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V Summaria

Publications and source records attributed to V Summaria.

34 records · Page 2Linked to original sources
PubMedDate not supplied

An introduction to benign thyroid disease: pathophysiologic, epidemiologic aspects and diagnostic methodology.

The role of preoperative noninvasive diagnostic procedures in the management of benign thyroid diseases is critically reviewed and on the basis of a series of more than 13,000 thyroid nodules, sequentially examined, the role of preoperative fine needle aspiration (FNA) cytology in discriminating benign from malignant lesions, is assessed. Retrospective studies were performed to determine the diagnostic accuracy of FNA adopted as routine preoperative screening procedure as compared to intraoperative frozen section (FS) analysis. US-guided FNA was shown to be more accurate allowing the preoperative identification of occult or minimal carcinoma: in fact about 3% of malignant thyroid nodules were detected. Moreover, the operation time is reduced, and unnecessary surgical treatments for benign lesions are eliminated, preventing the need of two-stage cancer surgery. FNA is a cost-effective diagnostic tool with about 20% reduction in the cost of care of patients with thyroid nodules. Most recent methods of molecular biology which seem promising in thyroid tissue sampled by FNA to detect malignant lesions missed by conventional cytology and included in the generic category of "follicular proliferation", are analyzed.

Biopsy, Needle↗
PubMedDate not supplied

Diagnostic imaging of the thyroid: methodology and normal patterns.

The diagnostic imaging of the thyroid is based on sonography and scintigraphy, which to-date play a unique role in the morphofunctional study of the thyroid gland. The high spatial resolution of sonography allows an accurate evaluation of the thyroid morphology, size and parenchymal structure. Color Doppler sonography allows a qualitative assessment associated with quantitative parameters of glandular vascularization. Furthermore, sonography is the simplest procedure to achieve an accurate, reproducible measurement of thyroid volume. Scintigraphy provides information unavailable by other methods on the regional thyroid function. The most common tracer for thyroid scintigraphy is 99mTc pertechnetate. 123I and 131I are essential for radioiodine uptake test. CT and MRI, while invaluable for other organs and apparatus, play a limited role in the diagnosis of thyroid disease.

Diagnostic Imaging↗
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Diagnostic imaging of euthyroid goiter.

In diffuse or nodular euthyroid goiter, diagnostic imaging is indicated to define, by sonography, the morphology, size and structure of the goiter and to evaluate, by scintigraphy, the regional thyroid function. The instrumental diagnosis of thyroid nodule is essentially based on sonography, scintigraphy and (US-guided) needle aspiration cytology. The evaluation of some sonographic findings (echogenicity, calcification, lesion margins and presence of peripheral ring) may direct to the differentiation of a benign or malignant lesion. The role of color Doppler in the characterization of thyroid nodules is still controversial. Scintigraphy provides information on nodular function, being also the only exam able to show the presence of autonomously functioning thyroid tissue ("hot" nodule), whose diagnosis allows to rule out the presence of thyroid carcinoma with a very strong probability. In intrathoracic goiter, CT and MRI and indicated to show the continuity with the cervical thyroid and to define the relationships with adjacent structures. Radioiodine scintigraphy shows with high (> 90%) diagnostic accuracy the thyroid nature of a mediastinal mass (plunging goiter).

Diagnostic Imaging↗
PubMedDate not supplied

Diagnostic imaging in thyrotoxicosis.

In thyrotoxicosis, imaging mainly scintigraphy, color Doppler sonography and radioiodine uptake test are used in the differential diagnosis as well as in the morphofunctional evaluation of the thyroid before and after therapy (mainly pharmacological or with radioiodine). Radioiodine uptake test differentiates high uptake thyrotoxicosis (Graves'disease, toxic nodular goiter) and low uptake thyrotoxycosis (subacute or silent thyroiditis, ectopic thyrotoxicosis, iodine-induced hyperthyroidism). In Graves'disease scintigraphy shows thyroid enlargement with intense homogeneous tracer uptake; rarely nodules with no uptake are present. On color Doppler sonography, a part from enlargement, typical findings are: diffuse structural hypoechogenicity (at times with echoic nodules), parenchymal hypervascularization ("thyroid inferno"), high systolic velocities (PSV > 70-100 cm/sec) in inferior thyroid arteries. Scintigraphy is the only method able to evidence an autonomously functioning thyroid nodule and stage it (in association to clinical findings and TSH, FT3, FT4 determination) as: toxic, non toxic (or pretoxic) and compensated, depending on whether there is inhibition of extranodular tissue. A scintigraphically "hot" nodule appears hypervascularized on color Doppler sonography (especially in the toxic or pre-toxic phase) with high PSV (> 50-70 cm/sec) in the ipsilateral inferior thyroid artery. The most reliable parameters in the evaluation of the therapeutic efficacy are: decreases in thyroid (Graves'disease) or nodular (autonomously functioning nodule) volume; decreased radioiodine uptake (Graves'disease); functional recovery of suppressed parenchyma (autonomously functioning nodule); decreased PSV in the inferior thyroid arteries.

