Ultrasonography for evaluation of the carotid artery in head and neck cancer.

The dynamic relationship of lymph node metastases to surrounding vascular structures in the neck is important for preoperative patient assessment. When carotid artery involvement is suspected, this relationship often determines whether or not to operate. In the case of adhesive neck metastases along the internal jugular vein, it becomes possible to predict preoperatively if the integrity of this vein may be preserved. Ultrasonography has the ability to differentiate subtle from gross adherence, or simple compression from vascular invasion. This is done by manually palpating the tumor mass and asking the patient to perform various maneuvers while observing on a monitor the relationship of the tumor mass to the nearby artery. This article correlates the preoperative computed tomography/magnetic resonance imaging (CT/MRI) and ultrasound findings in 41 patients with large nodal metastases which were subsequently confirmed during surgery. In case of positive ultrasonographic invasion of the carotid artery, a transcranial Doppler ultrasonography (TCD) exam was performed to confirm adequate crossflow. Our experience with ultrasonography and TCD in patients with suspected involvement of the carotid artery shows reliable results and obviates in our hands the routine need for more complex, invasive, and expensive tests.