Nodule Morphology Research Articles

Radioguided lung lesion localization: introducing a fluoroscopy system in a SPECT/CT scan.

The purpose was to report our experience in the use of radiotracer localization and resection of small, indistinct, or nonpalpable pulmonary lesions. We developed an innovative technique implementing a fluoroscopy system on a single-photon emission computed tomography/computed tomography (SPECT/CT) scan that allowed to perform CT-guided injection of radiotracer directly on SPECT/CT. Patients were selected for the radiotracer procedure in presence of difficulties in locating nodules with video-assisted thoracoscopic surgery (VATS). Overall, 0.2 ml of technetium-99m macroaggregated albumin and 0.3 ml of nonionic iodinated contrast were injected under CT guidance. During the VATS procedure, an endoscopic gamma detecting probe was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected. Between January 2016 and October 2018, 37 patients underwent CT-guided radiotracer injection. The mean nodule size was 11 mm. CT nodule morphology characteristics were as follows: 15 nodules were ground glass, 12 were solid, and 10 were partly solid. No significant adverse events occurred. In one patient, the surgeons decided for an open thoracotomy after unsuccessfully VATS. Overall, lobectomy was performed in two patients, segmentectomy in one, and wedge resection in 33 patients. No mortality occurred. The pathological diagnosis was 15 (42%) primary lung cancer, eight (22%) metastases, and 13 (36%) benign lesions. Radioguided pulmonary nodule localization is a reliable procedure with a high rate of success, minimal complications, and lower risk of failures, with no associated mortality or significant morbidity. Our SPECT/CT system is the first to benefit from the technological improvement with successfully implementation and application of fluoroscopy to SPECT/CT.

Three-dimensional study of nodule clustering and heterogeneous strain localization for tailored material properties in ductile iron

Tailored heterogeneous distributions of microstructural features enable extraordinary material performance in biological and physiological structures such as trees, the aortic arch, human teeth and dinosaur skulls. In ductile iron, a heterogeneous distribution in size and morphology of graphite nodules and variations of the fractions of ferrite and pearlite are created during solidification, and varies as a function of parameters such as local cooling rate, segregation and flow. In the current work, the size distribution as well as the orientation and relation between graphite nodules is obtained by a three-dimensional reconstruction of a ductile iron microstructure from X-ray tomography. The effect of the nodule morphology and clustering on the localization of plastic strains is studied numerically using finite element analysis of the reconstructed microstructure. Real castings have a variation in geometry, solidification conditions and are subjected to variations in loads. A framework for optimized geometry and solidification conditions in order to design and deliver castings with tailored local material performance is proposed.

Accuracy of the Vancouver Lung Cancer Risk Prediction Model Compared With That of Radiologists

Risk models have been developed that include the subject's pretest risk profile and imaging findings to predict the risk of cancer in an objective way. We assessed the accuracy of the Vancouver Lung Cancer Risk Prediction Model compared with that of trainee and experienced radiologists using a subset of size-matched nodules from the National Lung Screening Trial (NLST). One hundred cases from the NLST database were selected (size range, 4-20mm), including 20 proven cancers and 80 size-matched benign nodules. Three experienced thoracic radiologists and three trainee radiologists were asked to estimate the likelihood of cancer in each case, first independently, and then with knowledge of the model's risk prediction. The results generated by the model alone also were estimated using receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) for each viewing condition was calculated, and statistical significance in their differences was tested by using the Dorfman-Berbaum-Metz method. Human observers were more accurate (AUC value of 0.85 ± 0.05 [SD]) than was the model (0.77 ± 0.06) in estimating the risk of malignancy (P= .0010), and use of the model did not improve their accuracy (0.84 ± 0.06). Experienced radiologists performed better than did trainees. Human observers could distinguish benign from malignant nodule morphology more accurately than could the model, which relies mainly on nodule size for risk estimation. Experienced and trainee radiologists had superior ability to predict the risk of cancer in size-matched nodules from a screening trial compared with that of the Vancouver model, and use of the model did not improve their accuracy.

