97 and 1.00, respectively), as well as high negative predictive values (≥ 0.95 and 1.00, respectively). No significant differences were found for tumor staging or measurement of maximum tumor diameter. There was a weak agreement (κ = 0.35–0.49) between PET/CT and PET/MRI for T and N stages for both observers. Inter-observer agreement was higher for PET/MRI than for PET/CT, both for tumor staging (κ = 0.57 vs. 0.35) and nodal staging (κ = 0.69 vs. 0.55). The agreement between observers was comparable to the agreement between methods.

Conclusion: PET/MRI may be a viable alternative to PET/CT for locoregional staging (TN staging) and assessment of maximal tumor diameter in oropharyngeal squamous cell cancer.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
18F-FDG, cancer staging, Head and neck cancer, positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-202001 (URN)10.1177/02841851221140668 (DOI)000893509800001 ()36464816 (PubMedID)2-s2.0-85144223158 (Scopus ID)
Funder
Swedish Cancer SocietyUmeå UniversityRegion Västerbotten, RV-940921
Available from: 2022-12-29 Created: 2022-12-29 Last updated: 2023-07-13Bibliographically approved
Flygare, L., Al-Ubaedi, A., Öhman, W. & Jakobson Mo, S. (2020). Distant metastases and synchronous malignancies on FDG-PET/CT in patients with head and neck cancer: a retrospective study. Acta Radiologica, 61(9), 1196-1204
Open this publication in new window or tab >>Distant metastases and synchronous malignancies on FDG-PET/CT in patients with head and neck cancer: a retrospective study
2020 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 61, no 9, p. 1196-1204Article in journal (Refereed) Published
Abstract [en]

Background: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been proven to be a good method to detect distant spread of head and neck cancer (HNC). However, most prior studies are based on Asian populations and may not be directly transferable to western populations.

Purpose: To investigate the frequency and distribution of distant metastases and synchronous malignancies detected by PET/CT in HNC in a northern Swedish population.

Material and Methods: All primary whole-body FDG-PET/CT examinations performed on the suspicion of HNC (n = 524 patients) between 1 January 2013 and 31 December 2016 at Umeå University Hospital in Sweden were retrospectively reviewed . After the exclusion of 189 examinations without evidence of primary HNC, 335 examinations were analyzed.

Results: Distant metastases were detected in 10 (3%) patients, all with advanced primary tumors corresponding to TNM stage 3–4, most frequently in salivary gland adenocarcinoma, where 50% of patients had distant spread. Four patients had metastases below the diaphragm, representing 20% of the salivary gland malignancies. In the remaining six patients, metastases were supraphrenic, of which all but one were identified by CT alone. Synchronous malignancies were discovered in 14 (4.2%) patients, of which five were below the diaphragm.

Conclusion: The overall frequency of distant spread and synchronous malignancy in primary HNC was generally low. However, the risk for distant metastases below the diaphragm was relatively higher in salivary gland adenocarcinoma, supporting whole-body FDG-PET/CT in the primary diagnostic work-up in these patients.

Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
Head and neck cancer, metastases, synchronous neoplasms, PET-CT, 18F-FDG
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-167605 (URN)10.1177/0284185119896344 (DOI)000507208700001 ()31902218 (PubMedID)2-s2.0-85077542542 (Scopus ID)
Available from: 2020-02-25 Created: 2020-02-25 Last updated: 2023-03-24Bibliographically approved
Vestin Fredriksson, M., Kuoljok, J., Flygare, L., Berggren, D. & Tano, K. (2019). Clinical Manifestations and Symptoms of Maxillary Sinusitis of Odontogenic Origin Demonstrated by Cone Beam Computed Tomography. Journal of General Practice, 7(1), Article ID 371.
Open this publication in new window or tab >>Clinical Manifestations and Symptoms of Maxillary Sinusitis of Odontogenic Origin Demonstrated by Cone Beam Computed Tomography
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2019 (English)In: Journal of General Practice, E-ISSN 2329-9126, Vol. 7, no 1, article id 371Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare the symptomatology of patients with maxillary sinusitis of dental origin (MSDO) with sinusitis due to upper respiratory tract infection (URTI) with a special focus on time to correct diagnosis. To define the accuracy of cone beam computed tomography (CBCT) in detecting the dental origin of the sinusitis.

