European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 4, pp 1167–1173 | Cite as

The effectiveness of high-resolution ultrasound in the assessment of the carotid intima–media thickness for postirradiated neck

  • Yu-Chun Yeh
  • Kai-Min Fang
  • Wan-Lun Hsu
  • Li-Jen LiaoEmail author
Head & Neck



The carotid intimal–medial thickness (CIMT) is a strong predictor of future cardiovascular events. We assessed the mean CIMT and evaluated associated factors in head and neck cancer (HNC) patients.

Materials and methods

Between January 2016 and March 2018, 70 volunteers underwent automatic ultrasound measurement of the common carotid artery CIMT. A mean CIMT ≥ 1.0 mm was regarded as an elevated risk for cardiovascular disease (CVD). We aimed to investigate the risk factors for an increased mean CIMT.


We recruited 20 HNC survivors and 50 noncancer control individuals. Multiple linear regression analysis showed that old age (β = 0.006, 95% confidence interval, CI 0.004–0.008), increased weight (β = 0.003, 95% CI 0.001–0.005), hypertension (β = 0.10, 95% CI 0.03–0.17), and prior irradiation (β = 0.13, 95% CI 0.08–0.19) were positively correlated with the mean CIMT. From logistic regression analysis, it was shown that patients who underwent radiotherapy (OR 13.5, 95% CI 1.48–122.8) and who had higher bodyweight (OR 1.09, 95% CI 1.01–1.18) had a significantly higher risk of developing CVD.


Measurement of the mean CIMT using ultrasound could be useful for assessing CVD risk in HNC survivors after neck irradiation.


Carotid intima–media thickness Head and neck cancer Irradiation Cardiovascular disease 



This work was supported by grants from the Far Eastern Memorial Hospital Research Program (FEMH - 2017-C-012).

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

405_2019_5302_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 KB)


