RPS 1808 - Imaging of the neck: more than thyroid

Purpose:

To evaluate the efficacy of high-resolution ultrasonography (HRUS) in the diagnosis of periapical lesions.

Conventionally, the diagnosis of periapical lesions of the teeth has been based on clinical, radiological, and histopathological examinations. However, conventional radiological procedures do not allow for the differentiation between cystic and non-cystic periapical lesions. Recently, USG has been used to provide more detailed information.

Limited studies have been done to evaluate periapical lesions using USG with colour Doppler and power Doppler.

Methods and materials:

60 patients having inflammatory periapical lesions of maxillary or mandibular anterior teeth and requiring endodontic surgery were included in this study. We used conventional periapical radiographs as well as USG with colour Doppler and power Doppler for the diagnosis of these lesions. Their diagnostic performances were compared against histopathologic examination.

Results:

HRUS examination with colour Doppler and power Doppler identified 58 (38 cysts and 20 granulomas) of 60 periapical lesions accurately, with a sensitivity of 100% for cysts and 90.91% for granulomas, and a specificity of 90.91% for cysts and 100% for granulomas. In comparison, conventional intraoral radiography identified only 42 lesions (sensitivity of 78.9% for cysts and 45.4% for granulomas, and specificity of 45.4% for cysts and 78.9% for granulomas).

Conclusion:

HRUS imaging with colour Doppler and power Doppler is superior to conventional intraoral radiographic methods for diagnosing the nature of periapical lesions in the anterior jaws. This study reveals the potential of USG examination in the study of other jaw lesions.

Limitations:

n/a

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

Cervical traumatic neuromas (CTN) following lateral neck dissection for thyroid cancer may be misdiagnosed as metastatic lymph nodes. The purpose of this study was to present the B-mode, colour Doppler, and shear-wave elastography (SWE) ultrasound (US) features of the CTNs and the differences from lymphadenopathies.

Methods and materials:

79 patients with US CTNs features were selected from 206 patients who underwent cervical US after neck dissection if the following was present: 1) nodule continuity with cervical plexus, 2) posterolateral location, 3) fusiform morphology, 4) hypoechogenic internal lines, and 5) Doppler-flow absence. 31 patients (group 1, n=38 nodules) underwent fine-needle aspiration biopsy (FNAb). Two radiologists blinded to the cytological results evaluated 26 patients (n=31 nodules, group 1) with B-mode, colour Doppler, and SWE. US features (except SWE) were then compared to 42 patients (n=48 nodules, group 2) who had biopsy-proven metastatic (n=32) or reactive lymphadenopathies (n=16).

Results:

All group 1 nodules had a CTN diagnosis according to cytologic confirmation (n=15) and pain exacerbation during nodule puncture and undetectable thyroglobulin/calcitonin in FNAb washout fluid (n=38). B-mode, colour Doppler, and SWE US features were similar (p>0.05) between the biopsy-proven (n=11) and indeterminate-cytology CTNs (n=20). CTNs had a mean elastic score of 2, a shear-wave velocity of 3.2±0.5 cm/s, and an elasticity index of 33.3±11.3 kPa. The above-mentioned US CTNs features such as 1) and 4) showed a sensitivity, specificity, and accuracy of 0.95, 0.93, and 0.98, and 0.92, 1.00, and 0.97, respectively, to differentiate the CTNs from cervical metastatic or reactive lymphadenopathies.

Conclusion:

Continuity with the cervical plexus and the hypoechogenic internal lines with a moderate soft elastic score were the key US features for CTNs.

Limitations:

The small population was a study limitation.

Ethics committee approval

IRB approval and written informed consent was obtained.

Funding:

No funding was received for this work.

Purpose:

To compare the relative diagnostic performance of FNAC and CNB in parotid gland (PG) lesions.

Methods and materials:

Data from FNAC and CNB performed over a 2-year period was reviewed. Samples were included if the clinico-radiological suspicion was a PG neoplasm. Biopsies of lesions arising outside the PG, metastases, and microbiological aspirations were excluded as were recurrent pleomorphic adenomas. For excised lesions, final histopathology was assessed for concordance with the biopsy samples.

