Reliability of shear wave ultrasound elastography for neck lesions identified in routine clinical practice.

PURPOSE: To evaluate the reliability of shear wave ultrasound elastography (SWE) in the neck. MATERIALS AND METHODS: 176 neck lesions (40 thyroid, 56 lymph nodes, 46 salivary, 34 miscellaneous) identified in a routine US clinic underwent SWE by one or two blinded radiologists. For this study, SWE required the operator to acquire three 10 second dynamic colour-coded SWE cineloops per lesion, select one static image per cineloop, and place circular regions-of-interest within the entire lesion and stiffest part to generate 3 SWE measurements per static image. For logistical reasons, one radiologist evaluated all 176 lesions and the other evaluated 58 lesions. Both radiologists also reviewed 27 archived cineloops independently to assess SWE excluding practical technique. Reliability was assessed using intraclass correlation coefficients (ICCs) concordance correlation coefficients (CCCs) and coefficients of repeatability (CORs). RESULTS: Test-retest ICCs for the radiologist evaluating 176 lesions were 0.78 - 0.85 (fair-excellent agreement), CCCs were 0.85 - 0.88 (substantial agreement), and CORs were 14.9 - 36.1 kPa. For both radiologists evaluating 58 lesions, intra-rater and inter-rater ICCs were 0.65 - 0.78 and 0.72 - 0.77 respectively. For SWE excluding practical technique, inter-rater ICCs were 0.97 - 0.98 (excellent agreement). ICCs differed according to tissue, being higher in thyroid lesions than lymph nodes (p < 0.001), and higher in benign than malignant lesions (p values < 0.001). CONCLUSION: Intra- and inter-rater reliability of SWE is fair to excellent according to ICCs. SWE reliability is influenced appreciably by acquisition technique. Nevertheless, CORs for SWE are not negligible. To determine whether these results are acceptable clinically, further research is required to establish SWE stiffness values of normal and pathological tissues in the neck.

Biopsy of deep-seated head and neck lesions under intraoral ultrasound guidance.

Although transcutaneous ultrasound combined with fine-needle aspiration is often used as initial modality for evaluating superficial neck masses, its role in management of deep-seated neck masses is limited. Intraoral ultrasound and guided biopsy helps in obtaining tissue from deep-seated neck masses for an accurate histologic diagnosis, providing useful information in treatment planning. This article discusses the role of intraoral ultrasound and presents 3 cases in which biopsy of deep-seated neck masses under intraoral ultrasound guidance helped in diagnosis and management.

Vascular lesions of parotid gland in adult patients: diagnosis with high-resolution ultrasound and MRI.

Three adult patients with rare vascular lesions in the parotid gland including pseudoaneurysm, arteriovenous fistula and haemangioma are discussed. All patients presented with non-specific unilateral parotid mass. In all cases high-resolution ultrasound and MRI allowed accurate diagnosis and delineation of the extent of lesion. Conventional angiogram was utilized for planning definitive surgical or endovascular treatment.

The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy: a comparison with the conventional open transfacial approach.

The purpose of this paper is to study the efficacy of applying stereotactic navigation guidance to nasopharyngectomy via a minimally invasive transnasal approach as compared with the conventional open transfacial approaches. The nasopharynx is the centre of the anterior skull base, which is remote from the surface of the facial skeleton. It is well known that there are several surgical approaches for access to resect tumours from the nasopharynx. However, the open techniques have been associated with much morbidity and only provide access to, and identification of, the ipsilateral internal carotid artery that forms the lateral boundary and resection limit of the nasopharynx. The coupling of stereotactic navigation guidance and a minimally invasive transnasal approach for nasopharyngectomy allows the surgeon to identify and protect the internal carotid artery bilaterally at the nasopharynx. This technique reduces operating time and morbidity to a minimum and yet is oncologically sound for resecting nasopharyngeal lesions. We compare 15 patients who underwent the stereotactic navigation guidance approach with 20 patients who received a conventional open transfacial approach.

Imaging for thyroglossal duct cyst: the bare essentials.

Thyroglossal duct cyst is the most common congenital cyst in the head and neck, and imaging features have been well documented in the literature. However, there are several practical important points to bear in mind during preoperative imaging, which are often overlooked. This review aims to summarize the imaging findings and emphasize important points for trainees and radiologists, particularly those who may encounter this lesion infrequently.

Human cervical lymphadenopathy: evaluation with in vivo 1H-MRS at 1.5 T.

