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Sonographic Anatomy of the Head & Neck, How & Why
S174
Ultrasound in Medicine and Biology
T13. Otolaryngology & Head Neck Pre-Congress Workshop/Symposium
T13-13-IN01 Sonographic Anatomy of the Head & Neck, How & Why W. K. Tang, E. Dai, A. T. Ahuja Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China Sonographic examination of the neck consists of a series of sweeps, predominantly with the transducer held transversely. The examination may be altered depending on the patient’s clinical presentation. A complete examination includes evaluation of both sides of the neck beginning in the submental region, through the submandibular, parotid regions, along the carotid & internal jugular veins (including vagus nerve), down to medial head of clavicle & then transversely across the supraclavicular fossa & then the posterior triangle (including brachial plexus). The examination is finally completed by evaluating thyroid, trachea, esophagus, paratracheal areas & the tracheo-esophageal grooves. This comprehensive examination requires knowledge of sonographic anatomy, meticulous attention to detail, a high resolution transducer & ensures no obvious abnormalities are missed. Familiarization of anatomy of the neck is essential because lesions in the head & neck are site specific. Their embryologic origin & location are the first clue towards it’s diagnosis/narrow differential diagnosis (eg, dermoid/epidermoid, thyroglossal duct cysts, branchial apparatus abnormalities, vagus & brachial plexus schwannomas & carotid body paraganglioma). To their anatomical location, the addition of sonographic/imaging appearances often provides an accurate final diagnosis & obviates the need for pre-treatment biopsy in many cases. This presentation will discuss the sonographic technique, anatomy of the neck & the identifying abnormalities predominantly based on their anatomical location. T13-13-IN02 Neck lesions- FNA / Core Biopsy -Tips and Tricks Dr. Asif Momin, MD Prince Aly Khan Hospital, India With the expanded use of ultrasound guidance in neck lesions the demand for obtaining adequate, representative samples both in FNAC and core biopsies has become pivotal in diagnosis and management of various overlapping pathologies. There is specific need for obtaining samples for detection of primary neoplasm, metastatic spread, bacteriological studies in infected lesions and many confusing cases of post treatment neck. Specific tricks regarding aspiration of complex nodules with both cystic and solid components like thyroid lesions. Avoidance of many neurovascular structures during core biopsies by choosing correct needle path and notch sizes, correct patient position, small footprint probes, using colour as contrast and sometimes saline dissection are important. Patient safety, adequate anaesthesia and careful slide preparation using correct transport media are valuable points for successful outcome. Specific techniques to obtain adequate samples from orbital lesions, salivary glands neck nodes oesophageal lesions, superior mediastinal lesions extending in suprasternal region as well as routine thyroid/ parathyroid and nodal masses need to be planned. Specific cases like laryngeal lesions, prevertebral regions and tonsillar lesions need special attention. Rare complications and ways to avoid them should be kept in mind while using aseptic technique under universal precautions.
