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PubMed1996

Needle aspiration techniques in preoperative selection of patients with thyroid nodules: a long-term study.

PURPOSE: Long-term evaluation of the combination of two needle aspiration techniques (NAT) (fine-needle aspiration [FNA] and aspiration needle biopsy [ANB]) in performing an efficient preoperative selection of palpable thyroid nodules. PATIENTS AND METHODS: Eight years of extensive use of surgery for the detection of thyroid cancer was compared with 12 years of preoperative selection of by NAT. RESULTS: A total of 1,140 operations were performed from 1972 to 1979, and 35 malignant nodules were discovered (3.1%). Five thousand four hundred three patients were examined by NAT from 1980 to 1992; 483 (9%) underwent surgery and 158 malignant nodules were excised. The number of malignant nodules identified by NAT was 166 (eight were not excised) (3.1% of the total population examined). The principal clinical and pathologic features were similar in both groups. ANB yielded a definite benign diagnosis in 88 patients with inadequate FNA findings, it correctly identified four malignant nodules diagnosed as benign by FNA, it showed a macrofollicular component in 115 nodules diagnosed by FNA as microfollicular nodules, and it significantly changed the predictive value of 79 suspicions FNA diagnoses. CONCLUSION: Introduction of NAT reduced the number of operations for palpable thyroid nodules from 143 to 40 per year and increased from four to 13 the number of malignant nodules excised without any change in the overall incidence of malignant nodules. The combination of ANB to FNA significantly contributed to the high and efficient preoperative patient selection, principally by reducing the number of indeterminate or suspicious, as well as false-negative, preoperative FNA diagnoses.

Adolescent↗

PubMed1998

Suppressive therapy with levothyroxine for solitary thyroid nodules: a double-blind controlled clinical study and cumulative meta-analyses.

Levothyroxine suppressive treatment of solitary thyroid nodules is controversial. A 1-yr prospective randomized placebo-controlled trial was conducted to evaluate the effect of T4 on nodule volume and bone mineral density, and meta-analyses were performed to examine the quantitative synthesis of data from similar designed controlled trials. Forty-five euthyroid patients (42 females, age range: 19-73 yr) with single, colloid nodules were randomized to T4 (21 patients, 2.7 +/- 0.3 microg/kg, TSH < 0.3 microIU/mL) and placebo. Ultrasonography and densitometry were performed at baseline and repeated after treatment. Mean nodule volume or bone mineral density did not change. Nodule reduction more than 50% was observed in 6 of 21 treated patients and 2 of 24 placebo patients (P = 0.12). This study and another 6 prospective controlled trials (minimum 6 months, ultrasonographic nodule evaluation) were included in cumulative meta-analyses (risk-difference method). Nodule volume decreased more than 50% in a significantly higher percentage of patients in the T4 groups (risk difference, 16.7%; 95% confidence intervals, 5.8-27.6%). Four trials evaluated nodule growth with homogeneous results (Q = 0.42). Nodule volume increased more than 50% in a significantly smaller percentage of patients treated with T4 (risk difference, 9.7%; 95% confidence intervals, 2.0-17.4%). In conclusion, T4 treatment is associated with decreased nodule volume in 17% of patients and may inhibit growth in another 10%.

Adult↗

PubMed1993

Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules. Potential role in evaluation and management.

BACKGROUND: Positron emission tomography (PET), a new noninvasive imaging modality, utilizing 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG), has demonstrated increased FDG uptake in lung tumors. OBJECTIVE: To determine the diagnostic efficacy of PET-FDG imaging in differentiating benign from malignant solitary pulmonary nodules. PATIENT SELECTION: A prospective study of 30 patients who presented with indeterminate solitary pulmonary nodules less than 3 cm in size based on chest radiograph and computed tomographic (CT) scan. SETTING: Two tertiary care medical centers in Omaha, Neb: Creighton University Medical Center and the Omaha Veterans Administration Medical Center. MEASUREMENTS: Positron emission tomographic imaging of the lung was performed 1 h after intravenous injection of 10 mCi of F-18-FDG. Qualitative analysis of the images was performed independently by two observers by visual identification of the areas of increased FDG uptake in the lung nodules. Semiquantitative analysis was performed using computation of differential uptake ratio (DUR). Histologic specimens were obtained in 29 patients (thoracotomy 20, transthoracic needle aspiration biopsy 8, bronchoscopy 1). RESULTS: Positron emission tomographic imaging correctly identified 27 of 30 pulmonary nodules. Diagnostic accuracy was high with sensitivity of 95 percent and specificity of 80 percent. The positive and negative predictive value of PET imaging for solitary pulmonary nodules was 90 percent and 89 percent, respectively. The DUR values were significantly higher for malignant nodules (mean +/- SD, 5.55 +/- 2.79) than benign nodules (mean +/- SD, 0.95 +/- 0.99) (p < 0.001). There was one false-negative result in a patient with a 1-cm nodule identified as a scar adenocarcinoma. There were two false-positive cases and both had caseating granulomas with active inflammation and Histoplasma organisms. CONCLUSION: PET-FDG imaging of the lung, a new noninvasive diagnostic test, has a high degree of accuracy in differentiating benign from malignant pulmonary nodules. PET-FDG imaging could complement CT scanning in the evaluation and treatment of patients with solitary pulmonary nodules.

