Differentialdiagnostik sonographisch echoarmer Kopf-Halsläsionen

Zusammenfassung

Ziel Die Evaluation sonographisch echoarmer Läsionen (SEAL) der Kopf-Hals-Region zur Bestimmung der Entität und Planung der Operation.

Methoden Alle Patienten mit SEAL, die ein B-Bild-Ultraschall (US), eine farbkodierte Duplexsonographie (FKDS), einen kontrastverstärkten US (CEUS) und eine Kompressionselastographie (SE) erhalten haben und histologisch gesichert wurden, wurden eingeschlossen.

Ergebnisse 184 SEAL wurden eingeschlossen. Die Halslevel VIII, II und I waren mit 103, 40 und 21 Läsionen die am häufigsten betroffenen. Die Kohorte beinhaltete 40 Lymphknotenerkrankungen, 101 Speicheldrüsenerkrankungen, 31 zystische Läsionen und 12 andere, seltenere Entitäten. SEAL in Level II waren signifikant größer als in Level I und VIII (p < 0,001). In der FKDS zeigten SEAL in Level VI signifikant weniger bis keine Vaskularisation als in Level VIII (p < 0,01). Es gab keine Unterschiede in den B-Bild-Kriterien, in der SE oder im CEUS zwischen den einzelnen Halsleveln. Patienten mit zystischen Läsionen waren signifikant jünger als die mit Metastasen oder Warthintumoren (p = 0,026; 0,028). Pleomorphe Adenome waren signifikant kleiner als zystische Läsionen (p < 0,0006), Lymphome (p = 0,026), Metastasen (p = 0,0003) oder Warthintumore (p = 0,034). In der FKDS und im CEUS waren zystische Läsionen signifikant weniger bis gar nicht vaskularisiert und perfundiert als Lymphome (p = 0,014) und Warthintumore (p < 0,0001), während pleomorphe Adenome in der SE signifikant härter waren als zystische Läsionen (p = 0,0006).

Schlussfolgerung Die Bestimmung der Entität SEAL bleibt weiterhin schwierig. SE und CEUS bieten einen zusätzlichen Beitrag, Patienten zu selektieren, die eine intraoperative Schnellschnittuntersuchung mit möglicher Erweiterung der Operation benötigten und vom Einsatz des intraoperativen Nervenmonitorings profitierten.

Abstract

Aim To evaluate ultrasonographic hypoechoic lesions (HEL) of the head and neck region to predict their entity and plan surgery.

Methods Patients with HEL were included that were further analysed by B-mode ultrasound (US), colour-coded duplex sonography (CDS), contrast enhanced US (CEUS), and strain elastography (SE).

Results 184 patients were included. Level VIII, II, and I were affected frequently with 103, 40, and 21 HEL. The cohort comprised 40 lymph node disorders, 101 salivary gland diseases, 31 cystic lesions, and 12 other rarer entities. HEL in level II were significantly larger than in level I and VIII (p < 0.001). HEL in level VI showed less vascularisation than in level VIII in CDS (p < 0.01). There were no differences in B-mode criteria, SE, or CEUS between HEL in the different neck levels. Patients with cystic lesions were significantly younger than patients with metastases or Warthin’s tumours (p = 0.026, 0.028). Pleomorphic adenomas were significantly smaller than cystic lesions (p < 0.0006), lymphomas (p = 0.026), metastases (p = 0.0003), or Warthin’s tumours (p = 0.034). In CDS and CEUS, cystic lesions showed significantly less vascularisation and perfusion than lymphomas (p = 0.014) and Warthin’s tumours (p < 0.0001), while pleomorphic adenomas were stiffer than cystic lesions in SE (p = 0.0006).

Conclusion Predicting lesion’s entity is still challenging. The combination of different ultrasonographic criteria helped selecting patients that needed intraoperative fresh frozen section with possible extended surgery and profited from intraoperative nerve monitoring.

Schlüsselwörter

Ultraschall - farbkodierte Duplexsonographie - kontrastverstärkter Ultraschall - CEUS - Kompressionselastographie - Kopf-Halsläsionen - Elastographie

Key words

Ultrasound - colour-coded duplex sonography - contrast-enhanced ultrasound - strain elastography - head and neck lesion

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