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Bin-Bin Jin, Yan Ma, Xiu-Hua Zhao, Yi-Ling Teng, Shang-Yong Zhu Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of ChinaCorrespondence: Shang-Yong Zhu, Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of China, Email zhushangyong@sina.comObjective: To analyze the risk factors of the operators on contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy).Methods: We retrospectively collected 399 infertile women who underwent HyCoSy by the same sonographer. These patients were divided into two groups according to the way how the assistants connected the syringe to the uterus radiography catheter to inject the contrast agent. We analyzed whether the use of different contrast bolus injection methods had any influence on the incidence of intravasation during HyCoSy.Results: There was no significant difference between the two groups with different cross-sectional areas of the syringe outflow tract in the risk variables for intravasation, but the intravasation rates of the two groups were different, 26.4% in group A and 17.1% in group B, P < 0.05. The primary manifestation was that when both fallopian tubes were unobstructed, the intravasation rate of group B with smaller cross-sectional area of the outflow tract of the syringe was lower, and the difference was statistically significant. The inferences drawn from our physics model were also in line with the clinical results.Conclusion: The influence of different operators on the contrast agent intravasation rate of HyCoSy cannot be ignored. The assistants of HyCoSy examination should inject the contrast agent slowly and steady, and a needle can be used as a flow restrictor to control the flow into the uterine cavity per unit time, slow down the rising speed of intrauterine pressure, and avoid the accumulation of contrast agent in the uterine cavity, so as to reduce the intravasation caused by operator factors.Keywords: intravasation, hysterosalpingo-contrast sonography, ultrasonography, contrast agent, fallopian tube patency, infertility

Objective. This study is aimed at identifying stemness-related genes in pancreatic ductal adenocarcinoma (PDAC). Methods. The RNA-seq data of PADC patients were downloaded from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases. The mRNA expression-based stemness index (mRNAsi) and epigenetically regulated mRNAsi (EREG-mRNAsi) of PADC patients were evaluated. The mRNAsi-related gene sets in PADC were identified by weighted gene coexpression network analysis (WGCNA). The key genes were further analyzed using functional enrichment analysis. The Kaplan-Meier survival analysis and the Cox proportional hazards model were used to evaluate the prognostic value of the key genes. Prognostic hub genes were used to establish nomograms. The receiver operating characteristic (ROC) curves, concordance index ( C -index), and calibration curves were used to assess the discrimination and accuracy of the nomogram. Finally, these results were validated in the Gene Expression Omnibus (GEO) database. Results. A total of 36 key genes related to mRNAsi were identified by WGCNA. A prognostic gene signature compromising seven genes (TPX2, ZWINT, UBE2C, CCNB2, CDK1, BUB1, and BIRC5) was established to predict the overall survival (OS) of PADC patients. The Cox regression analysis revealed that the risk score was an independent prognostic factor for PADC. Patients were then divided into the high-risk and low-risk groups. The ROC curves, C -index, and calibration curves indicated good performance of the prognostic signature in the TCGA and GEO datasets. Moreover, the nomogram incorporating clinical parameters showed better sensitivity and specificity for predicting the OS of PADC patients. Conclusion. The stemness-related prognostic model successfully predicted the OS of PADC patients and could be used for the treatment of PADC.

Objective. The aim of this study is to explore the potential pathogenesis of juvenile dermatomyositis by bioinformatics analysis of gene chips, which would screen the hub genes, identify potential biomarkers, and reveal the development mechanism of juvenile dermatomyositis. Material and Methods. We retrieved juvenile dermatomyositis’s original expression microarray data of message RNAs (mRNAs) and microRNAs (miRNAs) from NCBI’s Gene Expression Omnibus database (GEO, http://www.ncbi.nlm.nih.gov/geo/); through the R package of limma in Bioconductor, we can screen the differentially expressed miRNAs and mRNAs, and then we further analyzed the predicted target genes by the methods such as Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and miRNA-mRNA regulatory network construction and protein-protein interaction (PPI) network using Cytoscape 3.6.1. Results. Compared with normal juvenile skin tissues, 6 upregulated microRNAs and 5 downregulated microRNAs were identified from 166 downregulated microRNAs and 58 upregulated microRNAs in juvenile dermatomyositis tissues. The enrichment pathways of differentially expressed microRNAs include cell adhesion molecules (CAMs), autoimmune thyroid disease, Type I diabetes mellitus, antigen and presentation, viral myocardium, graft-versus-host disease, and Kaposi sarcoma-associated herpes virus infection. By screening of microRNA-messenger RNA regulatory network and construction of PPI network map, three target miRNAs were identified, namely, miR-193b, miR-199b-5p, and miR-665. Conclusion. We identified mir-193b, mir-199b-5p, and mir-6653 target miRNAs by exploring the miRNA-mRNA regulation network mechanism related to the pathogenesis of juvenile dermatomyositis, which will be of great significance for further study on the pathogenesis and targeted therapy of juvenile dermatomyositis.

