RESUMEN

The vast array of acute nontraumatic diseases encountered in the head and neck of pediatric patients can be intimidating for radiologists in training in a fast-paced emergency setting. Although there is some overlap of pediatric and adult diseases, congenital lesions and developmental variants are much more common in the pediatric population. Furthermore, the relative incidences of numerous infections and neoplasms differ between pediatric and adult populations. Young patients and/or those with developmental delays may have clinical histories that are difficult to elicit or nonspecific presentations, underscoring the importance of imaging in facilitating accurate and timely diagnoses. It is essential that radiologists caring for children be well versed in pediatric nontraumatic head and neck emergency imaging. The authors provide an on-call resource for radiology trainees, organized by anatomic location and highlighting key points, pearls, pitfalls, and mimics of many acute nontraumatic diseases in the pediatric head and neck. ©RSNA, 2024 Supplemental material is available for this article.

Asunto(s)

Urgencias Médicas , Cabeza , Cuello , Humanos , Niño , Cabeza/diagnóstico por imagen , Cabeza/anomalías , Cuello/diagnóstico por imagen , Diagnóstico Diferencial

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Accurate and precise rigid registration between head-neck computed tomography (CT) and cone-beam computed tomography (CBCT) images is crucial for correcting setup errors in image-guided radiotherapy (IGRT) for head and neck tumors. However, conventional registration methods that treat the head and neck as a single entity may not achieve the necessary accuracy for the head region, which is particularly sensitive to radiation in radiotherapy. We propose ACSwinNet, a deep learning-based method for head-neck CT-CBCT rigid registration, which aims to enhance the registration precision in the head region. Our approach integrates an anatomical constraint encoder with anatomical segmentations of tissues and organs to enhance the accuracy of rigid registration in the head region. We also employ a Swin Transformer-based network for registration in cases with large initial misalignment and a perceptual similarity metric network to address intensity discrepancies and artifacts between the CT and CBCT images. We validate the proposed method using a head-neck CT-CBCT dataset acquired from clinical patients. Compared with the conventional rigid method, our method exhibits lower target registration error (TRE) for landmarks in the head region (reduced from 2.14 ± 0.45 mm to 1.82 ± 0.39 mm), higher dice similarity coefficient (DSC) (increased from 0.743 ± 0.051 to 0.755 ± 0.053), and higher structural similarity index (increased from 0.854 ± 0.044 to 0.870 ± 0.043). Our proposed method effectively addresses the challenge of low registration accuracy in the head region, which has been a limitation of conventional methods. This demonstrates significant potential in improving the accuracy of IGRT for head and neck tumors.

Asunto(s)

Tomografía Computarizada de Haz Cónico , Aprendizaje Profundo , Neoplasias de Cabeza y Cuello , Radioterapia Guiada por Imagen , Humanos , Radioterapia Guiada por Imagen/métodos , Tomografía Computarizada de Haz Cónico/métodos , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Algoritmos , Cabeza/diagnóstico por imagen , Cuello/diagnóstico por imagen

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Objective: To analyze the radiomic and clinical features extracted from 2D ultrasound images of thyroid tumors in patients with Hashimoto's thyroiditis (HT) combined with papillary thyroid carcinoma (PTC) using machine learning (ML) models, and to explore the diagnostic performance of the method in making preoperative noninvasive identification of cervical lymph node metastasis (LNM). Methods: A total of 528 patients with HT combined with PTC were enrolled and divided into two groups based on their pathological results of the presence or absence of LNM. The groups were subsequently designated the With LNM Group and the Without LNM Group. Three ultrasound doctors independently delineated the regions of interest and extracted radiomic features. Two modes, radiomic features and radiomics-clinical features, were used to construct random forest (RF), support vector machine (SVM), LightGBM, K-nearest neighbor (KNN), and XGBoost models. The performance of these five ML models in the two modes was evaluated by the receiver operating characteristic (ROC) curves on the test dataset, and SHapley Additive exPlanations (SHAP) was used for model visualization. Results: All five ML models showed good performance, with area under the ROC curve (AUC) ranging from 0.798 to 0.921. LightGBM and XGBoost demonstrated the best performance, outperforming the other models (P<0.05). The ML models constructed with radiomics-clinical features performed better than those constructed using only radiomic features (P<0.05). The SHAP visualization of the best-performing models indicated that the anteroposterior diameter, superoinferior diameter, original_shape_VoxelVolume, age, wavelet-LHL_firstorder_10Percentile, and left-to-right diameter had the most significant effect on the LightGBM model. On the other hand, the superoinferior diameter, anteroposterior diameter, left-to-right diameter, original_shape_VoxelVolume, original_firstorder_InterquartileRange, and age had the most significant effect on the XGBoost model. Conclusion: ML models based on radiomics and clinical features can accurately evaluate the cervical lymph node status in patients with HT combined with PTC. Among the 5 ML models, LightGBM and XGBoost demonstrate the best evaluation performance.

