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Introduction. Primary hyperparathyroidism may have several presentations, varying from an incidental asymptomatic biochemical finding to gastrointestinal, psychiatric, renal and bone manifestations. Brown tumors are rare non-neoplastic lesions because of abnormal bone metabolism. Herein, we describe a patient who presented with lytic bony lesions and severe asymptomatic hypercalcemia due to parathyroid adenoma. Case presentation. A 38-year-old male presented with multiple painful bony lesions over upper and lower limbs. Radiographs of long bones showed multiple lytic lesions with cortical thinning. Investigations revealed hypercalcemia and hyperparathyroidism. A radionuclide scan showed parathyroid adenoma. The patient was treated for hypercalcemia and a parathyroidectomy was performed. Conclusions. In a patient presenting with multiple bony swellings and asymptomatic hypercalcemia, hyperparathyroidism should be suspected. Parathyroid adenoma is a treatable cause of primary hyperparathyroidism. [ABSTRACT FROM AUTHOR]

In this review, we highlight current understanding of the pathogenesis of acalculous cholecystitis, as well as its key imaging and clinical features. We also review what happens after a diagnosis and outline current interventional methods., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

As the use of cross-sectional abdominal and pelvic imaging has increased exponentially in the past several decades, incidental musculoskeletal findings have become commonplace. These are often unrelated to the indication for the examination and are frequently referred to as the "radiologist's blind spot" on these studies. The differential diagnosis for abnormalities of the paraspinal and pelvic musculature is, in many cases, quite different from the anterior abdominal wall muscles. Furthermore, due to their relatively deep location, pathology involving the former muscle groups is more likely to be clinically occult, often presenting only incidentally when the patient undergoes cross-sectional imaging. Effective treatment of diseases of these muscles is dependent on adherence to a diverse set of diagnostic and treatment algorithms. The purpose of this review article is to familiarize the radiologist with the unique pathology of these often-overlooked muscles of the abdomen and pelvis., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Numerous conditions and pathologies affect the biliary system, many of which have underlying benign courses. However, these overall benign conditions can predispose the patient to malignant pathologies, often due to malignancy arising from abnormal biliary ducts (such as with cholangiocarcinoma) or due to malignancy arising from end-stage liver disease caused by the biliary condition (such as with hepatocellular carcinoma). While these malignancies can at times be obvious, some pathologies can be very difficult to detect and distinguish from the underlying benign biliary etiology. This paper discusses various benign biliary pathologies, with discussion of epidemiology, imaging features, malignant potential, and treatment considerations, with the goal of educating radiologists and referring clinicians to the risk and appearance of hepatobiliary malignancies associated with benign biliary conditions., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Hepatic ductopenia is a pathologic diagnosis characterized by a decrease in the number of intrahepatic bile ducts as a consequence of various underlying etiologies. Some etiologies, such as primary sclerosing cholangitis, primary biliary cholangitis, and ischemic cholangitis, often have distinctive imaging findings. In contrast, other causes such as chronic rejection following liver transplantation, drug-induced biliary injury, infection, malignancy such as lymphoma, and graft-versus-host disease may only have ancillary or non-specific imaging findings. Thus, diagnosing ductopenia in conditions with nonspecific imaging findings requires a multidimensional approach, including clinical evaluation, serological testing, imaging, and liver histology to identify the underlying cause. These etiologies lead to impaired bile flow, resulting in cholestasis, liver dysfunction, and, ultimately, cirrhosis and liver failure if the underlying cause remains untreated or undetected. In the majority of instances, individuals diagnosed with ductopenia exhibit a positive response to treatment addressing the root cause or cessation of the causative agent. This article focuses on acquired causes of ductopenia, its clinical manifestation, histopathology, imaging diagnosis, and management., (© 2024. The Author(s).)

We describe two new species of Cnemaspis from Alagarkovil, Madurai District and Mekkarai, Shenkottai, Tenkasi, southern India, based on molecular and morphological data. The new species differ from their congeners by genetic divergences of 4.816.1% and 14.831.6% for the ND2 mitochondrial gene. Two new species belong to the Cnemaspis gracilis and Cnemaspis beddomei clades, respectively. Molecular data for the newly described Cnemaspis aaronbaueri from its type locality is also presented, and its phylogenetic position is established.

