Development and validation of a nomogram for preoperative prediction of level VII nodal spread in papillary thyroid cancer: Radiologic-pathologic correlation.

PURPOSE: To develop and validate a diagnostic nomogram for preoperative prediction of the level VII nodal spread in papillary thyroid cancer (PTC) by incorporating CT features. METHODS: A dataset of 7896 patients experiencing thyroidectomy for thyroid cancer was collected retrospectively from two hospitals, and 300 patients were finally included in this study. The CT features of metastatic LN were extracted with a one by one match of radiologic-pathologic correlation. Multivariable binary logistic regression analysis was used to develop predicting model, and then a nomogram was developed utilizing a primary cohort of 152 patients from hospital #1. The nomogram was validated in external cohort of 62 patients from hospital #2 and an independent cohort of 86 patients from hospital #1. The performance of the nomogram was evaluated with respect to its calibration, discrimination. RESULTS: 531 LNs from 300 patients were analyzed. 42.6% LNs were > 5 mm in short diameter. A total of 7 selected CT features were significantly associated with LN status (P < 0.05), including nodular enhancement, cystic change, calcification and so on. These features were contained in the prediction nomogram. The model showed good discrimination and good calibration, with a C-index of 0.938 (95% CI, 0.913 to 0.963) and 0. 795 (95% CI, 0. 726 to 0.864) for the primary cohort and the validation cohort, respectively. Decision curve analysis demonstrated that the nomogram was clinically applicable. CONCLUSIONS: This nomogram incorporating pathologically relevant CT features has demonstrated a high diagnostic value for predicting level VII nodal spread in PTC. Our work may help thyroid surgeon to decide whether upper mediastinal lymphadenectomy should be performed, which is associated with thoracotomy or other surgery.

The white matter hyperintensities within the cholinergic pathways and cognitive performance in patients with Parkinson's disease after bilateral STN DBS.

BACKGROUND: White matter hyperintensities (WMHs) in the cholinergic pathways are associated with cognitive impairment in Parkinson's disease (PD). This study aimed to investigate the role of WMHs within the cholinergic pathways in cognitive performance following bilateral subthalamic nucleus deep brain stimulation (STN DBS) in patients with PD. METHODS: 38 patients with PD who underwent bilateral STN DBS were assessed using the Cholinergic Pathways Hyperintensities Scale (CHIPS) with magnetic resonance imaging before surgery. Their cognitive statuses were evaluated pre-surgically and 6 months, 1 year, and 2 years post operation. The correlations between the CHIPS score and cognitive performance were analyzed. The differences in cognitive performance before and after the surgery between the high-CHIPS and low-CHIPS groups were also compared. RESULTS: The CHIPS score in patients with PD negatively correlated with the general cognition assessed using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) both at baseline and after DBS. No correlation was found between the CHIPS score and the change of MMSE and MoCA scores after DBS. No significant difference was observed in the change in cognitive performance after the surgery between the high and low-CHIPS groups. CONCLUSION: The severity of cholinergic WMHs was correlated with the cognition in patients with PD both before and after the STN DBS. However, it does not correlate with the cognitive change in patients with PD after bilateral STN-DBS.

Hemangioma of long tubular bone: imaging characteristics with emphasis on magnetic resonance imaging.

OBJECTIVE: To investigate the imaging findings, especially the MRI findings, of intraosseous hemangioma of long tubular bones and to improve the recognition of this rare tumor. MATERIALS AND METHODS: The imaging characteristics of 16 histopathologically diagnosed long tubular bone hemangioma lesions were retrospectively reviewed on radiography (n = 16), CT (n = 16), and MRI (n = 15). RESULTS: Thirteen of 16 lesions were intramedullary, whereas the other three were cortical, subperiosteal, and mixed intracortical and intramedullary, respectively. The radiologic appearance of long bone intraosseous hemangioma was divided into five types: cyst-like (n = 7), mesh- or honeycomb-like (n = 6), medullary sclerosis (n = 1), cortical thickening (n = 1), and cortical lytic type (n = 1). Radiography and CT allowed the identification of sclerotic margins in eight cases, thickened trabeculae in six cases, internal calcification in one case, cortical thickening in one case, and fracture in four cases. Two lesions were confusing on radiography but clearly identifiable on MRI. All intraosseous hemangioma showed high signal intensity on T2-weighted imaging and intermediate signal intensity on T1-weighted imaging. Four cyst-like lesions showed peripheral and filling enhancement, whereas others exhibited diffuse enhancement with an intensity similar to adjacent vessels. CONCLUSION: Cystic and mesh types are the most common types of hemangioma in long tubular bones. MRI can help to define the location and extent of lesions. The tumor usually shows high signal intensity on T2-weighted imaging and intermediate signal intensity on T1-weighted imaging. Peripheral and filling or diffuse enhancement with an intensity similar to vessels is helpful for the diagnosis of intraosseous hemangioma.

Three-dimensional MRI with contrast diagnosis of diseases involving peripheral oculomotor nerve.

PURPOSE: The purpose was to evaluate three-dimensional magnetic resonance imaging with contrast (3D-CEMRI) in displaying peripheral oculomotor nerve (PON) and diagnosing peripheral oculomotor nerve diseases (POND). MATERIALS AND METHODS: The MRI findings of 80 patients with POND were reviewed and compared with digital subtraction angiography (DSA), operative or pathological results, and final clinical diagnosis. RESULTS: Twenty-three aneurysms (23/26) confirmed by DSA were detected with Magnetic Resonance Angiography (MRA). Twenty-five inflammatory lesions, 14 malignant lesions, and 5 benign lesions involving PON were shown with 3D-CEMRI corresponding with clinical diagnosis and pathology. Another 13 (13/80, 16.03%) cases were negative on MRI. CONCLUSION: 3D-CEMRI with MRA could show and diagnose the majority of the diseases involving PON.