Asunto(s)

Enfermedad de Hashimoto , Metástasis Linfática , Aprendizaje Automático , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Ultrasonografía , Humanos , Carcinoma Papilar/diagnóstico por imagen , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/diagnóstico por imagen , Ganglios Linfáticos/patología , Ganglios Linfáticos/diagnóstico por imagen , Cuello/diagnóstico por imagen , Radiómica , Curva ROC , Máquina de Vectores de Soporte , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/patología , Cáncer Papilar Tiroideo/complicaciones , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Ultrasonografía/métodos

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INTRODUCTION/OBJECTIVES: Neck lumps are a common presentation to primary care services. The aetiology of posterior neck lumps is poorly explored in the literature, and therefore remain a concern to patients and clinicians. This often results in an urgent referral for ultrasound assessment. The authors of this study sought to evaluate the aetiology of posterior neck lumps from a radiological perspective, to assess whether ultrasound can be used as a useful adjunct, rather than a first-line urgent investigation. METHODS: A retrospective case series was carried out, examining all primary care referred ultrasound studies for assessment of posterior neck lumps, performed at a single institution in Essex, United Kingdom, over a period of over 10 years dating between 2nd February 2012 to 8th November 2022. Data was collected on: patient age at the time of study, patient sex, whether the lump was single or multiple as palpated and documented by the primary care physician, size of the lump to the nearest 0.5 cm as documented on ultrasound using the longest dimension, sonographic diagnosis and any follow up imaging (not limited to ultrasound). RESULTS: A total of 623 neck ultrasounds were performed on 615 adults. Of the overall radiological diagnoses made from the 623 scans, 555 (89.09%) scans were benign, 63 (10.11%) scans had no lump found on sonography, and 3 (0.48%) scans showed malignancy. In the remaining 2 (0.32%) scans, the lump was deemed indeterminate. The most common aetiologies for benign lumps were due to: normal lymph nodes (n = 263; 42.21%), lipomas (n = 152; 24.39%), and benign dermal cysts (n = 105; 16.85%). All 3 malignant cases had co-existing anterior and posterior neck lumps. CONCLUSIONS: Given that the overwhelming majority of posterior neck lumps in our study had benign findings, we propose that patients with solitary or even multiple posterior neck lumps alone, regardless of size can either be investigated routinely or can be reassured depending on other clinical examination characteristics. Patients who have the presence of co-existing anterior and posterior neck palpable neck lumps justifies urgent or 2-week wait radiological investigation.

Asunto(s)

Cuello , Ultrasonografía , Humanos , Ultrasonografía/métodos , Estudios Retrospectivos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Anciano , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Adulto Joven , Reino Unido , Anciano de 80 o más Años , Adolescente , Atención Primaria de Salud

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OBJECTIVES: Compressed sensing allows for image reconstruction from sparsely sampled k-space data, which is particularly useful in dynamic contrast enhanced MRI (DCE-MRI). The aim of the study was to assess the diagnostic value of a volume-interpolated 3D T1-weighted spoiled gradient-echo sequence with variable density Cartesian undersampling and compressed sensing (CS) for head and neck MRI. METHODS: Seventy-one patients with clinical indications for head and neck MRI were included in this study. DCE-MRI was performed at 3 Tesla magnet using CS-VIBE (variable density undersampling, temporal resolution 3.4 s, slice thickness 1 mm). Image quality was compared to standard Cartesian VIBE. Three experienced readers independently evaluated image quality and lesion conspicuity on a 5-point Likert scale and determined the DCE-derived time intensity curve (TIC) types. RESULTS: CS-VIBE demonstrated higher image quality scores compared to standard VIBE with respect to overall image quality (4.3 ± 0.6 vs. 4.2 ± 0.7, p = 0.682), vessel contour (4.6 ± 0.4 vs. 4.4 ± 0.6, p < 0.001), muscle contour (4.4 ± 0.5 vs. 4.5 ± 0.6, p = 0.302), lesion conspicuity (4.5 ± 0.7 vs. 4.3 ± 0.9, p = 0.024) and showed improved fat saturation (4.8 ± 0.3 vs. 3.8 ± 0.4, p < 0.001) and movement artifacts were significantly reduced (4.6 ± 0.6 vs. 3.7 ± 0.7, p < 0.001). Standard VIBE outperformed CS-VIBE in the delineation of pharyngeal mucosa (4.2 ± 0.5 vs. 4.6 ± 0.6, p < 0.001). Lesion size in cases where a focal lesion was identified was similar for all readers for CS-VIBE and standard VIBE (p = 0.101). TIC curve assessment showed good interobserver agreement (k=0.717). CONCLUSION: CS-VIBE with variable density Cartesian undersampling allows for DCE-MRI of the head and neck region with diagnostic, high image quality and high temporal resolution.