Diagnosis, Differential↗
PubMedDate not supplied

Metastatic lymphadenopathy from ENT carcinoma: role of diagnostic imaging.

Problems concerning the use of different imaging modalities in N staging of the neck are dealt with. The peculiar features, findings, sensitivity, specificity and diagnostic accuracy of each modality in the diagnosis of nature of cervical lymphadenopathy are described, as reported in most recent reports of literature, and according to the personal experience. CT/MRI criteria commonly used to establish whether a lymph node is metastatic or benign/reactive are related to the size, morphology, density (CT), signal intensity (MRI), evidence of central necrosis and extracapsular spread. Color Doppler US is a reliable method in the diagnosis of cervical metastatic lymphadenopathy even if no parameter is highly predictive; the combination of different findings, especially cortical thickening and structural inhomogeneity with thin, compressed, displaced or non visualized hilum makes the procedure significantly sensitive and specific. Intranodal hilar vascularization on color Doppler, with high resistance arterial flow (PI > 1.5), enhances the predictive value of findings of bi-dimensional sonography. Extracapsular spread impacts on survival as well as on the number of recurrences, which increases in patients with extracapsular spread; the disease-free interval is less in these patients. The identification and definition of extracapsular spread is based on some CT/MRI criteria as: 1) lymph nodes with spiky, irregular margins; 2) loss of adipose cleavage planes around the node and thickening of adjacent fascia; 3) apparent invasion of an adjacent structures or muscles. Similarly to CT/MR, sonographic findings of extracapsular spread can be: 1) blurred margins and irregular contours; 2) invasion of an adjacent structure or muscle.

Diagnostic Imaging↗
PubMedDate not supplied

Diagnostic imaging of differentiated thyroid carcinoma.

The role of diagnostic imaging in differentiated thyroid carcinoma is analyzed. 99mTc-pertechnetate 123I and 131I scintigraphy allows the evaluation of nodules with their differentiation in cold (hypofunctioning) and hot (functionally autonomous) nodules; thyroid carcinomas are cold nodules even if most of them are benign. On sonography thyroid nodules are well visualized with the definition of their site, number, size (not very useful parameters for the diagnosis of malignancy), echoic structure, and vascularization on color Doppler. The sonographic findings suggestive of differentiated thyroid carcinoma are: solid and hypoechoic structure, irregular ill-defined margins, absent or discontinuous peripheral ring, microcalcification, intranodular vascularization, local lymphadenopathies. These findings are characteristic but not pathognomonic, mostly for papillary carcinoma, while in the frequently isoechoic follicular carcinoma microcalcification and lymph node metastases are rare. Only the finding, although rather infrequent, of the dissemination to adjacent structures (muscles and vessels) is a definite indication for malignancy of a thyroid nodule. Color Doppler sonography plays a major role in the postoperative staging and follow-up, in combination with thyroglobulin determination and 131I whole body scintigraphy and it allows the detection of local and/or laterocervical lymph node recurrence. The most typical sonographic findings of metastatic lymphadenopathy are the roundish shape (length/anteroposterior diameter ratio-L/A < 1.5), not visible or displaced nodal hilum, thickened cortical layer with echoic structure similar to that of thyroid parenchyma, at times with microcalcification, cortical vascularization and dismantled angioarchitecture. CT and MRI are occasionally more useful to evaluate the substernal or retrosternal extension of voluminous thyroid masses and to identify local or distant metastases.

Carcinoma↗
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Diagnostic approach, genetic screening and prognostic factors of medullary thyroid carcinoma.

