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Kang K, Kirberger RM, Hosgood G, Stander N. Computed tomographic, ultrasonographic, MRI and radiographic findings of a venous malformation with phleboliths in the thoracic limb of a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kevin Kang
- Diagnostic Imaging Department School of Veterinary Medicine Murdoch University Perth Western Australia Australia
| | - Robert M. Kirberger
- Department of Companion Animal Clinical Studies Faculty of Veterinary Science University of Pretoria Pretoria South Africa
| | - Giselle Hosgood
- Small Animal Surgery Department School of Veterinary Medicine Murdoch University Perth Western Australia Australia
| | - Nerissa Stander
- Vet Imaging Specialists The Animal Hospital, Murdoch University Perth Western Australia Australia
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2
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Samet JD, Restrepo R, Rajeswaran S, Lee EY, Green JR. Pediatric Vascular Malformations: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:179-192. [PMID: 34836564 DOI: 10.1016/j.rcl.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vascular malformations are commonly encountered in the pediatric population. This article reviews the imaging appearances of simple and syndromic vascular malformations in infants and children that radiologists should know and provides imaging guidelines based on an evidence-based approach. Malformations are discussed within the framework of the International Society for the Study of Vascular Anomalies classification system.
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Affiliation(s)
- Jonathan D Samet
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue Box 9, Chicago, IL 60611, USA.
| | - Ricardo Restrepo
- Department of Interventional Radiology and Body Imaging, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Shankar Rajeswaran
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue Box 9, Chicago, IL 60611, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jared R Green
- Joe DiMaggio Children's Hospital, Envision Radiology associates of Hollywood, 500 N Hiatus Road, Suite 200, Pembroke Pines, FL 33026, USA
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3
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Pattamapaspong N, Peh WC, Shek TW. Imaging of intramuscular haemangiomas of the extremities. Singapore Med J 2021; 61:122-128. [PMID: 32488279 DOI: 10.11622/smedj.2020030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intramuscular haemangiomas are benign soft tissue tumours that are more frequently seen in children and young adults. As they may be difficult to diagnose clinically, imaging has an important role in the detection, diagnosis and preoperative planning of these lesions. Haemangiomas of the extremities may be classified into capillary, cavernous, venous and mixed types, with or without an arteriovenous shunt, depending on the predominant vascular channels. Nonvascular components such as fat, smooth muscle, fibrous tissue and thrombus may also be present. This pictorial essay highlights the imaging features of intramuscular haemangiomas, with an emphasis on magnetic resonance imaging.
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Affiliation(s)
| | - Wilfred Cg Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Tony Wh Shek
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
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4
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Szymańska A, Szymański M, Gołąbek W, Drelich-Zbroja A, Jargiełło T. Doppler ultrasound appearance of neck tumors. J Ultrason 2018; 18:96-102. [PMID: 30335917 PMCID: PMC6440510 DOI: 10.15557/jou.2018.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 11/22/2022] Open
Abstract
Aim: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. Material and method: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. Results: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases – heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. Conclusions: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.
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Affiliation(s)
- Anna Szymańska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Marcin Szymański
- Department of Otolaryngology and Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
| | - Wiesław Gołąbek
- Professor Emeritus of Otolaryngology, Health Department, Pope John Paul II State School of Higher Education in Biała Podlaska, Biała Podlaska, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Agarwal K, Umarji HR, Kadam S, Agrawal N. The clinico-radiological spectrum of masseteric venous malformation: Case report. J Oral Biol Craniofac Res 2016; 6:S58-S61. [PMID: 27900253 DOI: 10.1016/j.jobcr.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/07/2015] [Indexed: 11/16/2022] Open
Abstract
Due to its location, intra-masseteric venous malformation often mistaken for a parotid swelling and clinical examination alone frequently underestimates the deep extension of the lesion and rarely gives accurate pre-operative diagnosis. But once it is diagnosed, the feasibility of the treatment and the plan of approach depend on accurate delineation of the extent, size and location of the lesion. Therefore, complimentary radiographic studies are essential for its management. In this case report, typical features of venous malformation within the masseter muscle, including clinical findings (turkey wattle sign) and imaging are presented. Ultrasonography and CT scan were non-contributory in the diagnosis, while on MRI, masseteric venous malformations have a typical appearance that allowed early identification, patient education and its management.