Agrobacterium rhizogenes-mediated transformation of Pisum sativum L. roots as a tool for studying the mycorrhizal and root nodule symbioses.

In this study, we demonstrated the successful transformation of two pea (Pisum sativum L.) cultivars using Agrobacterium rhizogenes, whereby transgenic roots in the resulting composite plants showed expression of the gene encoding the green fluorescent protein. Subsequent to infection with A. rhizogenes, approximately 70%–80% of pea seedlings developed transgenic hairy roots. We found out that the transgenic roots can be efficiently nodulated by Rhizobium leguminosarum bv. viciae and infected by the arbuscular mycorrhizal (AM) fungus Rhizophagus irregularis. The morphology of nodules in the transgenic roots was found to be identical to that of nodules observed in wild-type roots, and we also observed the effective induction of markers typical of the symbiotic association with AM fungi. The convenient protocol for highly efficient A. rhizogenes-mediated transformation developed in this study would be a rapid and effective tool for investigating those genes involved in the development of the two types of symbioses found in pea plants.

Correlation of papillary thyroid carcinoma different subtypes BRAF mutation and ultrasonic characteristics

Objective To investigate the correlation of BRAF mutation frequency with cervical lymph node metastasis, and to compare the ultrasonic characteristics in patients with BRAF mutation in papillary thyroid carcinoma (PTC) different subtypes. Methods The tumor samples were collected from 139 PTC patients who underwent thyroidectomy. And they were classified by histological subtype into 3 groups: classic variant of papillary thyroid carcinoma (CVPTC) group(34 cases), follicular variant of papillary thyroid carcinoma (FVPTC) group(36 cases), tall cell variant (TCV) group(69 cases). The BRAF mutation frequency and the correlation with cervical lymph node metastasis among 3 groups were analyzed, then the ultrasonic characteristics with BRAF mutation in PTC different subtypes were compared. Results ①The frequency of BRAF mutation was statistically significant different in different subtypes(χ2=6.390, P=0.041), and the frequency in TCV was 86.9%. There was also a statistical difference between BRAF mutation frequency and cervical lymph node metastasis among three subtypes (χ2=13.106, P=0.041). ②There was no statistically significant difference among the three groups in nodule number, echo level, internal structure, boundary, crossbar, morphology and acoustic halo of patients with BRAF mutation (P>0.05). ③A single factor analysis was performed for the ultrasonographic characteristics of patients with BRAF mutation, and there were significant statistical differences among the 3 groups in calcification type (χ2=21.7, P=0.001) and close to the envelope (χ2=7.726, P=0.021). ④Multivariate logistic regression showed that BRAF mutation was an independent influence factor affecting the calcification type of different histological subtypes in PTC patients. Conclusions ①BRAF mutation is correlated with cervical lymph node metastasis in different PTC subtypes. ②BRAF mutation is an independent influence factor affecting the morphology type of different calcification subtypes in PTC. The CVPTC group is mainly microcalcification, and the TCV group is mainly macrocalcification. Key words: Ultrasonography; Papillary thyroid carcinoma; Subtypes; BRAF gene

Evaluate the Malignancy of Pulmonary Nodules Using the 3-D Deep Leaky Noisy-OR Network.

Automatic diagnosing lung cancer from computed tomography scans involves two steps: detect all suspicious lesions (pulmonary nodules) and evaluate the whole-lung/pulmonary malignancy. Currently, there are many studies about the first step, but few about the second step. Since the existence of nodule does not definitely indicate cancer, and the morphology of nodule has a complicated relationship with cancer, the diagnosis of lung cancer demands careful investigations on every suspicious nodule and integration of information of all nodules. We propose a 3-D deep neural network to solve this problem. The model consists of two modules. The first one is a 3-D region proposal network for nodule detection, which outputs all suspicious nodules for a subject. The second one selects the top five nodules based on the detection confidence, evaluates their cancer probabilities, and combines them with a leaky noisy-OR gate to obtain the probability of lung cancer for the subject. The two modules share the same backbone network, a modified U-net. The overfitting caused by the shortage of the training data is alleviated by training the two modules alternately. The proposed model won the first place in the Data Science Bowl 2017 competition.

