Holtel Michael R
Telemedicine Research Institute, University of Hawaii, Honolulu, HI 96813, USA.
Otolaryngol Clin North Am. 2010 Dec;43(6):1267-74, vii. doi: 10.1016/j.otc.2010.08.003.
Increased use of ultrasonography of the head and neck by clinicians has resulted from more compact, higher resolution ultrasound machines that can be more readily used in the office setting. Palm-sized machines are already used for vascular access and bladder assessment. As the resolution of these machines becomes adequate for head and neck assessment, ultrasonography is likely to become a routine adjunct to the office physical examination. Further techniques to reduce artifact beyond spatial compounding, second harmonics, and broadband inversion techniques are likely to be developed to improve ultrasound images. Manual palpation using the ultrasound transducer or "sound palpation," using sound to recreate vibration provides information on tissue "stiffness," which has been successfully used to distinguish between benign and malignant lesions in the head and neck (particularly thyroid nodules). Microbubble contrast-enhanced ultrasound provides improved resolution of ultrasound images. Three- and four-dimensional ultrasonography provides for more accurate diagnosis. The ability of microbubbles with ligands affixed to their outer surface to target specific tissue makes them excellent delivery vehicles. DNA plasmids, chemotherapy agents, and therapeutic drugs can be released at a specific anatomic site. The motion of microbubbles stimulated by ultrasound can be used to increase drug penetration through tissues and has been shown to be effective in breaking up clots in stroke patients (without increased risk). High-intensity focused ultrasound can be used to create coagulation necrosis without significant damage to adjacent tissue. It has been effectively used in neurosurgery and urology, but its effectiveness in the head and neck is still being determined. A prototype for surgical navigation with ultrasound has been developed for the head and neck, which allows real-time imaging of anatomic surgical changes.
临床医生对头颈部超声检查的使用增加，是由于更紧凑、分辨率更高的超声机器，这些机器更易于在门诊环境中使用。手掌大小的机器已用于血管通路和膀胱评估。随着这些机器的分辨率足以用于头颈部评估，超声检查可能会成为门诊体格检查的常规辅助手段。除了空间复合、二次谐波和宽带反转技术之外，可能还会开发出更多减少伪像的技术，以改善超声图像。使用超声换能器进行手动触诊或“声触诊”（利用声音重现振动）可提供有关组织“硬度”的信息，这已成功用于区分头颈部的良性和恶性病变（尤其是甲状腺结节）。微泡对比增强超声可提高超声图像的分辨率。三维和四维超声检查能实现更准确的诊断。外表面附着有配体的微泡能够靶向特定组织，使其成为出色的递送载体。DNA质粒、化疗药物和治疗性药物可在特定解剖部位释放。超声刺激微泡的运动可用于增加药物在组织中的渗透，并且已证明对中风患者溶栓有效（且不会增加风险）。高强度聚焦超声可用于造成凝固性坏死，而不会对相邻组织造成重大损伤。它已在神经外科和泌尿外科中有效应用，但其在头颈部的有效性仍在确定中。已开发出一种用于头颈部的超声手术导航原型，可实现手术解剖变化的实时成像。
