Diagnostic Test Accuracy of Ultrasonography vs Computed Tomography for Papillary Thyroid Cancer Cervical Lymph Node Metastasis: A Systematic Review and Meta-analysis.

Importance: The use of ultrasonography (US) vs cross-sectional imaging for preoperative evaluation of papillary thyroid cancer is debated. Objective: To compare thyroid US and computed tomography (CT) in the preoperative evaluation of papillary thyroid cancer for cervical lymph node metastasis (CLNM), as well as extrathyroidal disease extension. Data Sources: MEDLINE and Embase were searched from January 1, 2000, to July 18, 2020. Study Selection: Studies reporting on the diagnostic accuracy of US and/or CT in individuals with treatment-naive papillary thyroid cancer for CLNM and/or extrathyroidal disease extension were included. The reference standard was defined as histopathology/cytology or imaging follow-up. Independent title and abstract review (2515 studies) followed by full-text review (145 studies) was completed by multiple investigators. Data Extraction and Synthesis: PRISMA guidelines were followed. Methodologic and diagnostic accuracy data were abstracted independently by multiple investigators. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool independently and in duplicate. Bivariate random-effects model meta-analysis and multivariable meta-regression modeling was used. Main Outcomes and Measures: Diagnostic test accuracy of US and CT of the neck for lateral and central compartment CLNM, as well as for extrathyroidal disease extension, determined prior to study commencement. Results: A total of 47 studies encompassing 31 942 observations for thyroid cancer (12 771 with CLNM; 1747 with extrathyroidal thyroid extension) were included; 21 and 26 studies were at low and high risk for bias, respectively. Based on comparative design studies, US and CT demonstrated no significant difference in sensitivity (73% [95% CI, 64%-80%] and 77% [95% CI, 67%-85%], respectively; P = .11) or specificity (89% [95% CI, 80%-94%] and 88% [95% CI, 79%-94%], respectively; P = .79) for lateral compartment CLNM. For central compartment metastasis, sensitivity was higher in CT (39% [95% CI, 27%-52%]) vs US (28% [95% CI, 21%-36%]; P = .004), while specificity was higher in US (95% [95% CI, 92%-98%]) vs CT (87% [95% CI, 77%-93%]; P < .001). Ultrasonography demonstrated a sensitivity of 91% (95% CI, 81%-96%) and specificity of 47% (95% CI, 35%-60%) for extrathyroidal extension. Conclusions and Relevance: The findings of this systematic review and meta-analysis suggest that further study is warranted of the role of CT for papillary thyroid cancer staging, possibly as an adjunct to US.

Stenotrophomonas maltophilia as a rare cause of meningitis and ventriculoperitoneal shunt infection.

Stenotrophomonas maltophilia is an extremely rare pathogen responsible for ventriculoperitoneal shunt infection and meningitis. This young female patient with history of multiple shunt revisions in the past, came to us with shunt dysfunction and exposure of the ventriculoperitoneal shunt tube in the neck. The abdominal end of the shunt tube was seen migrating into the bowel during shunt revision. The cerebrospinal fluid analysis showed evidence of Stenotrophomonas maltophilia growth. This is the first reported case of Stenotrophomonas maltophilia meningitis associated with ventriculoperitoneal shunt migration into the bowel.

Arm Numbness at 45 Degrees Abduction: A Case Report of Thoracic Outlet Syndrome After Brachial Neuritis.

OBJECTIVE: To describe a case of nerve kinking correlating with surgical findings in neurogenic thoracic outlet syndrome in a patient with history of brachial neuritis. Thoracic outlet syndrome and brachial neuritis are briefly reviewed. CASE REPORT: A 32-year-old woman with a history of bilateral brachial neuritis presented with paraesthesias in her hand when abducting her shoulder to 45° or higher. A kink in the superior trunk of the brachial plexus, as well as asymmetrically narrowed costoclavicular space, was found on magnetic resonance imaging with the shoulder abducted. Conservative measures failed, leading to partial anterior scalenectomy and neurolysis, which led to improvement in her symptoms. CONCLUSION: Anatomical variations in combination with biomechanical changes after brachial neuritis can be associated with neurogenic thoracic outlet syndrome.

