The suprahyoid region extends from the base of the skull to the hyoid bone and includes the pharyngeal, parapharyngeal, parotid, carotid, masticator, retropharyngeal, and perivertebral spaces, as well as the oral cavity. The areas that can be explored by ultrasound include the parotid, carotid, and masticator spaces; the oral cavity; the submandibular and sublingual spaces; the floor of the mouth; and the root of the tongue. The parotid space contains the parotid gland and the excretory duct of Steno, the facial nerve, the external carotid artery, the retromandibular vein, and the intraparotid lymph nodes. The carotid space in the suprahyoid region of the neck contains the internal carotid artery, the internal jugular vein, cranial nerves IX to XII, and the sympathetic plexus. Only some parts of the masticator space can be explored sonographically: these include the masseter muscle, the zygomatic arch and the outer cortex of the ramus of the mandible, and the suprazygomatic portion of the temporalis muscle. The submandibular space houses the submandibular gland, the submental and submandibular lymph nodes, and the anterior belly of digastric muscle. The facial artery and vein and the lower loop of the hypoglossal nerve all pass through the submandibular space. The sublingual space includes the sublingual gland, the deep portion of the submandibular gland and its main excretory duct, the hypoglossal nerve (cranial nerve XII), the lingual nerve (branch of the mandibular branch of trigeminal), and the glossopharyngeal nerve (IX cranial nerve), and the lingual artery and vein. The mylohyoid muscle forms the floor of the mouth. The deepest portion of the oral tongue, the root, consists of the genioglossus and geniohyoid muscles and includes the septum of the tongue. In this article we present the ultrasound features of the structures located in the suprahyoid region of the neck.Sommario La regione sovraioidea si estende dalla base cranica all'osso ioide, comprende gli spazi faringeo, parafaringeo, parotideo, carotideo, masticatorio, retrofaringeo, perivertebrale e il cavo orale.Tra questi sono ecograficamente esplorabili gli spazi parotideo, carotideo, masticatorio e, del cavo orale, gli spazi sottomandibolare, sottolinguale, il pavimento della bocca e la radice della lingua.Lo spazio parotideo accoglie la ghiandola parotide e il dotto escretore di Stenone, il nervo * Corresponding author. E-mail address: heart2@libero.it (A. Gervasio). faciale, l'arteria carotide esterna, la vena retromandibolare e linfonodi intraparotidei. Lo spazio carotideo, nel collo sovraioideo, comprende l'arteria carotide interna, la vena giugulare interna, i nervi cranici dal IX al XII e il plesso del simpatico.Lo spazio masticatorio è solo parzialmente esplorabile ecograficamente: è possibile visualizzare il muscolo massetere, l'arcata zigomatica e la corticale esterna del ramo della mandibola, parte del muscolo temporale nel tratto soprazigomatico.Lo spazio sottomandibolare accoglie la ghiandola sottomandibolare, linfonodi sottoma...
KEYWORDSUltrasound; Anatomy; Neck.Abstract The infrahyoid region of the neck includes the visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, and perivertebral spaces. The visceral space contains the thyroid, parathyroid glands, larynx, hypopharynx, the cervical trachea, and esophagus, the recurrent laryngeal nerve. The carotid space contains two parts, which extend from the skull base to the aortic arch and are delimited by the three layers of the deep cervical fascia (superficial, middle, and deep). It contains the internal carotid artery, the internal jugular vein, cranial nerves (IXeXII), the sympathetic plexus (suprahyoid compartment), the common carotid artery, the internal jugular vein, vagus nerve (infrahyoid compartment). The retropharyngeal space is a midlinespace containing adipose tissue that extends from the skull base to the upper mediastinum. It is located posterior to the pharynx and cervical esophagus, anterior to the danger area and the perivertebral space.The perivertebral space extends from the skull base to the clavicles and includes two parts: prevertebral and paraspinal. The prevertebral space includes the prevertebral muscles (long muscles of the neck and head), the scalene muscles (anterior, middle, and posterior), the roots of the brachial plexus, the phrenic nerve, the vertebral arteries and veins, and the vertebral bodies. The paraspinal space contains the paraspinal muscles and the posterior elements of the cervical spine.The posterior cervical space is a deep space located posterior to the sternocleidomastoid muscle. It contains the accessory nerve, the accessory chain lymph nodes, the pre-axillary component of the brachial plexus, and the dorsal scapular nerve. The anterior cervical space is located deep to the strap muscles and sternocleidomastoid muscle. It surrounds the front and sides of the visceral space and is related posteriorly to the carotid space. This article reviews the ultrasound features of the structures located in the infrahyoid region of the neck.Sommario Gli spazi viscerale, cervicale anteriore, cervicale posteriore, carotideo, retrofaringeo e perivertebrale, localizzati al di sotto dell'osso ioide, costituiscono la regione infraioidea.Lo spazio viscerale contiene tiroide, paratiroidi, linfonodi, laringe, ipofaringe, il tratto cervicale della trachea e dell'esofago, il nervo laringeo ricorrente. * Corresponding author. Radiology Department, Istituto Clinico Città di Brescia, Hospital Group San Donato, Brescia, Italy.E-mail address: heart2@libero.it (A. Gervasio). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j u sJournal of Ultrasound (2010) Lo spazio carotideo è costituito da due parti che si estendono dalla base cranica all'arco aortico, delimitati dai tre strati della fascia cervicale profonda (foglietti superficiale, medio e profondo). Contiene: arteria carotide interna, vena giugulare interna, nervi cranici (9e12), plesso simpatico (collo...