Methods: Retrospective review of the otolaryngology specialist care, primary health care and dental health care medical records of patients with maxillary sinusitis who has been referred for radiology. All patients were examined by CBCT, which has a better resolution regarding bony structures than low-dose computed tomography. To the best of our knowledge there is no previous study on this topic based on CBCT as diagnostic method.

Results: Sixty-one patients were included in the study; of these, 25 had MSDO and 36 had URTI sinusitis. The MSDO patients more frequently reported foul odour and foul taste than patients with URTI sinusitis. The URTI sinusitis patients more frequently reported symptoms such as facial pain, facial congestion and cold-related symptoms. Both the time from the onset of symptoms to the first medical visit and the subsequent time to a correct diagnosis were significantly longer in the MSDO group. The accuracy of CBCT for detecting dental pathology as the underlying cause of sinusitis was 97%.

Conclusion: The present study verifies that maxillary sinusitis of dental origin differs from viral-induced rhinosinusitis concerning symptomatology and clinical findings. Certain findings and symptoms could serve as valuable indicators of an underlying dental pathology, because although MSDO is well known, the present study shows that these patients are often misdiagnosed and the correct diagnose and treatment is often delayed several months. Consequently, better assessment is important. The suspicion of MSDO should be raised for patients with unilateral sinusitis presenting little pain, foul odour or foul taste and a long time course. These patients should be referred for radiology, preferably CBCT, to rule out odontogenic cause. CBCT is easy to perform for sinusitis examinations and has advances to common CT, especially regarding detection of pathology in bony structures as the periapical area. Because of this CBCT is a reliable tool in order to detect maxillary sinusitis of dental origin.

Place, publisher, year, edition, pages
OMICS Publishing Group, 2019
Keywords
Multidetector computed tomography, Cone beam computed tomography, Radiology, Periapical diseases, Periapical abscess, Paranasal sinuses, Maxillary sinuses, Sinusitis, Maxillary sinusitis, Signs and symptoms
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-169650 (URN)10.4172/2329-9126.1000371 (DOI)
Available from: 2020-04-14 Created: 2020-04-14 Last updated: 2023-04-17Bibliographically approved
Zborayova, K., Antti, H., Blomqvist, L., Flygare, L., Gebre-Medhin, M., Jonsson, J., . . . Zackrisson, B. (2019). Early changes in multiparametric imaging parameters during radiotherapy of squamous carcinoma. Paper presented at 7th International Congress on Innovative Approaches in Head and Neck Oncology (ICHNO), Barcelona, SPAIN, MAR 14-16, 2019.. Radiotherapy and Oncology, 132, 63-63
Open this publication in new window or tab >>Early changes in multiparametric imaging parameters during radiotherapy of squamous carcinoma
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2019 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 132, p. 63-63Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-158753 (URN)10.1016/S0167-8140(19)30289-0 (DOI)000463820400107 ()
Conference
7th International Congress on Innovative Approaches in Head and Neck Oncology (ICHNO), Barcelona, SPAIN, MAR 14-16, 2019.
Note

Supplement 1.

Available from: 2019-05-15 Created: 2019-05-15 Last updated: 2021-04-16Bibliographically approved
de Almeida, F. J., Flygare, L., Knutsson, K. & Wolf, E. (2019). 'Seeing is believing': a qualitative approach to studying the use of cone beam computed tomography in endodontics in Sweden. International Endodontic Journal, 52(10), 1519-1528
Open this publication in new window or tab >>'Seeing is believing': a qualitative approach to studying the use of cone beam computed tomography in endodontics in Sweden
2019 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 52, no 10, p. 1519-1528Article in journal (Refereed) Published
Abstract [en]

Aim: To gain insight into the decision processes of dentists when requesting a cone beam computed tomography (CBCT) examination in endodontic settings.

