Advanced laryngeal cancer: sonographic assessment

Endoscopy permits visualization of the endolaryngeal spread of laryngeal tumors, yet the depth of tumor infiltration often remains unclear. The authors used high-resolution sonography in 37 patients with advanced laryngeal cancer to assess the tumors and the cervical lymph nodes. Sonographic findings were compared to operative and histologic reports. Sonography demonstrated histologically confirmed infiltration into the thyroid (n = 8) and cricoid cartilages (n = 1), preepiglottic space (n = 12), base of the tongue (n = 4), hypopharynx (n = 8), subglottic space (n = 3), and thyroid gland (n = 2). Except for the retrolaryngeal portion of the tumor, sonography was valuable in assessing extralaryngeal spread of advanced cancers. It enabled detection of subclinical lymph node metastases in four patients. Furthermore, invasion of the wall of the carotid artery was found in two patients. For evaluating the endolaryngeal and hypopharyngeal portions of the tumor, endoscopy remains mandatory.     

Sonography in cervical lymph node metastases

The value of high resolution real time sonography for the detection of cervical lymph-node metastases in head and neck cancers was assessed in 118 histological proven cases. The accuracy of sonography (89%) proved to be superior to palpation (80%). In 9 patients a thrombosis of the internal jugular vein was detected. The ability of sonography to detect tumorous infiltration of the arterial vessel wall is discussed in 12 patients. Regarding possible artefacts, sonography is the only imaging modality which can solve this problem. Sonography should be performed preoperatively in all patients with malignant head and neck tumors for cervical lymph-node staging.     

Evaluation of topography and vascularization of cervical paragangliomas by magnetic resonance imaging and color duplex sonography

The management of cervical paragangliomas (PGs) depends on their specific type and their relation to adjacent vessels. The purpose of this study was to evaluate the potential of magnetic resonance imaging (MRI) and color duplex sonography (CDS) to classify PGs according to topography and vascularization. Sixteen patients harboring 22 PGs were studied retrospectively. With digital subtraction angiography as reference, the topographic relation of the tumors to the carotid arteries and the internal jugular vein and the patterns of vascularization were assessed. On MRI and CDS the typical feature of 15 carotid PGs was splaying of the carotid bifurcation, with the external carotid displaced anteriorly and the internal carotid artery and internal jugular vein located posteriorly. In five vagal PGs both modalities showed unidirectional anterior displacement of the external and internal carotid arteries. Two jugular PGs were found to extend within the lumen of the internal jugular vein. CDS completely depicted carotid body tumors but failed to delineate the high cervical portion of vagal and jugular PGs. MRI allowed us to assess the entire extent of all PGs. Nineteen lesions showed flow voids corresponding to abundant flow signal on CDS: three carotid body tumors appeared hypovascular on CDS and MRI. On CDS, intratumoral flow was directed cranially in carotid and inferiorly in vagal and jugular PGs. CDS and MRI are suitable for classification of cervical PGs as carotid, vagal or jugular PGs based on the topographic relation to the carotid arteries and internal jugular vein. Visualization of the intrinsic tumor vasculature proved an additional distinguishing criterion on CDS.     

Duplex sonography of tumors of the carotid body

Five histologically confirmed tumors of the carotid body and seven lymph node metastases in the area of the carotid bifurcation were investigated with real-time sonography. In addition, 10 patients underwent measurements of intratumorous flow by way of a pulsed Doppler system. The typically hypervascular tumors of the carotid body revealed flow signals with standardized adjustment of Doppler sonography. The hypovascularized lymph node metastases did not demonstrate flow on Doppler sonography. In all patients, either preoperative angiography or enhanced computerized tomography was done and these studies confirmed the degree of vascularization of the mass as determined by Doppler sonography. Duplex sonography permitted noninvasive demonstration of hypervascular tumors in the area of the carotid bifurcation, a finding highly suggestive of nonchromaphil paraganglioma of the carotid body.     