To investigate the feasibility of ultrasonography in detecting the oropharynx movement during deep breathing and to quantitatively analyze oropharynx airway lumen changes during deep breathing. The motions of oropharynx were monitored, and sonographic measurements of airway lumen were obtained during deep breathing in 448 healthy volunteers. Adequate visualization of oropharynx movement was obtained on all healthy volunteers. The anterior-posterior (AP) diameters and AP/transverse (T) diameter ratios were greater at the end of deep inspiration than that at the end of deep expiration for each sex (p < 0.01). The anterior-posterior dimensional changes were greater than lateral airway dimensional changes each sex (p < 0.05). Ultrasonography could provide realistic impression of the process on the oropharynx movement during deep breathing and perform the quantitative analysis of the oropharynx airway lumen changes during deep breathing. The results were encouraging and supported the utility of ultrasonography in future studies.

Feifei Liang,1 Rensheng Wang,1 Qinghua Du,2 Shangyong Zhu3 1Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 2Department of Radiation Oncology, Second Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 3Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of ChinaCorrespondence: Shangyong ZhuDepartment of Ultrasound, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, 530021, People’s Republic of ChinaEmail zhushangyong2021@163.comBackground: Epithelial-to-mesenchymal transition (EMT) program plays a critical role in cancer. Thus, we attempted to generate a risk score system according to the expression pattern of different EMT hallmark genes in head and neck squamous-cell carcinoma (HNSC).Methods: Differentially expressed EMT hallmark genes were screened to generate a risk score (RS) on TCGA HNSC dataset. The relative prognostic value of the RS compared to clinicopathological characteristics was explored using multivariable Cox analysis. Functional enrichment analysis was performed to reveal the biological characteristics. An external dataset was applied to validate the prognostic value of the RS.Results: Nine genes constituted the EMT hallmark gene-based RS, which is significantly associated with poor prognosis and could successfully divide patients with HNSC into high- and low-risk groups. The RS was also an independent prognostic indicator compared to routine clinical factors.Conclusion: We proposed and validated a nine-EMT hallmark gene-based risk score system in HNSC.Keywords: head and neck squamous-cell carcinoma, epithelial-to-mesenchymal transition, EMT, risk score system, angiogenesis

Objective: Aim of this study was to identify the stemness-related genes in Pancreatic ductal adenocarcinoma (PDAC). Methods: The RNA-seq data of PADC were downloaded from The Cancer Genome Atlas (TCGA) and the Genotype-Tissue Expression (GTEx) databases. mRNA expression base-index (mRNAsi) and epigenetically regulated mRNAsi (EREG-mRNAsi) of PADC were evaluated. The mRNAsi-based gene sets in PADC were identified by Weighted gene co-expression network analysis (WGCNA). Functional Enrichment Analyses were performed with key genes. Kaplan–Meier survival analysis and the Cox proportional hazards model were used to evaluate the prognostic value of the key genes. Prognosis-associated hub genes were applied to establish nomograms. The receiver operating characteristic curves (ROC) and concordance index (C-index) were utilized to assess the discrimination and accuracy of the nomogram. Finally, these results were validated in the Gene Expression Omnibus (GEO) database and immunohistochemistry (IHC). Results: 36 key genes associate with mRNAsi were screened via WGCNA. Next a five-gene signature compromised TPX2, NCAPH, UBE2C, CCNB2, CEP55. Based on the expression of the signature, the PADC patients were classify patients into high- and low-risk groups. Cox regression analysis revealed that the high-risk group was significantly positive with overall survival (OS). Moreover, the nomogram has better sensitivity and specificity for predicting the OS. And the ROC, C-index indicated good performance of the prognostic signature in the TCGA and GEO dataset. Conclusion: Prognostic model associated with cancer stem cells (CSCs) reliably predict OS in PADC. this might be beneficial for the treatment of PADC patients.