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Affiliation(s)
- Kavita Agarwal
- Reader, Department of Oral Medicine, Diagnosis and Radiology, Peoples College of Dental Sciences, Bhopal, India
| | - Hemant R Umarji
- Professor & Head, Department of Oral Medicine, Diagnosis and Radiology, Government Dental College & Hospital, Mumbai, India
| | - Sonali Kadam
- Professor, Department of Oral Medicine, Diagnosis and Radiology, Government Dental College & Hospital, Mumbai, India
| | - Neeraj Agrawal
- Reader, Department of Periodontology, People's Dental Academy, Bhopal, India
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6
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Current utilities of imaging in grading musculoskeletal soft tissue sarcomas. Eur J Radiol 2016; 85:1336-44. [DOI: 10.1016/j.ejrad.2016.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/21/2022]
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7
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Goel S, Gupta S, Singh A, Prakash A, Ghosh S, Narang P, Gupta S. The current approach to the diagnosis of vascular anomalies of the head and neck: A pictorial essay. Imaging Sci Dent 2015; 45:123-31. [PMID: 26125008 PMCID: PMC4483619 DOI: 10.5624/isd.2015.45.2.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/11/2015] [Accepted: 03/21/2015] [Indexed: 11/19/2022] Open
Abstract
Throughout the years, various classifications have evolved for the diagnosis of vascular anomalies. However, it remains difficult to classify a number of such lesions. Because all hemangiomas were previously considered to involute, if a lesion with imaging and clinical characteristics of hemangioma does not involute, then there is no subclass in which to classify such a lesion, as reported in one of our cases. The recent classification proposed by the International Society for the Study of Vascular Anomalies (ISSVA, 2014) has solved this problem by including non-involuting and partially involuting hemangioma in the classification. We present here five cases of vascular anomalies and discuss their diagnosis in accordance with the ISSVA (2014) classification. A non-involuting lesion should not always be diagnosed as a vascular malformation. A non-involuting lesion can be either a hemangioma or a vascular malformation depending upon its clinicopathologic and imaging characteristics.
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Affiliation(s)
- Sinny Goel
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - Swati Gupta
- Department of Radiodiagnosis, Lok Nayak Jaiprakash Hospital, Delhi, India
| | - Aarti Singh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - Anjali Prakash
- Department of Radiodiagnosis, Lok Nayak Jaiprakash Hospital, Delhi, India
| | - Sujoy Ghosh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
| | - Poonam Narang
- Department of Radiodiagnosis, Govind Ballabh Pant Hospital, Delhi, India
| | - Sunita Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, Delhi, India
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8
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Ultrasound of musculoskeletal soft-tissue tumors superficial to the investing fascia. AJR Am J Roentgenol 2014; 202:W532-40. [PMID: 24848846 DOI: 10.2214/ajr.13.11457] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to evaluate the diagnostic accuracy of ultrasound in assessing musculoskeletal soft-tissue tumors superficial to the investing fascia. MATERIALS AND METHODS Seven hundred fourteen superficial soft-tissue tumors evaluated with ultrasound by two musculoskeletal radiologists were retrospectively reviewed. In all ultrasound reports, the reporting radiologists provided one, two, or three diagnoses depending on their perceived level of diagnostic certainty. Two hundred forty-seven tumors had subsequent histologic correlation, thus allowing the accuracy of the ultrasound