High-resolution Real-time Sonography Research Articles

ROLE OF ULTRASOUND TO DIFFERENTIATE BETWEEN BENIGN AND MALIGNANT THYROID NODULES WITH HISTOPATHOLOGICAL CORRELATION

Background: The only endocrine gland that may be directly examined because to its supercial placement and size is the thyroid gland, which is the largest of all endocrine glands. High resolution real-time gray-scale sonography with the thyroid gland's supercial position enables good visibility and assessment of both its pathologic status and normal structure. The goal was to l Aim: ink histopathology results with sonographic criteria to distinguish between benign and malignant thyroid nodules. From April 2022 to November 2 Materials and Methods: 022, based on criteria for inclusion and exclusion, 50 cases with thyroid nodules were included in the study. Each nodule's sonographic features were identied. After that, the outcomes were contrasted with histopathological diagnosis. 40 Results: benign and 10 malignant solitary thyroid nodules assessed by ultrasound out of 50 total cases were determined, 43 out of 50 instances were benign and 7 were malignant, according to histopathological analysis. To distinguish between benign and malignant etiologies, ultrasound is a relatively safe and accurate investigation with sensitivity of 85.7 % and specicity of 90.7%. In order to distinguish between benign and malignant lesions, USG has proven to possess greater sensitivity. Conclusion: Thyroid nodules were prevalent in women between the ages of 31 and 45. With a sensitivity of 85.7% and a specicity of 90.7%, ultrasound is a relatively safe and accurate test to distinguish between benign and malignant etiologies.

CORRELATION BETWEEN HIGH-RESOLUTION ULTRASONOGRAPHY AND ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION CYTOLOGY FOR THE DETECTION OF MALIGNANT NODULES

Aims: Our study aims to evaluate the effectiveness of high-resolution real-time gray-scale ultrasonography with ultrasound-guided ne-needle aspiration cytology (FNAC) in identifying thyroid cancer nodules. Thyroid nodules are a frequent medical condition brought on by a number of thyroid problems. By palpating them, they can be detected in 4%–8% of adults, in 10%–41% of adults by ultrasonography (US), and in 50% of people by pathologic examination at autopsy. The thyroid gland's pathological states and thyroid gland morphology can be accurately assessed by using HRUSG. Our study's objective is to evaluate the reliability of HRUSG in identifying malignant nodules with the help of ultrasound-guided ne-needle aspiration cytology. It is a retrospective study of 50 Settings and Design: patients (aged 16–63 years) who were examined with high-resolution ultrasound (HRUSG) of the thyroid gland and for ultrasoundguided FNAC between January 2022 till August 31, 2022 This study comprised 5 Material and methods 0 patients with thyroid nodules identied by ultrasonography. Each nodule's properties were identied. Following that, the outcomes were differentiated with Ultrasound-guided FNAC. Sensitivity, specicity, positive pr Stastistical Analysis used: edictive value, negative predictive value and accuracy were used Out of 50 nodules examined, 10 (20%) were found to b Results: e malignant on cytology. In this study with the aid of Gray-scale ultrasound features of thyroid nodules Conclusions ,malignant thyroid nodules can be differentiated from those with benign ones. HRUSG ndings of hypoechogenicity, microcalcication, and poorly dened margins have high diagnostic accuracy for identifying malignant thyroid nodules as mentioned in our study.

CETP activity is not associated with carotid intima-media thickness in patients with poorly controlled type 2 diabetes.

The impact of cholesteryl ester transfer protein (CETP) on atherosclerotic development in humans remains unclear. Plasma cholesteryl ester transfer was shown to be associated with carotid intima-media thickness in type 2 diabetic (T2D) patients with adequate metabolic control. Since glycation of CETP may influence cholesteryl ester transfer processes, it is important to determine if plasma cholesteryl ester transfer is still a determinant of carotid intima-media thickness (IMT) in patients with poorly controlled diabetes. The aim of the present study was to determine whether CETP activity influences carotid IMT in T2D patients with poor metabolic control. In 110 individuals with T2D, we measured CETP mass concentration with ELISA, CETP activity with a radioactivity method and carotid intima-media thickness with high-resolution real-time B-mode ultrasonography. The mean HbA1C was 8.8 ± 1.7%. Carotid IMT did not correlate with CETP activity in the total population. In T2D patients with HbA1C < 8% (n = 33), mean HbA1C was 6.9% and the correlation between carotid IMT and CETP activity was not significant (p = 0.09). In a multivariable analysis that included the total population, carotid intima-media thickness was positively associated with diabetes duration (p = 0.02) but not with CETP activity or HbA1C. We observed no correlation between carotid intima-media thickness, a marker of early atherosclerosis, and CETP activity in T2D patients with poor metabolic control. Disease duration, which reflects accumulated metabolic abnormalities, may have blunted the potential effect of CETP on atherosclerosis. Metabolic control appears essential to determine the pro- or anti-atherogenic influence of CETP in patients with T2D.

