增强MRI对头颈部肿块诊断作用的初步评价

目的评价头颈部肿块在增强ＭＲＩ上的表现。方法２５例头颈部肿块经病理和随访证实者１７例。所有病例均行普通ＳＥＴ１加权平扫（ＴＲ／ＴＥ＝５００～６００／３０）和增强ＳＥＴ１加权扫描（ＴＲ／ＴＥ＝３００～５００／３０）。结果与平扫ＭＲＩ相比，ＧｄＤＴＰＡ静脉注入后，在ＳＥＴ１加权像上共２３例肿块有增强表现（２３／２５）。病变增强方式有均匀增强（１０／２３）和不均匀增强（１３／２３）两种。１６例头颈部肿块的病变范围在ＧｄＤＴＰＡ注入后清晰显示。结论使用ＧｄＤＴＰＡ后，头颈部肿块性病变增强的各种形态学表现与其内部结构密切相关。增强ＭＲＩ在显示病变内部结构和范围，评价复发性病变方面优于平扫ＭＲＩ。     

彩色多普勒超声在颌面部血管畸形诊断、分类及疗效评价中的应用

目的：评价彩色多普勒超声在颌面部血管畸形诊断、分类及疗效评价中的作用。方法：对110例颌面部血管畸形进行二维及彩色多普勒超声检查,根据超声特点,将其分为高流速病变和低流速病变。对DSA检查证实为高流速血管畸形者,常规行供血动脉栓塞治疗。所有数据采用SPSS10.0软件包进行t检验和χ2检验。结果：110例血管畸形中,67例二维显示形态不规则的网格状混合性回声,部分伴强回声静脉石,多谱勒显示彩色血流稀少或较丰富,动脉收缩峰血流速度（PSV）平均为（28.53±8.1）cm/s,超声诊断为低流速血管畸形。43例显示72条供血动脉增粗,病变内血流信号极丰富,PSV平均为（144.53±38.9）cm/s,呈低阻动脉型频谱,超声诊断为高流速血管畸形。经DSA检查或术后病理证实,高流速和低流速病变的超声诊断正确率分别为100%和97.02%。43例高流速血管畸形的供血动脉全部行栓塞治疗,栓塞前、后的PSV分别为（144.53±38.9）cm/s和（86.2±36.3）cm/s,阻力指数（RI）分别为（0.55±0.04）和（0.80±0.05）（P均〈0.01）。结论：彩色多普勒超声检查能对血管畸形病变做出较正确的诊断和分类,对临床选择合理的治疗方案及动脉栓塞术后疗效评价均具有重要的指导意义。     

头颈部癌组织中超氧化物歧化酶及脂质过氧化物含量的研究

对３３例经组织学检查确诊为原发于头颈部的恶性肿瘤患者组织中ＳＯＤ（超氧化物岐化酶）及ＭＤＡ（丙二醛）含量进行了测定，其中鳞癌２５例，腺癌８例。结果表明：头颈部癌组织中ＳＯＤ含量明显低于正常对照组织中该酶含量（Ｐ＜０．０１），而ＭＤＡ含量高于对照组（Ｐ＜０．０１）．ＳＯＤ含量与ＭＤＡ含量呈中度直线负相关关系（ｒ＝－０．５８，Ｐ＜０．０１）。不同分化程度鳞状细胞癌组织中ＳＯＤ含量不相同，各分级间差异显著（Ｐ＜０．０１），两两比较ｔ检验，Ⅱ级与Ⅲ级间无显著差异．鳞状细胞癌组织中ＭＤＡ含量也不相同，各分级间差异非常显著（Ｐ＜０．００１），两两比较ｔ检验均有显著差异．     

OSAS上气道的X线与MRI影像的比较

目的 探讨上气道二维影像替代三维影像的可能性。方法 １６名阻塞性睡眠呼吸暂述综合征（Ｏｂｓｔｕｒｃｔｉｖｅ Ｓｌｅｅｐ Ａｐｎｅａ Ｓｙｎｄｒｏｍｅ,ＯＳＡＳ）ｋｋｈｎｆｔｊ ｒｂｃｃｒｍｈｊｈ ｒｎｂ ｕｔｈｐｒ ｄｕ ａｗ ｒｄｆｅ（Ｍａｎｅｔｉｃ Ｒｅｓｏｎａｎｃｅ Ｉｍａｎｇｉｎｇ,ＭＲＩ）片及爷卧位Ｘ线头颅侧位片,２３名ＯＳＡＳ患者摄制及直立位Ｘ线片,分别对二者两种影像资料中的上气道及软     