diagnosis to be determined. Images of the lesions with a discordant ultrasound diagnosis and histologic diagnosis were reviewed, and the ultrasound features were further classified as concordant with the known histologic diagnosis, concordant with the known histologic diagnosis with atypical features present, or discordant with the known histologic diagnosis. Four hundred sixty-seven tumors without pathologic confirmation were followed up clinically. RESULTS Overall the accuracy of ultrasound examination for assessing superficial soft-tissue masses was 79.0% when all differential diagnoses were considered and 77.0% when only the first differential diagnosis was considered. The sensitivity and specificity of the first ultrasound diagnosis were 95.2% and 94.3%, respectively, for lipoma; 73.0% and 97.7% for vascular malformation; 80.0% and 95.4% for epidermoid cyst; and 68.8% and 95.2% for nerve sheath tumor. Reduced observer awareness of specific tumor entities tended to contribute to underdiagnosis more than poor specificity of ultrasound findings. Most tumors (236/247, 96%) were benign. The sensitivity and specificity of ultrasound for identifying malignant superficial soft-tissue tumors was 94.1% and 99.7%, respectively. CONCLUSION The diagnostic accuracy of ultrasound in the assessment of superficial musculoskeletal soft-tissue tumors is high and can be improved through increased radiologist awareness of less frequently encountered tumors. Ultrasound is accurate for differentiating benign from malignant superficial soft-tissue tumors.
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Wilmanska D, Antosik-Biernacka A, Przewratil P, Szubert W, Stefanczyk L, Majos A. The role of MRI in diagnostic algorithm of cervicofacial vascular anomalies in children. Pol J Radiol 2013; 78:7-14. [PMID: 23807878 PMCID: PMC3693840 DOI: 10.12659/pjr.883941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Vascular anomalies are usually diagnosed through their clinical picture and history. The purpose of this study was to assess the role of MR imaging in initial assessment of cervicofacial vascular anomalies in children. Material/Methods: Twenty pediatric patients with vascular anomalies located in the cervicofacial region underwent MRI examination in our department. Images were evaluated for lesion detectability and its signal characteristics (on T1w, T2w images with fat suppression and contrast enhanced T1w sequences); the extent of the lesions and surrounding tissue involvement were also assessed. Results: In the studied group MR images revealed all anomalies and provided information of their anatomic extent and invasion of surrounding anatomic structures. Nine hemangiomas and six venous malformations were found among studied patients. Two children had multiloculated lesions corresponding to lymphatic malformations. One examination visualized a lesion consisting mainly of dilated vascular channels with an apparent feeding artery, which was consistent with arteriovenous malformation. Two remaining lesions were mixed malformations. Nine patients had lesions limited to subcutaneous tissue. Two masses infiltrated bone structures. There was muscle involvement found in nine cases. Conclusions: MR imaging is a well-established method for detection and monitoring of vascular anomalies in children. With ultrasound used mostly for initial diagnosis and additional flow assessment, angiography viewed as an invasive therapeutic method and computed tomography used only in specific situations due to its high irradiation dose, magnetic resonance is the best imaging method used in differential diagnosis and topographical characterization of vascular malformations and tumors of cervicofacial area in pediatric patients. Noninvasively and without irradiation, it enables evaluation of the extent and characteristics of lesions and planning proper therapeutic strategy.