Medullary thyroid carcinoma is the least frequent thyroid neoplasm; it originates in thyroid parafollicular cells (calcitonin secreting C cells). In 80% of cases it is sporadic, in the remaining 20% it is familial, associated or not to other endocrinopathies as pheochromocytoma and hyperparathyroidism (MEN 2A, MEN 2B, and isolated familial medullary thyroid carcinoma). Preclinical diagnosis in relatives of affected subjects (preferably at pediatric age) is essential for successful therapy and is performed with genetic and biochemical screening tests. The genetic screening is based on DNA analysis (RET proto-oncogene mutations) of the patient, and if positive of all first degree relatives, to separate sporadic (somatic mutations) from familial (germline mutations) forms. The biochemical screening is based on calcitonin determination and its increase after pentagastrin stimulation, (a peculiar characteristic of medullary thyroid carcinoma, the first biochemical disorder in a subject at risk) and is mainly used in genetically silent familial medullary thyroid carcinoma. The principal negative prognostic factors of medullar thyroid carcinoma and the debate concerning the use of calcitonin determination in the diagnosis of the "cold" thyroid nodule have been analyzed.

Algorithms↗
PubMedDate not supplied

[Role of Doppler color ultrasonography in the diagnosis of thyroid carcinoma].

The aim of this study is to assess the efficacy and accuracy of color flow-Doppler sonography (CFDS) in predicting the malignancy of thyroid nodules. Seventy eight consecutive patients (52 females and 26 males), with 78 thyroid nodules (29 single nodules and 49 in a nodular goiter) have been examined by CFDS, before surgery, evaluating the hypoechogenicity of the nodule, the presence of microcalcifications and the halo sign absent and the vascular pattern, which has been classified as follows: absence of blood flow (type I), perinodular blood flow (type II), intranodular, with or without perinodular blood flow (type III), which is considered the most typical pattern of malignancy. On histology 22 nodules as carcinoma (CA) and 56 as benign nodules (BN) have been diagnosed. The most predictive for malignancy, sonographic pattern, "microcalcifications", has been found in 13/22 CA and in 4/56 BN (P < 0.0001, specificity 93%, sensitivity 59%); "hypoechogenicity" in 16/22 CA and in 8/56 BN (P < 0.0001, specificity 86%, sensitivity 73%), "absent halo sign" in 18/22 CA and in 16/56 BN (P < 0.0001, specificity 71%, sensitivity 82%.) have been found. On CFD type III pattern has been detected in 17/22 CA and in 24/56 BN (P < 0.15, specificity 57%, sensitivity 77%); type IIIa pattern (intranodular without perinodular blood flow) has been the most predictive for malignancy (P < 0.0001, specificity 100%, sensitivity 36%). The combination of type III pattern with "hypoechogenicity" in 13/22 CA and in 2/56 BN (p < 0.0001, specificity 93%, sensitivity 59%) has been found, with "absent halo sign" in 15/22 CA and in 3/56 BN (P < 0.0001, specificity 94.6%, sensitivity 68%), has been found, with "microcalcification" in 10/22 CA and in 0/56 BN (P < 0.0001, specificity 100%, sensitivity 45%) has been found. The combination of "microcalcifications" and absent halo sign" with type III pattern has been the most specific for malignancy, being detected in 11/22 Ca and 2/56 BN (P < 0.0001, specificity 96%, sensitivity 50%). In conclusion our results suggest that CFDS has an useful role in the assessment of thyroid nodules and it may provide information highly predictive for malignancy, above all when multiple, sonographic and vascular patterns are contemporaneously present in a thyroid nodule.

Adolescent↗
PubMedDate not supplied

Diagnostic imaging of genitourinary tuberculosis.

The mechanisms of the spread to the kidney and urinary tract of miliary tuberculosis which involves the urinary system with a rather high incidence, and, if not detected, may result in a functionless kidney for the often nonspecific symptomatology, are analyzed. These considerations account for the seriousness of the problem of urinary tuberculosis, whose great topical interest is unfortunately proven not only in the African continent where it is particularly common, but also in Europe. The lesions underlying the damage to the renal parenchyma and lower urinary tract are carefully examined for a correct interpretation of the radiologic signs. Most representative patterns of the various stages of urinary tuberculosis are described; the attention is focused on conventional radiology, still the most suitable imaging procedure for its early identification. The role of the other procedures which even if are not of first choice when urinary tuberculosis is suspected, in some cases may be useful in the approach to the disease. The mechanisms of the spread of genital tract tuberculosis, less frequent than urinary tuberculosis, but seemingly interesting for its clinical and diagnostic features, are considered. An accurate analysis of major patterns of tuberculosis of male and female genital tract is reported to better understand the various aspects of diagnostic imaging.

Diagnostic Imaging↗