Cystic lymph node metastases in papillary thyroid carcinoma

OBJECTIVE: The aim of this study was to illustrate and discuss the sonographic spectrum of surgically proven cystic nodal metastases from papillary thyroid carcinoma. By correlative evaluation of the sonographic imaging findings to gross pathology and histology, our purpose was to provide useful hints to differentiate cystic lymph node metastases from other benign cystic neck lesions such as branchial cysts. MATERIALS AND METHODS: Sonographic examinations of 74 patients (47 women, 27 men; mean age, 49 years) with 97 histologically confirmed cystic lymph nodes metastases from papillary thyroid carcinoma were included in the study. The anatomic relationship of the nodes relative to the primary tumor was recorded, and all cystic nodes were qualitatively categorized as either simple (purely cystic) or complex (thickened outer wall, internal nodules, internal septations, and calcifications). All imaging findings were compared with gross pathologic specimens. RESULTS: Most of the cystic metastases were ipsilateral to the primary tumor (87.8%) and located in the mid or lower jugular chain (73.2%). In 14.9% of all patients, cystic lymph node metastases were the initial manifestation of disease. Only 6.2% of all lymph node metastases were purely cystic (all of these occurred in patients less than 35 years old). Of the 91 complex metastases, a thickened outer wall was present in 35.2% of patients, internal nodules in 42.9%, and internal septations in 57.1%. No calcifications were seen in the 91 complex metastases, and two or more findings were seen in 23.1%. All sonographic findings were verified by surgery. CONCLUSION: In most of the patients, cystic lymph node metastases are characterized sonographically by the presence of a thickened outer wall, internal echoes, internal nodularity, and septations. However, in younger patients, the lymph nodes might appear purely cystic, thereby mimicking branchial cysts and thus requiring biopsy for final diagnosis and therapy planning.     

应用超声鉴别颈部交感及迷走神经鞘瘤

目的：研究颈交感、迷走神经鞘瘤的彩超诊断。材料和方法：收集２２例经临床、手术及病理确诊为颈交感１６例和迷走６例神经鞘瘤,均行彩超检查。结果：其中７例仅以肿瘤本身的声像图特征为诊断依据者,其术前作出神经鞘瘤诊断的４例,神经鞘瘤可疑、占位病变或淋巴结肿大各１例。无一例能确定神经来源。另１５例以动脉、颈内静脉与肿瘤三者间的相关位置作为彩超诊断的根据：发现１１例交感神经来源者,颈总（颈内）动脉移位并紧贴于肿瘤的前方至外方,颈内静脉移位于动脉之外后方,靠近动脉或与动脉相距３０°－９０°。４例迷走神经来源者,颈总（颈内）动脉移位于肿瘤之前内至内后方,颈内静脉与动脉相反方向移位于肿瘤外侧,动静脉相距１２０°～１８０°。结论：单纯肿瘤声像图难以区分颈神经鞘瘤,利用颈内动、静脉声像图可助诊断,其中颈内动、静脉－起被推移而相互位置不变或动、静脉相距０～９０°内时提示交感神经鞘瘤,动、静脉相距１２０°～１８０°时提示迷走神经鞘瘤。     

颈部转移淋巴结的CT、B超检查与病理对照研究(Ⅱ.包膜外侵犯的诊断)

目的：评价ＣＴ、Ｂ超检查颈部转移淋巴结包膜外侵犯的价值和诊断标准，以及颈动脉受侵的影像学诊断。材料与方法：对６０例颈淋巴结清扫术的患者做术前前瞻性ＣＴ、Ｂ超检查，术后与病理对照，并进行双盲法分析。结果：以淋巴结边缘不规则强化、脂肪间隙部分或全部消失为转移淋巴结包膜外侵犯的ＣＴ诊断指标，敏感性８１．０３％，特异性９３．０２％；以淋巴结边缘不规则，强回声包膜呈锯齿状中断为转移淋巴结包膜外侵犯的Ｂ超诊断指标，敏感性９５．３５％，特异性６３．６４％。１１例转移淋巴结粘连侵犯颈动脉者，ＣＴ准确评价９例，Ｂ超准确诊断１０例。结论：淋巴结边缘不规则强化，周围脂肪间隙部分或全部消失为ＣＴ评价颈部转移淋巴结包膜外侵犯的准确指标。ＣＴ结合Ｂ超能准确评价颈部转移淋巴结与颈动脉的关系。     