Contrast-enhanced ultrasound (CEUS) uses intravenously injected gas microbubbles as a pure blood pool contrast agent to demonstrate blood flow and tissue perfusion at a much higher sensitivity than color Doppler and power Doppler ultrasound. CEUS has gained traction in abdominal diagnostic imaging for improved lesion detection and characterization and a complementary problem-solving tool to CT and MRI. In addition to its diagnostic applications, CEUS has also proven useful for pre-procedure planning, procedure guidance, and post-procedure evaluation. This review provides a practical overview and guides to the application of CEUS in percutaneous, ultrasound-guided, needle-driven procedures, focusing on 2 common procedures, which illustrate the many benefits of CEUS- core needle biopsy (CNB) and percutaneous hepatic lesion ablation., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Primary sclerosing cholangitis (PSC) is notoriously challenging to manage given its heterogeneity with regard to diagnosis, management, and progression. The lack of disease-modifying therapy and variable rate of onset of cirrhosis, portal hypertension-related decompensating events, jaundice, pruritus, biliary complications, and need for liver transplantation is deeply unsettling to clinicians and patients alike. Recent updated practice guidance by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver endeavored to highlight some of these challenges. However, these references only briefly address clinical dilemmas that providers face on a daily basis. This review aims to further discuss these controversial topics, including providing insight into the utility of ursodeoxycolic acid, the significance of alkaline phosphatase normalization, when to consider PSC variants and mimickers, and the implications of continuous hepatobiliary malignancy screening. In particular, there has been a growing body of literature raising concern about repeat exposure to gadolinium-containing contrast. Patients with PSC are potentially at risk for large lifetime exposure to gadolinium related to frequent magnetic resonance imaging scans and whether this carries any negative long-term adverse effects remains unknown., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The original description of Natrix leonardi (currently Rhabdophis leonardi ) by Frank Wall in 1923, based on a specimen from the "Upper Burma Hills," lacked important morphological details that have complicated the assignment of recently collected material. Furthermore, although the holotype was never lost, its location has been misreported in one important taxonomic reference, leading to further confusion. We report the correct repository of the holotype (Natural History Museum, London), together with its current catalog number. We also describe key features of that specimen that were omitted from the original description, and provide new details on the morphology of the species, including sexual dichromatism unusual for the genus, based upon specimens from southern Sichuan, China. Rhabdophis leonardi is distinguished from its congeners by the following characters: 15 or 17 DSR at midbody and 6 supralabials; distinct annulus around the neck, broad and red in males, and narrow and orange with a black border in females; dorsal ground color light green or olive; some lateral and dorsal scales possessing black edges, the frequency of black edges gradually increasing from anterior to posterior, forming irregular and ill-defined transverse black bands; eye with prominent green iris; black ventral spots with a red edge, most numerous at midbody but extending halfway down the length of the tail. In southwestern China, this species is frequently found at 1730-2230 m elevation. It has been documented to prey upon anuran amphibians, including toads. A recently published phylogenetic analysis showed this species to be deeply nested with the genus Rhabdophis , as a member of the R. nuchalis Group. That analysis also revealed the existence of two closely related but geographically distinct subclades in the molecular analysis, one of which may represent an unnamed taxon., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Thyroid ultrasounds extend surgeons' outpatient capabilities and are essential for operative planning. However, most residents are not formally trained in thyroid ultrasound. The purpose of this study was to create a novel thyroid ultrasound proficiency metric through a collaborative Delphi approach., Methods: Clinical faculty experienced in thyroid ultrasound participated on a Delphi panel to design the thyroid Ultrasound Proficiency Scale (UPS-Thyroid). Participants proposed items under the categories of Positioning, Technique, Image Capture, Measurement, and Interpretation. In subsequent rounds, participants voted to retain, revise, or exclude each item. The process continued until all items had greater than 70% consensus for retention. The UPS-Thyroid was pilot tested across 5 surgery residents with moderate ultrasound experience. Learning curves were assessed with cumulative sum., Results: Three surgeons and 4 radiologists participated on the Delphi panel. Following 3 iterative Delphi rounds, the panel arrived at >70% consensus to retain 14 items without further revisions or additions. The metric included the following items on a 3-point scale for a maximum of 42 points: Positioning (1 item), Technique (4 items), Image Capture (2 items), Measurement (2 items), and Interpretation (5 items). A pilot group of 5 residents was scored against a proficiency threshold of 36 points. Learning curve inflection points were noted at between 4 to 7 repetitions., Conclusions: A multidisciplinary Delphi approach generated consensus for a thyroid ultrasound proficiency metric (UPS-Thyroid). Among surgery residents with moderate ultrasound experience, basic proficiency at thyroid ultrasound is feasible within 10 repetitions.

