The usefulness of ultrasound in identifying the underlying findings linked to pain in podagra patients.

AIM: To explore whether ultrasound (US) can be employed to identify the underlying characteristics associated with pain in patients with podagra by evaluating the relationship between ultrasound findings and clinical pain. MATERIAL AND METHODS:  Patients with podagra were recruited and grouped into a pain group (G1, 82 patients) and a non pain group (G2, 123 patients). US features were collected and compared. US data were analyzed by binary logistic regression analysis and ROC analysis. Interobserver reliability was assessed, too. RESULTS: A total of 205 patients (196 male and 9 female) were enrolled in this study. In multivariate analysis, the thickness of the synovium (OR=1.928, CI=1.074-3.463), CD (color Doppler) signal of the synovium (OR=1.458, CI=1.011-2.103), and CD signal of the tophi (OR=1.576, CI=1.142-2.177) were identified as risk factors for clinical pain. Areas under the ROC curves (AUC) were 0.713, 0.686 and 0.641 for the three indicators, respectively. The best cutoff points were 1 mm for the thickness of the synovium, grade 1 for the CD signal of the synovium and grade 2 for the CD signal of the tophi. CONCLUSIONS: Ultrasound can provide valuable information for determining underlying features associated with pain in patients with podagra.

Preoperative Clinical and Ultrasonographic Predictors for Aggressive Behaviors in Sporadic Medullary Thyroid Carcinomas.

Objective: To explore the clinical and ultrasonographic predictors for aggressive behaviors preoperatively in sporadic medullary thyroid carcinomas (MTCs). Materials and Methods: The preoperative clinical and ultrasonographic characteristics of patients diagnosed with MTCs between January 2009 and May 2022 were retrospectively reviewed. MTCs were described and categorized according to the American College of Radiology (ACR) thyroid imaging reporting and data system classification by 2 radiologists. Interobserver agreement was evaluated by kappa test. Univariate and multivariate analyses were performed to identify predictors of aggressive behaviors in MTCs. The log-rank test was utilized to compare differences in Kaplan-Meier (K-M) curves for postoperative disease-free survival (PDFS). Results: A total of 120 patients were enrolled in the final study. Male sex was significant risk factor for metastasis, perithyroidal invasion, and lateral cervical lymph node (LCLN) metastasis [odds ratio (OR): 3.109, P = .019; OR: 5.316, P = .018; OR: 5.154 P = .012, respectively]. The kappa values for all ultrasonic characteristics were high (ranged from 0.811 to 0.941). Size, focality, and margin of the nodule were independent risk factors for metastasis, as well as for LCLN metastasis. Whereas margin (P < .001) and a subcapsular location (P = .021) were risk factors for perithyroidal invasion. According to K-M analysis, PDFS of patients differed significantly between groups with/without metastasis (P < .001), groups with/without perithyroidal extension (P < .001) and groups with/without LCLN metastasis (P < .001). Conclusions: Male sex is an independent risk factor for metastasis, perithyroidal invasion, and LCLN metastasis. The large size (≥2.55 cm for metastasis, ≥2.15 cm for LCLN metastasis, respectively), multifocality, and irregular margin of nodules were independent risk factors for both metastasis and LCLN metastasis. Extrathyroidal extension and a subcapsular location were risk factors for perithyroidal invasion. Moreover, patients with metastasis/perithyroidal extension/LCLN metastasis exhibited worse PDFS.

Distribution patterns of microcalcifications in suspected thyroid carcinoma: a classification method helpful for diagnosis.

PURPOSE: The aim of this study was to compare the distribution patterns of microcalcifications in thyroid cancers with benign cases. METHODS: In total, 358 patients having microcalcifications on ultrasonography were analysed. Microcalcifications were categorised according to the distribution patterns: (I) microcalcifications inside one (a) or more (b) suspected nodules, (II) microcalcifications not only inside but also surrounding a suspected single (a) or multiple (b) nodules, and (III) focal (a) or diffuse (b) microcalcifications in the absence of any suspected nodule. Differences in distribution patterns of microcalcifications in benign and malignant thyroid lesions were compared. RESULTS: We found that the distribution patterns of microcalcifications differed between malignant (n = 325) and benign lesions (n = 117) (X 2 = 9.926, p < 0.01). Benign lesions were classified as type Ia (66.7%), type Ib (29.1%) or type IIIa (4.3%). The specificity of type II and type IIIb in diagnosing malignant cases was 100%. Among malignant lesions, 172 locations were classified as type Ia, 106 as type Ib, 12 as type IIa, 7 as IIb, 7 as type IIIa and 19 as type IIIb. Accompanying Hashimoto thyroiditis was most frequent in type III (51.6%). CONCLUSIONS: Types II and IIIb are highly specific for cancer detection. Microcalcifications outside a nodule and those detected in the absence of any nodule should therefore be reviewed carefully in clinical practice. KEY POINTS: • A method to classify distribution patterns of thyroid microcalcifications is presented. • Distribution features of microcalcifications are useful for diagnosing thyroid cancers. • Microcalcifications outside a suspicious nodule are highly specific for thyroid cancers. • Microcalcifications without suspicious nodules should also alert the physician to thyroid cancers.