Ultrasound findings in paediatric cholestasis: how to image the patient and what to look for.

Paediatric biliary tract and gallbladder diseases include a variety of entities with a wide range of clinical presentations. Cholestasis represents an impaired secretion of bilirubin by hepatocytes, manifesting with high blood levels of conjugated bilirubin and jaundice. Various causes may be involved, which can be recognised analysing blood tests and hepatobiliary imaging, while sometimes liver biopsy or surgery may be necessary. High-resolution real-time ultrasonography is an important tool for differentiation of obstructive and non-obstructive causes of jaundice in infants and children. In this paper, we briefly review the normal anatomy and the ultrasound aspects of main pathologies affecting gallbladder and biliary tree in neonatal and paediatric age.

The primacy of ultrasound in the assessment of muscle architecture: precision, accuracy, reliability of ultrasonography. Physiatrist, radiologist, general internist, and family practitioner's experiences.

With high-resolution real-time ultrasonography we investigated the muscle architectural parameters of vastus lateralis in healthy volunteers. We determined the reproducibility and validity of ultrasonography and the role of the ultrasonographer in assessing muscle architecture. We proposed the most appropriate clinical parameters for objective measurements and an ultrasound protocol of muscle architecture. We conducted an intraobserver and interobserver study. We investigated 21 healthy male volunteers. The subjects were independently evaluated by four different operators using high-resolution real-time ultrasonography. To assess the reproducibility of ultrasound examinations, four operators repeated measurements using the same ultrasound device. Muscle thickness, muscle volume, muscle fiber pennation angle, and subcutaneous adiposity of the vastus lateralis muscle were measured. Intra-observer (ICC 0.92-0.97), interobserver (ICC 0.78-0.92) reproducibility was good to excellent for all measurements. Simple, reproducible, non-invasive ultrasound measurements of muscle structure easily demonstrated differences in muscle morphology. With a protocol and with objective and repeatable measurements, sonographers from different backgrounds could obtain an objective measurement of ultrasound images with little differences and low variability in results, thanks to the upgrading of diagnostic ultrasound imaging and their clinical skills.

Correlation of high-resolution ultrasonography findings of thyroid nodules with ultrasound-guided fine-needle aspiration cytology in detecting malignant nodules: A retrospective study in Malabar region of Kerala, South India

Aims:The purpose of our study is to assess the role of high-resolution real-time gray-scale ultrasonography with ultrasound-guided fine-needle aspiration cytology (FNAC) in detecting malignant nodules in the thyroid gland.Settings and Design:It is a retrospective study of 25 patients (aged 16–63 years) who underwent high-resolution ultrasound (HRUSG) of the thyroid gland and ultrasound-guided FNAC from February 2017 till November 31, 2017.Materials and Methods:A total of 25 patients with thyroid nodules detected at ultrasound were included in this study. The characteristics of each nodule were determined. The results were then compared with FNAC (ultrasound-guided) findings.Statistical Analysis Used:Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were used.Results:Of the 25 nodules examined, 5 (20%) were found to be malignant on cytology.ConclusionsGray-scale ultrasound features of thyroid nodules are useful to distinguish malignant thyroid nodules from those with benign nodules. From our study, it is obvious that the HRUSG findings of hypoechogenicity, microcalcification, and poorly defined margins have high diagnostic accuracy for identifying malignant thyroid nodules.

Relation between high serum hepcidin-25 level and subclinical atherosclerosis and cardiovascular mortality in hemodialysis patients.