Liver transplantation is a potentially curative treatment for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy. Despite tremendous advancements in surgical techniques and immunosuppressive management, there remains a high rate of post-transplant complications, with one of the main complications being biliary complications. In addition to anastomotic leak and stricture, numerous additional biliary complications are encountered, including ischemic cholangiopathy due to the sole arterial supply of the bile ducts, recurrence of primary biliary disease, infections, biliary obstruction from stones, cast, or hemobilia, and less commonly cystic duct remnant mucocele, vanishing duct syndrome, duct discrepancy and kinking, post-transplant lymphoproliferative disorder, retained stent, and ampullary dysfunction. This article presents an overview of biliary anatomy and surgical techniques in liver transplantation, followed by a detailed review of post-transplant biliary complications with their corresponding imaging findings on multiple modalities with emphasis on magnetic resonance imaging and MR cholangiopancreatography., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Primary sclerosing cholangitis is a rare chronic inflammatory disease affecting the bile ducts, which can eventually result in bile duct strictures, cholestasis and cirrhosis. Patients are often asymptomatic but may present with clinical features of cholestasis. Imaging plays an important role in the diagnosis and management. This review covers the pathophysiology, clinical features, imaging findings as well as methods of surveillance and post-transplant appearance., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: A number of total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient factors, surgical technique and implant characteristics. The aim of the current study was to report the early functional results of a primary TKA system in support of the component design characteristics adapted for achieving increased functional expectations of the patients., Materials and Methods: A prospective, continuous series of 304 primary posterior-stabilized (PS) TKAs were performed in 208 patients by a single surgeon. Inclusion criterion was patients undergoing primary TKA with Freedom Total Knee system and willing to participate in the study. Exclusion criteria were patients undergoing revision TKA, patients not willing to participate and patients who were lost to follow-up. Patients were clinically and radiologically assessed for a minimum of 5 years post-operatively. Oxford Knee score (OKS) and range of motion (ROM) were assessed for the entire study population and by gender., Results: There were no patients who were lost to follow-up. Two patients (Two knees) required incision and secondary suturing for superficial skin wound complication. At minimum 5-year follow-up, there was no radiographic evidence of component loosening/failure. Clinical evaluation at 5 years post-operatively showed statistically significant increase in the OKS and ROM as compared to pre-operative values (OKS pre-operative 19.27 ± 1.86, post-operative 38.76 ± 1.5, p value < 0.001, ROM pre-operative 94.57 ± 3.49, post-operative 127.69 ± 3.65, p value < 0.001). There was no statistically significant difference in the clinical outcome between male and female genders as well as between unilateral and bilateral TKA., Conclusion: The study showed encouraging early results for the bone-conserving high flexion TKA system in 208 patients at minimum 5-year follow-up. The adapted design characteristics for improved functional expectations are confirmed in this reported Indian population study group cohort. Further continued evaluation is warranted for this primary TKA system across Indian and other ethnic population., Competing Interests: Conflict of InterestThe authors declare there are no financial conflicts of interest to disclose., (© Indian Orthopaedics Association 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: THA (Total hip arthroplasty) in advanced grade (grade 4) avascular necrosis (AVN) is a challenge to the treating surgeon as it affects young patients who have high functional demands and increased dislocation risk. The aim of the study was to evaluate the efficacy, survivorship, and dislocation rate of uncemented dual mobility cups (DMC) in advanced grade IV AVN young patients., Methods: Retrospective cohort study involving 204 DMC THA for advanced grade IV AVN from January 2013 to December 2015. The sample size of the study was estimated to be 188 hips with an α error of 0.05 and β error of 0.2. Inclusion criterion was patients less than 55 years of age with advanced grade IV AVN. Patients >55 years of age, patients diagnosed with primary osteoarthritis of the hip and hip fracture were excluded from the study. 172 patients (32 with bilateral & 140 with unilateral affection) with 204 DMC THA were evaluated clinically by Harris Hip Score (HHS) and radiologically at a follow up of 60 months. P value < 0.05 was considered significant., Results: Mean age of the patients was 42.5 ± 5.3. Preoperative HHS was 50.6 ± 10.5. Postoperative HHS at 5 years follow up was 96.4 ± 2.6. None of the operated patient had any dislocation episode or had undergone hip revision surgery (statistically significant against historical control of 2%, p value = 0.042). The radiological evaluation at 5 years showed no signs of radiolucent lines, periprosthetic osteolysis, polyethylene wear and signs of displacement or migration of the DMC. Cumulative survivorship rate at 5 years follow up was 100% without any revision/dislocation., Conclusion: Use of DMC THA in young, advanced grade IV AVN patients was found to be a reliable option showing excellent early functional results with no dislocation. Ongoing follow up of this cohort is required to confirm the maintenance of these excellent functional results at follow up in the long term., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests., (© 2022 Delhi Orthopedic Association. All rights reserved.)