  1. 1.
    Pulte D, Brenner H (2010) Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist 15(9):994–1001CrossRefGoogle Scholar
  2. 2.
    Funk GF, Karnell LH, Christensen AJ (2012) Long-term health-related quality of life in survivors of head and neck cancer. Arch Otolaryngol Head Neck Surg 138(2):123–133CrossRefGoogle Scholar
  3. 3.
    Haynes JC, Machtay M, Weber RS et al (2002) Relative risk of stroke in head and neck carcinoma patients treated with external cervical irradiation. Laryngoscope 112(10):1883–1887CrossRefGoogle Scholar
  4. 4.
    Liao LJ, Wang CT, Young YH, Cheng PW (2010) Real-time and computerized sonographic scoring system for predicting malignant cervical lymphadenopathy. Head Neck 32(5):594–598Google Scholar
  5. 5.
    Lo WC, Cheng PW, Wang CT, Liao LJ (2013) Real-time ultrasound elastography: an assessment of enlarged cervical lymph nodes. Eur Radiol 23(9):2351–2357CrossRefGoogle Scholar
  6. 6.
    Cheng PW, Chou HW, Wang CT, Lo WC, Liao LJ (2014) Evaluation and development of a real-time predictive model for ultrasound investigation of malignant thyroid nodules. Eur Arch Otorhinolaryngol 271(5):1199–1206CrossRefGoogle Scholar
  7. 7.
    Fukuhara T, Matsuda E, Endo Y et al (2015) Impact of fibrotic tissue on shear wave velocity in thyroid: an ex vivo study with fresh thyroid specimens. Biomed Res Int 2015:569367CrossRefGoogle Scholar
  8. 8.
    Matsuda E, Fukuhara T, Donishi R et al (2017) Usefulness of a novel ultrasonographic classification based on anechoic area patterns for differentiating Warthin tumors from pleomorphic adenomas of the parotid gland. Yonago Acta Med 60(4):220–226CrossRefGoogle Scholar
  9. 9.
    Ahn D, Roh JH, Kim JK (2017) Ultrasound-guided core needle biopsy for head and neck mass lesions in patients undergoing antiplatelet or anticoagulation therapy: a preliminary report. J Ultrasound Med 36(7):1339–1346CrossRefGoogle Scholar
  10. 10.
    Laslett LJ, Alagona P Jr, Clark BA 3rd et al (2012) The worldwide environment of cardiovascular disease: prevalence, diagnosis, therapy, and policy issues: a report from the American College of Cardiology. J Am Coll Cardiol 60(25 Suppl):S1–S49CrossRefGoogle Scholar
  11. 11.
    Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M (2007) Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115(4):459–467CrossRefGoogle Scholar
  12. 12.
    Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R (1986) Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 74(6):1399–1406CrossRefGoogle Scholar
  13. 13.
    Shariat M, Alias NA, Biswal BM (2008) Radiation effects on the intima–media thickness of the common carotid artery in post-radiotherapy patients with head and neck malignancy. Postgrad Med J 84(997):609–612CrossRefGoogle Scholar
  14. 14.
    Faruolo M, Fiorentino A, Gallucci G, Lapadula L, Fusco V (2013) Intimal–medial thickness and carotid arteries lumen in irradiated patients for head and neck cancer: preliminary data of an observational study. Clin Transl Oncol 15(10):861–864CrossRefGoogle Scholar
  15. 15.
    Cheng SW, Ting AC, Wu LL (2002) Ultrasonic analysis of plaque characteristics and intimal–medial thickness in radiation-induced atherosclerotic carotid arteries. Eur J Vasc Endovasc Surg 24(6):499–504CrossRefGoogle Scholar
  16. 16.
    Gujral DM, Chahal N, Senior R, Harrington KJ, Nutting CM (2014) Radiation-induced carotid artery atherosclerosis. Radiother Oncol 110(1):31–38CrossRefGoogle Scholar
  17. 17.
    Liao LJ, Cho TY, Huang TW (2017) Assessment of carotid artery intima–media thickness in patients with obstructive sleep apnoea. Clin Otolaryngol 42(5):974–978CrossRefGoogle Scholar
  18. 18.
    Chambless LE, Heiss G, Folsom AR et al (1997) Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 146(6):483–494CrossRefGoogle Scholar
  19. 19.
    Sullivan GM, Feinn R (2012) Using effect size—or why the P value is not enough. J Grad Med Educ 4(3):279–282CrossRefGoogle Scholar
  20. 20.
    Plummer C, Henderson RD, O’Sullivan JD, Read SJ (2011) Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke 42(9):2410–2418CrossRefGoogle Scholar
  21. 21.
    Hopewell JW, Campling D, Calvo W et al (1986) Vascular irradiation damage: its cellular basis and likely consequences. Br J Cancer Suppl 7:181–191Google Scholar
  22. 22.
    Cheng SW, Ting AC, Lam LK, Wei WI (2000) Carotid stenosis after radiotherapy for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 126(4):517–521CrossRefGoogle Scholar
  23. 23.
    Xu J, Cao Y (2014) Radiation-induced carotid artery stenosis: a comprehensive review of the literature. Interv Neurol 2(4):183–192CrossRefGoogle Scholar
  24. 24.
    Pereira Lima MN, Biolo A, Foppa M et al (2011) A prospective, comparative study on the early effects of local and remote radiation therapy on carotid intima–media thickness and vascular cellular adhesion molecule-1 in patients with head and neck and prostate tumors. Radiother Oncol 101(3):449–453CrossRefGoogle Scholar
  25. 25.
    Liao W, Zhou H, Fan S et al (2018) Comparison of significant carotid stenosis for nasopharyngeal carcinoma between intensity-modulated radiotherapy and conventional two-dimensional radiotherapy. Sci Rep 8(1):13899CrossRefGoogle Scholar
  26. 26.
    Dorth JA, Patel PR, Broadwater G, Brizel DM (2014) Incidence and risk factors of significant carotid artery stenosis in asymptomatic survivors of head and neck cancer after radiotherapy. Head Neck 36(2):215–219CrossRefGoogle Scholar
  27. 27.
    Smith GL, Smith BD, Buchholz TA et al (2008) Cerebrovascular disease risk in older head and neck cancer patients after radiotherapy. J Clin Oncol 26(31):5119–5125CrossRefGoogle Scholar
  28. 28.
    Jordan LC, Duffner PK (2009) Early-onset stroke and cerebrovascular disease in adult survivors of childhood cancer. Neurology 73(22):1816–1817CrossRefGoogle Scholar
  29. 29.
    Cheng SW, Wu LL, Ting AC et al (1999) Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies. Am J Surg 178(4):323–328CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Family MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan, ROC
  2. 2.Department of Otolaryngology Head and Neck SurgeryFar Eastern Memorial HospitalNew Taipei CityTaiwan, ROC
  3. 3.Genomics Research CenterAcademia SinicaTaipeiTaiwan, ROC
  4. 4.Department of Electrical EngineeringYuan Ze UniversityTaoyuanTaiwan, ROC
  5. 5.Biomedical Engineering OfficeFar Eastern Memorial HospitalNew Taipei CityTaiwan, ROC

Personalised recommendations