Diagnostic Accuracy of Five Different Classification Systems for Thyroid Nodules: A Prospective, Comparative Study.

OBJECTIVE: To compare the diagnostic performance of five different thyroid ultrasound classification systems, and determine which system is optimal for evaluating thyroid nodules and reducing the unnecessary biopsy rate. METHODS: In this prospective study, 1,010 nodules referred for biopsy during a 2-year period were classified using five classification systems: the Kwak Thyroid Imaging Reporting and Data System (Kwak TI-RADS), the European TI-RADS (EU TI-RADS, the Korean TI-RADS (K TI-RADS), the American College of Radiology TI-RADS (ACR TI-RADS), and the American Thyroid Association (ATA) classification. After fine needle aspiration biopsy, all classifications were compared for all nodules and also particularly for nodules sized 1-3 cm. Sensitivity, specificity, and interobserver agreement were evaluated for each classification system. RESULTS: Of the 939 nodules (after exclusion of Bethesda 3 nodules) finally classified according to the surgical histopathology and cytology results, 73 (7.8%) were malignant and 866 nodules were benign (92.2%). The sensitivity was highest (94.5%) for the ACR TI-RADS and lowest for the Kwak TI-RADS (69%). After exclusion of small (<1 cm) and large nodules (>3 cm); while sensitivity was highest for ATA (97.8%), ACR TI-RADS was the second best classification (91.3%). There was substantial agreement among all classification systems except the Kwak TI-RADS (fair agreement). CONCLUSIONS: The ACR TI-RADS was the most sensitive ultrasound risk stratification system for all nodules, while the Kwak TI-RADS was the most specific, ie, the most capable of excluding benign nodules based on the combined cytological and histopathological results. ATA and ACR-TIRADS were the most sensitive classification systems for nodules 1 to 3 cm in size. The ACR TI-RADS had higher sensitivity than the Bethesda classification system when compared according to the histopathological results.

A newly described imaging finding for idiopathic normal pressure hydrocephalus: Can hummingbird sign contribute to the diagnosis?

Background/aim: In this study, we aimed to evaluate whether morphological changes in the mesencephalon, which were previously described as a diagnostic tool for progressive supranuclear palsy, could be associated also with idiopathic normal pressure hydrocephal Materials and methods: Consecutive 52 patients with a possible diagnosis of idiopathic normal pressure hydrocephalus (32 female, mean age 73.6 years) and 40 controls (23 female, mean age 72.7 years) with similar demographic characteristics were included the study. The morphologic changes in mesencephalon, hummingbird sign, and the vascular compression to mesencephalon were noted. Besides, three independent observers evaluated the imaging parameters for idiopathic normal pressure hydrocephalus in magnetic resonance imaging. Inter-observer reliabilities for qualitative and quantitative data were assessed using the Cronbach's alpha and intra class correlation coefficient. The correlation of the imaging parameters with each other was evaluated with Pearson correlation. Results: Hummingbird sign was found to be significantly more common among patients with idiopathic normal pressure hydrocephalus (p < 0.0001). A statistically significant correlation was found between hummingbird sign and vascular compression of patients in the study group (p < 0.0001). A substantial, good, and perfect agreement was found between observers at all levels except callosal angle (fair agreement). Conclusion: Hummingbird sign can be used to support the diagnosis of idiopathic normal pressure hydrocephalus in addition to other radiological findings. A significant correlation between vascular compression and hummingbird sign in the patient group may explain the morphological changes in the mesencephalon that resemble the Hummingbird sign, which was previously described for progressive supranuclear palsy.

Differentiation of Benign and Malignant Parotid Gland Tumors with MRI and Diffusion Weighted Imaging.

OBJECTIVE: This study investigated the effectivity of Magnetic Resonance Imaging (MRI) findings and Apparent Diffusion Coefficient (ADC) value in evaluating parotid gland tumors (PGTs), and aimed to reduce the biopsy procedure before surgery. METHODS: This retrospective study included 54 PGTs of 42 patients' (24 female, 18 male, mean age; 51.4±15.9). All of the patients had an MRI, and histopathologic diagnosis. The signal intensity [T1 and T2 Weighted (W), T1W after intravenous contrast agent injection] and mean ADC values of the PGTs were measured. Also contrast enhancement pattern (homogenous, heterogeneous, peripheral or none), margin features (well or ill-defined), sizes, location (superficial lobe/deeplobe/both), perineural spread, presence of lymphadenopathy, and extension to adjacent structures were noted. RESULTS: The distribution of PGTs was; 21 pleomorphic adenomas, 18 Warthin tumors, 2 lymph nodes, 2 mucoepidermoid carcinomas, 5 adenoid cystic carcinoma, 1 basal cell carcinoma,2 metastases and 2 lymphomas; (13 malignant and 41 benign lesions). Morphologic parameters; ill-defined margin, perineural spread, lymphadenopathy, and extension to adjacent structures were found to be significantly associated with malign lesions (p<0.01). There was a significant difference between ADC values of malignant and benign PGTs (p<0.05). Also ADC values and T2 signal intensity was significantly lower in Warthin tumors rather than pleomorphic adenomas (p<0.05). CONCLUSIONS: Mean ADC values when considered with morphological features may be accessible methods to distinguish benign and malignant PGTs, also ADC values and T2 signal intensity may be useful for differentiating pleomorphic adenomas from Warthin tumors, thereby reducing the number of biopsies and thus complications.

