Magnetic resonance imaging assessment in patients with axial spondyloarthritis: development of checklists for use in clinical practice.

The objective of our study was to standardize magnetic resonance imaging (MRI) assessment of spine and sacroiliac joints in patients with axial spondyloarthritis (axSpA) and/or inflammatory spinal pain, by creating checklists and templates based on the opinions of rheumatologists and radiologists. A scientific committee developed a series of questionnaires with multiple items regarding MRI in patients with axial inflammatory pain and/or axSpA. Then an expert panel of rheumatologists and radiologists rated all items in a 9-point Likert scale. Finally, the scientific committee and the expert panel met to create the definitive documents. Several definitive checklists and templates were generated for rheumatologist-requested MRI and for radiologist-requested MRI reports of sacroiliac joint and spinal examinations. A technical requirement protocol was also agreed on. Our results could be useful in increasing understanding between rheumatologists and radiologists regarding MRI in axSpA diagnosis and follow-up.

Reproducibility of shear wave velocity measurements by acoustic radiation force impulse imaging of the liver: a study in healthy volunteers.

OBJECTIVES: The purposes of this study were to investigate interobserver reproducibility using acoustic radiation force impulse imaging and to develop an acoustic radiation force impulse scoring system. METHODS: Fifty healthy volunteers with normal liver function test values were selected for the study. Shear wave velocity measurements, expressed in meters per second, were taken in a deep portion of liver segment 6. Two observers with different levels of experience performed the measurements independently and blindly. RESULTS: All of the measurements taken by the 2 observers were valid, even in volunteers with a body mass index of greater than 28 kg/m(2). The results point to very good interobserver reproducibility of shear wave velocity measurements, with an intraclass coefficient correlation of 0.86 (P < .001). CONCLUSIONS: The results of this study show that shear wave velocity measurements using the acoustic radiation force impulse technique and a standardized protocol are accurate and reproducible.

Evaluation of the thyroid nodule with high-resolution ultrasonography and elastography without fine needle aspiration biopsy. / Evaluación del nódulo tiroideo con ecografía y elastografía de alta resolución sin la punción-aspiración con aguja fina.

INTRODUCTION: Fine needle aspiration biopsy (FNAB) is the gold standard screening technique used in the diagnostic protocol for thyroid nodules. However, it is not free of complications. OBJECTIVE: To identify thyroid nodules in which FNAB could be avoided during the diagnostic process by means of the use of a high-resolution ultrasonography or elastography. MATERIAL AND METHOD: A prospective, non-randomized study was carried out. Single thyroid nodules and dominant nodules of multinodular goiter were included. Patients who had undergone thyroid surgery in the past were excluded. All patients underwent a high-resolution ultrasound and elastography, and, subsequently, a FNAB. We analyzed the ultrasound variables in 2D and Doppler, followed by the elastographic variables, and the results of the FNAB according to Bethesda. To correlate the data, the nodules were classified as benign or malignant. Student's t test, the Chi-square test and a logistic regression analysis were applied for the statistical analysis. RESULTS: A total of 221 thyroid nodules were analyzed, 32 of which were malignant (14%). The most predictive ultrasound findings of malignancy (P<.05) were a hypoechoic or complex echostructure (OR=11.832), the presence of microcalcifications (OR=9.637) and chaotic vascularization observed in the Doppler (OR=46.464). With regard to the elastography, elastographic patterns i and ii were seen to be associated with benignity (P=.0004 and P<.0001, respectively). When type i or ii elastography was combined with an ultrasound showing a non-hypoechoic nor complex echostructure, without microcalcifications nor chaotic vascularization in the Doppler ultrasound, 100% of the cases were benign with a specificity of 100% and a sensitivity of 14%. CONCLUSIONS: The combination of a high-resolution ultrasound with an elastography makes it possible to select cases where a FNAB does not have to be performed. Cases susceptible to a periodic follow-up without the use of a FNAB are those without a hypoechoic nor complex structure, no microcalcifications, non-chaotic vascularization and a type i or ii elastography.