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Affiliation(s)
- Dagmara Wilmanska
- Department of Radiology and Imaging Diagnostics, Medical University of Łódź, Łódź, Poland
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10
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Eivazi B, Fasunla AJ, Güldner C, Masberg P, Werner JA, Teymoortash A. Phleboliths from venous malformations of the head and neck. Phlebology 2013; 28:86-92. [DOI: 10.1258/phleb.2011.011029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives/Hypothesis Phleboliths in venous malformations (VM) of the head and neck are often observed and may cause significant symptoms. Only a few articles refer to the morphology and composition of the phleboliths in VM. The objective of this study was to analyse and to demonstrate their composition and morphology. Methods Patients with VM presenting to a vascular anomalies centre during a three-year period were identified. The incidence of phleboliths was analysed followed by morphological and structural analysis with cone beam tomography and X-ray diffraction. Results Phleboliths were identified in 28/98 patients with VM of the head and neck. Seven patients underwent conventional surgery to reduce the volume of the VM or to remove the phleboliths, which were localized in the cheek (3 cases), submandibular region (2 cases), infrahyoidal neck or upper eyelid (1 case each). The structural analysis showed that more advanced lamination and an increasing radiopacity of the cortex was observed in larger phleboliths. X-ray powder diffraction analysis revealed that the main constituent in the pulverized phleboliths was carbonate-fluorohydroxylapatite. Conclusion This study shows in a vivid way that phleboliths from VM of the head and neck area show a laminar structure and consist of apatite, without any indication of differences in their chemical composition. Treatment of localized intravascular coagulopathy in VM might be able to prevent the formation and the progression of phleboliths. Hypothetically, another option might be lithotripsy.
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Affiliation(s)
- B Eivazi
- Department of Otolaryngology, Head and Neck Surgery
| | - A J Fasunla
- Department of Otolaryngology, Head and Neck Surgery
| | - C Güldner
- Department of Otolaryngology, Head and Neck Surgery
| | - P Masberg
- Department of Geography, Philipp University of Marburg, Germany
| | - J A Werner
- Department of Otolaryngology, Head and Neck Surgery
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11
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Eivazi B, Fasunla AJ, Hundt W, Wiegand S, Teymoortash A. Low flow vascular malformations of the head and neck: a study on brightness mode, color coded duplex and spectral Doppler sonography. Eur Arch Otorhinolaryngol 2011; 268:1505-11. [DOI: 10.1007/s00405-011-1514-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 01/19/2011] [Indexed: 01/11/2023]
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12
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Bhatia KSS, Rasalkar DD, Lee YP, Wong KT, King AD, Yuen YH, Ahuja AT. Real-time qualitative ultrasound elastography of miscellaneous non-nodal neck masses: applications and limitations. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1644-1652. [PMID: 20800941 DOI: 10.1016/j.ultrasmedbio.2010.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 07/07/2010] [Accepted: 07/11/2010] [Indexed: 05/29/2023]
Abstract
To evaluate real-time qualitative ultrasound elastography as an adjunct to conventional sonography for evaluation of non-nodal neck masses identified in routine clinical practice, 52 consecutive masses in 49 patients underwent both techniques. Lesion stiffness was graded visually on chromatic-scale elastograms from ES0-3 (low to high). Diagnosis was based on (cyto)pathology (11), corroborative cross-sectional imaging (18) or characteristic conventional sonography (23). There were 16 lipomas, 15 lymphatic/venous vascular malformations (LVVMs), six neurogenic tumours/neuromas, five thyroglossal duct cysts (TGCs), five (epi)dermoids, three abscesses, one second-arch branchial cleft cyst (BCC), and one soft-tissue metastasis. In general terms, lesion stiffness was high (ES2-3) for neurogenic tumours/neuromas, (epi)dermoids and metastasis, and low (ES0-1) for lipomas, LVVM, TGCs and BCC. Abscesses displayed variable stiffness according to fluid content. Technical limitations and artefacts of elastograms were identified. Data from real-time qualitative ultrasound elastography may be a useful adjunct to sonography for diagnosis of non-nodal neck masses.
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Affiliation(s)
- Kunwar S S Bhatia
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
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13
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Sharman AM, Kirmi O, Anslow P. Imaging of the Skin, Subcutis, and Galea Aponeurotica. Semin Ultrasound CT MR 2009; 30:452-64. [DOI: 10.1053/j.sult.2009.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Lee J, Fernandes R. Neck masses: evaluation and diagnostic approach. Oral Maxillofac Surg Clin North Am 2008; 20:321-37. [PMID: 18603194 DOI: 10.1016/j.coms.2008.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oral and maxillofacial surgeons frequently deal with patients who present with an unknown neck mass. Formulation of a differential diagnosis is essential and requires that the surgeon bring to bear a host of skills to systematically arrive at a definitive diagnosis and ensure that the correct treatment is rendered. This article highlights some of the skills needed in the workup of neck masses and reviews some of the available techniques that aid in achieving the correct diagnosis.