Thyroid Nodule Location on Ultrasonography as a Predictor of Malignancy

The diagnostic capacity of ultrasonography (US) for differentiating between malignant and benign thyroid nodules is crucial in preventing unnecessary invasive procedures. This is the first study to evaluate whether thyroid nodule location on US has predictive value for malignancy. We retrospectively reviewed data from 219 patients with thyroid nodules who underwent fine-needle aspiration biopsy in 1 year. Patients' demographics as well as nodule's laterality, polarity, morphology, and multinodularity were analyzed. All malignant lesions were confirmed by surgical pathology. The majority of the patients were female (86.2%). Nodules were evenly distributed between the right lobe (46.3%) and left lobe (49.5%). Eight nodules (4.2%) were located in the isthmus. Most nodules (79.3%) were located in the lower pole, while 9.6% were located in the upper pole and 6.9% in the middle pole. Seventy-five patients (39.9%) had multiple nodules. Fourteen nodules were malignant, representing a prevalence of 7.4%. A significantly higher frequency of malignancy was observed in upper pole (22.2%) compared to lower pole (4.7%) and middle pole (15.4%). A multiple logistic regression model confirmed such association after adjusting for age, body mass index, multinodularity, and laterality. The odds of malignancy in the upper pole were 4 times higher than other locations (odds ratio, 4.6; P = .03). Our study is the first showing that thyroid nodules located in the upper pole can be considered as having higher risk for malignancy. It may enhance the predictive value of malignancy if it is included in thyroid nodule ultrasound classification guidelines. AACE = American Association of Clinical Endocrinologists; ATA = American Thyroid Association; BMI = body mass index; FNA = fine-needle aspiration; TMS = total malignancy score; TTW = taller than wide; US = ultrasonography.

Sporadic synchronous triple primary cancers in elderly female: Microsatellite instability high resectable colon cancer, epidermal growth factor receptor-mutated metastatic lung cancer, and neuroendocrine tumor of appendix

Colorectal cancer and lung cancer are the most common malignancies in the world. However, not all pulmonary nodules in a case of colon cancer are considered as metastasis, especially with features suggestive of limited colon disease without any nodal or liver involvement. The morphology of the pulmonary nodules is also an important consideration before subjecting the patient to another invasive procedure, as solitary pulmonary nodule with irregular margins, suggestive of another primary lesion. We describe a case of a patient with colon cancer, nonsmall cell lung cancer with single bone lesion, and neuroendocrine tumor of appendix. Initially suspected to be a case of metastatic colon cancer, the patient was later diagnosed as epidermal growth factor receptor-mutant metastatic pulmonary adenocarcinoma, with localized microsatellite instability high phenotype colon cancer.

Analysis of Local Conditions on Graphite Growth and Shape During Solidification of Ductile Cast Iron

3D X-ray tomography recordings have been used to study graphite growth during solidification of ductile cast iron. Using data from such recordings, it is shown how local growth conditions influence growth rate and morphology of nodules during solidification. Experiments show that it is common for nodules to gradually change shape during solidification so that sphericity decreases. It is also found that different shaped nodules can evolve in direct contact with liquid iron and also after they are encapsulated in austenite. It is observed that a significant proportion of originally complete spherical nodules become less spherical via formation of protrusions on the surface; these new surfaces are observed to grow relatively faster. It is shown that encapsulation of the graphite nodule by austenite may be incomplete and that at the end of solidification, partial encapsulation and the effect of the number of nearest graphite nodules play a crucial role in determining the final graphite morphology.

A new species of Crocodile Newt Tylototriton (Caudata: Salamandridae) from Shan State, Myanmar (Burma).

A phylogenetic taxonomic analysis of a monophyletic subgroup of the salamandrid genus Tylototriton revealed that a newly discovered population from Ngar Su Village, 1 km south of Ywangan, Shan State, Myanmar is a new species and most closely related to T. shanorum from approximately 80 km to the west in the vicinity of Taunggyi, Shan State. Tylototriton ngarsuensis sp. nov. differs from other closely related species of Tylototriton on basis of varying combinations of characteristics associated with it shorter head, larger size, rib nodule morphology, and overall drab, very dark, coloration, along with its genetic differentiation. Tylototriton ngarsuensis sp. nov. also appears to breed later in the year than most other species. Unfortunately, this species like many other Asian newts, is being harvested for the pet and medicinal trade and given its restricted distribution, this could pose a serious threat to its long-term survival.

