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The goal of this study was to analyze the differences in ultrasound characteristics of papillary thyroid carcinoma (PTC) originating in the thyroid isthmus versus that originating from the lobes.From a retrospective review of our institution's database of records dated between January 2007 and December 2008, we identified 48 patients with classic PTCs located in the isthmus. All the patients had undergone preoperative ultrasound imaging, total thyroidectomy with bilateral central lymph node dissection, and postoperative follow-up for at least 2 years. As a control group, 96 patients with classic PTCs located in the lobe who had undergone total thyroidectomy with bilateral central lymph node dissection during the same period were randomly matched to the study patients for age, sex, and tumor size.According to the clinicopathologic analyses, the incidence of extrathyroidal extension was higher in the patients with a tumor originating in the isthmus than in the control group (p = 0.026). According to the imaging analyses, the tumors originating in the isthmus more frequently had a circumscribed margin (p = 0.030), a wider-than-tall shape (p0.001), and the suspicion of extrathyroidal extension (p0.001) than those originating from the lobes.The results of this study showed that PTCs originating in the isthmus were more likely to have extrathyroidal extension than those originating from the lobes. Therefore, careful ultrasound evaluation should be performed on masses in the thyroid isthmus even if ultrasound shows a circumscribed mass with a wider-than-tall shape.

BRAF(V600E) mutation (valine-to-glutamate substitution at residue 600 of the B-type Raf kinase gene) analysis from thyroid aspirates is increasingly used as a prognostic or diagnostic marker. However, it is limited under some conditions. The purpose of this study was to assess the incidence and predictive factors of thyroid nodules with specimens inadequate for BRAF(V600E) mutation analysis.We performed a retrospective cohort study of consecutive patients who underwent ultrasound-guided fine-needle aspiration (FNA) and molecular testing of aspiration specimens. Patients who had inadequate specimens in both allele-specific polymerase chain reaction and direct DNA-sequencing methods were selected. Univariate and multivariate logistic regression analyses were performed to identify predictive factors of specimens inadequate for molecular tests.Specimens inadequate for BRAF(V600E) mutation analysis were seen in 168 of 7001 (2.4%) patients. Factors, including patient age and sex, nodule size, ultrasound diagnosis, the presence of calcification, and cystic changes within thyroid nodules, were not significant predictors of inadequate mutation analysis. Oval-to-round or irregular shapes (e.g., not taller-than-wide) and final benign results were significant factors in univariate analysis (p = 0.0002 and p = 0.0013, respectively). However, nodules aspirated by operators with less than 1 year of experience (odds ratio [OR], 3.005; p = 0.0070), and those that had spiculated margins (OR, 6.139; p = 0.0142), isoechogenicity (OR, 10.374; p = 0.0442), or nondiagnostic cytologic findings (OR, 73.637; p = 0.0055) remained significant risk factors after adjustment in multivariable analysis.Thyroid nodule specimens inadequate for BRAF(V600E) mutation analysis were frequently associated with FNA aspiration performed by inexperienced operators, nondiagnostic cytologic findings, benign nodules on final diagnosis, and probably benign ultrasound findings, such as isoechogenicity and not-taller-than-wide shape.

The aim of this study was to evaluate whether sonography can diagnose medullary thyroid carcinoma (MTC) as a malignant lesion using widely accepted sonographic criteria and to compare which sonographic findings of MTC are different from findings for papillary thyroid carcinoma (PTC).The study included 42 patients (13 men and 29 women; mean age, 48 years) with 46 MTCs and 51 consecutive patients (10 men and 41 women; mean age, 48 years) with 55 PTCs that were confirmed at surgery. Two radiologists retrospectively determined the sonographic diagnoses according to malignant criteria (a taller-than-wide shape, spiculated margin, marked hypoechogenicity, and microcalcifications or macrocalcifications) and compared the sonographic findings of MTCs and PTCs.MTCs were diagnosed as malignant for 72% of cases by sonography, whereas PTCs were 87% malignant (p = 0.0511). Compared with PTCs, MTCs were larger (mean size, 2.3 +/- 1.5 cm vs 1.1 +/- 1.1 cm) (p = 0.001; odds ratio [OR], 3.84; 95% CI, 1.719-8.565), more frequently showed the presence of a cystic change (33% vs 4%) (p = 0.0226; OR, 0.10; 95% CI, 0.014-0.725), and more commonly showed homogeneous echotexture of the solid portion (59% vs 31%) (p = 0.0004; OR, 0.08; 95% CI, 0.019-0.321). MTCs tended to show an oval shape and circumscribed margin, but there was no statistical significance in multivariate analysis. There were no significant differences in echogenicity, presence, and type of calcification for MTCs and PTCs.Currently accepted sonographic criteria can be applied for a diagnosis of MTCs. MTCs differ from PTCs in size, presence of a cystic change, and echotexture.

The purpose of this study was to evaluate the applicability of the current BI-RADS for sonography to the assessment of synchronous breast nodules other than the primary malignant tumor in patients with breast cancer.One hundred eighty-nine synchronous nodules in 147 breast cancer patients were surgically excised after localization, and 412 synchronous nodules in 191 patients were observed or biopsied or excised without localization. Among a total of 601 synchronous nodules, 372 nodules were ipsilateral and 229 were contralateral to a primary malignant tumor. Two radiologists retrospectively reviewed sonograms of these nodules and determined the sonographic BI-RADS category without clinical information or pathologic results. For each nodule, the preoperative BI-RADS category and pathologic or follow-up results were compared.Four hundred eighty-two nodules were classified category 3; 112 nodules, category 4; and seven nodules, category 5. Fifty-five (11.4%) of the category 3 nodules and 57 (47.9%) of the category 4 and 5 nodules were confirmed malignant. Thirty-six (21.2%) of 170 category 3 synchronous nodules in the same quadrant as the primary tumor were confirmed malignant, as were 12 (9.8%) of 122 nodules in a different quadrant and eight (4.2%) of 190 nodules in the contralateral breast.For assessment of synchronous nodules in breast cancer patients, application of conventional screening sonographic BI-RADS categories may not account for possible increased risk of malignancy in synchronous nodules, especially those in the same quadrant of the breast as the index malignant tumor.

OBJECTIVE: This retrospective study was undertaken to evaluate the radiographic and clinical findings of adenoviral lower respiratory infection during an epidemic period. CONCLUSION: Epidemic adenoviral pneumonia may mimic bacterial pneumonia on radiographs. Findings that include bilateral and multifocal involvement on chest radiographs, normal or decreased WBC associated with lymphocytosis, and progression of illness despite extensive antibiotic therapy, help to differentiate epidemic adenoviral from bacterial pneumonia.

AJR:176, February 2001 s a result of recent developments in technology, helical CT is now used for evaluation of patients with aortic disease [1–4]. However, the imaging area during one scanning session using single-detector helical CT is still limited because of the low scan speed, patient intolerance of long breath-hold time, and overheating of the CT tube. If the slice thickness is reduced to 3 mm to obtain high-quality images from the aortic arch to the iliac arteries, it is impossible to scan the entire area during a single breath-hold. As a result, the patient must rest before the radiologist can continue to scan the abdominal aorta and iliac arteries. We designed a split-bolus injection technique to eliminate wasting contrast material during the pause for respiration between the two scan clusters and to secure optimal aortic enhancement in the abdominal aorta and iliac arteries. With this technique, the amount of contrast material is divided and then injected biphasically.