Zuckerkandl Tubercle of the Thyroid Gland: Correlations between Findings of Anatomic Dissections and CT Imaging.

BACKGROUND AND PURPOSE: The Zuckerkandl tubercle is located at the posteromedial border of the thyroid lobe, and it may be confused with a neoplasm or other mass. This study was performed to clarify the position and morphologic characteristics of the Zuckerkandl tubercle by dissecting cadavers and to compare the findings with the corresponding CT images obtained in the same cadavers. MATERIALS AND METHODS: One hundred thyroid lobes from 50 fresh cadavers were dissected for this study (20 males and 30 females; mean age at death, 77.3 ± 11.5 years). CT scans were obtained in 10 of the cadavers by using a 128-channel multidetector row CT scanner before dissection. RESULTS: The Zuckerkandl tubercle of the thyroid gland was observed in 83% of the specimens. It was mostly located at the posteromedial border of the thyroid lobe and within the middle two quarters (2nd and 3rd) of the thyroid lobe. The Zuckerkandl tubercle was classified into 3 types based on its direction of extension: posteromedial in 64% of the specimens, posteromedial and superior in 13%, and posteromedial and inferior in 6%. On axial CT, the Zuckerkandl tubercle was usually continuous with the posteromedial part of the thyroid lobe and extended posteromedially to the esophagus. The parts of the Zuckerkandl tubercle that protrude posteromedially and superiorly or posteromedially and inferiorly from the thyroid lobe appeared separated from the thyroid gland by a thin, low-density string on axial CT. CONCLUSIONS: Zuckerkandl tubercles that protrude toward the posteromedial and superior or inferior direction could cause confusion due to their separation when performing diagnoses with CT images.

DCE and DSC MR perfusion imaging in the differentiation of recurrent tumour from treatment-related changes in patients with glioma.

AIM: To retrospectively compare the utility of perfusion magnetic resonance imaging (MRI) in distinguishing treatment-related changes from recurrent disease in glioma patients. MATERIALS AND METHODS: Thirty-one patients with histologically diagnosed gliomas and increased enhancement after or during concurrent (chemo-) radiation therapy were enrolled. They underwent dynamic contrast-enhanced (DCE) permeability MRI followed by dynamic susceptibility contrast (DSC) perfusion MRI. The vascular transfer constant (rK(trans)) and initial areas under the concentration curve (riAUC) were obtained from DCE MRI, and cerebral blood volume (rCBV) was obtained from DSC MRI. Patients were classified as having treatment-related changes or recurrent tumours based on clinicoradiological results or pathological results from surgery. RESULTS: Nineteen patients were diagnosed as having recurrences and 12 patients as having treatment-related changes. The rK(trans), riAUC, and rCBV values in the recurrent group were significantly higher than the values in the group with treatment-related changes (p < 0.05). For all 31 patients, there was no significant difference between DSC MRI and DCE MRI for the differentiating power between recurrence and treatment-related changes (p = 0.7227). However, when including only the 24 patients with concordant values of rK(trans) and riAUC, DCE MRI showed a significant AUC value of 0.786 in the receiver operating characteristic (ROC) curve analysis (p = 0.003), whereas DSC MRI did not (AUC = 0.643, p = 0.229). CONCLUSION: MRI perfusion images appear to show promise in distinguishing treatment-related changes from recurrent tumours. When both rK(trans) and riAUC show concordant values, DCE MRI seems to be more powerful than DSC MRI in the differentiation of recurrence from treatment-related changes.

Rupture of benign thyroid tumors after radio-frequency ablation.

Rupture of benign thyroid tumors after RFA is very rare. We experienced 6 cases in 4 institutions. All patients presented with abrupt neck swelling and pain between 9 and 60 days after RFA. Imaging and clinical findings of the ruptured tumors were anterior subcapsular location, mixed composition, large size, and repeated ablations. Conservative treatment was sufficient in 3 cases, whereas surgical management was required in 3.

Treadmill exercise improves cognitive function and facilitates nerve growth factor signaling by activating mitogen-activated protein kinase/extracellular signal-regulated kinase1/2 in the streptozotocin-induced diabetic rat hippocampus.

This study aimed to investigate the effects of regular treadmill exercise on nerve growth factor (NGF) expression, the improvement of cognitive function in the hippocampus of diabetic rats, and to understand the molecular mechanisms through which the relevant signaling factors act. We investigated the effects of regular treadmill exercise for 6 weeks on NGF, tyrosine kinase receptor A (TrkA), p75 receptor, phosphatidylinositol 3-kinase (PI3-K), mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase 1/2 (Erk1/2), cyclic AMP response element-binding protein (CREB), and caspase-3 protein levels; we also assessed cell survival and cognitive function. Forty male Sprague-Dawley rats were divided into four groups: (1) normal control group (NCG: n=10); (2) normal exercise group (NEG: n=10); (3) diabetes control group (DCG: n=10), and (4) diabetes exercise group (DEG: n=10). Diabetes was induced by injecting streptozotocin (STZ; 55 mg/kg dissolved in 0.05 M citrate buffer, pH 4.5, i.p.) into rats. Rats were subjected to treadmill exercise for 5 days a week over 6 weeks, and the speed of the treadmill was gradually increased. In a passive avoidance test, the retention latency in the DCG was significantly shorter than that in the DEG (P<0.05). Increased 5-bromo-2'-deoxyuridine-5'-mono-phosphate (BrdU)-labeled cells (P<0.001) and significant increases in NGF and TrkA protein levels were observed in the hippocampal dentate gyrus in the NEG and DEG (P<0.001 and P<0.01, respectively). The p75 receptor protein level significantly increased in the NEG but decreased in the DCG (P<0.001). The p-PI3-K and t-CREB protein levels significantly increased in the NEG (P<0.001 and P<0.05, respectively), whereas t-Erk1/2 significantly decreased in the DCG (P<0.01, P<0.01, respectively). p-Erk1/2 and p-CREB protein levels significantly increased in the NEG and DEG (P<0.001, P<0.001, and P<0.01, respectively). Caspase-3 protein levels significantly increased in the DCG (P<0.001). These results show that treadmill exercise improves cognitive function, increases the number of BrdU-labeled cells, and increases NGF levels, by the activation of the MAPK/Erk1/2 signaling pathway in the hippocampus of diabetic rats.

Primary amyloidoma of the cervical spine.

Primary solitary amyloidoma of the spine is a disease characterized by localized deposits of amyloid. We describe and illustrate the radiologic appearance of primary solitary amyloidoma of the spine on plain radiographs, CT scans, and MR images. The imaging findings revealed features of a nonspecific soft-tissue mass with calcifications. Epidural extension of the amyloidoma caused spinal cord compression.

Parosteal lipoma with hyperostosis.

A case of parosteal lipoma of the femur combined with hyperostosis is presented. The parosteal lipoma is a rare benign tumor containing adipose tissue and is intimately related to the periosteum. We report the MRI features and correlative pathologic findings of a parosteal lipoma. The MRI technique is useful for evaluating the relationship between the periosteum and the lipoma.

Cemento-ossifying fibroma presenting as a mass of the parapharyngeal and masticator space.

We report a case of cemento-ossifying fibroma that presented as a large extraosseous mass in the masticator and parapharyngeal space. CT scanning and MR imaging showed a large extraosseous mass with central conglomerated, well-matured ossified nodules and fatty marrow. The central matured ossified nodules were of low density on CT scans and high signal intensity on T1- and T2-weighted MR images. Multiplanar reformatted CT scans revealed the origin of the mass to be at the extraction site of the right lower second molar tooth.