Soft Tissue Components Research Articles

Clinical outcomes and complications with minimally invasive plate osteosynthesis in closed extraarticular distal tibia fractures: A prospective study

Extra articular distal tibia fractures are not common injuries and are usually associated with soft tissue component. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) preserves the vascularity of the bone thereby achieving predictable healing. A total of 25 cases were included in the study who underwent MIPPO as treatment for the injuries using locking compression plate screws devices of fixation. Majority (92%) of the fractures united within 16-24 weeks. Infection and impingement were the two most recognised complications in our study. Most of our cases (90%) had excellent to good outcome. MIPPO proves to be a reliable method of fixation for these injuries and is met with good final outcome.

A sparse principal component analysis of Class III malocclusions.

To identify the most characteristic variables out of a large number of anatomic landmark variables on three-dimensional computed tomography (CT) images. A modified principal component analysis (PCA) was used to identify which anatomic structures would demonstrate the major variabilities that would most characterize the patient. Data were collected from 217 patients with severe skeletal Class III malocclusions who had undergone orthognathic surgery. The input variables were composed of a total of 740 variables consisting of three-dimensional Cartesian coordinates and their Euclidean distances of 104 soft tissue and 81 hard tissue landmarks identified on the CT images. A statistical method, a modified PCA based on the penalized matrix decomposition, was performed to extract the principal components. The first 10 (8 soft tissue, 2 hard tissue) principal components from the 740 input variables explained 63% of the total variance. The most conspicuous principal components indicated that groups of soft tissue variables on the nose, lips, and eyes explained more variability than skeletal variables did. In other words, these soft tissue components were most representative of the differences among the Class III patients. On three-dimensional images, soft tissues had more variability than the skeletal anatomic structures. In the assessment of three-dimensional facial variability, a limited number of anatomic landmarks being used today did not seem sufficient. Nevertheless, this modified PCA may be used to analyze orthodontic three-dimensional images in the future, but it may not fully express the variability of the patients.

04:03 PM Abstract No. 303 Percutaneous image-guided bone biopsy for suspected pediatric osteomyelitis

Osteomyelitis in children can produce significant debilitation and broadly includes infectious (acute and chronic) and non-infectious osteomyelitis, including chronic recurrent multifocal osteomyelitis (CRMO). Biopsy is often performed to aid in diagnosis and to identify the pathogen, frequently in cases wherein best management, based on clinical presentation, is ambiguous. The aim of our study was to characterize the yield and assess efficacy of image-guided bone biopsy for pediatric osteomyelitis. This was a retrospective review of patients with suspected osteomyelitis based on clinical data and imaging who underwent percutaneous bone biopsy in interventional radiology over a 10-year period at a tertiary pediatric hospital. Review parameters included procedural technical data and clinical data, including details of clinical presentation and microbiology and pathology results. 40 patients (mean age 9.5y, range 0.4-25.8y) underwent biopsy. Fluoroscopy was used in 29 cases, with rotational CT in 16 cases. Of these 16, Syngo iGuide guidance software was used in 9 cases, and MRI overlay was used in 4. CT guidance was used in 9. Additional US guidance for adjacent soft tissue component was used in 17 cases. Mean procedure time was 85 minutes, and mean fluoroscopy time was 3.6 min. A 16G bone biopsy cannula was utilized in 34 cases; a 13G cannula in 5; and an 11G in 1 case. The mean number of bone cores obtained was 3.6. Biopsy culture yielded a pathogen in 4 of 40 cases, and culture results did not show significant correlation with lesion location, fever, leukocytosis/blood culture, ESR/CRP, number of cores, instrument gauge, or aspiration of marrow. There was pathology adequacy in 100%. Based on culture and pathology results, 22 patients were diagnosed with infectious osteomyelitis (13 chronic and 9 acute) and were placed on antibiotic therapy. Fifteen patients were diagnosed with CRMO, based on pathology result. Although culture yield of bone biopsy was low, pathology results showed adequacy and aided in management of patients with suspected osteomyelitis. Results support bone biopsy as a safe and effective means to aid in management of pediatric osteomyelitis.