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Affiliation(s)
- Jason Lee
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32246, USA
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17
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Imaging of cystic or cyst-like neck masses. Clin Radiol 2008; 63:613-22. [PMID: 18455551 DOI: 10.1016/j.crad.2007.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/10/2007] [Accepted: 12/14/2007] [Indexed: 11/23/2022]
Abstract
Cystic or cyst-like neck masses form a unique category within head and neck radiology with unique differential diagnoses. The precise anatomical location and imaging appearances are important for accurate diagnosis and formulating the differential diagnoses of cystic lesions in the neck. In vast majority of cases ultrasound, sometimes supplemented by fine-needle aspiration cytology (FNAC), is adequate for pre-treatment assessment. For large, deep-seated lesions assessment using magnetic resonance imaging (MRI) or computed tomography (CT) often provides useful supplementary information. Radiologists should be aware of imaging findings of common cystic neck masses to help in their appropriate management.
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18
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Lee YYP, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol 2008; 66:419-36. [PMID: 18337041 DOI: 10.1016/j.ejrad.2008.01.027] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 01/11/2008] [Accepted: 01/14/2008] [Indexed: 12/16/2022]
Abstract
Salivary gland neoplasms account for <3% of all tumors. Most of them are benign and parotid gland is the commonest site. As a general rule, the smaller the involved salivary gland, the higher is the possibility of the tumor being malignant. The role of imaging in assessment of salivary gland tumour is to define intra-glandular vs. extra-glandular location, detect malignant features, assess local extension and invasion, detect nodal metastases and systemic involvement. Image guided fine needle aspiration cytology provides a safe means to obtain cytological confirmation. For lesions in the superficial parotid and submandibular gland, ultrasound is an ideal tool for initial assessment. These are superficial structures accessible by high resolution ultrasound and FNAC which provides excellent resolution and tissue characterization without a radiation hazard. Nodal involvement can also be assessed. If deep tissue extension is suspected or malignancy confirmed on cytology, an MRI or CT is mandatory to evaluate tumour extent, local invasion and perineural spread. For all tumours in the sublingual gland, MRI should be performed as the risk of malignancy is high. For lesions of the deep lobe of parotid gland and the minor salivary glands, MRI and CT are the modalities of choice. Ultrasound has limited visualization of the deep lobe of parotid gland which is obscured by the mandible. Minor salivary gland lesions in the mucosa of oral cavity, pharynx and tracheo-bronchial tree, are also not accessible by conventional ultrasound. Recent study suggests that MR spectroscopy may differentiate malignant and benign salivary gland tumours as well as distinguishing Warthin's tumor from pleomorphic adenoma. However, its role in clinical practice is not well established. Similarly, the role of nuclear medicine and PET scan, in imaging of parotid masses is limited. Sialography is used to delineate the salivary ductal system and has limited role in assessment of tumour extent.