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Medios de Contraste , Neoplasias de Cabeza y Cuello , Imagen por Resonancia Magnética , Humanos , Imagen por Resonancia Magnética/métodos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Adulto , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Cuello/diagnóstico por imagen , Aumento de la Imagen/métodos , Anciano de 80 o más Años , Cabeza/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Reproducibilidad de los Resultados , Adulto Joven , Compresión de Datos/métodos , Algoritmos

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OBJECTIVE: To compare the diagnostic accuracy of Contrast Enhanced Computed Tomography (CECT) compared to conventional imaging modalities and histopathological investigation in cervical lymph node metastasis in adults through a novel meta- analysis. METHOD: The review protocol is registered under PROSPERO(CRD42021225704) and performed in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis - Diagnostic Test Accuracy (PRISMA- DTA) checklist. Databases like PubMed, Google Scholar, EBSCOhost were searched from 2000 to 2023 to identify the diagnostic potential of CECT in cervical lymph node metastasis of oral carcinoma. True-positive, false-positive, true-negative, false-negative, sensitivity, specificity values were extracted or calculated if not present for each study. Quality of selected studies was evaluated based on Quality assessment of diagnostic accuracy studies (QUADAS)- 2 tool. Meta-analysis was performed in Meta-Disc 1.4 software and Review Manager 5.3 using a bivariate model parameter for the pooled sensitivity and pooled specificity. Additional analysis was performed in terms of positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) and summary receiver operating characteristics (SROC) with Area Under Curve (AUC) and p<0.05 as statistically significant. RESULTS: Six studies were included for qualitative synthesis and as well as for meta-analysis. Two studies had high risk of bias while four studies had low risk of bias. 651 patients underwent CECT and were taken for meta-analysis. The meta-analysis revealed that CECT for diagnosing cervical lymph node metastasis had a pooled sensitivity of 71%, pooled specificity of 14% with 60% Area Under Curve (AUC). +LR of 0.84, -LR of 1.36 and DOR of 0.59. CONCLUSION: CECT has an overall fair diagnostic ability and is a valid and reliable tool in diagnosing the target condition overcoming high reliance on master specialized capacity for their execution and understanding like other conventional imaging techniques. CECT can be concluded for secondary level of prevention for cervical node metastasis of oral carcinoma under early diagnosis and prompt treatment. However, further standardized accuracy studies are indicated to improve the overall diagnostic accuracy of CECT.

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Medios de Contraste , Ganglios Linfáticos , Metástasis Linfática , Neoplasias de la Boca , Tomografía Computarizada por Rayos X , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Neoplasias de la Boca/patología , Neoplasias de la Boca/diagnóstico por imagen , Cuello/diagnóstico por imagen , Cuello/patología , Pronóstico , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodos

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Cuello , Humanos , Femenino , Cuello/diagnóstico por imagen , Cuello/patología , Tomografía Computarizada por Rayos X , Ultrasonografía , Persona de Mediana Edad

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PURPOSE: To summarize the ultrasonographic features of head and neck Castleman disease (CD), and to clarify its diagnostic key points. METHODS: Seven patients with head and neck CD confirmed by histopathology were collected from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The clinical features and ultrasound findings of the patients were evaluated. RESULTS: Of the 7 patients (1 male and 6 females), the mean age at diagnosis was 31.4 years (7-60 years). All the cases were hyaline vascular type. On ultrasound, 3 lesions (42.9%) were located in the parotid gland, 4 lesions(57.1%) in the neck. All the lesions presented as a solitary, well-defined and solid mass without calcification. The echogenicity was markedly hypoechoic in 1 case(14.3%) and hypoechoic in 6 cases (85.7%). Of the 7 CD cases, 4 cases (57.1%) were heterogeneous masses with linear echogenic septa. All lesions had mixed pattern in vascularity on color Doppler sonography. CONCLUSIONS: Most CDs in the head and neck represent as a markedly hypoechoic or hypoechoic lesion with mixed pattern in vascularity. The neoplasm may be characterized by the presence of linear echogenic septa within the mass.

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Enfermedad de Castleman , Cuello , Ultrasonografía , Humanos , Enfermedad de Castleman/diagnóstico por imagen , Enfermedad de Castleman/patología , Masculino , Cuello/diagnóstico por imagen , Adulto , Femenino , Ultrasonografía/métodos , Persona de Mediana Edad , Cabeza/diagnóstico por imagen , Niño , Adolescente , Ultrasonografía Doppler en Color/métodos , Adulto Joven , Glándula Parótida/diagnóstico por imagen , Glándula Parótida/patología