A case of ectopic hamartomatous thymoma: controversy over the designation

BackgroundEctopic hamartomatous thymoma, which usually occurs in the lower neck, is a rare benign tumor containing spindle cells, epithelial nests, and adipose tissue. Although the origin of this tumor is still unknown, recent reports suggest that the designation of this tumor is inappropriate.Case presentationA 38-year-old with an anterior cervical mass in the suprasternal region of her neck was referred to our hospital. An ultrasound examination showed that the well-defined oval mass was 31 × 23 × 17 mm in size. A non-enhanced computed tomography scan of the neck revealed that the distinct neck mass in the subcutaneous tissue had a mixture of soft tissue and fatty components. The cervical tumor was clinically diagnosed to be an unusual lipoma with degeneration. The patient underwent the neck mass extirpation. During the surgery, the cervical mass was well demarcated and did not adhere to the surrounding tissues. The postoperative course was uneventful. The gross pathology report showed that the neck mass measured 3.0 × 2.5 × 2.0 cm. Microscopically, the tumor was composed of spindle cells, epithelial nests, and mature adipose tissue. Immunohistochemical examination revealed that both spindle cells and epithelial nests were positive for cytokeratin AE1/AE3. These histopathological findings were consistent with the features of ectopic hamartomatous thymoma. Over a follow-up period of 30 months, this patient exhibited no evidence of recurrence.ConclusionsEctopic hamartomatous thymoma should be considered in the differential diagnosis of subcutaneous tumors in the lower neck, when the CT shows the tumor has the mixed components of fat and soft tissues.

Ewing's Sarcoma and Primary Osseous Lymphoma: Spectrum of Imaging Appearances.

Ewing's sarcoma (ES) is a rare, highly malignant anaplastic stem cell tumor. Histologically, the tumor consists of uniform densely packed small monomorphic cells with round nuclei. The typical appearance at hematoxylin and eosin (H&E) staining is small blue round cells without any matrix formation. On conventional radiography, ES typically presents as a permeative lesion in the diaphysis of a long bone in a child. A large soft tissue component is another characteristic feature, best depicted by magnetic resonance imaging.Primary osseous lymphomas are most commonly highly malignant B-cell lymphomas. At H&E histologic staining, the tumor stroma consists of diffuse round-cell infiltrates that resembles the appearance of ES. Although there is no typical imaging appearance of an osseous lymphoma, it should be considered in an adult presenting with a Lodwick grade II or III lesion in the metaphysis or diaphysis of a large long bone, the pelvis, or the vertebral column. Histologic confirmation is mandatory.

Metastatic Squamous Cell Carcinoma of Sternum: An Oncological Curiosity

Skeletal metastasis is a frequent complication of cancer resulting in significant morbidity as well as mortality. We highlight a case of a 73-year-old gentleman with metastatic squamous cell carcinoma of the sternum. He denied dysphagia, shortness of breath, goitre, and presence of chronic non-healing ulcer. He was anaemic and carcinoembryonic antigen (CEA) was 18.7. Chest radiograph on lateral view showed a suspicious cortical irregularity. Computed tomography (CT) scan of thorax revealed an aggressive sternal lesion with soft tissue component. Ultrasound-guided biopsy was performed and the biopsy was consistent with metastatic squamous cell carcinoma. Squamous cell carcinoma has a predilection to metastasize via haematogenous spread, but direct extension of tumour into the bone is not frequently seen. Finding the primary cause is utmost importance either via imaging modalities or invasive procedures. Isolated secondary lesion is extremely rare but unfortunate among defaulters. We discuss its diagnostic work-up and treatment options conserved to manage this condition.