Lung cancer associated with cystic airspaces: Characteristic morphological features on CT in a series of 11 cases.

PURPOSE: To familiarize the reader with the entity 'lung cancer associated with cystic airspaces' (LC-CAS) and create an awareness about the potential for slow progressive development of cancer within these nonaggressive appearing cystic airspaces (CAS) encountered in routine radiology practice. MATERIAL AND METHODS: Morphological appearances of (n = 11) LC-CAS detected during routine radiological reporting of chest CT scans were studied. Patient demographics, clinical history, characteristics of LC-CAS including location, size, wall thickening, diffuse nodularity, eccentric nodule, ground glass change, emphysema and pathology results were collected from the hospital's internal database. RESULTS: Patients with LC-CAS (9F/2M) were between 49 and 77 years (mean 63.18 years). All patients (n = 11) had a history of smoking. LC-CAS had a characteristic multicystic bubbly appearance. Average size of CAS at initial detection of LC was 2.52 cm (range 1.3-4 cm). Lesions were located in the RLL (n = 4), RML (n = 2), RUL (n = 1), LLL (n = 1) and LUL (n = 3) with no lobar predilection and were more commonly peripheral (n = 7) than central (n = 4). Ground glass change (n = 2), extrinsic nodules (n = 4), diffuse wall nodularity (n = 3) and intrinsic nodules (n = 2) were observed and prompted biopsy. Lesions ranged between T1a to T4. Most cancers were T1a N0 (n = 5). Adenocarcinomas formed the majority of cases (n = 9). CONCLUSION: LC-CAS present as new development of diffuse nodularity, eccentric nodules or ground glass change associated with CAS. These are more commonly adenocarcinomas on histology. Recognition of CAS and appropriate malignancy workup when suspicious features are observed is essential to enable early detection of lung cancer.

Intra-articular solitary fibrous tumor of the knee.

A rare case of intra-articular solitary fibrous tumor of the knee in an 84-year-old man is presented. This case report illustrates that solitary fibrous tumor should be included in the extended differential diagnosis of an intra-articular soft tissue mass.

No More HF: Teflon-Assisted Ultrafast Removal of Silica to Generate High-Surface-Area Mesostructured Carbon for Enhanced CO2 Capture and Supercapacitor Performance.

An innovative technique to obtain high-surface-area mesostructured carbon (2545 m(2) g(-1)) with significant microporosity uses Teflon as the silica template removal agent. This method not only shortens synthesis time by combining silica removal and carbonization in a single step, but also assists in ultrafast removal of the template (in 10 min) with complete elimination of toxic HF usage. The obtained carbon material (JNC-1) displays excellent CO2 capture ability (ca. 26.2 wt % at 0 °C under 0.88 bar CO2 pressure), which is twice that of CMK-3 obtained by the HF etching method (13.0 wt %). JNC-1 demonstrated higher H2 adsorption capacity (2.8 wt %) compared to CMK-3 (1.2 wt %) at -196 °C under 1.0 bar H2 pressure. The bimodal pore architecture of JNC-1 led to superior supercapacitor performance, with a specific capacitance of 292 F g(-1) and 182 F g(-1) at a drain rate of 1 A g(-1) and 50 A g(-1) , respectively, in 1 m H2 SO4 compared to CMK-3 and activated carbon.

Diffusion tensor imaging of the normal foot at 3 T.

OBJECTIVE: The objective of this study was to establish normative diffusion tensor imaging (DTI) eigenvalues (λ1,λ2,λ3), apparent diffusion coefficient, and fractional anisotropy in asymptomatic foot muscles. METHODS: Ten healthy adults (mean [SD], 25.9 [4.3] years) were examined using a 3-T magnetic resonance imaging scanner. Diffusion tensor imaging indices were evaluated in 5 muscles in the foot: quadratus plantae, abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, and abductor digiti minimi. Signal-to-noise ratio was also measured for each muscle. RESULTS: In the various foot muscles, λ1 ranged from 1.88 × 10 to 2.14 × 10 mm/s, λ2 ranged from 1.39 × 10 to 1.48 × 10 mm/s, and λ3 ranged from 0.91 × 10 to 1.27 × 10 mm/s; apparent diffusion coefficient ranged from 1.48 × 10 to 1.55 × 10 mm/s; and fractional anisotropy ranged from 0.21 to 0.40. Statistical differences were seen in some eigenvalues between muscle pairs. Mean signal-to-noise ranged from 47.5 to 69.1 in the various muscles examined. CONCLUSIONS: Assessment of anisotropy of water diffusion in foot muscles was feasible using DTI. The measured DTI metrics in the foot were similar to those in calf and thigh skeletal muscles.