AIM: To evaluate the feasibility of performing in vivo proton magnetic resonance spectroscopy ((1)H-MRS) of cervical lymph nodes, and the clinical usefulness of the technique in the characterization of cervical lymphadenopathy. MATERIALS AND METHODS: Cervical lymphadenopathy was examined in 20 individuals with malignant disease, i.e. 10 with squamous cell carcinoma (SCC), 6 with undifferentiated carcinoma (UDC) and 4 with non-Hodgkin's lymphoma (NHL). Cervical lymphadenopathy was also examined in 4 individuals with benign disease, i.e. 3 with tuberculosis (TB) and 1 with Castleman's disease. A point-resolved spectroscopic sequence with echo times (TE) of 136 and 272 ms and a time-domain spectral fitting procedure were used to estimate peak amplitude of choline (Cho), creatine (Cr) and unsuppressed water. Cho/Cr and Cho/water ratios were measured for each lesion. The mean ratio for each lesion group was obtained and results were compared statistically. RESULTS: At TE of 136 ms, spectra were interpretable in all 24 cases and a Cr peak was identified with post-processing in 15 cases. The Cho/Cr and Cho/water ratios for NHL were 9.1 +/- 5.2 and 1.7 +/- 0.2 x 10(-3), for UDC were 4.4 +/- 0.9 and 1.2 +/- 0.4 x 10(-3), and for SCC were 2.1 +/- 0.6 and 0.5 +/- 0.3 x 10(-3), respectively. Both Cho/Cr and Cho/water ratios for UDC were significantly higher than SCC (p = 0.002 and 0.026, respectively). At TE of 272 ms, spectra were interpretable in 22 of 24 cases and a Cr peak was identified with post-processing in 11 cases. Cho/Cr and Cho/water ratios for NHL were 5.4 and 4.6 +/- 1.4 x 10(-3), for UDC were 4.2 +/- 1.5 and 2.6 +/- 1.0 x 10(-3) and for SCC were 2.5 +/- 1.1 and 1.3 +/- 0.6 x 10(-3), respectively. The Cho/water ratio for UDC was significantly higher than for SCC (p = 0.04). The Cho/Cr ratio for UDC was also higher than for SCC, but this difference was not statistically significant (p = 0.07). Neither Cho nor Cr was detected in the 3 cases of TB. CONCLUSION: In vivo (1)H-MRS is a feasible technique for the evaluation of cervical lymph nodes and it offers potential as a clinical tool in the investigation of cervical lymphadenopathy. However, further studies with larger patient cohorts are needed to validate the findings of this initial report.

Accuracy of high-resolution sonography compared with magnetic resonance imaging in the diagnosis of head and neck venous vascular malformations.

AIMS: To evaluate whether modern ultrasound examination helps to establish the diagnosis of head and neck venous vascular malformations (VVMs) and whether it can delineate their full extent. MATERIALS AND METHODS: Sonographic appearances of 30 head and neck VVMs were assessed for: location, extent, internal architecture, presence of flow and phleboliths. These results were compared with the magnetic resonance imaging (MRI) of the same patients. RESULTS: The lesions showed well-defined margins (22 of 30, 73%), heterogeneous (30 of 30, 100%) and hypoechoic echo pattern (27 of 30, 90%), with sinusoidal spaces (28 of 30, 93%) and phleboliths (24 of 30, 80%) on grey-scale imaging, and flow signal on Doppler (28 of 30, 93%). For delineating the extent, ultrasound was comparable with MRI in 53% (16 of 30) and inferior to MRI in 47% (14 of 30). Ultrasound did not detect deeper extent, intra-osseous involvement and other clinically occult VVMs. CONCLUSION: Ultrasound with high-resolution transducers can confidently suggest the diagnosis of head and neck VVMs in up to 90% of cases, and delineate the full extent of some superficial lesions. The major disadvantage is its inability to evaluate intra-osseous involvement and the entire extent of large, deep-seated lesions.

Imaging for primary hyperparathyroidism--what beginners should know.

For patients with primary hyperparathyroidism surgical removal of the hyperfunctioning parathyroid gland is curative. With advances in minimally invasive surgery, accurate pre-operative localization of the hyperfunctioning parathyroid tissue is essential to aid successful surgical treatment. The onus of identifying this hyperfunctioning parathyroid tissue therefore falls on imaging techniques such as high-resolution ultrasound, radionuclide imaging, computed tomography and magnetic resonance imaging. This article is not an exhaustive review, and its main aim is to familiarize the general radiologist, trainee radiologists and clinicians with the basics of various imaging techniques and their roles in practical management of patients with primary hyperparathyroidism.

Imaging in severe acute respiratory syndrome (SARS).

Severe acute respiratory syndrome (SARS) is a highly infectious disease caused by a novel coronavirus, and has become pandemic within a short period of time. Imaging plays an important role in the diagnosis, management and follow-up of patients with SARS. The current status of imaging in SARS is presented in this review.