甲状腺癌术后复发的CT表现

目的 分析甲状腺癌术后复发的ＣＴ表现,了解甲状腺术后复发的特点。方法 回顾性分析经手术及病理证实的甲状腺癌主后复发患者４２例,包括乳头状癌２５例,滤泡癌９例,髓样癌６例,透明细胞癌２例。结果 甲状腺床局部复发２３例,其中侵犯颈动脉１０例,气管、食管１７例,喉及下咽２例,９例滤泡癌中８例局部复发,７例肿特明显强化。对侧甲状腺复发１２例,病理类型与原发甲状腺癌一致。颈部淋巴结转移３１例,乳头状癌颈剖淋     

Extra-CNS metastases of glioblastoma: CT and MR studies

The case of a 29-year-old man with glioblastoma and multiple metastases outside the CNS is presented. Cervical lymph node involvement was ascertained with CT and magnetic resonance (MR), and numerous bone metastases were detected with skeletal scintigraphy. The extent of the cervical tumor and its relationship to the carotid artery could be better assessed with MR than with CT. The patient died despite repeat operations, radiotherapy, and intraarterial systemic chemotherapy. The importance of radiological screening for detecting glioblastoma metastases in patients with long survival is discussed.     

甲状腺癌的CT诊断

目的分析甲状腺癌及其颈部转移淋巴结的ＣＴ表现，探讨肿瘤侵犯周围重要器官的诊断指征。方法回顾性分析经手术及病理证实的５２例甲状腺癌的术前ＣＴ表现。结果５２例原发肿瘤均密度不均，３２例边缘不规则（８２．５％），１１例原发肿物及５例转移淋巴结内有细颗粒状钙化，４例原发肿瘤及６例转移淋巴结内有囊性变伴囊壁高密度乳头状结节，手术证实气管受侵２２例；１０例ＣＴ示气管内壁呈锯齿状，５例肿物突入气管腔内而明确诊断。食管受侵２１例，颈动脉受侵１０例。以肿物包绕食管１／２周或颈动脉１／３周以上为侵犯的诊断指标，敏感性分别为７１．４％、１００．０％；特异性分别为９６．３％、９５．２％。结论原发肿物及转移淋巴结内颗粒状钙化及囊性变伴高密度乳头状结节是甲状腺癌（特别是乳头状癌）的特征性密度变化。ＣＴ增强扫描对诊断甲状腺癌及评价其与周围结构的关系和制定手术方案十分重要     

Angiographic observations on chemodectomas of the head and neck.

Angiographic experience with chemodectomas in 21 patients is reviewed. Arterial supply was identified from the vertebral artery, the internal carotid artery, and branches of the external carotid artery. A striated cephalad extension from a cervical chemodectoma (five patients) is believed to represent arterial supply to tumor in vein. In two patients, internal and external carotid arteriograms did not opacify important arteries originating near the carotid bifurcation. Retrograde filling of sigmoid sinus (four patients), tumor mass in jugular vein (two patients), and arteriovenous shunting (nine patients) were observed during the venous phase. Thorough angiogra phy is essential for evaluation of chemodectomas of the head and neck.     

Sonography of the cervical vagus nerve: normal appearance and abnormal findings

OBJECTIVE: The purpose of this study was to assess the appearance of the cervical vagus nerve in healthy individuals and to investigate the potential role of sonography in revealing neck masses that cause vagal dysfunction. SUBJECTS AND METHODS: We examined 150 consecutive patients. In 144 patients the presence of thyroid, salivary gland, or lymph node disease was suspected. In three patients a cervical mass was palpable, and three patients had symptoms of dysfunction of the inferior laryngeal or vagal nerves. The pathologic diagnoses of the masses were obtained at biopsy. RESULTS: In 144 individuals the normal vagus nerve was recognized on each side of the neck as a thin band that occupied the posterior angle formed by the common carotid artery and the internal jugular vein. Three patients had tumors arising from the vagus nerve: one neurofibroma, one neurinoma, and one chemodectoma. These tumors were located in the neurovascular bundle and posterior to the vessels; their origin from the vagus nerve was clearly visible in all patients because of the contiguity of the mass with the nerve bundle. In the other three patients, sonography revealed an extrinsic mass that compressed and displaced the vagus nerve out of its longitudinal axis; two cases were hyperplastic nodules of the thyroid, and in one case the nodule was a branchial cyst. CONCLUSION: Sonography can reveal the vagus nerve in healthy conditions and correctly reveal the vagal origin of some tumors in the parapharyngeal spaces.     