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This study aimed to investigate the relationship between cervical measurements and difficult airways using ultrasonographic measurements. American Society of Anesthesiologists grade I to III, male or female, 120 adult patients, undergoing elective surgery were enrolled in the study. The study involved measuring the distance of the trachea, cricoid cartilage, thyroid cartilage, vocal cord anterior commissure, and hyoid bone to the skin using a 10 to 13 MHz linear ultrasound probe in the transverse plane. Additionally, the length of the cricothyroid and thyrohyoid membranes, along with their distance from the skin, were measured using the probe in the sagittal plane. Subsequently, another experienced anesthesiologist conducted mask ventilation and intubation after the patient's induction of general anesthesia. Throughout this process, the patient was assessed for difficulties in mask ventilation, laryngoscopy, and intubation. 28 (23.3%) patients had a difficult airway. Analyzing the measurements associated with difficult airways, the most reliable predictor was the epiglottis midline-skin distance [AUC (area under the curve): 0.847, P < .001, cutoff: >19.9, sensitivity: 78.6%, specificity: 79.4%]. Additionally, other factors such as hyoid bone to skin distance, thyroid cartilage to skin distance, thyrohyoid membrane to skin distance, and vocal cord anterior commissure-skin distance were also identified as predictors for a difficult airway. The increase in the distance of the epiglottis midline, vocal cord anterior commissure, hyoid bone, thyrohyoid membrane, and thyroid cartilage to the skin at the level of the isthmus measured by ultrasonography is predictive of difficult airways. Based on our study outcomes, we assert that ultrasonographic evaluation can be used in the prediction of difficult airways.

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Cuello , Ultrasonografía , Humanos , Masculino , Femenino , Estudios Prospectivos , Ultrasonografía/métodos , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Cuello/anatomía & histología , Adulto , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/anatomía & histología , Intubación Intratraqueal/métodos , Hueso Hioides/diagnóstico por imagen , Manejo de la Vía Aérea/métodos , Laringoscopía/métodos , Anciano , Cartílago Cricoides/diagnóstico por imagen , Cartílago Cricoides/anatomía & histología , Tráquea/diagnóstico por imagen , Tráquea/anatomía & histología , Pliegues Vocales/diagnóstico por imagen

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Photon-counting detectors (PCDs) represent a major milestone in the evolution of CT imaging. CT scanners using PCD systems have already been shown to generate images with substantially greater spatial resolution, superior iodine contrast-to-noise ratio, and reduced artifact compared with conventional energy-integrating detector-based systems. These benefits can be achieved with considerably decreased radiation dose. Recent studies have focused on the advantages of PCD-CT scanners in numerous anatomic regions, particularly the coronary and cerebral vasculature, pulmonary structures, and musculoskeletal imaging. However, PCD-CT imaging is also anticipated to be a major advantage for head and neck imaging. In this paper, we review current clinical applications of PCD-CT in head and neck imaging, with a focus on the temporal bone, facial bones, and paranasal sinuses; minor arterial vasculature; and the spectral capabilities of PCD systems.

Asunto(s)

Fotones , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/instrumentación , Cuello/diagnóstico por imagen , Cabeza/diagnóstico por imagen , Cabeza/irrigación sanguínea , Predicción

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BACKGROUND: Neck computed tomography (NCT) is essential for diagnosing suspected neck tumors and abscesses, but radiation exposure can be an issue. In conventional reconstruction techniques, limiting radiation dose comes at the cost of diminished diagnostic accuracy. Therefore, this study aimed to evaluate the effects of an AI-based denoising post-processing software solution in low-dose neck computer tomography. MATERIALS AND METHODS: From 01 September 2023 to 01 December 2023, we retrospectively included patients with clinically suspected neck tumors from the same single-source scanner. The scans were reconstructed using Advanced Modeled Iterative Reconstruction (Original) at 100% and simulated 50% and 25% radiation doses. Each dataset was post-processed using a novel denoising software solution (Denoising). Three radiologists with varying experience levels subjectively rated image quality, diagnostic confidence, sharpness, and contrast for all pairwise combinations of radiation dose and reconstruction mode in a randomized, blinded forced-choice setup. Objective image quality was assessed using ROI measurements of mean CT numbers, noise, and a contrast-to-noise ratio (CNR). An adequately corrected mixed-effects analysis was used to compare objective and subjective image quality. RESULTS: At each radiation dose level, pairwise comparisons showed significantly lower image noise and higher CNR for Denoising than for Original (p < 0.001). In subjective analysis, image quality, diagnostic confidence, sharpness, and contrast were significantly higher for Denoising than for Original at 100 and 50 % (p < 0.001). However, there were no significant differences in the subjective ratings between Original 100 % and Denoising 25 % (p = 0.906). CONCLUSIONS: The investigated denoising algorithm enables diagnostic-quality neck CT images with radiation doses reduced to 25% of conventional levels, significantly minimizing patient exposure.