Chondrosarcoma in Norway 1990–2013; an epidemiological and prognostic observational study of a complete national cohort

Background: Knowledge of chondrosarcoma (CS) of bone to date is based on institutional reports and registry publications with limits in reporting, detail and quality of data.Method: We have performed a retrospective search of CS of bone in the National Cancer Registry in Norway from 1990–2013, cross checked against local tumor databases with further quality control and supplementation of all data from clinical files. The time period is defined by the routine use of axial imaging in clinical practice. A total of 311 cases are included. We performed 108 pathological reviews and 223 radiological reviews. The manuscript was prepared according to the STROBE checklist for strengthening of observational studies. We performed uni-/multivariate cox analyses to define independent prognostic variables from the main cohort of central CS of bone.Results: The incidence of CS of bone in Norway is 2.85/million/yr. for both sexes overall, rising to 3.45/million/yr. in the last 5-year period. There is an increase in the most common central CS subtype, stronger for women than for men.Central CS had, in general 10–15% local recurrence rates, all evident by 5 years while metastasis rate increases with location and grade. Exceptions are extremity grade 1 CS which displayed no metastatic events and axial grade-3 disease with high rates (50%) of both local and metastatic relapse. Peripheral CS had limited metastatic potential (2%), but rates of local relapse (13%) continue to appear towards 10 years of follow up.Malignancy grade 3 independently predicts rate of metastasis and presence of soft tissue component predicts local recurrence, metastasis and survival.Conclusion: Rates of local recurrence, metastasis and disease specific survival follow clear patterns depending on subtype, location and grade allowing better tailoring of follow-up regimes. Malignancy grade 3 and the presence of a soft tissue component independently predict behavior for central CS of bone.

Changes in Volume and Density Parameters Measured on Computed Tomography Images Following Stereotactic Body Radiation Therapy of Nonspine Bone Metastases.

Introduction:Volumetric and density parameters measured from computed tomography scans were investigated for evaluating treatment response of nonspine bone lesions following stereotactic body radiation therapy.Methods:Twenty-three patients treated with stereotactic body radiation therapy to nonspine bone metastases with pre- and post-treatment radiological follow-up with computed tomography imaging were identified in a retrospective review. An expert radiologist classified 26 lesions by type (lytic, sclerotic) and by response. Two independent radiation oncologists created separate contours of the bone and soft tissue lesion volumes. Density and volume were assessed relative to baseline values.Results:For bone-only lesions, all lesions designated as local control decreased in volume or remained within 20% of baseline volumes. Lytic lesions classified as progressive disease exhibited much larger volume increases. Lytic bone lesions showed indications of remineralization with some exhibiting immediate increases in density (1-6 months) and others decreasing initially then increasing back toward baseline between 7 and 12 months. The majority of sclerotic lesions, all classified as local control, decreased slightly in both volume and density. Lesions with both soft tissue and boney involvement resulted in contradictory results when employing both radiological and size parameters for assessing treatment response. Classification was dominated by changes in soft tissue volume, despite associated volume or density changes in the corresponding boney lesion. In contrast, when soft tissue volume changes were minimal (<20% increase), classification appeared to be related primarily to density changes and not bone volume.Conclusions:Volume and density changes show promise as quantitative parameters for classifying treatment responses of nonspine osseous lesions. Further work is required for clarifying how these metrics can be applied to lesions with both boney and soft tissue components.

The spectrum of sonographic findings with radiographic correlation in patients with shoulder pain at kenyatta national hospital