Although stable hydrogen ( δ 2 H) and carbon ( δ 13 C) isotopic compositions of bird feathers have been increasingly used to understand the migration of birds through assignment of individuals to established isoscapes, far less is known about the structure of feather isoscapes based on stable sulphur isotope ( δ 34 S) assays. While δ 2 H isoscapes have been used to investigate the migratory origins of the Globe Skimmer ( Pantala flavescens ) dragonfly in India, no isotope studies have been applied to avian migration patterns in that region. Here, based on museum collections, we report the feather δ 34 S values of 13 avian species that included marine birds with expected 34 S enriched feathers, resident birds throughout India and a single migratory species, Bar-headed Goose ( Anser indicus ). Feathers from the marine birds were the most enriched (20.6 ± 1.2 ‰, n  = 10; range = 4.4 ‰) in 34 S but terrestrial resident species also showed unexpectedly high δ 34 S values (11.7 ± 4.8 ‰, n  = 74; range = 19.9 ‰) throughout most of India but the Himalayan region and Gangetic plain typically showed δ 34 S values less than 6.4 ‰. Our results show the utility of feather δ 34 S studies to decipher avian and other animal migration between these two regions.

Background: One of the most common fractures in the elderly population is a fracture of the neck of femur. Effective post-operative analgesia is a major challenge. Age-related co-morbidities restrict the choice of analgesics. The purpose of this study was to compare the efficacy and safety of transdermal buprenorphine [TDB] patch and conventional analgesics following hemiarthroplasty for intra-capsular fracture neck of femur., Materials and Methods: This was a prospective, randomized control study done in 60 patients undergoing hemiarthroplasty for intra-capsular fracture neck of femur over a period of 2 years. Patients were randomized in 2 groups. Group A received a combination of IV paracetamol and tramadol for first 48 h followed by oral formulation. In Group B patients, a transdermal buprenorphine patch of 5 mcg/h was applied at the beginning of surgery and was continued 2 weeks post-operative.Pain score by VAS was observed both at rest and on movement and followed up till 14 days post-operative. Primary target was to maintain a VAS ≤ 4. Rescue analgesic was given if the VAS was ≥ 6. Secondary targets were number of rescue analgesics required, adverse reactions and complications if any., Results: Group B had significantly lower pain scores at rest and during movement [ p value 0.0012 to ≤ 0.0001], so was rescue analgesia requirement. No significant side effects were seen in TDB group., Conclusion: TDB patch is safe and provides superior analgesia and compliance as compared to conventional analgesics in the post-operative period in proximal femur fracture surgeries., Competing Interests: Conflict of interestThe authors declare no financial conflicts of interest to disclose., (© Indian Orthopaedics Association 2022.)

