Multiple sialolithiasis in the parotid gland with Sjögren's syndrome and its sonographic findings--report of 3 cases.

We present 3 cases of Sjögren's syndrome in which multiple sialolithiasis were observed in the parenchyma of the parotid gland. The sonographic examinations showed microliths that were observed as hyperechoic spots. Some of the microliths were accompanied with comet sign, however most of them showed no particular posterior echoes. None of them showed acoustic shadows, which are normally observed in cases with sialolithiasis. We were able to prove that some of the hyperechoic spots observed sonographically in patients with severe Sjögren's syndrome were microliths. Although these multiple microliths are rarely detected, they may exist potentially in higher frequency in patients with severe Sjögren's syndrome.

Intraoral sonographic features of tongue cancer after radical radiotherapy.

PURPOSE: The purpose was to illustrate the sonographic changes of tongue cancer after radical radiotherapy. MATERIALS AND METHODS: In 24 patients with tongue cancer treated by interstitial brachytherapy (BRT) (uneventful recovery n = 16 , recurrence n = 5, severe soft tissue complication n = 3), follow-up examination were performed and both the margin and the vascular pattern were retrospectively assessed. We basically performed US examination at least once every 3 months after BRT within 1 year during follow-up period. RESULTS: In the healing process, intraoral sonography shows an unclear margin immediately after brachytherapy and a transient increase of the vascularity lasted within 6 months after BRT, followed by a decrease in the vascularity. The large difference in echogenicity between the primary site and the surrounding tissue and the increased difference suggested the possibility of either radiation ulceration or recurrence. CONCLUSION: Intraoral sonography could depict the sequence changes of the tongue after BRT, and it was thus useful to confirm the clinical findings of either radiation ulcers or recurrence.

Change of angiostructure and hemodynamics in lymph node metastases in rabbits.

OBJECTIVES: Experimental models of lymph node metastasis were developed for Doppler sonography. METHODS: Cervical lymph node (LN) metastasis was induced by the implantation of a VX-2 tumor on the oral floor of 10 rabbits. Twenty metastatic LNs were observed weekly by power Doppler sonography, and the presence of an avascular area and the peripheral vessels were evaluated. The time-averaged maximum velocity (TAMx) at the hilum was also measured. RESULTS: The percentage of the metastatic LNs presenting with an avascular area increased over time. The peripheral vessels were detected in 14 of 20 LNs. The peak time of the TAMx significantly correlated to that of the initial detection of the avascular area. CONCLUSIONS: In the beginning, metastatic LNs were depicted as hypervascular structures while the TAMx at the hilum increased. Later, an avascular area was detected and the TAMx at the hilum decreased, which resulted in a blood supply to the node from the peripheral vessels.

Value of computed tomography findings in differentiating between intraosseous malignant tumors and osteomyelitis of the mandible affecting the masticator space.

OBJECTIVES: We sought to evaluate the diagnostic efficacy of computed tomography (CT) images in the differentiation between intraosseous malignant tumors and osteomyelitis spreading into the masticator space. STUDY DESIGN: A retrospective evaluation was carried out by using CT images from 12 patients with intraosseous malignant tumors and 9 patients with osteomyelitis involving the masticator space and accompanying mandibular bone destruction. The following CT observations are discussed: (1) bone destruction pattern subdivided into spotty, gross, or permeative; (2) cortical bone expansion; (3) diffuse osteosclerotic changes; (4) periosteal reaction; (5) masticator muscle involvement; (6) enlargement of the facial muscle; and (7) attenuation in the subcutaneous adipose tissue. RESULTS: The pattern of permeative bone destruction, cortical bone expansion, and the enlargement of both the masseter and medial pterygoid muscles were all observed in patients with malignant tumors. In contrast, diffuse sclerotic change and a periosteal reaction were significant observations in patients with osteomyelitis. CONCLUSION: The efficacy of CT in establishing a differential diagnosis of malignant tumors or osteomyelitis is supported by this study.

Interpretation of the origin of a submandibular mass by CT and MRI imaging.

OBJECTIVE: To clarify the useful findings for determining whether the submandibular mass is intraglandular or extraglandular. STUDY DESIGN: Forty-eight patients with swelling of the submandibular region were reviewed. The relationship between the lesion and the submandibular gland and the displacement of the anterior facial vein were analyzed. RESULTS: The accuracy of the predictions based on the relationship between the lesion and the submandibular gland (SMG) was 87% on contrast-enhanced CT (CECT), 85% on CT sialography (CTS), and 91% on MRI. Although the displacement of the facial vein outside the lesion suggested an intraglandular lesion, and inside the lesion suggested an extraglandular lesion, these were not sufficient to differentiate the lesions in 7 out of 23 CECT cases and 4 out of 11 MRI cases. CONCLUSION: The finding of a relationship between the lesion and the SMG is the most important finding of this study.

