Utility of Ultrasonography for Diagnosing and Differentiating Periapical Granuloma from Radicular Cyst.

RATIONALE AND OBJECTIVES: This study aimed to investigate the reliability and accuracy of high-resolution ultrasonography (US) for diagnosing periapical lesions and differentiating radicular cysts from granulomas. MATERIALS AND METHODS: This study included 109 teeth with periapical lesions of endodontic origin from 109 patients scheduled for apical microsurgery. Ultrasonic outcomes were analyzed and categorized after thorough clinical and radiographic examinations using US. B-mode US images reflected the echotexture, echogenicity, and lesion margin, while color Doppler US assessed the presence and features of blood flow of interested areas. Pathological tissue samples were obtained during apical microsurgery and subjected to histopathological examination. Fleiss' κ was used to measure interobserver reliability. Statistical analyses were performed to assess the diagnostic validity and the overall agreement between US and histological findings. The reliability of US compared to histopathological examinations was assessed based on Cohen's κ. RESULTS: The percent accuracy of US for diagnosing cysts, granulomas, and cysts with infection based on histopathological findings was 89.9%, 89.0%, and 97.2%, respectively. The sensitivity of US diagnoses was 95.1% for cysts, 84.1% for granulomas, and 80.0% for cysts with infection. The specificity of US diagnoses was 86.8% for cysts, 95.7% for granulomas, and 98.1% for cysts with infection. The reliability for US compared to histopathological examinations was good (κ = 0.779). CONCLUSION: The echotexture characteristics of lesions in US images correlated with their histopathological features. US can provide accurate information on the nature of periapical lesions based on the echotexture of their contents and the presence of vascularity. It can help improve clinical diagnosis and avoid overtreatment of patients with apical periodontitis.

Gray scale and doppler ultrasonography features of the carcinoma ex pleomorphic adenoma.

OBJECTIVES: For lesions in the salivary glands, ultrasonography (US) is an ideal tool for initial assessment. The aim of this study was to characterize and differentiate between the Gray scale and Doppler US findings of intracapsular carcinoma ex pleomorphic adenoma (Ic-CxPA) and invasive carcinoma ex pleomorphic adenoma (Inv-CxPA). METHODS: A total of 87 patients (89 lesions) with histopathologically proven CxPA underwent US examination. The following characteristics were assessed on US images: size, shape, border, echogenicity, echo texture, posterior echo, vascularity, and regional lymph node enlargement. One-way analysis of variance (ANOVA), nonparametric test, Fisher's exact test, chi-square test and receiver operating characteristic (ROC) curve were used for the analyses of the US findings of Ic-CxPAs and Inv-CxPAs. RESULTS: We found that on US images, nearly all Ic-CxPAs (10/11) and a few of Inv-CxPAs (17/78) showed benign features, such as a regular shape, a well-defined border, and enhancement of posterior echo, while most Inv-CxPAs (61/78) showed one or more following features: an irregular shape, an ill-defined border, and lack of enhancement of posterior echo. CONCLUSIONS: Ic-CxPAs tended to exhibit benign features, whereas most Inv-CxPAs tended to exhibit one or more invasive features. US can provide strong evidence in differentiating Inv-CxPAs from Ic-CxPAs.

Improved Efficacy of Liposomal Doxorubicin Treatment of Superficial Tumors by Thermotherapy.

Our study aimed to investigate the effect of ultrasonic thermotherapy on the targeted delivery of liposomal doxorubicin to superficial tumors, local drug concentrations in tumor tissue, and the curative effect of chemotherapy. Twenty rabbits with VX2 tumors transplanted into the superficial muscle of the hind limb were randomly assigned to the following 4 treatment groups: (1) free doxorubicin, (2) liposomal doxorubicin hydrochloride, (3) liposomal doxorubicin hydrochloride plus 41 °C thermotherapy, and (4) liposomal doxorubicin hydrochloride plus 43 °C thermotherapy. Ultrasonic thermotherapy was delivered at 41 °C to 43 °C. Plasma, tumor, and organ/tissue homogenates were analyzed by high-pressure liquid chromatography to determine doxorubicin concentrations. The drug concentration in plasma and tumor tissue was significantly higher in the liposomal doxorubicin hydrochloride plus thermotherapy group than in the liposomal doxorubicin hydrochloride and free doxorubicin groups, but there were no significant differences among the 4 groups in the concentration in heart or kidney tissue. Combining thermotherapy with liposomal doxorubicin hydrochloride chemotherapy significantly increased the concentration of the drug in tumor tissue. The doxorubicin concentration was significantly higher in the liposomal doxorubicin hydrochloride plus 41 °C thermotherapy group.