Background Shoulder pain is a common musculoskeletal presentation. Prevalence estimates vary from 6.9% to 26% in the general population. The most frequent cause of shoulder pain is rotator cuff disease. Shoulder radiography is often used in the initial evaluation of shoulder pain but is limited in the evaluation of the soft tissues. MRI with its excellent soft tissue characterization is the main modality used in the evaluation of shoulder soft tissues locally but is limited by cost and availability. Shoulder ultrasonography is a cheaper modality for evaluating the soft tissues with results comparable to MRI, but is underutilized locally. Objective This study was designed to determine the spectrum of shoulder sonographic and radiographic findings in patients with shoulder pain at Kenyatta National Hospital. Setting Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. It is located within the old wing of Kenyatta National Hospital. Study design This was a cross sectional descriptive study. Sample size A total of 72 patients with shoulder pain who were referred for shoulder radiographs and offered complementary ultrasound. Method The study was conducted over a period of six months between the months of November 2015 to April 2016. 72 patients referred for Shoulder radiographs had a complementary shoulder ultrasound scan done and findings of both examinations recorded in the data collection form. Statistical analysis of the findings was then done using SPSS version 20 IBM. Results Radiographs picked abnormalities in 36 (50%) patients majority of which were degenerative changes. Ultrasound picked abnormalities in 57(79%) patients with the bulk of lesions seen within the rotator cuff. There was a 58% marginal increase in diagnostic yield when ultrasound was used in series with radiographs. Conclusion The combination of shoulder radiography and ultrasound significantly increased the diagnostic yield by evaluating both osseous and soft tissue components. These findings aim to increase the awareness and utility of shoulder ultrasound locally.

Cranial Intraosseous Meningiomas: CT and MRI Findings.

To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cranial intraosseous meningiomas (IOMs). This study included ten patients (six females and four males) with IOMs who underwent cranial CT and/ or MRI examinations during May 2009?June 2018. Lesions were classified based on the following locations: the sphenoid ridge, the calvarial convexity, other skull base bones, and the sphenoid ridge + calvarial extension. Bony extension, contour irregularity or radial bone spiculation, bony changes (hyperostotic, lytic, or mixed patterns), dural calcification, cerebral edema, and the presence of soft tissue were evaluated. A total of eleven IOMs were identified in ten patients. The age of patients was 46?80 (mean: 55.30 ± 9.84) years. Five of the lesions were located in the sphenoid ridge + calvarium, three in the sphenoid ridge, two in the skull base, and one in the calvarial convexity. Seven lesions exhibited radial bone spiculation. Moreover, nine lesions exhibited hyperostotic CT pattern; while, two exhibited a mixed pattern. Three IOMs were accompanied with dural calcification, and peritumoral edema was observed in six IOMs. IOMs are predominantly low-grade tumors, commonly located in the periorbital area and often accompanied by soft tissue components and dural infiltrations. They most commonly lead to radial bone spiculation and bone expansion. Patients primarily have single lesions but may occasionally have multiple ones.

A rare case of bilateral multiple ovarian dermoids with uterine fibroid and ectopic kidney

Ovarian dermoid cysts are made up of solid, cystic, and fat tissue arising from two of the three germ layers. The incidence of they being bilateral is rare and accounts for 10%–15%. A 42-year-old female came with chief complaints of increased bleeding during menses and pain in the abdomen. Ultrasonography revealed echogenic lesion with heterogeneous echotexture in both the ovaries with internal echogenic strands within which was s/o bilateral dermoid cyst. The patient had a left ectopic renal kidney on contrast-enhanced computed tomography of the abdomen; there was well–defined, rounded, mixed-density mass lesion seen in the pelvis showing fat density, areas of calcification (Rokitansky protuberance), soft tissue, and fluid components. After postoperative and histopathological correlation, it was found to be bilateral dermoid.

Conventional and functional imaging in the evaluation of temporomandibular joint rheumatoid arthritis: a systematic review.

To evaluate the efficacy of diagnostic imaging for temporomandibular joint rheumatoid arthritis (TMJ RA). Inflammation of the TMJ has a high correlation (> 17%) with the late stages of RA. Clinical recognition of TMJ RA using diagnostic imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and cone beam computed tomography (CBCT), is limited to osseous and soft tissue components of the TMJ. Positron emission tomography (PET) and positron emission tomography/CT (PET/CT) are novel technologies that have shown increasing relevance in the detection and management of TMJ RA. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA, 2009) guidelines, and using databases such as PubMed, Ovid Medline, Google Scholar, Web of Science, Scopus, and EBSCOhost, 94 publications were identified, and 27 studies were selected for this systematic review. A flowchart of the comprehensive study selection was generated. Quality assessment and data extraction were performed independently by three reviewers. It was noted that two-dimensional radiographs, CBCT, multidetector CT, and MRI are the most commonly used methods in TMJ RA assessment, although they are not useful for determination of active disease. MRI has excellent contrast resolution and can acquire dynamic imaging for demonstration of the functionality of the TMJ. CT and ultrasound imaging also have specific indication in imaging the TMJ. PET used in conjunction with CT is the only imaging modality that can quantify TMJ RA in active disease. PET/CT images provide unique quantitative information that cannot be obtained from any other imaging modalities.