阻塞性睡眠呼吸暂停综合征矫治后的上气道磁共振影响改变

目的探讨阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅ ｓｌｅｅｐ ａｐｎｅａ ｓｙｎｄｒｏｍｅ，ＯＳＡＳ）患者戴用口腔矫治器后，其上气道磁共振（ｍａｇｎｅｔｉｃ ｒｅｓｏｎａｎｃｅ ｉｍａｇｉｎｇ，ＭＲＩ）影像发生的改变。方法 选择１１例有治疗前后多导睡眠图评价、磁共振影像资料完整的ＯＳＡＳ患者，用于研究矫治器对上气道的形态学改变；另选１１名性别、年龄配比的无睡眠呼吸障碍者，作为ＭＲＩ三维形态     

牙周炎患者龈组织中的自氧化作用与临床指数的相关性研究

目的：探讨内源性超氧基（Ｏ２）损伤在慢性成人牙周炎（ＡＰ）发生发展过程中的作用。方法：采用化学发光法、氧化法和比色法对４２例ＡＰ患者龈组织中的超氧基（Ｏ２）、超氧化物歧化酶（ＳＯＤ）活性和过氧化脂质产物（ＭＤＡ）含量进行测定。并将反映自氧化作用的ＳＯＤ．ＭＤＡ与临床指数进行直线相关及多元线形回归分析。结果：实验组与对照组 Ｏ２、ＳＯＤ、 ＭＤＡ活性水平有显著性差异（Ｐ＜ ０． ００１）; ＳＯＤ与周袋深度（ＰＤ）、附着丧失（ＡＬ）呈负相关（Ｐ＜０．００１）;ＭＤＡ与ＰＤ、ＡＬ呈正相关（Ｐ＜０．００１）。结论：氧自由基参与牙周病的病理过程。     

牙周炎患者龈组织中的自氧化作用与临床指数的相关性研究

目的：探讨内源性超氧基（Ｏ２）损伤在慢性成人牙周炎（ＡＰ）发生发展过程中的作用。方法：采用化学发光法,氧化法和比色法对４２例ＡＰ患者龈组织中的超氧基（Ｏ２）超氧化物歧化酶（ＳＯＤ）活性和过氧化脂质产物（ＭＤＡ）含量进行测定,并将反映自氧化作用的ＳＯＤ,ＭＤＡ与临床指数进行直线相关及多元线形回归分析。结果;实验组与对照组Ｏ２,ＳＯＤ,ＭＤＡ活性水平有显著性差异（Ｐ〈０．００１）,ＳＯＤ与周袋深度（Ｐ     

氧自由基在牙周炎患者龈组织中作用的研究

选择１８例成人牙周炎（ＡＰ）患者，取同一研究对象的牙周病变龈组织（实验组）和健康龈组织（对照组），制成组织匀浆，取上清液，测定超氧自由基（Ｏ－２）和两项目自由基损伤指标：超氧化物歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）。采用开放型双向序贯ｔ检验。结果表明：两组（Ｏ－２）、ＳＯＤ、ＭＤＡ水平明显差异，实验组（Ｏ－２）、ＭＤＡ水平高于对照组，ＳＯＤ水平低于对照组。提示：自由基参与牙周组织病变过程。     

口腔颌面部血管外皮肉瘤(附6例报告)

口腔颌面部血管外皮肉瘤（附６例报告）ＨＥＭＡＮＧＩＯＰＥＲＩＣＹＴＩＣＳＡＲＣＯＭＡＯＮＯＲＡＬＡＮＤＭＡＸＩＬＬＯＦＡＣＩＡＬＲＥＧＩＯＮ：ＡＲＥＰＯＲＴＯＦ６ＣＡＳＥＳ杜晓军沈言备黄晓峰血管外皮肉瘤ＨｅｍａｎｇｉｏｐｅｒｉｃｙｔｅＳａｒｃｏ－ｍａ...     

头颈部肿瘤累及颈动脉的外科治疗

头颈部肿瘤累及颈动脉的外科治疗ＳＵＲＧＥＲＹＯＦＨＥＡＤＡＮＤＮＥＣＫＴＵＭＯＲＩＮＶＯＬＶＩＮＧＴＯＣＡＲＯＴＩＤＡＲＴＥＲＹ郑家伟综述邱蔚六张志愿审校作者单位：上海第二医科大学附属第九人民医院口腔颌面外科（２０００１１）头颈部恶性肿瘤发展至晚期，...     

Combined use of Doppler and conventional ultrasound for the diagnosis of vascular and other lesions in the head and neck

Twenty-three patients with swellings of the head and neck were prospectively investigated by Doppler ultrasound and ultrasound imaging to determine the type and vascularity of the lesions and thereby aid pre-operative diagnosis. Four vascular lesions were correctly identified while vascularity was not found in patients with lipoma, cysts, abscess, or muscular hypertrophy. Increased vascularity was found in or near some tumours and lymphangiomas, but by careful comparison of findings these lesions were not confused with true vascular lesions. The value of the investigations was demonstrated by a change in the treatment in 6 of the cases in this series.     