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Aprendizaje Profundo , Neoplasias de Cabeza y Cuello , Exposición a la Radiación , Interpretación de Imagen Radiográfica Asistida por Computador , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/métodos , Masculino , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Estudios Retrospectivos , Exposición a la Radiación/prevención & control , Exposición a la Radiación/análisis , Persona de Mediana Edad , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Dosis de Radiación , Anciano , Adulto , Relación Señal-Ruido , Cuello/diagnóstico por imagen

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PURPOSE: To determine the optimal virtual monochromatic images (VMIs) from dual-layer spectral detector computed tomography for the visualization and diagnosis of metastatic lateral cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). METHODS: Ninety-five lateral cervical LNs (49 metastatic and 46 non-metastatic) derived from 24 patients (16 females; mean age, 40.0 ± 13.4 years) were included. 40-100 kiloelectron voltage (keV) VMIs, 120 keV VMI and conventional 120 kV peak (kVp) polyenergetic image (PI) were reconstructed. Five-point scale of subjective image quality, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of LNs were assessed and compared among each VMI and 120 kVp PI. Receiver operating characteristic (ROC) curves and Delong tests were used to assess and compare the diagnostic efficacy of arterial enhancement fraction (AEF) based on each VMI and 120 kVp PI. RESULTS: 40 keV VMI showed significantly higher SNR and CNR in both arterial and venous phases, and better image quality in arterial phase than 70-100 keV VMIs, 120 keV VMI, and 120 kVp PI (all p < 0.05). In all sets of images, AEF values of metastatic LNs were significantly higher than those of non-metastatic LNs (all p < 0.05). When using AEF value of 40 keV VMI to diagnose metastatic lateral cervical LNs, an area under ROC curve (AUC) of 0.878, sensitivity of 87.8 % and specificity of 80.4 % could be obtained, while the AUC of AEF value of 120 kVp PI was 0.815 (p = 0.154). CONCLUSION: 40 keV VMI might be optimal for displaying and diagnosing the metastatic lateral cervical LNs in patients with PTC.

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Metástasis Linfática , Cuello , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Adulto , Metástasis Linfática/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/secundario , Cáncer Papilar Tiroideo/patología , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Cuello/diagnóstico por imagen , Sensibilidad y Especificidad , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/patología , Anciano , Reproducibilidad de los Resultados , Medios de Contraste , Relación Señal-Ruido , Interpretación de Imagen Radiográfica Asistida por Computador/métodos

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BACKGROUNDS: Manifestation of cystic hygroma in adulthood is very rare. The rarity of cystic hygroma in adults has caused problems in its diagnosis and management and few studies have reported cystic hygroma in adults. CASE PRESENTATION: In this study, we reported a rare case with cervical cystic hygroma in adults. We report a 20-year-old Iranian male (Iranian ethnicity) with a diagnosis of right-side neck cystic hygroma and discuss the presentation, diagnosis, and clinical, radiological, and operative aspects of it. CONCLUSION: Cystic hygromas are a rare occurrence in adults. They are typically asymptomatic, rarely complicated, and can be mistaken for a cystic neck mass. This study showed that in our case, surgical resection may be a safe and effective treatment for cystic hygroma, with minimal risk of complications during the procedure.

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Linfangioma Quístico , Humanos , Linfangioma Quístico/cirugía , Linfangioma Quístico/diagnóstico , Linfangioma Quístico/diagnóstico por imagen , Masculino , Adulto Joven , Neoplasias de Cabeza y Cuello/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Cuello/diagnóstico por imagen , Cuello/cirugía , Cuello/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

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The objective was to assess the diagnostic efficacy of Doppler ultrasound in detecting cervical lymph nodes in patients diagnosed with laryngeal and hypopharyngeal cancers. Patients undergoing surgery for laryngeal and hypopharyngeal cancers in the Otolaryngology Department from January 2021 to January 2023 were included. Two groups, with equal numbers, underwent ultrasound examination and intensive CT examination in the experimental and control groups, respectively, along with routine cervical lymph node dissection. A resident with over 6 years of clinical experience in the otolaryngology department performed routine bilateral cervical lymph node palpation. Sensitivity, specificity, and validity were compared among different examination methods. The McNemar test assessed specificity and sensitivity between palpation, color Doppler ultrasonography, and enhanced CT, while the Kappa concordance test evaluated the concordance between the 2 examination methods. Data were statistically analyzed using SPSS 23.0. Palpation showed a diagnostic sensitivity (DS) of 52.83% and specificity of 91.11% for all patients with cervical lymph node metastasis. Ultrasonography demonstrated a DS of 77.78% and specificity of 81.82% in patients with cervical lymph node metastasis, while intensive CT had a DS of 75.86% and specificity of 60.00%. Statistical significance (P < .05) was observed in the sensitivity between palpation and ultrasonography, and between palpation and enhanced CT. The specificity between enhanced CT and ultrasonography (P = .021) and between palpation and enhanced CT scan (P = .003) both showed statistical significance (P < .05). Doppler ultrasound yields diagnostic results highly consistent with pathological diagnoses in patients with laryngeal and hypopharyngeal cancers. Utilizing Doppler ultrasound can enhance the accuracy of diagnosing these cancers, aiding physicians in devising more suitable treatment plans for patients.