Methodology: Fourteen dentists (eight female) 33-58 years of age (mean = 44) practising in Sweden were interviewed. Ten of the dentists were specialists in Endodontics. The absolute inclusion criterion was experience of referring patients for CBCT for endodontic reasons. The included dentists comprised a strategically selected diverse sample in terms of gender, age, work experience, educational background, location of practice, service affiliation and accessibility to CBCT. Data were obtained through semistructured interviews exposing the context of their last three self-reported referrals. Dentists were encouraged to describe their experiences of the circumstances in their own words, aided by the interviewer's open-ended questions. The interviews were audio-recorded and transcribed verbatim. The text was analysed by qualitative content analysis.

Results: The manifest content was organized into three categories that were defined as visualization as a desire, facilitating tough decisions and allocating responsibility.

Conclusion: An overall theme (covering the latent content) was identified: A balance between clinical common sense and a 'better safe than sorry' attitude guides the use of CBCT in endodontic settings. Informants had high clinical standards, knowledge concerning radiation risks and good sense, which could compensate for their lack of knowledge of guidelines. The national radiation regulatory system was perceived to work as a slightly porous gatekeeper for over-usage.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
cone beam computed tomography, decision-making, endodontics, interviews, qualitative research, qualitative content analysis
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-164385 (URN)10.1111/iej.13144 (DOI)000485318200013 ()31077614 (PubMedID)2-s2.0-85067359489 (Scopus ID)
Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2023-03-24Bibliographically approved
Vestin Fredriksson, M., Öhman, A., Flygare, L. & Tano, K. (2017). When Maxillary Sinusitis Does Not Heal: Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis. Laryngoscope Investigative Otolaryngology (LIO), 2(6), 442-446
Open this publication in new window or tab >>When Maxillary Sinusitis Does Not Heal: Findings on CBCT Scans of the Sinuses With a Particular Focus on the Occurrence of Odontogenic Causes of Maxillary Sinusitis
2017 (English)In: Laryngoscope Investigative Otolaryngology (LIO), E-ISSN 2378-8038, Vol. 2, no 6, p. 442-446Article in journal (Refereed) Published
Abstract [en]

Objectives: This study sought to investigate the proportion of patients with suspected sinusitis referred for radiological examination who have radiologically verified sinusitis of odontogenic origin and to describe this type of sinusitis. Study Design: This investigation is a retrospective study. Methods: A total of 303 sinus examinations involving cone beam computed tomography (CBCT) performed at Sunderby Hospital, Lulea, Sweden in 2012 were independently reviewed by two radiologists. The number of cases of maxillary sinusitis and the correlation between maxillary sinusitis and odontogenic infections were determined. Results: Overall, 24% of the verified cases of sinusitis were odontogenic. An odontogenic origin was identified in 40% of unilateral maxillary sinusitis cases but only 6% of bilateral maxillary sinusitis cases (p=0.0015). Forty-nine out of 54 patients with periapical destruction had adjacent mucosal swelling in the maxillary sinus, but only 15 of these patients satisfied the criteria for sinusitis. Conclusion: The present study confirms the close relationship between odontogenic infections and unilateral maxillary sinusitis.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
computed tomography, radiology, dental infection, periapical abscess, sinusitis
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-143939 (URN)10.1002/lio2.130 (DOI)000418761500017 ()29299521 (PubMedID)2-s2.0-85050684551 (Scopus ID)
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2024-07-02Bibliographically approved
de Almeida, F. J., Knutsson, K. & Flygare, L. (2015). The impact of cone beam computed tomography on the choice of endodontic diagnosis. International Endodontic Journal, 48(6), 564-572
Open this publication in new window or tab >>The impact of cone beam computed tomography on the choice of endodontic diagnosis
2015 (English)In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, no 6, p. 564-572Article in journal (Refereed) Published
Abstract [en]

Aim To determine whether the outcome of cone beam computed tomography (CBCT) examinations performed in accordance with the European Commission guidelines in a clinical setting has an impact on choosing diagnoses in endodontics. Methodology A prospective observational study was conducted. Fifty-three consecutive patients (81 teeth) from two different endodontic specialist clinics in Sweden were followed. After performing a thorough clinical examination (based on the history, clinical findings, and diagnostic tests such as intra-oral radiography), the examiner wrote down a preliminary diagnosis before CBCT examination. After the CBCT examination, a new diagnosis was made by the same examiner. Both the pre- and the post-CBCT examination diagnoses were plotted according to patients and teeth. The CBCT examinations were performed using similar equipment and protocols that were standardized amongst the clinics. Results The diagnoses were changed for at least one tooth in 22 patients (41%); overall, the diagnoses were changed for 28 teeth (35%). Conclusion CBCT has a substantial impact on diagnostic thinking in endodontics when used in accordance with the European Commission guidelines.

