Carmen C.M. Cho

Shear wave elastography of focal salivary gland lesions: preliminary experience in a routine head and neck US clinic

Book synopsis: New Materialisms rethinks the relevance of materialist philosophy in the midst of a world shaped by forces such as digital and biotechnologies, global warming, global capital, and population flows. Moving away from modes of inquiry that have prioritized the study of consciousness and subjectivity over matter, the essays in this collection show that any account of experience, agency, and political action demands renewed attention to the urgent issues of our own material existence and our environment. The editors propose “new materialisms” as a way to take matter seriously without falling into the conceptual dualism that posits an opposition between matter and thought, materialism and idealism, and body and mind. They locate new materialisms within post-humanist discourses, explaining that new materialist philosophies do not privilege human bodies, but rather view human bodies as one of many bodies, or agential materialities, in the world. By revealing how emerging accounts of matter, materiality, and corporeality are combining with developments in science and technology to demand radically new conceptions of nature, agency, and social and political relationships, New Materialisms makes a significant contribution to the recent resurgence of interest in phenomenology and materialist philosophy in the humanities.

Shear wave elasticity imaging of cervical lymph nodes.

A pilot study of real-time shear wave ultrasound elastography (SWE) for cervical lymphadenopathy in routine clinical practice was conducted on 55 nodes undergoing conventional ultrasound (US) with US-guided needle aspiration for cytology. Elastic moduli of stiffest regions in nodes were measured on colour-coded elastograms, which were correlated with cytology. Malignant nodes (n = 31, 56.4%) were stiffer (median 25.0 kPa, range 6.9-278.9 kPa) than benign nodes (median 21.4 kPa, range 8.9-30.2 kPa) (p = 0.008, Mann Whitney U test). A cut-off of 30.2 kPa attained highest accuracy of 61.8%, corresponding to 41.9% sensitivity, 100% specificity and 0.77 area under the receiver operating characteristic curve. Qualitatively, elastograms of benign nodes were homogeneously soft; malignant nodes were homogeneously soft or markedly heterogeneous with some including regions lacking elasticity signal. SWE is feasible for neck nodes. It appears unsuitable for cancer screening but may detect a subset of malignant nodes. The cause of spatial heterogeneity of malignant nodes on SWE is yet to be established.

Real-Time Qualitative Ultrasound Elastography of Cervical Lymph Nodes in Routine Clinical Practice: Interobserver Agreement and Correlation with Malignancy

To evaluate real-time qualitative ultrasound (US) elastography for cervical lymphadenopathy in routine clinical practice, 74 nodes (37 malignant, 37 benign) in 74 patients undergoing sonography underwent US elastography prior to fine needle aspiration for cytology. Dynamic cine loops of elasticity imaging displayed using a chromatic-scale were qualitatively scored by three independent observers for the proportion of stiff areas from ES1-4 (soft to stiff). There was fair to good interobserver agreement as indicated by weighted kappa (κ) statistic from 0.374 to 0.738. Median ES for benign and malignant nodes were 2 and 3 respectively. ES was higher in malignant nodes (p = 0.0003-0.0049, Mann Whitney U tests) although areas under receiver operating characteristic curves (0.68-0.74) indicated suboptimal discrimination. The optimal discriminatory cut-off, ES > 2, achieved only 62.2% sensitivity, 83.8% specificity and 73% accuracy for malignancy. Improvements in reliability and accuracy of real-time qualitative ultrasound elastography are required for it to be adopted into routine clinical practice.

A pilot study evaluating real-time shear wave ultrasound elastography of miscellaneous non-nodal neck masses in a routine head and neck ultrasound clinic.

A pilot study was performed to evaluate shear wave ultrasound elastography (SWE) for miscellaneous non-nodal/salivary/thyroid neck lesions. Forty-six lesions undergoing conventional sonography also underwent SWE. Elastic moduli from the stiffest areas in lesions were correlated with diagnosis. Forty lesions were benign (9 lipomas, 8 lymphatic/venous vascular malformations, 7 thyroglossal duct cysts, 4 branchial cleft cysts, 4 abscesses/phlegmons, 3 neurogenic tumors and 1 each of paraganglioma, sebaceous cyst, pseudotumor, hypertrophic scar, ranula) and 6 were malignant (1 malignant fibrous histiocytoma, 2 primary squamous cell carcinomas and 3 intramuscular metastases [2 squamous cell carcinomas, 1 malignant melanoma]).Median stiffness of malignant lesions (226.4 kPa, range 55.6 to 300.0) was higher than benign lesions (28.3 kPa, range 4.0 to 300.0) (p < 0.001). SWE cut-off with highest accuracy (174.4 kPa) achieved 83.3% sensitivity and 97.5% specificity, and the cut-off with 100% sensitivity (55.6 kPa) achieved 75% specificity. All malignant lesions were suspected on conventional sonography. The preliminary data indicate that SWE is feasible for miscellaneous neck lesions. SWE would not have altered management in terms of detecting undisclosed malignancies, although as a quantitative technique, it may increase the diagnostic confidence of less experienced operators performing head and neck ultrasound.