CT Evaluation of Variations in the Middle Cranial Fossa Foramina: A Potential Guide for Skull Base Surgery.

OBJECTIVES: To evaluate and classify the variations of foramen ovale (FO), foramen spinosum (FS). METHODS: Six hundred fifty-eight computed tomographies (CTs) were evaluated by 2 observers. Foramen ovale was classified as oval, almond, round, and slit-like. Duplication, absence, and confluence for FS were noted. Bony outgrowths were categorized as tubercule, bony plate, and spine. RESULTS: Oval shaped FO was the most common subgroup. Most common FS variation was the confluence with FO. Of bony outgrowths, tubercule-shaped were the most common type and spine-shaped ones were the least. Substantial agreement for bony plate and tubercule, almost excellent agreement for all the other parameters were found between 2 observers. CONCLUSIONS: Foramen ovale called lobulated and had not classified previously was described in this study. Computed tomography is a reliable tool for anatomical evaluation of FO and FS, which would effect the methods of middle cranial fossa surgery. Thus, radiologists should be a pathfinder about the variations of these structures.

Investigation of the accessory maxillary ostium: a congenital variation or acquired defect?

OBJECTIVE: We sought to determine whether an accessory maxillary ostium (AMO) is a congenital or acquired condition and we investigated concomitant sinus pathologies associated with this structure. METHODS: Paranasal sinus CT examinations of individuals aged ≥13 years and <13 years were compared retrospectively. In total, 552 sinuses of 276 patients aged ≥13 years (Group 1) and 284 maxillary sinuses of 142 children aged <13 years (Group 2) were evaluated. Patients were classified as AMO-positive or -negative. The following features were evaluated in Group 1: AMO presence, mucus retention cysts, mucosal thickening, sinusitis of the maxillary sinus, nasal septum deviation, concha hypertrophy, concha bullosa, primary ostium obstruction, uncinate process atelectasis, paradox concha, Agger nasi and Haller cells, and sinus hypoplasia. The sizes and locations of AMOs were also evaluated. The presence of an AMO and sinusitis were evaluated in Group 2. RESULTS: AMOs were detected in 122 sinuses in Group 1. In the AMO-positive group, sinusitis, mucosal thickening, and primary ostium obstruction were significantly more common than in the AMO-negative group (p < 0.00001). Statistically significant associations were not observed between AMO presence and other parameters. AMOs were present in two sinuses in Group 2. CONCLUSION: Our results suggest that AMOs are acquired defects caused by sinus diseases. The rare occurrence of these structures in patients aged <13 years suggests that they may be a perforation or secondary drainage pathway in patients with sinusitis or primary ostium obstruction.

Clinical features, diagnosis, and treatment of traumatic pulmonary pseudocysts.

BACKGROUND: Traumatic pulmonary pseudocysts (TPP) are rare complications of blunt chest trauma. The aim of this study is to increase the understanding of this rare entity with imaging and clinical parameters for preventing complications and determining the correct treatment approach by observing 15 cases. METHODS: We retrospectively reviewed the medical data and thoracic computed tomography scans of 185 patients who underwent examinations in our department after chest trauma between July 2014 and December 2015. RESULTS: Fifteen patients had TPPs, and their clinical features and imaging findings were evaluated. Their average age was 26.33 (range, 1-89) years. The cause of TPP was traffic accident in 13 patients and falling from a height in two. Tube thoracostomy was required in five patients. None of the patients required thoracotomy, and 66% of them recovered without any complications. Five patients died because of serious concomitant injuries. CONCLUSION: Sudden shearing force across the pulmonary parenchyma results in an area of pulmonary contusion and airtransfer from the airway to the contused area, which in turn leads to pneumatocele formation. Conservative treatment is recommended for these patients, but complications can occur because of cyst rupture. Patients should be closely monitored and be made aware of the risk of life-threatening complications.

Diagnostic imaging findings of pelvic retroperitoneal ganglioneuroma in a child: a case report with the emphasis on initial ultrasound findings.

Ganglioneuromas are rare benign tumors of neural crest origin developed along the sympathetic chain. The pelvic retroperitoneum is the rarest location of these tumors. Clinically these tumors are commonly asypmtomatic even if they reach large sizes. Here we report the radiological features of a 16 year old boy with pathologically proven retroperitoneal ganglioneuroma that was detected initially by ultrasound. Relevant literature is also discussed.