Aged↗

PubMedDate not supplied

[Prevalence of thyroid nodules in 40 years-old or old women].

OBJECTIVES: Thyroid nodules constitute a very common clinical problem and the differential diagnosis includes thyroid cancer. As thyroid cancer is rare, it is important to know the prevalence of thyroid nodules in cohorts strongly predisposed to this problem to be able to measure its impact on the health care system, and to devise appropriate diagnostic strategies. The aim of this study was to determine the prevalence of thyroid nodules in women 40 year-old or older by echography. METHODS: Between August 1996 and December 1997, 207 women, 40 year-old or older, were consecutively evaluated by thyroid echography in the Radiology Division of the Hospital de Clínicas de Porto Alegre. Patients who came to the Division to be submitted to thyroid echography were excluded. The mean age of patients studied was 54.7 years (median: 53, range: 40-86 years). One hundred and twenty three patients (54.9%) had a normal thyroid and eighty-two had an abnormal gland (39.6%). Thyroid nodules were detected in seventy-three women (35.3%) and these were larger than 1 cm in 35 women (16.9%). Women without thyroid nodules were younger (53.1 +/-10.7 years) than women with thyroid nodules (58.2 +/-10.6 years) p=0.001; and the prevalence of any thyroid nodule (p=0.001) or nodules larger than 1 cm (p=0.007) increased with age. CONCLUSIONS: Thyroid nodules are very common in women 40 year-old or older, their prevalence increases with age in this cohort and these nodules are potentially palpable (larger than one cm) in one of six women in this age group It is important to have these data in mind when ordering thyroid echographic studies in women 40 year-old or older.

Adult↗

PubMed2003

[Treatment of autonomous and cystic thyroid nodules with intranodular ethanol injection].

UNLABELLED: Intranodular ethanol injection has been used for the past 10 years as an efficient modality for treating patients with thyroid nodules. Several studies have reported the success of this therapy in autonomous and cystic nodules and, more recently, in cold benign nodules. PURPOSE: To evaluate the efficacy of this therapeutic modality on the treatment of autonomous and cystic thyroid nodules. METHODS: 42 patients (26 with cystic and 16 with autonomous nodules) were treated with ultrasound guided intranodular 99% ethanol injection and followed for 6 months. RESULTS: No major complications were observed during or after treatment, however, most of the patients reported slight to moderate pain and/or discomfort after the injection. Most of the nodules showed reduction after the treatment. Autonomous nodules had a mean reduction of 50.3% and cystic nodules of 69.3%. No significant differences in pretreatment serum total T3, total T4 or TSH were observed among the patients in the cystic group. Patients in the autonomous group with hyperfunctioning nodules showed a decrease in serum total T3, total T4 and an increase in serum TSH levels, hence, proving the effectiveness of this therapy. CONCLUSIONS: Intranodular ethanol injection is a safe and efficient treatment for autonomous and cystic nodules of the thyroid.

Adolescent↗

PubMed2005

Pulmonary nodule detection with low-dose CT of the lung: agreement among radiologists.