Volume 43, Number S1, 2017
T13-13-IN03 Ultrasound Based Korean Thyroid Imaging Reporting and Data System (K-TIRADS) Byungjoo Lee Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University, Korea Recently, thyroid nodules increased a lot in the world. This increase maybe is due to an increase in the frequency of ultrasonography in asymptomatic patients, although there are some debates. The rate of malignancy of thyroid nodule detected ultrasonography is reported to be 8-12%. These rate is similar with the malignant rate of thyroid nodules found by palpation. Ultrasonography is very important basic tools for thyroid nodules. There are several roles of ultrasound in the evaluation of thyroid nodule. First, ultrasonography can easily detect thyroid nodules in asymptomatic patients. Second, the possibility of cancer of thyroid nodules found by ultrasonography can be assessed. Third, ultrasonography can be used to select thyroid nodules to perform FNA and to help determine the portion of the thyroid nodules to undergo FNA. Assessment of the location and size of thyroid cancer by ultrasonography will help determine the surgical method and extent of surgery in thyroid cancer. Ultrasonic evaluation of thyroid nodules used various parameters. Ultrasonography can assess the size of the thyroid nodule and helps to predict the malignancy and benignity of the diagnosed thyroid nodule using various sonographic findings, such as, internal content, echogenicity, shape, orientation, margin, calcification, halo sign, spongiform sign, vascularity. The risk stratification system was proposed to the Korean Radiological Society to evaluate the risk of cancer of the thyroid nodules based on internal content and echogenicity. I will present the Korean Thyroid Ultrasound based Thyroid Imaging Reporting and Data System (K-TIRADS). T13-13-IN04 ARFI Elastography (ARFI Imaging) for Diagnosing Cervical Lymph Node Metastasis from Head and Neck Squamous Cell Carcinoma Takahiro Fukuhara, MD, PhD Tottori University Faculty of Medicine Elastography is the novel tool for assessing a new characteristic of target tissues, i.e., elasticity. This tool has not been applied in the head and neck region. Conventional elastography using manual compression provides the degree of relative strain with color mapping. As color mapping changes continuously depending on variations in pressure, an examiner subjectively fixes the image, and thus images from conventional elastography are not reproducible. On the other contrary, elastography using acoustic radiation force impulse (ARFI) evaluates the tissue displacement generated by an acoustic push pulse. It can objectively assess the local elastic characteristics of target tissues using a gray scale image. ARFI elastography produces one image for each acoustic push pulse, and it is expected to exhibit high intra- and inter-examiner reliability. ARFI elastography may be particularly useful in the head and neck, where target tissues are superficial, because acoustic push pulses are less likely to be attenuated. I will present the utility of ARFI imaging for diagnosing metastasis lymph nodes associated with head and neck squamous cell carcinoma. T13-15-IN05 Ultrasound of Neck Masses in Pediatrics Panruethai Trinavarat Radiology, Chulalongkorn University, Bangkok, Thailand US plays an important role in the evaluation of palpable neck masses in pediatric patients. The superficially located structures are easily examined
Ultrasound in Medicine and Biology
T13. Otolaryngology & Head Neck Pre-Congress Workshop/Symposium
T13-13-IN01 Sonographic Anatomy of the Head & Neck, How & Why W. K. Tang, E. Dai, A. T. Ahuja Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China Sonographic examination of the neck consists of a series of sweeps, predominantly with the transducer held transversely. The examination may be altered depending on the patient’s clinical presentation. A complete examination includes evaluation of both sides of the neck beginning in the submental region, through the submandibular, parotid regions, along the carotid & internal jugular veins (including vagus nerve), down to medial head of clavicle & then transversely across the supraclavicular fossa & then the posterior triangle (including brachial plexus). The examination is finally completed by evaluating thyroid, trachea, esophagus, paratracheal areas & the tracheo-esophageal grooves. This comprehensive examination requires knowledge of sonographic anatomy, meticulous attention to detail, a high resolution transducer & ensures no obvious abnormalities are missed. Familiarization of anatomy of the neck is essential because lesions in the head & neck are site specific. Their embryologic origin & location are the first clue towards it’s diagnosis/narrow differential diagnosis (eg, dermoid/epidermoid, thyroglossal duct cysts, branchial apparatus abnormalities, vagus & brachial plexus schwannomas & carotid body paraganglioma). To their anatomical location, the addition of sonographic/imaging appearances often provides an accurate final diagnosis & obviates the need for pre-treatment biopsy in many cases. This presentation will discuss the sonographic technique, anatomy of the neck & the identifying abnormalities predominantly based on their anatomical location. T13-13-IN02 Neck lesions- FNA / Core Biopsy -Tips and Tricks Dr. Asif Momin, MD Prince Aly Khan Hospital, India With the expanded use of ultrasound guidance in neck lesions the demand for obtaining adequate, representative samples both in FNAC and core biopsies has become pivotal in diagnosis and management of various overlapping pathologies. There is specific need for obtaining samples for detection of primary neoplasm, metastatic spread, bacteriological studies in infected lesions and many confusing cases of post treatment neck. Specific tricks regarding aspiration of complex nodules with both cystic and solid components like thyroid lesions. Avoidance of many neurovascular structures during core biopsies by choosing correct needle path and notch sizes, correct patient position, small footprint probes, using colour as contrast and sometimes saline dissection are important. Patient safety, adequate anaesthesia and careful slide preparation using correct transport media are valuable points for successful outcome. Specific techniques to obtain adequate samples from orbital lesions, salivary glands neck nodes oesophageal lesions, superior mediastinal lesions extending in suprasternal region as well as routine thyroid/ parathyroid and nodal masses need to be planned. Specific cases like laryngeal lesions, prevertebral regions and tonsillar lesions need special attention. Rare complications and ways to avoid them should be kept in mind while using aseptic technique under universal precautions.
