Off-site evaluation of three-dimensional ultrasound for the diagnosis of thyroid nodules: comparison with two-dimensional ultrasound.

OBJECTIVES: We compared the diagnostic performance of off-site evaluation between prospectively obtained 3D and 2D ultrasound for thyroid nodules. METHODS: 3D and 2D ultrasonographies were preoperatively obtained from 85 consecutive patients (mean age, 51 years; age range, 28-83 years) who were referred for a total thyroidectomy. Three radiologists independently evaluated 3D and 2D images of 91 pathologically confirmed thyroid nodules (30 benign and 61 malignant nodules) for nodule characterization. Diagnostic performance, interobserver agreement and time for scanning were compared between 3D and 2D. RESULTS: 3D had significantly higher sensitivities than 2D for predicting malignancy (78.7 % vs. 61.2 %, P < 0.01) and extrathyroidal extension (66.7 % vs. 46.4 %, P = 0.03) in malignancy. In terms of specificities, there were no statistically significant differences between 2D and 3D for predicting malignancy (78.4 % vs. 74.8 %, P = 1.00) and extrathyroidal extension (63.6 % vs. 57.6 %, P = 0.46). With respect to interobserver agreement, 3D showed moderate agreement (κ = 0.53) for predicting extrathyroidal extension in malignancy compared with 2D ultrasound, which showed fair agreement (κ = 0.37). 3D saved time (30 ± 56.52 s) for scanning compared with 2D. CONCLUSION: For off-site evaluation, 3D US is more useful for diagnosis of thyroid nodules than 2D US. KEY POINTS: • 3D had higher sensitivity than 2D for predicting malignancy and extrathyroidal extension. • 3D showed better agreement for predicting extrathyroidal extension in malignancy than 2D. • 3D thyroid ultrasound saved time for scanning compared with 2D. • For off-site evaluation of thyroid nodules, 3D is more useful than 2D.

Transient subsolid nodules in patients with extrapulmonary malignancies: their frequency and differential features.

BACKGROUND: For pulmonary subsolid nodules (SSNs) in patients with extrapulmonary malignancies, it is still unclear what proportion of SSNs is transient and how we can more accurately diagnose these transient SSNs. PURPOSE: To investigate the frequency of transient SSNs and their differentiating clinical and thin-section computed tomography (CT) features in patients with extrapulmonary malignancies. MATERIAL AND METHODS: From January 2005 to February 2012, 78 SSNs in 63 individuals (30 men and 33 women; mean age, 55.1 years ± 15.5) with extrapulmonary malignancies were identified. Their clinical and thin-section CT characteristics were reviewed and compared between transient and persistent SSNs. Differentiating factors and their performance were also measured. RESULTS: Thirty-six of the 78 SSNs (46.2%) were transient. Between transient and persistent SSNs, there were significant differences in patients' age, sex, detection mode, and the presence of eosinophilia, lesion multiplicity, lesion margin, and pleural retraction (P < 0.05). Multivariate analysis revealed that follow-up detected SSNs (adjusted odds ratio [OR], 38.88), multiple lesions (OR, 7.64), and an ill-defined nodular margin (OR, 11.93) were significant discriminators of transient SSNs (P < 0.05). Discrimination of transient SSNs was significantly better upon incorporating both clinical and thin-section CT features than using clinical features alone (P < 0.05). CONCLUSION: Approximately half of the SSNs detected in patients with extrapulmonary malignancies were transient. Transient SSNs in these patients can be very accurately differentiated using their thin-section CT and clinical features.

Spine MR imaging features of subacute combined degeneration patients.