Utilidad de la elastografía en los nódulos tiroideos con citología indeterminada o sospechosa de malignidad / Utility of elastography in thyroid nodules with indeterminate cytology

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Evaluación del nódulo tiroideo con ecografía y elastografía de alta resolución sin la punción-aspiración con aguja fina / Evaluation of the thyroid nodule with high-resolution ultrasonography and elastography without fine needle aspiration biopsy

Introducción: La punción-aspiración con aguja fina (PAAF) es la técnica diagnóstica gold standard en el protocolo diagnóstico del nódulo tiroideo. Sin embargo, no está exenta de complicaciones. Objetivo: Establecer los nódulos tiroideos en los que se podría evitar la PAAF en el protocolo diagnóstico con la inclusión de la ecografía de alta definición y la elastografía. Material y método: Se realiza un estudio prospectivo no aleatorizado. Se incluyen nódulos tiroideos solitarios y los nódulos dominantes del bocio multinodular. Se excluyeron los pacientes con cirugía tiroidea previa. A todos los pacientes se les realiza primero una ecografía de alta resolución y una elastografía, y posteriormente una PAAF. Se analizan las variables ecográficas en 2D y doppler, las elastográficas, y el resultado de la PAAF según Bethesda. Para correlacionar los datos, los nódulos se clasifican como benignos o malignos. Para el análisis estadístico se aplica el test de la t de Student, el test de Chi-cuadrado y un análisis de regresión logística. Resultados: Se analizan 221 nódulos tiroideos, de los cuales 32 fueron malignos (14%). Los hallazgos ecográficos más predictores de malignidad (p<0,05) son la ecoestructura hipoecoica o compleja (OR=11,832), las microcalcificaciones (OR=9,637) y la vascularización caótica con el doppler (OR=46,464). Respecto a la elastografía, el patrón elastográfico I y II se asocian a benignidad (p=0,0004 y p<0,0001, respectivamente). Cuando se combina la elastografía tipo I o II, y la ecografía con ecoestructura no hipoecoica ni compleja, sin microcalcificaciones y sin vascularización caótica en la ecografía doppler, el 100% de los casos eran benignos, con una especificidad del 100% y una sensibilidad del 14%. Conclusiones: La combinación de la ecografía de alta resolución y la elastografía permite seleccionar casos donde no es necesario realizar una PAAF. Los casos susceptibles de seguimiento periódico sin realización de PAAF son aquellos que no presentan ecoestructura hipoecoica o compleja, que no muestran microcalcificaciones y en los que la vascularización no es caótica, junto con una elastografía tipo I y II

Introduction: Fine needle aspiration biopsy (FNAB) is the gold standard screening technique used in the diagnostic protocol for thyroid nodules. However, it is not free of complications. Objective: To identify thyroid nodules in which FNAB could be avoided during the diagnostic process by means of the use of a high-resolution ultrasonography or elastography. Material and method: A prospective, non-randomized study was carried out. Single thyroid nodules and dominant nodules of multinodular goiter were included. Patients who had undergone thyroid surgery in the past were excluded. All patients underwent a high-resolution ultrasound and elastography, and, subsequently, a FNAB. We analyzed the ultrasound variables in 2D and Doppler, followed by the elastographic variables, and the results of the FNAB according to Bethesda. To correlate the data, the nodules were classified as benign or malignant. Student's t test, the Chi-square test and a logistic regression analysis were applied for the statistical analysis. Results: A total of 221 thyroid nodules were analyzed, 32 of which were malignant (14%). The most predictive ultrasound findings of malignancy (P<.05) were a hypoechoic or complex echostructure (OR=11.832), the presence of microcalcifications (OR=9.637) and chaotic vascularization observed in the Doppler (OR=46.464). With regard to the elastography, elastographic patterns I and II were seen to be associated with benignity (P=.0004 and P<.0001, respectively). When type I or II elastography was combined with an ultrasound showing a non-hypoechoic nor complex echostructure, without microcalcifications nor chaotic vascularization in the Doppler ultrasound, 100% of the cases were benign with a specificity of 100% and a sensitivity of 14%. Conclusions: The combination of a high-resolution ultrasound with an elastography makes it possible to select cases where a FNAB does not have to be performed. Cases susceptible to a periodic follow-up without the use of a FNAB are those without a hypoechoic nor complex structure, no microcalcifications, non-chaotic vascularization and a type I or II elastography