Background and purposeChronic liver diseases are associated with increased bone fracture risk, mostly in end-stage disease and cirrhosis; besides, data in non-alcoholic fatty liver disease (NAFLD) are limited. Aims of this study was to investigate bone mineralization and microstructure in obese individuals with NAFLD in relation to the estimated liver brosis. MethodsWe analyzed data from 1872 obese individuals (44.6 ± 14.1 years, M/F: 389/1483; BMI: 38.3 ± 5.3 kg/m 2 ) referring to the Endocrinology outpatient clinics of Sapienza University, Rome, Italy. Participants underwent clinical work-up, Dual-Energy X-ray Absorptiometry for assessing bone mineral density (BMD) and microarchitecture (trabecular bone score, TBS). Liver brosis was estimated by Fibrosis Score 4 (FIB-4). Serum parathyroid hormone (PTH), 25(OH) vitamin D, osteocalcin and IGF-1 levels were measured. ResultsIndividuals with osteopenia/osteoporosis had greater FIB-4 than those with normal BMD (p < 0.001). FIB-4 progressively increased in presence of degraded bone microarchitecture (p < 0.001) and negatively correlated with the serum osteocalcin (p < 0.001) and IGF-1 (p < 0.001), which were both reduced in presence of osteopenia/osteoporosis. FIB-4 predicted IGF-1 reduction in multivariable regression models adjusted for confounders (β: −0.18, p < 0.001). Higher FIB-4 predicted bone fragility with OR 3.8 (95%C.I:1.5-9.3); this association persisted signi cant after adjustment for sex, age, BMI, diabetes, smoking status and PTH at the multivariable logistic regression analysis (OR 1.91 (95%C.I:1.15-3.17), p < 0.01), with AUROC = 0.842 (95%C.I:0.795-0.890; p < 0.001). ConclusionOur data indicate the presence of a tight relation between NAFLD-related liver brosis, lower bone mineral density and degraded microarchitecture in obese individuals, suggesting potential common pathways underlying liver and bone involvement in insulin-resistance associated disorders.
The aim of the study was to assess the value of quantitative attenuation values (Hounsfield units) and of gallstone pattern by computerized tomography in predicting response to bile acid therapy. We carried out a prospective study in a multicenter setting on 90 consecutive outpatients with radiolucent gallstones. All received bile acid therapy (UDCA 10 mg/kg/day or UDCA + CDCA 5 mg/kg/day of each) up to two years. Hounsfield units for gallstones were recorded using standardized criteria and six categories of patterns were defined: hypodense, isodense, homogenously dense, laminated, rimmed and speckled. We assessed gallstone dissolution rate (percent reduction in volume), response to therapy (> 25% reduction in volume), and final outcome of therapy. Eighty-one percent of patients with hypodense/isodense and all four patients with speckled stone pattern responded to therapy, whereas none of the 10 patients with laminated/rimmed and only 45% of patients with homogenously dense stone pattern did. Complete dissolution was achieved by 68%, 50%, 35%, 0% of the hypodense/isodense, speckled, homogenously dense, rimmed/laminated gallstones, respectively. The use of Hounsfield units did not show an advantage over gallstone pattern for predicting either response or final outcome to bile acid therapy. We conclude that computerized tomography analysis of gallstones is of value in predicting response to bile acid therapy and that gallstone pattern alone predicts response in most cases without the need for quantitative assessment.
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