OBJECTIVE: The purpose of our study was to assess relative intra- and interobserver agreement in detecting pulmonary nodules when interpreting low-dose chest CT screening examinations. MATERIALS AND METHODS: Two hundred ninety-three selected low-dose CT examinations of the lung were independently interpreted by three radiologists to detect and classify pulmonary nodules. The data set selected was enriched with examinations depicting pulmonary nodules. A subset of 30 examinations was interpreted twice. All pulmonary nodules greater than 1.0 mm were marked. All nodules greater than 3.0 mm were marked, measured, and scored as to their probability of being benign or malignant. Nodule-based and examination-based relative reviewer agreements were evaluated using percentage of agreement and kappa statistics. Similar assessments were performed on the subset of examinations interpreted twice. RESULTS: The three radiologists identified a total of 470, 729, and 876 pulmonary nodules of which 395, 641, and 778 were rated as noncalcified with some level of suspicion for being malignant. Nodule-based interobserver agreement among the radiologists was poor (highest kappa value in a paired comparison, 0.120). Examination-based agreement was higher (highest kappa value in a paired comparison, 0.458). Intraobserver agreement was higher than interobserver agreement for examination-based agreement (highest kappa = 0.889) but lower for nodule-based agreement (highest kappa = -0.035). Agreement improved as the suspicion of malignancy increased. CONCLUSION: Unaided intra- and interobserver agreement in detecting pulmonary nodules in low-dose CT of the lung is relatively low. Computer-assisted detection may provide the consistency that is needed for this purpose.

Female↗

PubMed2002

Incremental benefit of maximum-intensity-projection images on observer detection of small pulmonary nodules revealed by multidetector CT.

OBJECTIVE: Our purpose was to assess the incremental effect of maximum-intensity-projection (MIP) image processing on the ability of various observers to detect small (<1 cm in diameter) central and peripheral lung nodules revealed by multidetector CT. MATERIALS AND METHODS: We retrospectively identified 25 patients with metastatic disease, each having from two to nine nodules that were 3-9 mm in diameter. Two senior and three junior reviewers interpreted all images on a workstation. The observers first reviewed axial images (3.75-mm collimation, 3-mm reconstruction interval, multidetector acquisition) in cine and sequential fashion and recorded the size, lobe, and central or peripheral (within 1 cm of the edge of lung) location of each nodule. MIP images (10-mm slab, 8-mm interval) were then reviewed, and additional nodules detected were recorded. Final counts were established by consensus. RESULTS: The reviewers found 122 nodules (71 peripheral, 51 central) in the 25 patients. The addition of MIP slabs significantly enhanced reviewer detection of central nodules (p < 0.001) and junior reviewer detection of peripheral nodules (p < 0.001). MIP slabs also reduced the effects of reviewer experience, particularly for peripheral nodules. CONCLUSION: MIP processing reduces the number of overlooked small nodules, particularly in the central lung. Observer nodule detection remains imperfect even when lesions are clearly depicted on images.

Adult↗

PubMed2004

Volumetric assessment of pulmonary nodules with ECG-gated MDCT.

OBJECTIVE: The objective of our study was to assess physiologic lung deformation and compression originating from cardiovascular motion and their subsequent impact on determining the volume of small pulmonary nodules throughout the cardiac cycle on ECG-gated MDCT. SUBJECTS AND METHODS: Seventy-three small noncalcified pulmonary nodules were identified in 30 patients who underwent ECG-gated MDCT. The volume of each nodule was assessed throughout the cardiac cycle using computer-aided automatic segmentation algorithms, and the assessment was repeated three times. To ensure the validity of the subtle changes in volume that were detected, we determined the volume and signal attenuation in phantom data sets and patient nodules without temporal or spatial differentiation. Subsequently, nodules were assigned to pulmonary segments, and volume changes were correlated to cardiac phases, nodular location, and mean nodular size. Statistical multivariate tests were performed to evaluate significant patterns. RESULTS: The validity of significant measurements was proven in evaluated phantom data sets with a general tendency toward overestimating nodular volume (p = 0.492). Statistical evaluation of nodular signal attenuation confirmed true deformation and compression of nodules rather than partial volume effects as the reason for volume variations (p = 0.874). Differentiating pulmonary nodules in cardiac phases, pulmonary locations, and mean nodular volumes, we found that one single effect did not determine the amount of cardiovascular motion conveyed to pulmonary parenchyma and subsequently led to nodule deformation. Multivariate testing revealed statistically significant measures identifying patterns correlating variation in nodular volume with cardiac phase (p < 0.001), nodular location (p = 0.007), and mean nodular size (p < 0.001). CONCLUSION: Cardiovascular motion was disproportionately conveyed to various pulmonary segments and led to changes in the volume of pulmonary nodules, especially in small pulmonary nodules. A precise volumetric assessment was therefore possible only by identifying the underlying cardiac phase.