Interdisziplinäres Konzept zur Diagnostik und Therapie gefäßreicher Fehlbildungen im Gesichts- und Halsbereich

Purpose. In patients with extended vascular anomalies in the head and neck, therapeutic decisions may pose a challenge to maxillofacial surgeons, dermatologists, and interventional radiologists. We analyzed the value of an interdisciplinary classification and treatment concept. Patients and methods. The classification distinguishes hemangiomas and vascular malformations. Whereas hemangiomas are endothelial proliferations, vascular malformations are considered to be developmental anomalies, which are further classified into high-flow or low-flow lesions and according to the vascular channels into capillary, venous, or lymphatic malformations. Since 2000 we have provided interdisciplinary consultation for patients with vascular anomalies. In patients with hemangiomas and venous malformations, the clinical diagnosis is confirmed by color-coded duplex sonography and magnetic resonance imaging; angiography is performed as part of the treatment planning for patients with arteriovenous malformations. Patients with hemangiomas are treated surgically by cryosurgery or laser surgery or conservatively according to lesion size and behavior. In patients with venous malformations, percutaneous sclerotherapy is combined with surgical reduction; patients with arteriovenous malformations undergo transarterial embolization prior to surgical excision of the nidus. Results. A total of 73 patients attended the interdisciplinary consultation. This group included 53 patients with facial hemangiomas, 7 with venous malformations, 2 with capillary malformations, 5 with lymphatic malformations, and 6 with high-flow arteriovenous malformations. Conclusions. The interdisciplinary protocol increases diagnostic accuracy and helps to establish individual treatment plans for patients with extended vascular anomalies.     

Characterization of maxillofacial soft tissue vascular anomalies by ultrasound and color Doppler imaging: an adjuvant to computed tomography and magnetic resonance imaging.

PURPOSE: The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses. PATIENTS AND METHODS: Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study. RESULTS: A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective. CONCLUSIONS: 1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies.     

Selective embolization for head and neck vasculopathies

INTRODUCTION: Selective, transarterial embolization of vascular lesions through angiographic catheters, which in superficial vasculopathies is often accompanied by intralesional local administration of sclerosing agents, has been used for more than 65 years. However, the reported experience with this therapeutic modality for head and neck lesions is rather limited. METHODS AND MATERIALS: In the current study we describe our experience with all 12 patients having major head and neck vasculature pathologies who were admitted and treated by selective embolization in our institution during a 5-year period. RESULTS: Eight patients had congenital malformations, and 4 had acquired lesions induced by trauma, irradiation, or anticoagulant therapy. Four cases were potentially life-threatening because of severe blood loss and were thus treated immediately. In only 3 cases was subsequent surgical resection of the lesion necessary. The therapy administered is reported, and its outcome is discussed in respect to the available updated literature. CONCLUSIONS: The reported high rate of success with no complications may be the result of careful techniques and appropriate preoperative imaging, as well as the intraoperative and perioperative treatment with steroids and the multiple intralesional puncture sessions administered as necessary.     

The Role of Imaging and Surgery in the Management of Vascular Tumors of the Masseter Muscle

PURPOSE: Intramuscular vascular malformations are uncommon lesions in the head and neck that may mimic salivary gland disease. This study reports on the use of various imaging modalities and recommends a surgical approach in the management of vascular malformations of the masseter muscle. PATIENTS AND METHODS: This is a retrospective study of 7 consecutive patients with vascular tumors of the masseter muscle treated in one unit between 1995 and 2004. The age, gender, signs and symptoms, imaging methods, and surgical outcome are reported. A previously unreported surgical approach is described. RESULTS: All patients had atypical swellings in and around the parotid region that were difficult to diagnose on plain radiography and computed tomography. Magnetic resonance imaging provides accurate three-dimensional images and provisional diagnosis of lesions within the masseter muscle. Six of the 7 patients underwent surgery by the recommended approach. No patients developed permanent facial weakness following modified parotidectomy. No recurrence of the vascular tumors occurred when the recommended approach is used. CONCLUSIONS: Magnetic resonance imaging remains the imaging modality of choice for the management of tumors of the masseter muscle. The extended parotidectomy approach gives good and safe surgical access in the management of these uncommon lesions.     