Case-Control Study of Intra-arterial Verapamil for Intraprostatic Anastomoses to Extraprostatic Arteries in Prostatic Artery Embolization for Benign Prostatic Hypertrophy.

PURPOSE It is hypothesized that intra-arterial administration of verapamil is a safe and effective way to reverse the flow in intraprostatic anastomoses to extraprostatic arteries without compromising treatment outcomes in prostatic artery embolization (PAE) for benign prostatic hypertrophy (BPH). MATERIALS AND METHODS A prospective study of 62 prostate sides in 31 consecutive patients (median age, 66 y; range, 60-71 y) with symptomatic BPH was undertaken. Median prostate volume was 72.4 mL (range, 48.8-85.8 mL), median International Prostate Symptom Score was 21 (range, 15-23), and median urine peak flow rate was 4 mL/s (range, 2-6 mL/s). The arterial anastomoses were classified as types I-III according to vascular morphology. Treatment safety was assessed in terms of adverse events and complications, and treatment effectiveness was assessed in terms of success rate of angiographic flow reversal. RESULTS The PAE procedure was successfully completed in all 31 patients (100%). Adverse events in both groups were transient and mild and did not necessitate prolonged hospitalization. There was no clinical evidence of any significant nontarget ischemic complication in either group. Intraprostatic anastomosis was diagnosed in 19 of 31 patients (61.3%) and 22 of 62 prostate sides (35.5%). Success rates of verapamil treatment were 88.9% overall (20 of 22) and 100% (19 of 19) in type II and III anastomoses. There was no difference between the treatment group and the control group in clinical, urologic, and imaging outcomes of PAE. CONCLUSIONS Intra-arterial verapamil treatment was probably safe and effective in causing flow reversal in type II and III intraprostatic anastomoses and in preventing ischemic complications in PAE for BPH without compromising PAE outcomes.

Ultrasound of the abdominal wall and groin.

High-resolution sonography is widely accepted as Sonographic Anatomy and Pathology of the Groin and the method of choice for screening and diagnosis of abdominal wall and groin pathology. It provides a detailed view of the abdominal wall muscular layers and of the inguinal canal and its content. The major advantages of sonography include wide availability, low cost, speed, and lack of radiation. This pictorial essay presents a comprehensive and illustrative review of the use of high-resolution sonography in abdominal wall and groin diseases.

A Pancreatic Mass With Multiple Hepatic Lesions

57-year-old man presented with jaundice, right Aupper-quadrant pain, and weight loss. Ultrasonography reviewed diffuse hypoechoic enlargement of the pancreas and hypoechoic lesions in the right lobe of the liver. Computed tomography showed focal heterogeneous enlargement of the pancreatic head, diffuse pancreatic swelling with hypodense capsule-like rim, and multiple hypoechoic-enhancing masses over bilateral liver lobes (Figure A). A clinical suspicion of pancreatic cancer with hepatic metastasis was raised. Endoscopic biopsy of pancreatic head mass found inflamed necrotic debris with ova of Clonorchis sinesis (Figure B). A targeted liver biopsy showed a fibroinflammatory process with plasma cell-rich chronic inflammatory infiltrate (Figure C), eosinophilic granulomas (Figure D), and increased IgG4-positive plasma cells (Figure E). Subsequent serology showed marked increases of serum IgG and IgG4 levels. A final diagnosis of hepatic inflammatory pseudotumors (IPTs) complicated by IgG4-related autoimmune pancreatitis and Clonorchis infestation was established. A course of praziquantel was prescribed for Clonorchis infestation, and various immunosuppressants were given for IgG4related disease. However, the resolution of pancreatic and liver lesions was slow and fluctuated. Complete resolution finally was achieved after 3.5 years of immunosuppression (Figure F). C sinesis is the most common human liver fluke in East Asia and a well-known risk factor of cholangiocarcinoma. It is uncertain whether Clonorchis infestation contributes to tissue eosinophilia and eosinophilic granuloma in the liver biopsy of our patient because IgG4-related disease may have numerous tissue eosinophils. IgG4-related disease is an increasingly recognized fibroinflammatory disease characterized by tumefactive lesions, storiform fibrosis, IgG4-positive plasma cell-rich lymphoplasmacytic infiltrate, and an often increased serum IgG4 level. It affects virtually every organ: pancreas, salivary glands, liver, kidneys, lungs, lymph nodes, meninges, aorta, breast, prostate,