A good understanding of the anatomic structures of the neck surrounding the thyroid gland is a requisite for safely performing image guided procedures on the thyroid gland. Patients presenting for treatment of thyroid nodules can have anatomy that is distorted by the nodules or by prior surgery. This pictorial review describes the anatomy of the thyroid gland and surrounding structures. Additionally, a review of how to perform an ultrasound exam of the thyroid gland and how to categorize thyroid nodules is included., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Aim: To evaluate whether short-term treatment with a selective 11β-Hydroxysteroid dehydrogenase-1 (11β-HSD1) inhibitor, AZD4017, would block hepatic cortisol production and thereby decrease hepatic fat in patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH), with or without type 2 diabetes (T2D)., Materials and Methods: This was a randomized, double-blind, placebo-controlled, phase 2 study conducted at two sites. Key inclusion criteria were the presence of NAFLD or NASH on magnetic resonance imaging (MRI) or recent biopsy positive for NASH. Enrolled patients were randomly assigned (1:1) to AZD4017 or placebo for 12 weeks. Primary outcomes were between-group differences in mean change from baseline to week 12 in liver fat fraction (LFF) and conversion of 13 C cortisone to 13 C cortisol in the liver., Results: A total of 93 patients were randomized; 85 patients completed treatment. The mean (standard deviation [SD]) change in LFF was -0.667 (5.246) and 0.139 (4.323) in the AZD4017 and placebo groups (P = 0.441). For patients with NASH and T2D, the mean (SD) change in LFF was significantly improved in the AZD4017 versus the placebo group (-1.087 [5.374] vs. 1.675 [3.318]; P = 0.033). Conversion of 13 C cortisone to 13 C cortisol was blocked in all patients in the AZD4017 group. There were no significant between-group differences (AZD4017 vs. placebo) in changes in fibrosis, weight, levels of liver enzymes or lipids, or insulin sensitivity., Conclusion: Although the study did not meet one of the primary outcomes, AZD4017 blocked the conversion of 13 C cortisone to 13 C cortisol in the liver in all patients who received the drug. In patients with NASH and T2D, AZD4017 improved liver steatosis versus placebo., (© 2022 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to compare how often fine-needle aspiration (FNA) would be recommended for nodules in unselected, low-risk adult patients referred for sonographic evaluation of thyroid nodules by ACR Thyroid Imaging Reporting and Data System (TI-RADS), the American Thyroid Association guidelines (ATA), Korean Thyroid Imaging Reporting and Data System (K-TIRADS), European Thyroid Imaging Reporting and Data System (EU-TIRADS), and Artificial Intelligence Thyroid Imaging Reporting and Data System (AI-TIRADS)., Methods: Seven practices prospectively submitted thyroid ultrasound reports on adult patients to the ACR Thyroid Imaging Research Registry between October 2018 and March 2020. Data were collected about the sonographic features of each nodule using a structured reporting template with fields for the five ACR TI-RADS ultrasound categories plus maximum nodule size. The nodules were also retrospectively categorized according to criteria from ACR TI-RADS, the ATA, K-TIRADS, EU-TIRADS, and AI-TIRADS to compare FNA recommendation rates., Results: For 27,933 nodules in 12,208 patients, ACR TI-RADS recommended FNA for 8,128 nodules (29.1%, 95% confidence interval [CI] 0.286-0.296). The ATA guidelines, EU-TIRADS, K-TIRADS, and AI-TIRADS would have recommended FNA for 16,385 (58.7%, 95% CI 0.581-0.592), 10,854 (38.9%, 95% CI 0.383-0.394), 15,917 (57.0%, 95% CI 0.564-0.576), and 7,342 (26.3%, 95% CI 0.258-0.268) nodules, respectively. Recommendation for FNA on TR3 and TR4 nodules was lowest for ACR TI-RADS at 18% and 30%, respectively. ACR TI-RADS categorized more nodules as TR2, which does not require FNA. At the high suspicion level, the FNA rate was similar for all guidelines at 68.7% to 75.5%., Conclusion: ACR TI-RADS recommends 25% to 50% fewer biopsies compared with ATA, EU-TIRADS, and K-TIRADS because of differences in size thresholds and criteria for risk levels., (Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

COVID-19 can have an unpredictable and severe course, leading to many hypotheses regarding its pathophysiology and clinical manifestations. Haematological manifestations are a significant predictor of disease severity. The most common observation is lymphopenia with an increased neutrophil:lymphocyte ratio. Platelets have been implicated in thrombogenic events, but the most frequently reported abnormality is mild thrombocytopenia. Here we present an interesting case of a patient with moderate COVID-19 who presented with cutaneous ecchymoses and thrombocytosis, and discuss this paradox., Learning Points: Bleeding manifestations such as ecchymoses can occur as an idiosyncratic reaction to the administration of convalescent plasma therapy in COVID-19.Thrombocytosis can occur in COVID-19 and could be a contributory factor to disease vasculopathy., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2021.)