Results:

183 biopsies were obtained: 154 FNAC and 77 CNB. Of 154 FNAC, 27 were inadequate (82% adequacy rate), 85 yielded a cytological diagnosis (67% diagnostic rate), and 48 subsequently underwent CNB. From 76 CNB, 74 samples were adequate for diagnosis (97%) and 61 yielded a histopathological diagnosis (80%). Of 12 inadequate FNAC who had a CNB, 10 (83%) were diagnostic. In 68 of 183 patients, final excision histopathology was obtained: 82% FNA concordance and 92% CNB concordance. FNA sensitivity for malignancy was 60.0% (95% CI: 14.66%-94.73%) and FNA specificity was 90.2% (95% CI: 76.87-97.28%). CNB sensitivity was 100.00% (95% CI: 73.54%-100.00%) and specificity was 93.75% (95% CI: 69.77%-99.84%).

Conclusion:

CNB demonstrates superior performance with regard to sensitivity, specificity, and histopathological concordance compared to FNA, with no complications in our study. This study is in line with published studies in this field suggesting the preferential use of CNB over FNA may be warranted in the evaluation of primary PG lesions.

Limitations:

This was a retrospective, observational study. In cases where the cytology/histology was equivocal, interpretation was made by the authors on the final interpretation by consensus.

A relatively low number of lesions with final histopathological data (n=68) compared to total biopsy sample size (n=183).

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

Visualisation of peroneal vessels prior to autologous transplantation of osteomyocutaneous fibular flap for mandibular reconstruction is essential for surgical success. Our aim was to improve and simplify the pre-surgical diagnostics of peroneal perforators using a dedicated dual-energy CTA protocol and semiautomatic vessel unfolding algorithm.

Methods and materials:

CTA of the lower limbs was performed in 20 patients using dual-energy acquisitions from a third-generation dual-source CT and a high iodine flux (7mL/s, 350 mg/mL). Monoenergetic reconstructions (40 keV) were automatically reconstructed from the scanner and used for the semiautomatic centreline labelling of the peroneal arteries and their lateral perforators on a post-processing console using a dedicated vascular workflow. Curved MIP reconstruction was regarded as a gold standard. Vessel unfolding reconstruction was performed using a prototype software application. Number and length of perforator arteries were compared between curved MIP reconstruction, thin slice MIP in coronal orientation, posterior VRT, and coronal vessel unfolding of each lower limb.

Results:

The vessel unfolding algorithm was applicable in all patients and significantly more perforator arteries could be detected compared to thin slice MIP and VRT reconstructions. The mean perforator length was only 7% shorter than in the gold standard, whereas values from thin slice MIP and VRT were significantly shorter. Bone superposition was less frequent in vessel unfolding compared to thin slice MIP.

Conclusion:

The combination of low monoenergetic reconstructions and vessel unfolding allows for a comprehensive and precise presentation of small peroneal perforator vessels prior to autologous transplantation.

Limitations:

A limited number of patients in this preliminary study.

Ethics committee approval

n/a

Funding:

No funding was received for this work.

Purpose:

To review the preoperative MRI of patients with primary hyperparathyroidism who underwent surgery for parathyroid adenoma (PtA) and to investigate the morphological features that help differential diagnosis.

Methods and materials:

Parathyroid MRIs of 184 patients from 2015-2018 were reviewed. Only 69 patients were operated on. 5 patients were excluded and 5 patients had bilateral lesions. In summary, 69 lesions from a total of 64 patients were analysed. Axial, sagittal, and coronal fat-saturated T2W TSE and axial pre/post-contrast T1W TSE sequences were obtained in a 1.5T MR system. T2W hyperintensity, oblonged morphology, "reverse-D" appearance, strong enhancement, and the extension to paraesophageal region were investigated. Sensitivity, specificity, and positive and negative predictive value were calculated for each finding (p<0.05).