BACKGROUND AND PURPOSE: Subacute combined degeneration (SCD) is a potentially reversible neurological complication of a vitamin B12 deficiency; therefore, timely diagnosis and appropriate treatment are of great importance. The study was to evaluate the spine MR imaging features of SCD in a series of patients. MATERIALS AND METHODS: Eight patients diagnosed with SCD from 2008 to 2010 comprised the study population. Spine MRIs were available for all eight patients, and three of them had follow-up MRIs after vitamin B12 treatment. Two radiologists evaluated the prevalence of signal intensity abnormality of spinal cord and analyzed the distribution and pattern of the signal change in consensus. And they also evaluated post-treatment MRI to find interval change. RESULTS: Seven of eight patients showed abnormal hyperintensity within posterior aspect of spinal cord on T2-weighted images. The spinal cord abnormalities were seen at cervical spine in five patients (62.5 %) and at thoracic spine in the other two patients (25 %). For patients with cervical spinal cord abnormalities, axial T2-weighted images showed symmetric linear T2-hyperintensity as an "inverted V" at cervical spinal cord. For patients with thoracic spinal cord abnormalities, the abnormal signal intensity looked bilateral paired nodular T2-hyperintensity as "dumbbell" or "binoculars" at thoracic spinal cord. Follow-up MRIs after vitamin B12 treatment showed interval resolution of the areas of abnormal T2-hyperintensity in all. CONCLUSION: Symmetric T2-hyperintensity within dorsal column of spinal cord is commonly seen in SCD patients with a linear pattern in the cervical spine and a nodular pattern in the thoracic spine.

Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules.

INTRODUCTION: We aimed to evaluate the correlation between the size of the solid component on thin-section computed tomography (CT) and invasive component on pathology in small lung adenocarcinomas manifesting as subsolid nodules. METHODS: Fifty-nine subsolid nodules in 58 patients were evaluated. The maximum diameters of subsolid nodules and the solid component on CT were measured by two radiologists in three-dimensional (3D) and two-dimensional (2D) planes using in-house software. In addition, the maximum diameters of the tumor and invasive component were measured on pathology by two pathologists. CT measurements were compared with pathologic measurements. RESULTS: There was a strong correlation between the size of the solid component on CT and invasive component on pathology, as well as the size of subsolid nodules and the tumor size (r = 0.82-0.87 for 3D measurement, 0.72-0.88 for 2D measurement; p < 0.0001). The size of subsolid nodules in 3D and 2D measurements was significantly larger than tumor size (p < 0.0001). In regard to measurement of the solid component, 3D measurements tended to be larger than the size of the invasive component whereas 2D measurement tended to be similar to the size of the invasive component. By applying a size criteria of solid component that was 3 mm or lesser in maximum diameter, preinvasive and minimally invasive adenocarcinoma was predicted with a specificity of 100% (28 of 28). CONCLUSION: We found a significant correlation between the size of the solid component on thin-section CT and the invasive component on pathology.

Preoperative computed tomography of the chest in lung cancer patients: the predictive value of calcified lymph nodes for the perioperative outcomes of video-assisted thoracoscopic surgery lobectomy.

OBJECTIVES: To determine the predictive value of identifying calcified lymph nodes (LNs) for the perioperative outcomes of video-assisted thoracoscopic surgery (VATS). METHODS: Fifty-six consecutive patients who underwent VATS lobectomy for lung cancer were included. We evaluated the number and location of calcified LNs on computed tomography (CT). We investigated clinical parameters, including percentage forced expiratory volume in 1 s (FEV1%), surgery duration, chest tube indwelling duration, and length of hospital stay. We performed linear regression analysis and multiple comparisons of perioperative outcomes. RESULTS: Mean number of calcified LNs per patient was 0.9 (range, 0-6), mostly located in the hilar-interlobar zone (43.8 %). For surgery duration (mean, 5.0 h), FEV1% and emphysema severity were independent predictors (P = 0.010 and 0.003, respectively). The number of calcified LNs was an independent predictor for chest tube indwelling duration (P = 0.030) and length of hospital stay (P = 0.046). Mean duration of chest tube indwelling and hospital stay was 8.8 days and 12.7 days in no calcified LN group; 9.2 and 13.2 in 1 calcified LN group; 12.8 and 19.7 in ≥2 calcified LNs group, respectively. CONCLUSIONS: The presence of calcified LNs on CT can help predict more complicated perioperative course following VATS lobectomy.

Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features.

