Recent advances in ultrasound: high-resolution imaging of superficial structures

Ultrasonography of the Hand in Rheumatoid Arthritis

High resolution ultrasonography of the hand and wrist was performed on 20 patients with definite or probable rheumatoid arthritis (ARA standard criteria) in its early stage. In all the patients, swelling of the soft tissues of the fingers corresponded to an enlargement of the joint capsule containing a hypoechoic exudate. The rheumatoid nodules appeared as fluid-filled rounded cavities with sharp borders. Rheumatoid tenosynovitis was observed in 18/20 patients. This corresponded to oval or spindle-shaped cavities with a hypoechoic (10/18 cases) or anechoic content (8/18 cases) and with the tendon ribbon inside. Rupture of a tendon was diagnosed in 8/20 cases and it was always confirmed at surgery. Tenosynovitis of the flexor carpi ulnaris at the wrist level was observed in 10/20 patients. Ultrasonography is proposed as an effective first-line approach and as a periodical follow-up survey in early stage rheumatoid arthritis, in combination with standard radiography.

The diagnostic limitations of ultrasonography in maxillofacial surgery

The records of 63 patients having had ultrasound examinations with grey-scale B-mode scanners have been reviewed, to determine what contribution ultrasound made to the diagnosis of superficial maxillofacial masses, when compared with clinical examination and other methods of investigation. Most of the ultrasound parameters described in the literature are found in the cases we have examined. Despite the fact that the ultrasound image is often compatible with the disease, diagnosis using ultrasound was much less accurate than expected. From this series, it is concluded that ultrasound examination is not recommended for the diagnosis of all maxillofacial pathology, especially when the echographist has no special experience in this field of pathology, when ultrasound findings are not correlated with clinical ones, and when the ultrasound report is not precise and exhaustive.

Intraoral ultrasonic scanning as a diagnostic aid

Since ultrasonographic examination has the advantages of being non-invasive, rapid and easily reproducible, this technique can be a valuable aid in diagnosing oral lesions. However, the relatively large size of commercially available transducers and the acoustic attenuation by the air space within the oral cavity have been deterrents to the intraoral application of this technique. To resolve these problems a small intraoral transducer was developed and employed clinically in the diagnosis of oral soft tissue lesions. Performance tests reveal that this transducer provides 1mm axial resolution and 2 mm lateral resolution with a 30 mm focus. It can be easily employed within the oral cavity, using a small water bag or polymer gel as an acoustic coupling agent to the oral mucosa. Clinical application of this technique to oral soft tissue lesions allows definition of margins, size and location of lesions, and their relationship to adjacent structures, as well as discrimination between cystic, benign or malignant nature, by the sonic character. These results suggest that intraoral ultrasonic scanning can be useful in the diagnosis of oral soft tissue lesions.

Ultrasonographic study of the relation of metastatic nodes to the carotid artery

Ultrasonographic studies of the neck were performed in four patients with metastatic lymph nodes that exhibited limited mobility or fixation to the surrounding tissues on palpation to obtain information about the relationship of nodes to the carotid artery. Comparison of the ultrasonograms with the operative findings disclosed that when a metastatic lymph node adhered to the carotid artery, the lymph node pulsated with flattening of the carotid artery and the echoes between the metastatic lymph node and carotid artery were attenuated.

Ultrasound B-scans in the follow-up of head and neck tumors

In recent years, diagnostic ultrasound has become established in head and neck surgery. Modern equipment allows high resolution imaging of neck tissue masses, cervical vessels, and lymph nodes. The major advantage of B-mode sonography is its ability to detect neoplasms in solid scarred neck tissue, commonly seen in patients with radical neck surgery. Postoperative or radiogenic edema, tumor recurrence, and lymph node involvement can be differentiated. Inflammatory and neoplastic lymph node diseases detected by echography must be differentiated by biopsy. Tumor recurrence was seen in 21 of 152 patients by echography. Twelve patients were diagnosed by clinical examination and 17 were diagnosed by computed tomography. Two false positive and one false negative sonographic diagnoses were made. B-mode sonography is an important instrument in the follow-up examination of head and neck tumors for early detection of tumor recurrence or tumor persistence.

Submaxillary sialadenitis with a calculus in infancy diagnosed by ultrasonography

Ultrasonography of submandibular masses in infancy may be performed during the acute phase of the disease, rapidly providing information about the mass. Further steps in management follow as illustrated by our infant with submaxillary sialadenitis and a non-opaque calculus.

Ultrasound as a diagnostic aid in maxillofacial surgery. Report of a case

Ultrasonographic examination of masses in the neck can be a valuable diagnostic aid. It has the advantages of being noninvasive, rapid, easily repeated, and relatively inexpensive. Ultrasound is also a particularly convenient means of localizing lesions for percutaneous biopsy and for serially monitoring the response of a lesion to therapy. As experience increases and equipment improves, ultrasound will gain an even greater role as a diagnostic aid. A case is reported in which a mucus-retention phenomenon was evaluated, managed, and followed with the aid of B-scan ultrasonographic and real-time imaging.