Adult↗

PubMed2026

Estimating Rhizobial Fitness During Legume Symbiosis: Enriching Viable Undifferentiated Bacteria from Root Nodules.

Advances in understanding the evolutionary ecology of the rhizobia-legume mutualism have been constrained by methodological limitations in efficiently measuring relative strain frequencies alongside measurements of absolute population sizes of rhizobia living in nodules. To examine strain competition in natural and agricultural ecosystems that harbor multiple strains of rhizobia, an increasing number of manipulative and observational studies have recently begun to examine dozens or hundreds of strains simultaneously. Assessing the competitive fitness of multiple strains in legume nodules requires, first, processing pools of dozens to hundreds of nodules to overcome the stochasticity of nodule formation; second, focusing on the reproductively viable rhizobial population, since this trait represents rhizobia's reproductive success in nodules and is pivotal for evolutionary interpretations. Our approach has been optimized in the Medicago truncatula-Sinorhizobium meliloti system, where rhizobia induce the formation of indeterminate nodules that harbor two subpopulations: terminally-differentiated bacteroids and undifferentiated rhizobia that retain reproductive viability. This protocol has also been used for other legumes with terminally-differentiated bacteroids, such as pea and vetch, as well as for those with non-terminally differentiated bacteroids, such as soybean and cowpeas. The protocol we present enables rapid and reproducible homogenization of pools containing hundreds of nodules using a tissue homogenizer. We also enrich for undifferentiated rhizobia using two centrifugation steps: first, a low-speed centrifugation to deplete nodule debris and large, endoreduplicated, terminally-differentiated bacteroids, followed by a high-speed centrifugation to pellet the remaining undifferentiated rhizobia. The pellet can later be used for DNA extraction, followed by whole-genome or amplicon sequencing, and then downstream analysis to estimate strain fitness. Finally, we include an optional step for a reliable, reproducible system for nodule imaging, which is especially useful for quantifying nodule abundance and studying morphological variation. .

Symbiosis↗

PubMed2005

[Managing small pulmonary nodules in head and neck malignant tumors].

The recent increase in the use of helical CT has produced a higher detection rate of small pulmonary nodules than in conventional CT application, and has presented a serious problem in their treatment. We carried out a retrospective study to identify a clinical standard in the management of those nodules in head and neck malignant tumors. The subjects were 108 in-and out patients (87 men and 21 women) with head and neck malignant tumors who received radiation therapy in our university hospital between 2003 and 2004 (ages ranging from 25 to 93 years; mean, 66 years). Helical CT of the chest was applied to 92 patients of the 108 (85%). We determined small pulmonary nodules as round nodules 5 mm or more and less than 1 cm in diameter, and observed them in 14 of the 92 (15%). Firstly, we compared nodule growth by dividing the patients into 2 groups. The nodules grew in 2 of 7 patients of Group I, where chemotherapy was not done or where chemotherapy was not effective on the primary tumor, and in 3 of 7 patients of Group II, where chemotherapy was effective on the primary tumor. Secondly, disregarding the effects of chemotherapy, we analyzed nodule growth: the nodules grew in 5 of the 14 patients (36%). Those small pulmonary nodules were all pulmonary metastases. When small pulmonary nodules are detected by helical CT, accompanying malignant tumors of the head and neck, and bearing in mind the probability of their growth of at least 36%, we should therefore follow them up carefully.

Adult↗

PubMed2004

Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy.