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Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Ganglios Linfáticos , Metástasis Linfática , Cuello , Sensibilidad y Especificidad , Humanos , Neoplasias Hipofaríngeas/diagnóstico por imagen , Neoplasias Hipofaríngeas/patología , Masculino , Femenino , Persona de Mediana Edad , Metástasis Linfática/diagnóstico por imagen , Neoplasias Laríngeas/diagnóstico por imagen , Neoplasias Laríngeas/patología , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Cuello/diagnóstico por imagen , Anciano , Ultrasonografía Doppler/métodos , Ultrasonografía Doppler en Color/métodos , Palpación , Adulto , Tomografía Computarizada por Rayos X/métodos

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BACKGROUND: Consumer products such as electrical shavers exert a combination of dynamic loading in the form of pressure and shear on the skin. This mechanical stimulus can lead to discomfort and skin tissue responses characterised as "Skin Sensitivity". To minimise discomfort following shaving, there is a need to establish specific stimulus-response relationships using advanced tools such as optical coherence tomography (OCT). OBJECTIVE: To explore the spatial and temporal changes in skin morphology and microvascular function following an electrical shaving stimulus. METHODS: Ten healthy male volunteers were recruited. The study included a 60-s electrical shaving stimulus on the forearm, cheek and neck. Skin parameters were recorded at baseline, 20 min post stimulus and 24 h post stimulus. Structural and dynamic skin parameters were estimated using OCT, while transepidermal water loss (TEWL) was recorded to provide reference values for skin barrier function. RESULTS: At baseline, six of the eight parameters revealed statistically significant differences between the forearm and the facial sites, while only surface roughness (Rq) and reflectivity were statistically different (p < 0.05) between the cheek and neck. At 20 min post shaving, there was a significant increase in the TEWL values accompanied by increased blood perfusion, with varying magnitude of change dependent on the anatomical site. Recovery characteristics were observed 24 h post stimulus with most parameters returning to basal values, highlighting the transient influence of the stimulus. CONCLUSIONS: OCT parameters revealed spatial and temporal differences in the skin tissue response to electrical shaving. This approach could inform shaver design and prevent skin sensitivity.

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Piel , Tomografía de Coherencia Óptica , Humanos , Masculino , Tomografía de Coherencia Óptica/métodos , Adulto , Piel/irrigación sanguínea , Piel/diagnóstico por imagen , Antebrazo/irrigación sanguínea , Adulto Joven , Microvasos/diagnóstico por imagen , Microvasos/fisiología , Mejilla/irrigación sanguínea , Mejilla/diagnóstico por imagen , Pérdida Insensible de Agua/fisiología , Voluntarios Sanos , Fenómenos Fisiológicos de la Piel , Estimulación Eléctrica , Cuello/diagnóstico por imagen , Cuello/irrigación sanguínea , Microcirculación/fisiología

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Identification of vascular injuries is crucial for complete postmortem evaluation and understanding of trauma deaths by the Medical Examiner. Some vascular injuries are difficult to evaluate due to challenging anatomic locations, especially in the head and neck. Documenting injuries of the facial and vertebral arteries is challenging and necessitates time-consuming dissections that can create artifacts and disfigurement. In busy medical examiner offices with a significant number of traumatic injuries, finding a creative solution to employ reliable postmortem angiography is desirable. At the Office of the Chief Medical Examiner for the State of Maryland (OCME), we created and effectively implemented a selective angiography procedure using traditional indwelling Foley catheters and water-soluble barium swallow contrast to evaluate arterial injuries using either digital radiography or computed tomography imaging modalities. This technique and imaging interpretation can be performed by a medical examiner or forensic pathology fellow after basic technical training and basic radiology training. This study outlines the technique, methods, and utilization of the procedure and describes the findings of six deaths due to vascular lesions from different injury mechanisms and disease processes and describes the ease of implementation on a broader scale in busy Medical Examiner's offices.

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Medios de Contraste , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Angiografía/métodos , Lesiones del Sistema Vascular/diagnóstico por imagen , Cuello/diagnóstico por imagen , Cabeza/diagnóstico por imagen , Cabeza/irrigación sanguínea , Médicos Forenses , Tomografía Computarizada por Rayos X , Angiografía por Tomografía Computarizada , Patologia Forense/métodos , Anciano