Aim: The study retrospectively analysed the accuracy of preoperative contrast-enhanced ultrasound (CEUS) in differenti - ating stage Ta-T1 or low-grade bladder cancer (BC) from stage T2 or high-grade bladder cancer. Material and methods: We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library for original diagnostic articles of bladder cancer. The diagnostic accuracy of CEUS was compared with cystoscopy and/or transurethral resection of bladder tumors (TURBT). The bivariate logistic regression model was used for data pooling, couple forest plot, diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC). Results: Five studies met the selection criteria; the overall number of reported bladder cancers patients were 436. The pooled-sensitivity (P-SEN), pooled-specificity (P-SPE), pooled- positive likelihood ratio (PLR+), pooled-negative likelihood ratio (PLR−), DOR, and area under the SROC curve were 94.0% (95%CI: 85%–98%), 90% (95%CI: 83%–95%), 9.5 (95%CI: 5.1–17.6), 0.06 (95%CI: 0.02–0.17), 147 (95%CI: 35–612) and 97% (95% CI: 95%–98%) respectively. Conclusion: CEUS reaches a high efficiency in discriminating Ta-T1 or low-grade bladder cancer from stage T2 or high-grade bladder cancer. It can be a promising method in patients to distinguish T staging and grading of bladder cancer because of its high sensitivity, specificity and diagnostic accuracy.

PURPOSE/OBJECTIVE(S) To explore the impact of dose distribution on the parameter and predictive ability of equivalent uniform dose (EUD) model. MATERIALS/METHODS The brains of 103 nasopharyngeal carcinoma patients receiving IMRT were divided into left and right half-brains to create small-size virtual brains with similar dose distribution to brains. Difference of relative VD between brain and half-brain was analyzed by independent sample t-test. EUDs for different dose distributions were calculated in different VD (EUDVD). Predictive ability of EUDVD for radiation-induced brain injury was assessed by receiver operating characteristics curve (ROC) and area under the curve (AUC). The optimal volume-effect parameter a of EUD was selected when AUC was maximal (mAUC). The correlations between mAUC, a and D (specific dose of VD) were analyzed by Pearson correlation analysis and linear regression analysis to evaluate the impact of dose distribution. Paired samples t-test was used for comparisons of both mAUCs and parameters between brain and half-brain to evaluate the role of size. The optimal DV and VD points were calculated for a simple comparison. RESULTS Average-DVH curves of left half-brains, right half-brains and brains overlapped almost exactly, and the differences of relative VD were less than 0.01% (P > 0.5). The mAUC of EUDVD increased with D, and reached maximum when D was around 55 Gy. When D≤55 Gy, mAUC was linearly dependent on D. The optimal a was correlated with D strongly, and it decreased from 22 to 1 as D increased. The difference of mAUC/a between brain and half-brain was not significant. In the a range of 1 to 22, AUCs of EUDV55 Gy in brain/half-brain (0.830-0.857/0.830-0.845) were always larger than those of whole-volume EUD (0.681-0.819/0.691-0.821). AUCs of EUDV55 Gy (a = 1, equal to mean dose) and DV55 Gy/2 (dose delivered to V55 Gy/2, equal to median dose,) were larger than those of DV and VD (0.845/0.844 vs. 0.818/0.827 in half-brain). CONCLUSION Volume-effect parameter of EUD is variable and depends on dose distribution rather than volume size. Before using an empirical parameter, dose distributions (especially the gradients) should be similar. Critical-dose-volume EUD could improve the predictive ability (no matter what the a is) and has a stable volume-effect parameter. Mean dose may be the case in which critical-dose-volume EUD has the best predictive ability, while median dose, as a simple dose/volume point, is a convenient alternative.

The aim of this study was to investigate the characteristics of nasopharyngeal carcinoma (NPC) using contrast-enhanced ultrasonography (CEUS), including the enhancement patterns and the quantitative parameters.Having been scanned using conventional ultrasonography (US) and CEUS, every case was confirmed to be NPC under endoscopic biopsy, and no case received any anti-tumor treatment before CEUS examinations. Tumor/node/metastasis stages were determined in accordance with 2002 AJCC 6th edition. Contrast enhancement patterns and quantitative parameters were observed.CEUS imaging of NPC showed that the tumor signal intensity enhanced early, rapidly, and remarkably, and decreased slowly later. The patterns of enhancement included spot/linear enhancement, peripheral enhancement, and mass enhancement, and two types of time intensity curves of NPC included type I and type II. There was a significant difference between peak intensity (PI) and T stage (P0.05), whereas time-to-peak (TP) and slope did not show significant differences with T stage (P0.05).CEUS is feasible to be applied to the nasopharynx region. The use of CEUS makes it possible to observe vascular permeability of NPC. Our results suggest that the quantitative parameter PI of nasopharyngeal carcinoma is significantly different from T stages. Thus, PI may serve as a potential noninvasive radiological prognostic indicator for NPC.