Diagnosing Femoroacetabular Impingement From Plain Radiographs: Do Radiologists and Orthopaedic Surgeons Differ?

BACKGROUND: A diagnosis of femoroacetabular impingement (FAI) requires careful history and physical examination, as well as an accurate and reliable radiologic evaluation using plain radiographs as a screening modality. Radiographic markers in the diagnosis of FAI are numerous and not fully validated. In particular, reliability in their assessment across health care providers is unclear. PURPOSE: To determine inter- and intraobserver reliability between orthopaedic surgeons and musculoskeletal radiologists. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Six physicians (3 orthopaedic surgeons, 3 musculoskeletal radiologists) independently evaluated a broad spectrum of FAI pathologies across 51 hip radiographs on 2 occasions separated by at least 4 weeks. Reviewers used 8 common criteria to diagnose FAI, including (1) pistol-grip deformity, (2) size of alpha angle, (3) femoral head-neck offset, (4) posterior wall sign abnormality, (5) ischial spine sign abnormality, (6) coxa profunda abnormality, (7) crossover sign abnormality, and (8) acetabular protrusion. Agreement was calculated using the intraclass correlation coefficient (ICC). RESULTS: When establishing an FAI diagnosis, there was poor interobserver reliability between the surgeons and radiologists (ICC batch 1 = 0.33; ICC batch 2 = 0.15). In contrast, there was higher interobserver reliability within each specialty, ranging from fair to good (surgeons: ICC batch 1 = 0.72; ICC batch 2 = 0.70 vs radiologists: ICC batch 1 = 0.59; ICC batch 2 = 0.74). Orthopaedic surgeons had the highest interobserver reliability when identifying pistol-grip deformities (ICC = 0.81) or abnormal alpha angles (ICC = 0.81). Similarly, radiologists had the highest agreement for detecting pistol-grip deformities (ICC = 0.75). CONCLUSION: These results suggest that surgeons and radiologists agree among themselves, but there is a need to improve the reliability of radiographic interpretations for FAI between the 2 specialties. The observed degree of low reliability may ultimately lead to missed, delayed, or inappropriate treatments for patients with symptomatic FAI.

Femoroacetabular impingement in elite ice hockey players.

PURPOSE: The purpose of this study is to evaluate the presence of clinical and radiological femoroacetabular impingement (FAI) in elite ice hockey players and compare it to a control group of non-athletes. METHODS: Forty participants (20 non-athletes and 20 elite ice hockey athletes) underwent an evaluation of their hip joint, including assessment of range of motion and special provocative impingement tests. Two musculoskeletal radiologists assessed MRIs completed on each participant for radiological findings associated with FAI, including alpha angle, acetabular version angle, acetabular depth, and/or a lateral centre edge angle, and findings of labral and cartilage degeneration. A comparative analysis of the clinical and radiological findings was subsequently completed. RESULTS: There was a significant difference in the radiological CAM impingement measured by mean alpha angle between both groups (non-athletes: 43.2 degrees, SD 9.7; and athletes: 54.2 degrees, SD 12 (p = 0.003)). There were no statistically significant differences between the groups upon evaluating PINCER impingement. There were no statistically significant differences in clinical examination findings between both groups. CONCLUSION: MRI evidence suggests that CAM impingement is more common in the elite ice hockey athlete in comparison with non-athletes. However, as this is a pilot study examining findings in asymptomatic individuals, there is a need for a longitudinal prospective cohort study. In keeping with this, sufficient, long-term follow-up is required to assess at what point, if any, these subjects with radiological findings become symptomatic.

MR imaging of the spine and sacroiliac joints for spondyloarthritis: influence on clinical diagnostic confidence and patient management.