P2.16-20 Prognostic Utility of PET in Non-Small Cell Lung Cancer After Empiric Stereotactic Body Radiotherapy (SBRT)

Positron emission tomography (PET-CT) is valuable for diagnosing early stage non-small cell lung cancer (NSCLC) in the absence of biopsy. Here we investigate the diagnostic, prognostic, and treatment response of PET-CT in NSCLC treated with empiric stereotactic body radiotherapy (SBRT). We retrospectively reviewed 78 empiric lung SBRT cases with pre-treatment PET scans treated to biologic equivalent dose≥100 Gy10. We correlated pre and post-treatment standard uptake values (SUV) with local, regional, and distant control. Statistical analysis was conducted via SPSS v20. A total of 44 males and 34 females median age 77 were treated to 48 Gy in 4 fractions (n=47) or 50 Gy in 5 fractions (n=31). Lung nodules were 1.6 cm (0.6–4.5 cm) with a median planning target volume of 19.1 cc (3.7-97.4 cc). Median pre-treatment SUV=4.1 (0-20). Of the 43 patients with post-treatment PETs, median SUV = 2.7(0-7.2) or 53%(0-302%) of the pretreatment SUV. The median follow-up was 18 months with a 3-year survival of 50% for all patients. Local, regional, and distant control rates at 3 years were 91%, 81%, and 78%, respectively. Relative sisease control for pre-treatment SUV ≤4.0 compared to >4.0 is shown in Table 1: There was no difference in tumor size, location, nodule morphology, or prior cancer/smoking history between patients with pre-treatment SUV ≤ 4 (n=40) and > 4 (n=38). Receiver operating characteristic curve analysis identified optimal SUV cutoff values of 6.0, 3.5, and 4.0 to predict local, regional, and distant failure, respectively. Post-SBRT PET scans with SUV reduction ≥50% demonstrated a 2-year freedom from progression of 89% compared to 57% with SUV reduction <50% (P=0.08). Our study demonstrates a strong correlation between initial PET avidity and regional/distant recurrence, and a trend with local recurrence. Perhaps patients with pretreatment SUV>4 warrant a mediastinal evaluation or closer vigilance in follow-up, though this warrants prospective investigation.

P1.05-15 Benign Lung Nodule Resections in the Era of Advanced Imaging and Clinical Guidelines: Imaging Features and How we can Reduce the Resection Rate

Evaluation of lung nodules is a long standing clinical problem. Despite advances in diagnostics, many nodules are still resected that are benign. Although certain imaging characteristic can distinguish benign from malignant lung nodules on CT and PET/CT, overlap exists. Our purpose is to understand the benign resection rate with use of PET and PET/CT, and to review the patient and imaging characteristics of benign resected nodules in the PET-PET/CT era. We reviewed all 557 surgically resected lung nodules from 2001-2012. Patient demographics, smoking and cancer history, diagnostic tests prior to surgery, and pathology results were collected. All preoperative CT examinations were reviewed for nodule location, size, shape, border and attenuation, and PET/CTs for FDG-avidity. Of 557 resected nodules in 541 patients, 39 nodules in 38 patients were benign (15 females, 23 male) for a benign resection rate of 7% (39/557). There was no significant difference between benign and malignant groups across sex, race, nodule size or attenuation. Patients with benign nodules were younger (mean age 59 vs. 65 years in the malignant group; p=0.005). 75% of patients with benign nodules were smokers versus 80% in the malignant group (p=0.04). In the benign nodule group, 14 patients (36%) had a cancer history. Benign pathology results were: 15 granuloma, 6 chronic inflammation, 5 hamartoma, 5 abscesses, 2 inflammatory pseudotumor, 2 organizing pneumonia and 1 case each of bronchogenic cyst, fibrous tumor, lipoid pneumonia and lymphoepithelioma. 62% of were in the right lung, and 46% were in an upper lobe. Nodule size was 10-95 mm (mean 29). CT nodule morphology was round/ovoid in 16, and triangular/angular in 3. Nodule border was lobulated in 4, smooth in 7 and spiculated in 8. Cavitation was present in 4 nodules, 14 were exclusively soft tissue attenuation and one contained fat. By attenuation, 18 were solid, and 1 was non solid (ground glass). Of the 18/38 (47%) patients who underwent preoperative PET/CT scan, nodule FDG uptake was: 5 intense, 10 mild, 3 none. Our benign resection rate for lung nodules is 7%. While in many cases the imaging characteristics of surgically proven benign lung nodules and their clinical management are appropriate, following clinical guidelines for nodule management may further reduce the benign resection rate. The use of PET/CT and follow up low dose chest CT for PET/CT negative or mild uptake lesions to confirm nodule stability over time is a pathway for management that requires reinforcement.

