RESUMO
OBJECTIVE: To compare transcervical ultrasonography (US) to standard cross-sectional imaging for the visualization of human papillomavirus-related oropharyngeal cancer (HPV-OPC). MATERIALS AND METHODS: Patients with HPV-OPC and available standard imaging (CT and/or MRI) were identified in clinic and prospectively enrolled. US was performed to visualize the oropharynx and lymph nodes. Tumor characteristics across imaging modalities were evaluated (CT versus MRI, and US versus standard imaging (SI)). RESULTS: Forty-three patients were included. The overall blinded detection rates for CT and MRI were 83% and 71%, respectively. The unblinded detection rate for US was 98%. Agreement of tumor anatomic subsite was moderate for both CT vs MRI (κâ¯=â¯0.59) and US vs SI (κâ¯=â¯0.47). Comparison of tumor size by CT and MRI showed statistically significant correlations in craniocaudal (CC), anteroposterior (AP), and mediolateral (ML) dimensions (RhoCCâ¯=â¯0.51, pCCâ¯=â¯0.038; RhoAPâ¯=â¯0.81, pAPâ¯<â¯0.0001; RhoMLâ¯=â¯0.57, pMLâ¯=â¯0.012). Tumor size estimates by US and SI showed statistically significant correlations in CC and AP, but not ML (RhoCCâ¯=â¯0.60, pCCâ¯=â¯0.003; RhoAPâ¯=â¯0.71, pAPâ¯<â¯0.0001; RhoMLâ¯=â¯0.30, pMLâ¯=â¯0.08). Tumor volume estimates improved correlations between US and SI (Rhoâ¯=â¯0.66, pâ¯<â¯0.0001). Stratification of US patients into early and late imaging studies demonstrated an increase in correlation strength from early (Rhoâ¯=â¯0.32, pâ¯=â¯0.32) to late groups (Rhoâ¯=â¯0.77, pâ¯<â¯0.0001) demonstrating that ultrasound accuracy improved with experience. CONCLUSIONS: Our findings suggest that transcervical ultrasonography is a sensitive and relatively accurate adjunct to standard imaging for the evaluation of oropharyngeal tumors. Its cost, portability, and potential for in-clinic and serial imaging render US an attractive modality to further develop for imaging oropharyngeal tumors.
Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias Orofaríngeas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The reproducibility of transcranial Doppler (TCD) ultrasound measurements in Sturge-Weber syndrome (SWS) and TCD's ability to predict neurological progression is unknown. METHODS: In 14 individuals with SWS, TCD measured mean flow velocity, pulsatility index, peak systolic velocity, and end-diastolic velocity in the middle, posterior, and anterior cerebral arteries of the affected and unaffected hemisphere. TCD was performed either once (n = 5) or twice in one day (n = 9). We assessed the reproducibility of the measurements performed twice on the same day on subjects and compared the TCD measurements to previously published age-matched controls. Clinically obtained neuroimaging was scored for extent and severity of SWS brain involvement. Patients were prospectively assigned SWS neuroscores. RESULTS: Middle cerebral artery velocity (r = 0.79, P = 0.04, n = 7), posterior cerebral artery velocity (r = 0.90, P = 0.04, n = 5), and anterior cerebral artery pulsatility index (r = 0.82, P = 0.02, n = 7) were reproducible TCD measurements comparing same-day percent side-to-side differences. In subjects with SWS, affected and unaffected mean peak systolic velocity and end-diastolic velocity in the middle, posterior, and anterior cerebral arteries were globally lower compared with age-matched control subjects. Subjects with the lowest affected middle cerebral artery velocity had the greatest worsening in the total neurological score between time 1 and 2 (r = -0.73, P = 0.04, n = 8) and the most severe magnetic resonance imaging involvement of the affected frontal lobe (r = -0.82, P = 0.007, n = 9). CONCLUSIONS: TCD may be a reliable measure with potential clinical value, indicating that blood flow may be globally decreased in SWS patients with unilateral brain involvement.