RESUMEN

BACKGROUND: Ultrasonographic imaging has been recently become simple portable and non-invasive adjuvant for bedside assessment of anterior neck soft tissue thickness which when measured at different levels showed to have significant role in predicting difficult laryngoscopy. AIMS AND OBJECTIVES: Primary objective was Ultrasonographic measurement of anterior neck soft tissue thickness at 3 levels -Distance from skin to hyoid bone (DSHB) -Distance from skin to thyrohyoid membrane (DSTM) -Distance from skin to anterior commissure of vocal cord(DSAC) and to compare and correlate the findings with Cooks modification of Cormack-Lehane score in predicting difficult laryngoscopy. Secondary objective was to compare and correlate the ultrasonographic measurements with conventional airway assessment methods. MATERIALS AND METHODS: After obtaining approval from the ethical committee, 90 Patients with BMI above 25 kg /m2 was enrolled for the study. A day before the surgery a thorough Preanaesthetic evaluation and assessment of the airway is done using conventional methods. Then on the day of surgery ultrasonographic measurement of anterior neck at 3 levels was done and after inducing the patients laryngoscopy was done and Cooks modification of Cormack-Lehane score assessed. RESULTS: The optimal cut off values to predict difficult laryngoscopy was 1.26, 2 and 1.2 cms for DSHB, DSTM and DSAC respectively, and among the three skin to anterior commissure of vocal cord was observed to be best USG parameter with more area under the ROC curve. CONCLUSION: USG measurement of anterior neck soft tissue thickness can be useful in predicting difficult laryngoscopy in overweight and obese patients also it had more diagnostic accuracy than conventional methods like MMS in predicting difficult laryngoscopy.

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RésuméArrière-plan L'imagerie échographique est récemment devenue un simple adjuvant portable et non invasif pour l'évaluation au lit du patient de l'épaisseur des tissus mous du cou antérieur qui, lorsqu'elle est mesurée à différents niveaux, s'est avérée avoir un rôle important dans la prédiction d'une laryngoscopie difficile. Buts et objectifs L'objectif principal était la mesure échographique de l'épaisseur des tissus mous du cou antérieur à 3 niveaux -Distance de la peau à l'os hyoïde (DSHB) -Distance de la peau à la membrane thyrohyoïdienne (DSTM) -Distance de la peau à la commissure antérieure de la corde vocale (DSAC) et pour comparer et corréler les résultats avec la modification de Cooks du score de Cormack-Lehane pour prédire une laryngoscopie difficile. L'objectif secondaire était de comparer et de corréler les mesures échographiques avec les méthodes conventionnelles d'évaluation des voies respiratoires Matériels et méthodes Après avoir obtenu l'approbation du comité d'éthique, 90 patients présentant un IMC supérieur à 25 kg/m2 ont été inclus dans l'étude. Un jour avant la chirurgie, une évaluation préanesthésique approfondie et une évaluation des voies respiratoires sont effectuées à l'aide de méthodes conventionnelles. Ensuite, le jour de la chirurgie, une mesure échographique de la partie antérieure du cou à 3 niveaux a été effectuée et après l'induction des patients, une laryngoscopie a été effectuée et la modification de Cooks du score de Cormack-Lehane a été évaluée. Résultats Les valeurs seuil optimales pour prédire une laryngoscopie difficile étaient respectivement de 1,26, 2 et 1,2 cm pour DSHB, DSTM et DSAC, et parmi les trois paramètres de la peau à la commissure antérieure de la corde vocale, il a été observé que le meilleur paramètre USG avec plus de surface sous la courbe ROC Conclusion La mesure par USG de l'épaisseur des tissus mous du cou antérieur peut être utile pour prédire une laryngoscopie difficile chez les patients en surpoids et obèses. Elle a également une plus grande précision diagnostique que les méthodes conventionnelles comme le MMS pour prédire une laryngoscopie difficile.

Asunto(s)

Intubación Intratraqueal , Laringoscopía , Cuello , Sobrepeso , Ultrasonografía , Humanos , Masculino , Femenino , Ultrasonografía/métodos , Cuello/diagnóstico por imagen , Cuello/anatomía & histología , Laringoscopía/métodos , Adulto , Persona de Mediana Edad , Intubación Intratraqueal/métodos , Sobrepeso/diagnóstico por imagen , Anestesia General , Índice de Masa Corporal , Valor Predictivo de las Pruebas , Hueso Hioides/diagnóstico por imagen , Hueso Hioides/anatomía & histología

RESUMEN

ARID1B-related disorders constitute a clinical continuum, from classic Coffin-Siris syndrome to intellectual disability (ID) with or without nonspecific dysmorphic features. Here, we describe an 11-year-old boy with an ARID1B mutation whose phenotype changed from severe developmental delay and ID to a complex neurodevelopmental disorder with multidimensional impairments, including normal intelligence despite heterogeneous IQ scores, severe motor coordination disorder, oral language disorder and attention-deficit/hyperactivity disorder. Phenotypic changes occurred after early intensive remediation and paralleled the normalization of myelination impairments, as evidenced by early brain imaging. WHAT THIS PAPER ADDS?: This report describes a 10-year multidisciplinary follow-up of a child with an ARID1B mutation who received early intensive remediation and whose phenotype changed during development. Clinical improvement paralleled the normalization of myelination impairments. This case supports a dimensional approach for complex neurodevelopmental disorders.