OBJECTIVE: To correlate sonographic and color Doppler characteristics of thyroid nodules with the results of sonographically guided fine-needle aspiration biopsy to establish the relative importance of these features in predicting risk for malignancy. METHODS: We retrospectively analyzed the sonographic features of 34 malignant and 36 benign thyroid nodules with respect to size, echogenicity, echo structure, shape, border, calcification, and internal vascularity. Individual features and combinations of features were analyzed for their correlation with benign or malignant disease. A comparative analysis of several authors' previously proposed methods for distinguishing between benign and malignant nodules using sonographic criteria was also performed to determine their sensitivity and specificity in predicting nodule disease within our study data. RESULTS: Nodule size ranged from 0.8 to 4.6 cm in greatest dimension (mean, 1.96 cm; SD, 0.877 cm). The prevalence of malignancy in our study population was estimated to be nearly 5.33%. Intragroup comparison of sonographic features among benign and malignant nodules resulted in identification of intrinsic calcification as the only statistically significant predictor of malignancy (35.3% sensitive and 94.4% specific; P < .005). Presence of a "snowstorm" pattern of calcification was 100% specific for malignancy. Echogenicity, echo structure, shape, border classification, and grade of internal vascularity did not show any significant difference between benign and malignant nodules in this study. Various combinations of features previously suggested to be significant predictors of malignancy were also analyzed and shown to have very little sensitivity or specificity in predicting benign or malignant disease among nodules in our study population. CONCLUSIONS: This study indicates that the presence of intrinsic microcalcification is the only statistically reliable criterion on which to base increased suspicion for malignancy in thyroid nodules. Our results indicate the need for biopsy in determining further workup. All nodules that show the presence of intrinsic microcalcification should undergo biopsy, particularly if calcifications have a snowstorm appearance on sonography.

Biopsy, Fine-Needle↗

PubMed2005

Rates of malignancy in incidentally discovered thyroid nodules evaluated with sonography and fine-needle aspiration.

OBJECTIVE: The purpose of this study was to compare the rate of malignancy in thyroid nodules discovered incidentally on magnetic resonance imaging, computed tomography, and sonography with the rate of malignancy in nonincidentally discovered nodules. METHODS: All thyroid sonographic and fine-needle aspiration (FNA) procedures performed during a 6-month period were retrospectively reviewed. Study indications were categorized as incidental (thyroid nodules found on magnetic resonance imaging, computed tomography, or sonography performed for nonthyroid indications) or nonincidental (studies prompted by abnormal physical examination findings or laboratory values or signs or symptoms suggestive of thyroid disease). Rates of malignancy in patients with incidentally discovered nodules were compared with rates in patients with nonincidental thyroid abnormalities by the Fisher exact test. RESULTS: Of 225 thyroid sonographic studies, 35 (16%) were performed for incidentally discovered thyroid nodules, and 190 (84%) were performed for evaluation of nonincidental thyroid abnormalities. A total of 21 patients (60%) in the incidental group and 90 patients (47%) in the nonincidental group underwent FNA. The rate of malignancy in nodules examined by biopsy in the incidental group was 17% compared with 3% in the nonincidental group (P = .020). Patient sex, multiplicity of nodules, nodule size, echo texture, and presence of calcifications did not differ significantly between the groups. The mean age of patients in the incidental group was significantly higher (61 versus 51 years; P = .007); however, advanced age was not associated with a greater rate of malignancy. CONCLUSIONS: This study identified an unexpectedly high rate of malignancy in incidentally discovered thyroid nodules, suggesting that incidentally discovered thyroid nodules should be evaluated with follow-up thyroid sonography and FNA.

Biopsy, Fine-Needle↗

PubMedDate not supplied

Small solitary pulmonary nodules: assessment of enhancement and enhancement patterns in benign and malignant tumours by high resolution computed tomography.

Our aim was to determine the accuracy of quantitative and qualitative findings of contrast-enhanced computed tomography (CT) by means of differential analysis of small uncalcified solitary pulmonary nodules and to compare the CT diagnosis with the results of transthoracic needle biopsies (TTNB). We assessed a consecutive series of 109 patients with 66 malignant or 45 benign pulmonary nodules before TTNB and surgery with contrast and high resolution computed tomography (HRCT). Pulmonary nodules were classified as small when equal to or smaller than 15 mm and large when larger than 15 mm. Diagnostic accuracy of CT qualitative evaluation was 95% for large nodules and 92% for small nodules. Specificity was 92% for small nodules, 80% for large nodules. Enhancing regular septa were observed in 28 hamartomas (80%) while except for two cases (3%), inner septa were absent or irregular in malignant tumours. TTNB accuracy was 70% for small nodules and 94% for large ones. Low-enhancing hamartomas are more frequent in Italy than in the US where the prevalence of high-enhancing granulomas in benign nodules reduces the specificity of quantitative CT analysis. We propose that certain geographic areas would benefit from enhanced-CT in place of TTNB in managing lung nodules equal to or less than 1.5 cm.