Objective:In hemodialysis (HD) patients, cardiovascular disease (CVD) is the major cause of mortality and morbidity. In atherosclerotic diseases, iron gets accumulated in the arterial wall. Hepcidin is an important hormone in iron metabolism. Furthermore, hepcidin is associated with atherosclerotic disease. Therefore, this study aims to investigate the relation of serum hepcidin-25 (SH-25) and sub-clinic atherosclerosis measured by carotid intima-media thickness (CIMT) and mortality in HD patients.Methods:We enrolled 82 HD patients in a cross-control study. We measured SH-25 using ELISA kit and CIMT using high-resolution real-time ultrasonography. After 4 years of first assessment, we investigated the relation between all-cause and cardiovascular mortality and SH-25 and CIMT.Results:Two patients were excluded because of renal transplantation. The survivors were younger (53.7±15.1 vs. 65.2±15.5; p<0.05) and CIMT was lower (0.83±0.2 vs. 0.95±0.2; p<0.05); however, there was no significant difference in SH-25 levels between the groups (29.1±13 vs. 32.4±22.4; p=0.767). The patients who died of CVD were significantly older (63.7±16.1 vs. 53.7±15.1; p<0.05) and had significantly higher CIMT (0.94±0.2 vs. 83±0.2; p<0.05). The SH-25 levels were statistically significantly higher in patients who died of CVD (40.3±25 vs. 29.1±13; p<0.05). Linear regression analysis showed a positive correlation between CIMT and SH-25 in the study population and in those who died from CVD (r=0.41; p<0.05 and r=0.606; p<0.05, respectively).Conclusion:This study suggests that hepcidin is effective in cardiovascular mortality and pathophysiology of subclinical atherosclerosis in HD patients.

High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon

BackgroundPercutaneous Achilles tendon repair has been developed to minimise soft tissue complications following treatment of tendon ruptures. However, there are concerns because of the risk of sural nerve injury. Few studies have investigated the relationship between the Achilles tendon, the sural nerve and its several anatomical course variants. MethodsWe studied 7 cadaveric limbs (7 Achilles tendons) in which a percutaneous repair of the Achilles tendon was performed. On each tendon, high resolution real time ultrasonography examination was performed by an experienced musculoskeletal radiologist before and after the procedure, with the surgeons blind to the results of the scan both before and after surgery. ResultsIn two instances, high resolution real time ultrasonography examination revealed nerve entrapment at the level of most proximal lateral suture. ConclusionsSince the sural nerve can be easily visualised using high-frequency high resolution real time ultrasonography, intraoperative ultrasound can be of assistance during percutaneous repair of Achilles tendon rupture. Clinical relevanceThe sural nerve can be readily visualised by high-frequency high resolution real time ultrasonography probes. It could be beneficial to use high resolution real time ultrasonography intraoperatively or perioperatively to minimise the risks of sural nerve injury when undertaking percutaneous repair of Achilles tendon tears.

The Royal London Hospital Test for the clinical diagnosis of patellar tendinopathy.

To ascertain whether the Royal London Hospital test is reproducible, sensitive, and specific for diagnosis of patellar tendinopathy. Fifteen consecutive athletes with patellar tendinopathy were prospectively enrolled and compared with a control group of 15 non consecutive athletes with Achilles tendinopathy. Two testers examined separately each patient, using manual palpation and the Royal London Hospital test for diagnosis of patellar tendinopathy. High resolution real time ultrasonography was used as standard for diagnosis of tendinopathy and assessment of tendon thickness. The palpation test presented significantly higher sensitivity compared to the Royal London Hospital test (98 vs 88%; P=0.01); specificity was 94% for the palpation test and 98% for the Royal London Hospital test (P>0.05). Positive and negative predictive values were 94 and 98% for palpation test, 98 and 89% for the Royal London Hospital test, respectively. The two tests showed good to very good intra-tester and inter-tester agreement. At ultrasonography, pathological patellar tendons were significantly thicker compared to controlateral healthy tendon (P<0.001). In symptomatic patients with patellar tendinopathy, the Royal London Hospital test showed lower sensitivity and higher specificity than manual palpation. Both tests should be performed for a correct clinical diagnosis of patellar tendinopathy. Imaging assessment should be performed as a confirmatory test. III.

Radiological Evaluation of Thyroid Diseases using Gray Scale and Color Doppler Sonography