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Affiliation(s)
- Y Y P Lee
- Department of Diagnostic Radiology & Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong SAR
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19
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Shulman LP, Gabriel H. Management and localization strategies for the nonpalpable Implanon rod. Contraception 2006; 73:325-30. [PMID: 16531160 DOI: 10.1016/j.contraception.2005.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 09/01/2005] [Accepted: 10/10/2005] [Indexed: 11/23/2022]
Abstract
PURPOSE The goal of this paper is to review the imaging methods required for localizing nonpalpable Implanontrade mark. METHOD Different localization methods for nonpalpable Implanon rods are summarized, and clinical guidance is provided as to how best to localize such implants. RESULTS In the great majority of cases, optimal visualization of the single-rod Implanon rod is obtained with ultrasound using a high-resolution linear array transducer (10-15 MHz). An implant located just under the skin, under the fascia muscularis or one located deep in the muscle can most often be localized with ultrasound. In rare cases where ultrasound does not definitively locate the implant, magnetic resonance imaging is usually the next best choice. Measurements of serum etonogestrel levels may be necessary to confirm the presence or absence of the implant when it cannot be visualized by either of the two imaging methods. DISCUSSION Close clinical coordination between women's health care providers and radiologists is required to minimize or prevent removal complications and to facilitate subsequent contraceptive management of the patient.
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Affiliation(s)
- Lee P Shulman
- Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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20
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Connor SEJ, Flis C, Langdon JD. Vascular masses of the head and neck. Clin Radiol 2005; 60:856-68. [PMID: 16039921 DOI: 10.1016/j.crad.2005.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 03/22/2005] [Accepted: 04/14/2005] [Indexed: 12/19/2022]
Abstract
The classification, clinical presentation, natural history and imaging appearances of vascular masses of the head and neck are reviewed. The radiological appearances of congenital vascular masses (infantile haemangiomas and other congenital vascular tumours, high-flow and low-flow vascular malformations), acquired vascular masses (benign and malignant tumours, non-neoplastic lesions) and other hypervascular masses are described and illustrated, together with consideration of image-guided interventions.
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Affiliation(s)
- S E J Connor
- Neuroradiology Department, Kings College Hospital, London, UK.
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21
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Flis CM, Connor SE. Imaging of head and neck venous malformations. Eur Radiol 2005; 15:2185-93. [PMID: 16003510 DOI: 10.1007/s00330-005-2828-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 05/04/2005] [Accepted: 05/10/2005] [Indexed: 10/25/2022]
Abstract
Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team.
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Abstract
Vascular anomalies are lesions seen in all surgical disciplines, particularly in pediatric patients. Specialization in vascular anomalies involves a team effort, with the team consisting of plastic surgeons, general surgeons, neurosurgeons, pediatricians, interventional radiologists, dermatologists, ophthalmologists, otolaryngologists, hematologists, and pathologists. Inconsistent nomenclature in the literature has historically resulted in confusion about classification, diagnosis, and treatment. A biologic classification system has emerged, based on clinical observations, natural history, and cellular features, which separates vascular anomalies into two broad categories: vascular tumors and vascular malformations. For many vascular anomalies, photodocumentation, psychosocial support, and communication are important throughout the treatment course.
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Affiliation(s)
- Michelle A Spring
- Division of Plastic and Reconstructive Surgery, University of Wisconsin-Madison, 53792, USA
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Puig S, Casati B, Staudenherz A, Paya K. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 2005; 53:35-45. [PMID: 15607851 DOI: 10.1016/j.ejrad.2004.07.023] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 07/20/2004] [Accepted: 07/26/2004] [Indexed: 11/25/2022]
Abstract
Congenital vascular malformations (CVM) are made of dysplastic vessels with no cellular proliferation. Low- or slow-flow malformations (LFM) consist predominantly of venous and/or lymphatic vessels. Correct terminology is necessary for differentiating vascular malformations from tumours such as haemangiomas, in order to prevent ineffective or even adverse therapy. The role of the radiologist in the management of patients is two-fold: making the diagnosis with the use of ultrasound and magnetic resonance imaging, and performing sclerotherapy, which is the treatment of choice. Prior to sclerotherapy, percutaneous phlebography is necessary to visualize the dynamic situation inside the lesion and the flow into the adjacent vascular system. The double-needle technique is a useful therapy option reducing the risk of embolisation of the sclerosing agent. Large lesions might need subsequent surgical treatment. A multidisciplinary approach is substantial for optimal patient management.
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Affiliation(s)
- Stefan Puig
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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