Volume 43, Number S1, 2017
T13-13-IN03 Ultrasound Based Korean Thyroid Imaging Reporting and Data System (K-TIRADS) Byungjoo Lee Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University, Korea Recently, thyroid nodules increased a lot in the world. This increase maybe is due to an increase in the frequency of ultrasonography in asymptomatic patients, although there are some debates. The rate of malignancy of thyroid nodule detected ultrasonography is reported to be 8-12%. These rate is similar with the malignant rate of thyroid nodules found by palpation. Ultrasonography is very important basic tools for thyroid nodules. There are several roles of ultrasound in the evaluation of thyroid nodule. First, ultrasonography can easily detect thyroid nodules in asymptomatic patients. Second, the possibility of cancer of thyroid nodules found by ultrasonography can be assessed. Third, ultrasonography can be used to select thyroid nodules to perform FNA and to help determine the portion of the thyroid nodules to undergo FNA. Assessment of the location and size of thyroid cancer by ultrasonography will help determine the surgical method and extent of surgery in thyroid cancer. Ultrasonic evaluation of thyroid nodules used various parameters. Ultrasonography can assess the size of the thyroid nodule and helps to predict the malignancy and benignity of the diagnosed thyroid nodule using various sonographic findings, such as, internal content, echogenicity, shape, orientation, margin, calcification, halo sign, spongiform sign, vascularity. The risk stratification system was proposed to the Korean Radiological Society to evaluate the risk of cancer of the thyroid nodules based on internal content and echogenicity. I will present the Korean Thyroid Ultrasound based Thyroid Imaging Reporting and Data System (K-TIRADS). T13-13-IN04 ARFI Elastography (ARFI Imaging) for Diagnosing Cervical Lymph Node Metastasis from Head and Neck Squamous Cell Carcinoma Takahiro Fukuhara, MD, PhD Tottori University Faculty of Medicine Elastography is the novel tool for assessing a new characteristic of target tissues, i.e., elasticity. This tool has not been applied in the head and neck region. Conventional elastography using manual compression provides the degree of relative strain with color mapping. As color mapping changes continuously depending on variations in pressure, an examiner subjectively fixes the image, and thus images from conventional elastography are not reproducible. On the other contrary, elastography using acoustic radiation force impulse (ARFI) evaluates the tissue displacement generated by an acoustic push pulse. It can objectively assess the local elastic characteristics of target tissues using a gray scale image. ARFI elastography produces one image for each acoustic push pulse, and it is expected to exhibit high intra- and inter-examiner reliability. ARFI elastography may be particularly useful in the head and neck, where target tissues are superficial, because acoustic push pulses are less likely to be attenuated. I will present the utility of ARFI imaging for diagnosing metastasis lymph nodes associated with head and neck squamous cell carcinoma. T13-15-IN05 Ultrasound of Neck Masses in Pediatrics Panruethai Trinavarat Radiology, Chulalongkorn University, Bangkok, Thailand US plays an important role in the evaluation of palpable neck masses in pediatric patients. The superficially located structures are easily examined