ABSTRACT Introduction The thyroid gland is the largest of all endocrine glands and is the only one which is amenable to direct physical examination and high resolution real-time grayscale sonography because of its superficial location. High Resolution Ultrasonography (USG) with Color Doppler is used to assess the nature of the lesion according to its vascularity and also the hemodynamic characteristics of the gland. Thus, the combination of Gray scale Sonography and Color Flow Doppler provide huge benefits and help in increasing the sensitivity, specificity and accuracy in distinguishing benign and malignant thyroid nodules. Nearly 50% of patients with a clinically palpable solitary thyroid nodule have avoided surgery because of thyroid ultrasound. Aims and objectives The present study is aimed to determine the role of high resolution USG in the evaluation of lesions of the thyroid with Fine-needle aspiration cytology (FNAC) correlation and compare it with other studies. Materials and methods This is a prospective study carried out on 50 patients (44 female and 6 male) who attended ENT or Surgery outpatient department/inpatient department (OPD/IPD) and were referred to the Department of Radio-Diagnosis for high resolution USG of neck at Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. This study was conducted for a period of one year from March 2015 to February 2016. The ultrasound machine used was GE LOGIQ V5. Result and Conclusion Our present study consisted of 50 cases which were clinically suspected suffering from thyroid dysfunction. Thyroid ultrasound was very efficient in picking up lesions in all 50 cases in our study. In comparison, to other studies our study gave a similar picture in terms of benign lesions being much more common than malignant lesions. The most common benign lesion determined in our study was colloid goiter which was the most common benign lesion in many other studies. In comparison to other studies, we were able to detect malignant nodules with a better specificity. Chronic thyroiditis was also very efficiently detected using ultrasound in our study. How to cite this article Tyagi S, Kumar P, Mehrotra A, Parakh P, Kumar L, Hans P. Radiological Evaluation of Thyroid Diseases using Gray Scale and Color Doppler Sonography. Int J Adv Integ Med Sci 2016;1(4):173-182.

Is hepcidin‐25 a predictor of atherosclerosis in hemodialysis patients?

Atherosclerotic cardiovascular disease is an important cause of mortality and morbidity in hemodialysis patients. Iron accumulation in arterial wall macrophages is increased in atherosclerotic lesions. Hepcidin is a key hepatic hormone regulating iron balance. It inhibits iron release from macrophages and iron absorption from enterocytes by binding and inactivating the cellular iron exporter ferroportin. The aim of this study is to investigate the relation of hepcidin-25, iron parameters, and atherosclerosis measured by carotid intima media thickness (CIMT) in hemodialysis patients. Eighty-two hemodialysis patients were enrolled in this cross-sectional study. Predialysis blood samples were centrifuged at 1500 g and 4°C for 10 minutes and stored at -80°C for the measurement of hepcidin-25. DRG hepcidin enzyme-linked immunosorbent assay kit was used for the measurement of hepcidin-25. Ultrasonographical B-mode imaging of bilateral carotid arteries was performed with a high-resolution real-time ultrasonography (Mindray DC7). Mean age of the study population was 57.90 ± 16.08 years and 43.9% were men. Total study population was grouped into two according to median value of hepcidin-25. There was no difference between groups with respect to age, dialysis vintage, and C-reactive protein. CIMT was found to be statistically significantly higher in low hepcidin-25 group. In correlation analysis, CIMT was found to be correlated with age (P < 0.01, R = 0.33) and hepcidin-25 (P < 0.01, R = 0.46). In linear regression analysis, age (β = 0.31) and hepcidin-25 (β = 0.44) were found to be the determinants of CIMT in hemodialysis patients. Our results implicate that hepcidin may take part in pathophysiology of atherosclerosis and cardiovascular disease in hemodialysis patients.

The Relationship between Quadriceps Thickness, Radiological Staging, and Clinical Parameters in Knee Osteoarthritis.

[Purpose] The aim of this study was to investigate the relationship between clinical parameters, radiological staging and evaluated ultrasound results of quadriceps muscle thickness in knee osteoarthritis. [Subjects] The current study comprised 75 patients (51 female, 24 male) with a mean age of 57.9±5.2 years (range 40–65 years) and a diagnosis of osteoarthritis in both knees. [Methods] Knee radiographs were evaluated according to the Kellgren-Lawrence grading system. Clinical evaluation performed with the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the 50-meter walking test, and the 10-step stair test. The thickness of the muscle layer of the quadriceps femoris (M. vastus intermedius and M. rectus femoris) was measured with high-resolution real-time ultrasonography. [Results] The results of this study showed a significant negative correlation between quadriceps thickness and age, duration of disease, stage of knee OA, and VAS, WOMAC, 50-m walking test, and 10-step stair test scores. [Conclusion] The evaluation of quadriceps muscle thickness with ultrasound can be considered a practical and economical method in the diagnosis and follow-up of knee osteoarthritis.