Imaging findings of metallic implants associated lymphoma

Purpose Chronic inflammatory condition such as metallic implants insertion state has relevance to develop diffuse large B-cell lymphoma (DLBCL). The purpose of this study is to introduce the imaging features of the metallic implants associated lymphoma. Materials and Methods In 2016 September, a 58 years-old male underwent high tibial osteotomy at right leg after took a knee magnetic resonance image (MRI). After 15 months later, he underwent hardware removal operation. 2 weeks later after operation, he complained right leg pain and swelling. He was hospitalized and radiologic studies including ultrasound (US) and MRI were performed. Soft tissue mass in right popliteal fossa was seen and US-guided biopsy was done to confirm the mass. Results MRI which was taken after hardware removal, showed iso to slightly low signal intensity on T1 weighted image(WI), high signal intensity on T2WI with diffuse marrow involvement and heterogeneous patchy enhancement in right proximal tibia. Also extensive extraosseous soft tissue component was seen, with relatively preserved trabecular pattern in proximal tibia. This intraosseous and extraosseous lesions were not seen in previous MRI which taken before high tibial osteotomy. On US image, it was showed heterogeneous hypoechoic and hypervascular lesion in popliteal fossa of left lower leg. US guided biopsy was done on extraosseous soft tissue mass in left popliteal fossa. It was histologically confirmed as DLBCL. Conclusion Hypoechoic and hypervascular disproportionally large extraosseous soft tissue mass without prominent bone destruction is preferential finding of bone lymphoma. Lymphoma should be considered above all, when these findings were seen in patient who has metallic implant.

Skeletal metastatic distribution of HCC on 99mTc-MDP bone scan with a unique feature of soft tissue component

Skeletal metastatic distribution of HCC on 99mTc-MDP bone scan with a unique feature of soft tissue component

Prospective randomized controlled trial comparing the functional outcome of olecranon osteotomy versus triceps tongue elevation for surgical exposure of distal humerus in adults

Background: Fractures of the distal end of the humerus are difficult to treat. The goal of treatment is to achieve a stable, painless elbow with early adequate range of motion. They are operated mainly by posterior approach among which olecranon osteotomy (bony component violation) and triceps tongue elevation (soft tissue component breach) were used in this study.&#x0D; Objectives: The aim of this study was to compare olecranon osteotomy and triceps tongue elevation in terms of functional outcome (Mayo elbow performance index), rates of complications and others.&#x0D; Methodology: A randomized control trial was conducted including 39 eligible adults (20 in triceps tongue elevation and 19 in olecranon osteotomy group) presenting to B.P. Koirala Institute of Health Sciences during the study period of 12 months duration. All skeletally mature adult patients with isolated traumatic closed intra-articular or distal end fracture of humerus without distal neurovascular deficit were included. Patients with polytrauma, refractures, compartment syndrome and patient not giving consent were excluded from the study. They were operated and followed up at 2, 6, 12 and 24 weeks.&#x0D; Results: The demographic profiles of the two groups were comparable. There was significant difference between the intraoperative time between the two groups (p=0.009). At final follow up, there were no significant differences in functional outcome and complications.&#x0D; Conclusion: The approaches are comparable in terms of union, post-operative function and complications. There was increased intraoperative time in the olecranon osteotomy approach suggesting that patients who cannot tolerate longer intraoperative time may benefit from triceps tongue elevation approach.