MRI对双侧头颈部软组织病变的诊断意义

目的:基于双侧头颈部软组织病变的临床不典型性,旨在探讨核磁共振(magnetic resonance imaging,MRI)对其进行鉴别诊断的影像学依据。方法:对本组32例发生于双侧头颈部的软组织病变进行MRI检查,并与病理学结果进行对照。结果:本组32例的MRI诊断与病理学诊断结果的符合率约为84%(27/32)。结论:MRI是对累及双侧头颈部软组织病变的重要检查手段,并能为明确其诊断提供影像学依据。     

Whole-body (18)F-fluorodeoxyglucose positron emission tomography in patients with head and neck cancer

OBJECTIVE: Because of the high risk of secondary primary malignancies in addition to possible distant metastases, whole-body evaluation is critically important in patients with head and neck cancer. We evaluated the clinical usefulness of whole-body (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) before initial treatment. STUDY DESIGN: We performed whole-body FDG PET in 26 patients with head and neck cancer (squamous cell carcinoma, n = 20; salivary gland carcinoma, n = 6) before initial treatment. FDG images were prospectively evaluated, and further imaging studies were performed if required. Final diagnosis for the presence or absence of distant lesions was made by analysis of the pathologic findings of surgical specimens or by analysis of the clinical follow-up data for more than 1 year. RESULTS: PET images showed FDG avid lesions distant from the head and neck area in 3 of 26 patients (11.5%). Two patients were confirmed to have secondary primary cancer (one with colon cancer in the early stage and another with small lung metastasis from postoperative colon cancer). They were diagnosed and treated properly both for the head and neck cancer and the secondary primary cancer. One patient was confirmed to have large lung metastasis from head and neck cancer, and appropriate treatment was selected. CONCLUSIONS: Whole-body FDG PET has a clinical impact on the management of patients with head and neck cancer by detecting secondary primary malignancies as well as distant metastases.     

Treatment of vascular lesions in the head and neck using Nd:YAG laser.

INTRODUCTION: Vascular lesions in the head and neck region, including both haemangiomas and vascular malformations, are common and many different treatment modalities have been used for their removal. In the past decade, the Nd:YAG laser has emerged as a new mode of treatment for vascular lesions, and the purpose of this paper was to determine its clinical value. PATIENTS AND METHODS: A prospective study was conducted in 111 patients with vascular lesions in the head and neck region. They were treated with the Nd:YAG laser by photocoagulation. Of these, 96 had small lesions, with surface diameters of less than 3 x 3cm(2), and 5 had large lesions, with surface diameters of more than 3 x 3cm(2). The patients were all followed-up carefully until complete healing was recorded, along with any complications. RESULTS: In both groups of patients, tissue sloughing occurred within 2-3 days. Healing time in small lesions was 2-3 weeks, and in large lesions 3-4 weeks. Three patients with small lesions and one patient with a large lesion experienced minor complications. CONCLUSION: The Nd:YAG laser is a safe and effective tool for treating vascular lesions.     

43rd National AOMSI Conference

Vascular anomalies of the head and neck region are a complex group of lesions that challenge the head and neck physicians. From the very understanding of the difference between its two distinct forms, hemangiomas and vascular malformations to its management remain confusing. The review of this anomaly attempts at comprehensively understanding the disease. Vascular anomalies are easily diagnosed by their clinical presentation, but choice of imaging and management for this spectrum of lesions is varied. The author attempts to categorize the required imaging for the lesion with suggestions on the management of both hemangiomas and vascular malformations. The available treatment options are discussed, and a comprehensive algorithm for management is suggested. Further research in developing drugs that could restrict the growth of these lesions would be the future of the management of vascular lesions.     

The application of magnetic resonance imaging-guided fine-needle aspiration cytology in the diagnosis of deep lesions in the head and neck.

PURPOSE: Image-guided fine-needle aspiration cytology (FNAC) may be useful as an alternative diagnostic approach to lesions in the head and neck. This study reports on the use of magnetic resonance imaging (MRI)-guided FNAC for diagnostic evaluation of deep lesions in this region. MATERIALS AND METHODS: This was a prospective study of 12 patients with deep lesions in the head and neck who underwent MRI-guided FNAC at the Shanghai 9th People's Hospital. A 0.2-T open magnet was used for MRI and localization of the 20-gauge MRI-compatible needle. All of the aspirated samples were stained with hematoxylin and eosin and examined by a cytopathologist. RESULTS: The needle in all 12 cases was displayed on MRI in the central portion of the lesion under the guidance of MRI; 12 of 12 patients (100%) had diagnostic aspirations and none needed open biopsy for more specific histologic interpretation. Six of these 12 patients with tumors (4 malignant, 2 benign) underwent operative treatment with positive postoperative pathologic results. One patient had a diagnosis of inflammation. The diagnostic accuracy was 91.67% (11 of 12), the sensitivity was 85.71% (6 of 7), and the specificity was 100% (5 of 5). There were no false-positive results and 1 false-negative result, for a false-negative rate of 14.29% (1 of 7). All aspiration procedures were well tolerated and without complications. CONCLUSIONS: MRI-guided FNAC is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is helpful and accurate in the diagnosis of deep lesions in the head and neck and in follow-up of patients, thereby avoiding further surgical intervention.