The correlation of histologic features with a panoramic radiography pattern and a computed tomography pattern of bone destruction in carcinoma of the mandibular gingiva.

OBJECTIVE: We sought to clarify the correlation among a computed tomography (CT) or a panoramic radiography (PR) pattern of bone destruction, a histologic pattern of bone destruction, and a mode of invasion in carcinoma of the mandibular gingiva. STUDY DESIGN: CT images, panoramic radiographs, and decalcified, hematoxylin-eosin-stained preparations of the excised mandibular bone of 62 patients with carcinoma of the mandibular gingiva were retrospectively evaluated. Each computed tomograph, panoramic radiograph, and the histologic pattern of bone destruction was classified as 1 of 5 types: erosive, erosive and partly mixed, mixed, mixed and partly invasive, or invasive. The mode of invasion of the tumor was also assessed with a hematoxylin-eosin-stained preparation of the initial biopsy specimen. The relationships among the CT pattern, the PR pattern, the histologic pattern of bone destruction, and the mode of invasion of the tumor were statistically analyzed by using the Spearman rank correlation test. RESULTS: The CT pattern (P =.005) and the PR pattern (P =.003) were significantly correlated with the histologic pattern with respect to the bone destruction. The CT pattern (P =.996), the PR pattern (P =.997), and the histologic pattern (P =.521) of bone destruction were not correlated with the mode of invasion seen in the biopsy specimen. CONCLUSION: The CT pattern and the PR pattern of bone destruction reflect the histologic pattern of bone destruction caused by carcinoma of the mandibular gingiva but are not associated with the mode of invasion of the tumor.

The association between the computed tomography findings, histologic features, and outcome of osteosarcoma of the jaw.

PURPOSE: The study goal was to clarify the association between computed tomography (CT) findings, histologic features, and outcome of osteosarcoma of the jaw (OSJ). MATERIALS AND METHODS: The CT findings and histologic features of 10 patients with OSJ were retrospectively analyzed. The patients were histopathologically diagnosed to have OSJ. The points analyzed on the CT included the patterns of osteogenesis and any signs of bone destruction. The histologic types were classified according to the 1993 World Health Organization histologic classification of bone tumors. Furthermore, the histologic subtype was classified into the following 3 types: osteoblastic, chondroblastic, and fibroblastic. The grade of the tumor tissue was classified from I to IV. These were compared with the affected jaw site and the outcome of the patients with OSJ. RESULTS: All tumors were classified into the conventional central osteosarcoma histologically. Eight cases were osteoblastic, and 2 cases were chondroblastic. Grade I or II (4 of 5 patients are alive without disease) dominated in the maxilla, but in contrast, grade III or IV (4 of 5 patients are dead of disease or alive with disease) dominated in the mandible. A significant association was seen between the osteogenesis found on the CT images and the outcome, between the grade and the outcome, and between the outcome and the affected jaw site ( P = .02), respectively, in OSJ in this study. However, no significant association was observed between the CT findings and the histologic features in OSJ in this series. CONCLUSIONS: The osteogenesis on the CT, grade, and affected jaw site were considered to be prognostic factors in OSJ in this limited series.

Change of sonographic findings on cervical lymph nodes before and after preoperative radiotherapy.

The aim of this study was to assess the changes in the power Doppler sonographic findings in patients with oral cancer undergoing chemotherapy and radiotherapy. We performed US examinations on 187 cervical lymph nodes (71 metastatic and 116 reactive nodes) excised from 52 patients before and after preoperative therapy. On Power Doppler images, we calculated the vascular index (VI) and evaluated the vascular pattern. We also assessed the diagnostic power using receiver operating characteristic (ROC) curve analysis. Irradiation caused an increase of the VI and better visualization of the vessels within the lymph node in the reactive nodes; however, in the metastatic nodes, the VI was not significantly different between that before and after irradiation. When the reader observed the images before irradiation, the area under an ROC curve (Az values) observed by B-mode sonography were closely similar to those obtained by B-mode plus power Doppler sonography. With both images before and after irradiation, the Az value obtained by B-mode plus power Doppler sonography was higher than that by B-mode sonography alone. After irradiation, the enhanced Doppler signals contributed to a better visualization of the vessels and a better detection of any vascular abnormalities.