Background Contrast-enhanced ultrasound (CEUS) is a non-invasive method for the assessment of breast lesions. The accuracy of CEUS in diagnosing of breast cancer has never been systematically assessed. Purpose To determine the overall performance of CEUS in the differentiation of benign and malignant breast lesions using meta-analysis. Material and Methods PubMed, Embase, Cochrane Library, and article references published before October 2012 were searched. Published studies that used histopathologic results as golden reference to assess the diagnostic performance of CEUS in patients suspected of having breast cancer and the data necessary to calculate the diagnostic results were included. The qualities of eligible studies for final meta-analysis were assessed by using the quality assessment of diagnostic studies (QUADAS) instrument. Sensitivity, specificity, summary receiver-operating characteristic (sROC) curves, and area under the curve were calculated to examine the diagnostic performance of CEUS. Results Of 16 eligible studies, 957 breast lesions were included in the original meta-analysis, among which heterogeneity arising from factors other than threshold effect was explored. Meta-regression analysis confirmed the contrast agent was the most significant factor cause of heterogeneity ( P = 0.0012, relative diagnostic odds ratio [DOR] = 7.06). The use of perfluoro containing microbubbles (Sonovue or Optison) significantly increased the diagnostic precision compared with Levovist. The pooled weighted estimates of sensitivity and specificity for CEUS in the diagnosis of breast lesions were 0.86 (95% confidence interval [CI], 0.83, 0.89) and 0.79 (95% CI, 0.75, 0.83), respectively. Conclusion CEUS has good sensitivity and specificity in the characterization of breast lesions and can potentially help to select suspicious breast mass for surgery.

To evaluate the utility of the elastic ratio calculated using real-time tissue elastography for assessing liver fibrosis in patients with chronic hepatitis B (CHB).Ninety-six patients with CHB were enrolled between September 2012 and August 2013. The elastic ratio of the liver for the intrahepatic venous small vessel was calculated to measure liver stiffness. Diagnostic performance of the elastic ratio and aminotransferase-to-platelet ratio index (APRI) were compared with histological fibrosis stage at liver biopsy. In addition, 45 healthy adult volunteers were participated in intra- and interobserver reliability studies.There was no significant influence of hepatitis B e antigen (HBeAg) status or hepatitis B virus DNA levels on the elastic ratio measurements in CHB patients. The elastic ratio was significantly correlated with histological fibrosis stage (r = 0.873, p0.001). Cut-off values were 2.62 for stage 2 and over (S ≥ 2), 3.20 for state 3 and over, and 3.86 for stage 4, respectively. The areas under the receiver operating characteristic (ROC) curves for elastic ratio and APRI diagnosis of significant fibrosis (S ≥ 2) was 0.91 (95% CI: 0.84-0.98) and 0.71 (95% CI: 0.57-0.86), and 0.94 (95% CI: 0.89-0.99) and 0.81 (95% CI: 0.71-0.91) for cirrhosis (S = 4), respectively. The elastic ratio measurements had good reproducibility: 0.838 for intra-observer reliability and 0.805 for inter-observer reliability, respectively (p0.001).Elastic ratio determined using real-time tissue elastography was an accurate and reproducible method for evaluating liver fibrosis in patients with CHB.

OBJECTIVES The purpose of this study was to compare the use of sonography and non-contrast-enhanced magnetic resonance imaging (MRI) for detection and staging of glottic carcinoma. METHODS In this study, 30 consecutive patients with glottic squamous cell carcinoma underwent high-frequency sonography and non-contrast-enhanced MRI before surgical treatment. Tumor detectability and imaging findings were evaluated independently and then compared with the surgical and postoperative pathologic findings. RESULTS Sonography showed a trend toward higher detectability than MRI in early (stage T1 and T2) glottic carcinoma (94.1% [16 of 17 patients] for sonography versus 76.5% [13 of 17 patients] for MRI; P = .335). With regard to T staging, the overall accuracy rates were 80.0% (24 of 30) for sonography and 76.7% (23 of 30) for MRI; the difference was not statistically significant (P > .99). Non-contrast-enhanced MRI was superior to sonography in showing tumor involvement in the retrolaryngeal extent of glottic carcinoma. CONCLUSIONS Sonography is suggested as a noninvasive complementary modality for detection and initial staging of glottic carcinoma.