Adenocarcinoma↗

PubMed2002

Ultrasonographic contrast agent: evaluation of time-intensity curves in the characterisation of solitary thyroid nodules.

PURPOSE: To evaluate whether the time-intensity curve can improve characterisation of solitary thyroid nodules. MATERIAL AND METHODS: From June to December 2000 we studied 61 patients (16 men and 45 women, mean age 46 years) with solitary thyroid nodules that were not associated with any important hormonal alteration and that showed poor tracer uptake at scintigraphy. We evaluated the Power Doppler vascular pattern before and after a 60" intravenous injection of 2.5 g of Levovist (diluted in 7 ml). The study lasted 5 minutes from the beginning of the infusion. Finally, the time-intensity curves were processed. All the nodules underwent fine needle aspiration biopsy (FNAB) and excision biopsy. RESULTS: Histology revealed 43 benign lesions and 18 malignant lesions. At contrast-enhanced Power Doppler 83.4% (15/18) of the malignant nodules were found to be hypervascularized, while 16.6% (3/18) were hypovascularized. Of the benign lesions, 90.7% (39/43) were hypervascularized, 9.3% (4/43) were hypovascularized. All the nodules, both hyper- and hypovascularized, displayed rapid and intense wash-in curves. By contrast, the wash-out curves were regular and monophasic in 40/43 (93%) benign lesions (36 hypervascularized and 4 hypovascularized lesions) and irregular and polyphasic in 16/18 (89%) malignant lesions (13 hypervascularized and 3 hypovascularized lesions); 3/43 (7%) benign nodules showed polyphasic wash-out and 2/18 malignant lesions (11%) showed monophasic wash-out. DISCUSSION AND CONCLUSIONS: Time-intensity curves, and particularly wash-out curves, provide useful information for the characterisation of solitary thyroid nodules. 93% of benign nodules (with regular vascularization) showed a monophasic pattern of the wash-out curve, while 89% of malignant nodules ("anarchical" vascularization) had polyphasic wash-out curves. This behaviour was observed in both hypervascularized and hypovascularized lesions. Our method proved to have a sensitivity of 88% and a specificity of 93%. The study of time-intensity curves could therefore enable us to differentiate between benign and malignant lesions and characterise hypovascularized malignant nodules which would not be observed without contrast agent.

Adult↗

PubMed2003

Ultrasonography for assessment of subcutaneous nodules.

OBJECTIVE: To characterize a variety of subcutaneous lesions by their ultrasonographic (US) appearance, and establish these images as a starting point to measure changes with treatments. METHODS: Twenty-six patients with 48 subcutaneous nodular swellings of various types were imaged using a portable US machine equipped with a 10 MHz linear transducer. All patients had a known diagnosis of a rheumatic disease. We used US to examine subcutaneous lesions and the underlying cortical surface of the bone or joint. Two measurements of some tophi and rheumatoid nodules were done on different dates to examine reproducibility of the measurements. RESULTS: Nodular lesions included 20 tophi and 20 rheumatoid nodules, 2 sarcoid nodules, 2 lipomas, and 4 synovial cysts. Tophi most often appeared as heterogeneous masses; hypoechoic areas in 2 tophi were decreased after aspiration of chalky liquid tophaceous material. Occasionally tophi had calcifications appearing hyperechoic with acoustic shadowing. Cortical bone erosions could be seen adjacent to some tophi. The nodules in patients with rheumatoid arthritis were often attached closely to the bone surface and less erosive to bone, allowing the cortical bone to be seen easily. The nodules were more homogeneous. Some showed a central sharply demarcated hypoechoic area, possibly corresponding to necrosis inside the rheumatoid nodules. Nodules were easily measured. The repeated measurements of both tophi and rheumatoid nodules showed excellent reproducibility. Lipomas had different echogenic patterns depending on composition of the associated connective tissue and position of the mass. They could be hypoechogenic, hyperechogenic, or mixed, but were easily distinguished by oval shapes with well demarcated capsules. Synovial cysts seen in this study had a characteristic hypoechoic pattern. CONCLUSION: Subcutaneous nodules examined by sonography show characteristics and patterns that, although not diagnostic, can be used to help distinguish their etiology. Tophi and rheumatoid nodules can be easily measured and these measurements used to help follow disease progression or response to therapy.