A Comparative Evaluation of Rotator Cuff Injuries of the Shoulder Joint using High Resolution Ultrasound and Magnetic Resonance Imaging

Introduction: Pathology of the rotator cuff is the cause of most common problems at the shoulder joint and accurate diagnosis is essential for appropriate management. High-resolution real-time ultrasonography and MRI are successful imaging modalities for both rotator cuff and non–rotator cuff disorders and have important implications in the management of rotator cuff pathologies. This study was conducted to Compare the results obtained after the evaluation of rotator cuff injuries of shoulder joint by high resolution Ultrasonography and Magnetic Resonance Imaging. Methods: 50 patients with suspected rotator cuff injuries of the shoulder joint were included in this study over a period of 2years. Patients had presented with various complaints like prolonged pain in the shoulder joint with stiffness, restriction and difficulty in movement of the shoulder joint, traumatic injuries and recurrent dislocations of the shoulder joints. Results: Mean age was 41.6years ( range 15-80 ).Maximum patients were between 41-50 years (24%). 29 were males and 21 were females. In our study diagnostic accuracy of ultrasound in rotator cuff tears was 57. 14% for full thickness tears and 58.33 for partial thickness tears. The diagnostic accuracy of ultrasound in detection of complete tear of the supraspinatus muscle was 57.14% while that of MRI was 100%. Conclusion: High resolution Ultrasound being a dynamic study can be used as the first-line investigation for rotator cuff tear. Full-thickness rotator cuff tears can be identified using ultrasound and MRI with comparable accuracy. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6443 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 9-14

Fetal Surgery for Myelomeningocele?

The possibility of surgical repair of fetal anomalies in utero has long tantalized obstetricians and pediatric surgeons, especially since the development of high-resolution real-time ultrasonography. The presumption has been that earlier in utero repair would provide superior outcomes for the offspring than would postnatal surgery. However, postnatal treatment is much simpler and is not traumatic to the mother. Successful fetal surgery for any condition thus requires an accurate identification of which fetuses are at highest risk for a poor outcome if repair is delayed until after birth. Despite the promise of fetal surgical procedures, such repair of structural malformations has . . .

High resolution real time sonography of parathyroid tumors

A total of 15 patients with parathyroid tumours were scanned preoperatively using high-resolution real-time sonography (7 MHz). Of these, 14 had a single adenoma or primary hyperplasia, one had a carcinoma. In 13 out of 15 patients the echogenicity of the parathyroid tumours was consistently less than of the adjacent normal thyroid tissue; in 2 out of 15 cases parathyroid neoplasms were barely distinguishable in echogenicity from thyroid tissue. No specific echomorphologic differences were proved to exist between primary parathyroid hyperplasia, adenoma or carcinoma. The smallest parathyroid neoplasia in this study detected by sonography measured 5 x 8 mm in diameter. The value and limits of parathyroid sonography were discussed with regard to our own experience and the reports in the literature.

Changes in skeletal muscle architecture following a cycloergometer test to exhaustion in athletes

We determined whether a short-term exhaustive dynamic exercise (cycling) for about 18min induces changes in the intramuscular architecture of the quadriceps in trained athletes. Thirty-five male athletes (age 28.8+/-9.8 years; height: 175.4.+/-5.5cm; weight: 74+/-11.5kg; average years spent training: 11.1+/-8.4 years; mean weekly duration of training: 10.4+/-3.20h) underwent an incremental cycloergometer test to exhaustion. Muscle thickness of the right quadriceps femoris (rectus femoris + vastus intermedius), and the angle of pennation of the right vastus lateralis on the quadriceps tendon were determined by high-resolution real time ultrasonography. Quadriceps thickness increased from 32.1+/-3.3mm at rest to 34.9+/-3.0mm after the test (p=0.001). The pennation angles were significantly greater after exercise (12.8+/-2.1 degrees at rest; 14.4+/-2.5 degrees after the test (p=0.001)). There are marked changes in intramuscular architecture of the quadriceps following a bout of cycloergometer exercise to exhaustion, with significant increase of quadriceps thickness and pennation angle. Ultrasonography allows to evaluate the changes of muscle architecture following exercise.