Objective. The purpose of this study was to prospectively identify the normal sonographic values of human true and false vocal cords. Methods. In total, 229 healthy volunteers were divided into 8 groups according to their age and sex. High-frequency sonography was used to measure the length, width, and thickness of both true and false vocal cords. Measurements were compared between groups, and correlations with age were analyzed. Forty of the 229 volunteers also participated in reliability and reproducibility studies. Results. The sonographic measurements had good reproducibility, with intraclass correlation coefficient ranges of 0.736 to 0.903 for interobserver reliability and 0.723 to 0.943 for intraobserver reliability. Measurements for the 3 parameters of both true and false vocal cords in male adults were greater than those in female adults (P < .001). The length, width, and thickness of true and false vocal cords in participants younger than 18 years were obviously correlated with age (r = 0.835-0.957; P < .001), but no significant correlation was found in the adult groups. The rates of visualization in male groups were significantly lower than those in female groups (P < .001) and gradually decreased with increasing age. Conclusions. Both true and false vocal cords can be shown by high-frequency sonography, which can quantitatively measure both true and false vocal cords with good reliability and reproducibility.

To demonstrate whether a calculated vascularity index (VI) can predict metastases of cervical lymph nodes, the VI values of the primary tumors were obtained by using 3-D sonography in 87 subjects with laryngeal cancer confirmed by laryngoscope and biopsy. N-staging of the subjects was determined by pathological nodal harvesting. The relationship between the VI and pathological N-staging was evaluated by correlation coefficient. To test the accuracy of the VI for predicting cervical lymph node involvement, a receiver operating characteristic (ROC) curve was constructed, and the best operating point was determined by Youden's index. For comparison, 2-D sonography was applied to detect metastatic cervical lymph nodes. The accuracy, sensitivity and specificity of the VI, 2-D sonography and a combination of the two methods for diagnosis of metastatic cervical lymph nodes were compared. There was a positive linear correlation between the VI and pN-staging (r=0.740, p0.001). The area under the ROC curve for the VI was 0.919. The best operating point of the VI was 4.4565, which derived higher sensitivity than that of 2-D sonography (95% vs. 81%, p=0.031), but lower specificity (75% vs. 95%, p=0.012). The combination of the two methods yielded a higher accuracy (97% vs. 85% and 89%, p=0.002 and 0.016), a higher sensitivity to 2-D sonography (95% vs. 81%, p=0.031) and a higher specificity to VI (98% vs. 75%, p=0.002). The VI of laryngeal cancer can be a useful factor for predicting metastases of cervical lymph nodes.

Purpose Although conventional sonography is used widely for evaluation of the gastroesophageal junction, its use in the cervical esophagus is still limited. The aim of this study was to assess the use of sonography to demonstrate this portion of the esophagus. Methods The cervical esophagi in 60 cadavers and 435 healthy volunteers were examined sonographically. Among the healthy subjects 182 were scanned with a transducer operating at 7.5 MHz, 183 with a 10.0-MHz transducer, and 70 with a 12.0-MHz transducer. Sonographic layer patterns were compared among the groups. Sonographic and histologic analyses were also performed on 3 cadaveric esophageal specimens to correlate the sonographic appearances with the anatomical findings. Results Scans of the cadavers showed that the cervical esophagus lay between the trachea and vertebrae, with its origin at the midline; it gradually moved to the left as it descended toward the trunk. It moved to the right when the cadaver's head was turned to the left and the trachea was pushed gently to the left. Based on these anatomical characteristics, visualization of the cervical esophagus was optimized by scanning from both the left and the right lateral approaches, with manipulation of the trachea as needed. In scans of the 435 healthy subjects, the esophageal wall was shown as 5 layers in 423 (97.2%) and as 7 layers in the remaining 12 (2.8%). The demonstration rate of the 7-layer pattern was significantly higher for subjects scanned at 12.0 MHz than for those scanned at 10.0 and 7.5 MHz (p < 0.01). The layers demonstrated sonographically corresponded to histological structures evident on microscopy. Conclusions The left lateral approach is essential to sonography of the cervical esophagus. However, the right wall of the esophagus is best seen from the right. In transverse scans, the cervical esophagus wall usually appears to be composed of 5 layers, although 7 layers can also appear, especially as the transducer frequency is increased. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:163–171, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.20017