Asunto(s)

Proteínas de Unión al ADN , Discapacidad Intelectual , Micrognatismo , Fenotipo , Factores de Transcripción , Humanos , Masculino , Niño , Discapacidad Intelectual/genética , Factores de Transcripción/genética , Proteínas de Unión al ADN/genética , Micrognatismo/genética , Micrognatismo/diagnóstico por imagen , Estudios de Seguimiento , Cara/anomalías , Cara/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Encéfalo/anomalías , Deformidades Congénitas de la Mano/genética , Deformidades Congénitas de la Mano/diagnóstico por imagen , Cuello/anomalías , Cuello/diagnóstico por imagen , Trastorno por Déficit de Atención con Hiperactividad/genética , Imagen por Resonancia Magnética , Trastornos del Neurodesarrollo/genética , Anomalías Múltiples/genética , Anomalías Múltiples/diagnóstico por imagen , Discapacidades del Desarrollo/genética , Trastornos de la Destreza Motora/genética , Mutación , Deformidades Congénitas del Pie/genética , Deformidades Congénitas del Pie/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/genética

RESUMEN

OBJECTIVES: Ultrasound (US)-guided procedures can be used in the evaluation and treatment of neck masses. However, these procedures need to be practiced before being executed on humans. The aim of this study is to evaluate the efficacy of a training program using a gelatin phantom to practice US-guided procedures. METHODS: This program included a lecture and practice with a gelatin phantom. We recruited doctors from different hospitals to practice US-guided procedures, including fine-needle aspiration (FNA), core needle biopsy (CNB), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA). We used a questionnaire with a 5-point scale to evaluate the effectiveness of practicing US-guided procedures under a gelatin phantom. RESULTS: Forty-four doctors participated, and 37 of them completed the questionnaires. After training, the mean (SD) scores of the doctors were 4.68 (0.47) for "Satisfaction with this course," 4.54 (0.61) for "Ease in practicing FNA&CNB using the phantom," 4.49 (0.61) for "Ease in practicing PEI using the phantom," 4.49 (0.65) for "Ease in practicing RFA using the phantom," and 4.57 (0.55) for "The course effectively familiarizing participants with US-guided procedures." Participants without experience in US examination had higher scores than those with previous US experience, but the difference was not statistically significant. CONCLUSION: A combination of lectures and hands-on practice of US-guided procedures using a gelatin phantom is an effective educational method for doctors interested in head and neck US. After the training program, doctors gained a better understanding of the necessary steps and skills required for these procedures. They can correctly insert the instruments into the target lesion and perform different US-guided procedures.

Asunto(s)

Gelatina , Fantasmas de Imagen , Ultrasonografía Intervencional , Humanos , Ultrasonografía Intervencional/métodos , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Biopsia con Aguja Fina/métodos , Ablación por Radiofrecuencia/métodos , Competencia Clínica , Entrenamiento Simulado/métodos , Cuello/diagnóstico por imagen , Etanol/administración & dosificación , Encuestas y Cuestionarios

RESUMEN

BACKGROUND: There is growing interest in the association of CT-assessed sarcopenia with adverse outcomes in non-oncological settings. PURPOSE: The aim of this systematic review is to summarize existing literature on the prognostic implications of CT-assessed sarcopenia in non-oncological patients. MATERIALS AND METHODS: Three independent authors searched Medline/PubMed, Embase and Cochrane Library up to 30 December 2023 for observational studies that reported the presence of sarcopenia defined on CT head and neck in association with mortality estimates and other adverse outcomes, in non-oncological patients. The quality of included studies were assessed using the Quality of Prognostic Studies tool. RESULTS: Overall, 15 studies (3829 participants) were included. Nine studies were at low risk of bias, and six were at moderate risk of bias. Patient populations included those admitted for trauma or treatment of intracranial aneurysms, ischemic stroke, transient ischemic attack, and intracranial stenosis. Sarcopenia was associated with increased 30-day to 2-year mortality in inpatients and patients undergoing carotid endarterectomy or mechanical thrombectomy for acute ischemic stroke. Sarcopenia was also associated with poorer neurological and functional outcomes, increased likelihood of admission to long-term care facilities, and longer duration of hospital stays. The observed associations of sarcopenia with adverse outcomes remained similar across different imaging modalities and methods for quantifying sarcopenia. CONCLUSION: CT-assessed sarcopenia was associated with increased mortality and poorer outcomes across diverse patient populations. Measurement and early identification of sarcopenia in vulnerable patients allows for enhanced prognostication, and focused allocation of resources to mitigate adverse outcomes.

Asunto(s)

Sarcopenia , Tomografía Computarizada por Rayos X , Humanos , Sarcopenia/diagnóstico por imagen , Sarcopenia/mortalidad , Sarcopenia/complicaciones , Pronóstico , Cabeza/diagnóstico por imagen , Cuello/diagnóstico por imagen