基于 RTOG 分区的颈部淋巴结转移CT 及 MR分析

目的：探讨颈部转移淋巴结分布与其原发肿瘤的相关性,以及其CT、MR影像表现特点,旨在提高病变诊断的准确率。方法搜集经手术或穿刺病理证实的126例原发肿瘤颈部转移淋巴结患者C T和（或）M RI资料,分析颈部转移淋巴结分布与其原发肿瘤的相关性,以及其影像学表现。结果多数头颈部原发肿瘤均可转移到Ⅱb区,Ⅱa区及Ⅲ区也是常见的转移部位。颈部转移淋巴结分布与其原发肿瘤的来源有较大的相关性。结论颈部转移淋巴结分布与其原发肿瘤的淋巴引流区域相关,颈部淋巴结RT OG分区对判断颈部淋巴结转移的原发肿瘤来源具有重要的价值。     

US-guided biopsy of neck masses in postoperative management of patients with thyroid cancer

High-frequency (10-MHz) sonography demonstrated a cervical mass or lymphadenopathy, or both, during postoperative follow-up of 52 patients who had undergone surgery for thyroid cancer. Percutaneous biopsy with ultrasonographic (US) guidance was performed in all 52 masses, 44 of which were nonpalpable. Malignant cells were obtained in 29 biopsies, and the results of 20 biopsies were negative, yielding benign lymphocytes only. Results in three biopsies were nondiagnostic due to hypocellular specimens. Therefore, 94% of biopsy results (49) of 52) were confidently assigned as either positive (56%) or negative (38%) for malignancy. There were no complications. High-frequency sonography can demonstrate clinically occult thyroid bed tumor recurrence and lymph node metastases. US-guided biopsy is an accurate and safe technique to confirm or exclude malignancy in patients at high risk of recurrence of thyroid cancer.     

CT evaluation of anaplastic thyroid carcinoma

CT findings in 19 patients with anaplastic thyroid carcinoma were compared retrospectively with pathologic findings and the results of palpation. The carcinoma appeared as a large mass of low attenuation accompanied by dense calcification in 58% of the patients; there was necrosis in 74%. Often, adjacent structures were infiltrated. CT correctly showed tumor invasion of the carotid artery (7/7), internal jugular vein (9/10), larynx (5/6), trachea (8/10), esophagus (4/5), mediastinum (5/5), and regional lymph nodes (14/16). Seven patients (50%) had necrotic nodes. CT was superior to palpation in the detection of a primary tumor in one patient and of metastatic nodes in seven patients. It suggested a suitable place for biopsy in two patients, leading to a correct diagnosis. CT altered surgical planning in five patients with intrathoracic extension of the thyroid tumor, and in three patients with laryngeal or esophageal invasion of the tumor. CT can increase diagnostic accuracy in patients with anaplastic thyroid carcinoma by suggesting a likely diagnosis and by indicating an appropriate site for biopsy. It is indispensable in the planning of surgery for patients with this disorder.     

CT evaluation of anaplastic thyroid carcinoma

CT findings in 19 patients with anaplastic thyroid carcinoma were compared retrospectively with pathologic findings and the results of palpation. The carcinoma appeared as a large mass of low attenuation accompanied by dense calcification in 58% of the patients; there was necrosis in 74%. Often, adjacent structures were infiltrated. CT correctly showed tumor invasion of the carotid artery (7/7), internal jugular vein (9/10), larynx (5/6), trachea (8/10), esophagus (4/5), mediastinum (5/5), and regional lymph nodes (14/16). Seven patients (50%) had necrotic nodes. CT was superior to palpation in the detection of a primary tumor in one patient and of metastatic nodes in seven patients. It suggested a suitable place for biopsy in two patients, leading to a correct diagnosis. CT altered surgical planning in five patients with intrathoracic extension of the thyroid tumor, and in three patients with laryngeal or esophageal invasion of the tumor. CT can increase diagnostic accuracy in patients with anaplastic thyroid carcinoma by suggesting a likely diagnosis and by indicating an appropriate site for biopsy. It is indispensable in the planning of surgery for patients with this disorder.     