Competing Interests: None

Urbanization is one of the main drivers in the conversion of natural habitats into different land use and land cover types (LULC) which threaten the local as well as global biodiversity. This impact is particularly alarming in tropical countries like India, where ~18% of the world's population live, and its ever-growing economy (i.e., industrial development) expanded urban areas by several folds. We undertook this study to examine the impacts of urbanization (i.e., LULC) on terrestrial vertebrates (mammals, birds, reptiles, and amphibians) in the Mumbai Metropolitan Region (MMR), Western Ghats, India. We sampled different habitats ranged from highly disturbed urban areas to less disturbed forested areas. Multiple sampling methods such as quadrat sampling, line transect, point count, and camera trapping were used to quantify the target taxa. We used multi-species occupancy modeling in the Bayesian framework to estimate detection probability and occupancy and to assess the effect of various LULC on different species. All four groups showed a significant negative impact of increasing anthropogenic habitat cover on occupancy. Out of 213 species detected in this study, 96% of mammals, 85% of birds, 93.75% of amphibians, and 69.43% of reptiles showed a negative effect of anthropogenic habitat cover. Evidence suggests that historical and recent human disturbances could have played an important role in transforming this area from semi-evergreen and moist deciduous forest to open, scrubby, dry deciduous, and fire-prone landscape. This might be the reason for the high occupancy of open and degraded forest habitat preferring species in our study area. We recommend species-rich areas in the MMR, e.g., Karnala Bird Sanctuary (KBS) and Prabalgad-Matheran-Malanggad Hill Range (PMMHR), must be conserved through habitat restoration, ecotourism, public awareness, and policymaking., Competing Interests: The authors have declared that no competing interests exist.

Objective: To test the hypothesis that there is a measureable upward motion of the diaphragm during prolonged breath-holds that could have a detrimental effect on image quality in liver MRI and to identify factor that potentially influence the magnitude of this motion., Methods: 15 healthy volunteers underwent MRI examination using prolonged breath-holds in the maximum inspiratory position and a moderate inspiratory position. Coronal T 1 weighted three-dimensional gradient echo sequences of the entire thorax were acquired every 6 s during breath-holding allowing the calculation of total lung volume and the measurement of the absolute position of the dome of the liver. The potential impact of subject's gender, body mass index, and total lung capacity on the change in lung volume/diaphragmatic motion was assessed using random coefficient regression., Results: All volunteers demonstrated a slow reduction of the total lung volume during prolonged breath-holding up to 123 ml. There was a measurable associated upward shift of the diaphragm, measuring up to 5.6 mm after 24 s. There was a positive correlation with female gender ( p = 0.037) and total lung volume ( p = 0.005) and a negative association with BMI ( p = 0.012) for the maximum inspiratory position only., Conclusion: There is a measureable reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath-holding which likely contributes to motion artifacts in liver MRI., Advances in Knowledge: There is a measureable gas exchange-related reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath-holding which likely contributes to motion artifacts in liver MRI. Correcting for this predictable upward shift has potential to improve image quality.The magnitude of this effect does not seem to be related to gender, BMI or total lung capacity if a moderate inspiratory position is used.

Objectives: To assess the yield of neck ultrasound (US) when serum thyroglobulin (Tg) is undetectable (<0.1 ng/mL) compared to elevated serum Tg in patients with differentiated papillary thyroid carcinoma (PTC) treated with thyroidectomy and radioactive iodine 131 (RAI) ablation., Methods: A retrospective chart review was conducted from 2010 through 2015 at an academic institution evaluating US results in patients with serum Tg levels obtained within 6 months of a neck US examination after thyroidectomy and RAI. The reference standard for recurrence was pathologic results from US-guided fine-needle aspiration (FNA) or follow-up for at least 1 year., Results: Among 76 patients with undetectable serum Tg levels, there were 19 examinations in 18 patients in which US raised the possibility of recurrence. None of these 18 patients had recurrence by FNA (n = 8) or clinical follow-up of at least 1 year (n = 10). Among 65 patients with elevated serum Tg levels, there were 24 examinations in 22 patients in which US raised the possibility of recurrence. Twelve patients underwent FNA, with 9 patients (34.6%) showing PTC; 7 patients had follow-up neck US examinations showing stability of findings; and 3 patients were lost to follow up. The yield of neck US was significantly lower when serum Tg was undetectable compared to when levels were elevated (P = .001)., Conclusions: Neck US did not identify recurrent PTC when the serum Tg level was undetectable in patients who underwent total thyroidectomy and RAI therapy. Eliminating neck US when serum TG levels are undetectable could decrease unnecessary imaging examinations without negatively affecting the ability to detect recurrent disease., (© 2018 by the American Institute of Ultrasound in Medicine.)