Carotid atherosclerosis and arterial peripheral pulse wave velocity in cerebral thrombosis

Stiffening and thickening of the arterial walls are two important components of atherosclerosis. A better understanding of the relationship between stiffening and thickening of the large arteries might lead to optimal strategies for the prevention of cerebrovascular disease. However, there have been few investigations of the correlation between carotid artery wall thickening and arterial stiffness. In this study, we investigated the relationship between arterial stiffness (assessed by the ankle-brachial pulse wave velocity) and carotid plaque (detected by high-resolution real-time B-mode ultrasonography) in patients with cerebral thrombosis. The subjects were 109 patients with cerebral thrombosis aged 40–80 years. Fifty-six subjects had carotid plaque (27 had low-grade plaques (plaque score < 7.0) and 29 had high-grade plaques (plaque score ⩾ 7.0)) and 53 subjects did not have plaques. High pulse wave velocity was found to be significantly associated with existence of carotid plaque ( p < 0.001), but was not associated with the severity of the plaque ( p = 0.14) in multivariate logistic regression models. This study shows that the pulse wave velocity is associated with the existence of carotid atherosclerosis, but not with the severity of carotid atherosclerosis, in patients with cerebral thrombosis.

Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography.

High-resolution ultrasonography was used to classify carotid plaques into five different types in 72 patients with symptoms and in 49 without, and with stenosis of the origin of the internal carotid artery > 70 per cent. There were 72 plaques in the symptomatic group and 75 in the asymptomatic group. Type 1 plaques were uniformly echolucent, type 2 predominantly echolucent, type 3 predominantly echogenic, type 4 uniformly echogenic and type 5 consisted of plaques that could not be classified owing to heavy calcification and acoustic shadows. Type 1 plaque was found in 90 per cent of patients with symptoms and in 10 per cent of those without, type 2 plaque was found in 53 and 47 per cent, type 3 in 34 and 66 per cent, and type 4 in 5 and 95 per cent, respectively. The preponderance of echolucent plaques in symptomatic patients with stenosis > 70 per cent supports the hypothesis that this type of plaque is unstable and tends to embolize. In contrast, in patients without symptoms there is preponderance of echogenic plaques.

Ultrasonographic characteristics of thyroid nodules: prediction of malignancy.

High-resolution real-time ultrasonography (US) can detect characteristics of thyroid nodules, but the US differentiation between malignant nodules and benign nodules is not well described. Ultrasonography is useful for predicting malignancy of thyroid nodules. A retrospective study of 329 thyroid nodules (> or =5 mm) in 309 patients comparing US characteristics and pathological results. A center for the treatment of thyroid diseases where about 1400 thyroid operations are performed per year. Between January 1 and June 30, 1999, 309 patients were examined by US before thyroidectomy. The US characteristics to predict malignancy for both follicular and nonfollicular neoplasms by means of multiple logistic regression analysis. The sensitivity of preoperative US diagnosis was 86.5% for nonfollicular neoplasms and 18.2% for follicular neoplasms. The specificity was 92.3% and 88.7%, respectively. According to multiple logistic regression analysis, margin, shape, echo structure, echogenicity, and calcification were reliable indication of malignancy in nonfollicular neoplasms. According to a receiver operating characteristic curve constructed from this multiple logistic regression analysis, the best point not to overlook malignancy is the point at which sensitivity is 94% and specificity is 87%. The probability of malignancy at this point is greater than 0.2. For follicular neoplasms, ultrasonographic diagnosis was unreliable, even when multiple logistic regression analysis was applied. We can predict malignancy of nonfollicular neoplasms of the thyroid by using multiple logistic regression analysis based on only 5 features: margin, shape, echo structure, echogenicity, and calcification.

US approach to jaundice in infants and children.

High-resolution real-time ultrasonography (US) serves as an important tool for differentiation of obstructive and nonobstructive causes of jaundice in infants and children, independent of liver function. Unconjugated hyperbilirubinemia occurs in approximately 60% of normal term infants and in 80% of preterm infants. Persistence of neonatal jaundice beyond 2 weeks of age demands US evaluation to differentiate between the three most common causes: hepatitis, biliary atresia, and choledochal cyst. In all three conditions, the hepatic echotexture is diffusely coarse and hyperechoic, but this appearance may be seen in a variety of hepatic inflammatory, obstructive, and metabolic processes. Thus, hepatic scintigraphy and at times percutaneous liver biopsy are necessary to narrow the differential diagnosis and to identify patients who require more invasive techniques (eg, intraoperative cholangiography). US is useful for demonstrating inspissated bile and biliary duct stones. In infants, stones are usually secondary to obstructive congenital anomalies of the biliary tract, total parenteral nutrition, furosemide treatment, phototherapy, dehydration, infection, hemolytic anemia, and short-gut syndrome, whereas in older children, stones are usually associated with sickle cell disease, bowel resection, hemolytic anemia, and choledochal cyst. Jaundice in infants and children may also be due to cirrhosis, benign strictures, and neoplastic processes.