PURPOSE: To quantify the effect of magnetic resonance (MR) imaging of the spine and sacroiliac joints on clinical diagnostic confidence and to determine if MR imaging affects treatment of patients with axial spondyloarthritis. MATERIALS AND METHODS: This prospective observational study was approved by the research ethics board and included 55 consecutive patients referred by three rheumatologists for MR imaging of the spine and sacroiliac joints. Measures of diagnostic confidence for clinical features (inflammatory back pain, mechanical back pain, muscular back pain, radicular back pain, spondylitis, sacroiliitis, and other) and overall diagnoses were made by using a Likert scale both before and after MR imaging. Proposed treatment was similarly recorded before and after MR imaging interpretation. The McNemar test was performed to determine the change in diagnostic confidence and consequent effect on patient treatment. RESULTS: Diagnostic confidence for specific clinical features improved significantly after MR imaging for inflammatory back pain (14% vs 76%, before vs after; P < .001), mechanical back pain (4% vs 49%, P < .001), spondylitis (7% vs 76%, P < .001) and sacroiliitis (9% vs 87%, P < .001). Confidence for overall diagnoses also improved significantly after MR imaging for ankylosing spondylitis (29% vs 80%, P < .001), undifferentiated spondyloarthritis (58% vs 93%, P < .001) and osteoarthritis (29% vs 64%, P < .001). Of the 23 patients for whom tumor necrosis factor-α inhibitor (TNFi) therapy was recommended before MR imaging, 12 (52%) were prescribed TNFi therapy after MR imaging. Of the 32 patients for whom TNFi therapy was not recommended before MR imaging, 10 (31%) patients were prescribed TNFi therapy after MR imaging. Overall, 22 (40%) patients had a change in treatment recommendation regarding TNFi therapy after MR imaging. CONCLUSION: MR imaging of the spine and sacroiliac joints significantly influences the diagnostic confidence of rheumatologists regarding clinical features and overall diagnoses of axial spondyloarthritis, and consequently significantly affects treatment plans.

Radiology-pathology conference: neutrophilic fasciitis and panniculitis of the feet (Sweet's syndrome).

Sweet's syndrome is characterised by pyrexia, cutaneous lesions, neutrophilia and an infiltrate of mature neutrophils in the dermis. While extracutaneous disease is not uncommon, neutrophilic fasciitis has rarely been described. We report the imaging appearances with clinical and histological correlation of a case of drug-induced neutrophilic fasciitis in a 56-year-old man.

Radiology-pathology conference: cutaneous angiosarcoma of the leg.

Cutaneous angiosarcoma is a rare aggressive vascular neoplasm with a poor prognosis, seen usually in the elderly population in a background of chronic lymphedema. We present a case of cutaneous angiosarcoma of the leg without any chronic lymphedema with clinicoradiological and histological correlation.

Quantitative DTI assessment in human lumbar stabilization muscles at 3 T.

OBJECTIVES: To characterize diffusion tensor imaging (DTI) tensor eigenvalues (λ1, λ2, λ3), fractional anisotropy, mean diffusivity, and radial diffusivity in healthy lumbar musculature. METHODS: Seventeen healthy subjects (10 men, 7 women; mean age, 28 ± 7 years) were scanned using a 3.0-T magnetic resonance imaging. Axial DTI was performed using 15 diffusion directions (b = 400 mm/s) at the L4 level. Oswestry Low Back Pain and Godin Physical Activity questionnaires were administered to rule out underlying lower back problems. RESULTS: Skeletal muscle DTI metrics were similar to those previously published. All measurements showed low coefficients of variation, except for quadratus lumborum. Laterality was not significant. Significant sex differences were observed in the quadratus lumborum (P < 0.05). Significant correlations were found between subjects' weight and body mass index with fractional anisotropy and λ1 of the multifidus muscles. CONCLUSIONS: The DTI metrics in paraspinal muscles can be reliably measured and are influenced by body mass index and weight but not by age or physical activity.

The utility of multidetector computed tomography for detection of parathyroid disease in the setting of primary hyperparathyroidism.