PURPOSE: To retrospectively investigate the differentiating computed tomographic (CT) features between invasive pulmonary adenocarcinoma (IPA) and preinvasive lesions appearing as ground-glass nodules (GGNs) in 253 patients. MATERIALS AND METHODS: This study was approved by the institutional review board. From January 2005 to October 2011, 272 GGNs were pathologically confirmed (179 IPAs and 93 preinvasive lesions) in 253 patients and were included in this study. There were 64 pure GGNs and 208 part-solid GGNs. Preinvasive lesions consisted of 21 atypical adenomatous hyperplasias and 72 adenocarcinomas in situ. To identify the differentiating CT features between IPAs and preinvasive lesions and to evaluate their differentiating accuracy, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed, respectively. RESULTS: In pure GGNs, preinvasive lesions were significantly smaller and more frequently nonlobulated than IPAs (P < .05). Multivariate analysis revealed that lesion size was the single significant differentiator of preinvasive lesions from IPAs (P = .029). The optimal cut-off size for preinvasive lesions was less than 10 mm (sensitivity, 53.33%; specificity, 100%). In part-solid GGNs, there were significant differences in lesion size, solid portion size, solid proportion, margin, border, and pleural retraction between IPAs and preinvasive lesions (P < .05). Multivariate analysis revealed that smaller lesion size, smaller solid proportion, nonlobulated border, and nonspiculated margin were significant differentiators of preinvasive lesions (P < .05), with excellent differentiating accuracy (area under ROC curve, 0.905). CONCLUSION: In pure GGNs, a lesion size of less than 10 mm can be a very specific discriminator of preinvasive lesions from IPAs. In part-solid GGNs, preinvasive lesions can be accurately distinguished from IPAs by the smaller lesion size, smaller solid proportion, nonlobulated border, and nonspiculated margin.

Electronic cleansing for CT colonography: does it help CAD software performance in a high-risk population for colorectal cancer?

OBJECTIVE: To compare the performance of computer-aided detection (CAD) for CT colonography (CTC) with and without electronic cleansing (EC) in a high-risk population tagged with a faecal tagging (FT) protocol. METHODS: Thirty-two patients underwent CTC followed by same-day colonoscopy. All patients underwent bowel preparation and FT with barium and gastrografin. Each CTC dataset was processed with colon CAD with and without EC. Per-polyp sensitivity was calculated. The average number of false-positive (FP) results and their causes were also analysed and compared. RESULTS: Eighty-six polyps were detected in 29 patients. Per-polyp sensitivities of CAD with EC (93.8% and 100%) were higher than those without EC (84.4% and 87.5%) for polyps >or=6 mm and >or=10 mm, respectively. However, the differences were not significant. The average number (6.3) of FPs of CAD with EC was significantly larger than that (3.1) without EC. The distribution of FPs in both CAD settings was also significantly different. The most common cause of FPs was the ileocaecal valve in both datasets. However, untagged faeces was a significantly less common cause of FPs with EC, EC-related artefacts being more common. CONCLUSION: Electronic cleansing has the potential to improve per-polyp sensitivity of CTC CAD, although the significantly larger number of FPs with EC remains to be improved.

Importance of angiographic visualization of round ligament arteries in women evaluated for intractable vaginal bleeding after uterine artery embolization.

PURPOSE: To determine the incidence of angiographic visualization and the clinical significance of round ligament arteries in patients who present with intractable vaginal bleeding. MATERIALS AND METHODS: A review of 113 patients (age range, 20-67 years) who underwent pelvic angiography for intractable vaginal bleeding between June 1992 and May 2008 was retrospectively performed. It was recorded whether round ligament artery was visualized on pelvic aortography after uterine artery embolization (UAE). The medical records of the patients were reviewed to analyze the final clinical outcome. The Fisher exact test was used to correlate persistent vaginal bleeding after UAE with visualization of round ligament arteries. RESULTS: Of 111 patients who underwent UAE, 42 patients (postpartum bleeding, n = 40; postabortion bleeding, n = 2) had at least one visible round ligament artery on postembolization pelvic aortography. Ten patients received round ligament artery embolization. Persistent vaginal bleeding after adequate UAE was observed more commonly in patients whose round ligament artery was seen on postembolization pelvic aortography (P = .007). CONCLUSIONS: Round ligament arteries are commonly visualized in patients who present with postpartum bleeding and should be investigated when there is persistent bleeding, even after adequate UAE.