Objectives The purpose of this study was to prospectively assess the accuracy of sonography versus magnetic resonance imaging (MRI) for a diagnosis of primary nasopharyngeal carcinoma. Methods A total of 150 patients suspected of having nasopharyngeal carcinoma underwent sonography and MRI. A diagnosis was obtained from an endoscopic biopsy that was collected from the suspected tumor or a normal nasopharynx. The diagnostic performance of sonography and MRI for nasopharyngeal carcinoma was evaluated by receiver operating characteristic curve analysis. The sensitivity and specificity of the two imaging methods were compared by the McNemar test. Results Nasopharyngeal carcinoma was present in 71 of 150 patients (47.3%) and absent in 79 (52.7%). The sensitivity, specificity, and accuracy of sonography versus MRI for these cases were 90.1%, 84.8%, and 87.3% for sonography and 97.2%, 89.9%, and 93.3% for MRI, respectively. Both sonography and MRI had good diagnostic performance for nasopharyngeal carcinoma, with area under the curve values of 0.958 and 0.987, respectively. There was no significant difference in the rate of tumor detectability between sonography and MRI (P = .12), and the specificities of sonography and MRI were similar (P = .22). Conclusions Both sonography and MRI are useful tools for clinical screening of nasopharyngeal carcinoma. However, sonography is less expensive and easier to perform. The results of this study also suggest that nasopharyngeal sonography could be used for the initial investigation of primary cancer in patients suspected of having nasopharyngeal carcinoma.

OBJECTIVES The purpose of this study was to determine the sonographic performance in pathologically proven cases of nasopharyngeal carcinoma and its involvement in the parapharyngeal space. METHODS The study included 58 patients being treated for suspected nasopharyngeal carcinoma detected by routine nasopharyngoscopy who underwent pathologic biopsy. Sonography was performed immediately thereafter with a convex array transducer in both the B-mode and color mode. Forty-five of the 58 patients (90 parapharyngeal spaces) in whom nasopharyngeal carcinoma was proved by both sonography and pathologic biopsy underwent preradiotherapy magnetic resonance imaging (MRI). The sonographic findings were compared to the pathologic findings. The sonographic findings of parapharyngeal space involvement were correlated with the MRI findings. RESULTS The normal anatomy of the nasopharynx and parapharyngeal space, nasopharyngeal carcinoma, and its relationship with the parapharyngeal space were well shown on sonography. The sensitivity of sonography for detection of nasopharyngeal carcinoma was 97.8%, and the specificity was 41.7%. The sonographic findings of parapharyngeal space involvement had a high degree of agreement with MRI (κ = 0.757; P < .001). CONCLUSIONS These promising initial data indicate that sonography may be a useful tool for diagnosing nasopharyngeal carcinoma and defining the relationship between the tumor and the parapharyngeal space.

Purpose Although conventional sonography has been used widely in evaluation of the abdominal and cervical esophagus, its use in the thoracic esophagus is seldom mentioned. The aim of this study was to assess whether conventional sonography could demonstrate the thoracic esophagus and to determine this structure's normal sonographic appearance and measurements. Methods Transthoracic sonography was performed in 253 healthy volunteers ranging in age from 12 to 72 years (mean, 41 ± 15 years). The subjects were examined while supine with their hands raised over their heads; the transducer was placed along the left side of the sternum sequentially from the first to the fifth intercostal spaces. The ultrasound beam was directed to the thoracic aorta using the heart as an acoustic window. The detectable length of the thoracic esophagus was measured in the longitudinal scan from the upper most part visualized to the point at which it penetrated the diaphragm. The esophageal thickness was measured on the anterior wall at the level of the left atrium. Results In 188 (74%) of the 253 subjects, the thoracic esophagus could be demonstrated by sonography, except for the portion under the first and second intercostal spaces. In 3 of these 188 subjects, the esophagus also was not visualized at the third intercostal space. In these 188 subjects, the esophageal wall was shown as 3 layers. The esophageal lumen appeared as 1 or 2 hyperechoic bands in longitudinal sonograms. In 163 subjects, gas artifact and the comet-tail sign, with downward movement, were seen in the esophageal lumen after swallowing. The mean demonstrable length of the thoracic esophagus was 10.2 ± 1.9 cm and the mean thickness 3.2 ± 0.3 mm. Conclusions Most of the thoracic esophagus can be visualized by sonography, except for a short portion at the back of the left main bronchus. The heart and the thoracic aorta are 2 important landmarks in scanning. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 33:29–33, 2005