Evolutionary Distance Predicts Recurrence After Liver Transplantation in Multifocal Hepatocellular Carcinoma.

BackgroundLiver transplantation (LTx) is a potentially curative treatment option for hepatocellular carcinoma (HCC) in cirrhosis. However, patients, where HCC is already a systemic disease, LTx may be individually harmful and has a negative impact on donor organ usage. Thus, there is a need for improved selection criteria beyond nodule morphology to select patients with a favorable outcome for LTx in multifocal HCC. Evolutionary distance measured from genome-wide single-nucleotide polymorphism data between tumor nodules and the cirrhotic liver may be a prognostic marker of survival after LTx for multifocal HCC.MethodsIn a retrospective multicenter study, clinical data and formalin-fixed paraffin-embedded specimens of the liver and 2 tumor nodules were obtained from explants of 30 patients in the discovery and 180 patients in the replication cohort. DNA was extracted from formalin-fixed paraffin-embedded specimens followed by genome wide single-nucleotide polymorphism genotyping.ResultsGenotype quality criteria allowed for analysis of 8 patients in the discovery and 17 patients in the replication set. DNA concentrations of a total of 25 patients fulfilled the quality criteria and were included in the analysis. Both, in the discovery (P = 0.04) and in the replication data sets (P = 0.01), evolutionary distance was associated with the risk of recurrence of HCC after transplantation (combined P = 0.0002). In a univariate analysis, evolutionary distance (P = 7.4 × 10−6) and microvascular invasion (P = 1.31 × 10−5) were significantly associated with survival in a Cox regression analysis.ConclusionsEvolutionary distance allows for the determination of a high-risk group of recurrence if preoperative liver biopsy is considered.

Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging Scenarios.

The new guidelines for managing incidental pulmonary nodules published by the Fleischner Society in 2017 reflect an improved understanding of the risk factors and biologic features of lung cancer. Specific topics emphasized in the updated guidelines include a new threshold size for follow-up, the importance of the morphologic features of nodules, accurate nodule measurements, recognition of subsolid components, understanding interval growth or change in nodule morphology, and knowledge of patient risk factors. The updated guidelines enable greater personal flexibility in the decision-making process and encourage individualized management of pulmonary nodules. These factors may introduce new challenges for radiologists, who previously used solely nodule size to make management recommendations. The authors describe eight scenarios that illustrate the challenges potentially encountered when applying the new guidelines to pulmonary nodule management. ©RSNA, 2018.

Primary Structure and Graphite Nodules in Thin-Walled High-Nickel Ductile Iron Castings

This paper considers the most important quality factors in processing spheroidal graphite cast iron; namely, primary grains and graphite nodules in thin-walled ductile iron castings (TWDI). In the present study, the effect of grain refinement (by means of Ti, Nb and Zr) and of the holding time after spheroidization and inoculation on effecting the primary grains and eutectic structure in TWDI castings was investigated. Moreover, metallographic examinations (including electron backscattering diffraction, EBSD) were carried out to reveal the macro- and micro-structural features during the primary and eutectic solidification of the cast iron. EBSD results indicate that, within a single dendritic grain, there are numerous boundaries that split the grain into numerous smaller areas. In particular, it is found that the graphite nodules are in contact with the boundaries inside the primary dendritic grain. In turn, crystallization of highly branched dendrites is observed, which seems to “push” the graphite nodules into the interdendritic regions during their growth. The present work investigates the dominant mechanism that gives rise to the primary spheroidal graphite cast iron (SGI) structure. In addition, this work shows that the melt quality is closely associated with the resultant morphology and number of austenite dendrites, graphite nodules, and matrix structure.