PURPOSE: The aim of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the detection of parathyroid adenoma and hyperplasia in the setting of primary hyperparathyroidism. METHODS: Records of 48 patients with biochemically confirmed primary hyperparathyroidism, who underwent preoperative imaging with 16- or 64-slice contrast-enhanced MDCT and subsequent successful parathyroidectomy over a 3-year period, were reviewed. Two radiologists, blinded to the operative and histologic findings, independently evaluated multiplanar computed tomographic images for all patients. RESULTS: On pathologic examination, 63 abnormal glands were confirmed in 41 female and 7 male patients (mean age, 63 years). Of the 63 abnormal glands, 40 were adenomatous and 23 were hyperplastic. MDCT demonstrated an 88% (95% confidence interval [CI], 77%-99%) positive predictive value for localizing abnormal hyperfunctioning parathyroid glands. The sensitivity of MDCT in detecting single-gland disease was 80% (95% CI, 68%-92%); whereas the specificity for ruling out hyperfunctioning parathyroid tissue, either adenomatous or hyperplastic, was 75% (95% CI, 51%-99%). The sensitivity for exclusively localizing parathyroid hyperplasia was 17% (95% CI, 2%-33%). The parathyroid adenomas were substantially larger and heavier than their hyperplastic counterparts, with an average weight of 1.51 g (range, 0.08-6.00 g) and 0.42 g (range, 0.02-2.0 g) for adenoma and hyperplasia, respectively. CONCLUSIONS: Contrast-enhanced MDCT demonstrated an 88% positive predictive value for localizing adenomatous and hyperplastic parathyroid glands. The poor sensitivity for detection of multigland disease was likely a result of the smaller size and weight of the abnormal hyperplastic glands.

Imaging of ulnar-sided wrist pain.

Pain on the ulnar side of the wrist is a complex diagnostic dilemma. This is mainly due to the small size and complexity of the anatomical structures. The issue is compounded by the occurrence of positive imaging findings that are clinically asymptomatic. This pictorial essay deals with the imaging manifestations of different causes of ulnar-sided wrist pain.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation.

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.

Intra-articular nodular fasciitis of the shoulder: a case report and review of the literature.

Nodular fasciitis is a benign proliferation of myofibroblasts usually arising adjacent to the fascia. In this report, we describe a rare case in which nodular fasciitis occurred in an intra-articular location in the shoulder of a 26-year-old man. The mass developed in the subscapularis recess of the shoulder and histological evaluation showed a myofibroblastic proliferation. MRI findings of intra-articular nodular fasciitis are discussed along with a review of previous reports.

Medial ankle and heel: ultrasound evaluation and sonographic appearances of conditions causing symptoms.

The complex anatomy of the medial ankle and hindfoot can make clinical assessment of medial ankle and heel pain challenging. Ultrasound is an accessible, relatively inexpensive modality, and modern high-resolution probes allow eloquent demonstration of the main structures that are implicated as potential causes of medial ankle pain. In this work we review highlights the clinically relevant anatomy and normal sonographic appearances of structures around the medial ankle and heel and discuss key techniques to allow optimal ultrasound assessment. The conditions that cause medial-sided ankle and heel symptoms are discussed with their characteristic sonographic appearances.

MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation.

PURPOSE: Our objectives were to assess if diffusion-weighted imaging (DWI) can help identify abscess formation in the setting of soft tissue infection and to assess whether abscess formation can be diagnosed confidently with a combination of DWI and other unenhanced sequences. METHODS: Eight cases of soft tissue infection imaged with MRI including DWI were retrospectively reviewed. RESULTS: Two male and six female patients were studied (age range 23-50 years). Unenhanced MRI including DWI was performed in all patients. Post-contrast images were obtained in seven patients. All patients had clinically or surgically confirmed abscesses. Abscesses demonstrated restricted diffusion. DWI in conjunction with other unenhanced imaging showed similar confidence levels as post-contrast images in diagnosing abscess formation in four cases. In two cases, although the combined use of DWI and other unenhanced imaging yielded the same confidence levels as post-contrast imaging, DWI was more definitive for demonstrating abscess formation. In one case, post-contrast images had a better confidence for suggesting abscess. In one case, DWI helped detected the abscess, where gadolinium could not be administered because of a contraindication. CONCLUSION: This preliminary study suggests that DWI is a useful adjunct in the diagnosis of skeletal soft tissue abscesses.