Cavernous sinus invasion by pituitary adenomas

One hundred ninety-eight surgically explored pituitary adenomas were evaluated preoperatively by high-resolution computed tomography (CT). At surgery, evidence of direct cavernous sinus invasion was demonstrated in 19. CT findings in these cases included cavernous sinus expansion (17 patients) and visible encasement of the internal carotid artery (14 patients). The invasive tumor often enhanced to a lesser degree than the cavernous sinuses and ipsilateral internal carotid artery. Intracavernous cranial nerve compression, obliteration, or displacement (14 patients), invasion of the lateral wall of the cavernous sinus (seven patients), and diffuse bone destruction (seven cases) were other findings. Magnetic resonance imaging in three patients provided excellent demonstration of intracavernous internal carotid artery encasement, but displacement and obliteration of intracavernous cranial nerves was not shown as well as it was with CT. Histologically, only three patients showed anaplastic features and only one of them had distant metastases. There was no correlation between histologic features, hormone assays, and invasiveness. This experience indicates any type of pituitary adenoma, regardless of its endocrinologic activity, can invade the cavernous sinus. Cavernous sinus involvement makes complete surgical removal difficult. Preoperative recognition of invasive behavior of these tumors has prognostic value and aids in designing appropriate management. CT is the most useful technique generally available for evaluation and follow-up.     

介入放射学在颈静脉球瘤术前应用的价值

目的:评价介入放射学在颈静脉球瘤术前应用的价值.方法:本组9例颈静脉瘤患者均经手术病理证实,所有患者于术前行双侧颈内、外动脉和椎动脉造影检查,对其中7例患者行术前供血动脉栓塞及患侧颈内动脉球囊阻断试验以了解Willis'环功能.结果:9例颈静脉球瘤患者术前造影及7例供血动脉栓塞均获成功,肿瘤切除术中出血明显减少;6例通过颈内动脉球囊阻断试验,术中施行颈内动脉结扎术,术后随访均未出现神经系统症状或体征.结论:颈静脉球瘤术前供血动脉栓塞及颈内动脉球囊阻断试验是安全可靠的,可作为常规术前检查.     

Application of expandable metallic stents to the venous system.

Expandable metallic stents were successfully introduced in 12 patients; 6 with superior vena cava (SVC) obstruction due to tumor invasion or lymph node metastases, 3 with inferior vena cava (IVC) obstruction or stenosis due to lymph node metastases or hepatic tumor, one with common iliac vein (CIV) obstruction due to lymph node metastases, one with idiopathic obstruction of the hepatic IVC and Budd-Chiari syndrome, and one with CIV obstruction following a dialysis shunt. The length of the lesions was between 2 and 15 cm. Multiple (2-7) stents in tandem were inserted percutaneously from a femoral venous approach through a 12 to 16 F (4.0-5.3 mm) Teflon sheath. Postoperatively, all 12 patients became free from symptoms such as SVC syndrome or IVC syndrome. In 11 patients, the symptoms did not recur during the follow-up periods of 1 to 21 months.     

颈部神经源肿瘤的CT诊断

目的：探讨ＣＴ扫描对颈部神经源肿瘤的定位、定性诊断价值。材料与方法：复习经手术及病理证实的颈部神经源肿瘤的ＣＴ扫描３０例,包括神经鞘瘤１７例,神经纤维瘤６例,颈动脉体瘤３例,恶性神经源肿瘤４例。结果：肿瘤位于颈动脉间隙１５例,椎旁间隙９例,其他部位６例。颈动脉间隙肿物中,８例（５３．３％）使颈动、静脉向外侧移位,２例（１３．３％）使血管向前方移位,５例（３３．３％）使颈动、静脉分离（其中４例明确来