Semi-Supervised Multi-Task Learning for Lung Cancer Diagnosis.

Early detection of lung nodules is of great importance in lung cancer screening. Existing research recognizes the critical role played by CAD systems in early detection and diagnosis of lung nodules. However, many CAD systems, which are used as cancer detection tools, produce a lot of false positives (FP) and require a further FP reduction step. Furthermore, guidelines for early diagnosis and treatment of lung cancer are consist of different shape and volume measurements of abnormalities. Segmentation is at the heart of our understanding of nodules morphology making it a major area of interest within the field of computer aided diagnosis systems. This study set out to test the hypothesis that joint learning of false positive (FP) nodule reduction and nodule segmentation can improve the computer aided diagnosis (CAD) systems' performance on both tasks. To support this hypothesis we propose a 3D deep multi-task CNN to tackle these two problems jointly. We tested our system on LUNA16 dataset and achieved an average dice similarity coefficient (DSC) of 91% as segmentation accuracy and a score of nearly 92% for FP reduction. As a proof of our hypothesis, we showed improvements of segmentation and FP reduction tasks over two baselines. Our results support that joint training of these two tasks through a multi-task learning approach improves system performance on both. We also showed that a semi-supervised approach can be used to overcome the limitation of lack of labeled data for the 3D segmentation task.

The Mental Template in Handaxe Manufacture: New Insights into Acheulean Lithic Technological Behavior at Boxgrove, Sussex, UK

The morphological variability of large cutting tools (LCT) during the Middle Pleistocene has been traditionally associated with two main variables: raw material constraints and reduction intensity. Boxgrove — c.500 ka — is one of the most informative sites at which to analyze shaping strategies and handaxe morphological variability in the European Middle Pleistocene, because of the large number of finished handaxes, and the presence of complete operational chains. We focused on the entire handaxe and rough-out sample from Boxgrove-Q1/B with the aim of assessing the role of raw material characteristics — size, form, and homogeneity of nodules — in the shaping process, and to ascertain if they represent real constraints in the production of handaxes. Additionally, given the large number of handaxes and the intensity of the thinning work at Boxgrove, we also aimed to determine if reduction intensity affected the final shape to the degree that some authors have previously postulated. The methodology combines traditional technological descriptions, metrical analysis, and experimental reproduction of shaping processes together with geometric morphometry and PCA. The conclusions we draw are that the Q1/B handaxe knapping strategies were flexible and adapted to the characteristics of the blanks. These characteristics affected the reduction strategy but there is no clear relationship between initial nodule or blank morphology and final handaxe shape. Throughout the experiments, we explored the capacity to solve problems arising from reduction accidents, which led to re-configuring the knapping strategy to achieve the predetermined “mental template.” Furthermore, no substantial morphological differences related to reduction intensity were noticed with the Q1/B handaxes. Systematic re-sharpening as the cause of shape variation seems highly unlikely, perhaps related to the short use-life of the Boxgrove-Q1/B handaxes. Preferred forms constitute part of a broader pattern emerging for specific handaxe types at different times during the British Acheulean. The patterns have tentatively been interpreted as the result of changing environments and the movement of hominin populations.

Pearlitic ductile cast iron: fatigue crack paths and damaging micromechanisms

The influence of the graphite nodules morphology (shape, dimension and distribution) on ductile cast irons (DCIs) mechanical properties is experimentally confirmed both in static, quasi static and cyclic loading conditions. According to the most recent results, these graphite elements cannot be merely considered as “microvoids embedded in a metal matrix”, but their presence implies a modification of the damaging micromechanisms and this modification I s influenced by the metal matrix microstructure.In this works, the different damaging mechanisms that are active in the graphite nodules in a pearlitic DCI are semi-quantitatively analyzed using light optical microscope observations of the fracture surface profiles.