Place, publisher, year, edition, pages
John Wiley & Sons, 2015
Keywords
cone beam computed tomography, decision making, diagnosis; endodontics, Radiologi, diagnostik
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-93209 (URN)10.1111/iej.12350 (DOI)000354294300009 ()2-s2.0-84929134446 (Scopus ID)
Available from: 2014-09-15 Created: 2014-09-15 Last updated: 2023-03-23Bibliographically approved
Mota de Almeida, F. J., Knutsson, K. & Flygare, L. (2014). The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics. Dento-Maxillo-Facial Radiology, 43(4), Article ID 20130137.
Open this publication in new window or tab >>The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics
2014 (English)In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 43, no 4, article id 20130137Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems.

Methods: The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis.

Results: 4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%).

Conclusions: CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.

Place, publisher, year, edition, pages
British Institute of Radiology, 2014
Keywords
cone beam computed tomography, endodontics, decision-making, therapeutics, vertical root fractures, computed-tomography, periapical radiography, intraoral radiography, treated teeth, diagnosis, accuracy, lesions, efficacy, vivo
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-89538 (URN)10.1259/dmfr.20130137 (DOI)000335382800001 ()24766060 (PubMedID)2-s2.0-84901020193 (Scopus ID)
Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2023-03-23Bibliographically approved
Flygare, L., Öhman, A. & Kull, L. (2011). Letter to the editor concerning Parrott LA, Ng SY. A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study published in Dentomaxillofacial Radiology (2001;40:102–109).. Dento-Maxillo-Facial Radiology, 40(4), 262-263
Open this publication in new window or tab >>Letter to the editor concerning Parrott LA, Ng SY. A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study published in Dentomaxillofacial Radiology (2001;40:102–109).
2011 (English)In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 40, no 4, p. 262-263Article in journal (Refereed) Published
Place, publisher, year, edition, pages
British institute of radiology, 2011
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-89539 (URN)10.1259/dmfr/38497493 (DOI)000289506400009 ()21493884 (PubMedID)
Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2018-06-07Bibliographically approved
Horner, K., Islam, M., Flygare, L., Tsiklakis, K. & Whaites, E. (2009). Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dento-Maxillo-Facial Radiology, 38(4), 187-195
Open this publication in new window or tab >>Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology
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2009 (English)In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 38, no 4, p. 187-195Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To develop "basic principles" on the use of dental cone beam CT by consensus of the membership of the European Academy of Dental and Maxillofacial Radiology.

METHODS: A guideline development panel was formed to develop a set of draft statements using existing European directives and guidelines on radiation protection. These statements were revised after an open debate of attendees at a European Academy of Dental and Maxillofacial Radiology (EADMFR) Congress in June 2008. A modified Delphi procedure was used to present the revised statements to the EADMFR membership, utilising an online survey in October/November 2008.

RESULTS: Of the 339 EADMFR members, 282 had valid e-mail addresses and could be alerted to the online survey. A response rate of 71.3% of those contacted by e-mail was achieved. Consensus of EADMFR members, indicated by high level of agreement for all statements, was achieved without a need for further rounds of the Delphi process.

CONCLUSIONS: A set of 20 basic principles on the use of dental cone beam CT has been devised. They will act as core standards for EADMFR and, it is hoped, will be of value in national standard-setting within Europe.

Place, publisher, year, edition, pages
British institute of radiology, 2009
Keywords
cone-beam computed tomography; guideline; delphi techniques; consensus
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-89540 (URN)10.1259/dmfr/74941012 (DOI)000267815600001 ()19372107 (PubMedID)
Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2018-06-07Bibliographically approved
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