Effectiveness and Safety of Percutaneous CT-Guided Rib Biopsy

PurposeTo retrospectively evaluate effectiveness and safety of percutaneous CT-guided rib biopsy. Materials and MethodsCT-guided core rib biopsies were performed in 249 consecutive patients between January 2002 and June 2016. Mean patient age was 64.8 years ± 13.8. Additional patient demographics, rib lesion characteristics, and procedural techniques were reviewed. Diagnostic yield was assessed, and complications were classified using SIR criteria. ResultsMean maximal diameter of 249 rib lesions was 2.7 cm ± 1.8, and 107 (43%) rib lesions had an associated extraosseous soft tissue component. Of rib lesions, 172 (69%) were lytic, 75 (30%) were sclerotic, and 2 (1%) were identifiable only with positron emission tomography/CT correlation. Specimens from 241 (96.8%) biopsies were adequate for pathologic diagnosis, whereas 8 (3.2%) were nondiagnostic. Of diagnostic biopsies, 168 (69.7%) were positive for malignancy; 73 (30.3%) revealed benign etiologies. There was a significant difference in diagnostic biopsy rate depending on size of the rib lesion (mean 2.8 cm ± 1.8 for diagnostic biopsies vs mean 1.3 cm ± 0.5 for nondiagnostic biopsies; P = .007). Of rib lesions, 170 (99%) lytic lesions and 69 (92%) sclerotic lesions yielded diagnostic biopsies; diagnostic biopsy rate was significantly higher for lytic lesions than sclerotic lesions (P = .01). There were 14 (5.6%) minor complications and no major complications. ConclusionsPercutaneous CT-guided core rib biopsy resulted in high diagnostic yield and low complications. Diagnostic biopsy rates were higher with larger lesion size and lytic rib lesions.

Assessment of radiation dose distribution of different radioisotopes used to treatment of bone metastasis and pain relief patients in a bone model of foot

Introduction: Although there are several ways to relief pain in metastatic patients, the use of radionuclides is one of the known and effective ways to relieve the pain caused by bone metastases. The purpose of this study was to assessment of radiation dose distribution of different radioisotopes used to treatment and pain relief patients in a bone-based model based on Monte Carlo simulation for particle transport. Materials and Methods: Distribution of radiation dose of six different radioisotopes such as Sm-153, Re-188, Lu-177, Re-186, Sr-89, Ra-223 was done in a foot-bone model using the MCNPX computational code for particle transport. The RADAR decay nuclear data on gamma and beta radiation and the probability emission of each, as well as the recommended ICRU and ICRP data for bone marrow, bone and soft tissue components were used in the dose calculations. Results: After performing of simulation calculations, the absorbed dose spectrums of gamma and beta- rays of radioisotopes mentioned above were calculated according to foot phantom radius, separately. Also, bar charts were used for comparison of the absorbed dose to bone marrow, bone and soft tissue. The highest dose delivered to the bone was related to Ra-223 alpha ray and beta ray of Re-188 and Sr-89. Conclusion: The delivered absorbed dose to the bone tissue as a therapeutic target by alpha ray of Ra- 223 and beta rays of Re-188 and Sr-89 was maximum and the amount of absorbed dose delivered to bone marrow and soft tissue by gamma rays of Sr-89 and Re-188 was high. Accordingly, the choose of widespread clinically used radioisotopes such as Sr-89 and Sm- 153 to treatment and pain relief patients seems to need be revised and more careful.

Magnetic resonance imaging features of craniofacial fibrous dysplasia.