Aged↗

PubMedDate not supplied

Evaluation of effectiveness of a computer system (CAD) in the identification of lung nodules with low-dose MSCT: scanning technique and preliminary results.

PURPOSE: Evaluation of the effectiveness of computer-aided diagnosis (CAD) in the identification of pulmonary nodules. MATERIALS AND METHODS: Two observers (A1, A2) with different levels of experience independently evaluated 20 chest MSCT studies with and without the aid of a CAD system (LungCheck, R2 Technology, Inc). The study parameters were as follows: 140 kVs, 40 mAs, collimation 4 x 1 mm, slice thickness 1.25 mm, reconstruction interval 1.0 mm. The observers analysed the images with and without CAD and evaluated: 1) nodule size (longer axis); 2) number and location of nodules; 3) reading time for each observer. The gold standard was represented by the evaluation of both readers in consensus with the aid of the CAD system. RESULTS: Without CAD support the two readers identified 77 (A1) and 79 (A2) nodules and with CAD 81 (A1) and 82 (A2) nodules. Working in consensus the two observers identified 81 nodules without the aid of the CAD and 84 nodules with the aid of CAD. Total number of nodules identified by CAD was 104, 25 of which were false positive and 5 false negative. The average reading time with the aid of the CAD decreased by as much as 40% for both the observers. CONCLUSIONS: The preliminary results of our study suggest that the CAD technique is an accurate automatic support tool in the identification of pulmonary nodules. It reduces reading time and automatically supplies the size, volume, density and number of nodules, thus being useful both in screening programmes and in the follow-up of cancer patients, in whom comparison of the images is particularly difficult.

Adult↗

PubMed2005

[Thyroid nodule].

The thyroid nodule is a frequent, most often benign, chronic, multifocal and slowly progressive disease. The first line strategy is to diagnose cancerous nodules (<5%) and relies upon fine needle aspiration (FNA), a specialised technique which in trained hands has a false negative rate of below 5%. The interest to explore small thyroid nodules is controversial since the prognosis of thyroid cancer is excellent for lesions measuring less than 20 mm. Though imaging accuracy is quite limited in assessing the diagnosis of thyroid cancer, both ultrasounds (US) and thyroid scan are helpful to enhance nodular identification (>30%), to sort the nodules relevant for cytological sampling and to optimize the follow-up, the major source of health costs. Suspicious and non contributive FNAs must have a control FNA within 6 months. Nodules with a non suspicious FNA (>85%) require long term follow-up. This follow-up is mainly morphological. New or evolutive nodules, as assessed by palpation or US, will require iterative FNAs or should be considered for surgery. In patients with hyperfunctioning nodules on the scan (10 to 20%), a yearly evaluation of the TSH level is sufficient. These nodules account either for autonomously functioning ones, which slowly develop towards thyrotoxicosis, or for hyperplastic nodules frequently disclosing a lymphocytic thyroiditis. Morbidity due to thyroid autonomy is still underestimated especially in aging patients with TSH levels < or =0.60 mU/L. An algorithmic approach to the diagnostic and follow-up evaluation of thyroid nodule is suggested.

Algorithms↗

PubMed2004

Morphological characteristics of malignant solitary pulmonary nodules.

The solitary pulmonary nodule is a common radiologic abnormality, which is often detected incidentally. It is defined as focal, round or oval areas of increased opacity in the lung which are caused by a variety of disorders, including neoplasm, infection, inflammations, and vascular and congenital abnormalities. Most of the solitary pulmonary nodules are benign, but up to 30%-40% of them are malignant. The main goal of the radiologic evaluation of suspected solitary pulmonary nodules is to differentiate benign from malignant lesions as accurately as possible. The aim of the study was the assessment of the morphological characteristics of the malignant solitary pulmonary nodules. Large nodule size, irregular, spiculated margins, inhomogeneous density of nodule thick walls in cavitary nodules suggest the presence of the malignant lesion. Smooth, well-defined margins, homogeneous density or the presence of diffuse, laminated, central or popcorn-like calcifications suggest the benign nodule. Diffuse, irregular amorphous calcifications suggest the malignant process. Unfortunately there is a kind of overlapping, and some benign nodules may show features typical of malignancy, and some malignant lesions may appear benign. Morphologic characteristics in computed tomography is however helpful in differentiation of benign from malignant nodules.

Calcinosis↗