Nodule-in-Nodule Imaging Pattern in Hepatocellular Carcinoma Treated by Transarterial Chemoembolization - a Multiparametric Magnetic Resonance Imaging Study.

Emerging minimally invasive treatments for hepatocellular carcinoma (HCC) can significantly improve a patient's prognosis, but they may alter the imaging features of the treated nodules. This study focuses on a series of patients presenting with a rare pathology, the nodule-in-nodule imaging pattern of HCC, analyzes the imaging features and discusses possible approaches for the diagnosis of tumoral recurrence. Nine patients recruited over two years, having HCC with nodule-in-nodule imaging pattern on diagnosis, and treated by transarterial chemoembolization were monitored by magnetic resonance imaging (MRI). Nodule morphology, dynamic contrast behavior and size progression were followed in this study. All patients showed tumor recurrence. In 7 nodules, a T2 weighted-imaging hyperintense signal of the HCC foci was found, with isointensity of the background nodule. Restricted diffusion within the HCC foci was found in 6 cases but with no statistical significance. Dynamic contrast images evaluation showed a "classical" enhancement pattern in five patients. All nodules had hypointense HCC foci in the hepatobiliary phase. Four patients demonstrated progressive disease according to the mRECIST criteria. Due to the particularly challenging nodule characteristics, the sensitivity in diagnosing HCC foci in these nodules is about 77% when using conventional imaging criteria related to nodule morphology. Contrast media uptake curves may be altered by changes in nodule hemodynamics caused by embolization. The diagnostic rate may be significantly increased by considering the tumoral size increase in follow-up studies and completing the study with a hepatobiliary phase using Acidum Gadoxeticum.

Establishment of risk score for papillary thyroid carcinoma and comparison of diagnostic efficacy with thyroid fine needle aspiration cytodiagnosis

To develop a simple and easy promotion risk score to identify individuals with undiagnosed papillary thyroid carcinoma (PTC), and further to compare the diagnostic efficiency of PTC risk sore with fine needle aspiration cytodiagnosis (FNAC). in order to optimize the screening process of PTC. A sample of 1 003 individuals aged 11-82 years underwent a surgical treatment of thyroid nodule participated in the study. The risk score was developed by stepwise backward multiple logistic regression. And using the receiver operating characteristic (ROC) curve to evaluate the diagnostic efficacy, the best diagnostic cut-off point and the risk stratification of malignant. Compare the sensitivity, specificity, accuracy, and area under curve (AUC) of PTC risk score, FNAC and their combined diagnosis to judge their diagnostic efficiency. The risk score included age, TSH, nodule morphology and boundary by palpation, nodule characteristics, shape, boundary, calcification and blood flow signal by ultrasound. Its AUC=0.815, 6 point was the best cutoff point to differentiate benign from malignant thyroid nodules, and risk stratification of thyroid carcinoma were divided into four levels: very high risk group (score ≥ 9 points), high risk group (score were 5-8 points), moderate risk group (score were 3~4 points), low risk group (score ≤ 2 points). The sensitivity, specificity, and accuracy of FNAC were 86.3%, 90.0%, and 87.0% respectively, AUC=0.891, while the sensitivity, specificity, and accuracy of PTC risk rating scale were 83.8%, 70.0%, and 81.0% respectively, AUC=0.822. The sensitivity, specificity, and accuracy of their combined diagnosis were 97.5%, 85.0%, and 95.0%, AUC=0.965. This risk score can be used as a screening method before FNAC. If combined with FNAC, it may improve the diagnostic efficacy of PTC, and thereby possibly minimizing the unnecessary invasive examination and surgical treatment for patients with thyroid nodules and reducing personal costs. (Chin J Endocrinol Metab, 2017, 33: 755-759) Key words: Thyroid papillary carcinoma; Scale; Risk score; Logistic regression analysis; Fine needle aspiration cytology; Diagnostic test