PurposeTo assess the value of magnetic resonance imaging (MRI) in detecting craniofacial fibrous dysplasia (CFD) and diagnosing and differentiating it from intraosseous meningioma. Additionally, the MRI appearance of the typical computed tomography (CT) imaging feature, the ground glass phenomenon, was evaluated.Material and methodsMRI datasets of 32 patients with CFD were analysed retrospectively. Detectability in MRI was assessed by analysis of 10 randomly selected patients with CFD and 10 normal controls by two blinded readers. Changes of affected bone, internal lesion structure, T1 and T2 signal intensity, and contrast enhancement of the lesion in general and ground glass areas in particular were assessed. Ten patients with intraosseous meningioma (one in each) served as differential diagnosis for CFD.ResultsAll 10 CFD lesions were reliably detected in MRI. In 32 patients 36 CFD lesions were evaluated. In 66.7% CFD were iso- to hypointense in T1 and hyperintense in T2; this proportion was similar for ground glass areas (65.7%). Ground glass areas were more homogeneously structured than the whole CFD lesion in both T1 (100% vs. 56%, respectively) and T2 (91% vs. 61%, respectively). Contrast enhancement was found in 97% of complete CFD lesions and 93% of ground glass areas. The accuracy for CFD vs. intraosseous meningioma was 100% for ‘no soft-tissue component’ and 98% for ‘bone broadening’ in MRI.ConclusionsDistinct morphological changes of CFD are reliably detected in MRI and allow differentiation from intraosseous meningioma. Areas with ground glass phenomenon in CT show a predominantly homogenous internal structure in MRI with contrast enhancement.

Facial soft tissue growth in identical twins.

The aims of this longitudinal analysis of untreated monozygotic twins were to investigate the change of the facial soft tissues during growth, to determine the concordance of soft tissue growth patterns between genetically identical twins, and to assess the genetic component of soft tissue development. The sample consisted of 33 pairs of untreated monozygotic twins (23 male, 10 female) from the Forsyth Moorrees Twin Study (1959-1975); lateral cephalograms taken from 6 to 18years of age were analyzed at 3-year intervals. Cephalograms were traced, and longitudinal changes in the soft tissue profile between twins were analyzed with intraclass correlation coefficients and linear regression modelling. The concordance between monozygotic twins at 18years of age was moderate to high with intraclass correlation coefficients values between 0.37 and 0.87. Additionally, female twins showed higher concordance at 18years of age than did male twins for all included variables. However, about 10% to 46% of the twin pairs had large differences in their soft tissue parameters, even after the growth period. Although monozygotic twins possess the same genetic material, differences in the soft tissues were found. This supports the complex developmental mechanism of the human face and the varying influence of genetic and environmental factors.

Re-Evaluation of 162 Malignant Thyroid Nodules that were Interpreted as Benign Based on Ultrasound Findings.

PurposeThe goal of this study was to estimate the risk of malignant thyroid nodules being interpreted as benign based on ultrasound findings and to clarify the pathological features of these malignant nodules.Materials and Methods We retrospectively re-evaluated ultrasound and pathological findings for 162 malignant thyroid nodules that were initially interpreted as benign based on ultrasound findings at Kuma Hospital between April 2012 and June 2015. ResultsThe incidences of malignancy among “benign” thyroid nodules were 0.5% overall and 6.2% among resected nodules. In addition, 82.7% of thyroid nodules that were originally judged to have low or very low suspicion patterns were subsequently re-categorized as having high or intermediate suspicion patterns. The incidences of irregular margins (63.6%) and low echogenicity (36.4%) were higher than those of punctate microcalcification (17.9%) and the taller-than-wide shape (20.4%). Among microcarcinomas, the incidences were 65.7% for irregular margins and 51.4% for low echogenicity. Rim calcification with small extrusive soft tissue components and extrathyroidal extensions were not observed. After re-evaluation, 40.0% of papillary thyroid carcinomas remained benign based on their variants, such as the encapsulated, follicular, macrofollicular, and oxyphilic cell variants.ConclusionWe conclude that more careful observation, especially for lesions with irregular margins and low echogenicity, can help improve the diagnostic accuracy of thyroid ultrasonography. Furthermore, greater care may decrease the incidence of malignancy among thyroid nodules with low or very low suspicion patterns. Some variants of papillary thyroid carcinoma can have benign ultrasound findings.