Assuntos
Fluxo Pulsátil/fisiologia , Estatística como Assunto , Síndrome de Sturge-Weber/diagnóstico por imagem , Síndrome de Sturge-Weber/fisiopatologia , Ultrassonografia Doppler Transcraniana/métodos , Adolescente , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Criança , Pré-Escolar , Feminino , Hemodinâmica , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Transtornos da Percepção/etiologia , Reprodutibilidade dos Testes , Campos Visuais/fisiologia , Adulto JovemRESUMO
OBJECTIVE: The purposes of this article are to illustrate the sonographic appearance of the oropharynx and to discuss the potential role of ultrasound in evaluation of the oropharynx. CONCLUSION: Ultrasound is not currently used in the standard clinical evaluation of the oropharynx, but it is a promising imaging modality for evaluating the base of the tongue and the palatine tonsils. Ultrasound is comparable and complementary to CT and MRI, which have recognized limitations.
Assuntos
Neoplasias Orofaríngeas/diagnóstico por imagem , Orofaringe/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Tomografia Computadorizada por Raios X , Transdutores , UltrassonografiaRESUMO
Transcranial Doppler ultrasound is a noninvasive vascular assessment technique proved useful in the management of pediatric disorders predisposed to stroke and may have similar utility for Sturge-Weber syndrome. Eight children with Sturge-Weber syndrome had velocities measured in the major cerebral arteries via the Stroke Prevention Trial in Sickle Cell Anemia methodology. Velocities and pulsatility indexes were compared between the unaffected and affected sides. All subjects had reduced velocity on the affected side; the mean middle cerebral artery percentage difference was 20% (95% CI, 15%-25%). Pulsatility index was increased on the affected side; mean middle cerebral artery pulsatility index percentage difference, 34% (95% CI, 15%-53%). Six subjects also had reduced posterior cerebral artery velocity on the affected side. Side-to-side differences in middle cerebral artery and posterior cerebral artery velocities correlated with severity of MRI asymmetry (Spearman rho = 0.88, P = .02). Decreased arterial flow velocity and increased pulsatility index in the middle cerebral artery and posterior cerebral artery suggests a high resistance pattern that may reflect venous stasis and may contribute to chronic hypoperfusion of brain tissue. Further study of Transcranial Doppler in children with Sturge-Weber syndrome is indicated.
Assuntos
Encéfalo/irrigação sanguínea , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Síndrome de Sturge-Weber/diagnóstico por imagem , Síndrome de Sturge-Weber/fisiopatologia , Velocidade do Fluxo Sanguíneo , Encéfalo/fisiopatologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/fisiopatologia , Artérias Cerebrais/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Lateralidade Funcional , Hemangioma/diagnóstico por imagem , Hemangioma/fisiopatologia , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Fluxo Pulsátil , Fluxo Sanguíneo Regional , Síndrome de Sturge-Weber/complicações , Ultrassonografia Doppler TranscranianaAssuntos
Neoplasias da Coroide/patologia , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Biópsia por Agulha Fina , Neoplasias da Coroide/diagnóstico por imagem , Neoplasias da Coroide/metabolismo , Feminino , Humanos , Técnicas Imunoenzimáticas , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/metabolismo , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/metabolismo , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/tratamento farmacológico , Neoplasias do Seio Maxilar/patologia , Pessoa de Meia-Idade , Proteínas de Neoplasias/metabolismo , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Acuidade VisualRESUMO
Liver transplantation is performed in adults and children to treat patients with irreversible liver damage when medical or other surgical treatment has failed. The most common indications for transplantation are cirrhosis secondary to fulminant acute hepatitis or chronic active hepatitis, sclerosing cholangitis, primary biliary cirrhosis, Budd-Chiari syndrome, inborn errors of metabolism, and unresectable but local hepatocellular carcinoma. This article reviews the sonographic findings in the preoperative evaluation of liver transplant recipients, briefly describes the surgical technique, and demonstrates normal postoperative findings in liver transplant recipients as well as complications associated with liver transplantation.