Clinical Articles
Characterization of maxillofacial soft tissue vascular anomalies by ultrasound and color Doppler imaging: An adjuvant to computed tomography and magnetic resonance imaging

https://doi.org/10.1053/joms.2003.50003Get rights and content

Abstract

Purpose: The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses. Patients and Methods: Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study. Results: A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective. Conclusions: 1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:19-31, 2003

Section snippets

Patients and methods

Six patients with vascular or suspected vascular anomalies seen in the Department of Oral and Maxillofacial Surgery of Thomas Jefferson University Hospital (TJUH) for consultation and/or treatment between 1997 and 1999 composed the study group. CT, MRI (4 of 6 patients), US, and Doppler imaging were performed in the Department of Radiology, TJUH. Angiography was performed in 2 patients. All imaging analyses were written or reviewed by 2 authors (L.N.N. and V.M.R.), and US and Doppler studies

Case 1

MRI showed a lobulated mass that did not involve bone; progressive enhancement on the dynamic injection of contrast was in favor of a venous malformation. US/Doppler findings were diagnostic. Accurate measurements of the anatomic position of the lesion in relation to skin surface and buccinator muscle were made. Multiple “cystic” spaces within the mass were seen to be venous spaces when compressed by the US probe and showed venous flow on spectral analysis. Color Doppler gave no evidence of

Discussion

Ultrasound clinical studies in the OMS literature of the 1980s and 1990s can roughly be divided into 4 regions: neoplastic and inflammatory processes in major salivary glands,5, 6, 7, 8, 9, 10 neoplastic and non-neoplastic neck masses,6, 7, 8 inflammatory and abscess localization in oral and facial soft tissues,8, 9, 11 and intraoral soft tissue neoplasms.12, 13

Among this group of reports, 2 studies7, 9 also critically examined the clinical applications and diagnostic limitations of US in OMS.

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    Address correspondence and reprint requests to Dr Gold: Thomas Jefferson University Hospital, Department of Oral and Maxillofacial Surgery, 130 S 9th St, Philadelphia, PA 19107.

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