Results:

56 were classified as parathyroid adenoma and 8 as non-PtA, pathologically. MR was negative in 5 lesions. The mean lesion size was 15 mm (4-44.8 mm). Of the 56 adenomas, 51 were T2A hyperintense while 38 showed strong enhancement. Oblonged morphology was present in 40 adenomas, "reverse D" appearance in 36, and paraesophageal extension in 16 adenomas. None of non-PtA lesions showed extension. There was a statistical significance for the strong enhancement (p=0.019) and sensitivity, specificity, and accuracy values were 70%, 75%, and 71%, respectively. The “reverse D” appearance described for the first time in the literature has been shown to be a common finding in adenomas and sensitivity, specificity, and accuracy values were 64%, 63%, and 64%, respectively.

Conclusion:

Images on the sagittal plane may contribute to a morphological analysis for PtA in parathyroid MRI and oblonged morphology with reverse D appearance may facilitate the diagnosis.

Limitations:

The number of non-adenoma lesions was little.

Ethics committee approval

Ethics committee approved.

Funding:

No funding was received for this work.

Purpose:

The thyroid gland, as an inherently iodine-rich organ, shows uniquely higher attenuation in contrast to other neck structures on pre-contrast CT images. However, its attenuation varies among different thyroid disorders. We correlated iodine concentration (IC, mgI/ml) of thyroid parenchyma derived from dual-energy CT (DECT) datasets with hormonal status and pathologic results with phantom validation.

Methods and materials:

We retrospectively enrolled 227 patients (M:F=70:157, age= 47.9±10.6Yr) who consecutively underwent both US and neck CT examination before thyroid surgery during the past two years. On the additional iodine map from pre-contrast images obtained by dual-layer detector DECT scanner (120kVp), 3-dimensional IC measurement was done at the thyroid parenchyma sonographically devoid of nodules. After that, we statistically determined the mean IC of thyroid parenchyma depending on the thyroid hormonal status and pathologic results. A gammex phantom containing 7 iodine chambers with different IC ranging from 2 to 20mgI/ml was used to validate the accuracy of our scan parameters to calculate IC.

Results:

Among the 165 euthyroid patients, the mean parenchymal IC was significantly lower in patients with pathologically proven Hashimoto's thyroiditis than those devoid of thyroiditis (0.95±0.49 vs 1.44±0.50, p<0.01). In the other 56 hyper-/hypothyroidism patients, the mean parenchymal IC was 0.35±0.59. From the phantom study for IC quantification, measurement error ranged from -0.2% to 2.0% with our DECT protocols.

Conclusion:

DECT iodine quantification for inherent iodine could be helpful to understand thyroid parenchymal disorders.

Limitations:

Limited to the specific technical parameters, for example, type of DECT or scanning condition.

Ethics committee approval

IRB-approved study.

Funding:

Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education (2018R1D1A1B07045730).

Purpose:

To investigate the predictive value of head and neck CT angiography (CTA) in intraoperative haemorrhage of carotid body tumours.

Methods and materials:

Head and neck CT images of 36 patients with carotid body tumours confirmed by pathology were retrospectively analyzed. The intraoperative bleeding volume ＜500 ml group and intraoperative bleeding volume ≥500 ml group were compared and analysed. The patient's age, sex, Shamblin classification, size of the lesion, number of blood supply arteries, course of the disease, plain scan, and enhanced CT value were analysed. The ROC curve was established to determine the number of blood supply arteries, the maximum diameter of upper and lower, the longest diameter of the axis, and the sensitivity and specificity of the Shamblin type in judging the blood volume during the operation.

Results:

The amount of bleeding during the operation of carotid body tumours is related to the age of the patients, the maximum diameter of tumours, the longest diameter of axes, Shamblin classification, and the number of blood supply arteries. The AUC of the number of blood supply artery is larger than the other parameters, which can better predict intraoperative blood loss in patients with CBT.

Conclusion:

The number of blood supply artery detected in CTA is the best parameter to predict intraoperative blood loss.

Limitations:

The selected cases are few and lack of validation of research. Dual-energy data wasn't analysed.

Ethics committee approval:

This retrospective study was performed with institutional review board approval. Informed consent was obtained.

Funding:

Prof. Zhengyu Jin received research grants from National Public Welfare Basic Scientific Research Project of Chinese Academy of Medical Sciences (2018PT32003).

Dr. Yu Chen received research grants from Fundamental Research Funds for the Central Universities (3332018006).